Análise do levantamento de seio maxilar, pela técnica da janela lateral, para colocação de implantes dentários

Introduction: Edentulism is a condition characterized by the partial or total absence of teeth in a person and this reality is still considered significant in the current Brazilian population. This condition impacts the oral health, quality of life and general well-being of those affected. Oral rehabilitation through dental implants has emerged as an effective option for restoring masticatory function and aesthetics in edentulous patients. There are some situations in which, in order to install implants in the posterior region of the maxilla, it is necessary to lift the maxillary sinus, by creating a lateral opening in its bone wall, thus allowing precise surgical access to elevate the sinus membrane, creating an environment conducive to the safe installation of dental implants. The procedure involves elevating the sinus membrane to a more superior position, allowing the creation of a suitable space for the placement of bone grafts. Objective: This study aims to analyze the clinical applications of the lateral window technique for lifting the maxillary sinus and placing implants, with the aim of highlighting its specific indications, contraindications, and types of grafts used. Methodology: This is a literature review, based on scientific articles found in the PubMed/Medline, Virtual Health Library and SciELO databases. The search for articles was carried out using the descriptors: “Maxillary Sinus Floor Survey”, “Edentulous Maxilla”, “Dental Implants”, and as inclusion criteria original articles, literature reviews and case reports were used, in Portuguese, English and Spanish, published between 2008 and 2023. Results: It was observed that the technique described consists of creating a bone window in the lateral wall of the maxillary sinus, to create a bone height of the alveolar ridge. Within its clinical indications, it presents excellent results. An in-depth understanding of anatomy, combined with surgical skills and the use of advanced biomaterials, contribute to the long-term success of this technique, providing patients with a safe and effective option for oral rehabilitation. Final considerations: Maxillary sinus lifting using the lateral window technique is a valuable tool for bone correction, used in implant dentistry, offering effective solutions for patients with bone loss in the posterior region of the maxilla, requiring the dentist to have a deep knowledge of anatomy.Introdução: O edentulismo é uma condição caracterizada pela ausência parcial ou total de dentes em uma pessoa e essa realidade ainda é considerada significativa na atual população brasileira. Essa condição impacta a saúde bucal, qualidade de vida e o bem-estar geral dos acometidos. A reabilitação oral, por meio de implantes dentários tem se destacado como uma opção eficaz para restaurar a função mastigatória e a estética em pacientes desdentados. Existem algumas situações em que para a instalação de implantes na região posterior da maxila se faz necessário o levantamento do seio maxilar, através da criação de uma abertura lateral na sua parede óssea, permitindo assim um acesso cirúrgico preciso para a elevação da membrana sinusal, criando um ambiente propício para a instalação segura dos implantes dentários. O procedimento envolve a elevação da membrana sinusal para uma posição mais superior, permitindo a criação de um espaço adequado para a colocação de enxertos ósseos. Objetivo: Este estudo tem como objetivo analisar as aplicações clínicas da técnica da janela lateral para levantamento do seio maxilar e colocação de implantes, com o intuito de destacar suas indicações específicas, contraindicações, e tipos de enxertos utilizados. Metodologia: Trata-se de uma revisão de literatura, baseada em artigos científicos encontrados nas bases de dados PubMed/Medline, Biblioteca Virtual em Saúde e SciELO. A busca por artigos foi realizada utilizando os descritores: “Levantamento do Assoalho do Seio Maxilar”, “Maxila Edêntula”, “Implantes Dentários”, e como critérios de inclusão foram utilizados artigos originais, revisões de literatura e relatos de caso, em português, inglês e espanhol, publicados entre 2008 e 2023. Resultados: Observou-se que a técnica descrita consiste na confecção de uma janela óssea na parede lateral do seio maxilar, para confecção de altura óssea do rebordo alveolar. Dentro de suas indicações clínicas, apresenta ótimos resultados. A compreensão aprofundada da anatomia, aliada a habilidades cirúrgicas e o uso de biomateriais avançados, contribuem para o sucesso a longo prazo dessa técnica, proporcionando aos pacientes uma opção segura e eficaz para a reabilitação oral. Considerações finais: O levantamento de seio maxilar pela técnica da janela lateral é uma ferramenta valiosa para correção óssea, utilizada na implantodontia, oferecendo soluções eficazes para pacientes com perda óssea na região posterior da maxila, sendo necessário ao cirurgião-dentista um profundo conhecimento da anatomia. &nbsp

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding 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,5–7 vast areas of the tropics remain understudied.8–11 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 underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities 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 or ganism 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 ne glected 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 lostinfo:eu-repo/semantics/publishedVersio

Abordagens farmacológicas para a prevenção de recaídas em Depressão

As abordagens farmacológicas para a prevenção de recaídas em depressão desempenham um papel crucial na gestão contínua do transtorno. A personalização do tratamento, monitoramento atento e colaboração entre profissionais de saúde mental são elementos essenciais para otimizar os resultados e melhorar a qualidade de vida dos pacientes que enfrentam esse desafio persistente. Este estudo teve como objetivo avaliar o papel das abordagens farmacológica para a prevenção de recaídas em depressão. Para isso, se realizou uma revisão sistemática da literatura, utilizando as bases de dados Scielo, Lilacs e Medline. Com a análise qualitativa dos resultados, concluiu-se que as intervenções farmacológicas desempenham um papel significativo no cuidado mental, proporcionando benefícios em diversas situações. Contudo, o limite reside na necessidade de abordar cuidadosamente os desafios associados a essas intervenções e reconhecer a diversidade de respostas individuais à terapia farmacológica

Durvalumab Plus Carboplatin/Paclitaxel Followed by Maintenance Durvalumab With or Without Olaparib as First-Line Treatment for Advanced Endometrial Cancer: The Phase III DUO-E Trial

PURPOSE Immunotherapy and chemotherapy combinations have shown activity in endometrial cancer, with greater benefit in mismatch repair (MMR)-deficient (dMMR) than MMR-proficient (pMMR) disease. Adding a poly(ADP-ribose) polymerase inhibitor may improve outcomes, especially in pMMR disease. METHODS This phase III, global, double-blind, placebo-controlled trial randomly assigned eligible patients with newly diagnosed advanced or recurrent endometrial cancer 1:1:1 to: carboplatin/paclitaxel plus durvalumab placebo followed by placebo maintenance (control arm); carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab plus olaparib placebo (durvalumab arm); or carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab plus olaparib (durvalumab + olaparib arm). The primary end points were progression-free survival (PFS) in the durvalumab arm versus control and the durvalumab + olaparib arm versus control. RESULTS Seven hundred eighteen patients were randomly assigned. In the intention-to-treat population, statistically significant PFS benefit was observed in the durvalumab (hazard ratio [HR], 0.71 [95% CI, 0.57 to 0.89]; P = .003) and durvalumab + olaparib arms (HR, 0.55 [95% CI, 0.43 to 0.69]; P < .0001) versus control. Prespecified, exploratory subgroup analyses showed PFS benefit in dMMR (HR [durvalumab v control], 0.42 [95% CI, 0.22 to 0.80]; HR [durvalumab + olaparib v control], 0.41 [95% CI, 0.21 to 0.75]) and pMMR subgroups (HR [durvalumab v control], 0.77 [95% CI, 0.60 to 0.97]; HR [durvalumab + olaparib v control] 0.57; [95% CI, 0.44 to 0.73]); and in PD-L1-positive subgroups (HR [durvalumab v control], 0.63 [95% CI, 0.48 to 0.83]; HR [durvalumab + olaparib v control], 0.42 [95% CI, 0.31 to 0.57]). Interim overall survival results (maturity approximately 28%) were supportive of the primary outcomes (durvalumab v control: HR, 0.77 [95% CI, 0.56 to 1.07]; P = .120; durvalumab + olaparib v control: HR, 0.59 [95% CI, 0.42 to 0.83]; P = .003). The safety profiles of the experimental arms were generally consistent with individual agents. CONCLUSION Carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab with or without olaparib demonstrated a statistically significant and clinically meaningful PFS benefit in patients with advanced or recurrent endometrial cancer

Pervasive gaps in Amazonian ecological research

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

Pervasive gaps in Amazonian ecological research

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

Mortalidade e anos de vida ajustados por incapacidade de motociclistas na América Latina e Caribe na primeira década de segurança viária

Objetivo. Identificar a tendência temporal da mortalidade e dos anos de vida perdidos por morte ou incapacidade (DALY) de homens por acidente motociclístico na América Latina e Caribe no período de 2010 a 2019, utilizando estimativas do estudo Global Burden of Disease (GBD). Métodos. Este estudo ecológico analisou a série temporal pelo modelo de regressão linear segmentada (joinpoint), estimando-se e testando-se a variação percentual anual e a variação percentual anual média, com intervalo de confiança de 95%. Resultados. A grande região da América Latina e Caribe definida pelo GBD ocupou o primeiro lugar global em mortalidade e DALY de motociclistas homens de 15 a 49 anos em 2019. As taxas aumentaram significativamente de 2010 a 2013, havendo redução significativa de ambas após esse período. Durante a década analisada, a sub-região da América Latina Tropical (Brasil e Paraguai) apresentou as maiores taxas de mortalidade e DALY na população em estudo, porém foi a única com redução significativa das mesmas; a sub-região do Caribe (Bermudas, Dominica, Suriname, Guiana, Belize, Bahamas, Porto Rico, Santa Lúcia, República Dominicana, Haiti, São Cristóvão e Névis, Ilhas Virgens/EUA, Granada, Trinidad e Tobago, Barbados, São Vicente e Granadinas, Antígua e Barbuda, Cuba e Jamaica) apresentou aumento significativo de ambas as taxas, enquanto América Latina Andina (Equador, Bolívia e Peru) e América Latina Central (Colômbia, Costa Rica, El Salvador, Guatemala, México, Nicarágua, Panamá, Honduras e Venezuela) permaneceram estáveis. Conclusões. Os dados reforçam a importância das ações de vigilância destinadas à prevenção de acidentes motociclísticos, uma vez que os resultados de queda nas taxas ainda são insuficientes frente à morbimortalidade no trânsito como problema de saúde pública