O objetivo desse estudo foi avaliar o grau de conversão, a estabilidade de cor e translucidez de cimentos resinosos para cimentação de laminados cerâmicos em duas espessuras, submetidos a diferentes protocolos de envelhecimento. Foram utilizados 270 incisivos bovinos hígidos, cujas porções radiculares foram cortadas e as porções coronárias foram incluídas em matriz de PVC (25mm de diâmetro) com resina acrílica. As faces vestibulares foram planificadas até a dentina. Foram confeccionados 240 corpos-de-prova em cerâmica prensada (IPS e-max Press e IPS e- maxZirpress, IvoclarVivadent), em duas espessuras (0,5 mm e 1,0 mm), que foram separados aleatoriamente em dois grupos, segundo o tipo de cimento resinoso utilizado para fixação: fotoativado (Variolink II, Ivoclar/Vivadent) ou dual (Rely U 200, 3M ESPE). Após a cimentação, todas as amostras foram mantidas em estufa a 37°C por 24h, após o qual foram realizadas as leituras de cor e translucidez iniciais (Vita EasyShade, VITA). Em seguida, as amostras foram subdivididas em três grupos (n=10) de acordo com o envelhecimento a que foram submetidos: Controle sem envelhecimento; imersão em água destilada por 1 ano e fadiga termomecânica (1.200.000 ciclos, frequência de1,3Hz e ciclagem térmica de 5°C/37°C/55°C). Como controle, foram obtidos 30 corpos-de-prova de cada cimento resinoso (0,5mm) e 30 dentes foram planificados e submetidos aos mesmos processos de envelhecimento, após o qual leituras finais foram realizadas. Foram analisados também o grau de conversão dos cimentos polimerizados através das restaurações (FTIR) e a linha de cimentação em cada um dos grupos (n=3), antes e depois do envelhecimento. Para isso, as amostras, selecionadas aleatoriamente, foram seccionadas no sentido longitudinal e analisadas em estereomicroscópio de dupla coordenada (Nikon Measurescope). Os dados de estabilidade de cor (&Delta;E), translucidez, grau de conversão e linha de cimentação foram submetidas à análise estatística (3-way ANOVA, Tukey, p<0,05). O cimento autoadesivo apresentou maior grau de conversão que o fotoativado (p<0,05) quando utilizada a cerâmica Zirpress, mas produziu maior alteração de cor (p<0,05) e menor translucidez nas restaurações de E-maxPress de 0,5mm. A ciclagem termomecânica não foi significante para alterações óticas dos sistemas cerâmicos testados. Conclui-se que a espessura do laminado cerâmico não altera o grau de conversão dos cimentos resinosos e o tipo de cimento resinoso influencia a estabilidade de cor das restaurações cerâmicas quando submetido ao envelhecimento com água destilada. / The aim of this study is to evaluate the degree of conversion, color stability and translucency of resin cement for luting ceramic veneers with two thicknesses submitted to different aging protocols. Two hundred and seventy bovine incisors were used, which had the root cut, and the coronal were embedded in acrylic resin into PVC rings (25mm diameter). The buccal surface was flattened until dentin. Two hundred and forty pressed ceramic veneers (IPS e-max Press and IPS e-max ZirPress, IvoclarVivadent) were obtained, in two thicknesses (0,5 mm and 1.0 mm), that were randomly separated into two groups according to the type of resin cement used for luting: light-cured (Variolink II, Ivoclar / Vivadent) or dual cured (Rely U 200, 3M ESPE). After the cementation, all samples were maintained at 37 °C for 24 h; after first color and translucency readings (Vita EasyShade, VITA) were made. The samples were separated into 3 groups (n=10) according to the aging that was submitted: control without aging, immersion in distilled water for one year and thermomechanical cycling (1.200.000 cycles, frequency of 1,3Hz and thermal cycling of 5°C/37°C/55°C). As the control group, 30 samples of each resin cement (0,5 mm) and flattened teeth were obtained and submitted to the same aging protocols. After tests, the final color and translucency readings were taken. The degree of conversion of resin cements through veneer restoration, and the cement film thickness (n=3) for each group were analyzed (FTIR), before and after aging. For this, the samples were randomly selected, sectioned longitudinally and examined by a stereomicroscope (Nikon Measurescope). The results of color stability (&Delta;E), translucency, degree of conversion and cement film thicknesses were statistically analyzed (3-way, ANOVA, Tukey, p<0.05). The self-adhesive cement showed the higher degree of conversion than light-activated luting cement (p<0.05) when Zirpress ceramic was used, but produced higher color change (p<0.05) and lower translucency in 0.5mm E-maxPress restorations. The thermomechanical cycling was not significant for optical changes of tested ceramic systems. It was concluded that the thickness of ceramic veneers didnt alter the degree of conversion of resin cement and the type of resin cement has influenced the color stability of ceramic restorations when submitted to water aging.

A pesquisa de marcadores ultrassonográficos no segundo trimestre da gestação, após rastreamento combinado no primeiro, parece elevar substancialmente as taxas de detecção de Síndrome de Down, mas está amparada na assunção não comprovada de independência entre esses testes. O presente estudo investigou a relação entre a translucência nucal e uma série de marcadores ultrassonográficos no segundo trimestre. A medida da translucência nucal no primeiro trimestre era seguida pela realização da ultrassonografia morfológica entre 18 a 23 semanas e 6 dias de gestação, incluindo a pesquisa de três marcadores qualitativos (foco ecogênico intracardíaco, intestino hiperecogênico e defeito estrutural) e as medidas do osso nasal, da prega nucal, do comprimento do úmero, do comprimento do fêmur, do diâmetro anteroposterior das pelves renais e da espessura pré-nasal. Todas as variáveis contínuas foram expressas em múltiplos da mediana para a idade gestacional e os coeficientes de correlação entre a translucência nucal e essas variáveis (após transformação logarítmica) foram calculados. Em seguida, as frequências de marcadores clássicos no segundo trimestre, em casos com translucência nucal normal, foram comparadas àquelas com translucência nucal aumentada, usando pontos de corte definidos em múltiplos da mediana. Em população prospectiva de 1970 casos, a translucência nucal se correlacionou significativamente com todas as variáveis ultrassonográficas do segundo trimestre, em particular, com a prega nucal (r=0.10). Houve frequência significativamente maior de casos com prega nucal aumentada (10,7 versus 2,2%), definida como valor (em MoMs) acima do percentil 97,5, e intestino hiperecogênico (2,4% versus 0,1%) em casos com translucência nucal aumentada. Concluindo, a utilização de razões de verossimilhança baseadas na presença, ou ausência, de marcadores ultrassonográficos no segundo trimestre para modificar o risco calculado, no primeiro trimestre, poderia deteriorar a precisão das estimativas. Técnicas multivariadas por meio de marcadores ultrassonográficos quantitativos seriam opção mais adequada para a implantação de estratégias de rastreamento sequenciais / Genetic sonogram following first trimester combined screening appears to substantially increase detection rates for Down syndrome but it relies on the unproved assumption of independence between these tests. In this study we have investigated the relation of first trimester nuchal translucency to a series of secondtrimester soft markers. Nuchal translucency (NT) measurement in the first trimester was followed by second trimester scan (18-23w+6 days) including search for three categorical soft-markers (intracardiac echogenic foci, hyperechogenic bowel and structural defects) and measurements of nasal bone length, nuchal fold thickness, femur length, humerus length, renal pelvices diameter and prenasal thickness. All continuous variables were expressed in multiples of the medians for gestation (MoMs) and correlation coefficients between log-transformed NT and second trimester variables were calculated. In addition, frequencies of classical soft-markers in cases with increased NT were compared to those with normal NT, using MoMs cutoffs. In a dataset of 1970 cases, NT was significantly correlated (p<0.05) to all second trimester continuous variables, in particular to nuchal fold thickness (r=0.10). There was a higher frequency of cases with second trimester nuchal fold thickness above the 95th centile (10.7% versus 2.2%) and hyperechogenic bowel (2.4% versus 0.1%) in cases with increased NT. In conclusion, straightforward reassessment of risk using likelihood ratios derived from the classical genetic sonogram might lead to inaccurate estimates. Multivariate models using continuous second-trimester variables might be preferable in sequential screening strategies

O objetivo desse estudo foi avaliar o grau de conversão, a estabilidade de cor e translucidez de cimentos resinosos para cimentação de laminados cerâmicos em duas espessuras, submetidos a diferentes protocolos de envelhecimento. Foram utilizados 270 incisivos bovinos hígidos, cujas porções radiculares foram cortadas e as porções coronárias foram incluídas em matriz de PVC (25mm de diâmetro) com resina acrílica. As faces vestibulares foram planificadas até a dentina. Foram confeccionados 240 corpos-de-prova em cerâmica prensada (IPS e-max Press e IPS e- maxZirpress, IvoclarVivadent), em duas espessuras (0,5 mm e 1,0 mm), que foram separados aleatoriamente em dois grupos, segundo o tipo de cimento resinoso utilizado para fixação: fotoativado (Variolink II, Ivoclar/Vivadent) ou dual (Rely U 200, 3M ESPE). Após a cimentação, todas as amostras foram mantidas em estufa a 37°C por 24h, após o qual foram realizadas as leituras de cor e translucidez iniciais (Vita EasyShade, VITA). Em seguida, as amostras foram subdivididas em três grupos (n=10) de acordo com o envelhecimento a que foram submetidos: Controle sem envelhecimento; imersão em água destilada por 1 ano e fadiga termomecânica (1.200.000 ciclos, frequência de1,3Hz e ciclagem térmica de 5°C/37°C/55°C). Como controle, foram obtidos 30 corpos-de-prova de cada cimento resinoso (0,5mm) e 30 dentes foram planificados e submetidos aos mesmos processos de envelhecimento, após o qual leituras finais foram realizadas. Foram analisados também o grau de conversão dos cimentos polimerizados através das restaurações (FTIR) e a linha de cimentação em cada um dos grupos (n=3), antes e depois do envelhecimento. Para isso, as amostras, selecionadas aleatoriamente, foram seccionadas no sentido longitudinal e analisadas em estereomicroscópio de dupla coordenada (Nikon Measurescope). Os dados de estabilidade de cor (&Delta;E), translucidez, grau de conversão e linha de cimentação foram submetidas à análise estatística (3-way ANOVA, Tukey, p<0,05). O cimento autoadesivo apresentou maior grau de conversão que o fotoativado (p<0,05) quando utilizada a cerâmica Zirpress, mas produziu maior alteração de cor (p<0,05) e menor translucidez nas restaurações de E-maxPress de 0,5mm. A ciclagem termomecânica não foi significante para alterações óticas dos sistemas cerâmicos testados. Conclui-se que a espessura do laminado cerâmico não altera o grau de conversão dos cimentos resinosos e o tipo de cimento resinoso influencia a estabilidade de cor das restaurações cerâmicas quando submetido ao envelhecimento com água destilada. / The aim of this study is to evaluate the degree of conversion, color stability and translucency of resin cement for luting ceramic veneers with two thicknesses submitted to different aging protocols. Two hundred and seventy bovine incisors were used, which had the root cut, and the coronal were embedded in acrylic resin into PVC rings (25mm diameter). The buccal surface was flattened until dentin. Two hundred and forty pressed ceramic veneers (IPS e-max Press and IPS e-max ZirPress, IvoclarVivadent) were obtained, in two thicknesses (0,5 mm and 1.0 mm), that were randomly separated into two groups according to the type of resin cement used for luting: light-cured (Variolink II, Ivoclar / Vivadent) or dual cured (Rely U 200, 3M ESPE). After the cementation, all samples were maintained at 37 °C for 24 h; after first color and translucency readings (Vita EasyShade, VITA) were made. The samples were separated into 3 groups (n=10) according to the aging that was submitted: control without aging, immersion in distilled water for one year and thermomechanical cycling (1.200.000 cycles, frequency of 1,3Hz and thermal cycling of 5°C/37°C/55°C). As the control group, 30 samples of each resin cement (0,5 mm) and flattened teeth were obtained and submitted to the same aging protocols. After tests, the final color and translucency readings were taken. The degree of conversion of resin cements through veneer restoration, and the cement film thickness (n=3) for each group were analyzed (FTIR), before and after aging. For this, the samples were randomly selected, sectioned longitudinally and examined by a stereomicroscope (Nikon Measurescope). The results of color stability (&Delta;E), translucency, degree of conversion and cement film thicknesses were statistically analyzed (3-way, ANOVA, Tukey, p<0.05). The self-adhesive cement showed the higher degree of conversion than light-activated luting cement (p<0.05) when Zirpress ceramic was used, but produced higher color change (p<0.05) and lower translucency in 0.5mm E-maxPress restorations. The thermomechanical cycling was not significant for optical changes of tested ceramic systems. It was concluded that the thickness of ceramic veneers didnt alter the degree of conversion of resin cement and the type of resin cement has influenced the color stability of ceramic restorations when submitted to water aging.

Quando um dente anterior é restaurado toda uma técnica de proteção ao tecido remanescente e a recuperação funcional do elemento dental podem ser comprometidas se a escolha da cor do material restaurador empregado não for adequada. A familiaridade com as teorias da cor e da interação da luz com a matéria pode ajudar na tarefa de escolha da tonalidade do material restaurador. O desafio na busca de um material restaurador ideal na sua função estética sempre foi obter a translucidez própria do esmalte dental. Contudo, essa translucidez faz com que o material restaurador sofra influência da cor de fundo, que pode ser da cor do material de proteção, ou mais normalmente da cor da dentina. No que tange as atividades de restauração estética odontológico, através deste trabalho foi possível concluir que: 1) A colorimetria pode ser um importante meio na seleção e na comunicação de tonalidades de materiais restauradores; 2) Os resultados obtidos confirmam que a cor de fundo exerce grande influência sobre a cor do resultado final da restauração; e 3) Os guias de tonalidade devem ser reformulados de tal forma que levem em consideração a espessura do material restaurador e a cor de fundo. / When an anterior tooth is restorated, the whole remaining tissue protection technique and functional recuperation of the dental element can be compromised if the choice of the color of the restorative material is not adequate. The familiarity with the color and light interaction with matter theories may help with the task of choosing the restorative material shade. The challenge in searching for an ideal restorative material in its esthetic function was always obtaining the proper translucency of dental enamel. However, this translucency makes the restorative material suffer an influence of the background color, which can be the protection material color or, more commonly, the dentine color. Concerning the odontologic esthetic restorative activities, it was possible to conclude from this work that: 1) Colorimetry can be an important way for the selection and communication of the restorative material shades; 2) The results show that the background color has a large influence on the final color of the restoration; and 3) The shade guides must be reformulated so that it take into consideration the thickness of the restorative material and background color.

Made available in DSpace on 2017-07-24T19:22:21Z (GMT). No. of bitstreams: 1 Felipe Villa Verde.pdf: 899114 bytes, checksum: 339db35f81d16c1053ac909db81b72f5 (MD5) Previous issue date: 2012-02-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The aim of this study was to evaluate in vitro through the push-out test, if the use of opaque glass fiber posts (Exacto – Angelus [PO]) and translucent (Exacto Translucent – Angelus [PT]), adhesively cemented into the root with dual resin cement (Variolink II - Ivoclar Vivadent) under different polymerization time had an influence on the bond strength in three different root canal thirds. Forty-eight singlerooted extracted human premolars were selected from the Tooth Bank UEPG for research. They had their crowns sectioned to form roots with 15 mm in length. All teeth received endodontic treatment and then were divided into 6 groups (n=8), to receive the cementation according to the type of glass fiber post (opaque vs.translucent) and the time of photoactivation of resin cement (20, 40 and 60 seconds). After storage in water at 37° C for one week, the teeth were embedded in acrylic resin and sectioned perpendicular to its long axis to form discs 1 mm thick, with two discs for each root third, and then were taken to the machine universal testing. The push-out test was performed at a speed of 0.5 mm/min. The data were statistically analyzed by ANOVA and Tukey's test (p = 0.05). The mean values of bond strength (MPa) and standard deviation (SD) for groups in the cervical third, middle and apical regions were: PO20 - 21.02 ± 3.52, 15.83 ± 4.94 and 5.20 ± 10:48; PO40 - 14.42 ± 3.98, 12.12 ± 4.40 and 11.59 ± 4.89; PO60 - 16.27 ± 7.14, 13.33 ± 5.22 and 16.99 ± 7.82; PT20 - 18.34 ± 5.47, 10.83 ± 4.63 and 9.98 ± 4.76; PT40 - 17.51 ± 6.55, 14.06 ± 3.85 and 10.95 ± 4.65; PT60 - 19.42 ± 5.86, 15.35 ± 5.43 and 12.77 ± 5.93). There were no significant differences between the types of fiber posts used and the different times of polymerization (p>0.05) in relation to the root area were statistically significant differences only between the cervical and the other thirds (p>0.05). It can be concluded that the bond strength of the root canals was not affected by the type of glass fiber post (opaque vs. translucent) and photoactivation time. / O objetivo deste estudo in vitro foi avaliar por meio do teste de push-out, se a utilização de pinos de fibra de vidro opaco (Exacto – Angelus [PO]) e translúcido (Exacto Translúcido – Angelus [PT]), cimentados adesivamente no canal radicular com cimento resinoso de presa dual (Variolink II – Ivoclar Vivadent) sob diferentes tempos de fotoativação apresentavam influência na resistência de união nos três diferentes terços do canal radicular. Quarenta e oito pré-molares unirradiculares humanos extraídos foram selecionados no Banco de Dentes da UEPG para a pesquisa. Tiveram suas coroas seccionadas para formar raízes com 15 mm de comprimento. Todos os dentes receberam tratamento endodôntico e em seguida foram divididos em 6 grupos (n=8), para receber a cimentação de acordo com o tipo de pino de fibra de vidro (opaco vs translúcido) e com o tempo de fotoativação do cimento resinoso (20, 40 e 60 segundos). Após o armazenamento em água a 37o C por uma semana, os dentes foram embutidos em resina acrílica e seccionados perpendicularmente ao seu longo eixo para formar discos de 1 mm de espessura, sendo 2 discos para cada terço radicular, e em seguida foram levados à máquina de ensaios universal. O teste de push-out foi realizado a uma velocidade de 0,5 mm/min. Os dados obtidos foram analisados estatisticamente por meio do teste ANOVA e pós-teste de Tukey (p=0,05). Os valores médios de RU (MPa) e desvio padrão (DP) para os grupos nos terços cervical, médio e apical foram respectivamente: PO20 – 21,02 ± 3,52, 15,83 ± 4,94 e 10,48 ± 5,20; PO40 – 14,42 ± 3,98, 12,12 ± 4,40 e 11,59 ± 4,89; PO60 – 16,27 ± 7,14, 13,33 ± 5,22 e 16,99 ± 7,82; PT20 – 18,34 ± 5,47, 10,83 ± 4,63 e 9,98 ± 4,76; PT40 – 17,51 ± 6,55, 14,06 ± 3,85 e 10,95 ± 4,65; PT60 – 19,42 ± 5,86, 15,35 ± 5,43 e 12,77 ± 5,93. Não foram observadas diferenças significativas entre os tipos de pino de fibra utilizados e os diferentes tempos de fotoativação (p > 0,05); em relação à região radicular foram encontradas diferenças estatisticamente significativas somente entre o terço cervical e os demais terços (p > 0,05). Pode-se concluir que a resistência de união do canal radicular não foi afetada pelo tipo de pino de fibra de vidro (opaco vs translúcido) e tempo de fotoativação. O objetivo deste estudo in vitro foi avaliar por meio do teste de push-out, se a utilização de pinos de fibra de vidro opaco (Exacto – Angelus [PO]) e translúcido (Exacto Translúcido – Angelus [PT]), cimentados adesivamente no canal radicular com cimento resinoso de presa dual (Variolink II – Ivoclar Vivadent) sob diferentes tempos de fotoativação apresentavam influência na resistência de união nos três diferentes terços do canal radicular. Quarenta e oito pré-molares unirradiculares humanos extraídos foram selecionados no Banco de Dentes da UEPG para a pesquisa. Tiveram suas coroas seccionadas para formar raízes com 15 mm de comprimento. Todos os dentes receberam tratamento endodôntico e em seguida foram divididos em 6 grupos (n=8), para receber a cimentação de acordo com o tipo de pino de fibra de vidro (opaco vs translúcido) e com o tempo de fotoativação do cimento resinoso (20, 40 e 60 segundos). Após o armazenamento em água a 37o C por uma semana, os dentes foram embutidos em resina acrílica e seccionados perpendicularmente ao seu longo eixo para formar discos de 1 mm de espessura, sendo 2 discos para cada terço radicular, e em seguida foram levados à máquina de ensaios universal. O teste de push-out foi realizado a uma velocidade de 0,5 mm/min. Os dados obtidos foram analisados estatisticamente por meio do teste ANOVA e pós-teste de Tukey (p=0,05). Os valores médios de RU (MPa) e desvio padrão (DP) para os grupos nos terços cervical, médio e apical foram respectivamente: PO20 – 21,02 ± 3,52, 15,83 ± 4,94 e 10,48 ± 5,20; PO40 – 14,42 ± 3,98, 12,12 ± 4,40 e 11,59 ± 4,89; PO60 – 16,27 ± 7,14, 13,33 ± 5,22 e 16,99 ± 7,82; PT20 – 18,34 ± 5,47, 10,83 ± 4,63 e 9,98 ± 4,76; PT40 – 17,51 ± 6,55, 14,06 ± 3,85 e 10,95 ± 4,65; PT60 – 19,42 ± 5,86, 15,35 ± 5,43 e 12,77 ± 5,93. Não foram observadas diferenças significativas entre os tipos de pino de fibra utilizados e os diferentes tempos de fotoativação (p > 0,05); em relação à região radicular foram encontradas diferenças estatisticamente significativas somente entre o terço cervical e os demais terços (p > 0,05). Pode-se concluir que a resistência de união do canal radicular não foi afetada pelo tipo de pino de fibra de vidro (opaco vs translúcido) e tempo de fotoativação.

A pesquisa de marcadores ultrassonográficos no segundo trimestre da gestação, após rastreamento combinado no primeiro, parece elevar substancialmente as taxas de detecção de Síndrome de Down, mas está amparada na assunção não comprovada de independência entre esses testes. O presente estudo investigou a relação entre a translucência nucal e uma série de marcadores ultrassonográficos no segundo trimestre. A medida da translucência nucal no primeiro trimestre era seguida pela realização da ultrassonografia morfológica entre 18 a 23 semanas e 6 dias de gestação, incluindo a pesquisa de três marcadores qualitativos (foco ecogênico intracardíaco, intestino hiperecogênico e defeito estrutural) e as medidas do osso nasal, da prega nucal, do comprimento do úmero, do comprimento do fêmur, do diâmetro anteroposterior das pelves renais e da espessura pré-nasal. Todas as variáveis contínuas foram expressas em múltiplos da mediana para a idade gestacional e os coeficientes de correlação entre a translucência nucal e essas variáveis (após transformação logarítmica) foram calculados. Em seguida, as frequências de marcadores clássicos no segundo trimestre, em casos com translucência nucal normal, foram comparadas àquelas com translucência nucal aumentada, usando pontos de corte definidos em múltiplos da mediana. Em população prospectiva de 1970 casos, a translucência nucal se correlacionou significativamente com todas as variáveis ultrassonográficas do segundo trimestre, em particular, com a prega nucal (r=0.10). Houve frequência significativamente maior de casos com prega nucal aumentada (10,7 versus 2,2%), definida como valor (em MoMs) acima do percentil 97,5, e intestino hiperecogênico (2,4% versus 0,1%) em casos com translucência nucal aumentada. Concluindo, a utilização de razões de verossimilhança baseadas na presença, ou ausência, de marcadores ultrassonográficos no segundo trimestre para modificar o risco calculado, no primeiro trimestre, poderia deteriorar a precisão das estimativas. Técnicas multivariadas por meio de marcadores ultrassonográficos quantitativos seriam opção mais adequada para a implantação de estratégias de rastreamento sequenciais / Genetic sonogram following first trimester combined screening appears to substantially increase detection rates for Down syndrome but it relies on the unproved assumption of independence between these tests. In this study we have investigated the relation of first trimester nuchal translucency to a series of secondtrimester soft markers. Nuchal translucency (NT) measurement in the first trimester was followed by second trimester scan (18-23w+6 days) including search for three categorical soft-markers (intracardiac echogenic foci, hyperechogenic bowel and structural defects) and measurements of nasal bone length, nuchal fold thickness, femur length, humerus length, renal pelvices diameter and prenasal thickness. All continuous variables were expressed in multiples of the medians for gestation (MoMs) and correlation coefficients between log-transformed NT and second trimester variables were calculated. In addition, frequencies of classical soft-markers in cases with increased NT were compared to those with normal NT, using MoMs cutoffs. In a dataset of 1970 cases, NT was significantly correlated (p<0.05) to all second trimester continuous variables, in particular to nuchal fold thickness (r=0.10). There was a higher frequency of cases with second trimester nuchal fold thickness above the 95th centile (10.7% versus 2.2%) and hyperechogenic bowel (2.4% versus 0.1%) in cases with increased NT. In conclusion, straightforward reassessment of risk using likelihood ratios derived from the classical genetic sonogram might lead to inaccurate estimates. Multivariate models using continuous second-trimester variables might be preferable in sequential screening strategies

L’évanescence suppose un état de précarité qui se nourrit de sa propre incomplétude. Le corps qui s’éthérise est en permanente déperdition de matérialité et d’énergie, ce qui amènera le détachement de la conscience. L’acheminement de l’état « tout-corps » à celui de « dé-corps » passe par trois régimes visuels : par l’opacité, associée à la pierre et à la figure de Thanatos, par la translucidité, qui concerne la chair et le feu érotique et, enfin, par la transparence du verre et de l’air, marquant l’entrée sur les territoires de Narcisse. Le thème du corps évanescent est développé autour de ces trois axes selon une logique centrée sur l’existence d’un seuil – décliné comme mur opaque, paroi organique translucide ou écran transparent. Ce seuil signale la transgression d’ordres et d’interdits. Lors du passage, le corps perd graduellement son ancrage dans la réalité concrète, qui s’estompe à vite allure pour faire place à un complexe espace-temps construit graduellement, dans le malheur de la maladie et de la mort ou dans la joie de la projection heureuse. Le corps évanescent tend vers un ailleurs qui s’organise à mesure que le premier s’efface. Ce double conditionnement s’accompagne d’innombrables régressions temporelles qui réverbèrent au niveau de la conscience incorporée sous la forme de la fissure qui entraîne le détachement. Sous le régime de la pierre l’évanescence se cristallise autour de l’image de la statue qui parcourt le trajet symbolique entre figement et vivification. Le marbre, le plâtre et le sable sont les trois motifs qui expriment l’idée de fragilisation de la matière. Le retour à la vie se prolonge dans la tiédeur de la chair réchauffée. Alors qu’elle atteint le seuil de la liquéfaction dans la fugue érotique, l’intensité de la sensation commence à diminuer, ce qui amène à un nouveau refroidissement. Dans le domaine de la transparence le corps subit des formes de détachement selon une logique qui va de la réflexion dans le miroir en tant qu’expression d’un moi naissant à l’extrême affaiblissement du caractère réfléchissant qui altère l’image de soi. Fenêtre, vitrine et écran sous-tendent l’effacement sous le régime de la transparence tout en créant l’illusion d’une intériorité. Comble du processus évanescent, le corps éthérique est mis en rapport avec l’ineffable de l’élément aérien. Cette forme de corporalité ultime exprime le détachement de la conscience, dans la joie comme dans la souffrance. Elle décrit un état de précarité absolue, qui met en avant le fait que tout en se délivrant de ses amarres matérielles la conscience tend à conserver un engramme qui assure la réincorporation, et avec elle, la survie. L’envol, le survol et la descente décrivent trois formes d’évanescence « aérienne » qui marquent le retour symbolique à l’opacité à travers des images d’épaississement : par les motifs de la vapeur, du brouillard ou de la nuit « polie » on est ramené au point de départ de la réflexion. L’histoire du corps évanescent, qui commence et achève par des images de la mort, est également l’histoire d’un continuel retour à la vie, aux forces pulsionnelles, à l’euphorie de se sentir vivant. / The vanishing body depicts a state of extreme precariousness and reveals a progressive loss of substance and vitality which results in the disembodiment of the conscience. The way from being “all body” to being “out-of-body” is hallmarked by three visual categories, each one being assigned a certain classical element: stone, for opacity (the territory of Thanatos), erotic fire for the flesh representing translucency and air and glass for transparency, reminding Narcissus. In this structure water is always the transversal element. The theme is therefore sustained by a network of thresholds such as: the wall, the organic layer and the transparent or invisible screen. With every threshold comes the idea of transgression. Passing into another state or dimension interrupts the contact with reality which fades swiftly away and makes room for another time-space configuration gradually defined by death and illness, by joy and thrilling giddiness. The vanishing body tends to inhabit a no man’s land ever more present as the first one fades away. It is thus submitted to various temporal regressions which concern the embodied consciousness and evolves as a “crack” finally producing the separation body-conscience. Within the realms of Thanatos and the stone the evanescence concerns the representation of the statue which stiffens and then recovers the “flesh-state” progressively. The marble, the plaster and the sand present themselves as three “stages” of dematerialization. Coming back to life means entering a state of tepidness of the revived flesh. As the sexual temperature increases it reaches a threshold of erotic liquefaction which then diminishes to a new form of symbolic coldness represented by physical decay and loss of sexual interest. In the field of transparency the body suffers several forms of detachment stretching from the mirror reflection as expression of a newly-born ego to the extreme weakening of the reflexivity which alters the sense of self. Window, window display and transparent shield underlie the self-effacement and create the (illusion of) inhabitable space.Peak of the vanishing process, the ethereal body is finally connected to the air as classical element. This ultimate form of corporeality express the disembodiment of the conscience in symbolic projections of both joy and suffering. It shows a state of absolute precariousness which points out the fact that by loosening the grip on the immediate reality the consciousness tends to gradually build up an engram of the body which ensures the reincorporation and by that, the survival. The take-off, the overflight and the landing describe three forms of “aerial” vanishing which states a symbolic return to opacity declined through images of densification: the steam, the fog, and the “polished” opacity of the night represent a comeback to the starting point of reflection. The story of the vanishing body, which starts and ends through images of death, is nevertheless the story of the continuous return to life and its possibilities.

Quando um dente anterior é restaurado toda uma técnica de proteção ao tecido remanescente e a recuperação funcional do elemento dental podem ser comprometidas se a escolha da cor do material restaurador empregado não for adequada. A familiaridade com as teorias da cor e da interação da luz com a matéria pode ajudar na tarefa de escolha da tonalidade do material restaurador. O desafio na busca de um material restaurador ideal na sua função estética sempre foi obter a translucidez própria do esmalte dental. Contudo, essa translucidez faz com que o material restaurador sofra influência da cor de fundo, que pode ser da cor do material de proteção, ou mais normalmente da cor da dentina. No que tange as atividades de restauração estética odontológico, através deste trabalho foi possível concluir que: 1) A colorimetria pode ser um importante meio na seleção e na comunicação de tonalidades de materiais restauradores; 2) Os resultados obtidos confirmam que a cor de fundo exerce grande influência sobre a cor do resultado final da restauração; e 3) Os guias de tonalidade devem ser reformulados de tal forma que levem em consideração a espessura do material restaurador e a cor de fundo. / When an anterior tooth is restorated, the whole remaining tissue protection technique and functional recuperation of the dental element can be compromised if the choice of the color of the restorative material is not adequate. The familiarity with the color and light interaction with matter theories may help with the task of choosing the restorative material shade. The challenge in searching for an ideal restorative material in its esthetic function was always obtaining the proper translucency of dental enamel. However, this translucency makes the restorative material suffer an influence of the background color, which can be the protection material color or, more commonly, the dentine color. Concerning the odontologic esthetic restorative activities, it was possible to conclude from this work that: 1) Colorimetry can be an important way for the selection and communication of the restorative material shades; 2) The results show that the background color has a large influence on the final color of the restoration; and 3) The shade guides must be reformulated so that it take into consideration the thickness of the restorative material and background color.

Abstract The aim of the present study was to evaluate the efficacy of the first trimester screening for Down syndrome (DS) in an unselected low-risk Finnish population. The study involved 4,617 women who attended screening between the 8th and 14th weeks of pregnancy in 1998-2000. They gave a blood sample for the measurement of pregnancy associated plasma protein A (PAPP-A) and free beta human chorionic gonadotrophin (β-hCG). Of these women, 3,178 also had an ultrasound examination for the measurement of fetal nuchal translucency (NT). The risk figure for every screened woman was calculated using a computerized risk figure program. The risk 1 in 250 was used as a cut-off. The subgroup of screen positives comprised 5.8% of the study group. There were 16 DS cases. The combined method (maternal age, NT and the biochemical markers) detected 77% of the affected pregnancies. NT combined with maternal age gave a detection rate of 69%. Serum markers without NT combined with maternal age found 75% of the Down's. In 49 consecutive singleton in-vitro-fertilization pregnancies, the β-hCG value was more often elevated compared to spontaneous pregnancies, increasing the false positive rate. In 67 twin pregnancies, the serum marker levels were approximately double those in singletons. Smoking reduced PAPP-A by 20% making the smokers more likely to get a positive screening result. To determine the impact of the screening on the live born incidence of DS, two historical populations were compared. The first group was screened by second trimester serum samples (β-hCG and AFP) and the second group by first trimester ultrasound examination. When detection rates were at the same level, the second trimester screening reduced the number of live born Down's children more effectively. In conclusion, the first trimester combined method (maternal age, NT, β-hCG and PAPP-A) for Down syndrome screening is efficient in an unselected low risk population. The biochemical screening is not recommended in IVF-pregnancies.

A severe aphasia following a cerebral vascular accident is characterised by generalised deficits in most speech-language domains. The clinical dilemma remains focused on the extensive verbal speech impairment and in most cases little possibility of regaining verbal speech production. Many individuals living with severe aphasia use augmentative and alternative communication strategies to assist them in getting their communication needs met in their everyday lives. The Blissymbol system is one of the graphic symbol systems that can be used to supplement existing communication and speech strategies of the individual with little or no speech. Although the use of AAC strategies is gaining momentum in its application to severe aphasia, however, there still remain questions on how best to help these individuals learn and retain such strategies. Not only are individuals with severe aphasia faced with a memory task when learning AAC strategies such as Blissymbols, additional complexity to AAC interventions is derived from clinical presentation of severe aphasia. The presence of extensive damage to the neural centers responsible for linguistic processing and semantic retrieval makes learning of new AAC strategies all the more complicated. Research studies have looked at whether individuals with severe aphasia can learn to recognise and retain Blissymbols. Although these studies have successfully shown that individuals with severe aphasia can learn Blissymbols, there is little information available regarding how these symbols can best be taught and retained over time individuals with severe aphasia. Recently the research that has looked at the application of symbol learning with persons presenting with severe aphasia using computer technology and sophisticated application software has highlighted the importance of therapeutic methods that may enhance the learning of such software. This study looks at the application of the self-generation effect as a viable method for enhancing the recognition of Blissymbols in persons presenting with severe aphasia. The self-generation effect is the finding of superior retention and recall for stimuli constructed or generated by an individual. Memory for stimuli such as words, numbers and pictures were found to be enhanced by the extent to which the individual was involved in its construction. Using a 2X2X3 factorial design, this study compared the recognition levels for Blissymbols taught using two treatment approaches which was the self-generation condition and the non self-generation condition. During three experimental sessions which included two withdrawal periods participants were taught using both treatments to recognise a set of Blissymbols. Recognition levels were tested during recognition probes and retention probes. The results from these probes were compared in order to identify which treatment produced superior recognition levels. The data analysis conducted showed that although there was no recognition advantage for the self-generation effect seen during the three recognition probes some advantage for the self-generation effect was seen during the retention probes conducted. The self-generation effect began to emerge by the final retention probe following a withdrawal period of seven days. The self-generation treatment showed better retention of symbol recognition over time. Previous studies have shown that the self-generation effect failed to emerge with stimuli that were new or unfamiliar. This trend was also seen in this study. The results provide support for a semantic-association theory for the self-generation effect. / Thesis (PhD)--University of Pretoria, 2010. / Centre for Augmentative and Alternative Communication (CAAC) / unrestricted