Is Conventional Resin Cement Adhesive Performance to Dentin Better Than Self-adhesive? A Systematic Review and Meta-Analysis of Laboratory Studies.

CLINICAL RELEVANCE: Conventional multistep resin cements presented higher adhesive performance to dentin than simplified self-adhesive cements, which is an important criterion for indirect restoration prognosis. SUMMARY: This study aimed to conduct a systematic review of the literature on laboratory studies assessing bonding performance to dentin of conventional and self-adhesive resin cements, in cementing indirect restorations. This review was reported according to the PRISMA Statement. Of a total of 518 studies, 36 were screened full text and reviewed according to exclusion criteria. Nineteen papers were included in the systematic review and meta-analyses, according to the following inclusion criteria: studies that evaluated the bond strength to dentin of indirect restorations cemented with dual conventional or self-adhesive resin cements and those that presented bond strength data in MPa as an outcome. Statistical analyses were conducted using Rev-Man 5.1. Comparisons were performed with random effects models at 5% significance level. A global analysis comparing conventional and self-adhesive cements and three subgroup analyses comparing immediate and long-term results were performed. Global analysis showed a difference between groups, with conventional resin cements presenting higher bond strength results than self-adhesive resin cements, in immediate and long-term time periods (both p=0.03). Immediate and longterm bond strength results were different for self-adhesive cements, favoring immediate bond strength (p=0.03), but immediate and long-term bond strength results for conventional resin cements were not different (p=0.06). Medium or high risk of bias was found in all studies. Conventional multistep resin cements showed superior overall adhesive performance compared with simplified self-adhesive resin cements when used to cement indirect restorations to dentin.

The Use of Composite Layering Technique to Mask a Discolored Background: Color Analysis of Masking Ability After Aging-Part II.

The aim of this study was to evaluate the effectiveness of the layering technique to mask a discolored background (C4) after one year of water aging. The technique was used with three resin composite restorative systems (IPS Empress Direct, Charisma Diamond, and Filtek Z350XT). Ninety 1.5-mm-thick specimens were divided into groups and subgroups according to the restorative system and resin composite shade combination used in the layering technique (enamel, body, and dentin). The color measurements were made by reflection spectrophotometer (SP60, EX-Rite) over the C4 substrate at two time points: after 24-hour water immersion (T0) and after one-year water aging (T1). The masking ability was evaluated by calculating the ΔE between an inherent color background and a C4 background at T0 and T1. CIELAB and CIEDE2000 formulas were used for comparative analysis between T0 and T1 color measurements. Analysis of variance and Turkey's post hoc test (a=0.05) were performed to analyze ΔEab and ΔE00 mean values. The Z350XT restorative system presented adequate masking ability in the combinations of 0.5 mm body + 1.0 mm dentin, 0.5 mm enamel + 1.0 mm dentin, and 1.5 mm dentin after 24-hour water immersion. The masking ability was affected negatively by water aging in most of the combinations. The IPS Empress Direct was the only system that remained stable after aging in the combinations of 0.5 mm enamel + 1.0 mm dentin and + 1.5 mm dentin (p=0.05 and p=0.47 for CIELAB; p=0.15 and p=0.51 for CIEDE2000), although it did not present adequate masking ability in both time points. None of the combinations of any system presented adequate masking ability after prolonged water aging.

A Framework for Automatic Recognition of Cell Damage on Microscopic Images using Artificial Neural Networks.

Despite several technological advances in the past years, the vast majority of microscopy examinations continue to be performed in a very laborious, time-consuming manner, requiring highly experienced personnel to spend several hours to visually examine each microscope slide. Due to recent improvements in modern Digital Image Processing, professionals that work on microscopic exams could benefit from new tools that can apply image processing possibilities to their specific field. We propose a framework consisting of an image segmentation stage, feature extraction, and then a Shallow Neural Network related to human perception. The framework is used to classify among 5 types of animal cell damage analyzed in a case study. The case study used applies the Single Cell Gel Electrophoresis assay (SCGE, also known as comet assay) to the cells of land mollusk Helix aspersa in order to measure the DNA damage caused by mutagenic agents. To train and analyze the performance of our approach, we used a dataset manually segmented by a biologist and comprised of 130 slide samples with labeled cells. Our framework proved to be robust, achieving an average accuracy of 88.3%.

The Use of Resin Composite Layering Technique to Mask Discolored Background: A CIELAB/CIEDE2000 Analysis.

The purpose of this study was to evaluate the ability of three resin composite systems to mask a severely discolored background by the application of a layering technique through CIELAB and CIEDE2000 analysis. Ninety 1.5-mm-thick disc specimens were produced from three different resin composite restoration systems: IPS Empress Direct (Ivoclar Vivadent), Charisma Diamond (Heraeus Kulzer), and Filtek Z350 XT (3M-ESPE). The specimens were divided into groups according to the restoration system and the resin composite shade combination used for the layering technique (enamel, body, and dentin shades). Color measurements were performed by a reflectance spectrophotometer (SP60, EX-Rite) against a C4 shade background and an inherent color background, which simulates a severely discolored background and a tooth surface with no discoloration, respectively. The total color difference between both color measurements was calculated by CIELAB (ΔE*ab) and CIEDE2000 (ΔE00) formulas. The mean ΔEab* and ΔE00 values were analyzed by analysis of variance (general linear models) and Tukey's post hoc tests (α=0.05). Three groups presented clinically acceptable color difference values (ΔE*≦3.46 and ΔE00≦2.25): 1.5 mm dentin, 1.0 mm dentin/0.5 mm body, and 1.0 mm dentin/0.5 mm enamel; ie, all the groups from the Z350 XT restoration system. The resin composite layering technique is an effective way to mask severely discolored backgrounds. The Filtek Z350 XT system was the only restoration system capable of masking the C4 background.

Color stability of a resin composite: Effect of the immersion method and surface treatments.

BACKGROUND: In vitro staining methods expose the entire specimen to staining solutions. In a real clinical situation, this is not observed, since one should consider that the bonded surface is not exposed to the oral environment. Theoretically, the clinical condition would be the best simulated if the specimens were exposed to staining solutions by partial immersion. AIMS: To evaluate if different immersion methods and surface treatments influence the color stability of resin-based specimens. METHODOLOGY: A stainless steel matrix was used to prepare 30 disc-shaped specimens that were randomly allocated in three groups: Without polishing, polishing with abrasive discs, and surface sealant. Half of the specimens were isolated to maintain only the upper surface exposed to staining (partial immersion) and the other half was totally immersed in coffee solution for 48 h (total immersion). The coordinates ΔE*, ΔL*, Δa*, Δb* were assessed by spectrophotometer. STATISTICAL ANALYSIS: Two-way ANOVA and Tukey's post hoc tests (α =0.05). RESULTS: Specimens submitted to partial immersion showed lower values of ΔE*, ΔL*, Δa*, Δb*, in comparison to total immersion (P = 0.000). Specimens covered by a surface sealant presented lower ΔE* values regardless of the immersion method. CONCLUSIONS: Specimens totally immersed in staining solutions could in somehow overestimate the color change, once that in most clinical conditions not all of the restoration surfaces are exposed to the oral environment. Moreover, as the surface sealant application produces color change values that are clinically acceptable, it might be used in esthetic restorations as an adjunct treatment.

[Nurses' perception, experience and knowledge of palliative care in intensive care units]. / Percepciones, experiencias y conocimientos de las enfermeras sobre cuidados paliativos en las unidades de cuidados intensivos.

BACKGROUND: Adequate provision of palliative care by nursing in intensive care units is essential to facilitate a "good death" to critically ill patients. OBJECTIVE: To determine the perceptions, experiences and knowledge of intensive care nurses in caring for terminal patients. METHODOLOGY: A literature review was conducted on the bases of Pubmed, Cinahl and PsicINFO data using as search terms: cuidados paliativos, UCI, percepciones, experiencias, conocimientos y enfermería and their alternatives in English (palliative care, ICU, perceptions, experiences, knowledge and nursing), and combined with AND and OR Boolean. Also, 3 journals in intensive care were reviewed. RESULTS: Twenty seven articles for review were selected, most of them qualitative studies (n=16). After analysis of the literature it has been identified that even though nurses perceive the need to respect the dignity of the patient, to provide care aimed to comfort and to encourage the inclusion of the family in patient care, there is a lack of knowledge of the end of life care in intensive care units' nurses. CONCLUSION: This review reveals that to achieve quality care at the end of life, is necessary to encourage the training of nurses in palliative care and foster their emotional support, to conduct an effective multidisciplinary work and the inclusion of nurses in decision making.

Simulation and study of the behaviour of the transversalis fascia in protecting against the genesis of inguinal hernias.

Simulating the muscular system has many applications in biomechanics, biomedicine and the study of movement in general. We are interested in studying the genesis of a very common pathology: human inguinal hernia. We study the effects that some biomechanical parameters have on the dynamic simulation of the region, and their involvement in the genesis of inguinal hernias. We use the finite element method (FEM) and current models for the muscular contraction to determine the deformed fascia transversalis for the estimation of the maximum strain. We analysed the effect of muscular tissue density, Young's modulus, Poisson's coefficient and calcium concentration in the genesis of human inguinal hernia. The results are the estimated maximum strain in our simulations, has a close correlation with experimental data and the accepted commonly models by the medical community. Our model is the first study of the effect of various biological parameters with repercussions on the genesis of the inguinal hernias.

Effect of ethanol on proteolysis in isolated liver cells.

Ethanol, when tested alone, inhibited proteolysis by about 20%; however, no effect was detected when it was combined with exogenous oxidizable fuels which inhibited proteolysis by themselves. Ethanol was effective in inhibiting proteolysis in the presence of protease inhibitors like ammonia, leupeptin or methylamine, indicating that its mechanism of action involves a non-lysosomal pathway of degradation. Ethanol oxidation is mandatory for it to have effect on proteolysis, however, its action is not related to an increased state of reduction of the NAD system. In contrast to other reductants of the NAD system, ethanol effect is accompanied by a rise in the phosphorylation state of the adenine nucleotides, suggesting that its action might be related to the cellular energy state.

Acute effects of ethanol in the control of protein synthesis in isolated rat liver cells.

The acute effect of ethanol on hepatic protein synthesis is a rather controversial issue. In view of the conflicting reports on this subject, the effect of ethanol on protein labeling from L-[3H]valine in isolated liver cells was studied under a variety of experimental conditions. When tracer doses of the isotope were utilized, ethanol consistently decreased the rate of protein labeling, regardless of the metabolic conditions of the cells. This inhibition was not prevented by doses of 4-methylpyrazole large enough to abolish all the characteristic metabolic effects of ethanol, and it was not related to perturbations on the rates of L-valine transport and/or proteolysis. When ethanol was tested in the presence of saturating doses of L-[3H]valine no effect on protein labeling was observed. These observations suggest that the ethanol effect in decreasing protein labelling from tracer doses of the radioactive precursor does not reflect variations in the rate of protein synthesis but reflects changes in the specific activity of the precursor. These changes probably are secondary to variations in the dimensions of the amino acid pool utilized for protein synthesis. Even though it showed a lack of effect when tested alone, in the presence of saturating doses of the radioactive precursor ethanol inhibited the stimulatory effects on protein synthesis mediated by glucose and several gluconeogenic substrates. This effect of ethanol was not prevented by inhibitors of alcohol dehydrogenase, indicating that a shift of the NAD system to a more reduced state is not the mediator of its action. It is suggested that ethanol probably acted by changing the steady-state levels of some common effector(s) generated from the metabolism of all these fuels or else by preventing the inactivation of a translational repressor.