Langerhans Cell Histiocytosis of the Suprasellar Region: Diagnosis on Thyroid Cytology.

Langerhans cell histiocytosis (LCH) may present as unifocal disease of the suprasellar region, with symptoms and signs of hypopituitarism, arginine vasopressin deficiency (AVP-D) and weight gain. Transcranial biopsy is necessary, to define diagnosis and guide treatment decisions, but is associated with significant morbidity. We describe a patient with Hashimoto thyroiditis and a single hypothalamic mass in whom LCH diagnosis was done through thyroid fine-needle aspiration cytology (FNAC) performed despite nonspecific findings in thyroid imaging, on the basis of a slightly elevated [18F]-fluorodeoxyglucose avidity on positron emission tomography/-computed tomography (FDG-PET/-CT), and volume increase during follow-up.

Development of an Antibacterial Dentin Adhesive.

Nisin is a peptide that possesses potent antibacterial properties. This study evaluated the antibacterial activity of a nisin-doped adhesive against Streptococcus mutans, as well as its degree of conversion and microtensile bond strength (µTBS) to dentin. Nisin was added to the adhesive Adper Single Bond 2 (3M ESPE), resulting in four groups: Control Group (Single Bond 2); Group 1% (1 wt% nisin-incorporated), Group 3% (3 wt% nisin-incorporated) and Group 5% (5 wt% nisin-incorporated). Antibacterial activity against S. mutans was evaluated using colony-forming unit counts (CFU). The degree of conversion was tested using FTIR. Forty human teeth were restored for µTBS evaluation. Data were statistically analyzed with ANOVA and Tukey tests at α = 0.05. The nisin-doped adhesives, for all concentrations, exhibited a significant inhibition of the growth of S. mutans (p < 0.05); Incorporation of 5% and 3% nisin decreased the degree of conversion of the adhesive (p < 0.05). The µTBS (in MPa): Control Group­38.3 ± 2.3A, Group 1%­35.6 ± 2.1A, Group 3%­27.1 ± 1.6B and Group 5%­22.3 ± 1.0C. Nisin-doped adhesives exerted a bactericidal effect on S. mutans. The µTBS and degree of conversion of adhesive were not affected after incorporation of 1% nisin.

[Insulin allergy: how to manage it?] / Allergie à l'insuline : comment faire ?

Insulin allergy is a rare entity, complex to manage. Several types of hypersensitivity reaction are described, depending on the allergens (insulin itself vs additives). Type I, so-called immediate, IgE-mediated reactions are the most common. Their management requires a careful history and examination, as well as an allergological consult. If an IgE-mediated allergy is confirmed, insulin avoidance is recommended whenever possible. If insulin treatment is mandatory, another type of insulin may be offered. In case of failure, desensitization should be discussed, either via a dedicated protocol, or via insulin pump. In this article, we summarize the available data from the literature.

L'allergie à l'insuline est une entité rare, complexe à prendre en charge. Plusieurs types de réactions d'hypersensibilité sont décrits, selon les agents allergènes (insuline même vs additifs). Les réactions de type I, dites immédiates, IgE (immunoglobulines E) médiées sont les plus fréquentes. Leur prise en charge nécessite une anamnèse et un examen minutieux, ainsi qu'un avis allergologique. En cas de confirmation d'allergie IgE médiée, une éviction des insulines est dans la mesure du possible recommandée. Si la poursuite des traitements insuliniques est inévitable, un autre type d'insuline peut être proposé. En cas d'échec, une induction de tolérance devrait être discutée, soit via un protocole dédié, soit via la mise sous pompe à insuline. Nous résumons dans cet article les données de la littérature à disposition.

[Diabetic neuropathy: an update]. / Neuropathie diabétique : mise au point.

Diabetic neuropathy is a heterogeneous entity, grouping multiple disorders, of which the most classic form is distal symmetric polyneuropathy (DSPN). Its diagnosis is based in most cases on a compatible history and clinical examination. Screening for DSPN, to allow the implementation of preventive measures against its complications, remains the cornerstone of management, in the absence of specific treatment. In this article, we propose a review of the different forms of diabetic neuropathy and their management.

La neuropathie diabétique est une entité hétérogène regroupant des atteintes multiples, dont la forme la plus classique est la polyneuropathie distale symétrique (PNDS). Son diagnostic repose dans la majorité des cas sur une anamnèse et un examen clinique compatibles. Le dépistage de la PNDS, pour permettre la mise en place de mesures préventives de ses complications, reste la pierre angulaire de la prise en charge en l'absence de traitement spécifique. Nous proposons dans cet article une revue des différentes formes de neuropathie diabétique et de leur prise en charge.

Necropsies disclose a low helminth parasite diversity in periurban howler monkeys.

Primate-parasite interactions are often investigated via coprological studies given ethical and conservation restrictions of collecting primate hosts. Yet, these studies are inadequate to recover adult helminths for taxonomic identification and to accurately assess their prevalence, intensity, abundance, and site of infection. Fresh carcasses found in anthropogenic landscapes come as informative and reliable alternatives. In this study, we identified the helminths of brown howler monkeys (Alouatta guariba clamitans) and their sites of infection, and measured their prevalence, intensity, and abundance of infection. We necropsied 18 adult males, 11 adult females, and 7 juvenile males that died in conflicts with the anthropogenic environment (domestic dog attacks, n = 11; electrocutions and road-kills, n = 10 each; unknown, n = 5) in periurban landscapes of southern Brazil between 2013 and 2019. We found three nematodes (Trypanoxyuris minutus, Dipetalonema gracile, and Parabronema bonnei) and one cestode (Bertiella cf. studeri), a diversity estimated to account for a sampling completeness of 99%. Prevalence ranged from 3% for P. bonnei to 100% for T. minutus. Mean abundance ranged from 2 (D. gracile and B. cf. studeri) to 55,116 (T. minutus) and mean intensity of infection ranged from 4 (B. cf. studeri) to 55,116 (T. minutus). Trypanoxyuris minutus sex ratio was strongly male-biased. The intensity of infection with T. minutus was higher in juvenile males and adult females than in adult males. The low parasite diversity and the helminths' mode of transmission are compatible with howlers' arboreality and folivorous-frugivorous diet. The howlers were not infected with soil-transmitted helminth parasites of humans and domestic animals on the ground and probably did not eat invertebrates to complement the diet. Given the lack of evidence of howler health problems, we suggest that the causes of death of the necropsied howlers are the major threats to the long-term conservation of the species at the study periurban landscapes.

Minimal intervention in dentistry: which is the best approach for silorane composite restoration repairs?

BACKGROUND: This study aimed to evaluate surface treatments, adhesives and composites for repairing silorane based restorations. MATERIAL AND METHODS: One hundred and twenty truncated cones (2 mm smaller diameter and 4 mm larger diameter) made of silorane composite were divided in 12 groups according with the surface treatment (diamond bur and oxide aluminum abrasion), the adhesive (Adper Scothbond Multipurpose (3M ESPE), Ecusit (Voco) and Filtek P90 Adhesive (3M ESPE)). Each group was subdivided in two according with the composite used for repair (methacrylate and silorane). The repair was made with a second truncated cone build over the first one and bond strength assssed by tensile strength. Data were submitted to ANOVA 3-way and Tukey's test (p<0.05). RESULTS: There was difference only for the adhesives and the composites, with conventional adhesives (Adper Scothbond Mutipurpose) and methacrylate-based composites (Filtek Z350) presenting superior tensile strength compared to the silorane ones (P90 Adhesive system and composite). CONCLUSIONS: Therefore, it must be concluded that silorane composite can be repaired with methacrylate base composites and adhesives. Key words:Silorane composites, composites, bond strength, minimal intervention.

Avaliação das propriedades de um sistema adesivo modificado por um antibacteriano peptídico / Evaluation of the properties of an adhesive system modified by a peptidic antibacterial

O objetivo desse estudo foi avaliar as propriedades de um sistema adesivo modificado com a incorporação de um antibacteriano peptídico, Nisina pura (Handary, Belgium), a qual é amplamente utilizada para conservação de alimentos, em duas diferentes concentrações, 0,5% e 1,0%. Foram avaliados a resistência de união da interface adesiva, o grau de conversão e a atividade antibacteriana, além da análise por meio do Estereomicroscópio e Microscópio Eletrônico de Varredura (MEV). Os adesivos foram divididos em três grupos de acordo com a concentração de nisina (Handary, Belgium) incorporada ao sistema adesivo em cada grupo (n=10): SB ­ Adesivo Comercial Single Bond 2 (3M-ESPE), SBN05 ­ Single Bond 2 + Nisina 0,5%, SBN1 - Single Bond 2 + Nisina 1%. Para o teste de resistência de união foram utilizados 30 molares humanos hígidos (n=10). O grau de conversão foi feito por infravermelho por transformada de Fourier (FTIR), onde foram feitas três leituras das gotas do adesivo dos diferentes grupos. A atividade antibacteriana foi feita através dos testes de difusão em ágar e contagem da unidade formadora de colônia (UFC), realizado em triplicata, onde foram utilizados discos de adesivos polimerizados dos diferentes grupos. Os dados foram analisados estatisticamente quanto à sua normalidade. Como estes apresentaram distribuição normal, realizou-se o teste de análise de variância (ANOVA) e o teste de Tukey de 5%. Os resultados obtidos na microtração (MPa±Dp) foram SB 40,69±2,42A, SBN05 39,20±2,21A e SBN1 31,36±2,47B. No grau de conversão obtivemos como resultado SB 83,50±3,42A, SBN05 80,22±3,68A e SBN1 78,44±0,95A. Na atividade antibacteriana em difusão de ágar não houve diferença na formação de áreas de inibição, entretanto na unidade formadora de colônia obtivemos como resultado SB 0,51±0,02A, SBN1 0,36±0,03B e SBN05 0,30±0,04B. Pode-se concluir que a incorporação da nisina não interferiu no grau de conversão e na resistência de união na porcentagem de 0,5%, não apresentou área de inibição em difusão em ágar e apresentou atividade antibacteriana no teste UFC, mostrando seu efeito antibacteriano.

The objective of this study was to evaluate the properties of a modified adhesive system with the incorporation of a peptidic antibacterial, pure Nisin (Handary, Belgium), which is widely used for food preservation, in two different concentrations, 0.5% and 1.0%. The bond strength of the adhesive interface, the degree of conversion and antibacterial activity were evaluated, in addition to analysis using the Stereomicroscope and Scanning Electron Microscope (SEM). The adhesives were divided into three groups according to the concentration of nisin (Handary, Belgium) incorporated into the adhesive system in each group (n=10): SB ­ Single Bond 2 Adhesive (3M-ESPE), SBN05 ­ Single Bond 2 + Nisin 0,5%, SBN1 - Single Bond 2 + Nisin 1%. For the microtensile bond strength test, 30 healthy human molars (n = 10) were used. The degree of conversion was made in the Fourier transform infrared (FTIR), three readings of the drops of the adhesive of the different groups were made. The antibacterial activity was performed through the agar diffusion tests and colony forming unit (CFU) counting, performed in triplicate, where polymerized adhesive discs from different groups were used. The data were analyzed statistically for normality. As these presented normal distributions, the analysis of variance test (ANOVA) and the Tukey test of 5% were performed. The results obtained in microtensile (MPa±Dp) were SB 40,69±2,42A, SBN05 39,20±2,21A, SBN1 31,36±2,47B. In the degree of conversion, we got as a result SB 83,50±3,42A, SBN05 80,22±3,68A and SBN1 78,44±0,95A. In the antibacterial activity there was no difference in the formation of areas of inhibition. However, in the colony forming unit we obtained as a result SB 0,51±0,02A, SBN1 0,36±0,03B e SBN05 0,30±0,04B. It was concluded that the incorporation of nisin did not influence the degree of conversion of the adhesive and in the bond strength in the percentage of 0.5%, presented antibacterial activity (CFU), showing its antibacterial effect.

Scanning electron microscopy comparison of the resin-dentin interface using different specimen preparation methods.

Microscopy has been widely used to complement the data of studies related to dentin bonding; however, different specimen preparation methods may influence the analysis. Aiming to contribute to the reported scenario, this study evaluated the effect of two specimen-sectioning methods (cleavage and diamond disk cut) on the quality of the scanning electron microscopy (SEM) images. Four crowns of human molars were selected and had an area of approximately 6 mm2 of dentin exposed. They were then divided into two groups according to the universal adhesive application: total and self-etching modes. Then, composite blocks were built up and the specimens were stored in deionized water to allow the postcuring. The specimens were further divided according to the sectioning method: cleavage or diamond disk cut. Four specimens were obtained from each tooth. They were desiccated, placed on aluminum stubs, sputter-coated with gold, and observed in a scanning electron microscope, with ×2000 of magnification. The quality of the SEM images were evaluated by two calibrated examiners and classified into four scores (1-4). Mann-Whitney test (p < .05) showed that the diamond disk provided significantly higher scores than cleavage, whereas no significant difference was observed when comparing the total-etching and self-etching modes of application. The diamond disk cut method is preferable to the cleavage method to ensure the quality of the SEM analysis in studies involving the resin-dentin interface.

Adhesive systems effect over bond strength of resin-infiltrated and de/remineralized enamel.

Background: The purpose of this study was to evaluate the effect of different bonding agents on bond-strength to demineralized enamel after remineralizing treatments and resin infiltration. Methods: Buccal enamel of 120 bovine incisors was polished and then were divided into five experimental groups: SE (sound enamel); DE (demineralized enamel); AS (demineralized enamel immersed in artificial saliva for eight weeks); NaF (demineralized enamel treated with 0.05% sodium fluoride solution (one minute) for eight weeks); Ic (demineralized enamel infiltrated with a low-viscosity resin (Icon-DGM). These groups were subdivided according to adhesive system used: self-etching adhesive Adper Easy One (3M/ESPE) and etch-and-rinse adhesive Single Bond (3M/ESPE). The composite resin blocks were fabricated using a Teflon matrix. A thermomechanical cycling machine was used to carry out the artificial aging of the specimens and thus were sectioned into sticks. The microtensile tests were performed using a universal testing machine at a cross-head speed of 1 mm/min. Data (in MPa) were subjected to two-way ANOVA and Tukey's tests (5%). Results: Significant differences were found for both factors tested and interactions (p<0.05). Tukey's test results of µTBS (mean ± SD) were: etch-and-rinse SE (28.79±3.93); DE (30.41±7.22); AS (29.03±3.33); NaF (29.81±4.06)a; Ic (29.47±5.5);  and self-etching SE (30.37±6.96); DE (14.62±4.47); AS (9.79±2.32); NaF (9.36±2.31); Ic (30.78±8.68).   Conclusions: Resin infiltration did not affect the bond strength of demineralized enamel for both adhesive systems tested. For etch-and-rinse adhesive, no differences were observed for the tested groups. For self-etching adhesive, only the resin-infiltrated group showed similar bond strength to sound enamel. Both etch-and-rinse and self-etching adhesive systems can be used in resin-infiltrated enamel, if a composite restoration needs to be further performed. In enamel that has undergone the de/remineralization process, the use of a total-etch adhesive might be preferable for the restorative procedure.

[Chronic kidney disease and new antidiabetic drugs†: an overview in 2019]. / Insuffisance rénale chronique et nouveaux traitements antidiabétiques†: tour d'horizon en 2019.

Diabetic nephropathy is a leading cause of chronic kidney disease and dialysis. We know that a good diabetes control slows the progression of kidney disease, but the risk of hypoglycemia is greater in patients with chronic kidney disease and contributes to their mortality. Chronic kidney disease and diabetes are major cardiovascular risk factors with additive effects. Decreasing cardiovascular mortality is a major aim in chronic kidney disease. The ideal antidiabetic molecule in these patients should reduce the risk of dialysis, reduce cardiovascular mortality and carry no risk of hypoglycaemia. This article aims to summarize for the general practician the nephrological implications of new antidiabetic drugs and their use in chronic kidney disease patients.

La néphropathie diabétique est une cause majeure d'insuffisance rénale chronique et de mise en dialyse. Un bon contrôle du diabète permet un ralentissement de la progression de la maladie rénale, mais le risque d'hypoglycémie est plus important chez les patients en insuffisance rénale chronique et contribue à leur mortalité. L'insuffisance rénale chronique et le diabète sont des facteurs de risque cardiovasculaires additifs, et la diminution de la mortalité cardiovasculaire est un objectif majeur en insuffisance rénale chronique. La molécule antidiabétique idéale devrait diminuer le risque de mise en dialyse, réduire la mortalité cardiovasculaire et ne pas engendrer d'hypoglycémie. Cet article vise à résumer les implications néphrologiques des nouveaux antidiabétiques et leur possibilité d'utilisation chez l'insuffisant rénal chronique.

[Dyslipidemia management in patients with type 1 diabetes]. / Prise en charge de la dyslipidémie chez les patients avec un diabète de type 1.

Cardiovascular diseases are the main cause of mortality in patients with type 1 diabetes (T1DM) despite modern technology and careful metabolic control. The occurrence of dyslipidemia is frequent with T1DM and affects the risk for cardiovascular disease as occur with the occurrence of micro vascular complications. Lifestyle modifications and statin treatment should be regularly evaluated in patients with T1DM. There has been extensive discussion in the media about statin but facts are statins reduce the risk of cardiovascular disease in primary and secondary prevention. In individuals with T1DM, dyslipidemia remains underdiagnosed and insufficiently treated. This article provides a summary of the knowledge about dyslipidemia and T1DM and aims to better identify the patients that should be treated.

Les maladies cardiovasculaires restent la première cause de mortalité chez les patients avec diabète de type 1 (DT1) malgré les progrès technologiques et l'attention portée au contrôle métabolique. L'occurrence d'une dyslipidémie est fréquente en cas de DT1 et constitue un facteur de risque cardiovasculaire bien identifié au même titre que l'existence de complications microvasculaires. Le renforcement des mesures hygiéno-diététiques et la prescription de statine sont à évaluer régulièrement. Les controverses médiatiques sur les statines ne devraient pas occulter leur efficacité tant en prévention secondaire que primaire, car la dyslipidémie reste sous-diagnostiquée et insuffisamment traitée dans le DT1. Cet article résume les données de la littérature et vise à mieux identifier les patients à traiter.

Influence of simulated pulpal pressure on the variation of intrapulpal temperature during adhesive system light-curing / Influência da pressão pulpar simulada na variação de temperatura intrapulpar durante a fotopolimerização do sistema adesivo

Objective: To evaluate the effects of simulated pulpal pressure (SPP) on the variation of intrapulpal temperature (T) during lightcuring of the adhesive system. Material and Methods: One hundred sound human molars were sectioned from the highest pulp horn to obtain a 2-mm of thickness dentin. The specimens were randomly divided into two groups: (n = 50), according to the presence or absence of SPP (15 cm H2 O). The specimens were sequentially treated as follows: 37% phosphoric acid (Scotchbond Universal; 3M/ESPE), adhesive system (Scotchbond Universal/3M ESPE) and light-curing (10 s). T was evaluated during adhesive lightcuring with a K-type thermometer put inside the pulp chamber. Data were analysed by using Mann-Whitney's test (at 5%). Results: According to Mann-Whitney's test, the absence group presented a T of 2 °C, whereas the presence group 1 °C. The mean values of T were 0.82 ± 0.56 °C for the presence group and 2.30±0.73 °C for the absence group. Conclusion: Simulated pulpal pressure significantly reduced the temperature rise in the pulp chamber during light-curing of the adhesive system, showing the importance of inserting this protocol of simulated pulpal pressure in the laboratory procedures.(AU)

Objetivos: Avaliar os efeitos da pressão pulpar simulada (PPS) na variação de temperatura (DT) durante a fotopolimerização do sistema adesivo. Material e Método: Cem molares humanos hígidos foram seccionados para obtenção de 2 mm de espessura de dentina, a partir do corno pulpar mais alto. As amostras foram divididas aleatoriamente em 2 grupos (n = 50): ausência e presença de PPS (15 cm de H2 O). As amostras foram tratadas seqüencialmente com: ácido fosfórico 37% (Scotchbond Universal; 3M/ESPE), sistema adesivo (Scotchbond Universal/3M ESPE), seguida da fotopolimerização (10 s). Na seqüência, um bloco de resina composta (Filtek Z350 XT; 3M/ESPE) foi confeccionado sobre a área preparada. Para a fotopolimerização, utilizou-se o fotopolimerizador LED Light Curing System - Demi Plus (Kerr Corporation, Middleton, WI, USA), com potência de 1200 mW/cm2 . A DT foi avaliada durante a fotopolimerização do adesivo por meio de um termômetro digital no interior da câmara pulpar. Os dados obtidos foram avaliados pelo MannWhitney test (5%). Resultados: Segundo Mann-Whitney test, o grupo ausência sofreu DT de 2 °C, enquanto o grupo presença variou 1 °C. Os valores de média da DT foram de 0.82±0.56 °C para o grupo presenca de PPS e 2.30 ± 0.73 °C para o grupo ausência de PPS. Conclusão: A pressão pulpar simulada reduziu significantemente a elevação de temperatura na câmara pulpar durante a fotopolimerização do sistema adesivo, demonstrando a importância de inserir esse protocolo de simulação de pressão pulpar nos procedimentos laboratoriais.(AU)