Guided coronally advanced flap to treat gingival recession: Digital workflow and case report.

BACKGROUND: The inherently technique-sensitive nature of periodontal plastic procedures demands a significant level of skill and expertise. The incorporation of three-dimensional (3D) printing technologies emerges as a potential strategy to optimize and simplify surgical procedures. This case report describes the digital workflow and presents the clinical outcomes achieved using a guided coronally advanced flap for the treatment of a single gingival recession (GR). METHODS AND RESULTS: A female patient with a gingival recession type 1 (RT1 B-) defect on the mandibular second left premolar underwent successful treatment using a guided coronally advanced flap (g-CAF) and de-epithelized connective tissue graft (CTG). The digital planning included intraoral scanning of the mandible and hard palate using an intraoral scanner, with resulting polygon format (PLY) files exported for virtual model creation. The CAF guide was meticulously designed to orient horizontal and vertical incisions at the papillae base adjacent to the GR defect. For the donor site, a guide was specifically created, positioning the graft area 2 mm apically to the premolars' gingival margins. The delineation of this area involved two horizontal and vertical incisions, meticulously based on the dimensions of the GR. The digitally designed guides were then 3D-printed using a surgical guide-specific resin, contributing to the precise execution of the innovative surgical approach. Complete root coverage was achieved. CONCLUSION: This case report demonstrates that g-CAF can be a promising approach for the treatment of single GR. HIGHLIGHTS: Why is this case new information? To the best of the authors' knowledge, this is the first manuscript to report a guided procedure for the treatment of gingival recession. This report provides the digital workflow for the fabrication of a guide to perform the coronally advanced flap for single recession defects. What are the keys to successfully manage this case? It is necessary to adequately scan the recession defect area and palate. Properly not only design the guide using specific software but also print it. The guide has to be stable when in position for the surgical procedure. What are the primary limitations of this technique? This guide was designed to help surgeons during the incisions. However, it does not provide aid to split and release the flap and suture.

Treatment of single gingival recessions using biofunctionalized collagen matrix: A case series.

BACKGROUND: Connective tissue graft substitutes have been used widely to overcome autogenous graft limitations. Nevertheless, they do not provide comparable results in the treatment of periodontal and peri-implant soft tissue defects. Based on the principles of tissue-engineered materials, injectable platelet-rich fibrin (i-PRF) has been combined with collagen matrices (CMs) to enhance their clinical efficacy. To the best of our knowledge, this is the first case series demonstrating the use of i-PRF for the biofunctionalization of a volume-stable collagen matrix (VCMX) as an adjunct to coronally advanced flap (CAF) to treat single gingival recession (GR) defects. METHODS & RESULTS: The study included 10 patients. Bleeding on probing, probing depth, GR height, clinical attachment level, esthetics, and dentin hypersensitivity were evaluated. After 6 months, a significant GR reduction (RecRed: 2.15 ± 0.7 mm; p = 0.005) and percentage of root coverage (% RC) of 81.13% were observed. Additionally, 40% of the sites showed complete root coverage. Gingival thickness increased 0.64 mm. Patient-centered evaluations demonstrated dentin hypersensitivity and esthetics improvements by the end of follow-up. CONCLUSION: VCMX biofunctionalized with i-PRF associated with CAF technique showed promising clinical outcomes in the treatment of single RT1 GR defects.

The use of toxic baits for the suppression of Mediterranean fruit fly in mango orchards.

Ceratitis capitata (Wiedemann, 1824) is an insect of major economic importance in the mango orchards of the submedium of the São Francisco River Valley, the main area of mango production and exportation in Brazil. To provide alternatives for the management of C. capitata, toxic baits based on alpha-cypermethrin (Gelsura®) and spinosad (Success® 0.02 CB) were evaluated in three commercial mango experiments during two consecutive harvests: 2016/2017 (experiment 1 - area 1) and 2017/2018 (experiment 2 -area 2 and experiment 3 - area 3). According to the results, there was a large reduction in the infestation of C. capitata after five sequential applications of the alpha-cypermethrin (6 g.ha-1) and spinosad (0.38 g.ha-1) toxic baits performed at seven-day intervals during mango fruit ripening in all experiments and years (harvest) evaluated. Compared with the untreated plots, the plots with alpha-cypermethrin and spinosad applications showed a significant reduction in the damage induced (fallen fruits and/or on trees) by C. capitata. The management of C. capitata in mango orchards can include the use of the toxic bait based on alpha-cypermethrin, which represents an alternative to rotate with spinosad toxic bait in the São Francisco River Valley.

Barbell Technique for Three-Dimensional Bone Augmentation.

Introduction: Appositional bone augmentation is considered a challenging surgical problem to correct for the deficient alveolar ridge. To overcome this challenge, a novel concept was recently published called "Barbell Technique." This technique has been used more commonly for horizontal bone augmentation. To our knowledge, this is the first report on using the Barbell Technique for vertical bone augmentation. Case Report. This report describes and demonstrates the clinical feasibility of the use of this concept in the reconstruction of a tridimensional alveolar ridge defect in the anterior maxilla. Due to the severity of the defect, both hard and soft tissue deficiencies required augmentation. The first surgery involved a soft tissue grafting procedure while in the second surgical procedure, hard tissue augment was performed using the Barbell device to provide both vertical and horizontal support for the hard tissue graft. The donor material consisted of equal volume of xenograft and autogenous bone used to fill the defect and covered with a collagen barrier membrane. After a healing period of 9 months, the site was reopened. Bone formation clinically verified the correction of alveolar bone contour and volume permitted placement of two titanium implants after the removal of Barbell device. Conclusion: This case report demonstrates successful vertical and horizontal bone augmentation of a critical size defect in the anterior maxilla, correcting both hard and soft tissue contours, and providing the tissues needed to support dental implants in the anterior maxilla.

A new volume-stable collagen matrix (VCMX) to treat single gingival recession associated with partially restored non-carious cervical lesions: a case series.

Collagen matrixes have been developed as possible connective tissue graft substitutes to overcome patient discomfort, undesired palatal healing, and the limited amount of donor tissue. The aim of this case series is to assess a coronally advanced flap (CAF) with a new volume-stable collagen matrix (VCMX) to treat single gingival recession (GR) associated with partially restored non-carious cervical lesions (NCCL). Twelve patients diagnosed with single GR RT1 + NCCL (B+) were included in this study and received a restorative - partial resin composite with apical margin 1 mm beyond the estimated cementoenamel junction (CEJ) - and a surgical approach - CAF+VCMX. Clinical and patient-centered assessments were recorded at baseline and 6 months postoperatively from ten patients. Significant recession reduction (RecRed:2.1mm), clinical attachment level gain (CAL:1.34mm), and combined defect coverage (CDC) of 51.67% were observed at 6 months. The estimate root coverage (RC) was 69.48%, obtained using the estimated CEJ. No difference in keratinized-tissue width (KTW) was observed over time. A gain in gingival thickness (GT) of 0.42 mm was observed after 6 months (p=.002) and an improvement in patient satisfaction due to better esthetics (p<.001). Within the present study's limits, CAF plus VCMX provided significant improvement in treating single GR combined with partially restored NCCL (B+).

Evaluation of oral mucositis, candidiasis, and quality of life in patients with head and neck cancer treated with a hypofractionated or conventional radiotherapy protocol: a longitudinal, prospective, observational study.

BACKGROUND: Due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, recently, Radiotherapy (RT) protocols requiring fewer sessions (hypofractionated) have been used to shorten RT treatment and minimize patient exposure to medical centers, and decrease the risk of SARS-CoV-2 infection. METHODS: This longitudinal, prospective, observational study aimed to compare the quality of life (QoL) and the incidence of oral mucositis and candidiasis in 66 patients with head and neck cancer (HNC) who undergo a hypofractionated RT protocol (GHipo), total of 55 Gy for 4 weeks, or a conventional RT protocol (GConv), total of 66 - 70 Gy for 6 - 7 weeks. PURPOSE: To assess the incidence and severity of oral mucositis, the incidence of candidiasis, and QoL were evaluated using the World Health Organization scale, clinical evaluation, and the QLC-30 and H&N-35 questionnaires, respectively, at the beginning and the end of RT. RESULTS: The incidence of candidiasis did not show differences between the two groups. However, at the end of RT, mucositis had a higher incidence (p < 0.01) and severity (p < 0.05) in GHipo. QoL was not markedly different between the two groups. Although mucositis worsened in patients treated with hypofractionated RT, QoL did not worsen for patients on this regimen. CONCLUSIONS: Our results open perspectives for the potential use of RT protocols for HNC with fewer sessions in conditions that require faster, cheaper, and more practical treatments.

Multiple gingival recessions associated with non-carious cervical lesions treated by partial restoration and modified coronally advanced flap with either connective tissue graft or xenogeneic acellular dermal matrix: A randomized clinical trial.

BACKGROUND: This study aimed to compare a connective tissue graft (CTG) to a (porcine) xenogeneic acellular dermal matrix (XDM), both associated with modified coronally advanced flap (MCAF) and partial resin composite restoration to treat multiple combined defects (CDs). METHODS: Seventy-eight defects in 38 patients presenting multiple combined defects, that is, gingival recession associated with non-carious cervical lesions, were treated by partial resin composite restoration (apical margin up to 1 mm of the estimated cement-enamel junction) and MCAF along with CTG or XDM. After 6 months, the groups were compared with regard to clinical, patient-centered, and esthetic outcomes. RESULTS: CD coverage was 72.9% for CTG versus 50.7% for XDM (P < 0.001). Recession reduction was 2.3 mm for CTG versus 1.5 mm for XDM (P < 0.001). CTG resulted in a greater increase in keratinized tissue width (CTG: 0.96 mm vs. XDM: 0.3 mm, P = 0.04) and gingival thickness (CTG: 0.9 mm vs. XDM: 0.3 mm, P < 0.001). Both treatments successfully reduced dentin hypersensitivity and increased esthetics satisfaction, with no statistically significant intergroup differences. Moreover, XDM patients experienced a shorter surgery duration (CTG: 57.2 min vs. XDM: 37.4 min, P < 0.001) and less time to no pain (visual analog scale  =  0; CTG: 6.5 days vs. XDM: 3.5 days, P = 0.04). CONCLUSION: CTG resulted in significantly greater root coverage and increased keratinized tissue width compared to XDM for treating multiple partially restored CDs. However, increased root coverage at the CTG sites was accounted for by increased probing depth compared to the XDM sites.

Long-term evaluation (up to 7 years) of the use of a collagen matrix to treat gingival recession associated with noncarious cervical lesion: Report of two cases.

INTRODUCTION: Gingival recession (GR) is a relevant clinical condition due to its high prevalence worldwide, which leads to aesthetic demands and dentin hypersensitivity. Collagen matrices have been associated with different designs of coronally advanced flaps (CAFs) to treat GR defects. However, the literature lacks long-term follow-up of this treatment option. The aim of this study is to present the long-term follow-up (up to 7 years) of two GR defects (associated or not with noncarious cervical lesion) treated with a CAF and a collagen matrix (CM). CASE PRESENTATION: Case 1 underwent a CAF associated with a CM to treat a single GR defect. After 7 years, Case 1 presented with 3 mm of recession reduction, which corresponds with the 85.7% of root coverage. Case 2 presented two GR defects associated with noncarious cervical lesions (NCCLs). The NCCLs were partially restored with resin composite and then underwent a modified CAF for multiple defects and a CM. After 5 years of follow-up, Case 2 presented with 1.5 and 2.5 mm of recession reduction, which corresponds with the average 83.3% defect coverage. CONCLUSION: These two cases may show that CMs can provide long-term stable outcomes in the treatment of GR defects. Why is this case new information? One of the cases is the first one to describe a 7 years of follow-up after CAF+CM to treat gingival recession defects. What are the keys to successful management of this case? Correct material handling. Adequate restorative protocol and surgical technique. What are the primary limitations to success in this case? Diagnose Patient compliance.

Collagen matrix biofunctionalized with injectable platelet-rich fibrin for the treatment of single gingival recession: A case report.

INTRODUCTION: Collagen matrices have been used as connective tissue graft (CTG) substitutes. However, they do not have the same efficacy compared to CTG. Adding biological agents may increase collagen matrices' efficacy. The present case reports the use of a biofunctionalized volume-stable collagen matrix (VCMX) with injectable platelet-rich fibrin (iPRF) associated with the coronally advanced flap (CAF) to treat single gingival recession (GR) defect. CASE PRESENTATION: A Recession Type 1 (RT1 A-) defect at maxillary left canine in a male patient was treated using a VCMX biofunctionalized with iPRF associated with CAF. No swelling or edema was observed during the first 14 days after surgery. Complete root coverage was observed (RecRed of 4.0 mm) after 6 months. Gingival thickness (GT) increased (1.0 mm) by the end of the follow-up. CONCLUSION: The present case report shows that CAF associated with VCMX+iPRF presents good clinical outcomes for single GR defect. KEY POINTS: Why is this case new information? This case is the first one to our knowledge to describe the biofunctionalization of VCMX with iPRF to treat single gingival recession. What are the keys to successful management of this case? Proper material handling. Proper iPRF protocol execution. What are the primary limitations to success in this case? Need of venipuncture. Correct preparation of VCMX+iPRF. Patient compliance.

Maxillary Sinus Elevation Using the Bone Ring Technique with Immediate Implantation: A Case Report.

Compared to other areas of the oral cavity, an edentulous posterior maxilla poses a unique challenge for implant placement. The most important aspect to consider is the maxillary sinus. This paper describes a case in which the bone ring technique was used to raise the floor of the maxillary sinus, followed by immediate implantation. A 37-year-old woman presented with a ridge defect in the left maxilla and the absence of teeth 26 and 27 (FDI tooth-numbering system) on the same side. The treatment plan involved the extraction of tooth 25, periodontal regeneration on the distal face of tooth 24, and concomitant raising of the maxillary sinus (using the bone ring technique) with simultaneous implantation. The bone ring technique promotes bone augmentation, raises the maxillary sinus, and reduces the surgical time, surgical costs, and length of the rehabilitation period. In the case presented herein, bone tissue stability around the implants, ridge maintenance, and gingival margin stability were found at the 1-year follow-up after rehabilitation.

Bone Ring Technique for the Treatment of Vertical and Horizontal Bone Defects with Immediate Implants: A Report of Two Cases.

In dental implant surgery, bone grafts are used for the reconstruction and reestablishment of alveolar bone volume and to improve bone architecture for better positioning of an implant. The present report describes the use of the bone ring technique for vertical and horizontal bone augmentation with simultaneous implant placement. This is a simple technique for acquiring donor bone in a ring shape and performing 3D reconstruction of bone defects, with an increase in the alveolar crest, using autogenous bone in a surgical procedure together with implant placement. Block bone grafts taken from the mentum can be used for predictable bone augmentation of up to 6 mm in the horizontal and vertical dimensions. The thickness of the bone ring collected from the mentum is very important. It cannot be too thin due to the risk of fracture, nor can it be too thick, as its contour could become deformed when placed in the receptor site. For stabilization and synthesis, a horizontal mattress suture is performed at the receptor site without promoting tension, and simple sutures are used for the complete co-optation of the flap and consequent stabilization of the clot. In the present type of bone defect, single-stage implant placement may be useful to shorten the overall treatment period.

Field efficacy of Bt cotton containing events DAS-21023-5 × DAS-24236-5 × SYN-IR102-7 against lepidopteran pests and impact on the non-target arthropod community in Brazil.

The efficacy and non-target arthropod effects of transgenic DAS-21023-5 × DAS-24236-5 × SYN-IR102-7 Bt cotton, expressing proteins Cry1Ac, Cry1F and Vip3Aa19, was examined through field trials in Brazil. Fifteen field efficacy experiments were conducted from 2014 through the 2020 growing season across six different states in Brazil to evaluate performance against key lepidopteran pests through artificial infestations of Chrysodeixis includens (Walker), Spodoptera frugiperda (J.E. Smith,1797), Spodoptera cosmioides (Walker, 1858) and Chloridea virescens (F., 1781), and natural infestations of Alabama argillacea (Hübner) and S. frugiperda. The impact of this Bt cotton technology on the non-target arthropod community in Brazilian cotton production systems was also assessed in a multi-site experiment. DAS-21023-5 × DAS-24236-5 × SYN-IR102-7 cotton significantly reduced the feeding damage caused by S. frugiperda, S. cosmioides, C. includens, C. virescens and A. argillacea, causing high levels of mortality (greater than 99%) to all target lepidopteran pests evaluated during vegetative and/or reproductive stages of crop development. Non-target arthropod community-level analyses confirmed no unintended effects on the arthropod groups monitored. These results demonstrate the value of transgenic Bt cotton containing event DAS-21023-5 × DAS-24236-5 × SYN-IR102-7 for consideration as part of an integrated approach for managing key lepidopteran pests in Brazilian cotton production systems.

Tratamento de mucosite periimplantar pela técnica de enxerto gengival livre: relato de caso / Treatment of peri-implant mucositis through free gingival graft technique: case report

A Mucosite peri-implantar é considerada a precursora da peri-implantite, ela é uma lesão inflamatória da mucosa peri-implantar na ausência de perda óssea marginal contínua. O objetivo desse relato de caso, foi descrever o tratamento da mucosite periimplantar através da cirurgia de enxerto gengival livre. Foi proposto, portanto, um tratamento reabilitador envolvendo uma abordagem multidisciplinar de forma a resgatar e restabelecer estética, função e bem-estar através do enxerto gengival livre para melhorar as características de mucosa e viabilizar uma previsibilidade de uma prótese definitiva implantosuportada em condições teciduais mais estáveis. O uso do EGL para aumento da gengiva queratinizada na cirurgia de implantes em paciente idosos é uma solução prática e segura para a manutenção da saúde periodontal ao redor do implante... (AU)

Peri-implant mucositis is considered the precursor of peri-implantitis, it is an inflammatory lesion of the peri-implant mucosa in the absence of continuous marginal bone loss. The purpose of this case report was to describe the treatment of peri-implant mucositis through free gingival graft surgery. Therefore, a rehabilitation treatment involving a multidisciplinary approach was proposed in order to rescue and reestablish aesthetics, function and well-being through the free gingival graft to improve the characteristics of the mucosa and enable a predictability of a permanent implant prosthesis under more stable tissue conditions. The use of EGL to increase keratinized gingiva in implant surgery in elderly patients is a practical and safe solution for maintaining periodontal health around the implant... (AU)

Toxicity of Baits and Their Effects on Population Suppression of Anastrepha fraterculus (Diptera: Tephritidae): Implications for Field Management.

Anastrepha fraterculus (Wiedemann, 1830) is the main pest of fruit in southern Brazil. The use of toxic baits is one of the alternatives for its management. In this study, the toxic baits Anamed + malathion (10,000 mg/liter), Flyral 1.25% + malathion (2,000 mg/liter), and Gelsura (alpha-cypermethrin, 2,000 and 4,000 mg/liter) were highly toxic to the adults of A. fraterculus (lethal time [LT50] < 7 h). In contrast, Success 0.02 CB had an LT50 of 48.4 h. In the absence of rain, all the formulations had residual effects (>90% mortality) on A. fraterculus adults up to 21 d after treatment (DAT). In the presence of 5, 25, and 50 mm of rainfall, there was a significant reduction in the residual effect over time. However, with up to 50 mm of rain, Anamed + malathion and Gelsura 2,000 and 4,000 mg/liter caused between 43.0 and 79.0% of mortality. In the field, during two consecutive seasons (2015/2016 and 2016/2017), applications of Gelsura 2,000 mg/liter (four applications/season) caused population suppression of the pest throughout the apple fruiting period. However, in the 2016/2017 season, in the area using Gelsura, a higher percentage (≈12%) of apple fruits damaged by A. fraterculus females was observed when compared with the area with insecticide application (damage <3%). The toxic bait Gelsura (2,000 and 4.000 mg/liter) was shown to be promising for use in the management of A. fraterculus, with results similar to those with the application of synthetic insecticides.

A Facile Preparation of a New Water-Soluble Acridine Derivative and Application as a Turn-off Fluorescence Chemosensor for Selective Detection of Hg2.

A new acridine-based chemosensor was prepared, characterized and investigated for quantitative detection of Hg2+ ions in aqueous solutions. DFT and TD-DFT calculations showed that formation of a coordination bond between Hg2+ and the thiolate-sensor accounts for the fluorescence quenching, forming [HgLSCl2]2- as the most stable species. Limit of detection and limit of quantification were as low as 4.40 and 14.7 µmol L-1, respectively (R2 = 0.9892, least squares method), and a linear concentration range of 14.7-100 µmol L-1. Benesi-Hildebrand and Job formalisms are in accordance with the formation of a stable complex with a 1:1 (metal ion/sensor) ratio, and a determined binding constant of 5.14 × 103 L mol-1. Robustness was verified based on the variation of several analytical conditions. In addition, the method presented maximum relative standard deviation of 4.6%, and recovery results was (90.3 ± 4,6)% from distilled water, with no effect of interfering ions. Analytical figures of merit showed that the sensor can be an attractive low cost alternative for detection of Hg2+.

Toxicities and Residual Effect of Spinosad and Alpha-Cypermethrin-Based Baits to Replace Malathion for Ceratitis capitata (Diptera: Tephritidae) Control.

Ceratitis capitata (Wiedemann, 1824) is the main insect pest of fruits worldwide. The objective of this study was to evaluate the toxicity and residual effects of the ready-to-use toxic baits Success 0.02CB (0.24 g of active ingredient [a.i.] per liter of spinosad) and Gelsura (6 g of a.i./liter of alpha-cypermethrin) and to compare them with other food lures containing spinosad and malathion mixed with hydrolyzed protein (Biofruit 5% and Flyral 1.25%), Anamed without dilution or sugarcane molasses (7%) against adult C. capitata in laboratory and greenhouse trials. Ceratitis capitata adults were highly susceptible to all toxic bait formulations (mortality > 80%) until 96 h after exposure. The lowest LT50 (hours) of toxic baits were 2.32 (Gelsura at 4,000 mg/liter), 4.26 (Gelsura at 2,000 mg/liter), 4.28 (Anamed + malathion) and 4.89 (sugarcane molasses + malathion), while formulations containing spinosad (Biofruit, Flyral, Anamed and Success 0.02CB) showed LT50 of approximately 11 h. Without rain, Gelsura (2,000 mg/liter) and all spinosad formulations provided mortality superior to 80% 14 d after application. Gelsura and Anamed + spinosad showed higher resistance to a 5-mm simulated rain, similar to Anamed + malathion, while the other formulations had its efficacy decreased. All toxic baits were effective on adult C. capitata in residual experiments without rain while Anamed + spinosad caused high adult mortality after 5 to 25 mm rains. Gelsura and Anamed + spinosad can be used to replace toxic baits containing malathion for C. capitata population management.

Puzzling Reaction of Imidazole with Methyl Parathion: P=S versus P=O Mechanistic Shift Dilemma in Organophosphates.

Organophosphates (OPs) constitute many toxic agrochemicals and warfare and can undergo a wide spectrum of mechanisms, some which are fairly unexplored. In this sense, concise mechanistic elucidation stands out as a strategic tool for achieving efficient detoxification and for monitoring processes. Particularly intriguing is the effect of substituting the oxygen atom of the phosphoryl moiety (P=O) in OPs with a sulfur atom to give the thio-derived OPs (i.e., OTPs, P=S). In general, imidazole (IMZ) reacts very efficiently with OPs by targeting the phosphorus atom, although herein we evidence a thio-driven shift with OTPs: IMZ undergoes unusual nucleophilic attack at the aliphatic carbon atom of methyl parathion. Alkylation of IMZ under mild conditions (aqueous weakly basic medium) is also novel and should be applicable to other novel IMZ-based architectures, and thereby, it can be a great ally for organic synthesis. Overall, a broader understanding of the mechanistic trend involved in such highly toxic agents is provided.

No Improvement on the Learning of Golf Putting By Older Persons With Self-Controlled Knowledge of Performance.

The aim of this study was to verify if older adults would benefit from a self-controlled schedule of knowledge of performance (KP) in the motor skill learning. The study's participants included 22 women and 18 men, with an average age of 68 years (SD = 2.95 years). These were divided into two groups: "Self," in which participants had control over when they received KP and "Yoked," in which participants received KP in a paired manner with the Self group. The learning task was golf putting. Results showed that the groups had similar scores for accuracy and consistency of performance. Results also showed that KP requests were more based on bad trials than good trials. It appears that the important variable for motor learning is not who controls the provision of feedback, but also the older adults' ability to use the information.

A acupuntura vai além da agulha: trajetórias de formação e atuação de acupunturistas / Acupuncture goes beyond the needle: trajectories of formation and action of acupuncturists

O objetivo deste estudo foi analisar as trajetórias de formação e a atuação profissional de acupunturistas. Trata-se de estudo de natureza qualitativa, baseado no referencial metodológico das narrativas de histórias de vida. Participaram oito profissionais de saúde ­ cinco homens e três mulheres ­, graduados em enfermagem, fisioterapia e medicina, que utilizavam a acupuntura a partir da perspectiva da medicina chinesa (MC) e que responderam a entrevistas semiestruturadas. A análise das narrativas resultou em três categorias centrais: busca por novas racionalidades em saúde; adentrando no universo da acupuntura; a acupuntura vai além da agulha. Observou-se que a busca pela acupuntura foi motivada pela insatisfação com a formação inicial no paradigma biomédico. A trajetória de formação na acupuntura foi gradativa e envolveu profunda inserção na racionalidade da MC, devido à complexidade de sua proposta terapêutica, o que os levou a entender que a inserção da agulha representa a confluência de diversos aspectos da racionalidade, não podendo ser reduzida a mera aplicação técnica. Nesse sentido, aponta-se a necessidade de discutir a formação desses profissionais e sua atuação no Sistema Único de Saúde, bem como a aplicabilidade da perspectiva biomédica de pesquisa nos estudos sobre acupuntura.

Fatigue and Its Associated Factors in Spinocerebellar Ataxia Type 3/Machado-Joseph Disease.

Fatigue has been described in several neurodegenerative diseases, reducing quality of life. A systematic evaluation of this clinical feature is lacking in SCA3/MJD. The aim of this study was to evaluate the frequency and the factors associated with fatigue in SCA3/MJD. Patients with SCA3/MJD and matched healthy controls answered the Modified Fatigue Impact Scale (MFIS), Beck Inventory Depression (BDI) and Epworth Sleepiness Scale (ESS). Scale for the assessment and rating of ataxia (SARA) was used to determine ataxia severity. We used Mann-Whitney and Fisher exact tests to compare mean scores and proportions between groups. Linear regression analyses were employed to investigate factors associated with fatigue in SCA3/MJD. Seventy-four patients were included with a mean age and disease duration of 47.2 ± 12.8 and 9.5 ± 6.37 years, respectively. There were 38 men and 36 women. Mean (CAG)n was 72.2 ± 3.8. Mean MFIS score was higher in patients with SCA3/MJD (41.4 ± 16.2 vs 18.4 ± 12.9, p < 0.001). According to BDI scores, relevant depressive symptoms were found in 69.4 % of patients but only in 10.4 % of controls (p < 0.001). The proportion of patients with ESS scores indicating excessive daytime somnolence was also higher than controls (37.5 vs 22.3 %, p = 0.05). In the multiple regression analysis, both BDI and ESS scores were associated with fatigue (r = 0.67, p < 0.001 and p = 0.01). Fatigue is frequent and strongly associated with depression and excessive daytime somnolence in SCA3/MJD.