Effect of an aqueous 4% titanium tetrafluoride solution on preventing caries in orthodontic patients: a controlled clinical trial.

INTRODUCTION: Titanium tetrafluoride (TiF4) is a fluoride compound that, when is applied over enamel, promotes a protection against demineralization through a titanium dioxide (TiO2) acid-resistant coat. OBJECTIVES: This study sought to verify the hypothesis that a single application of 4% TiF4 increases the resistance of enamel to dental demineralization in orthodontic patients. MATERIALS AND METHODS: This controlled clinical trial followed CONSORT guidelines and investigated the prevention of enamel demineralization, fluoride retention, and the presence of a Ti layer after TiF4 application on banded teeth exposed to clinical cariogenic biofilm. Forty premolars were divided into a control group (CG; n = 20) and a test group (TG; n = 20). Teeth from both groups received prophylaxis and orthodontic bands with a cariogenic locus. In the TG, all teeth additionally underwent aqueous 4% TiF4 solution application after prophylaxis before being banded. After one month, teeth from both groups were extracted and prepared to assess the microhardness, fluoride retention, and evaluation of the Ti coating over the enamel surface. All data were analyzed with a paired Student's t-test (p<0.05). RESULTS: Enamel microhardness and fluoride uptake were higher in TG than in CG, while the Ti layer could be seen over TG teeth that received TiF4 application. CONCLUSION: Under clinical circumstances, the 4% aqueous TiF4 solution was effective in preventing enamel mineral loss through increasing the enamel resistance to dental demineralization, enhancing its microhardness and fluoride uptake, and forming a Ti coat.

Effect of an aqueous 4% titanium tetrafluoride solution on preventing caries in orthodontic patients: a controlled clinical trial

ABSTRACT Introduction: Titanium tetrafluoride (TiF4) is a fluoride compound that, when is applied over enamel, promotes a protection against demineralization through a titanium dioxide (TiO2) acid-resistant coat. Objectives: This study sought to verify the hypothesis that a single application of 4% TiF4 increases the resistance of enamel to dental demineralization in orthodontic patients. Materials and Methods: This controlled clinical trial followed CONSORT guidelines and investigated the prevention of enamel demineralization, fluoride retention, and the presence of a Ti layer after TiF4 application on banded teeth exposed to clinical cariogenic biofilm. Forty premolars were divided into a control group (CG; n = 20) and a test group (TG; n = 20). Teeth from both groups received prophylaxis and orthodontic bands with a cariogenic locus. In the TG, all teeth additionally underwent aqueous 4% TiF4 solution application after prophylaxis before being banded. After one month, teeth from both groups were extracted and prepared to assess the microhardness, fluoride retention, and evaluation of the Ti coating over the enamel surface. All data were analyzed with a paired Student's t-test (p<0.05). Results: Enamel microhardness and fluoride uptake were higher in TG than in CG, while the Ti layer could be seen over TG teeth that received TiF4 application. Conclusion: Under clinical circumstances, the 4% aqueous TiF4 solution was effective in preventing enamel mineral loss through increasing the enamel resistance to dental demineralization, enhancing its microhardness and fluoride uptake, and forming a Ti coat.

RESUMO Introdução: O tetrafluoreto de titânio (TiF4) é um composto fluoretado que, quando aplicado sobre o esmalte dentário, promove uma proteção contra desmineralização, por meio da formação de uma camada ácido-resistente de dióxido de titânio (TiO2). Objetivos: O presente estudo buscou verificar a hipótese de que uma única aplicação de TiF4 a 4% aumenta a resistência do esmalte dentário à desmineralização, em pacientes ortodônticos. Material e Métodos: Esse ensaio clínico controlado seguiu as diretrizes do CONSORT e investigou a prevenção da desmineralização do esmalte, retenção de flúor e a presença de uma camada de titânio após a aplicação do TiF4 em dentes bandados expostos ao biofilme cariogênico clínico. Quarenta pré-molares foram divididos em dois grupos: controle (GC; n = 20) e teste (GT; n = 20). Dentes de ambos os grupos receberam profilaxia e bandas ortodônticas com nicho cariogênico. No GT, todos os dentes também foram submetidos a aplicação de solução aquosa de TiF4 4 após profilaxia, antes de serem bandados. Após um mês, os dentes de ambos os grupos foram extraídos e preparados para avaliar a microdureza, retenção de flúor e avaliação da camada de titânio sobre a superfície do esmalte. Todos os dados foram analisados pelo teste t pareado (p<0,05). Resultados: A microdureza do esmalte e a absorção de flúor foram mais elevadas no GT do que no GC, enquanto uma camada de titânio pôde ser observada sobre os dentes do GT, que receberam aplicação TiF4. Conclusão: Em circunstâncias clínicas, a solução de TiF4 a 4% foi eficaz na prevenção da perda mineral do esmalte, por meio do aumento da resistência à desmineralização dentária, aumentando sua microdureza e absorção de flúor, e formando uma camada protetora de titânio.

Stem cells from adipose tissue improve the time of wound healing in rats

ABSTRACT PURPOSE: To evaluate the Adipose Stem Cells (ACS) therapy efficacy on the time and quality of wound healing process in rats. METHODS: Nine male Wistar rats were randomly distributed into three groups I) 7 days of healing; II) 14 days of healing; III) 21 days of healing. Four incisions were made on the dorsal surface of each rat and then treated with intralesional ACS, meloxicam, and no treatment and ACS+meloxicam. Macroscopic evaluation was measured by percentage of healing and histopathological by hematoxylin-eosin was performed. RESULTS: All groups have the wound reduced during the three weeks (p<0.001) and after 14 days of healing had greater reduction than others. Wounds treated with ASC had accelerated healing in relation to no treatment and only meloxicam (p<0.001), excepting the ASC+Meloxicam that was similar (p=0.13). There was no difference in histopathological analysis between lesions. CONCLUSION: Adipose stem cell have benefits in reducing time of healing of experimental model of wound in rats, observed 7 days of after application.

Stem cells from adipose tissue improve the time of wound healing in rats.

PURPOSE:: To evaluate the Adipose Stem Cells (ACS) therapy efficacy on the time and quality of wound healing process in rats. METHODS:: Nine male Wistar rats were randomly distributed into three groups I) 7 days of healing; II) 14 days of healing; III) 21 days of healing. Four incisions were made on the dorsal surface of each rat and then treated with intralesional ACS, meloxicam, and no treatment and ACS+meloxicam. Macroscopic evaluation was measured by percentage of healing and histopathological by hematoxylin-eosin was performed. RESULTS:: All groups have the wound reduced during the three weeks (p<0.001) and after 14 days of healing had greater reduction than others. Wounds treated with ASC had accelerated healing in relation to no treatment and only meloxicam (p<0.001), excepting the ASC+Meloxicam that was similar (p=0.13). There was no difference in histopathological analysis between lesions. CONCLUSION:: Adipose stem cell have benefits in reducing time of healing of experimental model of wound in rats, observed 7 days of after application.

Tratamento percutâneo da insuficiência mitral por MitraClip®: relato dos dois primeiros procedimentos no Brasil / Percutaneous treatment of mitral regurgitation by MitraClipTM: report on the first two procedures in Brazil

O sistema MitraClip® foi recentemente aprovado para uso clínico no Brasil para o tratamento percutâneo da insuficiência valvar mitral. Esse dispositivo se baseia na cirurgia de Alfieri, criando um orifício duplo pela união central das duas cúspides da valva mitral. Descrevemos aqui os dois primeiros procedimentos realizados em nosso meio utilizando esse dispositivo. Tratam-se de duas pacientes do sexo feminino, consideradas de alto risco cirúrgico pela idade avançada e pela presença de comorbidades, portadoras de insuficiência mitral degenerativa por prolapso/flail associado à rotura de cordoalhas. Nos dois casos, obteve-se redução expressiva da intensidade da regurgitação mitral com a utilização do MitraClip®, demonstrando o grande potencial dessa tecnologia inovadora para o tratamento percutâneo da insuficiência valvar mitral.

The MitraClipTM system has been recently approved for clinical use in Brazil for percutaneous treatment of mitral valve regurgitation. This device is based on the Alfieri surgical procedure, creating a double orifice by bringing together the central segments of the two mitral valve cusps. This report describes the first two procedures performed in Brazil using this device. Two female patients considered to be at high surgical risk due to advanced age and presence of comorbidities were treated, with degenerative mitral regurgitation due to prolapse/flail, associated with chordae tendineae rupture. In both cases, significant mitral regurgitation intensity reduction was obtained using the MitraClipTM, demonstrating the great potential of this innovative technology for the percutaneous treatment of mitral valve regurgitation.

Choosing a revascularization strategy in patients with diabetes and stable coronary artery disease: a complex decision.

Diabetes mellitus is associated with well-known increases in cardiovascular morbidity and mortality. In diabetics with stable coronary artery disease, the best therapeutic option is widely discussed. Current studies comparing surgical to percutaneous revascularization have been unable to definitely demonstrate any significant advantage of one strategy over the other regarding the prevention of cardiac death or acute myocardial infarction. Therefore, even taking into account clinical and angiographic information as well as the risks determined by each type of treatment, the decision regarding the best therapeutic strategy in diabetics with stable coronary artery disease is still complex.

Impact of diabetes on five-year outcomes of patients with multivessel coronary artery disease.

BACKGROUND: Diabetes mellitus is a major cause of coronary artery disease. Despite improvement in the management of patients with stable coronary artery disease, diabetes remains a major cause of increased morbidity and mortality. Although coronary artery bypass grafting surgery (CABG) and percutaneous coronary intervention are widely used, no conclusive evidence exists that either treatment modality is better than medical therapy alone for the treatment of stable single- or multivessel coronary disease in patients with diabetes. METHODS: We compared medical therapy, percutaneous coronary intervention, and CABG in 499 diabetic patients (38.5%) and 799 nondiabetic patients (61.5%) with single- or multivessel coronary disease. The composite primary endpoint was cardiac-related death, Q-wave myocardial infarction, or refractory angina requiring revascularization. RESULTS: We treated 1,298 patients with either CABG (n = 524), percutaneous coronary intervention (n = 378), or medical therapy (n = 396). More deaths occurred among patients with diabetes than among patients without diabetes, regardless of which option was used (p < 0.001). When treatment modalities were stratified according to the number of diseased vessels, CABG was shown to be more beneficial for patients with diabetes and multivessel disease than for patients with diabetes and single-vessel disease (p < 0.001). However, when stratified by treatment, patients with diabetes receiving medical therapy had a worse prognosis than patients with diabetes treated with CABG (p = 0.005). CONCLUSIONS: All three therapeutic regimens resulted in high rates of cardiac-related deaths among patients with diabetes compared with patients without diabetes. Moreover, we observed better outcomes among patients with diabetes and multivessel coronary artery disease undergoing CABG regarding the primary endpoint at 5-year follow-up.

Titanium penetration in human enamel after TiF4 application.

The TiF4 application produces a titanium coating on enamel surface, reducing solubility in presence of cariogenic challenge. However, it is not established if this titanium also penetrates inside the enamel. The aim of this study was to evaluate in vitro the presence of this superficial coat and titanium penetration into human sound and decayed enamel after TiF4 application. Twenty-four unerupted third molars were mesiodistally cut and divided into two groups (GA--sound and GB--artificial decayed). After a 4% TiF4 application, each sample was fractured longitudinally (occlusal-cervical). Through microprobe analysis with energy dispersive spectrometer (EDS), titanium penetration could be observed inside the enamel. The McNemar test (p=0.267) showed that there was no difference between the groups analyzed regarding to titanium penetration, although in group A the titanium penetrated more deeply (Wilcoxon test, p=0.047). It could be concluded that there was no difference between the groups regarding the titanium penetration, but titanium penetrated more deeply into sound enamel compared to artificially decayed enamel.

Concentração de fluoreto da urina em função da presença de cimento de ionômero de vidro na cavidade bucal / Urine fluoride concentration in the presence of glass ionomer cement in oral cavity

O presente estudo procurou verificar se há alteração da razão fluoreto/creatinina a nível urinário de 23 crianças, com idades compreendidas entre 7 a 12 anos, que tiveram seus dentes obturados, conforme a técnica do tratamento restaurador atraumático (ART). A média das superfícies obturadas foi de 0,761 ± 0,571 cm². Durante o período do estudo, as crianças mantiveram seus hábitos de higiene bucal e de alimentação, não fazendo uso de produtos fluoretados utilizados em aplicação profissional. Para a avaliação da concentração do fluoreto, de cada participante do estudo, foi colhido o volume total da primeira urina do dia anterior à restauração dos seus dentes, e do terceiro, do sétimo e do trigésimo dia após este ato. Os métodos do Eletrodo-Ion-Seletivo e da Cromatografia de Ion foram utilizados para a análise dos níveis de fluoreto; enquanto que para a análise dos teores de creatinina, utilizou-se a espectrofotometria. O teste não paramétrico de Kruskal-Wallis foi aplicado na avaliação dos resultados, não sendo detectada qualquer alteração dos níveis do fluoreto urinário, em função da presença de cimento de ionômero de vidro na cavidade bucal dos respectivos participantes. Diante desta conclusão é reconhecida a necessidade de um estudo nesta área, particularmente com vistas à ocorrência de fluorose

Myxoma of the mitral valve

Only rarely do myxomas originate from the mitral valve. This is the report of a 49-year-old woman presenting with congestive heart failure. The diagnosis of an intracardiac tumor involving the anterior cuspid of the mitral valve was mode by transesophageal echocardiography. The patient underwent surgery for tumor resection and plasty of the valve was made with reconstruction and preservation of the valve. The diagnosis of myxoma was confirmed by histology. This is the 23rd case of myxoma of the mitral valve reported in the literature.

Dissecção de Artéria coronária sem infarto agudo do miocárdio / Coronary artery dissection without acute myocardial infarction

A 57 year-old-man with acute aortic dissection (DeBakey type I) who developed right coronary artery dissection without acute myocardial infarction. He was successful surgically treated and became asymptomatic.

Cirurgia de revascularização miocárdica na lesão do tronco da coronária esquerda em pacientes acima de 65 anos de idade / Coronary Artery Bypass Surgery in Patients Aged 65 Years and Older With Left Main Coronary Artery Disease

PURPOSE--To study the short and long-term follow-up of patients with left main coronary artery disease (LMCAD) and age over 65 years, by comparing the results with patients under 65 years-old. METHODS--Twenty-two patients with LMCAD and mean age of 69 +/- 3.5 years (group I) were underwent isolated coronary artery bypass grafting (CABG) and compared to 31 patients with LMCAD, mean age of 54 +/- 7 years (group II), who also underwent isolated CABG. The life-table Kaplan-Meyer method was used to estimate the post-operative survival. The chi-square and Student "t" test were used when necessary. RESULTS--Despite higher operative mortality in group I (9.1 x 3.2), the difference was statistically not significant. The operative morbidity was similar in both groups. Actuarial survival at 4 years was 85 in group I and 95 in group II. Actuarial survival free of cardiac events was 69 in group II and 75 in group II. CONCLUSION--The CABG is well tolerated and had low morbidity and acceptable mortality in old patients with LMCAD. The long-term survival in these patients was very similar to the younger patients.

Avaliaçäo radiológica das evidências de afrouxamento na prótese de Müller com haste curva / Radiological evaluation of evidences of loosening Müller prosthesis with curved stem

Os autores apresentam uma análise clínica e radiológica de 17 próteses de quadril do tipo Müller com haste curva, com follow-up médio de 9,7 anos. A análise radiológica leva em consideraçäo a alteraçäo de posiçäo dos componentes acetabular e femoral, bem como a presença de linha radiolucente no fêmur e acetábulo. O método empregado na avaliaçäo radiológica é o descrito por Sutherland, que se mostra útil também na determinaçäo da posiçäo do componente do novo acetábulo a ser colocado em caso de revisäo