Indiana University-Purdue University Indianapolis (IUPUI) / The negative heath consequences of smoking are widely recognized, but there are still about 20% of the people in United States using tobacco products. Cigarette smoke condensate (CSC), the particulate matter of cigarette smoke, is comprised of thousands of chemicals (e.g., nicotine). Secondary only to bacterial plaque, cigarette smoking is a major risk factor for periodontal disease. Human gingival fibroblasts (HGFs) are the main cellular component of periodontal connective tissues. During the development of periodontal disease, collagen degradation occurs. Collagen is the major extracellular matrix component of the gingiva. The major extracellular matrix degrading enzymes produced by the HGFs are the matrix metalloproteinases (MMPs). The MMPs are mainly modulated by the tissue inhibitors of metalloproteinases (TIMPs). In this dissertation, three studies aimed at understanding the effects of tobacco on human gingival fibroblasts and their mechanisms have been conducted: the effects of CSC on HGF-mediated collagen degradation; comparison of the effects of CSC on HGFs with that of nicotine; and the combined effects of CSC and bacteria on HGFs. The cell proliferation of HGFs decreased and cytotoxicity increased in HGFs treated with increasing concentrations of CSC. CSC increased the collagen degrading ability of the HGFs by altering the production and localization of MMPs and TIMPs. Nicotine is one of the major components and the most pharmacologically active agent in tobacco. The percentage of nicotine in the CSC was 2.4%. CSC (100 µg/ml) increased the collagen degrading ability of the HGFs by affecting membrane associated MMP-2, MMP-14, and TIMP-2, but the level of nicotine in the CSC may only play a limited role in this process. Porphyromonas gingivalis (P. gingivalis) is an opportunistic pathogen involved in periodontal disease. The combined effects of CSC and P. gingivalis supernatant increased HGF-mediated collagen degradation by destroying the balance between the MMPs and TIMPs at the protein and mRNA levels. This project demonstrated that tobacco (with or without P. gingivalis) increased HGF mediated collagen degradation, as seen in the periodontal disease, through altering the MMPs and TIMPs.

Background: Snoring and obstructive sleep apnea (OSA) are both common disorders with a number of negative health effects. The safety and efficacy of treating snoring and OSA surgically have been questioned and there has been a lack of studies in the field. Aims: 1) To investigate the frequency of serious complications, including death, after surgery for the treatment of snoring and sleep apnea; 2) to evaluate the effect on daytime sleepiness after radiofrequency surgery of the soft palate in snoring men with mild or no OSA; 3) to evaluate the effect of tonsillectomy on sleep apnea in adults with OSA and tonsillar hypertrophy; 4) to investigate the morphology and cytoarchitecture of muscle fibers in human soft palatal muscles with immunohistochemical and morphological techniques. Methods and results: In paper 1, a retrospective database study. All Swedish adults who were treated surgically because of snoring or OSA from January 1997 to December 2005 were identified in the National Patient Register. None of the surgically treated patients died in the peri- and postoperative period. Severe complications were recorded in 37.1 of 1,000 patients treated with uvulopalatopharyngoplasty (UPPP), in 5.6 of 1,000 patients after uvulopalatoplasty (UPP) and in 8.8 of 1,000 patients after nasal surgery. In paper 2, the study was designed as a randomized, controlled trial. 35 snoring men with mild or no OSA were randomized to either radiofrequency or sham surgery of the soft palate. Radiofrequency surgery was not found to be effective since there was no significant difference between the two groups in relation to the Epworth Sleepiness Scale (ESS) or apnea-hypopnea index (AHI) at follow-up. Paper 3 was a prospective study, including 28 patients with an AHI of >10 and with large tonsils. In these patients, tonsillectomy was an effective treatment for OSA; the mean AHI was reduced from 40 units/h to 7 units/h (p<0.001), and the mean ESS was reduced from 10.1 to 6.0 (p<0.001) at the six-month follow-up after surgery. Minor and moderate swallowing dysfunction was found in seven of eight patients investigated before surgery and the swallowing function improved in 5 of them after surgery, while no one deteriorated. In paper 4, we investigated the morphology and cytoarchitecture in normal soft palate muscles. Human limb muscles were used as reference. The findings showed that the soft palate muscle fibers have a cytoskeletal architecture and cellmembrane complex that differs from that of the limb muscles. Conclusions No case of death related to surgery was found among 4,876 patients treated with UPPP, UPP or nasal surgery for snoring or OSA in Sweden between 1997 and 2005. Radiofrequency surgery of the soft palate has no effect on daytime sleepiness, snoring or apnea frequency in snoring men with mild or no OSA. Tonsillectomy can be an effective treatment for OSA in adults with large tonsils. A subgroup of muscle fibers in the human soft palate appears to have special biomechanical properties and their unique cytoarchitecture must be taken into account while assessing function and pathology in oropharyngeal muscles. / Snarkning och obstruktiv sömnapné (OSA) är idag en global folksjukdom. Snarkning är det ”oljud” som uppstår när luftvägen under sömn förminskas och vävnaden börjar vibrera under andning. Vid obstruktiv sömnapné faller vävnaden samman och blockerar luftflödet till lungorna. Ett andningsuppehåll, en s.k. apné inträffar. Ett andningsuppehåll kan pågå allt ifrån några sekunder till mer än en minut och kan uppstå hundratals gånger per natt. För att klassificeras som en patologisk apné enligt internationell standard måste andningsuppehållet vara längre än 10 sek. Snarksjukdomen förvärras sannolikt över tid och övergår succesivt i obstruktiv sömnapné med ökande antal andningsuppehåll under sömn. Detta leder till ett stresspåslag för kroppen med oftast uttalad dagtrötthet och en mängd negativa hälsoeffekter. Snarksjukdom och sömnapné ökar risken för bl.a. högt blodtryck och hjärt-kärlsjukdom samt också för att den drabbade ska orsaka trafikolyckor på grund av försämrad koncentrationsförmåga och trötthet. En del av den negativa utvecklingen från snarkning till sömnapné anses bero på att snarkvibrationer kan ge neuromuskulära skador i gom och svalg. Dessa vävnadsskador anses också vara orsaken till att personer som snarkat länge ofta uppvisar störd sväljningsfunktion i form av felsväljning, där maten i uttalade fall hamnar i luftstrupen istället för i matstrupen. I dagsläget är förstahandsbehandling vid sömnapné CPAP, en mask som placeras över näsa och mun och som skapar ett övertryck i luftvägen vilket förhindrar att luftvägen faller samman och att andningsstopp uppstår. CPAP har enligt flera studier den bästa effekten mot andningsuppehåll. En annan vanlig behandling är en bettskena som för underkäken nedåt och framåt så att luftvägen bli mer öppen. Bettskenan är en vanlig och effektiv behandlingsmetod för personer utan kraftig övervikt vid vanemässig snarkning eller måttlig sömnapné. För ett tjugotal år sedan var kirurgi förstahandsmetoden vid behandling av snarkning och måttlig sömnapné. Man utförde då ofta operationer i svalg och gomm, s.k. gomplastiker. Bruket av kirurgisk behandling har dock minskat med tiden, dels p.g.a. biverkningar men också för att det saknades vetenskapliga studier som bevisade att kirurgin gav önskad och långsiktig effekt. Kirurgi utgör dock fortfarande ett komplement till behandling av snarkning och sömnapné när CPAP eller bettskena av olika skäl inte fungerar eller kan tolereras av patienten. 8 Även barn kan lida av snarkning och sömnapné men behandlingsprinciperna för barn skiljer sig från dem hos vuxna och berörs inte i avhandlingen. I denna avhandling studeras: i) biverkningsfrekvenser efter olika typer av snarkkirurgi, ii) effekten av radiovågsbehandling i mjuka gommen på vuxna män med snarkning, iii) effekten av att operera bort halsmandlarna på vuxna med sömnapné och stora halsmandlar, iv) muskelvävnadens struktur och molekylära uppbyggnad i mjuka gommen hos friska personer som inte snarkar. Avhandlingen består av fyra delstudier: 1. En registerstudie med kartläggning av svåra biverkningar efter kirurgi i form av uvulopalatopharyngoplastik, uvulupalatoplastik samt näskirurgi för behandling av sömnapné och snarkning och utfört i Sverige mellan åren 1997-2005. Studien omfattade 4 876 patienter. Inga dödsfall noterades. Komplikationsrisken var störst vid operationer där man tog bort delar av mjuka gommen samt halsmandlarna, där i snitt 37 av 1000 opererade fick biverkningar, framförallt p.g.a. infektioner eller blödningar. 2. I en prospektiv, randomiserad placebostudie utvärderades effekten av radiovågsbehandling i mjuka gommen vid snarkning och lindrig sömnapne. Trettiotvå patienter lottades till att få radiovågsbehandling eller placebo behandling. Patienterna visste inte vilken grupp de tillhörde. Vid uppföljning efter 12 månader var det inga statistiska belägg för att radiovågsbehandling minskade vare sig antal andningsuppehåll eller dagtrötthet. 3. Effekten av att ta bort halsmandlarna på patienter med stora halsmandlar och olika grad av sömnapné utvärderades i denna studie. Totalt deltog 28 patienter. Vid uppföljning 6 månader efter operationen hade antalet andningsuppehåll sjunkit drastiskt, från i snitt 40 till 7 andningsuppehåll per timme nattsömn. Inga allvarliga biverkningar uppstod. Dessa fynd talar för att man som förstahandsmetod ska erbjuda patienter med sömnapné och stora halsmandlar att ta bort halsmandlarna. 4. I detta projekt undersökte vi utseendet och uppbyggnaden av cellskelettet i två normala muskler i mjuka gommen hos friska personer utan känd snarkning och sömnapné. Muskler från armar och ben användes som referens. Fynden i studien visar att de normala muskelfibrernas uppbyggnad i mjuka gomen skiljer sig från jämförade muskler i armar och ben. Detta kan vara ett uttryck för en evolutionär utveckling för att möjligöra de komplexa funktioner som krävs av svalgets muskulatur. 9 Sammanfattningsvis kan vi konstatera: Att inga dödsfall har skett i Sverige efter operationer i gom, svalg eller näsa, utförda för att behandla snarkning och sömnapné under åren 1997 till 2005. Att radiovågsbehandling av mjuka gommen hos snarkande män med lindrig sömnapné inte har någon effekt på dagtrötthet, snarkning eller andningsuppehåll vid uppföljning efter 12 månader. Metoden kan därför inte rekommenderas. Att när man opererar bort stora halsmandlar på personer med andningsuppehåll så leder detta ofta till att andningsuppehållen minskar drastiskt. Metoden kan därför oftast rekommenderas som en förstahandsbehandling för denna patientgrupp. Att mjuka gommens muskelfibrer är uppbyggda på ett unikt sätt indikerar att deras specifika biomekaniska egenskaper skiljer sig från referens muskler i armar och ben.

<p>Dental caries is a multi-factorial disease that affects everyone irrespective of race, class or gender, however, the burden of the disease is often found in children from lower socio-economic backgrounds. The nature of the disease is such that it can be prevented. Various international studies on fluoride have shown a reduction in the prevalence of dental caries. By using geographical information systems, oral health data can be linked to the fluoride levels and further analysis could be done to identify areas at risk of dental caries as well as show patterns in the distribution of dental caries. The aim of this study was therefore to assess the effects of different levels of fluoride on the prevalence of dental caries in selected towns in the Northern Cape and Westen Cape. It also examined the application of Geographical Information Systems (GIS) to oral health data.</p>

Public health aspects of pharmaceutical prescription patterns: Exemplified by treatments for prevention of cardiovascular disease. Louise Silwer. ISBN: 978-91-85721-18-4 ISSN: 0283-1961Main aim:To study patterns and trends of dispensed prescriptions, to explore what proportion of the population is exposed to some of the more prevalently prescribed pharmaceuticals, and to find possible ways of measuring drug-induced adverse symptoms in the population. Further, to illuminate conditions surrounding prescribing in primary prevention of cardiovascular disease. Methods: In three descriptive studies of prescription patterns, prescription data at aggregate level from a Swedish county were analysed retrospectively, and proportions were calculated. Data from the first ten years of the studies were obtained from a local prescription study, and data from another five years were local data from a national prescription survey. Data from a Danish database (OPED), with data at the individual level, were used for a prescription sequence symmetry analysis, and when Swedish national prescription data at the individual level became accessible, they were used for calculations of drug prevalence in the entire Swedish population. In a qualitative analysis of interview data, a phenomenographic approach was used. Main results: The purchase of pharmaceuticals on prescription almost doubled in the studied county in the period 1988-2002. Some common pharmaceuticals that increased to a great extent among the older part of the population were cardiovascular preventive drugs, such as antihypertensive and lipid modifying agents, and also hormone replacement therapy for women. In 2005, over half of all Swedish citizens, aged 60 or over, purchased antihypertensive or lipid modifying preparations during a six-month period. The different views that were found among GPs, regarding beliefs and practical management of primary prevention of CVD, could be interpreted as a reflection of the complexity of patient counselling in primary prevention in practice. Conclusion: The increase in dispensed prescriptions over the 15 years and the magnitude of the prevalence of the studied pharmaceuticals, such as antihypertensive, lipid modifying and hormonal treatments, which to a great extent are used by ‘healthy’ people, point to the need of following-up both beneficial and harmful consequences on public health. The prevalence of preventive treatments together with the variation in views of administration of primary prevention of cardiovascular disease, also point to the need of clarification of guidelines regarding pharmaceutical primary prevention and encouragement of therapy discussions among GPs.

<p>Hemioterapija koja se koristi za lečenje karcinoma utiče i na kardiovaskularni sistem. Ciljevi&nbsp; istraživanja&nbsp; su: u tvrditi uticaj kardiotoksičnosti&nbsp; na&nbsp; reživljavanje&nbsp; bolesnika&nbsp; sa uznapredovalim stadijumom NSCLC; utvrditi učestalost pojave kardiotoksičnosti kod bolesnika koji su lečeni hemioterapijom prve linije (gemcitabin/cisplatin i paclitaxel/carboplatin) sa i bez prethodnih kardiovaskularnih oboljenja i utvrditi učestalost pojave kardiotoksičnosti u toku primene protokola docetaxel/cisplatin kao hemioterapije druge linije, u odnosu na primenu protokola gemcitabin/ cisplatin i paclitaxel/carboplatin, kao terapije prve linije. Istraživanjem je obuhvaćeno 270 bolesnika sa citolo&scaron;ki ili patohistolo&scaron;ki dokazanim NSCLC kliničkog stadiju ma III i IV.&nbsp; Dobijeni su rezultati koji ukazuju da je preživljavanje bolesnika u III i IV stadijumu NSCLC koji su imali pojavu kardiotoksičnosti tokom hemioterapije prve i druge linije kraće u odnosu na bolesnike bez pojave kardiotoksičnosti, sa statističkom značajno&scaron;ću nakon prvog, drugog, četvrtog ciklusa hemioterapije i nakon &scaron;est meseci (p=0.004, p=0.020, p=0.030 i p&lt;0.0005. respektivno). Kardiotoksičnost kod bolesnika u III i IV stadijumu NSCLC koji su primali hemioterapiju prve linije prema protokolu gemcitabin/cisplatin se če&scaron;će javila ukoliko su imali prethodne kardiovaskularne bolesti, ali statistička značajnost nije utvrđena. Kardiotoksičnost kod bolesnika u III i IV stadijumu NSCLC koji su primali hemioterapiju prve linije prema protokolu paclita xel/carboplatin se če&scaron;će javila ukoliko su imali prethodne kardiovaskularne bolesti, a statistička značajnost utvrđena prilikom prvog kontrolnog pregleda kod bolesnika u III stadijumu (p=0.037). Kod bolesnika u III i IV stadijumu NSCLC koji su primali hemioterapiju prve linije prema protokolima gemcitabin/cisplatin paclitaxel / carboplatin kardiotoksičnost se če&scaron;će javila ukoliko su imali prethodna kardiovaskularna oboljenja, ali je statistička značajnost ustanovljena samo pri prvom kontrolnom pregledu , (p=0.022). Kod bolesnika koji su primali hemioterapiju druge linije kardiotoksičnost značajno če&scaron;će javila u toku prvog ciklusa hemioterapije (p=0.049) u odnosu&nbsp; na&nbsp; bolesnike&nbsp; koji&nbsp; su&nbsp; primali hemioterapiju&nbsp; prve&nbsp; linije.&nbsp; Kod bolesnika koji su imali prethodne kardiovaskularne bolesti u toku druge linije hemioterapije kardiotoksičnost se statistički značajno če&scaron;će javila u odnosu na prvu liniju hemioterapije u toku četvrtog ciklusa hemioterapije (p=0.020). Uspostavljanje ravnoteže između efektivnosti hemioterapije i rizika od o&scaron;tećenja kardiovaskularnog sistema zahteva blisku saradnju onkologa i kardiologa , sa ciljem kreiranja individualne terapije za svakog bolesnika.</p> / <p>Lung&nbsp; cancer&nbsp; chemotherapy&nbsp; affects&nbsp; the&nbsp; cardiovascular&nbsp; system&nbsp; as&nbsp; well. The research&nbsp; objectives&nbsp; were&nbsp; to&nbsp; establish:&nbsp; the&nbsp; effects&nbsp; of&nbsp; cardiotoxicity&nbsp; on&nbsp; the survival of advanced NSCLC patients;&nbsp; the frequency of cardiotoxicity in the patients&nbsp; treated&nbsp; with&nbsp; the&nbsp; first - line&nbsp; chemotherapy&nbsp; (gemcitabine/cisplatin&nbsp; and paclitaxel/carboplatin),&nbsp;&nbsp; with&nbsp;&nbsp; or&nbsp;&nbsp; without&nbsp;&nbsp; the&nbsp;&nbsp; history&nbsp;&nbsp; of&nbsp;&nbsp; cardiovascular comorbidities, and the frequency of cardiotoxicity registered in the course of the&nbsp; second - line&nbsp; chemotherapy&nbsp; with docetaxel/cisplatin,&nbsp; as&nbsp; compared&nbsp; to&nbsp; the first - line chemotherapy&nbsp; with gemcitabine/cisplatin and paclitaxel/carboplatin.&nbsp;&nbsp;&nbsp; The&nbsp;&nbsp;&nbsp; investigation&nbsp;&nbsp;&nbsp; included&nbsp;&nbsp;&nbsp; 270&nbsp;&nbsp;&nbsp; patients&nbsp;&nbsp;&nbsp; with citologically&nbsp; or histopathologically&nbsp; confirmed&nbsp; NSCLC&nbsp; at&nbsp; the&nbsp; clinical&nbsp; stages III&nbsp; and&nbsp; IV. The&nbsp; obtained&nbsp; research&nbsp; results&nbsp; suggest&nbsp; the&nbsp; patients&nbsp; with&nbsp; stage&nbsp; III and IV NSCLC who developed&nbsp; cardiotoxicity in the course of&nbsp; the first &ndash; and second - line&nbsp;&nbsp; chemotherapy&nbsp;&nbsp; had&nbsp;&nbsp; a&nbsp;&nbsp; shorter&nbsp;&nbsp; survival&nbsp;&nbsp; than&nbsp;&nbsp; those&nbsp;&nbsp; without cardiotoxicity,&nbsp; with&nbsp; the&nbsp; statistical&nbsp; significance&nbsp; registered&nbsp; after&nbsp; the&nbsp; first, second,&nbsp; and&nbsp; fourth&nbsp; chemotherapy&nbsp; course,&nbsp; as&nbsp; well&nbsp; as&nbsp; six&nbsp; months&nbsp;&nbsp;&nbsp; later (p=0.004,&nbsp; p=0.020,&nbsp; p=0.030&nbsp; and&nbsp; p&lt;0.0005&nbsp; respectively). Stage&nbsp; III&nbsp; and&nbsp; IV NSCLC&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; patients&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; receiving&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; the&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; first - line&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; chemotherapy&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; with gemcitabine/cisplatin developed cardiotoxicity more frequently if they had a former history of cardiovascular diseases, but with no statistical significance registered. Stage&nbsp; III and IV NSCLC patients on the&nbsp; first - line&nbsp; chemotherapy protocol&nbsp;&nbsp;&nbsp; with&nbsp;&nbsp;&nbsp; paclitaxel/carboplatin&nbsp;&nbsp;&nbsp; developed&nbsp;&nbsp;&nbsp; cardiotoxicity&nbsp;&nbsp;&nbsp; more frequently&nbsp; if&nbsp; they&nbsp; had&nbsp; a&nbsp; former&nbsp; history&nbsp; of&nbsp; cardiovascular&nbsp; diseases,&nbsp; and&nbsp; the&nbsp; statistical significance was registered at the first control examination in stage III&nbsp; NSCLC&nbsp; patients&nbsp; (p=0.037).&nbsp; Stage III&nbsp; and&nbsp; IV&nbsp; NSCLC&nbsp; patients&nbsp; receiving the&nbsp;&nbsp; first-line&nbsp;&nbsp; chemotherapy&nbsp;&nbsp; protocols&nbsp;&nbsp; with&nbsp;&nbsp; gemcitabine/cisplatin&nbsp;&nbsp; and paclitaxel/carboplatin&nbsp; developed&nbsp; cardiotoxicity&nbsp; more&nbsp; frequently&nbsp; if&nbsp; they&nbsp; had former cardiovascular diseases, but the statistical significance was registered at&nbsp;&nbsp; the&nbsp;&nbsp; first&nbsp;&nbsp; control&nbsp;&nbsp; examination&nbsp;&nbsp; only, one&nbsp;&nbsp; month&nbsp;&nbsp; after&nbsp;&nbsp; chemotherapy application (p=0.022). The&nbsp; patients receiving the&nbsp; second - line&nbsp; chemotherapy developed&nbsp; cardiotoxicity&nbsp; much&nbsp; more&nbsp; often&nbsp; during&nbsp; the&nbsp; first&nbsp; chemotherapy course (p=0.049),&nbsp;&nbsp; as&nbsp;&nbsp; compared&nbsp;&nbsp; to&nbsp;&nbsp; the&nbsp;&nbsp; patiens&nbsp;&nbsp; receiving&nbsp;&nbsp; the&nbsp;&nbsp; first - line chemotherapy.&nbsp; Among&nbsp; the&nbsp; patients&nbsp; with&nbsp; a&nbsp; former&nbsp; history&nbsp; of&nbsp; cardiovascular diseases,&nbsp;&nbsp;&nbsp; those&nbsp;&nbsp;&nbsp; receiving&nbsp;&nbsp;&nbsp; the&nbsp;&nbsp;&nbsp; second &ndash; line&nbsp;&nbsp;&nbsp; chemotherapy&nbsp;&nbsp;&nbsp; developed cardiotoxicity&nbsp; during&nbsp; the&nbsp; fourth&nbsp; chemotherapy&nbsp; course&nbsp; significanly&nbsp; more freequently&nbsp;&nbsp; than&nbsp;&nbsp; the&nbsp;&nbsp; patients&nbsp;&nbsp; on&nbsp;&nbsp; the&nbsp;&nbsp; same&nbsp;&nbsp; course&nbsp;&nbsp; of&nbsp;&nbsp; the&nbsp;&nbsp; first-line chemotherapy&nbsp; (p=0.020). To&nbsp; achieve&nbsp; the&nbsp; balance&nbsp; between&nbsp; chemotherapy efficacy&nbsp; and&nbsp; the&nbsp; risk&nbsp; of&nbsp; the&nbsp; cardiovascular&nbsp; system&nbsp; damage&nbsp; requires&nbsp; a&nbsp; close cooperation of an oncologist and a cardiologist, aimed at designing a unique, individual therapy for each patient.</p>

Os anti-hipertensivos bloqueadores de canais de cálcio, por interferirem no transporte de cálcio através das membranas celulares, podem afetar muitos processos metabólicos, incluindo o metabolismo ósseo. O objetivo deste estudo foi avaliar, de forma radiográfica, histológica e bioquímica, os efeitos do bloqueador de canais de cálcio amlodipina no processo de reparo de um defeito ósseo, simulando fratura, no ramo mandibular de ratos. Foram utilizados 50 ratos machos Wistar, que foram submetidos ao mesmo procedimento cirúrgico unilateral simulando fratura mandibular, e distribuídos em dois grupos de 25 animais: grupo experimental, que receberam amlodipina, via oral, na dosagem de 0,04 mg / rato / dia, iniciando 12 dias antes do procedimento e continuando até o sacrifício; grupo controle, que permaneceu não tratado. Os animais foram sacrificados nos períodos de 1, 7, 14, 30 e 90 dias pós-operatórios. Foram realizados testes bioquímicos de fosfatase alcalina e cálcio séricos. Exame radiográfico foi obtido para mensuração da área radiolúcida do defeito ósseo. O estudo histológico compreendeu a análise descritiva do processo de reparo ósseo e a avaliação histomorfométrica da quantidade de osso neoformado. Os valores numéricos foram submetidos a análises estatísticas. A análise radiográfica demonstrou maior área radiolúcida no interior do defeito ósseo para o grupo experimental, nos períodos de 14 (p=0,016), 30 (p=0,009) e 90 (p=0,028) dias. Na análise histológica não se observaram atrasos no processo de reparo ósseo para ambos os grupos. Porém, na análise histomorfométrica, o grupo da amlodipina apresentou redução significante do volume de osso neoformado nos períodos de 7 e 14 dias (p=0,049), não havendo diferenças significativas no período de 30 dias. Houve redução significante nos níveis de fosfatase alcalina para o grupo da amlodipina nos períodos iniciais (p=0,049). Não houve alterações para os níveis de cálcio sérico. Concluiu-se que o uso crônico da amlodipina prejudicou a neoformação óssea no processo de reparo do defeito cirúrgico no ramo mandibular de ratos, porém não impediu a consolidação da fratura. / Antihypertensive, calcium channel blockers, which interfere on calcium transport across the cell membrane, may affect many metabolic processes, including bone metabolism. The aim of this study was to evaluate by radiographic, histologic and biochemical analyses the effects of calcium channel blocker amlodipine on bone healing of a defect simulating a fracture in mandibular ramus of rats. Fifty male Wistar rats were used, and submitted to the same unilateral surgical procedure simulating a mandibular fracture, distributed into two groups of 25 animals: experimental group, which received oral doses of 0.04 mg / rat / day starting 12 days before of procedure and continuing until sacrifice; control group, which remained untreated. Animals were sacrificed at 1, 7, 14, 30 and 90 days postoperatively. Blood biochemical tests of alkaline phosphatase and serum calcium were made. Radiographic examination was obtained in order to mensurate the radiolucent area of bone defect. Histological study comprised descriptive analysis of bone healing and histomorphometric analysis of the amount of newly formed bone. Numerical values were submitted to statistical analyses. Radiographic analysis showed larger radiolucent area into bone defect to the experimental group at the periods of 14 (p=0.016), 30 (p=0.009) and 90 (p=0.028) days. In the histological analysis there was no delay in the bone repair stages in both groups. However, in the histomorphometric analysis, the experimental group presented significative lowering of newly formed bone volume at 7 and 14 days periods (p=0.049), with no significant differences at 30 days period. There was significative decrease of alkaline phosphatase levels in experimental group in the initial periods (p=0.049). There was no change in the serum calcium levels. It was concluded that chronic use of amlodipine compromised bone neoformation in the repairing process of surgical defect in the mandibular ramus of rats, but no precluded occurrence of fracture consolidation.

As atividades eletromiográficas dos músculos masseter e temporal anterior foram avaliadas em amostra constituída por 37 indivíduos assintomáticos, com maloclusão de Classe I divididos em dois grupos - Experimental e Controle. O grupo Experimental foi composto por 23 indivíduos, sendo 14 do gênero masculino e 9, do feminino, com média de idade de 23 anos e 7 meses, e foi submetido à desprogramação neuromuscular, com o uso de placa oclusal, pelo período médio de 6 meses e 3 dias. O grupo Controle foi formado por 14 indivíduos, sendo 11 do gênero feminino e 3, do masculino, com média de idade de 25 anos e 11 meses, e não fez uso de placa oclusal, nem foi submetido a qualquer intervenção oclusal, no período médio de observação de 8 meses e 10 dias. Os registros eletromiográficos foram realizados por meio de eletrodos bipolares de superfície durante o repouso mandibular e o apertamento oclusal máximo, em dois momentos - T1 e T2. Os valores obtidos foram mensurados pelo cálculo do \"Root Mean Square\" (RMS) e expressos em microvolts (&#956;V). Os índices de assimetria e atividade foram calculados em porcentagem (%). Os dados foram analisados estatisticamente por meio dos testes ANOVA e Bonferroni, considerando-se o nível de significância de 5%. Os resultados mostraram que no grupo Experimental, após o uso da placa oclusal, ocorreu redução significante das atividades eletromiográficas de repouso, assim como aumento significante da atividade eletromiográfica em apertamento oclusal máximo. O grupo controle não mostrou qualquer diferença estatisticamente significante entre os momentos. Os índices de assimetria mostraram que, no repouso mandibular, os músculos do lado esquerdo foram mais ativos. Os índices de atividade mostraram que o músculo temporal anterior apresenta maior contribuição relativa, quando comparado ao masseter, no repouso mandibular. Ambos os índices não sofreram alterações significantes entre os momentos estudados, nos dois grupos. / The electromyographic activity of the muscles masseter and temporal (anterior part) was evaluated in a sample of 37 asymptomatic subjects with Class II malocclusion. They were divided in two groups - experimental and control. The experimental group consisted of 23 subjects, 14 males and 9 females, mean age 23y 7m. This group was neuromuscularly deprogrammed with the use of occlusal splints during a mean period of 6 months and 3 days. The control group was formed by 14 individuals, 3 males and 11 females, mean age 25y 11m. This group did not wear occlusal splint nor suffered any occlusal intervention for a mean observation period of 8 months and 10 days. The electromyographic recordings were accomplished by means of surface bipolar electrodes. The recordings were taken at two different moments - T1 and T2, at mandibular rest position and maximal occlusal clenching. The obtained values were measured by the calculating \"Root Mean Square\" (RMS) and they were expressed in microvolts (&#1094;V). The asymmetry and activity indexes were calculated in percentage (%). The data was statistically evaluated by ANOVA and Bonferroni`s tests, considering the level of significance of 5%. The results showed that in the group that wore the occlusal splint occurred a significant reduction of the eletromyographics activities at rest position, as well as a significant increase of the electromyographics activities at maximal occlusal clenching. The control group did not show any significant change in the observated period. The asymmetry indexes showed at mandibular rest, that the left side muscles were more actives. The activity indexes also showed that the temporal muscle presents a relative greater contribution for the maintenance of the rest mandibular position. The indexes - asymmetry and activity - did not present significant changes between the moments for both groups.

Objetivo: checar se poluentes do ar urbano de São Paulo induzem alterações sangüíneas e cardiopulmonares. MM: camundongos Balb/c foram expostos por 7, 14, 21, 30 e 45 dias em 3 câmaras: Limpa (controle), Intermediária (seletiva ao PM) e Suja (ar externo). Após exposição, os animais foram ventilados (FlexiVent) e coletados dados de mecânica pulmonar, sangue, coração e pulmão. Foram registrados PM, CO, SO2 e NO2 diários. Resultados: aos 21 e 45 dias coincidentes com picos de poluição houve aumento da resistência de via aérea (45d p=0,012), leucocitose (21d p < 0,001 e 45d p=0,039) e vasoconstricção pulmonar (21d p=0,034) nos animais da Câmara Suja, sem alteração de coronárias. Nenhum poluente excedeu limites de qualidade de ar / Objective: verify if air pollution of São Paulo city induces alterations in blood and cardiopulmonary systems. MM: Balb/c mice were exposed during 7, 14, 21, 30 and 45 days to 3 chambers: Clean (control), Intermediate (PM only) and Dirty (external air). After exposure, animals were ventilated (FlexiVent) and collected lung mechanics data and blood, heart and lung. PM, CO, SO2 e NO2 were measured daily. Results: on day 21 and 45, coincidently to peak of pollutions, there was proximal airway resistance increase (45d p=0.012), leukocytosis (21d p < 0.001 and 45d p=0.039) and vasoconstriction of peribronchiolar arterioles (21d p=0.034) in animals of Dirty Chamber with no alterations of coronaries. Neither pollutants exceeded the standard limits

A poluição atmosférica de grandes centros urbanos é relacionada com o aumento dos índices de mortalidade e morbidade, principalmente em indivíduos com predisposição às doenças cardiovasculares e progressão da aterosclerose. Com o objetivo de verificar o potencial aterogênico da poluição atmosférica da cidade de São Paulo avaliamos o comportamento do estresse oxidativo e produção de auto-anticorpos em modelo murino experimental \"in vivo\". Foram analisados os seguintes parâmetros: quantidade de lipídeo e espessura da placa aterosclerótica por analisador de imagens, oxidação da LDL sérica (TBARS) e tecidual e imunohistoquímica (8-isoprostano), ativação macrofágica (imunohistoquímicaMAC2) e produção de anticorpos anti-LDL oxidada (LDLox) e anti-peptídeo D da apoB-100 (ELISA). Os dados foram estudados na emergência, arco e porção descendente da aorta em 40 camundongos LDLR - / - knockout, machos, 30 dias de idade expostos às câmaras de intoxicação seletiva não filtrada e filtrada para material particulado e gases tóxicos, no período de Maio/Setembro de 2004. Nesse período não houve ultrapassagem dos níveis aceitáveis de poluição. Os animais foram divididos em 4 grupos: Filtrada-Padrão (FP), Filtrada-E.Col.(FEcol), Poluída-Padrão (PP) e Poluída-E.Col.(PEcol). Obtivemos os seguintes resultados: maior aumento dos níveis de colesterol total nos grupos FEcol e PEcol (p<0,05); triglicérides séricos menores no grupo PEcol (p<0,05); aceleração de oxidação LDL sanguínea apenas no grupo PEcol; índices aumentados de anticorpos anti-LDLox e anticorpos anti-peptídeo D nos grupos PP e PEcol em relação aos demais (p<0,05); maior quantidade de gordura na raiz da aorta nos grupos com dieta Ecol (p<0,05) porém com espessura da placa superior apenas no grupo PEcol (p<0,05). A região descendente e o arco (núcleo necrótico e placa aterosclerótica) não apresentaram diferenças na análise de estresse oxidativo. A quantificação de macrófagos na aorta descendente foi maior no grupo FEcol em relação aos animais com dieta padrão (p<0,05). O núcleo necrótico e placa aterosclerótica do arco aórtico apresentaram o mesmo comportamento: FEcol maior que PP e FP (p<0,05). Concluímos que a poluição atmosférica urbana, mesmo em níveis considerados aceitáveis, potencializa a progressão da aterosclerose. / Epidemiologic studies have shown important relationship between atherogenic cardiovascular morbid-mortality and acute or chronic exposure to air pollution. We aim to study the atherogenic potential of São Paulo urban air pollution analyzing the plaque formation and its physiopathology through oxidative stress and auto-antibody production in a murine experimental model in vivo. We quantified the lipid deposit in the atherosclerotic plaque and its thickness by Image Analyzer, LDL oxidation in blood by TBARS and tissue by 8-isoprosthane, production of anti oxLDL and anti peptide D of apoB-100 antibodies by ELISA and macrophage activation through MAC2 staining. We analyzed three regions of the aorta: emergency, arch and descendent in 40 LDLR - / - knockout mice, male, 30 days old exposed to selective intoxication chambers with filters or not for particulate matter and toxic gases, during May to September 2004, when pollution did not overpass standard limits of air quality. Mice were divided in four groups: Filtered-Normal diet (FN), Filtered-enriched cholesterol diet (FEchol), Polluted-Normal diet (PN) and Polluted-enriched cholesterol diet (FEchol). Our results were: the highest amount of total cholesterol levels in FEchol and PEchol groups (p<0,05); the lowest triglycerides in PEchol mice (p<0,05); increment of oxLDL in blood only in PEchol animals; higher anti oxLDL and anti-peptide D antibodies in PN and PEchol than other groups (p<0,05); similar amounts of lipids in atherosclerotic plaque in Echol diet groups, but higher than mice submitted to Normal diet (p<0,05); PEchol mice presented the highest aorta thickness (p<0.05); oxidative stress showed similar results in both aortic regions in all groups; macrophage activation in descent region of the aorta showed that FEchol mice presented higher values than animals submitted to normal diet (p<0,05) and PEchol group reached higher values than PN animals (p<0,05); macrophage activation in the atherosclerotic necrotic core and plaque of the aortic arch showed similar pattern: FEchol higher than normal diet mice (p<0,05). We concluded that urban air pollution, even within standard limits of air quality, is able to potentate atherosclerosis progression.

Introdução: Os adolescentes usam freqüentemente Computador e videogame e podem estar expostos a desenvolver dores, lesões e síndromes do sistema músculo-esquelético. Objetivos: Avaliar e caracterizar a presença de dor, síndromes e lesões do sistema músculo-esquelético em adolescentes e relacioná-las com o uso de computador e videogame. Avaliar a ergonomia do uso do computador. Métodos: A população de estudo consistiu de 833 alunos de um colégio particular da cidade de São Paulo. Neles foi realizado um estudo transversal que incluiu: 1) Questionário com dados demográficos, características do uso dos aparelhos e sintomas dolorosos; 2) exame físico do aparelho músculo esquelético e 3) avaliação de alguns aspectos ergonômicos (postura e equipamentos) durante o uso do computador na escola. As seguintes doenças foram pesquisadas: fibromialgia juvenil, síndrome de hipermobilidade articular benigna, síndrome miofascial e lesões específicas dos membros superiores (tendinites, bursites e epicondilites). Na avaliação estatística foi realizada análise univariada por meio dos testes qui-quadrado, teste exato de Fischer, teste de Mann Whitney e análise multivariada por Regressão Logística. Os teste realizados foram bicaudais e o nível de significância adotado foi de 5% (p <= 0,05). Resultados: O estudo avaliou 791 alunos. A idade média foi de 14,17 ± 1,99 anos e a relação feminino:masculino foi de 1,1:1. 99% dos alunos utilizaram computador e 67% o usaram no dia anterior à pesquisa. 58% utilizaram videogame e 30% “minigame/gameboy". A disponibilidade e o uso dos aparelhos foi maior no sexo masculino (p < 0,001). Os alunos entre 10 e 14 anos utilizaram mais o videogame e o “minigame/gameboy" (p < 0,001) e os entre 15 e 18 o computador (p < 0,05). A utilização do videogame foi menor que o computador. Dor músculo-esquelética foi relatada por 312 alunos. 23% relataram dor na coluna vertebral, 9% nos membros superiores, 4% no músculo trapézio e 4%dor difusa. 11% dos alunos mencionaram que alguma das suas dores era desencadeada pelo uso do computador. Não foi evidenciada correlação entre a presença dor e o uso dos aparelhos. 359 alunos realizaram o exame físico, nestes a síndrome de hipermobilidade articular benigna foi encontrada em 10%, síndrome miofascial em 5%, tendinites em 2% e fibromialgia juvenil em 1%. Não foi observada correlação estatística entre a presença das entidades com a utilização dos aparelhos. A avaliação da ergonomia foi realizada em 402 alunos. Todos esses alunos apresentaram ergonomia inadequada em um ou mais dos aspectos avaliados. Conclusões: Os adolescentes usam o computador com tempo e freqüência consideráveis. A presença de dor, síndromes e lesões músculoesqueléticas não apresentou correlação com uso de computador ou videogame.Todos os alunos avaliados apresentaram ergonomia inadequada durante o uso do computador. / Introduction: Adolescents frequently use computer and video game and this may cause increased risk of pain, musculoskeletal pain syndromes and soft tissue injuries. Objectives: To evaluate and identify the presence of pain, musculoskeletal pain syndromes and soft tissue injuries in adolescents and correlate to computer and video game use. To evaluate ergonomics during computer use. Methods: The study group consisted of 833 adolescents from one private school in São Paulo, Brazil. A cross-sectional study was carried out that was composed of: a questionnaire with demographic data, use of computer and video game and presence of pain; clinical examination of the locomotor system and ergonomic evaluation of computer use. Juvenile fibromyalgia, benign joint hypermobility syndrome, myofascial syndrome, tendonitis, bursitis and epicondilitis were studied. Statistical analysis was carried out with Fisher, chi-square, Mann Whitney tests and Logistic Regression. In all of the statistical tests the level of significance was set at 5% (p <= 0.05) and were two-tailed. Results: 791 adolescent students were evaluated. The mean age was 14.17 ± 1.99 years and female/male relation was 1/1.1. The computer was used by 99% and 67% used the day before the survey, video game by 58% and minigame/gameboy by 30%. Computer and video game are more available to males and used more frequently by them (p < 0.001). The adolescents from 10 to 14 years (p < 0.001) reported more use of video game and minigame/gameboy and adolescents from 15 to 18 reported more use of computer (p < 0.05). The adolescents reported more use of computer than video game and minigame/gameboy. Pain was reported by 312 adolescents: 23% complained of back pain, 9% upper limbs pain, 4% diffuse pain and 4% pain in trapezium muscle. Pain related with computer use was reported in 11%. Statistical correlation was not observed between presence of any pain and use of either computer or video game. The clinical examination was carried out in 359 students. The musculoskeletal pain syndromes and soft tissue injuries was present in 56 students: benign joint hypermobility syndrome in 10%, myofascial syndrome in 5%, tendinitis in 2% and juvenile fibromyalgia in 1%. Statistical correlation was not observed between presence of musculoskeletal pain syndromes or soft tissue injuries and use of computer and video game. Ergonomic evaluation of computer use was carried out in 402 adolescents. All of these students presented inadequate ergonomics of computer use at school during computer class. Conclusions: Adolescents use frequently and for a considerable period of time computer and video game. Statistical correlation was not observed between presence of any pain and use of computer and video game. The presence of musculoskeletal pain syndromes and soft tissue injuries were not correlated to computer or video game use. All of the students presented inadequate ergonomics during of computer use.