RESUMO
BACKGROUND: Standardized reporting methods facilitate comparisons between studies. Reporting of data on benefits and harms of treatments in surgical RCTs should support clinical decision-making. Correct and complete reporting of the outcomes of clinical trials is mandatory to appreciate available evidence and to inform patients properly before asking informed consent. METHODS: RCTs published between January 2005 and January 2017 in 15 leading journals comparing a surgical treatment with any other treatment were reviewed systematically. The CONSORT checklist, including the extension for harms, was used to appraise the publications. Beneficial and harmful treatment outcomes, their definitions and their precision measures were extracted. RESULTS: Of 1200 RCTs screened, 88 trials were included. For the differences in effect size of beneficial outcomes, 68 per cent of the trials reported a P value only but not a 95 per cent confidence interval. For harmful effects, this was 67 per cent. Only five of the 88 trials (6 per cent) reported a number needed to treat, and no study a number needed to harm. Only 61 per cent of the trials reported on both the beneficial and harmful outcomes of the intervention studied in the same paper. CONCLUSION: Despite CONSORT guidelines, current reporting of benefits and harms in surgical trials does not facilitate clear communication of treatment outcomes with patients. Researchers, reviewers and journal editors should ensure proper reporting of treatment benefits and harms in trials.
ANTECEDENTES: Los métodos para la estandarización en la descripción de los resultados facilitan la comparación entre estudios. La toma de decisiones clínicas debe estar respaldada por los resultados que se obtienen en los ensayos clínicos aleatorizados (randomized clinical trials, RCTs) quirúrgicos sobre los efectos beneficiosos y nocivos de los tratamientos. Es obligado que la descripción de los resultados de los ensayos clínicos sea correcta y completa a fin de estimar la evidencia disponible y poder informar a los pacientes de forma adecuada antes de solicitar el consentimiento informado. MÉTODOS: Se revisaron de forma sistemática los RCTs publicados entre enero de 2005 y enero de 2017 en las 15 revistas principales en los que se comparaba un tratamiento quirúrgico con cualquier otro. Para evaluar las publicaciones, se utilizó la guía de comprobación del CONsolidated Standard of Reporting Trials (CONSORT), haciéndola extensiva también a los efectos nocivos. Se obtuvieron los resultados sobre los efectos beneficiosos y nocivos del tratamiento, sus definiciones y sus medidas de precisión. RESULTADOS: De 1.200 RCTs seleccionados, se incluyeron 88 ensayos. Para comparar las diferencias de los efectos beneficiosos de los resultados, en el 68% de los ensayos se aportó sólo un valor de la P pero no el intervalo de confianza del 95%. Para efectos nocivos, el porcentaje fue del 67%. En sólo 5 de 88 ensayos (6%) se informó del número de pacientes que es necesario tratar (number needed to treat, NNT), y en ningún estudio se precisó el número de pacientes que es necesario para perjudicar (number needed to harm, NNH). En sólo el 61% de los ensayos se informó de los resultados beneficiosos y nocivos de la intervención analizada en el mismo artículo. CONCLUSIÓN: A pesar de la guía CONSORT, la descripción actual de los efectos beneficiosos y nocivos en los ensayos quirúrgicos no permite obtener una clara información del resultado del tratamiento obtenido en los pacientes. Los investigadores, los revisores y los editores de las revistas deben garantizar una descripción adecuada los beneficios y efectos nocivos del tratamiento en los ensayos clínicos.
Assuntos
Lista de Checagem/normas , Publicações Periódicas como Assunto/normas , Editoração/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Humanos , Procedimentos Cirúrgicos Operatórios/efeitos adversosRESUMO
BACKGROUND: Mast cell localization within the airway smooth muscle (ASM)-bundle plays an important role in the development of airway hyper-responsiveness (AHR). Genomewide association studies implicate the 'alarmin' IL-33 in asthma, but its role in mast cell-ASM interactions is unknown. OBJECTIVES: We examined the expression and functional role of IL-33 in bronchial biopsies of patients with and without asthma, ex vivo ASM, mast cells, cocultured cells and in a mouse model system. METHODS: IL-33 protein expression was assessed in human bronchial tissue from 9 healthy controls, and 18 mild-to-moderate and 12 severe asthmatic patients by immunohistochemistry. IL-33 and ST2 mRNA and protein expression in human-derived ASM, epithelial and mast cells were assessed by qPCR, immunofluorescence and/or flow cytometry and ELISA. Functional assays were used to assess calcium signalling, wound repair, proliferation, apoptosis and contraction. AHR and inflammation were assessed in a mouse model. RESULTS: Bronchial epithelium and ASM expressed IL-33 with the latter in asthma correlating with AHR. ASM and mast cells expressed intracellular IL-33 and ST2. IL-33 stimulated mast cell IL-13 and histamine secretion independent of FcεR1 cross-linking and directly promoted ASM wound repair. Coculture of mast cells with ASM activated by IL-33 increased agonist-induced ASM contraction, and in vivo IL-33 induced AHR in a mouse cytokine installation model; both effects were IL-13 dependent. CONCLUSION: IL-33 directly promotes mast cell activation and ASM wound repair but indirectly promotes ASM contraction via upregulation of mast cell-derived IL-13. This suggests that IL-33 may present an important target to modulate mast cell-ASM crosstalk in asthma.
Assuntos
Asma/imunologia , Interleucina-13/imunologia , Interleucina-33/imunologia , Mastócitos/imunologia , Receptor Cross-Talk/imunologia , Adulto , Animais , Hiper-Reatividade Brônquica/imunologia , Ensaio de Imunoadsorção Enzimática , Citometria de Fluxo , Imunofluorescência , Humanos , Imuno-Histoquímica , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Pessoa de Meia-Idade , Músculo Liso/imunologia , Músculo Liso/metabolismo , Reação em Cadeia da PolimeraseRESUMO
OBJECTIVE: Previous work has suggested that the granulocyte macrophage colony stimulating factor (GM-CSF)-GM-CSF receptor α axis (GM-CSFRα) may provide a new therapeutic target for the treatment of rheumatoid arthritis (RA). Therefore, we investigated the cellular expression of GM-CSFRα in RA synovial tissue and investigated the effects of anti-GM-CSFRα antibody treatment in vitro and in vivo in a preclinical model of RA. METHODS: We compared GM-CSFRα expression on macrophages positive for CD68 or CD163 on synovial biopsy samples from patients with RA or psoriatic arthritis (PsA) to disease controls. In addition, we studied the effects of CAM-3003, an anti-GM-CSFR antibody in a collagen induced arthritis model of RA in DBA/1 mice. The pharmacokinetic profile of CAM-3003 was studied in naïve CD1(ICR) mice (see online supplement) and used to interpret the results of the pharmacodynamic studies in BALB/c mice. RESULTS: GM-CSFRα was expressed by CD68 positive and CD163 positive macrophages in the synovium, and there was a significant increase in GM-CSFRα positive cells in patients in patients with RA as well as patients with PsA compared with patients with osteoarthritis and healthy controls. In the collagen induced arthritis model there was a dose dependent reduction of clinical arthritis scores and the number of F4/80 positive macrophages in the inflamed synovium after CAM-3003 treatment. In BALB/c mice CAM-3003 inhibited recombinant GM-CSF mediated margination of peripheral blood monocytes and neutrophils. CONCLUSIONS: The findings support the ongoing development of therapies aimed at interfering with GM-CSF or its receptor in various forms of arthritis, such as RA and PsA.
Assuntos
Artrite Reumatoide/imunologia , Terapia de Alvo Molecular/métodos , Receptores de Fator Estimulador das Colônias de Granulócitos e Macrófagos/metabolismo , Membrana Sinovial/imunologia , Adulto , Idoso , Animais , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/sangue , Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/administração & dosagem , Antirreumáticos/sangue , Antirreumáticos/uso terapêutico , Artrite Experimental/sangue , Artrite Experimental/tratamento farmacológico , Artrite Experimental/imunologia , Artrite Psoriásica/imunologia , Estudos de Casos e Controles , Relação Dose-Resposta Imunológica , Avaliação Pré-Clínica de Medicamentos/métodos , Feminino , Humanos , Masculino , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos DBA , Pessoa de Meia-Idade , Osteoartrite/imunologia , Receptores de Fator Estimulador das Colônias de Granulócitos e Macrófagos/antagonistas & inibidoresRESUMO
BACKGROUND AND PURPOSE: For antibody therapies against receptor targets, in vivo outcomes can be difficult to predict because of target-mediated clearance or antigen 'sink' effects. The purpose of this work was to engineer an antibody to the GM-CSF receptor α (GM-CSFRα) with pharmacological properties optimized for chronic, s.c. treatment of rheumatoid arthritis (RA) patients. EXPERIMENTAL APPROACH: We used an in silico model of receptor occupancy to guide the target affinity and a combinatorial phage display approach for affinity maturation. Mechanism of action and internalization assays were performed on the optimized antibody in vitro before refining the modelling predictions of the eventual dosing in man. Finally, in vivo pharmacology studies in cynomolgus monkeys were carried out to inform the predictions and support future clinical development. KEY RESULTS: Antibody potency was improved 8600-fold, and the target affinity was reached. The refined model predicted pharmacodynamic effects at doses as low as 1 mg kg(-1) and a study in cynomolgus monkeys confirmed in vivo efficacy at 1 mg kg(-1) dosing. CONCLUSIONS AND IMPLICATIONS: This rational approach to antibody drug discovery enabled the isolation of a potent molecule compatible with chronic, s.c. self-administration by RA patients. We believe this general approach enables the development of optimal biopharmaceuticals.
Assuntos
Anticorpos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Receptores de Fator Estimulador das Colônias de Granulócitos e Macrófagos/antagonistas & inibidores , Receptores de Fator Estimulador das Colônias de Granulócitos e Macrófagos/imunologia , Animais , Artrite Reumatoide/imunologia , Técnicas de Visualização da Superfície Celular , Feminino , Humanos , Imunoglobulina G/metabolismo , Concentração Inibidora 50 , Macaca fascicularis , Masculino , Modelos Biológicos , Ligação Proteica , Engenharia de Proteínas , Proteínas RecombinantesRESUMO
BACKGROUND AND PURPOSE: IL-13 is a pleiotropic Th2 cytokine considered likely to play a pivotal role in asthma. Here we describe the preclinical in vitro and in vivo characterization of CAT-354, an IL-13-neutralizing IgG4 monoclonal antibody (mAb), currently in clinical development. EXPERIMENTAL APPROACH: In vitro the potency, specificity and species selectivity of CAT-354 was assayed in TF-1 cells, human umbilical vein endothelial cells and HDLM-2 cells. The ability of CAT-354 to modulate disease-relevant mechanisms was tested in human cells measuring bronchial smooth muscle calcium flux induced by histamine, eotaxin generation by normal lung fibroblasts, CD23 upregulation in peripheral blood mononuclear cells and IgE production by B cells. In vivo CAT-354 was tested on human IL-13-induced air pouch inflammation in mice, ovalbumin-sensitization and challenge in IL-13 humanized mice and antigen challenge in cynomolgus monkeys. KEY RESULTS: CAT-354 has a 165 pM affinity for human IL-13 and functionally neutralized human, human variant associated with asthma and atopy (R130Q) and cynomolgus monkey, but not mouse, IL-13. CAT-354 did not neutralize human IL-4. In vitro CAT-354 functionally inhibited IL-13-induced eotaxin production, an analogue of smooth muscle airways hyperresponsiveness, CD23 upregulation and IgE production. In vivo in humanized mouse and cynomolgus monkey antigen challenge models CAT-354 inhibited airways hyperresponsiveness and bronchoalveolar lavage eosinophilia. CONCLUSIONS AND IMPLICATIONS: CAT-354 is a potent and selective IL-13-neutralizing IgG4 mAb. The preclinical data presented here support the trialling of this mAb in patients with moderate to severe uncontrolled asthma.
Assuntos
Anticorpos Monoclonais/farmacologia , Asma/tratamento farmacológico , Inflamação/tratamento farmacológico , Interleucina-13/imunologia , Adolescente , Animais , Antígenos/imunologia , Asma/imunologia , Hiper-Reatividade Brônquica/tratamento farmacológico , Líquido da Lavagem Broncoalveolar , Linhagem Celular Tumoral , Modelos Animais de Doenças , Feminino , Células Endoteliais da Veia Umbilical Humana , Humanos , Imunoglobulina E/imunologia , Inflamação/imunologia , Macaca fascicularis , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Ovalbumina/imunologia , Receptores de IgE/imunologia , Índice de Gravidade de Doença , Especificidade da Espécie , Regulação para Cima/efeitos dos fármacosRESUMO
We investigated the role of granulocyte-macrophage colony-stimulating factor (GM-CSF) in a subchronic exposure model of cigarette smoke (CS)-induced inflammation using antibodies directed against GM-CSF or the GM-CSF receptor (GM-CSFR) α-chain. CS-induced mononuclear and neutrophilic inflammation following 4 days of CS exposure in BALB/c mice was assessed in bronchoalveolar lavage (BAL) fluid. An increase in mature dendritic cells (DCs) (CD11c+ and major histocompatibility complex II+) and Gr-1-high neutrophils was also observed by flow cytometric analysis of whole-lung tissue. Daily i.p. injection of 400 µg GM-CSF or GM-CSFR antibody prior to daily smoke exposure attenuated the accumulation of neutrophils within the BAL by 60%. A reduction in mature DCs was also observed. Anti-GM-CSFR antibody administration did not have an effect on the percentage of lung T-cells; however, a significant decrease in activated CD69+ CD8+ T-cells was observed. Anti-GM-CSFR antibody administration decreased the mRNA and protein expression of interleukin-12 p40 and matrix metalloproteinase 12. Taken together, intervention with this receptor antibody implicates the GM-CSF pathway as an important mediator of smoke-induced inflammation.
Assuntos
Anticorpos/imunologia , Neutrófilos/imunologia , Receptores de Fator Estimulador das Colônias de Granulócitos e Macrófagos/imunologia , Fumar/imunologia , Animais , Antígenos CD/imunologia , Antígenos de Diferenciação de Linfócitos T/imunologia , Líquido da Lavagem Broncoalveolar/imunologia , Antígeno CD11c/imunologia , Linfócitos T CD8-Positivos/imunologia , Células Dendríticas/imunologia , Feminino , Genes MHC da Classe II/imunologia , Fator Estimulador de Colônias de Granulócitos e Macrófagos/imunologia , Subunidade p40 da Interleucina-12/biossíntese , Subunidade p40 da Interleucina-12/imunologia , Lectinas Tipo C/imunologia , Pulmão/imunologia , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Knockout , Receptores de Quimiocinas/imunologia , Receptores de Interleucina-1/genética , Receptores de Interleucina-1/imunologiaRESUMO
BACKGROUND: Granulocyte-macrophage colony-stimulating factor (GM-CSF) has been implicated as an important mediator in the pathogenesis of asthma and chronic obstructive pulmonary disease (COPD). However, the expression of GM-CSF and its receptor in airway samples in asthma and COPD across disease severity needs to be further defined. METHODS: Sputum GM-CSF was measured in 18 control subjects, 45 subjects with asthma and 47 subjects with COPD. Enumeration of GM-CSF+ cells in the bronchial submucosa and airway smooth muscle bundle was performed in 29 control subjects, 36 subjects with asthma and 10 subjects with COPD. RESULTS: The proportion of subjects with measurable GM-CSF in the sputum was raised in those with moderate (7/14) and severe (11/18) asthma, and in those with COPD GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage II (7/16), III (8/17) and IV (7/14) compared with controls (1/18) and those with mild asthma (0/13); p = 0.001. The sputum GM-CSF concentration was correlated with the sputum eosinophilia in subjects with moderate to severe asthma (r(s) = 0.41; p = 0.018). The median (interquartile range) GM-CSF+ and GM-CSFR+ cells/mm(2) of submucosa was increased in severe asthma (1.4 (3.0) and 2.1 (8.4)) compared with those with mild to moderate asthma (0 (2.5) and 1.1 (5)) and healthy controls (0 (0.5) and 0 (1.6)), (p = 0.004 and p = 0.02, respectively). CONCLUSIONS: The findings support a potential role for GM-CSF in asthma and COPD and suggest that overexpression of GM-CSF in sputum and the bronchial mucosa is a particular feature of severe asthma.
Assuntos
Asma/metabolismo , Brônquios/metabolismo , Fator Estimulador de Colônias de Granulócitos e Macrófagos/metabolismo , Doença Pulmonar Obstrutiva Crônica/metabolismo , Mucosa Respiratória/metabolismo , Escarro/metabolismo , Idoso , Asma/patologia , Brônquios/patologia , Estudos Transversais , Eosinófilos/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/patologia , Mucosa Respiratória/patologiaRESUMO
OBJECTIVE: To determine the contribution of classical risk factors to the development of cardiovascular disease (CVD) in patients with heterozygous familial hypercholesterolaemia (FH). DESIGN: A retrospective, multi-centre, cohort study. Extensive data were collected by scrutinizing medical records and the use of questionnaires. Multivariate Cox regression was used to study the relationship between potential risk factors and the occurrence of CVD. SETTING AND SUBJECTS: We included 2400 FH patients from 27 Dutch lipid clinics. The diagnosis of FH was based upon the presence of a low-density lipoprotein receptor mutation or upon strict clinical criteria. MAIN OUTCOME MEASURES: Cardiovascular mortality and CVD. RESULTS: During 112.943 person-years, 782 (32.6%) patients had had at least one cardiovascular event. Male gender (RR 2.82, 95% CI 2.37-3.36), smoking (RR 1.67, 95% CI 1.40-1.99), hypertension (RR 1.36, 95% CI 1.06-1.75), diabetes mellitus (RR 2.19, 95% CI 1.36-3.54), low HDL-C (RR 1.37, 95% CI 1.15-1.63) and elevated lipoprotein(a) levels (RR 1.50, 95% CI 1.20-1.79) proved to be independent CVD risk factors. These six risk factors explained 18.7% of the variation in the occurrence of CVD. CONCLUSIONS: Male gender, smoking, hypertension, diabetes mellitus, HDL cholesterol and lipoprotein(a) levels proved to be important risk factors for CVD in FH patients. In addition to the routine institution of statin therapy, controlling these factors needs special attention in the management of this disorder.
Assuntos
Doenças Cardiovasculares/etiologia , Hiperlipoproteinemia Tipo II/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/genética , Doenças Cardiovasculares/mortalidade , HDL-Colesterol/sangue , Angiopatias Diabéticas/etiologia , Angiopatias Diabéticas/genética , Angiopatias Diabéticas/mortalidade , Feminino , Heterozigoto , Humanos , Hiperlipoproteinemia Tipo II/sangue , Hiperlipoproteinemia Tipo II/genética , Hipertensão/complicações , Lipoproteína(a)/sangue , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fumar/efeitos adversos , Análise de SobrevidaRESUMO
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with unknown pathogenesis. Loss of motor neurons leads to progressive weakness and, finally, respiratory failure with a mean survival of 3 years. A possible causal role of a retroviral infection has recently been suggested by studies of 7 HIV-infected patients who developed a rapid progressive ALS-like disorder as the first manifestation of their HIV-infection. All patients stabilised or improved with antiretroviral therapy. Other research groups have published on the detection of enterovirus RNA in the spinal cords of ALS-patients, also suggesting a viral aetiology of the disease. The results of these neuro-virological studies warrant further research into the possible role of viral infections as a cause of ALS, as well as clinical trials with anti-retroviral and anti-enteroviral drugs in ALS.
Assuntos
Esclerose Lateral Amiotrófica/etiologia , Infecções por Enterovirus/complicações , Infecções por Retroviridae/complicações , Esclerose Lateral Amiotrófica/tratamento farmacológico , Esclerose Lateral Amiotrófica/virologia , Terapia Antirretroviral de Alta Atividade , Antivirais/uso terapêutico , Progressão da Doença , Infecções por Enterovirus/tratamento farmacológico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Infecções por Retroviridae/tratamento farmacológicoRESUMO
Pulmonary alveolar proteinosis is characterized by the accumulation of proteinaceous material in the alveoli leading to varying degrees of impairment in gas exchange. Generally, the degree of hypoxemia is mild, and it is rare to have respiratory failure requiring mechanical ventilation. We present a 53-year-old woman with the most severe degree of hypoxemia associated with alveolar proteinosis reported in the English-language adult literature. Her therapy of sequential whole-lung lavage performed while receiving venovenous extracorporeal membrane oxygenation in one operative session is the first reported successful use of this approach.
Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Proteinose Alveolar Pulmonar/complicações , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Irrigação Terapêutica/métodos , Feminino , Humanos , Hipóxia/etiologia , Pessoa de Meia-Idade , Proteinose Alveolar Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios XAssuntos
Preconceito , Percepção Social , Idoso , Envelhecimento/fisiologia , Atitude , Humanos , Relação entre Gerações , Rejeição em PsicologiaAssuntos
Microcirculação , Oxigênio/metabolismo , Sepse/fisiopatologia , Animais , Humanos , Ratos , Fluxo Sanguíneo RegionalRESUMO
The association of HLA-B27 with certain forms of arthritis implies a role for MHC class I-restricted T cells in the arthritic process. Our aim was to study CD8(+) T cell responses towards specific antigens localized in joint tissue. Known determinants were introduced into chondrocytes of transgenic (TG) mice, under the control of the cis-regulatory sequences of the human type II collagen gene (COL2A1). Two Escherichia coli beta-galactosidase (beta-gal)-expressing lines were derived (CIIL73 and CIIL64) as well as two lines (CIINP) expressing influenza A virus nucleoprotein (NP). Expression of the antigens could be demonstrated in cartilaginous tissues. The TG lines showed variable degrees of responsiveness towards the transgene-introduced antigens; whilst 75% of CIIL73 mice had an impaired cytotoxic T lymphocyte (CTL) response towards beta-gal, the response in CIIL64 mice was essentially normal. However, both lines displayed normal proliferative and antibody responses to beta-gal. A reduced CTL response was seen to NP in the CIINP lines in approximately 65% of the animals. In spite of the persistence of T cell responses to the transgene antigens in these lines, induction of CTL responses alone has so far failed to induce clinical signs of arthritis. Interestingly, some animals expressing beta-gal were susceptible to arthritis following challenge with type II collagen alone, whilst their non-TG littermates and TG mice from other lines remained unaffected. As beta-gal is expressed by E. coli, a component of the normal gut flora, this suggests a possible role for gut-derived immune responses. We believe these lines could form the basis of a model for studying links between intestinal inflammation and arthritis.
Assuntos
Artrite/imunologia , Cartilagem Articular/imunologia , Condrócitos/imunologia , Proteínas de Ligação a RNA , Linfócitos T Citotóxicos , Animais , Animais Recém-Nascidos , Anticorpos , Artrite/etiologia , Colágeno/genética , Suscetibilidade a Doenças , Escherichia coli/genética , Vetores Genéticos , Humanos , Imunização , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Proteínas do Nucleocapsídeo , Nucleoproteínas/biossíntese , Nucleoproteínas/imunologia , Proteínas do Core Viral/biossíntese , Proteínas do Core Viral/imunologia , beta-Galactosidase/biossíntese , beta-Galactosidase/imunologiaAssuntos
Antropologia Cultural , Redes Comunitárias , Família , Zeladoria , Privacidade , Simbolismo , Antropologia Cultural/educação , Antropologia Cultural/história , Redes Comunitárias/história , Família/etnologia , Família/psicologia , Características da Família/etnologia , História do Século XVI , Zeladoria/economia , Zeladoria/história , Estilo de Vida/etnologia , Privacidade/legislação & jurisprudência , Privacidade/psicologia , Características de Residência , Cidade de Roma/etnologiaAssuntos
Hemangioma/congênito , Hemangioma/radioterapia , Hemangiossarcoma/patologia , Neoplasias Induzidas por Radiação/patologia , Segunda Neoplasia Primária/patologia , Neoplasias Cutâneas/congênito , Neoplasias Cutâneas/radioterapia , Idoso , Face , Hemangiossarcoma/secundário , Hemangiossarcoma/cirurgia , Humanos , Masculino , Neoplasias Induzidas por Radiação/secundário , Neoplasias Induzidas por Radiação/cirurgia , Segunda Neoplasia Primária/secundário , Segunda Neoplasia Primária/cirurgia , Neoplasias Cutâneas/patologiaRESUMO
The purpose of this article is to detail the preoperative, surgical, and postoperative steps necessary for achieving successful bone regeneration using a nonresorbable membrane in conjunction with demineralized freeze-dried bone allograft implants. Each step of the surgical procedure has been clinically documented. The results from seven reentered patients having nine intrabony defects are presented and discussed.
Assuntos
Perda do Osso Alveolar/cirurgia , Regeneração Tecidual Guiada Periodontal , Membranas Artificiais , Regeneração Óssea , Substitutos Ósseos , Transplante Ósseo/métodos , Humanos , Cuidados Pós-OperatóriosAssuntos
Antígenos de Histocompatibilidade Classe II/metabolismo , Macrófagos/imunologia , Proteína Básica da Mielina/imunologia , Sequência de Aminoácidos , Animais , Apresentação de Antígeno , Células Apresentadoras de Antígenos/imunologia , Células Apresentadoras de Antígenos/metabolismo , Linhagem Celular , Epitopos/genética , Epitopos/metabolismo , Macrófagos/metabolismo , Camundongos , Camundongos Endogâmicos BALB C , Dados de Sequência Molecular , Proteína Básica da Mielina/genética , Proteína Básica da Mielina/metabolismo , Fragmentos de Peptídeos/genética , Fragmentos de Peptídeos/imunologia , Fragmentos de Peptídeos/metabolismoRESUMO
To prevent postextraction alveolar ridge resorption, various methods, techniques, and materials have been developed and are utilized. The learning objective of this article is to present a review of these materials and procedures and a clinical rehabilitation of a patient with a high smile line utilizing the technique of "socket preservation" to prevent an unaesthetic collapse of the alveolar ridge. A complex periodontal-prosthetic rehabilitation is undertaken to accommodate the patient's high smile line and prevent a possible unaesthetic result. This case report is an extension of several other ridge preservation cases by the author, previously published in this journal. The importance of cooperation and teamwork between the periodontist and the restorative dentist is emphasized.