Obstructive sleep apnea in adults

Introdução: a Síndrome da Apneia e Hipopneia Obstrutiva do Sono (SAOS) é uma doença muito prevalente e que traz importantes consequências para a vida dos seus portadores. O tratamento da condição é relevante para a melhora do bem-estar geral e da expectativa de vida dos afetados. Os tratamentos odontológicos mais frequentes para a SAOS são os dispositivos de avanço mandibular (DAMs) e a cirurgia ortognática de avanço maxilomandibular (AMM) - essa última, possivelmente, é a única opção de tratamento com alta probabilidade de cura do problema. Objetivo: o presente artigo faz uma revisão narrativa da SAOS sob a perspectiva de 25 anos de experiência clínica no tratamento da doença. Conclusão: os DAMs são uma sólida opção de tratamento para o ronco primário e apneias leves ou moderadas. Apneias graves, em pacientes que não se adaptam ou se recusam a usar o CPAP, também podem ser tratadas com os DAMs. A cirurgia ortognática de AMM é uma alternativa segura e muito eficaz de solução da SAOS.Introduction: Obstructive Sleep Apnea and Hypopnea Syndrome (OSAS) is a highly prevalent disease with serious consequences for the patients’ lives. The treatment of the condition is mandatory for the improvement of the quality of life, as well as the life expectancy of the affected individuals. The most frequent treatments provided by dentistry are mandibular advancement devices (MAD) and orthognathic surgery with maxillomandibular advancement (MMA). This is possibly the only treatment option which offers high probability of cure. Objective: The present article provides a narrative review of OSAS from the perspective of 25 years of OSAS treatment clinical experience. Conclusion: MADs are a solid treatment option for primary snoring and mild or moderate OSAS. Patients with severe apnea who are non-adherent to CPAP may also be treated with MADs. Maxillomandibular advancement surgery is a safe and very effective treatment option to OSAS

Innovations orthogonalization: a solution to the major pitfalls of EEG/MEG "leakage correction"

The problem of interest here is the study of brain functional and effective connectivity based on non-invasive EEG-MEG inverse solution time series. These signals generally have low spatial resolution, such that an estimated signal at any one site is an instantaneous linear mixture of the true, actual, unobserved signals across all cortical sites. False connectivity can result from analysis of these low-resolution signals. Recent efforts toward "unmixing" have been developed, under the name of "leakage correction". One recent noteworthy approach is that by Colclough et al (2015 NeuroImage, 117:439-448), which forces the inverse solution signals to have zero cross-correlation at lag zero. One goal is to show that Colclough's method produces false human connectomes under very broad conditions. The second major goal is to develop a new solution, that appropriately "unmixes" the inverse solution signals, based on innovations orthogonalization. The new method first fits a multivariate autoregression to the inverse solution signals, giving the mixed innovations. Second, the mixed innovations are orthogonalized. Third, the mixed and orthogonalized innovations allow the estimation of the "unmixing" matrix, which is then finally used to "unmix" the inverse solution signals. It is shown that under very broad conditions, the new method produces proper human connectomes, even when the signals are not generated by an autoregressive model.Comment: preprint, technical report, under license "Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)", https://creativecommons.org/licenses/by-nc-nd/4.0

Caries risk assessment in schoolchildren - a form based on Cariogram® software

Identifying caries risk factors is an important measure which contributes to best understanding of the cariogenic profile of the patient. The Cariogram® software provides this analysis, and protocols simplifying the method were suggested. Objectives: The aim of this study was to determine whether a newly developed Caries Risk Assessment (CRA) form based on the Cariogram® software could classify schoolchildren according to their caries risk and to evaluate relationships between caries risk and the variables in the form. Material and Methods: 150 schoolchildren aged 5 to 7 years old were included in this survey. Caries prevalence was obtained according to International Caries Detection and Assessment System (ICDAS) II. Information for filling in the form based on Cariogram® was collected clinically and from questionnaires sent to parents. Linear regression and a forward stepwise multiple regression model were applied to correlate the variables included in the form with the caries risk. Results: Caries prevalence, in primary dentition, including enamel and dentine carious lesions was 98.6%, and 77.3% when only dentine lesions were considered. Eighty-six percent of the children were classified as at moderate caries risk. The forward stepwise multiple regression model result was significant (R2=0.904;

Does treating proximal cavities in primary molars non-restoratively affect intra-arch space and alignment of successor teeth negatively?:A 4-year longitudinal study

Background: Removing plaque with toothbrush and toothpaste from proximal cavities in primary molars without restoring them follows sound cariological principles. But does this treatment affect space for and alignment of their permanent successors negatively? Hypothesis: There is no difference in impaction and displacement of the premolars, as well as in the D+E space in quadrants with three different statuses of the proximal surface of primary molars over a 4-year period. Methods: A total of 936 quadrants (466 maxillary and 470 mandibular quadrants) in 233 children were assessed. Treatment of cavities in the proximal surfaces of the primary molars consisted of amalgam and ART restorations using high-viscosity glass-ionomer cement, and cleaning of open large- and medium-sized cavities with toothbrush and toothpaste (UCT) under supervision for 220 days per year over 3 years. Dental casts were made at baseline, and after two, three, and 4 years. The D+E spaces were measured digitally. Status of the proximal surface of the primary molars was assessed by two calibrated examiners, and quadrants were grouped into normal anatomy, defective restoration, and proximal cavity. ANCOVA, ANOVA and LSD tests were applied. Results: There was a statistically significant difference between groups (p <= 0.001) and between evaluation times (p < 0.001), for the D+E space in both the maxilla and mandible. A sex difference related to the D+E space in the maxilla was found (p = 0.007). For boys, quadrants in the maxilla of the group ‘proximal cavity’ showed a significant shorter D+E space when compared to quadrants of the group ‘normal anatomy’ at the 3- and 4-year evaluation time. For girls the difference between the two groups was only present at the 3-year evaluation time. There was no significant difference between the D+E space in quadrants with defective restorations and those with normal anatomy in the mandible and in the maxilla. Displacement and impaction of the premolars showed no significant difference between groups. Conclusion: Primary molars with open proximal cavities that are cleaned with toothbrush and toothpaste do not result in displacement and impaction of the successor teeth, neither do primary molars with defective restorations in proximal tooth surfaces

Epidemiologic aspects of closed-globe trauma

Purpose: To describe the epidemiologic aspects of closed-globe injury with contusion and its alterations. Methods: Forty patients with closed-globe injury, were analyzed prospectively between January 1998 and February 1999. They were attended at the Ocular Trauma Outpatient Clinic of the Department of Ophthalmology of the Escola Paulista de Medicina-Federal University of São Paulo. A complete ophthalmologic examination was performed in all patients and they were classified according to the new classification proposed by Pieramici et al (1997). Results: Sixty-seven and a half percent (67.5%) of the studied patients were less than 30 years old. The main causes were: accidents at home and acts of violence with 32.5% each. In relation to visual acuity, with best correction, 60.0% of the patients did not achieve 20/100 visual acuity. Seventy-five per cent (75.0%) showed improvement in visual acuity during follow-up and most in less than 1 month. Fifty-two and a half percent (52.5%) were classified as zone III. Fifty percent (50%) of the patients developed hyphema and 67.5% had some grade of angle recession, higher than 180° in 30.0%. Conclusions: In relation the patients attended at the Ocular Trauma Outpatient Clinic of the Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), more than 13 years old, males, with closed-globe injury we may conclude: 1. it is more prevalent in adults; 2. the main causes were domestic accidents and violence (32.5% each); 3. it presents good visual acuity recovery, except for zone III patients; 4. fifty per cent developed hyphema; 5. more than a half had angle recession (67.5%) and 30.0% had angle recession over 180°.Objetivo: Descrever os aspectos epidemiológicos do traumatismo ocular fechado com contusão e suas alterações. Métodos: Foram avaliados, prospectivamente, 40 olhos de 40 pacientes, com idade superior a 13 anos, do sexo masculino, com traumatismo ocular fechado contuso, no período de janeiro de 1998 a fevereiro de 1999, atendidos no Ambulatório de Trauma Ocular do Departamento de Oftalmologia da Escola Paulista de Medicina-Universidade Federal de São Paulo (UNIFESP). Todos foram submetidos a exame oftalmológico completo e classificados de acordo com a nova classificação proposta por Pieramici et al. (1997). Resultados: Sessenta e sete e meio por cento (67,5%) dos pacientes tinham menos de 30 anos. As principais causas de traumatismo ocular contuso foram acidentes domésticos e violência com 32,5% cada. Em relação à acuidade visual, medida com a melhor correção, 60,0% apresentaram acuidade menor que 20/100 e 75,0% melhora da acuidade visual durante o acompanhamento, sendo que a maioria evoluiu com melhora em menos de 1 mês. Cinqüenta e dois e meio por cento (52,5%) foram classificados como zona III. Cinqüenta por cento (50%) dos pacientes evoluíram com hifema e 67,5% com algum grau de recessão angular, sendo 30% maior que 180°. Conclusões: Em relação aos pacientes atendidos no Ambulatório de Trauma Ocular da Universidade Federal do Estado de São Paulo - Escola Paulista de Medicina com idade menor de 13 anos e sexo masculino, com traumatismo ocular contuso podemos concluir que: 1. apresentou maior prevalência no adulto jovem; 2. as principais causas foram: acidentes domésticos e violência (32,5% cada); 3. apresenta boa recuperação da acuidade visual, exceto os pacientes zona III; 4. cinqüenta por cento evoluiu com hifema; 5. mais da metade, 67,5% apresentaram algum grau de recessão angular, sendo 30,0% maior que 180°.UNIFESP Departamento de OftalmologiaUNIFESP Departamento de Oftalmologia setor de Pronto Socorro e Trauma OcularUNIFESP, Depto. de OftalmologiaUNIFESP, Depto. de Oftalmologia setor de Pronto Socorro e Trauma OcularSciEL

Absorption curves - mineral-extraction under an aeroponic system for white chrysanthemum (Dendranthema grandiflorum (Ramat.) Kitam. cv. Atlantis White)

The aim of this study focused on the construction of the absorption and extraction curves under an aeroponic system for D. grandiflorum cv. Atlantis White, and therefore, propose the periods of maximum and minimum nutrient accumulation from aboveground, root and total biomass. Vegetative cycle of the plant, measured from the day after transplantation (dat) to aeroponic system, and the first day of court lasted 49 days. Evaluations were carried out each week on plants, in absolute competition. For the average aboveground biomass, three replicates were recorded. To obtain total root biomass only one sample, was measured. Therefore, total biomass in average, had achieved 130.9313 g.plant-1, where 72.26% (94.163 g) corresponded to the aboveground biomass and 27.74% (36.3183 g) to root biomass. From nutrient contents reported in tissue analysis and biomass, nutrients absorbed-extracted were calculated. Overall, two plant stages development in nutrient absorption were observed as follows: the first, at day 21 dat; and second, from day 22 to day 49 dat. In this study, the reported elements (N, P, K, Ca, Mg and S), its accumulation during the first stage did not exceeded 29%, except for S, which reached 30.19%. Consequently, the mostly close to 70% nutrients were absorbed in the second stage of development, which coincided with the plant reproductive stage.El objetivo de este estudio se centró en la construcción de las curvas de absorción-extracción bajo un sistema aeropónico para D. grandiflorum cv. Atlantis White y así plantear los periodos de máxima y mínima acumulación de nutrientes de las biomasas aérea, radical y total. El ciclo vegetativo de la planta, medido desde el día de trasplante (ddt) al sistema aeropónico y el día de inicio de corte, duró 49 días. Las evaluaciones se realizaron cada semana sobre plantas en competencia absoluta. Para el promedio de la biomasa aérea se tomaron tres repeticiones, para la biomasa radical se tomó una sola muestra. La biomasa total promedio alcanzada fue de 130.9313 g planta-1, de la cual el 72.26% (94.163 g) correspondió a la parte aérea y el 27.74% (36.3183 g) a la radical. A partir de contenidos de nutrientes reportados en los análisis de tejidos y las biomasas se calculan los nutrientes absorbidos-extraídos. En términos generales, se observan dos etapas en la absorción de nutrientes, una primera hasta el día 21 ddt y la segunda desde el día 22 hasta el día 49 ddt. Para los elementos reportados en este estudio (N, P, K, Ca, Mg y S); su acumulación durante la primera etapa no supero el 29%, excepto el S que llegó hasta el 30.19 %. En consecuencia, la mayor cantidad de nutrientes, cerca al 70%, fueron absorbidas en la segunda etapa de desarrollo, coincidente con la fase reproductiva de la planta