Results Of Minimally Invasive Vats Thymectomy In Miastenia Gravis Patients Compared With More Invasive Approaches - 10-Year Experience In A Single Center.

INTRODUCTION: Myasthenia gravis (MG) is an autoimmune, neurologic disease that causes a wide range of symptoms. While the transsternal, transcervical and thoracotomy approaches are accepted as effective, there is still debate regarding the VATS approach. MATERIALS AND METHODS: We analyzed our center's surgical experience with thymectomy for myasthenia gravis, comparing the results of patients operated on using VATS and more invasive approaches, over a period of 10 years. A search of the department's surgical database for myasthenia gravis cases between January 2010 and January 2021, revealed a total of 40 cases. Twenty-four patients were included in the final analysis and were distributed into two groups: the VATS procedure group (group A) and the open procedure group (group B). The latter included sternotomy, thoracotomy, transcervical and hemiclamshell approaches. Only radical thymectomies were included. The established outcomes were clinical improvement defined as asymptomatic remission, reduction, or discontinuation of the medication necessary to achieve optimal symptom control. RESULTS: The median follow-up time was 27 months (ranging from 4 to 75 months). Videothoracoscopy radical thymectomy was performed on 12 patients. Complete remission with no medication was achieved in 1 case (8.3%), while 2 patients (16.7%) became asymptomatic with reduced medication. An improvement (reduced symptoms or decreased medication) was observed in 8 cases (66.6%). No change in clinical outcome was noted in 1 patient (8.3%). None of the patients reported worsening symptoms. Open thymectomy was performed on 12 patients. Complete remission with no medication was achieved in 1 case (8.3%), while 2 patients (16.7%) became asymptomatic with reduced medication. An improvement was noted in 6 cases (50%). No change in clinical outcome was observed in 3 patients (25%) whereas 2 of them (16.7%) experienced slightly better symptom control but with a significant increase in medication. One patient (8.3%) described the clinical results as without any significant change. None of the patients reported worsening symptoms. CONCLUSION: The videotoracoscopic approach in the treatment of myasthenia gravis is non-inferior compared to the open approach and effective in a long-term follow-up, offering all the additional benefits of less invasive surgery.

Enhancement of Subjective Quality of Life Following Surgical Intervention in Patients With Drug-Resistant Epilepsy: A Depressive Symptom-Independent Outcome.

PURPOSE: To evaluate the impact of depressive symptoms on the subjective perception of quality of life in patients with drug-resistant epilepsy (DRE) after surgical treatment for seizures.  Methods: A case-control study with DRE patients who received surgical treatment (n=19) and matched non-operated patients (n=23). We assessed the quality of life using the Subjective Handicap of Epilepsy (SHE) scale, alongside measuring depressive symptoms using the Beck Depression Inventory (BDI). RESULTS: The mean age of the participants was 45 years, with females constituting 52.4% of the patients. A majority (73.8%) had been diagnosed with temporal lobe epilepsy. Those who had undergone surgical intervention showed significantly enhanced performance across all quality-of-life domains on the SHE scale independently of depressive symptoms. The domains of "Work and Activity," "Physical Health," and "Self-Perception" displayed the greatest improvements, with the surgical group's averages outperforming the control group by factors of 1.87, 2.53, and 2.81, respectively. Influential differences impacting the quality-of-life scores included seizure frequency, the quantity of antiepileptic drugs utilized, and the incidence of convulsive seizures. CONCLUSION: The findings suggest that surgical control of seizures in drug-resistant focal epilepsy is associated with improvement in quality of life across various domains, independently of the depressive symptoms of the patients.

Single dominant lesion in capillary malformation-arteriovenous malformation (CM-AVM) RASA1 syndrome.

We report two cases with localized vascular malformations clinically resembling the "dominant lesion" seen in capillary malformation-arteriovenous malformation (CM-AVM) syndrome, however, lacking germline RASA1 variants but presenting double somatic RASA1 variants in affected tissue. Both patients presented with localized and superficial high-flow vascular malformations were treated with surgery and laser therapy and showed partial resolution. The study underscores the rarity of somatic RASA1 variants, contributes to understanding the "second-hit" pathophysiology in vascular lesions, and emphasizes the significance of clinical distinctions and genotyping for accurate diagnoses, offering implications for diagnosis, prognosis, and genetic counseling.

Monoclonal gammopathy of renal significance: An atypical presentation of Waldenström's disease.

Waldenström's disease is a rare lymphoproliferative syndrome in the bone marrow and sometimes in lymphoid organs which secretes high amounts of monoclonal immunoglobulin M into serum. It can remain indolent for years and rarely affects the kidney, with intraglomerular rather than intratubular damage being predominant, in contrast to multiple myeloma. Different studies identified AL amyloidosis as the most frequent renal lesion, followed by cryoglobulinemic glomerulonephritis. Signs and symptoms may be unspecific, as well as renal manifestations, so collaboration between nephrologists, hematologists, and pathologists is crucial to establish the role of paraprotein in the development of renal damage. We present an atypical case of Waldenström's disease that had a minimal monoclonal peak and clinically debuted with nephritic and nephrotic syndromes. The diagnosis was cryoglobulinemic glomerulonephritis. Currently, there are numerous treatment options, without enough evidence yet to establish a standardised treatment.

Autoimmune encephalitis in a resource-limited public health setting: a case series analysis / Encefalite autoimune em um hospital universitário público: análise de uma série de casos

Abstract Background Autoimmune encephalitis (AE) consists of a group of acquired diseases that affect the central nervous system. A myriad of phenotypes may be present at the onset. Due to the heterogeneity of clinical presentations, it is difficult to achieve uniformity for the diagnostic and therapeutic processes and follow-up strategies. Objective To describe a series of patients diagnosed with AE in a resource-limited public hospital in southern Brazil and to analyze therapeutics and outcomes. Methods We retrospectively reviewed the electronic medical records of patients diagnosed with AE at the Hospital de Clínicas de Porto Alegre from 2014 to 2022. Data collected included clinical presentation, neuroimaging, cerebrospinal fluid testings, electroencephalogram, autoantibodies, treatments, outcomes, follow-up time, degree of neurological impairment, and mortality. Results Data from 17 patients were retrieved. Eleven cases were classified as definite AE and 6 as possible AE. Autoantibodies were identified in 9 patients. Timing for diagnosis was impacted by the high costs associated with autoantibody testing. Most patients became functionally dependent (82.4%) and most survivors remained with autoimmune-associated epilepsy (75%). Five patients died during hospitalization, and one after a 26-month of follow-up. Conclusion In this resource-limited hospital, patients with AE had a worse clinical outcome than that previously described in the literature. Development of epilepsy during follow-up and mortality were greater, whilst functional outcome was inferior. Autoantibody testing was initially denied in most patients, which impacted the definitive diagnosis and the use of second-line therapies.

Resumo Antecedentes A encefalite autoimune (EA) consiste em um grupo de doenças adquiridas que afetam o sistema nervoso central. Objetivo Descrever uma série de pacientes diagnosticados com EA em um contexto de atenção terciária à saúde com recursos limitados e analisar a terapêutica e os resultados. Métodos Revisamos retrospectivamente os prontuários eletrônicos de pacientes diagnosticados com EA no Hospital de Clínicas de Porto Alegre de 2014 a 2022. Os dados coletados incluíram apresentação clínica, neuroimagem, exames de líquido cefalorraquidiano, eletroencefalograma, autoanticorpos, tratamentos, resultados, tempo de acompanhamento, grau de comprometimento neurológico e mortalidade. Resultados Dados de 17 pacientes foram coletados. Onze casos foram classificados como EA definitivo e seis como EA possível. Autoanticorpos foram identificados em nove pacientes. O tempo para o diagnóstico foi afetado pelos altos custos associados ao teste de autoanticorpos. A maioria dos pacientes tornou-se funcionalmente dependente (82,4%), e a maioria dos sobreviventes permaneceu com epilepsia autoimune associada (75%). Cinco pacientes faleceram durante a internação, e um após 26 meses de seguimento. Conclusão No hospital em questão, os pacientes com EA tiveram um desfecho clínico pior do que o previamente descrito na literatura. O desenvolvimento de epilepsia durante o acompanhamento e a mortalidade foram maiores, enquanto o desfecho funcional foi inferior. Os testes de autoanticorpos foram inicialmente negados para a maioria dos pacientes, o que impactou o diagnóstico definitivo e o uso de terapias de segunda linha.

Identification of a new polyomavirus in distinct human populations and tissues.

Several human polyomaviruses (HPyVs) have been described in the last 15 years. This work aimed to characterize a novel HPyV with cutaneous tropism. Swabs of healthy skin (forehead) of 75 immunocompetent individuals from Argentina were screened for HPyV through sequence amplification techniques. Publicly available metagenomic data sets were also analyzed. A previously unknown polyomavirus sequence was detected in two skin swab samples. A nearly identical sequence was detected in public data sets representing metagenomic surveys of human skin and feces. Further analyses showed that the new polyomavirus diverges from its nearest relative, human polyomavirus 6 (HPyV6), by 17.3%-17.7% (in nucleotides for the large T antigen), which meets criteria for a new species designation in the genus Deltapolyomavirus. The screening also revealed more distant HPyV6 relatives in macaque genital and chimpanzee fecal data sets. Since polyomaviruses are generally thought to cospeciate with mammalian hosts, the high degree of similarity to HPyV6 suggests the new polyomavirus species is human-tropic. Therefore, a novel polyomavirus was identified and characterized from samples of distinct populations and tissues. We suggest the common name human polyomavirus 16 (HPyV16).

Evolutionary analysis of JC polyomavirus in Misiones' population yields insight into the population dynamics of the early human dispersal in the Americas.

BACKGROUND: JC polyomavirus (JCV) has an ethno-geographical distribution across human populations. OBJECTIVE: Study the origins of the population of Misiones (Argentina) by using JCV as genetic marker. METHODS: Viral detection and characterization was conducted by PCR amplification and evolutionary analysis of the intergenic region sequences. RESULTS: 22 out of 121 samples were positive for JCV, including 5 viral lineages: MY (n = 8), Eu-a (n = 7), B1-c (n = 4), B1-b (n = 2) and Af2 (n = 1). MY sequences clustered within a branch of Native American origin that diverged from its Asian counterpart about 21,914 years ago (HPD 95% interval 15,383-30,177), followed by a sustained demographic expansion around 5000 years ago. CONCLUSIONS: JCV in Misiones reflects the multiethnic origin of the current population, with an important Amerindian contribution. Analysis of the MY viral lineage shows a pattern consistent with the arrival of early human migrations to the Americas and a population expansion by the pre-Columbian native societies.

Association between genetic variants of membrane transporters and the risk of high-grade hematologic adverse events in a cohort of Mexican children with B-cell acute lymphoblastic leukemia.

Background: Advances in the understanding of the pathobiology of childhood B-cell acute lymphoblastic leukemia (B-ALL) have led towards risk-oriented treatment regimens and markedly improved survival rates. However, treatment-related toxicities remain a major cause of mortality in developing countries. One of the most common adverse effects of chemotherapy in B-ALL is the hematologic toxicity, which may be related to genetic variants in membrane transporters that are critical for drug absorption, distribution, and elimination. In this study we detected genetic variants present in a selected group genes of the ABC and SLC families that are associated with the risk of high-grade hematologic adverse events due to chemotherapy treatment in a group of Mexican children with B-ALL. Methods: Next generation sequencing (NGS) was used to screen six genes of the ABC and seven genes of the SLC transporter families, in a cohort of 96 children with B-ALL. The grade of hematologic toxicity was classified according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) version 5.0, Subsequently, two groups of patients were formed: the null/low-grade (grades 1 and 2) and the high-grade (grades 3 to 5) adverse events groups. To determine whether there is an association between the genetic variants and high-grade hematologic adverse events, logistic regression analyses were performed using co-dominant, dominant, recessive, overdominant and log-additive inheritance models. Odds ratio (OR) and 95% confidence intervals (95% CI) were calculated. Results: We found two types of associations among the genetic variants identified as possible predictor factors of hematologic toxicity. One group of variants associated with high-grade toxicity risk: ABCC1 rs129081; ABCC4 rs227409; ABCC5 rs939338, rs1132776, rs3749442, rs4148575, rs4148579 and rs4148580; and another group of protective variants that includes ABCC1 rs212087 and rs212090; SLC22A6 rs4149170, rs4149171 and rs955434. Conclusion: There are genetic variants in the SLC and ABC transporter families present in Mexican children with B-ALL that can be considered as potential risk markers for hematologic toxicity secondary to chemotherapeutic treatment, as well as other protective variants that may be useful in addition to conventional risk stratification for therapeutic decision making in these highly vulnerable patients.

Adhesion of a sealant with pre-reacted glass ionomer particles under salivary contamination: an in vitro study

Objective: this in vitro study compared the adhesive strengths of the resin sealant with the Giomer technology sealant under salivary contamination. Materials and Methods: fifty-two bovine incisors were randomly divided into four groups (n=13): GI, a resin sealant (Fluroshield®) without salivary contamination (control of GII); GII, Fluroshield sealant + salivary contamination; GIII, a Giomer technology sealant (BeautiSealant®) without salivary contamination (control of GIV); and GIV, BeautiSealant® sealant + salivary contamination. In the salivary contamination groups, artificial saliva was used through a pipette, and after 20 s, it was air-dried and the sealant was applied. Shear strength tests were performed using a universal testing machine. One-way ANOVA variance and Tukey's test were used for multiple comparisons. The fracture types were analyzed using a stereomicroscope with 40X magnification. Results: the means and standard deviations (SD) of adhesion for Fluroshield® and BeautiSealant® in the group without salivary contamination were 15.27 (±0.96) and 11.90 (±0.94), and for the group with salivary contamination, 13.14 (±1.03) and 8.95 (±1.33), respectively, indicating a statistically significant difference between GI and GII p=0.020, GIII and GIV p=0.041. Mixed failures were detected in GI (38%), GII (44%), GIII (38%), and GIV (62%). Conclusion: there was a statistically significant decrease in the adhesive strength values in the groups with salivary contamination for both the sealants studied. However, no significant difference was observed between the two sealants when the materials used were compared.

Objetivo: este estudo in vitro comparou as forças adesivas do selante resinoso com o selante da tecnologia Giomer sob contaminação salivar. Materiais e Métodos: cinquenta e dois incisivos bovinos foram divididos aleatoriamente em quatro grupos (n=13): GI, um selante resinoso (Fluroshield®) sem contaminação salivar (controle do GII); GII, selante Fluroshield + contaminação salivar; GIII, um selante com tecnologia Giomer (BeautiSealant®) sem contaminação salivar (controle do GIV); e GIV, selante BeautiSealant® + contaminação salivar. Nos grupos de contaminação salivar, a saliva artificial foi utilizada por meio de uma pipeta e, após 20 s, foi seca ao ar e aplicado o selante. Os testes de resistência ao cisalhamento foram realizados usando uma máquina de teste universal. A variância ANOVA de uma via e o teste de Tukey foram usados para comparações múltiplas. Os tipos de fratura foram analisados em estereomicroscópio com aumento de 40X. Resultados: as médias e desvios padrão (DP) de adesão para Fluroshield® e BeautiSealant® no grupo sem contaminação salivar foram 15,27 (±0,96) e 11,90 (±0,94), e após contaminação salivar foram 13,14 (±1,03) e 8,95 (±1,33), respectivamente, indicando haver diferença estatisticamente significante entre GI e GII p=0.020, GIII e GIV p=0.041. Falhas mistas foram detectadas em GI (38%), GII (44%), GIII (38%) e GIV (62%). Conclusão: houve diminuição estatisticamente significativa dos valores de resistência adesiva nos grupos com contaminação salivar para ambos os selantes estudados. No entanto, não foi observada diferença significativa entre os dois selantes quando comparados os materiais utilizados.

The Genomic Landscape of Corticotroph Tumors: From Silent Adenomas to ACTH-Secreting Carcinomas.

Corticotroph cells give rise to aggressive and rare pituitary neoplasms comprising ACTH-producing adenomas resulting in Cushing disease (CD), clinically silent ACTH adenomas (SCA), Crooke cell adenomas (CCA) and ACTH-producing carcinomas (CA). The molecular pathogenesis of these tumors is still poorly understood. To better understand the genomic landscape of all the lesions of the corticotroph lineage, we sequenced the whole exome of three SCA, one CCA, four ACTH-secreting PA causing CD, one corticotrophinoma occurring in a CD patient who developed Nelson syndrome after adrenalectomy and one patient with an ACTH-producing CA. The ACTH-producing CA was the lesion with the highest number of single nucleotide variants (SNV) in genes such as USP8, TP53, AURKA, EGFR, HSD3B1 and CDKN1A. The USP8 variant was found only in the ACTH-CA and in the corticotrophinoma occurring in a patient with Nelson syndrome. In CCA, SNV in TP53, EGFR, HSD3B1 and CDKN1A SNV were present. HSD3B1 and CDKN1A SNVs were present in all three SCA, whereas in two of these tumors SNV in TP53, AURKA and EGFR were found. None of the analyzed tumors showed SNV in USP48, BRAF, BRG1 or CABLES1. The amplification of 17q12 was found in all tumors, except for the ACTH-producing carcinoma. The four clinically functioning ACTH adenomas and the ACTH-CA shared the amplification of 10q11.22 and showed more copy-number variation (CNV) gains and single-nucleotide variations than the nonfunctioning tumors.

Protease and gag diversity and drug resistance mutations among treatment-naive Mexican people living with HIV.

INTRODUCTION: In Mexico, HIV genotyping is performed in people living with HIV (PLWH) failing their first-line antiretroviral (ARV) regimen; it is not routinely done for all treatment-naive PLWH before ARV initiation. The first nationally representative survey published in 2016 reported that the prevalence of pretreatment drug mutations in treatment-naive Mexican PLWH was 15.5% to any antiretroviral drug and 10.6% to non-nucleoside reverse transcriptase inhibitors (NNRTIs) using conventional Sanger sequencing. Most reports in Mexico focus on HIV pol gene and nucleoside and non-nucleoside reverse transcriptase inhibitor (NRTI and NNRTI) drug resistance mutations (DRMs) prevalence, using Sanger sequencing, next-generation sequencing (NGS) or both. To our knowledge, NGS has not be used to detect pretreatment drug resistance mutations (DRMs) in the HIV protease (PR) gene and its substrate the Gag polyprotein. METHODS: Treatment-naive adult Mexican PLWH were recruited between 2016 and 2019. HIV Gag and protease sequences were obtained by NGS and DRMs were identified using the WHO surveillance drug resistance mutation (SDRM) list. RESULTS: One hundred PLWH attending a public national reference hospital were included. The median age was 28 years-old, and most were male. The median HIV viral load was 4.99 [4.39-5.40] log copies/mL and median CD4 cell count was 150 [68.0-355.78] cells/mm3. As expected, most sequences clustered with HIV-1 subtype B (97.9%). Major PI resistance mutations were detected: 8 (8.3%) of 96 patients at a detection threshold of 1% and 3 (3.1%) at a detection threshold of 20%. A total of 1184 mutations in Gag were detected, of which 51 have been associated with resistance to PI, most of them were detected at a threshold of 20%. Follow-up clinical data was available for 79 PLWH at 6 months post-ART initiation, seven PLWH failed their first ART regimen; however no major PI mutations were identified in these individuals at baseline. CONCLUSIONS: The frequency of DRM in the HIV protease was 7.3% at a detection threshold of 1% and 3.1% at a detection threshold of 20%. NGS-based HIV drug resistance genotyping provide improved detection of DRMs. Viral load was used to monitor ARV response and treatment failure was 8.9%.

Beyond the skin - A rare case of primary pulmonary melanoma and endobronchial aspergilloma.

Melanoma is an aggressive skin tumor, but it may be present in other locations. Primary lung melanoma and endobronchial aspergilloma are rare entities. The authors report a case of a 72-year-old, asthmatic woman, with worsening of her respiratory complaints. Imaging revealed finger in glove sign at the left hemithorax. Bronchoscopy revealed an elongated mass with evidence of Aspergillus. Despite endoscopic mass removal, the patient maintained the nodular imaging at the left hemithorax. She underwent thoracic surgery, and the histological evaluation identified malignant melanoma. After undergoing a thorough evaluation, we excluded other melanocytic lesions, and assumed the diagnosis of primary malignant lung melanoma. This case demonstrates a rare association between endobronchial aspergilloma and primary lung melanoma, raising awareness of considering the co-existence of lung tumor in the presence of endobronchial aspergilloma, and showing endobronchial aspergilloma mimicking malignant lesions.

Photoelastic, microhardness and roughness analysis of zirconia and stainless steel crowns for primary molars.

PURPOSE: To compare the stress distribution through photoelasticity, microhardness and roughness of intact crowns of primary molars (CC) and the preformed crowns of stainless steel (SSC) and zirconia (ZC) used in dental restorations in pediatric dentistry. METHODS: Six healthy primary molars were selected. For the photoelastic models, the teeth were fixed in photoelastic resin. A load of 100 N was applied, and the models were analyzed by transmission polariscope. The Tardy method was used to quantify the fringe order which calculates the maximum stress (T) value in each selected point. The teeth were prepared for cementation of the crowns. The photoelastic test was repeated for each experimental crown. Knoop microhardness was assessed on the buccal surfaces of the CCs, SSCs, and ZCs using a microhardness tester. Parameters were 50 gf for 5 seconds. Roughness was evaluated using a confocal 3-D laser scanning microscope/software at 216x magnification. Roughness average (Ra) values from each model (expressed in µm) were collected and group means were calculated. The stress distribution, microhardness, and roughness data were compared by using one-way ANOVA and the Tukey's test (α= 0.05). RESULTS: There was no difference in the stress distribution for the CCs, SSCs and ZCs. For the microhardness analysis, the ZCs obtained the highest values compared to the CCs and the SSCs (P< 0.001). The CCs were significantly higher than the SSCs (P= 0.027). There was no difference in roughness for the three models (P= 0.615). The SSCs and ZCs showed satisfactory mechanical behavior. CLINICAL SIGNIFICANCE: The use of preformed crowns, especially those made of esthetic materials, is currently increasing in the field of pediatric dentistry. The knowledge of mechanical properties of stainless steel- and zirconia-prefabricated crowns provides scientific foundation for safe clinical application, especially in primary teeth.

LUNG RESECTION FOR NON-SMALL-CELL LUNG CANCER - A NEW RISK SCORE TO PREDICT MAJOR PERIOPERATIVE COMPLICATIONS.

OBJECTIVES: Identify risk factors for major perioperative complications (MPC) after anatomical lung resection for NonSmall-Cell Lung Cancer (NSCLC) and establish a scoring system. METHODS: Single center retrospective study of all consecutive patients diagnosed with NSCLC submitted to anatomical lung resection from 2015 to 2019 (N=564). EXCLUSION CRITERIA: previous lung surgery, concomitant non-lung cancer related procedures, urgency surgery. STUDY POPULATION: 520 patients. PRIMARY END-POINT: MPC defined as a composite endpoint including at least one of the in-hospital complications. Univariable and Multivariable analyses were developed to identify predictors of perioperative complications and create a risk score. Discrimination was assessed using the C-statistic. Calibration was evaluated by Hosmer and Lemeshow test and internal validation was obtained by means of bootstrap replication. RESULTS: Mean age of 65 years and 327 (62.9%) were males. Mean hospital stay of 9 days after surgery. Overall MPC rate was 23.3%. Male gender, hypertension, FEV1<75%, thoracotomy, bilobectomy/pneumectomy and additional resection were independent predictors of MPC. A risk score based on the odds ratios was developed - Major Perioperative Complications of Lung Resection (MPCLR) scoring system - and ranged between 0 and 14 points. It was divided in 5 groups: 1-2 points (positive preditive value 15%); 3-4 (PPV 25%); 5-7 (PPV 35%); 8-9 (PPV 60%); >10 points (PPV 88%). The score showed rea- sonable discrimination (C-statistic=0.70), good calibration (P=.643) and it was internally validated (C-statistic=0,70 BCa95% CI,0.65-0.79). CONCLUSIONS: This study proposes a simple and daily-life risk score system that was able to predict the incidence of perioperative complications.

LYMPH NODE UPSTAGING AFTER SURGERY IN PATIENTS WITH NEGATIVE MEDIASTINAL STAGING BY EBUS.

INTRODUCTION: Mediastinal staging is a hot topic in thoracic oncology. According to the guidelines, and besides other criteria, in the presence of a primary lung cancer with increased mediastinal lymph node uptake on PET-CT, a negative result after lymph node sampling by Endobronchial Ultrasound (EBUS) is not enough to rule out mediastinal lymph node involve- ment, demanding a cervical mediastinoscopy to vouch for the results. METHODS AND OBJECTIVES: In order to study the percentage of lymph node surgical upstaging in patients with neg- ative mediastinal node staging by EBUS and evaluate the role of mediastinoscopy in these patients, we conducted a search in our department's database using the key-word EBUS in the period concerned between January 2014 and August 2020. A total of 302 patients were found. After applying defined criteria, we obtained 42 cases. RESULTS: Lymph node surgical upstaging occurred in 11 (26%) patients, of which 8 were upstaged to N2 and 3 to N1. Most of the cases were single station. Only in 5 (12% of the total) of the 11 patients, the upstaging was related to lymph node stations previously sampled by EBUS. Upstaging was more frequent among males and lower lobe tumours. DISCUSSION AND CONCLUSIONS: Regarding the 8 upstage cases for N2, 5 were single station. Of these 8 cases, only 5 would be approachable by cervical mediastinoscopy. Furthermore, 2 of them were single station, eligible for upfront surgery. Then, only in 3 (7%) of the 42 cases cervical mediastinoscopy would be of foremost importance.

Longitudinal Study after Sputnik V Vaccination Shows Durable SARS-CoV-2 Neutralizing Antibodies and Reduced Viral Variant Escape to Neutralization over Time.

Recent studies have shown a temporal increase in the neutralizing antibody potency and breadth to SARS-CoV-2 variants in coronavirus disease 2019 (COVID-19) convalescent individuals. Here, we examined longitudinal antibody responses and viral neutralizing capacity to the B.1 lineage virus (Wuhan related), to variants of concern (VOC; Alpha, Beta, Gamma, and Delta), and to a local variant of interest (VOI; Lambda) in volunteers receiving the Sputnik V vaccine in Argentina. Longitudinal serum samples (N = 536) collected from 118 volunteers obtained between January and October 2021 were used. The analysis indicates that while anti-spike IgG levels significantly wane over time, the neutralizing capacity for the Wuhan-related lineages of SARS-CoV-2 and VOC is maintained within 6 months of vaccination. In addition, an improved antibody cross-neutralizing ability for circulating variants of concern (Beta and Gamma) was observed over time postvaccination. The viral variants that displayed higher escape to neutralizing antibodies with respect to the original virus (Beta and Gamma variants) were the ones showing the largest increase in susceptibility to neutralization over time after vaccination. Our observations indicate that serum neutralizing antibodies are maintained for at least 6 months and show a reduction of VOC escape to neutralizing antibodies over time after vaccination. IMPORTANCE Vaccines have been produced in record time for SARS-CoV-2, offering the possibility of halting the global pandemic. However, inequalities in vaccine accessibility in different regions of the world create a need to increase international cooperation. Sputnik V is a recombinant adenovirus-based vaccine that has been widely used in Argentina and other developing countries, but limited information is available about its elicited immune responses. Here, we examined longitudinal antibody levels and viral neutralizing capacity elicited by Sputnik V vaccination. Using a cohort of 118 volunteers, we found that while anti-spike antibodies wane over time, the neutralizing capacity to viral variants of concern and local variants of interest is maintained within 4 months of vaccination. In addition, we observed an increased cross-neutralization activity over time for the Beta and Gamma variants. This study provides valuable information about the immune response generated by a vaccine platform used in many parts of the world.

Perioperative Broad-spectrum Antibiotics are Associated With Decreased Surgical Site Infections Compared to 1st-3rd Generation Cephalosporins After Open Pancreaticoduodenectomy in Patients With Jaundice or a Biliary Stent.

OBJECTIVE: Compare the effectiveness of 1st-3rd generation cephalosporins (1st-3rdCE) to broad-spectrum antibiotics in decreasing surgical site infections (SSI) after pancreatectomy. SUMMARY OF BACKGROUND DATA: SSI is one of the most common complications after pancreatic surgery. Various antibiotic regimens are utilized nationwide with no clear guidelines for pancreatectomy. As we await results of a recently initiated prospective trial, this study retrospectively evaluates over 15,000 patients using the same administrative data abstraction tools as in the trial. METHODS: All relevant clinical variables were collected from the 2016-2018 targeted-pancreatectomy database from the American College of Surgeon National Surgical Quality Improvement Program. Preoperative antibiotics were initially collected as first-generation cephalosporin, second or third-generation cephalosporin, and broad-spectrum antibiotics (Broad-abx). RESULTS: Of the 15,182 patients who completed a pancreatic surgery between 2016 and 2018, 6114 (40%) received a first-generation cephalosporin, 4097 (27%) received a second or third-generation cephalosporin, and 4971 (33%) received Broad-abx. On multivariate analysis, Broad-abx was associated with a decrease in all-type SSI compared to 1st-3rdCE (odds ratio = 0.73-0.77, P < 0.001) after open pancreaticoduodenectomy (PD). There was no difference in SSI between antibiotic-types after distal pancreatectomy. Subgroup multivariate analysis of open PD revealed decrease in all-type SSI with Broad-abx amongst patients with jaundice and/or biliary stent only, regardless of wound protector use (odds ratio = 0.69-0.70, P < 0.001). Propensity score matching of open PD patients with jaundice and/or biliary stent confirmed a decrease in all-type SSI (19% vs 24%, P = 0.001), and organ-space SSI (12% vs 16%, P < 0.001). CONCLUSION: Broad-abx are associated with decreased SSI after open PD and may be preferred specifically for patients with preoperative biliary stent and/ or jaundice.

Influência do autocuidado utilizando as práticas integrativas e complementares durante a pandemia da COVID-19 em crianças e adolescentes de 4 a 13 anos com bruxismo e disfunção temporomandibular / Influence of self-care using complementary and integrative therapies during the COVID-19 pandemic in children and adolescents aged 4 to 13 years with bruxism and temporomandibular disorders

O Bruxismo é um comportamento da musculatura mandibular, caracterizado pelo apertamento e/ou rangimento dental, tanto em estado de vigília quanto no sono, que pode acarretar na Disfunção Temporomandibular (DTM). Altamente prevalente em crianças e etiologia multifatorial, destacam-se os aspectos psicossociais, principalmente o estresse e ansiedade. A necessidade de distanciamento social durante a pandemia da COVID-19 trouxe consequências para as crianças e fez surgir novos formatos de ações na Odontologia. Esse estudo avaliou a influência do autocuidado nas manifestações do Bruxismo/DTM em crianças que estavam em tratamento, antes da pandemia, no Serviço de Atendimento de Bruxismo e DTM na Infância (SABDI) da FORP/USP, por meio de intervenções assistidas, implementadas remotamente, de Práticas Integrativas e Complementares (PICs). Previamente às intervenções (T0), os pais responderam o questionário (Q1) sobre a criança (no formato Google Forms, enviado por WhatsApp e e-mail). As práticas propostas foram explicadas em reuniões virtuais (Google Meet) e foram realizadas durante 21 dias, registradas em um "Diário de Controle". Um novo questionário (Q2) foi preenchido para análise comparativa após as intervenções (T1). Das 37 crianças que estavam em tratamento, a amostra final das 18 que concluíram todas as etapas propostas apresentou diferença quantitativa nos itens: "dor na boca/rosto quando mastiga"; "dor ou dificuldade de abrir e fechar a boca"; "acorda com dor no rosto ou dor de cabeça" e, "dor de cabeça durante o dia ou à noite", "range os dentes em vigília"; "frequência que range os dentes em vigília"; "range os dentes enquanto dorme" e, "frequência que range os dentes enquanto dorme", "sono agitado"; "pesadelo" e "insônia". Observou-se evidência de diferença estatística com valor P<0,05, no item "aperta os dentes em vigília" (p=0,0057). Conclui-se que as intervenções propostas influenciaram as manifestações do Bruxismo favorecendo o seu controle.

Bruxism is a behavior of the mandibular muscles, characterized by clenching and/or dental grinding, both in wakefulness and in sleep, which can lead to Temporomandibular Disorders (TMD). Highly prevalent in children and possessing a multifactorial etiology, psychosocial aspects stand out, especially stress and anxiety. The need for social distancing during the COVID-19 pandemic has had consequences for children and has given rise to new formats of actions in Dentistry. This study evaluated the influence of self-care on the manifestations of Bruxism/TMD in children who were undergoing treatment, before the pandemic, Care Center for children with Bruxism and TMD, whose acronyms in Portuguese is SABDI, located in Ribeirão Preto School of Dentistry (FORP-USP), through assisted interventions, implemented remotely, of Complementary and Integrative Therapies (CIT). Prior to the interventions (T0), the parents answered the questionnaire (Q1) about the child (in Google Forms, sent by WhatsApp and e-mail). The proposed practices were explained in virtual meetings (Google Meet) and performed for 21 days and recorded in a "Control Diary". A new questionnaire (Q2) was completed for comparative analysis after the interventions (T1). Of the 37 children who were undergoing treatment, the final sample of 18 who completed all the proposed steps showed a quantitative difference in the items: "pain in the mouth/face when chewing"; "pain or difficulty opening and closing the mouth"; "waking up with pain in the face or headache" and "headache during the day or night"; "grinding teeth while awake"; "frequency grinding teeth while awake"; "grinding teeth while sleeping"; "frequency grinding teeth while sleeping"; "restless sleep"; "nightmare"; and "insomnia". Evidence of statistical difference was observed with a P value <0.05, in the item "clenches teeth while awake" (p=0.0057). It is concluded that the proposed interventions influenced the manifestations of Bruxism, favoring its control.

Knowledge, attitudes, and psychosocial impacts among Brazilian Pediatric Dentists during COVID-19 pandemic

Abstract: In this study, we evaluated the knowledge, attitudes, and psychosocial impacts among Brazilian pediatric dentists during the COVID-19 pandemic. A cross-sectional study with primary data collection was carried out using an online structured questionnaire. Data were submitted to descriptive analysis by using absolute and relative frequencies. A chi-square test was used for association analysis and log-linear regression models to estimate the prevalence ratio (5%). The population comprised mostly women and knowledge regarding COVID-19 was satisfactory (above 80% in most items). N95 masks and faceshields were used, albeit 64.22% reported difficulty in providing dental care to children due to the need for extra Personal Protective Equipment. Thirty eight percent provided urgency/emergency dental care, 59.78% performed invasive procedures, 59.56% used high speed handpieces, 8.44% started using cariostatics, and 6.22% introduced the use of chemomechanical caries removal agents. Fear for the future (PR = 1.21) and use of medications (for anxiety, depression, or insomnia) increased (PR = 1.16) among the ones who had wage losses. Brazilian pediatric dentists have knowledge about COVID-19, and attitudes in their clinical routines changed due the pandemic. Financial life was harmed and a negative impact of the pandemic in psychosocial aspects of workers was found.

Effect of Saliva/Blood Contamination on Enamel Bond Strength / Efeito da Contaminação de Saliva/Sangue na Força de União ao Esmalte

Abstract In the routine clinical situation, the contamination by blood and/or saliva in restorative procedures can be happen in non-cooperation of the patient in dental office. The aim of the study was to assess in vitro shear bond strength of a resin sealant associated with two types of adhesives contaminated with saliva and blood. Healthy human molars were used and the specimens and the crowns were sectioned in the bucco-lingual direction, thus obtaining two segments of similar proportions (mesial and distal), totaling 60 surfaces, and the surfaces were randomly divided into 4 groups (n = 15). Group I (control) received no type of contamination and the sealant was applied. In group II, the surfaces were contaminated with 10 µl of saliva/blood and the sealant was applied. In group III, the surfaces were contaminated with 10 µl of saliva/blood and the Single Bond total-etch adhesive system was applied followed by application of sealant. In group IV, the surfaces were contaminated with 10 µl of saliva/blood and the Prime & Bond NT total-etch adhesive system was applied followed by the application of sealant. Samples were tested in the universal testing machine and the analysis of shear bond strength was performed. A difference between Group I (12.61MPa) and the other groups was found; Group II (2. 28MPa) was different than Groups III (7.07MPa) and IV (7.79MPa), but Groups III and IV were similar. The application of an adhesive system when there is contamination with saliva/blood is required prior to application of pit and fissure sealants. (AU)

Resumo Na situação clínica de rotina, a contaminação por sangue e/ou saliva em procedimentos restauradores pode ocorrer em pacientes que não colaboram no consultório odontológico. O objetivo do estudo foi avaliar a resistência ao cisalhamento in vitro de um selante de resina associado a dois tipos de adesivos contaminados com saliva e sangue. Foram utilizados molares humanos saudáveis e os espécimes e as coroas foram seccionados na direção bucal-lingual, obtendo assim dois segmentos de proporções semelhantes (mesial e distal), totalizando 60 superfícies, e as superfícies foram divididas aleatoriamente em 4 grupos (n = 15). O Grupo I (controle) não recebeu nenhum tipo de contaminação e o selante foi aplicado. No grupo II, as superfícies foram contaminadas com 10 µl de saliva / sangue e o selante foi aplicado. No grupo III, as superfícies foram contaminadas com 10 µl de saliva / sangue e o sistema adesivo Single-Bond foi aplicado seguindo a aplicação de selante. No grupo IV, as superfícies foram contaminadas com 10 µl de saliva / sangue e o sistema adesivo de ataque total Prime & Bond NT foi aplicado seguido da aplicação de vedante. As amostras foram testadas na máquina de ensaio universal e a análise da resistência à ligação ao cisalhamento foi realizada. Uma diferença entre o Grupo I (12,61MPa) e os outros grupos foi encontrada; O Grupo II (2,28 MPa) foi diferente dos Grupos III (7,07MPa) e IV (7,79 MPa), mas os Grupos III e IV foram semelhantes. A aplicação de um sistema adesivo quando existe contaminação com saliva / sangue é necessária antes da aplicação de selantes de fissura e fissura.