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Aims: This ex vivo study aimed to assess the dissolving capacity of 2.5% sodium hypochlorite using eight agitation protocols within swine pulp tissue. Subjects and Methods: Twelve lower first premolars were prepared and split into the fragments with a groove housing porcine dental pulp. Groups were assigned based on agitation systems: manual, passive ultrasonic, Easy Clean and XP-Endo Finisher. Two agitation time protocols were applied: One min (3 s × 20 s cycles) and 2 min (6 s × 20 s cycles). Wilcoxon Mann-Whitney U test was used to compare the groups. Results: Both time frames demonstrated superior results compared to manual group (P > 0.5). However, in the two min groups, no significant differences were observed among the other protocols (P < 0.5). Intriguingly, increasing cycle numbers significantly improved results within each group (P > 0.5). Conclusion: Extending the chemical agitation time during final irrigation enhances tissue removal, regardless of the irrigation protocol employed.

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OBJECTIVE: Our study aimed to investigate the effect of pre-operative sleep quality on post-operative pain and emergence agitation. MATERIALS AND METHODS: Our study was performed 80 patients with American Society of Anesthesiologists I-II and 18-65 years of age. The patients were divided into poor (Group A, n = 40) and good sleep quality (Group B, n = 40). All patients were operated on under standard general anesthesia. The emergence agitation and pain status of all groups were evaluated in the recovery room and post-operative period. RESULTS: There was no significant difference between the groups regarding demographic data. Post-operative numeric rating scale scores and analgesic consumption were significantly higher in Group A than in Group B (p < 0.05). There was no significant difference between the groups regarding post-operative emergence agitation and extubation quality (p > 0.05). CONCLUSION: In our study, poor pre-operative sleep quality increases post-operative pain and analgesic consumption; however, emergence agitation is not associated with sleep quality in the pre-operative period.

OBJETIVO: Nuestro estudio tuvo como objetivo investigar el efecto de la calidad del sueño preoperatorio sobre el dolor posoperatorio y la agitación de emergencia. MATERIALES Y MÉTODOS: Nuestro estudio se realizó en 80 pacientes con ASA I-II y de 18 a 65 años de edad. Los pacientes se dividieron en mala (grupo A, n = 40) y buena calidad del sueño (grupo B, n = 40). Todos los pacientes fueron operados bajo anestesia general estándar. La agitación de emergencia y el estado del dolor de todos los grupos se evaluaron en la sala de recuperación y en el período postoperatorio. RESULTADOS: No hubo diferencia significativa entre los grupos con respecto a los datos demográficos. Las puntuaciones NRS postoperatorias y el consumo de analgésicos fueron significativamente más altos en el Grupo A que en el Grupo B (p < 0.05). No hubo diferencia significativa entre los grupos con respecto a la agitación de emergencia postoperatoria y la calidad de la extubación (p > 0.05). CONCLUSIÓN: En nuestro estudio, la mala calidad del sueño preoperatorio aumenta el dolor posoperatorio y el consumo de analgésicos; sin embargo, la agitación de emergencia no se asocia con la calidad del sueño en el período preoperatorio.

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Abstract Neuropsychiatric or behavioral symptoms of dementia encompass a series of disorders, such as anxiety, depression, apathy, psychosis, and agitation, all commonly present in individuals living with dementia. While they are not required for the diagnosis of Alzheimer's disease (AD), they are ubiquitously present in all stages of the disease, contributing to negative clinical outcomes, including cognitive decline, functional disability, and caregiver burden. Neuropsychiatric symptoms have been conceptualized not only as risk factors but as clinical markers of decline along the AD spectrum. The concept of "mild behavioral impairment", the behavioral correlate of mild cognitive impairment, has been proposed within this framework. The first steps in the management of behavioral symptoms in AD involve defining the target and investigating potential causes and/or aggravating factors. Once these factors are addressed, non-pharmacological approaches are preferred as first-line interventions. Following the optimization of anticholinesterase treatments, specific pharmacological approaches (e.g., antidepressants, antipsychotics) can be considered weighing potential side effects.

Resumo Sintomas neuropsiquiátricos ou comportamentais de demência envolvem uma série de condições, como ansiedade, depressão, apatia, psicose e agitação, frequentemente observadas em indivíduos com demência. Embora esses sintomas não sejam necessários para o diagnóstico da doença de Alzheimer, estão presentes em todas as fases ou estágios da doença, contribuindo negativamente para o declínio cognitivo, comprometimento funcional e sobrecarga do cuidador. Os sintomas neuropsiquiátricos têm sido conceituados não apenas como fatores de risco, mas também como marcadores clínicos de progressão da doença de Alzheimer. O construto "comprometimento comportamental leve", correlato comportamental do comprometimento cognitive leve, tem sido proposto nesse contexto. Os primeiros passos na abordagem dos sintomas comportamentais da doença de Alzheimer envolvem definir os alvos-terapêuticos e investigar potenciais causas ou fatores agravantes. Após intervir nesses fatores, abordagens não farmacológicas constituem a primeira linha de intervenção. Depois da otimização do tratamento anticolinesterásico, terapias farmacológicas específicas (por exemplo, antidepressivos, antipsicóticos) podem ser consideradas, levando-se em conta potencias efeitos colaterais.

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The purpose of this study was to compare the impact of different irrigation protocols on debris extrusion. Single-rooted teeth were distributed into groups based on the irrigation protocols (n = 40): 2.5% NaOCl (biomechanical preparation: 20 mL and final irrigation: 5 mL); 2.5% NaOCl (biomechanical preparation: 20 mL) + 17% EDTA (final irrigation: 2 mL) + 2.5% NaOCl (final irrigation: 3 mL); and a mixture of 5% NaOCl +18% HEDP (biomechanical preparation: 20 mL and final irrigation: 5 mL). The canals were prepared using a reciprocating instrument size 40/0.06. For final irrigation, the groups were reassigned based on the agitation methods (n = 10): (a) no agitation; (b) ultrasonic; (c) sonic; and (d) continuous rotation. The control group (n = 10) received saline solution without agitation. The amount of debris extruded was measured by weight and analysed using One-way ANOVA (α < 0.05). The subgroups treated with NaOCl + HEDP mixture showed a significantly higher amount of extruded debris (p < 0.05), while there was no difference among agitation methods in all groups (p > 0.05).

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INTRODUCTION: Few instruments are available in Brazil to evaluate psychomotor activity in psychiatric emergency, clinical, and research settings. This study aimed to perform a cross-cultural adaptation of the Behavioral Activity Rating Scale (BARS) into Brazilian Portuguese and assess the adapted scale's psychometric properties. METHOD: An expert consensus committee conducted a translation and back-translation of the original scale, resulting in the BARS-BR. Four pairs of physicians administered the BARS-BR and the Sedation-Agitation Scale (SAS) to patients in a hospital psychiatry emergency room and patients in the hospital's psychiatric wards. The BARS-BR was compared to the SAS to assess concurrent validity and internal consistency was evaluated with the Bland-Altman technique. RESULTS: In the emergency room, the correlation coefficients between the first and second assessments were rho = 0.997 and rho = 1.0, respectively. In the hospital wards, the correlation coefficient between the pair of evaluators was rho = 0.951. There were strong correlations between the BARS-BR score of the first examiner and the SAS score of the second examiner (rho = 0.903) and between the SAS score of the first examiner and the BARS-BR score of the second examiner (rho = 0.893). CONCLUSION: The BARS-BR showed good psychometric properties, and we recommend its use because it constitutes an easy method for assessment of changes in psychomotor activity. Further studies are suggested to evaluate adoption and comprehension of the BARS-BR scale by all classes of healthcare professionals.

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Avaliou-se a influência da utilização da agitação ultrassônica na resistência de união à dentina, por meio de push-out, proporcionada pelos cimentos MTA-Angelus branco (MTA) e Biodentine (BD), empregados no selamento de perfurações de furca. Foram utilizados 48 primeiros ou segundos molares inferiores, com raízes não fusionadas, distantes cerca de 2 mm entre si na porção cervical das mesmas. Os dentes foram acessados e, em seguida, as raízes foram seccionadas transversalmente abaixo da junção cemento-esmalte. Os dentes foram montados em blocos de silicona de adição e perfurações de furca realizadas em seus assoalhos paralelamente ao longo eixo dos dentes e perpendiculares aos assoalhos dentais. A amostra foi dividida em quatro grupos (n = 12) em função do material reparador e da utilização ou não da agitação ultrassônica (AU). Quando empregada, a AU foi aplicada em 2 ciclos de 20 segundos por meio de inserto cônico liso acionado por ultrassom piezoelétrico. Concluídos os selamentos eles foram protegidos com cimento de ionômero de vidro e os dentes imersos em PBS. Decorridos 7 dias discos com 1 mm de altura foram retirados dos assoalhos dentais com auxílio de cortadora metalográfica e levados à máquina de ensaio universal. Os resultados expressos em MPa foram submetidos aos testes ANOVA dois fatores e de Bonferroni. Os maiores valores de resistência obtidos foram no grupo Biodentine com ultrassom (29,41 MPa), seguidos em ordem decrescente pelos grupos Biodentine sem ultrassom; MTA com ultrassom e MTA sem ultrassom (3,72 MPa). Nas condições do estudo concluiu-se que o BD apresentou maior resistência de união à dentina radicular; ainda, que a agitação ultrassônica influenciou positivamente na resistência de união do material à dentina.

We evaluated the influence of the use of ultrasonic agitation on the resistance to the dentin, by means of push-out, provided by the white MTA-Angelus (MTA) and Biodentine (BD) cements, used in the sealing of drilling holes. 48 first or second lower molars were used, with unfused roots, about 2 mm apart in the cervical portion of them. The teeth were accessed and then the roots were sectioned transversely below the cementenamel junction. The teeth were mounted in addition silicon blocks and hole drills performed on their floors parallel along the axis of the teeth and perpendicular to the dental floorings. The sample was divided into four groups (n = 12) depending on the repair material and whether ultrasonic agitation (AU) was used. When employed, the AU was applied in 2 20-second cycles by means of a smooth conical insert activated by piezoelectric ultrasound. Once the seals were completed, they were protected with glass ionomer cement and the teeth immersed in PBS. After 7 days, 1 mm high disks were removed from the dental floorboards with the aid of a metallographic cutter and taken to the universal test machine. Results expressed in MPa were submitted to two-factor and Bonferroni ANOVA tests. The highest resistance values obtained were in the group Biodentine with ultrasound (29.41 MPa), followed in descending order by the groups Biodentine without ultrasound; MTA with ultrasound and MTA without ultrasound (3.72 MPa). Under the conditions of the study, it was concluded that BD showed greater resistance to root dentin binding; also, that ultrasonic agitation positively influenced the resistance of the material to dentin binding.

influencia del uso de la agitación ultrasónica sobre la resistencia de la unión a la dentina se evaluó mediante un estiramiento, proporcionado por los cementos blancos (MTA) y biodentinos (BD) MTA-Angelus, empleados en el sello de los taladros. Se utilizaron los primeros o segundos molares inferiores, con raíces sin fundir, a unos 2 mm de distancia en la porción cervical de las raíces. Se accedió a los dientes y luego las raíces se seccionaron transversalmente por debajo de la unión cemento-enamel. Los dientes se ensamblaron además bloques de silicona y agujeros de perforación en sus pisos a lo largo del eje de los dientes y perpendiculares al suelo dental. La muestra se dividió en cuatro grupos (n = 12) según el material de reparación y si se utilizó o no la agitación ultrasónica (AU). Cuando se empleó, la UA se aplicó en 2 ciclos de 20 segundos mediante una inserción cónica suave activada por ultrasonido piezoeléctrico. Una vez concluidos los sellos, se protegieron con cemento ionómero de vidrio y los dientes se sumergieron en PBS. Al cabo de 7 días, los discos de 1 mm de altura se retiraron del suelo de corte metálico y se llevaron a la máquina de ensayo universal. Los resultados expresados como MPa se presentaron a las pruebas de dos factores ANOVA y Bonferroni. Los valores de resistencia más altos obtenidos fueron en el grupo de Biodentina con ultrasonido (29,41 MPa), seguidos en orden descendente por los grupos de Biodentina sin ultrasonido; MTA de ultrasonido y MTA libre de ultrasonido (3,72 MPa). En las condiciones del estudio se concluyó que la DB mostró mayor resistencia de la unión a la dentina raíz; y que la agitación ultrasónica tuvo una influencia positiva en la resistencia del material a la dentina.

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Abstract Introduction Few instruments are available in Brazil to evaluate psychomotor activity in psychiatric emergency, clinical, and research settings. This study aimed to perform a cross-cultural adaptation of the Behavioral Activity Rating Scale (BARS) into Brazilian Portuguese and assess the adapted scale's psychometric properties. Method An expert consensus committee conducted a translation and back-translation of the original scale, resulting in the BARS-BR. Four pairs of physicians administered the BARS-BR and the Sedation-Agitation Scale (SAS) to patients in a hospital psychiatry emergency room and patients in the hospital's psychiatric wards. The BARS-BR was compared to the SAS to assess concurrent validity and internal consistency was evaluated with the Bland-Altman technique. Results In the emergency room, the correlation coefficients between the first and second assessments were rho = 0.997 and rho = 1.0, respectively. In the hospital wards, the correlation coefficient between the pair of evaluators was rho = 0.951. There were strong correlations between the BARS-BR score of the first examiner and the SAS score of the second examiner (rho = 0.903) and between the SAS score of the first examiner and the BARS-BR score of the second examiner (rho = 0.893). Conclusion The BARS-BR showed good psychometric properties, and we recommend its use because it constitutes an easy method for assessment of changes in psychomotor activity. Further studies are suggested to evaluate adoption and comprehension of the BARS-BR scale by all classes of healthcare professionals.

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Introducción: En condiciones naturales, las raíces del arbusto, Phyllanthus acuminatus, producen bajas concentraciones de metabolitos secundarios de interés medicinal. Esto abre una oportunidad para el cultivo in vitro, para aumentar la concentración de metabolitos. Objetivo: Determinar las condiciones óptimas de cultivo líquido para raíces pilosas de P. acuminatus. Métodos: Se utilizó la evaluación del crecimiento de la biomasa según porcentaje de inóculo inicial (0.50 y 0.10 %), porcentaje de nutrientes de los medios (100, 50 y 25 %) y tasa de agitación (90, 100 y 110 min-1) (N= 15 repeticiones). Resultados: Las mejores condiciones de cultivo líquido fueron: 0.10 % de inóculo inicial, nutrientes al 25 % y 90 min-1 para la tasa de agitación. Hay diferencias entre las raíces pilosas y las raíces no transformadas. Conclusiones: es factible producir raíces pilosas de P. acuminatus a gran escala, aplicando e implementando las condiciones evaluadas de porcentaje de inóculo, nutrientes en el medio y tasas de agitación utilizadas en este estudio.

Introduction: Under natural conditions, the roots of the shrub, Phyllanthus acuminatus, produce low concentrations of secondary metabolites of medicinal interest. This opens an opportunity for in vitro culture, to increase metabolite concentration. Objective: To determine the optimal liquid culture conditions for hairy roots of P. acuminatus. Methods: We used biomass growth evaluation according to initial inoculum percentage (0.50 and 0.10 %), percentage of medium nutrients (100, 50 and 25 %) and agitation rate (90, 100 and 110 min-1) (N=15 replications). Results: The best liquid culture conditions were: 0.10 % of initial inoculum, nutrients at 25 % and 90 min-1 for the agitation rate. There are differences among hairy roots and non-transformed roots. Conclusions: It is feasible to produce P. acuminatus hairy roots at a large scale, applying and implementing the evaluated conditions of inoculum percentage, nutrients in the medium and agitation rates.

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Different environmental conditions can influence the effects of toxic agents on living beings. Recently, a series of experiments performed in Artemia salina submitted to different kinds of intoxication have shown that both, isotherapic and succussed watercan change Artemia salina ́s bio resilience at different levels. Moreover, it seems to vary according to the circalunar cycle. Objective:To verify if circalunar phases and water agitation can modify the toxicity of lead chloride on Artemia salina in vitro. Methodology:Artemia salina cysts were exposed to seawater containing 0.04% of lead chloride (equal to EC10 or 10% effective concentration, previously determined in a pilot study) in 96-well culture plates. Thirty-six experimental repetitions were performed in four series to observe the possible effects of adding stirred water, the so-called succussed water, and the moon phases. The hatched cysts were recorded after 48 hours using a digital microscope (1000x magnification) to identify the hatching percentage and the viability and mobility of the born nauplii. Results:The exposition of cysts to PbCl2 led to an increase in the hatching rate, and it was more evident during the full moon (p = 0.00014) The addition of succussed water into the seawater medium reduced this effect to the baseline levels. An increase in mobility was seen in nauplii born from exposed cysts during the full moon (p = 0.00077), but this effect was not affected by the treatment with succussed water. Discussion:Although the effects of lead chloride EC10 on the increase of nauplii hatching were expected, two environmental variables changed the sensitivity of cysts to this harmful stimulus. The circalunar cycle varied the hatching rate according to the moon phase, even in laboratory conditions, and the addition of succussed water into the medium reduced the hatching rate, even with different intensities according to the moon phase. The organization of nano and microbubbles generated after the succussion of water could be related to this protective effect and can explain, at least partially the effects of high diluted preparations on this biological context. Conclusion:Environmental factors, such as the circalunar cycle and products of water agitation, can modulate the adaptative control of hatching in Artemia salina exposed to lead chloride at EC10.

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BACKGROUND: Neuropsychiatric symptoms can be part of the clinical spectrum of COVID-19 infections. AIM: To devise an evidence based clinical algorithm as a guide for clinicians, to identify and treat underlying clinical syndromes of psychomotor agitation, such as delirium, catatonia or substance withdrawal in patients who are hospitalized and infected with SARS-CoV-2. MATERIAL AND METHODS: A review of the literature about the pharmacological management of neuropsychiatric manifestations of COVID-19 at the general hospital, to develop a clinical protocol based on a consensus from an interdisciplinary expert panel at a Clinical Hospital. Results: A consensual clinical algorithm for the management of delirium, catatonia, and substance withdrawal, manifested as psychomotor agitation in patients hospitalized with COVID-19, was developed as a clinical proposal for physicians at different levels of complexity in health services. CONCLUSIONS: Cooperation among different clinical units in the general hospital facilitated the implementation of a clinical algorithm for clinicians for the management of psychomotor agitation in COVID-19 patients.

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OBJECTIVE: To evaluate different doses of dexmedetomidine for the prevention of emergence agitation in children undergoing adenotonsillectomy. METHOD: One hundred and thirty children aged 3-10 years scheduled for adenotonsillectomy were randomly assigned to two groups. Anesthesia was induced with 0.5 µg.kg-1 dexmedetomidine (DEX 0.5 group) or 1 µg.kg-1 dexmedetomidine (DEX 1 group) at the beginning of surgery. Observers who recorded the data in the postanesthesia care unit were blinded to the allocation. The primary outcome was the percentage of emergence agitation. The times to spontaneous breath, awake, extubate, and postanesthesia care unit stay were also recorded. RESULTS: One hundred twenty four children were randomized into two groups. Five children were excluded because of adverse events and dropout (DEX 0.5 group, n = 58; DEX 1 group, n = 62). No significant differences were noted in the percentage of emergence agitation between the two groups. The times to extubation (p = 0.003), awake, and postanesthesia care unit stay in DEX 0.5 group were shorter than those in DEX 1 group (p < 0.0001). There was no significant difference between the two groups in the time to spontaneous breath. Approximately 8% of patients in DEX 0.5 group and 18% patients in DEX 1 group presented low SpO2, showing a significant difference between the two groups (p = 0.043). CONCLUSIONS: A dose of 0.5 µg.kg-1 dexmedetomidine was equally effective as 1 µg.kg-1 dexmedetomidine in preventing emergence agitation. TRIAL REGISTRATION: The trial is currently completed recruitment, registered in ClinicalTrials.gov (ID:NCT03760809). Inclusion began on 4 January, 2019.

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This study compared standard needle irrigation, passive ultrasonic irrigation, XP-Endo Finisher and Easy Clean in the apical extrusion of sodium hypochlorite (NaOCl) in a model simulating immature teeth. Ten bovine teeth were maintained in suspension in a container with the apical portion in contact with 0.2% agarose gel containing 0.1% metacresol purple. The canals were irrigated with 2.5% NaOCl, according to each irrigation protocol. After 3 min, apical extrusion of NaOCl was observed by the colour gel change when in contact with NaOCl. The containers were photographed, and the NaOCl extrusion area was measured. All protocols showed NaOCl extrusion, providing similar area (P > 0.05). Considering the similarity among the studied protocols, all of them can be considered during the endodontic treatment of immature teeth. Further studies on the particularities of immature teeth should be performed to evaluate cell viability, cleaning efficiency, disinfection capacity and dentin removal promoted by the irrigation protocols.

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Emergency delirium (ED) is characterized by inattention, irritability, disorientation, and hyperactivity that occurs in the period of early anesthetic awakening. It resolves spontaneously and apparently without sequelae, but it is a cause of anxiety for parents who see their children not responding in the way they normally would. The incidence reported in the literature is variable and depends on the definition used, but it is described between 10%-80%. It is associated with the use of powerful halogenated gases, such as sevoflurane and desflurane. Some risk factors for its appearance are age, type of surgery, duration of the intervention and preoperative anxiety. Its diagnosis is clinical and other causes of agitation must be ruled out prior to its diagnosis. There are various pharmacological and non-pharmacological strategies that have been tried to prevent its appearance. The treatment is pharmacological using drugs that produce transient sedation, such as propofol, opioids or dexmedetomidine.

El delirium de emergencia (DE) es un cuadro de inatención, irritabilidad, desorientación e hiperactividad que se produce en el período del despertar anestésico precoz. Se resuelve espontáneamente y aparentemente sin secuelas, pero es una causa de ansiedad en padres que ven a sus hijos que no responden de la forma que normalmente lo harían. La incidencia reportada en la literatura es variable y depende de la definición utilizada, pero se describe entre 10% ­ 80%. Se asocia al uso de gases halogenados potentes, como son el sevoflurano y desflurano. Algunos factores de riesgo para su aparición son la edad, tipo de cirugía, duración de la intervención y ansiedad preoperatoria. Su diagnóstico es clínico y debe descartarse otras causas de agitación previo a su diagnóstico. Existen diversas estrategias farmacológicas y no farmacológicas que se han intentado para prevenir su aparición. El tratamiento es farmacológico utilizando fármacos que produzcan sedación transitoria, como son el propofol, opioides o midazolam.

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Introdução: A descoloração da estrutura dentária representa um grande problema estético e uma das razões mais comuns pelas quais os pacientes vão ao cirurgião-dentista. Objetivo: O objetivo do presente estudo foi avaliar a descoloração dentinária causada pelo emprego dos cimentos obturadores endodônticos AH Plus, MTA Fillapex, Pulp Ca- nal Sealer EWT e Sealer Plus; além de avaliar a influência do uso da agitação ultrassônica (AUS). Métodos: Oitenta blocos de dentes bovinos foram confeccionados e tiveram cavidades circulares preparadas em suas faces palatinas, deixando remanescente de 2,0mm de espessura. Em seguida, os blocos foram randomicamente divididos em função do cimento utilizado e do uso ou não da AUS (n=10). A cor foi mensurada por meio de um espectrofotômetro após a inserção dos cimentos e restauração das cavidades, nos tempos: imediatamente após a inserção dos cimentos (T0 ), após 7 dias (T1 ) e após 180 dias (T2 ). Resultados: Observou-se alteração de cor clinicamente perceptível (ΔE>3,7) causada pelos quatro cimentos obturadores, tanto após 7 dias quanto após 180 dias. Não foram encontradas diferenças significativas entre os grupos nos dois tempos (p>0,05). Conclusões: Pôde-se concluir que os cimentos analisados causaram escurecimento dentinário clinicamente perceptível já após 7 dias, o qual perdurou por todo o período da análise; ainda, que a agitação ultrassônica não interferiu significativamente na ΔE, não influenciando na descoloração dentinária causada pelos cimentos testados (AU).

Introduction: Tooth discoloration is an aesthetic problem commonly reported by patients as one of the main reasons to seek a dentist. Thus, this study aimed to evaluate the dentin discoloration caused by AH Plus, MTA Fillapex, Sealer Plus and Pulp Canal Sealer EWT endodontic sealers, associated or not with ultrasonic agitation during the obturation. Methods: Round cavities were prepared on the palatal faces of eighty bovine teeth slabs, preserving a 2 mm of dentin thickness. The slabs were randomly separated in groups by type of sealer employed and based on the use or not of ultrasonic agitation (n = 10). The color was measured by a spectrophotometer after sealer insertion into the cavities (T0), after 7 (T1) and 180 days (T2). Results: Clinically detectable discoloration (∆E > 3,7) was present in all groups at T1 and T2. Statistically significant differences were not found between T1 and T2 (P > .05). Conclusion: All endodontic sealers tested caused dentin discoloration after 7 days. The color-changing persisted thought the entire experimental period. Moreover, the ultrasonic agitation did not influence on the dentin discoloration caused by the endodontic sealers tested (AU).

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Critical thermal maximum (CTmax ) is often used as an index of upper thermal tolerance in fishes; however, recent studies have shown that some fishes exhibit agitation or avoidance behavior well before the CTmax is reached. In this study, we quantified behavioral changes during CTmax trials in two Amazonian cichlids, Apistogramma agassizii and Mesonauta insignis. The thermal agitation temperature (Tag ) was recorded as the temperature at which fish left cover and began swimming in an agitated manner, and four behaviors (duration of sheltering, digging, activity, and aquatic surface respiration [ASR]) were compared before and after Tag . Both A. agassizii and M. insignis exhibited high critical thermal maxima, 40.8°C and 41.3°C, respectively. Agitation temperature was higher in M. insignis (37.3°C) than in A. agassizii (35.4°C), indicating that A. agassizii has a lower temperature threshold at which avoidance behavior is initiated. Activity level increased and shelter use decreased with increased temperatures, and patterns were similar between the two species. Digging behavior increased after Tag in both species, but was higher in A. agassazii and may reflect its substrate-oriented ecology. ASR (ventilating water at the surface film) was extremely rare before Tag , but increased in both cichlid species after Tag and was greater in M. insignis than in A. agassizii. This suggests that fish were experiencing physiological hypoxia at water temperatures approaching CTmax . These results demonstrate that acute thermal challenge can induce a suite of behavioral changes in fishes that may provide additional, ecologically relevant information on thermal tolerance.

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The shipping of liquid preserved semen is common practice in animal breeding and prior to cryopreservation for gene banking. Vibration emissions during transport may be harmful to spermatozoa. Therefore, strategies to minimize agitation-induced sperm injury are needed. The aim was to examine whether the type of semen extender, time after semen processing and the temperature in simulated transport conditions influence the response of boar spermatozoa to agitation stress. In Experiment 1, boar semen samples (n = 16) extended in Beltsville Thawing Solution (BTS) or Androstar Plus (APL) medium were filled in 90 mL tubes and shaken for 4 h at 200 rpm either at 22 °C or 17 °C. Samples were then stored at 17 °C for 144 h. In Experiment 2, semen samples (n = 11) extended in Androstar Premium were shaken either directly after filling at 22 °C or 20 h later after cooling to 5 °C. Samples were stored at 5 °C for 144 h. In Experiment 1, sperm motility and viability were lower (p < 0.05) in the shaken samples compared to the controls. The temperature, extender and the storage length had no effect on the agitation-induced loss of sperm quality. Sperm quality traits were higher in samples stored in APL compared to BTS. In Experiment 2, sperm motility at 24 h was reduced (p < 0.05) in those samples shaken at 22 °C but not at 5 °C. Sperm viability, membrane fluidity and mitochondrial membrane potential were not affected in either of the treatment groups. Extended boar semen designed for 17 °C storage and shipped on the day of collection is sensitive to agitation stress. In contrast, spermatozoa slowly cooled to 5 °C and shaken 20 h after processing are more resistant to agitation-induced shear forces and interfacial phenomena.

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INTRODUCTION AND OBJECTIVE: Emergence Delirium (ED), particularly in children, is characterized by mental confusion, irritability, disorientation, and inconsolable crying. ED prolongs the time required in the Post-Anesthesia Care Unit (PACU) and increases concern and anxiety in parents. The present study aimed to determine the effectiveness and safety of low-dose clonidine in preventing ED in children receiving sevoflurane anesthesia for tonsillectomy/adenotonsillectomy. METHODS: A randomized, double-blind clinical trial was conducted between November 2013 and January 2014. Sixty-two children aged 2-12 years, scheduled to undergo tonsillectomy/adenotonsillectomy, and classified as American Society of Anesthesiologists (ASA) physical status I/II were included, with 29 being randomized to receive 1 µg.kg-1 clonidine intravenously, and 33 allocated to a control group that received no clonidine. Anesthesia was induced and maintained with sevoflurane. Children with altered state of consciousness, neurological deficit, history of allergy to dipyrone, or receiving other drugs such as preanesthetic agents were excluded from the study. The primary outcome was the presence of ED in the initial 20 minutes in the PACU according to the Pediatric Anesthesia Emergence Delirium (PAED) scale. The Chi-Square test and Fisher's two-tailed exact test were used for statistical analysis, as applicable. Significance level was set at 5%, and Risk Ratios (RR) and their 95% Confidence Intervals (95% CI) were calculated. RESULTS: The frequency of ED was significantly decreased in the group of children who received clonidine (17.2% vs. 57.6%; RR = 0.30; 95% CI 0.13-0.70; p =  0.001). There was no difference between groups with respect to the frequency of postoperative self-harm (falls and bruises), dislodged catheters, and for most of the other adverse events evaluated. CONCLUSIONS: The use of 1 µg.kg-1 intravenous clonidine during anesthesia induction can effectively reduce the incidence of ED in children undergoing elective tonsillectomy/adenotonsillectomy under general inhalation anesthesia with sevoflurane. CLINICALTRIALS. GOV IDENTIFIER: NCT02181543.

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INTRODUCTION AND OBJECTIVES: Dexmedetomidine (DEX) has been associated with a decrease in postoperative cognitive and behavioral dysfunction in patients submitted to general anesthesia, whether inhalation or total intravenous anesthesia. Consequently, the DEX effects on postoperative agitation and delirium in patients submitted to general anesthesia for non-cardiac surgery have been investigated. METHOD: A systematic review and meta-analysis of randomized and double-blind clinical trials (RCTs) was undertaken assessing adults submitted to elective procedures under general anesthesia receiving DEX or placebo. The search included articles published in English in the Pubmed and Web of Science databases using keywords such as dexmedetomidine, delirium, and agitation. Duplicate publications, studies involving cardiac surgery or using active control (other than saline solution) were included. A random effects model was adopted using the DerSimonian-Laird method and estimate of Odds Ratio (OR) for dichotomous variables, and weighted mean difference for continuous variables, with their respective 95% Confidence Intervals (95% CI). RESULTS: Of the 484 articles identified, 15 were selected comprising 2,183 patients (1,079 and 1,104 patients in the DEX and control group, respectively). The administration of DEX was considered a protective factor for postoperative cognitive and behavioral dysfunction (OR=0.36; 95% CI 0.23-0.57 and p<0.001), regardless of the anesthesia technique used. CONCLUSION: Dexmedetomidine administration reduced by at least 43% the likelihood of postoperative cognitive and behavioral dysfunction in adult patients submitted to general anesthesia for non-cardiac surgery.

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BACKGROUND AND OBJECTIVES: The risk of emergence agitation (EA) is high in patients undergoing nasal surgery. The aim of the present study was to investigate the incidence of EA in adults undergoing septoplasty and the effect of ketamine on EA. METHODS: In this randomized study, a total of 102 ASA I-II patients who underwent septoplasty between July 2018 and April 2019 were divided into two groups: ketamine (Group-K, n=52) and saline (Group-S, n=50). After anesthesia induction, Group-K was intravenously administered 20mL of saline containing 1mgkg-1 ketamine, whereas Group-S was administered 20mL of saline. Sedation and agitation scores at emergence from anesthesia, incidence of cough, emergence time, and response to verbal stimuli time were recorded. The sedation/agitation and pain levels were recorded for 30minutes in the recovery unit. RESULTS: There was no significant difference between the groups in terms of the incidence of EA (Group-K: 15.4%, Group-S: 24%). The incidence of cough during emergence was higher in Group-S than in Group-K, but the response time to verbal stimuli and emergence time were shorter in Group-S. The sedation and agitation scores were similar after surgery. Pain scores were higher in Group-S at the time of admission to the recovery unit and were similar between groups in the other time points. CONCLUSION: Administration of 1mgkg-1 ketamine after anesthesia induction does not affect the incidence of EA in patients undergoing septoplasty, but it prolongs the emergence and response time to verbal stimuli and reduces the incidence of cough.

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