Two-year Clinical Performance of Self-etching Adhesive Systems in Composite Restorations of Anterior Teeth

Objective: The aim of this study was to evaluate the two-year clinical performance of Class III, IV, and V composite restorations using a two-step etch-and-rinse adhesive system (2-ERA) and three one-step self-etching adhesive systems (1-SEAs).Material and Methods: Two hundred Class III, IV, and V composite restorations were placed into 50 patients. Each patient received four composite restorations (Amaris, Voco), and these restorations were bonded with one of three 1-SEAs (Futurabond M, Voco; Clearfil S3 Bond, Kuraray; and Optibond All-in-One, Kerr) or one 2-ERA (Adper Single Bond 2/3M ESPE). The four adhesive systems were evaluated at baseline and after 24 months using the following criteria: restoration retention, marginal integrity, marginal discoloration, caries occurrence, postoperative sensitivity and preservation of tooth vitality. After two years, 162 restorations were evaluated in 41 patients. Data were analyzed using the chi(2) test (p<0.05).Results: There were no statistically significant differences between the 2-ERA and the 1-SEAs regarding the evaluated parameters (p>0.05).Conclusion: The 1-SEAs showed good clinical performance at the end of 24 months.

Intraoperative and Anesthesia-Related Cardiac Arrest and Its Mortality in Older Patients: A 15-Year Survey in a Tertiary Teaching Hospital

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Heydrichia (?) poignantii, sp nov (Sporolithaceae, Sporolithales, Rhodophyta), a 100 million year old fossil coralline red alga from north-eastern Brazil, and a new Hauterivian record of Sporolithon from Switzerland

Fossil specimens of Heydrichia (?) poignantii, sp. nov. (Sporolithaceae, Sporolithales, Rhodophyta), representing the first confirmation of the genus in the fossil record, were discovered in thin sections of Albian limestones from the Riachuelo Formation, Sergipe Basin, and in thin sections of Albian -Cenomanian limestones from the Ponta do Mel Formation, Potiguar Basin in north-eastern Brazil. A detailed morphological-anatomical account of the species is provided, and its placement in Heydrichia is discussed in relation to current classification proposals. Comparisons with the four other known species of the genus, all non-fossil, show that H. poignantii is the only known species of Heydrichia in which thalli are encrusting to sparsely warty to horizontally layered with overlapping lamellate branches that commonly appear variously curved or arched, and in which thalli have sporangial complexes that become buried in the thallus. The evolutionary history of Heydrichia remains uncertain, but available data suggest that the genus may have diverged from the sporolithacean genus Sporolithon, known as early as Hauterivian times (c. 129.4-132.9 +/- 1 Ma) from Spain (and newly reported here from Switzerland), or it may have arisen from a graticulacean alga such as Graticula, dating from mid-Silurian times (c. 427-435 Ma). Current data also suggest that Heydrichia is more likely to have arrived in Brazil from Central Atlantic waters than from higher latitude South Atlantic waters. This implies that currently living species in southern Africa probably arose later from ancestors further equatorward in the South Atlantic, although confirming studies are needed. All non-fossil species of Heydrichia are known only from the southern hemisphere.

Seroprevalence and seroincidence of Leptospira infection in dogs during a one-year period in an endemic urban area in Southern Brazil

Introduction: Leptospirosis is a zoonosis that affects both humans and animals. Dogs may serve as sentinels and indicators of environmental contamination as well as potential carriers for Leptospira. This study aimed to evaluate the seroprevalence and seroincidence of leptospirosis infection in dogs in an urban low-income community in southern Brazil where human leptospirosis is endemic. Methods: A prospective cohort study was designed that consisted of sampling at recruitment and four consecutive trimestral follow-up sampling trials. All households in the area were visited, and those that owned dogs were invited to participate in the study. The seroprevalence (MAT titers >= 100) of Leptospira infection in dogs was calculated for each visit, the seroincidence (seroconversion or four-fold increase in serogroup-specific MAT titer) density rate was calculated for each follow-up, and a global seroincidence density rate was calculated for the overall period. Results: A total of 378 dogs and 902.7 dog-trimesters were recruited and followed, respectively. The seroprevalence of infection ranged from 9.3% (95% CI; 6.7 - 12.6) to 19% (14.1 - 25.2), the seroincidence density rate of infection ranged from 6% (3.3 - 10.6) to 15.3% (10.8 - 21.2), and the global seroincidence density rate of infection was 11% (9.1 - 13.2) per dog-trimester. Canicola and Icterohaemorraghiae were the most frequent incident serogroups observed in all follow-ups. Conclusions: Follow-ups with mean trimester intervals were incapable of detecting any increase in seroprevalence due to seroincident cases of canine leptospirosis, suggesting that antibody titers may fall within three months. Further studies on incident infections, disease burden or risk factors for incident Leptospira cases should take into account the detectable lifespan of the antibody.

Chromium in soil organic matter and cowpea after four consecutive annual applications of composted tannery sludge

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Seal, replacement or monitoring amalgam restorations with occlusal marginal defects? Results of a 10-year clinical trial

The aim of this prospective and blind clinical trial was to assess the effectiveness of sealing localized marginal defects of amalgam restoration that were initially scheduled to be replaced. A cohort of twenty six patients with 60 amalgam restorations (n=44Class I and n=16Class II), that presented marginal defects deviating from ideal (Bravo) according to USPHS criteria, were assigned to either sealing or replacement groups: A: sealing n=20, Replacement n=20, and no treatment (n=20). Two blind examiners evaluated the restorations at baseline (K=0.74) and after ten years (K=0.84) according with USPHS criteria, in four parameters: marginal adaptation (MA), secondary caries (SC), marginal staining (MS) and teeth sensitivity (TS). Multiple comparison of restorations degradation/upgrade was analyzed by Friedman test and the comparisons within groups were performed by Wilcoxon test. After 10 years, 44 restorations were assessed (73.3%), Group A: n=14 and Group B: n=16; and Group C: n=14 sealing and replacement amalgam restorations presented similar level of quality in MA (p=0.76), SC (p=0.25) and TS (p=0.52), while in MS (p=0.007) presented better performance in replacement group after 10-years. Most of the occlusal amalgam restorations with marginal gaps showed similar long term outcomes than the restorations were sealed, replaced, or not treated over a 10-year period. Most of the restorations of the three groups were clinically acceptable, under the studied parameters. All restorations had the tendency to present downgrade/deterioration over time.

A comparative, prospective and randomized evaluation of roux-en-y gastric bypass with and without the silastic ring: a 2-year follow up preliminary report on weight loss and quality of life

Currently, Roux-en-Y gastric bypass (RYGB) is one of the most widely used bariatric surgeries. Banding the pouch forms a banded gastric bypass operation, an accepted and frequently used variant. Placing a silastic ring around the pouch to band the gastric bypass operation increases the restriction mechanism. However, the ubiquitous use of the banded gastric bypass remains controversial. One of the controversies is the effect of the silastic ring on patients' perception of their well being after surgery because of the frequency of vomiting. A prospective, blindly randomized, comparative trial was undertaken to resolve this controversy. Four hundred subjects scheduled for gastric bypass surgery were randomized into two arms of the trial, 200 with a silastic ring (WR) and 200 without (NR). After 2-year follow-up, the variables associated with the scores of Bariatric Analysis and Reporting Outcome System (BAROS) were analyzed. The initial median weight (125 kg), BMI (47), and age (36 years) were the same in both the NR and WR groups. The median excess weight loss, weight regain, and incidence of vomiting were 71, 10.5, and 7.75 %, respectively, in the NR group vs. 75.4 and 1.1, and 24.4 % in the WR group. The mean QOL score was 79 % in the NR group vs. 80 % in the WR group. After 2-year follow-up, silastic ring placement in the RYGB resulted in greater weight loss and weight stability and a threefold greater incidence of vomiting. There was no difference in the scores in the quality of life analysis.

Painful procedures and analgesia in the NICU: what has changed in the medical perception and practice in a ten-year period?

To compare the use of analgesia versus neonatologists' perception regarding analgesic use in painful procedures in the years 2001, 2006, and 2011. This was a prospective cohort study of all newborns admitted to four university neonatal intensive care units (NICUs) during one month in 2001, 2006, and 2011. The frequency of analgesic prescription for painful procedures was evaluated. Of the 202 neonatologists, 188 answered a questionnaire giving their opinion on the intensity of pain during lumbar puncture (LP), tracheal intubation, mechanical ventilation (MV), and postoperative period (PO) using a 10-cm visual analogic scale (VAS; pain >3cm). For LP, 12% (2001), 43% (2006), and 36% (2011) were performed using analgesia. Among the neonatologists, 40-50% reported VAS >3 for LP in all study periods. For intubation, 30% received analgesia in the study periods, and 35% (2001), 55% (2006), and 73% (2011) of the neonatologists reported VAS >3 and would prescribe analgesia for this procedure. As for MV, 45% (2001), 64% (2006), and 48% (2011) of patient-days were under analgesia; 56% (2001), 57% (2006), and 26% (2011) of neonatologists reported VAS >3 and said they would use analgesia during MV. For the first three PO days, 37% (2001), 78% (2006), and 89% (2011) of the patients received analgesia and more than 90% of neonatologists reported VAS >3 for major surgeries. Despite an increase in the medical perception of neonatal pain and in analgesic use during painful procedures, the gap between clinical practice and neonatologist perception of analgesia need did not change during the ten-year period.

Agricultural Economics: The Year In Review

Undergraduate programs continue to be a mainstay for the Department of Agricultural Economics. In an ongoing effort to match our offerings with the market demands for our graduates, we have implemented four new options in the Natural Resources and Environmental Economics major. This, combined with the options in the Agribusiness and Agricultural Economics majors allows students to customize their program to meet particular career goals. As a result of diligent efforts by faculty and staff, student enrollment for fall semester 2008 increased by 13.2 percent over the 2007 fall semester. This increase was greater than the College average.

First-year experience of a Brazilian tertiary medical center in supporting severely ill patients using extracorporeal membrane oxygenation

OBJECTIVES: The aim of this manuscript is to describe the first year of our experience using extracorporeal membrane oxygenation support. METHODS: Ten patients with severe refractory hypoxemia, two with associated severe cardiovascular failure, were supported using venous-venous extracorporeal membrane oxygenation (eight patients) or veno-arterial extracorporeal membrane oxygenation (two patients). RESULTS: The median age of the patients was 31 yr (range 14-71 yr). Their median simplified acute physiological score three (SAPS3) was 94 (range 84-118), and they had a median expected mortality of 95% (range 87-99%). Community-acquired pneumonia was the most common diagnosis (50%), followed by P. jiroveci pneumonia in two patients with AIDS (20%). Six patients were transferred from other ICUs during extracorporeal membrane oxygenation support, three of whom were transferred between ICUs within the hospital (30%), two by ambulance (20%) and one by helicopter (10%). Only one patient (10%) was anticoagulated with heparin throughout extracorporeal membrane oxygenation support. Eighty percent of patients required continuous venous-venous hemofiltration. Three patients (30%) developed persistent hypoxemia, which was corrected using higher positive end-expiratory pressure, higher inspired oxygen fractions, recruitment maneuvers, and nitric oxide. The median time on extracorporeal membrane oxygenation support was five (range 3-32) days. The median length of the hospital stay was 31 (range 3-97) days. Four patients (40%) survived to 60 days, and they were free from renal replacement therapy and oxygen support. CONCLUSIONS: The use of extracorporeal membrane oxygenation support in severely ill patients is possible in the presence of a structured team. Efforts must be made to recognize the necessity of extracorporeal respiratory support at an early stage and to prompt activation of the extracorporeal membrane oxygenation team.

Germination and seedling morphology of four South American Smilax (Smilacaceae)

Species of Smilax,, also known as greenbrier, are widely distributed in Brazil and their commercial trades are carried out by the extractivism of native species. We the aim to provide information about the germination and development of seedlings in four Smilax species, different experiments were developed under controlled conditions. We evaluated two germination treatments: temperature (30 degrees C and 20-30 degrees C) and light (presence/absence), and for few cases the tetrazolium treatment was applied. A different treatment response was observed among the studied species. Light had a significant influence in S. brasiliensis, with the highest germination rates at 20-30 C in dark conditions. S. campestris showed significant differences among temperature treatments, but not to light; while S. cissoides showed high germination rates (66-78%), independently of treatment. However, S. polyantha had low germination rates (19-24%). After one year, the expanded leaves showed different characteristics among the studied species. Leaves of S. brasiliensis were ovate, coriaceous, three main veins and prickle-like structures only on the midrib on abaxial face. S. campestris leaves were oblong, coriaceous and prickle-like structures were located at the leaf midrib and margin. S. cissoides had ovate-elliptic, membranaceous leaves, with three main veins with prickle-like structures on the abaxial face. S. polyantha leaves showed ovate-elliptic. coriaceous leaves, with three main veins, translucent secondary veins and no prickle-like structures. A seedling identification key was elaborated based on morphological characteristics. Rev. Biol. Trop. 60 (1): 495-504. Epub 2012 March 01.

Molecular epidemiology of extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae over a 10 year period in Calgary, Canada

A study was designed to investigate the molecular epidemiology of extended-spectrum -lactamase (ESBL)-producing Klebsiella pneumoniae isolated in a centralized region over a 10 year period (200009). Molecular characterization was done using isoelectric focusing, PCR and sequencing for bla(CTX-M), bla(TEM) and bla(SHV) genes and plasmid-mediated quinolone resistance determinants. Genetic relatedness was determined with PFGE using XbaI and multilocus sequencing typing. A total of 89 patients with incident infections were identified; the majority presented with hospital-onset urinary tract infections. The absolute number of ESBL-producing isolates remained very low until 2003, increased slightly in 2004, remained stable until 2008 and then in 2009 there was an abrupt increase in the numbers of ESBL producers identified. The majority of K. pneumoniae produced CTX-M-14 and -15, and have replaced SHV-12-producing isolates since 2005. We identified four different major sequence types (STs) among 32 of isolates (i.e. ST17, ST20, and the new ST573 and ST575) and provided insight into their clinical and molecular characteristics. The ST isolates were more likely to produce community-onset infections, were associated with bla(CTX-M) and emerged during the latter part of the study period. ST17 produced CTX-M-15 and SHV-12, and was more likely to be positive for qnrB; ST20 produced CTX-M-14 and was positive for qnrS. The multiresistant ST575 that produced CTX-M-15 appeared in 2009. Our study highlights the importance of molecular epidemiology in providing insight into the emergence, characteristics and distribution of STs among ESBL-producing K. pneumoniae.

RNA extraction from ten year old formalin-fixed paraffin-embedded breast cancer samples: a comparison of column purification and magnetic bead-based technologies

Abstract Background The development of protocols for RNA extraction from paraffin-embedded samples facilitates gene expression studies on archival samples with known clinical outcome. Older samples are particularly valuable because they are associated with longer clinical follow up. RNA extracted from formalin-fixed paraffin-embedded (FFPE) tissue is problematic due to chemical modifications and continued degradation over time. We compared quantity and quality of RNA extracted by four different protocols from 14 ten year old and 14 recently archived (three to ten months old) FFPE breast cancer tissues. Using three spin column purification-based protocols and one magnetic bead-based protocol, total RNA was extracted in triplicate, generating 336 RNA extraction experiments. RNA fragment size was assayed by reverse transcription-polymerase chain reaction (RT-PCR) for the housekeeping gene glucose-6-phosphate dehydrogenase (G6PD), testing primer sets designed to target RNA fragment sizes of 67 bp, 151 bp, and 242 bp. Results Biologically useful RNA (minimum RNA integrity number, RIN, 1.4) was extracted in at least one of three attempts of each protocol in 86–100% of older and 100% of recently archived ("months old") samples. Short RNA fragments up to 151 bp were assayable by RT-PCR for G6PD in all ten year old and months old tissues tested, but none of the ten year old and only 43% of months old samples showed amplification if the targeted fragment was 242 bp. Conclusion All protocols extracted RNA from ten year old FFPE samples with a minimum RIN of 1.4. Gene expression of G6PD could be measured in all samples, old and recent, using RT-PCR primers designed for RNA fragments up to 151 bp. RNA quality from ten year old FFPE samples was similar to that extracted from months old samples, but quantity and success rate were generally higher for the months old group. We preferred the magnetic bead-based protocol because of its speed and higher quantity of extracted RNA, although it produced similar quality RNA to other protocols. If a chosen protocol fails to extract biologically useful RNA from a given sample in a first attempt, another attempt and then another protocol should be tried before excluding the case from molecular analysis.

Responsiveness to change for the Brazilian Scale of Oral Health Outcomes for 5-year-old children (SOHO-5)

Abstract Background The responsiveness of oral health-related quality of life (OHRQoL) instruments has become relevant, given the increasing tendency to use OHRQoL measures as outcomes in clinical trials and evaluations studies. The purpose of this study was to assess the responsiveness of the Brazilian Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) to dental treatment. Methods One hundred and fifty-four children and their parents completed the child self- and parental’ reports of the SOHO-5 prior to treatment and 7 to 14 days after the completion of treatment. The post-treatment questionnaire also included a global transition judgment that assessed subject’s perceptions of change in their oral health following treatment. Change scores were calculated by subtracting post-treatment SOHO-5 scores from pre-treatment scores. Longitudinal construct validity was assessed by using one-way analysis of variance to examine the association between change scores and the global transition judgments. Measures of responsiveness included standardized effect sizes (ES) and standardized response mean (SRM). Results The improvement of children’s oral health after treatment are reflected in mean pre- and post-treatment SOHO-5 scores that declined from 2.67 to 0.61 (p < 0.001) for the child-self reports, and 4.04 to 0.71 (p < 0.001) for the parental reports. Mean change scores showed a gradient in the expected direction across categories of the global transition judgment, and there were significant differences in the pre- and post-treatment scores of those who reported improving a little (p < 0.05) and those who reported improving a lot (p < 0.001). For both versions, the ES and SRM based on change scores mean for total scores and for categories of global transitions judgments were moderate to large. Conclusions The Brazilian SOHO-5 is responsive to change and can be used as an outcome indicator in future clinical trials. Both the parental and the child versions presented satisfactory results.

Questionnaire for monitoring auditory and language development in the first year of life

Purpose: To validate a monitoring questionnaire about hearing and language development applied by community health agents in the first year of life. Methods: Seventy six community health agents, previously trained on infant hearing health, administered a questionnaire to the families of 304 children with ages from 0 to 1 year. The questionnaire contains questions regarding hearing and language development and, for all age groups, the question “Does your child hear well?” was presented. The validity of the questionnaire was assessed by analyzing false positive and false negative rates of the identified children. A double-blind study was conducted so that all children assessed by the questionnaire were submitted to hearing evaluation performed by audiologists. Results: Four children (1.32%) were diagnosed with sensorineural hearing loss (two unilateral), and 69 (22.7%) with conductive hearing loss. The monitoring questionnaire showed specificity of 96% and sensitivity of 67%, with a false-negative rate of 33% for not identifying the unilateral hearing loss, and a false-positive rate of 4%. Conclusion: The questionnaire used has shown to be feasible and relevant to actions of the community health agents of the Family Health Strategy program, with high specificity and moderate sensitivity. The use of the validated instrument should be considered to complement Newborn Hearing Screening Programs, in order to identify late onset or acquired hearing loss.