Abstract Introduction: Reinke’s Edema (RE) is a laryngeal lesion related to excessive tobacco smoking, voice overuse, and laryngopharyngeal reflux. Although the risk of malignancy has been considered low in literature, RE is classified among precancerous lesions. Objectives: We investigated DNA Copy Number Alterations (CNAs) in specimens of RE and its potential association with malignant progression. Methods: We used array-based comparative genomic hybridization (aCGH, Agilent 4 × 180 K platform) to study eight RE cases. All patients were heavy tobacco users for at least 30 years, and none of them progressed to cancer in the follow-up (>8 years). Two RE presented mild dysplasia, one moderate dysplasia, and no histological alterations were found in the remaining five cases. CNAs were compared with the Database of Genomic Variants (DGV) and genes mapped on altered regions had their functions annotated. Results: Six of eight patients showed different rare copy number alterations on chromosomes 2q37.3, 4q13.1, 4q13.3, 7q11.22, 10p14, and 13q34. A gain of the whole chromosome 8 were detected in one case. Of interest, four of eight RE cases showed copy number imbalances involving genes previously described in several tumor types (RASA3, COL6A3, LINC00707, LINP1, SMR3A, and SMR3B). Conclusion: The genomic imbalances herein found in RE have the potential to contribute to the phenotype but with limited or no risk of cancer. A long-term follow-up in a large series of patients could clarify the mechanisms involved in the malignant progression of RE. Level of evidence: 4.

Abstract Introduction Laryngeal leukoplakia corresponds to a white lesion in the mucosa developed by the deposit of keratin in the epithelium, potentiated by chronic smoking. It is considered a preneoplastic lesion. Surgery is the most adopted treatment; however, non-surgical treatment is advocated by some authors. Objective To evaluate the effectiveness of vitamin A in the management of vocal fold leukoplakia. Methods Patients with videolaryngoscopy diagnosis of vocal fold leukoplakia were selected. The endoscopic images were photographed and with the aid of the ImageJ software (National Institutes of Health, Bethesda, MD, USA), the proportion of the size of the leukoplakia was calculated. Eligible patients were prescribed 50,000U of vitamin A, twice daily for 2 months, at which point videolaryngostroboscopy was repeated for comparative analysis between pre and posttreatment. The efficacy of the treatment was classified as: outcome I – complete improvement of the lesion, outcome II – partial improvement, and outcome III – no difference or increased lesion size. Results Fifteen patients (eight women, seven men) were included, six of whom had bilateral lesions. Smoking was reported in 86.8% of patients. Complete improvement of the lesion was found in 7 cases (33.4%, outcome I), partial improvement in 6 (28.6%, outcome II), and worsening of the injury in 8 (38.1%, outcome III). Of the latter, 6 underwent microsurgery; histopathology indicated absence of dysplasia in 3, and mild dysplasia in 3. Conclusions In this study, the treatment with vitamin A at a dose of 100,000 IU daily for 2 months was effective in reducing the laryngeal leukoplakia size in 62% of cases.

Abstract Introduction Dysphonia and lower pitch after surgery of Reinke edema are common. They are caused especially due to chronic smoking but, probably, other factors should be associated. Objectives To evaluate the results of laryngeal microsurgery in patients with Reinke edema, following a standardized postoperative guidance protocol in our service. Methods Retrospective study. Thirty patients (3 males; 27 females) were included, 70% between 41 and 60 years old. The parameters analyzed in the pre- and postoperative (between 4 and 6 months) of patients undergoing laryngeal microsurgery for Reinke edema were: smoking, vocal symptoms, videolaryngostroboscopy, voice therapy, perceptual and acoustic vocal evaluation, histopathological report. Results Smoking was reported by 100% of the patients and maintained in the postoperative period by 80%. Complete improvement of symptoms in the postoperative period was reported by 43% of them, partial improvement by 40%, and maintenance by 17%. There was low adherence to voice therapy in the pre- and postsurgery. Postoperative videolaryngoscopy indicated congestion (19), atrophy and bowed vocal fold (1), subepithelial edema (2), and normal findings (8). The histological findings were subepithelial edema, enlargement of vessels, inflammation, epithelial hyperplasia, and thickening of the basement membrane. The perceptual and acoustic vocal analyzes indicated improvement of the analyzed parameters. Conclusions The maintenance of some vocal symptoms and laryngeal alterations in videolaryngoscopy after microsurgery of Reinke edema is frequent, even in patients who follow the recommendations of vocal rest and control of gastroesophageal reflux. Vocal symptoms are attributed to changes in the laryngeal mucosa caused by chronic smoking, aggravated by the maintenance of addiction in the postoperative period.

RESUMO Os levantamentos florísticos possibilitam ao apicultor determinar a época de permanência de colmeias em determinado local por meio da determinação das floradas. Objetivou-se realizar o levantamento florístico de remanescentes de mata nativa da região e de áreas de recuperação florestal para fins de conservação e produção, com o intuito de auxiliar os apicultores locais a definirem estratégias de exploração racional e de conservação dos remanescentes florestais e áreas de reflorestamento do Oeste paranaense. O levantamento das plantas foi realizado nas Estações Experimentais (EE) de Entre Rios do Oeste (ERO) e de Marechal Cândido Rondon (MCR), ambas vinculadas à Universidade Estadual do Oeste do Paraná (Unioeste) e no Refúgio Biológico de Santa Helena (RB-SH), que é uma Área de Relevante Interesse Ecológico (ARIE). Nas EE da Unioeste, MCR e ERO, foi delimitada, para cada ponto, uma área de 20 metros x 5 metros, pelo método de parcelas de áreas fixas retangulares e realizada a coleta de cada espécie em fase reprodutiva. Para mapeamento das áreas de coleta de plantas, foram georreferenciados quatro pontos em cada estação. As coletas foram quinzenais e mensais de dezembro de 2017 a novembro de 2019. No RB-SH, o método utilizado foi o de caminhamento nas trilhas ecológicas pré-existentes no local e o levantamento foi realizado por meio de coletas quinzenais de amostras botânicas em fase reprodutiva entre os meses de agosto de 2017 a junho de 2018. Foram coletadas 173 plantas, das quais 121 foram identificadas, sendo 103 em nível de espécie, nove em nível de gênero e nove em nível de família, pertencentes a 41 famílias botânicas. O índice de Shannon-Wiener (H’) geral foi de 3,15 nats indivíduo-1, sendo os valores encontrados de 2,30 nats indivíduo-1 em MCR; 2,94 nats indivíduo-1 em ERO e 4,22 nats indivíduo-1 no RB-SH. Com relação aos índices de similaridade, o menor valor foi observado entre as áreas amostradas de RB-SH e MCR e o maior entre ERO e RB-SH. Conclui-se que as famílias botânicas Poaceae e Myrtaceae foram representativas nos méis analisados, sendo identificados nas amostras de mel de Apis mellifera os tipos polínicos Myrceugenia euosma, Urochloa arrecta, Triticum aestivum, Albizia niopoides, Avena sativa e Eugenia uniflora.

ABSTRACT Floristic surveys make it possible for the beekeeper to determine the time of permanence of hives in a given location by determining the flowering. The objective was to carry out the floristic survey of remnants of a native forest in the region and areas of forest recovery for the purposes of conservation and production, in order to assist local beekeepers to define strategies for rational exploration and conservation of forest remnants and reforestation areas from western Paraná state. The plant surveys were carried out at the Experimental Stations (EE) of Entre Rios do Oeste (ERO) and Marechal Cândido Rondon (MCR), both linked to the State University of Western Paraná (Unioeste) and at the Biological Refuge of Santa Helena (RB-SH), which is an Area of Relevant Ecological Interest (ARIE). At the EE of Unioeste, MCR and ERO, an area of 20 meters x 5 meters was delimited for each point, by the method of plots of fixed rectangular areas, and the collection of each species in the reproductive phase was carried out. To map plant collection areas, four points were georeferenced in each season. The collections were biweekly and monthly from December 2017 to November 2019. At RB-SH the method used was to walk the pre-existing ecological trails at the site and the survey was carried out by means of biweekly collections of botanical samples in the reproductive phase, between August 2017 and June 2018. One hundred and seventy-three (173) plants were collected, 121 of which were identified, 103 at the species level, nine at the genus level and nine at the family level, belonging to 41 botanical families. The general Shannon-Wiener index (H’) was 3.15 nats individual-1, with the values found being 2.30 nats individual-1 in MCR; 2.94 nats individual-1 in ERO and 4.22 nats individual-1 in RB-SH. Regarding similarity indices, the lowest value was observed between the sampled areas of RB-SH and MCR and the highest between ERO and RB-SH. It is concluded that the botanical families Poaceae and Myrtaceae, were representative in the analyzed honeys, being identified in the honey samples of Apis mellifera the pollen types Myrceugenia euosma, Urochloa arrecta, Triticum aestivum, Albizia niopoides, Avena sativa and Eugenia uniflora.

Resumo O objetivo deste estudo foi avaliar in vitro a citotoxicidade dos cimentos endodônticos Sealapex Xpress e Real Seal XT pelo ensaio de MTT e a ativação de macrófagos J774.1. Os cimentos endodônticos Sealapex Xpress e Real Seal XT foram pesados e os extratos foram obtidos a partir da diluição em meio de cultura DMEM por 48 horas (10mg/mL, 1mg/m, e 0,1 mg/mL). A viabilidade celular foi avaliada pelo ensaio MTT e a produção de citocinas (TNF-a, IL-6 e IL-10) foi investigada pelo ensaio imunoenzimático (ELISA) em células de linhagem (macrofagos J774.1). Os dados obtidos foram analisados utilizando-se análise de variância de uma via e pós-teste de Tukey (a=0,05). A viabilidade celular após 24 ou 48 horas não foi afetada nas concentrações de 0,1 ou 1 mg/mL dos dois cimentos estudados (p>0,05). Por outro lado, na concentração 10 mg/mL, a viabilidade celular foi significativamente mais baixa (p <0,05). Observou-se que o Sealapex Xpress inibiu a produção de TNF-a, enquanto o Real Seal XT induziu a secreção de TNF-a às 24 h (p<0,05). A produção de IL-6 foi induzida pelo Real Seal XT, mas não pelo Sealapex Xpress (p<0,05). A secreção da citocina anti-inflamatória IL-10 foi induzida tanto pelo Real Seal XT quanto pelo Sealapex Xpress. IL-4 não foi detectada em nenhum grupo. Em conclusão, os dois cimentos obturadores apresentaram baixa toxicidade, mas ativaram os macrófagos de modo distinto. A ativação pelo Sealapex Xpress foi caracterizada pela inibição do TNF-a e indução da IL-10, enquanto o Real Seal XT induziu somente IL-6.

Abstract This study evaluated the cytotoxicity of Sealapex Xpress and Real Seal XT and their effect on macrophage activation. J774.1 macrophages were incubated with Sealapex Xpress and Seal Real XT (0.1, 1.0, and 10 mg/mL) for 24 and 48 h. Cell viability was assessed by the MTT assay and macrophage activation was measured by pro- and anti-inflammatory cytokine production using ELISA. Data were analyzed using one-way ANOVA and Tukey’s post-test (a=0.05). Cell viability was not affected with 0.1 or 1.0 mg/mL of extracts of Sealapex Xpress and Real Seal XT at 24 and 48 h (p>0.05), but was significantly lower when cells were exposed to 10 mg/mL of both sealers (p<0.05). Sealapex Xpress inhibited the production of TNF-a, whereas Real Seal XT induced TNF-a secretion at 24 h (p<0.05). IL-6 production was induced by Real Seal XT, but not by Sealapex Xpress (p<0.05). Real Seal XT and Sealapex Xpress induced the secretion of anti-inflammatory IL-10. IL-4 was not detected in any group. In conclusion, both sealers had low toxicity but differentially activated macrophages. Macrophage activation by Sealapex Xpress was characterized by inhibition of TNF-a and induction of IL-10, whereas Real Seal XT induced IL-6 solely.

RESUMO Objetivo Identificar a eficácia do serious game na melhoria dos resultados de aprendizagem em comparação às diferentes estratégias de ensino utilizadas na educação de estudantes de enfermagem. Método Revisão sistemática, realizada de julho/2019 a maio/2020, na PubMed®, Scopus, CINAHL, Web of Science e LILACS. Incluíram-se estudos de delineamento experimental e quasi-experimental, sem delimitação de recorte temporal, voltados a estudantes de enfermagem, que abordassem o uso do serious game como principal estratégia de ensino comparada com outros métodos pedagógicos. Resultados Foram incluídos seis artigos, os quais compararam o serious game com estratégias tradicionais e ativas de ensino e aprendizagem (aula expositiva, leitura de textos e simulação). Os estudos foram considerados de qualidade moderada, com escore médio de 12,83. Os estudantes de enfermagem submetidos ao serious game apresentaram melhores resultados de aprendizagem. Conclusão O serious game demonstrou-se mais efetivo para aprendizagem em enfermagem quando comparado a outras estratégias de ensino.

ABSTRACT Objective To identify the effectiveness of the serious game in improving learning outcomes compared to the different teaching strategies used in the education of nursing students. Method Systematic review, conducted from July 2019 to May 2020, at PubMed®, Scopus, CINAHL, Web of Science and LILACS. Studies of experimental and quasi-experimental design were included, with no delimitation of time frame, aimed at nursing students, who approached the use of the serious game as the main teaching strategy compared with other pedagogical methods. Results Six articles were included, which compared the serious game with traditional and active teaching and learning strategies (expository class, text reading and simulation). The studies were considered of moderate quality, with an average score of 12.83. Nursing students submitted to the serious game showed better learning results. Conclusion The serious game proved to be more effective for learning in nursing when compared to other teaching strategies.

RESUMEN Objetivo Identificar la efectividad del juego serio em la mejora de los resultados del aprendizaje en comparación con las diferentes estrategias de enseñanza utilizadas en la educación de los estudiantes de enfermería. Métodos Revisión sistemática, realizada de julio de 2019 a mayo de 2020, en PubMed®, Scopus, CINAHL, Web of Science y LILACS. Se incluyeron estudios de diseño experimental y cuasiexperimental, sin delimitación temporal, dirigidos a estudiantes de enfermería, quienes abordaron el uso del juego serio como principal estrategia de enseñanza frente a otros métodos pedagógicos. Resultados Se incluyeron seis artículos, que compararon el juego serio con estrategias de enseñanza y aprendizaje tradicionales y activas (clase expositiva, lectura de textos y simulación). Los estudios se consideraron de calidad moderada, con una puntuación media de 12,83. Los estudiantes de enfermería sometidos al juego serio mostraron mejores resultados de aprendizaje. Conclusión El juego serio demostró ser más efectivo para aprendizaje en enfermería en comparación con otras estrategias de enseñanza.

RESUMO Objetivo Avaliar os achados audiológicos de recém-nascidos expostos à sífilis materna, tratada adequadamente na gestação. Métodos Estudo de coorte única não concorrente, realizado em um hospital público. Fizeram parte da amostra recém-nascidos filhos de mães que apresentaram sorologia positiva para sífilis e que realizaram o tratamento adequado durante a gestação, compondo o grupo estudo, e recém-nascidos sem indicadores de risco para deficiência auditiva, grupo comparação. Resultados Participaram do estudo 90 recém-nascidos, sendo 41 do grupo estudo e 49 do grupo comparação. No exame de emissões otoacústicas por estímulo transiente, todos apresentaram presença de resposta bilateralmente e, na comparação das amplitudes de respostas nas bandas de frequências de 3,0 kHz, 3,5 kHz e 4,0 kHz observou-se menor amplitude de resposta no grupo exposto, com diferença estatisticamente significativa para a frequência de 4 kHz à direita. Na análise das respostas do exame de potencial evocado auditivo de tronco encefálico, não se observou assimetria de resposta entre as orelhas que sugerisse alteração retrococlear e nem diferenças nos valores das latências absolutas ou intervalos interpicos, entre os grupos. Conclusão As respostas eletroacústicas foram discretamente inferiores nos recém-nascidos exposto à sífilis materna, enquanto que as respostas eletrofisiológicas foram semelhantes às encontradas na população de baixo risco para deficiência auditiva.

ABSTRACT Purpose To evaluate the audiological findings of newborns exposed to maternal syphilis, properly treated during pregnancy. Methods This was a single, non-concurrent cohort study conducted in a public hospital. The sample included newborns whose mothers had positive syphilis serology and who underwent adequate treatment during pregnancy, composing the study group, and newborns without risk indicators for hearing loss, as a comparison group. Results Ninety newborns participated in the study, 41 were the study group and 49 were the comparison group. In the transient evoked otoacoustic emissions test, all newborns showed a bilateral response, and when comparing the amplitudes of responses in the 3.0 kHz, 3.5 kHz and 4.0 kHz frequency bands, a smaller amplitude of response in the studied group with a statistically significant difference for the frequency of 4 kHz on the right was observed. An analysis of the response of the brainstem auditory evoked potential test showed no asymmetry of response between the ears that suggest a retrocochlear alteration, nor difference in the values of absolute latencies or interpeak intervals between groups. Conclusion The electroacoustic responses were slightly lower in newborns exposed to maternal syphilis, whereas their electrophysiological responses were similar to those found in the population at low risk for hearing loss.

RESUMO Objetivos: analisar as (in)compatibilidades potenciais de medicamentos intravenosos com base no aprazamento de horários realizado pela equipe de enfermagem. Métodos: coorte histórica (retrospectiva) com 110 adultos de unidades críticas. Identificaram-se medicamentos intravenosos aprazados de modo concomitante, cujas duplas foram analisadas quanto à (in)compatibilidade por meio do sistema de screening Trissel’s™ 2 Compatibility IV-Micromedex 2.0. Utilizou-se estatística paramétrica e não paramétrica segundo natureza da variável. Resultados: identificaram-se 565 duplas de medicamentos. Destas, 44,9% foram compatíveis; e 8,8%, potencialmente incompatíveis. A maioria das duplas potencialmente incompatíveis envolveu substâncias com pH alcalino como fenitoína (32%) e bicarbonato de sódio (8%) e ácidos fracos como midazolam (12%) e dobutamina (6%), as quais poderiam resultar em precipitação. Conclusões: quase metade das misturas aprazadas simultaneamente foi compatível, aspecto que, indiretamente, reflete o trabalho orquestrado entre a equipe de enfermagem e o farmacêutico clínico nas discussões e decisões acerca do aprazamento de horários.

ABSTRACT Objectives: To analyze potential (in)compatibilities of intravenous drugs based on the scheduling prepared by the nursing team. Methods: historic cohort (retrospective) with 110 adults in critical units. Intravenous medications were identified concomitantly, whose pairs were analyzed for (in) compatibility using the screening system Trissel’s™ 2 Compatibility IV-Micromedex 2.0. Parametric and non-parametric statistic were used according to the nature of the variable. Results: 565 pairs of drugs were identified. Of these, 44.9% were compatible; and 8.8%, potentially incompatible. Most potentially incompatible pairs involved substances with alkaline pH such as phenytoin (32%) and sodium bicarbonate (8%) and weak acids such as midazolam (12%) and dobutamine (6%), which could result in precipitate formation. Conclusions: almost half of the mixtures simultaneously administrated was compatible, which indirectly reflects in the organized work between the nursing team and the clinical pharmaceutic in the discussions and decisions related to time scheduling.

RESUMEN Objetivos: analizar las (in)compatibilidades potenciales de medicamentos intravenosos basado en el aplazamiento de horarios realizado por equipo de enfermería. Métodos: cohorte histórica (retrospectiva) con 110 adultos de unidades críticas. Identificaron medicamentos intravenosos aplazados de modo concomitante, cuyas duplas han analizadas cuanto a la (in)compatibilidad por medio del sistema de screening Trissel’s™ 2 Compatibility IV-Micromedex 2.0. Utilizó estadística paramétrica y no paramétrica segundo naturaleza de la variable. Resultados: identificaron 565 duplas de medicamentos. De estas, 44,9% compatibles; y 8,8%, potencialmente incompatibles. Mayoría de las duplas potencialmente incompatibles envolvió substancias con pH alcalino como fenitoína (32%) y bicarbonato de sodio (8%) y ácidos débiles como midazolam (12%) y dobutamina (6%), las cuales podrían resultar en precipitación. Conclusiones: casi mitad de las misturas aplazadas simultáneamente fue compatible, aspecto que, indirectamente, refleja el trabajo orquestado entre el equipo de enfermería y el farmacéutico clínico en las discusiones y decisiones acerca del aplazamiento de horarios.

RESUMO CONTEXTO: A papilomatose recorrente da laringe, causada pelo vírus do papiloma humano, tem um impacto econômico significativo em todo o mundo e não existem dados epidemiológicos dessa doença no Brasil. OBJETIVO: O objetivo do estudo foi estimar a incidência e prevalência de papilomatose laríngea em alguns centros de otorrinolaringologia do estado de São Paulo (Brasil). MÉTODOS: Um questionário contendo dados sobre o número de casos novos e de retornos diagnosticados com papilomatose laríngea foi enviado aos serviços de otorrinolaringologia (n-35) do estado de São Paulo (Brasil). RESULTADOS: Vinte centros de otorrinolaringologia responderam ao questionário e, destes, os cinco maiores centros regionais de saúde foram selecionados da seguinte forma: Campinas (42 cidades - 4.536.657 habitantes), São José do Rio Preto (102 cidades - 1.602.845 habitantes), Ribeirão Preto (26 cidades - 1.483.715 habitantes), Bauru (68 cidades - 1.770.427 habitantes) e Sorocaba (47 cidades - 2.478.208 habitantes). A incidência e prevalência de cada centro de saúde regional foram, respectivamente: Campinas (5,51; 7,27), Sorocaba (2,02; 6,86), São José do Rio Preto (1,87; 7,49), Ribeirão Preto (11,46; 22,92), Bauru (3,95; 7,91). CONCLUSÃO: A incidência e prevalência da papilomatose laríngea dos cinco mais importantes centros regionais de saúde do interior do estado de São Paulo (Brasil) variaram entre 1,87 e 11,46 e 6,86 e 22,92, por 1.000.000 de habitantes, respectivamente, para uma população total de 11.871.852 habitantes.

SUMMARY BACKGROUND: Recurrent laryngeal papillomatosis, caused by the Human Papilloma Virus, has a significant economic impact worldwide and there are no epidemiological data of this disease in Brasil. OBJECTIVE: The objective of the study was to estimate the incidence and prevalence of laryngeal papillomatosis of some otorhinolaryngology centers in São Paulo State (Brasil). METHODS: A questionnaire containing data on the number of new and follow-up cases diagnosed with laryngeal papillomatosis was sent to the Otorhinolaryngology services (n=35) of São Paulo State (Brasil). RESULTS: A total of 20 otorhinolaryngology centers answered the questionnaire. Of these, the five largest regional health centers were selected as follows: Campinas (42 cities – 4,536,657 inhabitants), Sao Jose do Rio Preto (102 cities – 1,602,845 inhabitants), Ribeirão Preto (26 cities – 1,483,715 inhabitants), Bauru (68 cities – 1,770,427 inhabitants), and Sorocaba (47 cities – 2,478,208 inhabitants). The incidence and prevalence of each regional health centers were, respectively: Campinas (5.51;7.27), Sorocaba (2.02;6.86), São José do Rio Preto (1.87;7.49), Ribeirão Preto (11.46;22.92), and Bauru (3.95;7.91). CONCLUSION: The incidence and prevalence of the laryngeal papillomatosis of the five largest regional health centers of the interior of São Paulo State (Brasil) varied between 1.87 to 11.46 and 6.86 to 22.92 per 1,000,000 inhabitants, respectively for a total population of 11,871,852 inhabitants.

Abstract Purpose To evaluate the kinetics of apical periodontitis development in vivo , induced either by contamination of the root canals by microorganisms from the oral cavity or by inoculation of bacterial lipopolysaccharide (LPS) and the regulation of major enzymes and receptors involved in the arachidonic acid metabolism. Methodology Apical periodontitis was induced in C57BL6 mice (n=96), by root canal exposure to oral cavity (n=48 teeth) or inoculation of LPS (10 µL of a suspension of 0.1 µg/µL) from E. coli into the root canals (n= 48 teeth). Healthy teeth were used as control (n=48 teeth). After 7, 14, 21 and 28 days the animals were euthanized and tissues removed for histopathological and qRT-PCR analyses. Histological analysis data were analyzed using two-way ANOVA followed by Sidak’s test, and qRT-PCR data using two-way ANOVA followed by Tukey’s test (α=0.05). Results Contamination by microorganisms led to the development of apical periodontitis, characterized by the recruitment of inflammatory cells and bone tissue resorption, whereas inoculation of LPS induced inflammatory cells recruitment without bone resorption. Both stimuli induced mRNA expression for cyclooxygenase-2 and 5-lipoxygenase enzymes. Expression of prostaglandin E 2 and leukotriene B 4 cell surface receptors were more stimulated by LPS. Regarding nuclear peroxisome proliferator-activated receptors (PPAR), oral contamination induced the synthesis of mRNA for PPARδ, differently from inoculation of LPS, that induced PPARα and PPARγ expression. Conclusions Contamination of the root canals by microorganisms from oral cavity induced the development of apical periodontitis differently than by inoculation with LPS, characterized by less bone loss than the first model. Regardless of the model used, it was found a local increase in the synthesis of mRNA for the enzymes 5-lipoxygenase and cyclooxygenase-2 of the arachidonic acid metabolism, as well as in the surface and nuclear receptors for the lipid mediators prostaglandin E2 and leukotriene B4.

ABSTRACT Objective: To evaluate the levels of engagement of multi-professional health residents of a higher education institution in the northwest of São Paulo. Method: A cross-sectional census study in which the Utrecht Work Engagement Scale was used to identify the level of relationship with work (Total score) through 17 questions distributed in the Vigor, Dedication and Absorption dimensions. Results: Participation of 50 professionals, of which 92.0% were female, median age of 24 years, 88.0% were single; 82.0% were satisfied with the program, and 56.0% had thought of giving up. Professionals satisfied with the program had high levels for Total Score (4.0) and Dedication (4.5), and average levels for Absorption (3.9) and Vigor (3.8). Those who reported dissatisfaction had average levels in all dimensions (Vigor: 3.2, Absorption: 3.5, Dedication: 3.5) and in the Total score (3.2), which are considered positive results. Conclusion: Professionals presented good levels of engagement in spite of dissatisfactions with the program. The results showed a good relationship between professionals and preceptors and supervisors, which reinforces that support and recognition of professional performance are important for strengthening the engagement, especially at the beginning of the career.

RESUMEN Objetivo: Evaluar los niveles de engagement (compromiso) de residentes multiprofesionales en salud de un centro de enseñanza superior del noroeste del Estado de São Paulo. Método: Estudio censal transversal, que utilizó la Utrecht Work Engagement Scale para identificar el nivel de relación con el trabajo (Score general) por medio de 17 cuestiones distribuidas en las dimensiones Vigor, Dedicación y Absorción. Resultados: Participaron 50 profesionales. El 92,0% del sexo femenino, edad mediana de 24 años, el 88,0% solteros; el 82,0% se refirieron satisfechos con el programa; y el 56,0% ya pensaron en desistir. Los profesionales satisfechos con el programa presentaron Score general (4,0) y Dedicación (4,5) altos, y niveles medios de Absorción (3,9) y Vigor (3,8). Los que se refirieron insatisfechos presentaron niveles medios en todas las dimensiones (Vigor: 3,2; Absorción: 3,5; Dedicación: 3,5) y en el Score general (3,2), resultados considerados positivos. Conclusión: Los profesionales presentaron buenos niveles de engagement, aun habiendo insatisfacciones con el programa. Los resultados mostraron buena relación de los profesionales con preceptores y supervisores, reforzando que el apoyo y el reconocimiento del desempeño de los profesionales son importantes para el fortalecimiento del engagement, especialmente en el inicio de la carrera.

RESUMO Objetivo: Avaliar os níveis de engagement de residentes multiprofissionais em saúde de uma instituição de ensino superior do noroeste paulista. Método: Estudo censitário transversal, que utilizou a Utrecht Work Engagement Scale para identificar o nível de relação com o trabalho (Escore geral) por meio de 17 questões distribuídas nas dimensões Vigor, Dedicação e Absorção. Resultados: Participaram 50 profissionais. 92,0% do sexo feminino, idade mediana de 24 anos, 88,0% solteiros; 82,0% referiram-se satisfeitos com o programa, e 56,0% já pensaram em desistir. Os profissionais satisfeitos com o programa apresentaram Escore geral (4,0) e Dedicação (4,5) altos, e níveis médios de Absorção (3,9) e Vigor (3,8). Os que se referiram insatisfeitos apresentaram níveis médios em todas as dimensões (Vigor: 3,2; Absorção: 3,5; Dedicação: 3,5) e no o Escore geral (3,2), resultados considerados positivos. Conclusão: Os profissionais apresentaram bons níveis de engagement, mesmo havendo insatisfações com o programa. Os resultados mostraram boa relação dos profissionais com preceptores e supervisores, reforçando que o apoio e o reconhecimento do desempenho dos profissionais são importantes para o fortalecimento do engagement, principalmente no início da carreira.

Abstract Introduction Laryngeal granulomas are benign, recurrent lesions of many causes (reflux, voice abuse, intubation, and idiopathic), which renders its treatment difficult. Objective To describe our experience in the treatment of laryngeal granulomas. Methods From 16 medical records of the patients with laryngeal granulomas seen between 2010 and 2017 in a university hospital, the following data were analyzed: age, gender, vocal and gastroesophageal symptoms, vocal overuse, intubation, treatments, videolaryngoscopy before and after the treatment. Results Gender: female, 10; male, 6. Age: between 20 and 60 years old (11%). Etiology of the granulomas: intubation (9), reflux (4), idiopathic (3). The initial treatments adopted in all cases were: inhaled beclomethasone dipropionate 100 μg 12/12 hours (1month), proton pump inhibitor, omeprazole 40 mg/day (2months), and dietary and voice education. After this period, 10 patients (7 postintubation, 3 idiopathic) were submitted to surgery, since no improvements in the symptoms or in the lesions were seen. Of these, two recurred, requiring a second surgery, one of which recurred six times and received botulinum toxin A. Only one patient with granulomas due to laryngopharyngeal reflux presented no improvement in the symptoms nor in the lesion after the pharmacological treatment and had been submitted to microsurgery. All of the other patients with reflux granulomas were successfully treated with the drug treatment, and the longest treatment time for complete remission of the symptoms and of the lesions was 9 months. Conclusions In laryngeal granulomas caused by reflux, treatment with inhaled steroids and proton pump inhibitors proved to be effective, although prolonged. In postintubation and idiopathic granulomas, surgery was the best treatment.

Resumo Introdução: A disfonia é um sintoma comum após a tireoidectomia. Objetivo: Analisar os sintomas vocais, auditivo-perceptivos e acústica vocal, videolaringoscopia, procedimento cirúrgico e achados histopatológicos em pacientes submetidos à tireoidectomia. Método: Estudo prospectivo. Pacientes submetidos à tireoidectomia foram avaliados da seguinte forma: anamnese, laringoscopia e avaliações vocais acústicas. Momentos: pré-operatório, 1ª avaliação pós (15 dias), 2ª avaliação pós (1 mês), 3ª avaliação pós (3 meses) e 4ª avaliação pós-operatória (6 meses). Resultados: Dos 151 pacientes, 130 eram mulheres e 21, homens. Tipos de cirurgia: lobectomia + istmectomia n = 40, tireoidectomia total n = 88, tireoidectomia + dissecção de linfonodo n = 23. Sintomas vocais foram relatados por 42 pacientes na 1ª avaliação pós-operatória (27,8%), reduzidos para 7,2% após 6 meses. Na análise acústica, f0 e APQ estavam diminuídos nas mulheres. As videolaringoscopias mostraram que 144 pacientes (95,3%) tiveram exames normais no momento pré-operatório. Paralisia das cordas vocais foi diagnosticada em 34 pacientes na 1ª avaliação pós-operatória, 32 do nervo laríngeo recorrente (lobectomia + istmectomia - n = 6; tireoidectomia total - n = 17; tireoidectomia total + dissecção de linfonodos - n = 9) e 2 do nervo laríngeo superior (lobectomia + istmectomia - n = 1; tireoidectomia total + dissecção de linfonodos - n = 1). Após 6 meses, 10 pacientes persistiram com paralisia do nervo laríngeo recorrente (6,6%). Histopatologia e correlação com paralisia das cordas vocais: bócio coloide nodular (n = 76; paralisia n = 13), tireoidite (n = 8; paralisia n = 0) e carcinoma (n = 67; paralisia n = 21). Conclusão: Os sintomas vocais, relatados por 27,8% dos pacientes na 1ª avaliação pós-operatória, diminuíram para 7% em 6 meses. Na análise acústica, f0 e APQ diminuíram. A paralisia transitória de cordas vocais secundária à lesão do nervo laríngeo recorrente e nervo laríngeo superior ocorreu, respectivamente, em 21% e 1,3% dos pacientes, reduziu-se para 6,6% e 0% após 6 meses.

Abstract Introduction: Dysphonia is a common symptom after thyroidectomy. Objective: To analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy. Methods: Prospective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months). Results: Among the 151 patients (130 women; 21 men). Type of surgery: lobectomy + isthmectomy n = 40, total thyroidectomy n = 88, thyroidectomy + lymph node dissection n = 23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (lobectomy + isthmectomy n = 6; total thyroidectomy n = 17; thyroidectomy + lymph node dissection n = 9) and 2 superior laryngeal nerve (lobectomy + isthmectomy n = 1; Total thyroidectomy + lymph node dissection n = 1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n = 76; palsy n = 13), thyroiditis (n = 8; palsy n = 0), and carcinoma (n = 67; palsy n = 21). Conclusion: Vocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months.

RESUMO Objetivo: Avaliar os níveis de engagement de residentes multiprofissionais em saúde de uma instituição de ensino superior do noroeste paulista. Método: Estudo censitário transversal, que utilizou a Utrecht Work Engagement Scale para identificar o nível de relação com o trabalho (Escore geral) por meio de 17 questões distribuídas nas dimensões Vigor, Dedicação e Absorção. Resultados: Participaram 50 profissionais. 92,0% do sexo feminino, idade mediana de 24 anos, 88,0% solteiros; 82,0% referiram-se satisfeitos com o programa, e 56,0% já pensaram em desistir. Os profissionais satisfeitos com o programa apresentaram Escore geral (4,0) e Dedicação (4,5) altos, e níveis médios de Absorção (3,9) e Vigor (3,8). Os que se referiram insatisfeitos apresentaram níveis médios em todas as dimensões (Vigor: 3,2; Absorção: 3,5; Dedicação: 3,5) e no o Escore geral (3,2), resultados considerados positivos. Conclusão: Os profissionais apresentaram bons níveis de engagement, mesmo havendo insatisfações com o programa. Os resultados mostraram boa relação dos profissionais com preceptores e supervisores, reforçando que o apoio e o reconhecimento do desempenho dos profissionais são importantes para o fortalecimento do engagement, principalmente no início da carreira.

ABSTRACT Objective: To evaluate the levels of engagement of multi-professional health residents of a higher education institution in the northwest of São Paulo. Method: A cross-sectional census study in which the Utrecht Work Engagement Scale was used to identify the level of relationship with work (Total score) through 17 questions distributed in the Vigor, Dedication and Absorption dimensions. Results: Participation of 50 professionals, of which 92.0% were female, median age of 24 years, 88.0% were single; 82.0% were satisfied with the program, and 56.0% had thought of giving up. Professionals satisfied with the program had high levels for Total Score (4.0) and Dedication (4.5), and average levels for Absorption (3.9) and Vigor (3.8). Those who reported dissatisfaction had average levels in all dimensions (Vigor: 3.2, Absorption: 3.5, Dedication: 3.5) and in the Total score (3.2), which are considered positive results. Conclusion: Professionals presented good levels of engagement in spite of dissatisfactions with the program. The results showed a good relationship between professionals and preceptors and supervisors, which reinforces that support and recognition of professional performance are important for strengthening the engagement, especially at the beginning of the career.

RESUMEN Objetivo: Evaluar los niveles de engagement (compromiso) de residentes multiprofesionales en salud de un centro de enseñanza superior del noroeste del Estado de São Paulo. Método: Estudio censal transversal, que utilizó la Utrecht Work Engagement Scale para identificar el nivel de relación con el trabajo (Score general) por medio de 17 cuestiones distribuidas en las dimensiones Vigor, Dedicación y Absorción. Resultados: Participaron 50 profesionales. El 92,0% del sexo femenino, edad mediana de 24 años, el 88,0% solteros; el 82,0% se refirieron satisfechos con el programa; y el 56,0% ya pensaron en desistir. Los profesionales satisfechos con el programa presentaron Score general (4,0) y Dedicación (4,5) altos, y niveles medios de Absorción (3,9) y Vigor (3,8). Los que se refirieron insatisfechos presentaron niveles medios en todas las dimensiones (Vigor: 3,2; Absorción: 3,5; Dedicación: 3,5) y en el Score general (3,2), resultados considerados positivos. Conclusión: Los profesionales presentaron buenos niveles de engagement, aun habiendo insatisfacciones con el programa. Los resultados mostraron buena relación de los profesionales con preceptores y supervisores, reforzando que el apoyo y el reconocimiento del desempeño de los profesionales son importantes para el fortalecimiento del engagement, especialmente en el inicio de la carrera.