Different words for stroke: the same concept? an analysis of associated symptoms and intended reaction in Brazil.

BACKGROUND: Different names for stroke might mislead physicians and emergency medical service workers. This study aimed to assess the different words for stroke in Brazil and both intended response and related symptoms associated with those names. METHODS: Cross-sectional study enrolling healthy individuals from urban areas in Northeast of Brazil for an open-ended survey. We presented a typical clinical case of a stroke (an elderly who had sudden onset of hemiparalysis and slurred speech) and asked "what is happening?", "what would you do?" and "which other symptoms could happen in this condition?". RESUTS: From 1,475 interviewed individuals, 1,220 (82,7%) recognized the scenario as a stroke. There were 3 words to correctly identify (based on correct intended response and spontaneously evoked associated symptoms) the stroke, which were "AVC" (acronym for cerebrovascular accident, in Portuguese), "derrame" (spillage) and "trombose" (thrombosis). There were significant differences among them concerning demographic, economic, educational and geographical aspects, but there was no difference according to the intended reaction among them. The most cited associated symptoms (excluding those present in the case) were impaired consciousness (10.6%), headache (8.9%) and dysesthesia (7.7%). "Aneurisma" (aneurism) was also cited, by 3 individuals. CONCLUSION: There are at least three words for stroke in Portuguese ("AVC", "derrame" and "trombose"); they were similar in terms of correct intended responses and spontaneously cited accompanying symptoms. Stroke campaigns should apply different names to reach a broader audience and to improve stroke recognition.

Lumen-apposing stents versus plastic stents in the management of pancreatic pseudocysts: a large, comparative, international, multicenter study.

BACKGROUND: Larger caliber lumen-apposing stents (LAMSs) have been increasingly used in the management of pancreatic fluid collections, specifically when solid debris is present; however, their advantages over smaller caliber plastic stents in the management of pancreatic pseudocysts are unclear. The aim of this study was to investigate the safety and efficacy of LAMS specifically in the management of pancreatic pseudocysts compared with double-pigtail plastic stents (DPPSs). METHODS: We performed a multicenter, international, retrospective study between January 2012 and August 2016. A total of 205 patients with a diagnosis of pancreatic pseudocysts were included, 80 patients received LAMSs and 125 received DPPSs. Measured outcomes included clinical success, technical success, adverse events, stent dysfunction, pancreatic pseudocyst recurrence, and need for surgery. RESULTS: Technical success was similar between the LAMS and the DPPS groups (97.5 % vs. 99.2 %; P = 0.32). Clinical success was higher for LAMSs than for DPPSs (96.3 % vs. 87.2 %; P = 0.03). While the need for surgery was similar between the two groups (1.3 % vs. 4.9 %, respectively; P = 0.17), the use of percutaneous drainage was significantly lower in the LAMS group (1.3 % vs. 8.8 %; P = 0.03). At 6-month follow-up, the recurrence rate was similar between the groups (6.7 % vs 18.8 %, respectively; P = 0.12). The rate of adverse events was significantly higher in the DPPS group (7.5 % vs. 17.6 %; P = 0.04). There was no difference in post-procedure mean length of hospital stay (6.3 days [standard deviation 27.9] vs. 3.7 days [5.7]; P = 0.31). CONCLUSION: When compared to DPPSs, LAMSs are a safe, feasible, and effective modality for the treatment of pancreatic pseudocysts and are associated with a higher rate of clinical success, shorter procedure time, less need for percutaneous interventions, and a lower overall rate of adverse events.

Technological advances in endodontics: treatment of a mandibular molar with internal root resorption using a reciprocating single-file system.

The field of endodontics has become increasingly successful due to technological advances that allow clinicians to solve clinical cases that would have been problematic a few years ago. Despite such advances, endodontic treatment of teeth with internal root resorption remains challenging. This article presents a clinical case in which a reciprocating single-file system was used for endodontic treatment of a mandibular molar with internal root resorption. Radiographic examination revealed the presence of internal root resorption in the distobuccal root canal of the mandibular right first molar. A reciprocating single-file system was used for root canal instrumentation and final preparation, and filling was obtained through a thermal compaction technique. No painful symptoms or periapical lesions were observed in 12 months of follow-up. The results indicate that a reciprocating single-file system is an adequate alternative for root canal instrumentation, particularly in teeth with internal root resorption.

Photodynamic therapy in root canals contaminated with Enterococcus faecalis using curcumin as photosensitizer.

The aim of the study was to evaluate the photodynamic therapy (PDT) effect on root canals contaminated with Enterococcus faecalis using a light emitting diode (LED) light and a curcumin solution (CUR) as photosensitizer (PS). Eighty root canals from uniradicular human teeth were prepared with Protaper Universal rotary system and contaminated with E. faecalis for 21 days. They were divided as: GIa-PDT (CUR, pre-irradiation for 5 + 5 min of irradiation); GIb-PDT (CUR, pre-irradiation for 5 + 10 min of irradiation); GIIa-(CUR, pre-irradiation for 5 + 5 min without irradiation); GIIb-(CUR pre-irradiation for 5 + 10 min of irradiation); GIIIa-(physiological solution and irradiation for 5 min); and GIIIb-(physiological solution and irradiation for 10 min); positive and negative control groups. Collections from root canals were made at time intervals of 21 days after contamination, immediately after treatment, and 7 days after treatment, and submitted to colony forming units per milliter (CFU mL(-1)) counts. The data were submitted to ANOVA and Tukey multiple comparison tests, at a level of significance of 5 %. In the immediate post-treatment collection, group GIa showed greater bacterial reduction in comparison with GIIa, GIIb, GIIIa, GIIIb, and positive control (P < 0.05). At 7 days post-treatment, GIa showed significant bacterial reduction only in comparison with GIIIa (P < 0.05). Curcumin as sensitizer was effective by 5 min LED irradiation but not by 10 min irradiation PDT using LED light, and curcumin as PS was not effective in eliminating E. faecalis. No difference was observed for periods of irradiation.

Calibração do modelo hidrológico SWMM para a bacia do ribeirão vai e volta — Poços de Caldas, Minas Gerais / Calibration of SWMM's hydrological model for the watershed vai e volta stream — Poços de Caldas, Minas Gerais

RESUMO A impermeabilização de áreas em centros urbanos, resultante do processo de ocupação desordenada do solo, contribui para o aumento e a aceleração do escoamento superficial e, consequentemente, para a ocorrência de enchentes e inundações em bacias urbanas. Nesse contexto, atualmente, modelos hidrológicos vêm sendo empregados no desenvolvimento de políticas públicas de gestão das águas urbanas, com vistas à drenagem urbana sustentável. O presente trabalho teve como objetivo usar um modelo hidrológico para a bacia do ribeirão Vai e Volta, localizada no município de Poços de Caldas, Minas Gerais, para simular o hidrograma de cheia em um canal urbano. Utilizou-se o software Storm Water Management Model (SWMM) calibrando o modelo a dados de chuva e vazão medidos. Realizou-se a calibração manual do modelo para dois eventos de precipitação com a obtenção do coeficiente de eficiência de Nash-Sutcliffe (NSE) médio de 0,73 e erros da vazão de pico e do volume escoado inferiores a 15%. O modelo foi validado para outros três eventos distintos e obteve-se ajuste NSE médio de 0,79 e erros da vazão de pico e do volume escoado inferiores a 5%.

ABSTRACT The waterproofing of areas in urban centers, resulting from the disorderly occupation of the soil, contributes to increase and accelerate the runoff and, consequently, to the occurrence of floods and inundation in urban watersheds. In this context, hydrological models are currently being used in the development of public policies for urban water management, related to sustainable urban drainage. The present work aimed to use a hydrological model for the watershed of the Vai e Volta stream, located in the city of Poços de Caldas, Minas Gerais, to simulate the flood hydrograph in an urban open channel. The Storm Water Management Model (SWMM) software was used, calibrating the model to measured rainfall and flow data. The model was manually calibrated for two rainfall events with an average Nash-Sutcliffe coefficient (NSE) of 0.73 and errors in peak flow and runoff volume below 15%. The model was validated for three other distinct events and an average NSE adjustment of 0.79 was obtained and errors in peak flow and runoff volume below 5%.

Apical transportation of manual NiTi instruments and a hybrid technique in severely curved simulated canals.

AIM: To evaluate the apical transportation induced by two instrumentation techniques in severely curved simulated canals. MATERIALS AND METHODS: Forty simulated canals were divided into two groups (n = 20), according to the following instrumentation techniques: ProTaper Universal Manual System and a hybrid technique. The simulated canals in the ProTaper group were prepared following the technique recommended by the manufacturer: SX files in the cervical third of the root canal and S1, S2, and F1 files up to the working length. In the hybrid group, preparation was performed with K-files sizes 15, 20, and 25 to the working length, followed by cervical preparation with Gates Glidden burs 1, 2, and 3. Apical finishing was performed with the ProTaper manual files S2 and F1. To analyze apical transportation, the simulated canals were photographed before and after preparation at ×8. The images of the root canals pre- and post-instrumentation were superimposed to measure the distance between the inner and outer walls along the first 3 mm of the apical third. RESULTS: The hybrid group presented the highest apical transportation values; however, with no statistically significant difference in comparison with the ProTaper group (P > 0.05). CONCLUSIONS: Both techniques induced similar apical transportation in the original path of the simulated root canals.

Cleaning capacity of hybrid instrumentation technique using reamer with alternating cutting edges system files: Histological analysis.

AIM: The aim of the following study is to evaluate the cleaning capacity of a hybrid instrumentation technique using Reamer with Alternating Cutting Edges (RaCe) system files in the apical third of mesial roots of mandibular molars. MATERIALS AND METHODS: Twenty teeth were selected and separated into two groups (n = 20) according to instrumentation technique as follows: BioRaCe - chemomechanical preparation with K-type files #10 and #15; and files BioRaCe BR0, BR1, BR2, BR3, and BR4; HybTec - hybrid instrumentation technique with K-type files #10 and #15 in the working length, #20 at 2 mm, #25 at 3 mm, cervical preparation with Largo burs #1 and #2; apical preparation with K-type files #15, #20, and #25 and RaCe files #25.04 and #30.04. The root canals were irrigated with 1 ml of 2.5% sodium hypochlorite at each change of instrument. The specimens were histologically processed and photographed under light optical microscope. The images were inserted onto an integration grid to count the amount of debris present in the root canal. RESULTS: BioRaCe presented the highest percentage of debris in the apical third, however, with no statistically significant difference for HybTec (P > 0.05). CONCLUSIONS: The hybrid technique presented similar cleaning capacity as the technique recommended by the manufacturer.

Cleaning capacity promoted by motor-driven or manual instrumentation using ProTaper Universal system: Histological analysis.

AIM: The aim of this study was to assess the cleaning capacity of the Protaper system using motor-driven or manual instrumentation. MATERIALS AND METHODS: Ten mandibular molars were randomly separated into 2 groups (n = 5) according to the type of instrumentation performed, as follows: Group 1 - instrumentation with rotary nickel-titanium (Ni-Ti) files using ProTaper Universal System (Dentsply/Maillefer); and, Group 2 - instrumentation with Ni-Ti hand files using ProTaper Universal (Dentsply-Maillefer). Afterwards, the teeth were sectioned transversely and submitted to histotechnical processing to obtain histological sections for microscopic evaluation. The images were analyzed by the Corel Photo-Paint X5 program (Corel Corporation) using an integration grid superimposed on the image. RESULTS: Statistical analysis (U-Mann-Whitney - P < 0.05) demonstrated that G1 presented higher cleaning capacity when compared to G2. CONCLUSIONS: The rotary technique presented better cleaning results in the apical third of the root canal system when compared to the manual technique.

Morphometrical analysis of cleaning capacity of a hybrid instrumentation in mesial flattened root canals.

The cleaning capacity of hybrid and rotary instrumentation techniques in mesial flattened canals of mandibular first molars was evaluated by morphometrical analysis in this study. Twenty human mandibular first molars were randomly assigned into two groups, according to instrumentation technique, as follows: group 1, instrumentation with ProTaper Starter Kit (Dentsply/Maillefer) rotary system; group 2, manual instrumentation using K files (Dentsply/Maillefer) by crown-down technique in middle and apical thirds, cervical preparation with Gates-Glidden #1 and #2 (Dentsply/Maillefer) burs, and to finalise the preparation, ProTaper F2 and F3 rotary files. Serial transverse cross-sections (5 µm) of the apical third, stained with hematoxylin and eosin, were analysed at 100× original magnification. The images were submitted to morphometrical analysis with an integration grid to determine the percentage of root canal area with debris. Statiscal analysis (t-Student, P < 0.05) showed significant difference between the techniques (P < 0.05), although neither completely cleaned the root canal.

Pesquisas em animais: uma reflexão bioética / Investigación con animales: una reflexión bioética / Animal research: a bioethical reflection

Os modelos de experimentação animal constituem uma importante ferramenta na pesquisa científica. Sabe-se que essa prática deve estar baseada em princípios bioéticos, seja para impor limites de dor e sofrimento, como para fiscalizar instalações e procedimentos. Assim, o presente estudo teve por objetivo levantar e apresentar as normas atuais que regulamentam as pesquisas em animais no Brasil comprando-as a outros países, bem como fomentar reflexões bioéticas sobre esse mote. Para isso, apresentamos a legislação brasileira vigente e conduzimos uma revisão e discussão da literatura internacional. A busca de artigos foi realizada na base de dados PubMed, utilizando como palavra-chave os termos "bioética" e "bem-estar do animal". Foram incluídos dezenove artigos, publicados entre os anos de 1997 a 2013. Concluiu-se que é evidente a contribuição dos animais para pesquisas científicas de diversas áreas. Cabe moralmente ao Homem, como ser racional, garantir um tratamento digno aos animais que contribuem para a pesquisa. A forma mais segura de seguir este caminho é estabelecendo leis claras e pesquisas bem delineadas, que envolvam a sociedade para designar normas éticas. Dessa forma, o bem-estar animal estaria garantido.

Los modelos animales son una herramienta importante en la investigación científica. Se sabe que esta práctica debe basarse en principios bioéticos, sea para imponer límites sobre el dolor y el sufrimiento, o para inspeccionar las instalaciones y procedimientos. Este estudio tuvo el objetivo de evaluar y presentar las normas vigentes que rigen la investigación con animales en Brasil, comparándolas con otros países, así como fomentar la reflexión bioética sobre este tema. Para eso, presentamos la legislación brasileña vigente y realizamos una revisión y discusión de la literatura internacional. La búsqueda de artículos fue realizada en la base de datos PubMed, usando las palabras-clave "bioética" y "bienestar del animal". Se incluyeron diecinueve artículos publicados entre 1997 e 2013. Se concluyó que es evidente la contribución de los animales para la investigación científica de varias áreas. Cabe moralmente al ser humano, como ser racional, asegurar un tratamiento humanitario de los animales que contribuyen con la investigación. La forma más segura de seguir este camino es estableciendo leyes claras e investigaciones bien delineadas, que involucren la sociedad para designar normas éticas. Así, el bienestar de los animales estaría garantizado.

Animal models are an important tool in scientific research. It is known that this practice must be based on bioethical principles in order to impose limits about pain and suffering, or for inspecting proceedings and research site. This study has as aim to evaluate and present current legislation ruling animal research in Brazil, comparing it with other countries, as well as fostering bioethical reflection about this issue. For this, we present current Brazilian legislation and we have carried out international literature review and discussion. The articles were searched in PubMed data base, using the key words "bioethics" and "animal welfare". Nineteen articles from 1997 to 2013 were included. It was concluded the evident contribution of animal research for scientific research in several fields. It is morally relevant for humans, as rational beings, to secure humane treatment to animals contributing to research. The safest way to follow this path is establishing clear norms and studies well designed, involving society for assigning ethical norms. Thus, animal welfare would be guarantee.

Terapia fotodinâmica em dentes contaminados com Enterococcus faecalis utilizando a curcumina como fotossensibilizador / Photodynamic therapy on teeth contaminated with Enterococcus faecalis using curcumin as photosensitizer

O estudo avaliou a eficácia antibacteriana da terapia fotodinâmica (TFD) em canais radiculares contaminados com Enterococcus faecalis, utilizando o LED como fonte de luz e a curcumina como agente fotossensibilizador (FS) em diferentes tempos de irradiação. Oitenta raízes de dentes humanos unirradiculados foram fixados em placas de 24 poços. Todos os espécimes foram submetidos ao preparo biomecânico utilizando o sistema Protaper Universal® (Dentsply-Maillefer, Ballaigues, Suíça) na sequência técnica preconizada pelo fabricante até o instrumento F4, sendo, a seguir, esterilizados e distribuídos aleatoriamente nos seguintes grupos e sub-grupos (n=10): GIa: TFD (curcumina com 5 minutos de pré-irradiação + 5 minutos de irradiação); GIb: TFD (Curcumina com 5 minutos de pré-irradiação + 10 minutos de irradiação); GIIa: Curcumina com 5 minutos de pré-irradiação + 5 minutos sem irradiação; GIIb: Curcumina 5 minutos + 10 minutos sem irradiação; GIIIa: Soro fisiológico + Luz por 5 minutos; GIIIb: Soro fisiológico + luz 10 minutos; Grupos controle positivo e negativo. As coletas deram-se aos 21 dias da contaminação, pós- tratamento e 7 dias pós-tratamento. Os dados obtidos (UFC/mL) foram submetidos aos testes de ANOVA e Tukey com nível de significância de 5%. Os resultados mostraram redução bacteriana nos grupos GIa e GIb de forma significante em relação aos demais grupos no pós tratamento e, aos 7dias, somente em relação ao GIIIa (P<0,05). A TFD não foi eficaz na eliminação de E. faecalis dos canais radiculares. O tempo de irradiação de 10 minutos foi irrelevante em relação ao efeito da TFD

The study evaluated the antibacterial efficacy of photodynamic therapy (PDT) in root canals contaminated with Enterococcus faecalis, using LED as light source and curcumin as photosensitizer agent (FS) at different irradiation times. Eighty single-rooted and single-canalled human extracted teeth were selected for this study that were fixed in 24 well plates and contaminated by suspensions of E.faecalis for 21 days. All specimens were subjected to biomechanical preparation using Protaper Universal® (Dentsply-Maillefer, Ballaigues, Switzerland) system following the technique recommended by the manufacturer to the F4 instrument, and, then, sterilized and randomly divided into the following groups and sub-groups (n = 10): GIa: PDT (curcumin with 5 minutes of pre-irradiation time + 5 min of irradiation); GIb: PDT (curcumin with 5 minutes of pre-irradiation + 10 min irradiation); GIIA: 5 minutes with curcumin preirradiation + 5 minutes without irradiation; GIIB: Curcumin 5 minutes + 10 minutes without irradiation; GIIIa: saline + light for 5 minutes; GIIIb: saline + light 10 minutes; positive and negative control groups. The collected times of samples were after 21 days of infection, post-treatment and 7 days after treatment. The data (CFU mL-1) were submitted to ANOVA and Tukey test. Results showed bacterial reduction only in the group GIa and GIb significantly in relation to other groups in post-treatment (P <0.05). PDT was not effective in eliminating E. faecalis from root canals. The irradiation time of 10 minutes did not improve the effect of PDT

Reabilitação estético-funcional sobre implantes agulhados e endósseos / Aesthetic Functional Rehabilitation involving needle and endosseous dental implants

Este relato mostra a resolução de um caso clínico cujo objetivo foi promover a substituição de uma reabilitação em hemiarcada superior esquerda em uma paciente que apresentava implantes agulhados e endósseos, ausência estética no sorriso e mau posicionamento tridimensional dos implantes. Para melhorar o posicionamento das agulhas, realizou-se a dobra vestibulopalatina das mesmas, unindo-as com resina composta; removeram-se as próteses parafusadas nos implantes das regiões dos pré-molares (24 e 25) e molar (26), substituiram-se os minipilares nos dois últimos implantes e, no primeiro pré-molar e canino, utilizaram-se os pilares cimentados devido a inclinação dos mesmos, planejando a união com solda pelo pequeno diâmetro dos implantes e o contato de um deles com uma das agulhas, o que poderia interferir na íntima relação osso/implante; futuramente prejudicando a biomecânica. Para realização da moldagem de arrasto com moldeira aberta, utilizou-se fio afastador nos implantes agulhados e transferência dos implantes com os respectivos transferentes. Assim, os modelos foram montados em articulador semiajustável após a tomada de arco facial, registro com silicona e moldagem do antagonista. Realizada a confecção do modelo de trabalho e das infraestruturas, estas foram provadas realizando-se os ajustes necessários seguido da remontagem. As peças então foram submetidas à aplicação de cerâmica, prova, ajustes, acabamento, torque dos componentes e cimentação com cimento resinoso químico dos dentes 21 ao 24. Ao término do caso, pôde-se concluir que boa reabilitação estético-funcional depende de conhecimento profundo das técnicas e dos materiais para as indicações a cada situação clínica.

This report shows the resolution of a case study whose aim was promote the aesthetic and functional rehabilitation of upper left hemi-arch over endosseous and needle implant prostheses. To improve the position of the needle implants, we performed the bucco-palatal bending of needles splinting them with composite resin; we removed the screwed implant prosthesis in the regions of the premolars (24 and 25) and molar (26). The mini-abutments of the last two implants were replaced, and in the first premolar and canine, we used cemented abutments due to implant angulation having planned soldering because of implant size and contact with one needle implant that could interfere with intimate contact bone/implant damaging biomechanics. Pick-up impressions were performed with an open tray, using a retractor cord in the needle implants and respective transfer copings. There fore, models were related on semi-adjustable articulator after a face-bow recording and interocclusal indexes. After working cast fabrication and try-in of infra-structures, these were adjusted and related into the articulator again. Then, after ceramic build-up, adjustments, finishing, and torque, chemically-activated resin cement was applied on units 21 to 24. At the end of the case, we concluded that a good aesthetic and functional rehabilitation depends on thorough knowledge of techniques for each clinical situation