Exploring the Potential of Heteroatom-Doped Graphene Nanoribbons as a Catalyst for Oxygen Reduction.

In this study, we created a series of N, S, and P-doped and co-doped carbon catalysts using a single graphene nanoribbon (GNR) matrix and thoroughly evaluated the impact of doping on ORR activity and selectivity in acidic, neutral, and alkaline conditions. The results obtained showed no significant changes in the GNR structure after the doping process, though changes were observed in the surface chemistry in view of the heteroatom insertion and oxygen depletion. Of all the dopants investigated, nitrogen (mainly in the form of pyrrolic-N and graphitic-N) was the most easily inserted and detected in the carbon matrix. The electrochemical analyses conducted showed that doping impacted the performance of the catalyst in ORR through changes in the chemical composition of the catalyst, as well as in the double-layer capacitance and electrochemically accessible surface area. In terms of selectivity, GNR doped with phosphorus and sulfur favored the 2e- ORR pathway, while nitrogen favored the 4e- ORR pathway. These findings can provide useful insights into the design of more efficient and versatile catalytic materials for ORR in different electrolyte solutions, based on functionalized carbon.

Genetic and phenotypic parameters for sexual precocity and parasite resistance traits in Nellore cattle.

Indicator traits of sexual precocity are widely used as selection criteria for the genetic improvement of beef cattle; however, the impact of selection for these traits on resistance to endoparasites and ectoparasites is unknown. Therefore, this study aimed to estimate the genetic and phenotypic parameters for indicator traits of sexual precocity and parasite resistance in Nellore cattle. The sexual precocity traits evaluated were probability of first calving (PFC) and scrotal circumference at 12 and 18 months of age (SC12 and SC18). The resistance-related traits included tick (TC), gastrointestinal nematode egg (NEC), and Eimeria spp. oocyst (EOC) counts. (Co)variance components were estimated by Bayesian inference using multitrait animal models. The mean heritabilities for PFC, SC12, SC18, TC, NEC, and EOC were 0.23, 0.38, 0.42, 0.14, 0.16, and 0.06, respectively, and suggest that selection will change the mean values of these traits over time. The genetic and phenotypic correlations for most pairs formed by a precocity and a resistance trait were not different from zero, suggesting that selection for sexual precocity traits will not result in changes in resistance traits. Thus, selection for indicator traits of sexual precocity does not elicit unfavorable correlated responses in resistance to endoparasites and ectoparasites, and joint selection aimed at improving these traits can be performed using multitrait selection methods, when necessary.

Radiographic measurements of the hind limbs in capuchin monkeys (Sapajus spp.).

BACKGROUND: Radiographic measurements are a useful tool to assess skeletal health and development in primates. This study aimed to perform radiographic measurements of hind limbs in capuchin monkeys. METHODS: Twelve Sapajus spp. were used; ten adults and two sub-adults, nine females and three males. RESULTS AND CONCLUSIONS: The pelvimetry showed that the pelvic inlet area presented mean values of 7.63, 10.23, and 5.43 cm2 for adult males, adult females, and sub-adult females, respectively. The mean inclination angle was 129.45° and the mean values for the mechanical lateral proximal and distal femoral angles were 102.32° and 90.93°, respectively. The mean values for the anatomic lateral proximal and distal femoral angles were 104.59° and 85.98°, respectively. In conclusion, the radiographic measurements proved feasible for hind limb evaluation in Sapajus spp. and can be used for comparison with animals presenting orthopedic lesions.

Computed tomography and anatomy of the abdominal structures in the giant anteater (Myrmecophaga tridactyla).

The giant anteater (Myrmecophaga tridactyla) is the largest of the Neotropical vermilinguans. This animal is the second mammal most frequently run over on the roads of Cerrado biome, Brazil. Therefore, it is pivotal to know the anatomy of this species to contribute to the clinical care of these animals. Thus, the aim of this study was to identify the anatomical structures in the abdominal region of the giant anteater using computed tomography (CT). For this, the tomographic analysis was performed in sequential order in the craniocaudal direction in five giant anteaters. Moreover, four giant anteater corpses were used for anatomical studies, where two corpses were sectioned in cross sections of approximately 3 cm each, and two animals were dissected to identify the abdominal organs. The association between CT and anatomical study allowed the visualization of anatomical structures found in the abdominal cavity, such as the topographic anatomy facilitates the identification of organs on CT images. The findings of this study demonstrated that CT is a good technique to provide detailed information about the anatomical structures in the abdominal cavity and that this study can be used as CT and anatomical reference for veterinarians who care for wild animals.

Using Palladium and Gold Palladium Nanoparticles Decorated with Molybdenum Oxide for Versatile Hydrogen Peroxide Electroproduction on Graphene Nanoribbons.

Electrocatalytic production of H2O2 via a two-electron oxygen reduction reaction (ORR-2e-) is regarded as a highly promising decentralized and environmentally friendly mechanism for the production of this important chemical commodity. However, the underlying challenges related to the development of catalytic materials that contain zero or low content of noble metals and that are relatively more active, selective, and resistant for long-term use have become a huge obstacle for the electroproduction of H2O2 on commercial and industrial scales. The present study reports the synthesis and characterization of low metal-loaded (≤6.4 wt %) catalysts and their efficiency in H2O2 electroproduction. The catalysts were constructed using gold palladium molybdenum oxide (AuPdMoOx) and palladium molybdenum oxide (PdMoOx) nanoparticles supported on graphene nanoribbons. Based on the application of a rotating ring-disk electrode, we conducted a thorough comparative analysis of the electrocatalytic performance of the catalysts in the ORR under acidic and alkaline media. The proposed catalysts exhibited high catalytic activity (ca. 0.08 mA gnoble metal-1 in an acidic medium and ca. 6.6 mA gnoble metal-1 in an alkaline medium), good selectivity (over 80%), and improved long-term stability toward ORR-2e-. The results obtained showed that the enhanced ORR activity presented by the catalysts, which occurred preferentially via the two-electron pathway, was promoted by a combination of factors including geometry, Pd content, interparticle distance, and site-blocking effects, while the electrochemical stability of the catalysts may have been enhanced by the presence of MoOx.

Industry involvement in rheumatology consensus-based recommendations: a systematic review.

Consensus-based recommendations guide standards of care for clinical practice. Pharmaceutical industry involvement in producing such recommendations might undermine their objectivity. We did a systematic review of rheumatology consensus-based recommendations that were published in English from 2000 to 2020. We compared those that were endorsed by major professional societies to those that were sponsored by industry using the validated Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument. Of 234 consensus-based recommendation projects, 51 (22%) were endorsed by major societies and 74 (32%) were sponsored by the pharmaceutical industry. Among industry-sponsored projects, the sponsor was involved in the consensus-based process in 21 (28%), provided a medical writer in 12 (16%), offered honoraria for participation in five (7%), and was allowed to approve the final draft of one project. When compared with projects endorsed by major societies, industry-sponsored projects were less likely to have a high quality assessment on the AGREE II instrument. These results suggest that industry sponsorship of consensus-based recommendations is common in projects that do not receive endorsement by major societies. Such projects are often of lower quality than guidelines endorsed by major professional societies. Medical journals should consider steps to encourage greater rigour of development and to limit undue influence by industry sponsors.

Phononic Bandgap Optimization in Sandwich Panels Using Cellular Truss Cores.

The development of custom cellular materials has been driven by recent advances in additive manufacturing and structural topological optimization. These contemporary materials with complex topologies have better structural efficiency than traditional materials. Particularly, truss-like cellular structures exhibit considerable potential for application in lightweight structures owing to their excellent strength-to-mass ratio. Along with being light, these materials can exhibit unprecedented vibration properties, such as the phononic bandgap, which prohibits the propagation of mechanical waves over certain frequency ranges. Consequently, they have been extensively investigated over the last few years, being the cores for sandwich panels among the most important potential applications of lattice-based cellular structures. This study aims to develop a methodology for optimizing the topology of sandwich panels using cellular truss cores for bandgap maximization. In particular, a methodology is developed for designing lightweight composite panels with vibration absorption properties, which would bring significant benefits in applications such as satellites, spacecraft, aircraft, ships, automobiles, etc. The phononic bandgap of a periodic sandwich structure with a square core topology is maximized by varying the material and the geometrical properties of the core under different configurations. The proposed optimization methodology considers smooth approximations of the objective function to avoid non-differentiability problems and implements an optimization approach based on the globally convergent method of moving asymptotes. The results show that it is feasible to design a sandwich panel using a cellular core with large phononic bandgaps.

Joint Corticosteroid Injection Associated With Higher Physical Therapy Compliance in Knee Osteoarthritis.

Background Knee corticosteroid injection (KCSI) and physical therapy (PT) are two efficacious treatments for knee osteoarthritis (KOA). However, poor adherence to PT in resource-limited communities might limit its effectiveness. KCSI prior to PT might improve adherence in this population. Methodology This was a retrospective cohort analysis of patients referred to PT for KOA from January 01, 2018 to December 31, 2019 from an adult primary care resident clinic in Hartford, Connecticut, USA. Patients were divided into two groups, namely, those who had a KCSI around the time of the referral versus those who did not. PT adherence was evaluated in both groups. Results A total of 143 patients referred to PT were selected, and 11 patients were excluded. In total, 38/132 patients had a KCSI within a four-month window of the PT referral. Patients were mostly Hispanic (no injection 79.8% vs. injection 78.9%) females (80.9% vs. 71.1%), the average age was in the 60s, and over 90% were insured by either Medicaid or Medicare. In the injection group, 18/38 patients completed at least one PT visit (47.4%) versus 21/94 patients (22.3%) in the noninjection group. The odds ratio of undergoing PT was 1.38 (95% confidence interval [CI] = 1.14-1.69; p = 0.002), and the rate ratio of PT visits was 2.50 (95% CI = 1.82-3.42; p = 1.36 × 10-8), both adjusted for age, sex, and severity. Among those who attended at least one session, the mean number of PT visits was 5.4 in both injection and noninjection groups (median 5 versus 4).  Conclusions In a predominantly Hispanic patient population, those who underwent KCSI were more likely to undergo PT and, as a group, attend more sessions.

Absenteísmo nas consultas de especialidades clínicas em um Hospital 100% SUS / Absenteeism in clinical specialty consultations in a Hospital 100% SUS

Os recursos do serviço público de saúde são limitados, e por isso não se consegue dar conta das altas demandas, sejam na realização de exames, consultas com especialistas e até cirurgias. Entretanto um fator que onera o serviço é o absenteísmo dos pacientes, que gera dificuldades de gestão e impossibilita que um maior número de pacientes tenha o acesso de maneira mais rápida. A proposta do presente estudo foi quantificar a dimensão deste problema, focando especificamente nas consultas das especialidades clínicas agendadas no Hospital Nossa Senhora da Conceição (HNSC) do Grupo Hospitalar Conceição (GHC) na cidade de Porto Alegre. O estudo descritivo foi realizado com base em dados disponíveis no Sistema Administrativo do GHC. Após a obtenção dos números brutos, os dados foram tabulados e em seguida foi calculada a porcentagem do absenteísmo com o programa Excel®. O absenteísmo total no período de cinco anos ficou em 19,65%. Em números brutos deixaram de serem realizadas 230.940 consultas, somando todas as 22 especialidades clínicas. Essa alta taxa acarreta problemas ainda maiores para a gestão dos serviços de saúde, pois gera uma demanda reprimida, uma vez que o mesmo paciente que realizaria a consulta volta a necessitar do serviço, o que consequentemente também aumenta os gastos. Com isso algo muito contraditório fica evidente: faltam recursos públicos e há uma subutilização dos serviços (ao mesmo tempo em que há uma grande lista de espera). Assim é evidente a importância de uma maior eficiência nesses serviços e também que há uma grande área a ser explorada pelas inovações nos processos da administração pública. (AU)

A Mid-Ventricular Variant of Takotsubo Cardiomyopathy: A Case Study and Review of Literature.

Different variants of Takotsubo cardiomyopathy (TC) have been described recently. In the present case, we report a post-menopausal woman who had been experiencing significant emotional distress, admitted with typical chest pain, electrocardiographic changes, and elevated troponin levels. She underwent left heart catheterization that demonstrated mild non-obstructive coronary disease and mid-ventricular focal wall motion abnormality, consistent with the mid-ventricular variant of TC. One month after her discharge, a repeated echocardiogram showed preserved ejection fraction and no wall motion abnormalities. In the mid-ventricular variant, we usually observe a unique end-systolic appearance that resembles a Greek vase. It is possible that atypical patterns of left ventricle (LV) dysfunction related to TC are being underrecognized. Therefore, this case study highlights the importance of recognizing less frequent variants of TC.

Concomitant new diagnosis of systemic lupus erythematosus and COVID-19 with possible antiphospholipid syndrome. Just a coincidence? A case report and review of intertwining pathophysiology.

In the midst of the COVID-19 pandemic, further understanding of its complications points towards dysregulated immune response as a major component. Systemic lupus erythematosus (SLE) is also a disease of immune dysregulation leading to multisystem compromise. We present a case of new-onset SLE concomitantly with COVID-19 and development of antiphospholipid antibodies. An 18-year-old female that presented with hemodynamic collapse and respiratory failure, progressed to cardiac arrest, and had a pericardial tamponade drained. She then progressed to severe acute respiratory distress syndrome, severe ventricular dysfunction, and worsening renal function with proteinuria and hematuria. Further studies showed bilateral pleural effusions, positive antinuclear and antidouble-stranded DNA antibodies, lupus anticoagulant, and anticardiolipin B. C3 and C4 levels were low. SARS-Cov-2 PCR was positive after 2 negative tests. She also developed multiple deep venous thrombosis, in the setting of positive antiphospholipid antibodies and lupus anticoagulant. In terms of pathophysiology, COVID-19 is believed to cause a dysregulated cytokine response which could potentially be exacerbated by the shift in Th1 to Th2 response seen in SLE. Also, it is well documented that viral infections are an environmental factor that contributes to the development of autoimmunity; however, COVID-19 is a new entity, and it is not known if it could trigger autoimmune conditions. Additionally, it is possible that SARS-CoV-2, as it happens with other viruses, might lead to the formation of antiphospholipid antibodies, potentially contributing to the increased rates of thrombosis seen in COVID-19.

Extracorporeal Membrane Oxygenation Support in a Young Patient With COVID-19 Infection.

Critically ill patients with coronavirus disease 2019 (COVID-19) infection often require mechanical ventilation, and still many of them will progress to worsening hypoxia and death. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been used in some centers, but its role in the setting of COVID-19 infection is still unclear to date. We describe a case of a young female patient with obesity but otherwise no other underlying medical conditions who was admitted with respiratory failure secondary to COVID-19. Given her severe acute respiratory distress syndrome (ARDS) with refractory hypoxemia, she was treated with VV-ECMO. After a prolonged hospital course, she improved clinically and was able to have VV-ECMO explanted, after 18 days of extracorporeal therapy. The complexity of ECMO therapy requires a well-trained multidisciplinary team present only at expert centers. The high resource cost is a challenge to the health care system in times of a global pandemic. Considering the limitations of this resource-intensive therapy, clinical judgment is crucial to decide whether ECMO is an appropriate option for the patient. However, for young patients with no underlying conditions who are critically ill despite optimized mechanical ventilation, we believe that extracorporeal therapy represents a reasonable option when available.

Presumed Alcohol-Induced Ventricular Tachycardia Storm: A Case Report.

Alcohol abuse is a widely recognized cause of supra-ventricular fibrillation, but in some patients, it is also associated with ventricular arrhythmias and even sudden death. We describe a case of a 36-year-old patient who, with no risk factors for coronary disease and with a structurally normal heart, experienced two episodes of cardiac arrest five years apart, with both events occurring after significant alcohol consumption. It is important to recognize that the prognosis of alcohol-induced arrhythmias is usually good in patients who remain compliant with alcohol cessation and to avoid the misdiagnosis of "idiopathic" ventricular tachycardia/ventricular fibrillation (VT/VF).

Limitações da Avaliação Automatizada de Acessibilidade em uma Plataforma de MOOCS: Estudo de Caso de uma Plataforma Brasileira / Limitations of Automated Accessibility Evaluation in a MOOC Platform: Case Study of a Brazilian Platform

RESUMO Os Massive Open Online Courses (MOOCs) têm sido anunciados como uma ferramenta educacional promissora, impulsionando um elevado número de inscrições, de forma a viabilizar a aprendizagem de forma aberta e com ênfase na diversidade de usuários. No entanto, a literatura tem apontado a falta de acessibilidade em MOOCs. Com a intenção de aprimorar o suporte à acessibilidade de uma plataforma de MOOCs, um curso com material multiformato foi avaliado com uso de ferramentas automatizadas. Os resultados dos testes automatizados indicaram alguns problemas de acessibilidade da plataforma, que podem dificultar a participação de pessoas com deficiência, sinalizando a necessidade de projetar tais plataformas de forma inclusiva. Contudo, esse tipo de teste não é capaz de identificar áreas, funcionalidades e conteúdos relevantes dentro de uma página da web, bem como não é capaz de reconhecer diferentes papéis de usuários. O resultado é que áreas da plataforma que não são visíveis aos estudantes (como áreas de administração da plataforma e de edição dos cursos) também são avaliadas nesses testes - mesmo que não seja esse o objetivo. Por esse motivo, concluiu-se que, para avaliar o suporte à inclusão, é necessário aliar aos testes automatizados um método qualitativo. A indicação da limitação desse tipo de teste é a constatação mais importante.

ABSTRACT Massive Open Online Courses (MOOCs) have been announced as a promising educational tool, driving a high number of applications, enabling open learning with an emphasis on the diversity of users. However, literature has pointed to the lack of accessibility in MOOCs. With the intention of improving accessibility support for a MOOC platform, a multi-format course was evaluated using automated tools. The results of the automated tests indicated some accessibility problems of the platform, which can hinder the participation of people with disabilities, signaling the need to design such platforms in an inclusive way. However, this type of test is not capable of discriminate relevant areas, functionalities and contents within a web page, nor is it able to differentiate between different roles of users. The result is that platform areas that are not visible to students (such as platform administration and course editing areas) are also evaluated - even if that is not the goal. For this reason, it was concluded that, to evaluate the inclusion support, it is necessary to combine a qualitative method with the automated tests. The indication of the limitation of this type of test is the most important finding.

Surgical lung biopsy in onco-hematological patients with diffuse pulmonary infiltrates and mechanical ventilation in the ICU.

Among onco-hematological patients with acute respiratory failure (ARpF), surgical lung biopsy (SLB) could contribute to the medical management, by guiding initiation, maintenance or discontinuation of diagnostic and therapeutic interventions. The aim of the present study was to evaluate the results of SLB in these patients in an oncological center from a medium-income country, as well as analyze if this procedure is clinically useful in this context, and its impact on complications and mortality. This observational retrospective study analyzed onco-hematological patients with ARpF in the Intensive Care Unit (ICU) of a cancer center in southern Brazil between 2010-2016, who required mechanical ventilation and were submitted to open SLB. Among the studied population (n=17), the most commonly found etiology was infectious, present in ~50% of the biopsies, followed by unspecific inflammatory infiltrate acute respiratory distress syndrome and interstitial fibrosis, alveolar hemorrhage, neoplastic infiltrate and pulmonary embolism. Biopsy has led to a change of management in 63.3% of patients that were alive when results were available; however, 35% of patients succumbed prior to the pathological result. There was no requirement for re-operation or mortality attributable to the procedure. However, ICU mortality was elevated (88%). SLB in onco-hematological patients mechanically ventilated in the ICU is a safe procedure with few severe complications and that contributes for diagnosis and management in the majority of cases. Due to the high mortality of this population, controlled trials may be required to establish its benefit in mortality and ICU outcomes.

Highly Electroactive Ni Pyrophosphate/Pt Catalyst toward Hydrogen Evolution Reaction.

Robust electrocatalysts toward the resourceful and sustainable generation of hydrogen by splitting of water via electrocatalytic hydrogen evolution reaction (HER) are a prerequisite to realize high-efficiency energy research. Highly electroactive catalysts for hydrogen production with ultralow loading of platinum (Pt) have been under exhaustive exploration to make them cutting-edge and cost-effectively reasonable for water splitting. Herein, we report the synthesis of hierarchically structured nickel pyrophosphate (ß-Ni2P2O7) by a precipitation method and nickel phosphate (Ni3(PO4)2) by two different synthetic routes, namely, simple cost-effective precipitation and solution combustion processes. Thereafter, Pt-decorated nickel pyrophosphate and nickel phosphate (ß-Ni2P2O7/Pt and Ni3(PO4)2/Pt) were prepared by using potassium hexachloroplatinate and ascorbic acid. The fabricated novel nickel pyrophosphate and nickel phosphate/Pt materials were utilized as potential and affordable electrocatalysts for HER by water splitting. The detailed electrochemical studies revealed that the ß-Ni2P2O7/Pt (1 µg·cm-2 Pt) electrocatalyst showed excellent electrocatalytic performances for HER in acidic solution with an overpotential of 28 mV at -10 mA·cm-2, a Tafel slope of 32 mV·dec, and an exchange current density ( j0) of -1.31 mA·cm-2, which were close to the values obtained using the Vulcan/Pt (8.0 µg·cm-2 Pt), commercial benchmarking electrocatalyst with eight times higher Pt amount. Furthermore, the ß-Ni2P2O7/Pt electrocatalyst maintains an excellent stability for over -0.1 V versus RHE for 12 days, keeping j0 equal after the stability test (-1.28 mA cm-2). Very well-distributed Pt NPs inside the "cages" on the ß-Ni2P2O7 structure with a crystalline pattern of 0.67 nm distance to the Ni2P2O7/Pt electrocatalyst, helping the Volmer-Tafel mechanism with the Tafel reaction as a major rate-limiting step, help to liberate very fast the Pt sites after HER. The high electrocatalytic performance and remarkable durability showed the ß-Ni2P2O7/Pt material to be a promising cost-effective electrocatalyst for hydrogen production.

Genetic trends and trade-offs between growth and reproductive traits in a Nellore herd.

The knowledge of genetic trends and trade-offs between growth and reproductive traits might be useful to understand the evolution of these traits in livestock and natural populations of animals. We estimated the genetic trends and trade-offs between pre-weaning growth and calving intervals of Nellore animals from a commercial farm. Two-trait animal models were used to estimate covariance components and breeding values (EBV) for direct and maternal genetic effects of pre-weaning growth and direct genetic effects of calving intervals. Regression analyses were performed to examine the relationship between direct and maternal EBV of pre-weaning growth and direct EBV of calving intervals (dependent variables) and the coefficient of generation of each animal (independent variable). We also performed regression analyses to examine the relationship between direct EBV of calving intervals (dependent variables) and direct and maternal EBV of pre-weaning growth (independent variables). The genetic trends for direct and maternal genetic effect for pre-weaning growth were significant and presented genetic evolution in the studied Nellore herd. The genetic trends for the reproductive traits were also significant but indicated genetic changes in an unfavorable way. The genetic correlations between direct effects of pre-weaning growth and calving intervals traits and the genetic correlations between maternal effects of pre-weaning growth traits and direct effects of calving interval traits were not different from zero. The presence of trade-offs between the direct effects of growth and reproductive traits were confirmed through regression from direct EBV of calving intervals over EBV of pre-weaning growth traits. In addition, regression analyses showed that selection to increase pre-weaning growth also increased calving intervals. Our results showed that pre-weaning growth and calving intervals are increasing over generations and that trade-offs occurred between those traits in the studied Nellore herd.

Cirurgia mucogengival em Implantodontia / Mucogingival surgery in implant therapy

O objetivo deste trabalho foi discutir algumas técnicas de cirurgia mucogengival usadas em Implantodontia, suas indicações e o melhor momento para serem empregadas. Foram identificados quatro momentos de importância clínica na manipulação dos tecidos mucosos e suas principais técnicas cirúrgicas correspondentes: 1) antes da instalação do implante: enxerto gengival livre, e enxerto de tecido conjuntivo (para minimizar as complicações nas cirurgias de primeiro e segundo estágios); 2) durante a instalação do implante: selamento do alvéolo modificado, enxerto pediculado de tecido conjuntivo (para fechar o alvéolo), reposicionamento coronal (que pode diminuir a profundidade do vestíbulo), o reposicionamento lateral do retalho (podendo causar recessão no sítio doador), retalho palatino de espessura dividida (que evita as desvantagens das outras técnicas), e o enxerto de tecido conjuntivo subepitelial (para aumentar e manter a espessura da mucosa vestibular favorecendo a estética); 3) durante a conexão do pilar protético: retalho palatino ou incisão circular, incisão em H (que são conservadoras), retalho reposicionado apicalmente (que aumenta a gengiva queratinizada vestibular), enxerto da tuberosidade, retalho em rolo (que mantem a cor a textura, mas possui sitio doador limitado); e 4) após a conexão do pilar protético: enxertos onlay/inlay, enxerto conjuntivo envelopado, e as técnicas de recontorno gengival. Embora o cirurgião possa valer-se das técnicas de cirurgia mucogengival a qualquer tempo, uma abordagem criteriosa antes da instalação do implante ou mesmo durante sua instalação pode eliminar a necessidade de procedimentos cirúrgicos adicionais, reduzindo o custo e tempo de tratamento.

The aim of this study was to discuss some mucogingival surgery techniques for implant dentistry, their indications, and best moments for application. Four stages of clinical importance regarding mucosal tissue management were identified with their main corresponding surgical techniques: 1) before implant placement: free gingival graft and the connective tissue graft (to minimize complications in the first and second surgical stages); 2) during implant placement: modified socket seal, the pedicle connective tissue graft (to close the alveolus), coronal flap positioning (which can reduce the vestibular depth), the lateral flap positioning (which may cause recession in donor site), split-thickness palatal flap (which avoids the disadvantages of other techniques), and the subepithelial connective tissue graft (to augment and maintain the thickness of the buccal mucosa favoring aesthetics); 3) during abutment connection: palatal flap or circular incision, H-type incision (which is more conservative), the apically positioned flap (which increases the keratinized buccal gingiva), the tuberosity graft, the palatal roll flap (which keeps color and texture, but has limited donor site availability); and 4) after abutment connection: inlay/onlay grafts, the envelop connective tissue graft, and techniques for gingival recontouring. Although the surgeon can use all those mucogingival surgical techniques at any time, a careful approach before implant placement or even during its installation can eliminate the need for additional surgical procedures, reducing treatment time and costs.

Traumatic dental injury in permanent teeth: knowledge and management in a group of Brazilian school teachers.

BACKGROUND/AIM: School is a place with a high frequency of dental trauma, and several studies have shown that teachers' knowledge in how to act during acute dental emergencies is lacking. Therefore, this study aimed to assess the knowledge and actions of a group of Brazilian school teachers relative to dental trauma in permanent teeth. MATERIALS AND METHODS: A cross-sectional, observational study, from 27, schools randomized by lot was performed. All 205 teachers in the 27 schools answered a structured and self-administered questionnaire. The questionnaire contained questions about the participants' education level, work experience and first-aid training, as well as knowledge about and attitudes towards dental trauma in permanent teeth as well as their experience in dental emergency situations. RESULTS: Of the 205 teachers, 91.2% reported having no knowledge about dental trauma and 16.6% of teachers had seen cases of acute dental trauma. Among the 205 teachers, 23.9% had received first-aid training and 4.1% had been educated in dental trauma. Regarding actions of acute injuries to permanent teeth, the teachers showed a significant error rate. No association was found between the level of education and first-aid training or experience with dental trauma. In relation to the experience of the teacher, association was found when managing trauma to soft tissue. CONCLUSION: The knowledge and actions of Brazilian schoolteachers in relation to care of acute injuries in permanent teeth were inconsistent and based on unfounded concepts, beliefs and intuition, and lack of training. Continuing education of teachers in oral care due to a dental trauma should be a good plan of action.