Organic electrodes based on redox-active covalent organic frameworks for lithium batteries.

Electroactive organic materials have received much attention as alternative electrodes for metal-ion batteries due to their high theoretical capacity, resource availability, and environmental friendliness. In particular, redox-active covalent organic frameworks (COFs) have recently emerged as promising electrodes due to their tunable electrochemical properties, insolubility in electrolytes, and structural versatility. In this Highlight, we review some recent strategies to improve the energy density and power density of COF electrodes for lithium batteries from the perspective of molecular design and electrode optimisation. Some other aspects such as stability and scalability are also discussed. Finally, the main challenges to improve their performance and future prospects for COF-based organic batteries are highlighted.

Bacteria, yeasts, and fungi associated with larval food of Brazilian native stingless bees.

Stingless bees are a diverse group with a relevant role in pollinating native species. Its diet is rich in carbohydrates and proteins, by collecting pollen and nectar supplies the development of its offspring. Fermentation of these products is associated with microorganisms in the colony. However, the composition of microorganisms that comprise this microbiome and its fundamental role in colony development is still unclear. To characterize the colonizing microorganisms of larval food in the brood cells of stingless bees Frieseomelitta varia, Melipona quadrifasciata, Melipona scutellaris, and Tetragonisca angustula, we have utilized molecular and culture-based techniques. Bacteria of the phyla Firmicutes, Proteobacteria, Actinobacteria, and fungi of the phyla Ascomycota, Basidiomycota, Mucoromycota, and Mortierellomycota were found. Diversity analysis showed that F. varia had a greater diversity of bacteria in its microbiota, and T. angustula had a greater diversity of fungi. The isolation technique allowed the identification of 189 bacteria and 75 fungi. In summary, this research showed bacteria and fungi associated with the species F. varia, M. quadrifasciata, M. scutellaris, and T. angustula, which may play an essential role in the survival of these organisms. Besides that, a biobank with bacteria and fungus isolates from LF of Brazilian stingless bees was created, which can be used for different studies and the prospection of biotechnology compounds.

Percepções de pacientes sobre recuperação cirúrgica retardada: validação do diagnóstico de enfermagem / Percepciones de pacientes sobre recuperación quirúrgica retardada: validación del diagnóstico de enfermería / Perceptions of patients on delayed surgical recovery: validation of the nursing diagnosis

RESUMO Objetivo: validar qualitativamente o diagnóstico de enfermagem Recuperação Cirúrgica Retardada, a partir das percepções de pacientes. Método: estudo qualitativo, realizado com 20 pacientes de hospital de referência com seis dias ou mais de pós-operatório. Realizou-se entrevista semiestruturada como técnica de coleta de dados e, para análise de dados, procedeu-se ao método da análise de conteúdo temática. Resultados: obtiveram três categorias: Descrição das características definidoras e fatores relacionados a partir do relato dos pacientes; Percepção sobre a recuperação cirúrgica; e Repercussões do retardo da recuperação cirúrgica na vida, na saúde e no bem-estar dos pacientes. Considerações finais: as percepções dos pacientes estiveram intimamente ligadas ao tempo de pós-operatório e prolongamento da internação, o que corrobora a definição do diagnóstico Recuperação Cirúrgica Retardada. Investigações qualitativas auxiliam na compreensão da experiência do paciente quanto ao fenômeno do diagnóstico e situa o cuidado centrado na pessoa. Pode, ainda, auxiliar no delineamento de intervenções de enfermagem assertivas para o alcance da recuperação plena.

RESUMEN Objetivo: validar cualitativamente el diagnóstico de enfermería Recuperación Quirúrgica Retardada, a partir de las percepciones de pacientes. Método: estudio cualitativo, realizado con 20 pacientes de hospital de referencia con seis días o más de postoperatorio. Se realizó entrevista semiestructurada como técnica de recolección de datos y, para análisis de datos, se procedió al método del análisis de contenido temático. Resultados: obtuvieron tres categorías: Descripción de las características definitorias y factores relacionados a partir del relato de los pacientes; Percepción sobre la recuperación quirúrgica; y Repercusiones del retardo de la recuperación quirúrgica en la vida, en la salud y en el bienestar de los pacientes. Consideraciones finales: las percepciones de los pacientes estuvieron íntimamente conectadas al tiempo de postoperatorio y la prolongación de la internación, lo que corrobora la definición del diagnóstico Recuperación Quirúrgica Retardada. Investigaciones cualitativas ayudan en la comprensión de la experiencia del paciente en cuanto al fenómeno del diagnóstico y ubican el cuidado centrado en la persona. Pueden, además, ayudar en la definición de intervenciones de enfermería asertivas para el alcance de la recuperación plena.

ABSTRACT Objective: to qualitatively validate the nursing diagnosis Delayed surgical recovery based on patients' perceptions. Method: a qualitative study was conducted with 20 patients from a reference hospital six days or more after surgery. A semi-structured interview was conducted as the data collection technique, and the thematic content analysis method was used for data analysis. Results: three categories were obtained: Description of the defining characteristics and related factors based on the patients' statements, Perception of surgical recovery, and Repercussions of delayed surgical recovery on the patients' lives, health, and well-being. Final considerations: the patients' perceptions were closely linked to the postoperative period and length of stay, which corroborates the definition of Delayed surgical recovery. Qualitative investigations help to understand the patient's experience regarding the diagnosis phenomenon and situate person-centered care. It can also help design assertive nursing interventions to achieve full recovery.

Inappropriate empirical antimicrobial treatment in bloodstream infections patients in the era of multidrug resistance / Terapia Empírica Inapropriada no Tratamento de Infecções de Corrente Sanguínea na Era da Multirresistência Antimicrobiana / Tratamiento antimicrobiano empírico inadecuado en pacientes con infecciones del torrente sanguíneo

Background and objectives: Bloodstream infection (BSI) by multidrug-resistant Pseudomonas aeruginosa is a severe infection. This study aimed to evaluate and identify the predictors of mortality in patients who had bloodstream infection by carbapenem-resistant P. aeruginosa. Methods: This is a retrospective cohort study, approved by Committee of Ethics in Research with Human Participants, which included 87 consecutive patients hospitalized in a referral hospital in Brazil. Clinical and demographic information about each patient were obtained from hospital records. The Student's T-test was used to compare continuous variables and x2 or Fisher's exact tests to compare categorical variables. To determine independent risk factors for 30-day mortality, a multiple logistic regression model was used. A survival curve was constructed using the Kaplan­Meier method. Results: Among the patients, 87.3% use antibiotics previously, 60.9% received inadequate empirical treatment, and the 30-day mortality rate was 57.5%. Inappropriate antibiotic empirical therapy was independently associated with a 30-days death and mortality rate. Conclusion: These findings can show some insights about the relationship between higher mortality and inappropriate empirical therapy for patients with BSI by P. aeruginosa. There is a need for better diagnostic tests and infection control programs should focus on de-escalation the antibiotic inappropriate therapy, mainly in BSI caused by carbapenem-resistant P. aeruginosa.(AU)

Justificativa e objetivos: Infecção da corrente sanguínea (ICS) por Pseudomonas aeruginosa multirresistente é grave. Este estudo teve como objetivo avaliar e identificar os preditores de mortalidade em pacientes admitidos em uma Unidade de Terapia Intensiva que apresentaram infecção da corrente sanguínea por P. aeruginosa resistente aos carbapenêmicos. Métodos: Trata-se de um estudo de coorte retrospectivo, aprovado pelo Comitê de Ética em Pesquisa com Seres Humanos, que incluiu 87 pacientes consecutivos internados em um hospital de referência no Brasil. As informações clínicas e demográficas de cada paciente foram obtidas através de análise dos prontuários dos pacientes. O teste T de Student foi usado para comparar variáveis contínuas e o teste x2 ou exato de Fisher para comparar variáveis categóricas. Para determinar fatores de risco independentes para mortalidade em 30 dias, foi utilizado um modelo de regressão logística múltipla. Uma curva de sobrevida foi construída pelo método de Kaplan-Meier. Resultados: Do total de pacientes, 87,3% faziam uso prévio de antibióticos, 60,9% receberam tratamento empírico inadequado e a mortalidade em 30 dias foi de 57,5%. A terapia empírica inadequada foi fator de risco independente para mortalidade. Conclusão: Esses achados revelam alguns insights sobre a relação entre maior mortalidade e terapia empírica inadequada para pacientes com ICS por P. aeruginosa. Além disso, destacam a necessidade de melhores testes diagnósticos e os programas de controle de infecção devem se concentrar na redução da terapia inadequada com antibióticos, principalmente na ICS causada por P. aeruginosa resistente a carbapenêmicos.(AU)

Justificación y objetivos: La infección del torrente sanguíneo por Pseudomonas aeruginosa multirresistente es grave. Este estudio tuvo como objetivo evaluar e identificar predictores de mortalidad en pacientes ingresados en una Unidad de Cuidados Intensivos que presentaban infección del torrente sanguíneo por P. aeruginosa resistente a carbapenémicos. Métodos: Se trata de un estudio de cohorte retrospectivo, aprobado por el Comité de Ética en Investigación con Participantes Humanos, que incluyó 87 pacientes consecutivos ingresados en un hospital de referencia en Brasil. La información clínica y demográfica de cada paciente se obtuvo mediante el análisis de las historias clínicas de los pacientes. Se utilizó la prueba t de Student para comparar variables continuas y x2 o prueba exacta de Fisher para comparar variables categóricas. Para determinar los factores de riesgo independientes para la mortalidad a los 30 días, se utilizó un modelo de regresión logística múltiple. Se construyó una curva de supervivencia utilizando el método de Kaplan-Meier. Resultados: Del total de pacientes, el 87,3% utilizaba antibióticos previamente, el 60,9% recibió tratamiento empírico inadecuado y la tasa de mortalidad a los 30 días fue del 57,5%. La terapia empírica inadecuada fue un factor de riesgo independiente de mortalidad. Conclusión: Estos hallazgos revelan algunos conocimientos sobre la relación entre el aumento de la mortalidad y la terapia empírica inadecuada para los pacientes con infección del torrente sanguíneo por P. aeruginosa. Además, destacan la necesidad de mejores pruebas de diagnóstico y los programas de control de infecciones deben centrarse en reducir la terapia con antibióticos inapropiados, particularmente en infección del torrente sanguíneo causados por P. aeruginosa resistente a carbapenémicos.(AU)

Antimicrobial activity of supernatants produced by bacteria isolated from Brazilian stingless bee's larval food.

BACKGROUND: The discovery of new molecules with antimicrobial properties has been a promising approach, mainly when related to substances produced by bacteria. The use of substances produced by bees has evidenced the antimicrobial action in different types of organisms. Thus, the use of bacteria isolated from larval food of stingless bees opens the way for the identification of the new molecules. The effect of supernatants produced by these bacteria was evaluated for their ability to inhibit the growth of bacteria of clinical interest. Furthermore, their effects were evaluated when used in synergy with antibiotics available in the pharmaceutical industry. RESULTS: A few supernatants showed an inhibitory effect against susceptible and multiresistant strains in the PIC assay and the modulation assay. Emphasizing the inhibitory effect on multidrug-resistant strains, 7 showed an effect on multidrug-resistant Escherichia coli (APEC), Klebsiella pneumoniae carbapenemase (KPC), multidrug-resistant Pseudomonas aeruginosa, and multidrug-resistant Staphylococcus aureus (MRSA) in the PIC assay. Of the supernatants analyzed, some presented synergism for more than one species of multidrug-resistant bacteria. Nine had a synergistic effect with ampicillin on E. coli (APEC) or S. aureus (MRSA), 5 with penicillin G on E. coli (APEC) or KPC, and 3 with vancomycin on KPC. CONCLUSION: In summary, the results indicate that supernatants produced from microorganisms can synthesize different classes of molecules with potent antibiotic activity against multiresistant bacteria. Thus, suggesting the use of these microorganisms for use clinical tests to isolate the molecules produced and their potential for use.

Longevity of bulk fill and ormocer composites in permanent posterior teeth: Systematic review and meta-analysis.

PURPOSE: To evaluate the clinical longevity of bulk-fill resins and ormocer composites compared to conventional nanofill and nanohybrid resins in posterior permanent teeth. METHODS: PubMed, Web of Science, Scopus, Science Direct, Cochrane Library, and Scielo were electronically searched for randomized clinical trials, without language restrictions. The extracted data were analyzed using Review Manager, comparing the clinical behavior of bulk fill or ormocer restorations with nanofill or nanohybrid resins. Statistical analysis was performed with a significance level of 5% for all analyses (P= 0.05). The risk of bias was assessed using the Cochrane assessment tool. RESULTS: 11 randomized clinical trials were included, with an average follow-up time of 40.36 months. A total of 812 restorations were evaluated and 58 failures were analyzed: 18 of the 253 bulk-fill restorations (7.11%), 21 of the 173 (12.3%) ormocer restorations, and 20 of the 386 (5.18%) control group (nanofill or nanohybrid composites) restorations failed. In the meta-analysis, there was no significant difference between the bulk-fill and the control group (statistical power = 24.38%; P= 0.206; IC = 95%); whereas, when comparing between ormocer and control group, the control group exhibited better performance (statistical power = 81.62%; P= 0.0042; IC = 95%). CLINICAL SIGNIFICANCE: Conventional nanofill and nanohybrid resins exhibited better clinical longevity than ormocer composites in posterior restorations, but when compared to bulk fill, they had similar performance.

Socioeconomic inequalities explain the association between source of drinking water and dental caries in primary dentition.

OBJECTIVE: To evaluate the association between source of drinking water and dental caries at age 5 and to test whether socioeconomic conditions act as confounding factors in such association. METHODS: The study was carried out in a sub-sample of the 2004 Pelotas Birth Cohort, which comprised the application of a questionnaire and clinical oral examination. The exposure was source of drinking water, collected through a question to the primary caregiver. The outcome was dental caries in primary dentition, measured through several standardized indicators of the decayed, missing and filled teeth index (dmft), assessing past and present dental caries. Socioeconomic indicators (family income and maternal education) were identified as potential confounding factors. After descriptive analysis, the association between source of water and measures of dental caries was assessed by Regression models. RESULTS: 1,084 children were evaluated and had complete information in all variables (83.2 % of the targeted sample). Dental caries experience was observed in 48.7 % of the children, with a mean of 1.9 decayed, missing or filled teeth. Most children consumed water from public water supply (76.0 %), and a socioeconomic pattern was observed, with children from lower income more likely to drink water from public supply. In crude analysis, children who consumed bottled water had a lower risk of decayed teeth, lower experience of dental caries and less severe disease. No associations were observed after adjustments for socioeconomic conditions. CONCLUSION: Underlying socioeconomic inequalities explained the association between prevalence and severity of dental caries in primary dentition and source of drinking water. CLINICAL SIGNIFICANCE: Drinking fluoridated tap water is as effective in dental caries prevention as bottled water with acceptable levels of fluoride, with the advantage of being accessible to all. Oral health prevention and treatment should be implemented as early in life as possible and should take into consideration the family's socioeconomic context.

Resistência de união de pinos de fibra de vidro utilizando diferentes tratamentos radiculares / Resistencia a la unión de postes de fibra de vidrio utilizando diferentes tratamientos endodónticos / Bond strength of glass fiber posts using different endodontic treatments

Resumo Introdução: Os pinos de fibra de vidro têm sido amplamente utilizados na reconstrução de elementos com perda excessiva de estrutura dentária. Objetivo: Avaliar a força de adesão de pinos de fibra de vidro após diferentes tratamentos radiculares em diferentes regiões (terço cervical, médio e apical) da dentina radicular. Métodos: Este é um estudo experimental in vitro. Quarenta dentes bovinos foram selecionados, preparados e distribuídos em quatro grupos de acordo com o tratamento de superfície utilizado: adesivo (1), agente quelante (2), ácido poliacrílico (3), não tratado (4). A cimentação dos pinos de fibra de vidro foi realizada com cimento resinosante autocondicionante. Após vinte dias, cada raiz foi cortada em três fatias (um milímetro de espessura) obtidas de três regiões. A resistência de união de cada seção foi determinada usando um teste de resistência da junta de encaixe. Os dados de resistência à flexão (MPa) foram analisados pelos testes ANOVA e Tukey (α = 0,05). Resultados: Na porção cervical, o grupo com tratamento prévio com ácido poliacrílico apresentou menor resistência ao cisalhamento por extrusão (push-out) do que o grupo sem tratamento prévio. O grupo com aplicação do sistema adesivo (28,89 ± 6,64 MPa) e o grupo com tratamento prévio com EDTA (21,58 ± 6,39 MPa) não apresentaram diferenças estatisticamente significantes em relação ao grupo sem tratamento prévio (grupo controle) no terço cervical. Nas porções média e apical, o grupo tratado com adesivo FGM Ambar apresentou maiores valores de ligação em comparação com os outros grupos. Conclusão: A aplicação prévia do adesivo aumentou a resistência de união nos terços médio e apical, em comparação aos outros grupos, podendo ter um efeito benéfico no sucesso clínico do tratamento restaurador(AU)

Resumen Introducción: Los postes de fibra de vidrio se han utilizado ampliamente en la reconstrucción de elementos con pérdida excesiva de estructura dental. Objetivo: Evaluar la fuerza de adhesión de postes de fibra de vidrio después de distintos tratamientos de raíz en diferentes regiones (tercios cervical, medio y apical) de dentina de raíz. Métodos: Estudio experimental in vitro. Se seleccionaron cuarenta dientes bovinos, se prepararon y se distribuyeron en cuatro grupos de acuerdo con el tratamiento de superficie utilizado: (1) adhesivo, (2) agente quelante, (3) ácido poliacrílico, (4) sin tratar. La cementación de los postes de fibra de vidrio se realizó con cemento de resina autograbante. Después de 20 días, cada raíz se seccionó transversalmente en tres rodajas (1 mm de espesor) obtenidas de tres regiones. La resistencia a la unión de cada sección se determinó usando una prueba de resistencia al corte por extrusión (push-out). Los datos de resistencia a la flexión (MPa) se analizaron mediante pruebas ANOVA y Tukey (α = 0,05). Resultados: En la porción cervical, el grupo con tratamiento previo de ácido poliacrílico mostró menor resistencia que el grupo sin tratamiento previo. El grupo con aplicación del sistema adhesivo (28,89 ± 6,64 MPa) y el grupo con tratamiento previo de EDTA (21,58 ± 6,39 MPa) no presentaron diferencias estadísticamente significativas en comparación con el grupo sin tratamiento previo (grupo control) en el tercio cervical. En las porciones media y apical, el grupo tratado con adhesivo Ambar® de FGM Dental Group mostró valores más altos de unión en comparación con los otros grupos. Conclusión: La aplicación previa del adhesivo aumentó la fuerza de unión en los tercios medio y apical, en comparación con los otros grupos, puede tener un efecto beneficioso sobre el éxito clínico del tratamiento restaurador(AU)

ABSTRACT Introduction: Glass fiber posts have been widely used for the reconstruction of elements with excessive dental structure loss. Objective: Evaluate the bond strength of glass fiber posts after various root dentin treatments in different regions (cervical, middle and apical thirds). Methods: An experimental in vitro study was conducted. Forty bovine teeth were selected, prepared and distributed into four groups according to the surface treatment used: (1) adhesive, (2) chelating agent, (3) polyacrylic acid, (4) not treated. The glass fiber posts were cemented with self-etch resin cement. After 20 days, each root was sectioned crosswise into three slices (1 mm in thickness) obtained from three regions. Bond strength was determined in each section with a push-out bond strength test. Flexural strength data (MPa) were analyzed with ANOVA and Tukey's tests. Results: In the cervical portion, the group with previous polyacrylic acid treatment displayed lower push-out strength than the group without previous treatment. The group with application of the adhesive system (28.89 ± 6.64 MPa) and the group with previous EDTA treatment (21.58 ± 6.39 MPa) did not exhibit any statistically significant differences in comparison with the group without previous treatment (control group) in the cervical third. In the middle and apical portions, the group treated with the adhesive Ambar® of FGM Dental Group showed higher bond values in comparison with the other groups. Conclusion: Previous adhesive application increased bond strength in the middle and apical thirds in comparison with the other groups, and may thus have a beneficial effect on the clinical success of the restorative treatment(AU)

Expression of a recombinant bacterial L-asparaginase in human cells.

OBJECTIVE: L-Asparaginase (ASNase) is an enzyme used in the treatment of acute lymphoblastic leukemia (ALL). As the therapeutic ASNases has bacterial origin, severe side effects are associated with its use, among them hypersensitivity and inactivation of the enzyme. In this context, the objective of this work was to produce a recombinant ASNase of bacterial origin in human cells in order to determine the presence and consequences of potential post-translational modifications on the enzyme. RESULTS: Recombinant ASNase was expressed in human cells with a molecular weight of 60 kDa, larger than in Escherichia coli, which is 35 kDa. N-glycosylation analysis demonstrated that the increased molecular weight resulted from the addition of glycans to the protein by mammalian cells. The glycosylated ASNase presented in vitro activity at physiological pH and temperature. Given that glycosylation can act to reduce antigenicity by masking protein epitopes, our data may contribute to the development of an alternative ASNase in the treatment of ALL in patients who demonstrate side effects to currently marketed enzymes.

Acuracy and concordance of anthropometric indicators and body composition in heart failure / Precisão e concordância de indicadores antropométricos e composição corporal na insuficiência cardíaca

Background: Anabolic/catabolic disorder in heart failure (HF) favors cardiac cachexia, implying a reduction in HF survival. Objectives: To assess the accuracy and concordance of the diagnosis of protein malnutrition and excess fat among the anthropometric and body composition methods in individuals with HF. Method: A study of accuracy that included 60 individuals with HF. Body mass index (BMI), arm circumference (AC), triceps skinfold thickness (TST), adductor pollicis muscle thickness (APMT), arm muscle circumference (AMC) and corrected arm muscle area (cAMA). Fat free mass index (FFMI) and body fat percentage (BF%), obtained by electrical bioimpedance (EBI), were used to compare the diagnosis of protein malnutrition and excess fat. Accuracy was assessed by calculating sensitivity, specificity, positive and negative predictive value. The concordance of the EBI diagnosis and other methods was performed by the chi-square test and kappa (k) statistic, where p<0.05 was considered significant.Results: Higher frequencies of protein malnutrition were identified by cAMA and AMC, and excess fat by BF%. BMI presented low sensitivity (43%) and accuracy (38.5%), with moderate concordance (0.50). AMC sensitivity was 86%, accuracy 66.4%, and acceptable concordance (0.36) compared to FFMI. Similar percentages of moderate sensitivity and low accuracy were observed for TST and BMI.Conclusion: AMC may be useful to identify protein malnutrition and TST has not been adequate to diagnose adiposity. BMI was not sensitive to assess muscle and adipose reserve. EBI was more accurate

Effect of temperature and storage time on dental bleaching effectiveness.

OBJECTIVE: To evaluate the effect of storage time and temperature on the effectiveness of bleaching agents. METHODS: Enamel slabs were randomly allocated according to the concentration of carbamide peroxide (CP): 10% (CP10) and 16% (CP16). Shade evaluations were conducted at baseline and then after 3 and 12 months of storage at 3 different temperatures: 10°C (±2°C), 25°C (±2°C), and 35°C (±2°C). Objective color evaluation was performed (spectrophotometer CIEL*a*b* system and CIEDE2000) to calculate the color change (ΔE00 ). Subjective evaluation was performed using the VITA classical shade guide followed by shade variation (ΔS). RESULTS: The bleaching effect of different CP concentrations (10% and 16%) at baseline showed no differences with regard to objective (ΔE00 ) and subjective parameters (ΔS) (P > .05). No differences were observed between CP concentrations stored for the same length of time and at the same temperature for either parameter (P > .05). In terms of objective measurement (ΔE00 ), a reduction in the bleaching effect was shown for both CP concentrations (10% and 16%) when stored for 12 months at 35°C, and compared with the baseline (P < .05). As regards the subjective parameters (ΔS), after 12 months, both CP concentrations (10% and 16%) stored at 35°C showed a decrease in bleaching capacity compared to baseline (P < .05). CP10 and CP16 stored at 10°C and 25°C did not suffer any loss in bleaching ability, even after 12 months (P > .05). CONCLUSIONS: The storage of bleaching agents for long periods at high temperatures can reduce the bleaching effectiveness of CP at 10% and 16%. CLINICAL SIGNIFICANCE: Clinicians must be made aware that they should store their bleaching products under proper temperature conditions and use them within an appropriate time frame; otherwise, the bleaching effect could be lost.

Impact of radiotherapy on the bond strength of different adhesive systems to human dentin: one-year in vitro evaluation

Aim: The aim of this study is to evaluate the effect of radiotherapy on the bond strength of resin-based composite restorations to dentin, performed either 24 h or 1 year before or after radiation. Methods: Ninety-six posterior teeth were randomly distributed into the following groups: IB (n = 16), irradiated teeth were restored 1 year after x-ray application; NB (n = 16), not irradiated teeth were stored for 1 year and then restored. IA (n = 32), teeth were restored and irradiated at 24 h or 1 year after the restoration. NA (n = 32), teeth were restored, not irradiated, and tested as IA. Eight samples from each group were randomly assigned to either the three-step or two-step etch-and rinse adhesive system procedure. The irradiated specimens were subjected to 60 Gy of x-ray radiation fractionally. The restored teeth were vertically sectioned, and 1-mm2 resin­dentin sticks were obtained and submitted to the microtensile bond strength test. The bond strength data were analyzed by two-way analysis of variance (ANOVA) followed by Tukey's test (p < 0.05). Failure modes were examined by optical microscopy and scanning electron microscopy. Results: The IB group showed lower bond strength values compared to the NB group. The bond strength values between the adhesive systems were not statistically different. Conclusion: The application of radiation dose decreased the bond strength of the adhesive restorations to dentin when the bonding procedure was conducted 1 year after in vitro radiotherapy

Telecuidado para idosos com alzheimer e seus cuidadores: revisão sistemática / Telecuidado a los ancianos con alzheimer y sus cuidadores: revisión sistemática / Telecare to elderly people with alzheimer and their caregivers: systematic review

RESUMO Analisar a literatura sobre o uso do telecuidado como Intervenção de Enfermagem na assistência ao idoso com Alzheimer e seus cuidadores. Trata-se de revisão sistemática da literatura nas bases LILACS, PubMed, CINAHL e Elsevier, baseada na proposta PRISMA. Os critérios de inclusão foram: artigos que abordassem diretamente ações de telecuidado por enfermeiros; estudos de coorte e ensaios clínicos randomizados com sigilo de alocação; artigos indexados; publicados nos idiomas português, inglês e espanhol; recorte temporal de 2007 a 2017. Foram encontrados dois artigos sobre telecuidado como Intervenção de Enfermagem no suporte e apoio aos cuidadores familiares de idosos com demência. O uso do acompanhamento por telefone foi realizado associado a outra tecnologia assistida. O acompanhamento por telefone foi associado ao uso de câmeras, e os próprios cuidadores realizavam as filmagens da rotina; ainda foram realizadas teleconferências em chamadas de vídeo entre cuidadores e profissionais. O telecuidado pode ser considerado uma prática avançada da enfermeira e alternativa acessível na assistência aos idosos com Alzheimer e seus cuidadores.

RESUMEN Analizar la literatura sobre el uso del telecuidado como intervención de enfermería en el cuidado al anciano con Alzheimer y sus cuidadores e identificar en la literatura las principales tecnologías asistidas y los instrumentos de evaluación en el cuidado al anciano con Alzheimer y sus cuidadores. Se trata de una revisión sistemática de la literatura en las bases Lilacs, PubMed, Cinahl y Elsevier, basado en la propuesta PRISMA. Los criterios de inclusión fueron: artículos que tratasen directamente de acciones de telecuidado por enfermeros; estudios de cohorte y ensayos clínicos randomizados con sigilo de asignación; artículos indexados; publicados en los idiomas portugués, inglés y español; recorte temporal de 2007 a 2017. Fueron encontrados dos artículos sobre el uso del telecuidado como intervención de enfermería en la atención y el apoyo a los cuidadores familiares de ancianos con demencia. El uso del acompañamiento por teléfono fue realizado junto a otra tecnología asistida. En un estudio el acompañamiento por teléfono fue asociado al uso de cámaras, donde los propios cuidadores realizaban las filmaciones de la rutina de cuidados, y en el otro estudio fueron realizadas teleconferencias en video llamadas entre cuidadores y profesionales. Se concluye que el telecuidado puede ser considerado una práctica avanzada de la enfermera y una alternativa accesible en el cuidado a los ancianos con Alzheimer y sus cuidadores.

ABSTRACT This research aims to analyze the literature on the use of telecare as a nursing intervention in the care of the elderly with Alzheimer's and their caregivers and also to identify in the literature the main assisted technologies and the instruments of evaluation in the care of the elderly people with Alzheimer's and their caregivers. It is a systematic review of the literature on the bases Lilacs, PubMed, Cinahl and Elsevier, based on the PRISMA proposal. The inclusion criteria were: articles that directly addressed actions of telecare by nurses; cohort studies and randomized controlled trials with allocation confidentiality; indexed articles; published in Portuguese, English and Spanish; temporal cut from 2007 to 2017. Two articles on the use of telecare as the nursing intervention in the support to family caregivers of elderly people with dementia were found. The use of telephone monitoring was performed with other assisted technology. In one study, telephone follow-up was associated with the use of cameras, where the caregivers filmed the care routine, and in the other study teleconferences were performed on video calls between caregivers and professionals. It can be concluded that telecare can be considered an advanced practice of the nurse and an accessible alternative in the care of elderly people with Alzheimer's and their caregivers.

The Use of a Hybrid Pillar and Its Importance for Aesthetic Rehabilitation and Tissue Stability: A Clinical Report.

In the past, aesthetics had a secondary role in implant rehabilitation. Nowadays, the search for a perfect and harmonious aesthetic has stimulated the development of new materials and techniques. Due to this aesthetic requirement, the hybrid abutment (titanium link + zirconia) emerged as an alternative to metallic pillars. The hybrid abutment made a more favorable aesthetic possible, provided reliable mechanical properties, and increased biocompatibility to the surrounding tissues. Additionally, the individual zirconia abutment improves the emergency profile and the final white aesthetics. The objective of this paper is to report a clinical case with a manufactured individualized hybrid abutment for a metal-free indirect restoration, showing the applicability, mechanical properties, and biocompatibility of the hybrid abutment.

Carbapenem-resistant Pseudomonas aeruginosa: association with virulence genes and biofilm formation

Abstract Pseudomonas aeruginosa is an opportunistic pathogen that causes frequently nosocomial infections, currently becoming more difficult to treat due to the various resistance mechanisms and different virulence factors. The purpose of this study was to determine the risk factors independently associated with the development of bacteremia by carbapenem-resistant P. aeruginosa, the frequency of virulence genes in metallo-β-lactamases producers and to evaluate their ability to produce biofilm. We conducted a case–control study in the Uberlândia Federal University – Hospital Clinic, Brazil. Polymerase Chain Reaction was performed for metallo-β-lactamases and virulence genes. Adhesion and biofilm assays were done by quantitative tests. Among the 157 strains analyzed, 73.9% were multidrug-resistant, 43.9% were resistant to carbapenems, 16.1% were phenotypically positive for metallo-β-lactamases, and of these, 10.7% were positive for blaSPM gene and 5.3% positive for blaVIM. The multivariable analysis showed that mechanical ventilation, enteral/nasogastric tubes, primary bacteremia with unknown focus, and inappropriate therapy were independent risk factors associated with bacteremia. All tested strains were characterized as strongly biofilm producers. A higher mortality was found among patients with bacteremia by carbapenem-resistant P. aeruginosa strains, associated independently with extrinsic risk factors, however it was not evident the association with the presence of virulence and metallo-β-lactamases genes.

Molecular epidemiological survey of bacteremia by multidrug resistant Pseudomonas aeruginosa: the relevance of intrinsic resistance mechanisms.

The bacterial factors associated with bacteremia by multidrug-resistant and extensively drug-resistant P. aeruginosa, including overexpression of efflux pumps, AmpC overproduction, and loss/alteration of the OprD porin in isolates that are non-Metallo-ß-Lactamase producing were analyzed in a retrospective study. Molecular analyses included strain typing by Pulsed Field Gel Electrophoresis and identification of key genes via qualitative and quantitative PCR-based assays. Previous use of carbapenems and tracheostomy was independently associated with the development of bacteremia by extensively drug-resistant and multidrug-resistant strains of P. aeruginosa. A high consumption of antimicrobials was observed, and 75.0% of the isolates contained amplicons with the blaSPM-1 and blaVIM genes. Of the 47 non-Metallo-ß-Lactamase isolates, none had another type of carbapenemase. However, the isolates exhibited high rates of hyperproduction of AmpC, loss of the OprD porin (71.4%) and the presence of MexABOprM (57.1%) and MexXY (64.3%). This study suggests that in non-Metallo-ß-Lactamase isolates, the association of intrinsic resistance mechanisms could contributes to the expression of multidrug-resistant/extensively drug-resistant phenotypes.

Caracterização das lesões crônicas nos idosos atendidos na estratégia de saúde da família / Characterization of chronic injuries in the elderly assisted in the family health strategy

Objetivo: conhecer a realidade das lesões crônicas nos idosos atendidos na Estratégia de Saúde da Família (ESF). Método: estudo exploratório, descritivo, com abordagem quantitativa. Participaram 20 idosos, comida de entre os 60 aos 99 anos, a maioria do sexo feminino, acometidos por lesões crônicas, referenciados pelas ESF. Resultados: as lesões são do tipo úlceras por pressão, varicosa, diabética, arterial e ferida neoplásica, todas advindas de doenças crônicas não transmissíveis, onde todos os idosos faziam troca do curativo em domicílio pela equipe de enfermagem ou por cuidadores familiares. Observou-se que a técnica utilizada se distanciava da asséptica e as substâncias eram inadequadas ao tratamento específico de algumas lesões. Conclusão: diante da assistência revelada aos idosos com lesões crônicas, observamos a necessidade de implantar um protocolo de atendimento que orientasse o autocuidado.