Is phase angle associated with visceral adiposity and cardiometabolic risk in cardiology outpatients?

BACKGROUND/OBJECTIVES: Phase angle (PhA) serves as a prognostic marker in various clinical scenarios, reflecting oxidative stress and cellular damage. Despite its clinical relevance, its connection with adiposity and cardiovascular risk markers remains underexplored. Hence, our study sought to investigate the relationship between PhA and metabolic, adiposity, and cardiovascular risk parameters among outpatients with cardiology diagnosis. SUBJECTS/METHODS: Adults aged between 26 and 59 years, under the care of a cardiology unit, were included. Ultrasound imaging was used to assess visceral adipose tissue (VAT). Single-frequency bioelectrical impedance analysis (BIA) [50 kHz] was employed to calculate PhA, from BIA's resistance and reactance measurements. Muscle strength, body mass index, waist circumference, and waist-to-height ratio were also evaluated. Framingham's risk score was calculated to estimate the cardiovascular risk events. Metabolic blood samples' results were obtained from medical records. RESULTS: One hundred and five participants were included in our study. Low PhA was observed in 29.5% of our sample. Higher PhA values were independently and inversely associated with both higher VAT and cardiovascular risk (adjusted OR: 0.79 [95% CI 0.69;0.91], OR: 0.74 [95% CI 0.60;0.89], respectively). Lower PhA values (≤5.59) were goodly associated with high VAT (AUC: 0.82 p < 0.001). Lower PhA values (≤5.06) were fairly associated with higher cardiovascular risk (AUC: 0.70 p = 0.003). CONCLUSION: Our study provides evidence that PhA is independently and inversely associated with elevated VAT and cardiovascular risk. These findings underscore the potential of PhA as a valuable complementary marker in assessing cardiometabolic health.

On the interactions involving serine proteases obtained from Monacrosporium thaumasium (Ascomycota: Orbiliomycetes) and deoxyribonucleic acid (DNA): biological macromolecules in action.

The use of force spectroscopy approaches performed with optical tweezers can be very useful in determining the binding modes and the physical chemistry of DNA interactions with ligands, from small drugs to proteins. Helminthophagous fungi, on the other hand, have important enzyme secretion mechanisms for various purposes, and the interactions between such enzymes and nucleic acids are very poorly studied. Therefore, the main goal of the present work was to investigate, at the molecular level, the mechanisms of interaction between fungal serine proteases and the double-stranded (ds) DNA molecule. Experimental assays performed with this single molecule technique consist in exposing different concentrations of the protease of this fungus to dsDNA until saturation while monitoring the changes on the mechanical properties of the macromolecular complexes formed, from where the physical chemistry of the interaction can be deduced. It was found that the protease binds strongly to the double-helix, forming aggregates and changing the persistence length of the DNA molecule. The present work thus allowed us to infer information at the molecular level on the pathogenicity of these proteins, an important class of biological macromolecules, when applied to a target specimen.

Prospecting Plant Extracts and Bioactive Molecules with Antimicrobial Activity in Brazilian Biomes: A Review.

Antimicrobial resistance is currently one of the greatest threats to global health, food security, and development. In this aspect, medicinal plants have been studied to support the development of viable alternatives to prevent and treat infectious diseases. This study aimed to perform a review of the literature comprising the antimicrobial activity of vegetable species from Brazilian biomes. We selected 67 original scientific publications about extracts, fractions, or isolated molecules from plants in the Brazilian biomes, published between 2016 and 2020 in Pubmed, ScienceDirect, and Scielo. Data demonstrated that 98 plant species, especially collected in the Cerrado, Atlantic Forest, and Caatinga biomes, were tested against 40 fungi and 78 bacterial strains. Bioactive fractions of Eucalyptus globulus methanolic stump wood extract were active against Candida albicans and C. tropicalis (MIC 2.50 µg/mL). The catechin purified from Banisteriopsis argyrophylla leaves had activity against C. glabrata (MIC 2.83 µg/mL) and ethanolic extract obtained from Caryocar coriaceum bark and fruit pulp exhibited MIC of 4.1 µg/mL on Microsporum canis. For bacteria, compounds isolated from the dichloromethane extract of Peritassa campestris, lectin extracted from a saline extract of Portulaca elatior and essential oils of Myrciaria pilosa exhibited significant effect against Bacillus megaterium (MIC 0.78 µg/mL), Pseudomonas aeruginosa (MIC 4.06 µg/mL) and Staphylococcus aureus strains (MIC 5.0 µg/mL), respectively. The findings support the antimicrobial and bioeconomic potential of plants from Brazilian biodiversity and their promising health applications.

End-User Assessment of an Innovative Clothing-Based Sensor Developed for Pressure Injury Prevention: A Mixed-Method Study.

This study aimed to evaluate a clothing prototype that incorporates sensors for the evaluation of pressure, temperature, and humidity for the prevention of pressure injuries, namely regarding physical and comfort requirements. A mixed-method approach was used with concurrent quantitative and qualitative data triangulation. A structured questionnaire was applied before a focus group of experts to evaluate the sensor prototypes. Data were analyzed using descriptive and inferential statistics and the discourse of the collective subject, followed by method integration and meta-inferences. Nine nurses, experts in this topic, aged 32.66 ± 6.28 years and with a time of profession of 10.88 ± 6.19 years, participated in the study. Prototype A presented low evaluation in stiffness (1.56 ± 1.01) and roughness (2.11 ± 1.17). Prototype B showed smaller values in dimension (2.77 ± 0.83) and stiffness (3.00 ± 1.22). Embroidery was assessed as inadequate in terms of stiffness (1.88 ± 1.05) and roughness (2.44 ± 1.01). The results from the questionnaires and focus groups' show low adequacy as to stiffness, roughness, and comfort. The participants highlighted the need for improvements regarding stiffness and comfort, suggesting new proposals for the development of sensors for clothing. The main conclusions are that Prototype A presented the lowest average scores relative to rigidity (1.56 ± 1.01), considered inadequate. This dimension of Prototype B was evaluated as slightly adequate (2.77 ± 0.83). The rigidity (1.88 ± 1.05) of Prototype A + B + embroidery was evaluated as inadequate. The prototype revealed clothing sensors with low adequacy regarding the physical requirements, such as stiffness or roughness. Improvements are needed regarding the stiffness and roughness for the safety and comfort characteristics of the device evaluated.

T-cell activation, senescence, and exhaustion in asymptomatic HIV/Leishmania infantum co-infection.

Background: Leishmania infantum is an opportunistic parasitic infection. An immunocompromised state increases the risk of converting asymptomatic infection to symptomatic visceral leishmaniasis (VL), which has a ~5% fatality rate even with treatment. HIV coinfection increases the risk of death from VL. Methods: A cross-sectional study was performed between 2014 and 2016 to determine the prevalence of L. infantum infection in HIV positive subjects residing in the state of Rio Grande do Norte, Brazil (n=1,372) and of these a subgroup of subjects were followed longitudinally. Subsequent incident cases of VL were ascertained from a public health database through 2018. A subgroup (n=69) of the cross-sectional study subjects was chosen to assess immune status (T cell activation, senescence, exhaustion) and outcome. The data were compared between asymptomatic HIV+/L. infantum+ (HIV/Leish), symptomatic visceral leishmaniasis (VL), recovered VL, DTH+ (Delayed-Type Hypersensitivity response - Leishmanin skin test), AIDS/VL, HIV+ only (HIV+), and Non-HIV/Non L. infantum infection (control subjects). Results: The cross-sectional study showed 24.2% of HIV+ subjects had positive anti-IgG Leishmania antibodies. After 3 years, 2.4% (8 of 333) of these HIV/Leish coinfected subjects developed AIDS/VL, whereas 1.05% (11 of 1,039) of HIV subjects with negative leishmania serology developed AIDS/VL. Poor adherence to antiretroviral therapy (p=0.0008) or prior opportunistic infections (p=0.0007) was associated with development of AIDS/VL. CD4+ (p=0.29) and CD8+ (p=0.38) T cells counts or viral load (p=0.34) were similar between asymptomatic HIV/Leish and HIV subjects. However, activated CD8+CD38+HLA-DR+ T cells were higher in asymptomatic HIV/Leish than HIV group. Likewise, senescent (CD57+) or exhausted (PD1+) CD8+ T cells were higher in asymptomatic HIV/Leish than in AIDS/VL or HIV groups. Conclusion: Although asymptomatic HIV/Leish subjects had normal and similar CD4+ and CD8+ T cells counts, their CD8+T cells had increased activation, senescence, and exhaustion, which could contribute to risk of developing VL.

Layer-Specific Changes in the Prefrontal Glia/Neuron Ratio Characterizes Patches of Gene Expression Disorganization in Children with Autism.

Autism spectrum disorder (ASD) is manifested by abnormal cell numbers and patches of gene expression disruption in higher-order brain regions. Here, we investigated whether layer-specific changes in glia/neuron ratios (GNR) characterize patches in the dorsolateral prefrontal cortex (DL-PFC) of children with ASD. We analyzed high-resolution digital images of postmortem human brains from 11 ASD and 11 non-ASD children obtained from the Autism Study of the Allen Human Brain Atlas. We found the GNR is overall reduced in the ASD DL-PFC. Moreover, layers II-III belonging to patches presented a lower GNR in comparison with layers V-VI. We here provide a new insight into how brain cells are arranged within patches that contributes to elucidate how neurodevelopmental programs are altered in ASD.

Age, Education Years, and Biochemical Factors Are Associated with Selective Neuronal Changes in the Elderly Hippocampus.

Brain aging involves regional alterations of specific cellular subpopulations in the human hippocampus: a network hub for memory consolidation. The present study investigates whether age, sex, education years, and the concentration of neuropathological and inflammatory proteins influence neuronal-type marker expression in the elderly hippocampus. We analyzed the digital images (1 µm/pixel) of postmortem hippocampal sections from 19 non-demented individuals (from 78 to 99 years). This material was obtained from the "Aging Dementia and TBI Study" open database. Brain samples were processed through in situ hybridization (ISH) for the immunodetection of VGLUT1 (glutamatergic transporter) and GAT1 (GABAergic transporter) and mRNAs and Luminex protein quantifications. After image acquisition, we delineated the dentate gyrus, CA 3/2, and CA1 hippocampal subdivisions. Then, we estimated the area fraction in which the ISH markers were expressed. Increased VGLUT1 was observed in multiple hippocampal subfields at late ages. This glutamatergic marker is positively correlated with beta-amyloid and tau proteins and negatively correlated with interleukin-7 levels. Additionally, education years are positively correlated with GAT1 in the hippocampus of elderly women. This GABAergic marker expression is associated with interferon-gamma and brain-derived neurotrophic factor levels. These associations can help to explain how hippocampal sub-regions and neurotransmitter systems undergo distinct physiological changes during normal aging.

Microextraction technique associated with gas chromatography-mass spectrometry for determining pesticide residues in urine.

Urine is one of the biological matrices most used for detecting human contamination, as it is representative and easily obtained via noninvasive sampling. This study proposes a fast, accurate, and ecological method based on liquid-liquid microextraction with low-temperature partition (µLLE/LTP). It was validated to determine nine pesticides (lindane, alachlor, aldrin, chlorpyrifos, dieldrin, endrin, DDT, bifenthrin, and permethrin) in human urine, in association with gas chromatography coupled with mass spectrometry (GC-MS). The technique was optimized through a factorial design. The best conditions for the simultaneous extraction of the analytes comprised the addition of 600 µL of water and 600 µL of acetonitrile (extracting solvent) to a 500-µL urine sample, followed by vortexing for 60 s. By freezing the samples for 4 h, it was possible to extract the pesticides and perform the extract clean-up simultaneously. The parameters selectivity, linearity, limit of detection (LOD), limit of quantification (LOQ), precision, and accuracy were used to appraise the performance of the method. Good values of selectivity and linearity (R2 > 0.990), LOQ (0.39-1.02 µg L-1), accuracy (88-119% recovery), and precision (%CV ≤ 15%) were obtained. The µLLE/LTP-GC-MS method was applied to authentic urine samples collected from volunteers in Southeast Brazil.

Towards an inclusive digital literacy: An experimental intervention study in a rural area of Brazil.

About half of the world's population remains without access to internet in an era of digital transformation. In this study, we aimed to investigate the impact of implementing the use of logic and mathematics through digital literacy on a population of elementary school students in a town in Northeast Brazil. In a non-randomized experimental longitudinal intervention study, 5th-grade students were followed during one semester. They underwent observational testing during class with the use of scales to evaluate their activities in a digital environment, and they were evaluated with respect to their ability to use digital devices. A logic/math assessment was applied prior to and at the end of the course for intervention group and compared to a control group. Questionnaires were used to assess the educators', legal guardians' and students' perceptions on digital habits and their respective sociodemographic features. The intervention consisted of a 16-h long course developed consisting of 8 2-h long classes which focused on digital technology, digital culture, and computational thinking. The students had a strong interest in the classes. Although some students did not have prior contact with computers, their development was outstanding. Digital literacy competencies and technology-use behavior increased throughout the semester independent of family income and use of digital devices at home. Students progressively improved their interaction with the computer (e.g. touchpad and typing skills) and their confidence in the digital environment. Students' scores on the logic/math assessment showed significant improvement. This was not observed in the control group, demonstrating the importance of this type of intervention even with one provided by a 16-h course. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10639-021-10711-z.

Wound healing activity of lectin isolated from seeds of Centrolobium microchaete Mart. ex Benth. on cutaneous wounds in mice.

This study aims to evaluate the wound healing potential of lectin isolated from the seeds of Centrolobium microchaete (Mart. ex Benth) (CML) on cutaneous wounds in mice. CML did not show cytotoxicity on murine dermal fibroblasts (L929 cell line). The wounds treated with CML (200 µg/mL) showed a decrease in area within 12 days post-operative (P.O.) when compared to control. On 3rd and 7th day P.O., the CML-treated group exhibited fibroblast proliferation and neovascularization. On 12th day P.O., complete restructuring of the epithelial layer and connective tissue was observed in the CML-treated group, whereas control groups exhibited incomplete reepithelialization. CML treatment enhanced the wound closure via the wound contraction process, resulting in the restructuring of the skin layers on 12th day P.O. In conclusion, CML induced a fast and efficient wound healing, suggesting that it can be used as a promising therapeutic tool to heal acute wounds.

Effect of the nanofilm-coated zirconia ceramic on resin cement bond strength.

Background. New surface treatments have been proposed to expand the clinical indications of zirconia prostheses. This study aimed to evaluate the effect of silica and fluorine nanofilms on zirconia ceramic on the resin cement bond strength. Methods. Zirconia blocks and discs underwent different surface treatments: untreated zirconia (CON), sandblasted, silica-coated alumina particles (30 µm) (SC), silica nanofilm (SN), and fluorine nanofilm (FN). Nanofilm deposition was performed through plasma enhanced chemical vapor deposition (PECVD). Zirconia surfaces were characterized on disks by morphology (atomic force microscopy, AFM), chemical analysis (x-ray photoelectron spectroscopy, XPS), and contact angle analysis. A silane coupling agent was applied on each treated surface, and a cylinder of resin cement was built up. Half of the specimens in each group were submitted to 6000 thermal cycles (TC). Bond strength was analyzed using the shear test, and the fractographic analysis was performed with stereomicroscopy and SEM/EDS. Statistical analysis was performed through one-way ANOVA and Tukey test in the non-aged and aged specimens. Results. Nanofilms modified the zirconia surface, which became more hydrophilic and chemically reactive. Chemical bonding between Si-O was found in SN, and FN promoted a fluorination process on the ceramic surface, converting zirconia into zirconium oxyfluoride. Specimens of the SN (TC) group failed on pre-testing. FN (TC) bond strength (3.8 MPa) was lower than SC (TC) and CON (TC) after shearing. Adhesive failure predominated in the experimental groups. Silica nanofilm failure occurred after aging. Conclusion. Silica and fluorine nanofilms deposited by PECVD did not promote effective bonding between zirconia and resin cement.

Immunosuppressive CD14+/HLA-DRlow/‒ monocytes in patients with Chagas Disease.

Chagas Disease (CD) is a neglected illness whose immunopathological mechanisms have not yet been plainly elucidated. The asymptomatic (indeterminate) form of CD is a long-term condition and approximately 20% to 35% of the individuals with this form evolve into one of the three chronic symptomatic clinical forms of CD, namely: cardiac, digestive or cardio-digestive (mixed). A variant of blood monocytes characterized by low expression of the HLA-DR antigen (CD14+/HLA-DRlow/‒) constitutes a subtype of myeloid-derived suppressor cells (MDSCs) whose main function is to regulate exacerbated inflammatory processes. The development of the symptomatic forms of CD can be related to the interaction between the host's immune system and the CD14+/HLA-DRlow/‒ immunosuppressive monocytes. Here, we evaluated, by flow cytometry, the absolute number and the HLA-DR antigenic density of this population of MDSCs in 57 patients with the diagnosis of CD: 34 with the symptomatic clinical forms (26 cardiac and 8 mixed) and 23 with the asymptomatic (indeterminate) form. The asymptomatic form exhibited a greater number of CD14+/HLA-DRlow/‒ monocytes and, accordingly, a low HLA-DR antigenic density, when compared to the symptomatic forms. It is possible to speculate that the predominance of CD14+/HLA-DRlow/- monocytes in the patients with the asymptomatic (indeterminate) form might have been a factor that could delay or even prevent the evolution of the asymptomatic form to the symptomatic forms of Chagas Disease.

Disseminated Cutaneous Leishmaniasis and Alcohol Misuse, Northeast Brazil, 2015-2018.

Disseminated cutaneous leishmaniasis (DCL) is an uncommon form of Leishmania braziliensis infection. It remains unknown why some people develop this clinical condition. We describe 14 DCL patients in Northeast Brazil during 2015-2018. These patients regularly drank large amounts of alcohol, possibly increasing their risk for DCL.

Aging Alters Daily and Regional Calretinin Neuronal Expression in the Rat Non-image Forming Visual Thalamus.

Aging affects the overall physiology, including the image-forming and non-image forming visual systems. Among the components of the latter, the thalamic retinorecipient inter-geniculate leaflet (IGL) and ventral lateral geniculate (vLGN) nucleus conveys light information to subcortical regions, adjusting visuomotor, and circadian functions. It is noteworthy that several visual related cells, such as neuronal subpopulations in the IGL and vLGN are neurochemically characterized by the presence of calcium binding proteins. Calretinin (CR), a representative of such proteins, denotes region-specificity in a temporal manner by variable day-night expression. In parallel, age-related brain dysfunction and neurodegeneration are associated with abnormal intracellular concentrations of calcium. Here, we investigated whether daily changes in the number of CR neurons are a feature of the aged IGL and vLGN in rats. To this end, we perfused rats, ranging from 3 to 24 months of age, within distinct phases of the day, namely zeitgeber times (ZTs). Then, we evaluated CR immunolabeling through design-based stereological cell estimation. We observed distinct daily rhythms of CR expression in the IGL and in both the retinorecipient (vLGNe) and non-retinorecipient (vLGNi) portions of the vLGN. In the ZT 6, the middle of the light phase, the CR cells are reduced with aging in the IGL and vLGNe. In the ZT 12, the transition between light to dark, an age-related CR loss was found in all nuclei. While CR expression predominates in specific spatial domains of vLGN, age-related changes appear not to be restricted at particular portions. No alterations were found in the dark/light transition or in the middle of the dark phase, ZTs 0, and 18, respectively. These results are relevant in the understanding of how aging shifts the phenotype of visual related cells at topographically organized channels of visuomotor and circadian processing.

Factors Associated with Schistosoma mansoni Infestation in Northeast Brazil: A Need to Revisit Individual and Community Risk Factors.

In Brazil, schistosomiasis continues to be an important health issue. The aim of this study was to identify factors associated with Schistosoma mansoni infestation. A cross-sectional study was performed to assess factors associated with S. mansoni endemicity in a municipality in Northeast Brazil with a history of reporting schistosomiasis. Participants were divided into four groups: 1) new S. mansoni cases (n = 44), 2) past history of S. mansoni treatment (n = 78), 3) immediate neighbors (n = 158), and 4) nearby controls (n = 35). Multiple comparisons analysis was performed. Subjects had a mean of 6.6 ± 3.9 years of education, and no difference was observed regarding family income (one-way analysis of variance, P = 0.215). A total of 95.9% of the individuals had rudimentary cesspit as sanitary wastewater. The mean body mass index was 28.3 ± 5.1, with 41.0% and 24.1% overweight and obesity, respectively. Of note, 28.9% of adults had hypertension. Hemoglobin, mean corpuscular volume, and mean corpuscular hemoglobin were higher in the recent S. mansoni treated group (Wilks' lambda, P < 0.001). Male gender was more prevalent in new S. mansoni cases (likelihood ratio, P < 0.001), close proximity to water collections was a risk for S. mansoni infestation (likelihood ratio, P < 0.001), and a better hematological status was observed in individuals recently treated with praziquantel. This study indicates the need to maintain surveillance for S. mansoni in low-transmission areas and the need to establish community-based interventions to control transmission.

Effect of light and sucrose on photoautotrophic and photomixotrophic micropropagation of Physalis angulata / Efeito da luz e sacarose na micropropagação fotoautotrófica e fotomixotrófica de Physalis angulata

The biotechnological interest in genus Physalis has increased in the last decades, however, there are still few micropropagation studies of this genus. The objective of this study was to evaluate P. angulata photoautotrophic and photomixotrophic micropropagation with gas exchange under seven light spectra and five concentrations of sucrose. Lighting were yellow, blue, white, red, green, red + blue LEDs and natural light filtered by mesh. Sucrose concentrations were 0, 7.5, 15, 22.5 and 30 g.L-1. Phytotechnical, anatomical features and photopigment contents were evaluated through stem and root segment length, leaf number, leaf area, chlorophyll a and b contents, carotenoids, adaxial epidermis, palisadic and spongy parenchyma and abaxial epidermis. The data were compared by Scott-Knott's mean test and principal components analysis using the R software. Comparing the variables within lighting types, it was observed that only the screen treatment, screen-filtered natural illumination, obtained assessment in all variables. Comparing the levels of sucrose, it was observed that the treatment 15 g.L-1 sucrose obtained the highest number of averages with maximum evaluation. It was concluded that the natural light filtered by screen with 50% of shading allowed the photoautotrophic micropropagation of P. angulata. Better development results were observed in photomixotrophic micropropagation with 15 g.L-1 of sucrose.

O interesse biotecnológico em Physalis aumentou nas últimas décadas, porém, ainda existem poucos trabalhos de micropropagação desse gênero. Objetivou-se avaliar sua micropropagação fotoautotrófica e fotomixotrófica com troca gasosa sob sete tipos de iluminação e cinco concentrações de sacarose. Foram utilizados LEDs amarelo, azul, branco, vermelho, verde, vermelho + azul e luz natural filtrada por malha. As concentrações de sacarose foram 0, 7,5, 15, 22,5 e 30 g.L-1. Características fitotécnicas, anatômicas e teor de fotopigmentos foram avaliados através de comprimento de segmento de caule e raíz, número de folhas, área foliar, teores de clorofilas a e b, carotenoides, epiderme adaxial, parênquimas paliçádico e esponjoso e epiderme abaxial. Os dados foram comparados por teste de média Scott-Knott e análise de componentes principais utilizando-se o software R. Comparando-se as variáveis dentro de tipos de iluminação, observou-se que apenas o tratamento screen, iluminação natural filtrada por malha, obteve avaliação máxima em todas as variáveis. Comparando-se os níveis de sucrose, observou-se que o tratamento 15 g.L-1 sacarose obteve o maior número de médias com avaliação máxima. Concluiu-se que a luz natural filtrada por tela com 50% de sombreamento permitiu a micropropagação fotoautotrófica de P. angulata. Observou-se melhores resultados de desenvolvimento na micropropagação fotomixotrófica com 15 g.L-1 de sacarose.

Effect of Air-Particle-Abrasion Protocols on Surface Roughness and Early Biofilm Formation of Zirconia.

PURPOSE: The air-particle-abrasion on zirconia in the gingival area of connectors and pontics in fixed partial dentures appears to increase fracture resistance. This study evaluated 'in situ' biofilm formation on the zirconia surface after different air-particle-abrasion protocols. MATERIALS AND METHODS: Ninety sintered blocks (5 × 5 × 2 mm) of yttrium partially stabilised zirconia (Y-TZP) were obtained and randomised among nine groups according to the factors 'type of particle' (Alumina 50 and 110 µm; Cojet and Rocatec) and 'pressure' (2.5 and 3.5 bar) used for sandblasting for 10 s. The surface roughness (Ra/Rz) was measured before and after sandblasting. For the in-situ analyses, custom-made removable intraoral devices n = 10 with one sample of each group attached to the buccal area were used by volunteers for 8 h at night. The specimens were analysed under confocal microscopy to quantify both biovolume and thickness of the initial biofilm formed. One-way analysis of variance (ANOVA) and Dunnett's tests were performed (5%). RESULTS: The roughness values ranged from 0.05 to 0.39 µm for Ra and from 0.35 to 2.11 µm for Rz, p = 0.00. Mean biofilm thickness ranged from 0.06 and 0.54 µm (p = 0.005), while the biovolume values were between 0.02 and 0.61 µm3/µm2 (p = 0.002). Values statistically significant for biofilm thickness and biovolume were found in groups sandblasted with Rocatec using 3.5 bar. CONCLUSION: In order to increase the fracture resistance of zirconia fixed partial dentures (FPDs), the air particle abrasion of zirconia with SiO2 (110 µm/3.5 bar), in the gingival area of connectors and pontics, should be avoided.

Lean thinking by integrating with discrete event simulation and design of experiments: an emergency department expansion.

BACKGROUND: Many management tools, such as Discrete Event Simulation (DES) and Lean Healthcare, are efficient to support and assist health care quality. In this sense, the study aims at using Lean Thinking (LT) principles combined with DES to plan a Canadian emergency department (ED) expansion and at meeting the demand that comes from small care centers closed. The project's purpose is reducing the patients' Length of Stay (LOS) in the ED. Additionally, they must be assisted as soon as possible after the triage process. Furthermore, the study aims at determining the ideal number of beds in the Short Stay Unit (SSU). The patients must not wait more than 180 min to be transferred. METHODS: For this purpose, the hospital decision-makers have suggested planning the expansion, and it was carried out by the simulation and modeling method. The emergency department was simulated by the software FlexSim Healthcare®, and, with the Design of Experiments (DoE), the optimal number of beds, seats, and resources for each shift was determined. Data collection and modeling were executed based on historical data (patients' arrival) and from some databases that are in use by the hospital, from April 1st, 2017 to March 31st, 2018. The experiments were carried out by running 30 replicates for each scenario. RESULTS: The results show that the emergency department cannot meet expected demand in the initial planning scenario. Only 17.2% of the patients were completed treated, and LOS was 2213.7 (average), with a confidence interval of (2131.8-2295.6) min. However, after changing decision variables and applying LT techniques, the treated patients' number increased to 95.7% (approximately 600%). Average LOS decreased to 461.2, with a confidence interval of (453.7-468.7) min, about 79.0%. The time to be attended after the triage decrease from 404.3 min to 20.8 (19.8-21.8) min, around 95.0%, while the time to be transferred from bed to the SSU decreased by 60.0%. Moreover, the ED reduced human resources downtime, according to Lean Thinking principles.