The Midfoot Joint Complex (Foot Arch) Contributes to the Upper Body Position in Bipedal Walking and Coordinates With the Lower Limb Joints.

This study estimated the contribution of the midfoot joint complex (MJC) kinematics to the pelvis anterior-posterior positions during the stance phase of walking and investigated whether the MJC is functionally coordinated with the lower limb joints to maintain similar pelvic positions across steps. Hip, knee, ankle, and MJC sagittal angles were measured in 11 nondisabled participants during walking. The joints' contributions to pelvic positions were computed through equations derived from a link-segment model. Functional coordination across steps was identified when the MJC contribution to pelvic position varied and the summed contributions of other joints varied in the opposite direction (strong negative covariations [r ≤ -.7] in stance phase instants). We observed that the MJC plantarflexion (arch raising) during the midstance and late stance leads the pelvis backward, avoiding excessive forward displacement. The MJC was the second joint that contributed most to the pelvis positions (around 18% of all joints' contributions), after the ankle joint. The MJC and ankle were the joints that were most frequently coordinated with the other joints (≅70% of the stance phase duration). The findings suggest that the MJC is part of the kinematic chain that determines pelvis positions during walking and is functionally coordinated with the lower limb joints.

Neuroradiological features of patients with bilateral macronodular adrenocortical disease and meningiomas associated or not with genetic variants of ARMC5- a case series.

INTRODUCTION: Meningiomas are the most common primary brain and central nervous system tumors, accounting for approximately 40% of these tumors. The most important exams for the radiological study of meningiomas are computed tomography (CT) and magnetic resonance imaging (MRI). We aimed to analyze the radiological features of patients with meningioma related to the simultaneous presence of bilateral macronodular adrenocortical disease (BMAD), with or without pathogenic variants of ARMC5. METHODS: This study included 10 patients who were diagnosed with BMAD. All of them had a radiological diagnosis of expansive brain lesions suggestive of meningioma. All patients underwent brain MRI and a neuroradiolgist analyzed the following parameters: number, site and size of lesions; presence of calcification, edema and bone involvement. RESULTS AND DISCUSSION: Eight patients presented with germline variants of ARMC5; the other 2, did not. The most significant result was the incidence of multiple meningiomas, which was 50% in BMAD patients, whereas the average incidence described thus far is lower than 10%. Considering location, the 22 tumors in the BMAD patients were 5 convexity tumors (22.7%), and 17 skull base tumors (77.2%), the opposite proportion of patients without BMAD. A total of 40.9% of the tumors had calcification, 9% had cerebral edema and 40.9% had bone invasion due to hyperostosis. The literature describes meningioma calcification in 25% of patients, bone invasion by tumor hyperostosis in 20%, and cerebral edema in approximately 60%. CONCLUSION: Relevant results were found considering the rate of multiple meningiomas and tumor location. This finding reinforces the need for further research into the neurological effects caused by genetic variants of ARMC5 in patients with BMAD.

Left-sided epileptiform activity influences language lateralization in right mesial temporal sclerosis.

OBJECTIVE: To investigate the association between left epileptiform activity and language laterality indices (LI) in patients with right mesial temporal sclerosis (MTS). METHODS: Twenty-two patients with right MTS and 22 healthy subjects underwent fMRI scanning while performing a language task. LI was calculated in multiple regions of interest (ROI). Data on the presence of left epileptiform abnormalities were obtained during prolonged video-EEG monitoring. RESULTS: After correction for multiple comparisons, LI was reduced in the middle temporal gyrus in the left interictal epileptiform discharges (IED+) group, compared with the left IED- group (p < 0.05). SIGNIFICANCE: Using a responsive reading naming fMRI paradigm, right MTS patients who presented left temporal interictal epileptiform abnormalities on video-EEG showed decreased LI in the middle temporal gyrus, indicating decreased left middle temporal gyrus activation, increased right middle temporal gyrus activation or a combination of both, demonstrative of language network reorganization, specially in the MTG, in this patient population. PLAIN LANGUAGE SUMMARY: This research studied 22 patients with right mesial temporal sclerosis (a specific type of epilepsy) comparing them to 22 healthy individuals. Participants were asked to perform a language task while undergoing a special brain imaging technique (fMRI). The findings showed that patients with epilepsy displayed a change in the area of the brain typically responsible for language processing. This suggests that their brains may have adapted due to their condition, altering the way language is processed.

Como direcionar a formação do fisioterapeuta em Gerontologia no Brasil diante do envelhecimento populacional? / How to direct the training of physiotherapists in Gerontology in Brazil in the face of population aging?

O rápido envelhecimento populacional brasileiro mudou nosso cenário de saúde, o que exige que o profissional fisioterapeuta esteja preparado para lidar com as especificidades desta população. A Associação Brasileira de Fisioterapia em Gerontologia (ABRAFIGE), que tem a missão de fortalecer a especialidade e promover assistência qualificada em Fisioterapia em Gerontologia, propõe uma relação das competências fundamentais para formação no ensino nos cursos de graduação em Fisioterapia e de pósgraduação lato sensu em Fisioterapia em Gerontologia. Essa iniciativa visa auxiliar os gestores das Instituições de Ensino Superior das diversas regiões brasileiras no planejamento de tais cursos de forma a melhorar a qualidade da formação dos fisioterapeutas nessa área.

The rapid aging of the Brazilian population has changed the health scenario. Such a change requires physiotherapists to be prepared to deal with the specificities of this population. The Associação Brasileira de Fisioterapia em Gerontologia - ABRAFIGE (Brazilian Association of Physical Therapy in Gerontology), which has the mission of strengthening the specialty and the purpose of promoting qualified assistance in physical therapy in gerontology, proposes fundamental skills for training in teaching in undergraduate and graduate courses in physical therapy in gerontology. This initiative aims to assist administrators at higher education institutions in different regions of Brazil in the planning of such courses to improve the quality of the education of physiotherapists in this field.

Neurocircuitry of Deep Brain Stimulation for Obsessive-Compulsive Disorder as Revealed by Tractography: A Systematic Review.

Objective: Deep brain stimulation (DBS) was proposed in 1999 to treat refractory obsessive-compulsive disorder (OCD). Despite the accumulated experience over more than two decades, 30-40% of patients fail to respond to this procedure. One potential reason to explain why some patients do not improve in the postoperative period is that DBS might not have engaged structural therapeutic networks that are crucial to a favorable outcome in non-responders. This article reviews magnetic resonance imaging diffusion studies (DTI-MRI), analyzing neural networks likely modulated by DBS in OCD patients and their corresponding clinical outcome. Methods: We used a systematic review process to search for studies published from 2005 to 2020 in six electronic databases. Search terms included obsessive-compulsive disorder, deep brain stimulation, diffusion-weighted imaging, diffusion tensor imaging, diffusion tractography, tractography, connectome, diffusion analyses, and white matter. No restriction was made concerning the surgical target, DTI-MRI technique and the method of data processing. Results: Eight studies published in the last 15 years were fully assessed. Most of them used 3 Tesla DTI-MRI, and different methods of data acquisition and processing. There was no consensus on potential structures and networks underlying DBS effects. Most studies stimulated the ventral anterior limb of the internal capsule (ALIC)/nucleus accumbens. However, the contribution of different white matter pathways that run through the ALIC for the effects of DBS remains elusive. Moreover, the improvement of cognitive and affective symptoms in OCD patients probably relies on electric modulation of distinct networks. Conclusion: Though, tractography is a valuable tool to understand neural circuits, the effects of modulating different fiber tracts in OCD are still unclear. Future advances on image acquisition and data processing and a larger number of studies are still required for the understanding of the role of tractography-based targeting and to clarify the importance of different tracts for the mechanisms of DBS.

Foot pronation affects pelvic motion during the loading response phase of gait.

BACKGROUND: Increased foot pronation during walking has been associated with low back pain. This association may be due to the impact of increased pronation on pelvic motion. OBJECTIVE: To investigate the effects of increased bilateral foot pronation on pelvic kinematic in frontal and transverse planes during the loading response phase of gait. METHODS: Pelvic, hip, and foot angular positions of 20 participants were collected while they walked at fast speed wearing flat and medially inclined insoles inserted in the shoes. Pelvic motion in frontal and transverse planes was analyzed during the loading response phase. Foot eversion-inversion was analyzed during the complete stance phase to verify the insoles effectiveness in inducing increased pronation and to exclude excessive pronators. RESULTS: Inclined insoles were effective in inducing increased foot pronation. Pelvic and hip motion were altered in the increased pronation condition compared to the control condition. In the frontal plane, mean pelvic position was more inclined to the contralateral side (mean difference [MD]: 0.54°; 95%CI: 0.23, 0.86) and its range of motion (ROM) was reduced (MD: 0.50°; 95%CI: 0.20, 0.79). In the transverse plane, mean pelvic position was less rotated toward the contralateral leg (MD: 1.03°; 95%CI: 0.65, 1.60) without changes in ROM (MD: 0.04°; 95%CI: -0.17, 0.25). The hip was more internally rotated (MD: 1.37°; 95%CI: 0.76, 1.98) without changes in ROM (MD: 0.10°; 95%CI: -1.02, 1.23). CONCLUSION: Increased bilateral foot pronation changes pelvic motion during walking and should be assessed, as a contributing factor to possible pelvic and lower back disorders.

Stress, anxiety, self-efficacy, and the meanings that physical therapy students attribute to their experience with an objective structured clinical examination.

BACKGROUND: Excessive stress and anxiety can impair learning. The objective structured clinical examination (OSCE) is a valuable tool to assess and promote the acquisition of clinical skills. However, significant OSCE-related stress and anxiety are frequently reported. The aim of this study was to investigate the relationships between physiological stress, self-reported levels of anxiety due to an OSCE, self-efficacy, and the meanings that physical therapy students attribute to their experience with the exam. DESIGN: Concurrent mixed methods study. METHODS: A total of 32 students took part in this study. All were enrolled in the third semester of a 10-semester Physical Therapy Bachelor Program. Salivary cortisol levels, self-reported anxiety (State-Trait Anxiety Inventory, STAI) were measured before the OSCE. Exam scores and self-efficacy ratings were also recorded. Correlations between variables were tested with the Pearson correlation, with ɑ at 0.05. Semi-structured interviews were used to explore the personal perspectives of students. Thematic analysis was used to investigate emergent themes. RESULTS: Trait anxiety scores were significantly higher than normative values (p < 0.001). A high proportion of students showed high (STAI> 49) state anxiety (37.5%) and trait anxiety (65.6%). Salivary cortisol was not associated anxiety (p > 0.05). Neither stress nor anxiety correlated with OSCE scores. A moderate and significant direct correlation was found for self-efficacy scores and OSCE scores (r = 0.475, p = 0.007). Students reported that confidence had a calming effect and led to better self-perceived performance. They also reported that the OSCE can provide meaningful learning experiences despite being stressful. CONCLUSIONS: A high proportion of our students reported a stable/lingering negative affect. However, neither stress nor anxiety related to OSCE scores. Students' confidence in their capabilities was correlated with their performance. Their subjective reports suggest that self-confidence may have protected them from the negative effects of stress and anxiety on academic performance.

Avaliação in vitro da influência de cimentos endodônticos na resistência de união sobre estrutura dentinária da câmara pulpar de dentes restaurados imediatamente e mediatamente após obturação / In vitro evaluation of the influence of endodontic cements on bond strength on the dentin structure of the pulp chamber of teeth restored immediately and immediately after filling

Este estudo teve por finalidade avaliar a influência dos cimentos endodônticos com um protocolo de irrigação na resistência de união sobre a estrutura dentinária das paredes da câmara pulpar de dentes bovinos restaurados imediatamente e após 7 dias do tratamento endodôntico. Foram avaliados os cimentos endodônticos: Cimento à base de resina epoxy (AH Plus ­ Dentsply, DeTrey, Konstanz- Alemanha) e Cimento de óxido de zinco e eugenol (Endofill ­ Dentsply Ind.com. LTDA ­ Brasil). Para a realização das restaurações foi utilizado o sistema adesivo Single Bond 2® (3M/ESPE) e a resina composta Z 350TM (3M/ESPE). 60 faces vestibulares da câmara pulpar de dentes bovinos foram distribuídos aleatoriamente em 4 grupos experimentais (G1-AHPlus Imediato; G2-AHPlus Mediato; G3-OZE Imediato; G4-OZE Mediato) e 2 controles (G5- NaOCl + EDTA Imediato e G6-NaOCl + EDTA Mediato). O protocolo de irrigação endodôntica deu-se através da imersão dos espécimes em solução de hipoclorito de sódio a 2.5% por 30 minutos e em EDTA 17% por 3 minutos. Os cimentos testados estiveram em contato com a parede dentinária pelo tempo de presa inicial, seguido de limpeza com algodão embebido em álcool 70% por 1 minuto. Os grupos experimentais de restauração mediata foram mantidos em estufa a 37ºC por 7 dias. Após o corte e a obtenção dos palitos de +/-1,0 mm² foi aplicado o teste de microtração na Máquina de Ensaios Universal e, em seguida, observados em microscópio óptico para classificação da fratura. Os valores da resistência de união foram submetidos ao teste não-paramétrico Wilcoxon-Mann-Whitney comparando dois a dois grupos a um nível de significância de 5%. Os resultados mostraram que o grupo G5 obteve menor valor de resistência de união, com diferença estatisticamente significativa (p<0,05) para os demais. O padrão de fratura mais observado nos grupos foi a coesiva em camada híbrida. Conclui-se que a associação NaOCl + EDTA diminui a resistência de união nas restaurações imediatas e que os cimentos endodônticos não alteraram a resistência de união nos períodos testados (AU).

This study aimed to evaluate the influence of endodontic sealer with an irrigation protocol on the bond strength on the dentinal structure of the pulp chamber walls of bovine teeth restored immediately and after 7 days of endodontic treatment. Endodontic sealer were evaluated: epoxy resin-based sealer (AH Plus - Dentsply, DeTrey, Konstanz- Germany) and zinc oxide and eugenol sealer (Endofill - Dentsply Ind.com. LTDA - Brazil). To perform the restorations, the Single Bond 2® adhesive system (3M / ESPE) and the composite resin Z 350TM (3M / ESPE) were used. 60 vestibular faces of the pulp chamber of bovine teeth were randomly assigned to 4 experimental groups (G1-AHPlus Immediate; G2-AHPlus Mediato; G3-OZE Immediate; G4-OZE Mediato) and 2 controls (G5- NaOCl + EDTA Immediate and G6- NaOCl + EDTA Mediato). The endodontic irrigation protocol was carried out by immersing the specimens in 2.5% sodium hypochlorite solution for 30 minutes and in 17% EDTA for 3 minutes. The tested sealers were in contact with the dentin wall for the initial setting time, followed by cleaning with cotton soaked in 70% alcohol for 1 minute. The experimental groups of mediated restoration were kept in an oven at 37ºC for 7 days. After cutting and obtaining the +/- 1.0 mm² toothpicks, the microtensile test was applied to the Universal Testing Machine and then observed under an optical microscope to classify the fracture. The bond strength values were subjected to the non-parametric Wilcoxon-Mann-Whitney test comparing two to two groups at a significance level of 5%. The results showed that the G5 group had a lower bond strength value, with a statistically significant difference (p <0.05) for the others. The most observed fracture pattern in the groups was cohesive in a hybrid layer. It is concluded that the association NaOCl + EDTA decreases the bond strength in immediate restorations and that endodontic sealer did not change the bond strength in the tested periods (AU).

Promotion of cutaneous penetration of nifedipine for nanoemulsion

ABSTRACT This article reports the development and characterization of a nanoemulsion (NE) able to improve the cutaneous penetration of nifedipine. NE with nifedipine was development and characterized, presenting droplet size of 20 nm with low polydispersity index (IP<0.1), spherical shape without aggregation, pH compatible with typical skin levels and stability evaluated by seven months. In the permeation studies, a classical formulation based in an oil/water cream containing nifedipine was used for comparison with NE. Nanoemulsion promoted and improved the retention of nifedipine in the epidermis and dermis in relation to classical formulation. This promoting effect is related to the nanometric size of the droplets of the NE (20 nm), which give him a large superficial area, favoring the contact of the nanocarrier with the skin surface. The NE was efficient in promoting accumulation of nifedipine in the dermis, which is the site of vasodilation action. NE was not irritating according to the primary dermal irritation tests. NE is a promising release system to promote cutaneous penetration of nifedipine and can be used in the future in clinical trials to promote healing of lesions caused by peripheral vascular diseases.

The Effect of Walking Speed on Foot Kinematics is Modified When Increased Pronation is Induced.

BACKGROUND: The relation between walking speed and foot kinematics during gait is not well established, and neither is it clear whether this relation is modified in the presence of factors expected to increase pronation (eg, abnormal foot alignment). Understanding how foot kinematics is affected by walking speed under varying conditions could contribute to our understanding of stresses to the musculoskeletal system during walking. We evaluated the effect of walking speed on foot kinematics in the frontal plane during gait and determined whether this effect is modified by using medially inclined insoles that force the foot into increased pronation. METHODS: Twenty-six healthy young adults were assessed while walking on a treadmill wearing flat insoles and wearing medially inclined insoles. Foot kinematics in the frontal plane was measured with a three-dimensional motion analysis system. Data were analyzed during the stance phase of gait. RESULTS: There was no main effect of speed on average calcaneal position. However, there was a significant insole type × walking speed interaction effect. In the flat insole condition, increased walking speed was associated with a less inverted average calcaneal position (or greater magnitudes of eversion), whereas in the inclined insole condition, higher speeds were associated with a less everted average calcaneal position (or increased magnitudes of inversion). CONCLUSIONS: The magnitude of foot eversion increases at faster gait speeds under typical conditions. In the presence of factors that induce excessive pronation, however, this effect is reversed. Results suggest that individuals use greater active control of foot motion at faster speeds in the presence of excessive pronation to improve push-off efficiency. Potential clinical consequences of this functional strategy are discussed.

Reliability of the agar based method to assess the production of degradative enzymes in clinical isolates of Candida albicans.

The aim of this study was to establish a reproducible protocol using the methodology of hyaline zones around the colonies on specific agar plates for phospholipase and proteinase production. This was an in vitro double-blind experiment, in which the dependent variables were the enzymatic activity measurements (Pz) for the production of phospholipase (Pz-ph) and the production of secreted aspartyl proteinases (Pz-sap). Three independent variables give rise to different measurement protocols. All measurements were carried out at two different moments by four examiners (E1, E2, E3, and E4). The minimum sample size was 30 Candida albicans clinical isolates. Specific agar plates for phospholipase and SAPs production were prepared according the literature. The intra-and inter-examiner reproducibility for each protocol was estimated using the Intraclass Correlation Coefficient (ICC) and its confidence interval (95% CI). Based on the results obtained for both phospholipase and SAPs, there appears to be no consensus on the protocol chosen for each particular examiner. Measuring the colonies in triplicate may be the main factor associated with the increase in measurement accuracy and should therefore take precedence over measuring only one colony. When only one examiner is responsible for taking measurements, a standard protocol should be put in place and the statistical calibration of this researcher should be done prior to data collection. However, if two or more researchers are involved in the assessment of agar plates, our results suggest that the protocols using software to undertake plate reading is preferred.

Remote spinal cord injury in mucopolysaccharidosis type IVA after cervical decompression.

Morquio A syndrome (Online Mendelian Inheritance in Man #253000) is a lysosomal storage disease caused by deficiency of N-acetylgalactosamine-6-sulfatase encoded by the GALNS gene. Key clinical features are skeletal dysplasia and short stature.

Mucopolysaccharidosis type IVA: evidence of primary and secondary central nervous system involvement.

Mucopolysaccharidosis type IVA is a rare lysosomal storage disease caused by a deficiency of N-acetylgalactosamine 6-sulfatase. Studies usually focus on skeletal abnormalities and their consequences. This study explores the neurological manifestations in a cohort of mucopolysaccharidosis type IVA patients, with a detailed focus on brain and spinal magnetic resonance imaging (MRI) findings. We performed a cross-sectional study involving nine patients with a biochemical confirmation of mucopolysaccharidosis type IVA. The protocol consists of a comprehensive clinical examination and brain and spinal cord MRI analysis for all subjects. The mean age was 16.4 years (±5.7) and the mean onset of symptoms was 11.5 months (±6.3). Overall, cognition was spared in all but one patient and motor weakness was a constant finding in all patients. Deep sensation impairment was found in six patients. The brain MRIs showed non-specific white matter changes in two patients. Other abnormalities such as clival hypoplasia, basilar invagination, and arachnoid cists appeared in seven of the nine patients. Eight patients presented spinal cord compression, and in three of them, two spinal levels were compromised. Odontoid hypoplasia and degenerative features in the neuroaxis were present in all patients. Our experience with mucopolysaccharidosis type IVA patients supports the evidence of central nervous system involvement. We emphasize the importance of regular clinical assessments with complete MRI studies, as an attempt to detect the early signs of spinal cord compression. This evaluation may be especially important before surgical interventions, as occult lesions may become symptomatic and promote postoperative unfavorable outcomes.

New insights in mucopolysaccharidosis type VI: neurological perspective.

OBJECTIVE: Mucopolysaccharidosis type VI is a rare autosomal recessive storage disorder, caused by deficiency of arylsulfatase B. Data on neurological involvement in mucopolysaccharidosis type VI patients under enzyme-replacement therapy are limited. This study explores the neurological and magnetic resonance imaging findings in a sample of mucopolysaccharidosis type VI patients receiving enzyme-replacement therapy. METHODS: We performed a cross-sectional study including six patients with biochemical confirmation of mucopolysaccharidosis type VI and at least 105 consecutive weeks (two years) receiving intravenous enzyme-replacement therapy. The protocol included a comprehensive clinical examination, brain and spinal cord magnetic resonance imaging for all subjects. RESULTS: Overall, cognition was spared, while we found presence of hearing impairment, increasing in deep tendon reflexes and deep sensation reduction in three patients. In addition to the classical abnormalities related to other types of mucopolysaccharidosis, imaging studies demonstrated morphological changes in anatomy of middle cranial fossa and sella shape. Even in asymptomatic or mild compromised patients, spinal cord compression was found. In four patients we noticed atlantoaxial joint subluxation and three had cervical spinal stenosis. Degenerative processes involving vertebral column, including discal protrusion and axis abnormalities, were present in all patients. CONCLUSIONS: Neuroaxis involvement was a universal finding and neurological examination might not predict the severity of the disease in course. Image studies should not be performed according exclusively clinical parameters for these patients, once we have demonstrated that neurological involvement may be silent in these patients.

Influence of simulated pulpal pressure on efficacy of bleaching gels.

AIM: The aim of this study was to investigate the Influence of simulated pulpal pressure on efficacy of bleaching gels. MATERIALS AND METHODS: Cylindrical enamel-dentin specimens from bovine teeth (3 mm diameter, enamel and dentin layer each 1 mm thick) were divided into 4 groups, according to the bleaching treatment: negative control (non-bleached), bleached with 10% carbamide peroxide (CP), bleached with 7.5% hydrogen peroxide (HP) and bleached with 35% hydrogen peroxide. Ten percent CP gel was applied for 8 h/day and 7.5% HP for 1 h/day, during 14 days. For 35% HP treatment, two sessions of 45 minutes each were employed. In intermediate periods specimens were stored in artificial saliva. Experimental groups (n = 19) were subdivided according to the simulation of pulpal pressure (25 mm Hg) during bleaching treatment. Initial color measurement and after bleaching treatment were assessed by spectrophotometry, using CIE L*a*b* system. The data were statistically analyzed by ANOVA and Dunnett's post-hoc tests (p < 0.05). RESULTS: There was significant difference of ΔE for all experimental groups compared to negative control group, according to Dunnett's test (p < 0.0001). There were no significant difference for total color variation (ΔE) among experimental groups (p > 0.05). CONCLUSION: It was concluded that all bleaching gels showed bleaching efficacy compared to non-bleached group and that the simulated pulpal pressure did not Influence the bleaching outcomes of the tested gels. CLINICAL SIGNIFICANCE: Although numerous in vitro studies investigating the efficacy of bleaching agents have been performed, they do not properly simulate the pulpal pressure. In order to make these studies closer to clinical conditions, it is important to reproduce these conditions in laboratory, so the results can be more reliable. This in vitro study was performed under simulated pulpal pressure, aiming to investigate its Influence on dental bleaching outcomes.

Effect of chemical activation of 10% carbamide peroxide gel in tooth bleaching.

This study aimed to evaluate the efficacy of chemical agents to increase the bleaching effectiveness of 10% carbamide peroxide. Two hundred and ninety enamel-dentin discs were prepared from bovine incisors. The color measurement was performed by a spectrophotometer using the CIE L*a*b*system. The groups were divided according to the bleaching treatment: negative control group (NC): without bleaching; positive control group (PC): bleached with 10% carbamide peroxide gel without any chemical activator; Manganese gluconate (MG); Manganese chloride (MC); Ferrous gluconate (FG); Ferric chloride (FC); and Ferrous sulphate (FS). Three different concentrations (MG, MC, FG, FC: 0.01, 0.02 and 0.03% w/w; FS: 0.001, 0.002 and 0.003% w/w) for each agent were tested. The bleaching gel was applied on the specimens for 8 h, after which they were immersed in artificial saliva for 16 h, during 14 days. Color assessments were made after 7 and 14 days. The data were analyzed by repeated measures analysis of variance and Tukey's test (5%). Generally, the test groups were unable to increase the bleaching effect (ΔE) significantly compared to the PC group. Only for ΔL, significant higher values compared to the PC group could be seen after 7 days in groups MG (0.02%), and FS (0.002 and 0.003%). The NC group showed significantly lower values than all tested groups. It was concluded that for home bleaching procedures, the addition of chemical activators did not produce a bleaching result significantly higher than the use of 10% carbamide peroxide without activation, and that the concentration of chemical activators used did not significantly influence the effectiveness of treatment.

Levodopa versus non-levodopa brain language fMRI in Parkinson's disease.

OBJECTIVE: To identify the effect of levodopa in language areas in Parkinson's disease patients. METHODS: We evaluated 50 patients with mild to moderate Parkinson's disease, age and gender paired to 47 healthy volunteers. We selected two homogeneous groups of 18 patients taking levodopa and 7 no levodopa patients. The functional magnetic resonance imaging verbal fluency task, with low and high cognitive demands, was performed at a 3T magnetic resonance imaging equipment. Data was analyzed with XBAM software for group maps and ANOVA comparison. RESULTS: Patients without levodopa had more activation than the ones with levodopa in the medial frontal and in the left frontal and parieto-occipital areas. The striatal activation in patients taking levodopa had similar result of the activation detected in the healthy volunteer group. Parieto-occipital areas were less activated in the levodopa group than in the no levodopa one. CONCLUSION: Parkinson's disease patients without levodopa replacement, during a verbal fluency effort, had more diffuse and intense cerebral activation in left hemisphere, mainly in the frontal and parieto-occipital areas. The striatal activation in verbal fluency of patients with levodopa intake was more similar to the activation found in healthy volunteers. These initial evidences suggested a role of levodopa inhibiting activation in parieto-occipital compensating areas.

Levodopa versus non-levodopa brain language fMRI in Parkinson's disease / RMf de linguagem na doença de Parkinson: levodopa versus não levodopa

Objective: To identify the effect of levodopa in language areas in Parkinson's disease patients. Methods: We evaluated 50 patients with mild to moderate Parkinson's disease, age and gender paired to 47 healthy volunteers. We selected two homogeneous groups of 18 patients taking levodopa and 7 no levodopa patients. The functional magnetic resonance imaging verbal fluency task, with low and high cognitive demands, was performed at a 3T magnetic resonance imaging equipment. Data was analyzed with XBAM software for group maps and ANOVA comparison. Results: Patients without levodopa had more activation than the ones with levodopa in the medial frontal and in the left frontal and parieto-occipital areas. The striatal activation in patients taking levodopa had similar result of the activation detected in the healthy volunteer group. Parietooccipital areas were less activated in the levodopa group than in the no levodopa one. Conclusion: Parkinson's disease patients without levodopa replacement, during a verbal fluency effort, had more diffuse and intense cerebral activation in left hemisphere, mainly in the frontal and parieto-occipital areas. The striatal activation in verbal fluency of patients with levodopa intake was more similar to the activation found in healthy volunteers. These initial evidences suggested a role of levodopa inhibiting activation in parieto-occipital compensating areas.

Objetivo: Identificar o efeito da levodopa nas áreas de linguagem em pacientes com doença de Parkinson. Métodos: Foram avaliados 50 pacientes com doença de Parkinson leve a moderada e pareados, por gênero e idade, a 47 voluntários saudáveis. Foram selecionados dois grupos homogêneos de 18 pacientes que usavam e 7 que não usavam levodopa. O exame de ressonância magnética funcional, com tarefa de fluência verbal por geração de palavras de maiores e menores demandas cognitivas, foi realizado em equipamento de 3T. Os dados foram analisados pelo programa XBAM para os mapas de grupo e as comparações ANOVA. Resultados: Os pacientes sem utilização de levodopa tiveram maior ativação nas áreas frontais mediais e esquerdas e áreas parieto-occipitais que com levodopa. A ativação estriatal nos pacientes em uso de levodopa foi similar à detectada no grupo de voluntários saudáveis. Conclusão: Pacientes com doença de Parkinson, sem utilização de levodopa durante o esforço da fluência verbal, tiveram ativação mais difusa e intensa, principalmente no hemisfério esquerdo, em áreas frontais e parieto-occipitais. A atividade cerebral estriatal na fluência verbal de pacientes em uso de levodopa foi semelhante a dos voluntários saudáveis. Essas evidências iniciais sugerem um papel inibidor da levodopa na ativação compensatória de áreas parieto-occipitais.

Cisto odontogênico ortoqueratinizado x tumor odontogênico queratocístico: a importância da diferenciação histopatológica no tratamento / Orthokeratinized Odontogenic Cyst x Keratocystic Odontogenic Tumour: The Importance of Differential Histopathogenesis in the Treatment

O cisto odontogênico ortoqueratinizado (COO) e o tumor odontogênico queratocístico (TOQ) são lesões distintas, com comportamento clínico e características radiográficas semelhantes. Enquanto o COO é classificado como cisto odontogênico, o TOQ, com base na última classificação da OMS em 2005, passou a ser classificado como neoplasia odontogênica. Essa alteração realizada na classificação do TOQ baseou-se em evidências científicas que constataram uma taxa de proliferação celular dessas lesões não compatível com as lesões císticas, fato esse comprovado mediante os dos elevados índices de recidiva encontrados no TOQ. Em função das semelhanças clínicas e radiográficas, a diferenciação histológica dessas lesões torna-se preponderante para o delineamento de um plano de tratamento conservador ou agressivo. Neste trabalho, relata-se um caso de paciente com 28 anos, gênero masculino, leucoderma, com aumento de volume assintomático em mandíbula, na região dos dentes 33, 34 e 35, todos com vitalidade. Os exames de imagem revelaram lesão radiolúcida em parasínfise e corpo mandibular esquerdo. O paciente foi submetido à punção aspirativa, com resultado negativo, e à biópsia incisional. O material coletado foi enviado a um laboratório de anatomopatologia cujo laudo revelou tumor odontogênico queratocístico. Assim sendo, o paciente foi submetido à cirurgia de enucleação com curetagem marginal, evoluindo sem intercorrências no pós-operatório. O material coletado durante a enucleação foi encaminhado ao laboratório de Patologia Bucal da Faculdade de Odontologia de São José dos Campos - UNESP cujo laudo mostrou lesão cística revestida por epitélio ortoqueratinizado compatível com cisto odontogênico ortoqueratinizado, contradizendo o resultado obtido na biópsia incisional. Atualmente, o paciente encontra-se em proservação há 72 meses, sem indícios de recorrência lesional.

The orthokeratinized odontogenic cyst (OOC) and keratocystic odontogenic tumour (KCOT) are distinct lesions with similar clinical behavior and radiological features. According to the latest edition of the WHO classification, the KCOT is now classified as an odontogenic neoplasm and the OOC continuesto be classified as an odontogenic cyst. This change made in the classification of KCOT was based on scientific evidence that demonstrated that the proliferation rate of these lesions is not compatible with cystic lesions, a fact demonstrated by the high rate of recurrence found in KCOT. Due to their clinical and radiological similarities, the histological differentiation of these lesions is crucial when choosing whether to adopt a conservative or invasive plan of treatment. In this paper, we describe a 28-year-old male patient, caucasian, with asymptomatic increased volume in the mandible in the region of teeth 33, 34 and 35, all with vitality. The imaging studies revealed a radiolucent lesion in the left mandibular body and parasymphysis. The patient underwent aspiration with negative results and incisional biopsy. The material collected was sent to an anatomic pathology laboratory, and the report revealed a keratocystic odontogenic tumour. The patient therefore underwent a surgical enucleation with marginal curettage, with an unremarkable postoperative course. The material collected during the enucleation was sent to the Oral Pathology Department at the School of Dentistry, São José dos Campos - UNESP, whose report revealed a cystic lesion lined by orthokeratinizing epithelium compatible with an orthokeratinized odontogenic cyst, which was at odds with the result obtained in the incisional biopsy. The patient has been followed up for 72 months with no evidence of recurrence of the lesion.