Glomerular Filtration Rate Estimation Using ß2-Microglobulin and ß-Trace Protein in Adults With Solid Tumors: A Prospective Cross-Sectional Study.

RATIONALE & OBJECTIVE: ß2-Microglobulin (B2M) and ß-trace protein (BTP) are novel endogenous filtration markers that may improve the accuracy of estimated glomerular filtration rate (eGFR) beyond creatinine and cystatin C (eGFRcr-cys), but they have not been assessed in patients with cancer. STUDY DESIGN: Cross-sectional analysis. SETTING & PARTICIPANTS: Prospective cohort of 1,200 patients with active solid tumors recruited between April 2015 and September 2017. EXPOSURE: CKD-EPI equations without race combining B2M and/or BTP with creatinine with or without cystatin C (2-, 3-, or 4-marker panel eGFR). OUTCOME: Performance of equations compared with eGFRcr-cys and non-GFR determinants of serum B2M and BTP (SB2M, and SBTP, respectively). Measured GFR (mGFR) was determined using the plasma clearance of chromium-51 labeled ethylenediamine tetraacetic acid (51Cr-EDTA). ANALYTICAL APPROACH: Bias was defined as the median of the differences between mGFR and eGFR, and 1-P30 was defined as the percentage of estimates that differed by more than 30% from the mGFR (1-P30). Linear regression was used to assess association of clinical and laboratory variables with SB2M, and SBTP after adjustment for mGFR. RESULTS: Mean age and mGFR were 58.8±13.2 SD years and 78.4±21.7 SD mL/min/1.73m2, respectively. Performance of the 3-marker and 4-marker panel equations was better than eGFRcr-cys (lesser bias and 1-P30). Performance of 2-marker panel equations was as good as eGFRcr-cys (lesser bias and similar 1-P30). SB2M and SBTP were not strongly influenced by cancer site. LIMITATIONS: Participants may have had better clinical performance status than the general population of patients with solid tumors. CONCLUSIONS: B2M and BTP can improve the accuracy of eGFR and may be useful as confirmatory tests in patients with solid tumors, either by inclusion in a multimarker panel equation with creatinine and cystatin C, or by substituting for cystatin C in combination with creatinine. PLAIN-LANGUAGE SUMMARY: The most accurate method to assess estimate kidney function is estimated glomerular filtration rate (eGFR) using creatinine and cystatin C (eGFRcr-cys). We studied whether using ß2-microglobulin (B2M) and/or ß-trace protein (BTP) with creatinine with or without cystatin C (2-, 3-, or 4-marker panel eGFR) might be useful in patients with active solid tumors. The performance of the 3-marker and 4-marker panel equations was better than eGFRcr-cys. Performance of 2-marker panel equations was as good as eGFRcr-cys. We conclude that B2M and BTP can improve the accuracy of eGFR and may be useful as a confirmatory test in patients with solid tumors either by inclusion in multimarker panel equation with creatinine and cystatin C or by substituting for cystatin C in combination with creatinine.

A prospective cross-sectional study estimated glomerular filtration rate from creatinine and cystatin C in adults with solid tumors.

Current guidelines recommend estimating glomerular filtration rate (eGFR) using creatinine (eGFRcr) with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation as the first test for GFR evaluation, but the Cockcroft-Gault (CG) equation is still commonly used in oncology practice and clinical trials despite increasing evidence of its inaccuracy compared to measured GFR (mGFR). Guidelines recommend eGFR using cystatin C (eGFRcys) or both markers (eGFRcr-cys) as a confirmatory test, but neither was carefully evaluated in cancer patients. Therefore, we compared performance of the CKD-EPI equations and others to the CG equation in adults with a variety of solid tumors. The mGFR was determined by plasma clearance of 51Cr-EDTA. Bias was defined as the median of the differences between mGFR and eGFR while accuracy was defined as the percentage of estimates that differed by more than 30% from the measured GFR (1-P30). We prospectively recruited 1,200 patients between April 2015 and September 2017 with a mean age and mGFR of 58.8 years and 78.4 ml/min/1.73m2, respectively. Bias among eGFRcr equations varied from -8.1 to +6.1 ml/min/1.73 m2. CG was the least accurate, 1-P30 (95% confidence interval) was 24.9 (22.4- 27.3)%; CKD-EPI had 1-P30 of 19.1 (16.8-21.2)% while eGFRcr-cys had the best performance: bias -2.0 (-2.6 to -1.1) ml/min/1.73m2 and 1-P30 7.8 (6.3-9.4)%. Thus, the CG equation should not be preferred over CKD-EPI equation, and eGFRcr-cys can be used as a confirmatory test in adults with solid tumors. Hence, a major policy implication would be to adopt general practice guideline-recommended methods for GFR evaluation in oncology practice and clinical trials.

Alveolar Ridge Expansion: Comparison of Osseodensification and Conventional Osteotome Techniques.

OBJECTIVE: The aim of this in vivo study is to compare the osseointegration of endosteal implants placed in atrophic mandibular alveolar ridges with alveolar ridge expansion surgical protocol via an experimental osseodensification drilling versus conventional osteotome technique. METHODS: Twelve endosteal implants, 4 mm × 13 mm, were placed in porcine models in horizontally atrophic mandibular ridges subsequent to prior extraction of premolars. Implants were placed with osseodensification drilling technique as the experimental group (n = 6) and osteotome site preparation as the control group (n = 6). After 4 weeks of healing, samples were retrieved and stained with Stevenel's Blue and Van Gieson's Picro Fuschin for histologic evaluation. Quantitative analysis via bone-to-implant contact (BIC%) and bone area fraction occupancy (BAFO%) were obtained as mean values with corresponding 95% confidence interval. A significant omnibus test, post-hoc comparison of the 2 drilling techniques' mean values was accomplished using a pooled estimate of the standard error with P-value set at 0.05. RESULTS: The mean BIC% value was approximately 62.5% in the osseodensification group, and 31.4% in the regular instrumentation group. Statistical analysis showed a significant effect of the drilling technique (P = 0.018). There was no statistical difference in BAFO as a function of drilling technique (P = 0.198). CONCLUSION: The combined osseodensification drilling-alveolar ridge expansion technique showed increased evidence of osseointegration and implant primary stability from a histologic and biomechanical standpoint, respectively. Future studies will focus on expanding the sample size as well as the timeline of the study to allow investigation of long-term prognosis of this novel technique.

Ridge Architecture Preservation Following Minimally Traumatic Exodontia Techniques and Guided Tissue Regeneration.

OBJECTIVE: To compare hard-tissue healing after 3 exodontia approaches. MATERIALS AND METHODS: Premolars of dogs were extracted: (1) flapless, (2) flap, and (3) flap + socket coverage with polytetrafluoroethylene (dPTFE) nonresorbable membrane (flap + dPTFE). Animals were euthanized at 1 and 4 weeks. Amount of bone formation within socket and socket total area were measured. RESULTS: Amount of bone formation revealed significant difference between 1 and 4 weeks; however, there was no differences among groups. Socket total area decreased after 4 weeks, and the flap + dPTFE group showed significantly higher socket total area. As a function of time and group, flap + dPTFE 4 weeks presented similar socket total area values relative to flap + dPTFE at 1 week, and significantly higher socket total area than flapless and flap. The histological sections revealed almost no bone formation within socket after 1 week, which increased for all groups at 4 weeks. CONCLUSION: Socket coverage with polytetrafluoroethylene (dPTFE) membrane showed to effectively preserve bone architecture. Bone formation within sockets was not influenced by tooth extraction technique.

Change in Anopheles richness and composition in response to artificial flooding during the creation of the Jirau hydroelectric dam in Porto Velho, Brazil.

BACKGROUND: Anopheles mosquitoes are the only vectors of human malaria. Anopheles species use standing water as breeding sites. Human activities, like the creation of an artificial lake during the implementation of hydroelectric power plants, lead to changes in environmental characteristics and, therefore, may changes the species richness and composition of Anopheles mosquitoes. The aim of the present study was to verify whether or not there is an association between the artificial flooding resulting from the construction of the Jirau hydroelectric power plant, and the richness and composition of anophelines. METHODS: Mosquitoes samples were obtained monthly from the Jirau hydroelectric power plant area located at Porto Velho, Rondônia State, using Human Landing Catch (06:00-10:00 PM). Mosquitoes collected were transported to Laboratório de Entomologia Médica FIOCRUZ-RO where they were identified until species using dichotomous key. RESULTS: A total of 6347 anophelines belonging to eight different species were collected. The anophelines species richness was significantly lower during the first flooding stage. Differences in anophelines species composition were found when comparing the first flooding stage with the other stages. Furthermore, the mean number of Anopheles darlingi, the main vector of malaria in the region, increases during the first and the third flooding stages. CONCLUSIONS: The continual monitoring of these vectors during the late operational phase may be useful in order to understand how anophelines will behave in this area.

Early Healing Evaluation of Commercially Pure Titanium and Ti-6Al-4V Presenting Similar Surface Texture: An In Vivo Study.

OBJECTIVE: This study evaluated the osseointegration of commercially pure titanium (Ti) grade-2 (G2) and Ti-6Al-4V alloy (G5) implants with the same geometry and surface treatment. MATERIALS AND METHODS: Thirty-six dental implants with a grit-blasted acid-etched surface were used (n = 18, each). Two implants, one per group, were installed in each subject, in the radius diaphysis (n = 18 beagle dogs), with interchanged fixture position (proximal-distal) between animals for a balanced number of devices per group and time in vivo (1, 3, and 6 weeks). RESULTS: Similar topographical parameters between G2 and G5 were observed for average surface roughness, root mean square, developed surface ratio, maximum height of surface, and density of summits. Removal torque was significantly higher for G5 than for G2. No differences were observed for bone-to-implant contact and bone-area-fraction occupancy. Removal torque significantly increased with time for both groups. At 1 week, new bone formation in direct contact with the implant surface and osteogenic tissue migration was observed with an increase in woven bone formation at 3 weeks followed by the onset of lamellar bone formation at 6 weeks. CONCLUSION: Although both surfaces were biocompatible and osteoconductive, increased removal torque was observed for Ti-6Al-4V compared with commercially pure Ti implants.

The Effect of Osteotomy Dimension on Implant Insertion Torque, Healing Mode, and Osseointegration Indicators: A Study in Dogs.

PURPOSE: This study investigated the effect of the osteotomy diameter for implant placement torque and its effect on the osseointegration. MATERIALS AND METHODS: Eight male beagle dogs received 48 implants (3.75 mm × 10 mm) in their right and left radius, 3 implants per side and allowed to heal for 3 weeks. Three experimental groups were evaluated. Group 1: implant with an undersized osteotomy of 3.0 mm; group 2: osteotomy of 3.25 mm, and group 3: osteotomy of 3.5 mm. The insertion torque was recorded for all implants. Histological sectioning and histometric analysis were performed evaluating bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO). RESULTS: Implants of group 1 presented statistically higher insertion torque than those of groups 2 and 3 (P < 0.01). No differences in BIC or BAFO were observed between the groups. From a morphologic standpoint, substantial deviations in healing mode were observed between groups. CONCLUSION: Based on the present methodology, the experimental alterations of surgical technic can be clinically used with no detrimental effect over the osseointegration process.

Histomorphological and Histomorphometric Analyses of Grade IV Commercially Pure Titanium and Grade V Ti-6Al-4V Titanium Alloy Implant Substrates: An In Vivo Study in Dogs.

PURPOSE: To evaluate the bone response to grade IV commercially pure titanium (G4) relative to Ti-6Al-4V (G5). MATERIALS AND METHODS: Implant surface topography was characterized by optical interferometry and scanning electron microscopy (SEM). Thirty-six implants (Signo Vinces, n = 18 per group) were installed in the radius of 18 dogs. The animals were killed at 1, 3, and 6 weeks, resulting in 6 implants per group and time in vivo for bone morphology, bone-to-implant contact (BIC), and bone area fraction occupancy (BAFO) evaluation. RESULTS: SEM depicted a more uniform topography of G4 than G5. Surfaces were statistically homogeneous for Sa, Sq, and Sdr. At 1 week, new bone formation was observed within the healing connective tissue in contact with the implant surface. At 3 weeks, new bone in direct contact with the implant surface was observed at all bone regions. At 6 weeks, the healing chambers filled with woven bone depicted an onset of replacement by lamellar bone. No significant effect of substrate was detected. Time presented an effect on BIC and BAFO (P < 0.001). CONCLUSION: Both titanium substrates were biocompatible and osseoconductive at the bone tissue level.

Surface characterization and in vivo evaluation of laser sintered and machined implants followed by resorbable-blasting media process: A study in sheep.

BACKGROUND: This study aimed to compare the histomorphometric and histological bone response to laser-sintered implants followed by resorbable-blasting media (RBM) process relative to standard machined/RBM surface treated implants. MATERIAL AND METHODS: Six male sheep (n=6) received 2 Ti-6Al-4V implants (1 per surface) in each side of the mandible for 6 weeks in vivo. The histomorphometric parameters bone-implant contact (BIC) and bone area fraction occupancy (BAFO) were evaluated. RESULTS: Optical interferometry revealed higher Sa and Sq values for the laser-sintered/RBM surface in relation to standard/RBM implants. No significant differences in BIC were observed between the two groups (p>0.2), but significantly higher BAFO was observed for standard/RBM implants (p<0.01). CONCLUSIONS: The present study demonstrated that both surfaces were biocompatible and osseoconductive, and the combination of laser sintering and RBM has no advantage over the standard machined implants with subsequent RBM.

Seasonal genetic partitioning in the neotropical malaria vector, Anopheles darlingi.

BACKGROUND: Anopheles darlingi is the main malaria mosquito vector in the Amazonia region. In spite of being considered a riverine, forest-dwelling species, this mosquito is becoming more abundant in peri-urban areas, increasing malaria risk. This has been associated with human-driven environmental changes such as deforestation. METHODS: Microsatellites were used to characterize A. darlingi from seven localities along the Madeira River, Rondônia (Brazil), collected in the early and late periods of the rainy season. RESULTS: Two genetically distinct subpopulations were detected: one (subpopulation A) was associated with the late rainfall period and seems to be ecologically closer to the typical forest A. darlingi; the other (subpopulation B) was associated with the early rainfall period and is probably more adapted to drier conditions by exploiting permanent anthropogenic breeding sites. Results suggest also a pattern of asymmetric introgression, with more subpopulation A alleles introgressed into subpopulation B. Both subpopulations (and admixed mosquitoes) presented similar malaria infection rates, highlighting the potential for perennial malaria transmission in the region. CONCLUSIONS: The co-occurrence of two genetically distinct subpopulations of A. darlingi adapted to different periods of rainfall may promote a more perennial transmission of malaria throughout the year. These findings, in a context of strong environmental impact due to deforestation and dam construction, have serious implications for malaria epidemiology and control in the Amazonian region.

Natural Plasmodium infection in monkeys in the state of Rondônia (Brazilian Western Amazon).

BACKGROUND: Simian malaria is still an open question concerning the species of Plasmodium parasites and species of New World monkeys susceptible to the parasites. In addition, the lingering question as to whether these animals are reservoirs for human malaria might become important especially in a scenario of eradication of the disease. To aid in the answers to these questions, monkeys were surveyed for malaria parasite natural infection in the Amazonian state of Rondônia, Brazil, a state with intense environmental alterations due to human activities, which facilitated sampling of the animals. METHODS: Parasites were detected and identified in DNA from blood of monkeys, by PCR with primers for the 18S rRNA, CSP and MSP1 genes and sequencing of the amplified fragments. Multiplex PCR primers for the 18S rRNA genes were designed for the parasite species Plasmodium falciparum and Plasmodium vivax, Plasmodium malariae/Plasmodium brasilianum and Plasmodium simium. RESULTS: An overall infection rate of 10.9% was observed or 20 out 184 monkey specimens surveyed, mostly by P. brasilianum. However, four specimens of monkeys were found infected with P. falciparum, two of them doubly infected with P. brasilianum and P. falciparum. In addition, a species of monkey of the family Aotidae, Aotus nigriceps, is firstly reported here naturally infected with P. brasilianum. None of the monkeys surveyed was found infected with P. simium/P. vivax. CONCLUSION: The rate of natural Plasmodium infection in monkeys in the Brazilian state of Rondônia is in line with previous surveys of simian malaria in the Amazon region. The fact that a monkey species was found that had not previously been described to harbour malaria parasites indicates that the list of monkey species susceptible to Plasmodium infection is yet to be completed. Furthermore, finding monkeys in the region infected with P. falciparum clearly indicates parasite transfer from humans to the animals. Whether this parasite can be transferred back to humans and how persistent the parasite is in monkeys in the wild so to be efficient reservoirs of the disease, is yet to be evaluated. Finding different species of monkeys infected with this parasite species suggests indeed that these animals can act as reservoirs of human malaria.

The Influence of Implant Design Features on the Bone Healing Pathway: An Experimental Study in Sheep.

This study evaluated how implant design features influence osseointegration. Two implant macrogeometries and surface treatments were evaluated: (1) progressive buttress threads with an SLActive surface (SLActive/BL), and (2) inner and outer trapezoidal threads with a nanohydroxyapatite coating over a dual acid-etched surface (Nano/U). Implants were placed in the right ilium of 12 sheep, and histologic and -metric analyses were conducted after 12 weeks. Percentages of bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) within the threads were quantified. Histologically, the SLActive/BL group showed greater and more intimate BIC than the Nano/U group. In contrast, Nano/U group depicted woven bone formation within the healing chambers, between the osteotomy wall and implant threads, and bone remodeling was evident at the outer thread tip. Significantly higher BAFO was seen in the Nano/U group than the SLActive/BL group at 12 weeks (P < .042). Different implant design features influenced the osseointegration pathway, supporting further investigations to describe the differences and clinical performance.

Larval food quantity affects development time, survival and adult biological traits that influence the vectorial capacity of Anopheles darlingi under laboratory conditions.

BACKGROUND: The incidence of malaria in the Amazon is seasonal and mosquito vectorial capacity parameters, including abundance and longevity, depend on quantitative and qualitative aspects of the larval diet. Anopheles darlingi is a major malaria vector in the Amazon, representing >95% of total Anopheles population present in the Porto Velho region. Despite its importance in the transmission of the Plasmodium parasite, knowledge of the larval biology and ecology is limited. Studies regarding aspects of adult population ecology are more common than studies on larval ecology. However, in order develop effective control strategies and laboratory breeding conditions for this species, more data on the factors affecting vector biology is needed. The aim of the present study is to assess the effects of larval food quantity on the vectorial capacity of An. darling under laboratory conditions. METHODS: Anopheles darlingi was maintained at 28°C, 80% humidity and exposed to a daily photoperiod of 12 h. Larvae were divided into three experimental groups that were fed either a low, medium, or high food supply (based on the food amounts consumed by other species of culicids). Each experiment was replicated for six times. A cohort of adults were also exposed to each type of diet and assessed for several biological characteristics (e.g. longevity, bite frequency and survivorship), which were used to estimate the vectorial capacity of each experimental group. RESULTS: The group supplied with higher food amounts observed a reduction in development time while larval survival increased. In addition to enhanced longevity, increasing larval food quantity was positively correlated with increasing frequency of bites, longer blood meal duration and wing length, resulting in greater vectorial capacity. However, females had greater longevity than males despite having smaller wings. CONCLUSIONS: Overall, several larval and adult biological traits were significantly affected by larval food availability. Greater larval food supply led to enhance larval and production and larger mosquitoes with longer longevity and higher biting frequency. Thus, larval food availability can alter important biological traits that influence the vectorial capacity of An. darlingi.

Effect of leukocyte-platelet-rich fibrin in bone healing around dental implants placed in conventional and wide osteotomy sites: A pre-clinical study.

Leukocyte-platelet-rich fibrin (L-PRF) has been suggested for gap management for immediate implant placement when the distance is greater than 2 mm. However, there remains a paucity in hierarchically designed research to support this application. The present study aimed to evaluate the effect of L-PRF on the osseointegration parameters of dental implants placed after conventional osteotomy of surgically created bone defects that simulate post extraction sockets in a canine model after 3, 6, and 12 weeks in vivo. Eighty dental implants (Intra-Lock, Boca Raton, FL) were placed in the radius of 13 beagle dogs. The experiment consisted of 4 groups (n = 20 implants/group): 1) Regular osteotomy (Reg n/L-PRF); 2) Regular osteotomy and implant placement with L-PRF membrane (Reg L-PRF); 3) Wide osteotomy with no gap management performed, where an osteotomy/bony defect (6 mm of diameter and ~5 mm deep) was created to simulate immediate implant placement in post-extraction sockets, and the gap was left for spontaneous healing (Wide nL-PRF); and 4) Wide osteotomy with L-PRF gap management (Wide L-PRF). L-PRF membranes were obtained by blood drawn from each subject and centrifuged at 2700 rpm (408 RCF-clot) for 12 min. In the experimental groups where L-PRF was utilized, the membrane was inserted into the osteotomy site prior to implant placement. Six dogs had implants placed in the radius for 3 weeks; and 7 dogs had implants placed in the left radius for 6 weeks and in the right radius for 12 weeks. At the corresponding experimental time points, samples were harvested, and subjected to histological processing for qualitative and quantitative analyses, via bone-to-implant contact (BIC) and bone-area-fraction occupancy (BAFO). Qualitative analysis demonstrated increased amounts of bone formation around the implant and within the healing chambers over time for all groups. While comparable histological features were observed for both Reg groups (L-PRF and nL-PRF), the gap management performed in Wide L-PRF group resulted in effective gap filling with improved bone growth in close proximity to the implant surface. Quantitative analyses of BIC and BAFO yielded higher values for both variables at 3 weeks for Wide L-PRF (~38% and ~56% respectively) compared to Wide nL-PRF (~20% for BIC and BAFO) (p < .03). No statistical differences were detected between Wide groups at 6 and 12 weeks, neither between Reg groups, independent of the association with or without the L-PRF membrane at all healing times. L-PRF placed within wide osteotomies, prior to implant placement, resulted in increased early bone formation compared to unfilled wide osteotomies at the early healing time (3 weeks in vivo).

Laddec® versus Bio-Oss®: The effect on the healing of critical-sized defect - Calvaria rabbit model.

The aim of this study was to evaluate the in vivo performance of two different deproteinized bovine bone (DBB) grafting materials: DBBB (Bio-Oss®) and DBBL (Laddec®), for the regeneration of critically sized (8 mm) defects in rabbit's calvaria. Three round-shaped defects were surgically created in the calvaria of 13 New Zealand White rabbits proximal to the coronal suture in the parietal bone. Two of the defects were filled with one of the grafting materials while a third was left empty to serve as a negative control. Bone regeneration properties were evaluated at 4- and 8-weeks after implantation by means of histological and histomorphometrical analyses. Statistical analyses were performed through a mixed model analysis with fixed factors of time and material. Histological evaluation of the control group evidenced a lack of bridging bone formation across the defect sites at both evaluation time points. For the experimental groups, new bone formation was observed around the defect periphery and to progress radially inwards to the center of the defect site, regardless of the grafting material. Histomorphometric analyses at 4 weeks demonstrated higher amount of bone formation through the defect for DBBB group. However, at 8 weeks, DBBL and DBBB demonstrated osteoconductivity and low resorption rates with evidence of statistically similar bone regeneration through the complete boney defect. Finally, DBBB presented lower soft tissue migration within the defect when compared to DBBL at both evaluation time points. DBBB and DBBL presented similar bone regeneration performance and slow resorption rates. Although both materials promoted bone regeneration through the complete defect, DBBB presented lower soft tissue migration within the defects at 4- and 8-weeks.

Acute Chagas Disease Caused by Trypanosoma cruzi TcIV and Transmitted by Panstrongylus geniculatus: Molecular Epidemiological Insights Provided by the First Documented Autochthonous Case in Rondônia, Southwestern Amazonia, Brazil.

Recurrent outbreaks of oral infection and isolated cases characterize the new epidemiological scenario of Chagas disease (CD) in the Brazilian Amazon. Acute Chagas disease (ACD) is common in Pará and Amazonas, Northeastern and Northwestern Brazilian Amazonia. In the present study, we describe the first molecularly characterized autochthonous case of ACD in Rondônia, Southwestern Amazonia. The patient, a 39-year-old male resident in the small city of Cujubim, presented typical ACD symptoms: fever, asthenia, myalgia, progressive dyspnea, swelling of the legs, and tiredness at minimal efforts, all compatible with ACD and indicative of cardiac involvement. A thick blood drop test revealed trypomastigote forms of Trypanosoma cruzi genotyped as TcIV. An epidemiological investigation ruled out oral infection, and support for vectorial transmission included the finding of Panstrongylus geniculatus positive for T. cruzi (TcIII and TcIV) inside the tent used by the patient when harvesting forest timber, and a circular cutaneous lesion resembling a chagoma of inoculation. Treatment with benznidazole led to blood parasite clearance as confirmed by molecular tests. Altogether, our findings fitted well into the ecological scenario where deforestation and colonization of forested areas represent an important risk factor to the adaptation of P. geniculatus to human habitats, favoring vectorial transmission of CD in the Amazonian region.

Medial canthal region as an external reference point in orthognathic surgery.

PURPOSE: The aim of this investigation was to evaluate the effectiveness of using the medial canthal region (MCR) as an external reference point to determine the vertical dimension during maxillary repositioning as planned in model surgery and predictive tracing. MATERIALS AND METHODS: The analyzed group consisted of 43 consecutive patients who underwent maxillary or bimaxillary orthognathic surgery. Before downfracture, the vertical height was established from the distance of the MCR to the incisal edge of the right upper central incisor (UCI). The vertical dimension was obtained with frequent measurements by use of calipers as desired during cephalometric tracing and model surgery. After rigid fixation, the vertical height was verified again. The UCI was traced from the postoperative cephalogram and predictive tracing onto a preoperative tracing. Repositioning of the maxilla and postsurgical movements of the UCI were registered at the horizontal and vertical planes. Comparison was made between the predicted maxillary position on the cephalometric tracing and the actual position, as well as between the planned maxillary position in model surgery and the actual position. RESULTS: The mean difference between the planned UCI position on predictive tracing and postsurgical position was 0.30 mm (SD, 0.21 mm; P > .05) in the vertical plane. The variation between the planned maxillary position in model surgery and the actual position was 0.37 mm (SD, 0.31 mm; P > .05) in the vertical plane. CONCLUSIONS: Good surgical accuracy in positioning the mobilized maxilla can be achieved by use of the MCR as an external reference point.

Evaluation of Mansonia spp. Infestation on Aquatic Plants in Lentic and Lotic Environments of the Madeira River Basin in Porto Velho, Rondônia, Brazil.

The females of Mansonia are voraciously hematophagous. The spiracular apparatus of the immature, larval, and pupal forms is adapted to perforate submerged aquatic vegetation, from whose aeriferous aerenchyma they obtain the oxygen necessary for breathing. The proliferation of aquatic plants, in some cases linked to anthropic modifications that reduce water flow and/or increase organic matter content, may therefore contribute to the spread of these mosquitoes. This study aims to assess the presence of immature individuals of Mansonia in different aquatic plants of the Madeira River basin in 10 lentic and lotic environments and correlate their population density with abiotic factors such as water pH, dissolved O2, conductivity, and temperature. The sampling lasted from February 2016 to June 2018, a 29-month period during which 31,287 specimens belonging to the genus Mansonia were captured. Of the 12 species of macrophytes inspected, Eichhornia crassipes made up 70.1% of the samples. Lentic environments accounted for 58.9% of the samples and lotic environments for 41.1%. Immature individuals were most commonly found on Eichhornia crassipes, with this plant accounting for an average of 96.2% of all individuals, with a percentage ranging between 58.2% and 77.1% in different breeding areas. Only at the Foz do Igarapé Jirau site was a different distribution observed, with the number of aquatic plants more nearly equal: 83.3% of the larvae were found in Eichhornia crassipes, 9.2% in Ceratopteris pteridoides, 3.6% in E. azurea, 2.0% in Salvinia sp., and 1.9% in Pistia sp. The greatest richness was found in Iguapé do Raul. Concerning the larval/plant relationship, although less frequent, E. azurea had a higher larval density of Mansonia spp. It is important to emphasize that this finding may indicate a possible selection for this plant. Egg deposition by Mansonia spp. was more abundant in sample areas with Eichhornia crassipes and Pistia sp. The number of specimens collected was positively correlated with temperature, pH, and conductivity. These correlations showed a marked increase in the rainy season. Therefore, we were able to establish preliminary parameters of how environmental changes influence the ecology of this important genus of mosquitoes, the species of which are critical disease vectors.

Rhodnius spp. infestation in palm trees and natural infection by Trypanosoma cruzi and Trypanosoma rangeli in periurban and rural areas of state of the Rondônia, in the Brazilian Amazon.

The state of Rondônia in the Brazilian Amazon is prone to diseases transmitted by insect vectors because of the environmental and population changes resulting from large hydroelectric projects and the expansion of agricultural and livestock industries. The first case of Chagas disease by vectorial transmission was recorded in 2019 in a rural area in Rondônia, reinforcing the need for entomological surveillance. Hence, our goal was to estimate the abundance of Rhodnius spp. in palm trees located in rural and periurban areas and in Brazil-Bolivia border regions, perform domiciliary searches, and check for possible associations between triatomines and the presence/absence of palm-inhabiting fauna and outdoor farming, domestic animals, and buildings. The sampling took place in five municipalities of Rondônia in 2014 (June to August) and 2015 (April to June). Triatomines were collected by active searches during the selective pruning of palm tree crowns. Domiciliary inspections lasted from 30 to 60 min. A set of captured triatomines was analyzed for Trypanosoma cruzi and T. rangeli infection by PCR. Overall, 496 insects were captured during sampling of 150 palms in rural areas and 150 in periurban areas. No triatomine was found during active searches of 59 dwelling either indoors or outdoors. The majority of triatomines caught in the palm trees were identified as Rhodnius robustus (98.6%), and seven specimens were R. pictipes. Triatomine infestation was observed in only 20% of the sampled palms (61/300) in the vicinity of 26/59 households. Nearly half of the infested palm trees had only one or two triatomines, and few palms presented more than 15 triatomines. The municipality of Buritis had the highest triatomine abundance and percentage of infested palms; however, the highest triatomine density per infested palm was observed in Alvorada D'Oeste, where a quarter of the palms were infested. Ants, arachnids, termites, reptiles, and rodents were frequently found in palm trees. Dogs were the predominant domestic animals in households, whereas hens and cattle were the main farming animals. Model estimates showed that the number of triatomines was affected by the presence of henhouses and varied strongly between localities. No relationships were detected between the average number of triatomines and palm fauna and/or palm height. Overall, approximately half of the triatomines were infected with T. cruzi (51.4%) and/or T. rangeli (47.2%), reinforcing the need for continuous entomological surveillance and implementation of community-based approaches because the Brazilian state of Rondônia borders areas experiencing reinfestation by domiciled species and potential colonization of animal shelters by triatomines.