Relationship between initial PSA density with future PSA kinetics and repeat biopsies in men with prostate cancer on active surveillance.

The objective of our study is to examine the correlation between PSA density (PSAd) at the time of diagnosis with PSA velocity (PSAV), PSA doubling time and tumour progression, on repeat biopsy, in men with prostate cancer on active surveillance. Data from 102 patients with clinically localized prostate cancer on active surveillance in the period between 1992 and 2007, who had the necessary parameters available, were collected. PSAd was calculated and correlated with PSAV, PSA doubling time (PSADT), Gleason score at diagnosis and local progression on repeated biopsies. PSAV was 0.64 and 1.31 ng ml(-1) per year (P = 0.02), PSADT of 192 and 113 months (P = 0.4) for PSAd below and above 0.15, respectively. The rate of detecting high Gleason score (≥ 7) at diagnosis was 6 and 23% for PSAd below and above 0.15, respectively. A total of 101 patients underwent at least a second biopsy and the incidence of upgrading was 10 and 31% for PSAd below and above 0.15, respectively (P = 0.001). Although low PSAd is an accepted measure for suggesting insignificant prostate cancer, our study expands its role to indicate that PSAd < 0.15 may be an additional clinical parameter that may suggest indolent disease, as measured by future PSAV and repeat biopsy over time.

Preventing bone complications in advanced prostate cancer.

The diagnosis and treatment of prostate cancer have steadily been improving since the late 1980s. However, clinicians still confront a large group of men developing disease metastatic to bone. Adequate control of bone complications plays a fundamental role in achieving control of symptoms and quality of life in this group. Androgen deprivation therapy, the standard treatment for advanced prostate cancer, increases the risk of various complications, including bone disease. This review addresses the prevention of bone complications related not only to prostate cancer metastases but also to impaired bone integrity caused by androgen deprivation therapy.

Effect of different enamel treatments on bond strength using resin dental adhesives.

OBJECTIVE: The aim of this investigation was to evaluate the effect different cleaning techniques used on enamel surfaces have on the bond strength of a composite resin to the dental enamel. METHOD AND MATERIALS: Eighty-eight bovine enamel fragments were mounted in acrylic resin bases. The enamel surfaces were sanded using 200-, 400-, and 600-grit sandpapers, thus creating a smear layer. These surfaces were then randomly divided in 2 groups: 1 of them received salivary contact for 10 minutes, and the other received it for 60 minutes. Then all surfaces were cleaned with a pumice and water paste applied with a rubber cup, followed by the application of biological detergent, sodium bicarbonate jet, or air/water spray. After cleansing, the enamel surfaces received the application of the Scotchbond Multi-Purpose adhesive system and Z100 composite resin, following the manufacturer's instructions, using an appropriate matrix. After storage at 37 degrees C for 8 days, traction tests were carried out using an Instron machine operating at 0.5 mm/minute. Some fractured specimens (randomly chosen) were analyzed under scanning electron microscopy. RESULTS: The statistical analysis using descriptive and inferential methods did not show significant differences between the different periods of time of salivary contact. The technique of pumice and water paste cleaning followed by the application of biological detergent was significantly more efficient than the others. Scanning electron micrographs of the fragments after traction tests confirmed these results. CONCLUSION: The technique of pumice and water paste cleaning followed by the application of biological detergent was the treatment that allowed the best results in terms of resin bonding to bovine enamel covered with acquired pellicle, and the sodium bicarbonate jet technique presented the lowest bond strength values and seemed to disturb the acid conditioning of enamel surfaces.

Prevention of postoperative tooth sensitivity: a preliminary clinical trial.

The purpose of this study was to evaluate clinically the effects of pre-treatments with a 35% hydroxyethyl metacrylate/5% glutaraldehyde dentine desensitizer (Gluma Desensitizer) and a 2% chlorexidine-based cavity disinfectant (Cav-Clean) on postoperative sensitivity. Three premolar teeth with no pain symptoms were selected from each one of 17 patients, totalling 51 teeth, for which Class II restoration using a composite was indicated. Each one of the three premolar teeth of the same patient was submitted to a different treatment. After acid etching, only a dental adhesive was applied to the first tooth, which served as the control. Gluma Desensitizer dentinal desensitizer was applied to the second premolar tooth prior to applying the dental adhesive. Cav-Clean cavity disinfectant was used on the third premolar tooth before applying the dental adhesive. Only one tooth was restored per session, and all premolar teeth were restored with a condensable composite, according to current restoration technique guidelines. Sensitivity to different stimuli (cold, heat, sweet and dental floss) was assessed on Day 1, Day 4 and Day 7 by questionnaire following restorative procedures. The results of this clinical research showed that, as far as the investigated stimuli and postoperative course are concerned, there was no statistically significant difference in the three different treatments (P>0.05). Postoperative sensitivity resulting from Class II restorations using composite resin cannot be completely eliminated with the prior use of a dentinal desensitizer or a cavity disinfectant. In day-to-day clinical treatment, postoperative sensitivity may possibly be related to the technique employed.

Impaired regeneration of dystrophin-deficient muscle fibers is caused by exhaustion of myogenic cells.

Duchenne muscular dystrophy is one of the most devastating myopathies. Muscle fibers undergo necrosis and lose their ability to regenerate, and this may be related to increased interstitial fibrosis or the exhaustion of satellite cells. In this study, we used mdx mice, an animal model of Duchenne muscular dystrophy, to assess whether muscle fibers lose their ability to regenerate after repeated cycles of degeneration-regeneration and to establish the role of interstitial fibrosis or exhaustion of satellite cells in this process. Repeated degenerative-regenerative cycles were induced by the injection of bupivacaine (33 mg/kg), a myotoxic agent. Bupivacaine was injected weekly into the right tibialis anterior muscle of male, 8-week-old mdx (N = 20) and C57Bl/10 (control, N = 10) mice for 20 and 50 weeks. Three weeks after the last injection, the mice were killed and the proportion of regenerated fibers was counted and reported as a fibrosis index. Twenty weekly bupivacaine injections did not change the ability of mdx muscle to regenerate. However, after 50 weekly bupivacaine injections, there was a significant decrease in the regenerative response. There was no correlation between the inability to regenerate and the increase in interstitial fibrosis. These results show that after prolonged repeated cycles of degeneration-regeneration, mdx muscle loses its ability to regenerate because of the exhaustion of satellite cells, rather than because of an increase in interstitial fibrosis. This finding may be relevant to cell and gene therapy in the treatment of Duchenne muscular dystrophy.

Impaired regeneration of dystrophin-deficient muscle fibers is caused by exhaustion of myogenic cells

Duchenne muscular dystrophy is one of the most devastating myopathies. Muscle fibers undergo necrosis and lose their ability to regenerate, and this may be related to increased interstitial fibrosis or the exhaustion of satellite cells. In this study, we used mdx mice, an animal model of Duchenne muscular dystrophy, to assess whether muscle fibers lose their ability to regenerate after repeated cycles of degeneration-regeneration and to establish the role of interstitial fibrosis or exhaustion of satellite cells in this process. Repeated degenerative-regenerative cycles were induced by the injection of bupivacaine (33 mg/kg), a myotoxic agent. Bupivacaine was injected weekly into the right tibialis anterior muscle of male, 8-week-old mdx (N = 20) and C57Bl/10 (control, N = 10) mice for 20 and 50 weeks. Three weeks after the last injection, the mice were killed and the proportion of regenerated fibers was counted and reported as a fibrosis index. Twenty weekly bupivacaine injections did not change the ability of mdx muscle to regenerate. However, after 50 weekly bupivacaine injections, there was a significant decrease in the regenerative response. There was no correlation between the inability to regenerate and the increase in interstitial fibrosis. These results show that after prolonged repeated cycles of degeneration-regeneration, mdx muscle loses its ability to regenerate because of the exhaustion of satellite cells, rather than because of an increase in interstitial fibrosis. This finding may be relevant to cell and gene therapy in the treatment of Duchenne muscular dystrophy

Long-term clinical evaluation of fracture and pulp injury following glass-ionomer cement or composite resin applied as a base filling in teeth restored with amalgam.

The aim of this research was to analyse the long-term clinical behaviour of two dental materials applied as filling under silver amalgam restorations: glass-ionomer cement (GIC) and composite resin with adhesive system (CR). In this study, 117 posterior teeth (29 premolars and 88 molars) were selected with carious lesions which resulted in great loss of dentin and cusps with unsupported enamel. After caries removal, cavities were prepared and totally filled with GIC or with CR. In a following visit, new cavities were prepared, leaving the employed filling material as a base and support for the enamel, which were then restored with silver amalgam. Restorations were evaluated periodically after 6 months and up to 5 years. Both fracture and pulpal involvement rates were low. Although differences could be observed in the behaviour of the materials, statistical survival estimation showed that the performances of GIC and CR as filling material were similar. There was a significant association both between kind of tooth (molar or premolar) and long-term survival of the restorations; and between degree of unsupported enamel and the same long-term survival. Our results confirmed that the technique in which GIC or CR are used as filling under silver amalgam restorations is clinically acceptable.

SEM study of different treatments of the smear layer on different cavity walls.

The present study evaluated the effects of slightly demineralizing treatments on dentinal cavity walls, since some recently developed adhesive procedures are applied over the smear layer. Ten experimental treatments--mechanical, chemical or mechanical/chemical--were applied on MOD cavity walls prepared in vitro with diamond burs. The dentinal surface of a lateral and of a pulpal wall of each cavity was evaluated through scanning electron microscopy, and the effects of the treatments were compared. All treatments except air/water spray removed some of the smear layer, and slight differences were observed regarding the studied cavity walls: on dentin from pulpal walls the enamel hatchet associated with tannic acid produced a better effect than the other treatments, and on dentin from lateral walls the biological detergent rubbed with cotton pellets was a little more effective than the other treatments. The effect of the smear layer treatment on dentin is different according to the wall and to the applied treatment.

Fadiga psiquica: resultados da aplicacao de um metodo alternativo para a identificacao dos agentes etiologicos ligados ao ambiente de trabalho / Psychological fatigue: results of the application of an alternative method in order to identify etiological agents

A fadiga psiquica aparece nos nossos dias como uma doenca social ligada em parte ao ambiente de trabalho. Compromete o individuo e o trabalho, com prejuizo para ambos. O diagnostico de casos pode ser feito pelo medico do trabalho que, na maioria das vezes, identifica a inadaptacao ou mesmo a insatisfacao com o trabalho. O problema maior que apresenta nos casos de diagnostico de fadiga psiquica e o julgamento da importancia de um determinado agente agressivo. Para uma avaliacao geral na empresa, o trabalho interprofissional, principalmente do medico do trabalho e do psicologo industrial, assume proporcoes relevantes No presente estudo, apresenta-se uma alternativa de metodo de identificacao dos agentes etiologicos da fadiga psiquica, principalmente aqueles ligados ao ambiente de trabalho, e os resultados da aplicacao desse metodo durante 18 meses na companhia Forjas Acesita.Os dados apresentam uma caracteristica importante, que e o diagnostico implicito, ou seja o leitor reconhecera nao so o metodo sugerido como tambem tomara conhecimento dos problemas que afetam os recursos humanos da empresa no periodo citado. No final, conclui-se quanto aos aspectos de validade do metodo e propoe-se alteracoes no sentido de aperfeiçoá-lo