Revisão bibliográfica sobre restaurações estéticas diretas em dentes posteriores

As exigências estéticas por parte da sociedade, assim como questões inerentes à utilização da amálgama, levaram à necessidade da evolução dos materiais restauradores usados em dentística, e à consequente substituição da amálgama pelas resinas, permitindo restaurações cada vez mais estéticas. Posto isto, resolveu-se realizar esta revisão narrativa de forma a compreender o comportamento do material, assim como as vantagens, desvantagens e as suas indicações, tanto dos sistemas adesivos como das resinas compostas nos dentes posteriores. Assim, foi realizada uma pesquisa nas bases bibliográficas PubMed/ NCBI e B-On, tal como em livros, sem limitação cronológica, onde foram utilizadas as seguintes palavras: “Aesthetics restorations”, “Amalgam”, “All-in-One adhesives”, “Class II restorations”, “Ponto de contacto”, “Posterior dental restorations” e “Systems adhesives” Conclui-se que o sistema adesivo Etch-and-Rinse de 2 passos clínicos é o mais indicado, sendo as resinas compostas microhíbridas e nanoestruturadas aplicadas pela técnica incremental oblíqua, as mais utilizadas.Today’s society values, increasingly, the aesthetics. Thus, improving and simplifying techniques for restoring teeth, were imposed. The aesthetic demand from patients led to necessity of the development of restorative materials used in dentistry, and the consequent replacement of silver amalgam by composite resins. The purpose of this monograph, consisting of a literature review was to assessth specifcs characteristics, indications and limitations of adhesives systems and composite resins in posterior restorations. The search was made in PubMed/NCBI e B-ON, and in books without chronological limitations with the key words: “Aesthetics restorations”, “Amalgam”, “All-in-One adhesives”, “Class II restorations”, “Ponto de contacto”, “Posterior dental restorations” e “Systems adhesives”. In conclusion, the adhesive system more indicated is Etch-and-Rinse (two clinical steps) and micro-hybrid and nanostrutured resins applied by the oblique incremental technique are the most used

Revisão bibliográfica sobre restaurações estéticas diretas em dentes posteriores

As exigências estéticas por parte da sociedade, assim como questões inerentes à utilização da amálgama, levaram à necessidade da evolução dos materiais restauradores usados em dentística, e à consequente substituição da amálgama pelas resinas, permitindo restaurações cada vez mais estéticas. Posto isto, resolveu-se realizar esta revisão narrativa de forma a compreender o comportamento do material, assim como as vantagens, desvantagens e as suas indicações, tanto dos sistemas adesivos como das resinas compostas nos dentes posteriores. Assim, foi realizada uma pesquisa nas bases bibliográficas PubMed/ NCBI e B-On, tal como em livros, sem limitação cronológica, onde foram utilizadas as seguintes palavras: “Aesthetics restorations”, “Amalgam”, “All-in-One adhesives”, “Class II restorations”, “Ponto de contacto”, “Posterior dental restorations” e “Systems adhesives” Conclui-se que o sistema adesivo Etch-and-Rinse de 2 passos clínicos é o mais indicado, sendo as resinas compostas microhíbridas e nanoestruturadas aplicadas pela técnica incremental oblíqua, as mais utilizadas.Today’s society values, increasingly, the aesthetics. Thus, improving and simplifying techniques for restoring teeth, were imposed. The aesthetic demand from patients led to necessity of the development of restorative materials used in dentistry, and the consequent replacement of silver amalgam by composite resins. The purpose of this monograph, consisting of a literature review was to assessth specifcs characteristics, indications and limitations of adhesives systems and composite resins in posterior restorations. The search was made in PubMed/NCBI e B-ON, and in books without chronological limitations with the key words: “Aesthetics restorations”, “Amalgam”, “All-in-One adhesives”, “Class II restorations”, “Ponto de contacto”, “Posterior dental restorations” e “Systems adhesives”. In conclusion, the adhesive system more indicated is Etch-and-Rinse (two clinical steps) and micro-hybrid and nanostrutured resins applied by the oblique incremental technique are the most used

Veteranos da guerra colonial portuguesa: políticas públicas e associativismo

Para a presente dissertação de mestrado realizou-se um estudo de investigação qualitativa sobre Os Veteranos da Guerra Colonial Portuguesa: Políticas Públicas e Associativismo. Este tema ocupa um espaço de discussão recorrente e que suscita interesse para potenciar contributos nesta área em desenvolvimento. Foi necessário concentrar a análise nos veteranos de guerra que sofrem, ainda hoje, com os impactos da sua presença na Guerra Colonial Portuguesa e pela forma como as políticas públicas foram dando resposta aos seus problemas sociais. Nesta mesma linha de pensamento, privilegiou-se a pesquisa documental e bibliográfica junto das associações de veteranos de guerra e em diversas bibliotecas. A informação recolhida foi sujeita a uma análise de conteúdo com recurso ao software NVivo. Os resultados obtidos permitiram responder às questões e alcançar os objetivos definidos, isto é, verificou-se a tendência evolutiva das políticas públicas e compreendeu-se a atuação dos movimentos associativos para o reconhecimento e solidariedade com os veteranos de guerra; Para a presente dissertação de mestrado realizou-se um estudo de investigação qualitativa sobre Os Veteranos da Guerra Colonial Portuguesa: Políticas Públicas e Associativismo. Este tema ocupa um espaço de discussão recorrente e que suscita interesse para potenciar contributos nesta área em desenvolvimento. Foi necessário concentrar a análise nos veteranos de guerra que sofrem, ainda hoje, com os impactos da sua presença na Guerra Colonial Portuguesa e pela forma como as políticas públicas foram dando resposta aos seus problemas sociais. Nesta mesma linha de pensamento, privilegiou-se a pesquisa documental e bibliográfica junto das associações de veteranos de guerra e em diversas bibliotecas. A informação recolhida foi sujeita a uma análise de conteúdo com recurso ao software NVivo. Os resultados obtidos permitiram responder às questões e alcançar os objetivos definidos, isto é, verificou-se a tendência evolutiva das políticas públicas e compreendeu-se a atuação dos movimentos associativos para o reconhecimento e solidariedade com os veteranos de guerra; Veterans of the Portuguese Colonial War: Public Policies and Associativism Abstract: For this master's dissertation, a qualitative research study was carried out on The Veterans of the Portuguese Colonial War: Public Policies and Associativism. This theme occupies a space for recurrent discussion and raises interest to enhance contributions in this developing area. It was necessary to focus the analysis on war veterans who suffer, even today, from the impacts of their participation in the Portuguese Colonial War and the way in which public policies were responding to their social problems. In this same line of thought, was favored documental and bibliographic research in associations of war veterans and in various libraries. The information collected was subjected to a content analysis using the NVivo software. The results obtained allowed us to answer the questions and reach the defined objectives, that is, the evolutionary trend of public policies was verified and the role of associative movements for recognition and solidarity with war veterans was understood

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Efficacy and safety of sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT): 2-year results from a randomised, active-controlled, phase 3 trial

BackgroundSparsentan, a novel, non-immunosuppressive, single-molecule, dual endothelin angiotensin receptor antagonist, significantly reduced proteinuria versus irbesartan, an angiotensin II receptor blocker, at 36 weeks (primary endpoint) in patients with immunoglobulin A nephropathy in the phase 3 PROTECT trial's previously reported interim analysis. Here, we report kidney function and outcomes over 110 weeks from the double-blind final analysis.MethodsPROTECT, a double-blind, randomised, active-controlled, phase 3 study, was done across 134 clinical practice sites in 18 countries throughout the Americas, Asia, and Europe. Patients aged 18 years or older with biopsy-proven primary IgA nephropathy and proteinuria of at least 1·0 g per day despite maximised renin–angiotensin system inhibition for at least 12 weeks were randomly assigned (1:1) to receive sparsentan (target dose 400 mg oral sparsentan once daily) or irbesartan (target dose 300 mg oral irbesartan once daily) based on a permuted-block randomisation method. The primary endpoint was proteinuria change between treatment groups at 36 weeks. Secondary endpoints included rate of change (slope) of the estimated glomerular filtration rate (eGFR), changes in proteinuria, a composite of kidney failure (confirmed 40% eGFR reduction, end-stage kidney disease, or all-cause mortality), and safety and tolerability up to 110 weeks from randomisation. Secondary efficacy outcomes were assessed in the full analysis set and safety was assessed in the safety set, both of which were defined as all patients who were randomly assigned and received at least one dose of randomly assigned study drug. This trial is registered with ClinicalTrials.gov, NCT03762850.FindingsBetween Dec 20, 2018, and May 26, 2021, 203 patients were randomly assigned to the sparsentan group and 203 to the irbesartan group. One patient from each group did not receive the study drug and was excluded from the efficacy and safety analyses (282 [70%] of 404 included patients were male and 272 [67%] were White) . Patients in the sparsentan group had a slower rate of eGFR decline than those in the irbesartan group. eGFR chronic 2-year slope (weeks 6–110) was −2·7 mL/min per 1·73 m2 per year versus −3·8 mL/min per 1·73 m2 per year (difference 1·1 mL/min per 1·73 m2 per year, 95% CI 0·1 to 2·1; p=0·037); total 2-year slope (day 1–week 110) was −2·9 mL/min per 1·73 m2 per year versus −3·9 mL/min per 1·73 m2 per year (difference 1·0 mL/min per 1·73 m2 per year, 95% CI −0·03 to 1·94; p=0·058). The significant reduction in proteinuria at 36 weeks with sparsentan was maintained throughout the study period; at 110 weeks, proteinuria, as determined by the change from baseline in urine protein-to-creatinine ratio, was 40% lower in the sparsentan group than in the irbesartan group (−42·8%, 95% CI −49·8 to −35·0, with sparsentan versus −4·4%, −15·8 to 8·7, with irbesartan; geometric least-squares mean ratio 0·60, 95% CI 0·50 to 0·72). The composite kidney failure endpoint was reached by 18 (9%) of 202 patients in the sparsentan group versus 26 (13%) of 202 patients in the irbesartan group (relative risk 0·7, 95% CI 0·4 to 1·2). Treatment-emergent adverse events were well balanced between sparsentan and irbesartan, with no new safety signals.InterpretationOver 110 weeks, treatment with sparsentan versus maximally titrated irbesartan in patients with IgA nephropathy resulted in significant reductions in proteinuria and preservation of kidney function

Sparsentan in patients with IgA nephropathy: a prespecified interim analysis from a randomised, double-blind, active-controlled clinical trial

Background: Sparsentan is a novel, non-immunosuppressive, single-molecule, dual endothelin and angiotensin receptor antagonist being examined in an ongoing phase 3 trial in adults with IgA nephropathy. We report the prespecified interim analysis of the primary proteinuria efficacy endpoint, and safety. Methods: PROTECT is an international, randomised, double-blind, active-controlled study, being conducted in 134 clinical practice sites in 18 countries. The study examines sparsentan versus irbesartan in adults (aged ≥18 years) with biopsy-proven IgA nephropathy and proteinuria of 1·0 g/day or higher despite maximised renin-angiotensin system inhibitor treatment for at least 12 weeks. Participants were randomly assigned in a 1:1 ratio to receive sparsentan 400 mg once daily or irbesartan 300 mg once daily, stratified by estimated glomerular filtration rate at screening (30 to 1·75 g/day). The primary efficacy endpoint was change from baseline to week 36 in urine protein-creatinine ratio based on a 24-h urine sample, assessed using mixed model repeated measures. Treatment-emergent adverse events (TEAEs) were safety endpoints. All endpoints were examined in all participants who received at least one dose of randomised treatment. The study is ongoing and is registered with ClinicalTrials.gov, NCT03762850. Findings: Between Dec 20, 2018, and May 26, 2021, 404 participants were randomly assigned to sparsentan (n=202) or irbesartan (n=202) and received treatment. At week 36, the geometric least squares mean percent change from baseline in urine protein-creatinine ratio was statistically significantly greater in the sparsentan group (-49·8%) than the irbesartan group (-15·1%), resulting in a between-group relative reduction of 41% (least squares mean ratio=0·59; 95% CI 0·51-0·69; p<0·0001). TEAEs with sparsentan were similar to irbesartan. There were no cases of severe oedema, heart failure, hepatotoxicity, or oedema-related discontinuations. Bodyweight changes from baseline were not different between the sparsentan and irbesartan groups. Interpretation: Once-daily treatment with sparsentan produced meaningful reduction in proteinuria compared with irbesartan in adults with IgA nephropathy. Safety of sparsentan was similar to irbesartan. Future analyses after completion of the 2-year double-blind period will show whether these beneficial effects translate into a long-term nephroprotective potential of sparsentan. Funding: Travere Therapeutics

Efficacy and safety of sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT): 2-year results from a randomised, active-controlled, phase 3 trial

Background Sparsentan, a novel, non-immunosuppressive, single-molecule, dual endothelin angiotensin receptor antagonist, significantly reduced proteinuria versus irbesartan, an angiotensin II receptor blocker, at 36 weeks (primary endpoint) in patients with immunoglobulin A nephropathy in the phase 3 PROTECT trial's previously reported interim analysis. Here, we report kidney function and outcomes over 110 weeks from the double-blind final analysis. Methods PROTECT, a double-blind, randomised, active-controlled, phase 3 study, was done across 134 clinical practice sites in 18 countries throughout the Americas, Asia, and Europe. Patients aged 18 years or older with biopsy-proven primary IgA nephropathy and proteinuria of at least 1·0 g per day despite maximised renin–angiotensin system inhibition for at least 12 weeks were randomly assigned (1:1) to receive sparsentan (target dose 400 mg oral sparsentan once daily) or irbesartan (target dose 300 mg oral irbesartan once daily) based on a permuted-block randomisation method. The primary endpoint was proteinuria change between treatment groups at 36 weeks. Secondary endpoints included rate of change (slope) of the estimated glomerular filtration rate (eGFR), changes in proteinuria, a composite of kidney failure (confirmed 40% eGFR reduction, end-stage kidney disease, or all-cause mortality), and safety and tolerability up to 110 weeks from randomisation. Secondary efficacy outcomes were assessed in the full analysis set and safety was assessed in the safety set, both of which were defined as all patients who were randomly assigned and received at least one dose of randomly assigned study drug. This trial is registered with ClinicalTrials.gov, NCT03762850. Findings Between Dec 20, 2018, and May 26, 2021, 203 patients were randomly assigned to the sparsentan group and 203 to the irbesartan group. One patient from each group did not receive the study drug and was excluded from the efficacy and safety analyses (282 [70%] of 404 included patients were male and 272 [67%] were White) . Patients in the sparsentan group had a slower rate of eGFR decline than those in the irbesartan group. eGFR chronic 2-year slope (weeks 6–110) was −2·7 mL/min per 1·73 m2 per year versus −3·8 mL/min per 1·73 m2 per year (difference 1·1 mL/min per 1·73 m2 per year, 95% CI 0·1 to 2·1; p=0·037); total 2-year slope (day 1–week 110) was −2·9 mL/min per 1·73 m2 per year versus −3·9 mL/min per 1·73 m2 per year (difference 1·0 mL/min per 1·73 m2 per year, 95% CI −0·03 to 1·94; p=0·058). The significant reduction in proteinuria at 36 weeks with sparsentan was maintained throughout the study period; at 110 weeks, proteinuria, as determined by the change from baseline in urine protein-to-creatinine ratio, was 40% lower in the sparsentan group than in the irbesartan group (−42·8%, 95% CI −49·8 to −35·0, with sparsentan versus −4·4%, −15·8 to 8·7, with irbesartan; geometric least-squares mean ratio 0·60, 95% CI 0·50 to 0·72). The composite kidney failure endpoint was reached by 18 (9%) of 202 patients in the sparsentan group versus 26 (13%) of 202 patients in the irbesartan group (relative risk 0·7, 95% CI 0·4 to 1·2). Treatment-emergent adverse events were well balanced between sparsentan and irbesartan, with no new safety signals. Interpretation Over 110 weeks, treatment with sparsentan versus maximally titrated irbesartan in patients with IgA nephropathy resulted in significant reductions in proteinuria and preservation of kidney function.</p