Congenital ichthyosis: a multidisciplinary approach in a neonatal care unit.

Congenital ichthyoses are a rare group of genetic disorders caused by defects in the two outermost skin layers, resulting in an abnormal barrier function. We report the case of a male preterm neonate presenting at delivery with thickened and scaling skin, ectropium and eclabium. Supportive care aiming at improving skin condition and handling possible complications was provided. Following gradual clinical improvement, he was discharged after 27 days. Molecular testing identified mutations in a gene encoding lipoxygenase (ALOX12B), associated with autosomal recessive congenital ichthyosis. This case highlights an uncommon disease that can determine significant morbidity and mortality in the first few weeks of life. Management of this complex disease benefits from a multidisciplinary approach. Molecular studies allow a more accurate diagnosis and enable genetic counselling.

Desenvolvimento motor de bebês em intervenção parental durante a puericultura: série de casos / Desarrollo motor de bebés en intervención parental durante la puericultura: serie de casos / Infants motor development in parental intervention during childcare: case series

RESUMO O desenvolvimento infantil deve ser promovido pela família com apoio formal na puericultura. O presente estudo analisou o desempenho motor de bebês submetidos à intervenção parental na puericultura. Foi realizado um estudo de série de casos, observacional, longitudinal e descritivo, com 215 bebês de 0-18 meses atendidos em uma Unidade de Atenção Primária em Saúde de uma capital do Nordeste brasileiro. O desempenho motor dos bebês foi avaliado pela Alberta infant motor scale e orientações foram transmitidas aos pais a depender do atraso motor observado. Observou-se que 77,7% dos bebês tiveram seu primeiro atendimento no primeiro semestre de vida, 57,6% apresentaram baixo risco e 76,7% desempenho motor normal. Houve relação significativa entre a estratificação de risco e a idade gestacional e entre a estratificação de risco e o desempenho motor. Os intervalos entre as avaliações variaram de 7-252 dias. A porcentagem de bebês com atrasos motores é maior para os que chegam à puericultura após o terceiro trimestre de vida. Todos os bebês identificados com suspeita de atraso ou como atípicos, que frequentaram a puericultura, melhoraram o desempenho motor até a terceira avaliação. Bebês que são levados precocemente à puericultura, para orientações sobre intervenção parental, recuperam o atraso do desenvolvimento motor, porém muitas famílias não comparecem ao seguimento da puericultura ou chegam tardiamente para atendimento.

RESUMEN El desarrollo infantil debe ser promovido por la familia con apoyo formal en la puericultura. Este estudio analizó el desempeño motor de bebés sometidos a intervención parental en la puericultura. Se realizó un estudio de serie de casos, observacional, longitudinal y descriptivo, con 215 bebés de 0-18 meses de edad que recibían atención en una Unidad de Atención Primaria de Salud de una capital del Nordeste de Brasil. El desempeño motor de los bebés se evaluó mediante la escala motora infantil de Alberta y se suministró información a los padres cuando se observó retraso motor en los bebés. El 77,7% de los bebés recibieron su primer cuidado en el primer semestre de vida, el 57,6% tuvieron bajo riesgo, y el 76,7% presentaron un desempeño motor normal. Hubo una relación significativa entre la estratificación del riesgo y la edad gestacional, así como entre la estratificación del riesgo y el desempeño motor. Los intervalos entre evaluaciones oscilaron de 7 a 252 días. El porcentaje de bebés con retrasos motores es mayor para los que llegan a la puericultura después del tercer trimestre de vida. Todos los bebés identificados con sospecha de retraso o como atípicos, que asistieron a la puericultura, tuvieron una mejora de su desempeño motor hasta la tercera evaluación. Los bebés que se llevan precozmente a la puericultura para orientación sobre la intervención parental recuperan el retraso en el desarrollo motor, pero muchas familias no asisten al seguimiento de la puericultura o llegan tardíamente en esta atención.

ABSTRACT Child development should be promoted by the family with formal support from childcare services. This study aims to analyze the motor performance of infants submitted to parental intervention in childcare. This is an observational, longitudinal and descriptive case series study with 215 infants aged 0-18 months, who were cared for at a Primary Health Care Unit in a Brazilian Northeastern capital. The infants' motor performance was assessed by the Alberta infant motor scale and instructions were transmitted to parents according to the observed motor delay. We observed that 77.7% of the infants had their first appointment in their first semester of life, 57.6% had low risk and 76.7% had normal motor performance. Significant relationships between risk stratification and gestational age and between risk stratification and motor performance were found. The intervals between evaluations ranged from 7-252 days. A higher percentage of infants with motor delays was found in those who were taken to childcare after the third trimester of life. All infants who attended childcare and were identified with suspected delay or atypical development improved motor performance by the third evaluation. Infants who are taken to childcare early, for guidance on parental intervention, recover from motor development delay, but most families either do not attend childcare follow-up, or are long overdue for their appointment.

Effect of sintering temperature on microstructure, flexural strength, and optical properties of a fully stabilized monolithic zirconia.

STATEMENT OF PROBLEM: Fully stabilized monolithic zirconia (FSZ) has been developed as an alternative to zirconia veneered with porcelain. However, how sintering conditions might affect its microstructure and optical and mechanical properties is unclear. PURPOSE: The purpose of this in vitro study was to determine the effect of different sintering temperatures on the microstructure and optical and mechanical properties of FSZ. MATERIAL AND METHODS: Bar-shaped FSZ specimens were prepared and divided into 2 groups (n=15) according to final sintering temperatures (1450 °C and 1600 °C). The average reflectance, opacity, translucency parameter, and sum of light absorption-scattering values were obtained by using a spectrophotometer, and ΔE00 was calculated. The 3-point bend test was performed in a universal testing machine. Scanning electron microscopy (SEM) was conducted for microstructure analysis. Crystalline phase quantification was obtained by X-ray diffraction (XRD). Data were analyzed by using D'Agostino-Pearson and Student t tests (α=.05). RESULTS: A significant difference was detected in the reflectance and sum of light absorption-scattering values between the 2 groups. The translucency parameter, opacity, and flexural strength showed no statistical differences. ΔE00 was 0.98. XRD indicated cubic (47.41% for 1450 °C; 46.04% for 1600 °C) and tetragonal content (52.59% for 1450 °C; 53.96% for 1600 °C). No monoclinic content was found. SEM images showed more definite grain boundaries in the 1600-°C group. Mean grain size was 0.49 µm for the 1450-°C group and 1.99 µm for the 1600-°C group. CONCLUSIONS: Higher sintering temperatures increased the grain size but did not change the crystal phase concentration. A significant difference was found in the reflectance and sum of light absorption-scattering, but no differences were found among the translucency parameter, opacity, or flexural strength.

Intervenção psicomotora no desenvolvimento infantil: uma revisão integrativa / Psychomotor intervention in child development: an integrative review / Intervención psicomotora para el desarrollo infantil: una revisión integrativa

Objetivo: Analisar a relação entre o apoio social (AS) e a prática de atividade física (AF) de idosos por meio de uma revisão sistemática da literatura de estudos observacionais. Métodos: As buscas foram realizadas nas bases eletrônicas Scopus, PsycInfo, LILACS e MEDLINE, acessado via PubMed. Os termos Mesh utilizados foram relacionados ao "apoio social", "atividade física" e "idosos". Incluíram-se estudos observacionais, com amostra composta por idosos, que investigaram o AS para a AF por meio de instrumentos quantitativos publicados nos últimos 10 anos, com acesso online na íntegra e disponíveis nos idiomas inglês, português e espanhol. Excluíram-se estudos de revisão sistemática, metanálise, protocolos de intervenção e de construção ou validação de instrumentos, e aqueles que abordaram o AS para outros comportamentos além da AF. Resultados: A busca resultou em 1311 artigos e, após o processo de seleção, 9 foram incluídos nesta revisão. Em relação ao tipo de estudo, 8 transversais e 1 de coorte, predominando amostras compostas pelo sexo feminino. Os estudos abordaram diferentes instrumentos, tipos e fontes para avaliação do apoio social e avaliaram diferentes domínios da atividade física. Encontraram que, quanto maior o apoio social percebido, maior o nível de atividade física. Conclusão: Verificou-se que existe relação positiva entre o apoio social e a prática de atividade física de idosos, destacando a importância da sua função instrumental e de diferentes fontes, como de familiares, amigos e profissionais da saúde para a promoção de comportamentos ativos por parte dessa população. (AU)

Nitrogen-improved photosynthesis quantum yield is driven by increased thylakoid density, enhancing green light absorption.

A nitrogen supply is necessary for all plants. The multifaceted reasons why this nutrient stimulates plant dry weight accumulation are assessed herein. We compared tomato plants grown in full sunlight and in low light environments under four N doses and evaluated plant growth, photosynthetic and calorimetric parameters, leaf anatomy, chloroplast transmission electron microscopy (TEM) and a high resolution profile of optical leaf properties. Increases in N supplies allow tomato plants to grow faster in low light environments (91.5% shading), displaying a robust light harvesting machinery and, consequently, improved light harvesting efficiency. Ultrastructurally, high N doses were associated to a high number of grana per chloroplast and greater thylakoid stacking, as well as high electrodensity by TEM. Robust photosynthetic machinery improves green light absorption, but not blue or red. In addition, low construction and dark respiration costs were related to improved total dry weight accumulation in shade conditions. By applying multivariate analyses, we conclude that improved green light absorbance, improved quantum yield and greater palisade parenchyma cell area are the primary components that drive increased plant growth under natural light-limited photosynthesis.

Intervenção parental melhora o desenvolvimento motor de lactentes de risco: série de casos / La intervención parental mejora el desarrollo motor de lactantes de riesgo: estudio de serie de casos / Parental intervention improves motor development in infants at risk: case series

RESUMO A intervenção precoce no desenvolvimento, por meio de atividades parentais, favorece ganhos cognitivos, físicos, sociais e emocionais da criança, que são determinantes da saúde infantil. Contudo, estudos com intervenção precoce com atividades parentais são escassos. Assim, o objetivo deste estudo foi analisar o efeito da intervenção parental precoce no desenvolvimento motor de lactentes em seguimento em ambulatório de risco. Este é um estudo de série de casos, longitudinal e intervencionista, em 100 lactentes, com idade entre 0-18 meses, provenientes de um ambulatório de risco. O desenvolvimento motor dos lactentes foi avaliado pela escala motora infantil de Alberta. Foram transmitidas orientações aos pais, a depender do atraso motor observado. Não houve relação dos fatores de risco com o desenvolvimento motor. Porém, esses fatores apresentaram relação com a idade gestacional, que teve, por sua vez, relação com o desenvolvimento motor. Após intervenção precoce parental, a frequência amostral aumentou de 45% para 69% no grupo de crianças com desenvolvimento motor normal. No grupo com atraso no desenvolvimento, a frequência amostral reduziu de 55% para 31%. Fatores de risco pré-natal e/ou perinatal podem acarretar prematuridade e consequentemente atraso no desenvolvimento motor infantil. Para esses lactentes, protocolos de intervenção precoce com atividades parentais são efetivos para promover um desenvolvimento motor normal de crianças em seguimento em ambulatório de risco.

RESUMEN Por intermedio de actividades parentales, la intervención precoz en el desarrollo favorece logros cognitivos, físicos, sociales y emocionales a los bebés, factores determinantes para la salud infantil. Pero son pocos los estudios sobre la intervención precoz con actividades parentales. Así en este estudio se propone analizar los resultados de la intervención parental precoz para el desarrollo motor de lactantes en ambulatorio de una maternidad. Estudio de tipo serie de casos, longitudinal e intervencionista, del cual participaron cien lactantes, entre 0 y 18 meses de edad, provenientes del ambulatorio de la maternidad. Se evaluó el desarrollo motor de los lactantes por intermedio de la escala Alberta. Dependiendo del retraso motor observado en los bebés, se hicieron recomendaciones a los padres. No se encontró relaciones entre los factores de riesgo y el desarrollo motor. Sin embargo, estos factores presentaron relación con la edad gestacional, que se relacionó, a su vez, con el desarrollo motor. Tras la intervención precoz parental, la frecuencia del muestreo aumentó del 45% al 69% en el grupo de bebés con desarrollo motor normal. El grupo con retraso en el desarrollo sufrió una disminución en la frecuencia de la muestra del 55% al 31%. Los factores de riesgo prenatal y/o perinatal pueden implicar precocidad y, por consiguiente, retraso en el desarrollo motor infantil. Para lactantes en ambulatorios, estos protocolos de intervención precoz con actividades parentales son eficaces para promocionar su desarrollo motor normal.

ABSTRACT Early intervention based on parental activities promotes cognitive, physical, social, and emotional development, which are determinants for the child's health. However, studies about early intervention with parental education are scarce. The objective of this study was to analyze the effect of parental intervention in the motor development of infants. This is a case series, longitudinal, and interventional study, with 100 infants at risk, aged 0-18 months. Motor development of infants was assessed by the Alberta Infant Motor Scale, and the parents received information about positioning and exercises depending on the child's motor score. Risk factors were not related to infants' motor development. However, these risk factors were related to gestational age, which was related to motor development. After parental early intervention, the sample frequency increased from 45% to 69% in the group of children with normal motor development. Frequency was reduced from 55% to 31% in the group with delayed development. Prenatal and/or perinatal risk factors can cause prematurity, and consequently, delays in children's motor development. For these infants, early intervention protocols with parental education are effective to stimulate a normal motor development of children at risk in follow-up in outpatient clinics.

Multiple resistance to pirimiphos-methyl and bifenthrin in Tribolium castaneum involves the activity of lipases, esterases, and laccase2.

Several recent studies have elucidated the molecular mechanisms that confer insecticide resistance on insect pests. However, little is known about multiple resistance in red flour beetle (Tribolium castaneum) at molecular level. The multiple resistance is characterized as resistance to different classes of insecticides that have different target sites, and is mediated by several enzymatic systems. In this study, we investigated the biochemical and molecular mechanisms involved in multiple resistance of T. castaneum to bifenthrin (pyrethroid [Pyr]) and pirimiphos-methyl (organophosphate [Org]). We used artificial selection, biochemical and in silico approaches including structural computational biology. After five generations of artificial selection in the presence of bifenthrin (F5Pyr) or pirimiphos-methyl (F5Org), we found high levels of multiple resistance. The hierarchical enzymatic cluster revealed a pool of esterases (E), lipases (LIPs) and laccase2 (LAC2) potentially contributing to the resistance in different ways throughout development, after one or more generations in the presence of insecticides. The enzyme-insecticide interaction network indicated that E2, E3, LIP3, and LAC2 are enzymes potentially required for multiple resistance phenotype. Kinetic analysis of esterases from F5Pyr and F5Org showed that pirimiphos-methyl and specially bifenthrin promote enzyme inhibition, indicating that esterases mediate resistance by sequestering bifenthrin and pirimiphos-methyl. Our computational data were in accordance with kinetic results, indicating that bifenthrin has higher affinity at the active site of esterase than pirimiphos-methyl. We also report the capability of these insecticides to modify the development in T. castaneum. Our study provide insights into the biochemical mechanisms employed by T. castaneum to acquire multiple resistance.

Intervenções de educação em saúde em mães de crianças com paralisia cerebral / Interventions of health education in mothers of children with cerebral palsy

INTRODUCTION: The functional performance of children with cerebral palsy is directly influenced by the therapeutic guidelines offered to caregivers. OBJECTIVE: To evaluate the impact of educational health interventions in mothers of children with cerebral palsy about the guidelines of care. METHODS: A qualitative interventional study developed in three stages between April and October of 2015 in the Núcleo de Tratamento e Estimulação Precoce of the Universidade Federal do Ceará, Brazil. The participants were six mothers of children with cerebral palsy. In the first stage we used the technique of individual semi-structured interviews, full recorded and transcribed for the apprehension and exploration of the speeches; In the second stage, taking into account the saturation and categorization of the speeches, a protocol was developed and applied by the researchers divided into eight interventions of health education in the group of mothers then in the third stage the individual interviews were redone for new exploration and comparison of speeches. The analysis of the data of the speeches was made through content analysis according to the proposal of Bardin. RESULTS: Satisfaction reports on receiving care, improvements in the handling of children, greater safety in the implementation of therapeutic guidelines, better perception about the development of the child with the treatment and higher concern with self-care. CONCLUSIONS: The educational interventions promoted a better perception of mothers of children with cerebral palsy about the therapeutic orientations received from the health team, since they are based on the family-centered model offering conditions to the mothers for the confrontation and reduction of the physical overload, emotional and psychological; through self-care in health, and information about means and adaptations for the adequate continuity of child care.

INTRODUÇÃO: O desempenho funcional de crianças portadoras de paralisia cerebral sofre influência direta das orientações terapêuticas oferecidas aos cuidadores. OBJETIVO: Avaliar os efeitos de intervenções educativas em saúde no conhecimento de mães de crianças com paralisia cerebral sobre as orientações recebidas da equipe multiprofissional em relação ao tratamento de seus filhos MÉTODO: Estudo intervencional qualitativo desenvolvido em três etapas entre os meses de abril a outubro de 2015 no Núcleo de Tratamento e Estimulação Precoce da Universidade Federal do Ceará. As participantes foram seis mães de crianças com paralisia cerebral. Na 1ª etapa utilizou-se a técnica de entrevistas individuais semiestruturadas gravadas e transcritas na íntegra para apreensão e exploração dos discursos; na 2º etapa, levando-se em conta a saturação e categorização dos discursos, foi desenvolvido e aplicado pelas pesquisadoras um protocolo dividido em oito intervenções de educação em saúde no grupo de mães e na 3ª etapa as entrevistas individuais foram refeitas para nova exploração e comparação dos discursos. A análise dos dados dos discursos foi feita por meio de análise de conteúdo conforme a proposta de Bardin RESULTADOS: Relatos de satisfação em receber o cuidado, melhoras no manuseio das crianças, maior segurança na execução das orientações terapêuticas, maior percepção sobre o desenvolvimento da criança com o tratamento e maior preocupação com o autocuidado. CONCLUSÃO: As intervenções promoveram uma melhor percepção das mães de crianças com paralisia cerebral acerca das orientações terapêuticas recebidas da equipe de saúde, na medida em que se baseiam no modelo centrado na família oferecendo condições às mães para o o enfrentamento e redução da sobrecarga física, emocional e psicológica; através do autocuidado em saúde, e informações acerca de meios e adaptações para a continuidade adequada da assistência à criança.

Proposta de utilização da Classificação Internacional de Funcionalidade, Incapacidade e Saúde na avaliação da disfunção temporomandibular / Proposition for use of the International Classification of Functioning, Disability and Health for the assessment of temporomandibular disorders

Introdução: O Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) é um instrumento validado para a língua portuguesa, sendo usado para a padronização das pesquisas acerca das disfunções temporomandibulares (DTM). A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) é utilizada na classificação das mais diversas avaliações funcionais. Objetivo: Verificar se no RDC há padrões mínimos para o relato de funcionalidade e saúde através da ligação com a CIF. Material e métodos: Estudo descritivo realizando-se o linking entre os itens do instrumento de avaliação de critérios diagnósticos RDC/TMD e os códigos e categorias da CIF. Dois pesquisadores avaliaram independentes quais os códigos mais adequados para cada item do instrumento. O linking dos qualificadores foi realizado de forma cega sendo aplicado o teste estatístico de Kappa para observar o grau de concordância entre os pesquisadores. Resultados: Foi obtido grau de concordância completo entre os julgamentos dos pesquisadores (índice de Kappa = 1) para todos os qualificadores. Na ligação, foram utilizados os domínios da CIF "Funções do Corpo" (b), "Estrutura do Corpo" (s) e "Atividades e Participação" (d). Conclusão: A CIF deve ser utilizada para a classificação, mas não para avaliar pacientes com DTM, e aspectos importantes da funcionalidade destes pacientes devem ser acrescentados a instrumentos como o RDC. (AU)

Introduction: The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) is an instrument validated for the Portuguese language, which is receiving great credibility in the literature and is being used for the standardization of researches about temporomandibular joint dysfunctions (TMD). Objective: To verify if there are minimum standards in RDC for the reporting of functionality and health through the connection with the CIF. Methods: Descriptive study in which a linking is made between the items of the diagnostic criteria evaluation instrument RDC/TMD and the ICF codes and categories. Two researchers independently evaluated which codes were more appropriate for each item on the instrument, and dissents were mediated by a third researcher. The linking between the qualifiers was blinded, applying the Kappa statistical test to evaluate the degree of agreement between the researchers. Results: A complete agreement degree was obtained between the judgement of both researchers (Kappa index = 1) for all the qualifiers. In the linking, ICF domains "Body Function" (b), "Body Structure" (s) and "Activity and Participation" (d) were used. Conclusion: The ICF should be used for the TMD classification, but not for assessing patients with TMD and important aspects of the functionality of these patients should be added to instruments such as RDC. (AU)

Postural sway parameters and gait symmetry in preschool children: cross-sectional study

Abstract The most important function of posture is to ensure the maintenance of control during the start and the continuation of human movement, moreover, posture serves as a reference for the production of precise movements. The aim of this study was to relate the postural sway parameters and gait symmetry in preschool children.This study is a cross-sectional study, conducted in 49 children with a mean age of 4.65 ± 0.44 years. Initially, height and body mass of children were measured using anthropometric scales. Next, an electronic baropodometer was used to evaluate the distribution of dynamic plantar pressure (gait) and stabilometry (balance).A Student t test or Mann-Whitney test for comparing two groups was used. To correlate variables, a Pearson's correlation or Spearman's correlation coefficient was used. The stabilometric parameters showed no significant difference between an eyes open test and eyes closed test in preschool child. We found a moderate relationship between axis inclination and cadence symmetry (R=0.40;p=0.007). Postural sway parameters have relationship cadence symmetry of the gait in preschool children.

Effects of artificial aging conditions on yttria-stabilized zirconia implant abutments.

STATEMENT OF PROBLEM: Most ceramic abutments are fabricated from yttria-stabilized tetragonal zirconia (Y-TZP). However, Y-TZP undergoes hydrothermal degradation, a process that is not well understood. PURPOSE: The purpose of this in vitro study was to assess the effects of artificial aging conditions on the fracture load, phase stability, and surface microstructure of a Y-TZP abutment. MATERIAL AND METHODS: Thirty-two prefabricated Y-TZP abutments were screwed and tightened down to external hexagon implants and divided into 4 groups (n = 8): C, control; MC, mechanical cycling (1×10(6) cycles; 10 Hz); AUT, autoclaving (134°C; 5 hours; 0.2 MPa); and TC, thermal cycling (10(4) cycles; 5°/55°C). A single-load-to-fracture test was performed at a crosshead speed of 0.5 mm/min to assess the assembly's resistance to fracture (ISO Norm 14801). X-ray diffraction (XRD) analysis was applied to observe and quantify the tetragonal-monoclinic (t-m) phase transformation. Representative abutments were examined with high-resolution scanning electron microscopy (SEM) to observe the surface characteristics of the abutments. Load-to-fracture test results (N) were compared by ANOVA and Tukey test (α=.05). RESULTS: XRD measurements revealed the monoclinic phase in some abutments after each aging condition. All the aging conditions reduced the fracture load significantly (P<.001). Mechanical cycling reduced the fracture load more than autoclaving (P=.034). No differences were found in the process of surface degradation among the groups; however, the SEM detected grinding-induced surface flaws and microcracks. CONCLUSIONS: The resistance to fracture and the phase stability of Y-TZP implant abutments were susceptible to hydrothermal and mechanical conditions. The surface microstructure of Y-TZP abutments did not change after aging conditions.

Morpho-anatomical study of rhizome of Limonium brasiliense

AbstractLimonium brasiliense (Boiss.) Kuntze, Plumbaginaceae, is an herb popularly known as guaicuru, guaicurá or baicuru. The species inhabits salt marshes from the coastal region of southern Brazil, including Rio de Janeiro, to Uruguay and Argentina. Although widely used in folk medicine in the state of Rio Grande do Sul to treat genitourinary infections and to regulate menstrual periods, L. brasiliense has been little studied. The present morpho-anatomical study was undertaken to resolve some doubts in the literature as to the nature of the part of the plant that is used for medicinal purposes, a true rhizome or a root. The morpho-anatomical characteristics were analyzed with the aid of light and scanning electron microscopy. The botanical material was characterized as a rhizome with internodes that are evident in the younger but not the older portions. Microscopic analysis revealed the presence of a multilayered periderm with a cortex, ray parenchyma, and pith, formed by collenchyma tissue with abundant intercellular spaces in the outer portions of the cortex, responsible for the rigidity of the body, and with walls impregnated with phenolic compounds. The vascular bundles are collateral with elliptical to elongated cells, and with few conducting and sclerenchymal elements. Groups of sclereids are dispersed through the cortex and pith. These morpho-anatomical characteristics define the structure as a rhizome.

Influence of sterilization process on cutting effectiveness andurability of ultrasonic tips / Influência do processo de esterilização na efetividade de corte e durabilidade das pontas ultra-sônicas

Objetivo: O objetivo foi avaliar a influência de diferentes métodos de esterilização na efetividade de corte e durabilidade de pontas ultra-sônicas cilíndricas comparadas com pontas diamantadas cilíndricas convencionais. Material e Métodos:Quinze pontas diamantadas cilindricas (1092)(KG Sorensen) acopladas a um motor de de alta rotação, e quinze pontas ultrassonicas cilíndricas(8,2137) (CVDentus) acopladas a um ultra-som foram utilizadas para realizar preparos cavitários padronizados em fragmentos de dentes bovinos higidos, limpos com taça de borracha, pedra-pomes e água. Após cada um dos 10 preparos, as pontas foram9 vezes esterilizadas em autoclave (SA), estufa (SO), ou limpas com escova, sabão e água (C). Os fragmentos foram pesados e microfotografias das pontas foram tomadas no início e no final do experimento. Outras9 pontas de diamante CVD e 9 convencionais foram submetidos aos mesmos ciclos de esterilização em autoclave (SAC), forno (SOC) ou lavado com água e sabão (CC) no entanto, sem serem usadas para fazer preparos cavitários, servindo como controle. Realizou-se análise descritiva dos valores encontrados na pesagem e dos scores das microfotografias.Resultados: Diferenças estatisticamente significativas(teste t de Student pareado) foram observadas entre as pontas após a esterilização (p = 0,0001). SOe SA não influenciaram na efetividade de corte e durabilidade das pontas diamantadas ultra-sônicas e convencionais. As microfotografias mostraram diferenças morfológicas entre as pontas utilizadas para os preparos e o controle. Conclusão: As esterilizaçoes por autoclave e estufa não influenciaram a efetividade de corte e durabilidade das pontas diamantadas convencionais. Pontas diamantadas convencionais apresentaram maiores alterações estruturais após a realização de preparos cavitários e procedimentos de limpeza / esterilização, independentemente do processo utilizado.

Objectives: The aim was to evaluate influence of different sterilization methods on cutting effectiveness and durability of cylindrical ultrasonic burs compared with conventional cylindrical diamond-coatedburs. Material and Methods: Fifteen conventional cylindrical diamond-coated (1092) (KG Sorensen) coupled to a high-speed turbine, and fifteen cylindrical ultrasonic (8.2137) (CVDentus) burscoupled to an ultrasound-handpiece were used toper form standardized cavity preparations in healthy bovine tooth fragments, cleaned with rubber cup, pumice stone and water. After every 10 preparations, burs were sterilized 9 times in autoclave (SA), oven (SO), or cleaned with brush, soap and water (C). Fragments were weighed and microphotographs of burs were taken at the beginning and end of experiment. Another 9 conventional diamond-coatedand 9 CVD burs under went the same sterilizationcycles in autoclave (SAC), oven (SOC) or washedwith soap and water (CC) however, without beingused for making cavity preparations, serving ascontrol. Descriptive analyses were made of thevalues found by weighing and microphotographyscores. Results: Statistically significant differences (Paired Student’s-t test) were observed among bursafter sterilization (p = 0.0001). SO and SA didnot influence cutting effectiveness and durability of ultrasonic and conventional diamond-coatedburs. The microphotographs showed morphological differences between the burs used for preparation and the control. Conclusion: Sterilization by oven andautoclave did not influence cutting effectiveness and durability of CVD and conventional diamond-coatedburs. Conventional diamond-coated burs presented greater structural alterations after performing cavity preparations and cleaning/sterilization procedures, irrespective of the process used.

Persistent periventricular echogenicities in preterms are not related to smaller brains at term-equivalent age.

BACKGROUND: Periventricular white matter (PWM) is particularly vulnerable in very preterm infants. Non-cystic white matter injury, known as non-cystic periventricular leukomalacia (ncPVL), is the commonest 'lesion' affecting the preterm brain. There is no consensus about whether ncPVL can be reliably identified from cerebral ultrasound (cUS) or whether there is any reliable correlate of ncPVL on cUS at term-equivalent age (TEA). OBJECTIVE: To compare brain volumes and linear measures at TEA in infants with and without a diagnosis of ncPVL. METHODS: Preterm infants of ≤32 weeks' gestation without major lesions were serially assessed using cUS. ncPVL was defined as PWM echogenicity comparable to the choroid plexus on two scans at least 2 weeks apart after the first postnatal week. At TEA, infants were scanned for the estimation of brain volume and ventricular and tissue dimensions. Head circumference was measured. The data were compared between those with/without ncPVL. Observer agreement was assessed using kappa statistic. RESULTS: Of 63 eligible infants 29% had ncPVL. Significant differences were found between those with/without ncPVL for 5 min Apgar score, CRIB score, invasive ventilation rates and chronic lung disease but not for other relevant clinical data. No significant differences were found for estimated brain volume, ventricular size, corpus callosum length/thickness or central grey matter width. Intra-observer reliability was moderate (kappa = 0.51-0.56); inter-observer reliability was poor (kappa = 0.20-0.32). CONCLUSIONS: This study indicates that an ultrasound diagnosis of ncPVL should not be used as a sole predictor of lower brain growth detectable at TEA.

Resistência à fratura entre a resina acrílica e a resina composta em coroas provisórias implanto-suportadas unitárias imediatas anteriores: estudo in vitro / Fracture resistance between acrylic resin and composite resin in anterior immediate implant- supported provisional crowns: an in vitro study

O propósito do presente estudo foi avaliar a resistência à fratura de coroas provisórias implanto ­ suportadas unitárias imediatas anteriores confeccionadas com facetas de resina acrílica e resina composta após diferentes tratamentos superficiais. Para isto 64 coroas provisórias implanto-suportadas foram confeccionadas e divididas 8 grupos experimentais (n=8), de acordo com o material de confecção, resina acrílica(RA) no grupo 1 ou resina composta(RC) nos grupos 2 a 8, e, tratamentos superficiais realizados na faceta: 1- sem tratamento, 2- sem tratamento, 3- metilmetacrilato(MM), 4- primer para metal(PM), 5- sistema adesivo(SA), 6-jateamento com óxido de alumínio(Al3O2)+MM, 7- Al3O2+PM e 8- Al3O2+SA . Os espécimes foram submetidos a 1x104 ciclos térmicos variando entre duas temperaturas (5ºC e 55 ºC) e posteriormente ao ensaio de resistência à fratura, com carga aplicada com velocidade de 0,5 mm/ min até a ocorrência de falha. Quando os valores de carga máxima para fratura foram analisados, o grupo 1 (controle) obteve os maiores valores (332 N média e ± 67 desvio padrão). Comparados ao controle, os grupos 2, 3, 4, 6 e 7 se mostraram estatisticamente diferentes (P < 0.05), com valores de carga máxima para fratura inferiores ao controle. Por outro lado os grupos 5 e 8 foram semelhantes e não demonstraram diferença estatística quando comparados com o controle (P > 0.05). A partir da análise dos dados, de acordo com a metodologia utilizada, pode-se concluir que o tratamento com sistema adesivo é uma boa opção para uso clínico, aumentando a resistência das coroas provisórias implanto-suportadas confeccionadas com resina acrílica e resina composta

The purpose of this study was to evaluate the fracture resistance of the immediate implant-supported provisional crown prepared with denture tooth and composite resin, after different surface treatments. Sixty-four screw-retained implant-supported provisional crown were divided into 8 groups (n= 8) according to the crown material, acrylic resin(AR) group1 or composite resin(CR) groups 2 to 8 and surface treatment performed: 1- no surface treatment, and 2- no surface treatment, 3- methyl methacrylate(MM), 4- metal primer(MP), 5- bonding system(BS) 6- alumina air abrasion (Al3O2) +MM, 7- Al3O2+MP and 8- Al3O2+BS. Specimens were subjected to 1x104 thermal cycles at two temperatures (5ºC and 55 ºC) and after that was performed the static mechanical test with a crosshead speed of 0.5 mm/ min until the sample fracture. When the maximum load to failure was analyzed the group 1 (control) had the highest values (332 N ± 67 mean and standard deviation). Compared to the control, groups 2, 3, 4, 6 and 7 were statistically different (P <0.05), with lower values of maximum than the control. Moreover the 5 and 8 groups were similar and showed no statistical difference when compared with the control (p>0.05). From the analysis of the data in accordance with the methodology used, it can be concluded that the treatment with bonding system is a good option for clinical use, increasing the resistance of implant-supported provisional crowns made with acrylic resin and composite resin

Preterm cerebellum at term age: ultrasound measurements are not different from infants born at term.

BACKGROUND: Reduced supratentorial brain growth has been shown in preterm-born infants at term-equivalent age (TEA), but cerebellar growth may be preserved in the absence of supratentorial injury. Our study aims to compare cerebellar size assessed using cerebral ultrasound (cUS) at TEA between preterm infants and term-born controls. METHODS: Cerebellar dimensions (including transverse cerebellar diameter (TCD), cerebellar vermis height, anteroposterior vermis diameter (APVD), and cerebellar vermis area (CVA)) were measured using Image Arena software (TomTec Imaging Systems, Unterschleissheim, Germany) in 71 infants <32-wk gestation without significant scan abnormality at TEA and in 58 term-born control infants. Intra- and interobserver agreement were evaluated. RESULTS: In comparison with controls, preterms at TEA had smaller TCDs (4.9 vs. 5.2 cm; P < 0.001) but larger CVAs (4.7 vs. 4.3 cm(2); P < 0.005) and APVDs (2.4 vs. 2.2 cm; P < 0.001); however, these differences were no longer seen after accounting for head shape. In <28-wk gestational age infants, CVA was statistically similar to controls, as were for small-for-gestational-age infants. CONCLUSION: Our data support neonatal sparing of preterm cerebellar growth that is measureable using cUS, and this includes the most immature and small-for-gestational-age infants. We suggest cUS can be used to assess cerebellar size at TEA, with measures of both width and height being taken into account, and thus may be a useful tool for detecting infants with poorer cerebellar growth who are at increased risk of disability.

Cerebral volume at term age: comparison between preterm and term-born infants using cranial ultrasound.

BACKGROUND AND AIMS: Very preterm infants are at particular risk of neurodevelopmental impairments. This risk can be anticipated when major lesions are seen on cerebral ultrasound (cUS). However, most preterm infants do not have such lesions yet many have a relatively poor outcome. Our study aims were to describe a tri-dimensional cUS model for measuring cranial and brain volume and to determine the range of brain volumes found in preterm infants without major cUS lesions at term equivalent age (TEA) compared to term-born control infants. We also aimed to evaluate whether gestational age (GA) at birth or being small for gestational age (SGA) influenced estimated brain size. METHODS: We scanned a cohort of very preterm infants at TEA and term-born controls. Infants with major cerebral lesions were excluded. Measurements of intracranial diameters (bi-parietal, longitudinal, cranial height), brain structures, ventricles and extracerebral space (ECS) were made. A mathematical model was built to estimate from the cUS measurements the axial area and volumes of the cranium and brain. Appropriate statistical methods were used for comparisons; a p-value under 0.05 was considered significant. SGA infants from both groups were analysed separately. RESULTS: We assessed 128 infants (72 preterms and 56 controls). The preterms' head was longer (11.5 vs. 10.5 cm, p < 0.001), narrower (7.8 vs. 8.4 cm, p < 0.001) and taller (8.9 vs. 8.6 cm, p < 0.01) than the controls'. Estimated intracranial volume was not statistically different between the groups (411 vs. 399 cm(3), NS), but preterms had larger estimated ECS volume (70 vs. 22 cm(3), p < 0.001), lateral ventricular coronal areas (33 vs. 12 mm(2), p < 0.001) and thalamo-occipital distances (20 vs. 16 mm, p < 0.001), but smaller estimated cerebral volume (340 vs. 377 cm(3), p < 0.001). Smaller brain volumes were associated with being of lower gestational age and birth weight and being small-for-gestational age. CONCLUSIONS: We have developed a model using cranial ultrasound for measuring cranial and brain volumes. Using this model our data suggest that even in the absence of major cerebral lesions, the average extrauterine cerebral growth of very preterm infants is compromised. Our model can help in identifying those preterm infants with smaller brains. Later follow-up data will determine the neurodevelopmental outcome of these preterm infants in relation to their estimated brain volumes.

Assessment of gestational age using cerebellar measurements at cranial ultrasound: what is the best approach?

BACKGROUND AND AIMS: Clinical assessment of gestational age (GA) in preterm infants can be challenging. Several ultrasound approaches for estimating GA using cerebellar measurements are reported, claiming to be simpler and more accurate than clinical assessment, but they are not widely used. We aimed to compare the accuracy of four previously described measurements and compare their use in preterm infants. METHODS: We studied infants <32weeks of GA defined by in-vitro fertilization date or early fetal ultrasound, excluding infants with neurological problems. Vermis anterior-posterior diameter (VAPD), vermis height (VH), and transverse cerebellar diameter via anterior (TCDa) and mastoid fontanelles (TCDm) were measured.Estimated PMA was calculated using published equations, and compared to known PMA using intraclass correlation coefficient (ICC). Intra and inter-observer reliability were determined. RESULTS: We studied 80 infants (mean GA 28.5weeks [range 24-32], mean post-natal age 5.7days). ICC was 0.761 (VAPD), 0.632 (VH), 0.115 (TCDa) and 0.825 (TCDm). The TCDm equation gave the best estimate of GA (mean estimate -2days; 95% CI±13.8days). TCDa and TCDm absolute measurements were similar for each infant. Accuracy for estimating GA was similar for appropriately grown and small-for-gestation infants. Inter and intra-observer reliability was very good for all measurements. CONCLUSIONS: Three previously described equations for estimating GA from cerebellar measurements gave good estimates of GA in preterms. The equation described for TCDm gave the narrowest 95% CI. We recommend the TCDm equation for the estimation of GA in VLBW infants but the TCD measurement can be made via either the anterior or mastoid fontanelle.

Antibiotic prophylaxis in premature rupture of membranes at term: a randomized controlled trial.

OBJECTIVE: To determine whether prophylactic antibiotic administration in women presenting with premature rupture of membranes (PROM) at term can alter the rates of maternal and neonatal infections. METHODS: In a randomized, controlled, nonblinded trial, women at low risk with singleton term pregnancies presenting with PROM were assigned to either antibiotic administration or no treatment. Main outcomes evaluated were rates of maternal infection (chorioamnionitis and endometritis) and neonatal infection. RESULTS: A total of 161 patients were evaluated, 78 in the antibiotic group and 83 in the control group. Maternal infection was significantly lower when antibiotics were administered (2.6% compared with 13.2%; relative risk 0.89, 95% confidence interval 0.81-0.98; P=.013). All cases of maternal infection occurred in women with more than 12 hours of PROM. Newborns of mothers receiving antibiotics had fewer infections (3.8%) compared with those in the control group (6.0%), but the difference was not statistically significant (P=.375). CONCLUSION: Prophylactic use of antibiotics in PROM at term significantly reduced the risk of maternal infection in our population. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01633294. LEVEL OF EVIDENCE: I.