Low-cost, safe, and effective smoke evacuation device for surgical procedures in the COVID-19 age.

BACKGROUND: Smoke is generated by energy-based surgical instruments. The airborne by-products may have potential health implications. METHODS: We developed a simple way to use de conventional surgical evacuator coupled with de electrosurgical pen attached to a 14G bladder catheter for open surgery. It was used in ten prospective patients with breast cancer. RESULTS: We notice a high reduction in surgical smoke during all breast surgery. A questionnaire was used for all participants of the surgery to answer the impression that they had about the device. The subjective impression was that the surgical smoke in contact whit the surgical team was reduced by more than 95%. CONCLUSIONS: Surgical smoke is the gaseous by-product produced by heat-generating devices in various surgical procedures. Surgical smoke may contain chemicals particles, bacteria, and viruses that are harmful and increase the risk of infection for surgeons and all the team in the operation room due to long term exposure of smoke mainly in coronavirus disease 2019 age. The adapted device described is a very simple and cheaper way to use smoke evacuators attached with the monopolar electrosurgical pen to reduce smoke exposure to the surgical team worldwide.

Organ sparing of linac-based targeted marrow irradiation over total body irradiation.

PURPOSE: Targeted marrow irradiation (TMI) is an alternative conditioning regimen to total body irradiation (TBI) before bone marrow transplantation in hematologic malignancies. Intensity-modulation methods of external beam radiation therapy are intended to permit significant organ sparing while maintaining adequate target coverage, improving the therapeutic ratio. This study directly compares the dose distributions to targets and organs at risk from TMI and TBI, both modalities conducted by general-use medical linacs at our institution. METHODS: TMI treatments were planned for 10 patients using multi-isocentric feathered volumetric arc therapy (VMAT) plans, delivered by 6 MV photon beams of Elekta Synergy linacs. The computed tomography (CT) datasets used to obtain these plans were also used to generate dose distributions of TBI treatments given in the AP/PA extended-field method. We compared dose distributions normalized to the same prescription for both plan types. The generalized equivalent uniform dose (gEUD) of Niemierko for organs and target volumes was used to quantify effective whole structure dose and dose savings. RESULTS: For the clinical target volume (CTV), no significant differences were found in mean dose or gEUD, although the radical dose homogeneity index (minimum dose divided by maximum dose) was 31.7% lower (P = 0.002) and the standard deviation of dose was 28.0% greater (P = 0.027) in the TMI plans than in the TBI plans. For the TMI plans, gEUD to the lungs, brain, kidneys, and liver was significantly lower (P < 0.001) by 47.8%, 33.3%, 55.4%, and 51.0%, respectively. CONCLUSION: TMI is capable of maintaining CTV coverage as compared to that achieved in TBI, while significantly sparing organs at risk. Improvement on sparing organs at risk permits a higher prescribed dose to the target or the maximum number of times marrow conditioning may be delivered to a patient while maintaining similar typical tissue complication rates.

The impact of endodontic irrigating solutions on the push-out shear bond strength of glass fiber posts luted with resin cements.

Resin-based restorative materials, widely used to cement posts, may be influenced by irrigants used during endodontic chemical-mechanical preparation. This study evaluated the impact of endodontic irrigating solutions and adhesive cement systems on the push-out shear bond strength of glass fiber posts to root dentin. Ninety-six bovine incisors were divided into 12 groups (4 irrigants × 3 resin cements; n = 8). Prepared canals were irrigated with saline solution, 2.5% sodium hypochlorite (NaOCl), 5.25% NaOCl, or 2% chlorhexidine gel, and posts were cemented with RelyX ARC, Panavia F, or RelyX U100. The bond strength was evaluated by means of the push-out test, and results were subjected to analysis of variance. The mean bond strength observed for the combination of 5.25% NaOCl irrigant and RelyX U100 cement was significantly lower (8.82 MPa) than the values found for the other groups (P < 0.05). The other combinations of irrigating solution and resin cement had no adverse effect on the bond strength of the glass fiber posts to dentin.

Influence of remaining coronal structure and of the marginal design on the fracture strength of roots restored with cast post and core.

OBJECTIVE: The purpose of this study was to evaluate the fracture strength of roots that were prosthetically restored with cast post and core with or without any remaining coronal structure and with different finish lines. MATERIALS AND METHODS: Sixty bovine incisors were sectioned below the cementoenamel junction, endodontically treated and randomly divided into six experimental groups (n = 10) containing teeth with or without any remaining coronal structure and with a beveled shoulder, a chanfered or a shoulder finish line design. The cast post and core were luted with dual-cured resin cement. The metal crowns were cemented with zinc phosphate cement. The specimens were subjected to a tangential compressive load (135° angle) at a crosshead speed of 0.5 mm/min until failure, using a universal testing machine. The fracture strength data were analyzed using the ANOVA and LSMeans (least square means) tests (α = 0.05). RESULTS: The data indicated that the teeth with 2 mm of remaining coronal structure showed the highest fracture strength values when compared with the teeth without any remaining structure (p < 0.05). As to the different finish line designs, the highest fracture strength values were obtained for the beveled shoulder, followed by the chanfered and then by the shoulder designs (p < 0.05). CONCLUSIONS: It may be concluded that, to increase fracture strength, a beveled shoulder and 2 mm of remaining coronal structure are the ideal conditions.

A Novel Setup Technique for Radiation Treatment of a Severely Obese Patient With a Primary Brain Tumor.

Modern external beam radiation therapy (EBRT) techniques rely on the accurate positioning of the patient using the treatment couch. These motorized couches have weight limits that have decreased over time and are not able to support severely obese patients requiring EBRT. We aimed to develop a technique to support obese patients who are above their weight tolerance while accurately delivering radiation treatment to a brain tumor. This technique was used on a patient receiving adjuvant radiation for gliosarcoma, a variant of glioblastoma. The patient was CT scanned, and the 3D conformal radiation therapy plan was created. A custom treatment couch was created using a transport stretcher, Styrofoam, a CT couch-top, and an IMRT board, which allowed for a thermoplastic mask to be used for a reproducible setup. AP and lateral portal films were taken prior to each treatment to confirm the accuracy of the manual daily setup of the patient on the custom couch. The patient received 60 Gy in 30 daily fractions of 3DCRT in a reproducible fashion. The average deviation from the isocenter fell within the 10 mm and 8 mm planning margins applied to the clinical target volume (CTV) for the initial and boost fields, respectively. The average daily shifts in the anterior-posterior (AP) direction for the patient were 7.97 (-16.19 to 12.04) mm and 1.98 mm (-1.1 to 4.3) mm for the initial and boost treatments, respectively. The average daily shifts in the superior-inferior (SI) direction were 2.2 (-5.08 to 9.04) mm and 3.88 (-2.9 to 8.0) mm for the initial and boost treatments, respectively. This novel approach allowed treatment at 60 Gy for a gliosarcoma patient who had previously been denied treatment due to his weight. By utilizing readily available materials within the department, our team was able to create a reproducible setup technique to safely treat the patient.

Hepatic artery disorders associated with alcoholism.

OBJECTIVE: We aimed to characterize the relationship between severe chronic alcoholism and hepatic arterial wall disorders in humans. METHODS: We obtained hepatic arteries from 165 patients undergoing liver transplantation who were placed into two etiological groups: an Alcoholism group and a Non-alcoholism group. We compared the age, sex, lipid profile, and histologic characteristics of the hepatic arteries (normal, reduction in luminal diameter of ≤10%, or atherosclerosis) of the participants in the two groups using multifactor analyses. RESULTS: The Alcoholism group comprised 58 men and 40 women and the Non-alcoholism group comprised 63 men and 4 women. The mean ages of the groups were 52.5 ± 9.6 years and 44.2 ± 13.8 years, respectively. There were no circulating lipid abnormalities in any of the participants. In women, arterial disorders were found at a younger age than in men. Hepatic arterial disorders were more frequent in the non-alcoholic participants, and women with alcoholism showed less arterial narrowing. CONCLUSION: The heavy consumption of alcoholic beverages is associated with a lower incidence of atherosclerosis of the hepatic artery in humans.

Health changes during Covid-19: a nationwide study with dental students.

OBJECTIVE: To assess the changes in stress levels, social behavior, dietary and parafunctional habits, oral hygiene, among other conditions perceived by dental students in Brazil during the Covid-19 pandemic and evaluated the correlations between stress level and other variables. METHODS: An online questionnaire was developed and validated. Undergraduates enrolled in private and public dental schools were recruited by convenience sampling. Data were collected on the perceived changes regarding stress levels, financial and social characteristics, dietary habits, oral hygiene, health conditions, and parafunctional habits. Quantitative variables were expressed as absolute and relative frequencies. Wilcoxon test evaluated comparisons between perceived changes, and correlations between changes in stress levels and other variables were analyzed by Spearman correlation (α = 0.05). RESULTS: A total of 638 dental students, mean age of 22.95 ± 4.10 years, participated in the study. During the pandemic, the reported stress levels increased while household income decreased (p < 0.05). Late dinners and mindless eating increased in frequency, whereas oral hygiene decreased (p < 0.05). Most of the health conditions and parafunctional habits assessed changed (p < 0.05). Perceived stress levels showed poor negative correlations with household income (rS = -0.14), poor positive correlations with the pressure to contribute financially in the household (rS = 0.19), and poor positive correlations with food choice frequency (rS = 0.15) (p < 0.05). CONCLUSIONS: Dental students reported perceived changes in stress levels, dietary habits, oral hygiene, health conditions, parafunctional habits, and social behavior. Moreover, the results showed poor correlations, as students with higher stress levels tended to have the lowest household income, feel pressured to contribute financially in the household, and present a high meal intake frequency.

Do non-clinical subjective factors influence the treatment decisionmaking of Brazilian dentists?

The literature contains little information on several non-clinical factors such as the association between graduate residency programs and the application of minimally invasive dentistry, or on dentists' clinical decision-making processes for replacing restorations for esthetic reasons. This study evaluated whether non-clinical subjective factors influence the treatment decisions made by Brazilian dentists regarding technical and esthetic matters. Dentists were invited to participate in a cross-sectional survey by answering an electronic questionnaire containing clinical cases, regarding what treatment they would select for: T1 - a molar tooth with significant crown destruction and spontaneous pain, and T2 - premolar teeth with extensive amalgam restorations and no carious lesion or associated complaint. The survey also included questions about subjective variants (sociodemographic and professional). Chi Square test and Fischer's Exact test were used toanalyzetheanswers to T1, and one-factor analysis of variance and post-hoc Tamhane were applied to T2. The significance level was set at 5% for all analyses. A total 302 professionals participated in the study. For T1, it was found that clinical decision-making was influenced by the Brazilian region of clinical practice (p=0.005). For T2, a significant association was found between increased loss of patient tooth tissues and whether the professional had completed a residency program in Operative Dentistry (p=0.035), worked in a private practice (p=0.033), or if most of his/her patients belonged to a high estimated socioeconomic level (household income above $4350) (p=0.002). In conclusion, the clinical decision-making of Brazilian dentists varies according to professional profile, mainly with relation to the replacement of restorations due to esthetic concerns.

Vários fatores não clínicos, como a associação entre programas de especialização e a aplicação da odontologia minimamente invasiva, ainda são escassos na literatura. Outro aspecto relevante é a tomada de decisão clínica do dentista quanto à substituição de restaurações em função da aparência estética. Este estudo avaliou se fatores subjetivos não clínicos influenciam na tomada de decisão clínica de dentistas brasileiros com base em questões técnicas e estéticas. Foi realizado um estudo transversal com um questionário eletrônico contendo casos clínicos que foram apresentados a uma lista de profissionais. No questionário, interrogou-se o tratamento proposto para um dente molar com destruição coronária significativa e dor espontânea (T1). Também foi questionado o tratamento proposto para dentes prémolares com extensas restaurações de amálgama e sem lesão cariosa ou queixas associadas (T2). Em seguida, foram questionadas as variantessubjetivas(sociodemográfica eprofissional). Na análise de T1, foram utilizados os testes Qui Quadrado e Exato de Fischer. Em T2, foi aplicada a análise de variância de um fator e post-hoc Tamhane. Para todas as análises, o nível de significância foi estabelecido em 5%. Um total de 302 profissionais participaram deste estudo. A tomada de decisão clínica para T1 foi influenciada pela região brasileira de prática clínica (p = 0,005). Em T2, realizar especialização em Dentística Operatória (p = 0,035), trabalhar em consultório particular (p = 0,033) e a maioria dos pacientes apresentar nível socioeconômico estimado elevado (renda familiar acima de R$10.000,00) (p = 0,002) aumentou significativamente a perda de tecidos dentários. Em conclusão, a tomada de decisão clínica dos dentistas brasileiros varia de acordo com o perfil dos profissionais, principalmente no que se refere à substituição de restaurações por questões estéticas.

ECOG-ACRIN Guideline for Contouring and Treatment of Early Stage Anal Cancer Using IMRT/IGRT.

PURPOSE: Previous anal cancer guidelines delineate target volumes similarly for all patients with squamous cell carcinoma of the anal canal and/or perianal skin (SCCA), regardless of disease stage. The purpose of this guideline is to provide customized radiation treatment recommendations for early stage (T1-2 N0 M0) anal cancer treated with intensity modulated and image guided radiation therapy (RT). METHODS AND MATERIALS: A contouring atlas and radiation treatment recommendations for the ongoing, randomized phase II trial of deintensified chemoradiation for early stage SCCA (EA2182) was created by an expert panel of radiation oncologists. A literature search was conducted to update and expand these recommendations into a guideline for routine clinical use. RESULTS: For the majority of cases, we recommend treatment in the supine, frog leg position with the use of a customized immobilization device and daily image guided RT to ensure optimal bone and soft tissue alignment. Vaginal dilators can be used daily during RT to maximize genitalia sparing. We recommend use of a 10-mm margin on the gross tumor plus including the anal complex to create the primary clinical target volume. To define the elective lymph node clinical target volume, we recommend starting with a 7-mm expansion on blood vessels, but then further refining these volumes based on the anatomic location. A 5- to 10-mm planning target volume (PTV) margin is suggested based on institutional setup and patient-specific factors. When using a simultaneous integrated boost technique, a dose of 50.4 Gy to primary PTV and 42 Gy to lymph node PTV, both delivered over 28 fractions, with chemotherapy is appropriate for early stage anal cancer. CONCLUSIONS: This guideline provides anatomic, clinical, and technical instructions to guide radiation oncologists in the planning and delivery of intensity modulated and image guided RT for early stage SCCA.

Targeted Marrow Irradiation Intensification of Reduced-Intensity Fludarabine/Busulfan Conditioning for Allogeneic Hematopoietic Stem Cell Transplantation.

Reduced-intensity conditioning (RIC) regimens frequently provide insufficient disease control in patients with high-risk hematologic malignancies undergoing allogeneic hematopoietic stem cell transplantation (HSCT). We evaluated intensification of fludarabine/busulfan (Flu/Bu) RIC with targeted marrow irradiation (TMI) in a dose escalation with expansion phase I clinical trial. TMI doses were delivered at 1.5 Gy in twice daily fractions on days -10 through -7 (dose levels: 3 Gy, 4.5 Gy, and 6 Gy), Flu (30 mg/m2 for 5 days) and Bu (area under the curve, 4800 µM*minute for 2 days). Eligible patients were age ≥18 years with high-risk hematologic malignancy and compromised organ function ineligible for myeloablative transplantation (n = 26). The median patient age was 64 years (range, 25 to 76 years). Nineteen patients (73%) had active or measurable residual disease at transplantation. One-year disease-free survival and overall survival were 55% (95% confidence interval [CI], 34% to 76%) and 65% (95% CI, 46% to 85%), respectively. Day +100 and 1 year transplantation-related mortality were 4% (95% CI, 0.6% to 27%) and 8.5% (95% CI, 2% to 32%), respectively. The 1-year cumulative incidence of relapse was 43% (95% CI, 27% to 69%). Rates of grade II-IV and III-IV acute GVHD rates were 57% (95% CI, 39% to 84%) and 22% (95% CI, 9% to 53%), respectively. Whole blood immune profiling demonstrated enrichment of central/transitional memory-like T cells with higher TMI doses, which correlated with improved survival compared with control samples from patients undergoing allogeneic HSCT. Intensification of a Flu/Bu RIC regimen with TMI is feasible with a low incidence of transplantation-related mortality in medically frail patients with advanced malignancies. The recommended phase 2 TMI dose is 6 Gy.

Influence of brushing with natural dentifrices on color change: In vitro study.

BACKGROUND: To evaluate in vitro the influence of daily brushing with the use of natural toothpastes on the color change of enamel in bovine teeth. MATERIAL AND METHODS: Four dentifrices were used, one conventional Colgate Total 12 - Clean Mint (G1), and three natural, Contented Toothpaste with Organic and Natural Ingredients (G2); Dental Toothpaste (G3) and Aliv-Gaia Toothpaste (G4). Eighty bovine teeth were distributed in four experimental groups with 20 teeth each (n = 20). The buccal enamel surface of the teeth was subjected to brushing, with the related dentifrices of each group, for 2.13 seconds three times a day, with an electric brush Oral B 5000 Professional Care. Before and after brushing, color measurement tests with a spectrophotometer were performed. The color variation was calculated using the formula ΔE = [(ΔL *) 2+ (Δa *) 2+ (Δb *)2] 1/2. The results obtained were tabulated and submitted to the Kruskal Wallis non-parametric test. RESULTS: The color change (ΔE) observed was 7.551 and p-value equal to 0.056, determining that there was no statistically significant difference between the groups. However, qualitative tests showed the clearing of all experimental groups, G3 with the greatest change, followed by G2, G1 and G4. CONCLUSIONS: The evaluated dentifrices were not able to promote color change. Key words:Dental enamel, plant extracts, saliva, artificial, dentifrices.

Reduction in pregnancies and litters in mice couples with splenectomized male.

PURPOSE: The spleen is relevant in blood purification, hematopoiesis, metabolism, and immune response to antigens, in addition to the storage and control on the release of metals and amino acids. Its functions concerning reproduction characteristics are still unknown. The objective was to study the influence of splenectomies on reproduction. METHODS: This study analyzed 25 mice couples, distributed into five groups: group 1 - control, no surgery: group 2 - control, submitted to laparotomy and laparorrhaphy only; group 3 - splenectomy in male mice; group 4 - splenectomy in female mice; group 5 - splenectomy in male and female mice. The animals were studied as regards the number of gestations and offspring generated in each gestation. RESULTS: A decrease in both the number of gestations and the number of offspring was verified in the male mice that had received a splenectomy when coupled with normal female mice. It is important to emphasize lower reproduction level when paired asplenic males with normal females, otherwise, the couples in which both mice had been splenectomized did not present change in the reproduction pattern. CONCLUSIONS: A reduction in the number of pregnancies and litters occurs in mice couples when the male mice were previously splenectomized.

Influence of different photoinitiators on the resistance of union in bovine dentin: Experimental and microscopic study.

BACKGROUND: To evaluate in vitro the influence of photoinitiators on the microtensile strength of adhesive systems and composite resins in bovine dentin. MATERIAL AND METHODS: Forty dentin obtained from bovine teeth were randomly distributed in four groups (n = 10) according to the different adhesive systems and composite resins used: G1 - AAPS + VAPS (Ambar APS + Vittra APS); G2- AAPS + O (Ambar APS + Opallis); G3 - A + VAPS (Ambar + Vittra APS) and G4 - A + O (Ambar + Opallis). After restoration with the composite, the samples were sectioned to obtain toothpicks that were subjected to the microtensile and nanofiltration test (1.0 mm/min). RESULTS: The Kruskal-Wallis test did not show significant differences between the groups (p<0.05). The values in MPa were: AAPS + VAPS - 19.56 MPa; AAPS + O - 19.77 MPa; A + VAPS - 17.78 MPa; A + O - 22.44 MPa. The result of the Mann-Whitney test showed no significant differences depending on the adhesive (Ambar Universal- 19.11 MPa, Ambar APS Universal- 21.70 MPa) and the composite resin used (Vittra APS- 18.75 MPa, Opallis - 23.75 MPa). The AAPS + VAPS and AAPS + O groups showed intense silver nitrate infiltration. The A + APS group showed a moderate infiltration and the A + O group had a mild infiltration in the adhesive system/dentin interface. CONCLUSIONS: The use of different photoinitiators in the composition of adhesive systems and restorative composites did not affect their bond strength values and the presence of water in the solvent of the APS photoinitiator system had a negative influence, increasing the degree of infiltration in the hybrid layer when compared to the camphorquinone photoinitiator. Key words:Dentin, adhesive systems, composite resin, photoinitiators, tensile strength, nano-infiltration.

Influence of the volume of restorative material on the concentration of stresses in the restorative interface.

BACKGROUND: To evaluate the microtensile strength in the adhesive interface depending on the volume of the composite resin used to restore class I cavities. MATERIAL AND METHODS: Forty-eight human third molars received a standardized class I cavity preparation and they were separated into six experimental groups: G1 - single-bottle adhesive system; G2 - bonding system with load; G3 - single-bottle adhesive associated with low-viscosity composite resin; G4 - loaded adhesive associated with low-viscosity composite; G5 - resin-modified glass ionomer associated with single-bottle adhesive; and G6 - resin-modified glass ionomer associated with loaded adhesive. All cavities were restored with a universal restorative composite. After completing the restorations, the samples were stored for seven days in a stove (37°C) and the microtensile bond strength was evaluated by producing slices and applying axial loading in an Instron universal testing machine at a speed of 0.5 mm/min. The thickness of the intermediate layer formed on the cavity floor to verify the relationship between the volume of restorative composite and the concentration of stresses in the buccal wall. With the data obtained in the microtensile strength test, an Analysis of Variance (ANOVA) was performed entirely at random. RESULTS: Duncan's test showed that group 4 (Filtek Flow/Optibond Solo Plus) obtained the highest mean of microtensile strength with no statistically significant difference to groups 3 (Filtek Flow/Single Bond), 5 (Vitremer/Single Bond), and 6 (Vitremer/Optibond Solo Plus). It also showed a statistically significant difference to groups 2 (Optibond Solo Plus) and 1 (Single Bond), with no statistical difference between the other groups studied. CONCLUSIONS: The highest mean of microtensile strength was obtained when the volume of the restorative material decreased through the interposition between the material and the adhesive system of a base with low elasticity modulus. Key words:Adhesion, microtensile, composite resin.

Health changes during Covid-19: a nationwide study with dental students

ABSTRACT OBJECTIVE To assess the changes in stress levels, social behavior, dietary and parafunctional habits, oral hygiene, among other conditions perceived by dental students in Brazil during the Covid-19 pandemic and evaluated the correlations between stress level and other variables. METHODS An online questionnaire was developed and validated. Undergraduates enrolled in private and public dental schools were recruited by convenience sampling. Data were collected on the perceived changes regarding stress levels, financial and social characteristics, dietary habits, oral hygiene, health conditions, and parafunctional habits. Quantitative variables were expressed as absolute and relative frequencies. Wilcoxon test evaluated comparisons between perceived changes, and correlations between changes in stress levels and other variables were analyzed by Spearman correlation (α = 0.05). RESULTS A total of 638 dental students, mean age of 22.95 ± 4.10 years, participated in the study. During the pandemic, the reported stress levels increased while household income decreased (p < 0.05). Late dinners and mindless eating increased in frequency, whereas oral hygiene decreased (p < 0.05). Most of the health conditions and parafunctional habits assessed changed (p < 0.05). Perceived stress levels showed poor negative correlations with household income (rS = −0.14), poor positive correlations with the pressure to contribute financially in the household (rS = 0.19), and poor positive correlations with food choice frequency (rS = 0.15) (p < 0.05). CONCLUSIONS Dental students reported perceived changes in stress levels, dietary habits, oral hygiene, health conditions, parafunctional habits, and social behavior. Moreover, the results showed poor correlations, as students with higher stress levels tended to have the lowest household income, feel pressured to contribute financially in the household, and present a high meal intake frequency.

Evaluation of teaching low intensity laser in perspective dentist

Search knowledge dentist front surgeon to low intensity laser through a questionnaire. They were selected randomly in the city of Juiz de Fora and region 91 Dental Surgeons of Minas Gerais. These employees were sent during the months from July to October 2013, a standard form printed with questions about laser education assessment of low intensity. Of the 91 participants, 42 (46.2%) were female and 49 (53.8%) were male. Fifty-seven (62.6%) had dental public institution of higher education; 32 (35.2%) attended a private institution and 2 (2.2%) did not report this data. Eighty-nine dentists reported the time of graduation, and this varied with a minimum of 1 year and a maximum of 38 years of training, the average being 11 years and this is the standard deviation of 10.7. The age of these professionals is on average thirty-five years, ranging from twenty-two years to sixty-five years of age and the standard deviation of this is 10.8. The distribution according to academic title was: 35 dentists (38.5%) had a degree in dentistry; 13 (14.3%) were specialists; 14 (15.4%) had master's and 4 (4.4%) doctorate. 25 (27.5%) did not report the academic title. The most relevant mentioned specialties were general practitioner, endodontics and implantology. We can conclude that the Juiz de Fora dentist - MG and region makes little use of laser therapy and this is mainly due to little knowledge acquired at the undergraduate and graduate education.

Machine learning-based dual-energy CT parametric mapping.

The aim is to develop and evaluate machine learning methods for generating quantitative parametric maps of effective atomic number (Zeff), relative electron density (ρ e), mean excitation energy (I x ), and relative stopping power (RSP) from clinical dual-energy CT data. The maps could be used for material identification and radiation dose calculation. Machine learning methods of historical centroid (HC), random forest (RF), and artificial neural networks (ANN) were used to learn the relationship between dual-energy CT input data and ideal output parametric maps calculated for phantoms from the known compositions of 13 tissue substitutes. After training and model selection steps, the machine learning predictors were used to generate parametric maps from independent phantom and patient input data. Precision and accuracy were evaluated using the ideal maps. This process was repeated for a range of exposure doses, and performance was compared to that of the clinically-used dual-energy, physics-based method which served as the reference. The machine learning methods generated more accurate and precise parametric maps than those obtained using the reference method. Their performance advantage was particularly evident when using data from the lowest exposure, one-fifth of a typical clinical abdomen CT acquisition. The RF method achieved the greatest accuracy. In comparison, the ANN method was only 1% less accurate but had much better computational efficiency than RF, being able to produce parametric maps in 15 s. Machine learning methods outperformed the reference method in terms of accuracy and noise tolerance when generating parametric maps, encouraging further exploration of the techniques. Among the methods we evaluated, ANN is the most suitable for clinical use due to its combination of accuracy, excellent low-noise performance, and computational efficiency.

Evaluation of different surface treatments on fiber post cemented with a self-adhesive system.

Surface treatment of fiber-reinforced posts can increase adhesion, especially on the post/resin cement interface. The purpose of this in vitro study was to evaluate the effect of different surface treatments on fiber post cemented with a self-adhesive system. Sixty fiberglass epoxy resin posts were cleaned, dried and divided into 6 groups (n=10): Control (no surface treatment), silane (silane coupling agent was applied homogeneously on surface), 24% hydrogen peroxide (H2O2) (immersion during 1min), blasting (blasting with aluminum oxide for 30s), NH3 plasma (plasma treatment for 3min) and HMDSO plasma (plasma treatment for 15min). After the treatments, posts were inserted into a silicon matrix that was filled with the resin cement RelyX U200. Afterwards, the post/cement specimens were cut perpendicularly to the long axis of the posts into six 1.0mm thick discs and submitted to a push-out bond strength (POBS) test. Failure pattern was classified in 5 types: type I: cohesive in post; type II: cohesive in cement; type III: cohesive post and cement; type IV: adhesive post/cement; and type V: mixed (association between cohesive and adhesive). Data were analyzed by one-way ANOVA and Tukey HSD post hoc test (α=0.05). Silane (15.94±6.5), blasting (13.13±3.6), NH3 plasma (14.44±4.0) and HMDSO plasma (13.23±5.3) showed higher POBS when compared to control (p<0.05) and similar among them. H2O2 (9.40±4.0) treatment showed POBS values statistically similar to control (9.65±3.6). Failures were predominantly cohesive post and cement, type III, in all groups. In conclusion, surface treatments influenced in the adhesion of fiberglass post with the self-adhesive cement RelyX U200. Silane, blasting with aluminum oxide and plasmas (NH3 and HMDSO) showed results superior to 24% hydrogen peroxide.

Do non-clinical subjective factors influence the treatment decisionmaking of Brazilian dentists? / Fatores subjetivos não clínicos influenciam na tomada de decisão do tratamento de cirurgiões-dentistas brasileiros?

ABSTRACT The literature contains little information on several non-clinical factors such as the association between graduate residency programs and the application of minimally invasive dentistry, or on dentists' clinical decision-making processes for replacing restorations for esthetic reasons. This study evaluated whether non-clinical subjective factors influence the treatment decisions made by Brazilian dentists regarding technical and esthetic matters. Dentists were invited to participate in a cross-sectional survey by answering an electronic questionnaire containing clinical cases, regarding what treatment they would select for: T1 - a molar tooth with significant crown destruction and spontaneous pain, and T2 - premolar teeth with extensive amalgam restorations and no carious lesion or associated complaint. The survey also included questions about subjective variants (sociodemographic and professional). Chi Square test and Fischer's Exact test were used to analyze the answers to T1, and one-factor analysis of variance and post-hoc Tamhane were applied to T2. The significance level was set at 5% for all analyses. A total 302 professionals participated in the study. For T1, it was found that clinical decision-making was influenced by the Brazilian region of clinical practice (p=0.005). For T2, a significant association was found between increased loss of patient tooth tissues and whether the professional had completed a residency program in Operative Dentistry (p=0.035), worked in a private practice (p=0.033), or if most of his/her patients belonged to a high estimated socioeconomic level (household income above $4350) (p=0.002). In conclusion, the clinical decision-making of Brazilian dentists varies according to professional profile, mainly with relation to the replacement of restorations due to esthetic concerns.

RESUMO Vários fatores não clínicos, como a associação entre programas de especialização e a aplicação da odontologia minimamente invasiva, ainda são escassos na literatura. Outro aspecto relevante é a tomada de decisão clínica do dentista quanto à substituição de restaurações em função da aparência estética. Este estudo avaliou se fatores subjetivos não clínicos influenciam na tomada de decisão clínica de dentistas brasileiros com base em questões técnicas e estéticas. Foi realizado um estudo transversal com um questionário eletrônico contendo casos clínicos que foram apresentados a uma lista de profissionais. No questionário, interrogou-se o tratamento proposto para um dente molar com destruição coronária significativa e dor espontânea (T1). Também foi questionado o tratamento proposto para dentes prémolares com extensas restaurações de amálgama e sem lesão cariosa ou queixas associadas (T2). Em seguida, foram questionadas as variantes subjetivas (sociodemográfica e profissional). Na análise de T1, foram utilizados os testes Qui Quadrado e Exato de Fischer. Em T2, foi aplicada a análise de variância de um fator e post-hoc Tamhane. Para todas as análises, o nível de significância foi estabelecido em 5%. Um total de 302 profissionais participaram deste estudo. A tomada de decisão clínica para T1 foi influenciada pela região brasileira de prática clínica (p = 0,005). Em T2, realizar especialização em Dentística Operatória (p = 0,035), trabalhar em consultório particular (p = 0,033) e a maioria dos pacientes apresentar nível socioeconômico estimado elevado (renda familiar acima de R$10.000,00) (p = 0,002) aumentou significativamente a perda de tecidos dentários. Em conclusão, a tomada de decisão clínica dos dentistas brasileiros varia de acordo com o perfil dos profissionais, principalmente no que se refere à substituição de restaurações por questões estéticas.

Safety and immune response after two-dose meningococcal C conjugate immunization in HIV-infected children and adolescents in Rio de Janeiro, Brazil.

We aimed to evaluate immunogenicity and adverse events (AEs) after a booster dose of Meningococcal C conjugated (MCC) vaccine in HIV-infected children and adolescents, who had a previous low seroconversion rate after priming with MCC, at a reference HIV-care center in Rio de Janeiro. METHODS: 2-18 years old HIV-infected subjects with CD4+ T-lymphocyte cell (CD4) ≥15%, without active infection or antibiotic use, were enrolled to receive 2 doses of conjugated meningococcal C oligosaccharide-CRM197 12-18 months apart. All patients were evaluated before and 1-2 months after immunization for seroprotection [defined as human serum bactericidal activity (hSBA) titer ≥1:4]. AEs were assessed at 20 min, 3 and 7 days after each dose. Factors independently associated with seroprotection were studied. RESULTS: 156 subjects were enrolled and 137 received a booster MCC dose. 55% were female, and median age was 12 years. Eight-nine percent were receiving combined antiretroviral therapy (cART) at the booster visit (median duration of 7.7 years), 59.9% had undetectable viral load (VL) at baseline, and 56.2% at the booster visit. Seroprotection was achieved in 78.8% (108/137) subjects, with a significantly higher GMT than after the priming dose (p < 0.01). Mild AEs were experienced after a second MCC dose (38%). In logistic regression, undetectable viral load at entry [odds ratio (OR) = 7.1, 95% confidence interval (95%CI): 2.14-23.37], and probably higher CD4 percent at the booster immunization visit (OR): 1.1, 95%CI: 1.01-1.17 were associated with seroprotection after a booster dose of MCC. CONCLUSION: A booster dose of MCC was safe and induced high seroprotection rate even 12-18 months after priming. MCC should be administered after maximum virologic suppression has been achieved. These results support the recommendation of 2-dose of MCC for primary immunization in HIV-infected children and adolescents with restored immune function.