Direct resin composite restoration of endodontically-treated permanent molars in adolescents: bite force and patient-specific finite element analysis

Objective: To evaluate the influence of three levels of dental structure loss on stress distribution and bite load in root canal-treated young molar teeth that were filled with bulk-fill resin composite, using finite element analysis (FEA) to predict clinical failure. Methodology: Three first mandibular molars with extensive caries lesions were selected in teenager patients. The habitual occlusion bite force was measured using gnathodynamometer before and after endodontic/restoration procedures. The recorded bite forces were used as input for patient-specific FEA models, generated from cone-beam computed tomographic (CT) scans of the teeth before and after treatment. Loads were simulated using the contact loading of the antagonist molars selected based on the CT scans and clinical evaluation. Pre and post treatment bite forces (N) in the 3 patients were 30.1/136.6, 34.3/133.4, and 47.9/124.1. Results: Bite force increased 260% (from 36.7±11.6 to 131.9±17.8 N) after endodontic and direct restoration. Before endodontic intervention, the stress concentration was located in coronal tooth structure; after rehabilitation, the stresses were located in root dentin, regardless of the level of tooth structure loss. The bite force used on molar teeth after pulp removal during endodontic treatment resulted in high stress concentrations in weakened tooth areas and at the furcation. Conclusion: Extensive caries negatively affected the bite force. After pulp removal and endodontic treatment, stress and strain concentrations were higher in the weakened dental structure. Root canal treatment associated with direct resin composite restorative procedure could restore the stress-strain conditions in permanent young molar teeth

Effect of cavity preparation design and ceramic type on the stress distribution, strain and fracture resistance of CAD/CAM onlays in molars

Objective: This study aimed to evaluate the effect of the cavity preparation and ceramic type on the stress distribution, tooth strain, fracture resistance and fracture mode of human molar teeth restored with onlays. Material and Methods: Forty-eight molars were divided into four groups (n=12) with assorted combinations of two study factors: BL- conventional onlay preparation with boxes made from leucite ceramic (IPS-Empress CAD, Ivoclar Vivadent); NBL- conservative onlay preparation without boxes made from leucite ceramic; BD- conventional onlay preparation with boxes made from lithium disilicate glass ceramic (IPS e.max CAD, Ivoclar Vivadent); NBL- conservative onlay preparation with boxes made from lithium disilicate glass ceramic cuspal deformation (µS) was measured at 100 N and at maximum fracture load using strain gauge. Fracture resistance (N) was measured using a compression test, and the fracture mode was recorded. Finite element analysis was used to evaluate the stress distribution by modified von Mises stress criteria. The tooth strain and fracture resistance data were analyzed using the Tukey test and two-way ANOVA, and the fracture mode was analyzed by the chi-square test (α=0.05). Results: The leucite ceramic resulted in higher tooth deformation at 100 N and lower tooth deformation at the maximum fracture load than the lithium disilicate ceramic (P<0.001). The lithium disilicate ceramic exhibited higher fracture resistance than the leucite ceramic (P<0.001). The conservative onlay resulted in higher fracture strength for lithium disilicate ceramic. Finite element analysis results showed the conventional cavity preparation resulted in higher stress concentration in the ceramic restoration and remaining tooth than the conservative onlay preparation. The conservative onlays exhibited increased fracture resistance, reduced stress concentration and more favorable fracture modes. Conclusion: Molars restored with lithium disilicate CAD-CAM ceramic onlays exhibited higher fracture resistance than molars restored with leucite CAD-CAM ceramic onlays

Differential effects of swimming training on neuronal calcium sensor-1 expression in rat hippocampus/cortex and in object recognition memory tasks

AbstractPhysical activity has been proposed as a behavioral intervention that improves learning and memory; nevertheless, the mechanisms underlying these health benefits are still not well understood. Neuronal Calcium Sensor-1 (NCS-1) is a member of a superfamily of proteins that respond to local Ca2+ changes shown to have an important role in learning and memory. The aim of the present study was to investigate the effects of swimming training on NCS-1 levels in the rat brain after accessing cognitive performance. Wistar rats were randomly assigned to sedentary (SG) or exercised groups (EG). The EG was subject to forced swimming activity, 30min/day, 5 days/week, during 8 weeks. Progressive load trials were performed in the first and last week in order to access the efficiency of the training. After the 8 week training protocol, memory performance was evaluated by the novel object preference and object location tasks. NCS-1 levels were measured in the cortex and hippocampus using immunoblotting. The EG performed statistically better for the spatial short-term memory (0.73±0.01) when compared to the SG (0.63±0.02; P<0.05). No statistically significant exercise-effect was observed in the novel object preference task (SG 0.65±0.02 and EG 0.68±0.02; p>0.05). In addition, chronic exercise promoted a significant increase in hippocampal NCS-1 levels (1.8±0.1) when compared to SG (1.17±0.08; P<0,05), but had no effect on cortical NCS-1 levels (SG 1.6±0.1 and EG 1.5±0.1; p>0.05). Results suggest that physical exercise would modulate the state of the neural network regarding its potential for plastic changes: physical exercise could be modulating NCS-1 in an activity dependent manner, for specific neural substrates, thus enhancing the cellular/neuronal capability for plastic changes in these areas; which, in turn, would differentially effect ORM task performance for object recognition and displacement

Prescrição de Benzodiazepinas e outros Sedativos na Administração Regional de Saúde de Lisboa e Vale do Tejo de 2013 a 2020: Um Estudo Retrospetivo

Introdução: Portugal é o país da Organização para a Cooperação e Desenvolvimento Económico com maior consumo de ansiolíticos, hipnóticos e sedativos, sendo uma proporção significativa constituída por benzodiazepinas ou análogos, associados a efeitos de tolerância e dependência. Por este motivo, em alternativa às benzodiazepinas para tratamento da insónia, algumas publicações identificam outros fármacos com efeito hipnótico, como antidepressivos, anti-histamínicos, antipsicóticos ou anticonvulsivantes. Assim, torna-se necessário compreender a evolução do consumo destes medicamentos, pelo que foi objetivo deste estudo avaliar a evolução da dispensa de benzodiazepinas, outros fármacos ansiolíticos, hipnóticos ou sedativos não benzodiazepínicos, fármacos com potencial uso off-label na insónia e os resultados de indicadores dos Cuidados de Saúde Primários neste âmbito na região de Lisboa e Vale do Tejo. Material e Métodos: Realizou-se um estudo em base de dados, censitário e retrospetivo, no período de 2013 até 2020, avaliando-se a evolução das variáveis total de doses diárias definidas, doses diárias definidas por 1000 habitantes por dia (DHD) e dos indicadores relevantes. Os dados foram extraídos da plataforma SIARS da Administração Regional de Saúde de Lisboa e Vale do Tejo. Resultados: Verificou-se uma diminuição da dispensa de benzodiazepinas (de 57,44 para 51,77 DHD) mas o aumento da dispensa de não benzodiazepinas e de fármacos com potencial uso off-label (de 6,56 para 8,56 DHD e de 14,70 para 25,92 DHD, respetivamente). O zolpidem foi o mais dispensado entre os fármacos não benzodiazepínicos, acompanhando a tendência crescente de dispensa (de 4,86 para 6,96 DHD). Do conjunto de fármacos com potencial para uso off-label verificaram-se aumentos da dispensa para a trazodona (de 3,81 para 7,92 DHD), mirtazapina (de 3,52 para 6,48 DHD), pregabalina (de 3,15 para 4,87 DHD), quetiapina (de 2,68 para 4,59 DHD) e gabapentina (de 1,32 para 1,90 DHD), mas mais significativo ou apenas verificado nas formulações com dosagem mais baixa. A mediana dos resultados do indicador “proporção de idosos sem prescrição de sedativos, ansiolíticos e hipnóticos” em 2015 foi de 81,0, tendo em 2020 aumentado para 84,9. A mediana do indicador “proporção de utentes sem prescrição prolongada de ansiolíticos, sedativos e hipnóticos” em 2019 foi de 93,6 e aumentou para 94,3 em 2020. Conclusão: Globalmente, verificou-se uma redução da dispensa de benzodiazepinas prescritas na Região de Lisboa e Vale do Tejo. Parece existir uma alteração do padrão de prescrição no tratamento da insónia. São necessários estudos mais robustos para confirmar esta observação

Feedlot diets containing different starch levels and additives change the cecal proteome involved in cattle’s energy metabolism and inflammatory response

Diets for feedlot cattle must be a higher energy density, entailing high fermentable carbohydrate content. Feed additives are needed to reduce possible metabolic disorders. This study aimed to analyze the post-rumen effects of different levels of starch (25%, 35%, and 45%) and additives (monensin or a blend of essential oils and exogenous α-amylase) in diets for Nellore feedlot cattle. The cecum tissue proteome was analyzed via two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) and then differentially expressed protein spots were identified with liquid chromatography–tandem mass spectrometry (LC–MS/MS). The use of blends of essential oils associated with α-amylase as a feed additive promoted the upregulation of enzymes such as triosephosphate isomerase, phosphoglycerate mutase, alpha-enolase, beta-enolase, fructosebisphosphate aldolase, pyruvate kinase, glyceraldehyde-3-phosphate dehydrogenase (GAPDH), l-lactate dehydrogenase B, l-lactate dehydrogenase A chain, l-lactate dehydrogenase, and ATP synthase subunit beta, which promote the degradation of carbohydrates in the glycolysis and gluconeogenesis pathways and oxidative phosphorylation, support pyruvate metabolism through the synthesis of lactate from pyruvate, and participate in the electron transport chain, producing ATP from ADP in the presence of a proton gradient across the membrane. The absence of proteins related to inflammation processes (leukocyte elastase inhibitors) in the cecum tissues of animals fed essential oils and amylase may be because feed enzymes can remain active in the intestine and aid in the digestion of nutrients that escape rumen fermentation; conversely, the effect of monensin is more evident in the rumen and less than 10% results in post-ruminal action, corroborating the hypothesis that ionophore antibiotics have a limited effect on the microbiota and intestinal fermentation of ruminants. However, the increase in starch in these diets promoted a downregulation of enzymes linked to carbohydrate degradation, probably caused by damage to the cecum epithelium due to increased responses linked to inflammatory injuries

Overview of managed entry agreements : an integrative review towards policy making in Brazil

Resuminho (60 palavras): In order to provide legal and scientific embasement for policy making in Brazil, the aim of this study was to provide a panorama of Managed Entry Agreements around the world. A systematic review was conducted and the information about the agreements were summarized. It was included 25 studies, which described 446 agreements performed in 29 countries. Introduction (100 palavras): Managed Entry Agreements (MEA) are a reality in many countries. They are used as a tool to reduce the impact of uncertainty and the high cost of new drugs by providing access to new technologies under pre-established conditions. In Brazil, the Ministry of Health approved a high-cost technology under performance evaluation, being the first experience in the country. The aim of this study was to conduct a review to identify MEA performed worldwide to provide embasement to inform public health policy making in Brazil, as well as critical considerations surrounding the implementation of performance based agreements. Methods (75 palavras): A review of MEA for health technologies was conducted, using the question ‘What are the health technology managed entry agreements that have being performed around the world?’. The searches were conducted in april 2019, through PUBMED, EMBASE, LILACS and Cochrane Library databases, as well as manual search and gray literature. The selection of studies was performed by two independent reviewers and, in cases of disagreement, solved by a third reviewer. Results (75 palavras): A total of 25 studies were included, describing 446 agreements in 29 countries, being Australia (122), Italy (96), the United States (48) and Scotland (42) more frequent. Financial risk-sharing agreements were the most prevalent (43%). About 95% of the agreements involved medicines - more than half antineoplastic agents. The outcomes assessed and the impact of the agreements were not addressed in most studies, which may be due to the confidentiality character of them. Conclusions (100 palavras): We are likely to see a growth in MEA in the future with the continual launch of new high priced and complex treatments, coupled with increasing demands on available resources. They are an important tool to improve access to innovative and high cost medicines to achieve universal health coverage, although there are critical issues to consider. Besides the embedded confidentiality of most of the agreements, learning from already stablished knowledge, experiences and practices across countries can be a crucial strategy to guide Brazil’s initial experiences in this area

description of the methodological approach

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Repercussões Respiratórias no Pós – Operatório de Câncer de Mama

Introduction: Cancer is defined as a disorderly proliferation of cells that can spread and invade tissues and/or organs throughout the body, when a genetic mutation occurs, the deoxyribonucleic acid (DNA) undergoes an erroneous change of orders on how to multiply, classified as cancer cells, named according to their multiplication speed and ability to spread to other tissues. Objective: Check the respiratory repercussions in the postoperative period of breast câncer. Method: This is a descriptive, cross-sectional study with quantitative analysis, carried out with 20 female individuals in the postoperative period of breast cancer who were undergoing treatment at a Specialty Outpatient Clinic in Montes Claros - Minas Gerais. The instruments used were the MRC scale, which assesses the level of dyspnea during physical activity, cirtometry, which assesses chest expansion, and a manovacuometer, which measures respiratory muscle strength. Results: The average age of the participants was 50.40 ± 5.50, it was observed that 90.0% of the participants feel short of breath only during intense exercises, according to the MRC scale, in the cirtometry all the subjects showed a reduction in expandability thoracic. A significant decrease in respiratory muscle strength was observed, the average percentage achieved in forced inspiration was 86.77% and in forced expiration its average percentage was 71.75%. Conclusion: It is concluded that patients with breast cancer who underwent a surgical procedure may have respiratory changes, that is, the population studied showed changes in muscle strength and changes in expansion, but there was no association between the level of chest expansion and type of surgery.Introdução: O câncer é definido como uma proliferação de células desordenadas que pode se espalhar e invadir tecidos e/ou órgãos por todo o corpo, quando ocorre uma mutação genética. Objetivo: Verificar as repercussões respiratórias no pós-operatório do câncer de mama. Método: Trata-se de um estudo de caráter descritivo, corte transversal e análise quantitativa, realizado com 20 indivíduos do sexo feminino no pós-operatório do câncer de mama que estavam em tratamento em um Ambulatório de Especialidade em Montes Claros - Minas Gerais. Os instrumentos utilizados foram a escala de MRC que avalia o nível de dispneia durante atividade física, cirtometria que avalia a expansibilidade torácica e manovacuômetro que mensura a força muscular respiratória. Resultados: A idade média das participantes foi de 50,40 ± 5,50, observou-se que 90,0% das participantes sente falta de ar só durante exercícios intensos, segundo a escala de MRC, na cirtometria todos os sujeitos apresentaram redução da expansibilidade torácica. Foi observado uma diminuição significativa na força muscular respiratória, a média percentual alcançada na inspiração forçada foi de 86,77% e na expiração forçada sua média percentual foi de 71,75%. Conclusão: Conclui-se que pacientes portadoras de CA de mama que foram submetidas a um procedimento cirúrgico podem apresentar alterações respiratórias, ou seja, a população estudada apresentou alteração de força muscular e alteração da expansibilidade, porém não houve associação entre nível de expansibilidade torácica e tipo de cirurgia. &nbsp

O câncer e a criança: um impacto familiar

The aim of this work is a bibliographic review concerning the children living with cancer and their family, in order to identify the themes that have been already studied and to understand the impact on the family during the phases of childhood cancer. The information acquisition was based on documents from the Ministry of Health and on scientific studies available on the following databases: the Google Scholar, the Health virtual Library, the Scielo, the CAPES Journals, the MEDLINE, the LILACS and the Cochrane. The choice of the documents and journals was mainly justified by its link with the childhood health theme. The systematic of the studies research covered the period from 1999 to 2015. The keywords used for the research’s strategy were: childhood health, childhood cancer, family caregivers and grief. The results were presented in three themes: childhood cancer impact on the family, adaptation process of the family facing the sickness and the mourning regarding the death of the sick child. The review enabled to identify the need for special follow-up of the person, which is in direct contact with the child, usually the mother, since the moment of the diagnostic, until after the death.O objetivo desse estudo é revisar a literatura relativa à criança com câncer e sua família, a fim de identificar temas que têm sido pesquisados, e compreender o impacto causado na família durante as fases do câncer infantil. O levantamento de dados foi embasado em documentos do Ministério da Saúde e em trabalhos científicos disponibilizados no Google Acadêmico, Biblioteca virtual da Saúde, Scielo, Periodicos Capes, MEDLINE, LILACS e Cochrane. A escolha dos documentos e periódicos se deu pela sua relação com os temas Saúde da criança. A busca sistematizada de trabalhos abrangeram o período de 1999 a 2015. A estratégia de busca desse referencial utilizou as seguintes palavras-chave: Saúde da Criança, Câncer Infantil, Cuidadores Familiares e Luto. Os resultados foram apresentados em três temas: impacto do câncer infantil na familiar; processo de adaptação da família diante da doença e o luto diante da morte da criança. A revisão demonstrou que uma necessidade de acompanhamento especial a pessoa em contato direto com a criança, geralmente a mãe, desde o momento do diagnostico, e até após a morte