CIRSE Standards of Practice on Peri-operative Anticoagulation Management During Interventional Radiology Procedures.

This CIRSE Standards of Practice document is aimed at interventional radiologists and provides best practices for peri-operative anticoagulation management during interventional radiology procedures.

A Prospective Randomized Trial of Postural Changes vs Passive Supine Lying during the Second Stage of Labor under Epidural Analgesia.

There exist very few studies comparing different postures or postural changes during labor in parturients with epidural analgesia. AIM: To disclose whether the intervention of a multidisciplinary nursing team including a physiotherapist during the second stage of labor improves the obstetric outcome in parturients with epidural analgesia. DESIGN: Prospective randomized trial. SETTING: University-affiliated hospital. POPULATION: Women undergoing labor with epidural analgesia after a normal gestation. METHODS: 150 women were randomized either to actively perform predefined postural changes during the passive phase of the second stage of labor under the guidance of the attending physiotherapist (study group), or to carry out the whole second stage of labor lying in the traditional supine position (control group). RESULTS: There were significantly more eutocic deliveries (p = 0.005) and, conversely, significantly less instrumental deliveries (p < 0.05) and cesarean sections (p < 0.05) in the study group. The total duration of the second stage of labor was significantly shorter (p < 0.01) in the study group. This was at the expense of the passive phase of the second stage of labor (p < 0.01). Significantly less episiotomies were performed in the study group (31.2% vs 17.8%, p < 0.05). CONCLUSION: The intervention of a physiotherapist during the second stage of labor significantly improved the obstetric outcome.

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction.

INTRODUCTION AND HYPOTHESIS: There has been an increasing need for the terminology on the conservative management of female pelvic floor dysfunction to be collated in a clinically based consensus report. METHODS: This Report combines the input of members and elected nominees of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. An extensive process of nine rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Before opening up for comments on the webpages of ICS and IUGA, five experts from physiotherapy, neurology, urology, urogynecology, and nursing were invited to comment on the paper. RESULTS: A Terminology Report on the conservative management of female pelvic floor dysfunction, encompassing over 200 separate definitions, has been developed. It is clinically based, with the most common symptoms, signs, assessments, diagnoses, and treatments defined. Clarity and ease of use have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Ongoing review is not only anticipated, but will be required to keep the document updated and as widely acceptable as possible. CONCLUSION: A consensus-based terminology report for the conservative management of female pelvic floor dysfunction has been produced, aimed at being a significant aid to clinical practice and a stimulus for research.

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction.

Introduction and hypothesis There has been an increasing need for the terminology on the conservative management of female pelvic floor dysfunction to be collated in a clinically based consensus report. Methods This Report combines the input of members and elected nominees of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. An extensive process of nine rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Before opening up for comments on the webpages of ICS and IUGA, five experts from physiotherapy, neurology, urology, urogynecology, and nursing were invited to comment on the paper. Results A Terminology Report on the conservative management of female pelvic floor dysfunction, encompassing over 200 separate definitions, has been developed. It is clinically based, with the most common symptoms, signs, assessments, diagnoses, and treatments defined. Clarity and ease of use have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Ongoing review is not only anticipated, but will be required to keep the document updated and as widely acceptable as possible. Conclusion A consensus-based terminology report for the conservative management of female pelvic floor dysfunction has been produced, aimed at being a significant aid to clinical practice and a stimulus for research.

Periodontal evaluation of different toothbrushing techniques in patients with fixed orthodontic appliances.

INTRODUCTION: Plaque control is the major consensus during orthodontic treatment to prevent the occurrence of cavities and periodontal inflammation. The mechanic resource of greater effectiveness and frequent use in this control is the oral hygiene. The tooth brushing techniques most used in orthodontic patients are: Ramfjord's method, Modified Stillman technique and Bass method. OBJECTIVE: Since control studies evaluating the effectiveness of usual tooth brushing techniques do not show clear advantage, the objective of this study was to evaluate the effectiveness of three brushing methods, through periodontal clinical parameters of patients with fixed orthodontic appliances. METHODS: Thirty patients were selected, with ages between 14 and 22 years old, with fixed orthodontic appliances. After basic periodontal treatment the following factors were evaluated: 1--Plaque index and 2--Gingival index and each patient was randomly included in one of the three selected groups according to the brushing technique: Group 1--Scrubbing technique; Group 2--Modified Stillman technique and Group 3--Bass technique. Patients were evaluated for 9 months. RESULTS: The results showed a significant reduction of clinical parameters by the end of this period, however there was a very significant reduction of Gingival index on group 3 (13.6%) when compared to the other groups. CONCLUSION: Thus, it can be suggested that the Bass technique can be effective on the reduction of periodontal clinical parameters of Plaque index and Gingival index in patients with fixed orthodontic appliances.

Periodontal evaluation of different toothbrushing techniques in patients with fixed orthodontic appliances

INTRODUCTION: Plaque control is the major consensus during orthodontic treatment to prevent the occurrence of cavities and periodontal inflammation. The mechanic resource of greater effectiveness and frequent use in this control is the oral hygiene. The tooth brushing techniques most used in orthodontic patients are: Ramfjord's method, Modified Stillman technique and Bass method. OBJECTIVE: Since control studies evaluating the effectiveness of usual tooth brushing techniques do not show clear advantage, the objective of this study was to evaluate the effectiveness of three brushing methods, through periodontal clinical parameters of patients with fixed orthodontic appliances. METHODS: Thirty patients were selected, with ages between 14 and 22 years old, with fixed orthodontic appliances. After basic periodontal treatment the following factors were evaluated: 1 - Plaque index and 2 - Gingival index and each patient was randomly included in one of the three selected groups according to the brushing technique: Group 1 - Scrubbing technique; Group 2 - Modified Stillman technique and Group 3 - Bass technique. Patients were evaluated for 9 months. RESULTS: The results showed a significant reduction of clinical parameters by the end of this period, however there was a very significant reduction of Gingival index on group 3 (13.6%) when compared to the other groups. CONCLUSION: Thus, it can be suggested that the Bass technique can be effective on the reduction of periodontal clinical parameters of Plaque index and Gingival index in patients with fixed orthodontic appliances.

INTRODUÇÃO: o controle de placa bacteriana é o maior consenso durante o tratamento ortodôntico para prevenir a ocorrência de cáries e inflamação periodontal. O recurso mecânico de maior efetividade e uso frequente nesse controle é a higienização bucal. As técnicas de escovação dentária mais usadas por pacientes ortodônticos são: a friccional giratória de Ramfjord, a Stillman modificada e a sulcular de Bass. OBJETIVO: tendo em vista que estudos de controle avaliando a efetividade das técnicas de escovação mais comuns não demonstraram nenhuma superioridade clara, o objetivo desse estudo foi avaliar a efetividade de três técnicas de escovação, através dos parâmetros clínicos periodontais de pacientes portadores de aparelhos ortodônticos fixos. MÉTODOS: foram selecionados 30 pacientes, com idades entre 14 e 22 anos, portadores de aparelhos ortodônticos fixos. Após o final do tratamento periodontal básico, determinou-se o (1) Índice de Placa e o (2) Índice Gengival, e cada paciente foi incluído, aleatoriamente, em um dos três grupos, selecionados de acordo com a técnica de escovação (Grupo 1 = Técnica de esfregaço; Grupo 2 = Técnica de Stillman Modificada e Grupo 3 = Técnica de Bass). Os pacientes foram avaliados por um período total de 9 meses. RESULTADOS: os resultados mostraram uma diminuição significativa dos parâmetros clínicos ao final desse período, porém houve uma redução muito significativa do Índice Gengival no grupo 3 (13,6%), em comparação aos demais grupos. CONCLUSÃO: pode-se sugerir que a Técnica de Bass pode ser efetiva na redução dos parâmetros clínicos periodontais de Índice de Placa e Índice Gengival em pacientes portadores de aparelhos ortodônticos fixos.

Influência de agentes clareadores na rugosidade superficial do esmalte / Influence of bleaching agents in the surface roughness of enamel

O objetivo desse estudo in vitro foi avaliar a influência do pH de agentes clareadores na rugosidade superficial do esmalte após o clareamento dentário. Amostras em esmalte foram seccionadas (3mm X 5mm X 3mm) a partir de terceiros molares, previamente armazenados em saliva artificial. Foram distribuídas aleatoriamente em quatro grupos (n=10). O tratamento clareador foi realizado durante três semanas: G1: aplicação diária de peróxido de carbamina 10 por cento (Whiteness Perfect FGM) por 4 h: G2: peróxido de carbamida 16 por cento (Whiteness Perfect FGM) por 2 h: G3: peróxido de hidrogênio 6 por cento (White Class FGM) por 1 h e 30 minutos: G4: aplicação semanal de peróxido de hidrpogênio a 35 por cento (Whiteness HP FGM) com duas aplicações de 15 minutos por sessão. Após isso, foi realizada análise da rugosidade (Ra, um) com o rugosímetro, nas duas metades de cada especime. Os resultados foram analisados por meio do teste t pareado e revelaram um aumento dignificativo da rugosidade superficial do esmalte dos grupos clareados com peróxido de de carbamida 16 por cento, peróxido de hidrogênio 6 por cento e peróxido de hidrogênio 35 por cento. Concluiu-se que o uso de peróxido de carbamida 10 por cento é um método seguro que proporciona menores valores de rugosidade superficial, se utilizando em curtos períodos. Em adição, a alteração provocada no esmalte é dependente da concentração dos ingredientes ativos do produto clareador

The aim of this in vitro study was to evaluate whether the pH of bleaching agents affects the enamel surface after bleaching. Samples were prepared in enamel (3mm x 5mm x 3mm) from third molars, which were kept in artificial saliva. Were randomly divided into four groups (n = 10) and had half his face isolated. The bleaching treatment was performed for three weeks with daily application of 10% carbamide peroxide (Whiteness Perfect® FGM) for 4h (G1), 16% carbamide peroxide (Whiteness Perfect® FGM) for 2 hours (G2), hydrogen peroxide 6% (Class® White FGM) for 1 hour and 30 minutes (G3) weekly injections of hydrogen peroxide 35% (Whiteness HP® FGM) with two applications of 15 minutes per session (G4). After this, rugosimetric analysis was made in both sides of the surface specimen. The results were analyzed using the paired t test and revealed a significant increase of enamel surface roughness bleached with groups of 16% carbamide peroxide, hydrogen peroxide 6% and 35%. We conclude that the use of carbamide peroxide 10% is a safe method that gives lower values of surface roughness if used in short periods. Additionally, the enamel alteration is dependent on the concentration of active ingredients of bleaching.

Avaliação da proporção áurea no sorriso de pacientes submetidos ao tratamento ortodôntico / Assessment of the golden proportion in patients undergoing orthodontic treatment

O presente estudo avaliou a incidência da proporção áurea no sorriso de pacientes submetidos ao tratamento ortodôntico. Foram avaliados 37 pacientes com a ortodontia finalizada. Obteve-se, a partir dos modelos inicial e final de cada paciente, a medida intercaninos e, no próprio paciente, foi medida a largura do sorriso. Um compasso de ponta seca foi utilizado para a obtenção das medidas que, posteriormente, foram transferidas para uma régua milimetrada para obter os valores numéricos. A proporção dentária horizontal inicial e final de cada paciente foi obtida dividindo-se as distâncias intercaninos inicial e final pela largura do sorriso. Os resultados demonstraram que a proporção áurea foi a mais prevalente após o tratamento ortodôntico, representando 67,56% dos pacientes. Das 37 proporções finais, 3 apresentaram diminuição, enquanto que 17 aumentaram em relação à proporção inicial e 17 proporções mantiveram-se inalteradas após a ortodontia. Observaram-se pequenas variações em relação à proporção final de cada paciente, portanto é fundamental estabelecer a proporção mais apropriada para cada caso, evitando padronização do sorriso na proporção áurea, mesmo que esta seja considerada a mais harmoniosa na população geral.

This study evaluated the presence of the golden proportion in the smile of patients submitted to the orthodontic treatment. Thirty seven patients with finished orthodontic treatment were evaluated. Using the initial and final models of each patient the measure among the canine teeth was gotten and the width of the smile was measured in the proper patient. A dry tip compass was used to obtain the measures, which were transferred to a millimeter ruler in order to register the values in numbers. The horizontal initial and final dental proportion of each patient was gotten by dividing the initial and final distances among the canine teeth by the width of the smile. The results revealed that the golden proportion was the most prevalent after orthodontic treatment, representing 67.56% of the patients. Considering the total of 37 final proportions, 3 had presented a reduction, while 17 had increased in relation to the initial proportion and 17 proportions had remained unchanged after the orthodontics. Slight variations were observed in the final proportion of each patient, so it is necessary to establish the most appropriate proportion for each patient, avoiding the standardization of the smile, even that the golden proportion is considered most harmonious in the general population.

Alternative model of birth to reduce the risk of assisted vaginal delivery and perineal trauma.

INTRODUCTION AND HYPOTHESIS: This study was conducted to evaluate the effects of an alternative model of birth (AMB) on the incidence of assisted vaginal delivery (AVD) and perineal trauma (PT). METHODS: One hundred ninety-nine women with epidural anesthesia were randomized to a traditional model of birth (TMB) (n = 96) or AMB (n = 103). Women in TMB pushed immediately after complete dilatation and delivered in lithotomy position. In AMB, women followed a postural changes protocol while they delayed pushing and used a specific lateral position for delivery. RESULTS: AMB was associated with a significant reduction in AVD compared with TMB (19.8% vs 42.1%, p<0.001). TMB was strongly associated with AVD (OR = 4.49; p< 0.05), which, in turn, was significantly associated with nulliparity (OR = 5.52; p<0.005) and fetal head unengaged at full dilatation (OR = 5.35; p<0.05). AMB significantly increased the intact perineum rate compared with TMB (40.3% vs 12.2%, p<0.001). Episiotomy rate was significantly reduced in AMB (21.0% vs 51.4%, p<0.001). CONCLUSION: A combination of postural changes during the passive expulsive phase of labor and lateral position during active pushing time is associated with reductions in AVD and PT.

Lipid profile of people with diabetes mellitus type 2 and periodontal disease.

The objective of this study was to evaluate improvement of lipids and periodontal disease in patients with type 2 Diabetes mellitus, by means of the relationship between blood levels of total cholesterol and its fractions, triglycerides and clinical periodontal parameters. Twenty patients, in age-range 18-70 years, were selected and divided into 2 groups: (1) conventional periodontal scaling and root planing+controlled mechanic; (2) conventional periodontal scaling and root planing+controlled mechanical+maintenance therapy. The analyses were performed on day 0, 180 and 720 days, including plaque index, gingival index, probing depth and clinical attachment level, and evaluation of total cholesterol and its fractions, and triglycerides. The 2 groups presented significant reduction in clinical periodontal parameters, however, probing depth did not diminish significantly only in Group 1. There was significant improvement in all blood parameters in both groups. It was concluded that after 720 days of the experiment, there were significant improvements in clinical and blood parameters, in general. The group that received maintenance therapy also showed a more expressive improvement in clinical periodontal parameters, in general, suggesting that this therapy is important and necessary in patients with type 2 Diabetes mellitus and periodontal disease.

Computed tomography scans in severe asthma: utility and clinical implications.

PURPOSE OF REVIEW: Asthma is a global burden, affecting 5% of the general adult population, of whom approximately 5-10% suffer from severe asthma. Severe asthma is a complex heterogeneous disease entity, with high morbidity and mortality. Increasingly novel techniques in computed tomography (CT) are being used to understand the pathophysiology of severe asthma. The utility and clinical implications of these CT techniques are the focus of this review. RECENT FINDINGS: Novel qualitative and quantitative CT imaging techniques have enabled us to study the large airway architecture in detail, assess the small airway structure, and perform functional analysis of regional ventilation. SUMMARY: Despite advances in CT imaging techniques, there is an urgent need for both proof-of-concept studies and large cross-sectional and longitudinal clinical trials in severe asthma to validate and clinically correlate imaging derived measures. This will extend our current understanding of the pathophysiology of severe asthma, and unravel the structure-function relationship, with the potential to discover novel severe asthma phenotypes and predict mortality, morbidity, and response to existing and novel pharmacological and nonpharmacological therapies.

Seleção de cor e estratificação natural para reabilitação estética de dente anterior / Color selectiona and natural layering for aesthetic reproduction of anterior teetf

Em função da excelência em estética e desgaste mínimo da estrutura dentária, as resinas compostas ocupam uma posição de destaqque entre os materiais restauradores atuais. As novas resinas compsotas associadas ao melhor antendimento do comportamento dos tecidos dentários frente à incidência de luz permitem a estratificação natural dos dentes. A estratificação natural consiste em uma abordagem simples e efetiva para o emprego das resinas compostas nas restaurações, de modo a torná-las miméticas com a aparência natural do substrato dentário. Compreender e implementar princípios artísticos e científicos na escolha da cor dos materiais restauradores e a adequada inserção da resina composta, contudo, é imprescindível. Os passos operatórios para obter o sucesso restaurador com esse material serão descritos no relato do caso clínico.

Because of the excellence in aesthetics and minimal wear of the tooth structure, composite resins hold a prominent position among the current restorative materials. The new composite resins associated with better understanding of the behavior of dental tissues facing the incidence of light allows the natural stratification of teeth. This natural stratification consists of a simple and effective approach to the use of composite resins in restoration in order to make them mimetic with the natural appearance of the tooth substrate. Understanding and to implementing scientific and artistic principles in choosing the color of restorative materials and the proper insertion of the composite, however, is essential. The operative steps for success with this restorative material will be described in a clinical case report.

Imaging advances in asthma.

INTRODUCTION: Asthma is a global burden, affecting 5% of the general adult population, with approximately 5 - 10% suffering from severe asthma. Severe asthma is a complex heterogeneous disease entity, with high morbidity and mortality. Recent years have seen the introduction of a vast array of new imaging technologies, which have provided the ability to comprehensively, non-invasively and functionally assess the lungs. These advances have resulted in a better understanding of the pathophysiology in severe asthma and have the unprecedented potential to unravel the structure-function relationship of severe asthma in the future. AREAS COVERED: This review article chronologically describes the technological advances currently used and to be used in the future. The article covers pitfalls in imaging of the airways and lung parenchyma in asthma from chest x-rays, CT scans, MRI, confocal florescence endomicroscopy to computational fluid dynamics. EXPERT OPINION: Novel qualitative and quantitative imaging techniques have enabled us to study the large airway architecture in detail, assess the small airway structure and perform functional or novel physiological evaluations. Despite spectacular advances in imaging techniques and the birth of new modalities, there is an urgent need for both proof-of-concept studies, large cross-sectional and longitudinal clinical trials in severe asthma to validate and clinically correlate imaging-derived measures. This will extend our current understanding of the pathophysiology of severe asthma, and unravel the structure-function relationship, with the potential to discover novel severe asthma phenotypes, predict mortality, morbidity and response to existing and novel pharmacological and non-pharmacological therapies.