Snakebites by venomous snakes in Brazilian serpentaria and zoos over a 10-year period (2012-2021).

Despite the wide range of institutions that maintain venomous snakes in captivity in Brazil there are no comprehensive data on the occurrence of snakebites and envenomations in these places. We examined the range of native and exotic species of venomous snakes kept by Brazilian zoos and serpentaria (scientific and commercial) and assessed the frequency of snakebites in workers handling these snakes during a 10-year period (2012-2021). Twenty-two (73.3%) of 30 institutions returned a standard questionnaire, including 15 serpentaria and 7 zoos that together kept 10,607 venomous snakes in 2022/2023. Commercial and scientific serpentaria had many more snakes (n = 10,550, consisting of 10,499 native specimens and 51 exotic specimens) than zoos (n = 57 native specimens), with two genera accounting for the majority of native species (Bothrops spp. = 84.5% and Crotalus durissus ssp. = 13.5%). Thirty-seven snakebites were reported and involved primarily the hands (33), seven of which occurred during venom extraction and 30 in other circumstances, most of them while handling/manipulating the cages or snake boxes (10) and restraining (9) or feeding (5) the snake. In addition, there were two cases of venom accidently sprayed on the face, including the eyes. Most bites were caused by Bothrops spp. (31), followed by C. durissus ssp. (4), Lachesis muta (1) and Micrurus corallinus (1). Thirty-three bites (89.2%) were treated with antivenom, with four bites to the fingers by Bothrops spp. resulting in local functional sequelae. There were 366,918 venom extractions with a ratio of 1.9 bites/100,000 extractions; no bites were recorded in the six institutions that sedated the snakes prior to venom extraction, which accounted for 22.7% of all extractions. These findings show that although snakebites are rare in Brazilian zoos and serpentaria, severe envenomation may occur. The occurrence of snakebites could be reduced by measures such as sedation of the snakes before venom extraction.

Minimally invasive guided endodontic microsurgery with Zekrya bur: A 48-month follow-up case report.

Endodontic microsurgery guided by navigation systems represents a precise and minimally invasive approach for retreatment of apical periodontitis following failed conventional endodontic therapy. Accurate localization and minimal access to the root apex are paramount for successful outcomes and preservation of anatomical structures. Workflow considerations, such as three-dimensional (3D) virtual planning and endodontic guidance represent new crucial aspects for addressing complex cases. This clinical case report presents the successful reintervention of a complex case using a Zekrya bur, operative microscopy, cone beam computed tomography and biocompatible materials. After a 48-month follow-up, complete healing of the treated area was observed. This minimally invasive technique, employing a simple instrument widely available globally, underscores the potential for efficient and predictable outcomes in complex endodontic microsurgical retreatment.

Bone Incorporation of a Poly (L-Lactide-Co-D, L-Lactide) Internal Fixation Device in a Rat's Tibia: Microtomographic, Confocal LASER, and Histomorphometric Analysis.

This study evaluated the bone incorporation process of a screw-shaped internal fixation device made of poly (L-lactide-co-D, L-lactide) (PLDLLA). Thirty-two male Wistar rats received 32 fixation devices (2 mm × 6 mm) randomly assigned to either the right or left tibia and one implant in each animal. After 7, 14, 28, and 42 days, the rats were euthanized and the specimens were subjected to microtomographic computed tomography (microCT) and histomorphometric analyses to evaluate bone interface contact (BIC%) and new bone formation (NBF%) in cortical and cancellous bone areas. The animals euthanized on days 28 and 42 were treated with calcein and alizarin red, and confocal LASER microscopy was performed to determine the mineral apposition rate (MAR). Micro-CT revealed a higher percentage of bone volume (p < 0.006), trabecular separation (p < 0.001), and BIC in the cortical (p < 0.001) and cancellous (p = 0.003) areas at 28 and 42 days than at 7 and 14 days. The cortical NBF at 42 days was greater than that at 7 and 14 days (p = 0.022). No statistically significant differences were observed in cancellous NBF or MAR at 28 and 42 days. Based on these results, it can be seen that the PLDLLA internal fixation device is biocompatible and allows new bone formation around the screw thread.

Biochemical and toxicological profiles of venoms from an adult female South American bushmaster (Lachesis muta rhombeata) and her offspring.

In this work, we compared the biochemical and toxicological profiles of venoms from an adult female specimen of Lachesis muta rhombeata (South American bushmaster) and her seven offspring born in captivity, based on SDS-PAGE, RP-HPLC, enzymatic, coagulant, and hemorrhagic assays. Although adult and juvenile venoms showed comparable SDS-PAGE profiles, juveniles lacked some chromatographic peaks compared with adult venom. Adult venom had higher proteolytic (caseinolytic) activity than juvenile venoms (p < 0.05), but there were no significant inter-venom variations in the esterase, PLA2, phosphodiesterase and L-amino acid oxidase (LAAO) activities, although the latter activity was highly variable among the venoms. Juveniles displayed higher coagulant activity on human plasma, with a minimum coagulant dose ∼42% lower than the adult venom (p < 0.05), but there were no age-related differences in thrombin-like activity. Adult venom was more fibrinogenolytic (based on the rate of fibrinogen chain degradation) and hemorrhagic than juvenile venoms (p < 0.05). The effective dose of Bothrops/Lachesis antivenom (produced by the Instituto Butantan) needed to neutralize the coagulant activity was ∼57% greater for juvenile venoms (p < 0.05), whereas antivenom did not attenuate the thrombin-like activity of juvenile and adult venoms. Antivenom significantly reduced the hemorrhagic activity of adult venom (400 µg/kg, i. d.), but not that of juvenile venoms. Overall, these data indicate a compositional and functional ontogenetic shift in L. m. rhombeata venom.

Treatment of a severely compromised endodontically treated tooth with a 2-piece premanufactured glass-fiber post: A clinical report.

A 2-piece premanufactured glass-fiber post-and-core for a child with a severely compromised endodontically treated tooth to restore dental form, function, and esthetics, is described. A shorter chair time than for the conventional options was needed, and the post provided an adequate biomechanical response with a reduced intracanal cement thickness.

Comparing morphological and secretory aspects of cephalic glands among the New World coral snakes brings novel insights on their biological roles.

Oral and other cephalic glands have been surveyed by several studies with distinct purposes. Despite the wide diversity and medical relevance of the New World coral snakes, studies focusing on understanding the biological roles of the glands within this group are still scarce. Specifically, the venom glands of some coral snakes were previously investigated but all other cephalic glands remain uncharacterized. In this sense, performing morphological and molecular analysis of these glands may help better understand their biological role. Here, we studied the morphology of the venom, infralabial, rictal, and harderian glands of thirteen species of Micrurus and Micruroides euryxanthus. We also performed a molecular characterization of these glands from selected species of Micrurus using transcriptomic and proteomic approaches. We described substantial morphological variation in the cephalic glands of New World coral snakes and structural evidence for protein-secreting cells in the inferior rictal glands. Our molecular analysis revealed that the venom glands, as expected, are majorly devoted to toxin production, however, the infralabial and inferior rictal glands also expressed some toxin genes at low to medium levels, despite the marked morphological differences. On the other hand, the harderian glands were dominated by the expression of lipocalins, but do not produce toxins. Our integrative analysis, including the prediction of biological processes and pathways, helped decipher some important traits of cephalic glands and better understand their biology.

Unveiling underestimated species diversity within the Central American Coralsnake, a medically important complex of venomous taxa.

Coralsnakes of the genus Micrurus are a diverse group of venomous snakes ranging from the southern United States to southern South America. Much uncertainty remains over the genus diversity, and understanding Micrurus systematics is of medical importance. In particular, the widespread Micrurus nigrocinctus spans from Mexico throughout Central America and into Colombia, with a number of described subspecies. This study provides new insights into the phylogenetic relationships within M. nigrocinctus by examining sequence data from a broad sampling of specimens from Mexico, Guatemala, Honduras, Nicaragua, Costa Rica, and Panama. The recovered phylogenetic relationships suggest that M. nigrocinctus is a species complex originating in the Pliocene and composed of at least three distinct species-level lineages. In addition, recovery of highly divergent clades supports the elevation of some currently recognized subspecies to the full species rank while others may require synonymization.

Mobile Solutions for Clinical Surveillance and Evaluation in Infancy-General Movement Apps.

The Prechtl General Movements Assessment (GMA) has become a clinician and researcher toolbox for evaluating neurodevelopment in early infancy. Given that it involves the observation of infant movements from video recordings, utilising smartphone applications to obtain these recordings seems like the natural progression for the field. In this review, we look back on the development of apps for acquiring general movement videos, describe the application and research studies of available apps, and discuss future directions of mobile solutions and their usability in research and clinical practice. We emphasise the importance of understanding the background that has led to these developments while introducing new technologies, including the barriers and facilitators along the pathway. The GMApp and Baby Moves apps were the first ones developed to increase accessibility of the GMA, with two further apps, NeuroMotion and InMotion, designed since. The Baby Moves app has been applied most frequently. For the mobile future of GMA, we advocate collaboration to boost the field's progression and to reduce research waste. We propose future collaborative solutions, including standardisation of cross-site data collection, adaptation to local context and privacy laws, employment of user feedback, and sustainable IT structures enabling continuous software updating.

Cardiac Effects of Micrurus corallinus and Micrurus dumerilii carinicauda (Elapidae) Venoms and Neutralization by Brazilian Coralsnake Antivenom and Varespladib.

In this work, we examined the action of two South American coralsnake (Micrurus corallinus and Micrurus dumerilii carinicauda) venoms on rat heart function in the absence and presence of treatment with Brazilian coralsnake antivenom (CAV) and varespladib (VPL), a potent phospholipase A2 inhibitor. Anesthetized male Wistar rats were injected with saline (control) or a single dose of venom (1.5 mg/kg, i.m.) and monitored for alterations in echocardiographic parameters, serum CK-MB levels and cardiac histomorphology, the latter using a combination of fractal dimension and histopathological methods. Neither of the venoms caused cardiac functional alterations 2 h after venom injection; however, M. corallinus venom caused tachycardia 2 h after venom injection, with CAV (given i.p. at an antivenom:venom ratio of 1:1.5, v/w), VPL (0.5 mg/kg, i.p.) and CAV + VPL preventing this increase. Both venoms increased the cardiac lesional score and serum CK-MB levels compared to saline-treated rats, but only the combination of CAV + VPL prevented these alterations, although VPL alone was able to attenuate the increase in CK-MB caused by M. corallinus venom. Micrurus corallinus venom increased the heart fractal dimension measurement, but none of the treatments prevented this alteration. In conclusion, M. corallinus and M. d. carinicauda venoms caused no major cardiac functional alterations at the dose tested, although M. corallinus venom caused transient tachycardia. Both venoms caused some cardiac morphological damage, as indicated by histomorphological analyses and the increase in circulating CK-MB levels. These alterations were consistently attenuated by a combination of CAV and VPL.

Neoantigen T-Cell Receptor Gene Therapy in Pancreatic Cancer.

A patient with progressive metastatic pancreatic cancer was treated with a single infusion of 16.2×109 autologous T cells that had been genetically engineered to clonally express two allogeneic HLA-C*08:02-restricted T-cell receptors (TCRs) targeting mutant KRAS G12D expressed by the tumors. The patient had regression of visceral metastases (overall partial response of 72% according to the Response Evaluation Criteria in Solid Tumors, version 1.1); the response was ongoing at 6 months. The engineered T cells constituted more than 2% of all the circulating peripheral-blood T cells 6 months after the cell transfer. In this patient, TCR gene therapy targeting the KRAS G12D driver mutation mediated the objective regression of metastatic pancreatic cancer. (Funded by the Providence Portland Medical Foundation.).

Partial efficacy of a Brazilian coralsnake antivenom and varespladib in neutralizing distinct toxic effects induced by sublethal Micrurus dumerilii carinicauda envenoming in rats.

In this work, we reported the efficacy of a combination of Brazilian therapeutic coralsnake antivenom (CAV) and varespladib (phospholipase A2 inhibitor - VPL) in partially neutralizing selected toxic effects of Micrurus dumerilii carinicauda coralsnake venom in rats. Venom caused local myonecrosis and systemic neurotoxicity, nephrotoxicity, and hepatotoxicity within 2 h of injection. CAV and VPL administered separately failed to prevent most of these alterations. However, a combination of CAV plus VPL offered variable protection against venom-induced coagulation disturbances, leukocytosis, and renal-hepatic morphological alterations.

Transcriptomic profiles of neoantigen-reactive T cells in human gastrointestinal cancers.

Tumor-infiltrating neoantigen-reactive T cells can mediate regression of metastatic gastrointestinal cancers yet remain poorly characterized. We performed immunological screening against personalized neoantigens in combination with single-cell RNA sequencing on tumor-infiltrating lymphocytes from bile duct and pancreatic cancer patients to characterize the transcriptomic landscape of neoantigen-reactive T cells. We found that most neoantigen-reactive CD8+ T cells displayed an exhausted state with significant CXCL13 and GZMA co-expression compared with non-neoantigen-reactive bystander cells. Most neoantigen-reactive CD4+ T cells from a patient with bile duct cancer also exhibited an exhausted phenotype but with overexpression of HOPX or ADGRG1 while lacking IL7R expression. Thus, neoantigen-reactive T cells infiltrating gastrointestinal cancers harbor distinct transcriptomic signatures, which may provide new opportunities for harnessing these cells for therapy.

Innovative subtractive production of a digital removable complete denture from start to finish: a JPD Digital video presentation.

This JPD Digital video presentation presents the clinical treatment from start to finish in which a dual-shaded bi-coloured monolithic disk was used for the fabrication of an immediate digital complete denture followed by the delivery of a definitive digital complete denture. The treatment plan included extraction of the remaining maxillary and mandibular teeth followed by an esthetic evaluation with digital smile design. The digital definitive complete dentures were milled from a monolithic dual-shaded disk.

In vivo treatment with varespladib, a phospholipase A2 inhibitor, prevents the peripheral neurotoxicity and systemic disorders induced by Micrurus corallinus (coral snake) venom in rats.

In this study, we investigated the action of varespladib (VPL) alone or in combination with a coral snake antivenom (CAV) on the local and systemic effects induced by Micrurus corallinus venom in rats. Adult male Wistar rats were exposed to venom (1.5 mg/kg - i.m.) and immediately treated with CAV (antivenom:venom ratio 1:1.5 'v/w' - i.p.), VPL (0.5 mg/kg - i.p.), or both of these treatments. The animals were monitored for 120 min and then anesthetized to collect blood samples used for haematological and serum biochemical analysis; after euthanasia, skeletal muscle, renal and hepatic tissue samples were collected for histopathological analysis. M. corallinus venom caused local oedema without subcutaneous haemorrhage or apparent necrosis formation, although there was accentuated muscle morphological damage; none of the treatments prevented oedema formation but the combination of CAV and VPL reduced venom-induced myonecrosis. Venom caused neuromuscular paralysis and respiratory impairment in approximately 60 min following envenomation; CAV alone did not prevent the neurotoxic action, whereas VPL alone prevented neurotoxic symptoms developing as did the combination of CAV and VPL. Venom induced significant increase of serum CK and AST release, mostly due to local and systemic myotoxicity, which was partially prevented by the combination of CAV and VPL. The release of hepatotoxic serum biomarkers (LDH and ALP) induced by M. corallinus venom was not prevented by CAV and VPL when individually administered; their combination effectively prevented ALP release. The venom-induced nephrotoxicity (increase in serum creatinine concentration) was prevented by all the treatments. VPL alone or in combination with CAV significantly prevented the venom-induced lymphocytosis. In conclusion, VPL shows to be effective at preventing the neurotoxic, nephrotoxic, and inflammatory activities of M. corallinus venom. In addition, VPL acts synergistically with antivenom to prevent a number of systemic effects caused by M. corallinus venom.

Complete denture digital workflow: Combining basic principles with a CAD-CAM approach.

This report describes a digital workflow for the fabrication of a complete maxillary denture opposing an implant-retained overdenture. This procedure provides a predictable and accurate 3-visit technique to digitally scan and articulate edentulous ridges, avoiding the discomfort associated with analog impression making. Wax rims were applied to intraorally relined plastic edentulous stock trays. The occlusal relationship was registered at the appropriate vertical dimension of occlusion by using these tray and rim assemblies. The digital laboratory scanning of the relined tray and rim assemblies resulted in accurate virtual articulation of the digital edentulous intraoral scans. The removable restorations were digitally designed, milled, and delivered, and the clinical and laboratory steps are described.

Oceanography time series reveals annual asynchrony input between oceanic and estuarine waters in Patagonian fjords.

The postglacial Patagonian fjord system along the west coast of southern South America is one of the largest stretches of the southern hemisphere (SH) fjord belt, influenced by the SH westerly wind belt and continental freshwater input. This study reports a 3-year monthly time series (2017-2020) of physical and biogeochemical parameters obtained from the Reloncaví Marine Observatory (OMARE, Spanish acronym) at the northernmost embayment and fjord system of Patagonia. The main objective of this work was to understand the land-atmosphere-ocean interactions and to identify the mechanisms that modulate the density of phytoplankton. A key finding of this study was the seasonally varying asynchronous input of oceanic and estuarine water. Surface lower salinity and warmer estuarine water arrived in late winter to summer, contributing to water column stability, followed by subsurface higher salinity and less warmer oceanic water during fall-winter. In late winter 2019, an interannual change above the picnocline due to the record-high polarity of the Indian Ocean Dipole inhibited water column stability. The biogeochemical parameters (NO3-, NO2-, PO43-, Si(OH)4, pH, and dissolved oxygen) responded to the surface annual salinity variations, and oceanic water mass contributed greatly to the subsurface inorganic nutrient input. The water column N/P ratio indicated that no eutrophication occurred, even under intense aquaculture activity, likely because of the high ventilation dynamics of the Reloncaví Sound. Finally, a shift in phytoplankton composition, characterized by surface chlorophyll-a maxima in late winter and deepening of spring-summer blooms related to the physicochemical conditions of the water column, was observed. Our results support the ecosystem services provided by local oceanography processes in the north Patagonian fjords. Here, the anthropogenic impact caused by economic activities could be, in part, chemically reduced by the annual ventilation cycle mediated by the exchange of oceanic water masses into Patagonian fjords.

A Full Digital Workflow for the Duplication of an Existing Implant Retained Overdenture Prosthesis: A Novel Approach.

The purpose of this clinical case report is to describe a fully digital workflow for the duplication of an existing implant retained overdenture, highlighting the benefits of digitally fabricated dentures. The patient presented with an existing mandibular implant retained overdenture on Locator attachments that needed to be replaced. The existing overdenture was duplicated/scanned with the use of an intraoral scanner and was 3D printed using acrylic resin. This resin duplicate was sectioned in the midline and served as a unilateral record base to digitally record maxillo-mandibular relationship. The occlusal relationship was scanned unilaterally with the record base (sectioned duplicate) in place, and the procedure was repeated for the opposite side. All scans (edentulous, bite registrations and preliminary scan) were superimposed and the software managed to position and stich everything together. A try-in copy denture (ProArtCAD Try in, Ivoclar Vivadent AG, Schaan, Liechtenstein) was milled in order to imitate the conventional wax teeth try-in. A definitive milled overdenture was fabricated and delivered. A reinforcing polyetheretherketone mesh was fabricated, utilizing computer assisted design/computer assisted manufacturing technology and was incorporated into the pre-designed customized space into the polymethylmethacrylate base, using indirect light-polymerized nano-filled composite resin (crea.lign; bredent GmbH & Co. KG). Occlusion was verified and the patient was instructed oral hygiene, home maintenance and was informed for the required recall visits.