Cancer immune profiling unveils biomarkers, immunological pathways, and cell type score associated with glioblastoma patients' survival.

Introduction: Glioblastoma (GBM), isocitrate dehydrogenase (IDH) wild-type (IDH wt), and grade 4 astrocytomas, IDH mutant (IDH mut), are the most common and aggressive primary malignant brain tumors in adults. A better understanding of the tumor immune microenvironment may provide new biomarkers and therapeutic opportunities. Objectives: We aimed to evaluate the expression profile of 730 immuno-oncology-related genes in patients with IDH wt GBM and IDH mut tumors and identify prognostic biomarkers and a gene signature associated with patient survival. Methods: RNA was isolated from formalin-fixed, paraffin-embedded sections of 99 tumor specimens from patients treated with standard therapy. Gene expression profile was assessed using the Pan-Cancer Immune Profiling Panel (Nanostring Technologies, Inc., Seattle, WA, USA). Data analysis was performed using nSolverSoftware and validated in The Cancer Genome Atlas. In addition, we developed a prognostic signature using the cox regression algorithm (Least Absolute Shrinkage and Selection Operator). Results: We found 88 upregulated genes, high immunological functions, and a high macrophage score in IDH wt GBM compared to IDH mut tumors. Regarding IDH wt GBM, we found 24 upregulated genes in short-term survivors (STS) and overexpression of CD274 (programmed death-ligand 1, PD-L1). Immune pathways, CD45, cytotoxic, and macrophage scores were upregulated in STS. Two different prognostic groups were found based on the 12-gene signature (CXCL14, PSEN2, TNFRSF13C, IL13RA1, MAP2K1, TNFSF14, THY1, CTSL, ITGAE, CHUK, CD207, and IFITM1). Conclusion: The elevated expression of immune-oncology-related genes was associated with worse outcome in IDH wt GBM patients. Increased immune functions, CD45, cytotoxic cells, and macrophage scores were associated with a more aggressive phenotype and may provide promising possibilities for therapy. Moreover, a 12 gene-based signature could predict patients' prognosis.

Blockade of interleukin seventeen (IL-17A) with secukinumab in hospitalized COVID-19 patients - the BISHOP study.

BACKGROUND: Patients with severe COVID-19 seem to evolve with a compromised antiviral response and hyperinflammation. Neutrophils are critical players in COVID-19. IL-17A plays a major role in protection against extracellular pathogens and neutrophil attraction/activation. We hypothesized that secukinumab, an anti-IL17A monoclonal antibody, could prevent the deleterious hyperinflammation in COVID-19. METHODS: BISHOP was a randomized, open-label, single-centre, phase-II controlled trial. Fifty adult patients hospitalized with PCR-positive Covid-19, were randomized 1:1 to receive 300 mg of secukinumab subcutaneously at day-0 plus standard of care (group A) or standard of care alone (group B). A second dose of 300 mg of secukinumab could be administered on day-7, according to staff judgement. The primary endpoint was ventilator-free days at day-28 (VFD-28). Secondary efficacy and safety outcomes were also explored. RESULTS: An intention-to-treat analysis showed no difference in VFD-28: 23.7 (95%CI 19.6-27.8) in group A vs. 23.8 (19.9-27.6) in group B, p = .62; There was also no difference in hospitalization time, intensive care unit demand and the incidence of circulatory shock, acute kidney injury, fungal or bacterial co-infections. There was no difference in the incidence of severe adverse events. Pulmonary thromboembolism occurred only in males and was less frequent in secukinumab-treated patients (4.2% vs. 26.2% p = .04). There was one death in each group. Upper airway viral clearance was also similar in both groups. CONCLUSION: The efficacy of secukinumab in the treatment of Covid19 was not demonstrated. Secukinumab decreased pulmonary embolism in male patients. There was no difference between groups in adverse events and no unexpected events were observed.

Acute Limb Ischemia After Self-Injection of Crushed Morphine Tablets into the Radial Artery: Role of Infrared Thermography in the Assessment of Tissue Perfusion.

BACKGROUND This article presents a case involving complications after intentional injection of crushed tablets into the arterial circulation, its diagnosis, and the treatment adopted. The diagnosis process illustrates the potential of techniques based on thermal imaging as tools to assess tissue perfusion. Inadvertent intravenous injection of crushed tablets is more common, but there are few reports on arterial circulation, and no studies were found on the self-injection of crushed morphine tablets, particularly into the radial artery. CASE REPORT A 51-year-old man with alcoholism and a history of illegal drug usage intentionally self-injected 3 crushed morphine tablets into his right radial artery. The patient progressed with compartment syndrome, requiring decompressive fasciotomy of the right forearm and ischemia of the right fingers, which were amputated. He presented with rhabdomyolysis and required dialysis. The patient agreed to full heparinization, corticotherapy, and the use of nitroglycerin and prostaglandin E1. Due to the progression of the necrotic area, the patient underwent proximal phalanx excision and surgical reconstruction of the right-hand remnant. CONCLUSIONS The injection of morphine tablets into circulation caused severe complications, which led to the excision of the proximal phalanx and the surgical reconstruction of the remnant of the right hand. In the present case, infrared thermography proved to be an effective method in assessing tissue perfusion.

Orofacial Manifestations of Fetal Alcohol Syndrome: Two Case Reports and a Scoping Review.

Purpose: Fetal alcohol syndrome (FAS) results from the teratogenic effects of alcohol on the fetus. Oral manifestations are commonly found in FAS and contribute to the diagnosis. The purpose of this study was to provide a review of the literature and describe two cases of FAS.
Methods: Electronic searches were conducted in August 2021 in multiple databases. The cases of two children with FAS are reported.
Results: One hundred sixty-six articles were included. The oral features frequently reported were micrognathia, cleft palate, high arched palate, maxillary hypoplasia, prognathia and crowding. The first patient had systemic and orofacial changes, such as delayed physical and cognitive development, micrognathia, tooth impaction, malocclusion and enamel hypoplasia. The second child had cognitive, and speech and behavioral deficits, but no oral and dental abnormalities.
Conclusion: Dentists should be aware of clinical findings since they may take part in the diagnosis and management of FAS.

O método de fotopolimerização é capaz de influenciar nos valores de microdureza das resinas compostas? Um estudo in vitro / Is the photopolimerization method able to influence on the microhardness values of composite resins? An in vitro study

Introdução: a inovação dos métodos de fotopolimerização foi proposta na tentativa de diminuir o estresse de contração de polimerização das resinas compostas e proporcionar maior conforto ao paciente, reduzindo o tempo de atendimento odontológico. Objetivo: avaliar a microdureza de duas resinas compostas nanoparticuladas submetidas a diferentes técnicas de polimerização. Material e método: quarenta espécimes foram divididos em quatro grupos (n=10) da seguinte forma: Filtek Z350 XT® + técnica imediata (GI); Filtek One Bulkfill® + técnica imediata (GII); Filtek Z350 XT® + técnica de pulso tardio (GIII); Filtek One Bulkfill® + técnica de pulso tardio (GIV). Após o armazenamento em água destilada à temperatura ambiente, os corpos de prova foram direcionados para a medição de microdureza. Utilizou-se teste T para comparação de técnicas e teste Two-Way ANOVA para calcular os efeitos das resinas compostas, técnicas de polimerização e interações referentes à variável dependente (p ≤0,05). Resultado: a resina Filtek Z350 XT® apresentou maior dureza na técnica imediata (GI - 312,45 ± 64,37) e pulso tardio (GIII - 244,50 ± 75,63) comparado à resina Filtek One Bulkfill®, em ambas as técnicas. Observaram-se maiores valores de dureza referentes à técnica imediata, com diferença estatística significativa em relação à resina testada (p = 0,04 - Filtek Z350 XT®; p = 0,03 - Filtek One Bulkfill®). Ambos os fatores isolados (resina e técnicas) apresentaram efeito nos valores de microdureza (p = 0,02 e p < 0,01, respectivamente). Conclusão: a técnica convencional demonstrou atingir maiores valores de dureza quando comparada à técnica de polimerização alternativa.

Introduction: the innovation of photopolymerization methods was proposed in an attempt to reduce the polymerization shrinkage stress of composite resins and also provide more comfort to patient reducing the chair time. The aim of this in vitro study was to assess the microhardness of two nanofilled composite resins subject to different curing techniques. Objective: assess the microhardness of two nanofilled composite resins subject to different curing techniques. Material and method: forty specimens were divided into four groups (N=10) as follows: Filtek Z350 XT® + immediate technique (GI); Filtek One Bulkfill® + immediate technique (GII); Filtek Z350 XT® + delayed pulse technique (GIII); Filtek One Bulkfill® + delayed pulse technique (GIV). After storage in distilled water at room temperature the specimens were assessed for microhardness measurement. T-test was used for comparison of techniques and two-way ANOVA used to calculate the effects of composite resins, curing techniques and their interactions on dependent variable (p set at 0.05). Result: Filtek Z350 XT® resin presented greater hardness on immediate technique (GI - 312,45 ± 64.37) and delayed pulse (GIII - 244,50 ± 75.63) compared to Filtek One Bulkfill® under both techniques. Overall, it was observed greater hardness values under immediate technique with a significant statistical difference apart of tested resin (p = 0.04 - Filtek Z350 XT®; p = 0.03 - Filtek One Bulkfill®). Both isolated factors (resin and techniques) presented effect on microhardness values (p = 0.02 and p < 0.01, respectively). Conclusion: the conventional technique demonstrated to reach higher hardness values when compared to the alternative polymerization technique

Piora da fragilidade em pessoas idosas comunitárias com hipertensão e fatores associados / Worsening frailty in community-dwelling older people with hypertension and associated factors

Resumo Objetivo Estimar a prevalência e fatores associados à piora da fragilidade em idosos com hipertensão arterial. Métodos Estudo quantitativo, longitudinal prospectivo e analítico. Realizado em idosos hipertensos comunitários mineiros. A amostragem foi probabilística, por conglomerados em duas etapas. A coleta de dados ocorreu no domicílio dos idosos em dois momentos. Foram analisadas variáveis demográficas, socioeconômicas e clínico-assistenciais. A fragilidade foi mensurada pela Escala de Fragilidade de Edmonton. Utilizou-se a regressão de Poisson com variância robusta para obter as razões de prevalência brutas e ajustadas Resultados Participaram do estudo 281 idosos, 23,1% apresentaram piora do seu estado de fragilidade. A prevalência de fragilidade passou de 38,0%, no ano base, para 31,2% na primeira onda. A piora da fragilidade foi associada a autopercepção negativa da saúde, à polifarmácia e à internação nos últimos 12 mese Conclusão Houve transição entre os estados de fragilidade. Um contingente importante dos idosos apresentou piora da fragilidade.

Abstract Objective To estimate the prevalence and factors associated with the worsening of frailty in older people with arterial hypertension. Methods Quantitative, longitudinal, prospective and analytical study. Carried out in community-dwelling hypertensive older people from Minas Gerais. Sampling was probabilistic, by clusters in two stages. Data collection took place at the older people's homes in two moments. Demographic, socioeconomic and clinical-assistance variables were analyzed. Frailty was measured by the Edmonton Frailty Scale. Poisson regression with robust variance was used to obtain crude and adjusted prevalence ratios. Results 281 older people participated in the study, 23.1% showed a worsening of their state of frailty. The prevalence of frailty increased from 38.0% in the base year to 31.2% in the first wave. The worsening of frailty was associated with negative self-perception of health, polypharmacy and hospitalization in the last 12 months. Conclusion There was a transition between states of frailty. An important contingent of the older people showed worsening frailty.

Ações na área da sexualidade adolescente sob a perspectiva do programa Saúde na Escola: visão dos profissionais de saúde / Actions in the area of adolescent sexuality under the perspective of the school health program: the health professionals' perspective

Buscou-se analisar a visão dos profissionais de saúde acerca das ações promovidas pelo Programa Saúde na Escola, no âmbito da sexualidade na adolescência. Estudo de abordagem qualitativa, exploratório e descritivo, realizado com 12 agentes comunitários de saúde, dois enfermeiros e um médico que atuavam na Unidade de Saúde da Família do Bairro Dom José Rodrigues, em Juazeiro, Bahia. Realizado através de entrevista semiestruturada com amostra qualitativa do tipo não-probabilística, intencional, por exaustão. Os depoimentos foram analisados por meio da análise de discurso. A temática sexualidade na adolescência ainda traz estigmas que não foram rompidos pelos profissionais de saúde, dificultando a abordagem com os adolescentes. Atrelado a isso, a escassez de capacitações torna o programa de cunho curativo, baseado no modelo biomédico em saúde. Apesar das dificuldades enfrentadas, os profissionais de saúde apontam possibilidades, embora reconheçam que não possuem preparo e que há deficiência na assistência das gestões. A parceria entre escola e unidade de saúde proposta pelo programa oportuniza o acesso do adolescente ao conhecimento e cuidados com a sua saúde, tornando-o um sujeito capaz de adotar posturas responsáveis.

We sought to analyze the view of health professionals about the actions promoted by the School Health Program within the scope of sexuality in adolescence. Study of qualitative, exploratory, and descriptive approaches, conducted with 12 community health workers, 02 nurses, and 01 doctor who worked in the Family Health Unit of the neighborhood Dom José Rodrigues, in Juazeiro, Bahia. It was conducted through semi-structured interviews with a qualitative, non-probabilistic, intentional, and by exhaustion sample. The interviews were analyzed through discourse analysis. The theme of sexuality in adolescence also brings stigmas that were not broken by health professionals, making it difficult to address with adolescents. Coupled with this, the lack of training makes the program curative, based on the biomedical model of health. Despite the difficulties, health professionals point out opportunities, although they recognize their lack of preparation and that, by management, there is a failure in the assistance. The partnership between the school and the health unit proposed by the program gives adolescents access to knowledge and care of their health, making them subjects capable of adopting responsible attitudes.

Low MGMT digital expression is associated with a better outcome of IDH1 wildtype glioblastomas treated with temozolomide.

INTRODUCTION: Glioblastoma (GBM) is the deadliest primary brain tumor. The standard treatment consists of surgery, radiotherapy, and temozolomide (TMZ). TMZ response is heterogeneous, and MGMT promoter (MGMTp) methylation has been the major predictive biomarker. We aimed to describe the clinical and molecular data of GBMs treated with TMZ, compare MGMT methylation with MGMT expression, and further associate with patient's outcome. METHODS: We evaluate 112 FFPE adult GBM cases. IDH1 and ATRX expression was analyzed by immunohistochemistry, hotspot TERT promoter (TERTp) mutations were evaluated by Sanger or pyrosequencing, and MGMTp methylation was assessed by pyrosequencing and MGMT mRNA expression using the nCounter® Vantage 3D™ DNA damage and repair panel. RESULTS: Of the 112 GBMs, 96 were IDH1WT, and 16 were IDH1MUT. Positive ATRX expression was found in 91.6% (88/96) of IDHWT and 43.7% (7/16) of IDHMUT. TERTp mutations were detected in 70.4% (50/71) of IDHWT. MGMTp methylation was found in 55.5% (35/63) of IDHWT and 84.6% (11/13) of IDHMUT, and as expected, MGMTp methylation was significantly associated with a better response to TMZ. MGMT expression was inversely correlated with MGMTp methylation levels (- 0.506, p < 0.0001), and MGMT low expression were significantly associated with better patient survival. It was also observed that integrating MGMTp methylation and expression, significantly improved the prognostication value. CONCLUSIONS: MGMT mRNA levels evaluated by digital expression were associated with the outcome of TMZ-treated GBM patients. The combination of MGMT methylation and mRNA expression may provide a more accurate prediction of TMZ response in GBM patients.

Uso do doppler colorido das carótidas no diagnóstico de um paciente com fístula carotideocavernosa direta / Use of color doppler of carotids in the diagnosis of a patient with direct carotid-cavernous fistula

Adulto jovem de 18 anos que evoluiu após traumatismo craniencefálico leve com fístula carotídea direta. Apresentou zumbido e exoftalmia, ambos de característica pulsátil e à esquerda. Foi submetido a estudo com Doppler das carótidas, que mostrou elevadas velocidades do fluxo sanguíneo e índices de resistência reduzidos nas artérias carótidas comum e interna esquerdas, compatíveis com fístula carotídea direta. A angiotomografia computadorizada cerebral confirmou a fístula carotídea. Foi encaminhado para tratamento endovascular por embolização, com sucesso. O Doppler de carótidas pode ter papel importante no diagnóstico das fístulas carotídeas diretas e acompanhamento de pacientes submetidos à terapêutica endovascular.(AU)

Whitening toothpastes effect on nanoparticle resin composite roughness after a brushing challenge: An in vitro study.

BACKGROUND: Nowadays, the use of whitening toothpastes is a common habit, especially among young adults, due to aesthetic appeal. On the other hand, little is known regarding the effects of brushing with those newly dentifrices on wear properties of resin composites. MATERIAL AND METHODS: Thirty specimens of nanoparticle composite resin were fabricated and stored in distilled water for 24 h at 370C. After this, the roughness analysis was performed and submitted to the simulated brushing technique using three types of toothpastes: conventional (GI), and two with whitening effect (GII and GIII) for a period of 15 days, with 2 brushing sessions per day for 2 minutes each. The final surface roughness was analyzed after completing all the brushing cycles and stereoscopic images were taken for each group. The data was analyzed by one-way ANOVA and Tukey-test post hoc for intergroup comparison and the T-test for dependent samples as well (α = 0.05). RESULTS: However showing an increase of roughness for all groups after the brushing cycles (p = 0.01), no statistically significant differences among the groups after simulated brushing was verified (p = 0.17). Yet, just some cracks of the stereoscopic images were shown, demonstrating no distinct visual effects among the studied groups. CONCLUSIONS: After simulated brushing with the whitening toothpastes, similar degree of roughness was verified on the composite resin tested. Key words:Composite resin, toothpastes, whitening.

Effect of an hydrophobic layer on a universal adhesive / Efeito de uma camada hidrofóbica sobre um adesivo universal

ABSTRACT Objective: evaluate bond strength of a universal adhesive, associated to an extra hydrophobic sealing layer, and compare after three and six months immersed in distilled water. Methods: After ethical approval of the CEP / HUUFMA, 12 human third molars (n = 6) were extracted, which were divided into two groups: SB - control group - selfetching; and SBHidrof - selfetching group associated to the hydrophobic layer (Adhesive layer, 3m ESPE). After incremental restoration with composite resin (Opalis, FGM), the teeth were sliced to obtain specimens (1mm2) and then submitted to the universal test machine (INSTRON 1mm / min.), immediate and after three and six months. The data were submitted to normality (Shapiro Wilk), and comparative Analysis of variance (two ways: technique and time) and Tukey (p <0.05). Results Immediate values showed no statistically significant difference (p> 0.05), but after three and six months of immersion of the specimens, in distilled water, bond strength values were maintained in the group that received the hydrophobic layer (p<0.05). Conclusion: It was observed that, by incorporating a hydrophobic layer on a universal adhesive system, it was possible to preserve dentin adhesion.

RESUMO Objetivo: Avaliar a de resistência de união da interface adesiva associada a uma camada hidrofóbica extra de selamento, e comparar após três e seis meses de armazenamento em água destilada. Métodos: Foram utilizados 12 terceiros molares humanos extraídos hígidos (n=6), que foram divididos em dois grupos, sendo grupo SB - controle - autocondicionante; e grupo SBHidrof - autocondicionante associado à camada hidrofóbica (Adhesive layer, 3m ESPE). Após restauração incremental com resina composta (Opalis, FGM), os dentes foram fatiados para obtenção de espécimes (1mm2) e em seguida, submetidos à máquina de ensaio universal (INSTRON 1mm/min.) imediato e após três e seis meses. Os dados obtidos foram submetidos à normalidade (Shapiro Wilk), e análise comparativa ANOVA (dois fatores: técnica e tempo) e Tukey (p<0,05). Resultados: Nos valores imediatos não houve diferença estatisticamente significante (p>0,05), porém após três e seis meses de imersão dos espécimes, em água destilada, foi observado manutenção dos valores de resistência de união no grupo que recebeu a camada hidrofóbica (p<0,05). Conclusão: Ao incorporar uma camada hidrofóbica sobre um sistema adesivo universal, foi possível preservar a longevidade da adesão dentinária.

In vitro quantitative comparison of erosive potential of infant mouthwashes on glass ionomer cement.

BACKGROUND: The widespread use of mouthwashes, specially in children, is a concern, since the long-term use may modify the topography of dental materials. However, this process still unclear regarding the wear related to infant mouthwashes on glass ionomer cement. Thus, the purpose of this investigation was evaluate the erosive potential of infant mouthwashes on glass ionomer cement specimens. MATERIAL AND METHODS: Forty round-shaped specimens were divided into 4 groups (N=10) and submitted to erosive cycling for 15 days, being exposed 2X/day in the following children's active agents mouthwash solutions: G1- cetylpyridinium chloride, G2- xylitol and triclosan and G3 - Malva sylvestris and xylitol. Prior to cycling, the specimens were submitted to the surface roughness measurement. After erosive cycling, the specimens were reanalyzed, and calculated the increase of roughness (∆Ra). Additionally, it was adopted distilled water as a negative control (G4). As an extra analysis, the mouthwashes had their pH values measured. The results were submitted to T-test and ANOVA followed by Tukey test at 5%. RESULTS: In relation to pH values, G2 presented the most acidic pH value (pH = 6.83) in comparison to other substances. Regarding the comparison of the final roughness values (R) among the groups, it was verified that the mouthwashes showed significant roughness increase in comparison to control group, especially to G3 group (Rf = 1.67 ± 0.14) as well the ΔRa values with statistical difference in comparison to distilled water. Still, with exception of control group outcome, an increase of roughness of each mouthwash was verified after the studied period. CONCLUSIONS: Active agents present in infant mouthwashes were capable of roughness increased of glass ionomer cement surface, demonstrating an erosive potential of this material largely used in pediatric dentistry. Key words:Dental erosion, dental cements, mouthwash.

Effect of Dental Prophylaxis Techniques on the Surface Roughness of Resin Composites.

AIM: The aim of this study is to evaluate the effect of dental prophylaxis techniques on surface roughness of composite resins. MATERIALS AND METHODS: A total of 36 nanohybrid resin composite test specimens were fabricated and divided into three groups (n = 12). They were kept in distilled water at 37°C for 24 hours and submitted to the finishing and polishing technique. For the prophylactic techniques, in group G1, a mixture of pumice stone and distilled water was used with the aid of a rubber cup; in group G2, Herjos-F prophy paste was used with a rubber cup; and in group G3, a bicarbonate jet spray was used. Afterward, all the samples were repolished using the Soflex pop-on disks. A roughness meter was used to measure surface roughness at three points in time: Before the prophylactic techniques (1st evaluation), afterward (2nd evaluation), and following repeat polishing (3rd evaluation). RESULTS: It was found that roughness values changed significantly between the 1st and 2nd evaluations (p < 0.05) and between the 2nd and 3rd evaluations (p < 0.05), showing that the change in roughness depended on the type of prophylactic treatment. Roughness was significantly higher after the bicarbonate jet (p < 0.05). CONCLUSION: Prophylaxis using the sodium bicarbonate jet significantly altered the roughness of nanoparticle-reinforced resin. CLINICAL SIGNIFICANCE: Dental prophylaxis is the most common practice employed to remove bacterial plaque and other coatings. However, one side effect of the cleaning may be a rougher surface subject to degradation and staining. The correct use of prophylactic devices and avoiding prolonged use on resin restorations reduce surface roughness.

Aspectos psicossociais da sexualidade na adolescência: diálogos e aprendizagem na escola / Psychosocial aspects of sexuality in adolescence: dialogue and learning in school

A sexualidade se manifesta com mais intensidade na adolescência, fase em que há transformações intensas. Na escola, faltam espaços de discussão sobre a temática. Pretendeu-se compreender os aspectos psicossociais da sexualidade de adolescentes, revelados através do desenvolvimento de oficinas. Trata-se de estudo qualitativo, baseado na pesquisa-ação e na metodologia da problematização, realizado em uma escola pública do município de Juazeiro/BA, através da oficina crítico-emancipatória "Diz aí, professor, pois quero curtir a vida!", com adolescentes do Ensino Fundamental II e Médio. Os resultados indicam que muitos adolescentes têm receio de conversar com a família por acreditarem que serão repreendidos, bem como têm pouco conhecimento sobre Doenças Sexualmente Transmissíveis e sobre direitos sexuais e reprodutivos. A homossexualidade foi o tema mais polêmico e com opiniões divergentes. Logo, percebe-se a necessidade de enfatizar a educação sexual e reprodutiva nas escolas, abordando o tema de forma alternativa ao modelo tradicional. Os tabus, as crenças e os mitos referentes à sexualidade na adolescência precisam ser discutidos por meio de estratégias que reconheçam os adolescentes como atuantes. Além disso, é importante uma aprendizagem mais reflexiva, com princípios mais humanos, no que concerne à sexualidade, diminuindo o estigma, a discriminação e a violência na sociedade (AU).

The sexuality manifests itself more strongly in adolescence, a phase were there are intense transformations. At school, there is no room for discussion on the subject. The aim of this study was to understand the psychosocial aspects of teenager's sexuality, revealed through the development of workshops. A qualitative study, based on action research and problem-solving methodology, performed in a public school in the city of Juazeiro, Bahia, through the critical-emancipatory workshop "Tell me teacher, because I want to enjoy life!" with First and Secondary School Students. The results indicate that many teenagers are afraid to talk to their family because they believe they will be reprimanded, as well as have little knowledge about Sexually Transmitted Diseases and about sexual and reproductive rights. The homosexuality was the most controversial subject and with divergent opinions. Therefore, it is necessary to emphasize sexual and reproductive education in schools, approaching the theme in an alternative way to the traditional model. The taboos, beliefs and myths need to be discussed through strategies that recognize adolescents as performers. In addition, a more reflective learning with more humane principles is important in relation to sexuality, reducing stigma, discrimination and violence in society.regarding sexuality in adolescence need to be discussed through strategies that recognize adolescents as performers. In addition, a more reflective learning with more humane principles is important in relation to sexuality, reducing stigma, discrimination and violence in society (AU).

Doença coronariana obstrutiva grave em um adulto jovem com neurofibromatose tipo 1. Existe alguma conexão? / Severe obstructive coronary artery disease in a young adult with neurofibromatosis type 1. Is there any connection?

Paciente de 37 anos, portador de neurofibromatose tipo 1 que se apresentou com quadro de dor torácica típica. Exceto pelo sexo masculino, não apresentava outros fatores de risco pessoais ou familiares para doença arterial coronária. Com o eletrocardiograma de repouso normal e um ecocardiograma transtorácico mostrando apenas hipertrofia ventricular esquerda de grau discreto, realizou teste de esforço que foi fortemente positivo para doença arterial coronariana. Com esse resultado e considerando a baixa faixa etária e a escassez de fatores de risco, o paciente foi encaminhado para a ecocardiografia com estresse farmacológico, que deflagrou dor torácica típica e alterações segmentares da contratilidade com baixas doses de dobutamina. Encaminhado para a cineangiocoronografia, detectou-se lesão mulitvascular grave, com indicação para tratamento cirúrgico (revascularização do miocárdio). Questiona-se, após breve revisão da literatura, eventual associação entre a presença e gravidade da doença arterial coronariana e a neurofibromatose tipo 1.

Male patient, 37 years old, affected by neurofibromatosis type 1 who presented with typical chest pain. Except for being male, he had no other risk factors, personal or family history of coronary artery disease. With normal resting electrocardiography and a transthoracic echocardiogram showing mild left ventricular hypertrophy, we performed stress test, which was strongly positive for coronary artery disease. With this result and considering the young age and lack of risk factors, the patient was referred for pharmacologic stress echocardiography, which triggered typical chest pain and electrocardiographic changes with low doses of dobutamine. The patient was referred to cineangiocoronariography, which showed mulitvascular serious injury, with an indication for surgery (myocardial revascularization). After a brief literature review, we wonder if there is a possible association between the presence and severity of coronary artery disease and neurofibromatosis type 1.

In vivo Evaluation of Proximal Resin Composite Restorations performed using Three Different Matrix Systems.

OBJECTIVE: The aim of this in vivo study was to radiographically evaluate the proximal contour of composite resin restorations performed using different matrix systems. MATERIALS AND METHODS: Patients with premolars needing class II type resin composite restorations involving the marginal ridge were selected. Thirty premolars were selected and randomly divided into three groups (n = 10 each) to receive restorations using different matrix systems: group 1: metal matrix coupled to a carrier matrix and wood wedge (G1-MMW); group 2: sectioned and precontoured metal matrix and elastic wedge (G2-SME); and group 3: a polyester strip and reflective wedge (G3-PMR). After the restorative procedure, bitewing radiographs were performed and analyzed by three calibrated professionals. The quality of the proximal contact and marginal adaptation of the proximal surfaces was classified as either correct or incorrect (undercontour/overcontour). RESULTS: The Pearson Chi-square statistical test (α = 5%) revealed a statistically difference between frequencies of correct and incorrect restorations (α(2) = 6.787, p < 0.05). The group G2 SME produced a higher frequency of correct proximal contours (90%), while G1-MMW and G3-PMR had a ratio of 40% correct and 60% incorrect contours respectively. CONCLUSION: None of the matrix systems was able to prevent the formation of incorrect proximal contours; however, the sectioned and precontoured metal matrix/elastic wedge configuration provided better results as compared to the other groups.

Effect of Fluoride and Simplified Adhesive Systems on the Bond Strength of Primary Molars and Incisors.

The aim of this study was evaluate in vitro the influence of simplified adhesive systems (etch-and-rinse and self-etching) and 1.23% acidulated phosphate fluoride (APF) on the microshear bond strength (µ-SBS) of composite resins on primary molars and incisors. Forty primary molars and forty incisors vestibular enamel was treated with either the self-etching Clearfil SE Bond (CSE, Kuraray) or etch-and-rinse Adper Single Bond 2 (SB2, 3M/ESPE) adhesive system. Each group was subdivided based on the prior treatment of the enamel with or without the topical application of 1.23% APF. Thereafter, matrices were positioned and filled with composite resin and light cured. After storage in distilled water at 37 ± 1°C for 24 h, the specimens were submitted to µ-SBS in a universal testing machine. Kruskal-Wallis and Mann-Whitney tests (p < 0.05) showed that the prior application of 1.23% APF led to a significant reduction in bond strength. The type of adhesive exerted no significant influence bond strength. In the inter-group analysis, however, significantly bond strength reduction was found for the incisors when CSE was employed with APF. Adhesive failure was the most common type of fracture. The bond strength was affected by the prior application of 1.23% APF and type of tooth.

Effect of Fluoride and Simplified Adhesive Systems on the Bond Strength of Primary Molars and Incisors

The aim of this study was evaluate in vitro the influence of simplified adhesive systems (etch-and-rinse and self-etching) and 1.23% acidulated phosphate fluoride (APF) on the microshear bond strength (μ-SBS) of composite resins on primary molars and incisors. Forty primary molars and forty incisors vestibular enamel was treated with either the self-etching Clearfil SE Bond (CSE, Kuraray) or etch-and-rinse Adper Single Bond 2 (SB2, 3M/ESPE) adhesive system. Each group was subdivided based on the prior treatment of the enamel with or without the topical application of 1.23% APF. Thereafter, matrices were positioned and filled with composite resin and light cured. After storage in distilled water at 37±1°C for 24 h, the specimens were submitted to μ-SBS in a universal testing machine. Kruskal-Wallis and Mann-Whitney tests (p<0.05) showed that the prior application of 1.23% APF led to a significant reduction in bond strength. The type of adhesive exerted no significant influence bond strength. In the inter-group analysis, however, significantly bond strength reduction was found for the incisors when CSE was employed with APF. Adhesive failure was the most common type of fracture. The bond strength was affected by the prior application of 1.23% APF and type of tooth.

O objetivo deste estudo foi avaliar a influência dos sistemas adesivos simplificados (condicionamento ácido total e auto-condicionante) e fluorfosfato acidulado a 1,23% (FFA) na resistência de união ao microcisalhamento (μ-RUC) de resinas compostas em molares e incisivos decíduos. O esmalte vestibular de quarenta molares e quarenta incisivos decíduos foi tratado com Clearfil SE Bond (CSE, Kuraray) ou Adper Single Bond 2 (SB2, 3M/ESPE). Cada grupo foi subdividido com base no tratamento prévio do esmalte com ou sem aplicação tópica de FFA a 1,23%. Em seguida, matrizes foram posicionadas e preenchidas com resina composta e posterior fotopolimerização. Depois da armazenagem em água destilada a 37±1 °C por 24 h, os espécimes foram submetidos ao μ-RUC em uma máquina de ensaio universal. Teste Kruskal-Wallis e Mann-Whitney (p<0,05) mostraram que a aplicação prévia de FFA a 1,23% levou a uma redução significativa na resistência de união. O tipo de adesivo não exerceu influência significativa na resistência de união. Na análise intergrupos, entretanto, redução significativa na resistência de união foi encontrada para os incisivos quando CSE foi empregado sem FFA. Falha adesiva foi o tipo de fratura mais comum. A resistência de união foi afetada pela aplicação de FFA a 1,23% e tipo de dente.

21-Benzylidene digoxin: a proapoptotic cardenolide of cancer cells that up-regulates Na,K-ATPase and epithelial tight junctions.

Cardiotonic steroids are used to treat heart failure and arrhythmia and have promising anticancer effects. The prototypic cardiotonic steroid ouabain may also be a hormone that modulates epithelial cell adhesion. Cardiotonic steroids consist of a steroid nucleus and a lactone ring, and their biological effects depend on the binding to their receptor, Na,K-ATPase, through which, they inhibit Na+ and K+ ion transport and activate of several intracellular signaling pathways. In this study, we added a styrene group to the lactone ring of the cardiotonic steroid digoxin, to obtain 21-benzylidene digoxin (21-BD), and investigated the effects of this synthetic cardiotonic steroid in different cell models. Molecular modeling indicates that 21-BD binds to its target Na,K-ATPase with low affinity, adopting a different pharmacophoric conformation when bound to its receptor than digoxin. Accordingly, 21-DB, at relatively high µM amounts inhibits the activity of Na,K-ATPase α1, but not α2 and α3 isoforms. In addition, 21-BD targets other proteins outside the Na,K-ATPase, inhibiting the multidrug exporter Pdr5p. When used on whole cells at low µM concentrations, 21-BD produces several effects, including: 1) up-regulation of Na,K-ATPase expression and activity in HeLa and RKO cancer cells, which is not found for digoxin, 2) cell specific changes in cell viability, reducing it in HeLa and RKO cancer cells, but increasing it in normal epithelial MDCK cells, which is different from the response to digoxin, and 3) changes in cell-cell interaction, altering the molecular composition of tight junctions and elevating transepithelial electrical resistance of MDCK monolayers, an effect previously found for ouabain. These results indicate that modification of the lactone ring of digoxin provides new properties to the compound, and shows that the structural change introduced could be used for the design of cardiotonic steroid with novel functions.

Evaluation of the traditional and revised World Health Organization classifications of dengue cases in Brazil.

OBJECTIVE: Dengue is a worldwide public health problem with approximately 50 million cases reported annually. The World Health Organization proposed a revised classification system in 2008 to more effectively identify the patients who are at increased risk of complications from dengue. Few studies have validated this new classification system in clinical practice. We conducted a cross-sectional study of patients hospitalized for dengue in Dourados, Mato Grosso do Sul, Brazil, to evaluate the capacity of the two classification systems for detecting severe cases of dengue. MATERIALS AND METHODS: We conducted a cross-sectional study of survey data from the medical records of patients admitted to the University Hospital of the Federal University of Grande Dourados under clinical suspicion of dengue during an epidemic from September 2009 to April 2010. RESULTS: The distribution of patients according to the traditional classification system was as follows: dengue fever, 150/181 (82.9%); dengue hemorrhagic fever, 27/181 (14.9%); and dengue hemorrhagic shock, 4/181 (2.2%). Using the revised classification system, the distribution was as follows: dengue without warning signs, 45/181 (24.3%); dengue with warning signs, 107/181 (59.1%); and severe dengue, 29/181 (15.6%). Of the 150 patients classified as having dengue fever, 105 (70%) were reclassified as having dengue with warning signs or severe dengue. CONCLUSION: These data demonstrate that the revised classification system has greater discriminatory power for detecting patients at risk of progression to severe disease and those needing hospitalization.