10 research outputs found
Influence of a LED curing unit beam homogenization tip on the top and bottom microhardness of composite resins
Get PDFOrientador: Marcelo GianniniDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O objetivo do estudo foi avaliar o efeito de diferentes pontas transmissoras de luz de um aparelho fotoativador na microdureza da superfĂcie e da base de resinas compostas convencionais e do tipo bulk-fill, que contem diferentes fotoiniciadores como canforoquinona, Lucirin-TPO ou Ivocerin. Adicionalmente, foi analisado o perfil do feixe de luz emitido por cada ponta. Foi usado um aparelho fotoativador LED polywave Bluephase Style (Ivoclar Vivadent AG) e duas pontas transmissoras de luz desenhadas para uso nesse aparelho, uma ponta regular (RT) com emitĂąncia de 935 mW/cm2 e uma ponta homogeneizadora (HT), com emitĂąncia de 851 mW/cm2. Foram testadas duas resinas convencionais (Herculite Ultra, Kerr Corp (HER), e Tetric EvoCeram, Ivoclar Vivadent AG (TEC)) e duas resinas tipo bulk-fill (SonicFill, Kerr Corp (SOF). e Tetric EvoCeram Bulk Fill, Ivoclar Vivadent AG (TBF)). Foram fabricados corpos de prova em formato de disco, com 10mm de diĂąmetro e 2mm de espessura no caso das resinas convencionais, e 4mm de espessura para as resinas bulk-fill. Os discos foram polimerizados o tempo indicado pelos fabricantes, mantendo o aparelho fotoativador em uma posição fixa. A posição de saĂda da luz emitida por cada um dos trĂȘs LED do aparelho fotoativador (sendo que dois chips emitem luz azul com um pico de emissĂŁo de 456nm, o terceiro chip produz luz violeta com um pico de 409nm) foi sinalizada na ponta e marcada nos discos, como referĂȘncia para as mediçÔes posteriores. Foi medida a microdureza superficial Knoop (KHN), do topo e da base de cada disco, no ponto central de incidĂȘncia da luz emitida por cada chip. Os dados da caracterização da luz foram analisados com um teste t de Student. Os dados de microdureza foram analisados com ANOVA de 3 fatores (LED, topo ou base, e tipo de ponta; 'alfa'= 0.05). As imagens do perfil de feixe de luz demostraram melhor distribuição da luz na ponta transmissora, quando foi usada a HT. O uso da HT tambĂ©m resultou em uma diminuição da microdureza de HER nas posiçÔes associadas aos LED azuis na base dos discos, mas nĂŁo produz diferença no topo. Em TEC, o uso da HT aumentou a microdureza no topo nas regiĂ”es dos trĂȘs LED. O uso da HT produz um aumento na microdureza de SOF na posição de um dos LED azuis, e do LED violeta, na base, e em TBF aumentou a dureza do topo nas posiçÔes de todos os LED. Em todas as resinas testadas, a dureza media da superfĂcie dos discos foi maior, do que na base. De maneira geral, a dureza foi maior nas regiĂ”es dos LED azuis, do que na regiĂŁo do LED violeta, tanto no topo, quanto nas bases dos discos, independentemente da ponta transmissora usada. Os resultados sugerem que o uso da ponta homogeneizadora pode aumentar a microdureza da superfĂcie de resinas compostas que apresentam fotoiniciadores alternativos, mas o efeito Ă© perdido na base do materialAbstract: The purpose of this study was to evaluate the effect of a light guide (regular or homogenizing) from a light curing unit (LCU) on the top and bottom microhardness of conventional and bulk-fill composites disks, and to analyze the beam profile produced by each light guide. A polywave LED LCU Bluephase Style (Ivoclar Vivadent AG) with two different light guides were used: a regular tip (RT), with an emittance of 935 mW/cm2, and a homogenizer tip (HT), with an emittance of 851 mW/cm2.Two conventional composites (Herculite Ultra (HER), Kerr Corp and Tetric EvoCeram (TEC), Ivoclar Vivadent AG) and two bulk-fill composites (SonicFill (SOF), Kerr Corp and Tetric EvoCeram Bulk Fill (TBF), Ivoclar Vivadent AG). Disk-shaped composite samples, with a 10 mm diameter and 2 mm thickness for conventional composites and 4 mm thickness for bulk-fill composites were prepared. Samples were light cured according to the manufacturers recommended times, keeping the LCU in a fixed position, with external marks in the light guides to determine the areas for hardness measurements, which corresponded to the location of the three LED chips, emitting blue and violet light (two chips with emission peak at 456nm and one chip at 409nm). Knoop microhardness was measured at the top and bottom surface of each specimen in the central in irradiance spot of each chip. Microhardness data for each composite was analyzed by 3-way ANOVA ('alpha'=0.05). Beam profile images showed better light distribution across the surface of the light guide when HT was used. Using HT decreased microhardness of HER at the position of the blue LED chips at base of the sample but had no effect at the top surface. For TEC, use of HT increased microhardness of the three LED areas at the top surface. Use of the HT increased microhardness of SOF at the position of one of the blue and the violet LED chips at the bottom surface, and for TBF, HT increased the microhardness in all the top surface. All the tested composites showed a higher mean microhardness at top than that at the bottom of the samples. In general, all composites presented a higher microhardness at the blue LED areas, regardless of the surface or the used tip. Results suggest that using a homogenizer light guide may increase the microhardness at the top of composite resins containing alternative photoinitiators; however, that effect is not the same at the bottom of the materialMestradoDentĂsticaMestre em ClĂnica OdontolĂłgic
Synthesis, characterization, and incorporation of upconverting nanoparticles into a dental adhesive
Get PDFThe purpose of this study was to describe the synthesis, characterization, and functionalization of b-NaYF4:30%Yb/0.5%Tm upconverting nanocrystals for use as nanofillers in a dental adhesive and microscopically evaluate the interface between the particles and a commercial adhesive. The upconverting nanoparticles were synthesized and purified by thermal decomposition, and their chemical composition determined by energy dispersive X-Ray spectroscopy. The crystalline structure was characterized using X-Ray diffraction and morphology and size were observed with scanning and transmission electron microscopy. Upconverting emission was evaluated by spectrophotometry irradiating the particles with a 975 nm diode laser. Particles were functionalized with polyacrylic acid and the success was confirmed by measurement of Zeta Potential and transmission electron microscopy. The results of X-ray diffraction found a pure hexagonal phase crystalline pattern. Scanning electron microscopy showed uniform dispersion of hexagonal-shaped particles of approximately 150 nm. Upconversion emission was observed in 344 nm, 361 nm, 450 nm, 474nm, 646 nm, 803 nm. Functionalization success was confirmed by formation of a stable aqueous colloid with a Zeta potential of -29.5mV and the absence of voids in the particle-adhesive interface on the transmission electron microscopy images. The reported synthesis and functionalization process produced upconverting nanoparticles emitting photons within the blue spectral region (450 nm and 474 nm).Fil: Rocha Pacheco, Rafael. University Of Detroit Mercy; Estados UnidosFil: Garcia Flores, Ali Francisco. Universidad Federal do Abc; BrasilFil: Soto Montero, Jorge Rodrigo. Universidad de Costa Rica; Costa RicaFil: Lesseux, Guilherme Gorgen. Universidade Estadual de Campinas; BrasilFil: Rocha Acosta Lancelotti, Ailla Carla. Universidade Estadual de Campinas; BrasilFil: MartĂnez, Eduardo David. Universidade Estadual de Campinas; Brasil. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Oficina de CoordinaciĂłn Administrativa Ciudad Universitaria. Unidad Ejecutora Instituto de Nanociencia y NanotecnologĂa. Unidad Ejecutora Instituto de Nanociencia y NanotecnologĂa - Nodo Bariloche | ComisiĂłn Nacional de EnergĂa AtĂłmica. Unidad Ejecutora Instituto de Nanociencia y NanotecnologĂa. Unidad Ejecutora Instituto de Nanociencia y NanotecnologĂa - Nodo Bariloche; ArgentinaFil: Rettori, Carlos. Universidad de Costa Rica; Costa RicaFil: Rodrigues Urbano, Ricardo. Universidade Estadual de Campinas; BrasilFil: Rueggeberg, Frederick Allen. No especifĂca;Fil: Giannini, Marcelo. Universidade Estadual de Campinas; Brasi
Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial
Get PDFBackground: 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 18â85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25â75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300â5000 mg/g who had received maximum labelled or tolerated reninâangiotensin 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 â„30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for â„90 days, chronic dialysis for â„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 1·4â2·9). 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 0·49â0·88]; 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 0·85â2·07]; 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 0·75â1·59]; 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
Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial
Get PDFBackground: 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
MĂ©todos y mediciones
No full textActitud y conducta hacia la salud oral en estudiantes de la comuna de AraucoAnálisis de instrumentos de registro odontológicos en la red de APS de la Región MetropolitanaAnálisis de la eficiencia relativa del Hospital de Cabildo mediante la aplicación del análisis de fronteraAnálisis de letalidad intrahospitalaria y acumulada a 30 días de eventos IAM, 2003-2007Análisis del programa de cáncer cervicouterino en Chile con metodología de marco lógicoAños de vida perdidos por muerte prematura: efecto de diferentes criterios de corrección de subregistrosCalidad global de la alimentación de mujeres asistidas por el sistema de salud público chilenoCarga de mortalidad para el estado de Río de Janeiro, BrasilCausas de extracciones permanentes en adultos atendidos en la Posta Central, ChileComparación del consumo de drogas en escolares hombres utilizando metodología de pares y cuestionario autoregistradoCuidado hospitalario de pacientes con accidente cerebrovascular isquémico atendidos bajo régimen GESDescripción de dimensiones del constructo de calidad de vida en niños de 2-5 añosDistribución de benzodiacepinas en establecimientos del SNSS, período 2006-2008Evaluación de calidad, implementación del control odontológico del niño sano en CAP'S, Región del MauleEvaluación de la satisfacción del usuario interno de la Unidad de Cuidados Básicos del Hospital MetropolitanoEvaluación del protocolo de referencia de cefalea tensional y migraña en consultorio Llay-LlayEvaluación económica del Programa de Fluoración del Agua en ChileFactores de riesgo de enfermedad hipertensiva del embarazo en la UCI del H.G EcatepecImpacto de reforma sanitaria en autorizaciones sanitarias y de desempeño en instalaciones de radiodiagnóstico dentalInstitucionalidad de la investigación en salud pública en ChileLetalidad intrahospitalaria y a 30 días de los eventos de accidente cerebrovascular isquémico en ChileLimitaciones y desafíos de la investigación en salud pública en ChileMejora de agudeza visual y utilización cirugía de segundo ojo en pacientes con cataratas GESMortalidad infantil en la Región Metropolitana II del Estado de Río de Janeiro, 1981-2008Mortalidad por cáncer de tiroides en Chile en el período 1985-2007Mortalidad por tumores cerebrales en población infantil y adolescente, ciudad Río de Janeiro, 1980-2007Mortalidad por tumores del sistema nervioso central en adultos, Río de Janeiro, 1980 a 2007Prevalencia de anemia ferropriva en una muestra representativa de beneficiarios del PNACPrevalencia de caries y fluorosis previo a la fluoruración del agua potable en TemucoPrevalencia de traumatismos dentoalveolares en niños del Hospital Dr. Sótero del Río, enero-junio 2010Propuesta de un indicador de la calidad para los centros de salud familiarSalud pública y la emergencia del dispositivo clínico en la modernidad nacionalSatisfacción de funcionalidad familiar en adolescentes entre 12 y 18 años consumidores de drogasValidación cualitativa del cuestionario ASAQ para la determinación de la conducta sedentaria en escolare
MĂ©todos y mediciones
Get PDFActitud y conducta hacia la salud oral en estudiantes de la comuna de AraucoAnálisis de instrumentos de registro odontológicos en la red de APS de la Región MetropolitanaAnálisis de la eficiencia relativa del Hospital de Cabildo mediante la aplicación del análisis de fronteraAnálisis de letalidad intrahospitalaria y acumulada a 30 días de eventos IAM, 2003-2007Análisis del programa de cáncer cervicouterino en Chile con metodología de marco lógicoAños de vida perdidos por muerte prematura: efecto de diferentes criterios de corrección de subregistrosCalidad global de la alimentación de mujeres asistidas por el sistema de salud público chilenoCarga de mortalidad para el estado de Río de Janeiro, BrasilCausas de extracciones permanentes en adultos atendidos en la Posta Central, ChileComparación del consumo de drogas en escolares hombres utilizando metodología de pares y cuestionario autoregistradoCuidado hospitalario de pacientes con accidente cerebrovascular isquémico atendidos bajo régimen GESDescripción de dimensiones del constructo de calidad de vida en niños de 2-5 añosDistribución de benzodiacepinas en establecimientos del SNSS, período 2006-2008Evaluación de calidad, implementación del control odontológico del niño sano en CAP'S, Región del MauleEvaluación de la satisfacción del usuario interno de la Unidad de Cuidados Básicos del Hospital MetropolitanoEvaluación del protocolo de referencia de cefalea tensional y migraña en consultorio Llay-LlayEvaluación económica del Programa de Fluoración del Agua en ChileFactores de riesgo de enfermedad hipertensiva del embarazo en la UCI del H.G EcatepecImpacto de reforma sanitaria en autorizaciones sanitarias y de desempeño en instalaciones de radiodiagnóstico dentalInstitucionalidad de la investigación en salud pública en ChileLetalidad intrahospitalaria y a 30 días de los eventos de accidente cerebrovascular isquémico en ChileLimitaciones y desafíos de la investigación en salud pública en ChileMejora de agudeza visual y utilización cirugía de segundo ojo en pacientes con cataratas GESMortalidad infantil en la Región Metropolitana II del Estado de Río de Janeiro, 1981-2008Mortalidad por cáncer de tiroides en Chile en el período 1985-2007Mortalidad por tumores cerebrales en población infantil y adolescente, ciudad Río de Janeiro, 1980-2007Mortalidad por tumores del sistema nervioso central en adultos, Río de Janeiro, 1980 a 2007Prevalencia de anemia ferropriva en una muestra representativa de beneficiarios del PNACPrevalencia de caries y fluorosis previo a la fluoruración del agua potable en TemucoPrevalencia de traumatismos dentoalveolares en niños del Hospital Dr. Sótero del Río, enero-junio 2010Propuesta de un indicador de la calidad para los centros de salud familiarSalud pública y la emergencia del dispositivo clínico en la modernidad nacionalSatisfacción de funcionalidad familiar en adolescentes entre 12 y 18 años consumidores de drogasValidación cualitativa del cuestionario ASAQ para la determinación de la conducta sedentaria en escolare
Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Diseaseâ
No full textOBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease
Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients
No full textBackground: The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. Methods: Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2: 1). Results: Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days). Conclusion: Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding
Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort.
No full textObjective:To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL).Background:AL after RC resection often results in a permanent stoma.Methods:This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated.Results:This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76).Conclusions:The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies
