Time of clerkship rotations' interruption during COVID-19 and differences on Progress Test's scores

SUMMARY OBJECTIVES: The transition from face-to-face to remote teaching is yet to be fully understood. In clinical training, traditional teaching must prevail because it is essential for the acquisition of skills and professionalism. However, the responses of each school to the pandemic and the decision on when to resume clerkship rotations were mixed. In this study, we aimed to analyze whether the time to resume clerkship rotations was associated with the performance of the students by using a multi-institutional Progress Test. METHODS: This is a cross-sectional study conducted at nine different Brazilian medical schools that administer the same annual Progress Test for all students. We included information from 1,470 clerkship medical students and analyzed the time of clinical training interruption as the independent variable and the student's scores as the dependent variable. RESULTS: The comparisons of the students' scores between the schools showed that there are differences; however, they cannot be attributed to the time the clerkship rotations were paused. The correlation between the schools' average scores and the time to resume clerkship rotations was not significant for the fifth year (r= -0.298, p=0.436) and for the sixth year (r= -0.440, p=0.240). By using a cubic regression model, the time to resume clerkship rotations could explain 3.4% of the 5-year students' scores (p<0.001) and 0.9% of the 6-year students, without statistical difference (p=0.085). CONCLUSIONS: The differences between the students' scores cannot be attributed to the time when the schools paused the clerkship rotations.

Antimicrobial potential of plant extracts from the Brazilian Cerrado

Abstract Bacteria are related do different oral diseases, such as dental caries and periodontal disease. Therefore, the control or/and eradication of microorganisms and their by-products is primordial for the success of their treatment. An alternative for decrease bacterial load is the use of plant extracts used in popular medicine. The cytotoxicity and antimicrobial action of extracts of Cariniana rubra Gardiner ex Miers, Senna martiniana, Anadenanthera colubrina (Vell.) Brenan and Spiranthera odoratissima St. Hil. against strains of Streptococcus mutans, Enterococcus faecalis, Staphylococcus aureus, Escherichia coli, Aggregatibacter actinomyces- tencomitans and Candida albicans were investigated. Cytotoxicity was assessed at concentrations of 1, 10, 40, 80, 100 and 1000 μg/mL by means of the MTT test and compared to a control group with untreated cells. Those with acceptable cytotoxicity had the antimicrobial action measured by the XTT test. As a positive control, sodium hypochlorite was used. Cariniana rubra Gardiner ex Miers had the highest citototoxicity results while Spiranthera odoratissima St. Hil. had the best results, but all extracts showed acceptable cytotoxicity at different concentrations. The plant extracts showed higher activity against A. actinomycetencomitans: Anadenanthera columbrina (Vell.) Brenan (80.52%) at 40 μg/mL, Spiranthera odoratissima St. Hil (78.48%) in 1 μg/mL, Senna martiniana (73.28%) in the concentration of 40 μg/mL and Cariniana rubra Gardiner ex Miers (70.50%) in 10 μg/mL. All extracts analyzed showed acceptable cytotoxicity at different concentrations and were promising for inhibition of the pathogenic microorganisms studied.

Resumo Bactérias estão relacionadas a diferentes doenças bucais, como a cárie dentária e a doença periodontal. Assim, o controle e/ou erradicação de microrganismos e seus subprodutos é primordial para o sucesso dos tratamentos. Uma alternativa para diminuir a carga bacteriana é a utilização de extratos vegetais utilizados na medicina popular. A citotoxicidade e ação antimicrobiana de extratos de Cariniana rubra Gardinerex Miers, Senna martiniana H.S. Irwin & Barneby, Anadenanthera colubrina (Vell.) Brenan e Spiranthera odoratissima St. Hil. contra cepas de Streptococcus mutans, Enterococcusfaecalis, Staphylococcus aureus, Escherichia coli, Agartibacter actinomycetencomitans e Candida albicans foram investigados. A citotoxicidade foi avaliada nas concentrações de 1, 10, 40, 80, 100 e 1000 μg/mL por meio do teste MTT. Aqueles com citotoxicidade aceitável tiveram a ação antimicrobiana medida pelo teste XTT. Cariniana rubra Gardinerex Miers apresentou os maiores resultados de citototoxicidade, enquanto Spiranthera odoratissima St. Hil. obteve os melhores resultados, mas todos os extratos apresentaram citotoxicidade aceitável em diferentes concentrações. Os extratos vegetais apresentaram maior atividade contra A. actinomycetencomitans: Anadenanthera columbrina (Vell.) Brenan (80,52%) a 40 μg/mL, Spiranthera odoratissima St. Hil (78,48%) em 1 μg/mL, Senna martiniana H.S. Irwin & Barneby (73,28%) na concentração de 40 μg/mL e Cariniana rubra Gardinerex Miers (70,50%) em 10 μg/mL. Todos os extratos analisados apresentaram citotoxicidade aceitável em diferentes concentrações e foram promissores na inibição dos microrganismos patogênicos estudados.

Profile of host cell responses to exposure to stressed bacteria in planktonic; dislodged, and intact biofilm mode

Abstract The host defense response to microbial challenge emerging from the root canal system leads to apical periodontitis. The aim of this study was to evaluate the expression of inflammatory cytokines and Nitric Oxide (NO) by macrophages after interaction with Enterococcus faecalis in the: plankton and dislodged biofilm mode; intact biofilm mode stimulated by calcium hydroxide (CH), CH and chlorhexidine (CHX) or Triple Antibiotic Paste (TAP). For this purpose, culture of macrophages from monocytes in human peripheral blood (N=8) were exposed to the different modes of bacteria for 24 hours. Subsequently, the cytokines, such as, Tumor Necrotic Factor- alfa (TNF-α), interleukin (IL)-1β, IL-6, IL-10; and NO were quantified by Luminex xMAP and Greiss reaction, respectively. In addition to the potential therapeutic effects of the intracanal medication, their antimicrobial activity against Enterococcus faecalis biofilm were also tested in vitro by confocal microscopy. The experiments` data were analyzed by the Kruskal-Wallis test with the Dunn post hoc test (α < 0.05). Bacteria in dislodged biofilm mode were shown to be more aggressive to the immune system than bacteria in plankton mode and negative control, inducing greater expression of NO and TNF-α. Relative to bacteria in intact biofilm mode, the weakest antimicrobial activity occurred in Group CH. In Groups CH/CHX and TAP the percentage of dead bacteria was significantly increased to the same extent. Interestingly, the biofilm itself did not induce the release of pro-inflammatory cytokines - except for NO - while the biofilm treated with TAP and CH based pastes enhanced the levels of IL-6 and TNF-α; and IL-1 β, respectively. In contrast, the levels of a potent anti-inflammatory (IL-10) were increased in Group TAP.

Resumo A resposta de defesa do hospedeiro ao desafio microbiano que emerge do sistema de canais radiculares leva à periodontite apical. Os objetivos deste estudo foram avaliar a expressão de citocinas pró e anti-inflamatórias e Óxido Nítrico (NO) por macrófagos após interação com Enterococcus faecalis no modo: planctônio e de biofilme desalojado; biofilme intacto estimulado por hidróxido de cálcio (CH), CH e clorexidina ou Pasta Tri Antibiótica (TAP). Para isto, a cultura de macrófagos originados de monócitos do sangue periférico de humanos (N=8) foi exposta aos diferentes tipos de bactéria por 24 horas. Então, a quantificação da produção de of Fator de Necrose Tumoral- alfa (TNF-α), interleucina (IL)-1β, IL-6, IL-10 e NO por macrófagos se deu por meio do Luminex xMAP e reação de Greiss, respectivamente. Além dos potenciais efeitos terapêuticos desses compostos, sua atividade antimicrobiana contra E. faecalis também foi testada através microscopia confocal. Os dados dos experimentos foram analisados através do teste de Kruskal-Wallis com Dunn`s post hoc (α < 0.05). Bactéria em modo de biofilme desalojado se mostrou mais agressivo ao sistema imune que as bactérias planctônicas e controle negativo induzindo a maior excreção de NO e TNF-α. Em relação ao biofilme intacto, a atividade antimicrobiana mais fraca ocorreu no grupo de CH. Os grupos CHX e TAP aumentaram significativamente a porcentagem de bactérias mortas na mesma extensão. Interessantemente, o biofilme por ele mesmo não induziu a liberação de citocinas pro-inflamatórias - exceto por NO - enquanto que o biofilme tratado com TAP ou pastas a base de CH aumentaram os níveis de IL-6; e TNF-α e IL-1 β respectivamente. Em contraste, os níveis da potente citocina anti-inflamatória (IL-10) foram aumentados pelo grupo TAP.

Effects of Qualea grandiflora Extract on the Expression of MMP-14 and HIF-1α in Cultured Fibroblasts and Preosteoblasts

Abstract Background: Qualea grandiflora (QG) (Vochysiaceae), also known as "pau-ferro", "pau-terra" or "pau-de-tucano", is a very common deciduous tree in the Brazilian Cerrado used in traditional medicine to treat inflammations, ulcers, diarrhea, and infections. There are reports in the scientific literature that demonstrate the medicinal effects of the bark and leaf of the QG. However, studies involving this plant are rather imited. Aim of the study: To perform the phytochemical analysis of the QG hydroalcoholic extract (HAE) of leaves, and to investigate it effects on fibroblast and preosteoblasts. Methods: Phytochemical analysis was done by HPLC-DAD. Murine NIH/3T3 fibroblasts and MC3T3-E1 preosteoblasts cell lines (ATCC) were used for the experiments. Cell viability was assessed by the MTT colorimetric assay and the expression of MMP-14 and HIF-1α by immunofluorescence. Results and conclusion: The following compounds were identified by HPLC-DAD, such as quinic acid, ethyl galate, ellagic acid derivatives as O-methylellagic acid O-galloyl, O-methylellagic acid O-deoxyhexoside, galloyl derivatives, flavonol glycoside as kaempferol-O-deoxyhexoside, quercetin-O-deoxyhexoside, myricetin-O-deoxyhexoside and the pentacyclic triterpene arjunglucoside. Cell viability results demonstrated no cytotoxic effects in the studied concentrations. We found in QG HAE some compounds with therapeutic properties that can increase the expression of MMP-14 and HIF-1α, in fibroblasts and preosteoblasts. These data suggest that QG HAE has an action on these two molecules widely involved in physiological conditions, such as collagen remodeling, bone development and growth and pathological processes as HIF signaling in cancer metastasis.

The Dynamics of Subcutaneous Tissue Response to Microorganisms Associated with the Extract of Araçá (Psidium cattleianum): An Edemogenic and Microscopic Analysis / A Dinâmica da Resposta do Tecido Subcutâneo para Associação de Microorganismos com o Extrato de Araçá (Psidium cattleianum): Uma Análise Microscópica e Edemogênica

Objective: To evaluate in vivo tissue reaction to the extract of araçá (Psidium cattleianum) associated with inactivated microorganisms. Material and Methods: A 0.1 mL suspension was used containing Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Enterococcus faecalis, Peptostreptococcus micros, and Porphyromonas endodontalis, which were inactivated by heat and mixed into a 1.0 mL saline (control group), an aqueous solution, or a hydroalcoholic extract of araçá. Eighteen male rats (Rattus norvegiccus) under general anesthesia received 0.2 mL of 1% intravenous Evans blue. Thirty minutes later, 0.1 mL of one of the associations was injected into the animals' dorsal region. The animals were euthanized after 3 and 6 hours, and the materials obtained were placed in formamide for 72 hours then analyzed in a spectrophotometer (λ=630 ηm). For the morphological analysis, 30 rats received polyethylene tubes implants with the extracts or the saline with the associations in the dorsal region and euthanized after 7 and 30 days to be analyzed according to an inflammation cell score. Results: No significant difference (p>0.05) was observed in the edema among groups. The optical microscopy results showed a repair in the 30-day-period, which was higher when compared to the 7-day-period (p< 0.0001). Nevertheless, in the 7-day-period, the hydroalcoholic extract presented a significant response compared to the aqueous extract (p=0.05) and a trend for better results than the control group. Conclusion: The aqueous and hydroalcoholic araçá extracts associated with inactivated microorganisms showed similar responses to control, indicating no interference on the toxic effects of the bacterial components in tissue repair. (AU)

Objetivo: Avaliar in vivo a reação tecidual do extrato de araçá (Psidium cattleianum) associado com microorganismos inativados. Material e Métodos: Uma suspensão de 0.1mL foi usada contendo Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Enterococcus faecalis, Peptostreptococcus micros e Porphyromonas endodontalis dos quais foram inativos por aquecimento e misturados a 1,0 mL de soro fisiológico (grupo controle), uma solução aquosa ou hidroalcoólica de araçá. Dezoito ratos machos (Rattus norvegiccus) sob anestesia geral receberam 0,2mL de Azul de Evans a 1% intravenoso. Após trinta minutos, 0,1mL de um dos extratos (associado com microorganismos inativos) foi injetado nos animais na região dorsal. Os animais foram eutanasiados após 3 e 6 horas, e os materiais obtidos colocados em formamida por 72 horas para análise em espectrofotômetro (λ=630 ηm). Para análise morfológica, 30 ratos receberam implante subcutâneo de tubo de polietileno com as associações na região dorsal, eutanasiados após 7 e 30 dias para serem analisados de acordo com um escore de células inflamatórias. Resultados: Não houve diferença significativa (p>0,05) no edema entre os grupos. Os resultados obtidos em microscópio óptico apontaram reparo em 30 dias superior ao de 7 dias (p< 0,0001). No período de 7 dias a solução hidroalcoólica apresentou resposta superior a solução aquosa (p=0,05) e uma tendência de melhor resultado que o controle. Conclusão: A solução aquosa e hidroalcoólica de extrato de araçá associadas a microrganismos inativados apresentaram respostas biológicas semelhantes ao controle, indicando que não há interferência sobre os efeitos tóxicos advindos dos componentes bacterianos, no sentido de favorecer o reparo(AU)

Viability of Human Gingival Fibroblast (FGH) Treated with Ethanolic "Aroeira" Extract (Myracrodruon urundeuva Allemão)

ABSTRACT The aim of this study was to evaluate the effect of ethanolic "aroeira" (Myracrodruon urundeuva) extract on the viability of human gingival fibroblast. For this, fibroblasts (2x103 cells/well) were plated in a 96-well plate and incubated for 24 h; the medium (Eagle's medium modified by Dulbecco - DMEM) supplemented with 10% fetal bovine serum was replaced by DMEM with different ethanolic extract concentration (0, 0.1, 1, 10, 100, and 1000μg / mL). The fibroblast viability was analyzed after 48,72, and 96 h by the neutral red capture test and violet crystal. The "aroeira" extract, at high concentrations (100 and 1000 µg/mL) caused decrease in both cellular viability tests (p<0.05). However, dilutions between 0.1 and 10 µg/mL did not affect the viability of the cells. It was concluded that "aroeira" extract was able to change the gingival fibroblast viability, and this effect was concentration dependent.

Experimental Calcium Silicate-Based Cement with and without Zirconium Oxide Modulates Fibroblasts Viability

The aim of this study was to verify whether the use of zirconium oxide as a radiopacifier of an experimental calcium silicate-based cement (WPCZO) leads to cytotoxicity. Fibroblasts were treated with different concentrations (10 mg/mL, 1 mg/mL, and 0.1 mg/mL) of the cements diluted in Dulbecco's modified Eagle's medium (DMEM) for periods of 12, 24, and 48 h. Groups tested were white Portland cement (WPC), white Portland cement with zirconium oxide (WPCZO), and white mineral trioxide aggregate Angelus (MTA). Control group cells were not treated. The cytotoxicity was evaluated through mitochondrial-activity (MTT) and cell-density (crystal violet) assays. All cements showed low cytotoxicity. In general, at the concentration of 10 mg/mL there was an increase in viability of those groups treated with WPC and WPCZO when compared to the control group (p<0.05). A similar profile for the absorbance values was noted among the groups: 10 mg/mL presented an increase in viability compared to the control group. On the other hand, smaller concentrations presented a similar or lower viability compared to the control group, in general. A new dental material composed of calcium silicate-based cement with 20% zirconium oxide as the radiopacifier showed low cytotoxicity as a promising material to be exploited for root-end filling.

Resumo O objetivo deste estudo foi verificar se o uso do óxido de zircônia como radiopacificador de um cimento experimental à base de silicato de cálcio (WPCZO) levou a citotoxicidade. Os fibroblastos foram tratados com diferentes concentrações (10 mg/mL, 1 mg/mL e 0,1 mg/mL) dos cimento diluídos em meio Eagle modificado por Dulbecco (DMEM) durante períodos de 12, 24, e 48 horas. Os grupos testados foram: cimento Portland (WPC), cimento Portland branco com óxido de zircônio (WPCZO) e MTA Angelus branco (MTA). No grupo controle as células não foram tratadas. A citotoxicidade foi avaliada por meio da mitocondrial-atividade (MTT) e ensaio de densidade celular (cristal violeta). Todos os cimentos apresentaram baixa citotoxicidade. Em geral, na concentração de 10 mg/mL, houve um aumento na viabilidade desses grupos tratados com WPC e WPCZO quando comparado com o grupo controle (p <0,05). Um perfil semelhante para os valores de absorvância foi observado entre os grupos: 10 mg/mL apresentaram um aumento da viabilidade em relação ao grupo controle. Por outro lado, as concentrações menores apresentaram uma viabilidade semelhante ou inferior em comparação com o grupo controle, em geral. Um novo material odontológico composto de cimento à base de silicato de cálcio com 20% de óxido de zircônio, como o radiopacificador, apresentou baixa citotoxicidade e pode ser explorado como um material promissor para retrobturações.

Seven years of external control of fluoride levels in the public water supply in Bauru, São Paulo, Brazil

Fluoridation of the public water supplies is recognized as among the top ten public health achievements of the twentieth century. However, the positive aspects of this measure depend on the maintenance of fluoride concentrations within adequate levels. Objective: To report the results of seven years of external control of the fluoride (F) concentrations in the public water supply in Bauru, SP, Brazil in an attempt to verify, on the basis of risk/benefit balance, whether the levels are appropriate. Material and Methods: From March 2004 to February 2011, 60 samples were collected every month from the 19 supply sectors of the city, totaling 4,641 samples. F concentrations in water samples were determined in duplicate, using an ion-specific electrode (Orion 9609) coupled to a potentiometer after buffering with TISAB II. After the analysis, the samples were classified according to the best risk-benefit adjustment. Results: Means (±standard deviation) of F concentrations ranged between 0.73±0.06 and 0.81±0.10 mg/L for the different sectors during the seven years. The individual values ranged between 0.03 and 2.63 mg/L. The percentages of the samples considered “low risk” for dental fluorosis development and of “maximum benefit” for dental caries prevention (0.55-0.84 mg F/L) in the first, second, third, fourth, fifth, sixth, and seventh years of the study were 82.0, 58.5, 37.4, 61.0, 89.9, 77.3, and 72.4%, respectively, and 69.0% for the entire period. Conclusions: Fluctuations of F levels were found in the public water supply in Bauru during the seven years of evaluation. These results suggest that external monitoring of water fluoridation by an independent assessor should be implemented in cities where there is adjusted fluoridation. This measure should be continued in order to verify that fluoride levels are suitable and, if not, to provide support for the appropriate adjustments.

Fluoride effect on the process of alveolar bone repair in rats: evaluation of activity of MMP-2 and 9

Objective: The aim of this study was to evaluate comparatively the effect of fluoride (F) on the activity of matrix metalloproteinases 2 and 9 (MMP-2 and MMP-9) involved in process of alveolar bone repair. Material and methods: This study used 4 groups of Wistar rats with 80 days of life (n = 160) which received drinking water containing different doses of fluoride (NaF): 5, 15, 50 ppm and deionized water (control) throughout the experiment. These animals had their right upper incisors extracted. After extraction, the animals were euthanized at 7, 14, 21 and 30 days and the hemi-maxillae were collected for microscopic analysis (Hematoxylin and Eosin and immunohistochemistry for MMP-9) and zymography (MMP-2 and 9).Results: Microscopically the process of bone repair was similar in all groups, being noted only a delay of the blood clot resorption and bone formation in the group of 50 ppm F. The expression for MMP-9 showed differences betweengroups only during the initial repair (7 days). However, the zymography showed no significant differences between treated and control groups. Conclusion: Ours results suggest an effect of fluoride on the activity of MMPs 2 and 9 at the initial period of alveolar repair which could be associated to the process of blood clot remission and delay in bone repair. Further studies are needed to establish the relationship between the initial process of resorption of the blood clot, and the involvement of MMPs 2 and 9 and its regulators/tissue inhibitors.

Alkaline phosphatase activity in plasma and liver of rats submitted to chronic exposure to fluoride

The aim of this study was to compare the effect of fluoride (F) on alkaline phosphatase activity in the liver and plasma of the rats. Four groups of male Wistar rats (n=6), which received drinking water containing 5, 15 or 50 ppm F or deionized water (control) throughout the experiment were included in the study. The animals were euthanized and had their tissues and blood plasma collected for the analysis of fluoride and alkaline phosphatase. There was an increase in F concentration in most tissues in the animals treated with higher F concentrations, except for the heart. The alkaline phosphatase assay showed an increase in the activity in the liver and blood plasma of the animals treated with fluoride concentrations of 15 and 50 ppm (p<0.05). This study suggested that F at a concentration of 50 ppm in drinking water promotes increased the activity of alkaline phosphatase in the liver and blood plasma.

Matriz colagênica de tendão bovino como potencial biomaterial para bioengenharia de tecidos / Collagenic matrix from bovine tendon as a potential biomaterial for tissue bioengineering

A Engenharia de Tecidos é um campo interdisciplinar que busca preservar, restaurar ou criar um tecido funcional, apoiando- se em três elementos fundamentais: células, fatores tróficos e carreadores. Um desses elementos, que ainda permanece sob intensa investigação, é o carreador. O objetivo do trabalho foi avaliar o comportamento tecidual ao implante de membrana colagênica derivada de tendão bovino em subcutâneo de camundongos. Nos animais do grupo controle foi feita apenas a incisão, divulsão e sutura. Depois de 3, 7, 15, 30 e 60 dias, os camundongos foram eutanasiados por dose excessiva de anestésico, sendo os tecidos reacionais coletados para análise histológica. Foram observados os seguintes parâmetros: biodegradação em relação ao tempo, vascularização, integração tecidual e reação de corpo estranho. O tecido adjacente ao material implantado apresentou infiltrado inflamatório nos períodos iniciais, com angiogênese e proliferação fibroblástica. No grupo experimental constatamos uma moderada reabsorção da membrana nos períodos de 15 e 30 dias e absorção completa aos 60 dias. A absorção foi mediada por células tipo macrófagos, sem a necessidade de células gigantes. Concomitantemente, houve a regeneração tecidual. No grupo controle observamos resultados compatíveis com o procedimento operatório, mostrando formação de coágulo e rede de fibrina nos primeiros períodos, proliferação angioblástica e fibroblástica nos períodos seguintes e regeneração tecidual nos 2 últimos períodos analisados. Diante dos resultados obtidos, podemos concluir que a membrana de tendão bovino é biocompatível e reabsorvível, posicionando- se como um promissor material a ser explorado pela medicina regenerativa.

Tissue Engineering is an interdisciplinary field that seeks to preserve, restore or create a functional tissue, relying on three key elements: cells, growth factors and carriers. Thus, our objective was to evaluate the reactional tissue induced by collagenic matrices derived from bovine tendon in the subcutaneous tissue of mice. Thereafter, the animals were killed at 3, 7, 15, 30 and 60 days post-surgery of implantation and tissues collected for histological analysis for analyzing: biodegradation, angiogenesis, tissue integration and foreign body reaction. The reactional tissue showed a moderate inflammatory infiltrate, with angiogenesis and fibroblast- like cells proliferation, while a moderate resorption of the membrane was found at 15 and 30 days and it being complete at 60 days. Our results suggest that the absorption was mediated by mononuclear cells such as macrophages, without giant cells involvement. Based on these results, we conclude that the membrane of bovine tendon is biocompatible and absorbable, it being a promising material to be exploited for regenerative medicine.

Análise morfométrica da resposta tecidual ao osso bovino misto medular implantado em defeito ósseo na calvária de rato / Morphometric analysis of tissue response to mixed bovine bone marrow implanted in bone defects in rat calvaria

O propósito deste trabalho foi avaliar o reparo ósseo de defeito de tamanho crítico em crânio de ratos tratados com disco de osso bovino misto (OBM) medular poroso. Foram utilizados 30 ratos Wistar machos adultos submetidos à cirurgia para confecção de um defeito circular de 8 mm de diâmetro removendo toda a díploe da calvaria. Os defeitos foram preenchidos com um disco de OBM de 8 mm de diâmetro por 3 mm de espessura, enquanto no grupo controle o defeito ósseo foi preenchido com coágulo sanguíneo do próprio animal. Os animais foram mortos após 30, 60 e 120 dias. As peças foram removidas, fixadas em formol 10% tamponado, desmineralizadas e processadas pela técnica histotécnica padrão para coloração em hematoxilina e eosina. Os cortes foram submetidos à análise histológica descritiva e morfometria (densidade de volume). Os resultados demonstraram uma pequena diminuição do material implantado com o decorrer dos períodos experimentais, sugerindo uma reabsorção lenta e gradual do OBM. Em contrapartida foi observado uma pequena neoformação óssea nos dois grupos (teste e controle) e formação de tecido conjuntivo denso nas áreas do defeito ósseo aos 120 dias também nos dois grupos. O tecido conjuntivo, no grupo teste, foi capaz de penetrar nos poros do material e ocupar esses espaços com o passar dos períodos. Dentro dos limites desse estudo, pode-se afirmar que o OBM é biocompativel, no entanto, não apresenta capacidade osteocondutora ou osteoindutora em defeitos críticos na calvária de ratos Wistar.

The purpose of this study was to evaluate bone repair of critical size defects in the calvarias of rats treated with bovine bone mixed disk (OBM) porous medullary. We used 30 adult male Wistar rats that underwent surgery to confection a bone defect of 8 mm diameter circular removing diploe calvaria completely. The defects were filled with a disc of OBM 8 mm diameter and 3 mm thick, while the control group the bone defect was filled with blood clot. The animals were killed after 30, 60 and 120 days. The pieces were removed, fixed in 10% buffered formalin, demineralized and processed by standard technique to staining with hematoxylin and eosin. The sections were submitted to descriptive histology and morphometry (volume density). The results showed a small decrease of the implanted material in the course of the experimental periods, suggesting a slow and gradual resorption of the OBM. On the other hand, there was a small new bone formation observed in both groups (test and control) and formation of dense connective tissue areas of the bone defect at 120 days also in the two groups. The connective tissue in the test group was able to penetrate the pores of the material and occupy these spaces over the periods. Within the limits of this study, it can be said that the OBM is biocompatible, however, does not have osteoinductive or osteoconductive capacity in critical defects in the calvaria of rats.

Recovery of silver residues from dental amalgam

Dental amalgam residues are probably the most important chemical residues generated from clinical dental practice because of the presence of heavy metals among its constituents, mainly mercury and silver. OBJECTIVE: The purpose of this study was to develop an alternative method for the recovery of silver residues from dental amalgam. MATERIAL AND METHODS: The residue generated after vacuum distillation of dental amalgam for the separation of mercury was initially diluted with 32.5 percent HNO3, followed by precipitation with 20 percent NaCl. Sequentially, under constant heating and agitation with NaOH and sucrose, the sample was reduced to metallic silver. However, the processing time was too long, which turned this procedure not viable. In another sequence of experiments, the dilution was accomplished with concentrated HNO3 at 90ºC, followed by precipitation with 20 percent NaCl. After washing, the pellet was diluted with concentrated NH4OH, water and more NaCl in order to facilitate the reaction with the reducer. RESULTS: Ascorbic acid was efficiently used as reducer, allowing a fast reduction, thus making the procedure viable. CONCLUSIONS: The proposed methodology is of easy application and does not require sophisticated equipment or expensive reagents.

Biocompatibility evaluation of a new bioresorbable pin for membrane fixation

The aim of this study was to morphometrically analyze the tissue response to a customized pin obtained from devitalized bovine cortical bone (DBCB-pin) implanted in the subcutaneous tissue of rats, as well as to assess its microstructural aspect by scanning electron microscopy (SEM). The pins were implanted in the subcutaneous tissue of 20 rats, which were killed at 7, 14, 28 and 60 days (5 rats/period) after implantation. In the subcutaneous tissue, DBCB-pin promoted the formation of a fibrous capsule. At 7 days, capsule showed thickness of 70 ± 3.2 µm with higher density of newly formed capillaries and smaller density of collagen fibers. Between 14 and 60 days, more organized fibrous capsule exhibited smaller thickness (53 ± 5.5 µm) with higher density of fibroblasts and collagen fibers. In this period, a small and slow bioresorption of the DBCB-pin by macrophages and rare multinucleated giant cells without tissue damage was observed. The thickness of DBCB-pin resorbed was in mean only of 9.3 µm. During all experimental periods not occurred presence of immune reaction cells as lymphocytes and plasma cells. It was concluded that the pin derived from cortical bovine bone was well tolerated by subcutaneous tissue of rats and slowly resorbed could be an alternative material for membrane fixation in the guided tissue regeneration procedures.

O objetivo deste estudo foi analisar morfometricamente a resposta tecidual a um pino obtido a partir de osso bovino desvitalizado cortical (DBCB pinos) implantado no tecido subcutâneo de ratos, bem como para avaliar o seu aspecto microestrutural por microscopia eletrônica de varredura (MEV). Os pinos foram implantados no tecido subcutâneo de 20 ratos, que foram sacrificados aos 7, 14, 28 e 60 dias (5 animais / período) após a implantação. No tecido subcutâneo, o pino DBCB promoveu a formação de uma cápsula fibrosa. Aos 7 dias, a cápsula apresentou espessura de 70 ± 3,2 μm com maior densidade de capilares neoformados e menor densidade de fibras colágenas. Entre 14 e 60 dias, a cápsula fibrosa apresentava-se mais organizada e exibiram menor espessura (53 ± 5,5 μm) com maior densidade de fibroblastos e fibras colágenas. Nesse período, foi observada uma bioreabsorção pequena e lenta dos pinos DBCB por macrófagos e raras células gigantes multinucleadas, sem dano tecidual. A espessura dos pinos DBCB reabsorvidos foi em média de apenas 9,3 µm. Durante todos os períodos experimentais não ocorreu presença de células como linfócitos e células plasmáticas. Concluiu-se que o pino derivado de osso bovino cortical foi bem tolerado pelo tecido subcutâneo de ratos e reabsorvido lentamente, sendo um potencial material alternativo para fixação da membrana nos procedimentos de regeneração tecidual guiada.

The use of low-level laser therapy in the prevention and treatment of chemotherapy-induced oral mucositis

The management of oral mucositis is fundamental in maintaining the quality of life of cancer patients as well as the feasibility and effectiveness of non-surgical treatments of cancer. A literature review was carried out in order to update information on the use of low-level laser therapy for prevention and treatment of induced oral mucositis in patients undergoing chemotherapy or conditioning for hematopoietic cell transplantation. Lasertherapy is a simple, non-invasive and atraumatic technique which has shown good results in the prevention of oral mucositis through basic research and controlled clinical trials. Although the precise molecular mechanisms of low-level laser action have not been elucidated, in face of its proven effectiveness in the management of oral mucositis and the absence of side effects, its use should be continued and even encouraged while the results from new studies defining the optimal parameters for laser application are awaited.

Associação de tetraciclina à membrana de osso cortical bovino desmineralizado aumenta atividade de enzimas lisossomais / Association of tetracycline and membrane of demineralized bovine cortical bone increase lysosomal enzyme activity

A regeneração tecidual e óssea guiadas utilizando membranas (M) à base de colágeno é usual. A tetraciclina é utilizada algumas vezes para auxiliar a regeneração tecidual na forma tópica ou associada às barreiras absorvíveis, contudo acelerando a degradação da membrana. Enzimas lisossomais estão envolvidas na resposta celular a biomateriais. O objetivo deste estudo é avaliar o efeito da associação da tetraciclina à membrana derivada do osso cortical bovino desmineralizado (MT) na atividade de enzimas lisossomais. As membranas (M e MT) foram implantadas no tecido subcutâneo de ratos (n = 120) e 1, 3, 7, 14, 28 e 60 dias após a cirurgia os animais foram mortos e os respectivos tecidos reacionais coletados para análise bioquímica. O lisado do tecido foi obtido em tampão acetato 0,1 M, pH 5, contendo EDTA e β-mercaptoetanol 1 mM para a determinação da atividade das isoformas da fosfatase ácida, fosfatase alcalina de membrana e arilsultase e β-hexosamidase. No grupo MT observou-se maior atividade das enzimas lisossomais nos períodos de 1, 3 e 7 dias (p < 0,05). Os resultados obtidos permitem concluir que a associação de tetraciclina à membrana aumenta a atividade específica das enzimas analisadas, concorrendo para a aceleração da degradação da membrana + tetraciclina.

Guided bone and tissue regeneration using collagen-derived membranes (M) is a common practice. Topical application of tetracycline or its association to membranes intends to complement guided tissue regeneration, however, accelerated degradation was observed. Lysosomal enzymes are involved in the cell response to biomaterials. The aim of this work was to evaluate the effect of tetracycline association to the membrane (MT) obtained from demineralized bovine cortical bone to lysosomal enzymes. Membranes (M and MT) were implanted in the subcutaneous tissue of rats (n=120) 1, 3, 7, 14, 28 and 60 days after implantation the animals were killed and the granuloma removed for enzymatic analysis. Tissue lyses was obtained using 0.1M acetate buffer, pH 5.0, plus 1 mM of EDTA and β-mercaptoethanol for determination of acid phosphatase isoforms, cell membrane alkaline phosphatase, arilsulfatase and β-hexosaminadase activities. MT group showed higher lysosomal activity at 1, 3 and 7 days (p<0.05) than M group. Based on the results it could be concluded that the treatment of membranes with tetracycline significantly altered the specific activity of the enzymes, increasing MT degradation in the tissue.

Acompanhamento histomorfométrico e radiográfico do reparo de defeito crítico em crânio de ratos preenchidos com associação de osso medular bovino e BMP / Histomorphometric and radiographic monitoring the repair of critical defects in skulls of rats completed with combination of medular bovine bone plus BMP

O objetivo deste trabalho foi avaliar histomorfometricamente o processo de reparo de defeito ósseo perene na calvária de ratos preenchidos com grânulos de osso medular bovino desproteinizado, associado a um pool de proteínas morfogenéticas ósseas (BMPs) bovinas. Após 1, 3 e 6 meses, as calotas cranianas foram coletadas, processadas e as sessões obtidas coradas em Hematoxilina e Eosina. A análise histomorfométrica mostrou que o xenoenxerto não foi completamente degradado durante os períodos estudados, com a densidade de volume do material implantado permanecendo próximo de 50% em todos os períodos (p > 0,05). No grupo controle a densidade de volume do tecido conjuntivo era de 62,5% ± 8,81% (1° mês), diminuindo significantemente para 40,2% ± 7,5% após 6 meses (p < 0,05), enquanto que o volume de tecido ósseo neoformado passou de 37,5% ± 8,81% no 1° mês para 59,8% ± 7,5% aos 6 meses (p < 0.05). No grupo experimental, o volume de tecido conjuntivo diminuiu de 45,8% ± 7,8% (1° mês) para 31,8% ± 8,38% (6° mês), ao passo que o volume do tecido ósseo neoformado aumentou de 7,0% ± 2,45% (1° mês) para 19,6% ± 11,04% (6° mês) (p < 0,05). Conclui-se que, a despeito da biocompatibilidade e propriedade osteocondutora do xenoenxerto, o composto estudado retardou o reparo ósseo em defeito críticos no crânio de ratos.

The objective of this study was to evaluate the healing process of perennial bone defect in the skull of rats promoted by treating the defects with inorganic granules of bovine bone plus a pool of bone morphogenetic proteins (BMPs). After 1, 3 and 6 months from surgery, the whole skulls were carefully collected and sections obtained were stained with Hematoxylin & Eosin. We showed that implanted material was not completely resorbed during the periods studied, remaining around 50% in all periods (p > 0.05). In the control group the volume of connective tissue decreased significantly from 62.5% ± 8.81% (1 month) to 40.2% ± 7.5% after 6 months (p < 0.05), while that the amount of neoformed bone increased from 37.5% to ± 8.81% (1 month) to 59.8% ± 7.5% (6 months) (p < 0.05). On the other hand, in the experimental group, the volume of connective tissue decreased from 45.8% ± 7.8% (1 month) to 31.8% ± 8.38% (6 months), while the amount of neoformed bone tissue increased from 7.0% ± 2.45% (1 month) to 19.6% ± 11.04% (6 months) (p < 0.05). Based on results, we concluded that, despite the biocompatibility and osteoconductive property of signaling molecules such as BMPs, their combination with bovine bone particles delayed the new bone formation in critical defects rats.

Avaliação da influência do fluoreto no reparo ósseo em alvéolo dental de ratos: análise morfométrica e perfil de atividade das MMP-2 e 9 / Evaluation of the fluoride influence in alveolar bone repair in rats: morphometric analysis and MMP-2 activity

O flúor (F), na forma de fluoreto de sódio (NaF), é um elemento presente no cotidiano de quase a totalidade da população brasileira, sendo usado na água de abastecimento (Brasil) e também como terapêutico para osteoporose (comumente na Europa). Assim sendo, é importante o entendimento do efeito do flúor no reparo ósseo. Neste estudo foram utilizados 4 grupos com ratos Wistar de 80 dias (n=200), os quais receberam água de beber contendo 5, 15 e 50 ppm de flúor e água deionizada (grupo controle) durante todo experimento. Esses animais tiveram o incisivo superior direito extraído. Os animais foram eutanasiados O hora, 7, 14, 21 e 30 dias após a extração, sendo coletado sangue (análise da concentração de flúor), a região do alvéolo dental para análise microscópica (análise histológica e morfometria) e extração de proteínas referentes ao reparo ósseo (metaloproteinases de matriz - MMPs 2 e 9). A análise de concentração de flúor no plasma sangüíneo mostrou maior presença desse elemento no grupo tratado com 50 ppm de F nos períodos de 21 e 30 dias. A análise histológica detectou osso neoformado em todos os animais após 30 dias, porém o grupo de 50 ppm de F apresentou menor formação óssea que os outros grupos. A análise morfométrica mostrou um aumento na densidade de volume de osso neoformado, entre 7 e 30 dias, nos grupos controle, 5, 15 e 50 ppm de F, com concomitante diminuição na densidade de volume de tecido conjuntivo e coágulo sangüíneo. A atividade da MMP-2 foi mais acentuada no período inicial, enquanto a MMP-9 teve maior atividade no período final. Concluiu-se que o F, em altas concentrações, pode retardar o reparo alveolar diminuindo a formação de novo tecido ósseo, associado a um atraso na remissão do coágulo.

The fluorine (F), in the sodium fluoride (NaF) form, is an element daily present for most people, being used in water supply (Brazil) and also as therapy for osteoporosis (common in Europe). In such case it is important the understanding of the effect of fluoride in physiologic repair in bone tissue. This study used 4 groups of rats for 80 days (n = 200), which received drinking water containing 5, 15 and 50 ppm of fluoride, and deionized water (control group) throughout experimento These animais had the right upper incisor extracted. The animais were euthanized O hours, 7, 14, 21 and 30 days after extraction, and blood collected (analysis of the concentration of fluorine), the region of the dental alveolus for microscopic exa'mination (histological analysis and morphometry) and extraction of proteins for the bone repair (the matrix metalloproteinases - MMP 2 and 9). The analysis of concentration of fluoride in blood plasma showed greater presence of that element in the group treated with 50 ppm of F in periods of 21 and 30 days. Histological analysis detected neoformed bone in ali animais after 30 days, but the group of 50 ppm F showed lower bone formation than the other groups. Morphometric analysis showed an increase in the volume density of neoformed bone, between 7 and 30 days in control groups, 5, 15 and 50 ppm F, with a concomitant decrease in the volume density of connective tissue and blood dot. The activity of MMP-2 was more pronounced in the initial period, while MMP-9 had higher activity in the 30 days. It was concluded that the F, in high concentrations, may delay the tooth socket repair reducing the formation of new bone tissue, associated with a delay in remission of blood clot.

Marcadores bioquímicos e microscópicos como ferramentas investigativas da resposta tecidual envolvidas com a associação de osso cortical bovino/colágeno em subcutâneo de ratos / Biochemical and microscopic analyses as investigative tool of tissue response involved with the association of bovine cortical bone/collagen in subcutaneous of rats

O objetivo deste trabalho foi avaliar a reposta tecidual à associação de osso bovino inorgânico e colágeno bovino liofilizado, implantados em subcutâneo de ratos. O composto (osso bovino + colágeno) foi acondicionado em cápsulas de colágeno transparente e posteriormente implantado no tecido conjuntivo subcutâneo de ratos. Os animais foram mortos após 10, 20, 30 e 60 dias da cirurgia e as peças recolhidas para análise microscópica e enzimática. Foram analisados os aspectos microscópicos da resposta tecidual, bem como a atividade específica da fosfatase ácida total, fosfatase ácida lisossomal, fosfatase ácida de baixa massa molecular, fosfatase ácida resistente ao tartarato (marcador de osteoclastos e alguns tipos de células gigantes multinucleadas) e da fosfatase alcalina. A análise enzimática mostrou que a atividade da fosfatase ácida lisossomal coincidiu com os períodos de maior presença de células gigantes multinucleadas inflamatórias. A análise microscópica revelou um moderado infiltrado inflamatório apenas no período de 10 dias, desaparecendo nos períodos seguintes. A presença de linfócitos e plasmócitos foi leve, sendo notada apenas no período de 10 dias. O grau de fibrosamento tendeu de moderado a intenso até o final do experimento. Dentro dos limites deste trabalho pode-se concluir que a combinação de osso cortical bovino + colágeno bovino liofilizado é biocompatível não exibindo sinais de resposta imunogênica, além disso, a atividade das fosfatases ácidas pode ser modulada em função do tempo, durante a resposta tecidual ao composto implantado em subcutâneo de ratos. O exato papel de cada uma dessas enzimas nesta complexa cadeia de eventos deve, ainda, ser investigado.

The objective of this work was to evaluate the rat tissue response under association of inorganic bovine bone and bovine collagen. Before experimentation, the association (bovine bone + collagen) was conditioned in collagen capsules and after implanted in rats subcutaneous tissue. Afterwards, the animals were killed as follows: 10, 20, 30 and 60 days after surgery. Immediately, the biopsies were collected and appropriately conditioned for both microscopic and biochemical analysis. The biochemical parameters evaluated were: specific activity of total acid phosphatase, lisossomal acid phosphatase, low molecular weight phosphatase, tartarateresistant acid phosphatase and of alkaline phosphatase. These results showed that lisossomal acid phosphatase activity coincided with the periods of bigger incidence of inflammatory multinucleated giant cells. Results from microscopic analysis showed a moderate infiltrated inflammatory at 10 days, decreasing at the following periods. Also, the presence of lymphocytes and plasmocytes was scored as light at 10 days. We found that fibrosis degrees were between moderate to intense at the final periods. Taken together, our results showed that association of cortical bovine bone plus bovine collagen is biocompatible by not showing signals of immune response. On the other hand, both acid and alkaline and phosphatase activities were modulated along the periods evaluated as responsive events.