Searching for new antifungals for the treatment of cryptococcosis

ABSTRACT There is a consensus that the antifungal repertoire for the treatment of cryptococcal infections is limited. Standard treatment involves the administration of an antifungal drug derived from natural sources (i.e., amphotericin B) and two other drugs developed synthetically (i.e., flucytosine and fluconazole). Despite treatment, the mortality rates associated with fungal cryptococcosis are high. Amphotericin B and flucytosine are toxic, require intravenous administration, and are usually unavailable in low-income countries because of their high cost. However, fluconazole is cost-effective, widely available, and harmless with regard to its side effects. However, fluconazole is a fungistatic agent that has contributed considerably to the increase in fungal resistance and frequent relapses in patients with cryptococcal meningitis. Therefore, there is an unquestionable need to identify new alternatives or adjuvants to conventional drugs for the treatment of cryptococcosis. A potential antifungal agent should be able to kill cryptococci and "bypass" the virulence mechanism of the yeast. Furthermore, it should have fungicidal action, low toxicity, high selectivity, easily penetrate the central nervous system, and widely available. In this review, we describe cryptococcosis, its conventional therapy, and failures arising from the use of drugs traditionally considered to be the reference standard. Additionally, we present the approaches used for the discovery of new drugs to counteract cryptococcosis, ranging from the conventional screening of natural products to the inclusion of structural modifications to optimize anticryptococcal activity, as well as drug repositioning and combined therapies.

Restaurações endocrown em pré-molares: influência das paredes remanescentes da estrutura dentária e materiais restauradores na resistência à fadiga / Endocrown restorations in premolars: influence of remaining axial walls of tooth structure and restorative materials on fatigue resistance

Este estudo teve como objetivo avaliar o efeito da estrutura dentária remanescente e dois materiais diferentes de restauração CAD/CAM no desempenho à fadiga e no modo de falha de pré-molares tratados endodonticamente restaurados por endocrowns. Um total de 90 pré-molares superiores foram tratados endodonticamente e divididos aleatoriamente de acordo com o número de paredes axiais remanescentes, e os materiais restauradores foram divididos em 6 grupos (n = 15); quatro paredes restantes restauradas com zircônia ultratranslúcida 5Y-PSZ (grupo Fo-Z) e dissilicato de lítio (grupo Fo-L), três paredes restantes restauradas com 5Y-PSZ (grupo Th-Z) e dissilicato de lítio (grupo Th-L) e duas paredes restantes restauradas com 5YPSZ (grupo Tw-Z) e dissilicato de lítio (Tw-L). As restaurações foram cimentadas adesivamente e os espécimes foram submetidos a cargas de fadiga gradual em seu longo eixo (carga inicial: 200 N, frequência: 20 Hz). Uma carga incremental de 100 N por 10.000 ciclos foi aplicada com um pistão metálico de Ø 6 mm até a falha. A carga de falha por fadiga (FFL) e o número de ciclos de falha (CFF) no momento da falha foram registrados e analisados estatisticamente por ANOVA 2 fatores e teste de Kaplan-Meier (α = 0,05). Os espécimes fraturados foram examinados em estereomicroscópio em 8× e 25× e os modos de falha foram determinados como reparáveis ou catastróficos. FFL e CFF foram significativamente influenciados pelo material restaurador (p < 0,05). As restaurações de 5Y-PSZ apresentaram FFL (Fo-Z = 1487 N, Tw-Z = 1427 N, Tw-Z = 1533 N) e probabilidade de sobrevivência significativamente maiores quando comparadas com dissilicato de lítio (Fo-L = 1060 N, Th-L = 940 N, TwL = 1000 N). O número de paredes remanescentes não afetou o comportamento de fadiga ou modo de falha dos corpos de prova. Das restaurações de dissilicato de lítio, 51% tiveram falhas reparáveis, enquanto 95% das restaurações de zircônia ultratranslúcida 5Y-ZP tiveram falhas catastróficas. Endocrowns de zircônia apresentaram melhor desempenho em fadiga do que endocrowns de dissilicato de lítio, independentemente do número de paredes remanescentes do eixo. Endocrowns de pré-molares de dissilicato de lítio e 5Y-PSZ apresentaram maior FFL do que as cargas mastigatórias normais (AU)

This study aimed to evaluate the effect of the remaining tooth structure and two different CAD/CAM restoration materials on the fatigue performance and failure mode of endodontically treated premolars restored with endocrowns. A total of 90 maxillary premolars were endodontically treated and divided randomly according to the number of remaining axial walls, and the restorative materials were divided into 6 groups (n = 15); four remaining walls restored with ultratranslucent zirconia 5Y-PSZ (group Fo-Z) and lithium disilicate (group Fo-L), three remaining walls restored with 5Y-PSZ (group Th-Z) and lithium disilicate (Group Th-L), and two remaining walls restored with 5Y-PSZ (group Tw-Z) and lithium disilicate (Tw-L). The restorations were cemented adhesively and the specimens were subjected to stepwise fatigue loading along the long axis (initial load: 200 N, frequency: 20 Hz). An incremental step load of 100 N per 10,000 cycles was applied with a Ø6-mm metallic piston until failure. The fatigue failure load (FFL) and number of failure cycles (CFF) at the time of failure were recorded and statistically analyzed with two-way ANOVA and the Kaplan-Meier test (α = 0.05). Fractured specimens were examined under a stereomicroscope at 8× and 25× and failure modes determined as reparable or catastrophic. FFL and CFF were significantly influenced by restorative material (p < 0.05). 5Y-PSZ endocrowns showed significantly higher FFL (Fo-Z = 1487 N, Th-Z = 1427 N, Tw-Z = 1533 N) and survival probability when compared with lithium disilicate (Fo-L = 1060 N, Th-L = 940 N, Tw-L = 1000 N). The number of remaining walls did not affect the fatigue behavior or failure mode of the specimens. Of the lithium disilicate restorations, 51% had repairable failures, while 95% of ultratranslucent zirconia 5Y-ZP restorations had catastrophic failures. Zirconia endocrowns showed better fatigue performance than lithium disilicate endocrowns, regardless of the number of remaining axis walls. Lithium disilicate and 5Y-PSZ premolar endocrowns showed higher FFL than the normal masticatory loads (AU)

Las fallas en las castraciones simbolígenas y los efectos observables en la clínica. Comentario del caso de un niño de cinco años / Echecs des castrations symboligenes eteffets observables dans la clinique. Commentaires sur le cas d'un garçon de cinq ans / Failures in symboligenous castrations and observable effects in the clinic. Comments about the case of a five-year-old boy / Falhas em castrações simbolígenas e efeitos observáveis na clínica. Comentários sobre o caso de um menino de cinco anos

Concepto novedoso e indispensable propuesto por Françoise Dolto, las castraciones simbolígenas, asociadas a la noción de imagen inconsciente del cuerpo y su destino, se convierten en el corazón de su teoría. El tratamiento psicoanalítico con niños consistiría en trabajar sobre las pulsiones no castradas, puntos en donde han quedado detenidas las modalidades de satisfacción y fijadas a un fantasma. El presente escrito recorre fragmentos de sesiones del caso de un niño de cinco años y el trabajo con sus padres, durante dos años de análisis. Tomando como eje rector las fallas en las castraciones simbolígenas y los efectos que se observaron en la clínica, se ilustran articulaciones teóricas que permiten comprender la importancia y riqueza del concepto AU

Concept inédit et indispensable proposé par Françoise Dolto, les castrations symboliques, associées à la notion d'image inconsciente du corps et de son destin, sont au cœur de sa théorie. Le traitement psychanalytique avec les enfants consisterait à travailler sur les pulsions désencastrées, points où les modalités de satisfaction ont été retenues et fixées à un phantasme.Le présent article passe en revue des fragments de sessions du cas d'un garçon de cinq ans et du travail avec ses parents, pendant deux ans d'analyse. En prenant comme axe directeur les échecs des castrations symboliques et les effets observés dans la clinique, on illustre des articulations théoriques qui nous permettent de comprendre l'importance et la richesse du concept AU

An original and indispensable concept proposed by Françoise Dolto, the symbolic castrations, associated with the notion of the unconscious image of the body and its destiny, become the heart of her theory. Psychoanalytic treatment with children would consist in working on the uncastrated drives, places where the modalities of satisfaction have been stopped and set to a phantasm. The present paper reviews sessions fragments of a five years old boy and the work with his parents, during two years of analysis. Taking as a guiding axis the failures in the symbolic castrations and the effects that were observed, theoretical articulations are developed in order to show and understand the importance and richness of the concept AU

Um conceito novo e indispensável proposto por Françoise Dolto, as castrações simbólicas, associadas à noção de imagem inconsciente do corpo e do seu destino, estão no cerne da sua teoria. O tratamento psicanalítico com crianças consistiria em trabalhar em unidades desencarceradas, pontos onde as modalidades de satisfação foram mantidas e fixadas a um fantasma. O presente artigo analisa fragmentos de sessões do caso de uma criança de cinco anos e o trabalho com os seus pais, ao longo de dois anos de análise. Tomando como orientação os fracassos das castrações simbólicas e os efeitos observados na clínica, são ilustradas articulações teóricas que nos permitem compreender a importância e a riqueza do conceito AU

Challenges in the performance of awake craniotomies in the Philippine General Hospital: A case series

@#Awake craniotomy is a neurosurgical technique that involves an awake neurological testing during the resection of an intracranial lesion in eloquent cerebral cortical areas representing motor, language, and speech. This technique is highlighted by an intra-operative cortical mapping that requires active participation by the patient and poses unique challenges to the anesthesiologist. The surgical and anesthetic techniques have evolved significantly over time, as the neurosurgeon and the anesthesiologist learn new steps in making this technique safe to achieve reasonable patient satisfaction. A thorough understanding of this surgical technique's rationale will guide the anesthesiologist in planning the anesthetic management depending on the surgery and neurologic testing. Constant communication between the neurosurgeon, anesthesiologist, and the patient will define this surgical technique's success. It is already a well-established procedure; however, factors that contribute to failures in awake craniotomy procedures have not been well characterized in the literature. Failure is defined as the inability to conduct awake neurologic testing during the awake craniotomy procedure because of various factors which will be described. This paper aims to review the challenges in the performance of three (3) cases of awake craniotomies performed in the Philippine General Hospital. The challenges described in these three (3) cases reveal that this can be experienced by the neurosurgeon, neuroanesthesiologist, and most especially the patient in an acute critical condition. Identification of the procedures' failure and the steps taken to manage such situations with the patient's safety in mind are discussed.

Sucesso e insucesso nas licitações da modalidade pregão: revisão scoping review / Success and failure in bidding process for reverse auction modality: a scoping review

RESUMO: O pregão é uma das modalidades de licitação, instituído pela Lei 10.520/02, e tem sido amplamente utilizado em instituições públicas. Apesar dos benefícios desta modalidade serem muitos, existe um número considerável de insucessos nos procedimentos, de modo que os pregões podem terminar fracassados, desertos ou, até mesmo cancelados, anulados ou revogados. O objetivo desse artigo é avaliar na literatura quais os motivos de sucessos e insucessos de licitações na modalidade pregão por meio de uma revisão de literatura realizada através de Scoping Review, conforme a proposta do Joanna Briggs Institute, realizada através da pergunta "Quais os fatores de sucesso e/ou insucesso encontrados nas compras por licitação na modalidade pregão?", nas bibliotecas digitais Capes Periódicos e Scientific Electronic Library Online e na base de dados PubMed. (AU)

ABSTRACT: The reverse auction is one of the bidding modalities, which was instituted by Law 10,520/02 and has been widely used in public institutions. Although the benefits of this modality are many, there is a considerable number of failures in the procedures, so that the reverse auction sessions may fail, with no participants or even be canceled, nullified, or revoked. This article aims to evaluate in the literature the reasons for successes and failures of the bidding process for reverse auction modality through a Scoping Review, as proposed by the Joanna Briggs Institute. The research question was "What are the factors of success and/or failure found in bidding purchases for reverse auction modality?", and the databases used were Capes Journals, Scientific Electronic Library Online, and PubMed. (AU)

Reliability Analysis of Magnetic Resonance Imaging Equipment Based on Non-homogeneous Poisson Process / 中国医疗器械杂志

In order to evaluate the quality of different brands of magnetic resonance imaging system, optimize the quality of equipment repair and maintenance, and ensure the quality and safety of the equipment in clinical use. Meanwhile build the reliability evaluation model of magnetic resonance imaging equipment based on the large failure data collected by magnetic resonance repair system. In this paper, using the fault data of a certain brand of magnetic resonance in the past two years, applying the statistical judgment criterion, selecting the appropriate statistical distribution model, and finally fitting the equipment reliability evaluation model based on the non-homogeneous Poisson process, and then obtaining the magnetic resonance imaging equipment. Reliability evaluation indicators such as cumulative fault strength function, magnetic resonance imaging equipment fault density function, and mean time between failures. According to the calculated reliability index, on the one hand, it can evaluate the system reliability quality of a certain brand of magnetic resonance imaging equipment, and then evaluate the quality of different brands of magnetic resonance imaging equipment, on the other hand, it can help hospital equipment managers to carry out operational optimization, maintenance strategy development and safety management of magnetic resonance imaging equipment.

Clinical Study of Failures in Periodontal Therapy

The goal of periodontal therapy is to restore and maintain the health and function of the periodontium and natural dentition for a lifetime. This therapy has evolved over many years to include nonsurgical phase of therapy and subsequent surgical treatment followed by periodic maintenance therapy. The main objective is to study the failures in periodontal therapy. Methods: It is a hospital based study. It was conducted at Dental department of LTBRKM Gov. Medical College; Jagdalpur Chattissgarh.The study was carried out for a period of 6 months from June to Nov 2017. Total number of cases included in this study was 30. Permission from Institutional Ethics Committee was obtained. From each and every patient included in the study, initially informed individual consent was taken. Results: 6.7% cases were seen in 30 – 35 years of age group, 16.6% of cases were seen in 36 – 40 years of age group, 26.6% of cases were seen in 41 – 50 years of age group and 50% of cases were seen in 46 – 50 years of age group. Only 2 cases were failed in periodontal therapy due to age of the patient,3 cases were of poor maintenance, 5 cases are due to systemic diseases, 10 cases were due to smoking habit,1 case of poor healing potential,8 cases of local factors like plaque and only one case of psychological component. Conclusion: Careful attention to a few important points can improve the success rate of periodontal therapy. Periodontal health is achieved with a combination of treatment and regular periodontal maintenance care.

Clinicopathological features and renal outcomes of IgA nephropathy with acute tubulointerstitial nephropathy / 中华肾脏病杂志

Objective To evaluate the clinicopathological characteristics and outcomes of IgA nephropathy (IgAN) with acute tubulointerstitial nephropathy (ATIN).Methods Patients who were diagnosed as IgAN with ATIN and IgAN without ATIN by renal biopsy in Peking University First Hospital were enrolled.There were 74 cases of IgAN with ATIN,and seventy-four cases of IgAN without ATIN were enrolled based on stratified sampling (chosen by 1∶ 1).The two groups were well matched with age,gender,follow-up time,mesangial hypercellularity(M),endocapillaryhypercellularity (E),segmental glomerulosclerosis(S),tubular atrophy/interstitial fibrosis(T) and cellular/fibrocellular crescent(C).The clinicopathological characteristics and outcomes of two groups were retrospectively analyzed.A composite end point,defined as 30％ or 50％ estimated glomerular filtration rate (eGFR)decline and end stage renal disease (ESRD) was used.Renal function and proteinuria during follow-up were observed.Renal survival was calculated by Kaplan-Meier survival analysis and risk factors of progression were analyzed by using univariate and multivariate Cox regression models.Results Seventy-four cases of IgAN with ATIN and seventy-four cases of IgAN without ATIN were enrolled.Serum creatinine [(185.6±83.2) μmol/L vs (146.3 ±69.2) μmol/L,P=0.010] and incidence of acute kidney disease (AKD) (31.1％ vs 5.4％,P ＜ 0.001) were higher in IgAN with ATIN group than those in IgAN without ATIN group.Patients in ATIN group received more immunosuppressive treatment (86.5％vs 58.1％,P＜ 0.001).During 1 year after biopsy,mean eGFR increased significantly in IgAN with ATIN group [(39.7+ 14.6) ml· min-1· (1.73 m2)-1 vs (47.2+ 19.9) ml· min-1· (1.73 m2)-1,P=0.017],but mean eGFR was not statistic different in IgAN without ATIN group [(60.0±30.5) ml· min-1· (1.73 m2)-1 vs (59.0±31.7) ml· min-1· (1.73 m2)-1,P=0.567].Median follow-up was 23.0 months in IgAN with ATIN group,and Median follow-up was 30.0 months in IgAN without ATIN group.Incidence of composite end point had no significant differences between two groups.IgAN with ATIN was not the independent risk factor for end point.IgAN patients with ATIN were divided into two groups (with AKD and without AKD),then renal survival rate was higher (Log-rank test,x2=5.293,P=0.021) and the risk for composite end point decreased by 79.2％ (HR=0.208,95％CI 0.046-0.939,P=0.041) in the group with AKD.Conclusions In IgAN,there is a subgroup of patients with the specific pathological phenotype combined with ATIN.Compared with those without AKD,the risk for composite end point of IgAN patients with ATIN and AKD showed a 79.2％ decrease.

Cases and Causes of Depression among School Going Adolescents in Lahore, Pakistan

Depression is a mental syndrome and lifetime prevalence of depression is found to be 16.2% in general population. Symptoms of depression in adolescent are different in comparison to adults. These symptoms include disrupted sleep, weigh loss or gain, stubbornness, irritating behavior while getting ready for school and loss of interest in sports. Major risk factors for depressive disorder in adolescent are low socioeconomic status, poverty and low parental education. A descriptive study was conducted in which data was collected through a validated questionnaire from more than 15 randomly selected private and government schools in Lahore. Total 478 students (F=190, M=288) from different schools with different socioeconomics background participated in the present study. Around 438 (91.6%) students responded that they have gone through the depression at some phase of their life. 23.2% and 43.9% students answered that they feel ignored and worthless by their family members often or occasionally, respectively. Domestic fights, quarrel and unfriendly environment, like shouting and use of abusive language disturb the psychological health of the children and provoke feelings of loneliness and sadness. Depression is a mental illness and one should not be shy about and feel uncomfortable for getting help. Seminars for awareness should be conducted at Government and Private level to reduce the incidence of depression among teenagers.

Data collection about failures in fixed partial dentures: 1-year monitoring / Levantamento das falhas em prótese parcial fixa: acompanhamento de um ano

ABSTRACT Objective: The aim of this study was to evaluate the satisfaction of patients rehabilitated with fixed partial denture and the incidence of failures/clinical complications of prostheses after one year. Methods: The patients answered a questionnaire about the satisfaction degree with dental treatment performed and care maintenance for prosthesis conservation. Clinical and radiographic evaluations of the prosthesis were performed. Data were tabulated for descriptive analysis of the factors assessed, with calculation of absolute frequencies and percentages, and chi-square and Fisher's exact test.. Results: A total of 9.67% failures were found. The most common was the prosthesis loosening (57.14%), followed by ceramic fracture (28.57%), and abutment tooth fracture (14.29%). Biological failures were observed in 30.65%. The most common failure was gingival recession (52.00%), periodontal pocket (24.00%), support periodontal involvement (16.00%), and recurrent caries (4.00%). Radiographic examination showed that 70.97% of the total number evaluated had some kind of failure. There was statistically significant association between satisfaction degree and technical failure (p=0.04). Conclusion: Patients were satisfied after observation period of 1 year. The main failures detected were: crown cementation failure and ceramic fracture; gingival recession, periodontal pocket; manufacture and cementation of short intraradicular post with increased diameter and crown cervical misfit.

RESUMO Objetivo: O objetivo deste estudo foi avaliar a satisfação dos pacientes reabilitados com prótese parcial fixa e a incidência de falhas/complicações clínicas das próteses instaladas após um ano. Métodos: Os pacientes responderam um questionário abrangendo o grau de satisfação pelo tratamento odontológico efetuado e os cuidados de manutenção realizados para a conservação da prótese. Na sequência foi realizada avaliação clínica e radiográfica das próteses. Os dados obtidos foram tabulados para análise descritiva dos fatores avaliados com cálculo de frequência absoluta e percentual, e teste de Qui-quadrado e Fischer. Resultados: Foram encontradas 9,67% de falhas, sendo a mais comum a descimentação (soltura da prótese) (57,14%), seguida da fratura da cerâmica (28,57%), e um caso de fratura no dente pilar (14,29%). As falhas biológicas foram observadas em 30,65%. A falha mais comum foi a recessão gengival (52,00%), seguida por bolsa periodontal (24,00%), envolvimento periodonto de suporte (16,00%), e recidiva de cárie (4,00%). No exame radiográfico 70,97% do número total avaliado apresentaram algum tipo de falha. Houve associação estatisticamente significante entre grau de satisfação e falhas mecânicas (p=0,04). Conclusão: Os pacientes ficaram satisfeitos após um período de acompanhamento de 1 ano. As principais falhas detectadas foram: falha de cimentação da coroa e fratura da cerâmica; Recessão gengival, bolsa periodontal; confecção e cimentação de pino intraradicular curto, pino com diâmetro aumentado e desajuste cervical da coroa.

Acute kidney injury in Xinjiang: a cross-sectional survey / 中华肾脏病杂志

Objective To evaluate the etiology,epidemiological characteristics,clinical diagnosis,and outcomes of hospitalized patients with AKI in Xinjiang,analyzing the risk factors of their clinical prognosis.Methods A multicenter retrospective survey was conducted,investigating adult patients admitted to four hospitals in Xinjiang in January and July 2013.Patients with AKI were screened out based on KDIGO's inclusion and exclusion criteria.Clinical variables of patients with AKI including demographics,clinical data,laboratory tests,treatment measures and prognosis were collected.Results Among 32,157 adult hospitalized patients,there were 722 AKI patients.Excluding those with incomplete data,719 patients were enrolled in this study.The detection rate of AKI was 2.25％ (722 of 32,157) by KDIGO criteria.The main cause for AKI was pre-renal injury,led mainly by cardiac output,low blood volume,and the use of nephrotoxic drugs.The non-recognition rate of AKI was 72.4％ (407/557).Multivariate binary logistic regression analysis showed that AKI stage,peripheral vasodilation and renal parenchyma were protective factors of the omission diagnosis.In the short-term prognostic analysis,the overall mortality rate was 12.8％(92/719).Among the 323 patients with AKI who survived discharge,43.7％(141) had renal function recovery;40.2％(130) did not fully recover their renal function but ceased maintenance dialysis;16.4％ (53) were still on dialysis at discharge.Multivariate Cox regression model suggested that DIC,shock and department of obstetrics were independent risk factors for death during hospitalization of AKI.In addition,the risk of death for AKI from department of obstetrics and gynecology patients was higher than that of other departments.Conclusions The most common reason for AKI in hospitalized patients in Xinjiang was pre-renal injury.The main risk factors were low cardiac output and low blood volume.The omission diagnosis of AKI was serious;AKI stage,peripheral vasodilation and renal parenchymal injury however were its protective factors.Poor-DIC,shock,hospitalization in obstetrics were independent risk factors for death in patients with AKI.

Acute porcine reproductive and respiratory syndrome outbreaksin immunized sow herds: from occurrence to stabilization under whole herd vaccination strategy / 대한수의학회지

Outbreaks of porcine reproductive and respiratory syndrome virus (PRRSV) in vaccinated sow herds from occurrence to stabilization were monitored and analyzed in terms of serology and reproductive performance. Three different conventional pig farms experienced severe reproductive failures with the introduction of a type 1 PRRSV. These farms had adopted mass vaccination of sows using a type 2 PRRSV modified live vaccine (MLV). Therefore, to control the type 1 PRRSV, an alternative vaccination program utilizing both type 1 and type 2 MLV was undertaken. Following whole herd vaccinations with both types of MLV, successful stabilization of PRRS outbreaks was identified based on serological data (no viremia and downward trends in ELISA antibody titers in both sows and suckling piglets) and recovery of reproductive performance. Additionally, through comparison of the reproductive parameters between outbreak and non-outbreak periods, it was identified that PRRSV significantly affected the farrowing rate and the number of suckling piglets per litter at all three pig farms. Comparison of reproductive parameters between periods when the different vaccination strategies were applied revealed that the number of piglets born in total and born dead per litter were significantly increased after the introduction of the type 1 PRRS MLV.

Short implants versus longer implants with maxillary sinus lift. A systematic review and meta-analysis

Abstract This study compared the survival rate of dental implants, amount of marginal bone loss, and rates of complications (biological and prosthetic) between short implants and long implants placed after maxillary sinus augmentation. This systematic review has been registered at PROSPERO under the number (CRD42017073929). Two reviewers searched the PubMed/MEDLINE, Embase, LILACS, and Cochrane Library databases. Eligibility criteria included randomized controlled trials, comparisons between short implants and long implants placed after maxillary sinus augmentation in the same study, and follow-up for >6 months. The Cochrane Collaboration's tool for assessing the risk of bias in randomized trials was used to assess the quality and risk of bias of the included studies. The search identified 1366 references. After applying the inclusion criteria, 11 trials including 420 patients who received 911 dental implants were considered eligible. No significant difference was observed in the survival rate [p = 0.86; risk ratio (RR): 1.08; 95% confidence interval (CI): 0.46-2.52] or in the amount of marginal bone loss (p = 0.08; RR: −0.05; 95%CI: −0.10 to 0.01). However, higher rates of biological complications for long implants associated with maxillary sinus augmentation were observed (p < 0.00001; RR: 0.21; 95%CI: 0.10-0.41), whereas a higher prosthetic complication rate for short implants was noted (p = 0.010; RR: 3.15; 95%CI: 1.32-7.51). Short implant placement is an effective alternative because of fewer biological complications and similar survival and marginal bone loss than long implant placement with maxillary sinus augmentation. However, the risk of mechanical complications associated with the prostheses fitted on short implants should be considered.

Abortion and fetal death in bitches due anemia caused by vector-borne diseases / Abortamento e morte fetal em cadelas devido anemia causada por doenças transmitidas por vetores

Doenças infecciosas são as maiores responsáveis por falhas reprodutivas (FR) em cadelas, causando aborto, morte fetal e natimortalidade. Este estudo teve como objetivo investigar a associação entre agentes infecciosos, FR inexplicáveis e anemia em cadelas. Todas as amostras maternas e fetais foram negativas para a presença dos principais agentes infecciosos causadores de FR: herpes vírus canino 1, Neospora caninum, Brucella spp. e B. canis, enquanto agentes como o de Leishmania spp., parvovírus canino, Ehrlichia canis e Anaplasma platys foram encontrados em sangue materno. Coinfecções de A. platys/E. canis e A. platys/Leishmania spp. foram diagnosticadas. Os resultados indicam que os animais com anemia causadas por doenças transmitidas por vetores podem ser mais suscetíveis a sofrerem FR do que animais com valores hematológicos normais.(AU)

Impact of high-grade obstruction on outcomes in patients with appendiceal inflammatory masses managed by nonoperative treatment

PURPOSE: To retrospectively assess the impact of high-grade obstructions identified on initial CT on outcomes of patients with appendiceal inflammatory masses managed by nonoperative treatment. METHODS: Institutional Review Boards approved this retrospective study and informed consent was waived. Included were 52 consecutive patients diagnosed with appendiceal inflammatory masses by CT scan and managed by nonoperative treatment. The main outcome measure was treatment failure and secondary outcomes were complications and initial and total hospital stay. Patient demographics, inflammatory markers, and CT findings for presence of an appendiceal inflammatory mass and high-grade obstruction were assessed. Patients with and without high-grade obstruction were compared for patient characteristics and outcomes using Fisher exact test and Student t-test. RESULTS: Among 52 patients, 14 (27%) had high-grade obstruction on CT examination at presentation. No significant differences were observed in patient characteristics (P > 0.05), treatment failure (P = 0.33), complications (P = 0.29), or initial (P = 0.73) or total (P = 0.72) hospitalization between patients with and without high-grade obstruction. CONCLUSION: For patients who were managed by nonoperative treatment for appendiceal inflammatory masses, the presence of high-grade obstruction identified on initial CT scan did not significantly affect outcomes of treatment failure, complications, and initial and total hospitalization.

Avaliação do desenvolvimento neuropsicomotor em crianças com hepatopatias crônicas / Neuropsychomotor development evaluation in children with chronic liver diseases

Objetivos: avaliar o desenvolvimento neuropsicomotor (DNPM) de crianças de 3 a 6 anos com hepatopatias crônicas, utilizando teste de triagem de Denver II e verificar a associação entre DNPM e estado nutricional, renda familiar e intervenções cirúrgicas. Métodos: estudo seccional com grupo de comparação, descritivo e exploratório. Foram avaliadas 27 crianças, 16 do GP (grupo de pacientes) e 11 sem hepatopatias do GC (grupo comparação) pelo teste de desenvolvimento de acordo com a idade. Resultados: foi encontrado que 68,8% do GP apresentaram suspeita ou risco para o DNPM. A odds (chance) de ter o Denver positivo para suspeita ou risco no GP foi de 2,2, enquanto, entre as crianças do GC, foi de 0,375, ou seja, uma odds ratio de 5,87. Do GP, 45% com suspeita ou risco para o DNPM apresentaram-se acima do peso no IMC X Idade, 72% do GP com o Denver positivo pertenciam à classe econômica C1 e C2. No GP, 94,1% realizou algum procedimento cirúrgico; destes, mais da metade apresentou suspeita ou risco para DNPM. Conclusão: crianças com hepatopatias crônicas, acima do peso, com renda familiar baixa e as que sofreram algum procedimento cirúrgico apresentam maiores chances de suspeita ou risco para alterações no seu DNPM.

Objectives: to assess the neuropsychomotor development (DNPM) of children aged 3 to 6 years with chronic liver diseases, using Denver II screening test and check out the association between DNPM and nutritional status, family income and surgical interventions. Methods: sectional study with comparison group, descriptive and exploratory. 27 children were evaluated, 16 of the GP (Group of patients) and 11 without liver diseases (comparison group GC) for development testing according to age. Results: it was found that 68.8% of GP presented suspicion or risk for the DNPM. The odds of having the Denver positive for suspicion or risk in GP was 2.2, while among children of the GC was 0.375, i.e. an odds ratio of 5.87. The GP, 45% with suspicion or risk for the DNPM were overweight on BMI X age, 72% of GP with the positive Denver belonged to economy class C1 and C2. In GP, 94.1% conducted some surgical procedure, these more than half were suspected or risk for DNPM. Conclusion: children with chronic liver diseases, overweight, with low family income and those that suffered some surgical procedure have higher chances of suspicion or risk for changes in your DNPM.

Analysis of risk factors for perioperative heart failure following hip fracture surgery in the aged patients / 中华老年医学杂志

Objective To analyze risk factors for the perioperative heart failure following hip fracture surgery in the aged patients.Methods The present study included 186 elderly patients(≥ 65 years)who had received hip fracture surgery from August 2009 to Janurary 2014 in our department.Their clinical data were analyzed to define risk factors for perioperative heart failure.Results Factors significantly affecting the perioperative heart failure included age,gender,hypertension,time from injury to operation,general health before injury,pain score,perioperative blood transfusion,perioperative human serum albumin transfusion,fluid infusion during operation,perioperative balance between daily fluid intake and output,perioperative temperature changing and heart diseases.A multivariate Logistic regression analysis revealed that the independent risk factors for perioperative heart failure included general health before injury (OR =21.967,P=0.000),perioperative balance between daily fluid intake and output (OR =19.349,P =0.005),heart diseases (OR =6.009,P =0.006).Conclusions In aged patients undergoing hip fracture repair operations the independent risk factors for perioperative heart failure include general health before injury,perioperative balance between daily fluid intake and output,heart diseases.Perioperative risk assessment and prevention are the keys of better prognosis.

Acute-on-chronic liver failure: a new syndrome in cirrhosis

Patients with cirrhosis who are hospitalized for an acute decompensation (AD) and also have organ failure(s) are at high risk of short-term death. These patients have a syndrome called Acute-on-Chronic Liver Failure (ACLF). ACLF is now considered as a new syndrome that it is distinct from "mere" AD not only because of the presence of organ failure(s) and high short-term mortality but also because of younger age, higher prevalence of alcoholic etiology of cirrhosis, higher prevalence of some precipitants (such as bacterial infections, active alcoholism), and more intense systemic inflammatory response. ACLF is a new syndrome also because severe sepsis or severe alcoholic hepatitis do not account for 100% of the observed cases; in fact, almost 50% of the cases are of "unknown" origin. In other words, severe sepsis, severe alcoholic hepatitis and ACLF of "unknown origin" are subcategories of the syndrome.

A 3-Year Retrospective Evaluation of the Clinical Performance of Fiber Posts

This retrospective study evaluated the clinical outcome of 139 teeth restored with carbon fiber posts after 3 years of placement, considering the amount of remaining dentin as the main variable. Eighty-one patients received the fiber posts within a period of 16 months and were recalled after 3 years. The tooth type, amount of remaining dentin, and prosthetic crown material were evaluated. No loss of post or core retention was detected after 3 years of follow up. During the observed time, root or post fracture and secondary caries were not recorded. Only one failure concerning endodontic treatment was detected. The amount of remaining dentin was not an important characteristic in the restorative failure of endodontically treated teeth restored with carbon fiber posts within 3 years.

Resumo Este estudo avaliou de forma retrospectiva o desfecho clínico de 139 dentes restaurados com pinos de fibra de carbono após 3 anos em função, considerando a quantidade de dentina coronária remanescente como principal variável. Oitenta e um indivíduos receberam a cimentação dos pinos entre Janeiro de 2004 e Janeiro de 2005, e foram chamados para reavaliação após 3 anos. O tipo de dente restaurado, quantidade de dentina remanescente e material restaurador coronário foram avaliados. Nenhum caso de perda de retenção do pino e/ou núcleo foi encontrado durante o período de avaliação. Fraturas na raiz ou no pino e cáries secundárias também não foram registrados. Uma única falha foi encontrada em relação ao tratamento endodôntico. A quantidade de dentina remanescente não foi um fator importante para falha na restauração de dentes tratados endodonticamente, restaurados com pinos de fibra de carbono, após 3 anos de serviço clínico.

Avaliação do desenvolvimento neuropsicomotor em crianças com hepatopatias crônicas / Neuropsychomotor development evaluation in children with chronic liver diseases

Objetivos: avaliar o desenvolvimento neuropsicomotor (DNPM) de crianças de 3 a 6 anos com hepatopatias crônicas, utilizando teste de triagem Denver II e verificar a associação entre DNPM e estado nutricional, renda familiar e intervenções cirúrgicas. Métodos: estudo seccional com grupo de comparação, descritivo e exploratório. Foram avaliadas 27 crianças, 16 do GP (grupo de pacientes) e 11 sem hepatopatias (grupo comparação - GC) pelo teste de desenvolvimento de acordo com a idade. Resultados: foi encontrado que 68,8% do GP apresentaram suspeita ou risco para o DNPM. A odds de ter o Denver positivo para suspeita ou risco no GP foi de 2,2, enquanto entre as crianças do GC foi de 0,375, ou seja, uma odds ratio de 5,87. Do GP, 45% com suspeita ou risco para o DNPM apresentaram-se acima do peso no IMC X idade, 72% do GP com o Denver positivo pertenciam à classe econômica C1 e C2. No GP, 94,1% realizaram algum procedimento cirúrgico; destes mais da metade apresentou suspeita ou risco para DNPM. Conclusão: crianças com hepatopatias crônicas, acima do peso, com renda familiar baixa e as que sofreram algum procedimento cirúrgico apresentam maiores chances de suspeita ou risco para alterações no seu DNPM.

Objectives: to assess the neuropsychomotor development (DNPM) of children aged 3 to 6 years with chronic liver diseases, using Denver II screening test and check out the association between DNPM and nutritional status, family income and surgical interventions. Methods: sectional Study with comparison group, descriptive and exploratory. 27 children were evaluated, 16 of the GP (Group of patients) and 11 without liver diseases (comparison group GC) for development testing according to age. Results: it was found that 68.8% of GP presented suspicion or risk for the DNPM. The odds of having the Denver positive for suspicion or risk in GP was 2.2, while among children of the GC was 0.375, i.e. an odds ratio of 5.87. The GP, 45% with suspicion or risk for the DNPM were overweight on BMI X age, 72% of GP with the positive Denver belonged to economy class C1 and C2. In GP, 94.1% conducted some surgical procedure, these more than half were suspected or risk for DNPM. Conclusion: children with chronic liver diseases, overweight, with low family income and those that suffered some surgical procedure have higher chances of suspicion or risk for changes in your DNPM.