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Objective: The objective of this study was to assess outcomes of childhood systemic lupus erythematosus (cSLE) in three different age groups evaluated at last visit: group A early-onset disease (<6 years), group B school age (≥6 and <12 years) and group C adolescent (≥12 and <18 years). Methods: An observational cohort study was performed in ten pediatric rheumatology centers, including 847 cSLE patients. Results: Group A had 39 (4%), B 395 (47%) and C 413 (49%). Median disease duration was significantly higher in group A compared to groups B and C (8.3 (0.1–23.4) vs 6.2 (0–17) vs 3.3 (0–14.6) years, p < 0.0001). The median Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI) (0 (0–9) vs 0 (0–6) vs 0 (0–7), p = 0.065) was comparable in the three groups. Further analysis of organ/system damage revealed that frequencies of neuropsychiatric (21% vs 10% vs 7%, p = 0.007), skin (10% vs 1% vs 3%, p = 0.002) and peripheral vascular involvements (5% vs 3% vs 0.3%, p = 0.008) were more often observed in group A compared to groups B and C. Frequencies of severe cumulative lupus manifestations such as nephritis, thrombocytopenia, and autoimmune hemolytic anemia were similar in all groups (p > 0.05). Mortality rate was significantly higher in group A compared to groups B and C (15% vs 10% vs 6%, p = 0.028). Out of 69 deaths, 33/69 (48%) occurred within the first two years after diagnosis. Infections accounted for 54/69 (78%) of the deaths and 38/54 (70%) had concomitant disease activity. Conclusions: This large multicenter study provided evidence that early-onset cSLE group had distinct outcomes. This group was characterized by higher mortality rate and neuropsychiatric/vascular/skin organ damage in spite of comparable frequencies of severe cumulative lupus manifestations. We also identified that overall death in cSLE patients was an early event mainly attributed to infection associated with disease activity [ABSTRACT FROM AUTHOR]

Objectives: Anti-ribosomal P protein (anti-P) autoantibodies are highly specific for systemic lupus erythematosus (SLE). However, the evaluation of this autoantibody in childhood-onset SLE (cSLE) populations has been limited to a few small series, hampering the interpretation of the clinical and laboratorial associations. Therefore, the objective of this multicenter cohort study was to evaluate demographic, clinical/laboratorial features, and disease damage score in cSLE patients with and without the presence of anti-P antibody. Methods: This was a retrospective multicenter study performed in 10 pediatric rheumatology services of São Paulo state, Brazil. Anti-P antibodies were measured by ELISA in 228 cSLE patients. Results: Anti-P antibodies were observed in 61/228 (27%) cSLE patients. Frequencies of cumulative lymphadenopathy (29% vs. 15%, p=0.014), acute confusional state (13% vs. 5%, p=0.041), mood disorder (18% vs. 8%, p=0.041), autoimmune hemolytic anemia (34% vs. 15%, p=0.001), as well as presence of anti-Sm (67% vs. 40%, p=0.001), anti-RNP (39% vs. 21%, p=0.012) and anti-Ro/SSA antibodies (43% vs. 25%, p=0.016) were significantly higher in cSLE patients with anti-P antibodies compared to those without these autoantibodies. A multiple regression model revealed that anti-P antibodies were associated with autoimmune hemolytic anemia (odds ratio (OR)=2.758, 95% confidence interval (CI): 1.304-5.833, p=0.008) and anti-Sm antibody (OR=2.719, 95% CI: 1.365-5.418, p=0.004). The SLICC/ACR damage index was comparable in patients with and without anti-P antibodies (p=0.780). Conclusions: The novel association of anti-P antibodies and autoimmune hemolytic anemia was evidenced in cSLE patients and further studies are necessary to determine if anti-P titers may vary with this hematological manifestation. [ABSTRACT FROM AUTHOR]

We evaluated the prevalence and clinical associations of amenorrhea in 298 female juvenile systemic lupus erythematosus (JSLE) patients (ACR criteria) followed in 12 Brazilian Paediatric Rheumatology centres. Amenorrhea was observed in 35 patients (11.7%) with a mean duration of 7.2±3.6 months. The hormones were performed in 32/35 patients and none of them had FSH and LH levels above and estradiol below the normal range according to pubertal changes. JSLE patients with amenorrhea were younger (15.04±2.5 versus 17.8±3.1 years; P=0.001), and had a shorter period of time between menarche and current age (3.4±2.9 versus 6.7±5.4 years; P=0.001). Interestingly, the frequency, cumulative dose, number of pulses and duration of intravenous cyclophosphamide treatment were alike in patients with and without amenorrhea (P = 0.05). In contrast, patients with amenorrhea had significantly higher SLEDAI (P = 0.01) and SLICC/ACR-DI (P = 0.024) scores compared to those without this condition. Independent risk factors identified by multivariate analysis were higher SLEDAI (OR = 1.059; CI = 1.004-1.116; P = 0.034) and SLICC/ACR-DI (OR = 2.125; IC = 1.373–3.291; P = 0.001) scores. Our data suggest that in spite of immunosuppressive therapy, JSLE patients have an adequate ovarian follicular reserve and amenorrhea is particularly associated with disease activity and damage. [ABSTRACT FROM AUTHOR]

This in vitro study evaluated the effect of rebonding on microleakage of aresin composite, a condesabel resin and two polyacid-modified resin composite restorations. Standardized cylindrical Class V dentin cavities were prepared on the buccal root surfaces of 240 extracted bovine incisive teeth. The prepared teeth were randomly assigned to four groups of 60 teeth and restored with the following restorative systems: I—(ZS) Z100/Scotchbond Multi-Purpose Plus; II—(SS) Solitaire/Solid Bond; III—(FS) Freedom/State; IV—(FSB) F200/Single Bond. Thirty teeth of each group were rebounded with a low-viscosity resin (Fortify/BISCO), according to the manufacturer's instructions. The remaining teeth recieved no treatment. All teeth were thermocycled for 5,000 cycles and brushed by hand three times a day for 10 days using a toothbrush and a slurry of dentifrice and water. Specimens were stained in a 2% methylene blue solution and longitudinally sectioned with diamond disks. Microleakage was scored on a scale of 0 of 3. The Kruskal-Wallis test showed statistically significant differences among the groups (h=156.54; α<0.05). Pairwise comparison by means of the least significant differences showed that (SS) and (FS) with or without rebonding were not statistically different from each other. These groups showed the highest microleakage differences from (ZS) and (FSB) with or without rebonding. (ZS) with rebonding showed the lowest microleakage that was not statistically different from (ZS) without rebonding and (FSB) with rebonding. [ABSTRACT FROM AUTHOR]

This study evaluated the surface roughness pattern of resin-based restorative materials during blushing preceded by a regimen that simulated a dynamic pH-cycling. Restoratives included two resin composites (Renamel Microfill and Charisma), two polyacid-modified composite resins (Compoglass-F and Dyract AP) and one resin-modified glass ionomer cement (Fuji II LC Improved). Twenty standardized cylindrical specimens of each material were prepared according to a randomized complete block design. After finishing and polishing, the average surface roughness (Ra) and profile-length ratio (LR) of the specimens were determined. The experimental units were subjected to a pH-cycling regimen, and then to 10,000 brushing strokes. New readings of both the Ra and LR parameters were obtained. The same protocol of pH-cycling, brushing simulation and surface roughness measurements were repeated 10 times. Data was analyzed using ANOVA according to split-plot design and Tukey's test. Results showed the pH-cycling followed by 10,000 brushing strokes provided a remarkable increase in Ra for all restorative materials except for Renamel. Throughout the blushing simulation, Renamel, Charisma, Compoglass-F and Dyract AP showed steady textures, whereas Fuji II LC Improved exhibited a progressive increase in surface roughness. Among the materials tested, Renamel presented the smoothest surface, followed by Charisma and Compoglass-F, which did not differ from each other except at the baseline. Dyract AP was different from both these materials except at the baseline. Fuji II LC Improved had the roughest surface texture. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the microleakage of six glass-ionomer composite resin hybrid materials compared with a glass-ionomer cement and a composite resin. Standardized class 5 dentin cavities were prepared on root surfaces of 240 extracted human teeth that were randomly assigned to eight groups and restored using the following restorative systems: (I) Vitremer, (II) Compoglass, (III) Photac-Fil Aplicap, (IV) Variglass, (V) Dyract, (VI) Fuji II LC, (VII) Ketac-Fil Aplicap, and (VIII)ZI00. The teeth were thermocycled, placed in a 2% methylene blue solution, and sectioned with diamond disks. Dye penetration was scored on a scale of 0-3. Results showed no significant differences among groups VIII, IV, I, V, VI, III, and II. There were also no significant differences among groups VI, III, II, and VII. [ABSTRACT FROM AUTHOR]

Bauhinia pulchella Benth. (Fabaceae), is native to Brazil and popularly known as pata-de-bode. In folk medicine, it is used to treat diabetes. Pharmacological studies have demonstrated different properties, such as cytotoxic and antioxidant, and different chemical constituents, such as essential oil, triterpenoids, steroids, among others. In order to highlight the morphological differences of the species B. pulchella from the others of the genus, and its pharmacological potential, the present study aimed to carry out the anatomical and histochemical characterization of the stem and leaves of B. pulchella. Usual methods in plant anatomy were used in the preparation of semi-permanent slides containing cross sections of the stem, petiole and leaf blade and paradermal sections of the leaf blade for analysis in light microscopy and polarized light. Histochemical tests were also performed to localize the metabolites in the stem and leaf blade. The stem of B. pulchella has a cylindrical outline, the bark is composed of 7-8 layers of cells and discontinuously distributed sclerenchyma; petiole presents flat convex contour, prominences in the adaxial region, concentric amphicrivral vascular bundle, surrounding a small concentric anfivasal intramedullary bundle, adaxially two accessory bundles and tector trichomes; leaf blade with anisocytic and tetracytic stomata on the adaxial surface and anisocytic, tetracytic and anomocytic on the abaxial surface; and midrib with plain-convex outline, 1-2 layers of collenchyma and covering trichomes. Characteristics that differ from other species of the genus Bauhinia. Alkaloids, phenolic compounds, lipophilic compounds, lignin, triterpenes, steroids and tannins were observed in the species. The results are fundamental for the pharmacobotanical standardization of the studied species.

This study aimed to evaluate the effect of human saliva in vitro and salivary flow in situ on the roughness and mineral content of bleached enamel. Dental specimens were divided into five groups (n=15): not bleached (NB); bleached (35% hydrogen peroxide) and exposed to distilled water (DW); human saliva in vitro (IV); normal salivary flow in situ (NSF); and low salivary flow (LSF) in situ. Enamel roughness (Ra, Rz) and calcium/phosphorus contents were evaluated with laser profilometry and energy-dispersive spectroscopy, respectively, at baseline (T1), after bleaching (T2), and after seven days (T3). Salivary pH and buffer capacity were evaluated with colorimetric strips and salivary calcium and phosphorus with absorbance spectrophotometry. Data were analyzed with non-parametric tests and linear regression (α=0.05). After contact with saliva, Ra and Rz of LSF=DW>IV=NSF=NB was found. For DW and LSF, the roughness of T1

Purpose: To present a national guideline for ophthalmologic care and surveillance of juvenile idiopathic arthritis-associated uveitis (JIA-uveitis)., Methods: Review article based on medical literature and the experience of an Expert Committee composed of members of the Brazilian Society of Pediatric Ophthalmology/Brazilian Council of Ophthalmology and the Brazilian Society of Pediatrics/Brazilian Society of Rheumatology. Studies with a high level of evidence were selected by searching the PubMed/Medline database. The final document was approved by the experts., Results: The main recommendations are that children/adolescents with JIA should undergo screening according to their risk factors. Ophthalmological checkups should also consider ocular inflammation and therapy. Topical glucocorticoids should be the first line of therapy, with systemic glucocorticoids acting as bridge treatments in severe uveitis. Methotrexate should be the first-line systemic therapy and anti-tumor necrosis factor (anti-TNF alpha) the second for uncontrolled uveitis., Conclusions: This evidence-based guideline for JIA-uveitis will be useful for both ophthalmology and rheumatology practice.

This study was performed to evaluate the linear and volumetric effects of a technique for reconstruction of the posterior atrophic mandible, including the final bone gain of the graft, by three-dimensional assessment. Thirteen individuals were recruited into the study and submitted to a total of 15 mandibular autogenous bone block surgeries. Cone beam computed tomography images were obtained at three different times. Bone graft length and thickness, and the volume, height, and width of the graft were measured. Data were compared statistically among the time points using the Friedman test, and cluster analysis was performed to identify the association between the study variables and the resorption rate (α = 0.05). Linear analysis of the width and height of the recipient area at the different time points revealed a statistically significant difference. The final average increase in height was 1.6 mm; all subjects showed an average volume gain of 3.412mm 3 , and 77% of the subjects showed an average graft resorption of 0.688mm 3 construction of three-dimensional vertical defects of the posterior mandible resulted in good healing with minimal complications and minimal bone graft resorption, favouring vertical bone gain., (Copyright © 2019 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

It was possible to restore the shape and function of a severely ankylosed tooth by fabricating a ceramic crown for placement on a resin reconstruction supported by mini fiberglass posts. By increasing the retention of the morphological reconstruction for the future support of indirect restorations, cementable intradentinal fiberglass posts enhance the longevity of these restorations. Ultimately, all proposals that seek to improve the long-term prognosis of restorations on ankylosed teeth, especially severely impacted ones, are of extreme clinical relevance.

Objective: The aim of this study was to investigate the clinical performance and to validate the Lesion Activity Assessment (LAA) in conjunction with the International Caries Detection and Assessment System (ICDAS) for occlusal caries diagnosis in permanent teeth., Methods: Patients with erupted or partially erupted third molars were recruited from the surgery clinic of the School of Dentistry of the Universidade Federal de Minas Gerais, Brazil. A calibrated examiner evaluated 49 teeth using the ICDAS-LAA criteria. The histologic criterion proposed by Ekstrand and others was used to validate severity at the thresholds D1 (outer half of the enamel), D2 (inner half of the enamel and outer third of the dentin), and D3 (inner or middle third of the dentin). Lesion activity was validated using 0.1% methyl red solution., Results: The method demonstrated good reliability (weighted kappa for severity=0.60; unweighted kappa for activity=0.61). The ICDAS presented a higher performance for lesion detection (area under the receiver operating characteristic curve [Az]=0.79) using the threshold D3. At the thresholds D1 and D2, the results for Az were 0.57 and 0.74, respectively. Regarding the ICDAS-LAA, Az = 0.59., Conclusions: Clinical protocols can use ICDAS for the severity diagnosis of occlusal caries, but the LAA performance was poor.

Purpose: To investigate the effect of different light-curing units and depths on the degree of conversion (DC) through Fourier transform infrared spectroscopy (FTIR) and Knoop Hardness Number (KHN) of a silorane-based composite resin (Filtek LS, 3M ESPE, St Paul, MN, USA) (LS)., Materials and Methods: LS specimens mounted in a particular designed matrix were photoactivated by three light-cure units (LCUs) at depths of 2, 3, 4, and 5 mm. The DC was determined in a FTIR spectrometer with an attenuated total reflectance accessory. The KHN was measured in an automatic microhardness tester. The results were analyzed using the Friedman and Spearman statistical tests (α=0.05)., Results: There was no effect of LCUs on the DC (p=0.472) or KHN (p=0.174) for all of the studied depths. The highest DC and KHN means were found at 2-mm depth, which were not statistically different from 3-mm depth, but were higher than 4-mm and 5-mm depths (p=0.007). Spearman analysis found a positive linear correlation between the variables KHN and DC (r=0.858, p<0.000)., Conclusions: The LCUs' effect was not verified. Values of DC and KHN for LS decreased with increasing depth. The highest values for both DC and KHN were obtained at depths of 2-3 mm.

Purpose: This study evaluated the effect of light-curing access on the bond strength of fiber glass posts to the apical area of bovine roots using self-adhesive cement or dual-cured cement with an etch-and-rinse adhesive system., Materials and Methods: The root canals of 60 bovine teeth were endodontically treated and filled. A 15-mm-length post space was prepared and roots were randomly divided into three groups, simulating the levels of light-curing access: coronal (C), with 15-mm post space; middle (M), in which the coronal thirds of roots were cut out, leaving a 10-mm post space; and apical (A), in which the coronal and middle thirds of roots were cut out, leaving a 5-mm post space. Fiber glass posts (Reforpost # 3, Angelus) were cemented with RelyX U100 (3M ESPE) or RelyX ARC/Scotchbond Multi Purpose Plus (SBMP) (3M ESPE) (n=10) and light-cured. After 24 hours, the apical thirds of roots were sectioned perpendicularly to the long axis and submitted to a push-out test (0.5 mm/min, 200 N). The Kruskal-Wallis test compared the three levels of light-curing access, and the Mann-Whitney test compared the cements., Results: The bond strength was significantly higher in the groups C (p=0.028) and M (p=0.016) when U100 was used, whereas it was similar for both cements in group A. The bond strengths of posts cemented with ARC/SBMP were significantly higher in group A compared to group C (p=0.031)., Conclusions: The type of cement used and the light-curing access level influenced the bond strength between glass fiber posts and root canals. The bond strength of the RelyX ARC/SBMP cement proved to be more dependent on photoactivation than was the RelyX U100 cement. The light-curing access level did not influence the apical bond strength of RelyX U100.

Purpose: To investigate clinical performance of a low-shrinkage silorane-based composite resin when used for repairing conventional dimethacrylate-based composite restorations., Background: Despite the continued development of resin-based materials, polymerization shrinkage and shrinkage stress still require improvement. A silorane-based monomer system was recently made available for dental restorations. This report refers to the use of this material for making repairs and evaluates the clinical performance of this alternative treatment., Materials and Methods: One operator repaired the defective dimethacrylate-based composite resin restorations that were randomly assigned to one of two treatment groups: control (n=50) repair with Adper SE Plus (3M/ESPE) and Filtek P60 Posterior Restorative (3M/ESPE), and test (n=50) repair with P90 System Adhesive Self-Etch Primer and Bond (3M/ESPE) and Filtek P90 Low Shrink Posterior Restorative (3M/ESPE). After one week, restorations were finished and polished. Two calibrated examiners (Kw≥0.78) evaluated all repaired restorations, blindly and independently, at baseline and one year. The parameters examined were marginal adaptation, anatomic form, surface roughness, marginal discoloration, postoperative sensitivity, and secondary caries. The restorations were classified as Alpha, Bravo, or Charlie, according to modified US Public Health Service criteria. Mann-Whitney and Wilcoxon tests were used to compare the groups., Results: Of the 100 restorations repaired in this study, 93 were reexamined at baseline. Dropout from baseline to one-year recall was 11%. No statistically significant differences were found between the materials for all clinical criteria, at baseline or at one-year recall (p>0.05). No statistically significant differences were registered (p>0.05) for each material when compared for all clinical criteria at baseline and at one-year recall., Conclusions: The hypothesis tested in this randomized controlled clinical trial was accepted. After the one-year evaluations, the silorane-based composite exhibited a similar performance compared with dimethacrylate-based composite when used to make repairs.

The aim of the present paper was to review the literature concerning the dimensional stability of dental elastomeric impression materials, to support recommendations to control the variables that influence the accuracy of these materials. An electronic search of the Scopus and PubMed databases was performed in November 2010. Articles were selected according to the following inclusion criteria: investigation of the dimensional stability of dental elastomers, an experimental study, sample size reported, laboratory tests described, and published in an English language peer-reviewed journal. The search resulted in 47 articles published between 1958 and 2008; of these, 24 were selected for inclusion in the present study. Great variability was discovered in the experimental methodologies used, such as different working times, temperatures and storage mediums for the impressions, impression techniques, material thicknesses, tray types, and methods of evaluation. Despite the lack of standardization among the studies, this review supports the following recommendations to control the dimensional stability: impressions should be stored at temperatures between 21 +/- 2 degrees C; polyether impressions should be stored in an environment with a relative humidity below 50%; time until pouring has been settled for each elastomer material.

Objective: The purpose of this study was to evaluate the surface micromorphology of resin-modified glass-ionomer cements and polyacid-modified resin composites subjected to a neutral sodium fluoride (NNaF) and an acidulated phosphate fluoride (APF) gel application., Method and Materials: Thirty standardized cylindric specimens were randomly obtained from each of two resin-modified glass-ionomer cements-Fuji II LC Improved and Photac-Fil Aplicap-and two polyacid-modified resin composites--Dyract and F2000-amounting to 120 samples. After 1 week, the specimens were finished and polished with aluminum oxide disks. Surface treatments with fluoride gels, or distilled water as a control, were performed four times, interspersed with eight pH cycles, simulating high cariogenic challenges. Five calibrated evaluators assessed the surface micromorphology through photomicrographs., Results: The Kruskal-Wallis test showed no significant difference between the control and experimental groups for Fuji II LC Improved and Dyract. Photac-Fil Aplicap showed less micromorphologic change as a result of distilled water application, unlike the NNaF and APF treatments, which revealed no significant difference from each other. For F2000, there was no significant difference between the surfaces treated by NNaF and distilled water; the highest degradation occurred with the APF., Conclusion: Both the resin-modified glass-ionomer cements and the polyacid-modified resin composites showed erratic behaviors concerning their micromorphology when subjected to fluoride gel application.

Objective: This study was intended to quantify the marginal leakage of three glass-ionomer-resin composite hybrid materials and compare it with the leakage exhibited by a glass-ionomer cement and a bonded resin composite system., Method and Materials: Standardized Class V cavities were prepared on root surfaces of 105 extracted human teeth, randomly assigned to five groups of 21 each, and restored with either Ketac-Fil Aplicap, Z100/Scotchbond Multi-Purpose Plus, Vitremer, Photac-Fil Aplicap, or Dyract. The teeth were thermally stressed for 500 cycles and stained with methylene blue. The microleakage was quantified spectrophotometrically, and the data were statistically analyzed with Friedman's test., Results: There were no significant differences in microleakage among the five groups. Restorations of all tested materials showed some marginal leakage in Class V cavities., Conclusion: The microleakage performance of glass-ionomer-resin composite hybrid materials was similar to those of a conventional glass-ionomer and a bonded resin composite system.