Surgical Management of Severe Mandibular Actinomycosis: Segmental Mandibulectomy and Fibula Free Flap for Optimal Outcomes.

Actinomycosis is a chronic, suppurative, granulomatous bacterial infection primarily associated with Actinomyces israelii. The condition can be categorized into three distinct clinical types based on the affected anatomical region: cervicofacial, pulmonary, or abdominopelvic actinomycosis. The standard treatment for actinomycosis involves antibiotic therapy, with an empiric penicillin regimen as the first-line approach. Surgical interventions comprise curettage of the affected bone, resection of necrotic tissues, excision of existing sinus tracts, and drainage of abscesses. These procedures are considered a last resort for cases of actinomycosis unresponsive to antibiotic therapy. In this context, we present a case of severely unresponsive actinomycosis that necessitated aggressive surgical resection of the infected mandibular bone, followed by immediate reconstruction using a fibula-free flap. The outcome yielded both favorable functional and aesthetic results.

Therapeutic Reduction Mammoplasty: Experience of a Single Institute.

INTRODUCTION: Breast cancer is the most common malignancy in women worldwide as reported by the World Health Organization. The concept of oncoplastic breast surgery appeared as an extension of breast-conserving surgery, applying breast reduction techniques with more acceptable aesthetic and functional outcomes. The purpose of the present study was to describe the breast cancer population of a single institute submitted to lumpectomy and bilateral immediate breast reduction or mastopexy and its complications. MATERIAL AND METHODS: This is a retrospective observational study including patients submitted to lumpectomy and immediate bilateral breast reduction or mastopexy. Patients and tumour characteristics, surgical technique, complications, follow-up period, and recurrence data were obtained and analyzed. RESULTS: A total of 49 patients were submitted to lumpectomy and bilateral breast therapeutic reduction/mastopexy, with a mean age of 56.47 ±8.58 years and a mean body mass index of 28.68kg/m2 ±3.94 kg/m² between January 2019 and December 2021. Invasive tumours of no specific type, associated or not, with carcinoma intraductal in situ were the most common histological type corresponding to almost 80% of the cases with T1 stage corresponding to more than half of the cases. Sixteen percent of the patients had early minor complications with wound dehiscence associated with wound delayed healing, corresponding to 75% of the cases. Body mass index had a statistical difference between groups (p=0,006, t-test). CONCLUSIONS: The low rates of minor and major complications show that immediate therapeutic breast reduction can be a suitable approach in selected cases.

A case report of multiple endocrine neoplasia type 1 and autoimmune disease: Coincidence or correlation?

RATIONALE: Multiple Endocrine Neoplasia type 1 (MEN1) is a familial syndrome that results from the disruption of a tumor suppressor protein called MENIN. Its management is challenging, as MEN1 affects different endocrine tissues and predisposes to both benign and malignant tumors. MENIN-deficient cells have recently been recognized to play a role in triggering autoimmunity. Herein, we present a case of MEN1 with multiple endocrine and autoimmune disorders. PATIENT CONCERNS: A 50 years old female with a 25 years history of complicated nephrolithiasis presented with primary hyperparathyroidism. DIAGNOSES: Over several decades, she was diagnosed with recurrent primary hyperparathyroidism, autoimmune thyroiditis, multinodular goiter, pernicious anemia, metastatic gastric type 1 neuroendocrine tumor, macroprolactinemia, gonadotropin deficiency, mucosa-associated lymphoid tissue lymphoma of the thyroid gland, positive anti-calcium sensor receptor antibodies, and BRCA 1/2-negative invasive breast cancer. The autoimmune regulator gene was sequenced, but no pathogenic variants were found. Next-generation sequencing revealed both a pathogenic MEN1 mutation and a benign CDC73 gene variant. Familial genetic screening revealed a large kindred with multiple carriers of one or both genetic variants (MEN1 = 19; CDC73 = 7). INTERVENTIONS: The patient underwent surgical excision of three parathyroid glands, total thyroidectomy and breast tumorectomy plus tamoxifen, and monthly injections of octreotide. The patient and family members with the MEN1 mutation are under a life-long surveillance program for MEN1 prototypic tumors. OUTCOMES: The patient was stable and alive during a 24-years follow-up period. LESSONS: With the present case, the authors highlight a new interplay between MENIN and the immune system, which may have implications for future targeted life-long surveillance and treatment of MEN1 patients.

Estética y color en dientes calcificados: Informe de tres casos clínicos con blanqueamiento / Esthetics and shade in calcified teeth. Report of three clinical cases with whitening

Objetivo: El objetivo de este informe es presentar tres casos clínicos de piezas dentarias anterosuperiores calcificadas y con decoloración, resueltos según tres protocolos clínicos de blanqueamiento diferentes, con un mismo fin: devolver la estética al sector anterior. Casos clínicos: Cada una de las tres situaciones clínicas de decoloración dentaria se trató siguiendo un protocolo diferente. A partir del análisis clínico y radiográfico, se estableció un diagnóstico y un plan de tratamiento acorde. Todos los casos evolucionaron de manera favorable y siguen siendo controlados periódicamente. Conclusiones: En casos clínicos como los que se muestran en este trabajo, en los que el conducto y la cámara pulpar están calcificados u obliterados totalmente, sería posible realizar blanqueamiento interno y externo para recuperar la armonía óptica de forma conservadora. Este tipo de tratamientos permitiría responder a la alta prevalencia de demanda estética debido a traumatismos y cambios de coloración (AU)

Aim: To present three clinical cases of discoloration in calcified upper anterior teeth, that were resolved following different clinical protocols for teeth whitening to return the aesthetics of the anterior teeth. Clinical cases: Each clinical case of discoloration was treated following a different treatment protocol based on a correct clinical and radiographic diagnosis. All cases had a favourable outcome and have no regular review. Conclusion: In clinical cases as those presented in this article where the canal and pulp chamber are totally calcified or obliterated, it was possible to perform internal and or external whitening to restore optical harmony in a conservative way. This type of treatment would allow responding to the high prevalence of aesthetic demand due to trauma and colour changes (AU)

Ingestion of a THC-Rich Cannabis Oil in People with Fibromyalgia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

OBJECTIVE: To determine the benefit of a tetrahydrocannabinol (THC)-rich cannabis oil on symptoms and quality of life of fibromyalgia patients. METHODS: A double-blind, randomized, placebo-controlled clinical trial was conducted for eight weeks to determine the benefit of a THC-rich cannabis oil (24.44 mg/mL of THC and 0.51 mg/mL of cannabidiol [CBD]) on symptoms and quality of life of 17 women with fibromyalgia, residents of a neighborhood with a low socioeconomic profile and a high incidence of violence in the city of Florianopolis, Brazil. The initial dose was one drop (∼1.22 mg of THC and 0.02 mg of CBD) a day with subsequent increases according to symptoms. The Fibromyalgia Impact Questionnaire (FIQ) was applied at pre- and postintervention moments and in five visits over eight weeks. RESULTS: There were no significant differences on baseline FIQ score between groups. However, after the intervention, the cannabis group presented a significant decrease in FIQ score in comparison with the placebo group (P = 0.005) and in comparison with cannabis group baseline score. (P < 0.001). Analyzing isolated items on the FIQ, the cannabis group presented significant improvement on the "feel good," "pain," "do work," and "fatigue" scores. The placebo group presented significant improvement on the "depression" score after intervention. There were no intolerable adverse effects. CONCLUSIONS: Phytocannabinoids can be a low-cost and well-tolerated therapy to reduce symptoms and increase the quality of life of patients with fibromyalgia. Future studies are still needed to assess long-term benefits, and studies with different varieties of cannabinoids associated with a washout period must be done to enhance our knowledge of cannabis action in this health condition.

Eficacia del instrumento XP-endo Finisher y del sistema EndoActivator en la reducción/eliminación del biofilm bacteriano: un ensayo ex vivo / Ability of the XP-endo Finisher instrument and the EndoActivator system to reduce/eliminate of the bacterial biofilm: an ex vivo assay

Objetivos: Comparar ex vivo la eficacia del instrumento XP-endo Finisher y del sistema EndoActivator en la reducción/eliminación del biofilm microbiano en conductos radiculares infectados. Materiales y métodos: Se utilizaron 23 premolares inferiores humanos extraídos cuya longitud fue estandarizada en 17 mm. Todos los conductos se prepararon con el sistema WaveOne Gold Medium (#35.06). Los dientes se esterilizaron, se inocularon con Enterococcus faecalis y se separaron en dos grupos experimentales de 10 piezas cada uno. De los 3 dientes remanentes, 1 fue utilizado como control positivo y 2, como controles negativos. En el grupo 1, las soluciones irrigantes se agitaron con XP-endo Finisher. En el grupo 2, se utilizó EndoActivator. Se tomaron muestras antes de la contaminación, luego de esta y después de la agitación de los irrigantes mediante conos de papel estériles. La carga microbiana fue sembrada en agar sangre y los conos se cultivaron en caldo tripteína de soja. La remoción de la carga microbiana se determinó por la presencia o ausencia de turbiedad del medio. Las unidades formadoras de colonias (UFC) remanentes se cuantificaron y los resultados se categorizaron como R1 (≤10 UFC) o R2 (>10 UFC). Los datos fueron analizados mediante la prueba de Fisher. Resultados: No hubo diferencias significativas entre XP-endo Finisher y EndoActivator (P>0,05). El número de usos no influyó sobre la capacidad operativa de ambos instrumentos (AU)

Aim: To compare ex vivo the effectiveness of the XP-endo Finisher and the EndoActivator in biofilm reduction/ removal from infected root canals. Materials and methods: Twenty three extracted human single-rooted lower premolars were selected and standardised to 17 mm in length. All the canals were prepared with WaveOne Gold Medium reciprocating files (#35.06). The teeth were autoclaved and inoculated with Enterococcus faecalis. The infected teeth were then assigned to 2 experimental groups of 10 teeth each according to the final irrigation/agitation protocol. Of the three remaining teeth, one was used as a positive control, and the other two were used as negative controls. In Group 1 the irrigating solutions were agitated with XP-endo Finisher while in Group 2 the EndoActivator was used. All root canals were sampled before and after contamination, and again after irrigant agitation with sterile paper points. The microbial load was spread on blood agar plates and the paper points were cultured in sterile trypticase soy broth. The removal of the microbial load was determined by visual observation of the turbidity of the media and by quantification of the number of colony-forming units (UFC). The results were categorized as R1 (≤10 UFC) or R2 (>10 UFC). Data were analysed by the Fisher's exact test at P<0.05. Results: No significant differences was found between XP-endo Finisher and EndoActivator (P>0.05) regarding their effectiveness in the reduction/removal of the microbial biofilm. The number of uses of both instruments did not affect their operative performance (AU) Conclusion: XPF and EA were both equally effective for microbial biofilm reduction/removal from ex vivo infected root canals (AU)

Avaliação dos níveis de ansiedade, estresse e qualidade de vida em acadêmicos de Fisioterapia / Evaluation of the levels of anxiety, stress and quality of life in Physical Therapy students

Introdução: No âmbito acadêmico, os universitários, especialmente da área da saúde, estão expostos a diversas situações estressantes que podem afetar diretamente sua qualidade de vida. Objetivo: Caracterizar a qualidade de vida, ansiedade e estresse bem como a associação entre esses fatores em acadêmicos do curso de Fisioterapia da Universidade de Itaúna. Métodos: Foram convidados para o estudo todos os alunos matriculados no curso de fisioterapia da Universidade de Itaúna. Para avaliação foi utilizado um questionário sociodemográfico, o Medical Outcomes Study 36 (SF-36) e as escalas IDATE-traço, IDATE-estado e Escala de Percepção de Estresse ­ 10 (ESP-10). Resultados: Entre os 227 acadêmicos, a média de estresse foi de 23,53 (± 6,63), qualidade de vida no domínio físico 68,51 (± 18,29) e o mental, 55,17 ± 23,01. Os níveis de ansiedade variaram entre moderado e alto. Conclusão: Os graduandos de fisioterapia apresentam sintomas de estresse e ansiedade que podem influenciar diretamente na qualidade de vida. (AU)

Introduction: Academic students, especially in health care, are exposed to various stressful situations that can directly affect their quality of life. Objective: To characterize the quality of life, anxiety and stress as well as the association between these factors in the academic course of physical therapy at the University of Itaúna. Methods: All students enrolled in the course of physical therapy at the University of Itaúna were invited to the study. For evaluation we used a demographic questionnaire, the Medical Outcomes Study-Short Form 36 (SF-36) and the scales trait (STAI-T), state (STAI-S) and Perceived Stress Scale - PSS-10. Results: Among the 227 academics, the average stress was 23.53 ± 6.63 points, quality of life in the physical domain 68.51 ± 18.29 points and mental, 55.17 ± 23.01. Anxiety levels ranged between moderate and high. Conclusion: The physical therapy students present symptoms of stress and anxiety and these can influence directly on the quality of life. (AU)

Genes related to maintenance of autophagy and successful aging / Genes relacionados à manutenção da autofagia e envelhecimento bem-sucedido

ABSTRACT Considering aging as a phenomenon in which there is a decline in essential processes for cell survival, we investigated the autophagic and proteasome pathways in three different groups: young, older and oldest old male adults. The expression profile of autophagic pathway-related genes was carried out in peripheral blood, and the proteasome quantification was performed in plasma. No significant changes were found in plasma proteasome concentrations or in correlations between proteasome concentrations and ages. However, some autophagy- and/or apoptosis-related genes were differentially expressed. In addition, the network and enrichment analysis showed an interaction between four of the five differentially expressed genes and an association of these genes with the transcriptional process. Considering that the oldest old individuals maintained both the expression of genes linked to the autophagic machinery, and the proteasome levels, when compared with the older group, we concluded that these factors could be considered crucial for successful aging.

RESUMO Considerando o envelhecimento como um fenômeno em que há um declínio nos processos essenciais a sobrevivência celular, investigamos as vias autofágica e proteassômica em três grupos: jovens, idosos e longevos. O perfil de expressão dos genes relacionados à via autofágica foi analisado em sangue periférico, e a quantificação do proteassoma realizada em plasma. Não foram encontradas alterações significativas nas concentrações plasmáticas de proteassoma ou na correlação entre as concentrações de proteassoma e as idades. No entanto, alguns genes relacionados a autofagia e / ou apoptose foram expressos diferencialmente. Além disso, as análises de rede e de enriquecimento mostraram uma interação entre quatro dos cinco genes diferencialmente expressos e a associação desses ao processo transcricional. Considerando que os indivíduos longevos mantiveram tanto a expressão de genes ligados à maquinaria autofágica, quanto os níveis de proteassoma quando comparados aos idosos, concluímos que esses fatores poderiam ser considerados cruciais para o envelhecimento bem-sucedido.

Clinical outcomes of low and intermediate risk differentiated thyroid cancer patients treated with 30mCi for ablation or without radioactive iodine therapy.

OBJECTIVE: To retrospectively evaluate the outcomes of patients with low and intermediate risk thyroid carcinoma treated with total thyroidectomy (TT) and who did not undergo radioiodine remnant ablation (RRA) and to compare them to patients receiving low dose of iodine (30 mCi). SUBJECTS AND METHODS: A total of 189 differentiated thyroid cancer (DTC) patients treated with TT followed by 30mCi for RRA or not, followed in two referral centers in Brazil were analyzed. RESULTS: From the 189 patients, 68.8% was ATA low-risk, 30.6% intermediate and 0.6% high risk. Eighty-seven patients underwent RRA and 102 did not. The RRA groups tended to be younger and had a higher frequency of extra-thyroidal extension (ETE). RRA did not have and impact on response to initial therapy neither in low (p = 0.24) nor in intermediate risk patients (p = 0.66). It also had no impact on final outcome and most patients had no evidence of disease (NED) at final follow-up. Recurrence/persistence of disease was found in 1.2% of RRA group and 2% in patients treated only with TT (p = 0.59). CONCLUSIONS: Our study shows that in low and intermediate-risk patients, RRA with 30 mCi seems to have no major advantage over patients who did not undergo RRA regarding response to initial therapy in each risk group and also in long term outcomes.

Clinical outcomes of low and intermediate risk differentiated thyroid cancer patients treated with 30mCi for ablation or without radioactive iodine therapy

ABSTRACT Objective To retrospectively evaluate the outcomes of patients with low and intermediate risk thyroid carcinoma treated with total thyroidectomy (TT) and who did not undergo radioiodine remnant ablation (RRA) and to compare them to patients receiving low dose of iodine (30 mCi). Subjects and methods A total of 189 differentiated thyroid cancer (DTC) patients treated with TT followed by 30mCi for RRA or not, followed in two referral centers in Brazil were analyzed. Results From the 189 patients, 68.8% was ATA low-risk, 30.6% intermediate and 0.6% high risk. Eighty-seven patients underwent RRA and 102 did not. The RRA groups tended to be younger and had a higher frequency of extra-thyroidal extension (ETE). RRA did not have and impact on response to initial therapy neither in low (p = 0.24) nor in intermediate risk patients (p = 0.66). It also had no impact on final outcome and most patients had no evidence of disease (NED) at final follow-up. Recurrence/persistence of disease was found in 1.2% of RRA group and 2% in patients treated only with TT (p = 0.59). Conclusions Our study shows that in low and intermediate-risk patients, RRA with 30 mCi seems to have no major advantage over patients who did not undergo RRA regarding response to initial therapy in each risk group and also in long term outcomes.

Estudo sobre os fatores associados ao impacto da fibromialgia na qualidade de vida / Study on factors associated with the impact of fibromyalgia in the quality of life

Introdução: A fibromialgia (FM) leva a um impacto negativo na qualidade de vida, afetando a vida profissional, familiar, e social destes indivíduos, fazendo-se necessário uma avaliação multidimensional. Objetivos: O presente estudo buscou avaliar os fatores que estão associados ao impacto da FM na qualidade de vida de mulheres com essa condição. Material e métodos: Participaram do estudo 34 pessoas com FM e 21 controles saudáveis (CS). Os instrumentos utilizados foram: Questionário da dor de McGill, Índice de Religiosidade de Duke, Índice de qualidade do sono de Pittsburgh (PSQI), World Health Disability Assessment Schedule (WHODAS 2.0), Questionário de impacto da fibromialgia (FIQ). As análises, descritiva, intergrupos e de regressão foram realizadas no pacote estatístico IBM SPSS com nível de significância ajustado para  = 0,05. Resultados: As participantes com FM apresentaram níveis estatisticamente significativos de dor (p < 0,0001), pior qualidade do sono (p < 0,0001), maior nível de incapacidade (p < 0,0001) em relação aos CS. Em nenhuma dimensão da religiosidade houve diferença significativa. No FIQ o grupo FM obteve média de 65,56 ± 17,95 pontos. A análise de regressão mostrou que os domínios atividade e participação do WHODAS 2.0 estão fortemente relacionados com impacto da fibromialgia na qualidade de vida. Conclusão: A avaliação dos indivíduos com FM deve ser realizada de forma multidimensional, baseando-se em modelos como a Classificação Internacional de Funcionalidade, Incapacidade e Saúde, para que os tratamentos propostos sejam voltados às reais necessidades do indivíduo. (AU)

Introduction: Fibromyalgia (FM) leads to a negative impact on quality of life, affecting the professional, family, and social life of these individuals, making necessary a multidimensional evaluation. Objectives: This study aimed to evaluate the factors that are associated with the impact of FM in the quality of life of women with this condition. Methods: Thirty-four people with FM and 21 healthy controls (HC) participated in the study. The instruments used were: McGill Pain Questionnaire, Duke's Religiosity Index, Pittsburgh Sleep Quality Index (PSQI), World Health Disability Assessment Schedule (WHODAS 2.0), Fibromyalgia Impact Questionnaire (FIQ). Descriptive, intergroup and regression analyzes were performed on the IBM SPSS statistical package with a significance level set at  = 0.05. Results: Participants with FM presented statistically significant levels of pain (p < 0.0001), poorer sleep quality (p < 0.0001), and higher disability level (p < 0.0001) in relation to HC. In no religious dimension there was a significant difference. In the FIQ the FM group obtained an average of 65.56 ± 17.95 points. Regression analysis showed that the activity and participation domains of WHODAS 2.0 are strongly related to the impact of fibromyalgia on quality of life. Conclusion: The evaluation of individuals with FM should be performed in a multidimensional manner, based on models such as the International Classification of Functioning, Disability and Health, so that the proposed treatments are geared to the individual's real needs. (AU)

Patologias frequentes do joelho / Frequent injuries of the knee

Objetivos: Avaliar as lesões mais frequente do joelho. Este é local de acometimento de grande número de patologias, tanto agudas quanto crônicas, sendo queixa nesta região anatômica motivo frequente de atendimento e assunto amplo a ser debatido. Assim, uma forma de compreender algumas patologias que acometem o joelho é revisar as afecções mais frequentes conforme a faixa etária. Métodos: Foram revisados seis artigos que abordam as patologias mais frequentes desta região, conforme cada faixa etária. Resultados: Na criança, cita-se a doença de Osgood-Schlatter, osteocondrite dissecante e menisco discóide; já no adulto, as lesões ligamentares e meniscais assumem papel de destaque e no idoso, a osteoartrose do joelho équeixa importante deste grupo de pacientes. De modo geral, o raio-x é o primeiro exame a ser solicitado, de maneira complementar a uma anamnese e exame físico detalhados. O tratamento é definido pelo ortopedista. Medidas gerais como repouso articular, gelo, elevação do membro e imobilização podem ser orientadas até que o paciente consulte o especialista. Conclusões: As lesões de joelho são queixas frequentes e podem ter diversas etiologias, sendo o trauma a mais frequente. Dividir o tema por faixa etária facilita ao examinador direcionar a história e o exame físico.

Aims: Evaluate the mains injuries of the knee. This is a frequent site of injuries with a large amount of pathologies, as much as acute injuries as well as chronic injuries, what makes this anatomic region a frequent motivation for consultation and an extensive subject for debate. Thereby one way of understanding some of these pathologies that involves the knee is reviewing the affections more frequent by age. Methods: Six studies that evaluate the most frequent knee injuries were reviewed, according to each age range. Results: On childhood, Osgood-Schlatter disease, osteochondritis dissecans and discoid meniscus; On adulthood, the ligaments and meniscus injuries become the centerpiece; On the elderly patient osteoarthritis has a main part on the complains. Radiography is the first complementary exam requested, on a general waybeing used to complement the physical examination and the history. Definitive treatment is given by the orthopedist, general measures as joint rest, ice, elevation of the limb and immobilization can be orientated by any doctor until the patient consult a specialist. Conclusions: Knee injuries are frequents and can have multiple etiologies, being trauma the most frequent. Divide by age range makes it easier for the examiner to direct the history and physical examination.

A case study of the effect of cardiovascular training on cerebral palsy / Estudo do condicionamento cardiovascular na paralisia cerebral - um estudo de caso

Abstract Introduction: Cerebral palsy (CP) is a non-progressive disorder characterized by changes in muscle tone and voluntary movement, leading to adaptive changes in muscle length and in some cases, resulting in bone deformities and increased energy expenditure while performing activities of daily living. Objective: The aim of this study was to investigate the effects of cardiovascular training by an adult with athetoid CP. Methods: The sample was composed of one patient with athetoid CP. The instruments used were the timed ten-meter walk test; the SF-36 quality of life questionnaire, a six-minute walk test and the Timed Up and Go test. Using an exercise bike and resistance exercises for the upper limbs, the patient underwent 24 sessions lasting fifty minutes each during eight weeks. Results: In all tests, significant improvement was observed at four and eight weeks, especially in the first four, and progressed in the following four weeks. In the post-training period, improvement was observed when compared to pre-training values. The SF-36 questionnaire on quality of life showed increase in some areas and decrease in others. Conclusion: Patients with CP can benefit from a physical training program, which can improve their quality of life and be included in their rehabilitation protocol.

Resumo Introdução: A Paralisia Cerebral (PC) é um distúrbio não progressivo que caracteriza-se por alterações no tônus muscular e movimentação voluntária, levando a modificações adaptativas do comprimento muscular e em alguns casos, chegando a resultar em deformidades ósseas e aumento do gasto energético durante a realização de atividades da vida diária. Objetivo: Avaliar os efeitos do condicionamento cardiovascular em um adulto com PC atetóide. Métodos: Participou do estudo um paciente com quadriparesia atetóide. Como instrumentos foram utilizados o Teste de Dez metros; o Questionário de Qualidade de Vida SF-36, o Teste de Caminhada de 6 Minutos e Teste Timed Get Up and Go. Foram realizadas 24 sessões, com duração de cinquenta minutos, durante oito semanas, utilizando uma Bicicleta ergométrica e exercícios resistido de MMSS. Resultados: Em todos os testes aplicados foi possível observar melhora após a quarta e a oitava semanas, especialmente nas primeiras quatro semanas. No destreino, observou-se melhora quando comparado com os valores de pré-treinamento. O Questionário de Qualidade de Vida SF-36 apresentou melhora em alguns domínios e declínio em outros. Conclusão: Um paciente com PC pode se beneficiar de um programa de condicionamento, podendo este melhorar sua qualidade de vida, e ser incluído em seu protocolo de reabilitação.

Influence of Sealer and Light-Curing Units on Push-Out Bond Strength Of Composite Resin to Weakened Roots

Abstract The aim of this study was to assess the influence of sealer and light-curing unit on regional bond strength of resin composite to the weakened roots. Ninety roots of incisors were experimentally weakened, subjected to biomechanical preparation and filled with either Endofill, AH Plus or MTA Fillapex The roots were desobturated e reinforced with resin composite and fiber post light-activated with one of the light sources: halogen at 600 mW/ cm2 (QTH-600), LED at 800 mW/ cm2 (LED-800) and LED at 1500 mW/ cm2 (LED-1500). The roots were sectioned in slices from cervical, middle and apical root-reinforcement regions and analyzed by push out test, scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). Bond strength data were analyzed using three-way ANOVA and Tukey´s test (α=0.05). Specimens filled with AH Plus had higher bond strength, followed by MTA Fillapex and Endofill (p<0.05). For light-curing unit, LED-1500 presented superior bond strength than LED-800, which was higher than QTH-600 (p<0.05). The cervical region had the greatest mean values (p<0.05) while apical part showed the lowest bond strength (p<0.05). CLMS revealed remaining filling material in the dentinal tubules for all groups. The eugenol-containing sealer (Endofill) compromised the push-out bond strength of composite resin to the root dentin. Bond strength was favored in the cervical region, and when LED-1500 was used.

Resumo O objetivo neste estudo foi avaliar a influência do cimento endodôntico e da fonte de luz fotoativadora na resistência de união (RU) regional da resina composta às raízes fragilizadas. Noventa raízes de incisivos foram experimentalmente fragilizados, submetidos ao preparo biomecânico e obturadas com Endofill, AH Plus ou MTA Fillapex. Os canais foram desobturados e reforçados com pinos de fibra de vidro e resina composta fotoativada com uma das fontes de luz: halógena a 600 mW/cm2 (QTH-600), diodo emissor de luz a 800 mW/cm2 (LED-800) e LED a 1500 mW/cm2 (LED-1500). As raízes foram seccionadas em slices provenientes dos terços cervical, médio e apical das regiões da raiz reforçada e analisadas por meio do teste de push out, microscopia eletrônica de varredura (MEV) e microscopia confocal de varredura a laser (MCVL). Os dados de resistência de união foram analisados por ANOVA a três critérios e teste de Tukey (α=0,05). Os espécimes obturados com AH Plus apresentaram maior resistência de união, seguido do MTA Fillapex e do Endofill (p<0,05). Para fonte de luz fotoativadora, LED-1500 apresentou resistência de união superior ao LED-800 que foi maior que QTH-600 (p<0,05). A região cervical obteve as maiores médias (p<0,05), enquanto que a região apical apresentou a menor resistência de união (p<0,05). MCVL revelou remanescente de material endodôntico nos túbulos dentinários para todos os grupos. O cimento contendo eugenol (Endofill) comprometeu a resistência de união da resina composta à dentina radicular. A resistência de união foi favorecida na região cervical, e quando o LED-1500 foi empregado.

Realidade virtual na reabilitação de portadores da doença de Parkinson / Virtual reality in the rehabilitation of patients with Parkinson disease

Introdução: A doença de Parkinson é uma doença degenerativa que leva os pacientes a apresentarem alterações no equilíbrio. A realidade virtual tem sido estudada como um recurso para reabilitação destes pacientes. Objetivo: Verificar a influência da realidade virtual, com a utilização do Wii Fit, na melhora do equilíbrio, da qualidade de vida e do medo de quedas dos portadores da doença de Parkinson. Métodos: Onze voluntários, com doença de Parkinson até o estágio 3 da escala de Hoehn e Yahr, foram recrutados para este estudo. Os pacientes participaram de 12 sessões de cinesioterapia e de 12 sessões de terapia com realidade virtual. Foram utilizados os seguintes testes na coleta de dados para as avaliações inicial, póscinesioterapia e pós-realidade virtual: Timed Get Up and Go, Escala de Equilíbrio de Berg, teste de caminhada de 10 metros, Escala de Eficácia de Quedas e o Perfil de Saúde de Nottinghan. Após as intervenções foi aplicado um questionário qualitativo. Resultados: Não houve diferença estatística nas variáveis analisadas, porém no questionário qualitativo a maioria dos pacientes demonstrou preferência pela realidade virtual. Conclusão: Apesar de os resultados não apresentarem diferenças estatísticas, a realidade virtual pode ser uma nova ferramenta associada à fisioterapia tradicional.(AU)

Introduction: Parkinson's disease is a degenerative disease which causes alterations in body balance. Virtual reality has been studied as a rehabilitation method of these patients. Objective: To investigate the influence of virtual reality, using the Wii Fit in improving body balance, quality of life and fear of falls among patients with Parkinson's disease. Methods: Eleven volunteers, with diagnosis of Parkinson's disease until stage 3 of Hoehn and Yahr scale, were recruited for this study. Patients performed 12 kinesiotherapy sessions and 12 sessions with virtual reality. The following tests were used to collect data during initial, post-kinesiotherapy and post-virtual reality evaluations: Timed Get Up and Go, the Berg Balance Scale, 10-meter walk test, Falls Efficacy Scale and Health Profile Nottinghan. After the interventions was applied a qualitative questionnaire. Results: There was no statistical difference in the variables analyzed, but in the qualitative questionnaire most patients showed a preference for virtual reality. Conclusion: Although the results do not have statistical differences, virtual reality can be a new tool associated with traditional physical therapy. (AU)

Cross-cultural validation of a taste test with paper strips.

Taste dysfunctions influence food choices, interpersonal communication and danger/health. A gustometry protocol is the mainstream for clinical taste disorders diagnosis and suggests possible therapeutics. No clinical gustometry protocol has been adapted and validated to the Portuguese population so far. We aim to validate a gustometry protocol based on strips made from filter paper impregnated with different taste solutions. Four concentrations each for sweet, sour, salty and bitter were administered to 75 subjects. Hypogeusia threshold is of 4.8 in this population. Repeated measures indicated a good reliability and validity for the taste strips (ρ 75 = 0.68, p < 0.001). Although Mediterranean food implies a heathy eating pattern, taste threshold scores may be lower because of its habituation to natural food flavoring. The taste strip gustometry protocol can be applied to the clinical practice in Portugal. It is quick, effective and cheap. The diagnostic utility of this method is indisputable, as well as the advantages we can obtain with its application, for early diagnosis and distinction between disorders of taste and smell.

Iron and Oxidative Stress in Parkinson's Disease: An Observational Study of Injury Biomarkers.

Parkinson's disease (PD) is characterized by progressive motor impairment attributed to progressive loss of dopaminergic neurons in the substantia nigra (SN) pars compacta. In addition to an accumulation of iron, there is also an increased production of reactive oxygen/nitrogen species (ROS/RNS) and inflammatory markers. These observations suggest that iron dyshomeostasis may be playing a key role in neurodegeneration. However, the mechanisms underlying this metal-associated oxidative stress and neuronal damage have not been fully elucidated. To determine peripheral levels of iron, ferritin, and transferrin in PD patients and its possible relation with oxidative/nitrosative parameters, whilst attempting to identify a profile of peripheral biomarkers in this neurological condition. Forty PD patients and 46 controls were recruited to compare serum levels of iron, ferritin, transferrin, oxidative stress markers (superoxide dismutase (SOD), catalase (CAT), nitrosative stress marker (NOx), thiobarbituric acid reactive substances (TBARS), non-protein thiols (NPSH), advanced oxidation protein products (AOPP), ferric reducing ability of plasma (FRAP) and vitamin C) as well as inflammatory markers (NTPDases, ecto-5'-nucleotidase, adenosine deaminase (ADA), ischemic-modified albumin (IMA) and myeloperoxidase). Iron levels were lower in PD patients, whereas there was no difference in ferritin and transferrin. Oxidative stress (TBARS and AOPP) and inflammatory markers (NTPDases, IMA, and myeloperoxidase) were significantly higher in PD, while antioxidants FRAP, vitamin C, and non-protein thiols were significantly lower in PD. The enzymes SOD, CAT, and ecto-5'-nucleotidase were not different among the groups, although NOx and ADA levels were significantly higher in the controls. Our data corroborate the idea that ROS/RNS production and neuroinflammation may dysregulate iron homeostasis and collaborate to reduce the periphery levels of this ion, contributing to alterations observed in the pathophysiology of PD.

Supplementation with selenium can influence nausea, fatigue, physical, renal, and liver function of children and adolescents with cancer.

The drugs used in chemotherapy treatments have little specificity, attack tumor cells, and also injure proliferative tissues. Knowledge of the functions of micronutrients has greatly increased, especially of Selenium (Se) that presents immunomodulatory and antitumor functions. The present study evaluated the health-related quality of life of patients undergoing chemotherapy for the treatment of leukemias and lymphomas (LL) and solid tumors (ST) while receiving Selenium (Se) supplementation. This is a randomized, double-blind, crossover study that evaluated the quality of life (EORTC-QLQ-C30 questionnaire), renal and liver functions of patients supplemented with Se. There was no statistically significant alteration in LL patients. However, the fatigue and nausea scores after 30 days did decrease in this group as well as in the ST group. After 1 year supplementation with Selenium, a more noticeable decrease in the scores concerning fatigue and nausea could be observed in the ST group, when compared with the beginning of the study. The LL patients also presented a decrease in the fatigue scores and physical functions. The kidney function as well as liver function has improved after Selenium supplementation when compared with the placebo intake in LL and ST patients, more remarkably in the LL group. Supplementation with Selenium promotes the reduction of chemotherapy side effects in cancer patients, especially by improving the conditions of patients with fatigue, nausea, and impaired physical function. Renal and liver functions have also improved.

Biological effects of soft denture reline materials on L929 cells in vitro.

Soft denture reline materials have been developed to help patients when their oral mucosa is damaged or affected due to ill-fitting dentures or post-implant surgery. Although reports have indicated that these materials leach monomers and other components that do affect their biocompatibility, there is little information on what cell molecules may be implicated in these material/tissue interactions. The biocompatibility of six soft liners (Ufi Gel P, Sofreliner S, Durabase Soft, Trusoft, Softone and Coe Comfort) was evaluated using a mouse fibroblast cell line, L929. Within 2 h of material disc preparation, each of the materials was exposed by direct contact to L929 cells for periods of 24 and 48 h. The effect of this interaction was assessed by alamarBlue assay (for cell survival). The expression of integrin α5ß1 and transforming growth factor ß1 was also assessed using plate assays such as enzyme-linked immunosorbent assay. Trusoft, Softone and Coe Comfort showed significantly reduced cell survival compared with the other soft lining materials at each incubation period. Furthermore, there were significant differences with these same materials in the expression of both integrin α5ß1 and transforming growth factor ß1. Soft liner materials may affect cell viability and cellular proteins that have important roles in wound healing and the preservation of cell viability and function in the presence of environmental challenges and stresses.

[Appendiceal carcinoid tumors. Evaluation of long-term outcomes in a tertiary level]. / Tumores carcinoides apendiculares. Evaluación de los resultados a largo plazo en un hospital de tercer nive.

BACKGROUND: Appendiceal tumors are found in about 1% of appendectomies performed and 0.5% of intestinal neoplasias. Appendiceal carcinoids are the predominant histology in this group and are usually casual after appendectomy for other reasons. The prognosis is excellent and survival is 95% at 5 years after surgery. METHODS: Retrospective analysis of all patients with appendiceal carcinoid surgery in our hospital for 20 years (1990-2010) and survival at 5 years. We also discuss the need for additional treatment and testing for follow-up visits. RESULTS: 42 patients underwent surgery for appendiceal carcinoid tumor. 38 of them were operated on urgently, mostly for suspected acute appendicitis, without having reached the carcinoid tumor diagnosed preoperatively in any of them. The predominant symptomatology at admission was abdominal pain. Surgical treatment was appendectomy in 34 patients (12 laparoscopic), 7 patients required colon resections over intraoperatively by colonic involvement; only one patient required reoperation to complete right hemicolectomy. 2 patients had disseminated disease at diagnosis (liver metastases). The 5-year survival is over 95%, with no recurrence. CONCLUSIONS: The appendiceal carcinoid tumor is difficult to diagnose preoperatively. Appendectomy surgical treatment is usually sufficient, although colonic resections may be needed for dissemination. The 5-year survival is over 95%.

Antecedentes: los tumores apendiculares se encuentran en cerca de 1% de las apendicectomías y representan 0.5% de las neoplasias intestinales. El tipo de tumor más frecuente es el carcinoide apendicular, que casi siempre es un hallazgo durante la apendicectomía por otro motivo. Su pronóstico es excelente y la supervivencia es mayor de 95% a cinco años de la intervención. Objetivo: reportar una serie de casos y analizar la supervivencia media a cinco años posteriores a la identificación el tumor. Material y métodos: análisis retrospectivo (1990-2010) de pacientes con tumor carcinoide apendicular intervenidos en el servicio de Cirugía General y del Aparato Digestivo del Hospital Universitario Virgen del Rocío, Sevilla, España. Se analizaron: la supervivencia a cinco años, la necesidad de tratamiento complementario y las pruebas para seguimiento en la consulta. Resultados: se encontraron 42 pacientes intervenidos por tener un tumor carcinoide apendicular. En 38 pacientes la operación fue de urgencia, la mayoría por sospecha de apendicitis aguda, sin que en ninguno se hubiera establecido el diagnóstico de tumor carcinoide antes de la operación. El síntoma predominante al ingreso fue el dolor abdominal. El tratamiento quirúrgico fue: apendicectomía en 34 pacientes (12 por laparoscopia), en el intraoperatorio siete pacientes requirieron resecciones colónicas mayores debido a la afectación del colon; sólo uno requirió la reintervención para completar la hemicolectomía derecha. Al momento del diagnóstico dos pacientes tenían enfermedad diseminada (metástasis hepáticas). La supervivencia a cinco años fue superior a 95%, sin recidivas o tratamiento posterior de la enfermedad. Conclusiones: el tumor carcinoide apendicular difícilmente se diagnostica antes del procedimiento quirúrgico. La apendicectomía suele ser suficiente aunque en algunos pacientes las resecciones colónicas son necesarias por diseminación. La supervivencia a 5 años es superior a 95%.