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The p53 homolog p63 modulates acute and chronic damage in irradiated salivary glandsMitchell, Geoffrey C January 2010 (has links)
Head and neck cancer is diagnosed in more than 50,000 Americans each year, resulting in roughly 11,000 deaths. For this disease, a typical therapeutic regimen involves cisplatin, a radiosensitizer, given alongside targeted irradiation. While technological advances such as IMRT have been useful in sparing normal tissues from radiotherapy, the salivary glands occupy much of the head and neck and surround several lymph nodes, and thus, non-diseased salivary glands are often damaged. This causes reduced salivary output, damaged oral mucosa, dysphagia, malnutrition and tooth decay. Often, these side-effects are so severe that patients discontinue treatment, however, in many cases, salivary gland damage is permanent, and treatment options are palliative. Specifically, muscarinic-cholinergic agonists are used to enhance secretion from remaining salivary cells, although due to non-specific action, these drugs have a number of ill-effects. It is clear that therapies are needed to prevent radiation-induced salivary gland damage, as well as to restore glandular function in patients who are already suffering.Previous work from our group has shown that salivary gland dysfunction results from loss of acinar cells to radiation-induced apoptosis. Importantly, a single intravenous dose of IGF1 can prevent apoptosis and preserve salivary output when given immediately prior to irradiation. Because of its broad effects, however, IGF1 may never be a viable clinical option. Instead, our goal is to identify signaling events that mediate the radioprotective effects of IGF1 downstream of Akt. Because radiation-induced apoptosis in salivary glands is p53-dependent, we assessed the contributions of the p53 homologs p63 and p73 to the DNA damage response. Here, we show that IGF1 enhances cell cycle arrest following irradiation by reducing inhibitory binding of deltaNp63 to the p21 promoter. We hypothesize that IGF1-induced cell cycle arrest may allow time for DNA repair, thus preventing apoptosis and maintaining salivary function. In addition, we indicate chronic signaling events downstream of p63 that may contribute to permanent loss of salivary function by blocking differentiation of salivary progenitor cells. Together, these results indicate that p63 may be a valid therapeutic target for both prevention of damage and restoration of function in irradiated salivary glands.
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Unstimulated human whole saliva flow rate in relation to hyposalivation and dental caries /Flink, Håkan. January 2005 (has links)
Lic.-avh. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 2 uppsatser.
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Xerostomia and hyposalivation in HIV positive patients with and without HAARTCherian, A.P. January 2014 (has links)
Magister Scientiae Dentium - MSc(Dent) / Introduction: Xerostomia and reduced salivary flow have been reported often enough among HIV positive patients. Strong associations have also been established between HIV infection and oral effects of reduced salivary flow like xerostomia, high DMFT, increased candidial infection etc. Besides the direct effect of HIV infection, xerostomia and reduced salivary flow have also been reported as a side effect of Highly Active Anti Retroviral reatment (HAART). Studies have shown that xerostomia has a negative effect on the quality of life of people living with HIV & AIDS. Although reduced salivary flow is a main cause for xerostomia, complaints of xerostomia is also found in the absence of salivary flow deficiency. An exact correlation between the two is not always found.Aim: The aim of this study is to compare the prevalence of xerostomia and hyposalivation, in HIV positive patients on HAART, HIV positive patients not on HAART and HIV negative patients, attending Empilweni Gompo community health centre (EGCHC) in East London. Study Methods: This is a cross sectional analytical study. Xerostomia and resting & chewing- stimulated salivary flow rates were measured for 150 patients who were from three groups : group 1-HIV negative, group 2-HIV positive not on HAART and group 3-HIV positive on HAART for more than two years. Each group had 50 patients. Xerostomia was measured using a questionnaire and salivary flow rates were calculated after saliva collection over a three minute period. Results: There was significant difference in the prevalences for xerostomia (p=0.006) and less than normal chewing -stimulated flow rate (p=0.041) among the three groups with the HIV positive group not on HAART showing the greatest deficiency. HAART was not found to have a negative effect on salivary function. A statistical significance was also observed while comparing mean resting (p=0.010) and chewing –stimulated (p=0.034) salivary flow rates among the three groups. The mean salivary flow rate of those complaining of xerostomia was found to be significantly lower than that of those who did not have xerostomia (p=0.005). Conclusion: HIV positive patients not on HAART are more vulnerable to salivary gland dysfunction. HAART in itself does not to adversely affect xerostomic perceptions or salivary flow rates.The xerostomia questionnaire is a useful tool in indicating those with possible low salivary flow rates
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Xerostomia em adultosSilva, Luciana da January 2014 (has links)
Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Pública, Florianópolis, 2014 / Made available in DSpace on 2015-02-05T20:18:56Z (GMT). No. of bitstreams: 1
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Previous issue date: 2014 / Objetivou-se investigar a mudança nos episódios de sintomas de xerostomia ocorridos em adultos e estimar os fatores que contribuíram para esta mudança durante o período estudado. Tratou-se de um estudo prospectivo longitudinal de base populacional realizado na área urbana de Florianópolis, com acompanhamento de dois anos, sendo a primeira coleta de dados realizada em 2009, onde foram entrevistados 1720 indivíduos e a segunda em 2012, sendo entrevistados 1222 participantes da linha de base. Os dados, em ambos os anos, foram coletados nos domicílios dos participantes através de entrevistas face a face conduzidas por entrevistadores previamente treinados e calibrados. Sintoma de xerostomia foi avaliado em 2009 e 2012 através da questão "Com que frequência o Sr.(a) sente a boca seca?". As opções de resposta: "Nunca", "De vez em quando", "Frequentemente" e "Sempre" foram lidas imediatamente após a pergunta. O desfecho foi construído a partir da combinação das respostas nestes dois anos, sendo composto por três categorias, a saber: (0) "sintoma de boca seca regular", (1) "sintoma de boca seca irregular" e (2) ausência de sintoma (3). As variáveis exploratórias foram sexo, idade, mobilidade de renda, escolaridade, hábito de tabagismo e etilismo, mudança no estado de hipertensão e do IMC, doenças crônicas autorreferidas, mudança na auto-avaliação da necessidade de prótese e no uso e número de dentes (CPO-D). A análise dos fatores associados foi realizada através da regressão logística multinomial considerando "nunca" como referência. A prevalência de xerostomia regular foi igual a 3,8% (IC95%: 2,9-5,1), 12,2% (IC95%: 10,2-14,5) relataram sintoma de boca seca irregular e 83,9% (IC95%: 81,2-86,3) nunca relataram xerostomia. As variáveis associadas à persistência de boca seca foram a idade, escolaridade, tabagismo, uso de medicamentos, IMC e a depressão autorreferida, enquanto as associadas ao sintoma de xerostomia irregular foram número de dentes e a depressão autorreferida.<br> / Abstract: The objective was to investigate the change in episodes of symptoms of xerostomia occurred in adults and estimate the factors that contributed to this change during the study period. This was a prospective longitudinal population-based study conducted in the urban area of Florianópolis, with accompaniment of two years, the first data collection was made in 2009, where 1720 individuals were interviewed and the second in 2012, 1222 participants were interviewed baseline. The data in both years were collected at the homes of participants through face to face interviews conducted by interviewers previously trained and calibrated. Symptom of xerostomia was evaluated in 2009 and 2012 through the question "How often Mr. (a) feels dry mouth?". Response options: "Never", "Occasionally", "Often" and "Always" were read immediately after the question. The outcome variable was constructed from the combination of the responses in these two years, is divided into three categories, namely: (0) "regular symptom of dry mouth (1)" irregular symptom of dry mouth "and (2) absence of symptoms (3). The explanatory variables were gender, age, income mobility, education, smoking, and alcohol consumption, change in the state of hypertension and BMI, self-reported chronic disease, change in self-evaluation of the need for prostheses and the use and number of teeth (DMFT). The analysis of associated factors was performed by multinomial logistic regression considering "never" as a reference. The prevalence of regular xerostomia was equal to 3.8% (95% CI: 2.9 to 5.1), 12.2% (95% CI: 10.2 to 14.5) reported symptoms of dry mouth irregular and 83, 9% (95% CI: 81.2 to 86.3) ever reported xerostomia. The variables associated with persistence of dry mouth were age, education, smoking, medication use, BMI and self-reported depression, while those associated with the symptom of xerostomia were uneven number of teeth and self-reported depression.
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O efeito de frutas cítricas no fluxo salivar / The effect of citric fruits in the stream salivateMagalhães, Ana Carla Carvalho de January 2001 (has links)
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Previous issue date: 2001 / A xerostomia é a redução do fluxo salivar, que pode ocorrer devido a problemas relacionados diretamente com as glândulas salivares, ou por motivos de ordem geral. O paciente acometido pela xerostomia queixa-se de boca seca, dificuldade de mastigação e deglutição. A xerostomia atinge cerca de trinta por cento da população brasileira, sendo um dos efeitos colaterais mais comum do tratamento radio e quimioterápico. Esta dissertação está estruturada sob a forma de dois estudos baseados em um mesmo desenho experimental. O primeiro estudo descreve o efeito sialogogo de duas frutas cítricas, a acerola e o kiwi, associados ou não a estimulação mecânica da mastigação do látex. Os resultados obtidos neste estudo mostraram que a associação do estímulo mecânico da mastigação de um centímetro de látex a uma porção do cítrico kiwi ou acerola aumenta significativamente o fluxo salivar, sendo a associação com o cítrico kiwi mais sialogoga. O segundo estudo consiste em determinar a confiabilidade e a validade dos resultados obtidos na mensuração do pH salivar através do (kit) industrializado DentoBuff.(...). Porém, quando se classifica o pH salivar pela escala de cores do (kit) DentoBuff em ácido, neutro e alcalino essa diferença se dilui devido se estar trabalhando dentro de intervalos.
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A utilização do lauril-sulfato de sódio associado ao hidróxido de cálcio (HcT10) aumenta o fluxo salivar em pacientes submetidos à radioterapia /Semenoff, Tereza Aparecida Delle Vedove. January 2009 (has links)
Orientador: Éder Ricardo Biasoli / Banca: Eurípedes de Oliveira Marinho / Banca: Luiz Paulo Kowalski / Banca Laurindo Moacir Sassi / Banca: Glauco Issamu Miyahara / Resumo: Objetivo: Avaliar o fluxo salivar e a fração de eliminação cintilográfica de pacientes tratados com bochecho de lauril-sulfato de sódio associado ao hidróxido de cálcio (HcT10) durante ou após o tratamento radioterápico na região cervicofacial. Casuística e método: Os pacientes foram divididos em dois grupos: O grupo I (G1) foi composto por pacientes pós-irradiados (n=20) e o grupo II (G2) por pacientes que seriam submetidos à radioterapia no início deste estudo (n=23). Os pacientes foram avaliados através de sialometria, tendo sido realizada uma coleta de saliva antes do início dos bochechos e 4 outras a cada 14 dias (C1-C5), e de cintilografia, sendo uma realizada antes do início dos bochechos e outra entre 3 e 4 meses depois. Dois pacientes do G1 e oito pacientes do G2 não fizeram as secundas cintilografias. Resultados: Houve, a partir de C4, aumento significativo na quantidade de saliva quando comparada à C1 (p<0,05) para o G1 e decréscimo da quantidade de saliva para o G2 mesmo com o uso do HcT10 (p<0,05). Os resultados da cintilografia demonstraram que houve aumento da função das glândulas parótidas do G1 (p<0,05), sem, entretanto haver diferenças para as glândulas submandibulares (p>0,05). Em relação ao G2 houve decréscimo da função de todas as glândulas salivares (p<0,05). Conclusão: O HcT10 mostrou-se benéfico para o aumento de saliva no G1, porém não foi capaz de manter a quantidade de saliva para o G2 / Abstract: Objective: To evaluate salivary flow and the scintigraphic elimination of patients treated with a rinse of sodium lauryl sulphate associated with calcium hydroxide (HcT10) during or after radiation therapy in the cervicofacial area. Methods: Patients were divided into two groups: Group I (G1) was composed with post-irradiated patients (n=20) and Group II (G2) was composed with patients who were undergoing radiotherapy at the start of this study (n=23). Patients were evaluated by sialometry - one saliva collection before the start of mouthwash and 4 other every 14 days (C1-C5), and scintigraphy, the first one performed before the start of the mouthwash and the last one between 3 and 4 months later Two patients in G1 and eight patients in G2 did not perform the secondary scintigraphy. Results: There was, from C4, a significant increase in the amount of saliva when compared to C1 (p<0.05) for G1 and a decreased amount of saliva into G2 even with the use of HcT10 (p<0.05). The results of scintigraphy demonstrated an augmentation in the parotid gland function in G1 (p<0.05), without, however there are differences in the submandibular glands (p>0.05). Regarding the G2 to a decrease in light of all the salivary glands (p<0.05). Conclusion: HcT10 proved to be beneficial to increase salivary flow in G1, but it was unable to keep the amount of saliva for the G2 / Doutor
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Relação entre condições bucais e qualidade de vida em idosos com diferentes niveis de fragilidade / Relationship between oral health conditions and quality of life in elderly with different fragility levelsPerianes, Lilian Berta Rihs 15 August 2018 (has links)
Orientador: Maria da Luz Rosario de Sousa / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-15T13:15:51Z (GMT). No. of bitstreams: 1
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Previous issue date: 2010 / Resumo: Tendo em vista a escassez de trabalhos que avaliem as condições bucais relacionadas à qualidade de vida em idosos com diferentes níveis de fragilidade, os objetivos deste estudo foram: Avaliar as condições de saúde bucal em uma população idosa não institucionalizada que apresentava diferentes graus de fragilidade (capítulo 1); apresentar a prevalência de xerostomia e sua associação com variáveis sócio-demográficas, clínicas e de autopercepção em saúde bucal (capítulo 2); verificar a autopercepção sobre as condições de saúde bucal em idosos, segundo a fragilidade (capítulo 3); verificar o impacto das condições bucais na qualidade de vida em idosos com diferentes níveis de fragilidade (capítulo 4). Este trabalho é parte integrante de um projeto temático e multidisciplinar: "Qualidade de vida em idosos fragilizados: indicadores de saúde e bem estar subjetivo", realizado em freqüentadores de um ambulatório de geriatria. Foram realizados um exame bucal segundo recomendações da Organização Mundial de Saúde (OMS, 1997) e uma entrevista com questões relativas à: sua autopercepção de saúde bucal, a sensação de boca seca e Geriatric Oral Health Assessment Índex (GOHAI). A avaliação da fragilidade foi feita após a aplicação de 5 critérios clínicos propostos por Fried et al. (2001). Os idosos fragilizados foram divididos em: pré-frágeis e frágeis. A análise dos dados foi realizada através do programa SPSS 17. No capítulo 1(n=67) obtiveram-se como resultados que 61,2% (n=41) dos examinados eram edêntulos; a média de dentes presentes foi de 4,8 (DP=7,5) e o CPOD de 28,8 (DP=5,1), sendo a maior parte do índice composta pelo componente perdido (94,4%). 50,7% (n=34) foram considerados pré-frágeis e 49,3% (n=33), frágeis. Quando as variáveis odontológicas foram comparadas com a condição de fragilidade, todas foram melhores nos indivíduos pré-frágeis. No capítulo 2 (n=150), a prevalência de xerosotmia foi de 68%. Verificou-se que os idosos considerados não brancos apresentaram menos sensação de boca seca (p=0,017/RP=0,68 [IC95%=0,49-0,93]). Dentre os idosos frágeis, quem era analfabeto tinha mais xerostomia (p=0,03/RP=1,31 [IC95%=1,02-1,68]). No capítulo 3 (n=57), para as variáveis clínicas em que a autopercepção foi comparada entre os diferentes níveis de fragilidade, apenas para os que apresentavam necessidade de qualquer tipo de prótese observou- se que os pré-frágeis classificaram sua saúde bucal de forma negativa. No capítulo 4 (n=66), nos indivíduos que obtiveram uma autopercepção da sua saúde bucal negativa, apenas a média de dentes presentes foi menor entre os indivíduos frágeis. Pode-se concluir que, apesar deste grupo de idosos apresentar condições de saúde bucal precárias, com extensas perdas dentárias e alta prevalência de xerostomia, não foi verificada relação entre a condição de fragilidade e autopercepção de saúde bucal. Considera-se que outras condições sistêmicas de maior impacto no cotidiano destes idosos tiveram um peso maior que as condições bucais na sua autopercepção e, para reverter esta realidade, torna-se necessário o direcionamento de programas odontológicos específicos para adultos, voltados para promoção de saúde e controle da cárie e doença periodontal, evitando-se assim a perda dos elementos dentários em idosos, o que consequentemente melhorará sua ualidade de vida. / Abstract: Given the scarcity of studies to assess the oral health conditions related to quality of life in elderly people with different frailty levels, the objectives of this study were: to evaluate the oral health conditions in a non-institutionalized elderly population with different frailty levels (Chapter 1), to present the xerostomy prevalence and its association with socio-demographic and clinical variables, as well as the self-perceived oral health (Chapter 2); to verify the self-perception on the oral health conditions in elderly people, compared with the frailty level (Chapter 3) and to verify oral health-related quality of life impact elderly people with different frailty levels (Chapter 4). This work is part of a thematic and multidisciplinary project: "Quality of life in frail elders: health indicators and subjective well-being". Non-institutionalized elderly aged 60 or more that presented different frailty levels were examined, being attended at the geriatric clinic of the State University of Campinas (UNICAMP). An oral examination following the recommendations from WHO (1997) was carried out, as well as an interview with questions relating to: self-perceived oral health, dry mouth sensation and GOHAI. The frailty condition evaluation was made after the application of 5 clinical criteria proposed by Fried et al. (2001). The frail elders were divided into two groups: pre-frail and frail. Data analysis was performed using SPSS 17. Chapter 1 shows that 61.2% (n=41) of those examined were edentulous; the mean of present teeth was 4.8 (SD=7.5) and DMFT of 28.8 (SD=5.1), and most of the index was composed of the lost component (94.4%). 50.7% (n=34) were considered pre-frail and 49.3% (n=33), frail. When dental variables were compared with the frailty condition, all were better in pre-frail individuals. In Chapter 2, it was found that older people considered as non-white were less likely to experience dry mouth (p=0.017/RP=0.68 [IC95%=0.49-0.93]). Among the frail elderly, who were illiterate had more dry mouth (p=0.03/RP=1.31 [IC95%=1.02-1.68]). In chapter 3, for the clinical variables in which the self-perception was compared between the different frailty levels, only for those who had need of any type of prosthesis it was observed that pre-frails rated their oral health in a negative way. In Chapter 4, in individuals who have obtained a negative self-perception of their oral health, only the mean present teeth was worse among frail individuals. It could be concluded that although this group of elderly people presented poor oral health conditions, with extensive tooth loss and high dry mouth prevalence, no relationship was found between the frailty and selfperceived oral health. It was considered that other systemic conditions of greater impact on the daily life of these elderly individuals had a greater weight than the oral self-perceived oral conditions, and to reverse this situation, it is necessary targeting dental programs specific for adults aimed at promoting health and control of dental caries and periodontal disease, thus avoiding the loss of teeth in the elderly, which in turn will improve their quality of life. / Doutorado / Saude Coletiva / Doutor em Odontologia
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Förekomst av xerostomi hos studenter på Hälsohögskolan i Jönköping : En enkätstudie / Prevalence of xerostomia in students at School of Health Sciences in JönköpingHakkararinen, Caroline, Benjaminsson, Linda January 2015 (has links)
Background: Xerostomia is the subjective feeling of dry mouth and the state is because of its multifactorial character often limited to treating the symptoms that occurs instead of the causal factors. Xerostomia is a state which may affect both the oral and general health and can therefore have a negative impact on the individuals quality of life. Xerostomia was earlier defined as a state that affected old or sick people but investigations have lately showed that xerostomia also is prevalent in young healthy subjects. Aim: The aim of this study was to investigate the prevalence of xerostomia and potential risk factors in students at School of Health Sciences in Jönköping. Methods: Students from four education programs at School of Health Sciences was asked to participate and fill out a questionnaire including background variables, standard questions of dry mouth and Xerostomia Inventory. Result: Xerostomia was found in 20% of the subjects. These had higher scores on Xerostomia Inventory compared to the subjects without xerostomia. The difference was statistically significant (p≤0,05). Conclusion: Xerostomia is a state that is prevalent in young, healthy subjects and though the state is idiopathic further investigation about its prevalence and the causal factors are needed. / Bakgrund: Xerostomi innebär subjektiv muntorrhet och då tillståndet är av multifaktoriell karaktär begränsas behandling ofta till att lindra individens besvär och symtom. Xerostomi är ett tillstånd som påverkar både individens orala och generella hälsa negativt vilket även kan leda till en nedsatt livskvalitet. Xerostomi betraktades tidigare som ett tillstånd som drabbar äldre och sjuka men senare studier har funnit en förekomst även hos unga friska individer. Syfte: Syftet var att kartlägga prevalens samt möjliga orsaksfaktorer till xerostomi hos studenter på Hälsohögskolan i Jönköping. Metod: Individer som studerade fjärde terminen vid fyra av Hälsohögskolans totalt åtta utbildningsprogram tillfrågades om att besvara en enkät som omfattade bakgrundsvariabler, standardfrågor om muntorrhet samt Xerostomia Inventory. Resultat: Studien påvisade en förekomst av xerostomi hos 20 % av studenterna. Individer med xerostomi uppvisade högre poäng på Xerostomia Inventory än individer utan xerostomi Skillnaden var statistiskt signifikant (p≤0,05). Slutsats: Xerostomi är ett tillstånd som förekommer hos unga friska individer och då tillståndet är idiopatiskt är det angeläget att fortsätta utreda dess förekomst samt potentiella orsaksfaktorer.
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Detecção de proteínas e partículas virais do HTLV-1 em glândulas salivares de pacientes com Síndrome de Sjögren e de infectados pelo HTLV-1 / Detection of HTLV-1 viral proteins and particles in the salivary glands of patients with Sjögren\'s Syndrome and patients infected with HTLV-1Vale, Daniela Assis do 05 December 2017 (has links)
O HTLV-1 (human T-cell lymphotropic virus type 1) foi o primeiro retrovírus humano a ser identificado. O HTLV-1 tem a capacidade de ativar e gerar uma intensa resposta inflamatória, podendo levar a alterações em diversos tecidos que mimetizam uma doença autoimune. Do complexo de doenças associadas ao HTLV-1, a Síndrome de Sjögren (SS) figura entre as mais estudadas. No entanto, nenhuma relação definitiva foi ainda estabelecida. Este trabalho propõe-se a investigar indícios da presença do HTLV-1 em glândulas salivares menores de pacientes infectados por esse retrovírus e comparar as alterações morfológicas em glândulas salivares menores de pacientes com HTLV-1 e de pacientes com SS não infectados. Amostras de glândula salivar menor foram coletadas de 14 pacientes HTLV+ que apresentavam síndrome seca (grupo de estudo) e 5 pacientes diagnosticados com SS e negativos para o HTLV (grupo controle). No grupo de estudo, o infiltrado inflamatório visto era composto principalmente por linfócitos T CD4+, no grupo controle a população majoritária foi de linfócitos B CD20+. Alterações morfológicas como fibrose e infiltração gordurosa foram mais comumente vistas nas amostras do grupo de estudo, sendo a diferença estatisticamente significativa (p=0,038 e 0,033 respectivamente). Na análise por PCR 11 (78,57%) dos casos do grupo de estudo foi detectado o gene tax e/ou rex do HTLV-1, no entanto 4 (80%) das amostras do grupo controle também foram positivas. O HTLV-1 mostra indícios de estar presente nas glândulas salivares de indivíduos com síndrome seca, no entanto pacientes HTLV-1+ apresentam alterações morfológicas em padrões diferentes dos vistos em pacientes com SS, denotando uma provável diferença no processo de ativação imunológica. / Human T-cell lymphotropic virus type I (HTLV-1) was the first human retrovirus to be discovered. HTLV-1 has the ability to activate and generate an intense inflammatory response, which can lead to changes in several tissues that mimic an autoimmune disease Of the complex of diseases associated with HTLV-1, Sjögren\'s Syndrome (SS) is among the most studied. The aim of this study is to investigate the presence of HTLV-1 in the minor salivary glands of patients infected with this retrovirus and to compare the morphological alterations in the salivary glands of patients with HTLV-1 and patients with SS uninfected. Minor salivary gland samples were obtained from 14 HTLV + patients with dry syndrome (study group) and 5 patients diagnosed with SS and HTLV negative (control group). In the study group, the inflammatory infiltrate was mainly composed of CD4+ T lymphocytes, in the control group the majority population was of CD20+ B lymphocytes. Morphological changes such as fibrosis and adipose tissue infiltration were more common in the study group, the difference was statistically significant (p = 0.038 and 0.033, respectively). The HTLV-1 tax and/or rex genes were detected by PCR in 11 (78.57%) patients of the study group, but 4 (80%) samples from the control group were also positive. HTLV-1 shows signs of being present in the salivary glands of individuals with dry syndrome however, HTLV-1+ patients present morphological alterations in different patterns from those observed in SS patients, denoting a probable difference in the immunological activation process.
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Avaliação da acupuntura como método de tratamento preventivo e curativo de xerostomia decorrente da radioterapia. / Evaluating of acupuncture treatment used in preventive and curative methods for radiation-induced xerostomia.Braga, Fábio do Prado Florence 23 March 2006 (has links)
A xerostomia é um efeito adverso comum e frequentemente irreversível decorrente da radioterapia de neoplasias malignas da região de cabeça e pescoço, afetando, sobremaneira, a qualidade de vida dos pacientes. Diferentes métodos para solucionar tal problema são propostos, de resultados, todavia questionáveis. Este estudo avaliou a eficácia clínica da acupuntura como método de tratamento preventivo e curativo de tais condições. Os pacientes foram distribuídos, aleatoriamente, em três grupos: grupo preventivo, constituído de 12 indivíduos, sem queixa de secura bucal, tratados com 12 a 16 sessões de acupuntura, antes e durante a radioterapia; grupo curativo, constituído de 12 indivíduos, diagnosticados, clinicamente, com xerostomia severa, tratados com 12 aplicações de acupuntura após concluído o tratamento oncológico, e grupo controle, formado pelos mesmos indivíduos do grupo curativo no momento da primeira consulta, precedente à terapêutica com acupuntura. O tratamento foi conduzido de acordo com os princípios da medicina tradicional chinesa e medicina ocidental ortodoxa, realizado de forma padronizada para todos os pacientes, duas vezes por semana, por um período de 20 minutos cada sessão. A avaliação da eficácia terapêutica fundamentou-se na mensuração da xerostomia, conduzida sob duas formas: objetiva, através da sialometria, com o registro quantitativo dos índices de fluxo salivar em repouso e estimulado (IFSR e IFSE), e subjetiva, por intermédio dos questionários Xerostomia Inventory (XI) modificado, Escala Visual Analógica (EVA) e Treatment Emergent Symptom Scale (TESS), mensurando o grau de severidade dos sintomas. Os resultados obtidos no grupo preventivo foram estatisticamente significativos quanto as avaliações objetivas e subjetivas, evidenciados por índices de fluxo salivar mais elevados tanto para o IFSR (P<0.001) como para o IFSE (P<0.001) e pela menor intensidade dos sintomas (P<0.001), quando comparadas ao controle. Para o grupo curativo, resultados também significativos foram constatados em ambas as avaliações, demonstrados pelo aumento dos IFSR (P<0.05) e IFSE (P<0.05) e redução da sintomatologia (P<0.05), comparados aos valores iniciais. Constatamos também que houve efeito de grupo e os pacientes que se beneficiaram do método preventivo, obtiveram médias estatisticamente mais significativas (P<0.001), para ambas as respostas clínicas, objetivas e subjetivas. É lícito concluir que a acupuntura mostrou-se um importante método de tratamento de xerostomia decorrente da radioterapia, visto ter alcançado uma confiabilidade significativa de eficácia, que nos faz indicá-la e sugerir a disponibilização do método preventivo nos centros de tratamento. / Xerostomia is a common and usually irreversible radiotherapy side effect in patients with head and neck cancer, affecting the patients quality of life. Many attempts have been suggested to manage this condition nevertheless of questionable results. This study evaluated the acupuncture treatment efficacy as a preventive and curative method for radiation-induced xerostomia. The patients were randomly assigned in three groups: preventive, composed of 12 individuals, without complaints of dry mouth, treated with 12-16 acupuncture sessions, before and concomitant radiotherapy; curative, composed by 12 individuals, diagnosed with severe xerostomia, treated with 12 acupuncture sessions after radiation therapy, and control, comprised of the curatives group patients at the moment of the first visit, preceding this therapy. Acupuncture treatment, according to traditional Chinese medicine and occidental orthodox medicine concepts was performed twice a week, lasting 20 minutes each session, following standardize techniques for all patients. Acupuncture efficacy was evaluated, based upon objective and subjective methods of xerostomia measurements, performed by sialometry, measuring the resting and stimulated salivary flow rates (RSFR and SSFR), and by means of questionnaires such as Xerostomia Inventory (XI) modified, Visual Analog Scale (VAS) and Treatment Emergent Symptom Scale (TESS), which evaluated referred symptoms. Results obtained in preventive group, evidenced RSFR (P<0.001) and SSFR (P<0.001) significantly increased, and improvement of symptoms (P<0.001), compared with control. Within curative group, after acupuncture treatment, the results showed statistically significant improved for both resting and stimulated salivary flow rates (P<0.05) and reduces of referred symptoms (P<0.05). There were statistically differences between groups, being the patients in preventive group those who evidenced the most significant improved of values (P<0.001) for objective and subjective evaluations. We concluded that acupuncture plays an important role in xerostomias treatment, as shown by the results, reaching a significant confiability of efficacy, indicating and suggesting the preventive method at oncology centers.
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