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1.
J Formos Med Assoc ; 120(1 Pt 2): 476-482, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32600866

RESUMO

BACKGROUND/PURPOSE: Mineral trioxide aggregate (MTA) was widely used in endodontic therapy as bioceramic material. Although MTA has high biocompatibility, it may lead to tooth discoloration. The aim of this study was to investigate the discoloration of two different bioceramic materials and the effects of internal bleaching. METHODS: Thirty single-canal mandibular premolars were extracted and randomly assigned to three groups (n = 10), white ProRoot® MTA, SavDen® MTA and a control group. Endodontic access opening, cleaning and shaping were performed, then the teeth were obturated using the two bioceramic materials. Tooth color was recorded at baseline, day 1, and 1, 2, 4, 6, 8, 12, 16, and 24 weeks after treatment. At the end of 24 weeks, sodium perborate was used to perform internal bleaching. Tooth color was recorded at 1, 2, and 6 weeks subsequently. Teeth were measured using a DeguDent® spectrophotometer, and data were transformed into Commission Internationale de l'Eclairage (CIE) L∗a∗b∗ system. RESULTS: Teeth treated with white ProRoot® MTA showed significant color change and decrease in L∗ value. Internal bleaching leaded to decrease of the ΔE∗ value for all three groups and increase in the L∗ value. There was no difference in tooth discoloration between SavDen® MTA and the control group after obturation and internal bleaching. CONCLUSION: In terms of visual perception, white ProRoot® MTA tends to cause black and blue discoloration. SavDen® MTA, formulated with calcium lactate gluconate, could be used to reduce tooth discoloration in endodontic treatment.


Assuntos
Materiais Restauradores do Canal Radicular , Descoloração de Dente , Compostos de Alumínio/efeitos adversos , Clareadores , Compostos de Cálcio/efeitos adversos , Combinação de Medicamentos , Humanos , Óxidos/efeitos adversos , Materiais Restauradores do Canal Radicular/efeitos adversos , Silicatos/efeitos adversos , Descoloração de Dente/induzido quimicamente
2.
J Endod ; 46(12): 1913-1919, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32949559

RESUMO

INTRODUCTION: New tricalcium silicate cements have been shown to induce less coronal discoloration. The purpose of this in vitro study was to evaluate the degree of color change induced by various silicate materials in the presence and absence of blood. METHODS: One hundred human extracted anterior single-canal teeth were sectioned to standardized root lengths, accessed, and instrumented. Eight random experimental groups and 2 control groups were created wherein specimens were filled with experimental materials below the buccal cementoenamel junction as follows: EndoSequence RRM putty (Brasseler USA, Savannah, GA), EndoSequence RRM fast set putty (Brasseler USA), Biodentine (Septodont, Saint-Maur-des-Fossés, France), and white mineral trioxide aggregate (Dentsply Sirona, York, PA) either with the presence or absence of blood. Blood-only and saline-only samples were used for the positive and negative controls. After incubation in 100% humidity at 37°C, color changes were evaluated with a spectrophotometer (Ocean Optics, Dunedin, FL) on days 0, 30, 60, and 180 after material placement. Data were transformed into Commission International de I'Eclairage's L∗a∗b color values, and corresponding ΔE values were calculated. The 1-way analysis of variance test was performed for statistical analysis. RESULTS: Discoloration was observed in all specimens in the presence of blood. There was no statistical significance when comparing different materials in contact with blood. Intragroup observation at various time points, Biodentine, and EndoSequence RRM fast set putty showed significant difference between the presence and absence of blood at 180 days (P < .05). CONCLUSIONS: Contamination with blood of tricalcium silicate materials has the potential to cause coronal tooth discoloration.


Assuntos
Materiais Restauradores do Canal Radicular , Descoloração de Dente , Dente , Compostos de Alumínio , Compostos de Cálcio/efeitos adversos , Combinação de Medicamentos , França , Humanos , Óxidos , Materiais Restauradores do Canal Radicular/efeitos adversos , Silicatos/efeitos adversos , Descoloração de Dente/induzido quimicamente
3.
Ann Hematol ; 99(8): 1793-1804, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32613281

RESUMO

The phase 3, double-blind, placebo-controlled TOURMALINE-MM3 study (NCT02181413) demonstrated improved progression-free survival with ixazomib maintenance versus placebo post autologous stem cell transplant (ASCT) in multiple myeloma patients. We report additional safety data from TOURMALINE-MM3 to inform adverse event (AE) management recommendations. Patients were randomized 3:2 to receive ixazomib (n = 395) or placebo (n = 261) on days 1, 8, and 15 of 28-day cycles for ~ 2 years or until progressive disease/toxicity. The initial 3-mg ixazomib dose was escalated to 4 mg in cycle 5, if tolerated in cycles 1-4. Safety was a secondary endpoint assessed in all treated patients; AEs were graded using Common Terminology Criteria for AEs v4.03. The rate of grade ≥ 3 AEs was higher in the ixazomib arm (19%) than in the placebo arm (5%), but the rate of discontinuation due to AEs was similar (7% vs. 5%). For AEs of clinical interest, rates were higher with ixazomib versus placebo: nausea 39% versus 15%, vomiting 27% versus 11%, diarrhea 35% versus 24%, thrombocytopenia 13% versus 3%, and peripheral neuropathy 19% versus 15%. However, the majority of events were low-grade, manageable with supportive therapy or dose reduction, and reversible, and did not result in discontinuation. There was no evidence of cumulative, long-term, or late-onset toxicity with ixazomib maintenance. Ixazomib is an efficacious and tolerable option for post-ASCT maintenance. AEs associated with ixazomib maintenance can be managed in the context of routine post-ASCT supportive care due to the limited additional toxicity. ClinicalTrials.gov NCT02181413.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Mieloma Múltiplo , Transplante de Células-Tronco , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Autoenxertos , Compostos de Boro/administração & dosagem , Compostos de Boro/efeitos adversos , Intervalo Livre de Doença , Feminino , Seguimentos , Glicina/administração & dosagem , Glicina/efeitos adversos , Glicina/análogos & derivados , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/mortalidade , Mieloma Múltiplo/terapia , Silicatos/administração & dosagem , Silicatos/efeitos adversos , Taxa de Sobrevida
4.
BMC Oral Health ; 20(1): 163, 2020 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493290

RESUMO

BACKGROUND: To evaluate tooth discoloration by newly developed calcium silicate-based materials, and to examine the pre-application of dentin bonding agent (DBA) for preventing discoloration caused by mineral trioxide aggregate (MTA). METHODS: The roots of 50 premolars were randomly divided into five groups (n = 10) and cavities were prepared from resected root surfaces. MTA was placed in the cavities of teeth belonging to the ProRoot MTA (MTA) and RetroMTA (RMTA) groups. For teeth belonging to the ProRoot + DBA (MTA-B) and RetroMTA + DBA (RMTA-B) groups, DBA was first applied to the cavities prior to the addition of MTA. Teeth in the control group were restored with composite resin only (i.e., without MTA). After 12 weeks, MTA was removed from the MTA and RMTA groups and bleaching agents were applied for 3 additional weeks. Color assessments were recorded at baseline, and 1, 4, and 12 weeks, as well as after bleaching. A one-way ANOVA was performed to assess the differences between the two types of MTAs and color changes following DBA pre-application in each MTA group. A p-value of < 0.05 was considered indicative of statistical significance. RESULTS: Following 12 weeks of MTA treatment, there was a significant difference between the discoloration in the MTA and RMTA groups (p < 0.05). However, no significant difference was observed between the RMTA and RMTA-B groups (p > 0.05). Following bleaching, the color changes (ΔE values) of the MTA group were not significantly different from those of the MTA-B group (p > 0.05). The difference of ΔE between the RMTA group after internal bleaching and the RMTA-B group was also not significant (p > 0.05). CONCLUSIONS: RetroMTA caused significantly less discoloration than ProRoot MTA. Pre-application of DBA reduced discoloration caused by ProRoot MTA. MTA discoloration was improved equally well between DBA pre-application and post-bleaching.


Assuntos
Compostos de Alumínio/efeitos adversos , Compostos de Cálcio/efeitos adversos , Óxidos/farmacologia , Silicatos/efeitos adversos , Descoloração de Dente/prevenção & controle , Compostos de Alumínio/farmacologia , Compostos de Cálcio/farmacologia , Dentina/efeitos dos fármacos , Adesivos Dentinários/efeitos adversos , Combinação de Medicamentos , Humanos , Óxidos/efeitos adversos , Silicatos/farmacologia , Descoloração de Dente/induzido quimicamente
5.
Cochrane Database Syst Rev ; 6: CD013165, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32588430

RESUMO

BACKGROUND: Hyperkalaemia is a common electrolyte abnormality caused by reduced renal potassium excretion in patients with chronic kidney diseases (CKD). Potassium binders, such as sodium polystyrene sulfonate and calcium polystyrene sulfonate, are widely used but may lead to constipation and other adverse gastrointestinal (GI) symptoms, reducing their tolerability. Patiromer and sodium zirconium cyclosilicate are newer ion exchange resins for treatment of hyperkalaemia which may cause fewer GI side-effects. Although more recent studies are focusing on clinically-relevant endpoints such as cardiac complications or death, the evidence on safety is still limited. Given the recent expansion in the available treatment options, it is appropriate to review the evidence of effectiveness and tolerability of all potassium exchange resins among people with CKD, with the aim to provide guidance to consumers, practitioners, and policy-makers. OBJECTIVES: To assess the benefits and harms of potassium binders for treating chronic hyperkalaemia among adults and children with CKD. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 10 March 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-randomised controlled studies (quasi-RCTs) evaluating potassium binders for chronic hyperkalaemia administered in adults and children with CKD. DATA COLLECTION AND ANALYSIS: Two authors independently assessed risks of bias and extracted data. Treatment estimates were summarised by random effects meta-analysis and expressed as relative risk (RR) or mean difference (MD), with 95% confidence interval (CI). Evidence certainty was assessed using GRADE processes. MAIN RESULTS: Fifteen studies, randomising 1849 adult participants were eligible for inclusion. Twelve studies involved participants with CKD (stages 1 to 5) not requiring dialysis and three studies were among participants treated with haemodialysis. Potassium binders included calcium polystyrene sulfonate, sodium polystyrene sulfonate, patiromer, and sodium zirconium cyclosilicate. A range of routes, doses, and timing of drug administration were used. Study duration varied from 12 hours to 52 weeks (median 4 weeks). Three were cross-over studies. The mean study age ranged from 53.1 years to 73 years. No studies evaluated treatment in children. Some studies had methodological domains that were at high or unclear risks of bias, leading to low certainty in the results. Studies were not designed to measure treatment effects on cardiac arrhythmias or major GI symptoms. Ten studies (1367 randomised participants) compared a potassium binder to placebo. The certainty of the evidence was low for all outcomes. We categorised treatments in newer agents (patiromer or sodium zirconium cyclosilicate) and older agents (calcium polystyrene sulfonate and sodium polystyrene sulfonate). Patiromer or sodium zirconium cyclosilicate may make little or no difference to death (any cause) (4 studies, 688 participants: RR 0.69, 95% CI 0.11, 4.32; I2 = 0%; low certainty evidence) in CKD. The treatment effect of older potassium binders on death (any cause) was unknown. One cardiovascular death was reported with potassium binder in one study, showing that there was no difference between patiromer or sodium zirconium cyclosilicate and placebo for cardiovascular death in CKD and HD. There was no evidence of a difference between patiromer or sodium zirconium cyclosilicate and placebo for health-related quality of life (HRQoL) at the end of treatment (one study) in CKD or HD. Potassium binders had uncertain effects on nausea (3 studies, 229 participants: RR 2.10, 95% CI 0.65, 6.78; I2 = 0%; low certainty evidence), diarrhoea (5 studies, 720 participants: RR 0.84, 95% CI 0.47, 1.48; I2 = 0%; low certainty evidence), and vomiting (2 studies, 122 participants: RR 1.72, 95% CI 0.35 to 8.51; I2 = 0%; low certainty evidence) in CKD. Potassium binders may lower serum potassium levels (at the end of treatment) (3 studies, 277 participants: MD -0.62 mEq/L, 95% CI -0.97, -0.27; I2 = 92%; low certainty evidence) in CKD and HD. Potassium binders had uncertain effects on constipation (4 studies, 425 participants: RR 1.58, 95% CI 0.71, 3.52; I2 = 0%; low certainty evidence) in CKD. Potassium binders may decrease systolic blood pressure (BP) (2 studies, 369 participants: MD -3.73 mmHg, 95%CI -6.64 to -0.83; I2 = 79%; low certainty evidence) and diastolic BP (one study) at the end of the treatment. No study reported outcome data for cardiac arrhythmias or major GI events. Calcium polystyrene sulfonate may make little or no difference to serum potassium levels at end of treatment, compared to sodium polystyrene sulfonate (2 studies, 117 participants: MD 0.38 mEq/L, 95% CI -0.03 to 0.79; I2 = 42%, low certainty evidence). There was no evidence of a difference in systolic BP (one study), diastolic BP (one study), or constipation (one study) between calcium polystyrene sulfonate and sodium polystyrene sulfonate. There was no difference between high-dose and low-dose patiromer for death (sudden death) (one study), stroke (one study), myocardial infarction (one study), or constipation (one study). The comparative effects whether potassium binders were administered with or without food, laxatives, or sorbitol, were very uncertain with insufficient data to perform meta-analysis. AUTHORS' CONCLUSIONS: Evidence supporting clinical decision-making for different potassium binders to treat chronic hyperkalaemia in adults with CKD is of low certainty; no studies were identified in children. Available studies have not been designed to measure treatment effects on clinical outcomes such as cardiac arrhythmias or major GI symptoms. This review suggests the need for a large, adequately powered study of potassium binders versus placebo that assesses clinical outcomes of relevance to patients, clinicians and policy-makers. This data could be used to assess cost-effectiveness, given the lack of definitive studies and the clinical importance of potassium binders for chronic hyperkalaemia in people with CKD.


Assuntos
Quelantes/uso terapêutico , Terapia por Quelação/métodos , Hiperpotassemia/tratamento farmacológico , Potássio , Insuficiência Renal Crônica/complicações , Idoso , Causas de Morte , Quelantes/efeitos adversos , Terapia por Quelação/efeitos adversos , Doença Crônica , Humanos , Hiperpotassemia/etiologia , Hiperpotassemia/mortalidade , Pessoa de Meia-Idade , Polímeros/efeitos adversos , Polímeros/uso terapêutico , Poliestirenos/efeitos adversos , Poliestirenos/uso terapêutico , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Silicatos/efeitos adversos , Silicatos/uso terapêutico
6.
BMC Nephrol ; 20(1): 440, 2019 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791288

RESUMO

BACKGROUND: Reliable, timely-onset, oral treatments with an acceptable safety profile for patients with hyperkalemia are needed. We examined the efficacy and safety of sodium zirconium cyclosilicate (SZC; formerly ZS-9) treatment for ≤ 48 h in patients with baseline serum potassium level ≥ 5.5 mmol/L. METHODS: Data were pooled from two phase 3 studies (ZS-003 and HARMONIZE) among patients receiving SZC 10 g three times daily. Outcomes included mean and absolute change from baseline, median time to potassium level ≤ 5.5 and ≤ 5.0 mmol/L, and proportion achieving potassium level ≤ 5.5 and ≤ 5.0 mmol/L at 4, 24, and 48 h. Outcomes were stratified by baseline potassium. Safety outcomes were evaluated. RESULTS: At baseline, 125 of 170 patients (73.5%) had potassium level 5.5-< 6.0, 39 (22.9%) had potassium level 6.0-6.5, and 6 (3.5%) had potassium level > 6.5 mmol/L. Regardless of baseline potassium, mean potassium decreased at 1 h post-initial dose. By 4 and 48 h, 37.5% and 85.0% of patients achieved potassium level ≤ 5.0 mmol/L, respectively. Median (95% confidence interval) times to potassium level ≤ 5.5 and ≤ 5.0 mmol/L were 2.0 (1.1-2.0) and 21.6 (4.1-22.4) h, respectively. Fifteen patients (8.8%) experienced adverse events; none were serious. CONCLUSIONS: SZC 10 g three times daily achieved serum potassium reduction and normokalemia, with a favorable safety profile. TRIAL REGISTRATION: ClinicalTrials.gov identifiers: ZS-003: NCT01737697 and HARMONIZE: NCT02088073.


Assuntos
Hiperpotassemia , Silicatos , Administração Oral , Idoso , Método Duplo-Cego , Monitoramento de Medicamentos/métodos , Monitoramento de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Hiperpotassemia/sangue , Hiperpotassemia/tratamento farmacológico , Resinas de Troca Iônica/administração & dosagem , Resinas de Troca Iônica/efeitos adversos , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Silicatos/administração & dosagem , Silicatos/efeitos adversos , Resultado do Tratamento
7.
Stem Cell Res Ther ; 10(1): 351, 2019 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775910

RESUMO

BACKGROUND: Silicon-modified biomaterials have been extensively studied in bone tissue engineering. In recent years, the toxicity of silicon-doped biomaterials has gradually attracted attention but requires further elucidation. This study was designed to explore whether high-dose silicate can induce a cytotoxicity effect in bone mesenchymal stem cells (BMSCs) and the role of autophagy in its cytotoxicity and mechanism. METHODS: Morphologic changes and cell viability of BMSCs were detected after different doses of silicate exposure. Autophagic proteins (LC3, p62), LC3 turnover assay, and RFP-GFP-LC3 assay were applied to detect the changes of autophagic flux following silicate treatment. Furthermore, to identify the potential mechanism of autophagic dysfunction, we tested the acetyl-α-tubulin protein level and histone deacetylase 6 (HDAC6) activity after high-dose silicate exposure as well as the changes in microtubule and autophagic activity after HDAC6 siRNA was applied. RESULTS: It was found that a high dose of silicate could induce a decrease in cell viability; LC3-II and p62 simultaneously increased after high-dose silicate exposure. A high concentration of silicate could induce autophagic dysfunction and cause autophagosomes to accumulate via microtubule destabilization. Results showed that acetyl-α-tubulin decreased significantly with high-dose silicate treatment, and inhibition of HDAC6 activity can restore microtubule structure and autophagic flux. CONCLUSIONS: Microtubule destabilization caused by a high concentration of silicate via HDAC6 activation contributed to autophagic dysfunction in BMSCs, and inhibition of HDAC6 exerted a cytoprotection effect through restoration of the microtubule structure and autophagic flux.


Assuntos
Morte Celular Autofágica/efeitos dos fármacos , Células da Medula Óssea/enzimologia , Desacetilase 6 de Histona/metabolismo , Células-Tronco Mesenquimais/enzimologia , Microtúbulos/metabolismo , Silicatos/farmacologia , Animais , Células da Medula Óssea/citologia , Ativação Enzimática/efeitos dos fármacos , Células-Tronco Mesenquimais/citologia , Ratos , Silicatos/efeitos adversos
8.
Am J Nephrol ; 50(6): 473-480, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31658466

RESUMO

BACKGROUND: Sodium zirconium cyclosilicate (SZC; formerly ZS-9) is a selective potassium (K+) binder for treatment of hyperkalemia. An open-label extension (OLE) of the -HARMONIZE study evaluated efficacy and safety of SZC for ≤11 months. METHODS: Patients from HARMONIZE with point-of-care device i-STAT K+ 3.5-6.2 mmol/L received once-daily SZC 5-10 g for ≤337 days. End points included achievement of mean serum K+ ≤5.1 mmol/L (primary) or ≤5.5 mmol/L (secondary). RESULTS: Of 123 patients who entered the extension (mean serum K+ 4.8 mmol/L), 79 (64.2%) completed the study. The median daily dose of SZC was 10 g (range 2.5-15 g). The primary end point was achieved by 88.3% of patients, and 100% achieved the secondary end point. SZC was well tolerated with no new safety concerns. CONCLUSION: In the HARMONIZE OLE, most patients maintained mean serum K+ within the normokalemic range for ≤11 months during ongoing SZC treatment.


Assuntos
Hiperpotassemia/tratamento farmacológico , Resinas de Troca Iônica/administração & dosagem , Potássio/sangue , Silicatos/administração & dosagem , Idoso , Relação Dose-Resposta a Droga , Feminino , Humanos , Hiperpotassemia/sangue , Resinas de Troca Iônica/efeitos adversos , Masculino , Pessoa de Meia-Idade , Potássio/metabolismo , Estudos Prospectivos , Sistema Renina-Angiotensina , Silicatos/efeitos adversos , Resultado do Tratamento
9.
Nutrients ; 11(10)2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31581523

RESUMO

Cognitive function is critical for successful prolonged performance in eSports. This double-blind placebo-controlled study examined the effect of an inositol-enhanced arginine silicate oral supplement on cognitive performance and energy in eSports athletes. Sixty healthy men and women who spent 5 or more hours a week playing video games were randomly assigned to take supplement or placebo for 7 days. On day 1 and 7, before and 15 min after dosing, subjects completed the Trail Making Test (TMT), Parts A and B; Stroop Test; and Profile of Mood States (POMS) questionnaire, and then played a video game for 60 min. Immediately after, cognitive tests were repeated. Self-reported energy levels increased, anger decreased, and TMT-B test errors decreased in the supplement group compared to placebo (p < 0.05). Fatigue, TMT-B time, and TMT B-A score improved in the supplement group compared to baseline (p < 0.05). After 60 min of gaming, supplementation decreased Stroop Test errors and TMT-A time (p < 0.05). Adverse events were minimal and not different between groups. These data appear to support the use of the studies product (nooLVL®) in eSports gamers looking to improve their accuracy, decision making, and reaction time during gaming.


Assuntos
Afeto/efeitos dos fármacos , Arginina/administração & dosagem , Cognição/efeitos dos fármacos , Suplementos Nutricionais , Inositol/administração & dosagem , Saúde Mental , Estado Nutricional , Silicatos/administração & dosagem , Jogos de Vídeo/psicologia , Administração Oral , Adulto , Arginina/efeitos adversos , Tomada de Decisões/efeitos dos fármacos , Suplementos Nutricionais/efeitos adversos , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Inositol/efeitos adversos , Masculino , Missouri , Testes Neuropsicológicos , Estudos Prospectivos , Tempo de Reação/efeitos dos fármacos , Silicatos/efeitos adversos , Análise e Desempenho de Tarefas , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
10.
J Am Soc Nephrol ; 30(9): 1723-1733, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31201218

RESUMO

BACKGROUND: Patients with ESRD have minimal renal potassium excretion and, despite hemodialysis, often have persistent predialysis hyperkalemia. The DIALIZE study (NCT03303521) evaluated sodium zirconium cyclosilicate (SZC) in the management of hyperkalemia in hemodialysis patients. METHODS: In the DIALIZE study, a double-blind, placebo-controlled, phase 3b multicenter study, we randomized adults with ESRD who were managed by three-times weekly hemodialysis and had predialysis hyperkalemia to receive placebo or SZC 5 g once daily on non-dialysis days, and titrated towards maintaining normokalemia over 4 weeks, in 5 g increments to a maximum of 15 g. The primary efficacy outcome was proportion of patients during the 4-week stable-dose evaluation period who maintained predialysis serum potassium of 4.0-5.0 mmol/L during at least three of four hemodialysis treatments after the long interdialytic interval and did not require urgent rescue therapy to reduce serum potassium. RESULTS: In total, 196 patients (mean [standard deviation (SD)] age =58.1 [13.7] years old) were randomized to sodium zirconium cyclosilicate or placebo. Of 97 patients receiving sodium zirconium cyclosilicate, 41.2% met the primary end point and were deemed treatment responders compared with 1.0% of 99 patients receiving placebo (P<0.001). Rescue therapy to reduce serum potassium during the treatment period was required by 2.1% of patients taking sodium zirconium cyclosilicate versus 5.1% taking placebo. Serious adverse events occurred in 7% and 8% of patients in sodium zirconium cyclosilicate and placebo groups, respectively. The two groups displayed comparable interdialytic weight gain. There were few episodes of hypokalemia. CONCLUSIONS: Sodium zirconium cyclosilicate is an effective and well-tolerated treatment for predialysis hyperkalemia in patients with ESRD undergoing adequate hemodialysis.


Assuntos
Hiperpotassemia/tratamento farmacológico , Resinas de Troca Iônica/uso terapêutico , Falência Renal Crônica/complicações , Silicatos/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Humanos , Hiperpotassemia/etiologia , Hiperpotassemia/prevenção & controle , Resinas de Troca Iônica/efeitos adversos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Diálise Renal , Silicatos/efeitos adversos , Adulto Jovem
11.
Braz Dent J ; 29(5): 409-418, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30517438

RESUMO

This systematic review aimed to evaluate whether alternative materials to conventional triple antibiotic paste (TAP - metronidazole, ciprofloxacin, and minocycline) and grey mineral trioxide aggregate (GMTA) could avoid tooth discoloration in teeth submitted to Regenerative Endodontic Procedure (REP). It was also investigated if dental bleaching is able to reverse the color of darkened teeth due to REP. The search was conducted in four databases (Medline via PubMed, Scopus, ISI Web of Science and BVS - Virtual health library), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The retrieved papers were uploaded in the software EndNoteTM and two reviewers independently selected the studies and extracted the data. Only studies in humans (case reports, case series, clinical trials) were included in the review. From 1,122 potentially eligible studies, 83 were selected for full-text analysis, and 38 were included in the review. The included studies were mainly case reports (76.3 %). The studies described a total of 189 teeth submitted to REP. From these, about 54% of teeth presented some degree of discoloration. Most teeth presenting color alteration were treated with TAP, especially when combined with GMTA. Only three studies performed dental bleaching to restore the color of teeth and neither bleaching technique was able to restore the original color of the crowns. The use of alternative materials to TAP and GMTA, such as double antibiotic paste or Ca(OH)2 pastes and white mineral trioxide aggregate or BiodentineTM, reduces the occurrence of tooth discoloration.


Assuntos
Endodontia Regenerativa , Descoloração de Dente/induzido quimicamente , Descoloração de Dente/prevenção & controle , Compostos de Alumínio/efeitos adversos , Antibacterianos/efeitos adversos , Compostos de Cálcio/efeitos adversos , Combinação de Medicamentos , Humanos , Óxidos/efeitos adversos , Materiais Restauradores do Canal Radicular/efeitos adversos , Silicatos/efeitos adversos , Clareamento Dental
12.
Drugs ; 78(15): 1605-1613, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30306338

RESUMO

Sodium zirconium cyclosilicate (Lokelma™) [hereafter referred to as SZC] is a non-absorbed, non-polymer zirconium silicate compound that preferentially exchanges hydrogen and sodium for potassium and ammonium ions in the gastrointestinal tract (GIT), thereby increasing faecal potassium excretion and lowering serum potassium levels. It is available as a powder for oral suspension (in water) and is approved in the EU and the USA for the treatment of hyperkalaemia in adults. In two multinational, phase III studies in adults with hyperkalaemia, SZC 10 g three times daily lowered serum potassium levels to within the normal range (3.5-5.0 mmol/L) during the first 48 h of treatment, and SZC 5 and 10 g once daily maintained normokalaemia over ≤ 28 days' therapy. These beneficial effects were consistent across all patient subgroups (e.g. chronic kidney disease, diabetes, heart failure, concomitant use of RAAS inhibitor therapy), and appeared to be maintained over the longer term (≤ 12 months). SZC was generally well tolerated in adults with hyperkalaemia. Its tolerability profile was generally similar to that seen with placebo over ≤ 28 day, and its safety profile appeared to remain consistent over the longer term (≤ 12 months). Moreover, the incidence of hypokalemia was low. Current evidence indicates that SZC is a promising therapy for the management of hyperkalaemia in adults.


Assuntos
Hiperpotassemia/tratamento farmacológico , Potássio/sangue , Silicatos/uso terapêutico , Ensaios Clínicos Fase III como Assunto , Diabetes Mellitus/tratamento farmacológico , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Hiperpotassemia/complicações , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico , Silicatos/administração & dosagem , Silicatos/efeitos adversos , Resultado do Tratamento
13.
J Endod ; 44(11): 1692-1696, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30241682

RESUMO

INTRODUCTION: A lack of information exists regarding the efficacy of RetroMTA (BioMTA, Seoul, Korea) directly applied on the pulp in vital pulp therapy. This study was designed to examine the clinical efficacy of RetroMTA compared with ProRoot mineral trioxide aggregate (MTA) (Dentsply Tulsa Dental, Tulsa, OK) for partial pulpotomy. METHODS: Partial pulpotomy was performed in 22 healthy human maxillary and mandibular third molars planned for extraction. The teeth were randomly divided into 2 groups (n = 11) and underwent partial pulpotomy with RetroMTA and ProRoot MTA as the control. The teeth were then restored with glass ionomer cement. Clinical and electric pulp tests were performed after 1 and 8 weeks. The teeth were radiographed and extracted at 8 weeks. Histologic sections were prepared and analyzed for pulp inflammation and dentinal bridge formation. Data were analyzed using the Mann-Whitney U test. RESULTS: Clinical examination after 1 and 8 weeks showed no sensitivity to heat, cold, or palpation in the ProRoot MTA and RetroMTA groups. Periapical radiographs taken before the extraction of teeth showed no evidence of periapical pathology. Electric pulp testing revealed no sensitivity. Data comparisons using the Mann-Whitney U test showed no significant difference between the materials with regard to the pulp inflammation type, intensity and extension (P = .3), or bridge continuity (P = .12). However, these data revealed a significant difference between the 2 materials in pulp morphology (P < .05) and bridge thickness (P < .01). CONCLUSIONS: This is the first work to evaluate a RetroMTA histologic outcome in partial pulpotomy in human permanent teeth. It shows pulp disorganization, an absence of inflammation, and discontinuous mineralization, which may represent a potential drawback with RetroMTA in this indication.


Assuntos
Compostos de Alumínio/efeitos adversos , Compostos de Cálcio/efeitos adversos , Polpa Dentária/efeitos dos fármacos , Polpa Dentária/patologia , Dentição Permanente , Dente Serotino , Óxidos/efeitos adversos , Pulpotomia/métodos , Silicatos/efeitos adversos , Adolescente , Adulto , Combinação de Medicamentos , Feminino , Cimentos de Ionômeros de Vidro , Humanos , Masculino , Materiais Restauradores do Canal Radicular , Fatores de Tempo , Extração Dentária , Adulto Jovem
15.
Gen Dent ; 66(3): 64-67, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29714703

RESUMO

This study evaluated the effect of 3 commercially available calcium silicate materials (CSMs) on pH changes in simulated root resorption defects. Simulated root resorption defects were prepared on the facial root surface of 40 mandibular premolars. The depth of each defect was individually calculated to standardize the remaining dentin thickness to 1 mm. Prepared canals were obturated with the 3 CSMs. Ten specimens were kept as controls, filled with unbuffered normal saline. The pH measurements were taken at 1 hour, 6 hours, 1 day, 1 week, 2 weeks, 3 weeks, 1 month, and 2 months. All CSM groups exhibited an initial alkaline pH of 9.0-9.7. The pH decreased to 8.0-8.5 after 2 months of storage. There were no significant differences between pH measurements at other time intervals. The CSM groups exhibited higher pH levels than the control group. The results showed that intracanal placement of the CSMs maintained initial pH levels of 9.0-9.7 inside the simulated resorption defects; these measurements gradually decreased to 8.0-8.5 over the span of 2 months.


Assuntos
Compostos de Cálcio/uso terapêutico , Obturação do Canal Radicular/efeitos adversos , Reabsorção da Raiz/etiologia , Silicatos/uso terapêutico , Compostos de Cálcio/efeitos adversos , Preparo da Cavidade Dentária , Humanos , Concentração de Íons de Hidrogênio , Técnicas In Vitro , Obturação do Canal Radicular/métodos , Silicatos/efeitos adversos
16.
Am J Ind Med ; 61(5): 391-399, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29516526

RESUMO

BACKGROUND: Iron ore (taconite) mining and processing are an important industry in northern Minnesota and western Michigan. Concerns around exposures have centered largely on exposure to non-asbestiform amphibole elongate mineral particles (EMPs) found in the eastern portion of the Minnesota iron range. METHODS: A cross sectional survey was undertaken of current and former taconite workers and spouses along with a detailed exposure assessment. Participants provided an occupational history and had a chest radiograph performed. RESULTS: A total of 1188 workers participated. Potential exposures to non-amphibole EMPs were evident across multiple jobs in all active mines. Pleural abnormalities were found in 16.8% of workers. There was an association of pleural abnormalities with cumulative EMP exposure that was not specific to the eastern portion of the range. CONCLUSION: There was evidence of a mild to moderate increase in pleural abnormalities in this population of miners, associated with geographically non-specific cumulative EMP exposure.


Assuntos
Ferro/efeitos adversos , Doenças Profissionais/induzido quimicamente , Doenças Profissionais/epidemiologia , Exposição Ocupacional/efeitos adversos , Doenças Pleurais/induzido quimicamente , Doenças Pleurais/epidemiologia , Silicatos/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Monitoramento Ambiental/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mineração , Minnesota/epidemiologia , Doenças Profissionais/diagnóstico por imagem , Doenças Pleurais/diagnóstico por imagem , Análise de Regressão , Fatores de Risco
18.
Int Endod J ; 51(3): 284-317, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28846134

RESUMO

Mineral trioxide aggregate (MTA) is a dental material used extensively for vital pulp therapies (VPT), protecting scaffolds during regenerative endodontic procedures, apical barriers in teeth with necrotic pulps and open apices, perforation repairs as well as root canal filling and root-end filling during surgical endodontics. A number of bioactive endodontic cements (BECs) have recently been introduced to the market. Most of these materials have calcium and silicate in their compositions; however, bioactivity is a common property of these cements. These materials include the following: BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, Neo MTA Plus, Ortho MTA, Quick-Set, Retro MTA, Tech Biosealer, and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA but without the drawbacks. In Part I of this review, the available information on the chemical composition of the materials listed above was reviewed and their applications for VPT was discussed. In this article, the clinical applications of MTA and other BECs will be reviewed for apexification, regenerative endodontics, perforation repair, root canal filling, root-end filling, restorative procedures, periodontal defects and treatment of vertical and horizontal root fractures. In addition, the literature regarding the possible drawbacks of these materials following their clinical applications is reviewed. These drawbacks include their discolouration potential, systemic effects and retreatability following use as a root filling material. Based on selected keywords, all publications were searched regarding the use of MTA as well as BECs for the relevant clinical applications. Numerous publications were found regarding the use of BECs for various endodontic applications. The majority of these investigations compared BECs with MTA. Despite promising results for some materials, the number of publications using BECs for various clinical applications was limited. Furthermore, most studies had several methodological shortcomings and low levels of evidence.


Assuntos
Compostos de Alumínio/uso terapêutico , Compostos de Cálcio/uso terapêutico , Cimentos Dentários/uso terapêutico , Óxidos/uso terapêutico , Materiais Restauradores do Canal Radicular/uso terapêutico , Silicatos/uso terapêutico , Compostos de Alumínio/efeitos adversos , Animais , Compostos de Cálcio/efeitos adversos , Cimentos Dentários/efeitos adversos , Combinação de Medicamentos , Humanos , Óxidos/efeitos adversos , Materiais Restauradores do Canal Radicular/efeitos adversos , Silicatos/efeitos adversos
19.
São José dos Campos; s.n; 2018. 78 p. il., tab., graf..
Tese em Português | BBO - Odontologia | ID: biblio-1016154

RESUMO

No presente trabalho, avaliou-se o efeito de diferentes concentrações de ácido fluorídrico (5% e 10%), na resistência de união entre uma cerâmica de silicato de lítio reforçado por zircônia (sem cristalização adicional, com queima de glaze e com queima adicional de cristalização) e um cimento resinoso, com e sem envelhecimento. Avaliou-se também o comportamento em fadiga de uma cerâmica à base de silicato de lítio reforçado por zircônia (sem cristalização adicional, com de queima de glaze e com queima adicional de cristalização) cimentada adesivamente a um material análogo a dentina (NEMA G10), na ausência ou presença de envelhecimento. Para o teste de microtração os blocos cerâmicos de silicato de lítio reforçado por zircônia foram cortados em blocos menores e divididos aleatoriamente em 12 grupos (N = 72; n = 6). No teste de fadiga os espécimes foram em formato de discos (diâmetro de 12 mm e espessura de 1,2 mm) cimentados a discos de resina epoxi Nema G10 (diâmetro de 12mm e espessura de 2,3mm), divididos em 6 grupos (N = 120; n = 20) e submetidos a ensaio de fadiga pelo método da escada (100.000 ciclos, 20 Hertz de frequência). Os dados resistência de união (MPa) e fadiga (N) foram submetidos à ANOVA 2-fatores, e respectivamente submetidos aos testes de Tukey e Bonferroni (p<0,05). Os resultados mostraram diferença estatisticamente significante para o fator "termociclagem" (ANOVA 2 fatores, p<0,05) sendo os grupos sem termociclagem superiores aos grupos com envelhecimento (Tukey). O teste de Bonferroni indicou que dentro da mesma condição (sem termociclagem ou com termociclagem), os grupos com queimas adicionais cristalização ou glaze apresentam resultados superiores aos grupos sem realização de queimas adicionais. Dessa forma, a união entre ZLS e cimento resinoso foi negativamente afetada pelo envelhecimento térmico em água. Já o comportamento em fadiga dos discos de ZLS cimentados em Nema G10 foi superior nos grupos que receberam queimas de glaze ou de cristalização e inferior nos grupos envelhecidos(AU)


This study evaluated the effect of different hydrofluoric acid concentrations (5% and 10%) on the bond strength between a zirconium-reinforced lithium silicate ceramic (without additional crystallization, glaze firing and additional crystallization firing) and a resinous cement, with and without aging. The fatigue behavior of a zirconium-reinforced lithium silicate-based ceramic (without additional crystallization, glaze firing and additional crystallization firing) adhesively cemented to a material like dentin (NEMA G10) was also evaluated with or without thermal aging. For the microtensile test, the zirconia reinforced lithium silicate ceramic blocks were cut into smaller blocks and randomly divided into 12 groups (N=72; n=6). In the fatigue test, discs (diameter 12 mm and thickness 1.2 mm) were cut, cemented to NEMA G10 epoxy resin discs (diameter 12 mm and thickness 2.3 mm), assigned into 6 groups (N=120, n=20) and subjected to the fatigue test by the ladder method (100,000 cycles, 20 Hertz frequency). The bond strength (MPa) and fatigue (N) data were submitted to 2-Way ANOVA, and respectively submitted to Tukey and Bonferroni tests (p <0.05). The results showed a statistically significant difference for the "thermocycling" factor (2-Way ANOVA, p <0.05), with the groups without thermocycling been superior to the aged groups (Tukey). The Bonferroni test indicated that within the same condition (with or without thermocycling), the groups with additional crystallization or glaze firing showed higher results than the groups without additional firing. Thus, the bond between ZLS and the resin cement was negatively affected by thermal aging in water. On the other hand, the fatigue behavior of ZLS discs cemented on NEMA G10 was higher in the groups that received glaze or crystallization firing and lower in the aged groups(AU)


Assuntos
Humanos , Silicatos/efeitos adversos , Ácido Fluorídrico/administração & dosagem
20.
São José dos Campos; s.n; 2018. 80 p. il., graf., tab..
Tese em Português | BBO - Odontologia | ID: biblio-980023

RESUMO

No presente trabalho, avaliou-se o efeito de diferentes concentrações de ácido fluorídrico (5% e 10%), na resistência de união entre uma cerâmica de silicato de lítio reforçado por zircônia (sem cristalização adicional, com queima de glaze e com queima adicional de cristalização) e um cimento resinoso, com e sem envelhecimento. Avaliou-se também o comportamento em fadiga de uma cerâmica à base de silicato de lítio reforçado por zircônia (sem cristalização adicional, com de queima de glaze e com queima adicional de cristalização) cimentada adesivamente a um material análogo a dentina (NEMA G10), na ausência ou presença de envelhecimento. Para o teste de microtração os blocos cerâmicos de silicato de lítio reforçado por zircônia foram cortados em blocos menores e divididos aleatoriamente em 12 grupos (N = 72; n = 6). No teste de fadiga os espécimes foram em formato de discos (diâmetro de 12 mm e espessura de 1,2 mm) cimentados a discos de resina epoxi Nema G10 (diâmetro de 12mm e espessura de 2,3mm), divididos em 6 grupos (N = 120; n = 20) e submetidos a ensaio de fadiga pelo método da escada (100.000 ciclos, 20 Hertz de frequência). Os dados resistência de união (MPa) e fadiga (N) foram submetidos à ANOVA 2-fatores, e respectivamente submetidos aos testes de Tukey e Bonferroni (p<0,05). Os resultados mostraram diferença estatisticamente significante para o fator "termociclagem" (ANOVA 2 fatores, p<0,05) sendo os grupos sem termociclagem superiores aos grupos com envelhecimento (Tukey). O teste de Bonferroni indicou que dentro da mesma condição (sem termociclagem ou com termociclagem), os grupos com queimas adicionais cristalização ou glaze apresentam resultados superiores aos grupos sem realização de queimas adicionais. Dessa forma, a união entre ZLS e cimento resinoso foi negativamente afetada pelo envelhecimento térmico em água. Já o comportamento em fadiga dos discos de ZLS cimentados em Nema G10 foi superior nos grupos que receberam queimas de glaze ou de cristalização e inferior nos grupos envelhecidos(AU)


This study evaluated the effect of different hydrofluoric acid concentrations (5% and 10%) on the bond strength between a zirconium-reinforced lithium silicate ceramic (without additional crystallization, glaze firing and additional crystallization firing) and a resinous cement, with and without aging. The fatigue behavior of a zirconium-reinforced lithium silicate-based ceramic (without additional crystallization, glaze firing and additional crystallization firing) adhesively cemented to a material like dentin (NEMA G10) was also evaluated with or without thermal aging. For the microtensile test, the zirconia reinforced lithium silicate ceramic blocks were cut into smaller blocks and randomly divided into 12 groups (N=72; n=6). In the fatigue test, discs (diameter 12 mm and thickness 1.2 mm) were cut, cemented to NEMA G10 epoxy resin discs (diameter 12 mm and thickness 2.3 mm), assigned into 6 groups (N=120, n=20) and subjected to the fatigue test by the ladder method (100,000 cycles, 20 Hertz frequency). The bond strength (MPa) and fatigue (N) data were submitted to 2-Way ANOVA, and respectively submitted to Tukey and Bonferroni tests (p <0.05). The results showed a statistically significant difference for the "thermocycling" factor (2-Way ANOVA, p <0.05), with the groups without thermocycling been superior to the aged groups (Tukey). The Bonferroni test indicated that within the same condition (with or without thermocycling), the groups with additional crystallization or glaze firing showed higher results than the groups without additional firing. Thus, the bond between ZLS and the resin cement was negatively affected by thermal aging in water. On the other hand, the fatigue behavior of ZLS discs cemented on NEMA G10 was higher in the groups that received glaze or crystallization firing and lower in the aged groups(AU)


Assuntos
Humanos , Silicatos/efeitos adversos , Ácido Fluorídrico/administração & dosagem
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