Prior Restorative Procedures to Endodontic Treatment.

Tooth loss due to fracture and the failure of endodontic treatment (ET) are common situations in teeth with extensive tissue destruction. This is due to the fragility of the remaining dental structure and the difficulty in sealing cavities, which is sometimes associated with the violation of the supracrestal insertion tissue. The previous restoration of marginal ridges or cusps with composite resin (CR) restores their fracture resistance, due to the adhesive characteristics of the restorative material, while also protecting the quality of endodontic treatment through better sealing. However, the protocol adopted in teeth requiring endodontic treatment involves performing the restorative procedure only after the endodontic procedures. The objective of this study was to report a case in which restoration of marginal ridges and/or cusps was performed prior to endodontic treatment, focusing on maintaining the tooth in function without dental fracture. The restoration was performed with an inverted operative sequence before the endodontic treatment. There was a violation of the supracrestal insertion tissue, requiring crown lengthening surgery (CLS) prior to the restorative procedure. Clinical and radiographic evaluations were performed postoperatively at seven days, three, six, and nine months, and five years. Tooth function was maintained without dental fractures or restoration loss. Periradicular space healing occurred with the disappearance of the lesion. Performing the restorative procedure prior to endodontic treatment in teeth with extensive coronal destruction is an alternative technique that facilitates clinical procedures, reduces the likelihood of dental loss due to fracture, and promotes endodontic treatment success.

KNbO3 photoelectrode for DSSC: a structural, optical and electrical approach.

In this work, we present the potassium niobate (KNbO3) nanoparticles as a suitable mesoporous photoelectrode for dye-sensitized solar cells (DSSCs). The KNbO3 particles were synthesized by the microwave-assisted hydrothermal method using mild conditions and characterized by SEM, XRD, Raman, and UV-Vis diffuse reflectance. The particles presented a pyramidal tower-like shape with an orthorhombic structure and an indirect bandgap of (3.0 ± 0.1) eV. Dye-sensitized solar cells were assembled using the synthesized KNbO3 nanoparticles, which were deposited as a photoelectrode on a TiO2 recombination charge blocking layer. It is noticeable that the synergistic operation of the TiO2 blocking layer and KNbO3 photoelectrode is essential to achieve photovoltaic behaviour in our solar cells. The short-circuit current density of Jsc = 2.82 mA, open-circuit voltage Voc = 669 mV, fill factor FF = 0.62, and a power conversion efficiency PCE = 1.17%, reports elevated parameters if compared to other DSSCs alternative materials, becoming potassium niobate suitable as photoelectrode.

Skin Ulceration and Exposure of Herograft.

A 57 year-old catheter dependent dialysed woman with systemic erithematous lupus and central vein stenosis underwent HeRO graft placement in right internal jugular vein. In the next months she had multiple arm infections and venous outflow component was removed after impossibility to perform second thrombectomy at 14 months. Over time the graft migrated distally (Figure 1), and patient developed skin ulceration and graft exposition (Figure 2). No important weight loss was noted. Arterial graft was removed surgically and she had kidney transplantation. Arterial graft removal when HeRO graft is abandoned should be considered.

Low recombination rates and improving charge transfer as decisive conditions for high current densities and fill factors in ZnS complex systems.

The growth of ZnS photoelectrodes on ZnO particles identified as ZnO/ZnS(ZC + TAA) by the microwave-assisted hydrothermal method showed excellent photovoltaic parameters of JSC = 1.2 mA cm-2 and FF = 0.66, even compared to ZnS(ZC + TAA) used as a reference sample with JSC = 0.15 mA cm-2 and FF = 0.52. A careful analysis indicates that the better charge transfer and the higher resistance to recombination present in the ZnO/ZnS(ZC + TAA) samples were the origin of the best photovoltaic behavior. These assertions are supported by a set of samples synthesized from different precursors resulting in different crystal structures, which can be directly associated with current densities and fill factors. All aspects about synthesis and optical/electronic parameters associated with structural features will be available in this article.

Properties of zinc titanates synthesized by microwave assisted hydrothermal method.

Zinc titanates are compounds that have shown great application versatility, including in the field of semiconductors. Solid state reactions, the polymeric precursor method and the hydrothermal method are the most mentioned synthesis of these compounds in the literature. In the present work, we use microwave assisted hydrothermal method (MAH) to synthesize zinc titanate and evaluate its potential for solar cell applications through structural and optical characterization techniques. The synthesized samples were also subjected to a variable temperature heat treatment in the range of 500 °C-800 °C. The analysis showed that the crystallization of the material starts at 500 °C and that samples submitted to temperatures of 600 °C-800 °C showed the formation of two phases of zinc titanates, being a cubic phase of ZnTiO3, considered rare in the literature, predominant up to a temperature of 800 °C. The optical characterization, based on the techniques of photoluminescence spectroscopy and UV-Visible spectroscopy, showed that the photoluminescent activity and the energy of the band gap increased with the increase of the temperature of the heat treatment, having the highest response in 700 °C, facts that can be linked to the predominant formation of the cubic phase of ZnTiO3 and simultaneous of the cubic and rhombohedral phases of ZnTiO3 at 700 and 800 °C. Finally, we highlight as the most important results, the fact that it was possible to obtain these titanates at a temperature lower than that reported in the literature, and that the heat-treated sample at 500 °C is the one with the lowest energy expenditure to be synthesized and the one with the greatest potential for application in dye-sensitized solar cells (DSSC's).

Change in Domains that Influence Quality of Life after Major Lower Limb Amputation in Patients with Peripheral Arterial Disease.

BACKGROUND: Recent guidelines raise the concept of the importance of health-related quality of life (QoL). Change in QoL after amputation in ischemic patients is not well described. We aim to evaluate the change in quality of life after major limb amputation in patients with peripheral arterial disease. METHODS: We retrospectively identified all patients submitted to above-knee amputation (AKA) and below-knee amputation in our vascular surgery department in a 2-year period. Trauma excluded. A vascular amputee adapted QoL questionnaire was administered comparing the last 2 weeks to the 2 weeks before amputation. It included subjective and objective questions adapted from WHOQoL-BREEF and SF-36 divided into specific domains of QoL (physical health, role physical, pain, social, and psychological health) that were compared to 2 global items (overall QoL and general health). Independent samples tests and linear correlations were calculated. RESULTS: A total of 106 patients were included, 30-day mortality rate 16.3% and 1-year 39.1%. Patients had an increase in mean total score after amputation of 14.35 out of 100 points, with an improvement of 52.1 points in pain and 11 points in social and psychological health out of 100 (P<0.001). Physical health and role physical scores decreased after amputation. Overall QoL was correlated with total score (P<0.001). Mean QoL total score after amputation was 79.0% ± 12.6. In general, amputees scored higher in the domains social and psychological health. Older people, women, AKA and bilateral amputees had lower physical health scores (P<0.05), prosthesis was correlated with improvement in physical health after amputation (P = 0.026). Elderly and married people had big improvement in overall QoL after amputation (P = 0.008 and P = 0.056, respectively). CONCLUSIONS: QoL does not seem to diminish in advanced ischemic patients after amputation. Older people value more a decrease in pain and family support over physical health. Therefore, patient oriented treatments should be preferred. Future research should be made to validate a disease-specific questionnaire for this population.

Impact of Total Psoas Area and Lean Muscular Area on Mortality after Endovascular Aortic Aneurysm Repair.

BACKGROUND: Sarcopenia has assumed growing relevance as a morbimortality predictor after major abdominal surgery. The aim of this study is to access total psoas muscle area (TPA) and lean muscle area (LMA) impact in morbimortality after elective endovascular abdominal aortic aneurysm repair (EVAR). METHODS: Asymptomatic patients submitted to aortic endoprosthesis implantation between January 1, 2014 and December 31, 2018 at our vascular surgery department were retrospectively evaluated. After exclusion criteria were applied, 105 patients were included in the study; preoperative computed tomography scans were evaluated using OSIRIX software (Bernex, Switzerland). Two observers independently calculated TPA at the most caudal level of the L3 vertebra and respective density, therefore calculating LMA. Patients were separated by tertiles with the lowest being considered sarcopenic and with higher muscle steatosis and compared with the higher tertiles. Patient demographics and intraoperative and postoperative period variables were collected. Charlson comorbidity index was calculated and surgical complications classified according to Clavien-Dindo. The intraclass correlation coefficient and Bland-Altman plot were made to characterize interobserver variability. Survival analysis was performed with the Kaplan-Meier method, and differences between survival curves were tested with the log-rank test. The effect of sarcopenia on patient survival was assessed using Cox proportional hazard models. RESULTS: Considering TPA, univariate analyses revealed that patients in the lower tertile had inferior survival (P = 0.03), whereas multivariate analyses showed increased likelihood of mortality (P = 0.039, hazard ratio (HR) 3.829). For LMA, univariate analyses revealed that patients in the lower tertile had inferior survival (P = 0.013), whereas multivariate analyses showed increased likelihood of mortality (P = 0.026, HR 4.153). When analyzing patients in the lowest tertile of both TPA and LMA, both univariate (P = 0.002) and multivariate (P = 0.018, HR 4.166) analyses reveled inferior survival. CONCLUSIONS: Our study reveals reduced survival in patients with low TPA and low LMA submitted to elective EVAR; these factors should probably be taken into consideration in the future for preoperative risk evaluation and surgical planning.

Is There an Impact of COVID-19 on Admission of Patients to the Emergency Department for Vascular Surgery?

BACKGROUND: On March 2020, the World Health Organization declared the coronavirus disease 2019 outbreak a pandemic. During this period, surgical activity and admission to the Emergency Department (ED) decreased globally. The aim of this article is to understand how the admission of a patient to the ED for vascular surgery changed in our center in Portugal and if this situation prevented urgent surgical procedures. METHODS: Through a retrospective study, we compared the volume of patients admitted to the ED during the emergency state (ES) in Portugal with the same period in 2019. In addition, we analyzed the urgent surgical activity during the ES and in the correspondent period of the previous 10 years, regarding limb acute ischemia, acute aortic pathology, and vascular trauma. Two groups of patients were formed-patients operated during the ES and during the non-ES, for control. Statistical analysis was performed using IBM SPSS® Statistics, version 25. RESULTS: In the ES, 115 patients were observed at the ED and 179 in the 2019 corresponding period. During the ES, patients significantly recurred less to the ED directly from home (P < 0.001) and were less referred to the ED by primary care doctors (P < 0.001). Patients observed at the ED were significantly more urgent-required urgent surgery or were admitted to the department-than those in 2019 (40% vs. 24%). However, there were no differences when only considering urgent surgery (14% in ES vs. 10% in 2019). In the ES, 38% of patients observed at the ED were discharged with no follow-up related to vascular surgery against 60% in 2019, although this difference was not significant. Compared with the preceding 10 years, there are not significant differences in the number of patients who underwent urgent surgery in both ES and non-ES periods. In patients with acute limb ischemia, we did not find an increase in the time between onset of symptoms and ED admission, during the ES. CONCLUSIONS: Fewer patients were admitted at the ED during the ES, and those admitted were significantly more urgent. We did not find a decrease in the number of urgent surgeries when compared with the preceding 10 years. Therefore, we cannot assume that coronavirus pandemic precluded urgent surgical procedures.

Aortic Anastomotic Aneurysm After Infra Renal Grafting.

An 87 year-old male presented with a 71mm proximal anastomotic aneurysm causing left renal artery displacement (Figures 1 and 2), 19 years after infra-renal aorto-aortic grafting for an infra-renal abdominal aortic aneurysm. Dilatation of visceral aorta was also observed. Management would be challenging but patient denied further intervention.

Influence of Eu valence on the optical activity of BaTiO3 decorated with CaF2 synthesized by microwave-assisted hydrothermal method.

Inorganic hybrid materials have promising applications in absorbers and for the photon harvesting of solar irradiation, such as in DSSC photoanodes. Moreover, investigation of the interactions between the photoanode constituent materials is extremely important, since it is known that the properties of the materials are strongly dependent on the nucleation and growth process. Therefore, the purpose of this work was to synthesize a system consisting of a synergic combination of two inorganic hosts, BaTiO3 and CaF2, synthesized together through a microwave-assisted hydrothermal method, which allows single-phase materials to be obtained after short synthesis times and at low temperatures. The increase in optical activity was investigated after the insertion of Eu ions. From the structural results, it was possible to observe that the method used to obtain the system was efficient, even using temperatures as low as 140 °C and a reaction time of one minute. The optical properties (emission and excitation) were evaluated in the visible and VUV region from 2.5 to 10.5 eV. The XANES Eu Liii edge differences associated with the XEOL results indicate that the synthesis method incorporated Eu3+ in the hosts and the surface of the two compounds, BaTiO3 and CaF2. Therefore, the combination between the Eu3+ activators and the F centers of the host increased the range for photon harvesting, making these systems a promising material for future applications in photoanodes for DSSCs.

Structural and Electronic Properties of Bulk ZnX (X = O, S, Se, Te), ZnF2, and ZnO/ZnF2: A DFT Investigation within PBE, PBE + U, and Hybrid HSE Functionals.

Here, we have studied the crystalline structure of bulk ZnX (X = O, S, Se, Te) and ZnF2 systems as a first step to understand the structures like ZnX and Zn-based systems like ZnO/ZnF2 interfaces, which are of utmost importance for possible technological applications. In addition, an adequate methodological description based on density functional theory (DFT) calculations is necessary. It is well known that plain DFT calculations based on local or semilocal exchange-correlation functionals fail to describe the correct band gap energy for these systems, whereas nonlocal approaches, such as hybrid-based functionals, can compensate the underestimation of band gap. To contribute to the assessment, DFT studies were performed within semilocal Perdew-Burke-Ernzerhof (PBE) and two nonlocal functionals, hybrid Heyd-Scuseria-Ernzerhof (HSE) and PBE + U functionals. Our results confirm that PBE underestimates the energy band gap values, from 33.0 to 42.8% for ZnX compounds compared to the experimental values. Applying the hybrid HSE functional, we obtained a band gap dependency in relation to the range of separation of the nonlocal exact exchange, in general decreasing the band gap error and improving the lattice constant description. In addition, using the PBE + U approach, we have investigated the localization of the Zn d-states and its effect on the band gap in ZnX and ZnF2. We found an increase in the band gap with increasing Hubbard parameter, which introduces on-site Coulomb corrections for the Zn 3d states. In the same context, the relevance to include the Hubbard corrections for the O 2p states (and X p states) is highlighted. Thus, considering PBE + U, the error in ZnO band gap, for example, decreases to 5.1%, in relation to the experimental value. Finally, ZnO-12L/ZnF2-4L superlattices are found to exhibit conventional electronic properties, such as low fundamental band gap, smaller than either of the parent materials. Our first-principles calculations reveal that the unexpected band gap reduction is induced by the conducting layers that tend to penetrate the interface and decrease the band gap, leading to the transport of carriers through the interface to ZnF2, which, even with a high band gap for charge transfer, can be interesting for photovoltaic applications.

Combined Endovascular Exclusion with Percutaneous Sac Aspiration and Thrombin Injection in the Management of Popliteal Artery Aneurysm.

BACKGROUND: Symptomatic popliteal artery aneurysms (PAAs) can be managed by open surgery or endovascular exclusion. METHODS: The authors describe a case of a 68-mm PAA causing compressive symptoms and managed by endovascular exclusion combined with percutaneous sac decompression. RESULTS: Endovascular exclusion allows sac pressure reduction. Additional percutaneous sac aspiration and thrombin injection promote sac shrinking and avoid persistent collateral flow. CONCLUSIONS: In challenging cases, matching different techniques can be helpful.

External Iliac Artery Laceration Caused by Hip Prosthesis Migration.

Hip arthroplasty is a common and safe intervention in orthopedic surgery. However, the proximity of this joint to large vessels makes the occurrence of vascular injury a rare but serious and possibly lethal complication of this surgical technique. Acute vascular injuries in the context of a hip arthroplasty have variable etiologies and clinical presentations, and are more common in revision surgeries and in situations of medial intrapelvic migration and of chronic infection of the hip prosthesis. In the present article, the authors present a case of acute and late major vascular complication in the context of hip arthroplasty revision. The patient developed an acute laceration of the external iliac artery caused by chronic and progressive medial intrapelvic acetabular migration of the hip prosthesis associated with chronic infection.

Quantitative evaluation of the surface stability and morphological changes of Cu2O particles.

Cu2O low-index surfaces periodic models have been simulated based on density functional theory. The calculated surfaces energies allowed estimating the morphology by means of the Wulff theorem as well as the investigation of possible paths of morphological changes. Therefore, systematic morphology diagrams and change paths according to the energy modulation in relation to the surfaces stabilizations were elaborated. The applicability of this strategy was exemplified by comparing the obtained results with experimental available data from the literature. The morphology diagrams with the quantitative energetic point of view can be used as a guide to support experimental works in order to understand the relation between surface interactions and crystal growth.

External Iliac Artery Laceration Caused by Hip Prosthesis Migration / Laceração da artéria ilíaca externa por migração de prótese da anca

Abstract Hip arthroplasty is a common and safe intervention in orthopedic surgery. However, the proximity of this joint to large vessels makes the occurrence of vascular injury a rare but serious and possibly lethal complication of this surgical technique. Acute vascular injuries in the context of a hip arthroplasty have variable etiologies and clinical presentations, and are more common in revision surgeries and in situations of medial intrapelvic migration and of chronic infection of the hip prosthesis. In the present article, the authors present a case of acute and late major vascular complication in the context of hip arthroplasty revision. The patient developed an acute laceration of the external iliac artery caused by chronic and progressive medial intrapelvic acetabular migration of the hip prosthesis associated with chronic infection.

Resumo A artroplastia da anca é uma intervenção frequente e segura na cirurgia ortopédica. No entanto, a proximidade dessa articulação com vasos de grande calibre faz com que a ocorrência de lesão vascular maior seja uma complicação rara, mas grave e possivelmente letal, dessa técnica cirúrgica. As lesões vasculares agudas no contexto de uma artroplastia da anca têm etiologia e apresentação clínica variáveis e são mais frequentes em cirurgias de revisão e situações de migração medial intrapélvica e de infecção crônica de próteses da anca. No presente artigo, os autores apresentam um caso com complicação vascular maior aguda e tardia em contexto de revisão de prótese da anca. Trata-se de um paciente que desenvolveu uma laceração aguda da artéria ilíaca externa em contexto de migração acetabular intrapélvica crônica progressiva da prótese da anca associada a infecção crônica.

Unveiling the efficiency of microwave-assisted hydrothermal treatment for the preparation of SrTiO3 mesocrystals.

Material processing has become essential for the proper control, tuning and consequent application of the properties of micro/nanoparticles. In this case, we report herein the capability of the microwave-assisted hydrothermal (MAH) method to prepare the SrTiO3 compound, as a case study of inorganic compounds. Analyses conducted by X-ray diffraction, X-ray photoelectron and X-ray absorption spectroscopies confirmed that the MAH route enables the formation of pristine SrTiO3. The results indicated that the combination of thermal and non-thermal effects during the MAH treatment provides ideal conditions for an efficient and rapid synthesis of pristine SrTiO3 mesocrystals. Scanning electron microscopy images revealed a cube-like morphology (of ca. 1 µm) formed via a self-assembly process, influenced by the MAH time. Additionally, photoluminescence measurements revealed a broad blue emission related to intrinsic defects, which decreased with the MAH synthesis time.

[Aortic mural thrombus]. / Trombo aórtico mural.

Aortic mural thrombus is a rare clinical finding in the absence of aneurysm or atherosclerosis but an important source of noncardiogenic emboli with a difficult diagnosis and a high rate of complications, including high mortality. It appears to occur more frequently in young adults usually with underlying pro-thrombotic disorder. With the increasing use of high resolution imaging, the asymptomatic mural thrombus became an increasingly frequent finding, but its potential for embolization or the best treatment are still a matter of debate. The management of mural thrombus in non-atherosclerotic aorta represents a challenge because no guidelines are available, and should be individualized. The therapeutic approach should include the triple aspects of aortic mural thrombus: primary disease anticoagulation treatment, surgical thrombectomy to solve embolic complications and endovascular/classical surgery to exclude the thrombus from the aorta. Historically therapeutic anticoagulation was proposed as first-line therapy and surgical intervention was reserved for mobile thrombus, recurrent embolism and contraindication for anticoagulation. However, it is associated with a 25-50% embolic recurrence rate, thrombus persistence in 35% and secondary aortic surgery in up to 31% of the cases. Recent data suggest that endovascular coverage of the aortic thrombus, when feasible, appears to be an effective and safe procedure with a low recurrence and re-embolization rates. In this article we review the published literature concerning this topic.

O trombo aórtico mural é uma entidade rara na ausência de doença aterosclerótica ou aneurismática, mas uma causa importante de embolia não cardioembólica, com diagnóstico de presunção difícil e alta incidência de complicações, incluindo mortalidade elevada. Afeta mais frequentemente o adulto jovem geralmente com um distúrbio pró-trombótico subjacente. Com o maior acesso a exames de imagem de alta resolução, o trombo mural assintomático tornou-se um achado crescente, sem que se saiba atualmente prever o seu potencial embolígeno ou melhor orientação terapêutica. O seu tratamento representa um desafio, dada a ausência de guidelines disponíveis, devendo este ser individualizado. A abordagem terapêutica deve incluir os aspetos tríplices do trombo mural aórtico: anticoagulação para tratamento do distúrbio primário, trombectomia cirúrgica para resolução das complicações embólicas e a cirurgia endovascular/clássica para excluir o trombo da aorta. Historicamente a anticoagulação foi proposta como terapêutica de primeira linha e a intervenção cirúrgica reservada para os casos de trombo móvel, embolia recorrente refratária ou contra-indicação da mesma. No entanto o uso da AC isolado está associada a recorrência embólica em 25-50% dos casos, persistência do trombo em 35% e necessidade de cirurgia aórtica secundária em até 31%. Dados recentes sugerem que a técnica endovascular, quando possível, parece ser um procedimento eficaz e seguro com baixa incidência de recorrência ou re-embolização. Este artigo visa realizar uma revisão da literatura publicada.

Unusual Presentation of Ruptured Abdominal Aortic Aneurysm.

Abdominal aortic aneurysm affects 5-9% of the population over the age of 65 years; is more common in male smokers and in patients with a positive family history of aortic aneurysms. Most patients are asymptomatic; rupture is the most common and dreaded complication. The classical triad of back pain, hypotension and pulsatile mass is the most common presentation but is present in only 25-50% of patients. Clinical presentation seems dependent on rupture site. Our report illustrate a rare clinical presentation for a serious clinical condition. Knowledge of different presentations can lead to timely diagnosis and management and decrease in rupture related morbidity and mortality.

O aneurisma da aorta abdominal é uma doença que afecta 5-9% da população com mais de 65 anos. É mais comum em homens fumadores e em casos de história familiar de aneurisma da aorta. A maioria são assintomáticos. A rotura é a complicação mais frequente e fatal. A apresentação mais comum da rotura é a tríade clássica: dor lombar súbita e intensa, síncope/hipotensão e massa abdominal pulsátil. Contudo, apenas 25-50% dos casos se apresentam desta forma. O local de rotura parece influenciar o quadro clínico. Serve este caso para documentar uma apresentação clínica rara de uma patologia com morbi-mortalidade muito elevada. O conhecimento das diversas apresentações clínicas poderá levar ao diagnóstico e tratamento atempados, com impacto positivo na morbi-mortalidade do aneurisma da aorta abdominal em rotura.