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1.
Hautarzt ; 2020 May 12.
Artigo em Alemão | MEDLINE | ID: mdl-32399670

RESUMO

Chronic pruritus (CP) is a highly prevalent, difficult to treat, and burdensome condition. Nowadays, multiple substances are available for the treatment of CP. Systemic therapies play a pivotal role in modern CP therapy, particularly in severe cases and those refractory to general antipruritic measures. Current guidelines recommend the use of a vast array of, mostly off-label, drugs with different mechanisms, including antihistamines, gabapentinoids, antidepressants, immunosuppressive drugs, and µ­opioid receptor antagonists. The choice of the right agent depends on the indication, safety profile of the drug, and patient-specific features, such as comorbidities and comedication. Owing to a deeper understanding of the pathophysiology of CP, novel drugs have been developed and have already shown anti-pruritic efficacy in clinical studies and case reports. Of note, monoclonal antibodies, neurokinin­1 receptor antagonists, Janus kinase inhibitors, and opioid receptor modulators are on the frontline of innovative CP treatment. Other promising targets include structures of the peripheral and central nervous system, e.g., histamine 4 receptors, which are involved in itch signaling. This review provides an overview of currently available systemic therapies for CP and their indications and discusses novel innovative agents and promising new targets in CP.

2.
Artigo em Inglês | MEDLINE | ID: mdl-32078192

RESUMO

BACKGROUND: Chronic nodular prurigo (CNPG) is a condition characterized by chronic itch, a prolonged scratching behaviour and the presence of pruriginous nodules. A comprehensive understanding of this condition, especially regarding its clinical characteristics and impact on quality of life is still lacking. OBJECTIVES: Aim of this pan-European multicentre cross-sectional study was to establish the clinical profile of CNPG, including its associated burden. METHODS: Fifteen centres from 12 European countries recruited CNPG patients presenting at the centre or using the centres' own databases. Patients were asked to complete a questionnaire in paper or electronic format. Demography, current co-morbidities, underlying disease, itch intensity, additional sensory symptoms, quality of life, highest burden and emotional experience of itch were assessed. RESULTS: A total of 509 patients (210 male, median age: 64 years [52; 72]) were enrolled. Of these, 406 reported itch and CNPG lesions in the previous 7 days and qualified to complete the whole questionnaire. We recorded moderate to severe worst itch intensity scores in the previous 24 h. Scores were higher in patients with lower educational levels and those coming from Eastern or Southern Europe. Most patients experience itch often or always (71%) and report that their everyday life is negatively affected (53%). Itch intensity was considered to be the most burdensome aspect of the disease by 49% of the patients, followed by the visibility of skin lesions (21%) and bleeding of lesions (21%). The majority of patients was unaware of an underlying condition contributing to CNPG (64%), while psychiatric diseases were the conditions most often mentioned in association with CNPG (19%). CONCLUSIONS: This multicentre cross-sectional study shows that itch is the dominant symptom in CNPG and reveals that the profile of the disease is similar throughout Europe.

3.
Eur J Nucl Med Mol Imaging ; 47(6): 1468-1475, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31953672

RESUMO

PURPOSE: Imaging glioma biology holds great promise to unravel the complex nature of these tumors. Besides well-established imaging techniques such O-(2-[18F]fluoroethyl)-L-tyrosine (FET)-PET and dynamic susceptibility contrast (DSC) perfusion imaging, amide proton transfer-weighted (APTw) imaging has emerged as a promising novel MR technique. In this study, we aimed to better understand the relation between these imaging biomarkers and how well they capture cellularity and vascularity in newly diagnosed gliomas. METHODS: Preoperative MRI and FET-PET data of 46 patients (31 glioblastoma and 15 lower-grade glioma) were segmented into contrast-enhancing and FLAIR-hyperintense areas. Using established cutoffs, we calculated hot-spot volumes (HSV) and their spatial overlap. We further investigated APTw and CBV values in FET-HSV. In a subset of 10 glioblastoma patients, we compared cellularity and vascularization in 34 stereotactically targeted biopsies with imaging. RESULTS: In glioblastomas, the largest HSV was found for APTw, followed by PET and CBV (p < 0.05). In lower-grade gliomas, APTw-HSV was clearly lower than in glioblastomas. The spatial overlap of HSV was highest between APTw and FET in both tumor entities and regions. APTw correlated significantly with cellularity, similar to FET, while the association with vascularity was more pronounced in CBV and FET. CONCLUSIONS: We found a relevant spatial overlap in glioblastomas between hotspots of APTw and FET both in contrast-enhancing and FLAIR-hyperintense tumor. As suggested by earlier studies, APTw was lower in lower-grade gliomas compared with glioblastomas. APTw meaningfully contributes to biological imaging of gliomas.

4.
J Eur Acad Dermatol Venereol ; 34(1): 202-206, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31419339

RESUMO

BACKGROUND AND OBJECTIVE: Pruritus is a major symptom of many inflammatory diseases and impacts greatly the quality of life in patients. We aimed to specify the characteristics of experimentally induced pruritus in normal skin and in experimentally induced inflammatory dermatitis in healthy volunteers. METHODS: Skin inflammation was induced by the repeated application of sodium lauryl sulphate (SLS 2%) on the volar forearms of 30 healthy volunteers. Inflammatory dermatitis intensity was assessed using the eczema score adapted from Frosch and Kligman. Non-histaminergic pruritus was induced by cowhage spicules rubbed on the volar forearms and recorded for 30 min on a 10-cm visual analogue scale (VAS) in both non-inflamed and inflamed skin. RESULTS: Induction of inflammatory dermatitis by SLS resulted in a mild inflammatory dermatitis with an inflammation score of 2.3 ± 0.1 within 7 days of treatment. Cowhage-induced pruritus was of markedly higher intensity (P < 0.001), and all but two individuals had higher maximum pruritus intensity in inflamed skin as compared to non-inflamed skin, whereas the kinetics of the pruritus response were similar. The quality of cowhage-induced pruritus was significantly different with more 'burning' and 'painful sensations' in inflamed skin (P < 0.01). Maximum pruritus intensity in inflamed skin strongly correlated with maximum pruritus intensity in non-inflamed skin (r = 0.51, P = 0.004). Skin hydration, skin barrier integrity and dermatitis severity did not correlate with pruritus intensity. CONCLUSION: Taken together, pruritus in inflamed skin is perceived as more intense, painful and burning. This may explain, in part, why pruritus is a major driver of quality-of-life impairment in patients with chronic inflammatory skin conditions such as atopic dermatitis.

5.
Br J Dermatol ; 181(5): 877-878, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31674670
6.
AJNR Am J Neuroradiol ; 40(11): 1811-1817, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31649159

RESUMO

BACKGROUND AND PURPOSE: In addition to the 4 histopathologically defined entities of medulloblastoma, 4 distinct genetically defined subgroups have been included in the World Health Organization classification of 2016. The smallest subgroup is the medulloblastoma with activated wingless pathway. The goal of this study was to identify a typical MR imaging morphology in a larger number of pediatric patients with wingless pathway medulloblastoma. MATERIALS AND METHODS: From January 2001 to October 2017, of 75 patients with histologically confirmed and molecularly subgrouped wingless pathway medulloblastomas recruited to the German Pediatric Brain Tumor (HIT) trials, 38 patients (median age, 12.8 ± 4.6 years at diagnosis; 24 [63.2%] female) had preoperative imaging that passed the entry criteria for this study. Images were rated by the local standardized imaging criteria of the National Reference Center of Neuroradiology. Additionally, a modified laterality score was used to determine tumor localization and extension. RESULTS: Twenty-eight of 38 (73.7%) were primary midline tumors but with a lateral tendency in 39.3%. One extensively eccentric midline tumor was rated by the laterality score as in an off-midline position. Five tumors were found in the cerebellopontine angle; 3, in the deep white matter; and 2, in a cerebellar hemisphere. Leptomeningeal dissemination was rare (11.5%). In 60.5%, intratumoral blood-degradation products were found, and 26.3% showed cysts with blood contents. CONCLUSIONS: According to our observations, wingless pathway medulloblastomas are not preferentially off-midline tumors as postulated in previous studies with smaller wingless pathway medulloblastoma cohorts. Dense intratumoral blood-degradation products and cysts with blood contents are frequently found and might help to differentiate wingless pathway medulloblastoma from other medulloblastoma subtypes.

7.
Proc Natl Acad Sci U S A ; 116(41): 20500-20504, 2019 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-31548430

RESUMO

Skin wound infections are a significant health problem, and antibiotic resistance is on the rise. Mast cells (MCs) have been shown to contribute to host-defense responses in certain bacterial infections, but their role in skin wound superinfection is unknown. We subjected 2 MC-deficient mouse strains to Pseudomonas aeruginosa skin wound infection and found significantly delayed wound closure in infected skin wounds. This delay was associated with impaired bacterial clearance in the absence of MCs. Engraftment of MCs restored both bacterial clearance and wound closure. Bacterial killing was dependent on IL-6 released from MCs, and engraftment with IL-6-deficient MCs failed to control wound infection. Treatment with recombinant IL-6 enhanced bacterial killing and resulted in the control of wound infection and normal wound healing in vivo. Taken together, our results demonstrate a defense mechanism for boosting host innate immune responses, namely effects of MC-derived IL-6 on antimicrobial functions of keratinocytes.

8.
Tijdschr Psychiatr ; 61(7): 487-497, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31372970

RESUMO

BACKGROUND: Although the evidence is expanding, in mental health care shared decision making (SDM) is not widely applied. Moreover, little is known about the use of routine outcome monitoring (ROM) and eHealth in SDM.
AIM: PhD research on the added value of SDM using ROM and eHealth for patients and clinicians in mental health care.
METHOD: Three studies: 1. a literature research and a cross-sectional study on decisional conflict; 2. ROM implementation research and a cluster randomised trial on shared decision making using ROM (Breakthrough program); 3. a cluster randomised trial on shared decision making during the intake (regional).
RESULTS: The interventions did not lead to reduced decisional conflict for all patient groups. Decisional conflict gives insight into the patient's perspective on the quality of the decision making process and decisions being made. Only patients with depression, who participated in the national trial, reported less decisional conflict. This trial did not show a higher level of SDM, but did show increased usage of rom in clinical practice. Although the regional trial showed no results on decisional conflict, the application of SDM and treatment outcomes improved.
CONCLUSION: SDM in mental health care needs further improvement. We recommend investigating how to support patients better, taking into account the role that suits them.


Assuntos
Tomada de Decisões , Transtornos Mentais , Humanos , Transtornos Mentais/terapia , Saúde Mental , Participação do Paciente
9.
J Eur Acad Dermatol Venereol ; 33(9): 1755-1761, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31199524

RESUMO

BACKGROUND: In skin diseases and experimental models of pruritus, pure itch is accompanied by additional sensations that are poorly characterized. OBJECTIVES: This study compared the sensory qualities evoked by different models of experimentally induced pruritus including skin prick testing (SPT) with histamine or capsaicin and application of cowhage spicules. SPT as a method of capsaicin application was validated for this purpose. METHODS: Two pilot experiments were performed in eight healthy volunteers. First, a concentration of 8% capsaicin was identified as evoking a reproducible itch using SPT. Further, a list of the seven most frequently reported sensations was chosen after SPT with 10 mg/mL histamine, 8% capsaicin and application of 40-45 cowhage spicules. Finally, 31 subjects were challenged with the same itch-inducers. Wheal and flare were measured at 10, 20, 40, 60 and 90 min, itch intensity every minute for 30 min, and the overall evaluation of sensory descriptors were recorded on a 100-mm visual analogue scale once itching had subsided. RESULTS: Skin prick testing with histamine and capsaicin resulted in flare reactions, which were 23% smaller for capsaicin (P < 0.001). Histamine, capsaicin and cowhage-induced pruritus, the duration of which was shorter for cowhage than for histamine (13.5 ± 1.4 vs. 8.8 ± 1.2 min, P = 0.005). Different mediators induced sensations of different intensities. Capsaicin produced less itch and physical urge to scratch than histamine (P = 0.001) and cowhage (P < 0.001). However, both capsaicin and cowhage induced more burning than histamine (P = 0.002 and P = 0.04, respectively). Provocation with cowhage caused more intense sensations of pricking than histamine (P = 0.033). CONCLUSION: This study shows that provocation with histamine, capsaicin and cowhage results in itch responses that are different in their duration, the profile of accompanying sensations, and the flare that comes with the itch.


Assuntos
Capsaicina/efeitos adversos , Histamina/efeitos adversos , Mucuna/efeitos adversos , Prurido/etiologia , Adulto , Feminino , Voluntários Saudáveis , Humanos , Masculino , Medição da Dor , Testes Cutâneos , Fatores de Tempo
10.
J Neurooncol ; 143(1): 107-113, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30830679

RESUMO

BACKGROUND: Diffuse intrinsic pontine glioma (DIPG) is a devastating cancer of childhood and adolescence. METHODS: The study included patients between 3 and 20 years with clinically and radiologically confirmed DIPG. Primary endpoint was 6-month progression-free survival (PFS) following administration of nimotuzumab in combination with external beam radiotherapy (RT). Nimotuzumab was administered intravenously at 150 mg/m2 weekly for 12 weeks. Radiotherapy at total dose of 54 Gy was delivered between week 3 and week 9. Response was evaluated based on clinical features and MRI findings according to RECIST criteria at week 12. Thereafter, patients continued to receive nimotuzumab every alternate week until disease progression/unmanageable toxicity. Adverse events (AE) were evaluated according to Common Terminology Criteria for Adverse Events (CTC-AE) Version 3.0 (CTC-AE3). RESULTS: All 42 patients received at least one dose of nimotuzumab in outpatient settings. Two patients had partial response (4.8%), 27 had stable disease (64.3%), 10 had progressive disease (23.8%) and 3 patients (7.1%) could not be evaluated. The objective response rate (ORR) was 4.8%. Median PFS was 5.8 months and median overall survival (OS) was 9.4 months. Most common drug-related AEs were alopecia (14.3%), vomiting, headache and radiation skin injury (7.1% each). Therapy-related serious adverse events (SAEs) were intra-tumoral bleeding and acute respiratory failure, which were difficult to distinguish from effects of tumor progression. CONCLUSIONS: Concomitant treatment with RT and nimotuzumab was feasible in an outpatient setting. The PFS and OS were comparable to results achieved with RT and intensive chemotherapy in hospitalized setting.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Neoplasias do Tronco Encefálico/terapia , Quimiorradioterapia , Glioma/terapia , Adolescente , Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Quimiorradioterapia/efeitos adversos , Criança , Pré-Escolar , Progressão da Doença , Feminino , Glioma/diagnóstico por imagem , Humanos , Masculino , Ponte , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
11.
AJNR Am J Neuroradiol ; 40(3): 568-575, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30819765

RESUMO

BACKGROUND AND PURPOSE: HERBY was a Phase II multicenter trial setup to establish the efficacy and safety of adding bevacizumab to radiation therapy and temozolomide in pediatric patients with newly diagnosed non-brain stem high-grade gliomas. This study evaluates the implementation of the radiologic aspects of HERBY. MATERIALS AND METHODS: We analyzed multimodal imaging compliance rates and scan quality for participating sites, adjudication rates and reading times for the central review process, the influence of different Response Assessment in Neuro-Oncology criteria in the final response, the incidence of pseudoprogression, and the benefit of incorporating multimodal imaging into the decision process. RESULTS: Multimodal imaging compliance rates were the following: diffusion, 82%; perfusion, 60%; and spectroscopy, 48%. Neuroradiologists' responses differed for 50% of scans, requiring adjudication, with a total average reading time per patient of approximately 3 hours. Pseudoprogression occurred in 10/116 (9%) cases, 8 in the radiation therapy/temozolomide arm and 2 in the bevacizumab arm (P < .01). Increased target enhancing lesion diameter was a reason for progression in 8/86 cases (9.3%) but never the only radiologic or clinical reason. Event-free survival was predicted earlier in 5/86 (5.8%) patients by multimodal imaging (diffusion, n = 4; perfusion, n = 1). CONCLUSIONS: The addition of multimodal imaging to the response criteria modified the assessment in a small number of cases, determining progression earlier than structural imaging alone. Increased target lesion diameter, accounting for a large proportion of reading time, was never the only reason to designate disease progression.

12.
J Eur Acad Dermatol Venereol ; 33(2): 263-266, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30288812

RESUMO

BACKGROUND: Chronic prurigo (CPG) is a distinct disease characterized by chronic pruritus, history and/or signs of prolonged scratching and multiple pruriginous lesions. It may present with various clinical manifestations, including papules, nodules, plaques or umbilicated lesions. Some patients with chronic pruritus show pruriginous linear and scaring scratch lesions (LSSL) and it is unclear whether these lesions belong to the spectrum of CPG. OBJECTIVE: To achieve a consensus on the classification of pruriginous LSSL and establish criteria to differentiate them from similar appearing conditions of different nature. METHODS: Members of the Task Force Pruritus (TFP) of the European Academy of Dermatology and Venereology participated in the consensus conference, discussing representative clinical cases. Using the Delphi method, consensus was reached when ≥75% of members agreed on a statement. RESULTS: Twenty-one members of the TFP with voting rights participated in the meeting. It was consented that LSSL occurs due to chronic pruritus and prolonged scratching, and share common pathophysiological mechanisms with CPG. LSSL were thus considered as belonging to the spectrum of CPG and the term 'linear prurigo' was chosen to describe this manifestation. CONCLUSION: Considering linear prurigo as belonging to the spectrum of CPG has important clinical implications, since both the diagnostic and therapeutic approach of these patients should be performed as recommended for CPG. Importantly, linear prurigo should be differentiated from self-inflicted skin lesions as factitious disorders or skin picking syndromes. In the latter, artificial manipulation rather than pruritus itself leads to the development of cutaneous lesions, which can show clinical similarities to linear prurigo.


Assuntos
Guias de Prática Clínica como Assunto , Prurigo/classificação , Doença Crônica , Consenso , Fármacos Dermatológicos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Prurigo/tratamento farmacológico , Prurigo/patologia , Prurido/classificação , Prurido/tratamento farmacológico , Prurido/patologia
13.
Tijdschr Psychiatr ; 60(6): 397-402, 2018.
Artigo em Holandês | MEDLINE | ID: mdl-29943797

RESUMO

BACKGROUND: The increased attention for shared decision making (sdm) in mental health care creates a need to evaluate its application. The construct decisional conflict, which refers to the satisfaction of patients regarding both the decision making process and the decisions made, could be of added value.
AIM: Clarifying decisional conflict and reflecting on its feasibility to evaluate sdm in mental health care.
METHOD: A literature study exploring the construct of decisional conflict was conducted, followed by a translation of the results into a visual model.
RESULTS: Decisional conflict is a multi-dimensional construct and consists of factors influencing the decision making process (information, support, values clarity), level of uncertainty concerning the options and the quality of the decision making. Decisional conflict can be illustrated by using a model and assessed with the Decisional Conflict Scale.
CONCLUSION: Decisional conflict is informative and useful in the evaluation of the application of sdm and improvement of the quality of the decision making in mental health care as well. This is of importance since patients who experienced less decisional conflict are more engaged in treatment and show better clinical outcomes.


Assuntos
Tomada de Decisões , Transtornos Mentais/psicologia , Participação do Paciente , Técnicas de Apoio para a Decisão , Humanos , Pais/psicologia
14.
Hautarzt ; 69(8): 641-646, 2018 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-29931387

RESUMO

Chronic pruritus is one of the most common and stressful symptoms in medicine. Therapy remains a great challenge because of the lack of approved therapies. In the recent past a greater understanding of the pathogenesis has enabled the results to be translated into new forms of therapy. The various therapies target a wide range of points in the pruritic cascade-from blockade of intracellular and intercellular signaling pathways in the skin to the modulation of neurotransmission. This article provides a summary of current therapeutic options based on the current S2K guideline and gives an overview about recent developments in antipruritic treatments.


Assuntos
Antipruriginosos , Prurido , Doença Crônica , Humanos , Prurido/terapia , Pele
16.
Eur J Dent Educ ; 22(3): e573-e581, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29665243

RESUMO

PURPOSE: This research aimed to evaluate the students' usage and perceptions of using smartphones in their general dental education and learning tooth preparation with the individually designed virtual 3D instructional models in the pre-clinical removable partial denture course. MATERIALS AND METHODS: Second-year dental students were asked to voluntarily participate in a survey to investigate their demographic information, general usages of smartphones, perception of smartphones usage in dental education (construct 1) and perception of individually designed virtual 3D instructional models (construct 2). Students' responses of general usages of the smartphones were compared with their demographic and educational backgrounds using nonparametric Kruskal-Wallis test (for age) and Fisher's exact test (for sex, race and educational background). The sums of scores of the construct 1 and construct 2 were tested for associations with student's demographic and educational backgrounds using the Pearson product-moment correlation (for age), t test (for sex and educational background) or one-way ANOVA F test (for race) (α = .05). RESULTS: A 75% response rate (N = 90) was achieved in this study, and all 90 participants owned smartphones. Students' responses to general usages of the smartphones were not significantly influenced by their demographic background. For the construct 1, more than 73% of participants responded either agree or strongly agree to the usage of smartphones in general dental education and pre-clinical setting; however, only 49% of participants responded the same way in the clinical setting. For the construct 2, 48 of 90 participants viewed the 3D models, and more than 73% of these 48 participants responded either agree or strongly agree to the usage of the 3D models in the pre-clinical course. Student's demographic background did not have significant influence on the sums of scores of the construct 1 and construct 2. CONCLUSIONS: Within the limitations of this study, high usages and ownerships of smartphones were found amongst the students surveyed. The individually designed virtual 3D instructional models as supplemental teaching materials in the pre-clinical course were perceived positively by the students.


Assuntos
Educação em Odontologia/métodos , Educação em Odontologia/estatística & dados numéricos , Modelos Anatômicos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Smartphone/estatística & dados numéricos , Estudantes de Odontologia/estatística & dados numéricos , Materiais de Ensino , Preparo do Dente , Realidade Virtual , Prótese Parcial Removível , Feminino , Humanos , Masculino , Inquéritos e Questionários
17.
Oper Dent ; 43(2): E72-E80, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29504878

RESUMO

The purpose of this study was to evaluate the push-out bond strength of two different adhesive cements (total etch and self-adhesive) for glass fiber post (GFP) cementation in simulated, long-term service (thermocycling) when the root canal is treated with chlorhexidine before cementation. One hundred twenty premolar specimens with a single root canal were selected, endodontically treated, and shaped for GFP cementation (n=120). The specimens were randomly placed into one of 12 groups (10 specimens each) according to cement (T = total-etch RelyX ARC or S = self-adhesive RelyX Unicem), treatment with chlorhexidine (N or Y: without or with), and number of thermal cycles (00, 20, or 40: 0, or 20,000 or 40,000 cycles): 1. TN00, 2. TN20, 3. TN40, 4. TY00, 5. TY20, 6. TY40, 7. SN00, 8. SN20, 9. SN40, 10. SY00, 11. SY20, 12. SY40. The root of each specimen was cut perpendicular to the vertical axis, yielding six 1.0 mm-thick sections. A push-out bond strength test was performed followed by statistical analysis using a factorial analysis of variance. Pairwise comparisons of significant factor interactions were adjusted using the Tukey test. Significant differences of push-out bond strengths were found in the four main effects (resin cement [ p<0.0001], treatment with chlorhexidine [ p<0.0001], number of cycles [ p<0.0001], and root third [ p<0.0001]) and all interactions ( p<0.05 for all). Both resin cements produced higher bond strength in the cervical third followed by the middle third, and lower values were detected in the apical third. Additionally, the results suggest that the use of an additional disinfection treatment with chlorhexidine before the cement application produced the highest push-out bond strength regardless of root third. Further, the thermocycling simulation decreased the bond strength for both resin cements long-term when the chlorhexidine was not applied before cementation. However, when the root canal was treated with chlorhexidine and the fiber post was cemented with self-adhesive cement, the bond strength increased after 0, 20,000 and 40,000 cycles.


Assuntos
Cimentação/métodos , Clorexidina/química , Técnica para Retentor Intrarradicular/instrumentação , Cimentos de Resina/química , Dente Pré-Molar , Bis-Fenol A-Glicidil Metacrilato , Materiais Dentários/química , Análise do Estresse Dentário , Vidro , Humanos , Técnicas In Vitro , Teste de Materiais , Polietilenoglicóis , Ácidos Polimetacrílicos
19.
Allergy ; 73(7): 1393-1414, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29336054

RESUMO

This evidence- and consensus-based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on 1 December 2016. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-founded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF) and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life and affect performance at work and school. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.


Assuntos
Urticária/diagnóstico , Urticária/terapia , Gerenciamento Clínico , Europa (Continente) , Necessidades e Demandas de Serviços de Saúde , Humanos , Pesquisa , Urticária/etiologia
20.
J Eur Acad Dermatol Venereol ; 32(7): 1059-1065, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28857299

RESUMO

BACKGROUND: The term prurigo has been used for many decades in dermatology without clear definition, and currently used terminology of prurigo is inconsistent and confusing. Especially, itch-related prurigo remains unexplored regarding the epidemiology, clinical profile, natural course, underlying causes, available treatments and economic burden, although burdensome and difficult to treat. OBJECTIVE: To address these issues, the multicentre European Prurigo Project (EPP) was designed to increase knowledge on chronic prurigo (CPG). In the first step, European experts of the EADV Task Force Pruritus (TFP) aimed to achieve a consensus on the definition, classification and terminology of CPG. Additionally, procedures of the cross-sectional EPP were discussed and agreed upon. METHODS: Discussions and surveys between members of the TFP served as basis for a consensus conference. Using the Delphi method, consensus was defined as an agreement ≥75% among the present members. RESULTS: Twenty-four members of the TFP participated in the consensus conference. Experts consented that CPG should be used as an umbrella term for the range of clinical manifestations (e.g. papular, nodular, plaque or umbilicated types). CPG is considered a distinct disease defined by the presence of chronic pruritus for ≥6 weeks, history and/or signs of repeated scratching and multiple localized/generalized pruriginous skin lesions (whitish or pink papules, nodules and/or plaques). CPG occurs due to a neuronal sensitization to itch and the development of an itch-scratch cycle. CONCLUSION: This new definition and terminology of CPG should be implemented in dermatology to harmonize communication in the clinical routine, clinical trials and scientific literature. Acute/subacute forms of prurigo are separated entities, which need to be differentiated from CPG and will be discussed in a next step. In the near future, the cross-sectional EPP will provide relevant clinical data on various aspects of CPG leading to new directions in the scientific investigation of CGP.


Assuntos
Prurigo/classificação , Terminologia como Assunto , Doença Crônica , Consenso , Técnica Delfos , Humanos
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