Comprehensive Assessment of Cyclic Fatigue Strength in Five Multiple-File Nickel-Titanium Endodontic Systems.

The resistance of nickel-titanium endodontic instruments against cyclic fatigue failure remains a significant concern in clinical settings. This study aimed to assess the cyclic fatigue strength of five nickel-titanium rotary systems, while correlating the results with the instruments' geometric and metallurgical characteristics. A total of 250 new instruments (sizes S1/A1, S2/A2, F1/B1, F2/B2, F3/B3) from ProTaper Gold, ProTaper Universal, Premium Taper Gold, Go-Taper Flex, and U-Files systems underwent mechanical testing. Prior to experimental procedures, all instruments were meticulously inspected to identify irregularities that could affect the investigation. Using a stereomicroscope, design characteristics such as the number of spirals, length, spirals per millimeter, and average helical angle of the active blade were determined. The surface finishing characteristics of the instruments were examined using a scanning electron microscope. Differential scanning calorimetry was employed to establish the instruments' phase transformation temperatures, while energy-dispersive X-ray spectroscopy was utilized to analyze the elemental composition of the alloy. The instruments were subjected to cyclic fatigue testing within a stainless steel non-tapered artificial canal featuring a 6 mm radius and 86 degrees of curvature. Appropriate statistical tests were applied to compare groups, considering a significance level of 0.05. The assessed design characteristics varied depending on the instrument type. The least irregular surface finishing was observed in U-Files and Premium Taper Gold files, while the most irregular surface was noted in Go-Taper Flex. All instruments exhibited near-equiatomic proportions of nickel and titanium elements, whereas ProTaper Universal and U-Files instruments demonstrated lower phase transformation temperatures compared to their counterparts. Larger-sized instruments, as well as ProTaper Universal and U-Files, tended to display lower cyclic fatigue strength results. Overall, the design, metallurgical, and cyclic fatigue outcomes varied among instruments and systems. Understanding these outcomes may assist clinicians in making more informed decisions regarding instrument selection.

Circulating Tumor Cells in Cancer Diagnostics and Prognostics by Single-Molecule and Single-Cell Characterization.

Circulating tumor cells (CTCs) represent an interesting source of biomarkers for diagnosis, prognosis, and the prediction of cancer recurrence, yet while they are extensively studied in oncobiology research, their diagnostic utility has not yet been demonstrated and validated. Their scarcity in human biological fluids impedes the identification of dangerous CTC subpopulations that may promote metastatic dissemination. In this Perspective, we discuss promising techniques that could be used for the identification of these metastatic cells. We first describe methods for isolating patient-derived CTCs and then the use of 3D biomimetic matrixes in their amplification and analysis, followed by methods for further CTC analyses at the single-cell and single-molecule levels. Finally, we discuss how the elucidation of mechanical and morphological properties using techniques such as atomic force microscopy and molecular biomarker identification using nanopore-based detection could be combined in the future to provide patients and their healthcare providers with a more accurate diagnosis.

Construção de gerontotecnologias de cuidado no contexto da pessoa idosa com doença de Alzheimer / Building care gerontotechnologies in the context of elderly person with Alzheimer's disease

RESUMO Objetivo construir gerontotecnologias de cuidado para auxiliar familiares cuidadores nas dificuldades vivenciadas no contexto das pessoas idosas com doença de Alzheimer. Métodos pesquisa-ação estratégica, realizada com sete familiares cuidadores de idosos com doença de Alzheimer e 12 acadêmicos da saúde de uma universidade. Os dados foram coletados com os familiares cuidadores, por meio de entrevista semiestruturada. Com os acadêmicos, realizou-se três grupos focais. Os dados foram submetidos à técnica de análise textual discursiva. Resultados emergiram oito dificuldades vivenciadas pelos familiares cuidadores correspondentes aos aspectos cognitivos, as Atividades de Vida Diária e as questões relativas à família no cuidado. Foi possível construir 14 gerontotecnologias de cuidado na forma de produto. Conclusão foram construídas gerontotecnologias para auxiliar familiares cuidadores nas dificuldades vivenciadas junto às pessoas idosas que vivem com doença de Alzheimer. Contribuições para a prática: as gerontotecnologias construídas possuem potencial de contribuir com o processo de cuidado, uma vez que podem ser utilizadas por familiares cuidadores no cotidiano e serem adaptando para cada realidade, a partir da necessidade singular de cada pessoa idosa.

ABSTRACT Objective to build care gerontotechnologies to help family caregivers with the difficulties experienced in the context of elderly people with Alzheimer's disease. Methods strategic action research carried out with seven family caregivers of elderly people with Alzheimer's disease and 12 health academics from a university. Data was gathered from the family caregivers using a semi-structured interview. Three focus groups were held with the academics. The data was submitted to the discursive textual analysis technique. Results eight difficulties experienced by family caregivers emerged, corresponding to cognitive aspects, Activities of Daily Living and issues relating to family care. It was possible to construct 14 care gerontotechnologies in product form. Conclusion gerontotechnologies were built to help family caregivers with the difficulties experienced by elderly people living with Alzheimer's disease. Contributions to practice the gerontotechnologies developed have the potential to contribute to the care process, since they can be used by family caregivers on a daily basic and can be adapted to each reality, based on the unique needs of each elderly person.

Failure factors for carpal tunnel syndrome surgical treatment: When and how to perform a revision carpal tunnel decompression surgery.

Despite being a procedure widely used all over the world with high rates of symptom remission, surgical treatment of carpal tunnel syndrome may present unsatisfactory outcomes. Such outcomes may be manifested clinically by non-remission of symptoms, remission of symptoms with recurrence a time after surgery or appearance of different symptoms after surgery. Different factors are related to this unsuccessful surgical treatment of carpal tunnel syndrome. Prevention can be achieved through a thorough preoperative clinical evaluation of the patient. As such, the surgeon will be able to make differential or concomitant diagnoses, as well as determine factors related to patient dissatisfaction. Perioperative factors include the correct identification of anatomical structures for complete median nerve decompression. Numerous procedures have been described for managing postoperative factors. Among them, the most common is adhesion around the median nerve, which has been treated with relative success using different vascularized flaps or autologous or homologous tissue coverage. The approach to cases with unsuccessful surgical treatment of carpal tunnel syndrome is discussed in more detail in the text.

Failure factors for carpal tunnel syndrome surgical treatment: When and how to perform a revision carpal tunnel decompression surgery / Fatores de insucesso do tratamento cirúrgico da síndrome do túnel do carpo: Quando e como revisar a cirurgia de descompressão do túnel do carpo

Abstract Despite being a procedure widely used all over the world with high rates of symptom remission, surgical treatment of carpal tunnel syndrome may present unsatisfactory outcomes. Such outcomes may be manifested clinically by non-remission of symptoms, remission of symptoms with recurrence a time after surgery or appearance of different symptoms after surgery. Different factors are related to this unsuccessful surgical treatment of carpal tunnel syndrome. Prevention can be achieved through a thorough preoperative clinical evaluation of the patient. As such, the surgeon will be able to make differential or concomitant diagnoses, as well as determine factors related to patient dissatisfaction. Perioperative factors include the correct identification of anatomical structures for complete median nerve decompression. Numerous procedures have been described for managing postoperative factors. Among them, the most common is adhesion around the median nerve, which has been treated with relative success using different vascularized flaps or autologous or homologous tissue coverage. The approach to cases with unsuccessful surgical treatment of carpal tunnel syndrome is discussed in more detail in the text.

Resumo Apesar de ser um procedimento amplamente utilizado em todo o mundo e com elevadas taxas de remissão dos sintomas, o tratamento cirúrgico da síndrome do túnel do carpo pode apresentar resultados não satisfatórios ao paciente. Esse resultado não satisfatório pode se manifestar clinicamente pela não remissão dos sintomas, remissão dos sintomas mas recorrência desses após um período de tempo da cirurgia ou aparecimento de diferentes sintomas após a cirurgia. Diferentes fatores estão relacionados a esse insucesso do tratamento cirúrgico da síndrome do túnel do carpo (ITCSTC). A prevenção pode ser conseguida por meio de minuciosa avaliação clínica do paciente no período pré-operatório. Dessa forma o cirurgião poderá fazer diagnósticos diferenciais ou diagnósticos concomitantes, assim como identificar fatores ligados a insatisfação do paciente. Os fatores per-operatórios incluem a correta identificação das estruturas anatômicas para completa descompressão do nervo mediano. Inúmeros procedimentos têm sido descritos para o tratamento dos fatores que ocorrem no período pós-operatório. Desses o mais comum, a formação de aderências em torno do nervo mediano, tem sido tratado com relativo sucesso utilizando diferentes retalhos vascularizados ou cobertura com o uso de tecido autólogo ou homólogo. Descreveremos a abordagem do ITCSTC com maiores detalhes no texto.

Magnetic resonance imaging target fusion biopsy vs. transrectal ultrasound-guided biopsy - A comparative study of ISUP score upgrading risk in the final radical prostatectomy specimen.

OBJECTIVES: The aim of this study was to com-pare the risk of International Society of Urological Pathology (ISUP) score upgrading between magnetic resonance imaging targeted fusion biopsy (MRI-TB) and tran-srectal ultrasound-guided biopsy (TRUS-B) in the final radical prostatectomy (RP) specimen pathological report. MATERIALS AND METHODS: This retrospective single center study included 51 patients with prostate cancer (PCa) diagnosed with MRI-TB and 83 patients diagnosed with TRUS-B between October/2019 and July/2021. We compared the rates of ISUP score upgrading between both groups after robotic-assisted radi-cal prostatectomy (RARP) and the specific transition of each ISUP score based on biopsy modality. The rate of ISUP score concordance and downgrading were also assessed. To define the intra and interobserver concordance for each ISUP score in biopsy and RP specimen for each biopsy modality, the Cohen's Kappa coefficient was calculated. ISUP scores and biopsy modal-ity were selected for multivariate analysis and a logistic regres-sion model was built to provide independent risk factors of ISUP score upgrading. RESULTS: The difference of the rate of upgrading between MRI-TB group and TRUS-B group was statistically significant (p = 0.007) with 42.2% of patients of TRUS-B group experiencing an upgrade in their ISUP score while only 19.6% in MRI-TB group. Concordance and downgrading rates did not statistically differ between the two groups. Strength of concordance using Cohen's Kappa coefficient was fair in both groups but higher in MRI-TB group (TRUS-B group k = 0.230; p < 0.001; concordance: 47%vs. MRI/TB group k = 0.438; p < 0.001; concordance: 62.7%). Biopsy modality and ISUP 1 on biopsy were independent predic-tors of ISUP upgrading after RP. CONCLUSIONS: MRI-TB is highly accurate with lower risk of PCa upgrading after RP than TRUS-B. Patients with ISUP 1 on biopsy have greater susceptibility to upgrading their ISUP score.

A Multimethod Assessment of a New Customized Heat-Treated Nickel-Titanium Rotary File System.

This study aimed to compare three endodontic rotary systems. The new Genius Proflex (25/0.04), Vortex Blue (25/0.04), and TruNatomy (26/0.04v) instruments (n = 41 per group) were analyzed regarding design, metallurgy, and mechanical performance, while shaping ability (untouched canal walls, volume of removed dentin and hard tissue debris) was tested in 36 anatomically matched root canals of mandibular molars. The results were compared using one-way ANOVA, post hoc Tukey, and Kruskal−Wallis tests, with a significance level set at 5%. All instruments showed symmetrical cross-sections, with asymmetrical blades, no radial lands, no major defects, and almost equiatomic nickel−titanium ratios. Differences were noted in the number of blades, helical angles, cross-sectional design, and tip geometry. The Genius Proflex and the TruNatomy instruments had the highest and lowest R-phase start and finish temperatures, as well as the highest and lowest time and cycles to fracture (p < 0.05), respectively. The TruNatomy had the highest flexibility (p < 0.05), while no differences were observed between the Genius Proflex and the Vortex Blue (p > 0.05). No differences among tested systems were observed regarding the maximum torque, angle of rotation prior to fracture, and shaping ability (p > 0.05). The instruments showed similarities and differences in their design, metallurgy, and mechanical properties. However, their shaping ability was similar, without any clinically significant errors. Understanding these characteristics may help clinicians to make decisions regarding which instrument to choose for a particular clinical situation.

Cancer risk-reducing surgery: Brazilian society of surgical oncology guideline part 1 (gynecology and breast).

BACKGROUND: Risk-reducing operations are an important part of the management of hereditary predisposition to cancer. In selected cases, they can considerably reduce the morbidity and mortality associated with cancer in this population. OBJECTIVES: The Brazilian Society of Surgical Oncology (BSSO) developed this guideline to establish national benchmarks for cancer risk-reducing operations. METHODS: The guideline was prepared from May to December 2021 by a multidisciplinary team of experts to discuss the surgical management of cancer predisposition syndromes. Fourteen questions were defined and assigned to expert groups that reviewed the literature and drafted preliminary recommendations. Following a review by the coordinators and a second review by all participants, the groups made final adjustments, classified the level of evidence, and voted on the recommendations. RESULTS: For all questions including risk-reduction bilateral salpingo-oophorectomy, hysterectomy, and mastectomy, major agreement was achieved by the participants, always using accessible alternatives. CONCLUSION: This and its accompanying article represent the first guideline in cancer risk reduction surgery developed by the BSSO, and it should serve as an important reference for the management of families with cancer predisposition.

Cancer risk-reducing surgery: Brazilian Society of Surgical Oncology Guideline Part 2 (Gastrointestinal and thyroid).

BACKGROUND: Risk-reducing operations are an important part of the management of hereditary predisposition to cancer. In selected cases, they can considerably reduce the morbidity and mortality associated with cancer in this population. OBJECTIVES: The Brazilian Society of Surgical Oncology (BSSO) developed this guideline to establish national benchmarks for cancer risk-reducing operations. METHODS: The guideline was prepared from May to December 2021 by a multidisciplinary team of experts to discuss the surgical management of cancer predisposition syndromes. Eleven questions were defined and assigned to expert groups that reviewed the literature and drafted preliminary recommendations. Following a review by the coordinators and a second review by all participants, the groups made final adjustments, classified the level of evidence, and voted on the recommendations. RESULTS: For all questions including risk-reducing colectomy, gastrectomy, and thyroidectomy, a major agreement was achieved by the participants, always using accessible alternatives. CONCLUSION: This and its accompanying article represent the first guideline in cancer risk reduction surgery developed by the BSSO and it should serve as an important reference for the management of families with cancer predisposition.

Brazilian law of inclusion: an applied analysis of the correlation of bioethical principles / Ley brasileña de inclusión: un análisis aplicado de la correlación de los principios de la bioética / Lei brasileira de inclusão: uma análise aplicada da correlação dos princípios de bioética

Abstract: Objective: The present study aims to analyse whether bioethical principles are present in the Brazilian Law of Inclusion of the Disabled Person. Methods: The study is based on a textual analysis of Law No. 13.146, of July 6, 2015 (Brazilian Law of Inclusion) using a content analysis technique regarding the bioethical principles of beneficence, nonmaleficence, justice and autonomy. A qualitative analysis was conducted based on the concepts of these bioethical principles and their expression in the articles laid down in the Statute of the Disabled Person. Results: The obtained results demonstrate that the primary articles of the Brazilian Law of Inclusion correlate with the aforementioned bioethical principles according to the conceptualisation of each principle. Conclusion: The articles of the Brazilian Law of Inclusion, published on July 6, 2015, under the provisions of the Federal Constitution of 1988 and the Convention on the Rights of Persons with Disabilities, demonstrate a correlation with the stated bioethical principles.

Resumen: Objetivo: El presente estudio pretende analizar si los principios bioéticos están presentes en la Ley brasileña de inclusión de personas con discapacidad. Métodos: El estudio se basa en un análisis textual de la Ley nº 13.146 de 6 de julio de 2015 (Ley brasileña de inclusión) mediante una técnica de análisis de contenido sobre los principios bioéticos de beneficencia, no maleficencia, justicia y autonomía. Se realizó un análisis cualitativo basado en los conceptos de estos principios bioéticos y su expresión en los artículos establecidos en el Estatuto del Discapacitado. Resultados: Los resultados obtenidos muestran que los artículos primarios de la Ley de Inclusión brasileña se correlacionan con los principios bioéticos mencionados, según la conceptualización de cada principio. Conclusión: Los artículos de la Ley de Inclusión brasileña, publicada el 6 de julio de 2015, en virtud de las disposiciones de la Constitución Federal de 1988 y de la Convención sobre los Derechos de las Personas con Discapacidad, demuestran una correlación con los principios bioéticos enunciados.

Resumo: Objetivo: O presente estudo tem por objetivo analisar se os princípios bioéticos estão presentes na Lei Brasileira de Inclusão da Pessoa com Deficiência. Métodos: O estudo é baseado em uma análise textual da Lei nº 13.146, de 6 de julho de 2015 (Lei Brasileira de Inclusão) utilizando uma técnica de análise de conteúdo relativa aos princípios bioéticos de beneficência, não maleficência, justiça e autonomia. Uma análise qualitativa foi realizada com base nos conceitos destes princípios bioéticos e sua expressão nos artigos estabelecidos no Estatuto da Pessoa Deficiente. Resultados: Os resultados obtidos demonstram que os artigos primários da Lei de Inclusão brasileira se correlacionam com os princípios bioéticos acima mencionados, de acordo com a conceituação de cada princípio. Conclusão: Os artigos da Lei Brasileira de Inclusão, publicados em 6 de julho de 2015, sob as disposições da Constituição Federal de 1988 e da Convenção sobre os Direitos das Pessoas com Deficiência, demonstram uma correlação com os princípios bioéticos declarados.

The Percentage of [-2]Pro-Prostate-Specific Antigen and the Prostate Health Index Outperform Prostate-Specific Antigen and the Percentage of Free Prostate-Specific Antigen in the Detection of Clinically Significant Prostate Cancer and Can Be Used as Reflex Tests.

CONTEXT.­: There is a need to avoid the overdiagnosis of prostate cancer (PCa) and to find more specific biomarkers. OBJECTIVE.­: To evaluate the clinical utility of [-2]pro-prostate-specific antigen ([-2]proPSA) derivatives in detecting clinically significant PCa (csPCa) and to compare it with prostate-specific antigen (PSA) and with the percentage of free PSA (%fPSA). DESIGN.­: Two hundred thirty-seven men (PSA: 2-10 ng/mL) scheduled for a prostate biopsy were enrolled. Parametric and nonparametric tests, receiver operating characteristic curves, and logistic regression analysis were applied. Outcomes were csPCa and overall PCa. RESULTS.­: Both [-2]proPSA derivatives were significantly higher in csPCa and overall PCa (P < .001). The areas under the curves for the prediction of csPCa were higher for the percentage of [-2]proPSA (%[-2]proPSA) (0.781) and the prostate health index (PHI) (0.814) than for PSA (0.651) and %fPSA (0.724). There was a gain of 11% in diagnostic accuracy when %[-2]proPSA or PHI were added to a base model with PSA and %fPSA. Twenty-five percent to 29% of biopsies could have been spared with %[-2]proPSA (cutoff: ≥1.25%) and PHI (cutoff: ≥27), missing 10% of csPCas. The same results could have been achieved by using [-2]proPSA as a reflex test, when %fPSA was 25% or less (cutoffs: ≥1.12% and ≥24 for %[-2]proPSA and PHI, respectively). CONCLUSIONS.­: The [-2]proPSA derivatives improve the diagnostic accuracy of csPCa when the PSA value is between 2 and 10 ng/mL, sparing unnecessary biopsies and selecting patients for active surveillance. [-2]proPSA can be used as a reflex test when %fPSA is 25% or less, without reducing the diagnostic accuracy for csPCa and the number of spared biopsies.

Legislation for disabled people in Brazil: from human dignity to social inclusion: advancing capabilities as an ethical imperative / Legislación para los discapacitados en Brasil: de la dignidad humana a la inclusión social: el avance de las capacidades como imperativo ético / Legislação para os incapacitados no Brasil: da dignidade humana à inclusão social: o avanço das capacidades como imperativo ético

Abstract The study analyzes the ethical and legal basis of Brazilian legislation for people with disabilities and verifies whether the instruments used therein are in line with national and international law. It also investigates the coherence and cohesion of the law and its ethical norms to build an inclusive and just society. Through an exploratory and integrative review, it analyzed the legal provisions in force in Brazil published on the official websites of the Brazilian federal government and available on the Internet. It was evaluated whether the definition used for persons with disabilities follows the United Nations Convention on the Rights of Persons with Disabilities. Also, whether it is necessary to evaluate disabilities and who should perform this task professionally. Thirty-three legal norms were found, among which only three laws and two decrees are in line with the recommendations of the UN Convention. It is necessary to review the existing norms and promote the consolidation of laws, decrees, ordinances and normative instructions regarding the rights of persons with disabilities in a uniform manner, on an adequate technical-scientific basis. This review should be consistent with the provisions of the 1988 Federal Constitution, the International Convention on the Rights of Persons with Disabilities and the Brazilian Inclusion Law.

Resumen El estudio analiza el fundamento ético y jurídico de la legislación brasileña para las personas con discapacidad y comprueba si los instrumentos allí utilizados se ajustan al Derecho nacional e internacional. Además, investiga la coherencia y cohesión de la ley y sus normas éticas para construir una sociedad inclusiva y justa. Mediante revisión exploratoria e integrativa, analizó las disposiciones legales vigentes en Brasil publicadas en los sitios web oficiales del gobierno federal brasileño y disponibles en Internet. Se evaluó si la definición utilizada para las personas con discapacidad sigue la Convención de las Naciones Unidas sobre los Derechos de las Personas con Discapacidad. También, si es necesario evaluar las discapacidades y quién debe realizar esa tarea profesionalmente. Se encontraron 33 normas legales, entre las cuales solo tres leyes y dos decretos se ajustan a las recomendaciones de la Convención de las Naciones Unidas. Es necesario revisar las normas existentes y promover la consolidación de las leyes, decretos, ordenanzas e instrucciones normativas relativas a los derechos de las personas discapacitadas de manera uniforme, sobre una base técnico-científica adecuada. Esta revisión debe ser coherente con las disposiciones de la Constitución Federal de 1988, la Convención Internacional sobre los Derechos de las Personas con Discapacidad y la Ley de Inclusión brasileña.

Resumo O estudo analisa o fundamento ético e jurídico da legislação brasileira para as pessoas com incapacidade e comprova se os instrumentos ali utilizados se ajustam ao Direito nacional e internacional. Além disso, investiga a coerência e coesão da lei e suas normas éticas para construir uma sociedade inclusiva e justa. Mediante revisão exploratória e integrativa, analisou as disposições legais vigentes no Brasil publicadas nos sites web oficiais do governo federal brasileiro e disponíveis na Internet. Avaliou-se se a definição utilizada para as pessoas com incapacidade segue a Convenção das Nações Unidas sobre os Direitos das Pessoas com Incapacidade. Também, se é necessário avaliar as incapacidades e quem deve realizar essa tarefa profissionalmente. Se encontraram 33 normas legais, entre as quais somente três leis e dois decretos se ajustam às recomendações da Convenção das Nações Unidas. É necessário revisar as normas existentes e promover a consolidação das leis, decretos, regulamentos e instruções normativas relativas aos direitos das pessoas incapacitadas de maneira uniforme, sobre uma base técnico-científica adequada. Esta revisão deve ser coerente com as disposições da Constituição Federal de 1988, a Convenção Internacional sobre os Direitos das Pessoas com Incapacidade e a Lei de Inclusão brasileira.

Exploring the powerful phytoarsenal of white grape marc against bacteria and parasites causing significant diseases.

Natural extracts containing high polyphenolic concentration possess antibacterial, anti-parasitic and fungicidal activities. The present research characterises two extracts based on white grape marc, a winemaking by-product, describing their physicochemical features and antimicrobial capacities. The main components of these extracts are phenolic acids, flavan-3-ols and their gallates and flavonols and their glycosides. As a result of this complex composition, the extracts showed pronounced bioactivities with potential uses in agricultural, pharmaceutical and cosmetic industries. Polyphenol compounds were extracted by using hydro-organic solvent mixtures from the by-product of Albariño white wines (Galicia, NW Spain) production. The in vitro antimicrobial activity of these extracts was evaluated on Gram-positive and Gram-negative bacteria and Apicomplexan and Oomycota parasites. Microbial species investigated are causing agents of several human and animal diseases, such as foodborne illnesses (Bacillus cereus, Escherichia coli, Salmonella enterica, and Toxoplasma gondii), skin infections and/or mastitis (Staphylococcus aureus and Streptococcus uberis), malaria (Plasmodium falciparum) and plant infections as "chestnut ink" or "root rot" (Phytophthora cinnamomi). Both extracts showed activity against all the tested species, being nontoxic for the host. So, they could be used for the development of biocides to control a wide range of pathogenic agents and contribute to the enhancement of winemaking industry by-products.

Polymorphisms in Inflammatory Genes Modulate Clinical Complications in Patients With Sickle Cell Disease.

Sickle cell disease (SCD), the most common monogenic disease worldwide, is marked by a phenotypic variability that is, to date, only partially understood. Because inflammation plays a major role in SCD pathophysiology, we hypothesized that single nucleotide polymorphisms (SNP) in genes encoding functionally important inflammatory proteins might modulate the occurrence of SCD complications. We assessed the association between 20 SNPs in genes encoding Toll-like receptors (TLR), NK cell receptors (NKG), histocompatibility leukocyte antigens (HLA), major histocompatibility complex class I polypeptide-related sequence A (MICA) and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), and the occurrence of six SCD clinical complications (stroke, acute chest syndrome (ACS), leg ulcers, cholelithiasis, osteonecrosis, or retinopathy). This study was performed in a cohort of 500 patients. We found that the TLR2 rs4696480 TA, TLR2 rs3804099 CC, and HLA-G, rs9380142 AA genotypes were more frequent in patients who had fewer complications. Also, in logistic regression, the HLA-G rs9380142 G allele increased the risk of cholelithiasis (AG vs. AA, OR 1.57, 95%CI 1.16-2.15; GG vs. AA, OR 2.47, 95%CI 1.34-4.64; P = 0.02). For SNPs located in the NKG2D loci, in logistic regression, the A allele in three SNPs was associated with a lower frequency of retinopathy, namely, rs2246809 (AA vs. GG: OR 0.22, 95%CI 0.09-0.50; AG vs. GG: OR 0.47, 95%CI 0.31-0.71; P = 0.004, for patients of same origin), rs2617160 (AT vs. TT: OR 0.67, 95%CI 0.48-0.92; AA vs. TT: OR 0.45, 95%CI 0.23-0.84; P = 0.04), and rs2617169 (AA vs. TT: OR 0.33, 95%CI 0.13-0.82; AT vs. TT: OR 0.58, 95%CI 0.36-0.91, P = 0.049, in patients of same SCD genotype). These results, by uncovering susceptibility to, or protection against SCD complications, might contribute to a better understanding of the inflammatory pathways involved in SCD manifestations and to pave the way for the discovery of biomarkers that predict disease severity, which would improve SCD management.

Mechanical Tests, Metallurgical Characterization, and Shaping Ability of Nickel-Titanium Rotary Instruments: A Multimethod Research.

INTRODUCTION: This study aimed to compare the mechanical and metallurgical properties and shaping ability of different rotary systems using a multimethod approach. METHODS: New NeoNiti A1 (Neolix SAS, Châtres-La-Forêt, France), HyFlex EDM One File (Coltène/Whaledent, Altstätten, Switzerland), ProTaper Gold F2 (Dentsply Maillefer, Ballaigues, Switzerland), and ProTaper Universal F2 (Dentsply Maillefer) rotary instruments were tested regarding cyclic fatigue, torsional resistance, design, and morphologic characteristics using scanning electron microscopy, metal alloy characterization using differential scanning calorimetry, and energy-dispersive X-ray spectroscopy. Additionally, their shaping ability on the preparation of 48 canals of maxillary molars was evaluated using micro-computed tomographic technology. Mechanical and metallurgical analyses were compared using analysis of variance post hoc Tukey tests, whereas the independent Student t test was used to compare the shaping ability of the ProTaper systems or the thermomechanically treated instruments. The significance level was set at 5%. RESULTS: The highest cyclic fatigue was observed with the NeoNiti and HyFlex EDM instruments (P > .05), whereas HyFlex EDM had the highest angular rotation to fracture (P < .05). Scanning electron microscopic/energy-dispersive X-ray spectroscopic analyses confirmed similarities in the instruments' design and an almost equiatomic composition of the systems. Differential scanning calorimetry showed that ProTaper Gold had higher transformation temperatures than ProTaper Universal, whereas a similar transformation was observed between NeoNiti and HyFlex. Micro-computed tomographic analysis revealed that, despite the fact that none of the systems was able to prepare all root canal walls, no statistical differences were observed in either ProTaper systems (P > .05) or the thermomechanically treated instruments (P > .05). CONCLUSIONS: Apart from differences in the mechanical tests and metallurgical characterization, systems with comparable instrument dimensions and preparation protocols showed a similar percentage of untouched surface areas in the root canal preparation of maxillary molars.

Self-Assembled Collagen Microparticles by Aerosol as a Versatile Platform for Injectable Anisotropic Materials.

Extracellular matrices (ECM) rich in type I collagen exhibit characteristic anisotropic ultrastructures. Nevertheless, working in vitro with this biomacromolecule remains challenging. When processed, denaturation of the collagen molecule is easily induced in vitro avoiding proper fibril self-assembly and further hierarchical order. Here, an innovative approach enables the production of highly concentrated injectable collagen microparticles, based on collagen molecules self-assembly, thanks to the use of spray-drying process. The versatility of the process is shown by performing encapsulation of secretion products of gingival mesenchymal stem cells (gMSCs), which are chosen as a bioactive therapeutic product for their potential efficiency in stimulating the regeneration of a damaged ECM. The injection of collagen microparticles in a cell culture medium results in a locally organized fibrillar matrix. The efficiency of this approach for making easily handleable collagen microparticles for encapsulation and injection opens perspectives in active tissue regeneration and 3D bioprinted scaffolds.

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer.

BACKGROUND AND OBJECTIVES: The primary treatment for locally advanced cases of cervical cancer is chemoradiation followed by high-dose brachytherapy. When this treatment fails, pelvic exenteration (PE) is an option in some cases. This study aimed to develop recommendations for the best management of patients with cervical cancer undergoing salvage PE. METHODS: A questionnaire was administered to all members of the Brazilian Society of Surgical Oncology. Of them, 68 surgeons participated in the study and were divided into 10 working groups. A literature review of studies retrieved from the National Library of Medicine database was carried out on topics chosen by the participants. These topics were indications for curative and palliative PE, preoperative and intraoperative evaluation of tumor resectability, access routes and surgical techniques, PE classification, urinary, vaginal, intestinal, and pelvic floor reconstructions, and postoperative follow-up. To define the level of evidence and strength of each recommendation, an adapted version of the Infectious Diseases Society of America Health Service rating system was used. RESULTS: Most conducts and management strategies reviewed were strongly recommended by the participants. CONCLUSIONS: Guidelines outlining strategies for PE in the treatment of persistent or relapsed cervical cancer were developed and are based on the best evidence available in the literature.

A Potentially Inexpensive Diagnostic Method for A2 Pulley Ruptures.

Injuries to the flexor pulley system of the hand, while uncommon, can be problematic and debilitating for patients. Current standards of diagnosis for A2 pulley disruptions often include costly imaging studies and inaccurate clinical testing. We present the case of a patient with an isolated complete A2 pulley avulsion that was diagnosed by employing a simple technique using a silicone wedding ring. A silicone wedding band was applied over the region of a suspected A2 pulley rupture, resulting in the immediate restoration of full range of motion as well as complete resolution of the injury after three months, without any need for surgical intervention. The usage of this ring confirmed an A2 pulley avulsion that was visualized on magnetic resonance imaging (MRI). The proposed "Wedding Band Test" is potentially an accurate and inexpensive diagnostic tool for clinical evaluation of A2 pulley ruptures.