A Prospective Single-Center Brazilian Study Investigating the Efficacy and Safety of Prophylactic Phenylephrine Infusion for the Management of Hypotension During Cesarean Section Under Spinal Anesthesia.

Background Maternal hypotension occurs in up to 80% of parturients during cesarean section (CS) under spinal anesthesia. Phenylephrine, a direct-acting α-1 agonist, has been widely recommended for the prevention of hypotension. We evaluated the efficacy and safety of phenylephrine infusion to prevent hypotension in obese and non-obese patients during cesarean section. Methods One hundred forty-one patients were included in this single-arm study. Patients received prophylactic phenylephrine infusion at a rate of 50 µg/min-1 immediately after spinal local anesthetic injection until delivery. Hypotension was defined as a systolic blood pressure <100 mmHg or <20% of baseline. The primary outcome was the incidence of hypotension. Results The incidence of hypotension was 17%. The median and interquartile range (IQR) of the number of hypotensive episodes was 0 (0-0). It was observed that 79.1% of the patients had hypotension in the first six minutes. Reactive hypertension and bradycardia occurred in 20.5 and 12.7% of the patients, respectively. In addition, there was a higher incidence of bradycardia in pregnant women with a body index mass of < 30 kg/m-2. Patients with baseline systolic blood pressure <120 mmHg had a threefold increased risk of hypotension. The incidence of nausea and vomiting was 13.4 and 2.8%, respectively. The incidence of an Apgar score <7 at the first minute was 2.8%, and no neonates presented an Apgar score <7 at the fifth minute. A pH of <7.2 occurred in 6.3% of the neonates. All neonates had no sequelae and were discharged together with their mothers. Conclusion The prophylactic infusion of phenylephrine 50 µg/min-1 is safe and demonstrates efficacy in reducing maternal hypotension providing adequate maternal hemodynamic stability during CS under spinal anesthesia.

The third vaccine dose significantly reduces susceptibility to the B.1.1.529 (Omicron) SARS-CoV-2 variant.

The main coronavirus disease 2019 (COVID-19) vaccine formulations used today are mainly based on the wild-type severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike glycoprotein as an antigen. However, new virus variants capable of escaping neutralization activity of serum antibodies elicited in vaccinated individuals have emerged. The Omicron (B.1.1.529) variant caused epidemics in regions of the world in which most of the population has been vaccinated. In this study, we aimed to understand what determines individual's susceptibility to Omicron in a scenario of extensive vaccination. For that purpose, we collected nasopharynx swab (n = 286) and blood samples (n = 239) from flu-like symptomatic patients, as well as their vaccination history against COVID-19. We computed the data regarding vaccine history, COVID-19 diagnosis, COVID-19 serology, and viral genome sequencing to evaluate their impact on the number of infections. As main results, we showed that vaccination in general did not reduce the number of individuals infected by Omicron, even with an increased immune response found among vaccinated, noninfected individuals. Nonetheless, we found that individuals who received the third vaccine dose showed significantly reduced susceptibility to Omicron infections. A relevant evidence that support this finding was the higher virus neutralization capacity of serum samples of most patients who received the third vaccine dose. In summary, this study shows that boosting immune responses after a third vaccine dose reduces susceptibility to COVID-19 caused by the Omicron variant. Results presented in this study are useful for future formulations of COVID-19 vaccination policies.

Impact of Early Pandemic SARS-CoV-2 Lineages Replacement with the Variant of Concern P.1 (Gamma) in Western Bahia, Brazil.

BACKGROUND: The correct understanding of the epidemiological dynamics of COVID-19, caused by the SARS-CoV-2, is essential for formulating public policies of disease containment. METHODS: In this study, we constructed a picture of the epidemiological dynamics of COVID-19 in a Brazilian population of almost 17000 patients in 15 months. We specifically studied the fluctuations of COVID-19 cases and deaths due to COVID-19 over time according to host gender, age, viral load, and genetic variants. RESULTS: As the main results, we observed that the numbers of COVID-19 cases and deaths due to COVID-19 fluctuated over time and that men were the most affected by deaths, as well as those of 60 or more years old. We also observed that individuals between 30- and 44-years old were the most affected by COVID-19 cases. In addition, the viral loads in the patients' nasopharynx were higher in the early symptomatic period. We found that early pandemic SARS-CoV-2 lineages were replaced by the variant of concern (VOC) P.1 (Gamma) in the second half of the study period, which led to a significant increase in the number of deaths. CONCLUSIONS: The results presented in this study are helpful for future formulations of efficient public policies of COVID-19 containment.

Relative Yield Loss From Stem Borers (Lepidoptera: Crambidae) and Rice Water Weevil (Coleoptera: Curculionidae) in Rice.

The rice water weevil, Lissorhoptrus oryzophilus Kuschel, is the most important economic pest of rice in the United States with the ability to substantially reduce rice yields. Stem borers, including the Mexican rice borer, Eoreuma loftini (Dyar), are emerging as more consistent pests in Louisiana and Texas, but the relationship between blanked panicles (whiteheads) caused by stem borer feeding and yield loss is not well understood. A series of field trials was conducted in Louisiana from 2019 to 2020 to determine the relative yield loss by manipulating infestations of both pests with selective insecticides. Results indicate losses from L. oryzophilus infestations are greater than those for E. loftini in early planted rice. In contrast, relative yield losses were approximately equal in later planted rice in 2019, in which E. loftini infestations were high. Additive impacts of the root-feeding L. oryzophilus and the stem-feeding E. loftini were not observed in our study. Linear regression revealed that each increase of one whitehead per square meter is associated with a 1.7% loss in yield. Results from ratoon rice suggest that protection from L. oryzophilus in the main crop also improves yield in the second crop. Collectively, results demonstrate the continued need for effective L. oryzophilus management programs to prevent economic losses. Conversely, findings suggest that benefits of E. loftini control may be minimal in many instances. Control of E. loftini is most likely to be economical under conditions where high populations are anticipated such as in late-planted fields or regions that previously had high infestations.

Oviposition Preference and Survival of the Mexican Rice Borer (Lepidoptera: Crambidae) in Bioenergy and Conventional Sugarcane and Sorghum.

Oviposition preference and host suitability of the Mexican rice borer, Eoreuma loftini (Dyar) (Lepidoptera: Crambidae), on bioenergy and conventional cultivars of sugarcane, Saccharum spp., and sorghum, Sorghum spp., were examined in a series of greenhouse experiments. Two energycane cultivars, two sugarcane cultivars, two high-biomass sorghum cultivars, and one sweet sorghum cultivar were assessed at two phenological stages (immature and mature). Mature plants possessed greater availability of dry leaf material compared with immature plants, and all E. loftini eggs were observed exclusively on dry leaves. Oviposition did not vary among host combinations (cultivar by phenological stage); however, eggs per plant and eggs per oviposition event were numerically greater on mature plants than immature plants. In a no-choice experiment, survival from egg to adult did not vary among host combinations, with <2.0% of E. loftini larvae surviving to adulthood. Failed establishment by neonates on plants was 13.4- to 53.9-fold greater than successful establishment across all host combinations. Results from this study suggest that plant physical characteristics continue to play an important role in host selection, but further evaluations will be needed to quantify other characteristics which influence host suitability.

Monitoring Mexican Rice Borer (Lepidoptera: Crambidae) Populations in Sugarcane and Rice With Conventional and Electronic Pheromone Traps.

The Mexican rice borer, Eoreuma loftini (Dyar), is a major pest of sugarcane, Saccharum spp., rice, Oryza sativa L., and other graminaceous crops in Texas and Louisiana. The ability of conventional and electronic pheromone traps to monitor E. loftini in sugarcane and rice habitats was evaluated in two separate 2-yr field studies. Bucket traps baited with a synthetic female sex pheromone monitored E. loftini populations in commercial sugarcane fields in Calcasieu and Jefferson Davis Parishes throughout the 2014 and 2015 growing seasons. The number of E. loftini captured differed among months, but not between years or parishes. The percentage of E. loftini-injured stalks was greater in 2015 than in 2014, peaking in September of both years. Daily trap capture was correlated with the percentage of injured stalks. Injury from E. loftini in Louisiana sugarcane remained relatively low (<3% bored internodes) in both 2014 and 2015. In a second experiment, electronic traps were compared with conventional pheromone traps for monitoring E. loftini populations in sugarcane and rice habitats in Texas in 2013 and 2015. Performance of earlier electronic trap prototypes in 2013 was inconsistent and less effective than conventional traps. Improved trap design in 2015 resulted in more than threefold greater moth capture in electronic traps than in conventional pheromone traps. Electronic traps demonstrated potential to improve monitoring strategies for this pest and should be evaluated for lepidopterous pests in a variety of cropping systems.

Flagellar Cap Protein FliD Mediates Adherence of Atypical Enteropathogenic Escherichia coli to Enterocyte Microvilli.

The expression of flagella correlates with different aspects of bacterial pathogenicity, ranging from adherence to host cells to activation of inflammatory responses by the innate immune system. In the present study, we investigated the role of flagella in the adherence of an atypical enteropathogenic Escherichia coli (aEPEC) strain (serotype O51:H40) to human enterocytes. Accordingly, isogenic mutants deficient in flagellin (FliC), the flagellar structural subunit; the flagellar cap protein (FliD); or the MotAB proteins, involved in the control of flagellar motion, were generated and tested for binding to differentiated Caco-2 cells. Binding of the aEPEC strain to enterocytes was significantly impaired in strains with the fliCa nd fliD genes deleted, both of which could not form flagella on the bacterial surface. A nonmotile but flagellated MotAB mutant also showed impaired adhesion to Caco-2 cells. In accordance with these observations, adhesion of a EPEC strain 1711-4 to Caco-2 cells was drastically reduced after the treatment of Caco-2 cells with purified FliD. In addition, incubation of a EPEC bacteria with specific anti-FliD serum impaired binding to Caco-2 cells. Finally, incubation of Caco-2 cells with purified FliD, followed by immunolabeling, showed that the protein was specifically bound to the microvillus tips of differentiated Caco-2 cells. The a EPEC FliD or anti-FliD serum also reduced the adherence of prototype typical enteropathogenic, enterohemorrhagic, and enterotoxigenic E. coli strains to Caco-2 cells. In conclusion, our findings further strengthened the role of flagella in the adherence of a EPEC to human enterocytes and disclosed the relevant structural and functional involvement of FliD in the adhesion process.

Gastrointestinal helminths of wild hogs and their potential livestock and public health significance in Jamaica.

An investigation into the potential for transmission of gastrointestinal helminths from wild hogs to livestock and humans was prompted by concerns of recreational wild-hog hunting in the Caribbean region and the recent practice, by livestock farmers in Jamaica, of co-rearing wild and domesticated swine. Thirty-one wild hogs from the Hellshire Hills, a dry limestone forest in southern Jamaica, were necropsied during the period June 2004 to August 2006. Thirteen of the captured animals were male and 18 female. Four species of adult helminths were recovered from the gastrointestinal tracts of the wild hogs: Hyostrongylus rubidus (77%), Globocephalus urosubulatus (48%), Oesophagostomum dentatum (42%) and Macroacanthorhynchus hirudinaceus (77%). Two (6.2%), ten (32.2%) and 18 (58.0%) hogs harboured one, two and three species of helminths, respectively. Mean infection intensities varied from 8.1 for M. hirudinaceus, to 115.5 for O. dentatum. There was no association between any of the recovered helminths and sex of the host; however, a multivariate analysis indicated a positive association between the prevalence of G. urosubulatus and host age (odds ratio (OR) = 6.517). Domesticated hogs co-reared with wild hogs are potentially at risk of infection with all four helminths, while wild-hog hunters and pig farmers may be exposed to M. hirudinaceus.

Biology and Management of the Mexican Rice Borer (Lepidoptera: Crambidae) in Rice in the United States.

The Mexican rice borer, Eoreuma loftini (Dyar), is an invasive pest of rice, Oryza sativa L., in the Gulf Coast region of the United States. This pest also damages sugarcane, Saccharum spp. hybrids; corn, Zea mays L.; and sorghum, Sorghum bicolor (L.) Moench, and feeds on weedy noncrop grasses. Multiple aspects of integrated pest management including use of pheromone traps, manipulation of planting dates, harvest cutting height, stubble management, noncrop host management, soil fertility management, host plant resistance, use of insecticides, and biological control have been studied for Mexican rice borer management. However, the current management strategy in rice primarily relies on the use of chlorantraniliprole insecticide seed treatments. This profile addresses Mexican rice borer biology and management in rice in the United States.

El barrenador mexicano del arroz [Eoreuma loftini (Dyar)] es una plaga invasora de arroz (Oryza sativa L.) en la región de la Costa del Golfo de Estados Unidos. Esta plaga también afecta híbridos de caña de azúcar (Saccharum spp.), maíz (Zea mays L.), sorgo [Sorghum bicolor (L.) Moench), y se alimenta de malezas gramíneas. Múltiples aspectos del manejo integrado de plagas incluyendo el uso de trampas con feromonas, la manipulación de las fechas de siembra, la altura del corte durante la cosecha, el manejo de rastrojos, el manejo de hospederos alternos, el manejo de la fertilidad del suelo, la resistencia de la plantas, el uso de insecticidas y el control biológico han sido estudiados para el manejo del barrenador mexicano del arroz. Sin embargo, la estrategia de actual de manejo en arroz se basa principalmente en el tratamiento químico de la semilla con el uso del insecticida clorantraniliprol. Esta revisión se enfoca en la biología y manejo del barrenador mexicano del arroz en arroz en los Estados Unidos.

Yield Response to Mexican Rice Borer (Lepidoptera: Crambidae) Injury in Bioenergy and Conventional Sugarcane and Sorghum.

The Mexican rice borer, Eoreuma loftini (Dyar) (Lepidoptera: Crambidae) is an invasive stem borer of sugarcane, Saccharum spp., and sorghum, Sorghum bicolor (L.), and poses a threat against the production of dedicated bioenergy feedstocks in the U.S. Gulf Coast region. A 2-yr field study was conducted in Jefferson County, TX, to evaluate yield losses associated with E. loftini feeding on bioenergy and conventional cultivars of sugarcane and sorghum under natural and artificially established E. loftini infestations. Bioenergy sugarcane (energycane) 'L 79-1002' and 'Ho 02-113' and sweet sorghum 'M81E' exhibited reduced E. loftini injury; however, these cultivars, along with high-biomass sorghum cultivar 'ES 5140', sustained greater losses in fresh stalk weight. Negative impacts to sucrose concentration from E. loftini injury were greatest in energycane, high-biomass sorghum, and sweet sorghum cultivars. Even under heavy E. loftini infestations, L 79-1002, Ho 02-113, and 'ES 5200' were estimated to produce more ethanol than all other cultivars under suppressed infestations. ES 5200, Ho 02-113, and L 79-1002 hold the greatest potential as dedicated bioenergy crops for production of ethanol in the Gulf Coast region; however, E. loftini management practices will need to be continued to mitigate yield losses.

Maternal vaccination with a fimbrial tip adhesin and passive protection of neonatal mice against lethal human enterotoxigenic Escherichia coli challenge.

Globally, enterotoxigenic Escherichia coli (ETEC) is a leading cause of childhood and travelers' diarrhea, for which an effective vaccine is needed. Prevalent intestinal colonization factors (CFs) such as CFA/I fimbriae and heat-labile enterotoxin (LT) are important virulence factors and protective antigens. We tested the hypothesis that donor strand-complemented CfaE (dscCfaE), a stabilized form of the CFA/I fimbrial tip adhesin, is a protective antigen, using a lethal neonatal mouse ETEC challenge model and passive dam vaccination. For CFA/I-ETEC strain H10407, which has been extensively studied in volunteers, an inoculum of 2 × 10(7) bacteria resulted in 50% lethal doses (LD50) in neonatal DBA/2 mice. Vaccination of female DBA/2 mice with CFA/I fimbriae or dscCfaE, each given with a genetically attenuated LT adjuvant (LTK63) by intranasal or orogastric delivery, induced high antigen-specific serum IgG and fecal IgA titers and detectable milk IgA responses. Neonates born to and suckled by dams antenatally vaccinated with each of these four regimens showed 78 to 93% survival after a 20× LD50 challenge with H10407, compared to 100% mortality in pups from dams vaccinated with sham vaccine or LTK63 only. Crossover experiments showed that high pup survival rates after ETEC challenge were associated with suckling but not birthing from vaccinated dams, suggesting that vaccine-specific milk antibodies are protective. In corroboration, preincubation of the ETEC inoculum with antiadhesin and antifimbrial bovine colostral antibodies conferred a dose-dependent increase in pup survival after challenge. These findings indicate that the dscCfaE fimbrial tip adhesin serves as a protective passive vaccine antigen in this small animal model and merits further evaluation.

Expansion of the Mexican Rice Borer (Lepidoptera: Crambidae) into Rice and Sugarcane in Louisiana.

The Mexican rice borer, Eoreuma loftini (Dyar) (Lepidoptera: Crambidae), is an invasive pest of sugarcane, Saccharum spp., rice, Oryza sativa L., and other graminaceous crops in the Gulf Coast region of the United States. Traps baited with E. loftini female sex pheromones were used to document establishment and distribution of E. loftini near sugarcane, rice, and noncrop hosts in seven southwest Louisiana parishes from 2009 to 2013. Additional field surveys documented larval infestations in commercial sugarcane and rice. After its initial detection in 2008, no E. loftini were detected in Louisiana in 2009 and only two adults were captured in 2010. Trapping documented range expansion into Cameron, Beauregard, and Jefferson Davis parishes in 2011 and Allen, Acadia, and Vermilion parishes in 2013. During the course of this study, E. loftini expanded its range eastward into Louisiana 120 km from the Texas border (≈22 km/yr). Surveys of larval infestations provided the first record of E. loftini attacking rice and sugarcane in Louisiana. Infestations of E. loftini in rice planted without insecticidal seed treatments in Calcasieu Parish reached damaging levels.

Gut adhesive Bacillus subtilis spores as a platform for mucosal delivery of antigens.

Bacillus subtilis spores have been used as safe and heat-resistant antigen delivery vectors. Nonetheless, the oral administration of spores typically induces weak immune responses to the passenger antigens, which may be attributed to the fast transit through the gastrointestinal tract. To overcome this limitation, we have developed B. subtilis spores capable of binding to the gut epithelium by means of expressing bacterial adhesins on the spore surface. The resulting spores bound to in vitro intestinal cells, showed a longer transit through the mouse intestinal tract, and interacted with Peyer's patch cells. The adhesive spores increased the systemic and secreted antibody responses to the Streptococcus mutans P1 protein, used as a model antigen, following oral, intranasal, and sublingual administration. Additionally, P1-specific antibodies efficiently inhibited the adhesion of the oral pathogen Streptococcus mutans to abiotic surfaces. These results support the use of gut-colonizing B. subtilis spores as a new platform for the mucosal delivery of vaccine antigens.

Role of bacteriophages in STEC infections: new implications for the design of prophylactic and treatment approaches.

Shiga toxin (Stx) is considered the main virulence factor in Shiga toxin-producing Escherichia coli (STEC) infections. Previously we reported the expression of biologically active Stx by eukaryotic cells in vitro and in vivo following transfection with plasmids encoding Stx under control of the native bacterial promoter (1,2). Since stx genes are present in the genome of lysogenic bacteriophages, here we evaluated the relevance of bacteriophages during STEC infection. We used the non-pathogenic E. coli C600 strain carrying a lysogenic 933W mutant bacteriophage in which the stx operon was replaced by a gene encoding the green fluorescent protein (GFP). Tracking GFP expression using an In Vivo Imaging System (IVIS), we detected fluorescence in liver, kidney, and intestine of mice infected with the recombinant E. coli strain after treatment with ciprofloxacin, which induces the lytic replication and release of bacteriophages. In addition, we showed that chitosan, a linear polysaccharide composed of d-glucosamine residues and with a number of commercial and biomedical uses, had strong anti-bacteriophage effects, as demonstrated at in vitro and in vivo conditions. These findings bring promising perspectives for the prevention and treatment of haemolytic uremic syndrome (HUS) cases.

Bacillus subtilis endospores at high purity and recovery yields: optimization of growth conditions and purification method.

Bacillus subtilis endospores have applications in different fields including their use as probiotics and antigen delivery vectors. Such specialized applications frequently require highly purified spore preparations. Nonetheless, quantitative data regarding both yields and purity of B. subtilis endospores after application of different growth conditions and purification methods are scarce or poorly reported. In the present study, we conducted several quantitative and qualitative analyses of growth conditions and purification procedures aiming generation of purified B. subtilis spores. Based on two growth media and different incubations conditions, sporulation frequencies up to 74.2 % and spore concentrations up to 7 × 10(9) spores/ml were achieved. Application of a simplified spore isolation method, in which samples were incubated with lysozyme and a detergent, resulted in preparations with highly purified spores at the highest yields. The present study represents, therefore, an important contribution for those working with B. subtilis endospores for different biotechnological purposes.

Improved chemical control for the Mexican rice borer (Lepidoptera Crambidae) in sugarcane: larval exposure, a novel scouting method, and efficacy of a single aerial insecticide application.

A three-treatment aerial application insecticide experiment was conducted in five commercial sugarcane, Saccharum spp., fields in south Texas to evaluate the use of pheromone traps for improving chemical control of the Mexican rice borer, Eoreuma loftini (Dyar), in 2009 and 2010. A threshold of 20 moths/trap/wk was used to initiate monitoring for larval infestations. The percentage of stalks with larvae on plant surfaces was directly related to the number of moths trapped. Reductions in borer injury and adult emergence were detected when a threshold of >5% of stalks with larvae present on plant surfaces was used to trigger insecticide applications. Novaluron provided superior control compared with beta-cyfluthrin; novaluron treated plots were associated with a 14% increase in sugar production. A greenhouse experiment investigating establishment and behavior of E. loftini larvae on two phenological stages of stalkborer resistant, HoCP 85-845, and susceptible, HoCP 00-950, sugarcane cultivars determined that more than half of larvae on HoCP 00-950 and > 25% on HoCP 85-845 tunneled inside leaf mid-ribs within 1 d of eclosion, protected therein from biological and chemical control tactics. Exposure time of larvae averaged < 1 wk for all treatments and was shortest on immature HoCP 00-950 and longest on mature HoCP 85-845. This study shows a short window of vulnerability of E. loftini larvae to insecticide applications, and demonstrates the potential utility of pheromone traps for improving insecticide intervention timing such that a single properly timed application may be all that is required.

Effect of repeated microwave disinfections on bonding of different commercial teeth to resin denture base.

OBJECTIVE: To verify the influence of repeated microwave disinfections on the shear bond strength of two commercial types of teeth to acrylic resin, when the ridge lap surfaces were unmodified, bur abraded, bur grooved or etched by monomer. MATERIAL AND METHODS: Eighty specimens (n = 10) were adhered to the tooth ridge lap surface, polymerised in a water bath at 74°C for 9 h. Microwaved specimens were individually immersed in 150 ml of water and submitted to five simulated disinfections in a microwave oven calibrated at 650 W for 3 min. Control specimens were not microwave treated. Shear bond strength tests were performed in an Instron machine with a cross-speed of 1 mm/min. The fracture load values were transformed into shear bond strength as a function of the bonding area (0.28 cm(2)). Data were submitted to ANOVA and Tukey's test (α = 0.05). Fractured areas were classified as adhesive, cohesive (resin or tooth) or mixed failures. RESULTS: Repeated microwave disinfections increased the shear strength of the tooth/resin bond. Mechanical retention in microwaved and non-microwaved procedures improved the shear bond strength. CONCLUSIONS: The different commercial types of teeth influenced shear bond strength values, with Biotone teeth showing the lower values.

Effect of ridge-lap surface treatments on the bond of resin teeth to denture base.

PURPOSE: To test in vitro the shear bond strength of resin teeth to an acrylic resin denture base given different ridgelap surface treatments. MATERIALS AND METHODS: Ninety rectangular dies were made with wax and traditionally invested in metallic or plastic flasks. The stone molds were covered with silicone, in which were included an acrylic molar with a wax stick fixed on the ridge lap surface. After deflasking, the wax sticks were removed, the teeth were cleaned with detergent, the ridge lap surface was submitted to different treatments (unmodified, bur-cut grooves, aluminum oxide particle sandblasting, monomer swelling, and primer swelling), and the teeth were replaced in the silicone molds. Metallic flasks were placed in a thermopolymerizing unit to polymerize heat-curing denture-base polymer, and plastic flasks were placed in a domestic microwave oven at 900 W to polymerize microwaveable denture base polymer. After deflasking, the specimens were submitted to the shear bond test in an Instron machine at a cross-speed of 1 mm/min. Results were submitted to ANOVA and Tukey's test (5%). RESULTS: Shear bond strength values were influenced by the ridge-lap surface treatments only in the microwaved polymer. Sandblasting + monomer swelling and sandblasting + primer swelling interactions yielded lower strengths for microwaved polymer. Only the unmodified surfaces presented a significant difference when the resins were compared, where the microwaved polymer showed a higher value. CONCLUSION: Different tooth ridge-lap surface treatments promoted different strengths of the tooth/resin bond.

Resultados del tratamiento quirúrgico de los tumores del estroma gastrointestinal (GIST) en la IV Región de Chile / Surgical outcomes of gastrointestinal stromal tumors (GIST)

Background: Despite that current knowledge regarding the pathology and treatment of Gastrointestinal Stromal Tumors (GIST) is widely available; most patients in the developing world and mainly in rural areas of developing countries have limited access to diagnostic technology and modern specific therapy such as imatinib. Objective: To review the management and outcomes of GISTs treated at the hospitals of the IV Region of Chile. Patients and Methods: This retrospective, observational and descriptive study was performed with data obtained from the medical records of 3 community hospitals were all surgical practice of the IV Region is performed. During the study period, 24 consecutive patients with GISTs at different localizations of the gastrointestinal tract were treated. Results: Five patients were operated on with the preoperative diagnostic of GIST, in 19 patients the diagnostic of GIST was suspected during the operation and confirmed by histology and immunohistochemistry. Most patients were operated on emergency grounds. Of 10 patients requiring imatinib therapy, only 2 are currently receiving the medication sponsored by an international foundation. Conclusions: There were no disparities in the standard surgical care of our patients. The main differences with published series from Chile and developed countries are the available technology to perform a preoperative diagnosis and the availability of imatinib for the treatment of metastatic and recurrent disease.

Introducción: A pesar de que el conocimiento actual sobre la patología y tratamiento de los tumores del estroma gastrointestinal (GIST) se encuentra ampliamente disponible, la mayoría de los pacientes en los países en desarrollo, principalmente en las áreas rurales, tienen un limitado acceso a la tecnología diagnóstica moderna y a tratamientos específicos como el imatinib. Objetivo: Revisión del manejo y resultados de los GIST tratados en los hospitales de la IV Región de Chile. Pacientes y Métodos: Estudio retrospectivo, observacional y descriptivo de la información obtenida de las fichas clínicas de 3 hospitales tipo 2 en los cuales se realiza toda la práctica quirúrgica de la IV Región. Durante el período estudiado, 24 pacientes consecutivos con GISTs en diferentes localizaciones fueron tratados quirúrgicamente. Resultados: Cinco pacientes fueron operados con el diagnóstico preoperatorio de GIST, en los otros 19 pacientes el diagnóstico se sospechó durante la cirugía y fue confirmado por histología e inmunohistoquímica. La mayoría de los pacientes fueron operados de urgencia. Diez pacientes fueron candidatos a tratamiento con imatinib, sólo 2 pacientes se encuentran actualmente en tratamiento gracias a una fundación internacional. Conclusiones: El tratamiento quirúrgico de nuestros pacientes es similar a las publicaciones nacionales e internacionales. Las diferencias se presentan en la disponibilidad de estudios de imagen para el diagnóstico preoperatorio y en la disponibilidad de imatinib para el tratamiento de las recurrencias y metástasis.

Reflujo pancreáticobiliar en pacientes con colelitiasis y sin colelitiasis: estudio comparativo / Pancreaticobiliary reflux in patients with cholelithiasis and without cholelithiasis: a comparative study

Background. Pancreaticobiliary reflux is a pathologic phenomenon occurring in patients with gallstones. However, the occurrence of pancreaticobiliary reflux has not been studied in patients without gallstones. The objective of this study was to measure the bile levels of amylase and lipase in patients without gallstones submitted to cholecystectomy as part of another surgical procedure, and to compare these values with patients submitted to cholecystectomy for gallstone disease. Patients and Methods. A prospective observational comparative study was designed. A sample of 136 consecutive patients was included. Amylase and lipase levels were measured in bile. Normal serum amylase levels at our institution are 28-100 U/L and for lipase are 13-60 U/L. There are no established normal levels for pancreatic enzymes in bile. However, we considered elevated the bile amylase and lipase levels whenever they were higher than normal plasma levels. Results. One-hundred three patients (76 percent) had gallstones and 33 (24 percent) liad healthy gallbladders without gallstones. According to normal plasma levels for amylase and lipase, these enzymes in bile were elevated in 83.5 percent patients with gallstones, compared to elevated levels of amylase in 6 percent patients and lipase in 3 percent patients without gallstones. Conclusions. Pancreaticobiliary reflux is a common phenomenon in patients with gallstones and occurs sporadically in patients without gallstones.

Introducción. El reflujo pancreáticobiliar es un fenómeno patológico que ocurre en pacientes con colelitiasis. La ocurrencia de este fenómeno no ha sido estudiada en pacientes sin colelitiasis. El presente estudio tiene por objetivo medir los niveles de amilasa y lipasa en la bilis de pacientes sin colelitiasis, colecistectomizados como parte de otro procedimiento quirúrgico y comparar estos valores con pacientes colecistectomizados por colelitiasis. Pacientes y Métodos. Se diseñó un estudio observacional y comparativo. Una muestra de 136 pacientes consecutivos fue incluida. Se midieron los niveles de amilasa y lipasa en la bilis. En nuestra institución los valores normales para amilasa son 28-100 U/L y para lipasa 13-60 U/L. No se han establecido valores normales de enzimas pancreáticas en la bilis. Para efectos del presente estudio, se consideró como elevados los niveles biliares de amilasa y lipasa cuando fueron mayores a los valores plasmáticos normales. Resultados. 103 pacientes (76 por ciento) tenían colelitiasis y 33 (24 por ciento) tenían vesículas normales sin cálculos. De acuerdo a los valores plasmáticos normales de amilasa y lipasa, estas enzimas se encontraron elevadas en 83,5 por ciento de los pacientes con colelitiasis comparados con valores elevados de amilasa en 6 por ciento en pacientes sin colelitiasis y de lipasa en 3 por ciento de estos pacientes. Conclusiones. El reflujo pancreaticobiliar es un fenómeno común en pacientes con colelitiasis y ocurre esporádicamente en pacientes sin colelitiasis.