Low-intensity extracorporeal shockwave therapy in the treatment of erectile dysfunction - a narrative review

ABSTRACT Objectives: To provide an overview of low-intensity extracorporeal shockwave therapy (LIEST) for erectile dysfunction (ED), pointing out which concepts are already consolidated and which paths we still need to advance. Materials and Methods: We performed a narrative review of the literature on the role of shockwave therapies in erectile dysfunction, selecting publications in PUBMED, including only relevant clinical trials, systematic reviews and meta-analyses. Results: We found 11 studies (7 clinical trials, 3 systematic review and 1 meta-analysis) that evaluated the use of LIEST for the treatment of erectile dysfunction. One clinical trial evaluated the applicability in Peyronie's Disease and one other clinical trial evaluated the applicability after radical prostatectomy. Conclusions: The literature presents little scientific evidence but suggests good results with the use of LIEST for ED. Despite a real optimism since it is a treatment modality capable of acting on the pathophysiology of ED, we must remain cautious, until a larger volume of higher quality studies allows us to establish which patient profile, type of energy and application protocol will achieve clinically satisfactory results.

Oral lichen planus with cutaneous manifestations: case report with emphasis on dental diagnostic criteria / Líquen plano oral com manifestações cutâneas: relato de caso com ênfase nos critérios de diagnóstico odontológico

ABSTRACT Lichen planus is a chronic inflammatory disease involving the skin and mucosa, which often affects the oral cavity. The objective of this study is to report a case of oral lichen planus (OLP) with cutaneous manifestations and to discuss the clinical, histopathological aspects and the established treatment. A 61-years-old female white patient was referred for evaluation of white lesions in the oral mucosa. In the intraoral examination, multiple white lesions with striated appearance were observed in the jugal mucosa, tongue and border. The extraoral examination revealed scaly lesions on the arm, white spots on the legs, and nail dystrophy on feet. Based on biopsy of the oral lesions and the histopathological analysis, the diagnosis of OLP was confirmed. The patient underwent treatment with clobetasol propionate topical cream (0.5 mg), and was instructed to apply it to affected area, once or twice a day for four weeks. In the clinical follow-up after one month and 15 days, the improvement of the lesions could be analyzed. As OLP is a disease with an etiopathogenesis that is still poorly recognized, several factors may enable the development of this condition. Therefore, the dentist's clinical view is essential for the most effective treatment.

RESUMEN El liquen plano es una enfermedad inflamatoria crónica que involucra piel y mucosa, con frecuencia de la cavidad bucal. Los objetivos de este estudio son reportar un caso de liquen plano oral (LPO) con manifestaciones cutáneas y discutir sus aspectos clínicos e histopatológico, así como el tratamiento establecido. Reportamos el caso de una mujer de 61 años de edad, raza blanca, que fue remitida para evaluación de lesiones blancas en la mucosa bucal. En el examen intraoral se observaron lesiones blancas múltiples estriadas en mucosa yugal, lengua y cresta; en el examen extraoral, lesiones descamativas en el brazo, manchas blancas en las piernas y uñas distróficas en los pies. Basándose en la biopsia de las lesiones bucales y en el análisis histopatológico, el diagnóstico de LPO se confirmó. La paciente fue sometida a tratamiento con propionato de clobetasol crema (0,5 mg) y aconsejada a aplicar el medicamento sobre el área afectada, una o dos veces al día, por cuatro semanas. En el seguimiento clínico, al cabo de un mes y 15 días, fue posible analizar la mejoría de las lesiones. Por tratarse de una enfermedad de etiología todavía poco conocida, varios factores pueden favorecer su desarrollo. Así, el ojo clínico del cirujano dentista es imprescindible para un tratamiento más efectivo.

RESUMO O líquen plano é uma doença inflamatória crônica que envolve pele e mucosa, acometendo frequentemente a cavidade bucal. Os objetivos deste estudo são relatar um caso de líquen plano oral (LPO) com manifestações cutâneas e discutir os aspectos clínicos e histopatológicos, bem como o tratamento estabelecido. Relatamos o caso de uma mulher, 61 anos de idade, leucoderma, que foi encaminhada para avaliação de lesões brancas na mucosa bucal. Ao exame intraoral, foram observadas múltiplas lesões brancas com aspecto estriado em mucosa jugal, língua e rebordo; ao exame extraoral, lesões de aspecto descamativo no braço, manchas brancas nas pernas e unhas distróficas nos pés. Com base na biópsia das lesões bucais e na análise histopatológica, o diagnóstico de LPO foi confirmado. A paciente foi submetida ao tratamento com propionato de clobetasol em creme (0,5 mg) e orientada a fazer a aplicação na área afetada, uma a duas vezes ao dia, durante quatro semanas. No acompanhamento clínico após um mês e 15 dias, pôde-se analisar a melhora das lesões. Por se tratar de uma doença com etiopatogênese ainda pouco reconhecida, vários fatores podem possibilitar o desenvolvimento dessa condição. Dessa forma, é imprescindível o olhar clínico do cirurgião-dentista para o tratamento mais eficaz.

Dental adhesive microtensile bond strength following a biofilm-based in vitro aging model

Abstract Laboratory tests are routinely used to test bonding properties of dental adhesives. Various aging methods that simulate the oral environment are used to complement these tests for assessment of adhesive bond durability. However, most of these methods challenge hydrolytic and mechanical stability of the adhesive- enamel/dentin interface, and not the biostability of dental adhesives. Objective To compare resin-dentin microtensile bond strength (μTBS) after a 15-day Streptococcus mutans (SM) or Streptococcus sobrinus (SS) bacterial exposure to the 6-month water storage (WS) ISO 11405 type 3 test. Methodology A total of 31 molars were flattened and their exposed dentin was restored with Optibond-FL adhesive system and Z-100 dental composite. Each restored molar was sectioned and trimmed into four dumbbell-shaped specimens, and randomly distributed based on the following aging conditions: A) 6 months of WS (n=31), B) 5.5 months of WS + 15 days of a SM-biofilm challenge (n=31), C) 15 days of a SM-biofilm challenge (n=31) and D) 15 days of a SS-biofilm challenge (n=31). μTBS were determined and the failure modes were classified using light microscopy. Results Statistical analyses showed that each type of aging condition affected μTBS (p<0.0001). For Group A (49.7±15.5MPa), the mean μTBS was significantly greater than in Groups B (19.3±6.3MPa), C (19.9±5.9MPa) and D (23.6±7.9MPa). For Group D, the mean μTBS was also significantly greater than for Groups B and C, but no difference was observed between Groups B and C. Conclusion A Streptococcus mutans- or Streptococcus sobrinus-based biofilm challenge for 15 days resulted in a significantly lower μTBS than did the ISO 11405 recommended 6 months of water storage. This type of biofilm-based aging model seems to be a practical method for testing biostability of resin-dentin bonding.

Ameloblastic carcinoma arising from a preexistent ameloblastoma / Carcinoma ameloblástico decorrente de um ameloblastoma preexistente

ABSTRACT Ameloblastic carcinoma (AC) is a rare odontogenic tumor that represents the malignant counterpart of an ameloblastoma. There are few cases of AC in the English-language literature, with only 16 cases arising from preexisting ameloblastomas reported in the last 10 years. Multiple local recurrences of ameloblastomas precede this transformation. In the current report, we describe a case of AC at the posterior maxilla in a 42-year-old female submitted to surgical resection, with three recurrences of ameloblastoma in a period of four years. Imaging exams showed a radiodense mass with cortical bone disruption and maxillary sinus invasion. Histologic analysis demonstrated features of islands and nests of malignant epithelium transformation, atypia, pleomorphic cells, nuclear hyperchromatism, necrosis and desmoplasia. AC represents a rare and challenging histologic diagnosis. Surgical access with adequate hard and soft tissue margins is essential for influencing survival. The description of new cases may reveal, through of treatment and clinical follow-up, characteristics that allow us better understanding of AC behavior.

RESUMEN El carcinoma ameloblástico (CA) es un tumor odontogénico raro que representa el equivalente maligno de un ameloblastoma. Hay pocos casos de CA en la literatura en lengua inglesa: en los últimos 10 años, sólo se reportaron 16 casos originados de ameloblastomas previos. Múltiples recidivas locales de este tumor preceden esa transformación. En este reporte, describimos un caso de CA en región posterior de maxila en una mujer de 42 años de edad, sometida a resección quirúrgica. En un periodo de cuatro años, se produjeron tres recurrencias del ameloblastoma. Exámenes de imagen muestran una masa radiodensa con destrucción cortical e invasión del seno maxilar. El análisis histológico ha revelado islas y nidos característicos de transformación epitelial maligna, atipias, pleomorfismo celular, hipercromatismo nuclear, necrosis y desmoplasia. El diagnóstico histológico del CA representa un raro desafío. El abordaje quirúrgico con ampliación de los márgenes de tejido duro y blando es esencial en la sobrevida del paciente. La descripción de nuevos casos puede revelar, mediante tratamiento y acompañamiento clínico, características que ayuden a comprender mejor el comportamiento del CA.

RESUMO O carcinoma ameloblástico (CA) é um tumor odontogênico raro que representa o equivalente maligno de um ameloblastoma. Existem poucos casos de CA na literatura em inglês: nos últimos 10 anos, foram relatados apenas 16 casos surgidos de ameloblastomas preexistentes. Múltiplas recorrências locais desse tumor precedem essa transformação. Neste relato, descrevemos um caso de CA em região posterior de maxila em uma mulher de 42 anos de idade, submetida à ressecção cirúrgica. Em um período de quatro anos, ocorreram três recidivas do ameloblastoma. Exames de imagem exibiram uma massa radiodensa com destruição da cortical óssea e invasão do seio maxilar. A análise histológica revelou ilhas e ninhos característicos de transformação maligna epitelial, atipias, pleomorfismo celular, hipercromatismo nuclear, necrose e desmoplasia. O CA representa um raro e desafiador diagnóstico histológico. O acesso cirúrgico com ampliação das margens de tecido duro e mole é essencial para o impacto na sobrevida do paciente. A descrição de novos casos pode revelar, por meio do tratamento e do acompanhamento clínico, características que ajudem a entender melhor o comportamento do CA.

Perfil de estados de humor em atletas de basquetebol entre competições e posições de jogo / Profile of mood states in basketball athetes between competitions and gaming positions

O basquetebol é um esporte dinâmico com atletas que possuem características muito distintas quanto à estatura, massa corporal, funções e responsabilidade em quadra, que vivem uma busca por resultados e manutenção dos componentes físicos, somados a fatores estressantes da vida social e profissional, os quais podem leva-los a altos níveis de estresse e alterações no Perfi l de Estados de Humor (PEH) em situações de pré-jogo. Desta forma, o presente estudo tem por objetivo analisar os estados de humor pré-jogo em atletas de basquetebol entre competições e posições de jogo. Trata-se de uma pesquisa de caráter descritivo comparativo e transversal, os participantes foram atletas masculinos de basquetebol, divididos em dois grupos: 29 da competição um e 21 da competição dois, totalizando 50 atletas. Para a mensuração do humor foi utilizado a escala de humor de Brunel (BRUMS), que avalia por meio de 24 indicadores simples, que mede seis fatores: tensão, depressão, raiva, vigor, fadiga e confusão mental. A análise dos dados foi através do teste t independente e do teste Anova Oneway, com significância de 95% (p<0,05). A amostra apresentou média de idade de 19,8 ± 2,7 anos, estatura de 181,3 ± 8,5 cm e massa corporal de 78,7 ± 15,3 kg. Os resultados apontam que o PEH dos atletas de basquetebol, entre competições e entre as posições, apresentou um perfil iceberg, resultado considerado pela literatura favorável ao desempenho, não havendo diferenças significativas do PEH entre as posições e competições. Conclui-se que os atletas de basquetebol apresentam respostas semelhantes em relação ao estado emocional entre competições e posições....(AU)

Basketball is a dynamic sport with athletes who have very diff erent characteristics regarding height, body mass, functions and responsibility in court, who live a search for results and maintenance of the physical components, added to stress factors of the athlete's social and professional life, which can lead them to high levels of stress and changes in the Profi le of Mood States (PMS) in pre-game situations. In this way, the present study aims to analyze pre-game mood states in basketball athletes between competitions and game positions. It was a comparative and cross-sectional descriptive study, the participants were male, basketball athletes, divided into two groups: 29 from competition one and 21 from competition two, totaling 50 athletes. The Brunel Mood Scale (BRUMS) used to measure mood, using 24 simple indicators, measuring six factors: tension, depression, anger, force, fatigue and mental confusion. The data were analyzed using the independent t-test, with signifi cance of 95% (p <0.05). The sample had a mean age of 19.8 ± 2.7 years, height of 181.3 ± 8.5 cm and body mass of 78.7 ± 15.3 kg. The results show that the athletes' basketball score, between competitions and between positions, presented an iceberg profi le, result considered by the literature favorable to performance, with no signifi cant diff erences between the positions and competitions. We conclude that basketball athletes present similar responses regarding the emotional state between competitions and positions....(AU)

Parasitos gastrintestinais em caprinos no município de Quixadá, Ceará / Gastrointestinal parasites in goats from Quixadá, Ceará

O objetivo desse trabalho foi avaliar a ocorrência dos principais parasitos gastrintestinais que acometem caprinos adultos e jovens do município de Quixadá-Ceará durante a época seca e chuvosa, além de identificar e quantificar as espécies de Eimeria presentes no rebanho. Foram utilizados 654 animais, sendo 334 animais no período seco, dos quais eram 149 matrizes e 185 crias e 320 animais no período chuvoso, sendo 106 matrizes e 214 crias, independente de padrão racial e sistema de criação. As coletas foram realizadas nos meses de novembro e dezembro de 2012 e maio de 2013 no município de Quixadá-Ceará e encaminhadas ao Laboratório de Parasitologia da Embrapa Caprinos e Ovinos na cidade de Sobral-Ceará. Foram coletadas fezes para contagem do número de ovos por gramas de fezes (OPG), contagem de Oocistos por gramas de fezes (OOPG), coprocultura e identificação das espécies de Eimeria com base na morfometria. As matrizes apresentaram maiores médias de ovos do tipo Strongyloidea (372,03) e Strongyloides (8,45) no período seco e no período chuvoso apresentaram maiores médias apenas para Strongyloidea (502,85). O inverso aconteceu com o OOPG, onde as crias apresentaram maiores médias no período seco (9387,41) e no chuvoso (9630,37). O gênero de nematódeo mais frequente na coprocultura foi o Trichostrongylus sp. (63,67%) no período seco e o Haemonchus sp. no chuvoso (66,67%). Em 100% dos rebanhos, foram encontrados oocistos de Eimeria, com 81% dos animais infectados. A ocorrência da eimeriose nas categorias jovens e adultas foi de 64,3% e 83,2% no período seco e de 87,4% e 92,4% no período chuvoso. As espécies identificadas foram: Eimeria alijevi, E. apsheronica, E. arloingi, E. caprina, E. caprovina, E. christenseni, E. hirci, E. jolchijevi e E. ninakohlyakimovae. Nas crias a E. alijevi foi a mais freqüente no período seco e a E. ninakohlyakimovae no chuvoso. Já nas matrizes a espécie E. alijevi apresentou a maior frequência em ambos os períodos. Nos rebanhos estudados foi evidenciado a presença de ovos de nematódeos gastrointestinais e oocistos de Eimeria spp. independente da categoria animal.(AU)

The objective of this study was to evaluate the occurrence of main gastrointestinal parasites and to quantify and identify the species of Eimeria present in young goats and adults in the city of Quixadá, Ceará, during the dry and rainy season. Six hundred fifty-four animals were used, with 334 animals during the dry season, which were 149 mothers and 185 offspring and 320 animals during the rainy season, with 106 mothers and 214 offspring, independent of breed standard and creation system. Samples were collected in the months of November and December 2012 and May 2013 in the city of Quixadá, Ceará and sent to the Parasitology Laboratory of Embrapa Goats and Sheep at Sobral, Ceará, feces were collected for counting the number of eggs per gram of feces (EPG), counting oocysts per gram of feces (OOPG), coproculture and identification of Eimeria species based on the morphometry. Matrices showed higher means egg type Strongyloidea (372.03) and Strongyloides (8.45) in the dry season and the rainy season had higher mean only to Strongyloidea (502.85). The inverse happened to OOPG, where the offspring showed higher means in the dry season (9387.41) and rainy (9630.37). The genus most frequent of nematode in coprocultures was Trichostrongylus. (63.67%) in the dry season and Haemonchus sp. the rainy (66.67%). One hundred percent of the herds, oocysts of Eimeria were found, with 81% of infected animals. The occurrence of eimeriosis in young and adult categories was 64.3% and 83.2% in the dry season and 87.4% and 92.4% during the rainy season. The species identified were: Eimeria alijevi, E. apsheronica, E. arloingi, E. caprina, E. caprovina, E. christenseni, E. hirci, E.and E. jolchijevi ninakohlyakimovae. In the offspring E. alijevi was the most frequent in the dry season and the rainy E. ninakohlyakimovae. Already in matrices the species E. Alijevi showed the highest frequency in both periods. In herds studied it evidenced the presence of gastrointestinal nematodes eggs and oocysts of Eimeria spp. independent of animal category.(AU)

Retenção de placenta e endometrite subclínica: prevalência e relação com o desempenho reprodutivo de vacas leiteiras mestiças / Retained placenta and subclinical endometritis: prevalence and relation with reproductive performance of crossbred dairy cows

Objetivou-se avaliar os efeitos do tipo de parto (eutócico vs. distócico) e do período do ano (chuvoso vs. seco) sobre a prevalência de retenção de placenta (RP) e de endometrite subclínica (ES), verificar a relação entre as duas patologias, e os efeitos dessas sobre a taxa de descarte, o período de serviço (PS) e número de IA/concepção. A RP foi avaliada no primeiro dia pós-parto (DPP). A citologia endometrial foi realizada entre 30 e 80 DPP, considerando positivos casos contendo acima de 5% de neutrófilos. Os dados foram analisados por regressão logística e análise de variância no programa Minitab (P<0,05). A prevalência de RP foi de 14,93% (69/462) e de ES de 27,49% (127/462). Foi detectada tendência de efeito (P=0,10) da RP sobre a prevalência da ES. Partos distócicos aumentaram a prevalência de RP e vacas que pariram nos meses chuvosos tiveram maior prevalência de ES (P<0,05). A RP elevou a taxa de descarte (P<0,05), a duração do período de serviço (P<0,05) e o número de IA por concepção (P<0,05), enquanto a ES não afetou essas variáveis (P>0,05). Conclui-se que a retenção de placenta tende a ser um fator de risco para endometrite subclínica, distocia predispõe à retenção de placenta e partos ocorridos no período chuvoso aumentam os casos de endometrite subclínica. Há um impacto negativo na eficiência reprodutiva de vacas leiteiras mestiças acometidas por retenção de placenta.(AU)

This study aimed to evaluate the effects of type of calving (eutocic vs. dystocic), season of the year (rainy vs. dry) on retained placenta (RP) and subclinical endometritis (SE) prevalence, to verify the relation between these diseases, as well as its effects on culling rate, days open and number of AI/conception. Retention of fetal membranes was recorded on first day postpartum. Endometrial cytology was performed between 30 and 80 days in milk (DIM) and positive cases were considered ≥5% neutrophils. Data were analysed by logistic regression and analysis of variance on Minitab program (P<0.05). The prevalence of RP was 14.93% (69/462) and of SE was 27.49% (127/462). A tendency of effect of RP on SE prevalence was detected (P=0.10). Dystocia increased RP prevalence (P<0.05). Cows that calved during rainy months had greater SE prevalence (P<0.05). RP increased culling rate (P<0.05), calving to conception interval (P<0.05) and number of AI/conception (P<0.05), although SE occurrence did not affect these variables (P>0.05). In conclusion, RP tended to be a risk factor for SE, dystocia is a predisposing factor for RP and calvings that happens during rainy period increases SE. There is a negative impact on reproductive efficiency of crossbred dairy cows that had retained placenta.(AU)

Treatment of advanced melanoma - A changing landscape / Tratamento de melanoma avançado - Um panorama em transformação

Summary Following decades of relative ostracism, advances in the treatment of melanoma have brought a new reality for patients, physicians and researchers. While antibodies targeting molecules involved in the modulation of the interaction between melanoma and immune cells changed the meaning of the term "cancer immunotherapy," a better characterization of the molecular aberrations involved in melanoma carcinogenesis prompted the development of inhibitors of the mitogen-activated protein kinase pathway (MAPK) that also led to significant improvements both in response rates and survival. As a result, new drugs have been approved for clinical use in the United States and Europe, including the immune-checkpoint blockers ipilmumab, pembrolizumab and nivolumab, the oncolytic herpesvirus talimogene laherparepvec, and the targeted-agents vemurafenib, dabrafenib, cobimetinib and trametinib. In this article, we review the results of studies that brought new approaches to the bedside and discuss how these developments are being incorporated into the care of patients in Brazil.

Resumo Após décadas de ostracismo, os recentes avanços no tratamento do melanoma trouxeram uma nova realidade para pacientes, médicos e pesquisadores. Enquanto anticorpos monoclonais voltados a moléculas envolvidas na modulação da interação entre células do melanoma e do sistema imune consolidaram o uso da "imunoterapia", um melhor conhecimento acerca das aberrações genômicas envolvidas na carcinogênese do melanoma viabilizaram o desenvolvimento de inibidores da via mitogen-activated protein kinase pathway (MAPK), o que também resultou em ganhos significativos em taxas de resposta e sobrevida. Consequentemente, novas modalidades de tratamento foram aprovadas para uso clínico nos Estados Unidos e na Europa, incluindo os bloqueadores de correceptores imunes ipilimumabe, nivolumabe e pembrolizumabe, o herpesvírus oncolítico talimogene laherparepvec (T-VEC), e os agentes-alvo vemurafenibe, dabrafenibe, cobimetinibe e trametinibe. Nesse artigo, revisamos os resultados que trouxeram novas alternativas para a prática clínica e discutimos a incorporação desses avanços ao cuidado de pacientes no Brasil.

Paleoenvironmental evolution of the coastal plain of Southern Brazil: palynological data from a Holocene core in Santa Catarina State

ABSTRACT This paper presents a paleoenvironmental reconstruction from palynological analyses of a sedimentary core of Holocene age, drilled at municipality of Garopaba (Santa Catarina), Southern Brazil. A total of 46 samples was collected for palynological analyses in the 450 cm-long core PCSC-3, as also three samples for radiocarbon dating and granulometric analyses. The palynological content includes 84 taxa related to pollen grains of angiosperms (38) and gimnosperm (3), spores of pteridophyta (16) and bryophyta (2), spores of fungi (8), algae (3), acritarchs (3), dinoflagellate cysts (2) and microforaminiferal linings (1). Three specimens of acritarchs are described and illustrated in detail. Three palynological phases were defined based on changes in assemblages: Phase I, Phase II and Phase III. The Phase I is characterized as a lagoonal paleoenvironment with marine influence from the beginning of the sedimentation (5390 cal yr BP), based on occurrences of acritarchs, dinoflagellate cysts and microforaminiferal linings. The Phase II (3032 yr BP until 858 cal yr BP) also is characterized by a lagoonal paleoenvironment, however, presented decrease in percentage of marine elements and increase in freshwater algae record, suggesting less marine influence in the lagoonal body. In Phase III (last 856 years), underwater sedimentation prevailed, under swamp-like conditions.

¿Tiene cabida, hoy, el "privilegio terapéutico"? / Does therapeutic privilege have a place in modern medicine?

During the last years, bioethical discussion has highlighted the role of the patients' autonomy, being informed consent its particular expression, about decisions that they should make about their own health. The Hippocratic tradition, the deontological positions of the Geneva Declaration of the World Medical Association and numerous codes of ethics in various countries, require that the physician, above all, should ensure patients' health. In this context the discussion on pros and cons for the so-called "therapeutic privilege" are discussed. The "therapeutic privilege" refers to the withholding of information by the clinician during the consent process in the belief that disclosure of this information would lead to harm or suffering of the patient. The circumstances and conditions in which this privilege can become valid are discussed. Special reference is made in order to respect multiculturalism and to the possibility of obtaining advice from health care ethics committees. The role of prudence in the doctor-patient relation must be highlighted. Disclosure of information should be subordinated and oriented to the integral well-being of the patient.