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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
321

Erosion behaviour of human, bovine and equine dental hard tissues

Hertel, S., Basche, S., Schmidt, V., Staszyk, C., Hannig, C., Sterzenbach, T., Hannig, M. 16 January 2025 (has links)
Dental hard tissues from different species are used in dental research, but little is known about their comparability. The aim of this study was to compare the erosive behaviour of dental hard tissues (enamel, dentin) obtained from human, bovine and equine teeth. In addition, the protective effect of the pellicle on each hard tissue under erosive conditions was determined. In situ pellicle formation was performed for 30 min on enamel and dentin samples from all species in four subjects. Calcium and phosphate release was assessed during 120 s of HCl incubation on both native and pellicle-covered enamel and dentin samples. SEM and TEM were used to examine surface changes in native enamel and dentin samples after acid incubation and the ultrastructure of the pellicle before and after erosive exposure. In general, bovine enamel and dentin showed the highest degree of erosion after acid exposure compared to human and equine samples. Erosion of human primary enamel tended to be higher than that of permanent teeth, whereas dentin showed the opposite behaviour. SEM showed that eroded equine dentin appeared more irregular than human or bovine dentin. TEM studies showed that primary enamel appeared to be most susceptible to erosion.
322

The relative effectiveness of non-steroidal anti-inflammatory drugs (Ibuprofen®) and a taping method (Kinesio Taping® Method) in the treatment of episodic tension-type headaches

Henry, Justin Michael January 2009 (has links)
Dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Headaches are one of the most common clinical conditions in medicine, and 80% of these are tension-type headaches (TTH). TTH has a greater socioeconomic impact than any other type of headache due to its prevalence. Within the TTH category, episodic TTH are more prevalent than chronic TTH. The mainstay in the treatment of TTH are simple analgesics and NSAIDs. Unless contraindicated, NSAIDs are often the most effective treatment for ETTH. However patients suffering with TTH tend to relate their headaches to increased muscle stiffness in the neck and shoulders and thus the non-pharmacological treatment of ETTH could be directed at the associated musculoskeletal components of ETTH. It is therefore proposed that the Kinesio Taping® Method may have an effect in the treatment of the muscular component of ETTH. Method: This study was a prospective randomised clinical trial with two intervention groups (n=16) aimed at determining the relative effectiveness of a NSAID and the Kinesio Taping® Method in the treatment of ETTHs. The patients were treated at 5 consultations over a 3 week period. Feedback was obtained using the: NRS – 101, the CMCC Neck Disability Index and a Headache Diary. Results: The Headache Diary showed a reduction in the presence and number, mean duration and pain intensity of ETTH in both groups. These treatment effects were sustained after the cessation of treatment with the exception of mean pain intensity in the Kinesio Taping® Method group. The mean NRS score decreased in both groups but at a slightly faster rate in the Kinesio Taping® Method group. The CMCC showed an improvement in the functional ability of the patients in both groups. Conclusion: There seems to be no significant difference in the relative effectiveness of the treatment modalities. We can thus state that the overall short-term reduction in symptomatology supports the use of NSAIDs or Kinesio Taping® Method in the treatment of ETTH.
323

台灣發展醫藥研發服務產業之探討--以臨床試驗部分為例 / The Development of Contract Research Organizations in Taiwan:Case Study on Clinical Trials Management

洪錫娟, Hung, Hsi-Chuan Unknown Date (has links)
昂貴的藥物研發成本,促使製藥生技產業的委外營運模式,以合約方式提供在藥物研發過程中專業化服務的產業,而近年來由於委外研發服務的高效率,已明顯縮短了新藥開發的時程;同時,在全球醫藥研發服務產業的市場中,約有超過七成的收益來自於臨床試驗服務;由此顯見醫藥研發服務產業中的臨床試驗部分的重要性。 醫藥研發服務是個高度國際性競爭的產業,如何找到發展的核心利基以突破重圍,是許多後進企業或國家所必需面對的嚴峻考驗。因此,本研究主要描述台灣目前的醫藥研發服務產業以及臨床試驗產業發展概況,並探討台灣是否具備發展臨床試驗產業的實力。透過本研究,希望對於台灣發展臨床試驗產業,或是推動台灣成為亞太臨床試驗中心,都能提供作為規劃與執行時的參考資訊。 本研究重要結論與建議如下: 1. 以新藥研發價值鏈而言,台灣目前在每一個階段的工作均已佈局,其中又以臨床試驗階段最有潛力加入國際的競爭市場;長期而言,為追求醫藥產業最大的經濟效益,應強化國內的基礎研發工作,進而刺激與培養國內醫藥研發服務產業的能量。 2. 產業政策的落實不能只談邏輯架構或觀念,應該設定明確的推動方案、目標與達成時間表,要推動產業必須貫徹以管理的觀念;同時也應加速業者與官方之間的溝通協調,其中包括藥政主管單位對於產業發展應由被動轉為積極主動的角色,另外,政府部門跨部會的整合也是相當重要的。 3. 國內的全民健保制度涵蓋了所有醫療資源的運用,而健保制度的設計缺乏鼓勵預防與醫藥研發的投入的機制。因此建議應深入分析與探討健保對於產業的影響,進而能以更積極正面的態度促進製藥生技或醫藥研發服務產業的發展。 4. 建議國內可以由政府與製藥產業界共同出資,成立具有公信力且目標明確的教育訓練組織,提供以實務為導向且有系統的在職教育,用以規劃與培植國家未來所需要的專業臨床試驗人才。 5. 建議國內應就醫療院所執行臨床試驗相關作業訂定管理原則,包括臨床試驗贊助款的管理與運用規範、相關執行人員的權利義務等,藉由透明化的標準與明確的獎勵制度,提高醫師與醫院參與臨床試驗的動機;同時也應鼓勵醫院設立專責的臨床試驗辦公室,執行各項協調、整合與管理的工作,並促進與產業界間的互動。 / The cost of drug research and development has soared during the past years. And this compels pharmaceutical and biotechnology companies to look for new, smarter ways of running their businesses. One of their strategies is trying to accelerate drug development by outsourcing. The size of the outsourcing market for Contract Research Organizations (CROs) is rising. Clinical-trial operations hold over 70% of the revenue in the CRO industry. Competition in the CRO industry is extremely international in scope. The key issues for the catching-up company or country is to find their own niche. This study goes on to identify and profile the development of clinical trials and the CRO industry in Taiwan. It also seeks to identify ways of showcasing Taiwan as an Asia-Pacific Clinical Trail Service Center. There are several conclusions from this study: 1. In the value chain of new drug discovery and development, the current status in Taiwan has the potential to join the international market by conducting the clinical trials. In the long term, we should consolidate our basic medical research to pursue the maximum benefit of biotechnology and pharmaceutical industry, and then to enhance the capability of CRO in Taiwan. 2. The policy for improving industry must be set up after the explicit acting plans, goals and time schedule. It should go through with management, not just a structure or concept. We have to hasten the communication between industry and government. The medical legal authorities need to be more active. Ultimate integration of the functions of the related government departments is exceedingly important. 3. The National Health Insurance (NHI) system covers all of the medical resources in Taiwan, but it lack for the incentive to encourage the medical research. It is recommended that NHI Program should probe into the impact of the biotechnology and pharmaceutical industry, and then try to revise it with more positive thinking. 4. It is very important for Taiwan to improve the professional in clinical trials. Setting up a training center funded by both government and industries is strongly recommended. The organization will have the definite goals and accountability, and provide practical training and systematic continuing education. 5. We need more regulating operations of clinical trials of hospitals in Taiwan. These operations should include the usage of the fees from sponsors, and the rights and responsibilities of all staff. We should set up a transparent standard and obviously encourage a mechanism to enhance the motivation of physicians and hospitals to participate in clinical trials. Hospitals should be encouraged to establish an independent office for clinical trials to perform all the details. This office will promote the interaction within the industries.
324

Dengue diagnostics and therapeutic interventions in Viet Nam

Tricou, Vianney M. January 2011 (has links)
Dengue is a major public health problem that affects tens of millions of people annually in tropical and sub-tropical countries. This acute viral infection happens to be severe and even life threatening but there is still no available drug or vaccine. Previous studies have noted early higher viral burden in patients who develop more severe symptoms suggesting that administration of a potent and safe antiviral may prevent progression to severe dengue. To verify this hypothesis, we have conducted the first RCT directed towards reducing the viral burden in vivo by administrating chloroquine (CQ), a cheap and well-tolerated drug that inhibits DENV in vitro with concentrations achievable in vivo, to 307 Vietnamese adults with suspected dengue (257 of them were laboratory-confirmed cases). Unfortunately, we did not see an effect of CQ on the duration of infection. However in patients treated with CQ, we observed a trend towards a lower incidence of severe forms. We did not find any differences in the immune response that can explain this trend. We also found more adverse events, primarily vomiting, with CQ. In addition, we have explored the relationships between clinical features, antibody responses and virological markers in these patients. We found that the early magnitude of viremia is positively associated with disease severity and there are serotype dependent differences in infection kinetics. We found as well that DENV was cleared faster and earlier in patients with secondary infections. To complete this study, we have also evaluated 2 rapid lateral flow tests for the diagnosis of dengue in a panel of plasma samples from 245 RT-PCR confirmed dengue patients and 47 with other febrile illnesses. Our data suggest that the NS1 test component of these tests are highly specific and have similar levels of sensitivity (~60%). Both NS1 assays were significantly more sensitive for primary than secondary dengue. The IgM parameter in the SD Duo test improved overall test sensitivity without compromising specificity. All these findings are of major importance for further anti-viral drug testing.
325

Functional and Robust Human-Machine Interface for Robotic-Assisted Therapy of the Shoulder after Stroke

Paredes Calderon, Liliana Patricia 21 November 2016 (has links)
No description available.
326

COMPARISON OF LONGITUDINAL AND CONVENTIONAL DATA ANALYSIS METHODS FOR ASSESSING EFFECTIVENESS

Jadhav, Pravin R 01 January 2006 (has links)
Pharmaceutical drug development is a costly and time consuming process. Reportedly, it takes about 10-15 years and ~900 million dollars of investment to launch a new drug in the world market. Any measure that increases the power and also decreases uncertainty about that power also increases drug net present value. For some time now, it has been argued that judicious utilization of available data might lead to more efficient use of resources during drug development. Conventionally, assessment of effectiveness has been based on comparing change from baseline at some pre-specified time for the control and test treatment (SPA). The last observation carry forward (LOCF) is a widely used technique if the data are missing due to any reason. Although, LOCF is known to introduce bias, the direction and magnitude is debatable.The primary aim of the proposed simulation experiments was to assess the properties of the random effects model (REM) and mixed model repeated measures (MMRM) methods that utilize all the data collected during pivotal trials. A total of 43 scenarios based on disease progression, magnitude of drug effect, between and within subject variability and patient drop-outs were analyzed. Three analysis methods, viz. SPA, REM and MMRM, were investigated. For the SPA method, the missing data were imputed with four different methods, such as LOCF, mean imputation, population and individual regression. The false-positive, false-negative inferences and bias in estimating the effect size for each method was assessed.The most important finding of this report is that the REM and MMRM methods are efficient alternatives to the SPA methods with ~50% savings on sample size. These methods are based on sound scientific principles and provide stronger evidence against the null hypothesis. The choice of the REM versus MMRM method is dependent on the purpose of the analysis and data gathered from the experimental design. The results support the use of likelihood-based MMRM methods for regulatory decision making. The REM methods are useful in understanding the time course of the disease and drug effect, making predictions based on the data and gaining insights into time to steady state effect for rational decision making. The SPA methods are less powerful across all the scenarios. The SPA-LOCF yielded anticonservative results in some cases with type-1 error rate exceeding 15% if data were missing due to toxicity. On the other hand, the drug effect was consistently underestimated (~40%), if data were missing due to lack of effectiveness. The results demonstrate that the SPA-LOCF methods make it practically impossible to establish effectiveness in these areas with a reasonable sample size.
327

Prevenção de deiscência da aponeurose com uso profilático de tela pré-aponeurótica em laparotomias de emergência: ensaio clínico randomizado / Prevention of fascial dehiscence with prophylactic use of onlay mesh in emergency laparotomies: a randomized clinical trial

Lima, Helber Vidal Gadelha 11 June 2019 (has links)
INTRODUÇÃO: Laparotomias de emergência apresentam alto risco de complicações e evoluem com deiscência da aponeurose (DA) em até 14,9% dos casos. O uso profilático de tela no fechamento da parede abdominal reduz a incidência de hérnia incisional após cirurgias eletivas, sem aumento significativo de morbidade. Porém, não há estudos que comprovem seu benefício na prevenção de DA e seu uso ainda é controverso em laparotomias de emergência e em cirurgias contaminadas ou infectadas. OBJETIVOS: Avaliar se o uso profilático de tela no fechamento da parede abdominal reduz a incidência de DA em pacientes submetidos a laparotomia de emergência, assim como a morbidade de sua aplicação. MÉTODOS: Foi realizado um ensaio clínico randomizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Indivíduos com alto risco para DA e indicação de laparotomia mediana de emergência foram randomizados em grupos de sutura (síntese contínua da aponeurose com fio de polidioxanona e agulha de 36 mm, com objetivo de alcançar a relação entre os comprimentos do fio e da incisão igual ou superior a quatro) ou de tela profilática (síntese da aponeurose como no grupo de sutura, reforçada com tela pré-aponeurótica de polipropileno). Alto risco foi definido segundo escore de risco pré-operatório de Rotterdam adaptado. A equipe cirúrgica permaneceu cega no intraoperatório (randomização somente após síntese completa da aponeurose). RESULTADOS: De junho de 2015 a fevereiro de 2018, foram randomizados 145 pacientes, dos quais 30 foram excluídos (20,7%) por óbito ou reoperação nos primeiros 30 dias, não relacionados a intervenção do estudo; 52 foram alocados no grupo de sutura e 63 no de tela profilática. Ambos foram equivalentes quanto a dados demográficos e características clínicas, exceto idade, cuja média foi maior no grupo de sutura (66,1 anos vs 61,0 anos, p = 0,03). Os pacientes foram classificados como ASA III ou IV em 44 (38,3%) casos. Dentre as operações, 49 (42,6%) foram contaminadas ou infectadas, 63 (54,8%) envolveram a realização de ostomia e 89 (77,4%) foram cirurgias colorretais. Os tempos de internação hospitalar e em UTI foram semelhantes. O tempo operatório médio foi 50,8 minutos mais longo no grupo de tela profilática (p = 0,01). A DA ocorreu em sete casos do grupo de sutura (13,5%) e em nenhum do grupo de tela profilática (p = 0,003). Não houve diferença estatística em relação ao número de participantes que apresentou ocorrências de sítio cirúrgico (SSO) [15 (28,8%) vs 27 (42,9%), p = 0,12] ou ocorrências de sítio cirúrgico que necessitaram de intervenção (SSOPI) [9 (17,3%) vs 14 (22,2%), p = 0,51]. Porém, algumas SSO foram mais frequentes no grupo de tela profilática: seroma [3 (5,8%) vs 12 (19,0%), p = 0,03], infecção de sítio cirúrgico (SSI) [4 (7,7%) vs 13 (20,6%), p = 0,05] e deiscência superficial de ferida operatória [3 (5,8%) vs 15 (23,8%), p = 0,008]. Sete casos do grupo de tela profilática tiveram deiscência superficial com exposição de tela e foram tratados com curativos locais e cicatrização por segunda intenção, havendo resolução completa em menos de 90 dias. Nenhum caso necessitou de remoção completa da tela. Das SSO do grupo de tela profilática, 92,3% tiveram resolução espontânea ou com intervenções à beira-leito, o que aconteceu em 73,3% do grupo de sutura. CONCLUSÕES: A tela profilática pré-aponeurótica em laparotomias de emergência é segura e evita DA, com morbidade aceitável, em 30 dias / INTRODUCTION: Emergency laparotomies have a high risk of complication with reports of fascial dehiscence (FD) in up to 14.9% of cases. The use of onlay mesh in the closure of abdominal wall reduces incidence of incisional hernia after elective surgeries without increased morbidity. However, there are no studies demonstrating its benefit in FD prevention and its use is controversial in emergency laparotomies and in contaminated or infected surgeries. OBJECTIVES: To evaluate whether the use of onlay mesh in the closure of the abdominal wall reduces the incidence of FD in patients submitted to emergency laparotomy, as well as the morbidity of its application. METHODS: A randomized clinical trial was conducted at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. Patients at high risk for FD and indication of emergency midline laparotomy were randomized either to the suture group (running suture with polidioxanone thread and 36 mm needle size, aiming to achieve suture-to-wound length ratio of 4:1) or to the prophylactic mesh group (fascial closure as in the suture group, reinforced with polypropylene onlay mesh). High risk was defined according to the adapted Rotterdam preoperative risk model. The surgical team was blinded to the groups during the intraoperative period (randomization occurred only after complete fascial suture). RESULTS: From June 2015 to February 2018, 145 patients were randomized, 30 of whom were excluded (20.7%) because of death or reoperation, not related to the mesh procedure, in the first 30 days; 52 were allocated in the suture group and 63 in the prophylactic mesh group. Both groups were equivalent for demographic data and clinical characteristics, except for age, whose mean was higher in the suture group (66.1 years vs 61.0 years, p = 0.03). Patients were classified as ASA III or IV in 44 (38.3%) cases. Among the operations, 49 (42.6%) were contaminated or infected, 63 (54,8%) involved ostomy formation and 89 (77.4%) were colorectal surgeries. Hospital length of stay (LOS) and intensive care unit LOS were similar. Mean operative time was 50.8 minutes longer in the prophylactic mesh group (p = 0.01). FD occurred in seven cases of the suture group (13.5%) and none in the prophylactic mesh group (p = 0.003). There was no statistical difference between the groups regarding the number of patients with surgical site occurrence (SSO) [15 (28.8%) vs 27 (42.9%), p = 0.12], or surgical site occurrences that required procedural interventions (SSOPI) [9 (17.3%) vs 14 (22.2%), p = 0.51]. However, some SSO were more frequent in the prophylactic mesh group: seroma [3 (5.8%) vs 12 (19.0%), p = 0.03], surgical site infection (SSI) [4 (7, 7%) vs 13 (20.6%), p = 0.05] and superficial wound dehiscence [3 (5.8%) vs 15 (23.8%), p = 0.008)]. Seven cases of the prophylactic mesh group had superficial wound dehiscence with mesh exposure, treated with local dressings and healing by second intention, with complete resolution in less than 90 days. No case required complete removal of mesh. Of the SSO in the prophylactic mesh group, 92.3% had spontaneous resolution or with bedside interventions; the same occurred in 73.3% of the suture group. CONCLUSIONS: The onlay prophylactic mesh in emergency laparotomy is safe and avoids FD, with acceptable morbidity in 30 days
328

Facteurs épidémiologiques influençant la survie dans le lymphome à cellules du manteau / Epidemiological prognostic factors in Mantle Cell Lymphoma survival.

Augustin, Alix 18 December 2017 (has links)
Le Lymphome à Cellules du Manteau (LCM) est une entité récemment identifiée qui se caractérise par la translocation génétique t(11 ;14)(q13 ;q32) et compte pour 2 à 10 % de tous les Lymphomes non-Hodgkiniens. Avec une survie médiane entre 3 et 5 ans après le diagnostic, le LCM est une pathologie agressive et malgré les récentes avancées thérapeutiques, peu d’informations sont disponibles concernant ses facteurs pronostiques. Certaines études ont analysé le rôle des caractéristiques clinicopathologiques et des nouvelles stratégies thérapeutiques, mais on connait peut le rôle des facteurs environnementaux et du mode de vie sur le pronostic des patients atteints de LCM. Entre 2008 et 2012, le groupe LYSA a mené en France deux essais cliniques prospectifs multicentriques : LM manteau 2010 SA "RiBVD" (NCI01457144) et Manteau 2007 SJ "LyMa" (NCT00921414). Après une comparaison de ces patients avec les patients de population générale, l’effet de facteurs socioéconomiques et des habitudes de vie sur la survie des patients a été étudié à l’aide d’un questionnaire qualitatif administré à tous les volontaires après le diagnostic. Nos résultats suggèrent qu’un faible niveau d’éducation, un indice de masse corporelle élevé et de la consommation d’alcool sont associés à un risque de décès plus élevé chez les patients atteints de LCM. Toutefois, l’étude de tels facteurs et de leur influence sur un sous-type de LNH aussi rare requiert des échantillons d’étude de taille plus importante. L’élargissement des critères d’inclusion des patients dans les essais cliniques permettrait de sélectionner davantage de patients mais aussi des patients mieux représentatifs de la population générale. Enfin, l’intégration systématique de ce type de questionnaire dans les protocoles d’essais cliniques serait aussi un atout majeur. / Mantle Cell Lymphoma (MCL) is a recently defined entity, typically characterised by the genetic translocation t(11 ;14)(q13 ;q32) and counting for 2 - 10% of all non-Hodgkin Lymphomas. With a median survival between 3 and 5 years after diagnosis, MCL is an agressive disease and despite the recent therapeutic advances little in know about its prognostic factors. Some studies had investigated clinicopathological features and new treatment strategies, but there is a lack of knowledge regarding the impact of lifestyle and environnemental factors on outcome of MCL patients. From 2008 to 2012, the LYSA Group conducted in France two prospective multi center clinical trials on MCL : LM manteau 2010 SA "RiBVD" (NCI01457144) and Manteau 2007 SJ "LyMa" (NCT00921414). After a comparison of these patients with population-based data, socioeconomic factors, lifestyle factors and their influence on survival had been investigated through a qualitative survey administrated to each volunteer after diagnosis. Our findings suggest that low educational attainment, low body body mass index and alcohol consumption are associated with a higher risk of death in MCL. However, to investigate lifestyle factors in this rare NHL subtype, larger studies should be carried out. Clinical trial inclusion criteria must be widen to select more patients and patients more representative of general population. Implementation of these epidemiological studies in clinical practice should be considered.
329

Eficácia do cetoprofeno em programas de tratamento seletivo de casos naturais de mastite clínica em vacas leiteiras

Latosinski, Giulia Soares. January 2019 (has links)
Orientador: José Carlos de Figueiredo Pantoja / Resumo: Objetivou-se avaliar a eficácia do cetoprofeno em casos de mastite clínica (MC) com ausência de isolamento microbiológico nas amostras de leite cultivadas no sistema de cultura na fazenda (SCF). Vacas de três rebanhos foram alocadas aleatoriamente em dois grupos experimentais. Grupo cetoprofeno (N = 65 quartos) foi tratado com cetoprofeno (3 mg/kg, via intramuscular, dose única) e grupo controle (N = 64 quartos) não recebeu terapia. Amostras de leite foram coletadas no momento do diagnóstico da MC e 14 (D14) e 21 (D21) dias após o caso. Os desfechos avaliados foram risco de cura clínica, recidiva e recorrência de MC, risco de nova infecção intramamária (IIM) em D14 e D21 e contagem de células somáticas em D14 e D21. A proporção de cura clínica, recidiva e recorrência de MC nos grupos cetoprofeno e controle foi de 83,08% e 85,94%, 18,52% e 18,18% e 16,67% e 16,36%, respectivamente. O risco relativo de todos os desfechos mencionados não foi diferente entre os grupos experimentais. Em ambas as análises as chances de nova IIM não foram diferentes entre os grupos experimentais. Não houve diferença na CCS entre os grupos entre os dias de amostragem ou grupos experimentais. Os resultados sugerem que o uso de cetoprofeno em casos de MC com cultura negativa não foi associado ao risco de cura clínica, recidiva e recorrência de MC, novas IIM e CCS. / Abstract: The objective of this study was to evaluate the efficacy of ketoprofen in culture-negative clinical mastitis (CM) cases. Cows from three commercial herds were randomly allocated into two experimental groups. The ketoprofen group (N = 65 quarters) received a single intramuscular injection of 3 mg/kg of ketoprofen. The control group (N = 64 quarters). Milk samples were collected at the time of CM diagnosis and at 14 (D14) and 21 (D21) days after the case. The outcomes evaluated were clinical cure, relapse and recurrence of CM, risk of new intramammary infection (IIM) at D14 and D21, and somatic cell count at D14 and D21. The proportion of clinical cure, relapse and recurrence of CM in the ketoprofen and control groups was 83.08%, 85.94%, 18.52% and 18,18%, 16,67% and 16,36%, respectively. The relative risk of all mentioned outcomes was not different between the experimental groups. For both analyses, the odds of new IIM were not different between the experimental groups. Mean SCC was not different between sampling days or experimental groups. Results suggest that the use of ketoprofen for culture-negative CM was not associated with the risk of clinical cure, relapse and recurrence of CM, new IIM and SCC. / Mestre
330

Avaliação clínica randomizada de restaurações de classe II em dentes permanentes de ART e de resina composta / Randomized clinical trial of class II restorations of ART and composite resin in permanent teeth

Silva, Rafael Menezes 08 December 2017 (has links)
Este estudo avaliou a efetividade de restaurações de classe II por meio da técnica do Tratamento Restaurador Atraumático (ART), com retenções adicionais nas caixas proximais, em dentes permanentes, usando cimento de ionômero de vidro (CIV) de alta viscosidade, em comparação com restaurações convencionais de resina composta. Um exame epidemiológico foi realizado em uma população maior e representativa dos participantes da pesquisa. Cento e trinta e três participantes, de 8 a 28 anos, com boa saúde geral com uma a duas cavidades de classe II em dentes permanentes sem comprometimento pulpar e dor de dente foram incluídos neste estudo, com aprovação pelo Comitê de Ética sob o número: CAAE: 24012913.0.1001.5417. Foram feitas setenta e sete restaurações com cada material restaurador (Equia Fil-GC Corporation e Z350-3M). As restaurações foram avaliadas aos 6, 12 e 24 meses pelos critérios do ART e do Serviço de Saúde Pública dos Estados Unidos (USPHS) modificado. Correlação de Spearman e Regressão Linear Múltipla foram realizados entre as variáveis dor de dente, índice de placa visível (IPV), índice de sangramento gengival (ISG) e os índices CAST (The Caries Assessment Sprectrum and Treatment) e CPOD (contagem de dentes cariados, perdidos e restaurados) dos participantes do levantamento epidemiológico por meio do programa Statistica 7.1. Quanto à efetividade restauradora, os dados foram analisados, utilizando o programa SPSS 23.0, por meio dos testes de Mann-Whitnney, Qui-quadrado, Exato de Fisher, Qui-quadrado com tendência linear e Regressão logística pelo método Enter, quando pertinentes (p<0,050). O Teste de Kaplan-Meier avaliou as taxas de sobrevida das restaurações em relação ao critério do ART e USPHS modificado. O teste de Log-Rank comparou as curvas de sobrevida. Do índice CAST (1,53; 2,17) foi possível extrair o CPOD (0,58; 1,32) o qual apresentou menor especificidade e sensibilidade no registro da cárie. As taxas de sucesso para as restaurações de resina composta foram de 100% (6 meses), 98,7% (12 meses) e 91,5% (24 meses) para ambos os critérios de avaliação e para as restaurações de ART foram as mesmas para 6 meses (98,7%) e 12 meses (95,8%) e para 24 meses foram de 92% quando utilizado o critério do USPHS modificado e 90,3% quando utilizado o critério do ART, não sendo observada diferença estatística (p=0,466). As variáveis sexo, localidade, idade, CPOD, IPV, ISG, dor de dente, oclusão, contato proximal, tamanho da cavidade, anestesia e cooperação do paciente não apresentaram associação estatística com as taxas de sucesso das restaurações (p>0,050). Após 24 meses, as variáveis IPV e ISG não apresentaram odds ratio (OR) estatisticamente significante para as restaurações de ART (p>0,050). As restaurações de ART apresentaram uma sobrevida inferior pelo critério do ART (83,7%) quando comparado à sobrevida pelo critério do USPHS modificado (87,8%), após 24 meses (p=0,051). A sobrevida das restaurações de resina composta foi de 90,7% para ambos os critérios de avaliação. Conclui-se que não há diferença na taxa de sucesso de restaurações de classe II de ART com CIV de alta viscosidade, em dentes permanentes, com sulcos de retenção proximais, em comparação com restaurações de classe II de resina composta, após 24 meses. / This study evaluated the effectiveness of Class II restorations through the Atraumatic Restorative Treatment (ART) technique, with additional retentions in the proximal boxes, in permanent teeth, using high viscosity glass ionomer cement (HVGIC), as compared to restorations of composite resin. An epidemiological examination was conducted in a larger and representative population of the participants of study. One hundred and thirty three participants, aged 8 to 28 years, with good general health with 1 to 2 class II cavities in permanent teeth without pulp involvement and tooth pain were included in this study, with was approved by the Ethics Committee under the number: CAAE: 24012913.0.1001.5417. Seventy-seven restorations were made with each restorative material (Equia Fil-GC Corporation and Z350-3M). Restorations were evaluated at 6, 12, and 24 months by the criteria of ART and the modified United States Public Health Service (USPHS). Spearman Correlation and Multiple Linear Regression were performed between the variables tooth pain, visible plaque index (VPI), gingival bleeding index (GBI) and the CAST (The Caries Assessment Sprectrum and Treatment) and DMFT (Decayed, Missing and Filled teeth) obtained at the epidemiological survey using the Statistica program 7.1. As for restorative effectiveness, data were analyzed using the Mann-Whitnney, Chi-square, Fisher\'s Exact, Chi-square tests with linear trend and Logistic Regression by Enter method, where relevant (p<0.050). The Kaplan-Meier test evaluated the survival rates of the restorations in relation to the ART and modified USPHS criteria. The Log-Rank test compared the survival curves. From the CAST index (1.53; 2.17) it was possible to extract the DMFT (0.58; 1.32) which presented lower specificity and sensitivity in caries detection. The success rates for composite resin restorations were 100% (6 months), 98.7% (12 months) and 91.5% (24 months) for both assessment criteria and for ART restorations were the same for 6 months (98.7%) and 12 months (95.8%) and for 24 months were 92% when using the criteria of modified USPHS and 90.3% when using the criteria of ART, and no statistical difference was observed (p=0.466). The variables gender, locality, age, DMFT, VPI, GBI, toothache, occlusion, proximal contact, cavity size, anesthesia and cooperation of the participant did not present a statistical association with the success rates of the restorations (p>0.050). After 24 months, the VPI and GBI variables did not present a statistically significant odds ratio (OR) for ART restorations (p>0.050). ART restorations presented a lower survival rate by the criteria of ART (83.7%) when compared to the criteria of USPHS modified (87.8%), after 24 months (p=0.051). The survival of composite resin restorations was 90.7% for both evaluation criteria. It was concluded that there is no difference in the success rate of class II restorations of ART with HVGIC, in permanent teeth, with proximal retention grooves, compared to class II resin composite restorations, after 24 months.

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