Anti-resorptive therapy and MRONJ. A survey of the Italian Society of Periodontology and Implantology.

OBJECTIVES: Anti-resorptive agents have been linked to the development of MRONJ in patients undergoing dental surgical procedures. This survey aims to explore the level of knowledge and experience of Italian Society of Periodontology and Implantology members in the management of patients treated with anti-resorptive agents and with the risk of developing MRONJ. MATERIALS AND METHODS: An 18-item questionnaire was submitted by e-mail to the SIdP members. Statistical analyses were carried out. Continuous variables were described as mean ± standard deviation (SD) or median, and first and third quartile according to distribution's normality. Normality of data was checked with Shapiro-Wilk test. RESULTS: Four hundred and fifty-one questionnaires were returned by e-mail (32%). Most of the respondents were private practitioners (81.8%). Only 47.7% declared to be highly confident in managing patients on anti-resorptive therapy while 92.5% reported to have performed tooth extractions and 52.3% implant surgery in patients under anti-resorptive therapy for osteometabolic disorders. One or more MRONJ-affected patients were encountered by 63.2% of the respondents. CONCLUSIONS: This survey highlights the need to develop a "dedicated" program both for dentists and prescribers to improve the level of cooperation and to increase the level of awareness of patients treated with anti-resorptive agents.

2D/3D accuracies of implant position after guided surgery using different surgical protocols: A retrospective study.

PURPOSE: To compare the 2D and 3D positional accuracy of four guided surgical protocols using an analysis of linear and angular deviations. METHODS: DICOM and .STLs files obtained from a CBCT and a digital impression were superimposed with software to plan implant position. Fifty-six patients were subdivided into 4 groups: FGA group (template support [Ts]: teeth [T]; bed preparation [Bp]: fully guided [FG]; implant insertion [Ii]: 3D template [3Dt]; device [D]: manual adapter [MA], FGM group (Ts: T; Bp: FG; Ii: 3Dt; D: fully guided mounter [FGM]), PG group (Ts: T; Bp: FG; Ii: manual; D: none) and MS group (Ts: mucosa; Bp: FG; Ii: 3Dt; D: FGM). The position of 120 implants was assessed by superimposing the planned and final position recorded with a digital impression. RESULTS: In FGA group, 3D deviations were 0.92 ± 0.52 mm at the implant head and 1.14 ± 0.54 mm at the apex, and the angular deviation (ang. dev.) was 2.45 ± 1.24°. In FGM group, were 0.911 ± 0.44 mm (head) and 1.11 ± 0.54 mm (apex), and the ang. dev. was 2.73 ± 1.96°. In PG group, were 0.95 ± 0.47 mm (head) and 1.17 ± 0.488 mm (apex), and the ang. dev. was 3.71 ± 1.67°. In MS group, were 1.15 ± 0.45 mm (head) and 1.42 ± 0.45 mm (apex), and the ang. dev. was 4.19 ± 2.62°. Ang. dev. of MS group was different from the other groups (P < 0.05). CONCLUSIONS: Guided surgery showed a sufficient accuracy.

Incentives for recruiting trainee participants in medical education research.

INTRODUCTION: In the growing field of medical education research, participant recruitment can be challenging. Incentives, either tangible or intangible, may be offered to encourage participation. This study aimed to understand these incentives and explore the relationship between study quality and incentives in medical education research. METHODS: We reviewed research studies examining medical trainees published in five major journals in 2008. Tangible and intangible incentives used in recruitment were extracted by two researchers. For each quantitative article, medical education research quality instrument (MERSQI) score was calculated and citation counts for all articles were compiled. RESULTS: Of 215 included articles, 8% explicitly reported incentives. Tangible incentives (value range $15-$60 USD) were offered in 7.9% of studies. Intangible incentives were identified in 30% of studies but only one specifically discussed their use. Tangible incentives correlated with a higher MERSQI score (p < 0.001) and with citations (p < 0.001). CONCLUSION: Most studies in medical education did not describe incentives for participation. Information regarding incentives should be reported in all studies to help inform future recruitment efforts and also to understand the study context including factors that may influence participants motivation.

Effect of sodium reduction and flavor enhancer addition on probiotic Prato cheese processing.

The effect of partial substitution of NaCl with KCl and the flavor enhancers addition (arginine, yeast extract and oregano extract) on Probiotic Prato cheese processing with (L. casei 01, 7logCFU/mL) was investigated. Microbiological (lactic acid bacteria and probiotic counts), physicochemical (proximate composition, pH, proteolysis), bioactivity (antioxidant and angiotensin I-converting enzyme inhibitory activity), rheological (uniaxial compression and creep tests), water mobility (time domain low field magnetic resonance), microstructure (scanning electron microscopy) and sensory evaluation (consumer test) were performed. Sodium reduction and flavor enhancers addition did not constitute an obstacle to the survival of lactic and probiotic bacteria. Proximate composition, antioxidant and angiotensin I-converting enzyme inhibitory activity, and the rheological parameters were affected by the addition of flavor enhancer. No change in the fatty acid profile of cheeses was observed while good performance in the consumer test was obtained by the addition of yeast extract and oregano extract. Prato cheese can be an adequate carrier of probiotics and the addition of different flavor enhancers can contribute developing this functional product in the cheese industry.

Manufacture of Requeijão cremoso processed cheese with galactooligosaccharide.

The addition of galactooligosaccharide, (GOS, 0, 1.5, 3 or 4g/100g) on the quality parameters of requeijão cremoso was investigated. Chemical characteristics (pH, moisture, fat and protein), color (L*, a*, b*), water mobility by TD- nuclear magnetic resonance, rheology (flow curve and oscillatory tests), microstructure and sensory acceptance (consumer test) were evaluated. The addition of GOS provided a denser and compact structure and reduced number and size of fat globules. Increased GOS level (3 and 4g/100g) improved the softness and spreadability (decrease of G', G″ and apparent viscosity and an increase of tan δ and melting index) and impacted positively on the aroma and taste of the requeijão cremoso. Overall, the addition of GOS in requeijão cremoso was proved to be a potential and interesting technological option.

Comportamento biomecânico de diferentes placas de avanço da tuberosidade da tíbia em cães: estudo comparativo ex vivo / Biomechanical behavior of two different tibial tuberosity advancement plates in dogs: comparative ex vivo biomechanical study

Este é o primeiro estudo que compara o comportamento biomecânico de duas diferentes placas de avanço da tuberosidade tibial (ATT). Com o objetivo de minimizar a incidência de falhas de implante, foram realizados ensaios biomecânicos em 10 pares de membros pélvicos de cadáveres de cães. No membro pélvico direito, foi colocada placa de ATT fixa por garfo, e no membro pélvico esquerdo placa fixa por parafusos. Os ensaios foram realizados utilizando-se máquina universal de ensaios mecânicos Kratos(r), modelo KE3000, dotada de célula de carga de 3000N, com velocidade de ensaio de 20mm/min. O parâmetro força e os gráficos gerados foram gravados por meio de sistema de aquisição analógica TRACOMP-W95 (TRCV61285). A média da carga máxima até a falha foi de 128,70kg/F (mínimo 104,55kg/F e máximo 151,80kg/F) e de 141,99kg/F (mínimo 111,60kg/F e máximo 169,65kg/F) no grupo utilizando garfo e parafusos, respectivamente. O desvio-padrão dos grupos garfo e parafuso foi baixo, 12,99 e 17,21, respectivamente. Foi encontrada diferença significativa (P=0,03) entre as médias dos grupos. Com base nos resultados obtidos, conclui-se que existe diferença estatística significativa na resistência promovida entre as placas testadas, quando se observou que a placa fixa por parafusos promove maior resistência.(AU)

This is the first study to compare the biomechanical strength between the two different TTA plates. With the purpose of minimizing the incidence of implant failure, biomechanical tests were performed on 10 pairs of cadaveric hind limbs from dogs. The right hind limb of each dog was used as a model for the TTA plate fixed by fork, and the left pelvic limb was used as a model for the TTA plate fixed by screws. Tests were performed using a universal mechanical testing Kratos (r) machine, model KE 3000, equipped with a load cell of 3000N with a test speed of 20mm/min. The strength parameter and graphs generated were recorded via analog acquisition system TRACOMP-W95 (TRCV61285). The mean load to failure was 128.70kg/F (minimum 104.55kg and maximum 151.80kg/F) and 141.99kg/F (minimum 111.60kg/F and maximum 169.65kg/F) in the fork and screws groups respectively. The standard deviation of the fork and screws groups was low: 12.99 and 17.21 respectively. Significant difference (P= 0.03) between means of the groups was observed. From the results obtained it was concluded that there is a statistically significant difference in the resistance between plates and the plate fixed by screws promotes increased strength.(AU)

Effect of incorporation of antioxidants on the chemical, rheological, and sensory properties of probiotic petit suisse cheese.

This work investigated the effect of the addition of different antioxidants (ascorbic acid, glucose oxidase, cysteine, and jabuticaba extract) on the rheological and sensorial properties of the probiotic petit suisse cheese. Absence of influence of the antioxidants at the physico-chemical characteristics of the petit suisse cheese was observed. Overall, the petit suisse cheeses presented weak gel characteristics and behaved as pseudoplastic material, except for control. All treatments exhibited a thixotropic non-Newtonian behavior; however, higher hysteresis area was obtained for control sample, which indicates that antioxidants incorporated to petit suisse had a protective effect on the typical thixotropic behavior of the Quark gel. The commercial sample presented higher scores for all aspects by consumers, whereas the probiotic petit suisse samples presented opposite behavior. Projective mapping was able to generate a vocabulary where the sample containing jabuticaba skin extract obtained by supercritical extraction was characterized by the panelists as presenting grape flavor and purple color.

Physico-chemical changes during storage and sensory acceptance of low sodium probiotic Minas cheese added with arginine.

The partial substitution of sodium chloride by potassium chloride (0%, 25%, and 50%) and addition of arginine (1% w/w) in probiotic Minas cheese was investigated. Microbiological (Lactococcus lactis and Lactobacillus acidophilus counts, and functionality of the prebiotics L. acidophilus), physicochemical (pH, proteolysis, organic acids, fatty acids, and volatile profiles), rheological (uniaxial compression) and sensory (hedonic test with 100 consumers) characterizations were carried out. The sodium reduction and addition of arginine did not constitute a hurdle to lactic and probiotic bacteria survival, with presented values of about 9 log CFU/g, ranging from 7.11 to 9.21 log CFU/g, respectively. In addition, lower pH values, higher proteolysis, and a decrease in toughness, elasticity and firmness were observed, as well as an increase in lactic, citric, and acetic acid contents. In contrast, no change was observed in the fatty acid profile. With respect to the sensory acceptance, the probiotic low-sodium Minas cheese presented scores above 6.00 (liked slightly) for the attributes flavor and overall acceptance. The addition of arginine can be a potential alternative for the development of probiotic dairy products with reduced sodium content.

Preference mapping of dulce de leche commercialized in Brazilian markets.

Dulce de leche samples available in the Brazilian market were submitted to sensory profiling by quantitative descriptive analysis and acceptance test, as well sensory evaluation using the just-about-right scale and purchase intent. External preference mapping and the ideal sensory characteristics of dulce de leche were determined. The results were also evaluated by principal component analysis, hierarchical cluster analysis, partial least squares regression, artificial neural networks, and logistic regression. Overall, significant product acceptance was related to intermediate scores of the sensory attributes in the descriptive test, and this trend was observed even after consumer segmentation. The results obtained by sensometric techniques showed that optimizing an ideal dulce de leche from the sensory standpoint is a multidimensional process, with necessary adjustments on the appearance, aroma, taste, and texture attributes of the product for better consumer acceptance and purchase. The optimum dulce de leche was characterized by high scores for the attributes sweet taste, caramel taste, brightness, color, and caramel aroma in accordance with the preference mapping findings. In industrial terms, this means changing the parameters used in the thermal treatment and quantitative changes in the ingredients used in formulations.

Discrimination of Brazilian artisanal and inspected pork sausages: Application of unsupervised, linear and non-linear supervised chemometric methods.

The performance of different chemometric approaches to discriminate artisanal and industrial pork sausages using traditional physicochemical parameters was investigated. A total of 90 samples of sausages marketed in various supermarkets and open-markets in Rio de Janeiro, Brazil were analyzed for their content of moisture, protein, fat, nitrite, sodium and calcium. Principal component analysis (PCA) and hierarchical cluster analysis (HCA) were used as exploratory methods, while linear and non-linear classification methods, such as k-nearest neighbors (k-NN), soft independent modeling of class analogy (SIMCA), partial least square discriminant analysis (PLSDA) and artificial neural networks (ANN) were used for assessing the data. Different behaviors for all parameters were analyzed between the classes. Principal component analysis and hierarchical cluster analysis did not show a complete discrimination of the samples. KNN and ANN results showed excellent performance for both categories with 100% correct prediction while SIMCA and PLSDA presented performance of 100% and 85.7% for inspected and artisanal sausages, respectively. According to the SIMCA, PLSDA and ANN, the contents of moisture and fat showed the highest discriminative power. Overall, the findings emphasize the use of multivariate techniques to evaluate the quality of processed foods, as pork sausages.

Processing optimization of probiotic yogurt containing glucose oxidase using response surface methodology.

Exposure to oxygen may induce a lack of functionality of probiotic dairy foods because the anaerobic metabolism of probiotic bacteria compromises during storage the maintenance of their viability to provide benefits to consumer health. Glucose oxidase can constitute a potential alternative to increase the survival of probiotic bacteria in yogurt because it consumes the oxygen permeating to the inside of the pot during storage, thus making it possible to avoid the use of chemical additives. This research aimed to optimize the processing of probiotic yogurt supplemented with glucose oxidase using response surface methodology and to determine the levels of glucose and glucose oxidase that minimize the concentration of dissolved oxygen and maximize the Bifidobacterium longum count by the desirability function. Response surface methodology mathematical models adequately described the process, with adjusted determination coefficients of 83% for the oxygen and 94% for the B. longum. Linear and quadratic effects of the glucose oxidase were reported for the oxygen model, whereas for the B. longum count model an influence of the glucose oxidase at the linear level was observed followed by the quadratic influence of glucose and quadratic effect of glucose oxidase. The desirability function indicated that 62.32 ppm of glucose oxidase and 4.35 ppm of glucose was the best combination of these components for optimization of probiotic yogurt processing. An additional validation experiment was performed and results showed acceptable error between the predicted and experimental results.

Corticosteroid reduction with tacrolimus (CORRETA) TRIAL: a prospective Brazilian multicenter, randomized trial of early corticosteroid reduction versus regular corticosteroid dosage maintenance on a tacrolimus (Prograf) and mycophenolate mofetil (Cellcept) immunosuppression regimen in kidney transplant recipients: interim analysis.

Corticosteroids are a cornerstone of immunosuppressive therapy in renal transplantation despite their side effects and morbidity. Newer immunosuppressive agents may be more effective to allow corticosteroid sparing. An interim analysis of 60 completed out of 100 planned primary kidney transplant recipients is presented. All patients on tacrolimus (Prograf) and MMF (Cellcept) were randomized into two groups following a 1:1 distribution for early steroid reduction at posttransplant day 7 (G1; n = 31) versus to long-term maintenance steroids (G2; n = 29). Primary efficacy endpoints were composite endpoint of death, graft loss, or severe acute rejection at 6 and 12 months follow-up. Safety evaluation included severity and frequency of diabetes mellitus, hypertension, hyperlipidemia, leukopenia, infection, malignancy, and severe adverse events. Mean age was 39.1 years, with 45.0% males and 66.7% Caucasians. African-Americans were 25.8% in G1 and 27.6% in G2. One death occurred in each group, as well as one case of severe (Banff III) rejection in G1 (P = 1.00). The incidence of rejection episodes between groups was not significant, namely, 41.9% in G1 and 20.7% in G2 (P = .077). There were no differences between groups concerning mean, systolic and diastolic blood pressure, HbA1c, or creatinine at 12 months. This interim analysis showed no evidence of an increased risk of poorer performance among the early steroid reduction or safety differences in kidney transplant recipients versus a regular dosage steroid group of patients. Further analysis of the complete study data is underway.

Effect of silk flower hay (Calotropis procera Sw) feeding on the physical and chemical quality of Longissimus dorsi muscle of Santa Inez lambs.

The effect of different levels of silk flower hay (Calotropis procera Sw) in the diet of confined lambs by the substitution of the commonly used foraging broom corn hay (Sorghum bicolor L) was investigated to evaluate its possible effects on the growth and quality of the lamb meat. Twenty-four male Santa Inez lambs were divided in equal numbers into four treatment groups and fed diets containing 0%, 16.7%, 33.3% and 50% of silk flower hay (SFH). Growth rate, feed intake and meat quality were investigated. Mean daily gains of lambs were 170g for control, 180.5g for 16.7% SFH, 96.8g for 33.3% SFH and 22.9g for 50% SFH. The use of silk flower hay in the diet of Santa Inez lambs affected health of the animals and meat pH when the substitution of the forage was high, up to 50%; however, the general meat quality was not affected. Meat from animals fed with levels up to 50% SFH had physical (Aw, a(∗), b(∗) and L(∗)) and chemical (moisture, ash, lipid, phosphorus, iron, phospholipid and fatty-acid profile) parameters comparable to the control group (0% SFH). Among the various levels of substitution (16.7%, 33.3% and 50%) of silk flower hay in the diet tried in this work, the use of 16.7% was found to be an attractive and technically viable option for the Northeast region of Brazil.

Posttransplant prophylactic intravenous immunoglobulin in kidney transplant patients at high immunological risk: a pilot study.

The effects of posttransplant prophylactic intravenous immunoglobulin (IVIg) were investigated in renal transplant recipients at high immunological risk. Thirty-eight deceased-donor kidney transplant recipients with previous positive complement-dependent cytotoxicity crossmatch (n=30), and/or donor-specific anti-HLA antibodies (n=14) were recruited. IVIg (2 g/kg) was administrated on days 0, 21, 42 and 63 with quadruple immunosuppression. Biopsy-proven acute cellular and humoral rejection rates at month 12 were 18% and 10%, respectively. Glomerulitis was observed in 31% and 60% of patients at months 3 and 12, respectively, while allograft glomerulopathy rose from 3% at month 3 to 28% at 12 months. Interstitial fibrosis/tubular atrophy increased from 18% at day 0 to 51% and 72% at months 3 and 12 (p<0.0001). GFR was 50 +/- 17 mL/min/1.73 m(2) and 48 +/- 17 mL/min/1.73 m(2) at 3 and 12 months. PRA decreased significantly after IVIg (class I: from 18 +/- 27% to 5 +/- 12%, p<0.01; class II: from 25 +/- 30% to 7 +/- 16%, p<0.001). Patient and graft survival were 97% and 95%, respectively and no graft was lost due to rejection (mean follow-up 25 months). In conclusion, prophylactic IVIg in high-immunological risk patients is associated with good one-year outcomes, with adequate GFR and a profound decrease in PRA level, but a significant increase in allograft nephropathy.

Improved semiclassical density matrix: taming caustics.

We present a simple method to deal with caustics in the semiclassical approximation to the thermal density matrix of a particle moving on the line. For simplicity, only its diagonal elements are considered. The only ingredient we require is the knowledge of the extrema of the Euclidean action. The procedure makes use of complex trajectories, and is applied to the quartic double-well potential.

Fatal microcystin intoxication in haemodialysis unit in Caruaru, Brazil.

BACKGROUND: After a drought in February, 1996, all 126 patients in a haemodialysis unit in Caruaru, north-east Brazil, developed signs and symptoms of acute neurotoxicity and subacute hepatotoxicity following the use of water from a lake with massive growth of cyanobacteria (blue-green algae). 60 patients died. METHODS: Besides recording clinical details and outcome at follow-up, we arranged laboratory, radiological, and histological investigations on the patients and toxicological studies of serum and haemodialysis water filters. FINDINGS: The acute presentation was with malaise, myalgia and weakness, nausea and vomiting, and tender hepatomegaly, with a range of neurological symptoms from tinnitus, vertigo, headaches, and deafness to blindness and convulsions. Liver injury ranged from abnormal liver-function test results to rapidly progressive and fatal hepatic failure. Biochemical investigations revealed gross hyperbilirubinaemia, abnormal liver enzyme activities, and hypertriglyceridaemia, but there was no evidence of haemolysis or microangiopathy. Histology revealed a novel acute toxic hepatitis with diffuse panlobular hepatocyte necrosis, neutrophil infiltration, canalicular cholestasis, and regenerative multinucleate hepatocytes. Samples of serum, dialysis filters, and water-treatment columns contained microcystins, the highly toxic low-molecular-weight hepatotoxins produced by cyanobacteria. INTERPRETATION: Cyanobacteria present water-borne hazards to health via drinking water and recreational water. Haemodialysis presents an additional high-risk exposure route: when they enter directly into the circulation, microcystins can lead to fatal clinical syndromes ranging from acute neurotoxic illness to subacute liver failure.

[Effect of fire on understory birds of a gallery forest in central Brazil]. / Influência do fogo na avifauna do sub-bosque de uma mata de galeria do Brasil Central.

Habitat burning may cause significant population and community changes in animals and plants, specially when the humans increase fire frequency. We mist-netted the understory birds of a gallery forest from the cerrado region of central Brazil before and after a fire of unknown cause which burned the Ecological Reserve of the University of Brasília, Brasília, DF, in September 1987. We conducted mist-netting mostly during the morning, using 12 mist-nets distributed on 2.5 ha in the interior and border of the forest. We captured 137 individuals of 37 species, 51 individuals of 21 species during 135.5 net/h before the fire, and 98 individuals of 33 species during 233 net/h after the fire. The bird community as a whole did not change after the fire. The observed changes in the bird community were related to the type of habitat used by some species of birds than to their diet. Species typical to gallery forests are probably less adapted to habitat burning than species that occur in other habitats and may be suffering a decrease or a disturbance in their population structure, revealing an important problem of cerrado bird conservation.

Azathioprine hepatitis in kidney transplant recipients. A predisposing role of chronic viral hepatitis.

Influence of viral liver diseases on the occurrence of azathioprine hepatitis was evaluated in 21 kidney transplant recipients. Diagnosis of azathioprine hepatitis was always based on jaundice, which disappeared after azathioprine withdrawal in 18 patients and after azathioprine dose reduction in 3 patients. Histopathological diagnosis of azathioprine toxicity was ascertained in 14 patients. Rechallenge with azathioprine performed in 4 patients, within 2-4 months after the first jaundice episode, resulted in relapse of jaundice in all cases. Viral hepatitis B virus and hepatitis C markers were present in all 20 tested patients (serum hepatitis B surface antigen in 6 patients and anti-HCV antibodies in 17 patients). Biopsy-proven chronic hepatitis was observed in 18 patients, including 14 chronic active hepatitis, 3 chronic persistent hepatitis and cirrhosis in 1. In kidney transplant recipients, azathioprine hepatitis seems to be facilitated or induced by hepatitis B virus or hepatitis C virus chronic hepatitis. Azathioprine reduction or withdrawal should therefore be combined with the diagnostic evaluation and the treatment of viral liver diseases.