Local anesthesia with epinephrine is safe and effective for oral surgery in patients with type 2 diabetes mellitus and coronary disease: a prospective randomized study

OBJECTIVE: To investigate the variations in blood glucose levels, hemodynamic effects and patient anxiety scores during tooth extraction in patients with type 2 diabetes mellitus T2DM and coronary disease under local anesthesia with 2% lidocaine with or without epinephrine. STUDY DESIGN: This is a prospective randomized study of 70 patients with T2DM with coronary disease who underwent oral surgery. The study was double blind with respect to the glycemia measurements. Blood glucose levels were continuously monitored for 24 hours using the MiniMed Continuous Glucose Monitoring System. Patients were randomized into two groups: 35 patients received 5.4 mL of 2% lidocaine, and 35 patients received 5.4 mL of 2% lidocaine with 1:100,000 epinephrine. Hemodynamic parameters (blood pressure and heart rate) and anxiety levels were also evaluated. RESULTS: There was no difference in blood glucose levels between the groups at each time point evaluated. Surprisingly, both groups demonstrated a significant decrease in blood glucose levels over time. The groups showed no significant differences in hemodynamic and anxiety status parameters. CONCLUSION: The administration of 5.4 mL of 2% lidocaine with epinephrine neither caused hyperglycemia nor had any significant impact on hemodynamic or anxiety parameters. However, lower blood glucose levels were observed. This is the first report using continuous blood glucose monitoring to show the benefits and lack of side effects of local anesthesia with epinephrine in patients with type 2 diabetes mellitus and coronary disease

Interfascial Dissection For Protection Of The Nerve Branches To The Frontalis Muscles During Supraorbital Trans-eyebrow Approach: An Anatomical Study And Technical Note

Preservation of the temporal branches of the facial nerve during anterolateral craniotomies is important. Damaging it can inflict undesirable cosmetic defects to the patient. The supraorbital trans-eyebrow approach (SOTE) is a versatile keyhole craniotomy but still has a high rate of frontalis muscle (FM) palsy. Objective Anatomical study to implement the interfascial dissection during the SOTE to preserve the nerves to the FM. Methods Slight modification of the standard technique of the SOTE was performed in 6 cadaveric specimens (12 sides). Results Distal rami to the FMwere exposed. The standard "U-shape" incision of the FM can cross over the nerves. Alternatively, an "L-shape" incision was performed until the superior temporal line (STL). An interfascial dissection was performed near to the STL and the interfascial fat pad was used as a protective layer for the nerves. Conclusion Various pathologies can be addressed with the SOTE. In the majority of the cases the cosmetic results are good, but FM palsy remains a drawback of this approach. The interfascial dissection may be used in an attempt to prevent frontalis rami palsy.77326527

Precipitating Ordered Skyrmion Lattices from Helical Spaghetti

Magnetic skyrmions have been the focus of intense research due to their potential applications in ultra-high density data and logic technologies, as well as for the unique physics arising from their antisymmetric exchange term and topological protections. In this work we prepare a chiral jammed state in chemically disordered (Fe, Co)Si consisting of a combination of randomly-oriented magnetic helices, labyrinth domains, rotationally disordered skyrmion lattices and/or isolated skyrmions. Using small angle neutron scattering, (SANS) we demonstrate a symmetry-breaking magnetic field sequence which disentangles the jammed state, resulting in an ordered, oriented skyrmion lattice. The same field sequence was performed on a sample of powdered Cu2OSeO3 and again yields an ordered, oriented skyrmion lattice, despite relatively non-interacting nature of the grains. Micromagnetic simulations confirm the promotion of a preferred skyrmion lattice orientation after field treatment, independent of the initial configuration, suggesting this effect may be universally applicable. Energetics extracted from the simulations suggest that approaching a magnetic hard axis causes the moments to diverge away from the magnetic field, increasing the Dzyaloshinskii-Moriya energy, followed subsequently by a lattice re-orientation. The ability to facilitate an emergent ordered magnetic lattice with long-range orientation in a variety of materials despite overwhelming internal disorder enables the study of skyrmions even in imperfect powdered or polycrystalline systems and greatly improves the ability to rapidly screen candidate skyrmion materials

Extreme magnetic field-boosted superconductivity

Applied magnetic fields underlie exotic quantum states, such as the fractional quantum Hall effect and Bose-Einstein condensation of spin excitations. Superconductivity, on the other hand, is inherently antagonistic towards magnetic fields. Only in rare cases can these effects be mitigated over limited fields, leading to reentrant superconductivity. Here, we report the unprecedented coexistence of multiple high-field reentrant superconducting phases in the spin-triplet superconductor UTe2. Strikingly, we observe superconductivity in the highest magnetic field range identified for any reentrant superconductor, beyond 65 T. These extreme properties reflect a new kind of exotic superconductivity rooted in magnetic fluctuations and boosted by a quantum dimensional crossover

Volume de madeira em área reflorestada: um estudo simulado de inferência estatística

O entendimento de conceitos de inferência estatística clássica como distribuição amostral e intervalos de confiança pode ser facilitado e ampliado recorrendo-se a estudos simulados. Apresenta-se um exemplo fictício em que o volume médio de madeira por hectare precisa ser estimado a partir de informações amostrais sobre a quantidade, perímetros e alturas de árvores. A simulação é implementada no StatisticaÓ. Análise descritiva de 2000 réplicas permite conhecer as características do estimador não-convencional utilizado. Verifica-se que sua distribuição amostral é aproximadamente lognormal e que o estimador tem viés. A cobertura do intervalo de confiança e a probabilidade do erro II em um teste de hipótese são avaliadas, e os efeitos resultantes de suposições não atendidas, verificadas. Conclui-se que o processo de simulação é simples, e que sua utilização em cursos introdutórios de inferência é viável. Além da oportunidade de vivenciar concretamente os conceitos, abre-se ao estudante a possibilidade para explorar situações não-convencionais. Palavras-chave: estimação, teste de hipóteses, simulação estocástica. ABSTRACT Wood volume in a forested area: a simulated study in statistical inference Classical concepts of statistical inference like sampling distribution and confidence intervals can be simplified and made more effective with simulation studies. We present a fictitious example where the volume of wood per hectare needs to be estimated from sampling information about quantity, perimeter and height of trees. Simulations are implemented in StatisticaÓ. A basic descriptive analysis of 2000 replicates lets us know the characteristics of our unconventional estimator. We verify that the sampling distribution is approximately lognormal and that the estimator is biased. The coverage of the confidence interval and the type II error probability in a given hypothesis test are evaluated and the effects of unmatched suppositions verified. We conclude that the simulation procedure is simple and that its use in introductory inference courses feasible. It can give the student an opportunity to experience abstract concepts and simultaneously go beyond standard situations. Key-words: inference, test of hypotheses, stochastic simulation

Equidade de acesso à atenção básica em saúde bucal

The objective of this study was to demonstrate face validity with a novel resource allocation framework designed to maximize equity into dental booking systems. The study was carried out in 2014. Eleven experts in primary dental care practice in Southern Brazil participated, using a three-round consensus group technique. First, the experts reached consensus on the items to be included in a 5-level diagnostic scale. They identified 21 clinical conditions and categorized them according to the oral health intervention required. Then, they described workload and activity standards for dental staff to carry out health promotion, oral disease prevention, dental treatment, dental rehabilitation, and urgent dental care. Finally, they agreed upon a set of wait times for primary dental care, establishing maximum waits from 2 to 365 days, according to the diagnostic classification. The framework demonstrated potential ability to promote more equitable access to primary dental services, since equal diagnostic classifications share the same waiting times for the dental care they require.O objetivo do estudo foi demonstrar validade de face com uma nova matriz destinada a maximizar a equidade nos sistemas de agendamento odontológico. O estudo foi realizado em 2014, no qual participaram 11 dentistas com experiência de trabalho na rede básica de saúde da região sul do Brasil, utilizando a técnica de grupo de consenso em três rodadas de discussão. Primeiro, os participantes chegaram ao consenso quanto aos itens que deveriam estar presentes em uma escala de classificação diagnóstica de 5 níveis. Identificaram 21 condições clínicas de saúde bucal e as categorizaram conforme a intervenção necessária. A seguir, os participantes descreveram as cargas de trabalho e os padrões de atividade recomendados para a equipe odontológica realizar promoção da saúde, prevenção de doenças bucais, tratamento odontológico, reabilitação dentária, e atendimento odontológico de urgência. Por último, os dentistas chegaram ao consenso sobre tempos máximos de espera para atendimento odontológico na rede básica, estabelecendo prazos de 2 até 365 dias conforme a classificação diagnóstica atribuída. Este estudo demonstrou o potencial da matriz de alocação de recursos para promover acesso mais equitativo aos serviços odontológicos da rede básica, uma vez que classificações diagnósticas iguais compartilham os mesmos prazos de espera para o atendimento odontológico requerido

High quality aluminium doped zinc oxide target synthesis from nanoparticulate powder and characterisation of sputtered thin films

Nanoparticulate aluminium-doped zinc oxide powder was synthesised through detonation and subsequent rapid quenching of metallic precursors. This technique allows for precise compositional control and rapid nanoparticle production. The resulting powder was used to form sputter targets, which were used to deposit thin films by radio frequency sputtering. These films show excellent sheet resistance and transmission values for a wide range of deposition temperatures. Crystal structure analysis shows that crystals in the target have a random orientation, whereas the crystals in the films grow perpendicular to the substrate surface and propagate preferentially along the (002) axis. Higher temperature deposition reduces crystal quality with a corresponding decrease in refractive index and an increase in sheet resistance. Films deposited between room temperature and 300 °C were found to have sheet resistances equivalent to or better than indium tin oxide films for a given average transmission value

Occurrence of dental emergency events in primary health care services

The aim of this study was to describe the occurrence of dental emergency and its association with individual factors and primary health care services. A follow-up study was conducted with data extracted from an exploratory study about the classification of dental care needs over time according to a care framework. There were included 1831 patients of five services. The outcome was the occurrence of dental emergency analyzed according to sex, age, skin color, service and maximum waiting time for dental care. A multivariate analysis with Poisson regression was used to estimate weighted prevalence ratio (PR) with 95% Confidence Intervals (CI) and survival analysis was conducted. The prevalence of dental emergency was 12.6%, varying according to age (13–19: PRa =1.79 (95%CI: 1.0–3.21); 20–65: PRa = 2.71 (95%CI: 1.73–4.26); Over 65: PRa = 2.51 (95%CI: 1.41–4.46)) and Primary Health Care service (FHS 2: PRa = 2.20 (95%CI: 1.37–3.53), FHS 3: PRa = 1.43 (95%CI: 0.90–2.27); FHS 4: PRa = 3.25 (95%CI: 2.15–4.92), FHS 5: PRa = 2.49 (95%CI: 1.56–3.97)) For 231 cases classified as emergency, the failure rate was 7.4%. For 214 cases of emergency, the non-continuity after appointment rate was 53.7%. The incidence of dental emergency was 8.3% and recurrence was 7.2%. Considering all 262 emergency cases attended, the resolution rate was 93.5% and most cases (n = 252, 96.1%) received care within one day. The results point to high effectiveness in emergency dental care within Primary Health Care services. There are indications of the need for improvements in retention and continuity of care

Isolation, cryotomography, and three-dimensional reconstruction of centrioles

Centrioles and basal bodies (referred to hereafter as centrioles for simplicity) are microtubule-based cylindrical organelles that are typically ∼450-nm long and ∼250nm in diameter. The centriole is composed of three distinct regions: the distal part characterized by microtubule doublets, the central core that harbors microtubule triplets, which are also present in the proximal part that also contains the cartwheel, a structure crucial for centriole assembly. The cartwheel was initially revealed by conventional electron microscopy of resin-embedded samples and is thought to impart the near universal ninefold symmetry of centrioles. Deciphering the native architecture of the cartwheel has proven challenging owing to its small dimensions and the difficulties in isolating it. Here, we present a method to purify and analyze the structure of the exceptionally long Trichonympha centriole by cryotomography and subtomogram averaging. Using this method, we revealed the native architecture of the proximal cartwheel-containing region at ∼40Å-resolution. This method can be applied as a general strategy for uncovering the structure of centrioles in other species