Clinical longevity of metallic versus fiberglass intraradicular posts: a systematic review / Longevidade clínica de pinos intraradiculares metálicos versus de fibra de vidro: uma revisão sistemática

Objective: This systematic review aims to compare the clinical longevity of metallic and fiberglass intraradicular posts in teeth with severely compromised crowns, utilizing randomized clinical trials and case reports published in the last eleven years. Material and Methods: The research was conducted on PubMed, Medline, Lilacs, and BBO databases using the first search strategy with the descriptors 'dental posts,' 'longevity,' 'fiberglass-reinforced posts' or 'metallic posts.' The second search strategy involved analyzing the references of articles identified by the first search. Both studies were carried out with stringent inclusion and exclusion criteria. Results: No statistically significant and clinically relevant differences in longevity were observed between metallic and fiberglass posts. Conclusion: The clinical success and durability of the restorative procedure using intraradicular posts primarily depend on the remaining amount around the post (ferrule), the type and position of the tooth in the arch (impacting the masticatory forces exerted on the restored tooth), and the correct application of the cementation technique. It is noteworthy that fiberglass posts offer substantial advantages by presenting a modulus of elasticity similar to dental structure, ensuring a more homogeneous distribution of masticatory forces and reducing the risk of fractures. These findings have practical implications for material selection in restorative procedures involving intraradicular posts.(AU)

Objetivo: Esta revisão sistemática visa comparar a longevidade clínica de pinos intrarradiculares metálicos e de fibra de vidro em dentes com coroas severamente comprometidas, através de estudos clínicos randomizados e relatos de casos, publicados nos últimos onze anos. Material e Métodos: A pesquisa foi conduzida nas bases de dados PubMed, Medline, Lilacs e BBO, utilizando a primeira estratégia de busca com os s 'pinos dentais' e 'longevidade' e 'pinos reforçados com fibra de vidro' ou 'pinos metálicos'. A segunda estratégia de busca consistiu na análise das referências dos artigos identificados pela primeira estratégia. Ambos os estudos foram delineados com critérios rigorosos de inclusão e exclusão. Resultados: Não se constataram diferenças estatisticamente significativas e clinicamente relevantes na longevidade entre pinos metálicos e de fibra de vidro. Conclusão: O êxito clínico e a durabilidade do procedimento restaurador empregando pinos intrarradiculares dependem primordialmente da quantidade de remanescente ao redor do pino (férula), do tipo e posição do dente na arcada (o que impacta nas forças mastigatórias exercidas sobre o dente restaurado) e da aplicação correta da técnica de cimentação.Destaca-se que o pino de fibra de vidro oferece vantagens substanciais ao apresentar módulo de elasticidade similar à estrutura dentária, assegurando uma distribuição mais homogênea das forças mastigatórias e reduzindo o risco de fraturas (AU)

Neuroestimulación del nervio vago, hipocampal y de núcleos anteriores y centromedianos del tálamo en epilepsia temporal: revisión de la literatura / Neurostimulation of the vagus nerve, hippocampal and anterior and centromedian nuclei of the thalamus in temporal epilepsy: literature review

Introducción: En pacientes con epilepsia del lóbulo temporal refractarios que no son candidatos a cirugía, se debe considerar la estimulación eléctrica cerebral como una opción. Contenido: La estimulación eléctrica cerebral es la administración directa de pulsos eléctricos al tejido nervioso que permite modular un sustrato patológico, interrumpir la manifestación clínica de las crisis y reducir la gravedad de estas. Así, dada la importancia de estos tratamientos para los pacientes con epilepsia del lóbulo temporal refractaria, se hace una revisión de cuatro tipos de estimulación eléctrica. La primera, la del nervio vago, es una buena opción en crisis focales y crisis generalizadas o multifocales. La segunda, la del hipocampo, es más útil en pacientes no candidatos a lobectomía por riesgo de pérdida de memoria, con resonancia magnética normal o sin esclerosis mesial temporal. La tercera, la del núcleo anterior, es pertinente principalmente en pacientes con crisis focales, pero debe realizarse con precaución en pacientes con alto riesgo de cambios cognitivos, como los ancianos, o en los que presentan alteración del estado de ánimo basal, y, por último, la del núcleo centromediano se recomienda para el tratamiento crisis focales en el síndrome de Rasmussen y crisis tónico-clónicas en el síndrome de Lennox-Gastaut. Conclusiones: El interés por la estimulación eléctrica cerebral ha venido aumentando, al igual que las estructuras diana en las cuales se puede aplicar, debido a que es un tratamiento seguro y eficaz en pacientes con epilepsia del lóbulo temporal para controlar las crisis, pues disminuye la morbimortalidad y aumenta la calidad de vida.

Introduction: In patients with refractory temporal lobe epilepsy who are not candidates for surgery, electrical brain stimulation should be considered as another option. Contents: Electrical brain stimulation is the direct administration of electrical pulses to nerve tissue that modulates a pathological substrate, interrupts the clinical manifestation of seizures, and reduces their severity. Thus, given the importance of these treatments for patients with refractory temporal lobe epilepsy, four types of electrical stimulation are reviewed. The first, vagus nerve stimulation, is a good option in focal seizures and generalized or multifocal seizures. The second, hippocampal stimulation, is more useful in patients who are not candidates for lobectomy due to the risk of memory loss, with normal MRI or without mesial temporal sclerosis. The third, the anterior nucleus, is mainly in patients with focal seizures, but with caution in patients at high risk of cognitive changes such as the elderly, or in those with baseline mood disturbance and, finally, the centromedian nucleus is recommended for the treatment of focal seizures in Rasmussen's syndrome and tonic-clonic seizures in Lennox-Gastaut syndrome. Conclusions: the interest in brain electrical stimulation has been increasing as well as the target structures in which it can be applied because it is a safe and effective treatment in patients with temporal lobe epilepsy to control seizures, decreasing morbidity and mortality and increasing quality of life

Demographic characteristics and associated influencing factors in treated patients with chronic hepatitis B with hypoviremia : a single-center retrospective cross-sectional study / 中华肝脏病杂志

Objective: To investigate the demographic characteristics and clinical influencing factors which associates with the occurrence probability of persistent or intermittent hypoviremia (LLV) in patients with chronic hepatitis B (CHB) treated with nucleos(t)ide analogues (NAs). Methods: A single-center retrospective analysis was performed on patients with CHB who received outpatient NAs therapy for≥48 ± 2 weeks. According to the serum hepatitis B virus (HBV) DNA load at 48±2 weeks treatment, the study groups were divided into LLV (HBV DNA < 20 IU/ml and < 2 000 IU/ml) and MVR group (sustained virological response, HBV DNA < 20 IU/ml). Demographic characteristics and clinical data at the start of NAs treatment (considered as baseline) were retrospectively collected for both patient groups. The differences in the reduction of HBV DNA load during treatment was compared between the two groups. Correlation and multivariate analysis were further conducted to analyze the associated factors influencing the LLV occurrence. Statistical analysis was performed using the independent samples t-test, c2 test, Spearman analysis, multivariate logistic regression analysis, or area under the receiver operating characteristic curve. Results: A total of 509 cases were enrolled, with 189 and 320 in the LLV and MVR groups, respectively. Compared to patients with MVR group at baseline: (1) the demographics characteristics of patients showed that LLV group was younger in age (39.1 years, P = 0.027), had a stronger family history (60.3%, P = 0.001), 61.9% received ETV treatment, and higher proportion of compensated cirrhosis (20.6%, P = 0.025) at baseline; (2) the serum virological characteristics of patients showed that LLV group had higher HBV DNA load, qHBsAg level, qHBeAg level, HBeAg positive rate, and the proportion of genotype C HBV infection but decreased HBV DNA during treatment (P < 0.001) at baseline; (3) the biochemical characteristics of patients showed that LLV group had lower serum ALT levels (P = 0.007) at baseline; (4) the noninvasive fibrosis markers of patients showed that LLV group were characterized by high aspartate aminotransferase platelet ratio index (APRI) (P = 0.02) and FIB-4 (P = 0.027) at baseline. HBV DNA, qHBsAg and qHBeAg were positively correlated with LLV occurrence (r = 0.559, 0.344, 0.435, respectively), while age and HBV DNA reduction were negatively correlated (r = -0.098, -0.876, respectively). Logistic regression analysis showed that ETV treatment history, high HBV DNA load at baseline, high qHBsAg level, high qHBeAg level, HBeAg positive, low ALT and HBV DNA level were independent risk factors for patients with CHB who developed LLV with NAs treatment. Multivariate prediction model had a good predictive value for LLV occurrence [AUC 0.922 (95%CI: 0.897 ~ 0.946)]. Conclusion: In this study, 37.1% of CHB patients treated with first-line NAs has LLV. The formation of LLV is influenced by various factors. HBeAg positivity, genotype C HBV infection, high baseline HBV DNA load, high qHBsAg level, high qHBeAg level, high APRI or FIB-4 value, low baseline ALT level, reduced HBV DNA during treatment, concomitant family history, metabolic liver disease history, and age < 40 years old are potential risk factors for developing LLV in patients with CHB during the therapeutic process.

Early initiation of antiviral therapy reduces the risk of hepatocellular carcinoma in individuals with chronic hepatitis B virus infection / 临床肝胆病杂志

Chronic hepatitis B virus (HBV) infection is a major cause of viral hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC). From chronic HBV infection to HCC, most patients go through the stages of chronic hepatitis, liver cirrhosis, and HCC. During this long process, the ongoing integration of HBV DNA into host DNA increases the risk of HCC, and the death and compensatory proliferation of hepatocytes caused by persistent liver inflammation may promote the accumulation of oncogenic mutations and finally lead to the malignant transformation of hepatocytes. Currently, nucleos(t)ide analogues are widely used anti-HBV drugs, which controls infection by inhibiting HBV replication and can thus effectively slow down disease progression and end-stage liver disease; however, anti-HBV therapy often starts late and has a relatively low treatment rate, and there is still a tendency of increase in the incidence rate of HBV-related HCC. Therefore, how to improve current antiviral strategies to further reduce the risk of HBV-related end-stage liver disease including HCC has become a hotspot in clinical practice. This article summarizes the previous studies supporting the expansion of antiviral therapy and suggests that antiviral therapy should be initiated as early as possible to inhibit viral replication and the sequential events of HBV DNA integration and ultimately reduce the risk of HCC in patients with chronic HBV infection.

Effect of nucleos(t)ide analog antiviral treatment on the clinical features and prognosis of patients with hepatitis B virus-related hepatocellular carcinoma / 中华传染病杂志

Objective:To analyze the effect of nucleos(t)ide analog (NAs) antiviral treatment on the clinical features and prognosis of patients with hepatitis B virus-related hepatocellular carcinoma (HBV-HCC).Methods:A retrospective analysis was performed on the data of 450 HBV-HCC patients first diagnosed and treated in the Third Hospital of Hebei Medical University from January 2015 to January 2021, including 193 patients in the continuous NAs treatment group and 257 patients in the NAs treatment after hepatocellular carcinoma (HCC) group. The baseline data of the two groups were balanced by propensity score matching. The relapse-free survival rate of HCC was estimated by Kaplan-Meier method, and the risk factors for HCC recurrence were analyzed by Cox proportional risk models. Spearman correlation analysis was used to explore the association between clinical features of HCC and hepatitis B virus (HBV) DNA load in patients receiving continuous NAs treatment.Results:Before matching, the proportions of liver cirrhosis, body mass index≥25.0 kg/m 2, single tumor, maximum tumor diameter ≤5 cm, Child-Pugh grade A, China liver cancer staging Ⅰ in the continuous NAs treatment group were 93.8%(181/193), 45.1%(87/193), 70.5%(136/193), 82.4%(159/193), 74.6%(144/193) and 74.6%(144/193), respectively. All of them were higher than those in the NAs treatment after HCC group (87.5%(225/257), 44.0%(113/257), 61.1%(157/257), 55.3%(142/257), 63.8%(164/257) and 56.0%(144/257), respectively). The proportions of drinking history and portal vein tumor thrombi in the continuous NAs treatment group were 12.4%(24/193) and 3.1%(6/193), respectively, which were lower than 33.9%(87/257) and 10.5%(27/257) in the NAs treatment after HCC group.The differences were all statistically significant ( χ2=4.86, 7.58, 4.27, 36.63, 8.15, 21.05, 27.21 and 8.88, respectively, all P<0.05). After matching, the median relapse-free survival time of the patients in the continuous NAs treatment group and the NAs treatment after HCC group were 388 days and 277 days, respectively. The five-year cumulative relapse-free survival rates were 50.0% and 37.5%, respectively, with statistically significant difference ( χ2=5.30, P=0.021). Multivariate analysis showed that no antiviral therapy before diagnosis of HCC, multiple tumors, maximum tumor diameter ≥5 cm and palliative treatment were independent risk factors for HBV-HCC recurrence (hazard ratio ( HR)=1.509, 1.491, 0.446 and 1.472, respectively, all P<0.05). After matching, the maximum tumor diameter ( r=0.175, P=0.042), incidence of portal vein tumor thrombi ( r=0.210, P=0.014) and recurrence of HBV-HCC ( r=0.178, P=0.038) in the continuous NAs treatment group were positively correlated with HBV DNA load. Conclusions:Early initiation of NAs antiviral treatment can improve the tumor characteristics when the disease progresses to HBV-HCC, and improve the relapse-free survival rate of HBV-HCC patients. No antiviral therapy before diagnosis of HCC, multiple tumors, maximum tumor diameter ≥5 cm and palliative treatment are independent risk factors for HBV-HCC recurrence.

Oferta de práticas integrativas e complementares por profissionais do Núcleo Ampliado de Saúde da Família: reafirmando o cuidado integral e holístico / Offer of complementary therapies by Extended Family Health Center professionals: reaffirming holistic and integral care

RESUMO O estudo analisa a implantação e implementação das práticas integrativas e complementares (PIC), bem como limites e potencialidades desse processo, nos serviços de Atenção Primária à Saúde (APS) de uma região de saúde do estado de São Paulo, na perspectiva de profissionais dos Núcleos Ampliados de Saúde da Família (NASF). Trata-se de estudo de abordagem quanti-qualitativa cujos dados foram coletados por meio de questionário e entrevista semiestruturada on-line e analisados com uso de estatística descritiva e análise de conteúdo modalidade temática. Do conjunto de dados emergiram três unidades temáticas: (des)estrutura para compra de materiais para as PIC; PIC enquanto cuidado ampliado, resolutivo e integral; e (Des)estrutura na alocação de profissionais para oferta de PIC. Em um contexto marcado por políticas de desmonte do NASF e do Sistema Único de Saúde (SUS), a continuidade do cuidado com a oferta de PIC por profissionais do NASF emerge como prática de resistência que reafirma a vida e reitera a longitudinalidade, o acolhimento e a integralidade, essenciais à APS e ao SUS.

Abstract This study analyzes the implantation and implementation of Complementary Therapies (CT), as well as its limits and potentialities in Primary Health Care (PHC) services of a São Paulo health region, from the perspective of NASFExtended Family Health Centers (NASF) professionals. A quantitative and qualitative study was conducted with data collected by means of a questionnaire and online semi-structured interview, and examined using descriptive statistics and thematic content analysis. Three thematic units emerged from the data set: (Un)structured purchase of CT-related materials; CT as expanded, resolutive and integral care; and (un)structured allocation of professionals to CT. In a context marked by policies aimed at dismantling the NASF and SUS, continuity of care with CT offered by NASF professionals emerges as resistance practice that reaffirms life and reiterates longitudinality, embracement and integrality, essential to PHC and SUS.

Educação Permanente em Saúde como estratégia para trabalho colaborativo na Rede de Atenção Psicossocial / Permanent Education in Healthcare as a strategy for promoting collaborative practice in the Psychosocial Care Network / Educación Permanente en Salud como estrategia para el trabajo colaborativo en la Red de Atención Psicosocial

Resumo Trata-se de pesquisa qualitativa que buscou compreender o cuidado em Saúde Mental realizado pelas equipes dos Núcleos Ampliados de Saúde da Família e Atenção Básica (Nasf-AB) e Centros de Atenção Psicossocial (Caps), por meio da inserção na Rede de Atenção Psicossocial (Raps). Utilizou-se a Educação Permanente em Saúde (EPS) como estratégia fundamental para o grupo-intervenção, a fim de lidar com as dificuldades e virtudes do processo de articulação em rede. Ao oferecer espaço de diálogo entre profissionais de Saúde Mental, foi possível caracterizar os trabalhadores dos serviços envolvidos com a ação e analisar as seguintes categorias: (1) Estratégias para o trabalho articulado em Saúde Mental; (2) Desafios para o trabalho articulado em Saúde Mental; (3) Pandemia e Raps. Contribuiu-se para o fortalecimento da Raps, articulação entre os equipamentos e aprimoramento do cuidado que vem sendo ofertado à população com sofrimento mental da região. (AU)

Abstract This qualitative study aimed to understand the provision of mental health care in family health support centers (NASF-AB) and psychosocial care centers (CAPS) after their incorporation into the Psychosocial Care Network (RAPS). Permanent Education in Healthcare (EPS) was used as the core strategy for the group intervention to capture the difficulties and virtues of the network-based care process. By providing mental health professionals an opportunity for dialogue, it was possible to characterize the workers of the services involved in the action and analyze the following categories: (1) Coordinated mental health care strategies; (2) Challenges in promoting coordinated mental health care; and (3) The pandemic and the RAPS. The strategy helped strengthen the RAPS, enhance coordination between facilities, and improve mental health care in the region. (AU)

Resumen Se trata de una investigación cualitativa que busca entender el cuidado de la salud mental realizado por los equipos de los Núcleos Ampliados de Salud de la Familia y Atención Básica (NASF-AB) y Centro de Atención Psicosocial (CAPS), a partir de la inserción en la Red de Atención Psicosocial (RAPS). Se utilizó la Educación Permanente en Salud (EPS) como estrategia fundamental para el grupo-intervención, para manejar las dificultades y virtudes del proceso de articulación en red. Al ofrecer un espacio de diálogo entre profesionales de salud mental, fue posible caracterizar a los trabajadores de los servicios involucrados con la acción y analizar las categorías siguientes: (1) Estrategias para el trabajo articulado en salud mental; (2) Desafíos para el trabajo articulado en salud mental; (3) Pandemia y RAPS. Se contribuyó con el fortalecimiento de RAPS, articulación entre los equipos y perfeccionamiento del cuidado que se ofrece a la población con sufrimiento mental de la región. (AU)

O reforço escolar: "Não sou bom de escola, sou bom de coração" / School Tutoring: "I'm not good at school, I'm good at heart" / El Refuerzo Escolar: "No soy bueno de escuela, soy bueno de corazón"

A pesquisa apresentada neste artigo identificou significações atribuídas por estudantes do ensino fundamental ao processo de reforço escolar. A partir da perspectiva teórica da Psicologia Sócio-histórica, conceitos fundamentais da constituição psicológica da criança no período escolar foram elencados. Com o referencial teórico foi criado um roteiro de entrevista, aplicado a estudantes de escolas particulares de São Paulo, sendo que este artigo traz uma das análises realizadas, com foco em um estudante. As respostas dos estudantes geraram uma análise qualitativa, utilizando o referencial teórico dos Núcleos de Significação, procedimento de análise elaborado por Aguiar e Ozella. A análise da entrevista de Caio trouxe significações a respeito do aluno que precisa de reforço escolar como sinônimo de "mau aluno", contribuindo para a adoção de mecanismos de defesa por Caio, alimentados por sentimentos de exclusão, monotonia e cansaço com o ambiente escolar. A partir das informações encontradas, os adultos envolvidos com a criança podem reestruturar e orientar de forma diferente o processo de reforço escolar, visando à diminuição ou eliminação dos sentimentos de exclusão e desvalorização que o processo pode gerar. (AU)

The research presented in this article identified meanings attributed by elementary school students to the process of school tutoring. From the theoretical perspective of Socio-Historical Psychology, fundamental concepts of the psychological constitution of the child in the school period were listed. With the theoretical reference, an interview script was created, applied to students from private schools in São Paulo, and this article brings one of the analyses carried out with a student. The students' answers generated a qualitative analysis, using the theoretical reference of the Nuclei of Meaning core, an analysis procedure developed by Aguiar and Ozella. The analysis of Caio's interview brought up meanings about the student who needs tutoring as a synonym of "bad student", contributing to the adoption of defense mechanisms by Caio, fed by feelings of exclusion, monotony and tiredness with the school environment. From the information found, the adults involved with the child can restructure and orient the process of school tutoring in a different way, aiming at reducing or eliminating the feelings of exclusion and devaluation that the process can generate. (AU)

La investigación presentada en este artículo identificó significaciones atribuidas por estudiantes de la enseñanza fundamental al proceso de refuerzo escolar. A partir de la perspectiva teórica de la Psicología Socio-Histórica conceptos fundamentales de la constitución psicológica del niño en el período escolar fueron enumerados. Con la referencia teórica, se creó un guión de entrevista, aplicado a estudiantes de escuelas públicas de São Paulo, y este artículo trae uno de los análisis realizados, con um estudiante. Las respuestas de los alumnos generaron un análisis cualitativo, utilizando el marco teórico de los Núcleos de Significado, un procedimiento de análisis desarrollado por Aguiar y Ozella. El análisis de la entrevista de Caio aportó significados sobre el alumno que necesita refuerzo escolar como sinónimo de "mal alumno", contribuyendo a la adopción de mecanismos de defensa por parte de Caio, alimentados por sentimientos de exclusión, monotonía y cansancio con el ambiente escolar. A partir de las informaciones encontradas los adultos involucrados con el niño pueden reestructurar y orientar de forma diferente el proceso de refuerzo escolar, buscando la disminución o eliminación de los sentimientos de exclusión y devaluación que el proceso puede generar. (AU)

Esquecidos após a exclusão escolar: uma meta-análise do estudo da deriva educacional / Forgotten after school exclusion: an educational drift study meta-analysis / Olvidados tras la exclusión escolar: un metanálisis del estudio de la deriva educativa

Este artigo tem como objetivo analisar os desafios e possibilidades encontradas no estudo da deriva educacional, condição em que os sujeitos já estiveram na escola, mas foram dela excluídos antes de concluir a educação básica, sendo responsabilizados pelo retorno aos estudos. Trata-se de um ensaio teórico-metodológico que foca no pensamento categorial, sobretudo a categoria da dimensão subjetiva como recurso para apreensão da concreticidade do fenômeno social estudado. A deriva educacional é um fenômeno social pouco estudado no campo da Psicologia da Educação e a possibilidade de explicá-lo é desafiadora, tendo em vista as armadilhas presentes nos discursos carregados da intenção de ocultar o modo como se trata de uma condição social e historicamente determinada no modo de produção capitalista. Diante dessa dificuldade, ter como base teórico-etodológica o Materialismo Histórico-dialético (MHD) e a Psicologia Sócio-histórica (PSH) foi fundamental. O pensamento categorial possibilitou, partindo das significações dos participantes da pesquisa, superar as múltiplas camadas de aparência para compreender a deriva educacional em sua complexidade. A categoria da dimensão subjetiva e o processo de análise por meio dos núcleos de significação possibilitaram chegar a uma síntese das múltiplas determinações da deriva educacional que permitiu explicá-la de forma contra-hegemônica, apontando para os movimentos já existentes ou ainda necessários para a transformação, sem recorrer à justificativas individualizantes, psicologizantes ou sociologizantes. (AU)

This article aims to analyze the challenges and possibilities experienced in the educational drift study, condition in which the subjects had already been to school, but were excluded from it before completing basic education, being held responsible for returning to their studies. This is a theoretical-methodological essay that focuses on categorical thinking, especially the subjective dimension category as a resource for apprehending the social phenomenon concreteness. Educational drift is a social phenomenon on which there are few studies in the field of Educational Psychology. The possibility of explaining this issue is a challenge, since the pitfalls present in the discourses intended to hide the way in which it is a social and historically determined condition in the capitalist mode of production. Faced with this difficulty, it was fundamental to have Historical-Dialectical Materialism (MHD) and Socio-Historical Psychology (PSH) as a theoreticalmethodological basis. The categorical thinking enabled us, starting from the research participants significations, to overcome the appearance of multiple layers and to understand the educational drift in its complexity. The subjective dimension category and the analysis processes through the signification nuclei made it possible to reach an educational drift multiple determinations synthesis that allowed us to explain the issue in a counter-hegemonic way, pointing to the already existing or still necessary movements to transformation, without resorting to individualizing, psychologizing or sociologizing justifications. (AU)

Este artículo tiene como objetivo analizar los desafíos y las posibilidades encontradas en el estudio de la deriva educativa, condición en la que los sujetos ya habían ido a la escuela, pero fueron excluidos de ella antes de completar la educación básica, siendo responsables de regresar a sus estudios. Este es un ensayo teórico-metodológico que se centra en el pensamiento categorial, en especial la categoría de la dimensión subjetiva como recurso para aprehender la concreción del fenómeno social estudiado. Este es un fenómeno social poco estudiado en el campo de la Psicología Educativa, y la posibilidad de explicarlo es desafiante, dadas las trampas presentes en los discursos cargados con la intención de ocultar la forma en que es una condición social e históricamente determinada en la forma de producción capitalista. Ante esta dificultad, tener como base teórico-metodológica el Materialismo Histórico-Dialéctico (MHD) y la Psicología Socio-Histórica (PSH) fue fundamental. El pensamiento categórico nos permitió, a partir de los significados de los participantes de la investigación, superar las múltiples capas de apariencia para comprender la deriva educativa en su complejidad. La categoría de la dimensión subjetiva y los procesos de análisis a través de los núcleos de significación permitieron llegar a una síntesis de múltiples determinaciones de la deriva educativa que permitieron explicarla de manera contrahegemónico, apuntando a los movimientos ya existentes o aún necesarios a la transformación, sin recurrir a justificaciones individualizantes, psicologizantes o sociologizantes.(AU)

Common and uncommon neuroimaging manifestations of ataxia: an illustrated guide for the trainee radiologist. Part 2 - neoplastic, congenital, degenerative, and hereditary diseases / Manifestações de neuroimagem comuns e incomuns na ataxia: um guia ilustrado para radiologistas em treinamento. Parte 2 - doenças neoplásicas, congênitas, degenerativas e hereditárias

Abstract Ataxia is defined as a lack of coordination of voluntary movement, caused by a variety of factors. Ataxia can be classified by the age at onset and type (chronic or acute). The causative lesions involve the cerebellum and cerebellar connections. The correct, appropriate use of neuroimaging, particularly magnetic resonance imaging, can make the diagnosis relatively straightforward and facilitate implementation of the appropriate clinical management. The purpose of this pictorial essay is to describe the imaging findings of ataxia, based on cases obtained from the archives of a tertiary care hospital, with a review of the most important findings. We also discuss and review the imaging aspects of neoplastic diseases, malformations, degenerative diseases, and hereditary diseases related to ataxia.

Resumo Ataxia é definida como uma síndrome de falta de coordenação dos músculos de movimentação voluntária. Vários fatores podem causar ataxias, as quais podem ser classificadas de acordo com a idade, tipo de evolução (crônica ou aguda), cujas lesões envolvem o cerebelo e as conexões cerebelares. Com o uso correto e apropriado da neuroimagem, particularmente da ressonância magnética, o diagnóstico pode ser relativamente direito e o manejo clínico pode ser implementado de maneira correta. O objetivo deste artigo é descrever os achados de imagem na síndrome atáxica a partir de casos recuperados do arquivo digital de um hospital terciário, com a revisão dos principais achados de imagem. Neste ensaio revisamos e discutimos os aspectos de imagem de doenças neoplásicas, malformações, doenças degenerativas e doenças hereditárias relacionadas à ataxia.

Common and uncommon neuroimaging manifestations of ataxia: an illustrated guide for the trainee radiologist. Part 1 - acquired diseases / Manifestações de neuroimagem comuns e incomuns na ataxia: um guia ilustrado para radiologistas em treinamento. Parte 1 - doenças adquiridas

Abstract Ataxia is defined as a lack of coordination of voluntary movement, caused by a variety of factors. Ataxia can be classified by the age at onset and type (chronic or acute). The causative lesions involve the cerebellum and cerebellar connections. The correct, appropriate use of neuroimaging, particularly magnetic resonance imaging, can make the diagnosis relatively accurate and facilitate implementation of the appropriate clinical management. The purpose of this pictorial essay is to describe the imaging findings of ataxia, based on cases obtained from the archives of a tertiary care hospital, with a review of the most important findings. We also review and discuss the imaging aspects of infectious, toxic, vascular, and inflammatory diseases.

Resumo Ataxia é definida como uma síndrome de falta de coordenação dos músculos de movimentação voluntária. Vários fatores podem causar ataxias, os quais podem ser classificados de acordo com a idade, tipo de evolução (crônica ou aguda), cujas lesões envolvem o cerebelo e as conexões cerebelares. Com o uso correto e apropriado da neuroimagem, particularmente da ressonância magnética, o diagnóstico pode ser relativamente preciso e o manejo clínico pode ser implementado de maneira correta. O objetivo deste artigo é descrever os achados de imagem na síndrome atáxica com base em casos recuperados do arquivo digital de um hospital terciário, com a revisão dos principais achados de imagem. Neste ensaio revisamos e discutimos os aspectos imagem de doenças infecciosas, tóxicas, vasculares e inflamatórias.

Verification of the risk score of hepatocellular carcinoma in patients with hepatitis B virus-associated liver cirrhosis / 中华消化杂志

Objective:To evaluate the accuracy and practicability of hepatocellular carcinoma prediction score (PAGE-B) and modified hepatocellular carcinoma prediction score (mPAGE-B) in predicting the development of hepatocellular carcinoma in patients with hepatitis B virus (HBV)-associated liver cirrhosis and received nucleos(t)ide analogue (NA) treatment.Methods:From June 2009 to December 2014, at Department of Hepatology, the First Affiliated Hospital of Fujian Medical University, the clinical data of 707 patients with HBV-associated liver cirrhosis and received NA treatment were retrospectively collected, and the patients were followed up. The risk factors of development of hepatocellular carcinoma were analyzed. PAGE-B (including platelet count, age, gender), mPAGE-B (including platelet count, age, gender and albumin), Child-Turcotte-Pugh (CTP) score and aspartate aminotransferase to platelet ratio index (APRI) were compared in area under receiver operator characteristic curve (AUROC) for predicting the occurrence of hepatocellular carcinoma within 5 years. Risk stratification analysis was carried out for mPAGE-B and PAGE-B. Multivariate Cox regression analysis, receiver operator characteristic curve, Mann-Whitney U test and Kaplan-Meier method were used for statistical analysis. Results:The age of 707 patients was (46.7±12.2) years old, including 567 males (80.2%) and 140 females (19.8%). The positive rate of hepatitis B e antigen was 56.4% (399/707). The scores of PAGE-B, mPAGE-B, CTP and APRI were 15.90±4.24, 12.39±3.58, 6.88±2.15 and 1.80 (0.85, 3.79), respectively. The overall follow up time was (38.14±20.97) months and the incidence of hepatocellular carcinoma was 8.1% (57/707). The results of multivariate Cox regression analysis showed that advanced age, low platelet count and quantitative reduction of HBV DNA were independent risk factors of development of hepatocellular carcinoma (Wald=20.44, 5.64 and 9.25; HR(95% confidence interval (95% CI) 1.056(1.031 to 1.081), 0.994(0.989 to 0.999) and 0.769(0.649 to 0.911); P<0.001, =0.018 and 0.002). The AUROCs (95% CI) of PAGE-B, mPAGE-B, CTP score and APRI for predicting the occurrence of hepatocellular carcinoma within 5 years were 0.708 (0.639 to 0.778), 0.724 (0.657 to 0.778), 0.576 (0.500 to 0.652) and 0.516 (0.443 to 0.589), respectively. There were no statistically significant differences in AUROCs for predicting the occurrence of hepatocellular carcinoma within 5 years between mPAGE-B and PAGE-B, between APRI and CTP score (both P>0.05). The AUROC for predicting the occurrence of hepatocellular carcinoma within 5 years of CTP score was less than those of PAGE-B and mPAGE-B, and the differences were statistically significant ( Z=3.00 and 3.79; P=0.003, <0.001). The AUROC for predicting the occurrence of hepatocellular carcinoma within 5 years of APRI was less than those of PAGE-B and mPAGE-B, and the differences were statistically significant ( Z=4.75 and 5.46, both P<0.001). There were 51 cases (7.2%), 394 cases (55.7%) and 262 cases (37.1%) in the low-risk (<10) group, medium-risk (10 to 17) group and high-risk (>17) group as assessed by PAGE-B. The incidence of hepatocellular carcinoma was 0(0/51), 4.8% (19/394) and 14.5% (38/262), respectively the annual average incidence of hepatocellular carcinoma was 0, 1.6% and 5.5%, respectively, the 5-year cumulative incidence of hepatocellular carcinoma was 0, 7.3% and 31.3%, respectively. The 5-year cumulative incidence of hepatocellular carcinoma of high-risk group was higher than those of medium-risk group and low-risk group (log-rank test=19.27, P<0.001). There were 97 cases (13.7%), 246 cases (34.8%) and 364 cases (51.5%) in the low-risk group (<9), medium-risk group (9 to 12) and high-risk group (>12) as assessed by mPAGE-B. The incidence of hepatocellular carcinoma was 2.1% (2/97), 3.7% (9/246) and 12.6%(46/364), the annual average incidence of hepatocellular carcinoma was 0.6%, 1.1% and 4.7%, respectively, the 5-year cumulative incidence of hepatocellular carcinoma was 2.4%, 5.1% and 26.7%, respectively. The 5-year cumulative incidence of hepatocellular carcinoma of high-risk group was higher than those of medium-risk group and low-risk group (log-rank test value=18.64, P<0.001). Conclusions:Both PAGE-B and mPAGE-B can predict the occurrence of hepatocellular carcinoma within 5 years in patients with HBV-associated liver cirrhosis treated with antiviral therapy, identify liver cirrhotic patients at high risk of development of hepatocellular carcinoma and guide clinicans to use more efficient screening strategies.

Duas críticas às normativas dos Núcleos de Apoio à Saúde da Família / Two criticisms of the Family Health Support Centers regulations / Dos críticas a las normativas de los Núcleos de Apoyo a la Salud de la Familia

Resumo Estudos empíricos identificaram insuficiências e precariedades na atuação de apoio matricial dos Núcleos de Apoio à Saúde da Família. Este artigo, baseado em experiências assistemáticas diversas e literatura selecionada, defende duas teses interligadas que criticam aspectos das normativas federais originais para atuação desses Núcleos: uma concepção − implícita nas normativas − de atenção primária à saúde como cenário de ações situadas apenas em campos de competência compartilháveis, por um lado; e a opção de inserção desses Núcleos relativamente fora do fluxo assistencial dos usuários, por outro. Argumenta-se que ambas, provavelmente, geraram efeitos adversos envolvidos nos problemas de atuação desses Núcleos: contribuíram para a superestimação dos seus resultados esperados, para o seu subaproveitamento e subdesenvolvimento institucional e para a precarização da sua legitimidade, dificultada com a Política Nacional de Atenção Básica de 2017 e atingida gravemente com o desfinanciamento federal em 2019. Defende-se o aperfeiçoamento dos Núcleos de Apoio à Saúde da Família e sugere-se sua inserção no fluxo assistencial entre a atenção primária à saúde e a atenção secundária, para reduzir o isolamento entre ambas e aperfeiçoar a coordenação personalizada do cuidado, facilitar a legitimidade dos 'matriciadores', o apoio matricial e a educação permanente dos profissionais.

Abstract Empirical studies have identified shortcomings and precariousness in the matrix support activities of the Family Health Support Centers. This article, based on diverse unsystematic experiences and selected literature, defends two interconnected theses that criticize aspects of the original federal regulations for the performance of these Nuclei: a conception - implicit in the regulations - of primary health care as a scenario for actions located only in fields of shareable competences, on the one hand; and the option of inserting these Centers relatively outside the care flow of users, on the other. It is argued that both, probably, generated adverse effects involved in the problems of operation of these Nuclei: they contributed to the overestimation of their expected results, to their underutilization and institutional underdevelopment and to the precariousness of their legitimacy, hampered by the 2017 National Primary Care Policy and seriously affected by the federal underfunding in 2019. The improvement of the Family Health Support Centers is defended and their insertion in the care flow between primary health care and the secondary care, to reduce the isolation between the two and improve the personalized coordination of care, facilitate the legitimacy of collaborative care, matrix support and the continuing education of professionals in Brazil.

Resumen Estudios empíricos identificaron carencias y precariedades en las actividades de apoyo matricial de los Núcleos de Apoyo a la Salud de la Familia. Este artículo, basado en diversas experiencias asistemáticas y literatura seleccionada, defiende dos tesis interconectadas que critican aspectos de las normativas federales originales para el funcionamiento de estos Núcleos: una concepción - implícita en las normativas - de la atención primaria de salud como escenario de acciones ubicadas únicamente en campos de competencia compartibles, por un lado; y la opción de inserción de estos Núcleos relativamente fuera del flujo de atención a los usuarios, por el otro. Se argumenta que ambas, probablemente, generaron efectos adversos involucrados en los problemas de funcionamiento de estos Núcleos: contribuyeron a la sobreestimación de sus resultados esperados, a su subutilización y subdesarrollo institucional y a la precariedad de su legitimidad, obstaculizada por la Política Nacional de Atención Primaria de 2017 y gravemente afectada por la falta de financiación federal en 2019. Se defiende el perfeccionamiento de los Núcleos de Apoyo a la Salud de la Familia y se sugiere su inserción en el flujo asistencial entre la atención primaria a la salud y secundaria, para reducir el aislamiento entre ambas y mejorar la coordinación personalizada de la atención, facilitar la legitimación de los 'matriciadores', el apoyo matricial y la formación permanente de los profesionales en Brasil.

Techniques for removing root canal posts: an vitro study / Técnicas para remoção de pinos intrarradiculares: um estudo in vitro

Objetivo: O objetivo deste estudo foi responder qual é a melhor técnica para remoção de pinos de fibra de vidro e pinos metálicos fundidos considerando tempo, preservação da estrutura dentária e custos. Métodos: Foi realizado um estudo in vitro, randomizado e cego. Sessenta dentes tratados endodonticamente foram randomizados em dois grupos de acordo com o tipo de pino. Uma segunda randomização foi realizada para cada tipo de técnica de remoção (ultrassom, broca ou combinada; n=10). One-way ANOVA foi usado para comparar o tempo de remoção do pino, teste t pareado comparou a quantidade de estrutura dentária removida e Kruskal Wallis seguido pelo teste post hoc de Mann-Whitney foram usados para análise de custo (P = 0,05). Resultados: Não houve diferença no tempo de remoção do pino considerando o tipo ou técnica do pino (P=0,630). A perda média de estrutura dentária na região cervical foi superior a 30% quando apenas uma ponta diamantada foi usada para remover pino de fibra de vidro (P<0,00001) e pino metálico fundido (P=0,008). Conclusão: De acordo com os resultados deste estudo, podemos concluir que a seleção da técnica de remoção dependerá da habilidade do operador, e sempre ocorrerá alguma perda de estrutura dentária, embora seja esperada uma perda maior quando apenas pontas diamantadas são usadas para este fim.(AU)

Objective: The aim of this study was to answer which is the best technique to removing glass fiber post and cast metal post considering time, preservation of tooth structure, and costs. Methods: An in vitro, randomized, blinded study was conducted. Sixty endodontically treated teeth were randomized into two groups according to post type. A second randomization was performed for each type of removal technique (ultrasound, drill, or combined; n=10). One-way ANOVA was used to compare the time to post removal, paired t-test compared the amount of tooth structure removed and Kruskal Wallis followed by post hoc Mann-Whitney test were used for cost analysis (P=0.05). Results: There was no difference in post removal time considering post type or technique (P=0.630). The average loss of tooth structure in the cervical region was greater than 30% when only a diamond bur was used to remove fiber glass post (P<0.00001) and cast metal post (P=0.008). Conclusion: According to the results of this study, we can conclude that the selection of the removal technique will depend on the skill of the operator, and some loss of tooth structure will always occur, although greater loss is expected when only diamond burs are used for this purpose.(AU)

Transaxonal degenerations of cerebellar connections: the value of anatomical knowledge / Degenerações transaxonais das conexões cerebelares: o valor do conhecimento anatômico

ABSTRACT Transaxonal degenerations result from neuronal death or the interruption of synaptic connections among neuronal structures. These degenerations are not common but may be recognized by conventional magnetic resonance imaging. Objective: The learning objectives of this review include recognition of the imaging characteristics of transaxonal degenerations involving cerebellar connections, the identification of potential encephalic lesions that can lead to these degenerations and correlation of the clinical manifestations with imaging findings that reflect this involvement. Methods: In this report, we review the neuroanatomical knowledge that provides a basis for identifying potential lesions that can result in these degenerations involving cerebellar structures. Results: Hypertrophic olivary degeneration results from an injury that interrupts any of the components of the Guillain-Mollaret triangle. In this work, we describe cases of lesions in the dentate nucleus and central tegmental tract. The crossed cerebellar diaschisis presents specific imaging findings and clinical correlations associated with its acute and chronic phases. The Wallerian degeneration of the middle cerebellar peduncle is illustrated by fiber injury of the pontine cerebellar tracts. A T2-hyperintensity in the dentate nucleus due to a thalamic acute lesion (in ventral lateral nuclei) is also described. Each condition described here is documented by MRI images and is accompanied by teaching points and an anatomical review of the pathways involved. Conclusion: Neurologists and radiologists need to become familiar with the diagnosis of these conditions since their presentations are peculiar and often subtle, and can easily be misdiagnosed as ischemic events, degenerative disease, demyelinating disease or even tumors.

RESUMO Degenerações transaxonais resultam da morte neuronal ou da interrupção de conexões sinápticas entre estruturas neurais. Essas degenerações não são comuns, mas podem ser reconhecidas por imagens de ressonância magnética convencional. Objetivo: Os objetivos de aprendizado desta revisão incluem o reconhecimento das características de imagem de degenerações transaxonais envolvendo conexões cerebelares, a identificação de possíveis lesões encefálicas que podem levar a essas degenerações e a correlação das manifestações clínicas com os achados de imagem que refletem esse envolvimento. Métodos: Neste artigo, revisamos conhecimentos neuroanatômicos que fornecem a base para identificar possíveis lesões que podem resultar nessas degenerações envolvendo estruturas cerebelares. Resultados: A degeneração olivar hipertrófica resulta de uma lesão que interrompe algum dos componentes do triângulo de Guillain-Mollaret. Neste trabalho, descrevemos casos de lesões no núcleo denteado e no trato tegmentar central. A diásquise cerebelar cruzada apresenta achados de imagem específicos e correlações clínicas associadas às suas fases aguda e crônica. A degeneração walleriana dos pedúnculos cerebelares médios é ilustrada pela lesão dos tratos pontino-cerebelares. Uma hiperintensidade em T2 do núcleo denteado devido a uma lesão talâmica aguda (no núcleo ventrolateral) também é descrita. Cada condição aqui descrita é documentada por imagens de ressonância magnética e é acompanhada por pontos didáticos e uma revisão anatômica das vias envolvidas. Conclusão: Neurologistas e radiologistas precisam estar familiarizados com o diagnóstico dessas condições, uma vez que suas apresentações são peculiares e frequentemente sutis, e podem ser facilmente equivocadamente diagnosticadas como lesões isquêmicas, doenças degenerativas, desmielinizantes, ou mesmo tumorais.

Advances in research on HBV inhibitors based on new targets (1): capsid protein inhibitors / 药学学报

Hepatitis B virus (HBV) capsid protein plays an important role in the life cycle, thus becoming an ideal target for drug design. Capsid protein inhibitors can exert a synergistic antiviral effect with nucleoside drugs by inhibiting the replication of HBV. This paper reviews the research progress of capsid protein inhibitors with different structural types from the perspective of medicinal chemistry.

An expert consensus for the adjustment of treatment strategies in patients with chronic hepatitis B treated with non-first-line nucleos(t)ide analogues / 中华肝脏病杂志

Oral nucleos(t)ide analogues (NAs) is one of the main and efficient way for the treatment of chronic hepatitis B (CHB). Considering the antiviral potency and drug resistance of domestic and foreign guidelines, NAs are divided into first-line and non-first-line drugs. "An Expert Consensus for the Adjustment of Treatment Strategies in Patients with Chronic Hepatitis B Treated with Non-first-line Nucleos(t)ide Analogues," is mainly aimed at those patients who are currently using non-first-line NAs drugs. In addition, how to standardize the adjustment to first-line NAs drugs of choice, which can strengthen the effectiveness of initial antiviral treatment to obtain better antiviral efficacy, and improve patient compliance, coinciding with the avoidance of occurrence of serious drug adverse reactions in patients with CHB is presented.

An expert consensus for the adjustment of treatment strategies in patients with chronic hepatitis B treated with non-first-line nucleos(t)ide analogues / 中华肝脏病杂志

Oral nucleos(t)ide analogues (NAs) is one of the main and efficient way for the treatment of chronic hepatitis B (CHB). Considering the antiviral potency and drug resistance of domestic and foreign guidelines, NAs are divided into first-line and non-first-line drugs. "An Expert Consensus for the Adjustment of Treatment Strategies in Patients with Chronic Hepatitis B Treated with Non-first-line Nucleos(t)ide Analogues," is mainly aimed at those patients who are currently using non-first-line NAs drugs. In addition, how to standardize the adjustment to first-line NAs drugs of choice, which can strengthen the effectiveness of initial antiviral treatment to obtain better antiviral efficacy, and improve patient compliance, coinciding with the avoidance of occurrence of serious drug adverse reactions in patients with CHB is presented.

Considerations of using oral nucleos(t)ide analogues to interrupt mother-to-child transmission in HBV carrier pregnant woman with high viral load / 中华肝脏病杂志

The main transmission route of chronic hepatitis B virus infection is mother-to-child transmission of hepatitis B virus and the main cause of combined immune prophylaxis failure in neonates at the end of pregnancy is high viral load. Moreover, oral administration of nucleos(t)ide analogues (NAs) during the second and third trimesters of pregnancy can significantly reduce or even completely block mother-to-child transmission of HBV. This article focuses on the necessity and feasibility of oral NAs antiviral therapy for HBV carrier pregnant woman with high viral load, and the issues commences at the time of medication and viral load thresholds.

An expert consensus for the adjustment of treatment strategies in patients with chronic hepatitis B treated with non-first-line nucleos(t)ide analogues / 中华肝脏病杂志

Oral nucleos(t)ide analogues (NAs) is one of the main and efficient way for the treatment of chronic hepatitis B (CHB). Considering the antiviral potency and drug resistance of domestic and foreign guidelines, NAs are divided into first-line and non-first-line drugs. "An Expert Consensus for the Adjustment of Treatment Strategies in Patients with Chronic Hepatitis B Treated with Non-first-line Nucleos(t)ide Analogues," is mainly aimed at those patients who are currently using non-first-line NAs drugs. In addition, how to standardize the adjustment to first-line NAs drugs of choice, which can strengthen the effectiveness of initial antiviral treatment to obtain better antiviral efficacy, and improve patient compliance, coinciding with the avoidance of occurrence of serious drug adverse reactions in patients with CHB is presented.