Evaluation of an experimental rat model for comparative studies of bleaching agents

Dental materials in general are tested in different animal models prior to the clinical use in humans, except for bleaching agents. Objectives To evaluate an experimental rat model for comparative studies of bleaching agents, by investigating the influence of different concentrations and application times of H2O2 gel in the pulp tissue during in-office bleaching of rats’ vital teeth. Material and Methods The right and left maxillary molars of 50 Wistar rats were bleached with 20% and 35% H2O2 gels, respectively, for 5, 10, 15, 30, or 45 min (n=10 rats/group). Ten animals were untreated (control). The rats were killed after 2 or 30 days, and the maxillae were examined by light microscopy. Inflammation was evaluated through histomorphometric analysis with inflammatory cell count in the coronal and radicular thirds of the pulp. Fibroblasts were also counted. Scores were attributed to odontoblastic layer and vascular changes. Tertiary dentin area and pulp chamber central area were measured histomorphometrically. Data were compared by analysis of variance and Kruskal-Wallis test (

Evaluation of an experimental rat model for comparative studies of bleaching agents

ABSTRACT Dental materials, in general, are tested in different animal models prior to their clinical use in humans, except for bleaching agents. Objectives To evaluate an experimental rat model for comparative studies of bleaching agents by investigating the influence of different concentrations and application times of H2O2 gel in the pulp tissue during in-office bleaching of rats’ vital teeth. Material and methods The right and left maxillary molars of 50 Wistar rats were bleached with 20% and 35% H2O2 gels, respectively, for 5, 10, 15, 30, or 45 min (n=10 rats/group). Ten animals (control) were untreated. The rats were killed after 2 or 30 days, and the maxillae were examined by light microscopy. Inflammation was evaluated by histomorphometric analysis with inflammatory cell counting in the coronal and radicular thirds of the pulp. The counting of fibroblasts was also performed. Scores were attributed to the odontoblastic layer and to vascular changes. The tertiary dentin area and the pulp chamber central area were histomorphometrically measured. Data were compared by the analysis of variance and the Kruskal-Wallis test (

Convalescent plasma for COVID-19 in hospitalised patients : an open-label, randomised clinical trial

Background: The effects of convalescent plasma (CP) therapy in hospitalised patients with coronavirus disease 2019 (COVID-19) remain uncertain. This study investigates the effect of CP on clinical improvement in these patients. Methods: This is an investigator-initiated, randomised, parallel arm, open-label, superiority clinical trial. Patients were randomly (1:1) assigned to two infusions of CP plus standard of care (SOC) or SOC alone. The primary outcome was the proportion of patients with clinical improvement 28 days after enrolment. Results: A total of 160 (80 in each arm) patients (66.3% critically ill, 33.7% severely ill) completed the trial. The median (interquartile range (IQR)) age was 60.5 (48–68) years; 58.1% were male and the median (IQR) time from symptom onset to randomisation was 10 (8–12) days. Neutralising antibody titres >1:80 were present in 133 (83.1%) patients at baseline. The proportion of patients with clinical improvement on day 28 was 61.3% in the CP+SOC group and 65.0% in the SOC group (difference −3.7%, 95% CI −18.8–11.3%). The results were similar in the severe and critically ill subgroups. There was no significant difference between CP+SOC and SOC groups in pre-specified secondary outcomes, including 28-day mortality, days alive and free of respiratory support and duration of invasive ventilatory support. Inflammatory and other laboratory marker values on days 3, 7 and 14 were similar between groups. Conclusions: CP+SOC did not result in a higher proportion of clinical improvement on day 28 in hospitalised patients with COVID-19 compared to SOC alone

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Systemic and regional hemodynamic effects of fluid resuscitation with a hypertonic isoncotic solution guided by mixed venous oxygen saturation in experimental model of septic shock

Introdução: A disfunção de múltiplos órgãos induzida pela sepse é a principal causa de morte em Unidades de Terapia Intensiva. Complexas anormalidades hemodinâmicas, microcirculatórias e do metabolismo promovem dano tecidual e disfunção orgânica. Em particular, no território esplâncnico, os distúrbios da perfusão são precoces, desproporcionais ao comprometimento sistêmico e persistem apesar de uma ressuscitação sistêmica adequada, contribuindo para a disfunção de múltiplos órgãos. A reposição volêmica, fundamental no manejo inicial do choque séptico, é mais eficaz quando guiada por metas derivadas de oxigenação. Objetivo: avaliar os efeitos hemodinâmicos sistêmicos e regionais da ressuscitação volêmica guiada pela saturação venosa mista de oxigênio e avaliar se a utilização de uma solução isooncótica e hipertônica (poli O-2 hidroxietil amido a 6% e cloreto de sódio 7,2%, Hyper Haes®) promove benefícios adicionais à ressuscitação com cristalóides em modelo experimental de choque séptico induzido pela infusão de cepas vivas de E.coli. Método: Dezessete cães anestesiados e ventilados mecanicamente foram monitorados com cateterização da aorta abdominal e com cateter de artéria pulmonar. Após esplenectomia, foi cateterizada a veia porta e foram posicionados transdutores ultrasônicos de fluxo ao redor da veia porta e artéria hepática. O lactato e as variáveis de oxigenação foram obtidos a partir de amostras de sangue arterial, venoso misto e porta. Os animais foram randomizados em três grupos: Controle, n=3: E. coli 1,2 x1010ufc/kg em 30 minutos; sem intervenções adicionais; SF n=7: E. coli 1,2 x1010ufc/kg em 30 minutos + reposição volêmica inicial com SF 0,9% 32ml/kg, HS, n=7: E. coli 1,2x1010ufc/kg em 30 minutos + reposição volêmica inicial com Hyper Haes® 4ml/kg. Se após 30 e 60 minutos, SvO2 < 70%, reposições adicionais com SF 0,9% 32ml/kg eram realizadas em ambos os grupos. Posteriormente, os animais foram observados por 90 minutos e então sacrificados. Resultados: Após a inoculação de bactérias, houve redução de 20% do índice cardíaco, 15% da pressão arterial média e queda de 50% dos fluxos regionais com recuperação parcial e transitória após a ressuscitação volêmica. Observamos aumento progressivo das taxas de extração de oxigênio sistêmica e porta e dos gradientes veno-arterial e porta-arterial de CO2 nos três grupos. Embora os benefícios hemodinâmicos sistêmicos e regionais tenham sido parciais e transitórios nos dois grupos, o grupo tratado com Hyper Haes® apresentou menor grau de apoptose de células do epitélio intestinal. Conclusões: A ressuscitação volêmica guiada pela saturação venosa mista de oxigênio promoveu benefícios hemodinâmicos sistêmicos e regionais parciais e transitórios insuficientes para a restauração da perfusão sistêmica e regional neste modelo experimental de choque séptico hipodinâmico. A utilização de uma pequena quantidade de solução salina hipertônica e isoncótica promoveu benefícios hemodinâmicos sistêmicos e regionais semelhantes à ressuscitação volêmica com grandes volumes de cristalóides neste modelo de choque séptico hipodinâmico. Entretanto, observamos um menor grau de apoptose de células do epitélio intestinal no grupo tratado com solução salina hipertônica e isoncóticaIntroduction: Sepsis related multiple organ failure is the leading cause of death in intensive care units. Complex hemodynamic abnormalities and microcirculatory and cellular alterations promote tissue damage and organ dysfunction. Moreover, splanchnic perfusion is prone to early injury and is compromised in a larger extent than systemic perfusion and persists despite normalization of systemic hemodynamic and oxygen derived variables leading to multiple organ dysfunction. Volume replacement is essential in the management of septic shock and is more efficient when guided by oxigenation endpoints. Objectives: evaluate systemic and regional effects of resuscitation guided by mixed venous oxygen saturation and evaluate if a hypertonic isoncotic solution (poli O-2 hydroxyl ethyl amid 6% and NaCl 7.2%, Hyper Haes®) would improve the benefits of crystalloid resuscitation in experimental septic shock induced by live E.coli infusion. Methods: Seventeen dogs were anesthetized and mechanically ventilated; they were monitored with aorta and pulmonary artery catheterization. After splenectomy, portal vein was canullated. Ultrasonic flow probes were placed around portal vein and hepatic artery. Blood gases and lactate levels were obtained from arterial, mixed venous and portal vein samples. Animals were randomized into three groups: Control, n=3: E. coli 1,2 x1010cfu/kg in 30 minutes; no additional interventions; NS n=7: E. coli 1,2 x1010cfu/kg in 30 minutes + initial fluid replacement with normal saline 32ml/kg, if after 30 and 60 minutes, SvO2 was below 70%, additional replacement with normal saline 32ml/kg was performed; HS, n=7: E. coli 1,2x1010cfu/kg in 30 minutes + initial fluid replacement with Hyper Haes® 4ml/kg, if after 30 and 60 minutes, SvO2 was below 70%, additional replacement with normal saline 32 ml/kg was performed. Animals were observed for 90 minutes and than were euthanized. Results: After bacterial infusion, decreases of cardiac index (20%) mean arterial blood pressure (15%), and regional blood flows (50%) were observed. Both solutions promoted similar and transient benefits at systemic and regional levels. We also observed increases in systemic and portal oxygen extraction rates and veno-arterial and portalarterial pCO2 gradients in all groups. A lesser degree of gut epithelial cells apoptosis was observed in Hyper Haes® treated group. Conclusions: Normalization of mixed venous oxygen saturation was not able to restore splanchnic perfusion markers or other systemic perfusion variables. Although both solutions promoted similar, partial and transient benefits at systemic and regional levels in this experimental model of hypodynamic septic shock hypertonic saline administration was associated with a decrease in gut epithelial cells apoptosi

CONHECIMENTO EM SAÚDE BUCAL DA CRIANÇA E SUA APLICAÇÃO NA PRÁTICA DE MÉDICOS DE FAMÍLIA

Introdução: O cirurgião-dentista é o profissional mais capacitado para trabalhar assuntos relativos à situação de saúde bucal. No entanto, algumas equipes de ESF ainda não possuem o profissional cirurgião-dentista presente. Muitas vezes, o profissional médico passa a ser o principal contato da equipe de saúde com a população. Assim, observa-se a necessidade do mesmo ter o conhecimento de práticas preventivas em relação à saúde bucal. Objetivos: Verificar o conhecimento em saúde bucal da criança dos médicos de família.  Material e Métodos: Foi realizada uma entrevista semi-estruturada com oito Médicos de Família do Serviço de Saúde Comunitária (SSC) do Grupo Hospitalar Conceição (GHC). Resultados: Apenas 37,5% da amostra citou que a dentição decídua deveria estar completa abaixo de 4 anos. Quanto à transmissibilidade da doença cárie, 50% dos médicos consideraram que esta não é transmissível de uma pessoa para outra. Todos os médicos entrevistados consideraram que o fator bacteriano não é o único capaz de desencadear o processo carioso, necessitando de outras variáveis associadas. O período mais recomendado pelos médicos para a 1ª consulta odontológica da criança seria quando da erupção dos primeiros dentes (37,50%). Em relação à utilização de mamadeiras, 50% dos entrevistados orientam a higienização bucal após a mamada e 62,50% orientam mínima ou não utilização de açúcar nas mamadeiras. Conclusão: Diante do número reduzido de dentistas em atenção primária no Brasil, e das necessidades odontológicas apresentadas pela população, vê-se a necessidade de capacitação de profissionais médicos para atuação direcionada à prevenção em saúde bucal

Fluid Replacement With Hypertonic or Isotonic Solutions Guided by Mixed Venous Oxygen Saturation in Experimental Hypodynamic Sepsis

Background: Splanchnic perfusion is prone to early injury and persists despite normalization of global hemodynamic variables in sepsis. Volume replacement guided by oxygen derived variables has been recommended in the management of septic patients. Our hypothesis was that a hypertonic isoneotic solution Would improve the benefits of crystalloids replacement guided by mixed venous oxygen saturation. Methods: Seventeen anesthetized and mechanically ventilated mongrel dogs received an intravenous infusion of live E. coli in 30 minutes. They were then randomized into three groups: control group (n = 3) bacterial infusion without treatment; normal saline (n = 7), initial fluid replacement with 32 mL/kg of normal saline during 20 minutes; hypertonic solution (n = 7), initial fluid replacement with 4 mL/kg of hypertonic solution during 5 minutes. After 30 and 60 Minutes, additional boluses of normal saline were administered when mixed venous oxygen saturation remained below 70%. Mean arterial pressure, cardiac output; regional blood flows, systemic and regional oxygen-derived variables, and lactate levels were assessed. Animals were observed for 90 minutes and then killed. Hystopathological analysis including apoptosis detection using terminal deoxynucleotidil transferase mediated dUTP-biotin nick end labeling was performed. Results: A hypodynamic septic shock was observed after bacterial infusion. Both the fluid-treated groups presented similar transient benefits in systemic and regional variables. A greater degree of gut epithelial cells apoptosis was observed in normal saline-treated animals. Conclusions: Although normalization of mixed venous oxygen saturation was not associated with restoration of markers of splanchnic or other systemic perfusion variables, the initial fluid savings with hypertonic saline and its latter effect on gut apoptosis may be of interest in sepsis management.FAPESP (Fundacao de Amparo a Pesquisa do Estado de Sao Paulo

Pub. 65 Undiff erentiated Pulmonary Adenocarcinoma of Clear Cells Associated to Hypertrophic Osteopathy in a Dog

ABSTRACT Background: Most of the primary pulmonary tumors in dogs are malignant and from epithelial origin, being bronchioalveolar tumors more prevalent. Adenocarcinoma of clear cells, however, is a very rare pulmonary tumor and its origin is still unknown. It is related to several clinical abnormalities, including hypertrophic osteopathy, an unusual paraneoplastic syndrome characterized by a periosteal reaction along the shaft of long bones. Because of the unusual presentation of the pulmonary adenocarcinoma, the aim of this study was to describe the radiographic, histopathological, and immunohistochemical fi ndings of a dog affl icted with hypertrophic osteopathy secondary to an undifferentiated pulmonary adenocarcinoma of clear cells. Case: A 12-year-old, 45 kg, not castrated male Great Dane dog was presented with painful swelling of all four limbs and moderate respiratory distress. Radiographic examination and computed tomography of the limbs showed palisade-like periosteal bone proliferation involving radius, ulna, femur, patella, tibia, fi bula, tarsus, metacarpal, metatarsal and digits, suggesting hypertrophic osteopathy. Radiographic examination and computed tomography of the lungs also showed a round mass well delimited localized in the right diaphragmatic lobe. A lobectomy of the right diaphragmatic lobe and partial lobectomy of accessory lobe were performed. A poorly differentiated clear squamous cell carcinoma was diagnosed by histological examination. An immune-panel of CK5/CK6, CK7, p63 and TTF-1 was used for immunophenotyping. Immunostaining was weakly positive for CK5/CK6 and negative to all others. Therefore, the diagnosis was poorly differentiated clear cell adenocarcinoma. The dog showed improvement in clinical signs seven days after surgery. One month postoperatively, radiographic examination of the limbs showed less intense periosteal reaction and initiation of bone remodeling. Discussion: Primary pulmonary tumors are considered very infrequent in small animals, but its true incidence rate is diffi cult to establish in animal populations. The histological origin of the tumor in the present case, as verifi ed in the literature, is not well established by histological analysis. In these situations, the immunohistochemistry panel may be useful. The modifi cation of the diagnosis between histological analysis and by immunohistochemistry, among other factors, might be due to transdifferentiation from one phenotype to another at various stages in the neoplastic process. The clear cell appearance observed in this case may be verifi ed in all types of carcinoma due to intracellular accumulation of glycogen, most of which is dissolved during the preparation of paraffi n sections. This uncommon neoplasm apparently did not infl uence the radiographic or tomographic fi ndings of the hypertrophic osteopathy in the present case. The frequency of metastases depends on the histological type of the tumor, being common in the pulmonary adenocarcinoma and usually to tracheobronchial lymph nodes and pulmonary parenchyma. Although in this case the imaging studies did not show metastases to other pulmonary lobes, the histological exams showed metastatic lesions that may be associated to the dog&apos;s death after the surgery

Kombinacija fotodinamičke terapije i fototerapije u liječenju otvorenih kožnih rana pasa - prikazi slučajeva

The evolution of cutaneous open wounds was evaluated in five client-owned dogs treated with photodynamic therapy (PDT), mediated by methylene blue and phototherapy with light-emitting diodes (LED) as the light source. On the first day of treatment, the wound was irrigated with sterile 0.9% sodium chloride solution, the surface was dried, and 3% solution of hydrogen peroxide soaked for 1 minute. The hydrogen peroxide was mechanically removed and, immediately after, 0.01% methylene blue was used in the wound for five minutes, after which a cluster of red LEDs (650 - 670 nm wavelength, 350 mW power, and irradiance of 200 mW/cm2) was used. Subsequently, single phototherapy sessions, every 48 hours or more, were applied until wound healing. In general, 24J was used for PDT and 12J for phototherapy. In all cases, the cutaneous open wounds treated with PDT associated with phototherapy healed without complications, and it may be considered as a treatment option, especially for extensive lesions.U istraživanje je uključeno pet pasa s poznatim vlasništvom kod kojih je procijenjeno cijeljenje otvorenih kožnih rana. Psi su liječeni fotodinamičkom terapijom (PDT) uz primjenu metilnog modrila i fototerapijom uz primjenu svjetlećih dioda (LED) kao izvora svjetla. Prvi dan pokusa rana je tretirana sterilnom 0,9 %-tnom otopinom natrijeva klorida, njezina je površina posušena te je tijekom jedne minute vlažena 3 %-tnom otopinom hidrogen-peroksida. Odmah potom hidrogen-peroksid mehanički je uklonjen, zatim je tijekom pet minuta upotrijebljeno 0,01 %-tno metilno modrilo, a nakon toga više povezanih crvenih LED dioda (valne dužine 650 – 670 nm, snage 350 mW i zračenja 200 mW/cm2). Poslije toga primijenjena je fototerapija, svakih 48 sati ili u duljem intervalu, sve dok rane nisu zacijelile. Primijenjeno je 24 J za PDT i 12 J za fototerapiju. U svim su slučajevima otvorene kožne rane, koje su liječene kombinacijom PDT-a i fototerapije, zacijelile su bez komplikacija. Navedeno otvara mogućnosti primjene ovih metoda, posebice na ranama s velikim lezijama