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3.
Epigenomics ; 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31509016

RESUMO

Aim: We investigated associations of prenatal socioeconomic status (SES) with DNA methylation at birth, and to explore persistence of associations into early (∼3 years) and mid-childhood (∼7 years) among 609 mother-child pairs in a Boston-area prebirth cohort. Materials & methods: First, we created a prenatal SES index comprising individual- and neighborhood-level metrics and examined associations of low (lowest 10%) versus high (upper 90%) SES with genome-wide DNA methylation in cord blood via the Infinium HumanMethylation450 BeadChip. Next, we evaluated persistence of associations detected in cord blood with DNA methylation of the same CpG sites measured in peripheral leukocytes in early- and mid-childhood. Results & conclusion: Low prenatal SES was associated with methylation at CpG sites near ACSF3, TNRC6C-AS1, MTMR4 and LRRN4. The relationship with LRRN4 persisted into early childhood.

4.
Infectio ; 23(3): 246-251, July-Sept. 2019. tab
Artigo em Espanhol | LILACS-Express | ID: biblio-1002158

RESUMO

Resumen Objetivo: Caracterizar de forma sociodemográfica y clínica pacientes con diagnóstico nuevo de VIH, que fueron hospitalizados en una Clínica Universitaria de alta complejidad entre el año 2010 - 2016. Materiales y métodos: Se realizó un estudio observacional, descriptico, de corte transversal por medio de revisión de historias clínicas, que incluyo pacientes ≥14 años, a quienes se les diagnosticó VIH durante la hospitalización y tuvieran al menos un conteo de linfocitos CD4. Resultados: La mediana para la edad fue 41 años (RIC 31 - 51), el 85,1% eran hombres. Los principales síntomas al ingreso fueron generales/sistémicos (70,2%). 99 pacientes (61,5%) tenían infecciones oportunistas siendo tuberculosis la más frecuente (34,3%). La mediana para el conteo de CD4 fue 88 células/mm3 RIC (27 - 327) y el 77% se clasificó como SIDA. 29 pacientes murieron (18%) encontrando como posible factor de riesgo tener conteo de CD4 fue 88 células/mm3 RIC (27 - 327) y el 77% se clasificó como SIDA. 29 pacientes murieron (18%) encontrando como posible factor de riesgo tener conteo de CD4<200 células/mm3 , no pertenecer al régimen contributivo, ingresar con síntomas respiratorios, tener diagnóstico de neumonía, criterios de falla multiorgánica o necesidad de UCI/UCE. Conclusión: Para nuestro caso la mayoría de pacientes con diagnóstico nuevo de VIH se encontraban en estados avanzados de inmunosupresión con alta carga de enfermedades definitorias de SIDA. Es importante fortalecer las políticas de salud pública para diagnosticar más temprano la infección por VIH.


Abstract Purposes: To characterize sociodemographic and clinical aspects in newly diagnosed HIV patients that were hospitalized at a university health center between 2010 - 2016. Methods: We made an observational descriptive cross - sectional study reviewing clinical records, including patients older than 14 years old, who were diagnosed with HIV infection during hospitalization and at least a CD4 count. Results: Median age at diagnosis was 41 years old (IQR 31 - 51), 85% were men. The main symptoms were general/systemic (70.2%). 99 patients (61.5%) had opportunist infections, being tuberculosis the most frequent (34.3%). The median CD4 were 88 cells/mm3 (IQR 27 - 327) and 77% were classified as AIDS. 29 patients died (18%), finding as a risk factor for mortality don't having a good health care insurance, low CD4 count, having respiratory symptoms, pneumonia diagnosis, multiple organic failure's criteria and ICU admission. Conclusion: In our case, the majority of patients with a new diagnosis of HIV were in advanced stages of immunosuppression with a high burden of AIDS defining diseases. It is important to strengthen public health policies to diagnose HIV infection earlier.

5.
Am J Epidemiol ; 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31497855

RESUMO

Prenatal maternal smoking is a risk factor for lower birth weight. We performed epigenome-wide association analyses of placental DNA methylation (DNAm) at 720077 Cytosine-phosphate-Guanine-sites (CpGs) and prenatal maternal smoking among 441 mother-infant pairs (2010-2014) and evaluated if DNAm mediates the association between smoking and birth weight using mediation analysis. Mean (SD) birth weight was 3443 grams (423) and 38 mothers (8.6%) reported smoking at a mean of 9.4 weeks of gestation. Prenatal maternal smoking was associated with a 175-gram lower birth weight (95% CI: -305.5, -44.8) and with differential DNAm of 71 CpGs in placenta robust to latent-factor adjustment reflecting cell-types (Bonferroni-P<6.94x10-8). Of the 71 CpGs, seven mediated the association between prenatal smoking and birth weight (MDS2, PBX1, CYP1A2, VPRBP, WBP1L, CD28 and CDK6 genes) and prenatal smoking by DNAm interactions on birthweight were observed for five CpGs. The strongest mediator, cg22638236, was annotated the PBX1 gene body involved in skeletal patterning and programming with a mediated effect of 301-gram lower birth weight (95% CI: -543, -86) among smokers but no mediated effect for non-smokers (ß= -38-gram; 95% CI: -88, 9). Prenatal maternal smoking might interact with placental DNAm at specific loci mediating the association with lower infant birth weight.

6.
Neurotoxicology ; 75: 105-115, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31513824

RESUMO

BACKGROUND: Lead is an established neurotoxicant and early life exposure to lead is associated with detrimental impacts on IQ and several neurobehavioral domains. Less is known, however, about effects of prenatal lead exposure below 5 µg/dL on executive function and on social, emotional and self-regulatory behaviors in childhood. OBJECTIVES: To examine the association between prenatal lead exposure and childhood executive function and social, emotional and self-regulatory behaviors. METHODS: We included 1006 mother-child pairs from the Project Viva prospective pre-birth cohort. We measured prenatal maternal lead in second-trimester erythrocytes. In mid-childhood (median 7.7 years), parents and teachers rated executive function related behaviors using the Behavior Rating Inventory of Executive Function (BRIEF) and behavioral difficulties using the Strengths and Difficulties Questionnaire (SDQ). We used multivariable linear regression models adjusted for maternal, paternal, and child characteristics and metal co-exposures. RESULTS: Mean maternal erythrocyte lead concentration was 1.2 µg/dL (interquartile range [IQR] 0.8-1.5 µg /dL), equivalent to approximately 0.4 µg/dL in whole blood. In adjusted models, associations with parent and teacher-rated scales were largely null, although effect estimates were consistently positive, suggesting worse scores with increasing lead levels. For an IQR increase in lead, BRIEF Global Executive Composite (GEC) was 0.73 (95% CI: -0.06, 1.52) points higher for parent-rated scores and 0.42 (95% CI: -0.39, 1.23) points higher for teacher-rated scores. Associations were strongest for parent-rated BRIEF plan/organize (ß = 0.85; 95% CI: 0.12, 1.59) and shift (ß = 0.88; 95% CI: 0.01, 1.75) subscales, as well as the SDQ emotional problems subscale (ß = 0.18; 95% CI: 0.03, 0.33). DISCUSSION: In this cohort with lead levels commonly experienced by U.S. women, there were few statistically significant associations with childhood executive function and behavior. However, there was a trend of worse neurobehavioral scores with increasing prenatal lead concentrations, in particular for childhood emotional problems and capacity to plan/organize and shift. Our results highlight the importance of continuing efforts to eliminate lead exposure in the general population.

7.
Clin Oral Investig ; 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31468261

RESUMO

OBJECTIVES: A systematic review and meta-analysis were performed to answer this research question: "Does combined in-office (IO) and at-home (AH) bleaching produce improved color change and lower tooth sensitivity (TS) better than solely AH or IO bleaching in adults?" MATERIAL AND METHODS: Randomized controlled trials in adults that compared combined versus sole application bleaching were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. Meta-analyses were conducted for color change in shade guide units (∆SGU) and with a spectrophotometer (∆E*), risk, and intensity of TS, using the random effects model. Heterogeneity was assessed with Cochran's Q test and I2 statistics. GRADE assessed the quality of the evidence. PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, SIGLE, IADR abstracts, unpublished, ongoing trial registries, dissertations, and theses were searched on August 28, 2017 (updated on January 29, 2019). RESULTS: Twelve studies remained. Two were considered to have low RoB. For combined vs. IO bleaching, no significant difference for ∆E*, ∆SGU, and risk of TS were observed; data were not available to analyze the intensity of TS. For combined vs. AH bleaching, no significant difference for ∆E*, ∆SGU, but lower TS to risk (RR 1.40, 95% 1.10 to 1.80) and intensity (MD 1.40, 95% CI 0.18 to 2.63) were detected for AH bleaching. Quality of evidence was graded as low or very low in all meta-analyses. CONCLUSION: Lower risk and intensity of TS was observed for the solely AH group without jeopardizing color change. However, more studies are still encouraged due to the low quality of evidence for most of the outcomes. CLINICAL RELEVANCE: If clinicians are to choose between combined or sole AH bleaching, the solely AH may be preferable; combined bleaching may potentiate the risk of TS without benefits in color change. For combined or sole IO bleaching, no important clinical difference in color change and risk of TS were detected; however, intensity of TS could not be compared due to lack of data. Further studies should be conducted due to the low/very low quality of the evidence.

8.
J Adhes Dent ; 21(4): 319-327, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31432046

RESUMO

PURPOSE: To evaluate the effect of different application modes of a recently introduced self-etching ceramic primer on the microshear bond strength (µSBS) and ceramic surface-etching pattern of two glass-ceramic surfaces. MATERIALS AND METHODS: Twenty-two CAD/CAM blocks of lithium disilicate (LD) and feldspathic glass ceramic (VTR) were each cut into 4 rectangular sections (n = 88 for ceramic surface). The LD and VTR specimens were divided into one control group (hydrofluoric acid + silane coupling agent [HF+SII]), and 10 experimental groups using Monobond Etch and Prime (MEP) applied for a combination of scrubbing times (5, 10, 20, 40, and 60 s) and reaction times (20 or 40 s). After each treatment, Tygon matrices (n = 8) were filled with a resin cement and light cured for each ceramic specimen. The specimens were stored in water at 37°C for 24 h and subjected to the µSBS test. The failure pattern and µSBS were statistically evaluated (α = 0.05). In addition, the ceramic surface etching pattern was analyzed using scanning electron microscopy. RESULTS: For the LD groups, the application of MEP 60/40 resulted in a higher mean µSBS compared to HF+SI (p < 0.05). Groups 5/40, 10/40, and 20/40 resulted in mean µSBS similar to that obtained by HF+SI (p > 0.05). For VTR, no significant difference was observed among the groups (p = 0.32). Compared with MEP, HF better promoted the dissolution of glass matrix for both ceramics. However, prolonged MEP scrubbing or reaction caused significant dissolution of the glass matrix for both evaluated ceramics. CONCLUSION: Active and prolonged application of MEP may be a viable alternative to HF+SI for increasing the bond strength to LD.

9.
Diabetes Care ; 42(9): 1824-1832, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31296647

RESUMO

OBJECTIVE: Perfluoroalkyl and polyfluoroalkyl substances (PFASs) are suspected endocrine disruptors widely detected across populations. We examine the extent to which PFASs are associated with diabetes incidence and microvascular disease. Secondarily, we tested whether a lifestyle intervention modifies associations and decreases concentrations. RESEARCH DESIGN AND METHODS: We analyzed data from a prospective cohort of 957 participants from the Diabetes Prevention Program (DPP) trial and Diabetes Prevention Program Outcomes Study (DPPOS). At baseline, participants were randomized to an intensive lifestyle intervention of diet, physical activity, and behavior modification or a placebo medication. We quantified plasma concentrations of six PFASs at baseline and 2 years after randomization. Participants were monitored for ∼15 years, repeatedly tested for diabetes, and evaluated for microvascular disease at the end of the follow-up. RESULTS: A doubling in baseline branched perfluorooctanoic acid concentration was associated with a 14% increase in diabetes risk for the placebo (hazard ratio [HR] 1.14, 95% CI 1.04, 1.25) but not in the lifestyle intervention group (HR 1.01, 95% CI 0.92, 1.11, P interaction = 0.11). Mean change in plasma baseline branched perfluorooctanoic acid concentration was greater for the placebo (0.96 ng/mL; 95% CI 0.71, 1.22) compared with the lifestyle intervention group (0.31 ng/mL; 95% CI 0.14, 0.48) 2 years after randomization. Each doubling in N-ethyl-perfluorooctane sulfonamido acetic acid was associated with 17% greater odds of prevalent microvascular disease (OR 1.17, 95% CI 1.05, 1.31), and a similar association was observed for perfluorodimethylhexane sulfonic acid (OR 1.18, 95% CI 1.04, 1.35), regardless of treatment. CONCLUSIONS: Some plasma PFASs were associated with diabetes and microvascular disease. Our results suggest that exercise and diet may attenuate the diabetogenic association of PFASs.

10.
Nat Commun ; 10(1): 3095, 2019 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-31300640

RESUMO

The nasal cellular epigenome may serve as biomarker of airway disease and environmental response. Here we collect nasal swabs from the anterior nares of 547 children (mean-age 12.9 y), and measure DNA methylation (DNAm) with the Infinium MethylationEPIC BeadChip. We perform nasal Epigenome-Wide Association analyses (EWAS) of current asthma, allergen sensitization, allergic rhinitis, fractional exhaled nitric oxide (FeNO) and lung function. We find multiple differentially methylated CpGs (FDR < 0.05) and Regions (DMRs; ≥ 5-CpGs and FDR < 0.05) for asthma (285-CpGs), FeNO (8,372-CpGs; 191-DMRs), total IgE (3-CpGs; 3-DMRs), environment IgE (17-CpGs; 4-DMRs), allergic asthma (1,235-CpGs; 7-DMRs) and bronchodilator response (130-CpGs). Discovered DMRs annotated to genes implicated in allergic asthma, Th2 activation and eosinophilia (EPX, IL4, IL13) and genes previously associated with asthma and IgE in EWAS of blood (ACOT7, SLC25A25). Asthma, IgE and FeNO were associated with nasal epigenetic age acceleration. The nasal epigenome is a sensitive biomarker of asthma, allergy and airway inflammation.

11.
Environ Int ; 129: 343-353, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31150976

RESUMO

Exposure to per- and polyfluoroalkyl substances (PFASs) may interfere with lipid regulation. However, most previous studies were cross-sectional with the risk of reverse causation, suggesting a need for long-term prospective studies. We examined the relationship of baseline plasma PFAS concentrations with repeated measures of blood lipids. We included 888 prediabetic adults from the Diabetes Prevention Program (DPP) and DPP Outcomes Study, who had measurements of 6 plasma PFAS concentrations at baseline (1996-1999) and repeated measures of blood lipids over 15 years of follow-up, and were initially randomized to placebo or a lifestyle intervention. We used linear regression to examine cross-sectional associations of PFAS concentrations and lipid levels at baseline, and evaluated prospective risks of hypercholesterolemia and hypertriglyceridemia using Cox proportional hazard models, and tested for effect modification by study arm. Participants (65.9% female, 57.0% White, 65.9% aged 40-59 years) had comparable PFAS concentrations [e.g., median (IQR) perfluorooctanoic acid (PFOA) 4.9 ng/mL (3.2)] with the general U.S. population in 1999-2000. We observed higher total cholesterol at baseline per doubling of PFOA (ß: 6.1 mg/dL, 95% CI: 3.1, 9.04), perfluorohexane sulfonic acid (PFHxS, ß: 2.2 mg/dL, 95% CI: 0.2, 4.3), and perfluorononanoic acid (PFNA, ß: 2.9 mg/dL, 95% CI: 0.7, 5.0). Prospectively, baseline concentrations of several PFASs, including PFOA, PFOS, PFHxS and PFNA, predicted higher risks of incident hypercholesterolemia and hypertriglyceridemia, but only in the placebo group and not the lifestyle intervention group. For example, participants in the placebo group with PFOA concentration > median (4.9 ng/mL) were almost twice as likely (HR: 1.90, 95% CI: 1.25, 2.88) to develop hypertriglyceridemia compared to those ≤median. Findings suggest adverse effects of some PFASs on lipid profiles in prediabetic adults. However, the detrimental effect was attenuated with a lifestyle intervention.

12.
Epigenetics ; 14(10): 961-976, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31156022

RESUMO

Aging is associated with progressive and site-specific changes in DNA methylation (DNAm). These global changes are captured by DNAm clocks that accurately predict chronological age in humans but relatively little is known about how clocks perform in vitro. Here we culture primary human fibroblasts across the cellular lifespan (~6 months) and use four different DNAm clocks to show that age-related DNAm signatures are conserved and accelerated in vitro. The Skin & Blood clock shows the best linear correlation with chronological time (r = 0.90), including during replicative senescence. Although similar in nature, the rate of epigenetic aging is approximately 62x times faster in cultured cells than in the human body. Consistent with in vivo data, cells aged under hyperglycemic conditions exhibit an approximately three years elevation in baseline DNAm age. Moreover, candidate gene-based analyses further corroborate the conserved but accelerated biological aging process in cultured fibroblasts. Fibroblasts mirror the established DNAm topology of the age-related ELOVL2 gene in human blood and the rapid hypermethylation of its promoter cg16867657, which correlates with a linear decrease in ELOVL2 mRNA levels across the lifespan. Using generalized additive modeling on twelve timepoints across the lifespan, we also show how single CpGs exhibit loci-specific, linear and nonlinear trajectories that reach rates up to -47% (hypomethylation) to +23% (hypermethylation) per month. Together, these high-temporal resolution global, gene-specific, and single CpG data highlight the conserved and accelerated nature of epigenetic aging in cultured fibroblasts, which may constitute a system to evaluate age-modifying interventions across the lifespan.

13.
Clin Oral Investig ; 2019 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-31190231

RESUMO

OBJECTIVES: The aim of this study was to investigate the effects of collagen cross-linking agents on nanomechanical and bonding properties of eroded dentin (ED), 24 h and 2 years after water storage. MATERIALS AND METHODS: Human molar dentin surfaces, eroded by soft drinks or citric acid, were acid-etched and treated with primers containing proanthocyanidin (PA) and riboflavin (RI) or were untreated (control) and tested after 24 h and 2 years. After acid etching and adhesive application (Prime&Bond Elect (PBE); Scotchbond Universal (SBU); Tetric n-bond Universal (TEU)), specimens were sectioned into beams and tested for microtensile bond strength (µTBS) and silver nitrate deposition (NL) after 24 h and 2 years. The beams were used to evaluate the 24-h in situ conversion of degree (DC). Nanohardness (NH) and Young's modulus (YM) were evaluated via resin-bonded dentin slices after 24 h and 2 years. A three-way ANOVA and Tukey's test were used for statistical analysis (5%). RESULTS: For both storage times, ED with citric acid resulted in lower µTBS, NH, and YM and higher NL for each adhesive system than soft drink ED (p < 0.05). After 2 years of water storage, cross-linking primers maintained the µTBS, NH, and YM (p < 0.05) when compared with the control group. Althougth, the NL values decreased for all groups after 2 years of water storage, PA and RI treatments showed NI values lower than control group (p < 0.001). No significant differences were observed between PA and RI treatments (p > 0.05). Cross-linking primers maintain or improve DC (p < 0.03). In general, TEU and SBU yielded higher µTBS, DC, NH, and YM and lower NL than PBE. CONCLUSION: Cross-linking agents improved the results and maintained the resin-ED interface bonding and nanomechanical properties, without jeopardizing adhesive polymerization. CLINICAL RELEVANCE: Cross-linking agents are a viable alternative for improving and maintaining resin-ED interface bonding and nanomechanical properties.

14.
Braz Dent J ; 30(2): 171-178, 2019 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30970061

RESUMO

To evaluate the effect of combining 5% hydrofluoric acid (HF) and silane (SI) with the self-etching ceramic primer on the immediate and after 1-year of water storage on bonding efficacy, conditioning pattern (CP) and chemical interaction (CI) to the lithium disilicate. A total of 16 CAD/CAM blocks of lithium disilicate (LD) were cut into four square sections (n=64). For bonding efficacy evaluation, the LD specimens were divided into 4 groups (n=10): 1) HF+SI; 2) self-etching ceramic primer (MEP); 3) HF+MEP; 4) MEP+SI. After each treatment, an adhesive system was applied and Tygon matrices were filled with a dual-cured resin cement followed by light curing. Cylinder specimens (0.8 mmx0.5mm) were stored in water (37 °C for 24 h or 1-year) and submitted to the µSBS test (2-way ANOVA and Tukey's test; a=0.05). CP and CI were only evaluated qualitatively. No significant difference on the µSBS was observed between groups (p=0.73), but reduced µSBS was observed after 1-year of water storage (p>0.0001). After application of HF+SI and MEP, reduction in a number of siloxane bonds was observed, suggesting the coupling of SI on the LD surface. HF or HF+MEP produced a higher dissolution of the glassy matrix than the use of MEP alone. The MEP can be an alternative to traditional ceramic treatment once the chemical interaction and long-term bond strength were similar between both groups. The association of hydrofluoric acid or silane with a self-etching ceramic primer did not add any benefits in terms of chemical interaction and bonding stability.

15.
J Adhes Dent ; 21(2): 149-158, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30949628

RESUMO

PURPOSE: To evaluate the effect of two phosphoric acids containing protease inactivators (chlorhexidine and proanthocyanidin) on the resin/eroded-dentin microtensile bond strength (µTBS), nanoleakage (NL), and in situ degree of conversion (DC) of three universal adhesives applied in the etch-and-rinse mode. MATERIALS AND METHODS: One hundred twenty-six molars were randomly assigned to 18 experimental conditions according to the combination of the independent variables: eroded dentin (soft drink and citric acid), adhesive (Prime&Bond Elect [PBE, Dentsply Sirona], Scotchbond Universal Adhesive [SBU, 3M Oral Care], and Tetric N-Bond Universal [TEU, Ivoclar Vivadent]), and acid pretreatment (conventional phosphoric acid [CP acid]; chlorhexidine acid [CHX acid]; and proanthocyanidin acid [PA acid]). After restorations, specimens were sectioned into resin-dentin sticks (ca 0.8 mm2) that were then tested under tension (crosshead speed: 0.5 mm/min). Selected sticks from each tooth were used to evaluate NL and DC. Data from all tests were subjected to three-way ANOVA and Tukey's test (α=0.05). RESULTS: Dentin eroded with citric acid showed a significant reduction in µTBS for each adhesive in comparison to dentin eroded with the soft drink (p < 0.001). For dentin eroded with CHX acid and PA acid, the µTBS (p > 0.03) significantly improved and NL decreased for all adhesives (p < 0.004); in addition, the DC improved for two of the three adhesives tested (SBU and TEU) (p < 0.03) when CHX acid and PA acid were compared to CP acid. CONCLUSION: The addition of chlorhexidine and proanthocyanidin to phosphoric acid improved the adhesive performance when compared with conventional phosphoric acid, without jeopardizing adhesive polymerization at the resin/eroded-dentin interface.

16.
Braz. dent. j ; 30(2): 171-178, Mar.-Apr. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1001436

RESUMO

Abstract To evaluate the effect of combining 5% hydrofluoric acid (HF) and silane (SI) with the self-etching ceramic primer on the immediate and after 1-year of water storage on bonding efficacy, conditioning pattern (CP) and chemical interaction (CI) to the lithium disilicate. A total of 16 CAD/CAM blocks of lithium disilicate (LD) were cut into four square sections (n=64). For bonding efficacy evaluation, the LD specimens were divided into 4 groups (n=10): 1) HF+SI; 2) self-etching ceramic primer (MEP); 3) HF+MEP; 4) MEP+SI. After each treatment, an adhesive system was applied and Tygon matrices were filled with a dual-cured resin cement followed by light curing. Cylinder specimens (0.8 mmx0.5mm) were stored in water (37 °C for 24 h or 1-year) and submitted to the μSBS test (2-way ANOVA and Tukey's test; a=0.05). CP and CI were only evaluated qualitatively. No significant difference on the μSBS was observed between groups (p=0.73), but reduced μSBS was observed after 1-year of water storage (p>0.0001). After application of HF+SI and MEP, reduction in a number of siloxane bonds was observed, suggesting the coupling of SI on the LD surface. HF or HF+MEP produced a higher dissolution of the glassy matrix than the use of MEP alone. The MEP can be an alternative to traditional ceramic treatment once the chemical interaction and long-term bond strength were similar between both groups. The association of hydrofluoric acid or silane with a self-etching ceramic primer did not add any benefits in terms of chemical interaction and bonding stability.


Resumo Avaliar o efeito da combinação de ácido fluorídrico ou silano com o primer autocondicionante de cerâmicas sobre a eficácia da união imediata e após 1 ano de armazenamento em água, padrão de condicionamento e interação química desses tratamentos com o dissilicato de lítio. Um total de 16 blocos CAD/CAM de dissilicato de lítio (DL) foram cortados em quatro seções quadradas (n=64). Os espécimes de DL foram divididos em 4 grupos: 1) ácido fluorídrico a 5% + silano (HF + SI); 2) primer autocondicionante de cerâmica (MEP); 3) HF + MEP; 4) MPE + SI. Após cada tratamento, o sistema adesivo foi aplicado e as matrizes Tygon foram preenchidas com cimento resinoso dual (Variolink® II), seguido de fotopolimerização. Espécimes em forma de cilindro (0.8 mmÆ x 0.5 mm), foram armazenados em água (37 °C por 24h ou 1 ano) e submetidos ao teste μSBS (ANOVA dois fatores e teste de Tukey; a=0,05). Para avaliação das interações químicas por Espectroscopia Raman, os espécimes de DL foram divididos em 3 grupos (n=4): 1) sem tratamento (DL); 2) HF + SI; e 3) MEP. Para avaliação do padrão de condicionamento da superfície cerâmica após os tratamentos por MEV, os espécimes de DL foram divididos em 3 grupos (n=3): 1) DL; 2) HF; 3) MEP; e 4) HF + MEP. Ambos os métodos foram avaliados apenas qualitativamente. Não foi observada diferença significativa na μSBS imediata entre os grupos (p=0,73), mas após 1 ano de armazenamento das amostras em água, reduziu μSBS (p>0,0001). HF ou HF + MEP produziram uma maior dissolução da matriz vítrea do que o uso de MEP sozinho. Após a aplicação de SI e MEP, observou-se redução de ligações de siloxano, sugerindo o acoplamento da camada de silano na superfície do DL. O primer autocondicionante cerâmico pode ser uma alternativa ao tratamento cerâmico tradicional, uma vez que a interação química e a resistência de união a longo prazo, quando comparada ao tratamento tradicional foram estatisticamente semelhantes. A associação de ácido fluorídrico ou agente de acoplamento silano com um primer autocondicionante de cerâmicas não agregou nenhum benefício em termos de interação química e estabilidade.

18.
Liver Transpl ; 25(5): 797-806, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30861294

RESUMO

On August 10, 2017, a formal policy was enacted in the United States that defined listing criteria for simultaneous liver-kidney transplantation and priority for patients who received a liver transplantation (LT) and subsequently developed significant kidney disease after LT. This article reviews and summarizes the rationale for such policies, the policies themselves, and the potential impact on LT candidates.

19.
Semin Liver Dis ; 39(2): 178-194, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30912098

RESUMO

Failure to control variceal bleeding with current recommendations occurs in 10 to 20% of cases. This systematic review and meta-analysis analyzes the experience, results, and complications of "bridge" therapies for failure to control acute variceal bleeding: balloon tamponade and esophageal stents. The main outcomes assessed were failure to control bleeding and mortality in the short-term and medium-term follow-up, and adverse events. Balloon tamponade studies had a pooled rate of short-term failure to control bleeding of 35.5%, and adverse events in over 20% of cases; 9.7% resulting in death. Stenting failed to control bleeding in the short term and medium term in 12.7 and 21.5% of cases of severe or refractory variceal bleeding, respectively, despite stent migration in 23.8% of cases. Medium-term mortality rates were similar in both therapies. Although only one trial compared these treatments, the available evidence consistently supports that stents serve as a better and safer bridge therapy in refractory acute variceal bleeding.

20.
Clin Epigenetics ; 11(1): 56, 2019 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-30925934

RESUMO

BACKGROUND: Maternal mood disorders and their treatment during pregnancy may have effects on the offspring epigenome. We aim to evaluate associations of maternal prenatal antidepressant use, anxiety, and depression with cord blood DNA methylation across the genome at birth and test for persistence of associations in early and mid-childhood blood DNA. METHODS: A discovery phase was conducted in Project Viva, a prospective pre-birth cohort study with external replication in an independent cohort, the Generation R Study. In Project Viva, pregnant women were recruited between 1999 and 2002 in Eastern Massachusetts, USA. In the Generation R Study, pregnant women were recruited between 2002 and 2006 in Rotterdam, the Netherlands. In Project Viva, 479 infants had data on maternal antidepressant use, anxiety, depression, and cord blood DNA methylation, 120 children had DNA methylation measured in early childhood (~ 3 years), and 460 in mid-childhood (~ 7 years). In the Generation R Study, 999 infants had data on maternal antidepressants and cord blood DNA methylation. The prenatal antidepressant prescription was obtained from medical records. At-mid pregnancy, symptoms of anxiety and depression were assessed with the Pregnancy-Related Anxiety Scale and the Edinburgh Postnatal Depression Scale in Project Viva and with the Brief Symptom Inventory in the Generation R Study. Genome-wide DNA methylation was measured using the Infinium HumanMethylation450 BeadChip in both cohorts. RESULTS: In Project Viva, 2.9% (14/479) pregnant women were prescribed antidepressants, 9.0% (40/445) experienced high pregnancy-related anxiety, and 8.2% (33/402) reported symptoms consistent with depression. Newborns exposed to antidepressants in pregnancy had 7.2% lower DNA methylation (95% CI, - 10.4, - 4.1; P = 1.03 × 10-8) at cg22159528 located in the gene body of ZNF575, and this association replicated in the Generation R Study (ß = - 2.5%; 95% CI - 4.2, - 0.7; P = 0.006). In Project Viva, the association persisted in early (ß = - 6.2%; 95% CI - 10.7, - 1.6) but not mid-childhood. We observed cohort-specific associations for maternal anxiety and depression in Project Viva that did not replicate. CONCLUSIONS: The ZNF575 gene is involved in transcriptional regulation but specific functions are largely unknown. Given the widespread use of antidepressants in pregnancy, as well as the effects of exposure to anxiety and depression, implications of potential fetal epigenetic programming by these risk factors and their impacts on development merit further investigation.

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