Skull base surgery for malignant tumors: The 2nd international collaborative study (1995-2015).

BACKGROUND: The current study presents the effort of a global collaborative group to review the management and outcomes of malignant tumors of the skull base worldwide. PATIENTS AND METHODS: A total of 28 institutions contributed data on 3061 patients. Analysis evaluated clinical variables, survival outcomes, and multivariable factors associated with outcomes. RESULTS: The median age was 56 years (IQR 44-67). The open surgical approach was used in 55% (n = 1680) of cases, endoscopic resection was performed in 36% (n = 1087), and the combined approach in 9.6% (n = 294). With a median follow-up of 7.1 years, the 5-year OS DSS and RFS were 65%, 71.7% and 53%, respectively. On multivariable analysis, older age, comorbidities, histology, dural/intracranial involvement, positive margins, advanced stage, and primary site were independent prognostic factors for OS, DSS, and RFS. Adjuvant RT was a protective prognostic factor. CONCLUSION: The progress across various disciplines may have contributed to improved OS and DSS in this study compared to previous reports.

Intraoperative Angle Measurement of Anatomical Structures: A Systematic Review.

Ensuring precise angle measurement during surgical correction of orientation-related deformities is crucial for optimal postoperative outcomes, yet there is a lack of an ideal commercial solution. Current measurement sensors and instrumentation have limitations that make their use context-specific, demanding a methodical evaluation of the field. A systematic review was carried out in March 2023. Studies reporting technologies and validation methods for intraoperative angular measurement of anatomical structures were analyzed. A total of 32 studies were included, 17 focused on image-based technologies (6 fluoroscopy, 4 camera-based tracking, and 7 CT-based), while 15 explored non-image-based technologies (6 manual instruments and 9 inertial sensor-based instruments). Image-based technologies offer better accuracy and 3D capabilities but pose challenges like additional equipment, increased radiation exposure, time, and cost. Non-image-based technologies are cost-effective but may be influenced by the surgeon's perception and require careful calibration. Nevertheless, the choice of the proper technology should take into consideration the influence of the expected error in the surgery, surgery type, and radiation dose limit. This comprehensive review serves as a valuable guide for surgeons seeking precise angle measurements intraoperatively. It not only explores the performance and application of existing technologies but also aids in the future development of innovative solutions.

Longitudinal bond strength of a universal adhesive and chemical dentin characterization under different acid etching protocols

Abstract Objective This study aimed to analyze the longitudinal bond strength of a universal adhesive and chemically characterize the dentin substrate under different acid etching protocols. Methodology Dentin samples were etched with polyacrylic acid 25% (PAA) for 10 seconds (n=3) and phosphoric acid 32% (PA) for 15 seconds (n=3) and analyzed by Fourier transform infrared spectroscopy - attenuated total reflectance (FTIR-ATR) before and after treatment. For collagen degradation, samples (n=12) were divided into 3 groups: PAA, PA, and Deionized water (control), and analyzed by the quantity of solubilized type I collagen C-terminal cross-linked telopeptides and solubilized C-terminal peptide in relation to total protein concentration (ICTPtp and CTXtp) and by their ultimate tensile strength (UTS). For the adhesive interface analysis, dentin samples (n=72) were divided into 3 groups: PAA, PA, and Self-etch (SE), and subdivided into 2 groups: 24 h (baseline) and 1 year. The following tests were performed: microtensile bond strength (μTBS) (n=48), scanning electron microscopy (SEM) (n=12), and nanoleakage (n=12). Results The FTIR of PAA showed lower reduction of the peaks in the phosphate group when compared to PA. For ICTPtp, PA showed a significantly higher value. For CTXtp, PA and PAA groups failed to statically differ from each other. UTS was significantly lower for PA. For μTBS, storage time significantly affected bond strength. The results were unaffected by the etching protocol. For SEM, after 1 year, PA had little evidence of degradation in the upper third of the adhesive interface in comparison to the other groups. Nanoleakage showed no considerable silver impregnation after 1 year in the SE group. Conclusion The use of PAA prior to a universal adhesive (when compared to PA) represents a less aggressive type of etching to dentin. However, self-etching still seems to be the best option for universal adhesive systems that have functional monomers in their composition.

Scientific writing with artificial intelligence: key considerations and alerts / Escrita científica com inteligência artificial: principais considerações e alertas

A integração de geradores de texto de inteligência artificial (IA) em relatórios científicos exige uma avaliação cuidadosa de considerações éticas específicas. Embora essas tecnologias de IA ofereçam suporte à geração de texto, abordar as implicações éticas é fundamental. Este editorial destaca a necessidade de uma abordagem ponderada e responsável, enfatizando o estabelecimento de diretrizes e melhores práticas por parte de pesquisadores e comunidades científicas. Esforços colaborativos entre desenvolvedores de IA, pesquisadores e comitês éticos podem garantir a integração perfeita das tecnologias de IA, ao mesmo tempo em que mantêm a integridade, qualidade e padrões éticos da divulgação científica. Este texto oferece um resumo abrangente considerações-chave ao se utilizar geradores de texto de inteligência artificial em relatórios científicos (AU)

The integration of artificial intelligence (AI) text generators in scientific reports demands careful evaluation of specific ethical considerations. While these AI technologies offer text generation support, addressing the ethical implications is vital. This editorial highlights the need for a thoughtful and responsible approach, emphasizing the establishment of guidelines and best practices by researchers and scientific communities. Collaborative efforts between AI developers, researchers, and ethical committees can ensure the seamless integration of AI technologies while upholding the integrity, quality, and ethical standards of scientific reporting. This text comprehensively summarizes the key considerations to be followed when utilizing artificial intelligence text generators in scientific reports.(AU)

A história da telemedicina no Brasil: desafios e vantagens / The history of telemedicine in Brazil: challenges and advantages

Resumo A utilização de novas tecnologias de informação para um atendimento mais efetivo e à distância é algo que se impõe no contexto de serviços em saúde, no atual panorama sociopolítico. Entretanto, o Brasil ainda está receoso em integrar de forma permanente esses avanços. Esta pesquisa tem como objetivo revisar os marcos da história da telemedicina no Brasil, destacando as questões éticas e legislativas, bem como evidenciar os desafios para sua implantação e gerar uma proposta para superá-los. Trata-se de uma revisão integrativa da literatura acerca da história, dos desafios e da realidade da telemedicina no cenário brasileiro. A telemedicina é uma atividade recente no Brasil, defrontando-se com resistências por parte dos profissionais, em especial médicos, que diversas vezes não vislumbram claramente seus benefícios. Apesar das dificuldades previstas em aceitar este modelo, é relevante ressaltar as vantagens que esse padrão abarca, como ampliar e facilitar o acesso à assistência de saúde. Propor alternativas para superar resistências e alcançar um padrão otimizado é essencial e abrange maior abertura no campo político, legislativo e educacional.

Abstract The use of new information technologies for a more effective remote service is required in the context of health services, especially when it comes to the current socio-political panorama. Nevertheless, Brazil is still afraid to permanently integrate these advances. This research aims to review the milestones in the history of telemedicine in Brazil, highlighting the ethical and legislative issues, as well as evidencing the challenges for its implementation and generating a proposal to overcome them. It is an integrative literature review about the history, challenges, and reality of telemedicine in the Brazilian scenario. Telemedicine is a recent activity in Brazil, facing resistance from professionals, especially doctors, who often do not clearly see its benefits. Despite the anticipated difficulties in accepting this model, it is important to highlight the advantages that this standard encompasses, such as expanding and facilitating access to health care. Proposing alternatives to overcome resistance and reach an optimized standard is essential and encompasses greater openness in the political, legislative, and educational fields.

Impact of photoinitiator quality on chemical-mechanical properties of dental adhesives under different light intensities / Impacto da qualidade de fotoiniciadores nas propriedades químico mecânicas de adesivos dentais sob diferentes intensidades de luz

Objective: Evaluate the mechanical properties of experimental adhesive models with different photoinitiators (PI) polymerized by LED units of different power densities. Material and Methods: Three groups of adhesive models based on HEMA/BisGMA (45/55) were prepared in association with different PI combinations: G2 (control) ­ 2 PI: 0.5% CQ, 0.5% EDMAB; G3 - 3 PI: 0.5% CQ; 0.5% DMAEMA, 0.5% DPIHP; G4 - 4 PI: 0.5% CQ; 0.5% EDMAB; 0.5% DMAEMA; 0.5% DPIHP. The three formulations were polymerized at two different LED power densities: 550 mW/cm2 and 1200 mW/cm2. The degree of conversion (DC) of adhesive monomers was monitored in situ through the FTIR for 600 s. Specimens were prepared for each formulation for analysis mong adhesive systems (G2

Objetivo: Avaliar as propriedades mecânicas de modelos adesivos experimentais com diferentes fotoiniciadores (PI) polimerizados por unidades de LED de diferentes densidades de energia. Material e Métodos: Três grupos de modelos adesivos baseados em HEMA/BisGMA (45/55) foram preparados em associação com diferentes combinações de PI: G2 (controle) ­ 2 PI: 0,5% CQ, 0,5% EDMAB; G3 - 3PI: 0,5% CQ; 0,5% DMAEMA, 0,5% DPIHP; G4 - 4 PI: 0,5% CQ; 0,5% EDMAB; 0,5% DMAEMA; 0,5% DPIHP. As três formulações foram polimerizadas em duas densidades de potência de LED: 550 mW/cm2 e 1200 mW/cm2. O grau de conversão (DC) dos monômeros adesivos foi monitorado in situ através do FTIR durante 600 s. Amostras foram preparadas para cada formulação para análise de resistência à flexão (FS), módulo de elasticidade (ME), sorção (SOR) e solubilidade (SOL). Os dados foram submetidos aos testes ANOVA 2-fatores e Tukey (5%). Resultados: DC: houve diferença significativa entre os sistemas adesivos (G2

Combination of surgical techniques and reconstructive devices as an alternative treatment after fibula free flap mandibular reconstruction failure: a case report

Loss of mandibular continuity and functionality in cancer patients undergoing extensive mandible resections is challenging. In these situations, the gold standard treatment is fibula free flap reconstruction. The major challenge occurs when there is a failure of the transplanted fibula. Here we report the case of a patient who underwent right hemimandibulectomy with disarticulation and immediate mandibular reconstruction with a fibula free flap. Subsequently, the flap viability was lost, and there was necrosis of the transplanted bone segment in the short-term follow-up. Considering the best form of rehabilitation for the patient, minimizing the risks of loss and optimizing the reconstructive quality, we opted to install a customized prosthesis including a condylecavity joint component associated with a new free flap and subsequent rehabilitation of the dental occlusion with an implant-supported fixed prosthesis.

Gas Permeability and Mechanical Properties of Polyurethane-Based Membranes for Blood Oxygenators.

The production of medical devices follows strict guidelines where bio- and hemocompatibility, mechanical strength, and tear resistance are important features. Segmented polyurethanes (PUs) are an important class of polymers that fulfill many of these requirements, thus justifying the investigation of novel derivatives with enhanced properties, such as modulated carbon dioxide and oxygen permeability. In this work, three segmented polyurethane-based membranes, containing blocks of hard segments (HSs) dispersed in a matrix of soft segment (SS) blocks, were prepared by reacting a PU prepolymer (PUR) with tris(hydroxymethyl)aminomethane (TRIS), Congo red (CR) and methyl-ß-cyclodextrin (MBCD), rendering PU/TRIS, PU/CR and PU/MBCD membranes. The pure (control) PU membrane exhibited the highest degree of phase segregation between HSs and SSs followed by PU/TRIS and PU/MBCD membranes, and the PU/CR membrane displayed the highest degree of mixing. Pure PU and PU/CR membranes exhibited the highest and lowest values of Young's modulus, tangent moduli and ultimate tensile strength, respectively, suggesting that the introduction of CR increases molecular mobility, thus reducing stiffness. The CO2 permeability was highest for the PU/CR membrane, 347 Barrer, and lowest for the pure PU membrane, 278 Barrer, suggesting that a higher degree of mixing between HSs and SSs leads to higher CO2 permeation rates. The permeability of O2 was similar for all membranes, but ca. 10-fold lower than the CO2 permeability.

Loss of an eye to mucormycosis following corticosteroid therapy for COVID-19

Mucormycosis is a rare, sometimes severe fungal infection that has emerged as a possible complication of COVID-19. We report a case of a non-diabetic, apparently immunocompetent patient diagnosed with rhino-orbital-cerebral mucormycosis shortly after COVID-19 treatment with dexamethasone. The patient received optimized systemic antifungal therapy and extensive surgical treatment. So far, four months after the last hospital discharge, the patient has been in good general condition. This case is a dramatic reminder that beneficial corticosteroid therapy in general inevitably carries a risk of opportunistic infection, and corticosteroid therapy for COVID-19 risks orbital-rhinocerebral mucormycosis that clinicians should watch for with vigilance.

Effect of fluoride, chlorhexidine or Nd:YAG on the progression of root dentin demineralization after removal of the demineralized organic matrix

Abstract Quantification of collagen degradation is an important parameter to evaluate dentin caries for preventive aid. Objectives: Evaluate preventive methods against root collagen degradation by the hydroxyproline assay (HYP) and microradiography technique (MRT). Methodology: Five bovine root dentin blocks were obtained and subjected to an artificial demineralization process by acetate buffer (pH 5) to induce carious lesion formation. Samples were subjected to the following therapeutic treatments: 1) 0.12% chlorhexidine for 1 min, 2) 2% fluoride for 1 min, 3) Nd:YAG Laser (400 μm diameter optical fiber, 10 Hz frequency, 60 mJ/pulse energy, 48 J/cm2 energy density, in noncontact mode for 10 s), 4) deionized water (control) for 1 min, 5) MRT control group (without treatment and removal of collagen). Samples were exposed to degradation by a collagenase enzyme for five days. The enzyme solution was collected, by colorimetry in a spectrophotometer, from the collagen matrix for the hydroxyproline release analysis. The same samples were subjected to an additional two days of demineralization to induce the progression of mineral loss. Samples were analyzed by MRT for the visualization of their degraded areas (estimation of lesion depth and mineral loss). ANOVA was applied to compare hydroxyproline release rates. MRT data were subjected to the Kruskal-Wallis test, followed by the Dunn's test. Comparisons between the initial five-day and the subsequent two-day demineralization processes were performed by repeated t-test or Wilcoxon (p<0.05) measurements. Results: The amount of HYP released from the dentin samples failed to show significant differences among the groups (p=0.09). Fluoride and chlorhexidine were able to interact with the samples, reducing the progression of dentin caries after removal of the demineralized organic matrix. CHX was the only treatment able to show significant lower lesion depth than the negative control. Conclusion: Chlorhexidine and fluoride were effective in reducing root caries progression.

Short-term survival in extensive craniofacial resections.

OBJECTIVES: Craniofacial resection (CFR) procedures for craniofacial tumors with cranial extension are often extensive. Although CFRs may yield good oncological results, there are concerns about high perioperative morbidity and mortality. This study aimed to determine risk factors for perioperative mortality after open CFR in terms of deaths occurring during index hospitalizations. METHODS: We conducted a retrospective analysis of CFRs conducted at a tertiary oncology hospital from May 2009 through December 2018. RESULTS: Our analysis included data from the medical records of 102 patients, the majority of whom were male (n=74, 72.5%). The mean age was 61 years (±18.3 years). Skin malignancies (n=64, 63.4%) accounted for nearly two-thirds of the treated tumors, and most of these were squamous cell carcinoma. Postoperative medical complications occurred in 33 patients (33%), and surgical complications occurred in 48 (47%). Multivariate analysis revealed the only independent risk factors for perioperative deaths to be the presence of intracranial tumor extension on preoperative imaging (hazard ratio [HR]=4.56; 95% confidence interval [CI]: 1.74-11.97; p=0.002) and the unexpected emergence of postoperative neurological dysfunction (HR=10.9; 95% CI: 2.21-54.3; p=0.003). CONCLUSIONS: In our study, factors related to tumor extension were associated with a higher risk of perioperative death.

Comparative study on anticancer drug access times between FDA, EMA and the French temporary authorisation for use program over 13 years.

INTRODUCTION: The cancer incidence continues to rise worldwide. Medical innovation has a major impact on patient survival, but within drug development, it can take more than 10 years to obtain marketing authorisation (MA). The time required for access to therapeutic innovation remains critical, so France has developed a specific expanded access program named ATU, which allows the administration of drugs before the European Medicines Agency (EMA) approval. The purpose of this study is to put in perspective the average time to access antineoplastic drugs worldwide, taking into account ATU, US Food and Drug Administration (FDA) and EMA approvals. METHODS: The ATU system allows the use of a medicine before its MA, under exceptional conditions. All antineoplastic drugs in oncology that have benefited from the ATU system are analysed in terms of tumour site, biomarkers and number of patients who have access to the drug. RESULTS: Between 1st January 2007 and 31st December 2019, 36 of 64 drugs (56.2%) that received MA in oncology were assigned an ATU, to the benefit of 16,927 patients. Thanks to the ATU, 25 of 36 drugs (69.4%) were made available early, on average 203 d (95% CI, 76-330) before FDA approval and on average 428 d (95% CI, 272-583) before EMA approval. Only three of 36 drugs were approved by the EMA before the FDA, and the average time lapse between European MA and FDA approval for these 36 drugs was 216 d (95% CI, 140-293). CONCLUSION: This article demonstrates that the ATU system allows patients to benefit from therapeutic innovations before MA in Europe and USA, with full coverage by the healthcare system.

Hip arthroscopy with initial access to the peripheral compartment provides significant improvement in FAI patients.

PURPOSE: This study was designed to evaluate the clinical and radiographic results of arthroscopic treatment of femoroacetabular impingement (FAI) using the technique of initial access to the peripheral compartment. It is based on a single surgeon large case series with a minimum of 2 years follow-up. METHODS: Prospective longitudinal study with consecutive patients. Inclusion criteria were the presence of FAI syndrome that had failed non-operative treatment and had a hip arthroscopy with initial access to the peripheral compartment. Exclusion criteria were previous hip surgery, patients younger than 16 or older than 60 years, Tönnis grade ≥ 2 osteoarthritis, hip dysplasia based on radiographic evidence of LCEA less than 25° and workers compensation cases. One hundred and sixty hips met the inclusion criteria, 84 were female and 70 were male patients (six bilateral cases), with a median age of 36 years (range 16-59). RESULTS: The median alpha angle correction was 22.6º (range 5.9-46.7) (p < 0.01) and the average LCEA correction when acetabuloplasty was undertaken was 6.5º (range - 1.4-20.8) (p < 0.01). The mean NAHS at baseline was 56.1 (range 16-96) and improved to 83.2 at the last follow up (range 44-100) for the patients that had no additional procedure (p < 0.01). The mean average improvement was 27.7º points (range - 16-73). No iatrogenic labral perforation and no full-thickness chondral damage were recorded during the arthroscopic procedures. CONCLUSIONS: Favourable outcomes are reported for the arthroscopic treatment of FAI with initial access to the peripheral compartment. The technique is protective against iatrogenic chondral and labral damage, more conservative to the joint capsule, but the mean traction time was relatively long when suture anchors were used. The results are comparable to the classic initial central compartment approach. LEVEL OF EVIDENCE: Level IV.

Amalgam allergy and Burning Mouth Syndrom: treatment and 25 years recall / Alergia ao amálgama e Síndrome da ardência bucal: tratamento e 25 anos de proservação

Background: Burning mouth syndrome (BMS) is a non-neuropathic chronic orofacial pain condition, characterized by the presence of burning/warm sensation without specific mucosal lesions. Objective: The aim of the present clinical case report is to describe the positive outcome of dental treatment of a patient with BMS and followed up for 25 years. Data Treatment: This report describes the case of a 50-year-old black woman sought treatment for burning, and persistent swelling of tong (24h/day) occurring over years. Clinical evaluation of the oral environment revealed the tongue with cracking, darkened points areas, surrounded by whitish areas. Twelve teeth presented extensive amalgam restorations. Patch testing revealed a very strong hypersensitivity to Amalgam. All amalgam restorations were substituted by composite resin restorations. Results and Conclusion: Burning sensation disappeared completely after these restorations had been changed. After 25-year follow-up period, it was observed that burning sensation has never been felt anymore. Clinical Significance: Burning mouth syndrome is a chronic orofacial pain, usually without specific mucosal lesions. The etiology is complex and multifactorial and the treatment should be made specifically for each pacient. (AU)

Introdução: A síndrome de ardência bucal (SAB) é uma condição de dor orofacial crônica não neuropática, caracterizada pela presença de sensação de queimação/calor sem lesões específicas da mucosa. Objetivo: Oobjetivo do presente relato de caso clínico é descrever a evolução positiva do tratamento odontológico de uma paciente com SAB e o retorno após 25 anos. Tratamento dos Dados: Este relato descreve o caso de uma mulher negra de 50 anos que buscou tratamento por queimadura e edema persistente da língua (24h/dia) ocorrendo ao longo dos anos. A avaliação clínica da cavidade bucal revelou a língua com áreas fissuradas e áreas com pontos escurecidos circundadas por áreas esbranquiçadas. Doze dentes apresentavam restaurações extensas de amálgama de prata. O teste de contato revelou hipersensibilidade muito forte ao amálgama de prata. Todas as restaurações de amálgama de prata foram substituidas por restaurações de resina composta. Resultados e Conclusão: A sensação de queimação desapareceu completamente após a substituição das restaurações. Após um periodo de 25 anos, observou-se que a sensação de queimação nunca foi mais relatada. Significado Clínico: a síndrome da ardência bucal é uma dor orofacial crônica, geralmente sem lesões específicas da mucosa. A etiologia é complexa e multifatorial e o tratamento deve ser feito especificamente para cada paciente.(AU)

Full digital workflow in fixed adhesive dental prosthesis: Description of a clinical technique / Fluxo de trabalho digital completo em prótese fixa adesiva: descrição de uma técnica clínica

Digital dentistry has gained space in several dental specialties. It is possible to achieve excellent results with the digital workflow, which combines the efficiency of the restorative material with a greater marginal adaptation. This study aimed to report a clinical case through the digital workflow, with a faster and clinically acceptable prosthetic resolution. In this clinical case report, digital workflow allowed a faster and clinically acceptable prosthetic resolution. A 45-year-old female patient reported cementation failure of the prosthetic crown on tooth 14. As it was a vital tooth, the tooth received a total crown preparation. In the same clinical session, the patient's mouth was scanned then a capture software obtained a virtual model. After, the design software planned a digital "diagnostic wax-up", so a leucitic ceramic was chosen for the rehabilitation. The ceramic block was milled and receive stain and glaze, dispensing the prosthesis laboratory. Then, the adhesive cementation was performed with a dual-polymerized resin cement. The final crown had ideal adaptation, with no need for interproximal and occlusal adjustments, with an excellent marginal fit. Within the limitations of this study, this case report showed that the digital workflow allowed a favorable result in a shorter working time, which brought back function and aesthetics, without the need for interproximal and occlusal adjustments. (AU)

A odontologia digital vem ganhando espaço em diversas especialidades odontológicas. Com o fluxo de trabalho digital, é possível alcançar excelentes resultados na reabilitação protética, combinando a eficiência do material restaurador com a adaptação marginal proporcionada pela odontologia digital. O objetivo desse estudo foi relatar um caso clínico através do fluxo de trabalho digital, com uma resolução protética mais rápida e clinicamente aceitável. Paciente do sexo feminino, 45 anos, relatou falha de cimentação da coroa protética do dente 26. Por ser um dente vital, o dente recebeu um preparo de coroa total e os dentes foram escaneados e um software de captura obteve um modelo virtual. Posteriormente, o software de projeto planejou um "enceramento diagnóstico" digital, sendo escolhida uma cerâmica leucítica para a reabilitação. O bloco cerâmico foi fresado e recebeu acabamento, maquiagem e glaze pelo próprio dentista, dispensando um técnico laboratorial de prótese dentária. Em seguida, foi realizada cimentação adesiva definitiva. Este relato de caso mostra que, dentro das limitações desse estudo, o fluxo digital permite um resultado favorável em um menor tempo de trabalho, devolvendo a função e estética, sem necessidade de ajustes interproximais e oclusais (AU)

Short-term survival in extensive craniofacial resections

OBJECTIVES: Craniofacial resection (CFR) procedures for craniofacial tumors with cranial extension are often extensive. Although CFRs may yield good oncological results, there are concerns about high perioperative morbidity and mortality. This study aimed to determine risk factors for perioperative mortality after open CFR in terms of deaths occurring during index hospitalizations. METHODS: We conducted a retrospective analysis of CFRs conducted at a tertiary oncology hospital from May 2009 through December 2018. RESULTS: Our analysis included data from the medical records of 102 patients, the majority of whom were male (n=74, 72.5%). The mean age was 61 years (±18.3 years). Skin malignancies (n=64, 63.4%) accounted for nearly two-thirds of the treated tumors, and most of these were squamous cell carcinoma. Postoperative medical complications occurred in 33 patients (33%), and surgical complications occurred in 48 (47%). Multivariate analysis revealed the only independent risk factors for perioperative deaths to be the presence of intracranial tumor extension on preoperative imaging (hazard ratio [HR]=4.56; 95% confidence interval [CI]: 1.74-11.97; p=0.002) and the unexpected emergence of postoperative neurological dysfunction (HR=10.9; 95% CI: 2.21-54.3; p=0.003). CONCLUSIONS: In our study, factors related to tumor extension were associated with a higher risk of perioperative death.

Polyphenol-enriched extract of Arrabidaea chica used as a dentin pretreatment or incorporated into a total-etching adhesive system: Effects on bonding stability and physical characterization.

The aim of this paper was to evaluate the physical properties and the long-term bond strength of a 2.5% polyphenol-enriched extract of Arrabidaea chica (AC) incorporated into both the phosphoric acid and the primer of a three-step total-etch adhesive, or into an aqueous solution as a dentin pretreatment. Fifty dentin surfaces received the treatments (n = 10): CON (control) - application of the three-step adhesive system (Adper Scotchbond Multipurpose, 3M ESPE); WAT - distilled water used as a pretreatment after dentin etching and before application of the adhesive system; ACPA - AC incorporated into the phosphoric acid; ACW - dentin pre-treatment with AC incorporated into an aqueous solution after etching; ACP - AC incorporated into the primer. Microtensile bond strength tests were performed after 24 h, 6 and 12 months of storage. Slices from the resin-dentin interface were obtained for scanning electron microscopy analysis of the hybrid layer. Degree of conversion of AC incorporated into the primer was evaluated. The particle size, polydispersity index and zeta potential of all the solutions prepared by incorporating AC (phosphoric acid, primer and distilled water) were measured by dynamic light scattering, which brought about changes after incorporation. Degree of conversion of the primer was not affected after incorporating AC. ACP showed lower microtensile bond strength values than the other groups. Bond strength decreased after 6 months of storage, stabilizing at the 12-month evaluation. Therefore, use of AC incorporated into the primer led to lower bond strength values, since AC modified the physical properties (particle size, polydispersity index and zeta potential) of the primer, but did not change the degree of conversion. Application of AC as a dentin pretreatment did not affect bond strength or the micromorphological characteristics of the hybrid layer.

A giant hand lipoma as a rare cause of secondary carpal tunnel syndrome - A case report.

INTRODUCTION: Lipomas are a rare cause of compressive neuropathy and they lead to atypical clinical presentation that can mimic carpal tunnel syndrome. CASE PRESENTATION: The authors describe a rare presentation of a carpal tunnel syndrome recurrence after a hand giant lipoma, presenting with rapidly compression neuropathy of the median nerve, 6 months after de primary surgery. DISCUSSION: Lipomas are common benign soft tumours. Their occurrence in the hand remains rare and they rarely cause secondary entrapment neuropathies. Carpal tunnel syndrome is mostly idiopathic and bilateral. Local factors should be suspected when these neuropathies present with atypical symptomatology or even when they recur after primary conventional surgical release. Investigation should consider images studies as this correct preoperative assessment leads to successful diagnosis and treatment.

Protocols to control contamination and strategies to optimize the clinical practice in Restorative Dentistry during the COVID-19 pandemic / Protocolos para controle de contaminação e estratégias para otimizar a prática clínica em Odontologia Restauradora durante a pandemia de COVID-19

The current outbreak of coronavirus 2019 (COVID-19) challenges how professional standards have been defined so far. In Dentistry, biosafety measures already taken by professionals have been intensified, aiming to offer the patient urgent and emergency treatment with safety for both. In this context, Restorative Dentistry is responsible for the care of patients with caries injuries, with or without symptoms and, fractures of teeth and existing restorations. This article guides professionals, during the pandemic period, on the risks involved in adult and pediatric dental care for patients with restorative needs. It also discusses strategies to optimize clinical practice, reducing risks of contamination and virus transmission. (AU)

O atual surto de coronavírus 2019 (COVID-19), fez com que muitos profissionais repensassem sua postura de trabalho. Na Odontologia, medidas de biossegurança já realizadas pelos profissionais, foram intensificadas, com o objetivo de oferecer ao paciente um tratamento de urgência e emergência com segurança para ambos. Neste contexto, a Odontologia Restauradora é responsável pelo atendimento de pacientes com lesões de cárie, com ou sem sintomatologia, e fraturas de dentes e restaurações já existentes. Este trabalho orienta os profissionais quanto aos riscos envolvidos no atendimento odontológico, adulto e pediátrico, de paciente com necessidades restauradoras durante o período de pandemia. O artigo também discute estratégias para otimizar o atendimento, diminuindo riscos de contaminação e transmissão do vírus. (AU)

Temporomandibular disorders: Guidelines and Self-Care for Patients During COVID-19 Pandemic / Desordem Temporomandibular: Orientações e Autocuidados para Pacientes Durante a Pandemia do COVID-19

Background: Temporomandibular disorder (TMD) belongs to a heterogeneous group of musculoskeletal and neuromuscular conditions involving the temporomandibular joint complex, musculature and adjacent components. These conditions can generate signs and symptoms and be influenced by an altered biopsychosocial condition. Objective: This study aims to seek information to assist the patient in the presence of TMD signs and symptoms and Orofacial Pain, associated with the period of social isolation during the COVID-19 pandemic. Material and methods: For the preparation of this manual, a bibliographic search was performed in the databases PubMed, Latin American and Caribbean Health Sciences Literature (LILACS), BBO (BVS), Scopus, Web of Science and The Cochrane Library, using the keywords: orofacial pain, temporomandibular disorders, bruxism, stress, anxiety, biopsychosocial, diagnosis, self-care with important information on how to reduce and control the signs and symptoms of TMD and Orofacial Pain in this moment of pandemic that we are experiencing a social detachment. Results: The results show that the pandemic of COVID-19 and the need for social isolation, generates psychological impact that raises the pattern of anxiety and can directly affect patients with bruxism and TMD. Conclusion: Psychological factors associated with the pandemic can lead to an increased risk of developing, worsening and perpetuating bruxism, especially waking bruxism and TMD, so dentists should be aware of the occurrence of signs and symptoms to manage the multifactorial aspects of this condition. At that time, individual self-management strategies are advised for the patient, which consist of self-massage techniques, body education, exercise practices, sleep hygiene, meditation also the use of mobile apps and online tools that facilitate this activity. (AU)

Introdução: A Desordem Temporomandibular (DTM) pertence a um grupo heterogêneo de condições musculoesqueléticas e neuromusculares envolvendo o complexo articular temporomandibular, a musculatura e os componentes adjacentes. Essas condições podem gerar sinais e sintomas e serem influenciadas por uma condição biopsicossocial alterada. Objetivo: Esse estudo teve como objetivo buscar informações que possam auxiliar ao paciente na presença de sinais e sintomas de DTM e Dor Orofacial associado ao período de isolamento social durante a pandemia do COVID -19. Material e Métodos: Para a elaboração deste manual, foi realizada uma pesquisa bibliográfica nas bases de dados PubMed, Latin American and Caribbean Health Sciences Literature (LILACS), BBO (BVS), Scopus, Web of Science e The Cochrane Library, utilizando as palavras-chaves: dor orofacial, desordem temporomandibular, bruxismo, estresse, ansiedade, biopsicossocial, diagnóstico e autocuidados, com informações importantes sobre como reduzir e controlar os sinais e sintomas de DTM e Dor Orofacial nesse momento de pandemia que estamos vivenciando um distanciamento social. Resultados: Os resultados mostram que a pandemia de COVID-19 e a necessidade de isolamento social, gera impacto psicológico que eleva o padrão de ansiedade e pode afetar diretamente pacientes com bruxismo e DTM. Conclusão: Fatores psicológicos associados à pandemia podem levar a um maior risco de desenvolver, piorar e perpetuar o bruxismo, principalmente bruxismo de vigília e DTM, por isso os cirurgiões-dentistas devem estar atentos a ocorrência de sinais e sintomas para gerenciar os aspectos multifatoriais dessa condição. Aconselha-se, nesse momento, estratégias individualizadas de autogerenciamento para o paciente que consistem em técnicas de automassagem, educação corporal, práticas de exercícios, higiene do sono e meditação. Além do uso de aplicativos digitais e ferramentas online facilitadores dessa atividade (AU)