Safety and oncological effectiveness after desensitization in patients with previous hypersensitivity reactions to chemotherapy.

INTRODUCTION: Taxanes and platinum are first-line treatments in gynecological tumors with high rates of hypersensitivity reactions (HSRs), leading to discontinuation of treatment. Desensitization involves induction of temporary tolerance to previously sensitized medications. The aims of this study are to describe HSRs to paclitaxel and carboplatin and evaluate the safety and effectiveness of desensitization protocols in gynecological cancer patients. METHODS: Original, retrospective, descriptive, analytical study, approved by Bioethics and Research Committee, included >18-year-old patients with gynecological tumors experiencing HSRs to first-line chemotherapy. Patients underwent 3-bag-12-step desensitization. RESULTS: 174 desensitization (95 paclitaxel, 79 carboplatin) in 33 female patients, mean age 45.5 years (18-71y). Cancer diagnosis: breast 8 (24.2%), ovarian 14 (42.2%), endometrial 2 (6.1%) and cervix 9 (27.2%). HSR occurred in paclitaxel during cycles 1-2 and in carboplatin after 6 cycles. The most frequently seen HSR symptom was cardiovascular with paclitaxel (94.7%), and cutaneous (93.3%) with carboplatin. Three-bags 12-steps desensitization protocol (initial dilution 1:100) in 5.67hrs. All patients reached total dose desensitization: 82% with no reaction, 12% mild, 6% moderate and 0% severe reaction. Mean disease-free interval and progression-free interval in months (m): breast cancer 29 m and 14 m, ovarian 22 m and 9 m, endometrial 40 m and cervical cancer: 67.5 m and 27 m. Twenty-five patients (73.5%) are still alive. CONCLUSION: HSRs to paclitaxel manifest in the first 1-2 cycles and to carboplatin after 6 cycles. Symptoms include cardiovascular, atypical neuromuscular and urticaria. Changing treatment lines impacts prognosis. Our study revealed that ovarian cancer patients undergoing desensitization protocols achieved longer progression-free intervals. All patients successfully reached total dose desensitization. This study provides evidence of the effectiveness and safety of desensitization and promising perspective for continuing first-line treatment with HSRs.

Comparison of the superelasticity of different nickel-titanium orthodontic archwires and the loss of their properties by heat treatment.

The aim of this work is to describe and compare mechanical properties of eight widely used nickel-titanium orthodontic wires under uniform testing conditions and to determine the influence of the heat treatments on the loss of the superelasticity. Ten archwires from two batches from eight different manufacturers were evaluated. A three-point bending test was performed, in accordance with ISO 15841:2006, on 80 round nickel-titanium archwire segments of 0.016 inch. To obtain a load-deflection curve, the centre of each segment was deflected to 3.1 mm and then unloaded until force became zero. On the unloading curve, deflection at the end of the plateau and forces delivered at that point, and at 3, 2, 1 and 0.5 mm of deflection, were recorded. Plateau slopes were calculated from 3 and from 2 mm of deflection. Data obtained were statistically analysed to determine inter-brand, intra-brand and inter-batch differences (P < 0.05). The results show that at 2 mm of deflection, maximum differential force exerted among brands [Nitinol SuperElastic (1.999N)-Sentalloy M (1.001 N)] was 0.998 N (102 gf). The Nitinol SuperElastic plateau slope (0.353 N/mm) was the only one that was statistically different from 2 mm of deflection, as compared with the other brand values (0.129-0.155 N/mm). Damon Optimal Force described the gentlest slope from 3 mm of deflection (0.230 N/mm) and one of the longest plateaus. Titanol and Orthonol showed the most notable intra-brand differences, whereas inter-batch variability was significant for Nitinol (Henry Schein), Euro Ni-Ti and Orthonol. Superelasticity degree and exerted forces differed significantly among brands. Superelasticity of Nitinol SuperElastic was not observed, while Damon Optimal Force and Proclinic Ni-Ti Superelástico (G&H) showed the most superelastic curves. Intra-brand and inter-batch differences were observed in some brands. In all cases, the heat treatment at 600 °C produces precipitation in the matrix. The precipitates are rich in titanium and this fact produce changes in the chemical composition of the matrix and the loss of the superelasticity. At 400 °C these precipitates are not produced and the forces delivered by the wires are very similar with wires untreated.

The Relationship between Nocturnal Enuresis and Obstructive Sleep Apnea in Children.

BACKGROUND: The aim of this study is to determine the prevalence of nocturnal enuresis (NE) in children with obstructive sleep apnea (OSA), the effect of adenotonsillectomy (AT) and the width of the arches, and to compare them with control children without respiratory problems. METHODS: Children from 2 to 12 years old were divided into three groups: children with OSA and NE (n = 51), children with OSA without NE (n = 79), and the control group (n = 168). NE was defined as at least one bedwetting incident per month. Arch widths were measured at the baseline and one year after. OSA was diagnosed by means of polysomnography, and the apnea-hypopnea index (AHI) was obtained. Parents completed the Pediatric Sleep Questionnaire (PSQ) to classify their children into those with and without NE. RESULTS: NE was present in 39.2% of children with OSA compared to 28% in the control group (p = 0.04). After AT, 49% of the children with OSA and NE significantly improved. Both OSA groups had narrower arch widths than the control group (p = 0.012), with the NE group having the narrowest widths. NE is more prevalent in children with OSA and should be considered one of the first signs of breathing disorders. Adenotonsillectomy reduces NE in about half of the affected children. Both arch widths are narrower in children with OSA, particularly in those with NE.

Properties of Superelastic Nickel-Titanium Wires after Clinical Use.

The aim of the present study was to describe and determine changes in the superelastic properties of NiTi archwires after clinical use and sterilization. Ten archwires from five different manufacturers (GAC, 3M, ODS, GC, FOR) were cut into two segments and evaluated using a three-point bending test in accordance with ISO 14841:2006. The center of each segment was deflected to 3.1 mm and then unloaded to 0 N to obtain a load-deflection curve. Deflection at the end of the plateau and forces at 3, 2, 1 and 0.5 mm on the unloading curve were recorded. Plateau slopes were calculated at 2, 1 and 0.5 mm of deflection. Data obtained were statistically analyzed to determine differences (p < 0.001). Results showed that the degree of superelasticity and exerted forces differed significantly among brand groups. After three months of clinical use, FOR released a greater force for a longer activation period. GC, EURO and FOR archwires seemed to lose their mechanical properties. GC wires released more force than other brand wires after clinical use. Regarding superelasticity after sterilization, GAC, 3M and FOR wires recovered their properties, while EURO archwires lost more.

Enamel Evaluation after Debonding of Fixed Retention and Polishing Treatment with Three Different Methods.

Lack of standardization of the retention phase has led to many studies of stability of movements and characteristic of retainers, disregarding the enamel repercussions of fixed retention on this phase. This study aimed to analyze different methods of enamel polishing after detachment of orthodontic retainers. Forty-five healthy premolars were divided into three groups according to the polishing bur after debonding, and four specimens without intervention were used as control. A 0.038 × 0.015 inches gold chain was bonded between the premolars and then removed. The adhesive remnant was removed with three types of burs according to the study groups (Group 1: white stone at high speed; Group 2: high-speed handpiece with a 30-blade tungsten carbide bur; Group 3: low-speed handpiece and a 30-blade tungsten bur). After debonding and polishing, all samples were analyzed with a confocal microscopy on surface roughness parameters: Sa: Arithmetic mean of the height of the surface. Rq: Square mean of the height of the surface and Sz: Maximum surface height. Mechanical tests were carried out to determine the bonding stress of the retention adhered to the teeth using an electromechanical testing machine. The adhesion stress was 8.23 MPa (±0.87). The quality of the refinement of the enamel after debonding is essential in order to preserve its integrity. The use of the 30-blade tungsten carbide bur provides a smooth enamel surface after polishing.

Comparison of changes in the dental transverse and sagittal planes between patients treated with self-ligating and with conventional brackets.

INTRODUCTION: Several advantages have been established regarding the efficiency of self-ligating brackets (SL). In spite of some controversy surrounding this question in the literature, clinical results confirm that "arch development" requires fewer extractions. OBJECTIVE: The objective of this study was to compare changes in the transverse and sagittal planes in patients treated with conventional ligating brackets (CL)as well as in patients treated with SL brackets and oversized arches. METHODS: A sample was selected from a pool of 300 consecutive cases treated by a single clinician: 51 patients with SL brackets and oversized wires, and 55 with CL brackets. These two groups were compared with a control group of 20 patients. All plaster models were scanned and dental landmarks were measured to identify changes from commencement (T0) to conclusion (T1) of treatment. Lateral cephalograms were analyzed for changes in the lower incisor (IMPA) and the first lower molar distal angulation (MAng). Intraoperator reliability was tested with linear regression analysis. To assure all groups were comparable at T0, an ANOVA test with a 95%confidence interval (CI) was performed for all values. To assess changes from T0 to T1 in all groups, a Student's t-test with 95% CI was used. Finally, results from the three groups were compared using an ANOVA-test (95% CI) and a post-hoc test. RESULTS: Increases in all the transverse variables were recorded in the two groups treated (SL and CL), except for the lower intercanine distance in the SL group. IMPA difference from T0 to T1 was higher in the CL group, and molar distal angulation (MAng) took place in the SL group. CONCLUSIONS: Self-ligating brackets with oversized arches and conventional ligating brackets showed increases in all variables in the transverse plane, except for the SL group at the mandibular intercanine distance. In comparison with the CL group, fewer different IMPA values were observed in the SL group, in which distal molar angulation occurred.

In Vitro Study of Shear Bond Strength in Direct and Indirect Bonding with Three Types of Adhesive Systems.

This study aimed to compare the shear bond strength (SBS) and adhesive remaining index (ARI) using one conventional and two novel adhesive systems with clinical step reduction and direct and indirect bonding. A sample of 72 human premolars were divided into six groups of 12 samples. The first three groups (G1, G2, G3) were bonded with a direct technique, while the remaining groups (G4, G5, G6) were bonded by the indirect technique. Groups G1 and G4 used conventional acid-etching primer composite (XT); groups G2 and G5 used self-etching bonding (BO), and groups G3 and G6 had an acid-etching treatment followed by a self-adhesive composite (OC). All groups were exposed to thermocycling. Shear bond strength was analyzed with a universal test machine, and the ARI was examined with 4× magnification. The results showed statistically significant differences between the three adhesive systems. The highest strength values were observed in the XT group G1 (13.54 ± 4 MPa), while the lowest were shown in the BO G2 samples (5.05 ± 2 MPa). There was no significant difference between the direct or indirect bonding techniques on the three compared groups. The type of primer and bonding material significantly influenced the SBS. Values with self-etching bonding were below the minimum recommended for clinical use (5.9-7.8 MPa). There was no difference between indirect and direct bonding techniques. The lowest ARI scores (0-1) were observed in both self-etching and BO groups. Further clinical studies are needed to compare in vivo results.

Tumor of the epididymis: an uncommon presentation of disseminated coccidioidomycosis.

Coccidioidomycosis is an endemic disease of arid regions in the Western hemisphere. Its clinical presentation varies from asymptomatic nodules on chest x-rays to disseminated disease. We present the case of a 48-year-old man with a hard and heterogeneous tumor in the posterior aspect of the right testis. Color flow doppler testicular ultrasonography was performed and two nodular masses in the tail of the right epididymis were identified. An epididymectomy was performed and histopathological examination revealed coccidioidomycosis. After diagnosis, the patient was successfully treated with fluconazol.

"In Vitro" Study About Variables that Influence in Arch Friction with Conventional and Self-Ligating Brackets.

Many advantages have been described surrounding self-ligating (SL) brackets compared to metallic conventional ligating (CL) brackets, such as: Less total treatment time, alignment efficiency, patient comfort, plaque retention, and low friction. The objective of this in vitro simulation was to know the variables that affect arch displacement in CL and SL brackets-active (ASL) and passive (PSL)-and analyze if static friction values are affected by bracket design, arch wire section, kind of ligature, and use of a friction reducer agent (FRA) in a wet state. Larger values of static friction were found in CL with metallic ligature (ML) (8.01 ± 1.08 N/mm) and elastic ligature (EL) (6.96 ± 0.48 N/mm). Lower values were found in PSL brackets combined with FRA (0.58 ± 0.21 N/mm). The study was carried out using different stereographical models of a maxillary upper right quadrant with canine, first and second premolar, and first molar bonded brackets. A section of 25 mm of 0.019 × 0.025" stainless steel arch with a rectangular section (SS) and hybrid section (HY) was inserted into the different bracket models. Static friction values were collected using a universal test machine in wet conditions and testing the effect of a friction reducer agent (FRA). To assure the reliability of the study, different wire combinations were repeated after two weeks by the same operator and a linear analysis of regression was done. Each bracket model analysis-with the different wires, use of the FRA, and comparison among brackets in similar conditions-was done using an ANOVA test with a confidence interval of 95% and comparative Post-Hoc tests (LSD). In this in vitro simulation we found higher static friction values in CL compared to ASL and PSL. In PSL, lower values were achieved. CL brackets using ML showed the highest static friction values with a great variability. In this setting, the use of HY wires did not reduce static friction values in ASL and PSL, while in CL brackets with EL friction the values were reduced significantly. An FRA combined with ASL reduced significantly static friction values but not with PSL. In the case of CL, the FRA effect was higher with SS and better than with HY wires. ML values were similar to ASL static friction. The direct extrapolation of the results might be inaccurate, since all these findings should be tested clinically to be validated.

Comparison of changes in the dental transverse and sagittal planes between patients treated with self-ligating and with conventional brackets

ABSTRACT Introduction: Several advantages have been established regarding the efficiency of self-ligating brackets (SL). In spite of some controversy surrounding this question in the literature, clinical results confirm that "arch development" requires fewer extractions. Objective: The objective of this study was to compare changes in the transverse and sagittal planes in patients treated with conventional ligating brackets (CL)as well as in patients treated with SL brackets and oversized arches. Methods: A sample was selected from a pool of 300 consecutive cases treated by a single clinician: 51 patients with SL brackets and oversized wires, and 55 with CL brackets. These two groups were compared with a control group of 20 patients. All plaster models were scanned and dental landmarks were measured to identify changes from commencement (T0) to conclusion (T1) of treatment. Lateral cephalograms were analyzed for changes in the lower incisor (IMPA) and the first lower molar distal angulation (MAng). Intraoperator reliability was tested with linear regression analysis. To assure all groups were comparable at T0, an ANOVA test with a 95%confidence interval (CI) was performed for all values. To assess changes from T0 to T1 in all groups, a Student's t-test with 95% CI was used. Finally, results from the three groups were compared using an ANOVA-test (95% CI) and a post-hoc test. Results: Increases in all the transverse variables were recorded in the two groups treated (SL and CL), except for the lower intercanine distance in the SL group. IMPA difference from T0 to T1 was higher in the CL group, and molar distal angulation (MAng) took place in the SL group. Conclusions: Self-ligating brackets with oversized arches and conventional ligating brackets showed increases in all variables in the transverse plane, except for the SL group at the mandibular intercanine distance. In comparison with the CL group, fewer different IMPA values were observed in the SL group, in which distal molar angulation occurred.

RESUMO Introdução: Já foram enumeradas diversas vantagens quanto à eficiência dos braquetes autoligáveis (BAL). Apesar das controvérsias na literatura, resultados clínicos confirmam que o "desenvolvimento da arcada" demanda menos extrações. Objetivo: O objetivo deste estudo foi comparar as mudanças nos planos transversal e sagital em pacientes tratados com braquetes convencionais (BC) e pacientes tratados com BAL e arcos superdimensionados. Métodos: A amostra foi selecionada de um grupo de 300 pacientes tratados consecutivamente por um mesmo ortodontista: 51 pacientes com BAL e arcos superdimensionados, e 55 com BC. Esses dois grupos foram comparados a um grupo controle (GC) de 20 pacientes. Todos os modelos de gesso foram escaneados e pontos de referência dentários foram mensurados, para se identificar as mudanças entre o início (T0) e o fim do tratamento (T1). Radiografias cefalométricas laterais foram analisadas para identificar mudanças nos incisivos inferiores (IMPA) e na angulação distal dos primeiros molares inferiores (MAng). A confiabilidade intraexaminador foi testada por meio de uma análise de regressão linear. Para garantir que os grupos fossem comparáveis em T0, realizou-se o teste ANOVA com intervalo de confiança (IC) de 95% para todos os valores. Para avaliar as mudanças entre T0 e T1 em todos os grupos, foi utilizado o teste t de Student com IC de 95%. Por fim, os resultados dos três grupos foram comparados utilizando-se o teste ANOVA (IC 95%) e um teste post-hoc. Resultados: Foram registrados aumentos em todas as variáveis transversais nos dois grupos tratados (BC e BAL), com exceção da distância intercaninos inferiores no grupo BAL. As maiores diferenças de T0 para T1 ocorreram no IMPA do grupo BC e na angulação distal de molares (MAng) do grupo BAL. Conclusões: Ambos os grupos, BAL com arcos superdimensionados e BC, apresentaram aumento em todas as variáveis no plano transversal, com exceção da distância intercaninos inferiores no grupo BAL. Em comparação ao grupo BC, menores diferenças nos valores de IMPA foram observadas no grupo BAL, no qual aconteceu angulação distal de molares.

Disruption of amyloid plaques integrity affects the soluble oligomers content from Alzheimer disease brains.

The implication of soluble Abeta in the Alzheimer's disease (AD) pathology is currently accepted. In fact, the content of soluble extracellular Abeta species, such as monomeric and/or oligomeric Abeta, seems to correlate with the clinico-pathological dysfunction observed in AD patients. However, the nature (monomeric, dimeric or other oligomers), the relative abundance, and the origin (extra-/intraneuronal or plaque-associated), of these soluble species are actually under debate. In this work we have characterized the soluble (defined as soluble in Tris-buffered saline after ultracentrifugation) Abeta, obtained from hippocampal samples of Braak II, Braak III-IV and Braak V-VI patients. Although the content of both Abeta40 and Abeta42 peptides displayed significant increase with pathology progression, our results demonstrated the presence of low, pg/µg protein, amount of both peptides. This low content could explain the absence (or below detection limits) of soluble Abeta peptides detected by western blots or by immunoprecipitation-western blot analysis. These data were in clear contrast to those published recently by different groups. Aiming to explain the reasons that determine these substantial differences, we also investigated whether the initial homogenization could mobilize Abeta from plaques, using 12-month-old PS1xAPP cortical samples. Our data demonstrated that manual homogenization (using Dounce) preserved the integrity of Abeta plaques whereas strong homogenization procedures (such as sonication) produced a vast redistribution of the Abeta species in all soluble and insoluble fractions. This artifact could explain the dissimilar and somehow controversial data between different groups analyzing human AD samples.

Traumatismo grave de pié / Severe traume to the foot

Siempre una amputación es una resolución terapéutica difícil de tomar, y más aún cuando se trata de un paciente sano, que por un accidente pierde la capacidad de recuperar su miembro, máxime cuando el nivel de amputación ideal va mucho más allá de la zona lesionada, como es este caso, una amputación por debajo de la rodilla, estando la lesión localizada en el medio y antepié. Si bien es cierto que una amputación que permita un rápido equipamiento protésico puede reinsertar social y laboralmente al paciente mucho más rápido, siempre y cuando se cuente con los medios adecuados para ello, hay que tener en cuenta el aspecto psicológico del accidentado en el cual, la pérdida de parte de su cuerpo, genera un desequilibrio en su esquema corporal