Research progress on dental materials for preventing root caries / 口腔疾病防治

@#The high incidence and untreated rate of root caries, a common and frequently occurring oral disease with challenging treatment in elderly individuals, is the main cause of tooth loss among elderly people, as rapid development results in pulpitis and periapical periodontitis or residual crown and root, which has been regarded as one of the common chronic oral diseases seriously affecting the quality of life of elderly people. Thus, early intervention and prevention are important. Traditional dental materials for preventing root caries have been widely used in clinical practice; however, they have the disadvantages of tooth coloring, remineralization and low sterilization efficiency. A series of new dental materials for preventing root caries have gradually become a research hotspot recently, which have the advantages of promoting the mineralization of deep dental tissue, prolonging the action time and enhancing adhesion. Future caries prevention materials should be designed according to the characteristics of root surface caries and the application population and should be developed toward simplicity, high efficiency and low toxicity. This review describes current research regarding anti-caries prevention material application, serving as a theoretical underpinning for the research of root caries prevention materials, which is important for both promotion in the effective prevention of root caries and improvement in the status of oral health and the quality of life among old people.

Despigmentação precoce em caso de ceratopigmentação / Early depigmentation in case of keratopigmentation

RESUMO A ceratopigmentação teve seu primeiro registro pelo filósofo Galeno há muitos séculos como uma estratégia utilizada para o tratamento estético de pacientes com leucomas. As córneas com leucoma são patológicas e, muitas vezes, intolerantes a lentes de contato cosméticas ou próteses oculares, sendo comum a queixa de desconforto excessivo, proporcionado pela superfície corneana irregular. Assim, a ceratopigmentação é uma alternativa para a melhora estética de pacientes com opacidades corneanas. Descrevemos o caso de um paciente do sexo masculino, 39 anos, que apresentou despigmentação precoce em caso de ceratopigmentação associado a quadro de ceratite herpética necrotizante. O paciente foi submetido ao tratamento com aciclovir 2g ao dia e doxiciclina 200mg ao dia, evoluindo com melhora do quadro clínico, apesar da má adesão medicamentosa.

ABSTRACT Keratopigmentation was first recorded many centuries ago by the philosopher Galeno, as a strategy used for the aesthetic treatment of patients with leukomas. Corneas with leucoma are pathological and often intolerant of cosmetic contact lenses or ocular prostheses, with complaints of excessive discomfort provided by the irregular corneal surface being common. Therefore, keratopigmentation is an alternative for the aesthetic improvement of patients with corneal opacities. We describe the case of a 39-year old male patient, who presented early depigmentation in a case of keratopigmentation associated with necrotizing herpetic keratitis. The patient was treated with Acyclovir 2g/day and Doxycycline 200mg/day, evolving with clinical improvement, despite poor medication adherence.

Effects of acidic beverages on color stability of bulk-fill composites with different viscosities / Efectos de las bebidas ácidas sobre la estabilidad del color de resinas tipo Bulk con diferentes viscosidades

Abstract The aim of this in vitro study is to investigate the effects of acidic beverages on the discoloration of bulk-fill composites with different viscosities. 144 disc-shaped specimens (8mm diameter × 2mm thick) were prepared from four different composite resins including a nanohybrid (Filtek Ultimate), two packable bulk- fill (Filtek Bulk Fill, Tetric N Ceram Bulk Fill), and a flowable bulk-fill composite (Tetric N Flow Bulk Fill). The specimens of each group were divided into 3 subgroups and submerged in distilled water, orange juice and coke (n=12). Color difference (ΔE) were measured using CIELab color space and a compact spectrophotometer (VITA Easyshade) at baseline and after 30 days of immersion. Data were analyzed using two- way ANOVA and Tukeys HSD post-hoc tests (P2.7) was observed for all bulk-fill composites tested. It can be speculated that orange juice has a more negative effect on the color stability compared to coke. Additionally, flowable bulk-fill composite was more prone to discoloration than condensable bulk-fill composites.

Resumen El objetivo de este estudio fue investigar los efectos de las bebidas ácidas en la decoloración de resinas compuestas tipo Bulk con diferentes viscosidades. Se prepararon 144 muestras en forma de disco (8mm de diámetro x 2mm de grosor) a partir de cuatro resinas compuestas diferentes que incluyen un nanohíbrido (Filtek Ultimate), dos de pasta condensables tipo Bulk (Filtek Bulk Fill, Tetric N Ceram Bulk Fill) y una fluida (Tetric N Flow Bulk Fill). Las muestras de cada grupo se dividieron en 3 subgrupos y se sumergieron en agua destilada, jugo de naranja y Coca-Cola (n=12). La diferencia de color (ΔE) se midió utilizando el CIELab y un espectrofotómetro compacto (VITA Easyshade) al inicio y después de 30 días de inmersión. Los datos se analizaron mediante ANOVA bidireccional y pruebas post-hoc HSD de Tukey (P2,7) para todos los materiales resinosos. Se puede especular que el jugo de naranja tiene un efecto más negativo sobre la estabilidad del color en comparación con la Coca-Cola. Además, la resina fluida fue más propensa a la decoloración que las resinas condensables.

¿La glicerina influye en la estabilidad del color de la resina compuesta? / Does glycerin influence the color stability of composite resin?

Introducción: El efecto del oxígeno sobre la superficie de las resinas al momento de la fotopolimerización origina una capa que es susceptible a los pigmentos. El uso de la glicerina puede bloquear este efecto. Objetivo: Determinar si existe diferencia en la estabilidad del color de la resina compuesta nano-híbrida sometida a un agente colorante, al aplicar o no la glicerina. Métodos: 60 discos de resina se dividieron en Grupo 1 (sin glicerina) y Grupo 2 (con glicerina). La fotopolimerización se realizó por 20 s con la lámpara LED Bluephase®N. Se realizó la primera medición del color con el espectrofotómetro Easyshase®V y se registraron los valores arrojados para L* (luminosidad), a* (eje rojo-verde) y b* (eje azul-amarillo). Posterior a la inmersión por 1 mes de las muestras en Coca-Cola®, manteniéndolas en una incubadora a 37 ºC, se realizó la segunda medición del color. Se procesaron los datos estadísticamente con la prueba t de Student para determinar las variaciones en la estabilidad del color de ambos grupos y compararlos entre sí. Resultados: En todos los especímenes del experimento existió alteración en la estabilidad del color de la resina. La media de la distancia entre el color inicial y el color final del Grupo 1 fue de ΔE = 6,91, mientras en el Grupo 2 fue ΔE = 3,74. Se halló diferencia estadísticamente significativa entre ambos grupos analizados (p < 0,001). Conclusiones: La glicerina es una sustancia efectiva para bloquear el efecto del oxígeno en la superficie de la resina y evitar la formación de la capa inhibida de oxígeno, aumentando la estabilidad del color de la resina compuesta nano-híbrida(AU)

Introduction: The effect of oxygen on the surface of resins at the moment of photopolymerization creates a layer which is susceptible to pigments. The use of glycerin may block this effect. Objective: Determine whether there is a difference in the color stability of nanohybrid composite resin subjected to a coloring agent when glycerin is either applied or not applied. Methods: Sixty resin disks were distributed into Group 1 (without glycerin) and Group 2 (with glycerin). Photopolymerization was performed for 20 s with a Bluephase®N LED lamp. The first color measurement was taken with an Easyshase®V spectrophotometer, recording the values obtained for L* (luminosity), a* (red-green axis) and b* (blue-yellow axis). The second color measurement was taken after immersion of the samples for one month in Coca-Cola®, maintaining them in an incubator at 37ºC. Statistical data analysis was performed with Student's t test to determine the color stability changes occurring in the two groups and compare them. Results: Color stability changes were observed in all the resin samples. Mean distance between initial and final color was ΔE = 6.91 in Group 1 and ΔE = 3.74 in Group 2. A statistically significant difference was found between the two groups analyzed (p < 0.001). Conclusions: Glycerin is an effective substance to block the effect of oxygen on the resin surface, preventing the formation of an oxygen-inhibited layer and raising the color stability of the nanohybrid composite resin(AU)

Indocyanine green staining technique combined with laparoscopic hepatectomy with a Glisson pedicle approach for the treatment of liver cancer in 68 patients / 中国基层医药

Objective:To investigate the clinical value of indocyanine green (ICG) staining technique combined with laparoscopic hepatectomy with a Glisson pedicle approach in the treament of liver cancer.Methods:The clinical data of 150 patients with primary liver cancer, who received treatment in Yuyao People's Hospital from January 2019 to December 2020, were retrospectively analyzed. Group A ( n = 82) and group B ( n = 68) were designated according to the surgery methods used. The group A was subject to laparoscopic hepatectomy with a Glisson pedicle approach. The group B received ICG staining technique combined with laparoscopic hepatectomy with a Glisson pedicle approach. Operation-related conditions, postoperative complications, and the change in liver function indexes after surgery relative to before surgery were compared between the two groups. Results:There were no significant differences in the time taken to first anal exhaust, extubation time, and length of hospital stay between group A and group B (all P > 0.05). Operative time and intraoperative bleeding in the group B were (205.04 ± 35.01) minutes and (230.05 ± 17.53) mL, respectively, which were significantly lower than those in the group A [(228.07 ± 28.05) minutes, (255.07 ± 19.00) mL, t = 4.47, 8.31, both P < 0.05]. R0 resection rate was significantly lower in group B than in group A [85.29% (58/68) vs. 70.73% (58/82), χ2 = 4.50, P < 0.05]. There were no significant differences in postoperative complications between the two groups ( P > 0.05). Before treatment, there were no significant differences in serum levels of alanine aminotransferase (ALT), aspartate transaminase (AST), and total bilirubin between the two groups (all P > 0.05). At 1 day after surgery, serum ALT, AST, and TBil levels in each group were significantly increased compared with before surgery (all P < 0.05). Furthermore, serum levels of ALT, AST and TBil in the group A were (108.51 ± 30.23) U/L, (107.66 ± 26.93) U/L, and (32.16 ± 4.73) μmol/L, respectively, which were significantly higher than those in the group B [(88.38 ± 24.76) U/L, (86.85 ± 19.74) U/L, (27.95 ± 4.31) μmol/L, t = 4.40, 5.30, 5.65, all P < 0.05]. At 3 days after surgery, serum levels of ALT, AST, and TBil in each group were significantly lower than those at 1 day after surgery, but they were still higher than those before surgery. At 3 days after surgery, serum levels of ALT, AST and TBil in group A were (74.20 ± 13.83) U/L, (65.22 ± 9.68) U/L, and (28.18 ± 4.14) μmol/L, respectively, which were significantly higher than those in group B [(54.72 ± 10.31) U/L, (55.41 ± 7.63) U/L, (24.25 ± 3.98) μmol/L, t = 9.61, 6.79, 5.89, all P < 0.05]. Conclusion:Although the ICG staining technique has certain limitations, it can improve the accuracy of hepatectomy to a certain extent. ICG staining technique combined with laparoscopic hepatectomy with the Glisson pedicle approach is a safe and accurate treatment for liver cancer. The combined therapy is worthy of clinical application.

Clinical application of laparoscopic sentinel lymph node mapping in early staged cervical cancer / 中华妇产科杂志

Objective:To investigate the application of sentinel lymph node biopsy (SLNB) in early-staged cervical cancer by laparoscopy.Methods:It was a prospective, single-arm, single-center clinical study. Seventy-eight cases of cervical cancer patients were collected from July 2015 to December 2018 at the Fourth Hospital of Hebei Medical University. All the patients were injected with tracer into the disease-free block of cervical tissue after anesthesia by the same surgeon who learned sentinel lymph node (SLN) mapping technique in Memorial Sloan-Kettering Cancer Center, and underwent SLN mapping followed by complete pelvic lymphadenectomy. Moreover, all the dissected lymph nodes were stained with hematoxylin eosin staining (HE) pathological examination. Besides, the negative SLN on hematoxylin-eosin staining were detected by immunohistochemistry cytokeratin staining micro-metastasis. To analyze the distribution, detection rate, false negative rate the sensitivity and negative predictive value of the SLN in early-staged cervical cancer by laparoscopy, and explore the value of SLN mapping in predicting the lymph nodes metastasis in early-staged cervical cancer.Results:The overall detection rate of SLN in cervical cancer was 99% (77/78), bilateral detection rate was 87% (68/78). The average of 12.4 lymph node (LN) and 3.6 SLN were dissected for each patients each side. SLN of cervical cancer were mainly distributed in the obturator space (61.5%, 343/558), followed by external iliac (23.5%, 131/558), common iliac (7.3%, 41/558), para-uterine (3.8%, 21/558), internal iliac (2.2%, 12/558), para abdominal aorta (1.1%, 6/558), and anterior sacral lymphatic drainage area (0.7%, 4/558). Fourteen cases of LN metastasis were found among all 78 cases. There were a total of 38 positive LN, including 26 SLN metastasis and 12 none sentinel LN metastasis. Through immunohistochemical staining and pathological ultra-staging, 1 SLN was found to be isolated tumor cells (ITC), and 5 SLNs were found to be micro-metastases (MIC), accounting for 23% (6/26) of positive SLN. SLN mapping with pathological ultra-staging improved the prediction of LN metastasis in cervical cancer (2/14). Metastatic SLN mainly distributed in the obturator space (65%, 17/26), peri-uterine region (12%, 3/26), common iliac region (15%, 4/26), and external iliac region (8%, 2/26). The consistency of the diagnosis of lymph node metastasis by SLN biopsy and postoperative retroperitoneal lymph node metastasis showed that the Kappa value was 1.000 ( P<0.001), indicated that the metastasis status of SLN and retroperitoneal lymph node were completely consistent. The sensitivity, specificity, accuracy, false-negative rate, and negative predictive value of SLN biopsy in the diagnosis of lymph node metastasis were 100%, 100%, 100%, 0, and 100%, respectively. Conclusions:SLN in early-staged cervical cancer patients were mainly distributed in the obturator and external iliac space, pathalogical ultra-staging of SLN could improve the prediction of LN metastasis. Intraoperative SLN mapping is safe, feasible and could predict the state of retroperitoneal LN metastasis in early-staged cervical cancer. SLNB may replace systemic pelvic lymphadenectomy.

Evaluation of resin composite staining by beverages with acid pH / Avaliação do manchamento de resinas compostas por bebidas de pH ácido

ABSTRACT Introduction: Composite resins are an extensively used esthetic material that has excellent adaptation, reproduces the characteristics of the tooth structure and is suitable for the conditions of the oral environment. However, this material is also very susceptible to staining due to pigmentation coming from the diet and habits of the patient. Objectives: To evaluate the staining of two brands of composite resin, one nanoparticle and a nanohybrid type (Filtek Z350XT® and IPS Empress Direct®), in direct contact with the acid pH of beverages. Methods: In total 40 specimens were made, 20 of each type of resin studied. After being inserted into a Teflon matrix and light activated, the samples were removed, stored in containers with 2 ml of artificial saliva and kept in the refrigerator. Every day 20 of these samples were placed in direct contact with 2 ml Gatorade, and the other 20 samples, in 2 ml of wine, each set for 30 minutes. After 30 minutes, the acid pH substances were removed, and 2 ml of artificial saliva was again placed in the container. This process was repeated every day for 10 days. Results: The results showed that the nanoparticle resin (Filtek Z350XT) was more susceptible to staining than the nanohybrid type (Empress Direct®) when in contact with the wine. When wine and Gatorade were compared, the solution with higher staining capacity was shown to be wine. Conclusion: The two resins tested were susceptible to staining in a 10-day period. Mottling and more staining was visibly detected after samples were immersed in the solution with the higher pH, and nanoparticulate resin was more susceptible to staining.

RESUMO Introdução: As resinas compostas são altamente utilizadas por serem um material estético, com excelente adaptação, reproduz as características da estrutura dental e se adequa ao meio bucal. Porém, este material é muito susceptível à pigmentação por corantes vindos da dieta e de hábitos do paciente. Objetivos: Avaliar o manchamento de duas marcas comerciais de resina composta: Nanoparticulada e Nanohíbrida, em contato direto com bebidas de pH ácido (Filtek Z350XT® e IPS Empress Direct®). Métodos: Foram confeccionados 40 corpos de prova, 20 de cada tipo de resina estudada, depois de inseridas em matriz de teflon e fotoativados, os corpos de prova foram removidos, armazenados em recipientes com 2ml de saliva artificial e mantidos na geladeira. Diariamente 20 dos mesmos eram colocados em contato direto com 20mL Gatorade e os outros 20mL de vinho durante 30 minutos cada. Passados os 30 minutos, as substâncias de pH ácido eram retiradas e novamente, 2 mL de saliva artificial eram colocadas no recipiente. Este processo foi repetido todos os dias durante 10 dias. Resultado: Os resultados mostraram que a resina nanoparticulada (Filtek Z350XT®) é mais susceptível ao manchamento que a nanohíbrida (Empress Direct®) quando em contato com o vinho. Quando comparados vinho e Gatorade, a solução com maior teor de manchamento é o vinho. Conclusão: As duas resinas testadas foram sensíveis ao manchamento num período de 10 dias, esse manchamento foi visivelmente detectado, a solução com o pH mais elevado manchou mais e a resina nanoparticulada é mais susceptível ao manchamento.

Comparación de las tinciones con hematoxilina y eosina versus azul de toluidina en la evaluación de los carcinomas cutáneos durante la cirugía micrográfica de Mohs / Comparative study of toluidine blue and hematoxylin and eosin staining in evaluating skin-carcinoma during Mohs micrographic surgery / Comparação da coloração de hematoxilina e eosina versus azul de toluidina na avaliação de carcinomas cutâneos durante a cirurgia micrográfica de Mohs

Resumen: Introducción: la cirugía micrográfica de Mohs es una técnica quirúrgica especializada para el tratamiento del cáncer de piel no melanoma. La histopatología cumple un rol fundamental, y la elección de la tinción es un punto de controversia. Objetivos: comparar el rendimiento de las tinciones de hematoxilina y eosina (HyE) versus azul de toluidina (AT) durante la cirugía. Método: estudio observacional, descriptivo y transversal a partir de noviembre de 2017 hasta mayo de 2018. Se incluyeron las láminas empleadas durante la cirugía en el período mencionado. Estas fueron analizadas por el cirujano de Mohs, tres residentes y una dermopatóloga. Se valoró el rendimiento de ambas tinciones, teniendo en cuenta las características celulares y los elementos del estroma. Resultados: se estudiaron 23 tumores (16 carcinomas basocelulares y 7 carcinomas espinocelulares). Al observarse al microscopio óptico tanto con la tinción de AT como con HyE no se encontraron diferencias significativas entre ambos grupos en lo global, sólo en algunas características, especialmente con la HyE. Conclusiones: es el primer trabajo en Uruguay que compara la eficacia de las dos tinciones durante la cirugía micrográfica de Mohs. Como conclusión tanto la tinción de HyE como el AT son muy buenas técnicas para el diagnóstico de carcinomas cutáneos.

Abstract: Introduction: Mohs micrographic surgery is a specialized surgical technique used to treat nonmelanoma carcinoma. Histopathology plays a vital role in the diagnosis of this condition, and the choice staining method is controversial. Objective: to compare results in the use of hematoxylin and eosin (H&E) versus Toluidine blue (TB) staining during surgery. Method: observational, descriptive and transversal study conducted from November, 2017 until May, 2018 of the slides used during surgeries in the selected period. Slides were analysed by the Mohs surgeon, 3 residents and a dermopathologist to evaluate the results of both staining methods, in consideration of cell features and stromal elements. Results: 23 tumors were analysed (16 Basal Cell carcinomas and 7 Squamous Cell Carcinoma). Microscopic observation of slides prepared with Toluidine blue and hematoxylin and eosin stains did not show significant global differences between both groups, except in terms of a few characteristics, in particular with hematoxylin and eosin stains. Conclusions: this was the first study in Uruguay to evaluate the effectiveness of both staining methods during Mohs micrographic surgery, and it concluded that both Toluidine blue and hematoxylin and eosin stains are very good techniques in evaluating skin-cancer.

Resumo: Introdução: a cirurgia micrográfica de Mohs é uma técnica cirúrgica especializada para o tratamento do câncer de pele não melanoma. A histopatologia desempenha um papel fundamental, onde a escolha da coloração é um ponto de controvérsia. Objetivos: comparar o desempenho das colorações de hematoxilina e eosina versus azul de toluidina durante a cirurgia. Método: estudo observacional, descritivo e transversal de novembro de 2017 a maio de 2018. Foram incluídas as lâminas utilizadas durante as cirurgias no referido período. Estas foram analisadas pelo cirurgião especializado na técnica de Mohs, 3 residentes e um dermatopatologista onde foi avaliado o desempenho de ambas as colorações, levando em consideração as características celulares e os elementos do estroma. Resultados: foram estudados 23 tumores (16 carcinomas basocelulares e 7 carcinomas espinocelulares). Quando observados ao microscópio de luz para coloração AT e H&E, não foram encontradas diferenças significativas entre os dois grupos em geral, apenas em algumas características, especialmente com o H&E. Conclusões: é o primeiro estudo no Uruguai que compara a eficácia dos 2 corantes durante a cirurgia micrográfica de Mohs. Em conclusão, tanto a coloração com hematoxilina e eosina quanto com azul de toluidina são técnicas muito boas para o diagnóstico de carcinomas de pele.

Salivary glands of fetuses are adversely affected by artificial food colorings in rats

SUMMARY OBJECTIVE: Artificial food colorings, as types of food additives, are widely used at present in daily life. We aimed to investigate the effects of exposure to artificial food colorings during the intrauterine period on the salivary glands in adulthood. METHODS: A total of 30 Wistar albino female pregnant rats were included in this study. The treatment group was given a mixture of nine artificial food colorings at no observed adverse-effect-level doses. Neither mothers nor offspring were fed with food colorings after delivery. When the offspring became adults, they were sacrificed, and the possible histopathological and immunohistochemical effects of artificial food colorings on the salivary glands were investigated. In these glands, anti-matrix metallopeptidase 2 (anti-MMP2), anti-MMP9, anti-tissue inhibitor of metalloproteinases (TIMP) metallopeptidase inhibitor 1 (anti-TIMP1), anti-TIMP2, and anti-TIMP3 were examined. RESULTS: The expressions of anti-MMP2, anti-TIMP1, anti-TIMP2, and anti-TIMP3 parameters were found to be higher in treatment groups (p<0.05). CONCLUSION: It was suggested that intrauterine exposure of synthetic food colorings may lead to deterioration of the tissue structure of the salivary glands in adulthood, thereby increasing susceptibility to chronic illnesses including malignancy and chronic inflammation. Therefore, pregnant women should give importance to their nutrition in terms of foods containing synthetic colorings.

Análise da pigmentação de cerâmicas odontológicas submetidas a diferentes corantes / Analysis of the pigmentation of dentistry ceramics submitted to different dyes

Objetivo: É mérito deste estudo avaliar a pigmentação de cerâmicas odontológicassubmetidas a diferentes tratamentos de superfície e imersasem soluções corantes.Métodos: Foram confeccionadas 60 amostras de cerâmica, divididas em seis grupos. Os grupos G1, G2 e G3 receberam aplicação prévia de glaze, enquanto G4, G5 e G6 foram submetidos a desgastes e polimento. Os grupos foram mantidos em água destilada, açaí e café por um período de 30 dias. Foram realizadas fotografias digitais, seguidas da mensuração de cor da superfície com o programa mColorMeter, com base no sistema CIELab, antes da imersão, após 15 e 30 dias. Para avaliação quantitativa da variação de cor foi utilizada fórmula de ∆E, onde foram obtidos média e desvio padrão de cada grupo. Os dados foram submetidos à análise estatística ANOVA de dois fatores. Resultados: Após a realização da análise estatística, foram estabelecidos as médias e desvios-padrão para variância de cor (∆E) e foi constatado que não houve resultado estatisticamente significativo, em que p ≤ 0,05, para pigmentação em nenhum dos grupos de cerâmicas. Conclusão: Nesse contexto, infere-se que as substâncias café e açaí não promoveram alterações de cor significativas, bem como o glaze e o polimento mostraram-se igualmente eficientes na manutenção da estabilidade de cor das cerâmicas.

Aim: The present study sought to evaluate the pigmentation of dental ceramics submitted to different surface treatments and immersed in staining solutions. Methods: Sixty ceramic samples were manufactured and divided into six groups. Groups G1, G2, and G3 received a prior glaze application, while groups G4, G5, and G6 were submitted to wear and polishing. The groups were maintained in distilled water, açaí, and coffee for a period of 30 days. Digital photographs were taken, followed by color measurement of the surface with the mColorMeter program, based on system CIELab, before immersion, after 15 and 30 days. For quantitative evaluation of color variation, a formula from ∆E was used, where mean and standard deviation of each group were obtained. The data were submitted to ANOVA statistical analysis of two factors. Result: After the statistical analysis, the means and standard deviations for color variance (∆E) were established, and it was found that there were no statistically significant results, with p ≤ 0.05, for pigmentation in any of the groups of ceramics. Conclusion: Therefore, it can be inferred that coffee and açaí substances did not promote significant color changes. Glaze and polishing also proved equally efficient in maintaining the color stability of the ceramics.

Patent blue V dye anaphylaxis: a case report and literature review / Anafilaxia por corante azul patente V: relato de caso e revisão da literatura

Abstract Background: Anaphylaxis is a constant perioperative concern due to the exposure to several agents capable of inducing hypersensitivity reactions. Patent blue V (PBV), also known as Sulfan Blue, a synthetic dye used in sentinel node research in breast surgery, is responsible for 0.6% of reported anaphylactic conditions. We present a case of a 49-year-old female patient who underwent left breast tumorectomy with sentinel lymph node staging using PBV and experienced an anaphylactic reaction. Methods: We conducted a literature search through PubMed for case reports, case series, review and systematic reviews since 2005 with the keywords "anaphylaxis" and "patent blue". We then included articles found in these publications' reference sections. Results: We found 12 relevant publications regarding this topic. The main findings are summarized, with information regarding the clinical presentation, management, and investigation protocol. Hypotension is the most common clinical manifestation. The presentation is usually delayed when compared with anaphylaxis from other agents and cutaneous manifestations are occasionally absent. Patients may have had previous exposure to the dye, used also as a food, clothes and drug colorant. Conclusion: The diagnosis of anaphylaxis in patients under sedation or general anesthesia may be difficult due to particularities of the perioperative context. According to the published literature, the presentation of the reaction is similar in most cases and a heightened clinical sense is key to address the situation appropriately. Finding the agent responsible for the allergic reaction is of paramount importance to prevent future episodes.

Resumo Introdução: A anafilaxia pode ocorrer durante o período perioperatório devido à exposição a diversos agentes capazes de induzir reações de hipersensibilidade. O corante sintético Azul Patente V (APV), também conhecido como Sulfan Blue, é usado na pesquisa de linfonodo sentinela em cirurgia de mama, e é responsável por 0,6% dos eventos anafiláticos relatados. Descrevemos o caso de uma paciente de 49 anos de idade submetida à tumorectomia de mama esquerda com estadiamento de linfonodo sentinela, em que se empregou o APV e que apresentou reação anafilática. Método: Por meio do PubMed, pesquisamos publicações que documentavam relatos de casos, séries de casos, revisões e revisões sistemáticas desde 2005, usando as palavras-chave "anaphylaxis" e "patent blue". Em seguida, incluímos artigos encontrados na lista de referências dessas publicações. Resultados: Encontramos 12 publicações relevantes sobre o tópico. Os principais achados estão resumidos, com informações do quadro clínico, tratamento e protocolo de investigação. A hipotensão foi a manifestação clínica mais frequente. De forma geral, o quadro clínico tem início tardio quando comparado à anafilaxia por outros agentes e, ocasionalmente, as manifestações cutâneas estão ausentes. Os pacientes podem ter tido exposição prévia ao APV, que também é usado como corante de alimentos, roupas e medicamentos. Conclusão: O diagnóstico de anafilaxia em pacientes sob sedação ou anestesia geral pode ser difícil devido às peculiaridades do contexto perioperatório. Segundo a literatura publicada, a apresentação da reação é semelhante na maioria dos casos e um discernimento clínico aguçado é fundamental para enfrentar o evento adequadamente. Encontrar o agente responsável pela reação alérgica é essencial para a prevenção de futuros episódios.

Effect of tooth enamel staining by coffee consumption during at-home tooth bleaching with carbamide peroxide / Efeito da coloração do esmalte dentário pelo consumo de café durante o clareamento dentário caseiro com peróxido de carbamida

Introduction: Obtaining the result expected during tooth bleaching requires a correct diagnosis of the type of staining presented. The causes of tooth staining differ depending on the etiological factor. Objective: To assess the color change caused by the immersion of bovine teeth in coffee solution during at-home tooth bleaching using a 16% carbamide peroxide gel. Material and method: Thirty-three sound bovine teeth were assigned to three groups of eleven teeth each: 1 - Teeth bleached (TB) four hours per day for 21 days; 2 - TB four hours per day for 21 days and immersed in coffee solution immediately after tooth bleaching; 3 - TB four hours per day for 21 days and immersed in coffee solution four hours after the end of tooth bleaching. Immersed in coffee was performed for 15 minutes and tooth color was assessed before the start of the bleaching procedure and after 21 days with an intraoral spectrophotometer. Test Shapiro-Wilk was used to assess homoscedasticity and data were submitted to one-factor Analysis of Variance (ANOVA) and Tukey's test (p <0.05). Result: The color change observed in group 1 (5.76 ± 2.74)A was not statistically different from group 2 (8.83 ±5.11)A, which was immersed in coffee solution immediately after tooth bleaching, and from group 3, which was immersed in coffee solution four hours after tooth bleaching (8.20 ±3.71)A. Conclusion: Coffee did not interfere with the tooth bleaching results, regardless of the time after the procedure. Hence, diet restrictions are not necessary during tooth bleaching.

Introdução: A obtenção do resultado esperado durante o clareamento dental exige um diagnóstico correto do tipo de coloração apresentado. As causas da coloração dos dentes diferem dependendo do fator etiológico. Objetivo: Avaliar a mudança de cor causada pela imersão dos dentes bovinos na solução de café durante o clareamento dentário caseiro, utilizando gel de peróxido de carbamida a 16%. Material e método: Trinta e três dentes bovinos hígidos foram distribuídos em três grupos de onze dentes cada: 1 - Dentes clareados quatro horas por dia durante 21 dias; 2 - Dentes clareados quatro horas por dia durante 21 dias e imerso em solução de café imediatamente após o clareamento dentário; 3 - Dentes clareados quatro horas por dia durante 21 dias e imerso em solução de café quatro horas após o término do clareamento dentário. Imersão em café foi realizada durante 15 minutos e a cor dos dentes foi avaliada antes do início do procedimento do clareamento e após 21 dias com um espectrofotômetro intraoral. O teste Shapiro-Wilk foi utilizado para avaliar a homocedasticidade e os dados foram submetidos à análise de variância de um fator (ANOVA) e ao teste de Tukey (p <0,05). Resultado: A mudança de cor observada no grupo 1 (5,76 ± 2,74)A não foi estatisticamente diferente do grupo 2 (8,83 ± 5,11)A, imerso em solução de café imediatamente após o clareamento dentário, e do grupo 3, imerso em café quatro horas após o clareamento dental (8,20 ± 3,71). Conclusão: O café não interferiu nos resultados do clareamento dental, independentemente do tempo após o procedimento. Portanto, restrições alimentares não são necessárias durante o clareamento dental.

Severe anaphylactic reaction to patent blue in breast cancer surgery

Sentinel lymph node biopsy in the surgical treatment of initial breast cancer has been increasingly adopted to assess axillary status as a way to replace total lymphadenectomy. The sentinel lymph node can be identified using coloring agents or radiopharmaceuticals. In Brazil, patent blue is the most used dye for this type of procedure, with high rates of identification and safety; however, in some cases, the use of this substance can lead to the occurrence of anaphylactic reactions. The case presented here refers to a 41-year-old female patient admitted for a surgical procedure for total mastectomy associated with sentinel lymph node biopsy with patent blue. After surgical initiation, the patient developed severe anaphylactic shock, staying 21 days in the intensive care unit (ICU) for recovery. Most anaphylactic reactions that occur in the transoperative period are mediated by IgE antibodies, resulting in the degranulation of mast cells and basophils, with the release of mediators such as histamine, prostaglandins, proteoglycans, and cytokines, leading to the clinical manifestations of anaphylaxis. There is evidence that part of the population is allergic to patent blue, and may present with manifestations ranging from hives and pruritus to severe cardiovascular collapse, requiring hospitalization in an ICU. The purpose of this article was to report a case of severe anaphylactic reaction to patent blue and to review the literature regarding this infrequent and potentially serious situation.

Coloring Narrative Therapy for Hospitalization Patients of Hospice Palliative Care Wards without Special Psychological Test: A Case Report

Art therapy would help end-of-life care who hospitalized in hospice palliative care wards. This case report aims to examineYeonmyeong (Prolongation of life) cure or spontaneous healing and so on have developed over the last 3 years. The case reportprovides an analysis of palliative care through coloring narrative therapy from torture and injection of ill treatment. Significantdevelopments include the following: (1) The older persons who have chronic terminal cancers realize their here and now. (2) Thepatients have terminally accepted their end of life. (3) Their families were greeting adieu with their palliative care clients. InKorea, Yeonmyeong cure is approved by modern society patients and their families. Therefore, medical palliative care groupsare thinking more well-being healing method for human being.

Primer reporte de albinismo para el cuy silvestre Cavia tschudii (Mammalia: Rodentia) / First albinism report for the wild guinea pig Cavia tschudii (Mammalia: Rodentia)

En mamíferos silvestres los patrones de coloración atípica como el albinismo ocurren en baja frecuencia y en la literatura científica sus reportes son escasos. Por lo cual los hallazgos de este tipo son importantes para comprender mejor este fenómeno. En el presente trabajo realizamos el primer reporte de albinismo para el cuy silvestre Cavia tschudii (Rodentia) en la costa central de Perú. Este hallazgo también representa el primer registro de albinismo para el género Cavia en el Neotrópico.

In wild mammals, atypical coloration patterns such as albinism occur at a low frequency and are poorly reported in the literature. Therefore, discovery of cases of coloration anomalies are important to better understand this phenomenon. Here, we describe the first reported case of albinism in Cavia tschudii "Wild Guinea Pig" from the central coast of Peru. This discovery also represents the first record of albinism for the genus Cavia in the Neotropics.

Color Change of Different Dual-Cure Resin Cements After Thermocycling / Cambio de color de diferentes cementos de resina de curado doble después del termociclaje

ABSTRACT The purpose of this study is to evaluate the effect of thermocycling on the color change of the amine-free dual-cure resin cements. IPS e.max CAD blocs were cut into specimens of 1 mm thickness (N=28) and cemented with one of the 4 different amine-free dual-cure resin cements (NX3 Nexus [NX], Kerr Dental; Variolink Esthetic DC [VE], Ivoclar Vivadent; Panavia V5 [PV], Kuraray Dental; G-CEM Linkforce [GC], GC Corporation) (n=7). A spectrophotometer was used for color measurements. Specimens were subjected to thermocycling (5°C and 55°C; 5000 and 10000 cycles). Normality of data distribution was tested by using the Kolmogorov-Smirnov test. Statistical analysis was performed using a two-way analysis of variance (ANOVA) and Tukey's multiple comparison tests at a significance level of p<0.05.∆E values were significantly influenced by the resin cements and the cycle periods (p<0.05). There were no significant differences between NX and VE groups after 5000 thermocycling, however after 10000 thermocycling VE group showed higher ∆E1 values than NX group (p>0.05). There were no statistically significant differences between the ∆E0 and ∆E1 values of the GC group, however the other groups were affected after 10000 thermocycling (p>0.05). Amine-free resin cements used for cementation showed color change after thermocycling except GC group. All resin cements were showed clinically acceptable color change after thermocycling (∆E<3.5).

RESUMEN El propósito de este estudio es evaluar el efecto del termociclaje en el cambio de color de los cementos de resina de doble curado sin aminas. Los bloques IPS e.max CAD se cortaron en muestras de 1 mm de espesor (N=28) y se cementaron con uno de los 4 diferentes cementos de resina de curado doble libres de aminas (NX3 Nexus [NX], Kerr Dental; Variolink Esthetic DC [VE], Ivoclar Vivadent; Panavia V5 [PV], Kuraray Dental; G-CEM Linkforce [GC], GC Corporation) (n=7). Se usó un espectrofotómetro para las mediciones de color. Las muestras se sometieron a termociclaje (5°C y 55°C; 5000 y 10000 ciclos). La normalidad de la distribución de datos se probó utilizando la prueba de Kolmogorov-Smirnov. El análisis estadístico se realizó mediante un análisis de varianza de dos vías (ANOVA) y las pruebas de comparación múltiple de Tukey a un nivel de significación de p<0.05. Los valores de ∆E fueron significativamente influenciados por los cementos de resina y los períodos de ciclo (p<0.05). No hubo diferencias significativas entre los grupos NX y VE después de 5000 termociclos, sin embargo, después de 10000, el grupo VE mostró valores ∆E1 mayores que el grupo NX (p>0.05). No hubo diferencias estadísticamente significativas entre los valoresn∆E0 y ∆E1 del grupo GC, no obstante, los otros grupos se vieron afectados después de 10000 termociclos (p>0.05). Cementos de resina libres de aminas. utilizados para la cementación mostró cambio de color después del termociclaje, excepto el grupo GC. Todos los cementos de resina mostraron un cambio de color clínicamente aceptable después del termociclaje (∆E<3.5).

USE OF DYE IN THE PREOPERATIVE MARKING OF NONPALPABLE BREAST LESIONS LITERATURE REVIEW / Uso de corantes na marcação pré-cirúrgica de lesões impalpáveis de mama: revisão de literatura

Objective: To evaluate and compare the use of different dyes in the marking of nonpalpable breast lesions indicated for surgical resection. Method: We analyzed the following variables: number of cases, types of dye, technique used for marking (patent blue, indocyanine green, or methylene blue), associated techniques (guidewire or Tc-99m), free margins of the surgical specimen (when the diagnosis was cancer), pain during the marking, and allergic events. The main results of the articles were organized in tables, using the software Microsoft Excel 2011. Results: We selected 11 articles for analysis. A total of 510 women had 516 nonpalpable breast lesions marked with dyes. The main dyes used were patent blue, methylene blue, and indocyanine green. The rate of free margins in cancer cases was 95%. Methylene blue was superior to other dyes in obtaining free margins. Out of the 11 articles selected, three associated dye with radioactive materials, and two with guidewire. Two studies analyzed the pain during the marking and revealed that 75% of the patients classified it as moderate or minimal, with mammography being the method most associated with pain. No allergic event was reported. Conclusion: The use of dyes in the preoperative marking of nonpalpable breast lesions is a viable, safe, and cheap technique. The initial results of several groups indicate significant advantages compared to the methods currently available. Methylene blue has a lower rate of positive margins than other dyes. Prospective randomized studies are still necessary to verify the superiority of the technique in comparison to others

Objetivo: Avaliar e comparar o uso de diferentes corantes na marcação de lesões não palpáveis de mama que possuem indicação para ressecção cirúrgica. Método: Foram analisadas as seguintes variáveis: número de casos, tipos de corante, técnica utilizada na marcação (azul patente, indocianina verde ou azul de metileno), técnicas associadas (fio-guia ou TC-99), margens livres do espécime cirúrgico (quando o diagnóstico era câncer), dor durante a marcação e eventos alérgicos. Organizou-se os principais resultados dos artigos em tabelas, utilizando o programa Microsoft Excel 2011. Resultados: Foram selecionados 11 artigos para análise. Ao todo, 510 mulheres realizaram marcação com corantes em 516 lesões impalpáveis de mama. Os principais corantes utilizados foram azul patente, azul de metileno e indocianina verde. A taxa de margens livres em casos de câncer foi de 95%. O azul de metileno foi superior aos demais corantes na obtenção de margens livres. Dos 11 artigos selecionados, em três foi feita a associação do corante com materiais radioativos, e em dois, com o fio guia. A dor durante a marcação foi analisada por dois estudos e classificada como moderada ou mínima por 75% das pacientes, sendo a mamografia o método mais associado à dor. Não foram reportados eventos alérgicos. Conclusão: O uso de corantes na marcação pré-operatória de lesões impalpáveis de mama é uma técnica viável, segura e mais barata. Os resultados iniciais de diversos grupos apontam vantagens significativas em relação aos métodos disponíveis atualmente. O azul de metileno apresenta menor taxa de margens comprometidas em relação aos demais corantes. Estudos prospectivos randomizados ainda são necessários para atestar a superioridade da técnica em relação às demais.

Técnica modificada de blanqueamiento de dientes vitales empleando DMC peróxido de hidrógeno al 35% / Modified technique for vital teeth whitening using DMC 35% hydrogen peroxide

RESUMEN Introducción: Los fabricantes de DMC peróxido de hidrógeno al 35% proponen una técnica de blanqueamiento de dientes vitales que malgasta el producto y el tiempo de tratamiento, por lo que una técnica modificada traería beneficios materiales y económicos para operadores y pacientes. Objetivo: Describir la aplicación de una técnica modificada de blanqueamiento dental en dientes vitales utilizando DMC peróxido de hidrógeno al 35%. Presentación del caso: Paciente femenina de 44 años a quien se le realiza un tratamiento de blanqueamiento dental con una modificación de la técnica propuesta por el fabricante del producto. La modificación consistió en el empleo de una sola aplicación del gel blanqueador, en lugar de tres aplicaciones, y aumento del tiempo de exposición a 40 min, en lugar de los 10-15 min recomendados por el fabricante. Las variables empleadas para evaluar el tratamiento y sus resultados fueron definidas por el registro del color inicial y posterior al tratamiento, y por la satisfacción de la paciente con el resultado del mismo. Los dientes expuestos al tratamiento se encontraban con tejidos de esmalte sanos sin exposición de la dentina en ninguna de las superficies. Conclusiones: La modificación descrita de la técnica de blanqueamiento propuesta por el fabricante con DMC Lase Peroxide Sensy (peróxido de hidrógeno al 35%) consistente fundamentalmente en el empleo de una sola aplicación y aumento del tiempo de exposición en una sola sesión de tratamiento, aportó un ahorro del producto sustancial y condujo al cambio de la coloración final de los dientes, con la plena satisfacción de la paciente y protegido el esmalte superficial de sus dientes tratados.

ABSTRACT Introduction: The manufacturers of DMC 35% hydrogen peroxide propose a whitening technique of vital teeth that waste the product and the time of treatment, so a modified technique would bring material and economic benefits for operators and patients. Objective: To describe the application of a modified technique in vital teeth whitening using DMC 35% hydrogen peroxide. Case presentation: A 44-year-old female patient undergoing a whitening treatment with a modification of the technique proposed by the product manufacturer. The modification consisted in the use of a single application of the bleaching gel instead of three applications, and an increase in the exposure time to 40 min instead of the 10-15 min recommended by the manufacturer. The variables used to evaluate the treatment and its results were defined by the registration of the color before and after treatment and also by the satisfaction of the patient with the result. The teeth exposed to treatment were found with healthy enamel tissues without dentine exposure on any of the surfaces. Conclusions: The described modification of the whitening technique proposed by the manufacturer with DMC Lase Peroxide Sensy (35% hydrogen peroxide) consisting mainly on the use of a single application and the increase of the exposure time in a single treatment session contributed to a considerable saving of the product and led to the change of the final coloring of the teeth, which resulted in the full satisfaction of the patient and the protection of her exposed teeth and tissues.

Planting Seeds into the Lung: Image-Guided Percutaneous Localization to Guide Minimally Invasive Thoracic Surgery

Image-guided localization materials are constantly evolving, providing options for the localization of small pulmonary nodules to guide minimally invasive thoracic surgery. Several preoperative methods have been developed to localize small pulmonary lesions prior to video-assisted thoracic surgery. These localization techniques can be categorized into 4 groups according to the materials used: localization with metallic materials (hook-wire, microcoil, or spiral coil), localization with dye (methylene blue or indigo carmine), localization with contrast agents (lipiodol, barium, or iodine contrast agents), and radiotracers (technetium-99m). However, the optimal localization method has not yet been established. In this review article, we discuss the various localization techniques and the advantages and disadvantages of localization techniques as well as the available safety and efficacy data on these techniques.