AVALIAÇÃO DA ALTERAÇÃO DE COR DE CIMENTOS RESINOSOS APÓS A TERMOCICLAGEM

Avaliar a alteração de cor dos cimentos resinosos após a termociclagem. Foram confeccionados 5 espécimes por meio de moldes metálicos cilíndricos (diâmetro 10 mm e espessura 1,0 mm) dos cimentos: Rely-X ARC, Rely-X U-Cem, All-Cem, Enforce, Variolink e Multilink. Foram realizadas as leituras instrumentais das coordenadas de cor CIELab por meio do colorímetro Vita Easyshade imediata e após termociclagem (500 ciclos). Posteriormente, foi realizado o cálculo das diferenças de cor ΔE.  No método visual foi realizada a avaliação das cores por meio de dois examinadores cegos e experientes. A avaliação instrumental demonstrou que os fundos branco e preto influenciaram nos valores CIELab para todos os cimentos, e que os cimentos que apresentaram valor de ΔE maior que 3.3 sofreram alterações de cor perceptíveis ao olho humano. Foram encontradas diferenças significativas entre as coordenadas de cor de alguns dos cimentos medidos imediatamente e após a termociclagem. Após o envelhecimento para os cimentos que apresentaram alterações significativas, os valores de L* diminuíram e de a* e b* aumentaram. A avaliação visual revelou baixa porcentagem (27,5%) de concordância entre as cores selecionadas pelos examinadores com as dos cimentos. Concluiu-se que a avaliação instrumental fornece resultados mais objetivos e confiáveis que o método visual.

Analysis of the association between lactotransferrin (LTF) gene polymorphism and dental caries

OBJECTIVE: The present study evaluated the association between lactotransferrin (LTF) gene polymorphism (exon 2, A/G, Lys/Arg) and dental caries. MATERIAL AND METHODS: A convenience sample of 110 individuals, 12 years old, was divided into: group 1, 48 individuals without caries experience (DMFT=0), and group 2, 62 subjects with caries experience (DMFT>;1). DNA was obtained from a mouthwash with 3% glucose solution, followed by a scrapping of the oral mucosa. After DNA purification, polymerase chain reaction (PCR), single strand conformation polymorphism (SSCP) was performed to access the study polymorphism. The LTF A/G (Lys/Arg) polymorphism had been previously reported as located in exon 1. RESULTS: Allele 1 of the study polymorphism was associated with low DMFT index and showed a protective effect against caries experience (OR=0.16, IC=0.03-0.76, p=0.01). CONCLUSIONS: Lactotransferrin A/G (exon 2, Lys/Arg) polymorphism was associated with susceptibility to dental caries in 12-year-old students

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Análise da resistência adesiva à dentina de diferentes sistemas adesivos pelo teste de microtração e microscopia eletrônica de varredura

O objetivo deste trabalho foi realizar, in vitro, avaliação da resistência de adesiva pelo teste de microtração de dez sistemas adesivos diferentes. Os sistemas adesivos One Up Bond F - Tokuyama, Clearfil SE Bond - Kuraray, Adper Prompt L-Pop, Single Bond - 3M/ESPE, One Step - Bisco, One Step Plus - Bisco, Prime&Bond NT - Dentsply, Excite - Vivadent, Scotchbond Multi - Uso - 3M/ESPE e All Bond 2 - Bisco. Para a realização do teste foram utilizados quarenta dentes molares hígidos, sendo que destes dentes dez foram utilizados para a microscopia eletrônica de varredura. Para a realização do teste de microtração os dentes foram cortados na superfície oclusal com disco diamantado e posteriormente foram desgastados com discos de lixa. Posteriormente as amostras foram restauradas com os respectivos sistemas adesivos e resina composta Z-100 com tempo de polimerização de 40 segundos cada incremento. Após vinte e quatro horas de armazenagem em temperatura de 37ºC os dentes foram seccionados com disco diamantado com finalidade de obter palitos com área de 1,0 +- 0,2 mm2. Após o corte os palitos foram armazenados em temperatura de 37ºC por vinte e quatro horas e em seguida foram levados para a máquina de ensaio universal EMIC 500 DL onde os palitos foram tracionados com velocidade de 1 mm/min. Os resultados foram analisados pelo através dos testes de normalidade de Lilliefors e de homogeneidade de variância de Bartlett. Quando alguns dos pressupostos não se verificaram, utilizou-se o teste não paramétrico de Kruskal - Wallis. Os resultados obtidos foram em ordem decrescente de 36,73 +- 10,52 para o sistema adesivo One Up Bond F, seguido do sistema de três etapas All Bond 2 com 34,29 +- 12,63 para o sistema adesivo One Step Plus foi de 33,18 +- 11,33 para o sistema Adper Prompt L-Pop de 31,76 +- 11,3, sistema One Step de 29,02 +- 11,28, para o... .The aim of this study was to analyze the bond strength of ten adhesive systems: One Up Bond F - Tokuyama (OU); Adper Prompt L-Pop - 3M-ESPE (AP); Clearfil SE Bond - Kuraray CO. (SE); Prime Bond NT - Caulk-Dentsply (NT); Single Bond - 3M-ESPE (SB); One Step - Bisco (OS); One Step Plus - Bisco (OP); Excite - Vivadent (EX); Scotchbond Multi - Purpose (SMP) e All Bond 2 - Bisco (AB). Methods: Forty freshly extracted human teeth were transversely wetcut using a diamond disk in order to expose the occlusal dentin surface. Then the adhesive systems were applied according to the manufacturer's instruction. The teeth were restored with composite resin Z-100 (3M) and stored in distilled water at 37ºC for 24 hours. A slow-speed diamond disk was used to prepare microtensile test specimens, with a bonded area of 1,00 +- 0,2 mm2. Each group was composed of thirty sticks, which were stored in distilled water at 37ºC for 24 hours. The sticks were bonded on a universal testing machine at a cross head speed of 1 mm/min. The following results demonstrate values microtensile bond strengths in MPa. Data were statistically analyzed by Kruskal-Wallis Test (p<-0.05). The bond strength values were 36,73 +- 10,52 for One Up Bond F, 34,29 +- 12,63 for All Bond 2, 33,18 +- 11,33 for One Step Plus, 31,76 +- 11,3 for Adper Prompt L-Pop, 29,02 +- 11,28 for One Step, 28,82 +- 14,74 for Single Bond, 28,08 +- 12,09 for Clearfil SE Bond, 26,31 +- 9,02 for Scotchbond Multi - Purpose, 21,35 +- 10,22 for Prime&Bond NT and 19,52 +- 10,08 for Excite. Ten teeth were analysed by SEM and all of them showed resin into the dentin tubules. Most of fractures were adhesive in the composite/teeth interface. One up bond F (OU) resulted in higher bond strength when compared to all the other systems tested and Excite resulted in lower bond strength. Self-etching systems were not statistically... (Complete abstract, click electronic address below)