Snakebite envenoming in Brazilian children: clinical aspects, management and outcomes.

Snakebite envenoming is currently considered a neglected tropical disease, which affects over 5 million people worldwide, and causes almost 150 000 deaths every year, as well as severe injuries, amputations and other sequelae. Snakebite envenoming in children, although proportionally less frequent, is generally more severe, and represents an important challenge for pediatric medicine, since they often result in worse outcomes. In Brazil, given its ecological, geographic and socioeconomic characteristics, snakebites are considered an important health problem, presenting approximately 30 000 victims per year, approximately 15% of them in children. Even with low snakebite incidence, children tend to have higher snakebite severity and complications due to the small body mass and same venom volume inoculated in comparison to adults, even though, due to the lack of epidemiological information about pediatric snakebites and induced injuries, it is difficult to measure the treatment effectiveness, outcomes and quality of emergency medical services for snakebites in children. In this review, we report how Brazilian children are affected by snakebites, describing the characteristics of this affected population, clinical aspects, management, outcomes and main challenges.

Q-Meter: Quality Monitoring System for Telecommunication Services Based on Sentiment Analysis Using Deep Learning.

A quality monitoring system for telecommunication services is relevant for network operators because it can help to improve users' quality-of-experience (QoE). In this context, this article proposes a quality monitoring system, named Q-Meter, whose main objective is to improve subscriber complaint detection about telecommunication services using online-social-networks (OSNs). The complaint is detected by sentiment analysis performed by a deep learning algorithm, and the subscriber's geographical location is extracted to evaluate the signal strength. The regions in which users posted a complaint in OSN are analyzed using a freeware application, which uses the radio base station (RBS) information provided by an open database. Experimental results demonstrated that sentiment analysis based on a convolutional neural network (CNN) and a bidirectional long short-term memory (BLSTM)-recurrent neural network (RNN) with the soft-root-sign (SRS) activation function presented a precision of 97% for weak signal topic classification. Additionally, the results showed that 78.3% of the total number of complaints are related to weak coverage, and 92% of these regions were proved that have coverage problems considering a specific cellular operator. Moreover, a Q-Meter is low cost and easy to integrate into current and next-generation cellular networks, and it will be useful in sensing and monitoring tasks.

Granular cell tumors of the sellar region: what should be done after subtotal resection? A systematic review.

PURPOSE: Granular cell tumors (GCT) are highly vascularized and adherent to adjacent structures, and so, complete resection represents a challenge. Adjuvant therapy decisions for residual GCTs currently relies on individual clinician decisions due to a paucity of systematic literature data. We present a comprehensive analysis about the impact of adjuvant therapy in reported cases of patients with incomplete GCT resection. METHODS: One database (PubMed) and crossed references were queried for GCT with incomplete resection or biopsy from 1962 to 2020. Literature review was performed according to the PRISMA guidelines. Also, two patients with residual GCT from our institutions are added to the analysis. Data regarding clinical presentation, surgical approach, use of adjuvant therapy, Ki-67 labeling, and follow up assessments were extracted and analyzed from selected publications. RESULTS: Thirty-three studies met the predetermined inclusion criteria and 53 patients were selected (including our two reported cases). The median of age was 49 [IQR, 39-60 years], with a slight male predominance (1.2:1). Among the surgical procedures, seven (13%) were biopsies alone. Adjuvant therapy was used in 18 patients (radiotherapy, 94.5%; chemotherapy, 5.5%) but there is no statistical correlation with adjuvant therapy and the progression of the remnant tumor (p = 0.33). Our institutions' patients did not receive adjuvant therapy and did not show tumor progression on MRI. CONCLUSION: Our systematic literature review suggests there is a limited role for chemo and/or radiotherapy in the management of incomplete GCT resection. It may be reasonable recommending close clinical follow up in patients with incomplete resection.

Salvage Free Tissue Transfer for Clival Osteoradionecrosis After Repeat Proton Beam Therapy.

BACKGROUND: Craniocervical junction chordoma treated with surgery and Proton Beam Therapy evolved with Osteonecrosis and CSF leak. As the vascularization of the head was compromised, we harvested an Anterolateral thigh musculofascial flap to seal the leak. CASE DESCRIPTION: A 56-year-old man presented with a history of chronic headaches and dysarthria with tongue deviation to the right. Magnetic resonance imaging showed a lesion at the craniocervical junction with imaging characteristics compatible with chordoma. Endoscopic endonasal resection was followed by proton beam therapy. Recurrence of the chordoma was subsequently resected via far lateral approach again followed by proton beam therapy accumulating a total dose of 75 Gy. Unfortunately, this led to osteoradionecrosis of the skull base resulting in a cerebrospinal fluid (CSF) leak more than 1 year after treatment. After multiple failed attempts to seal the defect using local vascularized tissue and free fat grafts, the defect was reconstructed with a vastus lateralis free tissue transfer. Six weeks later, the flap had mucosalized, the patient was pain free, and there was no evidence of a CSF leak. CONCLUSIONS: In select cases, vascularized free flaps offer a superior reconstruction for osteoradionecrosis because radiotherapy often compromises the blood supply of local tissues.

Avaliação da influência da contaminação salivar na resistência de sistema adesivo autocondicionate de dois passos / Influence of Saliva contamination on the bonding resistance of a two-step self-etching

Este estudo teve o objetivo de avaliar a influência da contaminação salivar sobre a resistência de união (RU) em dentina de um sistema adesivo autocondicionante de dois passos. Sessenta dentes bovinos foram incluídos e lixados para exposição de dentina superficial, onde foi preparado smear layer padronizado. Seis grupos (n=10) foram divididos de acordo com os fatorers de variação: momento da contaminação [antes do sistema adesivo (G2 e G3); após aplicação do primer (G4); e após a aplicação do bond (G5 e G6)] e tratamento do contaminante [secagem (G2, G4 e G5) ou lavagem (G3 e G6)]. No grupo controle (G1), não houve contaminação. O sistema adesivo Clearfil SE Bond (SE) foi utilizado de acordo com as recomendações do fabricante. A contaminação foi efetuada com saliva aplicada sobre a área de dentina exposta, sendo o contaminante lavado por 10 segundos com jato de água ou secado por 10 segundos com jato de ar. A resina composta (Filtek Z-250, 3M ESPE) foi utilizada para montar os corpos-de-prova, que foram tracionados após 24 horas de estocagem em água a 37ºC. Os resultados obtidos (em MPa) foram avaliados por meio do teste ANOVA e comparados através do intervalo de confiança. Os resultados obtidos [G1-24,27(±2,82); G2-18,71(±5,51); G3-19,90(±4,56); G4-17,54(±6,24); G5-5,95 (±4,58); G6-6,91(±0,03)] demonstraram que a saliva influencia significativamente na RU, mas não os tratamentos do contaminante, e há influência estatisticamente significativa quanto ao momento em que ocorreu a contaminação.

Concluiu-se que a presença do contaminante reduz a resistência de união do sistema autocondicionate em dentina, sendo que o momento mais crítico para ocorrer a contaminação é após a aplicação do bond. Nenhum dos tratamentos da saliva realizados foi capaz de recuperar a resistência de união

Influence of blood contamination on bond strength of a self-etching adhesive to dental tissues.

PURPOSE: The aim of this study was to detect the influence of (1) storage period of heparinized blood, (2) type of blood and presence of contaminant, (3) application mode of cleansing agents, and (4) efficacy of cleansing agents on contaminated enamel and dentin during the adhesion process of a one-step adhesive system. MATERIALS AND METHODS: One hundred four human molars were sectioned into halves along the long axis for enamel and dentin tests. Heparinized and fresh blood were obtained from the same donor, applied and dried to maintain a layer of dry blood on the top of samples. The cleansing agents used were hydrogen peroxide, anionic detergent, and antiseptic solution. A one-step adhesive system (Clearfil S3 Bond) was applied on the dental surface, and composite resin cylinders were built up using Tygon tubing molds. After 24 h, the µSBS test (1 mm/min) and fracture analysis were performed. RESULTS: There was no statistically significant difference in bond strength values regarding the storage period of heparinized blood and the types of blood. Groups without contamination presented higher bond strengths than contaminated groups. The application mode of the cleansing agents had no influence on bond strength results. There was no statistically significant difference among cleansing agents and they were as effective as a water stream in counteracting the effect of blood contamination. CONCLUSION: Heparinized blood can be used as a contaminant for up to one week, and it is a reliable procedure to standardize the contaminant. The cleansing agents can be used without friction. A water stream is sufficient to remove blood contamination from dental tissues, before the application of a one-step adhesive system.

Influence of blood contamination on bond strength of a self-etching system.

OBJECTIVES: To detect the influence of blood contamination (BC) on the bond strength (BS) of a self-etching bonding system (SES) to enamel and dentine. METHODS: 25 human molars were longitudinally sectioned on the mesio-distal axis in order to obtain 50 specimens, which were embedded in acrylic resin. At first, the specimens were ground to expose a flat surface of enamel, and a bond strength test was performed. Afterwards, the samples were ground again in order to obtain a flat surface of dentine. Ten groups (total: n=100) were assigned according to substrate (enamel and dentine), step in the bonding sequence when contamination occurred (before the acidic primer and after the bonding resin), and contamination treatment (dry or rinse and dry procedure). Fresh human blood was introduced either before or after SES application (Clearfil SE Bond) and treated with air drying, or by rinsing and drying following application. Composite resin (Filtek Z-250,3M ESPE) was applied as inverted, truncated cured cones that were debonded in tension. RESULTS: The mean tensile BS values (MPa) for enamel/dentine were 19.4/23.0 and 17.1/10.0 for rinse-and-dry treatment (contamination before and after SES, respectively); while the measurements for the dry treatment, 16.2/23.3 and 0.0/0.0 contamination before and after SES, respectively. CONCLUSIONS: It was determined that blood contamination impaired adhesion to enamel and dentine when it occurred after bond light curing. Among the tested contamination treatments, the rinse-and-dry treatment produced the highest bond strength with BC after SES application, but it was not sufficient to recover the BS in the contamination-free group.

Longitudinal evaluation of the effect of saliva contamination during the bonding protocol with a self-etch adhesive system

Aim: To evaluate the influence of saliva contamination on the short- and long-term bond strength of a self-etch adhesive system. Methods: One hundred and twelve non-carious human molars were randomly divided according to: substrate (enamel/dentin); presence of saliva [none (control- C), before primer (BP), after primer (AP) and after bonding agent (AB)]; treatment of the contamination [none (1), rinsing + drying (2), drying (3) and primer re-application (4)] and specimen storage (24 h or 6 months). A self-etch adhesive system was applied to the dental surfaces followed by incremental insertions of composite resin. After storage in water at 37oC, the specimens were perpendicularly cut into beams for microtensile bond strength testing. Data in MPa were compared by A NOVA followed by Tukey’s test (p< 0.05). Micrographs were obtained by low vacuum scanning electron microscopy. Results: Control groups (G1 and G8) presented higher bond strength than all other groups. The factors presence of saliva, treatments of the contaminant and specimen storage showed no statistically significant results for the two dental substrates. Contaminants could be detected by LV-SEM. Six-month storage did not affect bond strength. Conclusions: The presence of saliva during the application of the self-etch system was deleterious to the bond to enamel and dentin, irrespective of the operative step in which the contamination occurred.

Effect of saliva contamination on the bond strength of an etch-and-rinse adhesive system to dentin / Efeito da contaminação salivar na resistência de união de um adesivo etch-and-rinse em dentina

Purpose: The aim of this study was to investigate the effect of saliva contamination on bond strength of an etch-and-rinse system to dentin. Methods: Fifty bovine incisors were embedded in acrylic resin and divided into 5 groups: G1 (control) - application of the adhesive system (Adper Single Bond 2 - 3M-ESPE); G2 - saliva contamination after acid etching of dentin, rinsing and drying; G3 - saliva contamination after acid etching of dentin and drying; G4 - saliva contamination after adhesive application, rinsing and drying; G5 - saliva contamination after adhesive application and drying. Contamination was performed by using 4 µL of simulated human saliva for 20 s. The adhesive system was applied according to the manufacturer's instructions; a composite resin was built as an inverted cone and was tested after 24 h at a cross-head speed of 0.5 mm/min. Results: When saliva contamination occurred after the adhesive photo-polymerization, bond strength was significantly reduced. The adhesive strength (MPa) mean values were: G1 = 18.1(±4.7) a; G2 = 20.5(±5.7) a; G3 = 17.3(±3.4) a; G4 = 12.6(±4.0) b; G5 = 9.8(±2.1) b (means followed by distinct letters are statistically different, P < 0.05). Conclusion: Saliva contamination negatively influenced bond strength of an etch-and-rinse adhesive, especially after the final polymerization of the adhesive system; in this condition, treatments were not efficient to recover adhesion.

Objetivo: Investigar o efeito da contaminação salivar na resistência de união de um adesivo condicione-e-lave em dentina. Metodologia: Cinquenta incisivos bovinos foram divididos em 5 grupos: G1 = (controle) aplicação do sistema adesivo (Adper Single Bond 2 - 3M-ESPE); G2 = contaminação com saliva após condicionamento ácido da dentina + lavagem e secagem; G3 = contaminação após o condicionamento ácido da dentina + secagem; G4 = contaminação com saliva após a aplicação do adesivo + lavagem e secagem; G5 = contaminação com saliva após a aplicação do adesivo + secagem. A contaminação foi realizada com 4 µL de saliva humana estimulada por 20 s. O sistema adesivo foi usado de acordo com as instruções do fabricante. A resina composta foi aplicada na forma de cone invertido, com o teste de tração realizado após24 h a 0,5 mm/min de velocidade. Resultados: As médias de resistência de união (em MPa): G1 = 18,1(±4,7) a; G2 = 20,5(±5,7) a; G3 = 17,3(±3,4) a; G4 = 12,6(±4,0) b; G5 = 9,8(±2,1) b, demonstrando que a resistência de união foi reduzida significativamente quando a contaminação salivar ocorreu após a fotopolimerização do adesivo. Conclusão: A contaminação influenciou negativamente a resistência de união do adesivo somente após a sua polimerização; nesta condição os tratamentos realizados não foram eficientes para recuperar a adesão.

Can the method of primer application influence adhesion to Er:YAG-laser irradiated dentin?

AIM: The aim of this study was to evaluate how cavity preparation and primer application methods influence the adhesion of composite resin to dentin using a self-etching system. METHODS AND MATERIALS: Forty-eight extracted, sound human molars were divided into six groups (n=8) according to the method used for the surface preparation of the teeth (#600-grit paper disc, diamond bur, and Er:YAG laser) and the primer application method utilized (active or passive). Following the adhesive procedure using a self-etching system, 5 mm high composite buildups were created with Z-250 composite resin. After storage in water at 37 degrees C for 24 hours, the specimens were vertically sectioned into serial 1 mm2 sticks and tested for microtensile strength (micro-TBS). Nine additional molars were prepared for morphological analysis using scanning electron microscopy (SEM). RESULTS: Statistical analysis showed surface preparation technique (p < 0.00) and primer application methods (p < 0.001) do influence bond strength of the self-etching system tested. The best adhesion was achieved with specimens having the dentin ground with sandpaper followed by those ground with diamond burs. The worst bonding was obtained with Er:YAG laser ablated dentin. The active primer application method increased bonding performance compared to the passive method. CONCLUSIONS: Within the limitations of the study, it can be stated surface treatment can influence the bond strength of the self-etching system tested and the active primer application method is more effective in achieving success in bonding to dentin compared with the passive application method. CLINICAL SIGNIFICANCE: Clinicians should use the active application method to apply a mild acidic self-etching primer along with an appropriate tooth surface preparation to facilitate the bond strength between dentin and composite resin.

Influence of oil contamination on in vitro bond strength of bonding agents to dental substrates.

PURPOSE: To evaluate the influence of cleaning procedures (pumice, anionic detergent and both procedures together) on the tensile bond strength of etch-and-rinse and self-etch adhesive systems to bovine enamel and dentin in vitro. METHODS: Eighty non-carious, bovine incisors were extracted, embedded in acrylic resin to obtain enamel/dentin specimens. Flat bonding surfaces were obtained by grinding. Groups were divided according to substrate (enamel or dentin), adhesive system [etch-and-rinse, Adper Single Bond 2 (SB) or self-etch, Clearfil Protect Bond (PB)]; and cleaning substances (pumice, anionic detergent and their combination). The teeth were randomly divided into 20 groups (n=8): G1--Enamel (E) + SB; G2--E + oil (O) + SB; G3--E + O + Pumice (P) + SB; G4--E + O + Tergentol (T) + SB; G5--E + O + P + T + SB; G6--E + PB; G7--E + O + PB; G8--E + O + P + PB; G9--E + O + T + PB; G10--E + O + P + T + PB; G11--Dentin (D) + SB; G12 D + SB + O; G13--D + SB + O + P; G14--D + SB + O + T;G15--D + SB + O + P + T; G16--D + PB; G17--D + O + PB +; G18--D + O + P + PB; G19--D + O + T + PB; G20--D + O + P + T + PB. Specimens were contaminated with handpiece oil for 5 seconds before bonding. Adhesive systems and resin composite were applied according to manufacturers' instructions. Specimens were tested in tension after 24 hours of immersion using a universal testing machine at a crosshead speed of 0.5 mm/minute. Bond strengths were analyzed with ANOVA. Failure sites were observed and recorded. RESULTS: Tensile bond strength in MPa were: G1 (23.6 +/- 0.9); G2 (17.3 +/- 2.2); G3 (20.9 +/- 0.9); G4 (20.6 +/- 0.5); G5 (18.7 +/- 2.3); G6 (23.0 +/- 1.0); G7 (21.5 +/- 2.4); G8 (19.9 +/- 1.3); G9 (22.1 +/- 1.2); G10 (19.1 +/- 1.2); G11 (18.8 +/- 1.3); G12 (15.7 +/- 2.1); G13 (17.8 +/- 3.3); G14 (15.3 +/- 2.9); G15 (15.6 +/- 1.9); G16 (14.7 +/- 2.3); G17 (5.5 +/- 0.9); G18 (19.3 +/- 1.8); G19 (15.6 +/- 1.6); G20 (20.3 +/- 3.9). Statistical analysis showed that the main factors substrate and cleaning were statistically significant, as well as the triple interaction between factors of variance. However, the factor adhesive system did not show statistical difference. Oil contamination reduced bond strengths, being less detrimental to enamel than to dentin. Etch-and-rinse (SB) and two-step self-etch (PB) systems had similar bond strengths in the presence of oil contamination. For etch-and-rinse (SB), the cleaning procedures were able to clean enamel, but dentin was better cleaned by pumice. When self-etch (PB) system was used on enamel, anionic detergent was the best cleaning substance, while on dentin the tested procedures were similarly efficient.