Impact of Renal Transplantation and Immunosuppressive Therapy on Muscle Strength, Functional Capacity, and Quality of Life: A Longitudinal Study.

Renal transplantation is the best long-term treatment option compared with maintenance dialysis in patients with chronic kidney disease. This treatment should be combined with immunosuppressive drugs to obtain positive effects; however, the adverse effects of these medications in the respiratory and peripheral muscle strength, functional capacity, and quality of life of patients remain unknown. OBJECTIVE: The objective of this study is to evaluate the respiratory and peripheral muscle strength, functional capacity, and quality of life of patients undergoing renal transplantation in the preoperative period and during the first 6 months of postoperative period. METHODS: The respiratory and peripheral muscle strength, quality of life, and functional capacity of 40 patients were evaluated from the pretransplant period to 6 months post-renal transplantation. RESULTS: Compared with the preoperative period, the patients experienced improvement of the respiratory and peripheral strength 6 months after transplant (maximal inspiratory pressure 44% and maximal expiratory pressure 28.96%, handgrip 13.81%, and lower limbs 26.95%) and also in the quality of life. CONCLUSION: We conclude that 6 months after transplant, patients showed improvement in respiratory and peripheral muscle strength and quality of life, but even with the improvement, patients presented an unsatisfactory quality of life and muscle strength, regardless of immunosuppressive therapy.

Effect of Instrumentation Techniques, Irrigant Solutions and Artificial accelerated Aging on Fiberglass Post Bond Strength to Intraradicular Dentin.

OBJECTIVE: To evaluate the effect of instrumentation techniques, irrigant solutions and specimen aging on fiberglass posts bond strength to intraradicular dentine. MATERIALS AND METHODS: A total of 120 bovine teeth were prepared and randomized into control and experimental groups resulting from three study factors (instrumentation techniques, irrigant solutions, specimen aging). Posts were cemented with RelyX U100. Samples were submitted to push-out test and failure mode was evaluated under a confocal microscope. RESULTS: In specimens submitted to water artificial aging, nickel-titanium rotary instruments group presented higher bond strength values in apical third irrigated with NaOCl or chlorhexi-dine. Irrigation with NaOCl resulted in higher bond strength than ozonated water. Artificial aging resulted in significant bond strength increase. Adhesive cement-dentin failure was prevalent in all the groups. CONCLUSION: Root canal preparation with NiTi instruments associated with NaOCl irrigation and ethylenediaminetetra acetic acid (EDTA) increased bond strength of fiberglass posts cemented with self-adhesive resin cement to intraradicular dentine. Water artificial aging significantly increased post-Clinical significance: The understanding of factors that may influence the optimal bond between post-cement and cement-dentin are essential to the success of endodontically treated tooth restoration.

Effect of root canal sealer and artificial accelerated aging on fibreglass post bond strength to intraradicular dentin.

OBJECTIVES: To evaluate the effect of root canal sealers (RCS) and specimen aging on the bond strength of fibre posts to bovine intraradicular dentin. MATERIAL AND METHODS: 80 teeth were used according the groups - Sealapextm, Sealer 26®, AH Plus® and specimens aging - test with no aging and with aging. The canals prepared were filled using one of each RCS. The posts were cemented. Roots were cross-sectioned to obtain two slices of each third. Samples were submitted to push-out test. Failure mode was evaluated under a confocal microscope. The data were analysed by ANOVA, Tukey's, and Dunnet tests (α = 0.05). RESULTS: No significant difference was detected among RCS. Aged control presented higher bond strength than immediate control. The aging did not result significant difference. Adhesive cement-dentin failure was prevalent in all groups. CONCLUSIONS: RCS interfered negatively with bonding of fibreglass posts cemented with self-adhesive resin cement to intraradicular dentin. Key words:Fibreglass post, bond strength, root dentin, endodontic sealer, aging.

Ações de saúde na estratégia saúde da família no município goiano na perspectiva da integralidade / Health activities in the family health strategy of a Goiás municipality from the perspective of comprehensiveness / Acciones de salud en la estrategia salud de la familia en municipio de Goiânia en la perspectiva de integralidad

Objetivou-se com este estudo analisar as ações de saúde desenvolvidas por equipes de saúde da família em um município do sudeste goiano à luz da integralidade. Trata-se de pesquisa exploratória descritiva de abordagem qualitativa. A coleta de dados foi realizada por meio de entrevistas e, após uma análise de conteúdo, elegeram-se três categorias temáticas: Ações dos trabalhadores e articulação entre elas; A ESF não funciona como Estratégia Saúde da Família; Atualização das equipes de saúde da família. Os resultados demonstram a fragmentação das ações e desarticulação entre os trabalhadores, o que dificulta a integralidade. Concluiu-se, assim, que existe uma necessidade de investimentos na educação permanente em saúde, no fortalecimento do controle social, na avaliação participativa no SUS e no aprimoramento de tecnologias de gestão e cuidado.

The objective of this study was to analyze the health activities developed by the family health team (FHT) in a municipality in Southeast Goiás under the light of comprehensiveness. This exploratory descriptive study was performed using a qualitative approach. Data collection was performed by means of interviews and then submitted to content analysis. Three thematic categories were elected: Workers' activities and the connection between them; the FHT does not work as a Family Health Strategy; and An update of family health teams. Results demonstrate a fragmentation of the activities and a lack of connection between workers, which makes comprehensiveness more difficult. In conclusion, there is a need to make permanent investments in health, strengthen social control, perform participative evaluations in the national health system (SUS) and improve management and health care technologies.

Se objetivó con este estudio analizar las acciones de salud desarrolladas por equipos de salud de la familia en un municipio del sudeste de Goiânia según la óptica de la integralidad. Se trata de una investigación exploratoria, descriptiva, de abordaje cualitativo. La recolección de datos se realizó mediante entrevistas y, luego de un análisis de contenido, se eligieron tres categorías temáticas: Acciones de los trabajadores y articulación entre ellas; La ESF no funciona como Estrategia Salud de la Familia; y Actualización de los equipos de salud de la familia. Los resultados demuestran la fragmentación de las acciones y la falta de articulación entre los trabajadores, lo cual dificulta la integralidad. Se concluye en que existe necesidad de inversiones en capacitación permanente en salud, además de fortalecimiento del control social, evaluación participativa en el SUS y mejoramiento de tecnologías de gestión y cuidado.

Longitudinal clinical evaluation of post systems: a literature review.

In this survey, retrospective and prospective clinical studies dealing with cast-post-and core and fiber posts were reviewed regarding the rate of survival of restorations and the most prevalent failures. Electronic searches of the literature were performed in MEDLINE by crossing the key words: "Fiber post and clinical study", "Fiber post and clinical evaluation", "Cast post-and-core and clinical study", and "Root post and retrospective survival study". The cut-off dates were December 1990 through the end of December 2010. Review of literature showed that several interrelated biological, mechanical, and aesthetic factors are involved in the survival rate of restorative procedures in endodontically treated teeth, and post selection should fulfill and optimize these factors. Data based on long-term clinical studies are essential for the general practitioner when making clinical decisions. An adequate selection of teeth and post system must be made, and a minimal amount of existing tooth substance should be removed. A ferrule must be present for safe indication of the fiber posts. Fiber glass posts have demonstrated good survival in clinical studies, with similar performance to cast-post-and cores. Metallic posts have good clinical survival, but the associated failures are mostly irreversible, unlike what happens with the glass fiber posts.

Longitudinal clinical evaluation of post systems: a literature review

In this survey, retrospective and prospective clinical studies dealing with cast-post-and core and fiber posts were reviewed regarding the rate of survival of restorations and the most prevalent failures. Electronic searches of the literature were performed in MEDLINE by crossing the key words: "Fiber post and clinical study", "Fiber post and clinical evaluation", "Cast post-and-core and clinical study", and "Root post and retrospective survival study". The cut-off dates were December 1990 through the end of December 2010. Review of literature showed that several interrelated biological, mechanical, and aesthetic factors are involved in the survival rate of restorative procedures in endodontically treated teeth, and post selection should fulfill and optimize these factors. Data based on long-term clinical studies are essential for the general practitioner when making clinical decisions. An adequate selection of teeth and post system must be made, and a minimal amount of existing tooth substance should be removed. A ferrule must be present for safe indication of the fiber posts. Fiber glass posts have demonstrated good survival in clinical studies, with similar performance to cast-post-and cores. Metallic posts have good clinical survival, but the associated failures are mostly irreversible, unlike what happens with the glass fiber posts.

O objetivo foi realizar revisão de estudos clínicos retrospectivos e prospectivos de pinos e núcleos metálicos e pinos de fibra em relação à taxa de sobrevivência e tipo de falhas prevalentes. A revisão de literatura foi realizada utilizando a base de dados MEDLINE com os seguintes termos para pesquisa: “Pino de fibra e estudo clínico”, “Pino de fibra e avaliação clínica”, “Pinos e núcleos metálicos e estudo clínico”, “Pinos intra-radiculares e estudo clínicos retrospectivos”. O período avaliado foi de Dezembro de 1990 até o final de Dezembro de 2010. Vários fatores biológicos, mecânicos e estéticos estão envolvidos na taxa de sobrevivência do procedimento restaurador de dentes tratados endodonticamente. A seleção do pino deve satisfazer e otimizar esses fatores. Dados com base em estudos clínicos de longo prazo são essenciais para o clínico geral na tomada de decisões. Adequada indicação na seleção do sistema de pino devem ser feitas. Adicionalmente, desgaste mínimo da estrutura dentária existente deve ser priorizado. A presença de férula deve estar presente para garantir e melhorar a previsibilidade de pinos de fibra. Pinos de fibra de vidro têm demonstrado boa sobrevivência em estudos clínicos, com desempenho semelhante aos pinos metálicos e núcleos moldados e fundidos. Retentores metálicos apresentam boa sobrevivência clínica, no entanto as falhas envolvidas são em sua maioria irreversíveis, ao contrário do que acontece com os pinos de fibra de vidro.

Surface treatment of glass fiber and carbon fiber posts: SEM characterization.

Morphology, etching patterns, surface modification, and characterization of 2 different fiber posts: Gfp, Glass fiber post; and Cfp, carbon fiber were investigated by SEM analysis, after different surface treatments. Thirty fiber posts, being 15 Gfp and 15 Cfp were divided into a 5 surface treatments (n = 3): C-alcohol 70% (control); HF 4%-immersion in 4% hydrofluoric acid for 1min; H(3) PO(4) 37%-immersion in 37% phosphoric acid for 30s; H(2) O(2) 10%-immersion in 10% hydrogen peroxide for 20 min; H(2) O(2) 24%-immersion in 24% hydrogen peroxide for 10 min. Morphology, etching patterns, surface modification and surface characterization were acessed by SEM analysis. SEM evaluation revealed that the post surface morphology was modified following all treatment when compared with a control group, for both type of reinforced posts. HF seems to penetrate around the fibers of Gfp and promoted surface alterations. The Cfp surface seems to be inert to treatment with HF 4%. Dissolution of epoxy resin and exposure of the superficial fiber was observed in both post groups, regardless the type of reinforcing fiber, H(2) O(2) in both concentrations. Relative smooth surface area was produced by H(3) PO(4) 37% treatment, but with similar features to untreated group. Surface treatment of fiber post is a determinant factor on micromechanical entanglement to resin composite core. Post treatment with hydrogen peroxide resulted strength of carbon and glass/epoxy resin fiber posts to resin composite core.

Fracture strength of composite fixed partial denture using bovine teeth as a substitute for human teeth with or without fiber-reinforcement.

This study evaluate the use of bovine teeth as a substitute for human teeth on fracture strength tests of composite fixed partial dentures (Cpd), with and without fiberglass reinforcement (Fg). Eighty teeth were selected, being 40 bovine incisors, 20 human premolars and 20 molars. Bovine incisors were ground to get a platform, simulating an occlusal surface of human molar. Teeth in pairs were embedded in polystyrene resin, simulating the periodontal ligament and divided in 4 groups: B-Cpd-Fg: bovine teeth restored with Cpd with Fg; B-Cpd-NFg: bovine teeth restored with Cpd without Fg; H-Cpd-Fg: human teeth restored Cpd with Fg; and H-Cpd-NFg: human teeth restored with Cpd without Fg. The Cpd were adhesively fixed and submitted to an axial compression load at the pontic center with a crosshead speed of 0.5 mm/min until fracture. Failure modes were assessed and classified. Data were subjected to two-way ANOVA and Tukey's HSD test (α=0.05). The tooth type had no influence on fracture strength and fracture mode. The inclusion of fiberglass increased significantly the fracture strength. The failure modes were more reparable in groups with fiber-reinforcement. Bovine teeth can be used as a substitute for human teeth in these types of fracture strength tests.

Fracture strength of composite fixed partial denture using bovine teeth as a substitute for human teeth with or without fiber-reinforcement

This study evaluate the use of bovine teeth as a substitute for human teeth on fracture strength tests of composite fixed partial dentures (Cpd), with and without fiberglass reinforcement (Fg). Eighty teeth were selected, being 40 bovine incisors, 20 human premolars and 20 molars. Bovine incisors were ground to get a platform, simulating an occlusal surface of human molar. Teeth in pairs were embedded in polystyrene resin, simulating the periodontal ligament and divided in 4 groups: B-Cpd-Fg: bovine teeth restored with Cpd with Fg; B-Cpd-NFg: bovine teeth restored with Cpd without Fg; H-Cpd-Fg: human teeth restored Cpd with Fg; and H-Cpd-NFg: human teeth restored with Cpd without Fg. The Cpd were adhesively fixed and submitted to an axial compression load at the pontic center with a crosshead speed of 0.5 mm/min until fracture. Failure modes were assessed and classified. Data were subjected to two-way ANOVA and Tukey's HSD test (?=0.05). The tooth type had no influence on fracture strength and fracture mode. The inclusion of fiberglass increased significantly the fracture strength. The failure modes were more reparable in groups with fiber-reinforcement. Bovine teeth can be used as a substitute for human teeth in these types of fracture strength tests.

Este estudo avaliou a utilização de dentes bovinos como substituto de dentes humanos em testes de resistência à fratura de próteses adesivas de resina composta (Cpd), com e sem fibra de reforço. Oitenta dentes foram selecionados sendo 40 incisivos bovinos, 20 pré-molares humanos e 20 molares. Incisivos bovinos foram desgastados para obter plataforma, simulando superfície oclusal de molares humanos. Dentes em pares foram incluídos em resina de poliestireno, simulando o ligamento periodontal. As amostras foram divididas em 4 grupos: B-Cpd-Fg, dentes bovinos restaurados com reforço de fibra de vidro, Fg; B-Cpd-NFg, dentes bovinos restaurados com Cpd sem Fg; H-Cpd-Fg, dentes humanos restaurados com Cpd Fg e H-Cpd-NFg, dentes humanos restaurados com Cpd sem Fg. O Cpd foi fixado adesivamente e submetido a carga de compressão axial no centro do pôntico com velocidade de 0,5 mm/min até a fratura. Padrões de fratura foram classificados. Os dados foram submetidos ANOVA fatorial e teste de Tukey HSD (?=0,05). O tipo de dente não teve nenhuma influência na resistência à fratura e modo de fratura. A inclusão de fibra de vidro aumentou significativamente a resistência à fratura. Os padrões de fratura foram mais reparáveis nos grupos com fibra de reforço. Os dentes bovinos podem ser usados como substituto para dentes humanos nesses tipos de testes de resistência à fratura.

Influence of airborne-particle abrasion on mechanical properties and bond strength of carbon/epoxy and glass/bis-GMA fiber-reinforced resin posts.

STATEMENT OF PROBLEM: Controversy exists concerning the use of fiber-reinforced posts to improve bond strength to resin cement because some precementation treatments can compromise the mechanical properties of the posts. PURPOSE: The purpose of this study was to analyze the influence of airborne-particle abrasion on the mechanical properties and microtensile bond strength (MTBS) of carbon/epoxy and glass/bis-GMA fiber-reinforced resin posts. MATERIAL AND METHODS: Flexural strength (delta(f)), flexural modulus (E(f)), and stiffness (S) were assessed using a 3-point bending test for glass fiber-reinforced and carbon fiber-reinforced resin posts submitted to airborne-particle abrasion (AB) with 50-microm Al(2)O(3), and for posts without any surface treatment (controls) (n=10). Forty glass fiber (GF) and 40 carbon fiber (CF) posts were submitted to 1 of 4 surface treatments (n=10) prior to MTBS testing: silane (S); silane and adhesive (SA); airborne-particle abrasion with 50-microm Al(2)O(3) and silane (ABS); airborne-particle abrasion, silane, and adhesive (ABSA). Two composite resin restorations (Filtek Z250) with rounded depressions in the lateral face were bilaterally fixed to the post with resin cement (RelyX ARC). Next, the specimen was sectioned with a precision saw running perpendicular to the bonded surface to obtain 10 bonded beam specimens with a cross-sectional area of 1 mm(2). Each beam specimen was tested in a mechanical testing machine (EMIC 2,000 DL), under stress, at a crosshead speed of 0.5 mm/min until failure. Data were analyzed by 2-way ANOVA followed by Tukey HSD test (alpha=.05). Failure patterns of tested specimens were analyzed using scanning electron microscopy (SEM). RESULTS: The 3-point bending test demonstrated significant differences among groups only for the post type factor for flexural strength, flexural modulus, and stiffness. The carbon fiber posts exhibited significantly higher mean flexural strength (P=.001), flexural modulus (P=.003), and stiffness (P=.001) values when compared with glass fiber posts, irrespective of surface treatment. An alteration in the superficial structure of the posts could be observed by SEM after airborne-particle abrasion. MTBS testing showed no significant effect for the surface treatment type; however, significant effects for post system factor and for interaction between the 2 factors were observed. For the carbon fiber post, the ABSA surface treatment resulted in values significantly lower than the S surface treatment. SEM analysis of MTBS-tested specimens demonstrated adhesive and cohesive failures. CONCLUSIONS: Airborne-particle abrasion did not influence the mechanical properties of the post; however, it produced undesirable surface changes, which could reduce the bond strength to resin cement. For the surface treatments studied, if silane is applied, the adhesive system and airborne-particle abrasion are not necessary.

Effect of chlorhexidine application on microtensile bond strength to dentin.

This study evaluated the effect on microtensile bond strength (microTBS) of chlorhexidine application to dentin at different times during an indirect restoration luting procedure. Sixty bovine incisors had their superficial dentin subjected to 0.12% and 2% chlorhexidine solutions for 15 seconds before, during and after 37% phosphoric acid etching, resulting in six groups (n=10): 1) 0.12% chlorhexidine + etching; 2) 2% chlorhexidine + etching; 3) etching + 0.12% chlorhexidine; 4) etching + 2% chlorhexidine; 5) etching with 2% chlorhexidine; 6) etching without chlorhexidine (control). An adhesive system (Adper Single Bond 2) was applied and an indirect resin composite restoration (Filtek Z250) was luted using dual cured resin cement (Rely X ARC). After 24 hours of water storage, the specimens were tested by microtensile bond test (microTBS) at 0.5 mm/minute in a universal testing machine. The data were analyzed by one-way ANOVA (alpha=0.05), demonstrating no significant differences among the groups. The microTBS values in MPa were: 6: 22.83+/-3.53; 5: 22.4+/-3.52; 2: 21.62+/-2.5; 1: 21.28+/-3.17; 3: 19.62+/-2.05; 4: 19.55+/-2.34. The use of chlorhexidine at concentrations of 0.12% and 2% before, after or associated with acid etching did not significantly affect the microTBS values to dentin.

Influence of method and period of storage on the microtensile bond strength of indirect composite resin restorations to dentine.

This study evaluated the influence of the method and period of storage on the adhesive bond strength of indirect composite resin to bovine dentin. Ninety bovine incisors were stored in three different solutions: 0.2% thymol, 10% formalin, and 0.2% sodium azide, during 3 periods of storage: 7 days, 30 days and 6 months, resulting in 9 groups (n = 10). The roots were cut off and the buccal surface was ground with #600-grit silicon carbide paper. The surface was conditioned with 37% phosphoric acid for 15 s and a composite resin restoration (TPH Spectrum) was fixed using a one-bottle adhesive system (Adper Single Bond) and a dual-cured resinous cement (Rely X ARC) under a load of 500 g for 5 minutes. The samples were serially cut perpendicular to the bonded interface to obtain slices of 1.2 mm in thickness. Each slab was trimmed with a cylindrical diamond bur resulting in an hourglass shape with a cross-sectional area of approximately 1 mm(2). The microtensile bond strength (microTBS) testing was performed in a testing machine (EMIC 2000 DL) at a 0.5 mm/minute crosshead-speed until failure. After fracture, the specimens were examined under SEM to analyze the mode of fracture. muTBS Means were expressed in MPa and the data were analyzed by two-way ANOVA (3X3) and the Tukey test (alpha = 0.05). The storage times of 7 and 30 days produced no significant difference irrespective of the solution type. The formalin and thymol solutions, however, did have a negative influence on bond strength when the teeth were stored for 6 months.

Influence of method and period of storage on the microtensile bond strength of indirect composite resin restorations to dentine

This study evaluated the influence of the method and period of storage on the adhesive bond strength of indirect composite resin to bovine dentin. Ninety bovine incisors were stored in three different solutions: 0.2 percent thymol, 10 percent formalin, and 0.2 percent sodium azide, during 3 periods of storage: 7 days, 30 days and 6 months, resulting in 9 groups (n = 10). The roots were cut off and the buccal surface was ground with #600-grit silicon carbide paper. The surface was conditioned with 37 percent phosphoric acid for 15 s and a composite resin restoration (TPH Spectrum) was fixed using a one-bottle adhesive system (Adper Single Bond) and a dual-cured resinous cement (Rely X ARC) under a load of 500 g for 5 minutes. The samples were serially cut perpendicular to the bonded interface to obtain slices of 1.2 mm in thickness. Each slab was trimmed with a cylindrical diamond bur resulting in an hourglass shape with a cross-sectional area of approximately 1 mm². The microtensile bond strength (μTBS) testing was performed in a testing machine (EMIC 2000 DL) at a 0.5 mm/minute crosshead-speed until failure. After fracture, the specimens were examined under SEM to analyze the mode of fracture. μTBS Means were expressed in MPa and the data were analyzed by two-way ANOVA (3X3) and the Tukey test (α = 0.05). The storage times of 7 and 30 days produced no significant difference irrespective of the solution type. The formalin and thymol solutions, however, did have a negative influence on bond strength when the teeth were stored for 6 months.

In vitro analysis of the radiodensity of indirect composites and ceramic inlay systems and its influence on the detection of cement overhangs.

The purpose of this study was to evaluate the radiodensity of indirect restorative systems and to determine its influence on detection of resin cement overhangs. Sixty sound molars with similar dimensions were selected, and MOD inlay preparations were made in a standardized fashion with 6 degrees taper of the walls. Restorations were made with a porcelain, Duceram LFC, and with three indirect composites, Solidex, Artglass, and Targis. Digital radiographic images were taken before and after cementation of the inlays (Digora system) and were analyzed on two regions, the cervical and the isthmus floor. Digital radiodensity measurements were performed on standardized points symmetrically distributed over each restoration and tooth structure. Cement overhangs were detected through visual analysis by three evaluators. Data were statistically analyzed utilizing ANOVA following Tukey's test (p < 0.05), showing that Solidex presented lower radiodensity than Duceram LFC, and both Artglass and Targis presented similar higher levels of radiodensity than the other groups. Radiodensity of cervical regions was always greater than for isthmus floor regions. Detection of the resin cement overhangs is easier observed on Solidex and Duceram LFC. Radiodensity is highly influenced by restorative material type and tooth regions. The detection of radiopaque resin cement overhangs is influenced by radiodensity of restorative materials.