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This clinical report presents a technique to reconstruct extensively resected mandibles using a combination of autologous bone grafts and additive manufacturing techniques. Mandibular defects, often arising from trauma, tumors, or congenital anomalies, can severely impact both function and aesthetics. Conventional reconstruction methods have their limitations, often resulting in suboptimal outcomes. In these reports, we detail clinical cases where patients with different mandibular defects underwent reconstructive surgery. In each instance, autologous grafts were harvested to ensure the restoration of native bone tissue, while advanced virtual planning techniques were employed for precise graft design and dental implant placement. The patients experienced substantial improvements in masticatory function, speech, and facial aesthetics. Utilizing autologous grafts minimized the risk of rejection and complications associated with foreign materials. The integration of virtual planning precision allowed customized solutions, reducing surgical duration and optimizing implant positioning. These 2 cases underscores the potential of combining autologous grafts with virtual planning precision and dental implants produced by additive manufacturing for mandible reconstruction.

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Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%-18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost.

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For more than three decades, major efforts in sampling and analyzing tree diversity in South America have focused almost exclusively on trees with stems of at least 10 and 2.5 cm diameter, showing highest species diversity in the wetter western and northern Amazon forests. By contrast, little attention has been paid to patterns and drivers of diversity in the largest canopy and emergent trees, which is surprising given these have dominant ecological functions. Here, we use a machine learning approach to quantify the importance of environmental factors and apply it to generate spatial predictions of the species diversity of all trees (dbh ≥ 10 cm) and for very large trees (dbh ≥ 70 cm) using data from 243 forest plots (108,450 trees and 2832 species) distributed across different forest types and biogeographic regions of the Brazilian Amazon. The diversity of large trees and of all trees was significantly associated with three environmental factors, but in contrasting ways across regions and forest types. Environmental variables associated with disturbances, for example, the lightning flash rate and wind speed, as well as the fraction of photosynthetically active radiation, tend to govern the diversity of large trees. Upland rainforests in the Guiana Shield and Roraima regions had a high diversity of large trees. By contrast, variables associated with resources tend to govern tree diversity in general. Places such as the province of Imeri and the northern portion of the province of Madeira stand out for their high diversity of species in general. Climatic and topographic stability and functional adaptation mechanisms promote ideal conditions for species diversity. Finally, we mapped general patterns of tree species diversity in the Brazilian Amazon, which differ substantially depending on size class.

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Background: Neurocytokines may upregulate or downregulate neuropathic pain. We hypothesized that dextrose (D-glucose) injections for therapeutic purposes (dextrose prolotherapy: DPT) in painful knee osteoarthritis (KOA) would favorably affect synovial-fluid neurocytokine concentrations. Methods: Twenty participants with grade IV symptomatic KOA received synovial-fluid aspiration followed by dextrose or simulated dextrose injections, followed by the reverse after one week. All participants then received open-label dextrose injections monthly for 6 months, with serial assessments of walking pain at 20 min for 9 months, as well as synovial-neurocytokine-concentration measurements (calcitonin gene-related peptide, substance P (SP), and neuropeptide Y (NPY)) at one week and three months. Results: Clinically important analgesia was observed at 20 min and for 9 months post dextrose injection. One -week synovial-fluid SP concentration rose by 111% (p = 0.028 within groups and p = 0.07 between groups) in the dextrose-injected knees compared to synovial-fluid aspiration only. Three-month synovial-fluid NPY concentration dropped substantially (65%; p < 0.001) after open-label dextrose injection in all knees. Conclusions: Prompt and medium-term analgesia after intra-articular dextrose injection in KOA was accompanied by potentially favorable changes in synovial-fluid neurocytokines SP and NPY, respectively, although these changes were isolated. Including neurocytokines in future assessments of DPT to elucidate mechanisms of action is recommended.

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Forests that regrow naturally on abandoned fields are important for restoring biodiversity and ecosystem services, but can they also preserve the distinct regional tree floras? Using the floristic composition of 1215 early successional forests (≤20 years) in 75 human-modified landscapes across the Neotropic realm, we identified 14 distinct floristic groups, with a between-group dissimilarity of 0.97. Floristic groups were associated with location, bioregions, soil pH, temperature seasonality, and water availability. Hence, there is large continental-scale variation in the species composition of early successional forests, which is mainly associated with biogeographic and environmental factors but not with human disturbance indicators. This floristic distinctiveness is partially driven by regionally restricted species belonging to widespread genera. Early secondary forests contribute therefore to restoring and conserving the distinctiveness of bioregions across the Neotropical realm, and forest restoration initiatives should use local species to assure that these distinct floras are maintained.

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Height measurements are essential to manage and monitor forest biomass and carbon stocks. However, accurate estimation of this variable in tropical ecosystems is still difficult due to species heterogeneity and environmental variability. In this article, we compare and discuss six nonlinear allometric models parameterized at different scales (local, regional and pantropical). We also evaluate the height measurements obtained in the field by the hypsometer when compared with the true tree height. We used a dataset composed of 180 harvested trees in two distinct areas located in the Amapá State. The functional form of the Weibull model was the best local model, showing similar performance to the pantropical model. The inaccuracy detected in the hypsometer estimates reinforces the importance of incorporating new technologies in measuring individual tree heights. Establishing accurate allometric models requires knowledge of ecophysiological and environmental processes that govern vegetation dynamics and tree height growth. It is essential to investigate the influence of different species and ecological gradients on the diameter/height ratio.

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Synovial chondromatosis (SC) in the temporomandibular joint (TMJ) is an uncommon entity, mostly when the involvement is bilateral. The authors report a rare case of bilateral SC, with a follow-up of 13 months, and a literature review. A 60-year-old Caucasian woman, with the chief complaint of pain for 6 years in the bilateral pre-auricular region, had a progressive clacking and discomfort on the left side during mouth opening. The panoramic image was suggestive of SC. The bilateral lesion was surgically removed by direct access. Histopathological examination confirmed the clinical diagnosis of bilateral SC. This article shows the importance of a multidisciplinary approach for the early diagnosis and appropriate treatment. Also, it encourages the referral of such cases to professionals with a greater familiarity with this entity.

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INTRODUCTION/BACKGROUND: Distraction osteogenesis (DO) with an external distraction device such as the rigid external distraction frame has become an established method for treating midface hypoplasia in faciocraniosynostosis. It allows for greater advancement of the midface in comparison with traditional Le Fort III osteotomies, associated or not with fronto-orbital osteotomies (Le Fort IV). However, the forward movement of the bone segments may not always be performed obeying an ideal distraction vector, resulting in asymmetries, anterior open bite, and loosening of screws. In addition, the cost of the distraction devices is significant and may preclude their routine use in developing countries. METHOD: We present an alternative device and method for craniofacial advancement in a clinical case of Crouzon's syndrome. RESULTS: A 3D virtual simulation of the distraction vector and a modified external device were used in the current case. CONCLUSION: The alternative external device in this case proved to be safe, effective, and reliable.

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Tropical forests hold 30% of Earth's terrestrial carbon and at least 60% of its terrestrial biodiversity, but forest loss and degradation are jeopardizing these ecosystems. Although the regrowth of secondary forests has the potential to offset some of the losses of carbon and biodiversity, it remains unclear if secondary regeneration will be affected by climate changes such as higher temperatures and more frequent extreme droughts. We used a data set of 10 repeated forest inventories spanning two decades (1999-2017) to investigate carbon and tree species recovery and how climate and landscape context influence carbon dynamics in an older secondary forest located in one of the oldest post-Columbian agricultural frontiers in the Brazilian Amazon. Carbon accumulation averaged 1.08 Mg·ha-1 ·yr-1 , and species richness was effectively constant over the studied period. Moreover, we provide evidence that secondary forests are vulnerable to drought stress: Carbon balance and growth rates were lower in drier periods. This contrasts with drought responses in primary forests, where changes in carbon dynamics are driven by increased stem mortality. These results highlight an important climate change-vegetation feedback, whereby the increasing dry-season lengths being observed across parts of Amazonia may reduce the effectiveness of secondary forests in sequestering carbon and mitigating climate change. In addition, the current rate of forest regrowth in this region was low compared with previous pan-tropical and Amazonian assessments-our secondary forests reached just 41.1% of the average carbon and 56% of the tree diversity in the nearest primary forests-suggesting that these areas are unlikely to return to their original levels on politically meaningful time scales.

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Synovial chondromatosis (SC) in the temporomandibular joint (TMJ) is an uncommon entity, mostly when the involvement is bilateral. The authors report a rare case of bilateral SC, with a follow-up of 13 months, and a literature review. A 60-year-old Caucasian woman, with the chief complaint of pain for 6 years in the bilateral pre-auricular region, had a progressive clacking and discomfort on the left side during mouth opening. The panoramic image was suggestive of SC. The bilateral lesion was surgically removed by direct access. Histopathological examination confirmed the clinical diagnosis of bilateral SC. This article shows the importance of a multidisciplinary approach for the early diagnosis and appropriate treatment. Also, it encourages the referral of such cases to professionals with a greater familiarity with this entity.

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INTRODUCCIÓN: Creatinina y sus ecuaciones presentan claras limitaciones en relación a su baja sensibilidad para identificar etapas iniciales de disfunción renal. Cistatina-c ha sido propuesta como un marcador prometedor, pero hasta ahora, no hay evidencia que demuestre la superioridad de sus ecuaciones por sobre las de creatinina. Sin embargo, no existen estudios que comparen el rendimiento de la última ecuación de cistatina desarrollada por Grubb y colaboradores en 2014, la ecuación "CAPA". OBJETIVOS: Analizar el rendimiento de CAPA para detectar disminución temprana del filtrado glomerular en pacientes VIH, en comparación con ecuaciones dependientes de creatinina: Cockroft-Gault, MDRD-4, CKD-EPI y MCQ. MATERIAL Y MÉTODOS: Estudio analítico, observacional, transversal. Realizado entre julio y noviembre de 2017, en un hospital de tercer nivel de Argentina. Incluyó pacientes VIH realizando antirretrovirales, ≥18 años. Se excluyeron casos con creatinina ≥1,2 mg/dl. RESULTADOS: Se reclutaron 100 pacientes, y se incluyeron 89: 47 (52,8%) fueron mujeres. CAPA detectó disminuciones más pronunciadas del FG que las ecuaciones dependientes de creatinina. Las medias de FG por CAPA mostraron diferencias con las medias por Cockroft-Gault (p<0,0001); MDRD-4 (p=0,005); CKD-EPI (p<0,0001) y MCQ (p<0,0001). De los 46 casos (51,7%) con FG <90ml/min detectados a través de cualquier ecuación utilizada CAPA detectó 82,6% vs. 71,7% detectados por las cuatro fórmulas de creatinina en conjunto (p<0,0001), y que cada ecuación de creatinina individualmente: CAPA vs. Cockroft-Gault (p=0,01); vs. MDRD-4 (p<0,0001); vs. CKD-EPI (p=0,005). CONCLUSIONES: CAPA detectó disminuciones más marcadas del FG que las ecuaciones dependientes de creatinina en pacientes VIH

INTRODUCTION: Creatinine and its equations have clear limitations regarding their low sensitivity to identify initial stages of renal dysfunction. Cystatin C has been proposed as a promising marker, but so far, there has been no evidence showing the superiority of its equations over the creatinine ones. However, there are no studies which compare the performance of the latest cystatin equation developed by Grubb and collaborators in 2014: the "CAPA" equation. OBJECTIVES: To analyze the performance of CAPA equation to detect early reduction of glomerular filtration in HIV-infected patients, in comparison with creatinine-dependent equations: Cockroft-Gault, MDRD-4, CKD-EPI and MCQ. METHODS: An analytical, observational, cross-sectional study was conducted between July and November 2017, at an Argentinian specialty hospital. ≥18-year old HIV-infected patients undergoing antiretroviral therapy were included. Cases with creatinine ≥1.2 mg/dL were excluded. RESULTS: 100 patients were recruited, and 89 were included: 47 (52.8%) were women. CAPA equation detected more pronounced decreases in GFR than the creatinine-dependent equations. The mean values of GFR obtained by CAPA showed differences with the ones found through Cockroft-Gault (p <0.0001); MDRD-4 (p = 0.005); CKD-EPI (p <0.0001) and MCQ (p <0.0001). Of the 46 cases (51.7%) with GFR <90 ml/min detected through the use of any equation, CAPA detected 82.6% vs. 71.7% detected by the four creatinine formulas together (p <0.0001) and by each creatinine equation individually: CAPA vs. Cockroft-Gault (p = 0.01); vs. MDRD-4 (p <0.0001); vs. CKD-EPI (p = 0.005). CONCLUSIONS: CAPA equation detected more marked decreases in GFR than the creatinine-dependent equations in HIV-infected patients

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Vaccines have become fundamental in the control and elimination of Glässer Disease, a systemic disease of pigs caused by Haemophilus parasuis. The classic vaccines available for prevention of this infection were developed without a robust knowledge about host immunological mechanisms. In this study, we demonstrated the presence of cross-reactive epitopes on both the N-lobe and C-lobe of variants of transferrin binding protein B (TbpBs) expressed on the surface of 6 virulent serovars of H. parasuis. Antibodies against TbpB-derived antigens were capable of increasing the phagocytic capacity of neutrophils and were also capable of blocking porcine transferrin from binding to TbpB. Surprisingly, none of the pig or mice antisera from animals immunized with TbpB-derived antigens mixed with Montanide IMS 2215 VG PR adjuvant were able to activate the classical complement pathway (CCP). In contrast, antisera from mice immunized with TbpB-derived antigens adjuvanted with Freund's adjuvants or Montanide Gel 01 were able to activate the CCP and kill H. parasuis. Our results demonstrate that the type of adjuvant can modulate the functional response induced by TbpB-derived antigens. Based on these results, we propose that a properly formulated TbpB-based vaccine may elicit a functional protective antibody response with broad cross-reactivity against heterologous strains of H. parasuis.

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Lineages tend to retain ecological characteristics of their ancestors through time. However, for some traits, selection during evolutionary history may have also played a role in determining trait values. To address the relative importance of these processes requires large-scale quantification of traits and evolutionary relationships among species. The Amazonian tree flora comprises a high diversity of angiosperm lineages and species with widely differing life-history characteristics, providing an excellent system to investigate the combined influences of evolutionary heritage and selection in determining trait variation. We used trait data related to the major axes of life-history variation among tropical trees (e.g. growth and mortality rates) from 577 inventory plots in closed-canopy forest, mapped onto a phylogenetic hypothesis spanning more than 300 genera including all major angiosperm clades to test for evolutionary constraints on traits. We found significant phylogenetic signal (PS) for all traits, consistent with evolutionarily related genera having more similar characteristics than expected by chance. Although there is also evidence for repeated evolution of pioneer and shade tolerant life-history strategies within independent lineages, the existence of significant PS allows clearer predictions of the links between evolutionary diversity, ecosystem function and the response of tropical forests to global change.

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Rosai-Dorfman disease (RDD), formerly called sinus histiocytosis with massive lymphadenopathy, is a non-neoplastic proliferative histiocytic disorder with behavior ranging from highly aggressive to spontaneous remission. Although the lymph nodes are more commonly involved, any organ can be affected. This study aimed to describe the features and the follow-up of a case of extranodal RDD. Our patient was a 39-year-old woman who was referred with an 11-month history of pain in the right maxilla. On clinical examination, some upper right teeth presented full mobility with normal appearance of the surrounding gingiva. Radiographic exams showed an extensive bone reabsorption and maxillary sinus filled with homogeneous tissue, which sometimes showed polypoid formation. An incisional biopsy demonstrated a diffuse inflammatory infiltrate rich in foamy histiocytes displaying lymphocytes emperipolesis. Immunohistochemistry showed positivity for CD68 and S-100, and negativity for CD3, CD20, and CD30. Such features were consistent with the RDD diagnosis. The patient was referred to a hematologist and corticotherapy was administrated for 6 months. RDD is an uncommon disease that rarely affects the maxilla. In the present case, the treatment was conservative, and the patient is currently asymptomatic after 5 years of follow-up.

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ABSTRACT The efficacy of 28 individual or blended disinfectants against avian Salmonella enterica serovar Enteritidis and Escherichia coli strains was determined. An in vitro test in the presence and absence of serum as source of organic material was conducted. Povidone-iodine (releasing 1% available iodine), 1% potassium permanganate, 70% ethanol, 2% chlorhexidine digluconate and three commercial formulations based on quaternary ammonium compounds + formaldehyde or cresol derivates were the most effective against all strains tested and reduced bacterial counts by more than 106 times (6-log10) regardless of the presence of organic matter. These commercial compounds as well as ethanol and chlorhexidine among the individual substances tested might be helpful in the adoption of environmental control measures against these two enterobacteria in poultry industry.

RESUMO: A eficácia de 28 desinfetantes individuais ou combinados sobre cepas de Salmonella enterica serovar Enteritidis e Escherichia coli foi determinada. Um teste in vitro em presença e ausência de soro como fonte de matéria orgânica foi realizado. Iodopovidona (contendo 1% de iodo ativo), permanganato de potássio a 1%, etanol a 70%, digliconato de clorexidina e três formulações comerciais, baseadas em compostos de amônia quaternária + formaldeído ou em derivados de cresóis, foram mais eficazes contra as cepas bacterianas testadas, reduzindo em mais 106 vezes (6-log) a contagem bacteriana, independente da presença de matéria orgânica. Esses compostos comerciais, bem como o etanol e a clorexidina entre as substâncias químicas individuais avaliadas, podem ser úteis para a implementação de medidas de controle ambiental contra estas duas enterobacterias de importância para a indústria aviária.

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The efficacy of 28 individual or blended disinfectants against avian Salmonella enterica serovar Enteritidis and Escherichia coli strains was determined. An in vitro test in the presence and absence of serum as source of organic material was conducted. Povidone-iodine (releasing 1% available iodine), 1% potassium permanganate, 70% ethanol, 2% chlorhexidine digluconate and three commercial formulations based on quaternary ammonium compounds + formaldehyde or cresol derivates were the most effective against all strains tested and reduced bacterial counts by more than 106 times (6-log10) regardless of the presence of organic matter. These commercial compounds as well as ethanol and chlorhexidine among the individual substances tested might be helpful in the adoption of environmental control measures against these two enterobacteria in poultry industry.(AU)

A eficácia de 28 desinfetantes individuais ou combinados sobre cepas de Salmonella enterica serovar Enteritidis e Escherichia coli foi determinada. Um teste in vitro em presença e ausência de soro como fonte de matéria orgânica foi realizado. Iodopovidona (contendo 1% de iodo ativo), permanganato de potássio a 1%, etanol a 70%, digliconato de clorexidina e três formulações comerciais, baseadas em compostos de amônia quaternária + formaldeído ou em derivados de cresóis, foram mais eficazes contra as cepas bacterianas testadas, reduzindo em mais 106 vezes (6-log) a contagem bacteriana, independente da presença de matéria orgânica. Esses compostos comerciais, bem como o etanol e a clorexidina entre as substâncias químicas individuais avaliadas, podem ser úteis para a implementação de medidas de controle ambiental contra estas duas enterobacterias de importância para a indústria aviária.(AU)

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Rosai-Dorfman disease (RDD), formerly called sinus histiocytosis with massive lymphadenopathy, is a non-neoplastic proliferative histiocytic disorder with behavior ranging from highly aggressive to spontaneous remission. Although the lymph nodes are more commonly involved, any organ can be affected. This study aimed to describe the features and the follow-up of a case of extranodal RDD. Our patient was a 39-year-old woman who was referred with an 11-month history of pain in the right maxilla. On clinical examination, some upper right teeth presented full mobility with normal appearance of the surrounding gingiva. Radiographic exams showed an extensive bone reabsorption and maxillary sinus filled with homogeneous tissue, which sometimes showed polypoid formation. An incisional biopsy demonstrated a diffuse inflammatory infiltrate rich in foamy histiocytes displaying lymphocytes emperipolesis. Immunohistochemistry showed positivity for CD68 and S-100, and negativity for CD3, CD20, and CD30. Such features were consistent with the RDD diagnosis. The patient was referred to a hematologist and corticotherapy was administrated for 6 months. RDD is an uncommon disease that rarely affects the maxilla. In the present case, the treatment was conservative, and the patient is currently asymptomatic after 5 years of follow-up.

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The calcifying odontogenic cystic tumor (CCOT) is a benign lesion of odontogenic origin characterized by an ameloblastoma-like epithelium with ghost cells that may calcify. Despite broadly considered as a cyst, some investigators prefer to classify it as a neoplasm. Clinically, it occurs predominantly during the third decade of life. No difference in gender prevalence has been observed nor predilection of the lesion between maxilla and mandible. The most affected region extends from the incisor tooth to bicuspids. The classic treatment of the lesion is full excision, although a different approach may be determined by the possible association with another odontogenic tumor. Depending on the tumor size and the vicinity with important structures, decompression may be undertaken before its complete removal. The present report describes a case of CCOT with large proportions, located at the right maxilla and extending to the maxillary sinus, nasal cavity, and orbital floor. The treatment option was surgical decompression as the initial procedure, with satisfactory outcome. After partial remission, the lesion was fully removed, and the post-operative follow-up was uneventful.

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A well fixed endotracheal tube is essential for safety during general anesthesia. In maxillofacial surgeries, securely fixing a nasotracheal tube in place has always been problematic. The aim of this article is to describe a simple but effective technique to fasten the nasotracheal tube using a wire support that allows a full range of head movement without interference in the surgical field. During the last 5 years, this device was successfully used in almost two hundred patients with very few complications.

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Lipoma of the tongue is an uncommon benign tumor, being even more rare when there are multiple lesions. Lipoma accounts for 1-5% of all oral neoplasms. Lipoma occurs predominantly in males over the age of forty, although, in rare cases, children can be affected. Here, we report an unusual case of a female patient with bilateral lingual lipomas that were treated through surgical excision.