Avaliação de tres metodos radiograficos - periapical, panoramico e sistema digital - no diagnostico de lesões apicais produzidas artificialmente

Orientador: Solange Maria AlmeidaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O presente estudo teve por finalidade avaliar três métodos radiográficos, radiografia periapical, radiografia panorâmica e sistema digital, no diagnóstico de lesões apicais produzidas artificialmente em mandíbulas maceradas. E se o tamanho das lesões interferem no diagnóstico radiográfico. Para tanto, as lesões apicais foram produzidas utilizando-se brocas esféricas com diâmetros diferentes, permitindo assim que o diâmetro das lesões sofresse alteração em tamanho conforme a broca utilizada. Assim, o estudo foi dividido em 04 fases: fase inicial ou 1, caracterizada pela ausência de lesão; fase 2, caracterizada pela lesão produzida com a broca 6 com medida da ponta ativa de 1,8mm; fase 3, caracterizada pela lesão produzida com a broca 8 com medida da ponta ativa de 2,3mm; fase 4, caracterizada pela lesão produzida com a broca 10 com medida da ponta ativa de 2,7mm; e fase cortical ou 5, quando a lesão atingia as corticais ósseas. Todas as fases foram, realizadas em 04 regiões da mandíbula: incisivo, canino, pré-molares e molares. As radiografias foram obtidas após cada fase e, posteriormente, foram analisadas por 04 radiologistas. Houve diferença estatisticamente significante na fase broca 6 (R) nos incisivos a favor do sistema digital. O mesmo ocorreu na fase cortical (LI) na região de pré-molares. Na região dos molares houve uma diferença etatisticamente significante na fase broca 10 (D) para a radiografia panorâmica e na fase cortical esta técnica foi a menos eficaz. Nas demais fases e regiões não houve uma diferença estatisticamente significanteAbstract: The aim of this study was to evaluate three radiographys techniques: periapical radiography, panoramic and digital radiography, about diagnostic accuracy of artificially produced bony lesions in human jaw dry. The periapical diseases were done using burs numbers 6, 8 and 10 thus allowing the lesions diameter to incresing according to burs size. Therefore, the study was dividided in four phases: phase 1 without periapical disease, phase 2 periapical disease made by bur number 6, phase 3 periapical disease made by bur number 8, phase 4 periapical disease made by bur number 10 and phase 5 periapical disease touchs junction area of the cortex. The phases were in four regions in the jaw, anterior, canine, premolar and molar. The radiographies were evaluated by four oral radiologists observers. The results showed that in the anterior region there was a significant statistically difference only at phase 2, that is the lesion was produced with bur 6, the digital radiography was more successfull and it was also observed in the premolar region in the cortical phase. In the molar region there was a false true result during the inicial phase, without lesion. During phase 4 (burn 10 ) and cortical phase there was a statistically significant difference in favor of the panoramic radiographyMestradoRadiologiaMestre em Odontologi

Serum soluble-Fas is a predictor of red blood cell transfusion in critically ill patients

OBJECTIVE: To investigate the relation between the need for red blood cell transfusion and serum levels of soluble-Fas, erythropoietin and inflammatory cytokines in critically ill patients with and without acute kidney injury. METHODS: We studied critically ill patients with acute kidney injury (n=30) and without acute kidney injury (n=13), end-stage renal disease patients on hemodialysis (n=25) and healthy subjects (n=21). Serum levels of soluble-Fas, erythropoietin, interleukin 6, interleukin 10, iron status, hemoglobin and hematocrit concentration were analyzed in all groups. The association between these variables in critically ill patients was investigated. RESULTS: Critically ill patients (acute kidney injury and non-acute kidney injury patients) had higher serum levels of erythropoietin than the other groups. Hemoglobin concentration was lower in the acute kidney injury patients than in other groups. Serum soluble-Fas levels were higher in acute kidney injury and end-stage renal disease patients. Critically ill patients requiring red blood cell transfusions had higher serum levels of soluble-Fas (5,906±2,047 and 1,920±1,060; p<0.001), interleukin 6 (518±537 and 255+502; p=0.02) and interleukin 10 (35.8±30.7 and 18.5±10.9; p=0.02), better iron status and higher mortality rates in the first 28 days in intensive care unit. Serum soluble-Fas levels were independently associated with the number of red blood cell units transfused (p=0.02). Serum soluble-Fas behaved as an independent predictor of the need for red blood cell transfusion in critically ill patients (p=0.01). CONCLUSIONS: Serum soluble-Fas level is an independent predictor of the need for red blood cell transfusion in critically ill patients with or without acute kidney injury. Further studies are warranted to reconfirm this finding.OBJETIVO: Investigar a relação entre a transfusão de hemácias e os níveis séricos de Fas solúvel, eritropoietina e citocinas inflamatórias em pacientes gravemente enfermos, com e sem insuficiência renal aguda. MÉTODOS: Os seguintes grupos foram estudados: pacientes gravemente enfermos com insuficiência renal aguda (n=30) e sem insuficiência renal aguda (n=13), pacientes portadores de doença renal crônica terminal em hemodiálise (n=25) e indivíduos saudáveis (n=21). Os níveis séricos de Fas solúvel, eritropoietina, interleucina 6, interleucina 10 e ferro, além da concentração de hemoglobina e de hematócrito, foram analisados em todos os grupos. A associação entre tais variáveis foram estudadas nos pacientes gravemente enfermos. RESULTADOS: Os níveis séricos de eritropoietina mostraram-se mais elevados nos pacientes gravemente enfermos do que nos dos demais grupos. Concentrações mais baixas de hemoglobina foram documentadas nos pacientes com insuficiência renal aguda em relação aos demais. Níveis séricos mais elevados de Fas solúvel foram observados nos pacientes com insuficiência renal aguda e doença renal crônica terminal. Pacientes gravemente enfermos transfundidos apresentaram níveis séricos mais elevados de Fas solúvel (5.906±2.047 e 1.920±1.060; p<0,001), interleucina 6 (518±537 e 255±502; p=0,02), interleucina 10 (35,8±30,7 e 18,5±10,9; p=0,02) e ferro, além de maior mortalidade em 28 dias. Os níveis séricos de Fas solúvel mostraram-se independentemente associados ao número de transfusões (p=0,02). O nível sérico de Fas solúvel foi um preditor independente da necessidade de transfusão de hemácias em pacientes gravemente enfermos (p=0,01). CONCLUSÃO: O nível sérico de Fas solúvel é um preditor independente da necessidade de transfusão de hemácias em pacientes gravemente enfermos, com ou sem insuficiência renal aguda. Mais estudos clínicos e laboratoriais são necessários para confirmar tal resultado.Universidade Federal de São Paulo (UNIFESP)Hospital Israelita Albert EinsteinUNIFESPSciEL

Analise comparativa, in vitro, da eficiencia na odontometria de tres localizadores apicais (Root ZX, Bingo 1020 e Novapex).

Orientador: Francisco Jose de Souza FilhoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: A presente pesquisa teve por finalidade avaliar, in vitro, a eficácia dos localizadores apicais, Bingo 1020, Novapex e Root ZX, nas posições 1mm aquém do ápice e na posição 0 (zero). Comparar a odontometria eletrônica na posição 0 com a medida real dos dentes. Comparar a odontometria radiográfica com a odontometria eletrônica utilizando o Bingo 1020 na posição 1mm aquém do ápice e na posição 0. Para tanto foram utilizadas 71 raízes de molares humanos, extraídos, com rizogênese completa e sem sinais de fratura apical. Dos molares inferiores utilizou-se raízes mesiais e dos molares superiores as raízes vestibulares. Foi realizada a abertura coronária . Após a radiografia, sendo essa o segundo critério de seleção, os dentes foram colocados em uma plataforma para a odontometria eletrônica. Essa plataforma teve a finalidade de manter os dentes em posição, com os respectivos ápices em contato com uma solução salina . A exploração do canal foi realizada com as limas 10 e 15 e a odontometria com a lima 20, sendo que a medida real foi obtida com lupa de aumento de 2,5 vezes , considerando a posição em que a lima emergia da constrição apical. A primeira medida eletrônica foi realizada na posição em que o localizador apical marcou 1mm aquém do ápice. A segunda medida, na posição 0. Esse procedimento foi realizado com os três localizadores apicais, perfazendo um total de 213 medidas na posição 1mm e 213 medidas na posição 0. Quarenta e quatro canais foram utilizados para avaliação radiográfica. O cálculo estatístico demonstrou que os localizadores apicais Bingo 1020, Novapex e Root ZX não foram significativamente diferentes entre si, nas medidas 1mm aquém do ápice e na posição 0mm, nas condições da pesquisa. Na comparação com a medida real o Root ZX apresentou uma maior porcentagem de aproximação, embora não significante, nos desvios de 0,5 mm e 0,75mm. Na odontometria radiográfica, considerando três avaliadores, houve diferença estatisticamente signicante em dois, em relação à odontometria eletrônica com o localizador apical Bingo 1020Abstract: The aim of this study was to evaluate, in vitro, the measurement efficiency of the apex locators known as Bingo 1020, Novapex and Root ZX, at the positions of 1mm and 0mm from the apex; compare the electronic measurement at 0mm with the real measurement of the teeth; and compare the radiographic root canal measurement to the electronic measurement obtained by the Bingo 1020. For this, 71 extracted human molar roots, presenting complete root formation and no signs of apical fracture were selected and only the mesial roots of the inferior molars and the buccal roots of the superior molars were included in the study. The teeth were embedded in a resin ring and coronary access and radiographs were performed. After tooth radiography, considered the second criteria for selection, these were placed upon a platform for electronic root measurement. Such platform had the finality to maintain the teeth in position, with the respective apexes in contact with saline solution. Canal exploration was accomplished using files #10 and 15#, root measurement was performed with a file #20, and the real root measurement was determined when file emergence from the apical constriction was observed using a 2.5X magnifying glass. The first electronic measurement was made when the apex locator marked 1mm from the apex. The second measurement was noted at 0mm. Such sequence was performed using the three apex locators, adding up to a total of 213 measurements at 1mm and at 0mm from the apex. Forty-four root canals were used for radiographic evaluation. Statistic evaluation demonstrated that the apex locators Bingo 1020, Novapex and Root ZX were not statistically different among each other at the measurements of 1mm and 0mm from the apex under the conditions of this experiment. During the comparison with real root measurements, Root ZX presented the highest percentage approximation, although not statistically significant during deviation of 0.5mm and 0.75mm. Three different evaluators revealed significant statistical difference among two, when radiographic root measurement were compared to the Bingo 1020 apex locatorDoutoradoEndodontiaDoutor em Clínica Odontológic

Force degradation of different elastomeric chains and nickel titanium closed springs

Aim: The purpose in this study was to evaluate the degradation force of conventional synthetic orthodontic elastics and synthetic orthodontic elastics with memory properties. Methods: Specimens of each material (Plastic chain, Memory chain and Closed spring NiTi) were stretched and adapted to the test specimens composed of resin plates and orthodontic wires, simulating retraction units. Degradation force was verified in an Instron universal test machine at the following intervals: 1, 2, 18, 24, 48 h; 7, 14, 21, and 28 days. Data (gF) were analyzed statistically using Friedman and Kruskal-Wallis tests at 5% significance level. Results: It was observed a significant force reduction of Plastic chain and Memory chain after 2 h (p<0.05). For NiTi spring significantly force reduction was observed after 18 h, but no significant change was showed up to 21 days. NiTi spring showed force significantly higher than synthetic elastomeric materials (p<0.05). There was no significant difference between Memory chain and Plastic chain up to 24 h. However, from 48 h to 21 days Memory chain showed force significantly higher than Plastic chain. Conclusions:There was higher force degradation in the synthetic elastomeric materials in comparison with NiTi springs, which allows the preferential indication of these space closure jigs for clinical use

Force degradation of different elastomeric chains and nickel titanium closed springs

e purpose in this study was to evaluate the degradation force of conventional synthetic orthodontic elastics and synthetic orthodontic elastics with memory properties. Methods: Specimens of each material (Plastic chain, Memory chain and Closed spring NiTi) were stretched and adapted to the test specimens composed of resin plates and orthodontic wires, simulating retraction units. Degradation force was verified in an Instron universal test machine at the following intervals: 1, 2, 18, 24, 48 h; 7, 14, 21, and 28 days. Data (gF) were analyzed statistically using Friedman and Kruskal-Wallis tests at 5% significance level. Results: It was observed a significant force reduction of Plastic chain and Memory chain after 2 h (p<0.05). For NiTi spring significantly force reduction was observed after 18 h, but no significant change was showed up to 21 days. NiTi spring showed force significantly higher than synthetic elastomeric materials (p<0.05). There was no significant difference between Memory chain and Plastic chain up to 24 h. However, from 48 h to 21 days Memory chain showed force significantly higher than Plastic chain. Conclusions: There was higher force degradation in the synthetic elastomeric materials in comparison with NiTi springs, which allows the preferential indication of these space closure jigs for clinical use

The impact of continuous renal replacement therapy on renal outcomes in dialysis-requiring acute kidney injury may be related to the baseline kidney function

Abstract Background Many controversies exist regarding the management of dialysis-requiring acute kidney injury (D-AKI). No clear evidence has shown that the choice of dialysis modality can change the survival rate or kidney function recovery of critically ill patients with D-AKI. Methods We conducted a retrospective study investigating patients (≥16 years old) admitted to an intensive care unit with D-AKI from 1999 to 2012. We analyzed D-AKI incidence, and outcomes, as well as the most commonly used dialysis modality over time. Outcomes were based on hospital mortality, renal function recovery (estimated glomerular filtration rate-eGFR), and the need for dialysis treatment at hospital discharge. Results In 1,493 patients with D-AKI, sepsis was the main cause of kidney injury (56.2%). The comparison between the three study periods, (1999–2003, 2004–2008, and 2009–2012) showed an increased in incidence of D-AKI (from 2.56 to 5.17%; p = 0.001), in the APACHE II score (from 20 to 26; p < 0.001), and in the use of continuous renal replacement therapy (CRRT) as initial dialysis modality choice (from 64.2 to 72.2%; p < 0.001). The mortality rate (53.9%) and dialysis dependence at hospital discharge (12.3%) remained unchanged over time. Individuals who recovered renal function (33.8%) showed that those who had initially undergone CRRT had a higher eGFR than those in the intermittent hemodialysis group (54.0 × 46.0 ml/min/1.73 m2, respectively; p = 0.014). In multivariate analysis, type of patient, sepsis-associated AKI and APACHE II score were associated to death. For each additional unit of the APACHE II score, the odds of death increased by 52%. The odds ratio of death for medical patients with sepsis-associated AKI was estimated to be 2.93 (1.81–4.75; p < 0.001). Conclusion Our study showed that the incidence of D-AKI increased with illness severity, and the use of CRRT also increased over time. The improvement in renal outcomes observed in the CRRT group may be related to the better baseline kidney function, especially in the dialysis dependence patients at hospital discharge

Outcomes from a cohort of patients with acute kidney injury subjected to continuous venovenous hemodiafiltration: The role of negative fluid balance

<div><p>Background</p><p>Several factors influence the outcomes in acute kidney injury (AKI), especially in intensive care unit (ICU) patients. In this scenario, continuous renal replacement therapies (CRRT) are used to control metabolic derangements and blood volume. Knowing this fact, it may be possible to change the course of the disease and decrease the high mortality rate observed. Thus, we aimed to evaluate the main risk factors for death in AKI patients needing CRRT.</p><p>Results</p><p>This was a prospective, observational cohort study of ICU patients (N = 183) with AKI who underwent continuous venovenous hemodiafiltration (CVVHDF) as their initial dialysis modality choice. The patients were predominantly male (62.8%) and their median age was 65 (55–76) years. The most frequent comorbidities were cardiovascular disease (39.3%), hypertension (32.8%), diabetes (24%), and cirrhosis (20.7%). The main cause of AKI was sepsis (52.5%). At beginning of CVVHDF, 152 patients (83%) were using vasopressors. The median SAPS 3 and SOFA score at ICU admission was 61 (50–74) and 10 (7–12), respectively. The dialysis dose delivered was 33.2 (28.9–38.7) ml/kg/h. The median time between ICU admission and CVVHDF initiation was 2 (1–4) days. The median cumulative fluid balance during the CVVHDF period was -1838 (-5735 +2993) ml. The mortality rate up to90 days was 58%. The independent mortality risk factors in propensity score model were: chronic obstructive pulmonary disease (OR = 3.44[1.14–10.4; p = 0.028]), hematologic malignancy (OR = 5.14[1.66–15.95; p = 0.005]), oliguria (OR = 2.36[1.15–4.9; p = 0.02]), positive daily fluid balance during CVVHDF (OR = 4.55[2.75–13.1; p<0.001]), and total SOFA score on first dialysis day (OR = 1.27[1.12–1.45; p<0.001]).</p><p>Conclusions</p><p>Dialysis-related factors may influence the outcomes. In our cohort, positive daily fluid balance during CRRT was associated with lower survival. Multicenter, randomized studies are needed to assess fluid balance as a primary outcome to define the best strategy in this patient population.</p></div