Smear layer removal and chelated calcium ion quantification of three irrigating solutions

The purpose of this study was to evaluate, by scanning electron microscopy (SEM), smear layer removal and quantify, by atomic absorption spectrophotometry, the amount of calcium ion present in the chelating solutions after their use. Sixteen extracted canines were instrumented using the step-back technique and were assigned to 3 groups according to the irrigating solution used: G1: 1 mL 17% EDTAC between each file; G2: 1 mL 17% CDTA; G3: 1 mL 17% EGTA. The solutions were collected after use. The teeth were cleaved longitudinally, evaluated under SEM and assessed for smear layer by blinded examiners and scored from 1 to 4. In order to quantify calcium ion release, the collected solutions were examined by atomic absorption spectrophotometry. Freidman's test was used for statistical analysis of SEM values and showed that canals irrigated with 17% EDTAC and 17% CDTA had significantly less smear layer throughout the canals than 17% EGTA (p<0.01). For analysis of the collected solutions, Tukey's test was used and showed that EDTAC and CDTA had a greater amount of calcium ions (22.8+/-7.54 and 60.6+/-20.67 microg/mL, respectively) compared to EGTA (70.5+/-14.2 microg/mL) (p<0.01). The association both methodologies may contribute to the understanding of how these solutions act in the root canal.     

Evaluation of the complexity of postoperative care following breast and gynecologic cancer surgery

The purpose of this study was to evaluate the complexity of postoperative care required by women who had undergone breast or gynecologic cancer surgery, using the Therapeutic Intervention Scoring System-28. An observational, longitudinal study was carried out on 83 women admitted postoperatively to the Intensive Care Unit of the Center for Women's Integrated Healthcare. The results of this study show that women diagnosed with gynecologic cancer had a significantly higher mean Therapeutic Intervention Scoring System-28 score compared with women who had been diagnosed with breast cancer (P = .01). Women who underwent gynecologic surgery had a significantly higher mean Therapeutic Intervention Scoring System-28 score than women who had breast surgery (P = .03). Most of the activities performed by staff during the postoperative intensive care unit period involved only basic care procedures. Only advanced age and hypertension were related to death during the postoperative period. In conclusion, from the nursing standpoint, the complexity of care required in the intensive care unit during the postoperative period was moderate. Women aged 80 years or older were at the highest risk of death during this period.     

Expression of vascular endothelial growth factor in the lower urinary tract in rats after castration and estrogen administration

OBJECTIVE: To evaluate quantitatively, by means of immune histochemistry, the expression of the vascular endothelial growth factor (VEGF) in the bladder, vesicourethral junction, and urethra in normal, castrated adult rats and under estrogen administration. DESIGN: Sixty adult virgin rats (Rattus norvergicus albinus, Rodentia, Mammalia) from the CEDEME-UNIFESP Animal House were used. Rats were divided into three groups. Group I comprised noncastrated rats, group II comprised oophorectomized rats, and group III comprised castrated rats administered 17beta-estradiol in the form of subcutaneous implants at the dose of 0.18 mg/implant for 30 days. After performing standard immunohistochemistry procedures, the intensity of the dark-brown color was used as the cytoplasmic protein expression of VEGF. Cells without this coloration or weakly stained were considered negative. percentile of VEGF expression was obtained by counting 1,000 cells per slide and establishing the ratio between positive and total cells. RESULTS: The VEGF expression was uniform and similar along the urinary tract in group I. After castration, protein expression was almost absent in the bladder and was low in the vesicourethral junction and urethra. With estrogen replacement, very little of the expression was recovered in the bladder, and the reaction became evident in the vesicourethral junction and urethral sections. CONCLUSIONS: The present study implies a potential relationship between VEGF and urinary tract physiology. The results suggest that there are quantitative differences in VEGF expression in these tissues depending on steroid hormone status.     

Accidental seizure with repetitive transcranial magnetic stimulation

Accidental induction of convulsions by using repetitive transcranial magnetic stimulation (rTMS) has been reported to have occurred in 6 normal voluntary subjects, in 1 patient with depression and in 1 patient who had temporal lobe epilepsy, with secondary generalization. In addition, 3 other cases have been published relating its use with seizure induction and in 1 case, using 1-Hz stimulation. In this paper, we report a patient who was participating in a protocol for the use of rTMS in chronic pain, with stimulation in the motor cortex, who developed a generalized seizure in the fifth application. Intertrain interval was within safety guidelines, but the combination of 10 Hz for 10 seconds was excessive and must be considered the main cause for the episode. No further complication has been noted after she was withdrawn from the study protocol.     

Cytotoxic profile of natural and some modified bufadienolides from toad Rhinella schneideri parotoid gland secretion

Cutaneous secretions of toad species are an important source of bufadienolides, compounds that exhibit interesting structural features and biopharmacological properties. Here we describe the isolation of bufadienolides from the Brazilian toad Rhinella schneideri parotoid glands secretion, including: marinobufagin (1), bufalin (2), telocinobufagin (3), hellebrigenin (4), and the atypical 20S,21R-epoxymarinobufagin (5) besides the widespread β-sitosterol (6). Starting from natural bufadienolides four derivatives were prepared: 3β-acetoxy-marinobufagin (7), 3β-acetoxy-bufalin (8), 3β-acetoxy-telocinobufagin (9), and 3β-acetoxy-20S,21R-epoxymarinobufagin (10). The cytotoxic evaluation showed that all natural bufadienolides and their derivatives exhibited moderate to strong activity against human HL-60, SF-295, MDA-MB-435, and HCT-8 cancer cell strains without hemolysis of mouse erythrocytes. The acetylated bufadienolides (7-9) and the epoxide 10 showed lesser peripheral blood lymphocytes (PBLs) inhibitory activity than their precursors, suggesting that chemical modifications on such compounds can play an important role on the modulation of their cytotoxic profile.     

Outcomes of a novel bariatric stent in the management of sleeve gastrectomy leaks: a multicenter study

BackgroundThe management of laparoscopic sleeve gastrectomy leaks remains a challenge. This can be treated with placement of self-expandable metal stents, which are most effective in the acute and early settings. However, migration is a frequent adverse event (AE). Novel, fully covered stents with a larger proximal flare to limit migration designed specifically to treat postsleeve leaks were recently introduced.ObjectivesThe aim of this study was to evaluate the safety and efficacy of a novel stent specifically designed for postsleeve leaks treatment.SettingMulticenter retrospective study.MethodsThis is a multicenter study, including patients with acute and early post laparoscopic sleeve gastrectomy leaks, treated with a large bariatric stent. The outcomes include technical success, clinical success, and safety profile. A multivariable regression was performed to assess predictors of success.ResultsThirty-seven patients were included (10 acute and 27 early leaks), with 30 stents in the postpyloric (POST) and 7 in the prepyloric position. Technical success was 100%. Mean stent dwell time was 29.08 days. Clinical success was achieved in 78.37%. Leak duration, leak size, and stent dwell time did not correlate with clinical success. During follow-up, 8 patients had stent migration (21.62%) and all were in a POST position. AE poststent removal were also evaluated (prepyloric: 57.14% vs POST: 33.3%, P = .45). There was no difference between prepyloric and POST position in the severe AE analysis.ConclusionsThis novel, large-caliber, fully covered stent specifically designed for sleeve leaks appears to be effective at treating acute and early leaks. However, the large flanges and long stent length do not appear to reduce migration rate and may be associated with higher overall severe AE rates. Avoiding placement in the POST position may help mitigate migration risk; however, owing to the risk profile this stent should be used with caution.     

Structured Ultrasound and Magnetic Resonance Imaging Reports for Patients with Suspected Endometriosis: Guide for Imagers and Clinicians

In this article we propose a structured imaging report applied to ultrasound and magnetic resonance imaging in patients with suspected endometriosis.     

Predictors of dependence after MCA ischemic stroke submitted to thrombolysis

Objectives: Stroke is one of the most common causes of disability-adjusted life years worldwide. The aim of this study is to identify variables associated with dependence at 3 months and also after the first 3 months after the first-ever ischemic stroke (IS) in middle cerebral artery (MCA) territory submitted to intravenous thrombolysis (IVT).

Methods: A single-center cohort study of patients with first-ever MCA IS treated with IVT at the Hospital de Clínicas, Universidade Federal do Paraná, was followed over 5 years. Logistic regression was performed to determine predictors of early and late dependence.

Results: A total of 144 patients were included; 48.6% women, and 47.2% were dependent at 3 months after stroke. NIHSS at admission (OR = 1.3, 95%CI = 1.16–1.45, p < 0.001), large artery atherosclerosis (LAA) stroke (OR = 4.11, 95%CI = 1.31–12.85, p = 0.014) and pneumonia during hospitalization (OR = 9.17, 95%CI = 1.42–59.07, p = 0.019) were predictors for early dependence. For the late dependence analyses, 99 patients were included; 49.5% women and 39.4% were dependent after 3 months of stroke. NIHSS at admission (OR = 1.33, 95%CI = 1.15–1.54, p < 0.001), pneumonia during hospitalization (OR = 11.08, 95%CI = 1.45–84.73, p = 0.019) and seizure after discharge (OR = 5.82, 95%CI = 1.06–32.01, p = 0.040) were predictors for late dependence.

Discussion: .Dependence is an important indicator of the efficacy of stroke care. Besides it was not possible to evaluate rehabilitation, this is the first study on predictors of post-stroke dependence that focus exclusively on patients with first-ever MCA IS submitted to IVT. NIHSS, LAA stroke, in-hospital pneumonia and seizures after discharge were associated with dependence after first-ever MCA IS submitted to IVT.     

Effects of cerebellar neuromodulation in movement disorders: A systematic review

Background

The cerebellum is involved in the pathophysiology of many movement disorders and its importance in the field of neuromodulation is growing.