Postendodontic Tooth Restoration - Part I: The Aim and the Plan of the Procedure

Endodontskim zahvatom uklanjamo pulpu, nekrotičan dentin i dio zdrava tvrdoga zubnog tkiva. Time smanjujemo otpornost preostala zubnoga tkiva na sile vlaka i tlaka koje nastaju pri okluzijskim dodirima zuba. Zato restaurativna opskrba endodontski liječena zuba mora zadovoljiti zahtjeve retencije restorativnoga nadomjestka, otpornosti nadomjestka i zubnoga tkiva na sile unutar žvačnoga sustava, dobra koronarnog i intraradikularnoga brtvljenja te estetske zahtjeve. Poslijeendodontska opskrba uključuje sljedeće postupke: nadoknadu izgubljena zubnoga tkiva aloplastičnim materijalima u izravnoj ili neizravnoj izvedbi (ispunom amalgamom, kompozitom, stakleno ionomernim cementom, ili izradbom inleja, onleja ili overleja); uporabom intrakanalnih i parapulpnih kolčića uz nadoknadu zubne krune aloplastičnim materijalom; izradbu batrljka zuba aloplastičnim materijalom s uporabom intrakanalnih i parapulpnih kolčića ili bez njih uz nadoknadu zubne krune protetskim nadomjestkom; laboratorijski izrađenom nadogradnjom uz nadoknadu zubne krune protetskim nadomjestkom. U nekim slučajevima bit će dovoljno samo zabrtviti pristupni kavitet nekim od aloplastičnih materijala, a u drugim bit će potrebno osigurati okomitu stabilizaciju preostaloj kruni u obliku intraradikularne nadogradnje i izraditi protetski nadomjestak. Izbor postupka ovisit će o stupnju razorenosti zubne krune, smještaju zuba u zubnome luku, okluzijskim dodirima zuba, morfologiji korijenskih kanala, funkcijskim i estetskim zahtjevima, materijalnim mogućnostima te o vremenu koje imamo na raspolaganju. Pravilno prepoznata indikacija uz poštivanje svih faza izabranog postupka poslijeendodontske opskrbe osigurat će opskrbljenom zubu punopravnu ulogu u stomatognatom sustavu.Endodontic procedure requires removal of the pulp tissue and necrotic dentine, as well as a significant amount of healthy hard dental tissue, which results in reducing the resistance of the tooth to the occlusal loading forces. Restoration of such a tooth needs to satisfy requirements for retention of the restorative material, its resistance, as well as the resistance of the remaining dental tissue to occlusal forces, good coronal and intraradicular obturation and also aesthetic requirements. Postendodontic treatment includes the following procedures: replacement of lost tissues using alloplastic materials directly or indirectly (amalgam, composite resin and glass-ionomer cement fillings or inlay, onlay or overlay restorations); the alloplastic material crown restorations using intracanal posts and parapulpal pins; the alloplastic material core buildup with or without intracanal posts and parapulpal pins covered with prosthetic crown; restoration of lost tooth structure using laboratory made post and core covered with prosthetic crown. Sealing of endodontic cavity using one of the alloplastic materials would be the treatment of choice in uncomplicated cases, whereas in severely damaged teeth ensuring remaining tooth structure by vertical stabilization and the prosthetic crown would be necessary. The choice of procedure depends on the severity of crown damage, the tooth position in the arch, occlusal contacts, morphology of root canal spaces, functional and aesthetic aspects, financial ability and available time for performing the procedure. The correct indication evaluation respecting all steps of the chosen procedure will provide long term survival of the postendodontically treated tooth in the stomatognathic system

Visualización de maclas en partículas de silicio en aleaciones de aluminio para moldeo

Desde hace un tiempo se viene estudiando la relación que presentan las fracturas de las aleaciones de aluminio para moldeo de baja ductilidad con distintas características, entre otras las propiedades mecánicas, el tamaño de las partículas de Si, el factor de forma de las mismas y la direccionalidad de las fracturas. En este tipo de aleaciones el silicio adopta diferentes morfologías que están relacionados con las distintas condiciones de solidificación, la cantidad de Si y la modificación química o térmica del mismo. Se ha comprobado que la modificación térmica de las partículas de Si en aleaciones de Al-Si, provoca un cambio en la trayectoria de las fracturas a través de las mismas, pasando de ser longitudinal a transversal a medida de que las partículas de Si disminuyen de tamaño. Las maclas desarrolladas en las partículas de Si constituyen concentradores de tensiones, de efecto creciente con el tamaño de las mismas y serían dichas maclas en las aleaciones hipoeutécticas de Al-Si las que indican cual es el plano de fractura del Si cuando se carga el material en tracción. En lo que respecta a la observación de las maclas se ha avanzado con la técnica de microscopía óptica en aleaciones sin modificación de las partículas de Silicio, pero resulta imposible visualizar con esta herramienta las partículas modificadas. Se ha verificado la teoría de Makhlouf para partículas grandes (sin modificación), que indica que las maclas crecen en la dirección del eje longitudinal de la misma. Actualmente se está trabajando con diferentes técnicas con microscopía electrónica de barrido para poder llegar a observar las maclas en partículas más pequeñas y de esta forma relacionar las mismas con el comportamiento que presentan las aleaciones estudiadas. Según la teoría del autor antes mencionado, en partículas modificadas el crecimiento de las maclas sería transversal a la longitud de la misma. Este trabajo muestra el avance logrado en la técnica logrado visualizar maclas en las partículas de Silicio en muestras de aluminio con modificación térmica.Facultad de Ingenierí

Visualización de maclas en partículas de silicio en aleaciones de aluminio para moldeo

Desde hace un tiempo se viene estudiando la relación que presentan las fracturas de las aleaciones de aluminio para moldeo de baja ductilidad con distintas características, entre otras las propiedades mecánicas, el tamaño de las partículas de Si, el factor de forma de las mismas y la direccionalidad de las fracturas. En este tipo de aleaciones el silicio adopta diferentes morfologías que están relacionados con las distintas condiciones de solidificación, la cantidad de Si y la modificación química o térmica del mismo. Se ha comprobado que la modificación térmica de las partículas de Si en aleaciones de Al-Si, provoca un cambio en la trayectoria de las fracturas a través de las mismas, pasando de ser longitudinal a transversal a medida de que las partículas de Si disminuyen de tamaño. Las maclas desarrolladas en las partículas de Si constituyen concentradores de tensiones, de efecto creciente con el tamaño de las mismas y serían dichas maclas en las aleaciones hipoeutécticas de Al-Si las que indican cual es el plano de fractura del Si cuando se carga el material en tracción. En lo que respecta a la observación de las maclas se ha avanzado con la técnica de microscopía óptica en aleaciones sin modificación de las partículas de Silicio, pero resulta imposible visualizar con esta herramienta las partículas modificadas. Se ha verificado la teoría de Makhlouf para partículas grandes (sin modificación), que indica que las maclas crecen en la dirección del eje longitudinal de la misma. Actualmente se está trabajando con diferentes técnicas con microscopía electrónica de barrido para poder llegar a observar las maclas en partículas más pequeñas y de esta forma relacionar las mismas con el comportamiento que presentan las aleaciones estudiadas. Según la teoría del autor antes mencionado, en partículas modificadas el crecimiento de las maclas sería transversal a la longitud de la misma. Este trabajo muestra el avance logrado en la técnica logrado visualizar maclas en las partículas de Silicio en muestras de aluminio con modificación térmica.Facultad de Ingenierí

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

Análisis metodológico de la gestión del municipio El Cerrito Valle periodo 1995-1997

Tesis (Economista)--Universidad Autónoma de Occidente, 1998PregradoEconomist

Obesity increases blood-brain barrier permeability and aggravates the mouse model of multiple sclerosis

Obesity-induced insulin resistance (OIR) has been associated with an increased prevalence of neurodegenerative disorders such as multiple sclerosis. Obesity results in increased blood-brain barrier (BBB) permeability, specifically in the hypothalamic regions associated with the control of caloric intake. In obesity, the chronic state of low-grade inflammation has been implicated in several chronic autoimmune inflammatory disorders. However, the mechanisms that connect the inflammatory profile of obesity with the severity of experimental autoimmune encephalomyelitis (EAE) are poorly defined. In this study, we show that obese mice are more susceptible to EAE, presenting a worse clinical score with more severe pathological changes in the spinal cord when compared with control mice. Analysis of immune infiltrates at the peak of the disease shows that high-fat diet (HFD)- and control (chow)-fed groups do not present any difference in innate or adaptive immune cell compartments, indicating the increased severity occurs prior to disease onset. In the setting of worsening EAE in HFD-fed mice, we observed spinal cord lesions in myelinated regions and (blood brain barrier) BBB disruption. We also found higher levels of pro-inflammatory monocytes, macrophages, and IFN-γ+CD4+ T cells in the HFD-fed group compared to chow-fed animals. Altogether, our results indicate that OIR promotes BBB disruption, allowing the infiltration of monocytes/macrophages and activation of resident microglia, ultimately promoting CNS inflammation and exacerbation of EAE.</p

Ghrelin effects on mitochondrial fitness modulates macrophage function

Over the past years, systemic derived cues that regulate cellular metabolism have been implicated in the regulation of immune responses. Ghrelin is an orexigenic hormone produced by enteroendocrine cells in the gastric mucosa with known immunoregulatory roles. The mechanism behind the function of ghrelin in immune cells, such as macrophages, is still poorly understood. Here, we explored the hypothesis that ghrelin leads to alterations in macrophage metabolism thus modulating macrophage function. We demonstrated that ghrelin exerts an immunomodulatory effect over LPS-activated peritoneal macrophages, as evidenced by inhibition of TNF-alpha and IL-beta secretion and increased IL-12 production. Concomitantly, ghrelin increased mitochondrial membrane potential and increased respiratory rate. In agreement, ghrelin prevented LPS-induced ultrastructural damage in the mitochondria. Ghrelin also blunted LPS-induced glycolysis. In LPS-activated macrophages, glucose deprivation did not affect ghrelin-induced IL-12 secretion, whereas the inhibition of pyruvate transport and mitochondria-derived ATP abolished ghrelin-induced IL-12 secretion, indicating a dependence on mitochondrial function. Ghrelin pre-treatment of metabolic activated macrophages inhibited the secretion of TNF-alpha and enhanced IL-12 levels. Moreover, ghrelin effects on IL-12, and not on TNF-alpha, are dependent on mitochondria elongation, since ghrelin did not enhance IL-12 secretion in metabolic activated mitofusin-2 deficient macrophages. Thus, ghrelin affects macrophage mitochondrial metabolism and the subsequent macrophage function1456166COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPnão tem2015/15626-8; 2017/06225-5; 2016/18031-8; 2017/23679-0; 2017/12848-5; 2017/00079-7; 2018/22505-

PD-1/PD-L1 blockade abrogates a dysfunctional innate-adaptive immune axis in critical β-coronavirus disease

International audienceSevere COVID-19 is associated with hyperinflammation and weak T cell responses against SARS-CoV-2. However, the links between those processes remain partially characterized. Moreover, whether and how therapeutically manipulating T cells may benefit patients are unknown. Our genetic and pharmacological evidence demonstrates that the ion channel TMEM176B inhibited inflammasome activation triggered by SARS-CoV-2 and SARS-CoV-2–related murine β-coronavirus. Tmem176b −/− mice infected with murine β-coronavirus developed inflammasome-dependent T cell dysfunction and critical disease, which was controlled by modulating dysfunctional T cells with PD-1 blockers. In critical COVID-19, inflammasome activation correlated with dysfunctional T cells and low monocytic TMEM176B expression, whereas PD-L1 blockade rescued T cell functionality. Here, we mechanistically link T cell dysfunction and inflammation, supporting a cancer immunotherapy to reinforce T cell immunity in critical β-coronavirus disease

PD-1/PD-L1 blockade abrogates a dysfunctional innate-adaptive immune axis in critical β-coronavirus disease

Severe COVID-19 is associated with hyperinflammation and weak T cell responses against SARS-CoV-2. However, the links between those processes remain partially characterized. Moreover, whether and how therapeutically manipulating T cells may benefit patients are unknown. Our genetic and pharmacological evidence demonstrates that the ion channel TMEM176B inhibited inflammasome activation triggered by SARS-CoV-2 and SARS-CoV-2- related murine β-coronavirus. Tmem176b-/- mice infected with murine β-coronavirus developed inflammasome-dependent T cell dysfunction and critical disease, which was controlled by modulating dysfunctional T cells with PD-1 blockers. In critical COVID-19, inflammasome activation correlated with dysfunctional T cells and low monocytic TMEM176B expression, whereas PD-L1 blockade rescued T cell functionality. Here, we mechanistically link T cell dysfunction and inflammation, supporting a cancer immunotherapy to reinforce T cell immunity in critical β-coronavirus disease.Fil: Duhalde Vega, Maite. Institut Pasteur de Montevideo; Uruguay. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Química y Físico-Química Biológicas "Prof. Alejandro C. Paladini". Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Química y Físico-Química Biológicas; ArgentinaFil: Olivera, Daniela. Institut Pasteur de Montevideo; Uruguay. Universidad de la República; UruguayFil: Davanzo, Gustavo Gastão. Universidade Estadual de Campinas; BrasilFil: Bertullo, Mauricio. Immunoregulation And Inflammation Lab; UruguayFil: Noya, Verónica. Sanatorio Americano; UruguayFil: de Souza, Gabriela Fabiano. Universidade Estadual de Campinas; BrasilFil: Muraro, Stéfanie Primon. Universidade Estadual de Campinas; BrasilFil: Castro, Icaro. Hospital Israelita Albert Einstein; BrasilFil: Arévalo, Ana Paula. Institut Pasteur de Montevideo; UruguayFil: Crispo, Martina. Institut Pasteur de Montevideo; UruguayFil: Galliussi, Germán. Institut Pasteur de Montevideo; UruguayFil: Russo, Sofía. Institut Pasteur de Montevideo; Uruguay. Universidad de la República; UruguayFil: Charbonnier, David. Institut Pasteur de Montevideo; UruguayFil: Rammauro, Florencia. Institut Pasteur de Montevideo; Uruguay. Universidad de la República; UruguayFil: Jeldres, Mathías. Institut Pasteur de Montevideo; Uruguay. Universidad de la República; UruguayFil: Alamón, Catalina. Institut Pasteur de Montevideo; UruguayFil: Varela, Valentina. Institut Pasteur de Montevideo; UruguayFil: Batthyany, Carlos. Institut Pasteur de Montevideo; UruguayFil: Bollati Fogolín, Mariela. Institut Pasteur de Montevideo; UruguayFil: Oppezzo, Pablo. Institut Pasteur de Montevideo; UruguayFil: Pritsch, Otto. Institut Pasteur de Montevideo; Uruguay. Universidad de la República; UruguayFil: Proença Módena, José Luiz. Universidade Estadual de Campinas; BrasilFil: Nakaya, Helder I.. Hospital Israelita Albert Einstein; BrasilFil: Trias, Emiliano. Institut Pasteur de Montevideo; UruguayFil: Barbeito, Luis. Institut Pasteur de Montevideo; UruguayFil: Anegon, Ignacio. Center For Research In Transplantation And Immunology; FranciaFil: Cuturi, María Cristina. Center For Research In Transplantation And Immunology; FranciaFil: Moraes Vieira, Pedro. Universidade Estadual de Campinas; BrasilFil: Segovia, Mercedes. Institut Pasteur de Montevideo; Uruguay. Universidad de la República; UruguayFil: Hill, Marcelo. Universidad de la República; Uruguay. Institut Pasteur de Montevideo; Urugua