INTRODUÇÃO: O conhecimento de valores de normalidade do fluxo sanguíneo da artéria mesentérica superior (AMS) em recém-nascidos prematuros (RNPT) saudáveis pode prevenir quadros de intolerância alimentar e a ocorrência da enterocolite necrosante. MÉTODOS: Com o objetivo de descrever a evolução dos índices de avaliação da dopplerfluxometria da AMS em RNPT saudáveis de idade gestacional entre 27 e 34 semanas completas, no primeiro, no terceiro, no sétimo e semanalmente (14, 21, 28, 35 e 42 dias de vida), foi realizado este estudo coorte prospectivo em RNPT de idade gestacional ao nascimento entre 27 e 34 semanas completas. O exame dopplerfluxométrico foi realizado, após o consentimento livre e esclarecido dos responsáveis pelos RNPT, através do aparelho Logic Book 8C-RS (General Eletric EUA); obtendo-se as seguintes medidas: pico de velocidade sistólica (PVS), pico de velocidade diastólica final (PVDF) e média de velocidade de fluxo; sendo, após, calculadas o Índice de Pourcelot, sendo: [pico de velocidade sistólico pico diastólico final] / pico de velocidade sistólico, que representa um índice de resistência (IR); e índice de pulsatilidade (IP). Foram excluídos: recém-nascidos com instabilidade hemodinâmica; em ventilação assistida com altos parâmetros; síndromes mal-formativas; intolerância alimentar ou enterocolite necrosante; fototerapia; presença de cateteres umbilicais, persistência de canal arterial e pequenos para a idade gestacional. O exame pré-prandial foi realizado antes da alimentação (até 30 minutos) e pós-prandial entre 15 e 60 minutos após a alimentação. Foram realizados no primeiro dia (entre 6 a 24 horas de vida), no terceiro, no sétimo, e após, semanalmente até 42 dias de vida. Os resultados foram expressos em médias e desvios-padrão e descritos de maneira evolutiva. RESULTADOS: Ao total, foram estudados 77 RNPT e realizados 125 exames. Os valores em média±desvio-padrão são descritos na seqüência do primeiro, terceiro, sétimo e, consecutivamente a cada semana, até 42 dias de vida; sendo: IR pré-prandial de 0,69±0,09; 0,67±0,15; 0,75±0,07; 0,74±0,07; 0,75±0,07; 0,76±0,07; 0,79±0,03; 0,78±0,05 e IR pós-prandial de 0,66±0,10; 0,70±0,21; 0,74±0,07; 0,73±0,08; 0,75±0,06; 0,76±0,06; 0,77±0,04; 0,77±0,03. Os resultados de IP pré-prandial foram: 1,45±0,30; 1,35±0,28; 1,68±0,29; 1,50±0,23; 1,47±0,22; 1,52±0,20; 1,62±0,09; 1,68±0,06 e IP pós-prandial: 1,38±0,39; 1,40±0,29; 1,58±0,26; 1,46±0,26; 1,45±0,24; 1,50±0,27; 1,58±0,10; 1,64±0,04. Obtivemos PVS pré-prandial: 60,51±22,24; 55,24±26,04; 90,61±12,74; 95,33±18,11; 92,89±15,40; 96,96±12,18; 63,18±14,08; 58,12±9,78 e pós-prandial: 59,60±24,14; 110,82±32,45; 118,10±20,15; 121,95±24,18; 124,15±25,16; 126,07±18,17; 96,68±11,12; 96,12±8,98. Quanto a PVDF pré-prandial, obtivemos: 18,85±6,09; 18,66±10,01; 20,99±8,12; 22,02±8,50; 23,04±7,89; 22,24±8,02; 11,99±6,15; 12,05±5,12 e PVDF pós-prandial: 20,63±6,89; 30,15±12,78; 27,98±9,72; 29,02±10,05; 34,56±9,00; 32,02±8,45; 19,02±4,95; 21,15±3,43. A partir dos resultados acima, demonstra-se que o fluxo sanguíneo da AMS em RNPT saudáveis apresenta uma evolução peculiar a partir do nascimento tanto dos valores basais quanto após a estimulação com a dieta, representados por uma evolução característica dos índices de resistência, melhora dos picos de velocidades sistólica e diastólica e melhora da resposta vasodilatadora após a alimentação enteral. CONCLUSÕES: RNPT saudáveis de idade gestacional ao nascimento de 27 a 34 semanas completas apresentam uma evolução do fluxo sanguíneo da artéria mesentérica superior de maneira peculiar, do nascimento até 42 dias de vida, tanto dos valores basais quanto em resposta à alimentação. O conhecimento destes valores pode indicar a dopplerfluxometria como um método preventivo de avaliação específico de cada RNPT para a introdução e progressão mais segura da alimentação, reduzindo a ocorrência de quadros gastrintestinais, melhorando os índices de morbi-mortalidade neonatal. / INTRODUCTION: The knowledge of the normal values of indices of Doppler velocimetry of the superior mesenteric artery in healthy premature neonates may help to prevent feeding intolerance situations and necrotizing enterocolitis. METHODS: In order to describe the indices for evaluation of Doppler velocimetry of the superior mesenteric artery in healthy premature neonates with gestational age between 27 and 34 weeks, on the first, third, seventh days, and then weekly, until six weeks of life; this is a prospective cohort study. The Doppler velocimetric examination was done by means of the Logic Book 8C-RS (General Electric USA), using a 8 MHz imaging transducer, with the pulsed color Doppler readings being obtained by sonographic waves at 4 MHz. The neonate was kept in a supine position, with the transducer positioned in the epigastric region, immediately below the xyphoid appendix, obtaining two-dimensional images of the celiac trunk and of the superior mesenteric artery, a few millimeters after its emergence from the aorta in the sagittal plane. The flux measurements were obtained in the longitudinal direction of the vessel and at an angle of insonation between 0 and 20 degrees. The blood flow curves were recorded after a sequence of five stable measurements, with respect to the quality of the waves, and with respect to their audible characteristics; thus obtaining the following measurements: peak systolic velocity (PSV), end diastolic velocity (EDV) and average flow velocity; with the Pourcelot Index being calculated subsequently, that is: [peak of systolic velocity end diastolic velocity / peak of systolic velocity, which represents a resitance index (RI); and pulsatility index (PI). The values obtained were expressed as averages and standard deviations. The results were stored in an Excel database, with blind analysis after the conclusion of data gathering. Uncomplicated and appropriate for gestational age premature neonates with gestational age between 27 and 34 weeks at birth were included in the study. We adopted as criteria for exclusion from the study: neonates in unstable hemodynamic conditions; needing assisted ventilation with high parameters; large deformations or clinical syndromes; feeding intolerance or diagnosis of necrotizing enterocolitis; conditions that alter the mesenteric flow, such as: phototherapy, presence of umbilical catheters, patent ductus arteriosus and sepsis. The exams were done prior to feeding (up to 30 minutes) and after feeding (between 15 and 60 minutes). If the neonate was fasting, only one of the above parameters was measured, in order to establish behavior of the basal mesenteric flow at that moment. The exams were done on the first day (between the 6th and 24th hours of life), third, seventh days, and then weekly, until six weeks of life. Data are shown as the mean ± standard deviation and described for each postnatal age group. RESULTS: A total of 77 neonates were studied and realized 125 exams. The values of the resistance and pulsatility indices (RI and PI); peaks of systolic (PSV) and final diastolic velocity (EDV) on the first, third, seventh days, and then, on sequentially for each week until six weeks of postnatal life; as mean and standard deviations, was described: RI prior to feeding were 0,69±0,09; 0,67±0,15; 0,75±0,07; 0,74±0,07; 0,75±0,07; 0,76±0,07; 0,79±0,03; 0,78±0,05 and RI after feeding were 0,66±0,10; 0,70±0,21; 0,74±0,07; 0,73±0,08; 0,75±0,06; 0,76±0,06; 0,77±0,04; 0,77±0,03. The results of PI prior to feeding: 1,45±0,30; 1,35±0,28; 1,68±0,29; 1,50±0,23; 1,47±0,22; 1,52±0,20; 1,62±0,09; 1,68±0,06 and PI after feeding: 1,38±0,39; 1,40±0,29; 1,58±0,26; 1,46±0,26; 1,45±0,24; 1,50±0,27; 1,58±0,10; 1,64±0,04. The values of PSV prior to feeding were: 60,51±22,24; 55,24±26,04; 90,61±12,74; 95,33±18,11; 92,89±15,40; 96,96±12,18; 63,18±14,08; 58,12±9,78 and after feeding: 59,60±24,14; 110,82±32,45; 118,10±20,15; 121,95±24,18; 124,15±25,16; 126,07±18,17; 96,68±11,12; 96,12±8,98. And the results of EDV prior to feeding: 18,85±6,09; 18,66±10,01; 20,99±8,12; 22,02±8,50; 23,04±7,89; 22,24±8,02; 11,99±6,15; 12,05±5,12 and EDV after feeding: 20,63±6,89; 30,15±12,78; 27,98±9,72; 29,02±10,05; 34,56±9,00; 32,02±8,45; 19,02±4,95; 21,15±3,43. These results shows that healthy premature neonates with gestational age between 27 and 34 weeks presents a peculiar evolution in blood flow in the superior mesenteric artery after birth, represented by the resistance patterns caracteristics, improvement in peaks of systolic and diastolic velocity, and improvement in vasodilation in response to feeding. CONCLUSION: These results suggest for the Doppler velocimetry as specific and preventive evaluation method for each premature neonate, as a way to a safer introduction and progression of feeding, reducing the prevalence of gastrointestinal inflammatory diseases in neonates, and improving the indices of neonatal morbidity and mortality. Knowledge of blood-flow velocity in the superior mesenteric artery in uncomplicated preterm infants might provide a clue in investigating the maturation of intestinal circulation and the pathogenesis or pathophysiology of gastrointestinal diseases in newborn infants.

Coronary heart diseases (CHD) remain the most prevalent cause of premature death. Ischemic hearts often result from coronary vasculature occlusion. Significant efforts have been made for the treatment of CHD, including medications and surgical procedures. Currently there are still no effective drugs or therapeutics available for the treatment of the disease. Growing new coronary vessels to naturally bypass narrowed/occluded arteries or forming sufficient collaterals to the ischemic region would lead to substantially improved blood perfusion and correction of ischemia. However, this aim remains a theoretical ideal due to the negligible ability to grow new coronary vessels even with current advances in therapeutic angiogenesis. In the present study, we have isolated and identified an active fraction of Geum japonicum (AFGJ) showing significant activity in induction of efficient coronary angiogenesis and heart function improvement. / In addition, proteomics methods were applied to investigate the protein alterations in CHD ischemic hearts and HUVECs. Two dimensional polyacrylamide gel electrophoresis (2-D PAGE) of the heart tissues of CHD rats showed 16 differentially expressed spots compared with sham and vehicle hearts, of which 8 were identified. Furthermore, 11 identified proteins of HUVECs treated with AFGJ or Angio-G at different time points were also observed by 2-D PAGE. The majority of identified proteins was found to be involved in the process of energy metabolisms. / In conclusion, these results have demonstrated therapeutic properties of AFGJ to induce early reconstitution of damaged coronary vasculature through both angiogensis and vasculogenesis. AFGJ treatments may provide a novel therapeutic modality for effective treatment of ischemic heart diseases. / The therapeutic effect of AFGJ on CHD through reconstitution of partially occluded coronary vessels in CHD animal models was demonstrated with underlying signaling mechanisms identified. Briefly, AFGJ could promote the proliferation of human umbilical vein endothelial cells (HUVECs) in vitro and the growth of new blood vessels or coronary collaterals in CHD models after 2-week treatment. The number of newly formed coronary vessels in treated hearts was more than that of vehicle treated hearts, as indicated by both MicroCT and histology analysis. Echocardiography studies demonstrated significant improvement of heart functions 2 weeks after treatment with AFGJ. Furthermore, ECG measurements showed that the altered ST segment in AFGJ treated CHD models almost had full recovery to a normal level while rats in the vehicle group consistently suffered from heart ischemia. Moreover, the results of MicroCT reconstruction directly demonstrated the reconstitution of the damaged coronary vessels with newly formed functional coronary collaterals, as illustrated by more blood vessels density (AFGJ vs vehicle [%]: 4.5+/-0.5 vs 2+/-0.35) and more branching points (AFGJ vs vehicle: 0.94+/-0.07 vs 0.65+/-0.10). These data suggest that AFGJ treatment significantly corrects the ischemia of the affected regions of the heart. / We also explored possible mechanisms underlying the effect of AFGJ. Firstly, AFGJ could induce mesenchymal stem cell (MSC) differentiation into vascular endothelial cells and the differentiated MSCs were involved in the tube formation. Secondly, Angio-G, the component derived from AFGJ, was able to stimulate significant proliferation of HUVECs in a dose dependent manner. Thirdly, in our tube-like capillary formation test of HUVECs in vitro, the length of formed tubes was greatly amplified with increasing concentration of Angio-G. Furthermore, the total length of Angio-G induced tubes was significantly reduced with increasing concentrations of AG490, an inhibitor of JAK/STAT pathways indicating possible involvement of the JAK/STAT signaling pathway. / Chen, Hao. / "December 2009." / Source: Dissertation Abstracts International, Volume: 72-01, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 136-145). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

A poluição atmosférica de São Paulo (SP) pode provocar alterações cardiovasculares em seres humanos e animais experimentais, com maior vulnerabilidade em crianças e fetos. O mecanismo fisiopatológico que explicaria a relação entre a exposição aos poluentes e doenças cardiovasculares não está totalmente estabelecido, sendo que o estresse oxidativo pode estar ligado ao dano e morte celular. Há evidências de que o dano oxidativo pelo mecanismo da peroxidação lipídica pode estar relacionado às causas de diversas cardiovasculopatias. Estudamos o efeito da exposição ao ar ambiental nos níveis de peroxidação lipídica no coração de camundongos nos períodos pré e pós-natal. Os animais foram mantidos em duas câmaras de exposição, uma recebendo ar ambiente e outra ar filtrado, em quatro diferentes grupos: 1) LL: gestados e crescidos em câmara com ar filtrado, 2) PP: gestados e crescidos em câmara com ar poluído de SP, 3) PL: gestados na câmara poluída e crescidos na limpa, e 4) LP: gestados na câmara limpa e crescidos na poluída. A peroxidação lipídica do miocárdio foi avaliada tanto pelo método TBA como por imunohistoquímica para 15-F2t-isoprostano. As concentrações de malondialdeído (MDA, indicador de peroxidação lipídica) foi maior nos animais PP quando comparados aos LL (p = 0,004) e PL (p = 0,026), e não mostrou diferença significativa em relação ao grupo LP (p = 0,894). Os valores de MDA para animais PL e LP mostraram-se equivalentes (p = 0,168). Chama a atenção que o grupo PL apresentou um valor de MDA maior que o LL (p = 0,026). A fração de volume de miocárdio marcada imunohistoquimicamente para 15- F2t-isoprostano apresentou valores maior em PL (p = 2,884x10-5), LP (p = 6,632x10-6) e PP (p = 5,45x10-8) que em LL. O valor de PP foi maior que os de PL e LP (p = 3,661x10-4 e 1,058x10-3, respectivamente), sendo esses últimos equivalentes entre si (p = 0,624). A análise ultra-estrutural mostrou de maneira consistente a presença de lisossomos secundários contendo estruturas lipídicas membranosas nos grupos LP e PP. A porcentagem média de arteríolas com área entre 200 e 1000 ?m² em relação ao número total de vasos de cada grupo foi maior no grupo PP do que nos grupos LL e PL (p=0,0387 e p=0,0362, respectivamente). Estes resultados sugerem que existem altos níveis de peroxidação lipídica no tecido cardíaco dos animais expostos ao ar ambiental de SP. Chama a atenção o fato de que a exposição intra-uterina ter implicado em níveis maiores de estresse oxidativo na fase adulta, mesmo com a melhoria das condições ambientais. Comparam-se estes achados no miocárdio a outros resultados da literatura. / I t is well known that air pollution exposure in São Paulo can elicit cardiovascular injuries in humans and experimental animals and that children and fetuses appear to be particularly vulnerable. However, the mechanisms involved in this cardiovascular damage are not well understood. It has been suggested that the oxidative stress generated by air pollution exposure can trigger tissue injury. There is evidence supporting the idea that injury caused by lipid peroxidation may be related to the causes of several cardiovascular diseases. The aim of this study was to investigate the effects of prenatal and postnatal exposure to urban air pollution on the myocardium lipid peroxidation levels of adult mice. Myocardium lipid peroxidation was determined by the TBA method and by the detection of 15-F2t-isoprostan by immunohistochemical technique. The animals were placed in two chambers: one received air that passed through an air filter (clean) and the second received ambient air (polluted), according to four different exposure procedures: 1) Clean (CC): prenatal and postnatal in the clean chamber (control group), 2) Polluted (PP): prenatal and posnatal in the polluted chamber, 3) Polluted-clean (PC): prenatal in the polluted and posnatal in the clean chamber and 4) Clean-polluted (CP): prenatal in the clean and posnatal in the polluted chamber. The concentration of of malondialdehyde (MDA, a indicator of lipid peroxidation) was higher in group PP compared to CC (p = 0.004) and to PC (p = 0.026), and was not different of group CP (p = 0.894). The values of MDA for groups PC and CP turned to be equal (p = 0.168). Interestingly, group PC had a higher value of MDA than group CC (p = 0.026). The volume fraction of myocardium with detection of 15-F2tisoprostane is higher in PC (p = 2.884x10-5), CP (p = 6.632x10-6) and PP (p = 5.45x10-8) than in CC. The value of PP in higher than those of PC and CP (p = 3.661x10-4 and 1.058x10-3, respectively), while the latter two were equal to each other (p = 0.624). ). The mean ratio of arterioles wiht lumen area between 200 and 1000?m² to the total number of vessels in each group was higher in PP than in CC and PC (p=0.0387 and p=0.0362, respectively). These results, which suggest that exposure to air pollution is associated to higher levels of lipid peroxidation in the myocardium, are compared to other results previously published about respiratory and reproductive alterations related to pollution. Interestingly, the increased levels of lipid peroxidation in the PC group gives evidence that the prenatal exposure to urban air pollution can be linked to cardiovascular effects in adult life.

A poluição do ar é um importante fator ambiental de risco para muitos desfechos gestacionais e reprodutivos negativos. Neste estudo nós investigamos os efeitos da poluição particulada em dois períodos de exposição (antes da concepção e durante a gestação) sobre alguns desfechos reprodutivos e gestacionais em camundongos. Utilizando câmaras de exposição, uma recebendo ar filtrado (F) e outra ar não-filtrado (nF), observamos que as fêmeas expostas ao ar não filtrado apresentaram alterações na duração do ciclo estral, estro persistente e o número de folículos antrais reduziu cerca de 36% (75±35,2, P=0,04) comparado às expostas ao ar filtrado (118,6 ±18,4). Nossos resultados mostram ainda um aumento significativo no tempo necessário para que o acasalamento ocorra, uma diminuição nos índices de fertilidade e gestação (P=0.003) nos casais expostos ao ar não filtrado (nF). A taxa média de perdas pós implantacionais (PPI) está aumentada em 70% (P0,005) no grupo de fêmeas expostas ao ar não filtrado antes e durante a gestação quando comparada ao grupo exposto antes de durante a gestação ao ar filtrado. O peso fetal (PF) é significativamente maior no grupo exposto nos dois períodos ao ar filtrado quando comparado aos demais grupos expostos antes e/ou durante a gestação ao ar não filtrado. O PF e a taxa média de PPI são influenciados tanto pela exposição durante a gestação quanto a exposição que ocorre antes da gestação. A exposição materna prévia a gestação e durante a primeira fase gestacional são críticas para o aumento no risco de baixo peso em camundongos. Nós também verificamos que a exposição ao ar não filtrado está associada a uma redução no volume, calibre e área de superfície dos espaços sanguíneos maternos, a um aumento na área de superfície dos capilares fetais, e na condutância de difusão da placenta. Alterações morfológicas no cordão umbilical também foram encontradas. Este estudo demonstra que a exposição aos níveis ambientais de poluição particulada de origem veicular afeta diferentes funções e estágios do processo reprodutivo. Nossos resultados também indicam que a exposição materna prévia está ligada a desfechos gestacionais negativos mesmo quando a exposição ocorre somente antes da concepção / Air pollution is an important environmental health risk factor for many different gestational and reproductive negative outcomes. In this study we have investigated the effects of two different timing of exposure (before conception and during pregnancy) to urban ambient particulate matter on reproductive and pregnancy outcomes in mice. Using exposure chambers receiving filtered (F) and non-filtered (NF) we observed that exposed females presented changes in the length of estrus cycle, extended estrus and antral follicles number declined by 36% (P=0.04) in mice exposed to non filtered air (75±35.2) compared to mice exposed to filtered air(118.6 ±18.4). Our results further indicate a significant increase in time necessary to mating and decreased fertility and pregnancy indices (P=0.003) in NF couples. Mean postimplantation loss (PIL) rate was increased by 70% (P0.005) in the group exposed before and during pregnancy to non-filtered air when compared to the group exposed before and during pregnancy to filtered air. Fetal weight (FW) was significantly higher in group exposed during both periods to filtered air when compared to other groups exposed before and/or during pregnancy to non filtered air. FW and PIL mean rate were influenced by both pre-gestational (p<0.01) and gestational (p<0.01) period exposure. Maternal pre-gestational and the first stage of pregnancy exposure are critical to increased risk for low birth weight in mice. We also found that gestational exposure to non-filtered air was associated with reduced volumes, calibres and surface areas of maternal blood spaces and with greater fetal capillary surfaces and diffusive conductances of the placenta. Umbilical cord morphology was also altered. This study demonstrated that exposure to ambient levels of urban traffic generated particulate matter negatively affects different functions and stages of the reproductive process. Our results also indicate that maternal exposure to air pollution is linked to negative pregnancy outcomes even if maternal exposure occurs only before conception

Introdução- Obstrução das vias aeríferas superiores associadas a mudanças nos padrões de sono, estão diretamente relacionados a problemas de crescimento e aprendizagem, o que interfere com a qualidade de vida das crianças com este quadro. Métodos de expansão maxilar já mostraram efeito favorável sobre a função respiratória. Aparelhos removíveis intra-orais têm sido usados no tratamento do ronco e apneia do sono, buscando reequilibrar a postura da mandíbula e da língua para melhorar a função respiratória. O objetivo deste trabalho é avaliar as dimensões da faringe, o crescimento craniofacial e os sintomas respiratórios obstrutivos em crianças com ronco e aumento das tonsilas faríngeas e palatinas em tratamento com um aparelho ortodôntico e ortopédico bucal. Métodos- Quarenta crianças de 6 a 9 anos de idade com tonsilas faríngeas e palatinas graus 3 e 4 e apresentando maxila atrésica e sobressaliência anterior foram divididos em dois grupos aleatórios: 24 pacientes tratados com o aparelho oral e 16 controles não tratados. As dimensões da faringe foram medidas por faringometria acústica. Cefalometria avaliou o crescimento facial, incluindo os valores relacionados com a apnéia do sono. Os pais preencheram questionários sobre os sintomas respiratórios da criança. Os pacientes foram reavaliados após 6 meses, em ambos os grupos. Resultados: A faringometria acústica confirmou um aumento volumétrico de 3,1 cm3 (d.p. ± 2,5) na faringe, no grupo de estudo e uma redução volumétrica de -1,2 cm3 (d.p. ± 1,3) no não tratado (p <0,001). A área mínima de colapsibilidade no grupo de estudo apresentou incremento de 1,1 cm2 (dp ± 0,2) para 1,3 cm2 (d.p. ± 0,2) e uma redução no grupo controle de 1,5 cm2 (dp ± 0,3) para 1,3 cm2 (d.p. ± 0,3) estatisticamente significante (p <0,001). A cefalometria comprovou crescimento craniofacial mais favorável no grupo de estudo, em comparação aos controles, incluindo os valores relacionados a apnéia do sono, como ANB, MMPA e H-ML (p <0,001) . O questionário de sintomas confirmou uma melhoria no padrão de respiração e sono no grupo tratado. Conclusão- As crianças que foram submetidos a esse protocolo de tratamento apresentaram aumento de dimensões da faringe, direção de crescimento mais favorável, e uma melhora na respiração e qualidade do sono / Introduction- Airway obstruction due to associated changes in sleep patterns are directly related to problems of growth and learning, which interfer with the quality of life for these children. Maxillary expansion methods have shown favorable effect on respiratory function. Intra-oral removable appliances have been used in the treatment of snoring and sleep apnea, seeking to rebalance the posture of the jaw and tongue to improve breathing function. The purpose of this thesis is evaluate the facial growth, pharyngeal dimensions and respiratory symptoms in snoring children with enlarged tonsils and adenoids under treatment with an orthodontic and orthopedic oral appliance. Methods- Forty snoring children ages 6 to 9 years old with tonsil and adenoid enlargement grades 3 and 4 and presenting constricted maxilla were divided into two randomized groups: 24 patients treated with the oral appliance and 16 untreated controls. Pharyngeal size was measured by acoustic pharyngometry. Cephalometry evaluated the facial growth including values related to sleep apnea. Pharyngeal size was measured by acoustic pharyngometry. Parents filled out questionnaires about their child\'s respiratory symptoms. Patients were re-evaluated after 6 months, in both groups Results- Acoustic pharyngometry confirmed a volumetric gain of 3.1 cm3 (s.d. ±2.5) in the pharynx at the study group and a volumetric reduction of -1.2 cm3 (s.d. ±1.3) at the untreated (p<0.001). The minimum area on collapsibility at the study group showed an increment from1.1 cm2 (s.d.±0.2) to 1.3 cm2 (s.d.±0.2) and a reduction on the control group from 1.5 cm2 (s.d.±0.3) to 1.3 cm2 (s.d.±0.3) statistically significant (p<0.001). Cephalometry showed a more favorable facial growth on the study group compared to controls, including values related to sleep apnea prediction such as ANB, MMPA and H-ML (p<0.001). The symptoms questionnaire confirmed an improvement on the breathing pattern at the group treated. Conclusions- Children who underwent this treatment protocol presented more favorable growth direction, enlargement of pharyngeal dimensions, and an improvement in breathing and sleep

The control of reproductive cycles in higher primates is largely dependent on negative and positive feedback mechanisms by both steroidal and non-steroidal substances of the ovaries which regulate the function of hypothalamo-pituitary system. To gain insights into the role of INH A, the non steroidal ovarian hormone in the feedback control of pituitary FSH secretion, studies were conducted to examine the interrelationships of hormones throughout the menstrual cycle of the bonnet macaque. The findings of chapter II provide a detailed description of endocrine hormone profile during the menstrual cycle of the bonnet macaques with special attention to the feedback role of INH A on pituitary FSH secretion. To characterize the endocrine profile of different hormones, both ovarian (E2, P4, INH A) and pituitary (FSH, LH) hormones were measured daily for more than 40 days. To further examine the site of secretion of INH A and its relationship with pituitary FSH dynamics, surgical lutectomy and pharmacological induction of luteolysis employing the third generation GnRH R antagonist, Cetrorelix (CET) studies were carried out in the subsequent experiments. The results obtained from these studies suggest that INH A and P4 secreted from the CL during luteal phase regulate pituitary FSH secretion. The selective rise in FSH observed during the late menstrual cycle and during menstruation (referred to as luteo-follicular transition), as has been reported previously in higher primates, considered necessary for initiation of follicular growth and recruitment of follicles for ensuing menstrual cycle was characterized in the monkey. Surgical lutectomy and induction of luteolysis by CET experiments suggested that increased GnRH secretion is essential for this selective rise in FSH following withdrawal of inhibition by P4 and INH A. In clinical cases of reproductive ageing, the shortened follicular phase in human females has been identified to be the result of occurrence of early onset of FSH rise during the luteal-follicular transition period. The cause(s) of declining fertility with age in women who still have regular menstrual cycles are not clear, but issues of relationship between dysregulation of selective FSH rise in the late luteal phase and associated infertility could be examined using bonnet monkey as a model system. INH A is secreted in significant quantities by CL in higher primates and the feto placental unit suggesting its importance during fertility and pregnancy. Apart from the negative feedback regulation of pituitary FSH secretion, the complete repertoire of actions of this hormone during pregnancy is yet to be fully understood. The data presented in this thesis is the first comprehensive report showing the endocrine hormone profile of gonadotropins and ovarian hormones including INH A throughout the menstrual cycle of the bonnet macaque. The characterization of INH A profile in bonnet monkey will be of significant value for studies examining the role of INH A in higher primates. Dimeric inhibin has been suggested to be important for regulation of fertility and reproductive functions. Also, inhibin-α (one of the subunits of the dimeric protein) knock out mice model has provided convincing evidence that it acts as a tumour suppressor. A great deal of new information has been generated in recent years regarding the potential clinical usefulness of monitoring inhibin levels in blood and biological fluids in gynaecological diseases, pathological pregnancies and other disorders. Emerging clinical roles of inhibin have made INH A an important candidate molecule to study its molecular regulation. The results presented in chapter II suggested that LH regulates luteal INH A secretion (induction of luteolysis by CET administration experiment). As a first step towards understanding molecular regulation of inhibin-α expression in the macaque CL, in silico promoter analysis of macaque inhibin-α was performed and it revealed several transcriptional factor binding sites that were conserved across species. In rats FSH up regulates while preovulatory LH surge suppresses inhibin-α mRNA expression in the ovary and this suppression has been suggested to be necessary for occurrence of secondary FSH surge during metestrus. To address differential regulation of inhibin-α by LH and FSH in rat ovary during the periovulatory period, studies employing immature rats were carried out and the results are presented in chapter III. The results suggest that immature rat ovaries respond to exogenous gonadotropins in terms of LH signaling (cAMP production), luteinization (P4 production) and as well induction of ICER expression required for repression of inhibin-α subunit expression. PDE4 inhibitor (rolipram) treatment enhanced the ovarian cAMP concentrations suggesting that PDE4 play a major role in controlling intraovarian cAMP concentrations in rat ovaries. However increased cAMP concentrations did not appear to up regulate the ICER expression at the time point examined in this study. In higher primates time course of second FSH surge and continued synthesis and secretion of INH A in the CL are different from non primate species. In the monkey, the second FSH rise occurs during the late luteal phase and experiments have been carried out to examine the regulation of inhibin-α subunit expression by ICER. Expressions of ICER (mRNA/protein) and INH A were examined during different stages of CL and the results indicated no clear inverse relationship between the ICER and inhibin-α mRNAs. With no conclusive role for the ICER in regulating luteal inhibin-α observed in the study, the role of transcriptional activators in the regulation of inhibin-α like GATA4, SF-1, β-catenin were further examined. Since luteal INH A secretion was dependent on pituitary LH as determined earlier in chapter II, expressions of transcriptional activators were examined in CL of different stages and also during induced luteolysis and the results are described in chapter IV. In conclusion, our results indicate cross talk between WNT, cAMP and P38 MAP kinase signaling pathways in the regulation of luteal INH A secretion. The pituitary gonadotropin, LH, is the primary luteotropin in primate species acting to maintain the structure and function of the CL during the menstrual cycle. However whether the actions of LH are direct or mediated by local factors such as P4 remain unknown. Moreover, P4 secretion which is dominant during luteal phase has any role in regulating CL structure and function is not clearly defined. To address these and issues concerning P4 actions, initially, experiments were performed in the rat model to study the importance of P4 in the regulation of ovarian functions. An antiprogestin, RU486, was employed as a tool to uncover the PR regulated pathways during ovulation in rats and the findings are presented in the chapter V. The results indicated that blockade of PR action by RU486 during gonadotropin-induced superovulation resulted in inhibition of follicular rupture and ovulation in immature rats. Further to understand the downstream effectors of PR action, and to identify the candidate target genes of PR activation, semi-quantitative RT-PCR and western blot analyses were performed. The results obtained indicated that betacellulin, a member of EGF family and MMP-9 a proteolytic enzyme, were markedly repressed in response to RU486 treatment in rat ovaries. Also, the down stream pathway of EGF signaling leading to activation of ERK was markedly repressed in RU486 treated ovaries. It was next examined what role the P4/PR system has in the regulation of CL structure and function. Surprisingly, PR expression is absent in CL of rats, while it is present in higher primates. Experiments were carried out to examine intracrine actions of P4 in the regulation of CL structure and function in monkeys. The recently reported model system of induced luteolysis yet capable of responsive to trophic support from the laboratory provided an ideal opportunity to examine direct effects of P4 on structure and function of CL in the monkey. A series of pilot experiments were carried out in monkeys experiencing summer amenorrhea, to determine dose and mode of administration of exogeneous P4 to simulate mid luteal phase circulating P4 concentrations in monkeys subjected to induced luteolysis. Based on the results of pilot experiments, implantation of Alzet pumps containing 97.5mg of P4 was selected for maintaining mid luteal phase P4 concentrations. The microarray data of induced luteolysis previously deposited by the laboratory in NGBI’s gene expression omnibus were mined for identification and validation of differentially expressed genes of PR and its target genes following LH depletion and LH replacement experiments. Expressions of PR, PR cofactors and expressions of PR downstream target genes through out the luteal phase and in CL from day1 of menses were also examined. Analysis of expressions of genes revealed that of the 45 genes identified to be regulated by LH treatment, 4 genes were found to be responsive to P4, and 14 were identified to be responsive to both P4 and LH. Morphology of CL tissue sections revealed that P4 treatment appeared to have reversed the induced-luteolysis changes. In another experiment, implantation of P4 during late luteal phase (i.e., the period of declining P4 concentrations) for 24h caused changes in expressions of genes associated with tissue remodeling and morphology of luteal cells. Taken together, the results suggest that induced luteolysis plus P4 replacement model is suitable for assessing the effects of P4 on CL function. The results also suggest that CL could serve as target tissue for examining the genomic and non genomic actions of P4. In summary, studies carried out in the present thesis provides a comprehensive endocrine hormone profile throughout the menstrual cycle of the bonnet monkey with special emphasis on time course of INH A and FSH secretion which is very useful for future investigations. Studies have been carried out in rats and monkeys with different experimental model systems to address molecular mechanisms underlying inhibin-α regulation in the ovary in general and CL in particular. Experimental findings in monkeys could help elucidate the underlying molecular nature of CL functionality and extrapolate to understand luteal insufficiency and infertility producing conditions in humans. Also different model systems have been validated to examine the actions of P4/PR system in rats and monkeys and more importantly to address the direct effects of P4 upon monkey CL structure and function were established. Future investigations based on findings of these studies should help clarify relative roles for LH and P4 during maintenance of CL function and luteolysis.

O diabetes melito gestacional (DMG) está relacionado ao crescimento fetal exagerado. Entender a influência de fatores relacionados ao crescimento fetal auxilia na identificação dos fetos com maior risco de desvios da normalidade. Objetivo: comparar fatores clínicos, laboratoriais e a expressão placentária de transportadores de glicose segundo o crescimento fetal em pacientes com DMG. Método: Para análise dos fatores clínicos e laboratoriais foi realizado um estudo retrospectivo com 425 gestantes com DMG do Setor de Endocrinopatias da Divisão de Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC FM-USP) no período de janeiro de 2003 a novembro de 2009. Para a análise da expressão placentária dos transportadores de glicose dos tipos 1 (GLUT1), 3 (GLUT3) e 4 (GLUT4) foram selecionados todos os casos de recém-nascidos grandes para idade gestacional (RNGIG) pareados com um caso controle de recém-nascido adequado para idade gestacional (RNAIG). Foram incluídas apenas gestações únicas e com DMG diagnosticado pelo teste de tolerância à glicose oral de 100 gramas, sem malformações fetais e com idade gestacional definida e confiável. Todas as gestantes realizaram dieta para diabetes, controle glicêmico diário e uso de insulina quando necessário. Os critérios de seguimento e tratamento seguiram rigorosamente as normas do Protocolo de Condutas do Setor de Endocrinopatias da Divisão de Clínica Obstétrica do HC-FMUSP. As gestantes foram divididas para análise dos dados em dois grupos: Fatores clínicos e laboratoriais com: 376 RNAIG e 49 RNGIG num total de 425 DMG. Expressão Placentária dos Transportadores de Glicose: 50 RNAIG e 44 RNGIG. Foram realizados testes de associação e médias das variáveis e relacionadas com os grupos de RNAIG e RNGIG. Resultados: Na análise univariada, dos fatores clínicos e laboratoriais, não houve diferenças entre os grupos quanto a: idade materna, antecedente familiar de diabetes, antecedente pessoal de hipertensão arterial, número de gestações, valores de glicemia de jejum e 1 hora no TTGO-100g, idade gestacional no parto, sexo do RN, tipo de parto e índice de Apgar no 1º e 5º minutos. Houve diferenças estatisticamente significativas entre os grupos quanto a: índice de massa corpórea pré-gestacional (p < 0,02); uso de insulina (p < 0,041); macrossomia anterior (p < 0,001); idade gestacional do diagnóstico do DMG (p < 0,001); glicemias de duas e três horas no TTGO-100g respectivamente com (p < 0,003) e (p < 0,026). Na análise de regressão logística foram considerados preditores independentes da ocorrência de RNGIG: o índice de massa corpórea pré - gestacional, a macrossomia anterior, aidade gestacional do diagnóstico do DMG e a glicemia de duas horas após sobrecarga de 100 gramas. Em relação a expressão dos transportadores de glicose não diferiram entre os grupos em relação a expressão de GLUT1 na decídua, GLUT3 na decídua e vilosidades e GLUT4 na decídua e vilosidades. Houve diferença entre os grupos quanto à: a expressão do GLUT1 nas vilosidades. Conclusões: O índice de massa corpórea pré - gestacional, a macrossomia anterior, a idade gestacional do diagnóstico do DMG e a glicemia de duas horas após sobrecarga de 100 gramas foram preditores da ocorrência de RNGIG. A expressão de GLUT1 nas vilosidades coriônicas teve relação com a ocorrência de RNGIG / Gestational diabetes mellitus (GDM) is related to excessive fetal growth. Knowing the influence of factors related to fetal growth assists in the identification of fetuses at high risk of deviations from normality. Objective: To compare clinical and laboratory tests and the placental expression of glucose transporters according to fetal growth in patients with GDM. Method: A retrospective study of clinical and laboratory factors related with large for gestational age newborns, included 425 pregnant women with GDM was carried out at Sector Endocrine Clinic of Obstetrics Hospital of the School of Medicine, University of São Paulo (HC-FMUSP), between January 2003 to November 2009. For the analysis of placental expression of glucose transporters types 1 (GLUT1), 3 (GLUT3) and 4 (GLUT4) were selected all cases of newborns large for gestational age (LGA) paired with a case control newly born appropriate for gestational age (AGA). We included only patients with singleton pregnancies and GDM diagnosed by OGTT-100g, with newborns without malformations and birth weight classified as adequate or large for gestational age. All pregnant women received diet for diabetes, daily glycemic control and insulin when necessary. The criteria for monitoring and treatment followed strictly the standards of Conduct Protocol Endocrine Obstetric Clinic of the Clinic Hospital, School of Medicine, University of São Paulo. The pregnancies were divided for analysis into two groups: 376 cases of newborns AGA and 49 cases of newborns LGA. Data were analyzed and considered the probability value p <0.05. Results: In the univariate analysis of clinical and laboratory factors, there were no differences between the groups regarding maternal age, family history of diabetes, personal history of hypertension, number of pregnancies, blood fasting glucose and 1 hour in- OGTT 100g, gestational age at delivery, gender of the newborn, type of delivery, Apgar score at 1st and 5th minutes. There were statistically significant differences between the groups regarding: body mass index before pregnancy (p <0.02), insulin (p <0.041), previous macrosomia (p <0.001), gestational age at diagnosis of GDM (p <0.001), blood glucose levels two and three hours at 100 g OGTT, respectively, with (p <0.003) (p <0.026). In logistic regression analysis were considered independent predictors of the occurrence of LGA: body mass index before pregnancy, previous macrosomia gestational age at diagnosis of GDM and two hours after glucose overload 100 grams. Regarding the expression of glucose transporters, the groups did not differ regarding the expression of GLUT1 in the decidua, GLUT3 in the decidua and villi and GLUT4 in the decidua and villi. There were differences between the groups regarding the expression of GLUT1 in the villi. Conclusions: The body mass index before pregnancy, previous macrosomia, gestational age of diagnosis of GDM and two hours after glucose overload 100 grams were predictors of the occurrence of LGA. The expression of GLUT1 in chorionic villi was related to the occurrence of LGA newborn

O diabetes melito gestacional (DMG) está relacionado ao crescimento fetal exagerado. Entender a influência de fatores relacionados ao crescimento fetal auxilia na identificação dos fetos com maior risco de desvios da normalidade. Objetivo: comparar fatores clínicos, laboratoriais e a expressão placentária de transportadores de glicose segundo o crescimento fetal em pacientes com DMG. Método: Para análise dos fatores clínicos e laboratoriais foi realizado um estudo retrospectivo com 425 gestantes com DMG do Setor de Endocrinopatias da Divisão de Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC FM-USP) no período de janeiro de 2003 a novembro de 2009. Para a análise da expressão placentária dos transportadores de glicose dos tipos 1 (GLUT1), 3 (GLUT3) e 4 (GLUT4) foram selecionados todos os casos de recém-nascidos grandes para idade gestacional (RNGIG) pareados com um caso controle de recém-nascido adequado para idade gestacional (RNAIG). Foram incluídas apenas gestações únicas e com DMG diagnosticado pelo teste de tolerância à glicose oral de 100 gramas, sem malformações fetais e com idade gestacional definida e confiável. Todas as gestantes realizaram dieta para diabetes, controle glicêmico diário e uso de insulina quando necessário. Os critérios de seguimento e tratamento seguiram rigorosamente as normas do Protocolo de Condutas do Setor de Endocrinopatias da Divisão de Clínica Obstétrica do HC-FMUSP. As gestantes foram divididas para análise dos dados em dois grupos: Fatores clínicos e laboratoriais com: 376 RNAIG e 49 RNGIG num total de 425 DMG. Expressão Placentária dos Transportadores de Glicose: 50 RNAIG e 44 RNGIG. Foram realizados testes de associação e médias das variáveis e relacionadas com os grupos de RNAIG e RNGIG. Resultados: Na análise univariada, dos fatores clínicos e laboratoriais, não houve diferenças entre os grupos quanto a: idade materna, antecedente familiar de diabetes, antecedente pessoal de hipertensão arterial, número de gestações, valores de glicemia de jejum e 1 hora no TTGO-100g, idade gestacional no parto, sexo do RN, tipo de parto e índice de Apgar no 1º e 5º minutos. Houve diferenças estatisticamente significativas entre os grupos quanto a: índice de massa corpórea pré-gestacional (p < 0,02); uso de insulina (p < 0,041); macrossomia anterior (p < 0,001); idade gestacional do diagnóstico do DMG (p < 0,001); glicemias de duas e três horas no TTGO-100g respectivamente com (p < 0,003) e (p < 0,026). Na análise de regressão logística foram considerados preditores independentes da ocorrência de RNGIG: o índice de massa corpórea pré - gestacional, a macrossomia anterior, aidade gestacional do diagnóstico do DMG e a glicemia de duas horas após sobrecarga de 100 gramas. Em relação a expressão dos transportadores de glicose não diferiram entre os grupos em relação a expressão de GLUT1 na decídua, GLUT3 na decídua e vilosidades e GLUT4 na decídua e vilosidades. Houve diferença entre os grupos quanto à: a expressão do GLUT1 nas vilosidades. Conclusões: O índice de massa corpórea pré - gestacional, a macrossomia anterior, a idade gestacional do diagnóstico do DMG e a glicemia de duas horas após sobrecarga de 100 gramas foram preditores da ocorrência de RNGIG. A expressão de GLUT1 nas vilosidades coriônicas teve relação com a ocorrência de RNGIG / Gestational diabetes mellitus (GDM) is related to excessive fetal growth. Knowing the influence of factors related to fetal growth assists in the identification of fetuses at high risk of deviations from normality. Objective: To compare clinical and laboratory tests and the placental expression of glucose transporters according to fetal growth in patients with GDM. Method: A retrospective study of clinical and laboratory factors related with large for gestational age newborns, included 425 pregnant women with GDM was carried out at Sector Endocrine Clinic of Obstetrics Hospital of the School of Medicine, University of São Paulo (HC-FMUSP), between January 2003 to November 2009. For the analysis of placental expression of glucose transporters types 1 (GLUT1), 3 (GLUT3) and 4 (GLUT4) were selected all cases of newborns large for gestational age (LGA) paired with a case control newly born appropriate for gestational age (AGA). We included only patients with singleton pregnancies and GDM diagnosed by OGTT-100g, with newborns without malformations and birth weight classified as adequate or large for gestational age. All pregnant women received diet for diabetes, daily glycemic control and insulin when necessary. The criteria for monitoring and treatment followed strictly the standards of Conduct Protocol Endocrine Obstetric Clinic of the Clinic Hospital, School of Medicine, University of São Paulo. The pregnancies were divided for analysis into two groups: 376 cases of newborns AGA and 49 cases of newborns LGA. Data were analyzed and considered the probability value p <0.05. Results: In the univariate analysis of clinical and laboratory factors, there were no differences between the groups regarding maternal age, family history of diabetes, personal history of hypertension, number of pregnancies, blood fasting glucose and 1 hour in- OGTT 100g, gestational age at delivery, gender of the newborn, type of delivery, Apgar score at 1st and 5th minutes. There were statistically significant differences between the groups regarding: body mass index before pregnancy (p <0.02), insulin (p <0.041), previous macrosomia (p <0.001), gestational age at diagnosis of GDM (p <0.001), blood glucose levels two and three hours at 100 g OGTT, respectively, with (p <0.003) (p <0.026). In logistic regression analysis were considered independent predictors of the occurrence of LGA: body mass index before pregnancy, previous macrosomia gestational age at diagnosis of GDM and two hours after glucose overload 100 grams. Regarding the expression of glucose transporters, the groups did not differ regarding the expression of GLUT1 in the decidua, GLUT3 in the decidua and villi and GLUT4 in the decidua and villi. There were differences between the groups regarding the expression of GLUT1 in the villi. Conclusions: The body mass index before pregnancy, previous macrosomia, gestational age of diagnosis of GDM and two hours after glucose overload 100 grams were predictors of the occurrence of LGA. The expression of GLUT1 in chorionic villi was related to the occurrence of LGA newborn

Chlamydiae growing in target mucosal human epithelial cells in vitro can transition from their normal developmental cycle progression, alternating between infectious but metabolically inactive elementary bodies to metabolically active but noninfectious reticulate bodies (RBs) and back to elementary bodies, into a state of persistence. Persistence in vitro is defined as viable but noncultivable chlamydiae involving morphologically enlarged, aberrant, and nondividing RBs. The condition is reversible, yielding infectious elementary bodies after removal of the inducers, including penicillin, interferon-gamma, iron or nutrient starvation, concomitant herpes infection, or maturation of the host cell into its physiologically differentiated state. All aberrant RB phenotypes are not the same, owing to differing up- or down-regulated chlamydial gene sets and subsequent host responses. Although all persistence-inducing conditions exist in vivo, key questions include (1) whether or not aberrant chlamydial RBs occur in vivo during the alternating acute-silent chronic-acute chlamydial infection scenario that exists in infected patients and animals and (2) whether such aberrant RBs can contribute to prolonged, chronic inflammation, fibrosis, and scarring.

Balding causes widespread psychological distress but is poorly controlled. The commonest treatment, minoxidil, was originally an antihypertensive drug that promoted unwanted hair. We hypothesized that another serendipitous discovery, increased eyelash growth side-effects of prostamide F(2alpha)-related eyedrops for glaucoma, may be relevant for scalp alopecias. Eyelash hairs and follicles are highly specialized and remain unaffected by androgens that inhibit scalp follicles and stimulate many others. Therefore, we investigated whether non-eyelash follicles could respond to bimatoprost, a prostamide F(2alpha) analog recently licensed for eyelash hypotrichosis. Bimatoprost, at pharmacologically selective concentrations, increased hair synthesis in scalp follicle organ culture and advanced mouse pelage hair regrowth in vivo compared to vehicle alone. A prostamide receptor antagonist blocked isolated follicle growth, confirming a direct, receptor-mediated mechanism within follicles; RT-PCR analysis identified 3 relevant receptor genes in scalp follicles in vivo. Receptors were located in the key follicle regulator, the dermal papilla, by analyzing individual follicular structures and immunohistochemistry. Thus, bimatoprost stimulates human scalp follicles in culture and rodent pelage follicles in vivo, mirroring eyelash behavior, and scalp follicles contain bimatoprost-sensitive prostamide receptors in vivo. This highlights a new follicular signaling system and confirms that bimatoprost offers a novel, low-risk therapeutic approach for scalp alopecias.