Rehabilitation with zygomatic implants: a treatment option for the atrophic edentulous maxilla--9-year follow-up.

This article reports the 9-year clinical outcome of the two-stage surgical rehabilitation of a severely atrophic edentulous maxilla with a metal-resin fixed denture supported by implants anchored in the zygomatic bone and the maxilla. After clinical and radiographic examination, zygomatic implants were inserted bilaterally and four standard implants were placed in the anterior region of the maxilla. Six months later, the implants were loaded with a provisional acrylic resin denture, and the definitive implant-supported metal-resin fixed denture was provided 1 year after implant placement. After 9 years of follow-up, no painful symptoms, peri-implant inflammation or infection, implant instability, or bone resorption was observed. In the present case, the rehabilitation of severe maxillary atrophy using the zygomatic bone as a site for implant anchorage provided good long-term functional and esthetic results. Therefore, with proper case selection, correct indication, and knowledge of the surgical technique, the use of zygomatic implants associated with standard implants offers advantages in the rehabilitation of severely resorbed maxillae, especially in areas with inadequate bone quality and volume, without needing an additional bone grafting surgery, thereby shortening or avoiding hospital stay and reducing surgical morbidity.

Economies of difficult viability: an option to be examined

Includes bibliography

The basic needs strategy as an option: its possibilities in the Latin American context

Includes bibliography

Tilted implants and prototyping: A security option for improving the anchorage in atrophic maxilla

Rehabilitating atrophic maxilla poses many challenges. Reconstructive techniques that require sinus grafting are viable and acceptable; however, these techniques also are considered to be expensive, invasive, and time-consuming. Tilted implants anchored in distal areas using available bone have been reported as a less invasive and highly predictable treatment option. This article presents a case involving implant anchorage via tilted implants as an alternative technique to bone grafting procedures. Copyright © 2013 by the Academy of General Dentistry.

The Geography of Brazilian External Trade: Right Option for a BRIC?

Words can make a difference sometimes.Brazil is – together with the other ´BRIC´- a large economy, with an increasingly high profile in the international scenario. Large domestic market makes it more likely to obtain ‘growth-led exports’ rather than ‘export-led growth’, which implies a pro-active role in international relations. The option for intensifying regional trade links is a reasonable one and perhaps even inevitable, taking into account the experience elsewhere, but the actual regional conditions raise a number of questions that have to do both with further empirical assessment and to more specific identification of expectations with regard to probable achievements. This article has shown that the road to reach significant progress in this direction is not flat and requires more clear signalling to economic agents, strong political will and a good deal of specific measures. But it has also suggested that it might provide positive results.

Tropical tanniniferous legumes used as an option to mitigate sheep enteric methane emission

This study presents the first results from Brazil using SF6 tracer technique adapted from cattle to evaluate the capability of condensed tannin (CT) present in three tropical legume forages, Leucaena leucocephala (LEU), Styzolobium aterrimum (STA), and Mimosa caesalpiniaefolia Benth (MIM) to reduce enteric CH4 production in Santa Ins sheep. Twelve male lambs [27.88 +/- 2.85 kg body weight (BW)] were allocated in individual metabolic cages for 20-day adaptation followed by 6 days for measuring dry matter intake (DMI) and CH4 emission. All lambs received water, mineral supplement, and Cynodon dactylon v. coast-cross hay ad libitum. The treatments consisted of soybean meal (710 g/kg) and ground corn (290 g/kg) [control (CON)]; soybean meal (150 g/kg), ground corn (30 g/kg), and Leucaena hay (820 g/kg) (LEU); soybean meal (160 g/kg), ground corn (150 g/kg), and Mucuna hay (690 g/kg) (STA); and soybean meal (280 g/kg), ground corn (190 g/kg), and Mimosa hay (530 g/kg) (MIM); all calculated to provide 40 g/kg CT (except for CON). DMI (in grams of DMI per kilogram BW per day) was lower for LEU (22.0) than CON (29.3), STA (31.2), and MIM (31.6). The LEU group showed emission of 7.8 g CH4/day, significantly lower than CON (10.5 g CH4/day), STA (10.4 g CH4/day), and MIM (11.3 g CH4/day). However, when the CH4 emission per DMI was considered, there were no significant differences among treatments (0.37, 0.36, 0.33, and 0.35 g CH4/g DMI/kg BW/day, respectively, for CON, LEU, STA, and MIM). The sheep receiving STA had shown a tendency (p = 0.15) to reduce methane emission when compared to the CON group. Therefore, it is suggested that tropical tanniniferous legumes may have potential to reduce CH4 emission in sheep, but more research is warranted to confirm these results.

Ivabradine: Just another New Pharmacological Option for Heart Rate Control?

Ivabradine (IVB) is a heart rate lowering agent that acts via selective inhibition of the pacemaker funny current in sinoatrial nodal P cells, thus, reducing heart rate at rest and during exercise with minimal effect on myocardial contractility, blood pressure, and intracardiac conduction. IVB exerts no effect on external respiratory function parameters and it may also play a role in patients with concurrent chronic obstructive pulmonary disease. This property constitutes an important advantage over β-blockers. IVB acts by reducing the heart rate in a mechanism different from β-blockers, calcium channel blockers or late sodium channel blockers, three commonly prescribed antianginal drugs. As clinical trials have shown, it is remarkably well-tolerated and offers an alternative for patients who cannot take β-blockers. The combination of IVB and atenolol at commonly used doses in patients with chronic stable angina produced additional efficacy with no untoward effect on safety or tolerability. Additionally, side effects are rare and largely limited to a luminous phenomenon or phosphenes. This sensation is thought to be due to a block of Ih in the retina, a current very similar to cardiac If channels. IVB is contraindicated in patients with sick sinus syndrome or sinus node dysfunction and in patients taking hepatic inhibitors of Cytochrome P450 family 3, subfamily A, polypeptide 4 (abbreviated CYP3A4), with exception of omeprazole or lansoprazole. This review briefly summarizes the main studies regarding this drug.

Semidirect restorations in multidisciplinary treatment: viable option for children and teenagerssemidirect restorations in multidisciplinary treatment: viable option for children and teenagers

Due to the esthetic necessity required nowadays, the multidisciplinar treatment became a fundamental step in the restoration success. When the patient exhibits dental agenesis of one or more elements, he can show difficulty in social interactions. The age of the patient is a limiting factor to esthetic procedures, however, it should be evaluated as a real indicative with each case. The utilization of semi-direct restorations is a viable option due the cost, esthetic and improvement of physical and mechanical properties. The purpose of this paper is to present a case detailing the confection and cementation of anterior semi-direct restorations aimed at an anatomic reestablishment associated with integrated treatment with periodontics and orthodontics.

Orthodontic extrusion as treatment option for crown-root fracture: literature review with systematic criteria

To review the literature searching for a consensus for the choice of orthodontic extrusion as treatment for crown-root fracture. An electronic search was performed in the databases PubMed, Cochrane Central Register of Controlled Trials and Scopus and a manual search of the Journal Dental Traumatology. Forty articles were found in PubMed and 38 in Scopus and after removal of duplicate sample 51 contained articles. Of these, 48 were excluded for not having orthodontic treatment, no follow-up or follow-up less than 6 months, or not report the presence of crown-root fracture. In manual search in Dental Traumatology 20 articles were found, but none of them met the prerequisites established. So, three articles formed the basis of the study. The choice of how to treat orthodontic extrusion of crown-root fracture was effective and stable, without root and periodontal changes. Factors, such as root formation and presence of pulp vitality were decisive for determining the stages of treatment, however, there is no consensus based on scientific evidence about these protocols.

Guanylate cyclase inhibition by methylene blue as an option in the treatment of vasoplegia after a severe burn. A medical hypothesis

Today it is known that severe burns can be accompanied by the phenomenon of vasoplegic syndrome (VS), which is manifested by persistent and diffuse vasodilation, hypotension and low vascular resistance, resulting in circulatory and respiratory failure. The decrease in systemic vascular resistance observed in VS is associated with excessive production of nitric oxide (NO). In the last 2 decades, studies have reported promising results from the administration of an NO competitor, methylene blue (MB), which is an inhibitor of the soluble guanylate cyclase (sGC), in the treatment of refractory cases of vasoplegia. This medical hypothesis rationale is focused on the tripod of burns/vasoplegia catecholamine resistant/methylene blue. This article has 3 main objectives: 1) to study the guanylate cyclase inhibition by MB in burns; 2) to suggest MB as a viable, safe and useful co-adjuvant therapeutic tool of fluid resuscitation, and; 3) to suggest MB as burns hypotensive vasoplegia amine-resistant treatment.

Enhancing spiral-wound ultrafiltration performance for direct drinking water treatment through operational procedures improvement: A feasible option for the Sao Paulo Metropolitan Region

This work aimed to evaluate the influence of specific operational conditions on the performance of a spiral-wound ultrafiltration pilot plant for direct drinking water treatment, installed at the Guarapiranga's reservoir, in the Sao Paulo Metropolitan Region. Results from operational tests showed that the volume of permeate produced in the combination of periodic relaxation with flushing and chlorine dosage procedures was 49% higher than the volume obtained when these procedures were not used. Two years of continuous operation demonstrated that the ultrafiltration pilot plant performed better during fall and winter seasons, higher permeate flow production and reduced chemical cleanings frequency. Observed behavior seems to be associated with the algae bloom events in the reservoir, which are more frequent during spring and summer seasons, confirmed by chlorophyll-a analysis results. Concentrate clarification using ferric chloride was quite effective in removing NOM and turbidity, allowing its recirculation to the ultrafiltration feed tank. This procedure made it possible to reach almost 99% water recovery considering a single 54-hour recirculation cycle. Water quality monitoring demonstrated that the ultrafiltration pilot plant was quite efficient, and that potential pathogenic organisms, Escherichia coil and total coliforms, turbidity and apparent color removals were 100%, 95.1%, and 91.5%, respectively. (C) 2012 Elsevier B.V. All rights reserved.

Using Mitrofanoff's principle and Monti's technique as a surgical option for bladder augmentation with a continent stoma: a case report

Abstract Introduction Hydronephrosis, reflux and renal failure are serious complications that occur in patients with neurogenic bladder associated with myelomeningocele. When the bladder compliance is lost, it is imperative to carry out surgery aimed at reducing bladder storage pressure. An ileocystoplasty, and for patients not suitable for intermittent catheterization, using the Mitrofanoff principle to form a continent stoma and the subsequent closure of the bladder neck, can be used. We report here, for the first time to the best of our knowledge, an association between two previously described techniques (the Mitrofanoff principle and the technique of Monti), that can solve the problem of a short appendix in obese patients. Case presentation A 33-year-old male Caucasian patient with myelomeningocele and neurogenic bladder developed low bladder compliance (4.0 mL/cm H2O) while still maintaining normal renal function. A bladder augmentation (ileocystoplasty) with continent derivation principle (Mitrofanoff) was performed. During surgery, we found that the patient's appendix was too short and was insufficient to reach the skin. We decided to make an association between the Mitrofanoff conduit and the ileal technique of Monti, through which we performed an anastomosis of the distal stump of the appendix to the bladder (with an antireflux valve). Later, the proximal stump of the appendix was anastomosed to an ileal segment of 2.0 cm that was open longitudinally and reconfigured transversally (Monti technique), modeled by a 12-Fr urethral catheter, and finally, the distal stump was sutured at the patient's navel. After the procedure, a suprapubic cystostomy (22 Fr) and a Foley catheter (10 Fr) through the continent conduit were left in place. The patient had recovered well and was discharged on the tenth day after surgery. He remained with the Foley catheter (through the conduit) for 21 days and cystostomy for 30 days. Six months after surgery he was continent with good bladder compliance without reflux and fully adapted to catheterization through the navel. Conclusion The unpublished association between the Mitrofanoff and Monti techniques is feasible and a very useful alternative in urologic cases of derivation continent in which the ileocecal appendix is too short to reach the skin (i.e., in obese patients).

Oxymoron,progetto di un grattacielo direzionale a Shenzhen, Cina applicazione della Soft Kill Option (SKO) nella progettazione architettonica

Lo scopo della tesi è quello di affrontare la progettazione con un approccio,quanto più attuale e per certi versi avanguardista, chiamato Parametric design (progettazione parametrica), accoppiato efficacemente col concetto di Arte generativa (in questo caso Architettura). Già nel 1957 Luigi Moretti affrontò il tema dell’architettura parametrico-generativa fondando l’IRMOU (Istituto per la Ricerca Matematica e Operativa applicata all'Urbanistica) e oggi è una mentalità molto diffusa nei più grandi studi del mondo. Il tema non è solo tecnologico o informatico strumentale, ma è proprio un modo di pensare e immaginare il possibile, costruito o naturale che sia. E’ un modo di vivere la propria creatività. L’aggettivo “generativa” è legato al fatto che l’arte in esame è generata seguendo regole preimpostate e ben definite dal progettista, coerentemente agli obiettivi e alle finalità del progetto. L’evoluzione delle stesse, seguendo relazioni molto semplici, può dar vita a risultati sorprendenti e inaspettati, dotati di una notevole complessità che però, se letta nell’insieme, è perfettamente in armonia con l’idea progettuale di partenza. Il fascino di questa materia è il legame entusiasmante che crea tra architettura, ingegneria, poesia, filosofia, matematica, biologia, fisica, pittura ecc ecc. Questo perché i concetti di evoluzione, di relazione e di generazione appartengono a tutto ciò che ci circonda, e quindi alla concezione umana di vita. E’ possibile in questo modo permeare il costrutto progettuale con principi e regole oggettivamente riconoscibili e apprezzabili dallo spettatore perché instrisi di una forte veridicità processuale. Il titolo "Oxymoron" è la traduzione inglese della figura retorica ossimoro,la quale è strettamente connessa all’ispirazione progettuale: proviene dall’indagine approfondita di processi evolutivi (distruttivi in questo caso) caratterizzanti realtà naturali che, esplorate con sempre più accuratezza, determinano morfologie e forme aventi profonde radici strutturali. La distruzione che crea lo spazio. La genesi stessa della forma segue predominanti algoritmi matematici governati e corretti da variabili di diversa natura che definiscono l'enviroment di influenze interagenti ed agenti sul campione di studio. In questo caso la ricerca è focalizzata su processi erosivi fisici e chimici, di agenti esterni (quali vento e sali rispettivamente) ,di cui materiali inorganici, quali minerali e aggregati degli stessi (rocce), sono soggetti. In particolare, l’interesse è approfondito su fenomeni apparentemente emergenti dei tafoni e dei cosiddetti Micro canyon. A tal scopo si sfrutterà un metodo di soft kill option (SKO) di ottimizzazione topologica (optimization topology) attraverso gli strumenti informatici più idonei quali software di modellazione parametrica e di calcolo computazionale. La sperimentazione sta proprio nell'utilizzare uno strumento concepito per uno scopo, con un'ottica strettamente ingegneristica, per un'altra meta, ossia ricavare e ottenere se possibile un metodo di lavoro o anche solo un processo generativo tale da riprodurre o simulare casi e situazioni riscontrabili in natura negli eventi soggetti a erosione. Il tutto coerente con le regole che stanno alla base della genesi degli stessi. Il parallelismo tra singolarità naturale e architettura risiede nella generazione degli spazi e nella combinazione di questi. L’ambizioso obiettivo è quello di innescare un ciclo generativo, che messo in comunicazione diretta con un contesto variegato ed eterogeneo, dia vita a una soluzione progettuale dall'alto contenuto morfologico e spaziale.