Reliability of functional compressive bandaging in the treatment of lymphedema secondary to the treatment of breast cancer.

Functional compressive bandaging (FCB) is a therapeutic resource used to control lymphedema resulting from the treatment of breast cancer. However, the reliability of the technique is unknown. We evaluated intra- and inter-rater reliability of the spiral technique in the four-layer FCB of the arm and forearm in breast cancer survivors with lymphedema. Forty-five breast cancer survivors with a mean age of 64.88±10.01 years participated in the study. Evaluations were performed by two examiners at different times analyzing the pressure exerted (mmHg) by the spiral FCB in the arm and forearm of the upper limb affected by lymphedema. The intraclass correlation coefficient (ICC2,1) was used to determine intraand inter-examiner reliability, with a 95% confidence interval, minimum detectable change, and standard error of the measurement. Intrarater reliability was considered low to high in the arm and forearm region. Inter-rater reliability in the arm region was considered low and in the forearm region low to moderate. Our results indicate that spiral FCB has low to moderate intra-examiner and inter-examiner reliability.

Combined Bleaching Technique Versus At-home Bleaching-A Single-blind Randomized Controlled Trial.

OBJECTIVE: To compare the efficacy, color stability, and tooth sensitivity (TS) of combined bleaching, using a modified protocol with at-home bleaching. METHODS: Eighty participants were randomized into two groups. In the combined group, a desensitizing gel was applied (10 minutes) prior to in-office bleaching (35% hydrogen peroxide (H2O2), 2×15 minute applications) and at-home bleaching (4% H2O2, 2×30 minutes for 21 days) started the next day. In the at-home group, only the at-home bleaching was performed. Color was recorded at the beginning and postbleaching with two scales (VITA Classical and Bleachedguide) and Easyshade spectrophotometer. The TS was recorded daily with a 0-10 visual analogue scale (VAS) and five-point numeric rating scale (NRS). RESULTS: A 40% lower risk (RR=1.4; 95% CI 1.1-1.9) was observed in the at-home group. Higher color change and intensity of TS [mean difference 2.3 (95% CI 1.3-3.3) in the VAS] was observed in the first week for the combined group. After the end of the protocol, a bleaching degree was detected for both groups, with no significant difference between both groups (p>0.05). CONCLUSION: The combined group produced a slightly higher degree of color change than at-home bleaching but with a higher risk and intensity of TS.

Heritability and genetic correlation of body weight and Kleiber ratio in Limousin and Charolais beef cattle breeds.

Reducing the environmental impact of livestock production is now indispensable and genetic selection can be of great support for this purpose. Measures that can identify high body growth at low maintenance costs in production animals are particularly useful since resources have been increasingly limited. Therefore, the goal of this study was to estimate genetic parameters for BW and Kleiber ratio (KR) in 210-day-old and 365-day-old Charolais and Limousin breeds. A database comprising animals born from 1999 to 2018 was used in a multitrait model applying Bayesian inference. The heritability for BW is high in Charolais (0.39 and 0.42 for BW210 and BW365, respectively) and moderate in Limousin (0.22), indicating possible genetic gains for BW in both breeds. The genetic variability of KR should also allow satisfactory genetic gains. In addition, the genetic correlation between BW and KR ranged from low to moderate. Thus, selection over KR should have no effects on BW, showing that high body growth can be obtained without changes in efficiency.

Fístula de gerbode adquirida após cirurgia de correção valvar / Gerbod fistula acquired after valve repair surgery

INTRODUÇÃO: Fístula de Gerbode é uma comunicação entre o ventrículo esquerdo e o átrio direito (VE-AD). O defeito é raro, pode ser congênito ou adquirido. A forma adquirida é mais frequentemente observada após cirurgia valvar, endocardite ou infarto. Relataremos 2 casos de pacientes com fístula de Gerbode adquirida pós-intervenção valvar. Caso 1: Mulher, 56 anos, com diagnóstico pré-operatório de insuficiência mitral (IM) importante, fibrilação atrial, hipertensão pulmonar (HP) e insuficiência tricúspide (IT) discreta. Foi submetida à plastia mitral, tricúspide e exclusão de ambas as auriculetas. Um ano após a cirurgia, paciente assintomática, sem sinais de insuficiência cardíaca (IC), porém foi auscultado um sopro sistólico rude em borda esternal esquerda (BEE). O ecocardiograma transesofágico (ETE) demonstrou presença da fístula com 3,5mm do VE para o AD com gradiente de VE-AD de 95 mmHg, redução da HP (de 50 para 36 mmHg) e função do VD normal. A paciente foi mantido em observação. Caso 2: Homem, 61 anos, diagnóstico pré-operatório de IM importante primária, HP importante (PSAP 116mmHg) e IT moderada. Foi submetido a implante de bioprótese mitral e plastia tricúspide. Evoluiu com melhora sintomática e redução da HP. Foi observado sopro sistólico rude em BEE. O ETE demonstrou uma fístula VE-AD, com gradiente de 92 mmHg. Paciente assintomático, sem repercussão hemodinâmica, mantido em tratamento conservador. DISCUSSÃO: Na literatura, a evolução de casos com a fístula varia desde assintomáticos até desfechos desfavoráveis como insuficiência cardíaca, endocardite e necessidade de oclusão da fístula. Apesar de ser relatado como defeito raro, a incidência está aumentando devido ao maior número de intervenção cirúrgica. O diagnóstico é difícil e muitas vezes necessário complementação com ETE para melhor definição do tamanho e localização do defeito e para melhor programação da correção quando houver indicação. A intervenção pode ser cirúrgica ou percutânea. Em paciente assintomáticos, defeitos pequenos e sem sobrecarga de VD podem ser mantidos em conduta conservadora desde que com acompanhamento frequente. CONCLUSÃO: Foram relatados dois casos de fístula de Gerbode (comunicação entre o VE e o AD) adquiridas após cirurgia de correção valvar. Ambos os pacientes relatados foram tratados clinicamente, estão em CF I, sem alterações das câmaras cardíacas.

Effect of Daily Usage Time of 4% Hydrogen Peroxide on the Efficacy and Bleaching-induced Tooth Sensitivity: A Single-blind Randomized Clinical Trial.

OBJECTIVE: Compare the risk/intensity of tooth sensitivity (TS) and color change of a 30-minute vs. the recommended 120-minute application time of 4% hydrogen peroxide (HP) for at-home bleaching. METHODS: A single-blind, parallel, randomized clinical trial was conducted with 92 adult patients with caries and restoration-free anterior teeth A2 or darker, randomly allocated to two groups. Bleaching trays containing 4% HP were used for three-weeks. A four-week regimen was also offered to the patients for the 30-min group after the end of the 3-week protocol. The color change was assessed with the Vita Classical (VITA Zahnfabrik, Bad Säckingen, Germany) and Vita Bleachedguide shade guides (VITA Zahnfabrik) and the Vita Easyshade spectrophotometer (VITA Zahnfabrik) at baseline, weekly, and 30 days after the bleaching. The absolute risk and the intensity of TS were assessed daily using the 0-10 visual analogue scale (VAS) and 5-point Numerical Rating Scale (NRS) scale, and patient satisfaction was recorded with a Likert 0-7 scale. Risk of TS (Fisher's test), intensity of TS in NRS scale (Mann-Whitney test), VAS scale (t-test), and a color change (t-test) were compared. RESULTS: The 30-minute group saw color change of around 1 SGU inferior to the 120-minute group in all-time assessments (p<0.05). After an extra week of bleaching, mean color change was similar (p>0.05). Patient satisfaction was high for both groups (p>0.05). CONCLUSIONS: A four-week protocol of at-home dental bleaching with 4% HP for 30 minutes/day whitened teeth similarly to the 120 minutes/day protocol, with low intensity of dental sensitivity and high patient satisfaction.

Evaluation of At-home Bleaching Times on Effectiveness and Sensitivity with 10% Hydrogen Peroxide: A Randomized Controlled Double-blind Clinical Trial.

OBJECTIVES: The aim of this randomized double-blind controlled clinical trial was to evaluate different protocols for at-home use of 10% hydrogen peroxide in whitening effectiveness and tooth sensitivity. METHODS: Seventy-two patients were selected according to the inclusion and exclusion criteria, with the upper central incisors having color A2 or darker according to the Vita Classical scale (VITA Zahnfabrik, Bad Säckingen, Germany) and randomized into two groups: 10% hydrogen peroxide applied once daily for 15 minutes (HP 15) or applied once daily for 30 minutes (HP 30). Bleaching was performed for 14 days in both groups. The color was evaluated before bleaching, during bleaching (1st and 2nd weeks), and 1 month after the bleaching treatment using the Vita Classical, Vita Bleachedguide 3D-MASTER, and Vita Easyshade spectrophotometer (VITA Zahnfabrik). Dental sensitivity was recorded by the patients using the numerical rating scale (0-4) and visual analogue scale (0-10 cm). Color data were evaluated by two-way analysis of variance (ANOVA) of repeated measures (group vs. treatment time). The Mann-Whitney test was performed to contrast the means (α=0.05). Tooth sensitivity was assessed by Fisher's exact test (p=1.00) and intensity of tooth sensitivity was evaluated by the Mann-Whitney test (α=0.05) for both scales. RESULTS: A significant whitening effect was observed after 2 weeks of bleaching for all color measurements (p=0.01), with no difference between HP 15 and HP 30 (p>0.05). Also, the absolute risk and intensity of tooth sensitivity were similar (47%; p>0.05). CONCLUSIONS: The effectiveness and tooth sensitivity of at-home bleaching carried out with 10% hydrogen peroxide applied for 15 minutes or 30 minutes are similar.

Topical application of a desensitizing agent containing potassium nitrate before dental bleaching: a systematic review and meta-analysis.

OBJECTIVES: To conduct a systematic review and meta-analysis to evaluate the risk and intensity of tooth sensitivity (TS) after topical application of desensitizers containing potassium nitrate before dental bleaching. METHODS: We searched PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and SIGLE. We also surveyed gray literature without restrictions. We meta-analyzed the data using the random-effects model to compare potassium nitrate and placebo in terms of risk and intensity of TS and color change (∆SGU or ∆E). The quality of the evidence was rated using the GRADE approach. The risk of bias (RoB) of the included studies was analyzed using the Cochrane RoB tool. RESULTS: After the database screening, 24 articles remained. A significant 12% lower risk for the groups where desensitizing agents were applied (p = 0.02), with a risk ratio of 0.88 (95% CI 0.78 to 0.98). About the intensity of TS, a significant average mean difference of - 0.77 units of VAS units (95%CI - 1.34 to - 0.19; p = 0.01) in favor of the desensitizer group. In the NRS scale, a significant average mean difference of - 0.36 (95% CI - 0.61 to - 0.12; p value = 0.004) in favor of the desensitizer group. No significant difference was observed in color change (p > 0.28) in ∆SGU and ∆E. CONCLUSIONS: Although a significant reduction in the risk and intensity of TS was observed in groups treated with a potassium nitrate at some point during the bleaching, the clinical significance of this reduction is subtle and clinically questionable. Color change is not affected by the use of agents. CLINICAL RELEVANCE: The reduction in the risk and intensity of TS with the topical application of potassium nitrate-based desensitizing agents in dental bleaching is subtle and maybe clinically questionable.

Improved function and strength in patients with knee osteoarthritis as a result of adding a two-day educational program to usual care. Prospective randomized trial.

Objective: The primary aim was to quantify the improvements on function and pain of patients with knee osteoarthritis (KOA), short education and low income by a two-day self-management program. Secondary aims were verifying if the program improves clinically relevant measures of weight and strength. Design: A prospective randomized clinical trial was conducted in a tertiary hospital in Brazil with 191 patients with Kellgren & Lawrence grades II and III KOA who were allocated to two groups: control (usual care- CG) and intervention (usual care and two days of an OA self-management program with a multiprofessional team - IG). Western Ontario and McMaster Universities Index (WOMAC), weight, body mass index (BMI), Timed up and go (TUG) and five Times Sit to Stand Test (FTSST) were assessed at baseline, six, 12 and 24 months. Results: Groups were similar at baseline (p â€‹> â€‹0.05). Both groups exhibited improved WOMAC total and subsets scores throughout the study (p â€‹< â€‹0.001). However, only IG improved WOMAC total and subsets in all follow-ups above 20% (minimally clinically important difference), with differences in WOMAC pain, function and total scores (p â€‹= â€‹0.001, p â€‹< â€‹0.001, and p â€‹< â€‹0.001, respectively) and best effect sizes at 1 year (0.355, 0.651 and 0.770, respectively). IG group lost weight (p â€‹< â€‹0.001) and BMI (p â€‹< â€‹0.01). Both groups exhibited improvements in TUG and FTSST (p â€‹< â€‹0.001) that remained in all evaluations. FTSST results favored the IG, p â€‹= â€‹0.032. Conclusions: An educational program to patients with KOA, short schooling and low income improves clinically important measures of pain and function.

Transarterial Treatment of Cranial Dural Arteriovenous Fistulas: The Role of Transarterial and Transvenous Balloon-Assisted Embolization.

BACKGROUND AND PURPOSE: Treatment of dural arteriovenous fistulas can be performed by transarterial or transvenous accesses. For those fistulas located at a dural sinus wall, obliteration of the sinus might lead to a substantial risk of complications if the occluded sinus impairs normal venous drainage. For those fistulas with direct leptomeningeal venous drainage, navigation to reach the arteriovenous shunting point of a leptomeningeal vein is usually technically demanding. We report the outcomes of patients with dural AVFs treated by transarterial injection of liquid embolic agents assisted by transarterial double-lumen balloon catheters and/or transvenous balloon catheters. MATERIALS AND METHODS: This was a retrospective, 3-center study including patients with dural AVFs treated with a balloon-assisted technique in at least 1 treatment session. Angiographic follow-up was performed at 6 months. Clinical assessment was performed at admission and discharge and was reassessed at 30-day and 6-month follow-ups. RESULTS: Forty-one patients with 43 dural AVFs were treated. Thirty-four fistulas were located at a dural sinus wall. Treatment was performed using only a transarterial approach in 42 fistulas. Only 1 session was needed for complete obliteration of the fistula in 86% of the patients. Immediate complete angiographic occlusion was achieved in 39 fistulas. Of the 41 controlled fistulas, 40 (97.6%) were completely occluded at 6 months. Thirty-nine fistulas (95.1%) were cured without any report of major neurologic events or death during follow-up. CONCLUSIONS: Transarterial balloon-assisted treatment of dural AVFs with or without transvenous balloon protection was shown to be safe and effective.

Variações fisiológicas, influência da idade e sexo no perfil bioquímico sanguíneo de aves da linhagem pesada de frango de corte na fase de recria / Physiological variations and influence of age and gender on poultry of heavy lineage of chicken´s biochemical profile during the rearing stage

Este estudo teve o objetivo de comparar o perfil bioquímico sérico de machos e fêmeas da linhagem pesada de frango de corte, nas idades de quatro, 12 e 20 semanas, em uma unidade de produção industrial, no município de Uberlândia-MG. Após a pesagem das aves, foram coletadas amostras de sangue de 15 aves de cada sexo de cada faixa etária. Os soros obtidos foram avaliados em analisador automático para os seguintes parâmetros bioquímicos: proteína total, albumina, globulinas, ácido úrico, colesterol, triglicérides, gamaglutamiltransferase, aspartato aminotransferase, alanina aminotransferase, creatina quinase, fosfatase alcalina, cálcio e fósforo. Imediatamente após a coleta de cada amostra, avaliou-se a glicemia no sangue total, utilizando-se um glicosímetro. As alterações fisiológicas e metabólicas que as aves apresentaram na fase de recria refletiram na variação dos níveis bioquímicos séricos na maioria dos constituintes avaliados, os quais exibiram diferenças significativas (P<0,05), comparando-se sexo e idade.(AU)

This study aimed to compare the levels of glucose in the blood and serum´s metabolites enzymes and minerals of poultry of heavy lineage of chicken at the age of four, twelve and twenty weeks in an industrial production unit in the city of Uberlândia-MG. After weighing the birds, blood samples were collected from 15 birds of each gender in the three ages. The serum obtained was evaluated in an automatic biochemical analyzer for the following parameters: total protein, albumin, globulin, uric acid, cholesterol, triglycerides, alkaline phosphatase, gamma-glutamyl transferase, aspartate aminotransferase, alanine aminotransferase, creatine kinase, calcium and phosphorus. Immediately after the collection of each sample, we evaluated glucose levels by means of a glycosimeter. The physiological and metabolic changes that birds present in the rearing age reflected in the variation of serum biochemical levels in most constituents evaluated, showing significant differences (P< 0.05) comparing age and gender.(AU)

Randomized 36-month follow-up of posterior bulk-filled resin composite restorations.

OBJECTIVE: The aim of this double blind, randomized controlled trial was to evaluate the 36-month clinical performance of the layering technique (incremental [IF] vs. bulk-fill [BF]) in posterior composite resin restorations bonded with self-etch (SE) and etch-and-rinse (ER) strategies. METHODS: Posterior dental cavities of 72 participants (n = 236), with a cavity depth of at least 3 mm, were randomly divided into four groups. The restorations were bonded using either the Tetric N-Bond ER or Tetric N-Bond SE. The composite resin Tetric N-Ceram Bulk-Fill was placed either IF or using BF. Two experienced and calibrated examiners evaluated the restorations using FDI criteria in the baseline and after 12, 24 and 36-month. The statistical analyses were performed using the Wilcoxon Signed rank test (α = 0.05) RESULTS: After 36-month, 14, 21 and 33 restorations showed minor fractures, marginal desadaptation and color mismatch, respectively (p > 0.05). Thirty-three restorations showed some marginal discoloration after 36-month with significant difference between ER (3 for ER-IF; 3 for ER-BF) and SE (14 for SE-IF; 12 for SE-BF; p < 0.05). CONCLUSION: The BF technique showed excellent clinical performance, which was comparable during the 36-month of clinical evaluation with the 2-mm IF and it was not affected by the adhesive strategy. However, using the ER strategy reduces the risk of some marginal discoloration, irrespectively of the filling technique. CLINICAL RELEVANCE: The bulk-fill material showed excellent clinical behavior when compared to its use in an incremental filling technique, mainly when associated to etch-and-rinse adhesive material after 3 years of clinical evaluation.

Highly porous multiwalled carbon nanotube buckypaper using electrospun polyacrylonitrile nanofiber as a sacrificial material.

Polyacrylonitrile (PAN) was solubilized in N,N-dimethyl formamide (DMF) and the electrospinning process has been employed to obtain PAN nanofibers (PF). Multiwalled carbon nanotubes (MWCNT) were dispersed with the aid of Triton X-100 surfactant and subsequently centrifugated. Buckypapers (BP/PF) were prepared by vacuum filtration procedure of MWCNT suspension supernatant stacking four PF layers over a nylon membrane. The PF removal was carried out by immersing the BP/PF system in DMF and removal periods of 10 and 30 min were evaluated. Scanning electron microscopy (SEM) has not shown any PAN residue in the MWCNT network resulting in highly porous BP. However, by Fourier transform infrared spectroscopy (FT-IR) a PAN band was found around of 2243 cm-1 corresponding to nitrile group (C≡N). Besides, PAN leftover was evidenced by thermogravimetric analysis (TGA), high-resolution transmission electron microscopy (HR-TEM), electrical characterization through four-point probe, nitrogen adsorption at 77 K, and X-ray diffraction (XRD).

Tooth Sensitivity After Dental Bleaching With a Desensitizer-containing and a Desensitizer-free Bleaching Gel: A Systematic Review and Meta-analysis.

OBJECTIVES:: A systematic review and meta-analysis were performed to evaluate the risk and intensity of tooth sensitivity (TS) after dental bleaching with a desensitizer-containing and a desensitizer-free bleaching gel in adult patients. Color change and risk of gingival sensitivity was also evaluated. METHODS:: A comprehensive search was performed MEDLINE via PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database (LILACS), Brazilian Library in Dentistry (BBO), EMBASE and Cochrane Library, and System for Information on Grey Literature in Europe (SIGLE) without restrictions to identify randomized clinical trials. Abstracts from the annual conference of the International Association for Dental Research (1990-2016), unpublished and ongoing trials registries, dissertations, and theses were also searched. The quality of the evidence was rated using the Grading of Recommendations: Assessment, Development and Evaluation (GRADE) approach. DATA:: After duplicates were removed, 1352 articles were identified. After title and abstract screening, only 47 studies remained for qualitative evaluation. Most of the studies had unclear risk of bias. No difference between groups were observed for the risk ratio of TS (risk ratio = 0.99; 95% confidence interval [CI] = 0.74-1.33); intensity of TS (standardized difference in means [SMD] = 0.04; 95% CI = 0.79-0.70); color change in shade guide units (SMD - 0.04; 95% CI = 0.50-0.42); color change in ΔE* (SMD = 0.41 (95% CI = 0.07-0.89); and risk ratio of gingival irritation (SMD = 1.05; 95% CI = 0.81-1.36). Except for the risk of TS, graded as moderate quality of evidence, all other outcomes were rated as low and very low quality. CONCLUSIONS:: Incorporating desensitizers in the bleaching gel did not reduce the risk of TS, and the quality of this evidence was considered moderate. On the other hand, the intensity of TS, color change, and risk of gingival irritation was similar between groups, but the quality of the evidence for these outcomes was graded as low or very low, thus reducing the level of confidence in these outcomes.

Clinical Study of Bleaching Gel Storage Temperature on Tooth Color and Sensitivity.

OBJECTIVE: The objective of this triple-blind, split-mouth, randomized clinical trial was to evaluate the bleaching efficacy and tooth sensitivity of an in-office bleaching agent submitted to different storage temperatures (room temperature at 21.04°C±3.13°C or refrigeration at 5°C). METHODS AND MATERIALS: Thirty volunteers were selected who had central incisors with color A2 or higher. The volunteers' maxillary hemi-arches received either the bleaching treatment with room temperature or refrigerated storage temperatures (two sessions of 3×15 minutes, one-week interval). Color variation was evaluated by subjective (Vita Classic and Vita Bleachedguide) and objective methods (Vita Easyshade spectrophotometer). Tooth sensitivity was evaluated with the visual analog scale (0-10) and the numerical rating scale (five points). The consistency of bleaching gels was evaluated by flow test, and pH was measured, both in triplicate. Color variation (SGU) and ΔE were analyzed by paired t-test (α=0.05). The absolute risk of pain was assessed by McNemar test (α=0.05), data from the numerical rating scale by the Wilcoxon signed-rank test (α=0.05), and visual analog scale by paired t-test. Comparison between the times within each group was analyzed by Friedman test. Gel consistency and pH were analyzed by one-way analysis of variance and Tukey post-test. RESULTS: Regarding the absolute risk of tooth sensitivity, no significant difference was observed between the groups. The relative risk for tooth sensitivity was 1.13 (95%, confidence interval 0.70-1.82). Both tooth sensitivity scales were statistically similar. The results of the subjective evaluation (Vita Classic: p=0.73, Vita Bleachedguide: p=1.00) and the objective evaluation (p=1.00) of bleaching efficacy corresponded to the hypothesis of equality between groups after bleaching. Both pH values were around 7, and for the consistency test, there were significant differences between the groups (p=0.002). CONCLUSIONS: Storage temperature of the analyzed in-office bleaching agent had no influence on tooth color effectiveness and tooth sensitivity.

Analgesic efficacy of ketorolac associated with a tramadol/acetaminophen combination after third molar surgery - a randomized, triple-blind clinical trial.

BACKGROUND: This study compared the efficacy of ketorolac alone versus its combination with tramadol/acetaminophen for pain control after mandibular third molar surgery. MATERIAL AND METHODS: A randomized, triple-blind clinical trial was carried out with 52 patients divided into 2 groups: Group K+T+A (1 tablet of Ketorolac 10 mg plus and 1 capsule of Tramadol 37.5 mg/acetaminophen 325 mg) and Group K (1 tablet of Ketorolac 10 mg plus and 1 placebo capsule). The treatments were given 1 h before the surgery and was repeated 4 times per day, for 48 h. The difference in postoperative pain was assessed by 4 primary end-points: pain intensity (VAS 100mm, for 48 h), rescue medication, overall assessment and adverse effects. RESULTS: Significant differences in pain intensity were observed in the different times (p < 0.05). The comparison of groups in each time showed significant differences only of 9 h, with lower level of pain intensity for group K+T+A (p = 0.005). The need of analgesics was higher in Group K (p < 0.001), the need of antiemetic were greater in Group K+T+A (p < 0.0001). No significant difference between groups were observed in overall assessment. The adverse effects was higher in Group K+T+A. CONCLUSIONS: The current study showed that both ketorolac and the combination of ketorolac plus tramadol/acetaminophen showed good control of pain after the extraction of the lower third molars. Although the combination group showed lower pain at 9 h, the difference is small and not clinically relevant.

Performance of rapid prescreening and 100% rapid review as internal quality control methods for cervical cytopathology.

BACKGROUND: An objective of quality control for cervical cytopathology is reducing high rates of false-negative results of laboratory tests. Therefore, methods to review smears such as rapid prescreening and 100% rapid review, which have shown better performance detecting false-negative results, have been widely used. The performance of rapid prescreening and the performance of 100% rapid review as internal quality control methods for cervical cytology examinations were evaluated. METHODS: For 24 months, 9318 conventional cervical cytology smears underwent rapid prescreening and routine screening. The 100% rapid review method was performed for 8244 smears classified as negative during routine screening. Any discordant results underwent detailed review to define the final diagnosis. This was considered the gold standard for evaluating the performance of rapid prescreening and 100% rapid review. RESULTS: Routine screening showed increases of 13.3% and 11.5% in the detection of abnormal smears with rapid prescreening and 100% rapid review, respectively. The relative percentage variation showed a 38.1% increase in the diagnosis of atypical squamous cells of undetermined significance with routine screening and rapid prescreening and a 12.5% increase in the diagnosis of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion with both rapid prescreening and 100% rapid review. Sensitivity rates of rapid prescreening and routine screening were 48.2% and 83.2%, respectively. Sensitivity rates of rapid prescreening and 100% rapid review were 65.7% and 57.8%, respectively, for detecting false-negative results. CONCLUSIONS: Inclusion of rapid prescreening and/or 100% rapid review improved the diagnostic sensitivity of the cervical cytology examination and reduced false-negative results of routine screening and can provide good quality control.

Effectiveness of and Dental Sensitivity to At-home Bleaching With 4% and 10% Hydrogen Peroxide: A Randomized, Triple-blind Clinical Trial.

OBJECTIVES: To evaluate the risk for and intensity of tooth sensitivity and color change of at-home dental bleaching with 4% and 10% hydrogen peroxide (HP). METHODS: For this study, 78 patients were selected according to the inclusion and exclusion criteria and randomized into two groups: HP 4 (White Class 4%, FGM) and HP 10 (White Class 10%, FGM). In both groups, the at-home bleaching was performed for a period of 30 minutes twice a day for two weeks. The color was assessed by Vita Classical, Vita Bleachedguide 3D-MASTER and spectrophotometer Vita Easyshade (Vita Zahnfabrik) at baseline, during bleaching (first and second weeks) and after bleaching (one month). Patients recorded their tooth sensitivity using a numeric rating scale (0-4) and visual analog scale (0-10). Data from color change (DeltaE data) was submitted to two-way analysis of variance. The color change data in Delta SGU from the two shade guide units were compared with the Mann Whitney test. The risk of tooth sensitivity was evaluated by χ2 test and the intensity of tooth sensitivity from both scales was evaluated by a Mann-Whitney test (α=0.05). RESULTS: The absolute risk and intensity of tooth sensitivity was higher in the group that used HP 10 than the one that used HP 4. Data from change in the number of shade guide units and color variation after one month of bleaching for both groups showed significant whitening, with no difference between groups. CONCLUSIONS: At-home bleaching is effective with 4% and 10% HP concentrations, but 10% HP increased the absolute risk and intensity of tooth sensitivity during at-home bleaching.

Combination of Acetaminophen/Codeine Analgesics Does Not Avoid Bleaching-Induced Tooth Sensitivity: A Randomized, Triple-Blind Two-Center Clinical Trial.

Bleaching-induced tooth sensitivity (TS) is highly prevalent. OBJECTIVE: This study aimed to determine if the combination of opioids and nonopioids analgesics (Tylex) may provide a better analgesic effect. METHOD: A triple-blind, parallel, randomized two-center clinical trial was conducted with 105 healthy patients who received either a placebo or a combination of acetaminophen/codeine. The first dose of Tylex 30 mg (acetaminophen 500 mg/codeine 30 mg) or placebo was administered one hour before the in-office bleaching (35% hydrogen peroxide), and extra doses were administered every six hours for 48 hours. The TS was recorded using a visual analog scale of 0 to 10 and a numeric rating scale of 0 to 4 in different periods: during bleaching, one hour up to 24 hours, and 24 hours up to 48 hours postbleaching. The color was measured before and one month after dental bleaching with a visual shade guide (Vita Classical), Vita Bleachedguide 3D-MASTER, and the spectrophotometer Vita Easyshade. The absolute risk of TS was evaluated using the Fisher exact test. Data of TS intensity with numeric rating scale of the two groups were compared with the Mann-Whitney U-test and the Friedman test, while data from the visual analog scale were evaluated by two-way repeated measures analysis of variance and the Tukey test for pairwise comparison. The color changes between groups were compared using the Student t-test (α=0.05). RESULTS: No significant differences between the groups were observed in the risk and intensity of TS. The overall absolute risk of TS was approximately 96%. No significant differences between groups were observed in terms of color change ( p>0.05) for any scale. CONCLUSION: The use of an acetaminophen/codeine combination prior to in-office bleaching does not reduce the risk and intensity of bleaching-induced TS.

Nutritional content of bat-consumed fruits in a forest fragment in Southern Brazil / Conteúdo nutricional de frutos consumidos por morcegos em um fragmento florestal do sul do Brasil

Abstract The State Park Mata dos Godoy has 42 identified bat species, among which 21 are frugivorous and belong to the Phyllostomidae family. Current study investigated the concentrations of carbohydrate, lipid and protein in fruits consumed by Artibeus lituratus, Carollia perspicillata and Sturnira lilium to understand their potential differentiated food preferences. The Sampling effort it was from April/2013 to March/2014. Animals captured in mist nets were identified in the field and maintained in cotton bags for 30 minutes to defecate. The diet was inferred from fecal samples analyzed in the laboratory, the fruits whose seeds were found in the feces had the determinations of the nutrients accomplished by centesimal composition method. Kruskal-Wallis test and Dunn's multiple comparison method verified the most abundant nutrients for each species of bat. Whereas Carollia perspicillata and Sturnira lilium feeds mainly in food with carbohydrates that provide them with more energy, the diet of Artibeus lituratus is richer in carbohydrates and lipids. Only fruits considered scarcely represent a complete nutrition for the three bat species, however, the complementarity with other food items such as leaves, pollen, and insects, can provide a complete nutrient diet for these animals.

Resumo O Parque Estadual Mata dos Godoy possui 42 espécies descritas de morcegos, dentre as quais 21 são frugívoras e representadas pela família Phyllostomidae. O objetivo foi verificar qual a concentração de carboidratos, lipídeos e proteínas nos frutos consumidos por Artibeus lituratus, Carollia perspicillata, e Sturnira lilium para entender suas preferências alimentares diferenciadas. A amostragem se deu de abril/2013 a março/2014. Os animais capturados em redes de neblina foram identificados em campo e alocados em sacos de algodão por 30 minutos para defecarem. A dieta foi inferida a partir de amostras fecais analisadas em laboratório, os frutos cujas sementes foram encontradas nas fezes tiveram as determinações dos nutrientes realizadas por composição centesimal. Para verificar qual nutriente mais abundante na dieta foi realizado, para cada espécie de morcego, o teste de Kruskal Wallis seguido do método de comparações múltiplas de Dunn. Enquanto que Carollia perspicillata e Sturnira lilium alimentam-se de frutos que provém energia a partir de mais carboidratos, a dieta de Artibeus lituratus é rica não apenas em carboidratos como também lipídeos. Apenas os frutos analisados não representam uma nutrição completa para as três espécies de morcegos, no entanto, a complementariedade com outros itens alimentares como folhas, pólen e insetos, pode fornecer uma dieta completa em nutrientes para estes animais.

Effect of acidity of in-office bleaching gels on tooth sensitivity and whitening: a two-center double-blind randomized clinical trial.

OBJECTIVES: The study aimed to compare the tooth sensitivity (TS) and bleaching efficacy of two hydrogen peroxide gels with different pHs (acid pH [Pola Office, SDI] and the neutral pH [Pola Office+, SDI]) used for in-office bleaching. MATERIALS AND METHODS: Fifty-four patients from Brazil and Chile, with right superior incisor darker than A2, were selected for this double-blind, split-mouth randomized trial. Teeth were bleached in two sessions, with 1-week interval. Each session had three applications of 8 min each, according to the manufacturer's instructions. The color changes were evaluated by subjective (Vita Classical and Vita Bleachedguide) and objective (Easy shade spectrophotometer) methods. Participants recorded TS with 0-10 visual analog scale. Color change in shade guide units (SGU) and ΔE was analyzed by Student's t test (α = 0.05). The absolute risk and intensity of TS were evaluated by McNemar's test and Wilcoxon-paired test, respectively (α = 0.05). RESULTS: All groups achieved the same level of whitening after 30 days of clinical evaluation. The use of a neutral in-office bleaching gel significantly decreases the absolute risk of TS (28%, 95% CI 18-41) and intensity of TS when compared to the acid bleaching gel (absolute risk of 50%, 95% CI 37-63). CONCLUSION: The use of a neutral in-office bleaching agent gel produced the same whitening degree than an acid bleaching gel but with reduced risk and intensity of tooth sensitivity. CLINICAL SIGNIFICANCE: Clinicians should opt to use in-office bleaching with a neutral gel than an acid product because the former causes a significant lower risk and intensity of tooth sensitivity.