Modular, Enantioselective Entry into Polysubstituted Shapeshifting Molecules.

Dynamic, shapeshifting hydrocarbons have emerged as enabling frameworks across drug discovery, materials science, and catalysis. Their employment, however, is often hampered by a lack of efficient synthetic methods for their preparation. Herein, we report a unified, concise, and modular synthesis of enantioenriched shapeshifting hydrocarbons (barbaralones and bullvalones) and multisubstituted bullvalenes, leveraging mild photochemical and base-induced rearrangements.

Transgressive gene expression and expression plasticity under thermal stress in a stable hybrid zone.

Interspecific hybridization can lead to myriad outcomes, including transgressive phenotypes in which the hybrids are more fit than either parent species. Such hybrids may display important traits in the context of climate change, able to respond to novel environmental conditions not previously experienced by the parent populations. While this has been evaluated in an agricultural context, the role of transgressive hybrids under changing conditions in the wild remains largely unexplored; this is especially true regarding transgressive gene expression. Using the blue mussel species complex (genus Mytilus) as a model system, we investigated the effects of hybridization on temperature induced gene expression plasticity by comparing expression profiles in parental species and their hybrids following a 2-week thermal challenge. Hybrid expression plasticity was most often like one parent or the other (50%). However, a large fraction of genes (26%) showed transgressive expression plasticity (i.e. the change in gene expression was either greater or lesser than that of both parent species), while only 2% were intermediately plastic in hybrids. Despite their close phylogenetic relationship, there was limited overlap in the differentially expressed genes responding to temperature, indicating interspecific differences in the responses to high temperature in which responses from hybrids are distinct from both parent species. We also identified differentially expressed long non-coding RNAs (lncRNAs), which we suggest may contribute to species-specific differences in thermal tolerance. Our findings provide important insight into the impact of hybridization on gene expression under warming. We propose transgressive hybrids may play an important role in population persistence under future warming conditions.

A retrospective cohort study on oesophageal food bolus obstruction in the North Denmark region in 2021-two thirds were never diagnosed with a cause.

BACKGROUND: Food bolus obstruction (FBO) leading to hospital treatment is often associated with eosinophilic oesophagitis (EoE), stenosis, or oesophageal cancer (1). Danish national guidelines recommend that patients with FBO undergo a diagnostic upper endoscopy within two weeks of presentation to exclude possible malignancy, and histological evaluation of eight biopsies (2, 3). AIMS: The aims of this study were to (1) report the incidence and describe the causes and treatment of FBO in the North Denmark Region (NDR), (2) determine the proportion of patients who underwent upper endoscopy and biopsy according to regional and national guidelines, and (3) identify International Classification of Diseases 10th Revision (ICD-10) diagnosis and procedure codes applied to the hospital visits due to FBO in the NDR. METHODS: Among all acute hospital visits in the NDR in 2021, all visits with ICD-10 codes possibly reflecting FBO, as well as a random sample of 14,400 visits with unspecific ICD-10 codes (R and Z codes), were screened manually for possible FBO. Diagnosis, follow-up, and treatment of all patients with FBO were recorded. RESULTS: The median patient age was 66.0 (Q1-Q3: 49.8-81.0) years, and half of the patients had experienced FBO before. Two thirds of patients (66.0%) were never diagnosed with a cause of FBO, followed by 17.3% with EoE. 30% of patients did not undergo upper endoscopy within two weeks of the hospital visit, and 50.7% were never biopsied in the oesophagus. Of 1886 hospital visits with registry ICD-10 codes that possibly reflected FBO, 8.4% were due to FBO, while FBO was present in 0.028% of the random sample of unspecific ICD-10 codes. CONCLUSIONS: Most hospitalized FBO patients in the NDR in 2021 were never diagnosed with a cause. In these patients there is a high risk of overlooked EoE or upper gastrointestinal cancers. The area needs immediate focus and changed routines to improve treatment and prevent new FBO.

Cooperation between Nodal and FGF signals regulates zebrafish cardiac cell migration and heart morphogenesis.

Asymmetric vertebrate heart development is driven by an intricate sequence of morphogenetic cell movements, the coordination of which requires precise interpretation of signaling cues by heart primordia. Here we show that Nodal functions cooperatively with FGF during heart tube formation and asymmetric placement. Both pathways act as migratory stimuli for cardiac progenitor cells (CPCs), but FGF is dispensable for directing heart tube asymmetry, which is governed by Nodal. We further find that Nodal controls CPC migration by inducing left-right asymmetries in the formation of actin-based protrusions in CPCs. Additionally, we define a developmental window in which FGF signals are required for proper heart looping and show cooperativity between FGF and Nodal in this process. We present evidence FGF may promote heart looping through addition of the secondary heart field. Finally, we demonstrate that loss of FGF signaling affects proper development of the atrioventricular canal (AVC), which likely contributes to abnormal chamber morphologies in FGF-deficient hearts. Together, our data shed insight into how the spatiotemporal dynamics of signaling cues regulate the cellular behaviors underlying organ morphogenesis.

Long-term stability of clinical-grade lentiviral vectors for cell therapy.

The use of lentiviral vectors in cell and gene therapy is steadily increasing, both in commercial and investigational therapies. Although existing data increasingly support the usefulness and safety of clinical-grade lentiviral vectors used in cell manufacturing, comprehensive studies specifically addressing their long-term stability are currently lacking. This is significant considering the high cost of producing and testing GMP-grade vectors, the limited number of production facilities, and lengthy queue for production slots. Therefore, an extended shelf life is a critical attribute to justify the investment in large vector lots for investigational cell therapies. This study offers a thorough examination of essential stability attributes, including vector titer, transduction efficiency, and potency for a series of clinical-grade vector lots, each assessed at a minimum of 36 months following their date of manufacture. The 13 vector lots included in this study were used for cell product manufacturing in 16 different clinical trials, and at the time of the analysis had a maximum storage time at -80°C of up to 8 years. The results emphasize the long-term durability and efficacy of GMP-grade lentiviral vectors for use in ex vivo cell therapy manufacturing.

Reinfusion of CD19 CAR T cells for relapse prevention and treatment in children with acute lymphoblastic leukemia.

ABSTRACT: Relapse after CD19-directed chimeric antigen receptor (CAR)-modified T cells remains a substantial challenge. Short CAR T-cell persistence contributes to relapse risk, necessitating novel approaches to prolong durability. CAR T-cell reinfusion (CARTr) represents a potential strategy to reduce the risk of or treat relapsed disease after initial CAR T-cell infusion (CARTi). We conducted a retrospective review of reinfusion of murine (CTL019) or humanized (huCART19) anti-CD19/4-1BB CAR T cells across 3 clinical trials or commercial tisagenlecleucel for relapse prevention (peripheral B-cell recovery [BCR] or marrow hematogones ≤6 months after CARTi), minimal residual disease (MRD) or relapse, or nonresponse to CARTi. The primary endpoint was complete response (CR) at day 28 after CARTr, defined as complete remission with B-cell aplasia. Of 262 primary treatments, 81 were followed by ≥1 reinfusion (investigational CTL019, n = 44; huCART19, n = 26; tisagenlecleucel, n = 11), representing 79 patients. Of 63 reinfusions for relapse prevention, 52% achieved CR (BCR, 15/40 [38%]; hematogones, 18/23 [78%]). Lymphodepletion was associated with response to CARTr for BCR (odds ratio [OR], 33.57; P = .015) but not hematogones (OR, 0.30; P = .291). The cumulative incidence of relapse was 29% at 24 months for CR vs 61% for nonresponse to CARTr (P = .259). For MRD/relapse, CR rate to CARTr was 50% (5/10), but 0/8 for nonresponse to CARTi. Toxicity was generally mild, with the only grade ≥3 cytokine release syndrome (n = 6) or neurotoxicity (n = 1) observed in MRD/relapse treatment. Reinfusion of CTL019/tisagenlecleucel or huCART19 is safe, may reduce relapse risk in a subset of patients, and can reinduce remission in CD19+ relapse.

Intrathecal bivalent CAR T cells targeting EGFR and IL13Rα2 in recurrent glioblastoma: phase 1 trial interim results.

Recurrent glioblastoma (rGBM) remains a major unmet medical need, with a median overall survival of less than 1 year. Here we report the first six patients with rGBM treated in a phase 1 trial of intrathecally delivered bivalent chimeric antigen receptor (CAR) T cells targeting epidermal growth factor receptor (EGFR) and interleukin-13 receptor alpha 2 (IL13Rα2). The study's primary endpoints were safety and determination of the maximum tolerated dose. Secondary endpoints reported in this interim analysis include the frequency of manufacturing failures and objective radiographic response (ORR) according to modified Response Assessment in Neuro-Oncology criteria. All six patients had progressive, multifocal disease at the time of treatment. In both dose level 1 (1 ×107 cells; n = 3) and dose level 2 (2.5 × 107 cells; n = 3), administration of CART-EGFR-IL13Rα2 cells was associated with early-onset neurotoxicity, most consistent with immune effector cell-associated neurotoxicity syndrome (ICANS), and managed with high-dose dexamethasone and anakinra (anti-IL1R). One patient in dose level 2 experienced a dose-limiting toxicity (grade 3 anorexia, generalized muscle weakness and fatigue). Reductions in enhancement and tumor size at early magnetic resonance imaging timepoints were observed in all six patients; however, none met criteria for ORR. In exploratory endpoint analyses, substantial CAR T cell abundance and cytokine release in the cerebrospinal fluid were detected in all six patients. Taken together, these first-in-human data demonstrate the preliminary safety and bioactivity of CART-EGFR-IL13Rα2 cells in rGBM. An encouraging early efficacy signal was also detected and requires confirmation with additional patients and longer follow-up time. ClinicalTrials.gov identifier: NCT05168423 .

Immunotherapy targeting B cells and long-lived plasma cells effectively eliminates pre-existing donor-specific allo-antibodies.

Pre-existing anti-human leukocyte antigen (HLA) allo-antibodies constitute a major barrier to transplantation. Current desensitization approaches fail due to ineffective depletion of allo-specific memory B cells (Bmems) and long-lived plasma cells (LLPCs). We evaluate the efficacy of chimeric antigen receptor (CAR) T cells targeting CD19 and B cell maturation antigen (BCMA) to eliminate allo-antibodies in a skin pre-sensitized murine model of islet allo-transplantation. We find that treatment of allo-sensitized hosts with CAR T cells targeting Bmems and LLPCs eliminates donor-specific allo-antibodies (DSAs) and mitigates hyperacute rejection of subsequent islet allografts. We then assess the clinical efficacy of the CAR T therapy for desensitization in patients with multiple myeloma (MM) with pre-existing HLA allo-antibodies who were treated with the combination of CART-BCMA and CART-19 (ClinicalTrials.gov: NCT03549442) and observe clinically meaningful allo-antibody reduction. These findings provide logical rationale for clinical evaluation of CAR T-based immunotherapy in highly sensitized candidates to promote successful transplantation.

Hallazgos por imagen de lipoma pericárdico. Revisión de la literatura / Imaging findings of pericardial lipoma. Review of the literature

Introducción: El lipoma pericárdico es un tumor benigno infrecuente cuya presentación clínica es variada. Se revisaron los hallazgos por imagen descritos en la literatura en las modalidades de radiografía, ecocardiografía, tomografía axial computarizada (TAC) y resonancia magnética (RM). Metodología:Se identificaron reportes de caso, presentaciones en congreso y estudios observacionales de lipomas pericárdicos en PubMed, Scopus, Web of Science, Embase y Cochrane hasta el 01 de junio de 2022. Resultados: El lipoma pericárdico se ha descrito proporcionalmente en hombres y mujeres, en promedio a los 51 años de edad. Por lo general, los pacientes no presentan comorbilidades y de presentarlas, corresponden a factores de riesgo cardiovascular. Los síntomas más comunes son el dolor torácico y las palpitaciones. Hasta el 15 % de los casos son hallazgos incidentales en pacientes asintomáticos. Los métodos de imagen más frecuentemente descritos son la ecografía y la TAC, seguidos de la radiografía y la RM. Las descripciones incluyen masas ecogénicas, cardiomegalia, masas con densidad grasa menor a las 0 UH y por RM hiperintensas en T1 y T2 con saturación grasa y sin realce del medio de contraste. Un hallazgo frecuente es el derrame pericárdico. Conclusión: El rendimiento de las imágenes para el diagnóstico de lipomas pericárdicos no se ha calculado. Sin embargo, los hallazgos multimodales son altamente confiables para el diagnóstico no invasivo.

Introduction: Pericardial lipomas are benign and infrequent cardiac tumors with variable clinical presentation. We reviewed the imaging findings reported in the literature in radiography, echocardiography, computed tomography, and magnetic resonance. Methodology: We identified case reports, congress presentations and observational studies published in PubMed, Scopus, Web of Science, Embase and Cochrane until June 1st, 2022. Results: Pericardial lipoma occurs proportionally in women and men, at a mean age of 51 years. Past medical history is unremarkable and if present, cardiovascular risk factors are the most common comorbidity. The most common symptoms are chest pain and palpitations. Up to 15% of cases are incidental findings in asymptomatic patients. The most frequent imaging methods are echocardiography and computed tomography followed by radiography and magnetic resonance. Descriptions include echogenic masses, cardiomegaly, densities below 0 UH, T1 and T2 hyperintensity, fat saturation and lack of contrast enhancement. A frequent finding was pericardial effusion. Conclusions: The accuracy of the different imaging methods for lipomas has not been estimated. However, multimodal imaging is highly reliable for non-invasive diagnosis.

Comparación de diversos métodos de estimación de edad dental aplicados por residentes de Postgrado de Odontopediatría / Comparação na aplicação de métodos de estimação da idade dental aplicado por residentes de graduação em odontopediatria / Outcomes of dental age calculation performed by Pediatric Dentistry residents

La estimación de la edad dental en los pacientes pediátricos que recibirán tratamiento odontológico es de gran importancia ya que permite evaluar su estado de maduración. Objetivo: Determinar la precisión en la estimación de la edad dental a través de la utilización del método de Nolla, Demirjian y Willems, aplicado por residentes del Postgrado de Odontopediatría en un grupo de niños venezolanos del Distrito Capital. Materiales y métodos: Se seleccionó a conveniencia una muestra estratificada por edad y género incluyendo 71 radiografías panorámicas de alta calidad de niños aparentemente sanos con edades comprendidas entre los 4 y 11 años, evaluando la edad dental según los métodos de Nolla, Demirjian y Willems. Cada radiografía fue evaluada por mínimo dos observadores de forma aleatoria. Resultados: Se obtuvo mayor correlación entre la edad dental y cronológica para los métodos de Demirjian y Willems. Hubo diferencia estadísticamente significativa entre la edad cronológica y la edad dental calculada con Nolla (-0,30 p=0,001) y Demirjian (0,272 p<0,001), no siendo estadísticamente significativa la diferencia para Willems (0,02 p=0,74). Se obtuvieron diferencias en el cálculo de la edad dental entre los tres métodos, siendo el más sensible al efecto del observador el de Nolla. Conclusión: La estimación de la edad dental en pacientes pediátricos puede ser realizada por observadores entrenados. La edad dental siempre dependerá de la variabilidad de cada paciente, de la aplicabilidad del método de estimación para una población determinada y del grado de experiencia del observador.

A estimativa da idade dentária nos pacientes pediátricos que receberão tratamento odontológico é de grande importância, pois permite avaliar seu estado de maturação. Objetivo: Para determinar a precisão na estimativa da idade dental através do uso do método de Nolla, Demirjian e Willems, aplicado por residentes de graduação Odontologia em um grupo de crianças venezuelanas no Distrito Capital. Materiais e métodos: Foram selecionados uma amostra de conveniência estratificada por idade e sexo, incluindo 71 radiografias panorâmicas de alta qualidade crianças aparentemente saudáveis com idade entre 4 e 11 anos avaliando a idade dental de acordo com os métodos de Nolla, Demirjian e Willems. Cada radiografia foi avaliada por pelo menos dois observadores aleatoriamente. Resultados:Uma maior correlação entre a idade dentária e cronológica foi obtida para os métodos de Demirjian e Willems. Houve uma diferença estatisticamente significativa entre idade cronológica e idade dentária calculado Nolla (-0,30 p = 0,001) e Demirjian (0,272 p <0,001), não sendo diferença estatisticamente significativa para Willems (0,02 p = 0,74 ). Diferenças foram obtidas no cálculo da idade dental entre os três métodos, sendo o mais sensível ao efeito do observador que o de Nolla. Conclusão: A estimativa da idade dentária em pacientes pediátricos pode ser feita por observadores treinados. A idade dentária dependerá sempre da variabilidade de cada paciente, da aplicabilidade do método de estimação para determinada população e do grau de experiência do observador

Dental age estimation for pediatric patients who will receive dental treatment is of upmost importance because this allows the determination of their maturation level. Aim: To determine the precision in the estimation of the dental age through the use of the Nolla, Demirjian and Willems methods applied by pediatric dentistry residents in a group of Venezuelan children from the Capital District. Materials and methods: 71 high quality panoramic radiographs from healthy children ages 4 to Comparación de diversos métodos de estimación de edad dental aplicados por residentes de Postgrado de OdontopediatríaResumoA estimativa da idade dentária nos pacientes pediátricos que receberão tratamento odontológico é de grande importância, pois permite avaliar seu estado de maturação. Objetivo: Para determinar a precisão na estimativa da idade dental através do uso do método de Nolla, Demirjian e Willems, aplicado por residentes de graduação Odontologia em um grupo de crianças venezuelanas no Distrito Capital. Materiais e métodos: Foram selecionados uma amostra de conveniência estratificada por idade e sexo, incluindo 71 radiografias panorâmicas de alta qualidade crianças aparentemente saudáveis com idade entre 4 e 11 anos avaliando a idade dental de acordo com os métodos de Nolla, Demirjian e Willems. Cada radiografia foi avaliada por pelo menos dois observadores aleatoriamente. Resultados:Uma maior correlação entre a idade dentária e cronológica foi obtida para os métodos de Demirjian e Willems. Houve uma diferença estatisticamente significativa entre idade cronológica e idade dentária calculado Nolla (-0,30 p = 0,001) e Demirjian (0,272 p <0,001), não sendo diferença estatisticamente significativa para Willems (0,02 p = 0,74 ). Diferenças foram obtidas no cálculo da idade dental entre os três métodos, sendo o mais sensível ao efeito do observador que o de Nolla. Conclusão: A estimativa da idade dentária em pacientes pediátricos pode ser feita por observadores treinados. A idade dentária dependerá sempre da variabilidade de cada paciente, da aplicabilidade do método de estimação para determinada população e do grau de experiência do observador.Palavras chave: Idade dentária, radiografia panorámica.Comparação na aplicação de métodos de estimação da idade dental aplicado por residentes de graduação em odontopediatria.Artigo original 11 years old were selected and stratified by age and gender. Dental age was estimated using the Nolla, Demirjian and Willems ́s methods. Each radiograph was randomly assigned and evaluated by at least two observers. Results: The highest correlation between chronologic and dental age was found for the Demirjian and Willems methods. The difference between dental and chronologic age was significant for Nolla (-0.30 years; p=0.001) and Demirjian (0.272 years; p<0.001), but not significant for Willems (0.02 years; p=0.74). All 38Revista de Odontopediatría Latinoamericanamethods presented differences in dental age estimation being the Nolla method the most sensible to assessor's performance. Conclusion: The estimation of dental age in pediatric patients can be made by trained observers. Dental age will always depend on the variability of each patient, the applicability of the estimation method for a given population and the degree of experience of the assessor

Practicas alimentarias y factores asociados al estado nutricional de lactantes ingresados al Programa Alimentario Nutricional Integral en un servicio de salud

Introducción: Niño/as con desnutrición son usuarios del Programa Alimentario Nutricional Integral (PANI), poco se sabe de sus prácticas alimentarias o condiciones sociodemográficas. Objetivo: Evaluar la asociación de las prácticas alimentarias y variables sociodemográficas con el estado nutricional de lactantes de 6 a 23 meses usuarios al Programa Alimentario Nutricional Integral (PANI). Materiales y Métodos: Estudio de casos y controles, con niños de 6-23 meses del Hospital Materno Infantil de San Lorenzo asignados a 2 grupos: a)Gupo Estudio-GE: 25 niños del PANI (desnutridos(DNT) o riesgo de desnutrir(RD) b)Grupo Control-GC: 25 niños eutróficos E), pareados por edad y sexo. Se averiguó sobre alimentación y variables sociodemográficas. Fueron utilizados (2, Mann Whitney, T Student y regresión logística, p<0,05 fue significativo. Resultados: Previa aprobación de Comité de Ética, fueron evaluados 50 niños, la mediana de edad fue 13,9 meses, el 72% (18/25 por grupo) eran varones en ambos grupos, 46/50 (92%) pertenecían a zona urbana. En GE tenían RD 20/25(80%) niños, DNT 5/20(20%); en GC todos eutroficos. No hubo diferencias significativas entre grupos, acceso a agua y saneamiento, duración de lactancia materna (LM) exclusiva o inicio de alimentación complementaria. El GE presentó menor promedio de peso de nacimiento que el GC (2724,6 vs 3430,6 gramos; Mann-Whitney, p=0,001), menor duración de LM total (7,5 vs 10,7 meses, T Student p=0,04), menor escolaridad materna (8,68 vs 10,4años; T Student p=0,03). en el ingreso económico.) Conclusión: Menor peso de nacimiento, escolaridad materna y de tiempo de lactancia materna se asocian a peor estado nutricional del niño, pero ninguna es predictora.

Introduction: Children with malnutrition are users of the Comprehensive Nutritional Food Program (PANI). Little is known about their eating habits or sociodemographic conditions. Objective: To evaluate the association of eating habits and sociodemographic variables with the nutritional status of infants aged 6 to 23 months referred to the Comprehensive Nutritional Food Program (PANI). Materials and Methods: This was a case-control study of children from 6-23 months seen at the San Lorenzo Maternal and Child Hospital, who were assigned to one of two groups: a) Study Group-SG: 25 children of the PANI with malnutrition (MLN) or at risk of malnutrition (ROM) b) Control Group-CG: 25 healthy children (H), matched by age and sex. We reviewed eating and sociodemographic variables. Χ2, Mann Whitney, T Student and logistic regression were used, p <0.05 was significant. Results: After study approval by the Ethics Committee, 50 children were evaluated. The median age was 13.9 months, 72% (18/25 per group) were boys in both groups, 46/50 (92%) came from urban areas. In the SG, 20/25 (80%) children had MLN, 5/20 (20%) were at ROM; in CG all had normal nutritional status. There were no significant differences between groups regarding access to water and sanitation, exclusive breastfeeding duration (EBD) or start of solid feeding. The SG had a lower average birth weight than the CG (2724.6 vs. 3430.6 grams; Mann-Whitney, p = 0.001), shorter duration of total EBD (7.5 vs. 10.7 months, Student T p = 0.04), lower maternal education (8.68 vs 10.4 years; Student T p = 0.03) and in lower economic income groups. Conclusion: Lower birth weight, lower maternal education and shorter breastfeeding duration are associated with worsening of a child's nutritional status, but none of these is predictive.

Corrección de mordida cruzada anterior de origen dental y recesión gingival en dentición mixta temprana / Correção da mordida cruzada anterior de origem dentária e recessão gengival na dentição mista precoce / Correction of anterior crossbite of dental origin and gingival recession in early mixed dentition

Introducción: La mordida cruzada anterior ocurre cuando los incisivos superiores ocluyen lingualmente a los inferiores, pudiendo ser de origen dental o esquelético. La corrección temprana de esta maloclusión favorece una correcta relación interincisiva, permitiendo el adecuado crecimiento y desarrollo en sentido sagital del complejo máxilo facial. Reporte del caso: Paciente masculino de 8 años de edad. Se realizó estudio ortodóncico completo siendo el diagnóstico cefalométrico Clase I y dentario de Clase I tipo 3 con retroinclinación de incisivos superiores, casoy mordida cruzada de origen dental. Presentó recesión gingival en encía vestibular de 41 y 31. El tratamiento realizado incluyó aparato removible con placa de levantamiento posterior, tornillo expansor anterior y arco de Eschler. Se realizó seguimiento por 16 meses, obteniendo el descruzamiento de la mordida anterior, conformación de arco e inclinación apropiada del incisivo superior. Conclusiones: El tratamiento de la mordida cruzada anterior de origen dentario puede ser logrado en dentición mixta utilizando mecánicas sencillas.

Introdução: a mordida cruzada anterior acontece quando os incisivos superiores ocluem de forma lingual aos inferiores, podendo ser de origem dentária ou esquelética. A correção precoce dessa má oclusão favorece uma relação interincisiva correta, permitindo crescimento e desen-volvimento adequados no sentido sagital do complexo facial da maxila. Relato de caso: Paciente masculino de 8 anos de idade. Efetuou-se um estudo ortodôntico completo. O diagnóstico cefalométrico foi classe 1 e o dentário foi classe 1 tipo 3, apresentando retroinclinação incisiva superior e mordida cruzada anterior dentária. Apresentou recessão gengival na gengiva vestibular de 41 e 31. O tratamento feito incluiu aparelho móvel com placa de levante posterior, aparelho expansor anterior e arco de Eschler. O tratamento foi acompanhado durante 16 meses. Obteve-se o descruzamento da mordida anterior, a conformação do arco e a inclinação adequada do incisivo superior. Conclusão: a mordida cruzada anterior dentária em casos de dentição mista se pode tratar utilizado aparelhos simples.

Introduction: Anterior cross-bite occurs when maxillary incisors occlude lingually to the mandibular incisors, which may be of dental or skeletal origin. The early correction of this malocclusion favors a correct interincisive relationship, allowing adequate growth and development in the sagittal direction of the maxillofacial complex. Case Report: 8 year-old male presented with cephalometric diagnosis of Class I and dental relation of Class I type 3, retruded maxillary incisors and anterior cross-bite. Presented gingival recession in vestibular gingiva of 41 and 31 Treatment was performed with removable appliance, posterior bite planes, expansion screw and Eschler arch. 16 month follow-up was performed obtaining and proper overjet, proclination of incisors and dental arch conformation. Conclusions: Dental anterior cross-bite may be successfully treated in the early mixed dentition with simple appliances.

Relajación residual posoperatoria en la unidad de cuidados postanestésicos de un hospital universitario: Estudio de corte transversal / Postoperative residual curarization at the post-anesthetic care unit of a university hospital: A cross-sectional study

Abstract Introduction: Postoperative residual curarization has been related to postoperative complications. Objective: To determine the prevalence of postoperative residual curarization in a university hospital and its association with perioperative conditions. Method: A prospective registry of 102 patients in a period of 4 months was designed to include ASA I-II patients who intraoperatively received nondepolarizing neuromuscular blockers. Abductor pollicis response to a train-of-four stimuli based on accelleromyography and thenar eminence temperature (TOF-Watch SX®. Organon, Ireland) was measured immediately upon arrival at the postanesthetic care unit and 30 s later. Uni-bivariate analysis was planned to determine possible associations with residual curarization, defined as two repeated values of T4/T1 ratio <0.90 in response to train-of-four stimuli. Results: Postoperative residual curarization was detected in 42.2% of the subjects. Pancuronium was associated with a high risk for train-of-four response <0.9 at the arrive at postoperative care unit [RR:2.56 (IC95% 1.99-3.30); p = 0.034]. A significant difference in thenar temperature (°C) was found in subjects with train-of-four <0.9 when compared to those who reach adequate neuromuscular function (29.9 ± 1.6 vs. 31.1 ± 2.2; respectively. p = 0.003). However, we were unable to demonstrate a direct attribution of findings in train-of-four response to temperature (R² determination coefficient = 0.08%). Conclusions: A high prevalence of postoperative residual curarization persists in university hospitals, despite a reduced use of "long-lasting" neuromuscular blockers. Strategies to assure neuromuscular monitoring practice and access to therapeutic alternatives in this setting must be considered. Intraoperative neuromuscular blockers using algorithms and continued education in this field must be priorities within anesthesia services.

Introducción: La relajación residual postoperatoria ha sido asociada con mayores complicaciones postoperatorias. Objetivo: determinar la prevalencia de relajación residual postoperatoria en un hospital universitario y su relación con condiciones perioperatorias. Métodos: Se diseñó un registro prospectivo de 4 meses de duración, que incluyó pacientes ASA I-II que intraoperatoriamente recibieran bloqueadores neuromusculares. Se registró la respuesta del abductor pollicis a un estímulo de tren de cuatro mediante aceleromiografía y se midió la temperatura de la eminencia tenar (TOF-Watch SX®.Organon, Ireland) inmediatamente al ingreso a recuperación y a los 30 segundos. Se realizó análisis uni y bivariado para determinar posibles asociaciones con relajación residual postoperatoria, definida como dos respuestas sucesivas al estímulo tren-de-cuatro con una relación T4/T1 <0.90. Resultados: Se reclutaron 102 pacientes, encontrando una prevalencia de relajación residual del 42.2%. Pancuronio fue asociado con un riesgo elevado de TOF < 0.9 al ingreso a recuperación [RR:2,56 (IC95% 1.99-3.30); p = 0.034]. Se evidenció una diferencia significativa en la temperatura tenar de los pacientes que presentaban relajación residual, al compararla con pacientes que recuperaron su función neuromuscular [Grupo evento = 29.9 ± 1.6 (n = 43); Grupo control = 31.1 ±2.2 (n = 59)]. Sin embargo no se logró determinar una atribución directa de relajación residual a esta medición (coeficiente de determinación = 0.08%). Conclusión: Persiste una alta prevalencia de relajación residual postoperatoria en los hospitales universitarios, a pesar del uso reducido de bloqueadores neuromusculares de larga duración. Se hace indispensable encaminar estrategias para incentivar la monitoria neuromuscular y establecer algoritmos que permitan un manejo eficiente de los bloqueadores neuromusculares.

Relación entre el apoyo social y las complicaciones agudas de la diabetes tipo 2: un estudio de corte transversal / Relationship Between Social Support and Acute Complications of Diabetes Type 2: A Cross-Sectional Study / Relação entre o apoio social e as complicações agudas da diabetes tipo 2: um estudo de corte transversal

Resumen Objetivo: evaluar la relación entre apoyo social y la frecuencia de pacientes con complicaciones agudas de la diabetes tipo 2. Materiales y métodos: se realizó un estudio de corte transversal en pacientes con diabetes mellitus tipo 2 que ingresaron a una clínica de tercer nivel entre 2014 y 2015. Se midió la percepción de apoyo social (media, IC 95%) con el cuestionario del estudio de desenlaces médicos de apoyo social (MOS, por su sigla en inglés) en los pacientes con y sin complicaciones agudas de la diabetes; se aplicó un modelo de regresión logística para identificar variables predictoras de complicaciones agudas. Resultados: se incluyeron 205 pacientes, de edad media 66 años, 51,2% mujeres, 56,6% de los pacientes eran casados, 50,7% con complicaciones agudas, la mayoría con apoyo social (83,6%; IC 95%, 76,1%-91,2%); la media de apoyo social global en pacientes sin complicaciones agudas fue 78,9 (76,8-88,1), con complicaciones 70,8 (68,3-73,2) para una diferencia entre grupos de 8,2 (IC 95 %, 4,9-11,4). La falta de apoyo social (P:3,581), el intervalo de glucometrías entre 177 y 309 al ingreso (P:2,930), estar casado (P:1,845) o en tratamiento con insulina (P:1,672) fueron predictores de las complicaciones agudas de la diabetes. Conclusión: los pacientes con complicaciones agudas presentaron puntajes más bajos de apoyo social. La falta de apoyo social se relacionó con otras variables sociodemográficas y clínicas para predecir el riesgo de complicaciones agudas. Debe explorarse al apoyo social como una opción para mejorar las estrategias de tratamiento en los pacientes diabéticos.

Abstract Objective: To evaluate the relationship between social support and the frequency of patients with acute complications of type 2diabetes. Materials and methods: A cross-sectional study was carried out on type 2 diabetic patients who consulted a level III hospital, between 2014 and 2015; the perception of social support (ci 95 %) was measured with the questionnaire for medical outcomes studies on social support (mos) in patients with and without acute complications of diabetes. A logistic regression model was applied to identify predictive variables for acute complications. Results: 205 patients were selected, average age 66 years old, 51,2% female, 56,6% married, 50,7% with acute complications, the majority with social support (83,6%; ci 95 %, 76,1-91,2 %); the average global social support in patients without acute complications was 78,9 (76,8-88,1), with complications 70,8 (68,3-73,2) for a group difference of 8,2; (ci 95 %, 4,9-11,4). The lack of social support (-3:3,581), the glucometry interval range between 177-309 (-3:2,930), being married (P:1,845) and insulin treatment (-:1,672) predicted acute diabetes complications. Conclusion: Patients with acute complications had lower social support scores, and the interaction between the lack of social support and sociodemographic variables predicted a risk of acute complications. Social support should be explored in diabetic patients to improve treatment strategies.

Resumo Objetivo: avaliar a relação entre apoio social e a frequência de pacientes com complicações agudas da diabetes tipo 2. Materiais e métodos: Se realizou um estudo de corte transversal em pacientes com Diabetes mellitus tipo 2 que ingressaram a uma clínica de III nível entre 2014 e 2015. Mediu-se a percepção de apoio social (média, IC95%) com o Questionário do Estudo de Desenlaces Médicos de Apoio Social (MOS) nos pacientes com e sem complicações agudas da diabetes; aplicou-se um modelo de regressão logística para identificar variáveis preditoras de complicações agudas. Resultados: incluíram-se 205 pacientes, idade mediana (p25-p75) 66 anos (56-76), 51,2% mulheres, 56,6% casados, 50,7% com complicações agudas, a maioria com apoio social (83,6%; IC95%, 76,1%-91,2%); a média de apoio social global em pacientes sem complicações agudas foi 78,9 (76,8-88,1), com complicações 70,8 (68,3-73,2) para uma diferença entre grupos de 8,2 (IC95%, 4,9-11,4). A falta de apoio social (-:3,581), o intervalo de concentração de glicose entre 177-309 ao ingresso (-:2,930), estar casado (-:1,845) ou em tratamento com insulina (-:1,672), foram preditores das complicações agudas da diabetes. Conclusão: os pacientes com complicações agudas apresentaram pontuações mais baixos de apoio social e a falta de apoio social se relacionou com outras variáveis sociodemográficas/clínicas para predizer o risco de complicações agudas. Deve explorar-se ao apoio social como uma opção para melhorar as estratégias de tratamento nos pacientes diabéticos.

Comparación de la actividad antimicrobiana de meropenem genérico y meropenem innovador por la técnica de micro dilución en cepas resistentes / Comparison of the antimicrobial activity of meropenem generic and innovative meropenem in resistant strains by micro dilution method

Objetivo: comparar la actividad antimicrobiana de meropenem genérico y meropenem innovador, frente a cepas resistentes de interés clínico mediante la técnica de micro dilución. Método: se determinó la concentración mínima inhibitoria y la concentración máxima bactericida según el protocolo de micro dilución del Clinical and Laboratory Standars Institute. Resultado: se determinó una concentración mínima inhibitoria de 320 µg/mL y una concentración máxima bactericida de 640 µg/mL para Staphylococcus aureus con ambos antibióticos, Escherichia coli presentó una concentración mínima inhibitoria de 640 µg/mL y una concentración máxima bactericida de 1 280 µg/mL con los dos antibióticos y por último Klebsiella pneumoniae tuvo una concentración mínima inhibitoria de 5 120 µg/mL y una concentración máxima bactericida de 2 0480 µg/mL con ambos antibióticos. Conclusión: no existen diferencias significativas en las concentración máxima bactericida y la concentración mínima inhibitoria de meropenem genérico y meropenem innovador(AU)

Objective: To compare the antimicrobial activity of generic meropenem and innovative meropenem on resistant strains of clinical interest by using the microdilution technique. Method: The minimum inhibitory concentration and maximum bactericidal concentration were determined by the microdilution according to the protocol set by the Clinical and Laboratory Standards Institute (CLSI). Result: Minimum inhibitory concentration (MIC) of 320 µg / mL and a maximum bactericidal concentration (MBC) of 640 µg/mL for both antibiotics against Staphylococcus aureus. MIC reached 640 µg/mL and MBC of 1 280 µg/mL in both antibiotics for Escherichia coli whereas the MIC was 5 120 µg/mL and WBC of 20 480 µg /mL with both antibiotics against Klebsiella pneumoniae. Conclusion: No significant differences were observed in minimum inhibitory concentration and maximum bactericidal concentration between generic meropenem and innovative meropenem(AU)