The Role of Macrolides in Noncystic Fibrosis Bronchiectasis

Objective. The present study aims at reviewing the main publications on the use of macrolides as immunomodulators in patients with noncystic fibrosis bronchiectasis. Source of Data. The Medline database was our source of data for this research carried out until June 2011, using the key words: macrolides and bronchiectasis, while searching for original articles and reviews. Summary of Data. Seven clinical studies that evaluated the action of the macrolides in patients with bronchiectasis were found. There was the sputum volume, reduction in pulmonary exacerbation frequency, and in the use of antimicrobial treatment, in addition to pulmonary function improvement. Conclusions. Anti-inflammatory action and immunomodulatory effects can be attributed to macrolides when administered in low doses and on the long term. This use has been well established both in diffuse panbronchiolitis and in cystic fibrosis. Evidence indicates possible benefits in bronchiectasis. Future studies are needed, though, to establish the ideal dose and treatment duration and to understand the implications in the generation of microbial resistance

Intentional Replantation as Treatment of Extrusive Luxation: A Case Report

Accurate diagnosis, immediate care and proper treatment planning are important factors for the successful treatment of dental traumatic injuries. In extrusive luxation, postponement in treatment may lead to the need for new strategies for the resolution of unwanted consequences. The present case report describes an unusual condition of delayed treatment regarding extrusive luxation of two anterior teeth treated by intentional replantation. An 18-year-old female patient attended the Dental School for the treatment of a traumatic injury to the anterior teeth 5 days after a fall from a bicycle. Clinically, teeth #21 and #22 were extruded in incisal edges for 5 mm from their neighboring teeth, had edematous gingiva, showed grade II mobility and were painful to percussion. Radiographically, the roots were intact and the periodontal ligament space was thickened along its entire length. As immediate repositioning could not be performed, intentional replantation was recommended. After detaching the periodontal ligament, the teeth were extracted and the alveolus was curetted and irrigated with saline solution to remove the already-formed clot. After replantation, the teeth were restrained and the patient was medicated with antibiotics as well as analgesics. After 10 days, the splint was removed, the root canals were instrumented and then, filled with calcium hydroxide. After 30 days, they were completely obturated using gutta-percha. The 5-year follow-up showed root integrity, absence of mobility and normal periodontium. The outcomes of the current case report revealed that when intentional replantation was properly conducted, it could be considered an option for the treatment of extrusive luxation where the teeth were not to be immediately repositioned

Cirurgia laparoscópica robotizada a distância: experiência inicial

Robotic surgery is an option to laparoscopy that may offer some benefits including the possibility of performing surgery when the surgeon is geographically away from the patient and faster tireless repetitive movements with greater precision. At present, robot-assisted surgery has been done routinely in several institutions around the world, however, to the best of our knowledge, it is the first time such procedure is performed in our academic environment and herein is reported the first telerobotic-assisted laparoscopic cystectomy performed in a domestic pig at our institution using the Zeus®robotic system (Computer Motion, EUA). The procedure was performed using two different operating rooms geographically apart from each other. The assistant was in an operating room that was set with the operating table and the pig as well as with the Zeus® robotic arms. In the other operating room, the surgeon was seated in the control console with a three-dimensional imaging five meters away from the operating table connected with electric cables. The assistant surgeon established the pneumoperitoneum and five trocars were placed in a fan configuration. The surgeon started performing the surgery using three out of the five ports taking control of the laparoscope (voice control) and manual control of laparoscopic instruments connected to the robotic arms using the joysticks. The other two ports were used by the assistant for traction and clips placement that was also necessary for exchanging the many laparoscopic instruments connected to the robot. The laparoscopic total cystectomy was successfully performed in 25 minutes with no complications. The truly benefits as well as the cost-effectiveness of the robotic surgery in our environment is yet to be determined after experience acquisition with telerobotic before start performing such procedures routinely in humans. The present report shows the technical feasibility of telerobotic surgery in a developing country.A cirurgia totalmente robotizada é uma opção à laparoscopia que pode proporcionar alguns benefícios, entre os quais a realização dos incansáveis movimentos de repetição com maior precisão e rapidez e com o cirurgião localizado em ambiente geograficamente diferente do paciente. Relatamos, em nossa instituição, a primeira cistectomia totalmente robotizada à distância em um porco (raça Landrace) doméstico com o sistema robótico Zeus® (Computer Motion, EUA). A cirurgia foi realizada em duas salas geograficamente separadas, sendo que em uma delas, o porco foi posicionado na mesa cirúrgica bem como os braços do sistema Zeus® fixados de forma segura. Na seqüência, o assistente introduziu os cinco trocateres em forma de leque pela via transperitoneal após obtenção do pneumoperitônio pelo método fechado. Em outra sala, o cirurgião principal comandava os braços do robô através de controles manuais sentado dentro do console de comando do sistema Zeus ®, auxiliado por imagem de vídeo em três dimensões transmitida pelo laparoscópio, que era comandado por sistema de voz, pelo cirurgião. A distância do console de comando e da mesa cirúrgica era de 5 metros e estes estavam conectados por cabos elétricos. A cistectomia total foi realizada em 25 minutos sem intercorrências. O assistente auxiliou apenas nas manobras de troca de instrumento do sistema Zeus ®, apresentação dos tecidos e introdução do clipador, utilizando apenas dois trocartes. Os reais benefícios do sistema robótico em nosso meio ainda será determinado através da aquisição de maior experiência com o sistema e pelo início da realização deste procedimento em humanos.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of SurgeryUNIFESP, EPM, Department of SurgerySciEL

Surgical and Orthodontic Treatment of Severely Intruded Permanent Incisors: A Case Report

Traumatic dental intrusion is a serious injury and results in significant damage to the periodontal ligament, dentin-pulp complex, and alveolar bone. This article presents a case of severe intrusion of the two upper permanent central incisors where the treatment option was the combination of the surgical and orthodontic technique. The difficulty of accessing the crowns of these teeth to bond the brackets was solved by lifting a full thickness flap. To disengage the teeth from the alveolus, a careful dislocation motion was performed. After suturing the flap, a removable orthodontic appliance was installed and an extrusive force was applied for 8 weeks. After 10 weeks, the endodontic treatment was performed and the crowns were restored. The 10-year clinical control showed normal mobility. Radiographically, minor losses of the cervical alveolar cortical bone and integrity of the periodontal ligament were observed.Keywords: Dental Trauma; Intrusive Luxation; Orthodontic Extrusio

Genetic diversity in Mentha cervina based on morphological traits, essential oils profile and ISSRs markers

Morphological, phytochemical and genetic differences were studied to evaluate the level and distribution of diversity in twelve populations of the Portuguese endangered medicinal plant Mentha cervina L. Morphological variation was correlated with ecological conditions at the site of origin. Pulegone was the major essential oils compound in all of the populations collected at full flowering (68–83%), in different growing conditions (51–82%), and for all the developmental stages studied (47–82%). Although clusters were defined, the analysis revealed a high chemical correlation among all populations (Scorr 0.95%). Intersimple sequence repeats markers were used to assess the population structure and genetic variation. Populations exhibited a relatively low genetic diversity (PPB ¼ 14.3–64.6%, He ¼ 0.051–0.222, I ¼ 0.076–0.332), with high structuring between them (GST ¼ 0.51). However, the genetic diversity at species level was relatively high (PPB ¼ 97.7%; He ¼ 0.320). The levels and patterns of genetic diversity were assumed to result largely from a combination of evolutionary history and its unique biological traits, such as breeding system, clonal growth, low capacity of dispersion and habitat fragmentation. The relatively low genetic diversity in the populations analyzed indicates that the maintenance of their evolutionary potential is at risk if population sizes are maintained and if there is no protection of the habitats

A INCONSTITUCIONALIDADE DO ART. 20-B, §3º, II, DA LEI Nº 10.522/2002, COM REDAÇÃO DADA PELA LEI Nº 13.606/2018: INDISPONIBILIDADE DE BENS E DIREITOS SEM DECISÃO JUDICIAL

A Lei Ordinária nº 13.606/2018, que alterou diversos outros dispositivos legais, incluiu na Lei 10.522/2002 os arts. 20-B, 20-C, 20-D e 20-E. De acordo com o art 20-B, §3º, II da Lei nº 10.522/2002, o devedor que possuir débitos federais inscritos em dívida ativa da União poderá ter seus bens e direitos tornados indisponíveis pela Procuradoria Geral da Fazenda Nacional, sem decisão judicial, caso não efetue o pagamento do débito nos cinco dias seguintes à ciência da inscrição do crédito em dívida ativa da União. Assim, o presente trabalho teve como objetivo geral demonstrar a inconstitucionalidade da indisponibilidade de bens e direitos sem decisão judicial. A pesquisa foi de finalidade do tipo básica, com objetivos descritivos e resultados analisados qualitativamente. Seguiu-se a premissa do método dedutivo, partindo da análise doutrinária e legal para a inconstitucionalidade defendida no caso concreto. Para tanto, os procedimentos adotados foram a documentação indireta por meio da análise de documentos oficiais como leis e portarias e precipuamente o procedimento bibliográfico, através da utilização de livros impressos e disponíveis na rede mundial de computadores. A elaboração do trabalho e discussão do assunto no meio acadêmico e na sociedade em geral mostra-se de extrema importância ante a gravidade das lesões a princípios constitucionais que podem decorrer da aplicabilidade da medida, principalmente considerando o cenário econômico atual do Brasil, onde muitos contribuintes não conseguem conciliar a alta carga tributária do país com a situação financeira desfavorável

Development of a pneumatic consolidometer: compaction modeling, penetrometry and tensile strength of soil aggregates

A compactação é um dos processos responsáveis pela degradação física do solo que pode ocasionar a perda da sustentabilidade da produção agrícola. Assim, é fundamental dispor de estratégias instrumentais para quantificar as propriedades físicas que são influenciadas pela compactação e utilizadas para avaliar a qualidade do solo. Os objetivos deste trabalho foram: desenvolver um consolidômetro com propulsão pneumática de baixo custo; avaliar sua funcionalidade mediante estudo do comportamento compressivo de um Latossolo Vermelho distrófico de textura argilo-arenosa sob plantio direto; e avaliar o potencial de utilização da propulsão pneumática para determinações de resistência do solo à penetração (RP) e de resistência tênsil de agregados (RT). A avaliação do comportamento compressivo do solo foi realizada mediante curvas de compressão, utilizando amostras indeformadas, obtidas das posições de amostragem relativas à linha e à entrelinha da cultura de aveia-preta. Nessas amostras, foram realizados ensaios de compressão uniaxial em condição de teor de água correspondente ao potencial mátrico de -10 kPa, sendo determinados o índice de compressão (IC) e a pressão de preconsolidação (&#963;p), bem como suas relações com outras propriedades físicas do solo. A RP foi determinada em amostras indeformadas de um Argissolo Vermelho-Amarelo distrófico de textura franco-arenosa sob citros. Para as determinações da RT foram utilizados agregados de dois solos: um Argissolo Acinzentado distrófico arênico coeso e um Argissolo Amarelo distrófico arênico. Os resultados mostram que a densidade do solo, antes do ensaio de compressão uniaxial, foi maior (p < 0,05) para a entrelinha da cultura de aveia-preta. A curva de compressão foi sensível às alterações estruturais do solo entre as posições de amostragem; a &#963;p e o IC indicaram, respectivamente, maior capacidade de suporte de carga e menor suscetibilidade à compactação (p < 0,05) para a entrelinha da cultura de aveia-preta. A utilização de propulsão pneumática não influenciou os resultados da RP e da RT. Isso permite concluir que a curva de compressão do solo, a RP e a RT podem ser determinadas utilizando o equipamento desenvolvido neste estudo.Soil compaction is one of the processes responsible for soil physical degradation that may result in the loss of sustainability of agricultural production. Therefore, it is important to have instrumental strategies to quantify soil physical properties that are influenced by soil compression and used to assess soil quality. The objectives of this study were to: (i) develop an inexpensive pneumatic consolidometer, (ii) evaluate its functionality by the study of the compressive behaviour of a sandy clay Rhodic Hapludox under no-tillage, (iii) evaluate the potential use of pneumatic propulsion to determine penetration resistance (PR) and tensile strength of aggregates (TS) using the proposed consolidometer. Compression curves based on undisturbed soil sampled in and between rows under black oat were used to evaluate the soil compressive behaviour. Uniaxial compression tests were performed in these samples at a soil water content corresponding to a matric potential of -10 kPa and used to determine the compression index (CI) and preconsolidation pressure (&#963;p) and their correlations with other soil physical properties. PR of undisturbed samples of a sandy loam soil under citrus was determined. Aggregates from two Ultisols were used to determine TS in a hardsetting and a non-hardsetting horizons. Results showed that soil bulk density before the uniaxial compression test was higher (p < 0.05) in-between the black oat rows. The compression curve was sensitive to differences in soil structure between sampling positions, and &#963;p and CI indicated, respectively, higher load support and less susceptibility to compaction (p < 0.05) in-between the black oat rows. The use of pneumatic propulsion did not influence the results of PR and TS. Therefore, the soil compression curve, PR and TS can be determined with the equipment developed in this study