Impact of the immunotherapy induction on allograft outcome and survival in kidney transplant patients with donor-specific antibodies to HLA-DQB1.

BACKGROUND: The presence of donor-specific antibodies (DSAs) against HLA-DQB1 is considered a significant barrier to good outcome and allograft survival in kidney transplantation (KT). This study aimed to assess the impact of induction immunotherapy on the outcome and allograft survival in KT patients with HLA-DQB1-DSA. METHODOLOGY: Thirty-two patients who had undergone KT and found to be positive for HLA-DQB1-DSA were monitored at least one to 10 years. They were allocated into two groups of patients: G1 received induction immunotherapy (n = 14 patients; 43.75%), and G2 did not (n = 18 patients; 56.25%). RESULTS: In G1, 6 (42.86%) patients experienced rejection episodes (RE), 2 (14.29%) due to antibody-mediated rejection (ABMR) and 4 (28.57%) due to T-cell-mediated rejection (TCMR). In G2, 13 (72.22%) patients experienced RE, 3 (16.67%) due to ABMR, and 10 (55.56%) due to TCMR. Graft loss occurred in 4 patients from G1, 2 (14.29%) due to ABMR and 2 (14.29%) due to non-immunological causes. In G2, 9 (50.00%) patients lost their grafts, 2 (11.11%) due to TCMR, 2 (11.11%) due to ABMR, and 5 (27.78%) due to non-immunological causes. The graft survival rate was 64.29% in G1 and 45.83% in G2. Glomerulitis and peritubular capillaritis were observed in 3 and C4d-positive patients with/or without induction who lost their grafts by ABMR by HLA-DQ DSA. Two patients from G2 lost their graft by TCMR due to interstitial lymphocytic infiltrate (i1), foci of mild tubulitis (t2), interstitial edema, moderate interstitial fibrosis and tubular atrophy. Better graft survival rates were shown in patients from G1 who received induction immunotherapy. CONCLUSION: Our study suggests that patients with an immunological profile of HLA-DQ+ DSA+ treated by immunotherapy induction have a decreased risk of ABMR and increased allograft survival, and the presence of anti-HLA-DQB1 DSA+ detected before and after KT were associated with ABMR episodes and failure.

A new record of Tayassuidae (Mammalia: Cetartiodactyla) from the Pleistocene of northern Brazil.

In this contribution, we described a new fossil of a Pleistocene Tayassuidae from northern Brazil. The specimen is a left dentary with molars assigned to cf. Pecari tajacu recovered from an outcrop of the Rio Madeira Formation, State of Rondônia, Brazil. It represents the first Pleistocene fossil of this clade with stratigraphic provenance in the Amazon region of Brazil. This record contributes to the knowledge on the paleofauna of Rio Madeira Formation as well as extend the past geographic distribution of peccaries in South America.

Unraveling the nomenclatural puzzle of the collared and white-lipped peccaries (Mammalia, Cetartiodactyla, Tayassuidae).

The nomenclatural history of the collared and white-lipped peccaries, two well-recognized taxonomic entities, has been confusing. From the 18th century to the beginning of the 20th century, several genera were created, most of them without an explicit designation of type species. Due to differing opinions as to whether the two species should be included in a single genus or, if separate genera were recognized, which generic name should be applied to each of the two taxa, the validity of generic and specific names oscillated until even recently. This paper aims to solve these nomenclatural issues by reviewing the different taxonomic arrangements of these two peccaries and applying appropriately the International Code on Zoological Nomenclature. We contend that the valid generic name for the white-lipped peccary is Tayassu Fischer, 1814 (type Sus pecari Link, 1795), while Dicotyles Cuvier, 1816 (type Dicotyles torquatus Cuvier, 1816) is the valid genus for the collared peccary, with Pecari Reichenbach, 1835 as its junior synonym.

Effects of immunotherapy induction on outcome and graft survival of kidney-transplanted patients with different immunological risk of rejection.

BACKGROUND: In kidney transplantation, immunotherapy with thymoglobulin (rATG) has been used to down-regulate the patient immune system. rATG is a powerful immunobiologic drug used to deplete lymphocytes to prevent early acute rejection. The aim of this research was to evaluate the effects of immunotherapy by rATG on graft suvival during a 9-year period in kidney-transplanted patients with different immunological profiles. METHODS: A sample of 469 patients were allocated into four groups (G) based on immunological risk of rejection: G1, low risk, not sensitized recipients, solid-phase immunoassay with single antigen beads (SPI-SAB) < 10%; G2, medium risk I, sensitized recipients, SPI-SAB ≥ 10 < 50%; G3, medium risk II sensitized (SPI-SAB ≥50%); and G4, high risk, sensitized recipients, SPI-SAB- donor-specific antibody positive (DSA+). Only patients from G3 and G4 received immunotherapy. RESULTS: Of 255 patients who received a kidney from a living donor (LD), 42 (16.47%) from all groups (G) had T-cell-mediated rejection (TCMR) and four (G1) lost their grafts, 8 (3.14%) had antibody-mediated rejection (AMR), and two lost their graft in G1 and G4. Of 214 patients who received a kidney from deceased donors (DD), 37 (17.29%) had TCMR with one lost graft in G1. AMR was shown in 13 (6.07%) patients, with three losses observed in G2. Statistical differences between the groups in the 9-year graft survival rate were found only in the comparison of G1 versus G2 (P = 0.005) and G2 versus G4 (P = 0.047) for DD. For LD, no statistical differences were found. CONCLUSION: This clinical retrospective study shows that immunotherapy induction was associated with improvement of outcomes, graft function, and survival in patients treated with immunotherapy in comparison with patients who did not received induction therapy. These findings strongly suggest that immunotherapy should be used for all patients transplanted with kidneys from deceased donors.

Bioaccessibility and antioxidant activity of phenolic compounds in frozen pulps of Brazilian exotic fruits exposed to simulated gastrointestinal conditions.

This study characterized the phenolic profile in siriguela, umbu-cajá and mangaba, as well in their frozen pulps (FPs). The bioaccessibility of phenolic compounds and the antioxidant activity of the FP dialysates were determined following exposure to simulated gastrointestinal conditions. The profile of phenolic compounds identified in fruit and FPs were relatively similar. After pulp processing, increases of 33.60% and 68.72% in free phenolics were observed for mangaba and umbu-cajá, respectively, whereas in siriguela, the free phenolic was reduced by 56.55%. Generally, phenolic levels decreased after exposure to simulated gastric conditions in all FPs. The bioaccessibility of phenolics varied among the evaluated FPs. The highest bioaccessibility was observed for gallic acid in the umbu-cajá FP (73.92%) and the lowest for gentisic acid in the mangaba FP (8.71%). Siriguela and umbu-cajá FP dialysates presented the highest capacity for the capture of the radical 2,2'-diphenyl-2-picrylhydrazyl hydrate, whereas the mangaba FP dialysate demonstrated the highest iron reducing capacity.

Late Pleistocene echimyid rodents (Rodentia, Hystricognathi) from northern Brazil.

Echimyidae (spiny rats, tree rats and the coypu) is the most diverse family of extant South American hystricognath rodents (caviomorphs). Today, they live in tropical forests (Amazonian, coastal and Andean forests), occasionally in more open xeric habitats in the Cerrado and Caatinga of northern South America, and open areas across the southern portion of the continent (Myocastor). The Quaternary fossil record of this family remains poorly studied. Here, we describe the fossil echimyids found in karst deposits from southern Tocantins, northern Brazil. The analyzed specimens are assigned to Thrichomys sp., Makalata cf. didelphoides and Proechimys sp. This is the first time that a fossil of Makalata is reported. The Pleistocene record of echimyids from this area is represented by fragmentary remains, which hinders their determination at specific levels. The data reported here contributes to the understanding of the ancient diversity of rodents of this region, evidenced until now in other groups, such as the artiodactyls, cingulates, carnivores, marsupials, and squamate reptiles.

Bone Volume Changes After Sinus Floor Augmentation with Heterogenous Graft.

PURPOSE: The aim of this study was to evaluate the volumetric stability of deproteinized bovine bone after sinus augmentation, using cone beam computed tomography (CBCT) and three-dimensional (3D) analysis. MATERIALS AND METHODS: Using a specific selection tool and 3D reconstruction from InVesalius 3.0, volumetric analysis of CBCT scans was performed in patients undergoing a sinus elevation technique in critical defects, using deproteinized bovine bone. The first scan was performed immediately after graft surgery (T1), and the second was performed 8 months after graft surgery (T2). RESULTS: A total of 13 patients met the inclusion criteria of this retrospective study; 26 postoperative CBCT scans were analyzed for these patients. All patients exhibited an increase in bone volume (9.10%). The mean bone volume increase from T1 to T2 was 0.137 cm(3) (SD: ± 0.104 cm(3)). There was a statistically significant correlation between bone volume and time (P < .0001). The mean bone volume was 1.506 cm(3) (SD: ± 0.473 cm(3)) for T1 and 1.644 cm(3) (SD: ± 0.506 cm(3)) for T2. CONCLUSION: Within the limited sample, the study demonstrated an increase in graft volume after sinus elevation with deproteinized bovine bone in critical defects.

Peri-implantite (Parte I): etiologia, características e diagnóstico / Peri-implantitis: causes, characteristics and diagnosis

A peri-implantite é uma infecção dos tecidos ao redor do implante que resulta na perda do osso de suporte. Alguns fatores locais e sistêmicos influenciam na evolução desta doença e seu tratamento pode ser cirúrgico ou não. O objetivo desta revisão bibliográfica foi orientar os profissionais a diagnosticar as doenças peri-implantares, conhecer suas características e avaliar os fatores de risco. O estudo bibliográfico foi realizado utilizando os bancos de dados Medline e Ebsco, no qual o período de referência foi entre 1992 e 2013. A pesquisa foi limitada a artigos completos publicados no idioma inglês. Todos os níveis de evidência foram incluídos, tais como relato de caso, experimentos em animais, revisões bibliográficas e estudos estatísticos com humanos. De acordo com a revisão bibliográfica o principal agente etiológico das doenças peri- implantares ainda é a placa bacteriana, no entanto, fatores de risco sistêmicos e locais influenciam no seu desenvolvimento. Os principais microrganismos presentes nas infecções peri-implantares são os mesmos encontrados na periodontite, ou seja, bactérias gram e anaeróbios. Contudo, nenhuma definição evidente da microbiota associada com a peri-implantite foi estabelecida até o momento, dificultando um diagnóstico mais preciso e a determinação do protocolo de tratamento. O tratamento não cirúrgico isoladamente não apresentou resultados satisfatórios, no entanto, quando combinado com antibiótico oral ou antisséptico reduziu a infecção peri-implantar. O tratamento cirúrgico permite o debridamento exato da área contaminada peri-implantar do implante, o que resulta em ganho de inserção clínica e reconstrução óssea. Até a presente data, nenhum protocolo de tratamento padrão foi definido para peri-implantite.

Peri-implantitis is an infection of the tissues around the dental implant resulting in loss of supporting bone. Many local and systemic factors influence the development of the disease and its treatment can be surgical or non-surgical. The purpose of this literature review is to guide professionals to diagnose peri-implant diseases, knowing their characteristics, assess to risk factors and choosing appropriate treatments for each situation. The literature search was performed using Medline and Ebsco database and the period between 1992 and 2013. The search was limited to full-text articles published in English. All levels of evidence were included such as case report, animal experiments, literature reviews and statistical studies with humans. According to literature review the main etiological agent of peri-implant diseases still is the plaque, however, systemic and local risk factors influence its development. The main present microorganisms in the periimplant infection are the same found in periodontitis such as Gram- and anaerobic bacteria. However, no clear definition of the microbiota associated with the peri-implantitis has been established yet, making a more accurate diagnosis and determination of the treatment protocol. The non-surgical treatment alone did not show satisfactory results, however, when combined with oral antibiotic or antiseptic reduces peri-implant infection. Surgical treatment allows accurate debridement of the peri-implant area, decontamination of the implant surface and results in gain of clinical attachment and bone reconstruction. To date, no standard treatment protocol of peri-implantitis.

Rinoplastia endonasal: um estudo do grau de satisfação dos pacientes em cinco anos / Endonasal rhinoplasty: a study of patient satisfaction in five years

Introdução: Muito tem sido discutido a respeito das várias técnicas e vias de acesso em rinoplastia. Todas as técnicas buscam um resultado previsível e reprodutível, associado à melhora estética e funcional do nariz. Nesse trabalho, foi avaliado o nível de satisfação dos pacientes submetidos à rinoplastia nos últimos cinco anos: rinoplastia reducional por via endonasal associada ou não a rinodinâmica. Método: Por meio de um estudo retrospectivo foram identificados 201 pacientes submetidos à rinoplastia endonasal entre 2005 e 2010. Todos os procedimentos foram realizados com a mesma rotina cirúrgica, conforme indicação. Os pacientes foram avaliados de maneira objetiva quanto à cirurgia realizada e, de maneira subjetiva, a respeito de sua função respiratória anterior e posterior à intervenção cirúrgica e o grau de satisfação quanto à estética nasal por meio de um questionário. Resultados: A idade dos pacientes variou de 14 a 68 anos; com predominância da raça branca (96,75%). Referiram melhora no padrão respiratório após a cirurgia, 83,87% dos pacientes estudados.Em relação à estética nasal, 30 (32,26%) pacientes tiveram suas expectativas superadas, 42(45,16%) consideraram muito boa, 18 (19,36%), como boa e três (3,22%), como abaixo do esperado. Conclusão: O procedimento resultou em melhora da função respiratória em quase 90% dos pacientes, além disso, o alto grau de satisfação com a estética exposto pelos pacientes permite concluir que rinoplastia endonasal tem apresentado ótimos resultados até o momento.

Background: Much has been discussed about the various techniques and access routes in rhinoplasty. All seek a predictable and reproducible associated with improved aesthetic and functional nose. This study evaluated the level of satisfaction of patients under going rhinoplastyin the past five years: by endonasal reductional rhinoplasty associated or not to rhinodynamic. Methods: Through a retrospective study identified 201 patients who under went endonasal rhinoplasty the period between 2005 and 2010. All procedures were performed with the same routine as surgical indication. Were evaluated in an objective manner about the surgery and subjectively about their lung function before and after surgery and the degree of satisfaction with the nasal aesthetics through a questionnaire. Results: The age ranged between 14 and 68 years of age; predominant among Caucasians (96.75%). 83.87% of the patients changed their minds after surgery, indicating improvement in breathing pattern. Regarding the nasal aesthetic, 30 (32.26%) patients had exceeded their expectations, 42(45.16%) felt very good, 18 (19.36%) looked as good and three (3.22%) evaluated with lower than expected. Conclusion: The high degree of satisfaction with the aesthetics espoused by patients as well as lead to an improvement of respiratory function in 90% notest hat the procedure performed has great result so far.

Mamaplastia redutora com implante de silicone / Using prosthesis in breast reduction

A cirurgia plástica da mama é uma das mais realizadas no mundo. Em alguns casos de hipertrofia mamária, observa-se um grande excesso de pele e flacidez. O resultado estético da mamoplastia redutora é insatisfatório na maioria dos pacientes, ocasionando o retorno precoce destas pacientes, solicitando a colocação de implante mamário para a complementação do seu resultado. A observação de bons resultados, a satisfação das pacientes e a diminuição de casos complementares à mamaplastia redutora confirmam a necessidade de se realizar a mamoplastia redutora com colocação de implante mamário, num mesmo tempo cirúrgico, em casos selecionados.

Plastic surgery of the breast is one of the most popular in the world. These patients had breast enlargement, with large excess of loose skin. In such cases, the aesthetic result of breast reduction is unsatisfactory in most patients. It is reflected in the early return of these patients requesting the placement of breast implants. Based on, patient satisfaction, fewer cases of reduction mammoplasty revision, suggests the need to perform breast reduction with breast implant surgery, at the same time, in many selected cases.

Effect of hydrogen peroxide topical application on the enamel and composite resin surfaces and interface.

OBJECTIVES: The objective of the present study was to analyze the superficial roughness and the interface between enamel and composite resin restorations after dental bleaching procedure. MATERIALS AND METHODS: Black's class V cavities were made and restored with composite resin, and the whole set, enamel-restorative material, was treated with 35% hydrogen peroxide. Seven procedures of 30 min each were performed. A profilometric assessment was carried out before and after the treatment of each sample, and roughness scores were obtained. Treated and untreated samples were analyzed under scanning electronic microscope and images of their surface were obtained. RESULTS AND CONCLUSION: The treatment with 35% hydrogen peroxide caused no alteration in the interface between enamel and composite resin, Tetric Ceram, fillings and the topical application of 35% hydrogen peroxide on enamel and composite resin, Tetric Ceram, caused an alteration of their surface topography, featuring a predominance of depressions after the bleaching treatment.

Influência do sistema adesivo na microinfiltração em restaurações de compômeros em dentes decíduos / Influence of adhesive system on microleakage of compomer restorations in primary teeth

O objetivo deste estudo in vitro foi comparar a microinfiltração em restaurações classe V de dentes decíduos restaurados com compômero (Dyract AP/Dentsply), após a utilização de diferentes sistemas adesivos: Prime & Bond 2.1 (Dentsply) e Prompt L-Pop (ESPE). Foram selecionados vinte dentes decíduos anteriores que, após a confecção dos preparos cavitários, foram divididos em dois grupos: G1 (n=10), aplicação do Prime & Bond 2.1; G2 (n=10), aplicação do Prompt L-Pop. Todas as amostras foram restauradas com o Dyract AP, seguindo-se as recomendações do fabricante. A seguir foram termocicladas (500 ciclos - 5°C e 55°C - 30 segundo em cada banho) impermeabilizadas e imersas em azul de metileno a 0,5 por cento por 4 horas. Foram seccionadas e avaliadas quanto à microinfiltração através de escores. Os resultados demonstraram que as amostras do G1 apresentaram valores menores de microinfiltração. A análise estatística (teste de Mann-Whitney, p=0,002) indicou que a diferença foi significante. Concluiu-se que o uso do Prime & Bond 2.1 propiciou um melhor vedamento da interface dente-restauração

Effects of a 10% carbamide peroxide bleaching agent on rat oral epithelium proliferation.

The purpose of the present study was to evaluate the influence of short course topical application of carbamide peroxide on proliferating cell nuclear antigen (PCNA) immunohistochemical expression in the oral tongue mucosa of rats. Twelve male Wistar rats were submitted to topical application of 10% carbamide peroxide on one side of the dorsal tongue once a week for three consecutive weeks. Only distilled water was applied on the control side. The animals were killed on days 0, 10, and 20 after the last application. The tongue was fixed in buffered formalin for 24 h and embedded in paraffin. Tissue blocks (3 microns) were subjected to the biotin-streptavidin amplified system for identification of PCNA. The percentage of epithelial-positive basal cells in each side of the tongue mucosa was calculated. The results demonstrated that topical application of 10% carbamide peroxide increases PCNA immunohistochemical expression on the basal layer of the oral mucosa epithelium of rats on day 0 after treatment. In conclusion, short-course use of carbamide peroxide induces transient epithelial cell proliferation of the oral mucosa of rats.

Effects of a 10 percent carbamide peroxide bleaching agent on rat oral epithelium proliferation

The purpose of the present study was to evaluate the influence of short course topical application of carbamide peroxide on proliferating cell nuclear antigen (PCNA) immunohistochemical expression in the oral tongue mucosa of rats. Twelve male Wistar rats were submitted to topical application of 10 percent carbamide peroxide on one side of the dorsal tongue once a week for three consecutive weeks. Only distilled water was applied on the control side. The animals were killed on days 0, 10, and 20 after the last application. The tongue was fixed in buffered formalin for 24 h and embedded in paraffin. Tissue blocks (3 æm) were subjected to the biotin-streptavidin amplified system for identification of PCNA. The percentage of epithelial-positive basal cells in each side of the tongue mucosa was calculated. The results demonstrated that topical application of 10 percent carbamide peroxide increases PCNA immunohistochemical expression on the basal layer of the oral mucosa epithelium of rats on day 0 after treatment. In conclusion, short-course use of carbamide peroxide induces transient epithelial cell proliferation of the oral mucosa of rats

Oral squamous cell carcinoma: a retrospective study of 740 cases in a Brazilian population / Carcinoma epidermóide de boca: um estudo retrospectivo de 740 casos no Brasil

The purpose of this study was to evaluate, retrospectively, the profile of patients with oral squamous cell carcinoma. They were referred to two hospitals of Belo Horizonte (MG, Brazil) between 1986 and 1996. The medical records of 740 patients presenting oral squamous cell carcinoma were reviewed in detail. The TNM classification and staging, age, gender, race, occupation, and site of the primary tumor were recorded. The male-to-female ratio was 4.8:1. The mean age was 58.6 years. Most of the patients were in their sixties and were farm workers. The tumors were found principally on the tongue. There was a close relationship between some habits (tobacco and alcohol consumption) and the development of oral squamous cell carcinoma. Most of the patients sought medical care in the first year, even though almost half of them had lesions in stage T4. The identification of the characteristics of this specific population might reflect either accomplishments or problems in oral cancer control and can enable the development of a primary prevention program for oral squamous cell carcinoma.

Avaliação clínica de cinco anos de uma restauração de amálgama associada a um sistema adesivo / Five-years clinical evaluation of amalgam restorations associated an adhesive system

Após revisão da literatura sobre restaurações com amálgamas odontológicos associadas a sistemas adesivos, os autores relatam uma avaliação clínica de cinco anos de uma restauração extensa com amálgama utilizando adesivos de última geração. Os objetivos são mostrar alternativas de tratamentos restauradores nos elementos dentários associadas a aplicação de sistemas adesivos como opção a retenções adicionais, bem como suas vantagens, desvantagens, indicações e contra-indicações

Microabrasão do esmalte dental para remoção de manchas por fluorose / Enamel microabrasion for removal of fluorosis stains

Os autores aplicam uma técnica de remoção de manchas por fluorose, utilizando o sistema Prema Compound (Premier Dental Products) em um jovem de 12 anos de idade. A técnica mostrou-se prática, rápida e eficaz; e os resultados mostram-se satisfatórios, evidenciando acentuada melhora estética