ABSTRACT Peripheral nerves are most commonly affected by pressure, traction, friction, anoxia or cutting and these injuries can easily cause allodynia of the limbs. Beta-endorphin is an endogenous pain inhibitor. It can produce profound and long-lasting analgesia for patients with intractable pain. Prominent endogenous opioid peptides are modulated by the hypothalamic-pituitary-adrenal axis. The expression of pro-opiomelanocortin (POMC) produces opioid peptides, including the beta-endorphins, other shorter endorphins, adrenocorticotropic hormones (ACTH), and melanocyte-stimulating hormones (MSH). The aim of this study is to evaluate the efficacy of POMC gene therapy for neuropathic pain that is caused by chronic constriction injury (CCI) in a rat model. Experimental painful peripheral neuropathy is induced by CCI of the sciatic nerve which results in allodynia of the hind limb. We used the method of conventional electrical stimulation to quantitatively analyze the efficacy of gene therapy. In addition, two nociceptive tests, including thermal-withdrawal latency and mechanical withdrawal threshold, were also conducted to evaluate the effect of treatment. Adult male Sprague Dawley rats (250-300 g, n = 24) were divided into three groups: (1) the control group (n = 8); (2) the sciatic nerve ligation group that received an injection of adenoviral vectors with green fluorescent protein (Ad-GFP) (n = 8); and (3) the sciatic nerve ligation group that received an injection of adenoviral vectors with POMC gene (Ad-POMC) (n = 8). The electrophysiological studies and nociceptive tests were carried out on day 3 before ligation and days 3, 7 and 14 after ligation. The POMC injection was performed on day 3 after ligation. We measured the amplitude and onset latency of maximal compound muscle action potential (CMAP) in braches of the sciatic nerve (nerves to the gastrocnemius, tibialis anterior), motor nerve conduction velocity, H-reflex and F-wave by electrical stimulation and denervation sign by electromyography (gastrocnemius, tibialis anterior). In addition, the latency of the thermal-withdrawal and threshold of mechanical withdrawal were also recorded. The results showed that prominent thermal-withdrawal latencies and mechanical withdrawal thresholds were elevated in the sciatic nerve ligation group with POMC gene therapy on days 14 and 21 after ligation. It also demonstrated that administrations of POMC gene therapy which produced the beta-endorphins to elevate the pain threshold and reduced the allodynia of the injured limbs. In conventional electrophysiological studies, no significant differences were noted between the Ad-GFP and Ad-POMC groups. The reduction of CMAP amplitude was recorded in rats of the sciatic nerve ligation groups. There was no significant difference in the mean onset latency of CMAP and nerve conduction velocity (NCV) within these three groups, except for the fact that the NCV of the tibial nerve was slowing in the Ad-GFP group on day 14. Electrophysiological analysis was revealed prolonged or absent H-reflex and F-wave in animals of the neuropathy groups by electrical stimulation. Electromyography showed prominent denervation potentials over the sampling muscles in the sciatic nerve ligation groups. In conclusion, POMC gene therapy for neuropathic pain is very efficacious. However, the influence of POMC gene therapy for nerve protection or minimizing the progress of nerve injury will require further investigations.

No description available.

Les discontinuités granulaires dans les ouvrages hydrauliques ou dans leur fondation constituent une source majeure d’instabilités à l’origine des phénomènes d’érosion. L’érosion interne est ainsi définie comme une migration de particules engendrée par un écoulement interne parasite, dans un sol ou dans un ouvrage en terre. A long terme, les conséquences de cette migration peut affecter la stabilité des ouvrages et peut même conduire à leur rupture. La sécurité des ouvrages en terre dépend principalement de la performance de leurs filtres, c’est-à-dire de la capacité du filtre, mis en interne en phase de conception ou en externe en phase de réparation, à retenir les particules fines. L’espace poral d’un filtre granulaire est divisé en volumes élémentaires, appelés pores, reliés entre eux par des étranglements plus étroits appelés constrictions. Des recherches récentes ont montré que la distribution des tailles de constriction (CSD) joue un rôle fondamental dans la compréhension des propriétés de filtration des sols granulaires. Ce travail vise à étudier la CSD et son impact sur les mécanismes de filtration dans les matériaux granulaires. Pour atteindre cet objectif, deux approches ont été suivies dans ce travail: l’une numérique et l’autre analytique. Dans le cas des matériaux de forme sphérique, la méthode des éléments discrets (DEM) permet de calculer la CSD en s’appuyant sur une partition de Delaunay en tétraèdres. Cependant, une CSD plus réaliste peut être obtenue par association des tétraèdres voisins selon un critère basé sur le chevauchement de leurs sphères de vide inscrites. A partir de cette considération et en se basant sur les modèles analytiques existants, un modèle révisé est proposé pour obtenir rapidement la CSD. Les échantillons DEM générés sont ensuite utilisés pour examiner le potentiel de transport des particules fines à travers un filtre d’épaisseur donnée. Les résultats des essais de filtration numériques menés ont montré une corrélation entre la CSD et la possibilité de migration des particules fines. En conséquence, une formule analytique a été proposée pour calculer le diamètre d’ouverture de contrôle des filtres granulaires. Cette taille caractéristique qui prend en compte la granulométrie et la densité du matériau granulaire, a été introduite dans un critère de filtre construit sur la base de la CSD, en vue de le représenter de manière plus physique. Le critère proposé reproduit correctement des résultats expérimentaux rapportés dans la littérature. / The granular discontinuities in hydraulic structures or in their foundation constitute a major source of instabilities causing erosion phenomena, process by which finer soil particles are transported through the voids between coarser particles, under seepage flow. In the long term, the microstructure of the soil will change and the excessive migration become prejudicial to the stability of the structures and may also induce their failure. The safety of earth structures is mainly dependent on the reliability of their filter performance, i.e. the ability of the filter placed inside the structure during construction or outside during repair, to retain fine particles. Indeed, the void space of a granular filter is divided into larger volumes, called pores, connected together by throats or constrictions. Recent researches showed that the distribution of throats (Constriction Size Distribution or CSD) between pores plays a key role to understand the filtration properties of a granular soil. This research is devoted to investigate the constriction sizes and their impact on the mechanisms of filtration in granular spherical materials. To achieve this objective, two approaches were followed in this work: numerical and analytical approaches. In the case of spherical materials, the Discrete Element Method (DEM) can help to compute the CSD using the Delaunay tessellation method. However, a more realistic CSD can be obtained by merging adjacent Delaunay cells based on the concept of the overlap of their maximal inscribed void spheres. Following this consideration and by extending the previously developed analytical models of CSD, a revised model is proposed to quickly obtain the CSD. The DEM data generated are then used to explore the potential of transport of fine particles through a filter of a given thickness by means of numerical filtration tests. A correlation has been found between the CSD and the possibility of migration of fine grains. Accordingly, an analytical formula has been proposed to calculate the controlling constriction size of a filter material. This characteristic size, which takes into account the particle size distribution (PSD) and the density of the material, has been used to reformulate a constriction-based criterion in a more physical manner. The proposed filter design criterion is verified based on experimental data from past studies and a good agreement has been found.

Flow-mediated dilation (FMD) is used as a surrogate marker for endothelial function, a subclinical indicator of coronary artery disease (CAD) and for that reason; FMD is commonly used to compare endothelial function across groups differing in age and number and/or type of CAD risk factors. The traditional calculation of FMD involves arterial diameter prior to cuff inflation and then peak arterial diameter following cuff release. Generally, arterial response during cuff inflation is not taken into consideration. The aims of the present study were to determine 1) if there were differences in brachial artery response, more specifically vasoconstriction, during cuff inflation in a diverse population of subjects, 2) if variability existed, the resulting impact on the calculation of traditional FMD, and 3) if arterial stiffness was a physiological determinant in this process. A total of 84 subjects, varying in age (18-62 years) and CAD risk factor profiles were studied. Low flow-mediated constriction (L-FMC), during cuff inflation, traditional FMD, and modified FMD, which accounts for L-FMC, were calculated to investigate brachial artery response during all three stages of the FMD measurement. Subjects ≥ 50 years old had lower FMD response compared with those ≤ 35 years old but only the modified FMD was statistically significant. The same effect was seen when comparing healthy subjects to those with multiple risk factors for CAD; there was an attenuated FMD response that only reached statistical significance with modified FMD. L-FMC was modestly but significantly associated with FMD. L-FMC was weakly but positively correlated with brachial pulse wave velocity (PWV). Our results indicate that modified FMD, which takes into consideration brachial response to cuff inflation, may be a more sensitive indicator of endothelial dysfunction and that arterial stiffening may be a physiological determinant in this process. / text

Membrane separation is known as an economic and environmental friendly mode of separation and is used in various types of separation processes. The major challenges regarding membrane separation are the internal and external fouling of the membrane which reduces the permeate flux of the membranes by inducing extra resistance to flow. Synthetic membranes are designed and implemented to separate solutes or particles in a feed stream by rejecting them and permitting the liquid to pass through the membrane pores; however, most of the feed streams, such as wastewaters, contain more than one type of solute. This yields a distribution of particle sizes in the feed. Many wastewaters contain supracolloidal particles (1-100µm). Most membrane separations aim to remove these particles from the feed solution. Wastewaters also contain colloidal particles (0.001-1µm). These particles are less concentrated than supracolloidal particles in the feed but they are more problematic since they are able to penetrate into the membrane pores and cause internal fouling which is the main source of irreversible flux decline. Fouling mechanisms are traditionally classified into four types. Among these mechanisms, standard pore blocking (pore constriction) refers to internal fouling while the other types model external fouling. On the effect of pore geometry, as a morphological factor, studies to date have been limited to external membrane fouling. However, it is believed that up to 80% of the permeate flux can be affected by pore constriction which is caused by particle penetration and deposition into membrane pores (internal fouling). The effect of pore geometry, as a factor, in flux decline due pore constriction of membranes was investigated in this work. Pore constriction by particles was approximated by maximum particle deposition onto the interior wall of the pores and simulated using MATLAB image processing toolbox (MIPT). Sixteen different basic geometries were considered for the simulation of pore constriction by particles. These include circular pores, 3 groups of rectangular, triangular and oval geometries at four different aspect ratios (3, 7, 15 and 30) and three combined geometries of star, cross and a rectangle with rounded ends. The simulation of maximum particle deposition onto pore walls was carried out for a range of particle diameters to pore hydraulic diameters (λ) of 0.1 to the complete rejection of the particle by the pore. As the result of the simulation, the ratio of the available pore cross-sectional area after pore constriction to initial pore cross-sectional area (α) and the ratio of pore channel hydraulic diameter after pore constriction to initial pore hydraulic diameter (β) were measured and recorded. It was observed that for λ<0.2 (small particles compared to pore size) some geometries showed the same values of α and β. However, for λ>0.2, other geometries showed different values of α and β. It was also observed that several geometries reject the particle at different λ ratios. Using the values of α and β, the fluxes of membranes having different pore geometries, after pore constriction by particles, were calculated and compared. These results show that for a very small particle size, compared to pore size, there is no preference for a specific geometry over another; however, for intermediate particle sizes, membranes having triangular and star pore shapes provide higher fluxes compared to other membranes. The effect of pore aspect ratio (PAR) on the flux of membranes after pore constriction was also examined. In order to compare the combined effect of pore geometry on particle rejection and pore constriction, fluxes of membranes having different pore shapes were compared in light of several pore size distributions (PSDs). For this part of the study, the pore geometries of circular, rectangular, triangular and oval were considered at four PARs. Different values for the hydraulic diameter of the largest rejecting pore (D_(H,LRP)) were observed for different geometries. Rectangular pores showed the largest values of D_(H,LRP), at a constant PAR, which affirms their superior rejection behavior. The overall flux of the membranes after pore constriction was determined by a combination of three effects: the position of D_(H,LRP) in the PSD, the pore constriction behavior of the pore geometry and the shape of the PSD. Generally, for the PSDs for which most of the pores in the membrane physically reject the particles, membranes having rectangular pores showed higher fluxes, due to the greater rejection of particles. However, for PSDs for which a major number of pores are constricted by the particles, membranes with triangular pores offered higher flux after membrane pore constriction. The results of this work indicate a new direction for the design of membranes having defined pore geometries.

Membrane separation is known as an economic and environmental friendly mode of separation and is used in various types of separation processes. The major challenges regarding membrane separation are the internal and external fouling of the membrane which reduces the permeate flux of the membranes by inducing extra resistance to flow. Synthetic membranes are designed and implemented to separate solutes or particles in a feed stream by rejecting them and permitting the liquid to pass through the membrane pores; however, most of the feed streams, such as wastewaters, contain more than one type of solute. This yields a distribution of particle sizes in the feed. Many wastewaters contain supracolloidal particles (1-100µm). Most membrane separations aim to remove these particles from the feed solution. Wastewaters also contain colloidal particles (0.001-1µm). These particles are less concentrated than supracolloidal particles in the feed but they are more problematic since they are able to penetrate into the membrane pores and cause internal fouling which is the main source of irreversible flux decline. Fouling mechanisms are traditionally classified into four types. Among these mechanisms, standard pore blocking (pore constriction) refers to internal fouling while the other types model external fouling. On the effect of pore geometry, as a morphological factor, studies to date have been limited to external membrane fouling. However, it is believed that up to 80% of the permeate flux can be affected by pore constriction which is caused by particle penetration and deposition into membrane pores (internal fouling). The effect of pore geometry, as a factor, in flux decline due pore constriction of membranes was investigated in this work. Pore constriction by particles was approximated by maximum particle deposition onto the interior wall of the pores and simulated using MATLAB image processing toolbox (MIPT). Sixteen different basic geometries were considered for the simulation of pore constriction by particles. These include circular pores, 3 groups of rectangular, triangular and oval geometries at four different aspect ratios (3, 7, 15 and 30) and three combined geometries of star, cross and a rectangle with rounded ends. The simulation of maximum particle deposition onto pore walls was carried out for a range of particle diameters to pore hydraulic diameters (λ) of 0.1 to the complete rejection of the particle by the pore. As the result of the simulation, the ratio of the available pore cross-sectional area after pore constriction to initial pore cross-sectional area (α) and the ratio of pore channel hydraulic diameter after pore constriction to initial pore hydraulic diameter (β) were measured and recorded. It was observed that for λ<0.2 (small particles compared to pore size) some geometries showed the same values of α and β. However, for λ>0.2, other geometries showed different values of α and β. It was also observed that several geometries reject the particle at different λ ratios. Using the values of α and β, the fluxes of membranes having different pore geometries, after pore constriction by particles, were calculated and compared. These results show that for a very small particle size, compared to pore size, there is no preference for a specific geometry over another; however, for intermediate particle sizes, membranes having triangular and star pore shapes provide higher fluxes compared to other membranes. The effect of pore aspect ratio (PAR) on the flux of membranes after pore constriction was also examined. In order to compare the combined effect of pore geometry on particle rejection and pore constriction, fluxes of membranes having different pore shapes were compared in light of several pore size distributions (PSDs). For this part of the study, the pore geometries of circular, rectangular, triangular and oval were considered at four PARs. Different values for the hydraulic diameter of the largest rejecting pore (D_(H,LRP)) were observed for different geometries. Rectangular pores showed the largest values of D_(H,LRP), at a constant PAR, which affirms their superior rejection behavior. The overall flux of the membranes after pore constriction was determined by a combination of three effects: the position of D_(H,LRP) in the PSD, the pore constriction behavior of the pore geometry and the shape of the PSD. Generally, for the PSDs for which most of the pores in the membrane physically reject the particles, membranes having rectangular pores showed higher fluxes, due to the greater rejection of particles. However, for PSDs for which a major number of pores are constricted by the particles, membranes with triangular pores offered higher flux after membrane pore constriction. The results of this work indicate a new direction for the design of membranes having defined pore geometries.

Outre ses effets sur le système visuel classique permettant la formation des images, la lumière agit sur plusieurs fonctions « non-visuelles ». Celles-ci incluent la constriction pupillaire, la température corporelle, la sécrétion hormonale, le cycle veille-sommeil, la vigilance et les performances cognitives. Les fonctions non-visuelles sont préférentiellement sensibles aux lumières à longueurs d’ondes courtes (lumière bleue) en comparaison aux longueurs d’ondes plus longues (lumière verte). Il est proposé que le vieillissement s’accompagne d’une diminution de la sensibilité des fonctions non-visuelles à la lumière. Cette recherche vise à évaluer les effets de l’âge sur la constriction pupillaire et la sensibilité cérébrale à la lumière lors de l’exécution de tâche cognitive. Deux groupes de sujets, 16 jeunes (18-30 ans) et 14 âgés (55-70 ans), ont suivis un protocole de pupillométrie visant à mesurer la dynamique pupillaire lors d’exposition à des lumières bleues et vertes monochromatiques de trois intensités différentes. Les résultats ont montré davantage de constriction en bleu qu’en vert et des effets plus importants suivant l’augmentation de l’intensité lumineuse. Nos résultats ne montrent cependant pas de différence d’âge sur la constriction pupillaire à la lumière suggérant la préservation de cette réponse non-visuelle. Dans un deuxième temps, les mêmes sujets ont exécuté une tâche cognitive en imagerie par résonance magnétique fonctionnelle (IRMf) tandis qu’ils étaient maintenus dans la noirceur, ou exposés à des lumières bleues. Les résultats ont montré une diminution des effets de la lumière avec l’âge dans le thalamus, l’amygdale, l’insula et l’aire ventrale tegmentale, régions engagées dans la vigilance, l’attention et les processus émotionnels. Les modifications qui s’opèrent sur les différentes fonctions non-visuelles avec l’âge ne semblent pas homogènes. Ces résultats corroborent les évidences animales qui montrent différents seuils de sensibilités à la lumière et la présence de réseaux neuronaux partiellement indépendants pour les diverses réponses non-visuelles. De plus, ils sont les premiers à démontrer que les effets neuronaux stimulants de la lumière bleue sur la cognition sont diminués avec l’âge. Les recherches devront évaluer si cette diminution de sensibilité influence les performances cognitives au cours du vieillissement. Enfin, un raffinement de nos connaissances permettra de mieux adapter l’environnement lumineux avec l’âge. / Notwithstanding its effects on the classic visual system allowing image formation, light acts upon several «non-visual» functions including body temperature, hormonal secretions, sleep-wake cycle, alertness and cognitive performances. Results have shown that non-visual functions are maximally sensitive to blue wavelength (460-480nm), in comparison the longer light wavelengths (i.e. green: 550nm). Changes as to the sensitivity of these responses during the aging process were reported. In our research project, two groups of subjects, 16 young (18-30) and 14 older (55-70), followed a pupillometry protocol in order to measure the pupillary dynamic while being exposed to three different intensities of blue and green monochromatic lights. Results revealed more constrictions in blue than in green lights, and significant effects following the increase of light intensity. Our results also demonstrated a similar pupillary constriction between the two age groups, suggesting that this non-visual response remains intact with age. In the second phase, the same subjects executed cognitive tasks involving functional magnetic resonance imaging while maintained in darkness, or exposed to blue monochromatic lights. Results indicate a decrease of the impact of light with age namely, at the level of the thalamus, amygdala, insula and in the tegmental ventral area. These brain regions are involved in alertness, awakeness, attention and emotional processes. Consequently, the modifications which occur in the different non-visual responses during the aging process do not appear to be homogeneous. Our results are coherent with animal evidences which demonstrate different sensitivity thresholds to light and the presence of neuronal networks partially independent for various non-visual responses. In addition, they are the first indications of a decrease of the stimulating neuronal effects of light during the aging process. Future studies will help to verify whether the brain sensitivity reduction is linked to age-related behavioral differences. A better understanding of light effects on non-visual functions will permit an adapted light exposure in healthy aging and will also contribute to optimal lighting environment.

O envelhecimento implica em modificações na função vocal e de deglutição do idoso, causando impacto na sua qualidade de vida. Dentre as características laríngeas do idoso, destaca-se que o movimento da constrição supraglótica é, frequentemente, considerada prejudicial durante a fonação, enquanto que durante a deglutição, compõe o mecanismo de defesa do trato aéreo. O objetivo do presente estudo é descrever as características supraglóticas da laringe do idoso durante as funções de respiração e fala, as características orofaríngeas de deglutição e investigar as relações entre estas características supraglóticas e de deglutição. Neste estudo retrospectivo, foram analisados dados de prontuários e exames de nasofibroscopia da fonação e da deglutição de 60 idosos saudáveis com média de 68,8 anos. Como características laríngeas foram investigados a presença e os graus de aumento de volume das pregas vestibulares, de constrição mediana na emissão de vogal e na fala encadeada e de constrição anteroposterior na emissão de vogal. Como características de deglutição foram analisados a presença e os graus de resíduos em seios piriformes, valéculas, orofaringe e laringofaringe, a ocorrência e os graus de penetração/aspiração laringotraqueal, escape posterior prematuro e atraso do início da fase faríngea nas consistências líquida pudim e sólida. Foram considerados como dados as análises realizadas por dois juízes com índice confiabilidade intra-avaliador ótima (teste Kappa). Os resultados foram analisados descritivamente e para verificar a associação entre características supraglóticas e a presença de escape posterior prematuro e atraso do início da fase faríngea de deglutição foi utilizado o teste Qui-quadrado (p<0,05). Foi verificado que o aumento de volume das pregas vestibulares e as constrições supraglóticas ocorreram para a maioria dos idosos, sendo que o aumento de volume das pregas vestibulares foi, quase sempre, bilateral e distribuído em graus discreto e evidente de forma semelhante; houve maior ocorrência de constrição mediana nos graus discreto e moderado; quase todos os casos de constrição anteroposterior foram produzidos com movimento apenas das aritenoides ou das aritenoides concomitantemente com a epiglote, além de haver mais casos no grau discreto; a maior parte dos idosos apresentou deglutição normal ou funcional; poucos idosos apresentaram resíduos em valéculas, seios piriformes, orofaringe e laringofaringe; ocorreram poucos casos de penetração laríngea de alimentos e apenas um de aspiração laringotraqueal; o escape posterior prematuro ocorreu em maior número para a consistência líquida, seguida das consistências sólida e pudim e o atraso da fase faríngea ocorreu para a minoria dos idosos; houve relação entre o escape posterior prematuro e: aumento do volume das pregas vestibulares na consistência líquida, constrição mediana durante emissão de vogal na consistência de pudim, constrição anteroposterior para a consistência de pudim e constrição mediana na fala na consistência sólida. Concluiu-se que os idosos saudáveis frequentemente apresentaram constrições supraglóticas e deglutição funcional e que os idosos com aumento de volume das pregas vestibulares manifestaram com maior frequência escape posterior prematuro de líquido, enquanto que os idosos que manifestaram constrição anteroposterior evidente e presença de constrição mediana na fala apresentaram, com maior frequência, escape posterior prematuro na consistência de pudim e sólido, respectivamente. / Aging implies changes in the vocal and swallowing functions of the elderly, causing an impact on their quality of life. Among the laryngeal characteristics of the elderly, it is noted that supraglottic constriction is usually considered a harmful factor during phonation, whereas, during swallowing, this behavior is an airway defense mechanism. The objective of the present study was to describe the supraglottic characteristics of the larynx of the elderly during the breathing and speech functions and the laryngopharyngeal characteristics of swallowing, besides investigating the relations between the supraglottic and swallowing characteristics. In this retrospective study, data from charts and nasopharyngoscopy examinations of phonation and deglutition of 60 healthy elderly subjects with an average of 68.8 years were analyzed. The presence and degrees of increase of the volume of vestibular folds, medial constriction in the emission of vowel and connected speech, and anteroposterior constriction in the vowel emission were investigated. The presence and degrees of the following parameters of food swallowing in liquid, pudding and solid consistencies: residues in pyriform sinuses, valleculae, oropharynx and laryngopharynx, laryngeal penetration/aspiration, premature spillage and delayed onset of pharyngeal phase, were analyzed as well. The results of analyses performed by two judges with optimal intra-rater reliability (Kappa test) were considered. The results were analyzed descriptively and the Chi-square test was used to verify the association between supraglottic characteristics and the presence of premature spillage and delayed onset of the pharyngeal swallowing phase (p<0.05). It was verified that the volume increase of vestibular folds and supraglottic constrictions occurred for the majority of the elderly. The volume increase of vestibular folds was almost always bilateral and distributed in discrete and evident degrees of similar form. There was greater occurrence of median constriction in the discrete and moderate degrees. Almost all cases of anteroposterior constriction were produced with movement only of the arytenoids or approximation of the arytenoids with the epiglottis, in addition to having a greater number of cases in a discrete degree; the majority of the elderly had normal or functional swallowing; there were few occurrences of residues in vallecules, pyriform sinuses, oropharynx and laryngopharynx, few cases of laryngeal penetration of food and only one of aspiration; the premature spillage occurred in greater number for the liquid, followed by the solid and pudding consistencies while the pharyngeal phase delay occurred for the minority of the elderly; there was a relationship between premature spillage and: increased volume of vestibular folds in liquid, medial and anteroposterior constriction in pudding and medial constriction in speech in solid consistency. It was concluded that the healthy elderly patients frequently had supraglottic constrictions and functional swallowing. The elderly with an increased volume of vestibular folds demonstrated less premature spillage in liquid, while the elderly who manifested evident anteroposterior constriction and presence of medial constriction in the speech presented greater premature spillage in pudding and solid consistencies, respectively.

O interesse pela doença de Crohn tem aumentado progressivamente em nosso país.Muitas publicações têm surgido na área nos últimos anos. O tratamento inicial é clínico, mas a maioria dos doentes precisa de tratamento cirúrgico ao longo da evolução. Mais de 70% dos pacientes com doença de Crohn serão operados durante o curso da doença. A recorrência sintomática ou não da doença de Crohn na anastomose íleo-cólica tem levado diversos autores a tentar novas técnicas cirúrgicas com o objetivo de retardá-la ou previni-la. Taxas de reoperação de 40% em cinco anos e 55% em dez anos já foram publicadas. O tipo de técnica cirúrgica utilizada e a sua relação com a recorrência na anastomose após ressecção ileal ou ileocolônica é, portanto, um tópico de grande importância quando se trata a doença de Crohn. Considerando-se a importância da recidiva na qualidade de vida dos pacientes com Doença de Crohn, julgamos oportuno avaliar e comparar a taxa de recorrência da doença de Crohn e a morbidade das anastomoses látero-laterais em relação às termino-terminais em pacientes com acometimento da doença em íleo terminal. Foram revisados prontuários cujos dados foram coletados prospectivamente no ambulatório de doenças inflamatórias no período de setembro de 1984 a março de 2004. Apenas os pacientes com diagnóstico de doença de Crohn em intestino delgado exclusivamente ou associada a manifestação em intestino grosso que foram submetidos a enterectomia ou a ressecção de intestino delgado e cólon direito em algum momento do tratamento foram incluídos na pesquisa (total de 141 pacientes e 185 procedimentos analisados-média de 1,65 por paciente). A indicação cirúrgica mais frequente foi por intratabilidade clínica, seguida por fístula intestinal, das quais a mais frequente foi a enterocutânea.Em 185 procedimentos realizados,101 foram seguidos de anastomose látero-lateral mecânica e 84 seguidos de término-terminal manual. Das cirurgias realizadas, a mais frequente foi a enterectomia associada a ressecção de colon direito.As complicações foram divididas em precoces e tardias.A complicação precoce mais frequente foi deiscência de anastomose.A taxa global de complicações foi de 15,1%.Dos 84 procedimentos com anastomose término-terminal realizados, 40 recidivaram(47,6%), com um intervalo médio de cinco anos entre o procedimento inicial que deu origem à recidiva e o procedimento de correção. Entre os 101 procedimentos realizados com anastomose látero-lateral, apenas seis pacientes foram reoperados, num intervalo médio de três anos, e nenhum deles foi por complicação junto à anastomose látero-lateral. Concluímos portanto, que a enterectomia seguida de anastomose láterolateral mecânica deve se constituir na técnica cirúrgica de eleição, por determinar número de reoperação por Doença de Crohn sintomática significativamente menor que as anastomoses término-terminais. / Around 70% of patients with ileal Crohn´s disease will be submeted to a surgical procedure during their lives. This study compares the recurrence rates and morbidity between surgeries followed by a wide-lumen stapled anastomosis and conventional endto-end anastomosis. We studied 185 surgical procedures in a retrospective analyses. There were 84 procedures followed by an end-to-end anastomosis and the recurrence rate was 47,6%.Among the 101 wide-lumen stapled anastomosis procedures, only 6 patients had to be submeted to a new surgery. We conclude that the enterectomy followed by a wide-lumen stapled anastomosis is the gold standard surgery for patients with ileal Crohn´s disease.

A atresia maxilar é um quadro de desarranjo de desenvolvimento do arco dentário presente em diversos tipos de má oclusão, desde as alterações transversais mais simples e puras até as formas mais graves, contemplando as divergências verticais e sagitais. O diagnóstico desta atresia, muitas vezes, é simplificado na presença ou não de mordida cruzada posterior, sendo ela unilateral ou bilateral. No entanto, faz-se necessário uma avaliação mais criteriosa que compreenda não só a própria alteração de forma do arco dentário, mas também as modificações oclusais subsequentes, como relação sagital de classe II ou III de Angle ou as discrepâncias verticais. Uma das possíveis formas de tratamento ortodôntico está ligada as expansões rápidas da maxila, método de incrementos ósseos por meio de forças ortopédicas, quando o indivíduo ainda apresenta potencial de crescimento craniofacial, ou seja, crianças e adolescentes. Já na vida adulta, esta possibilidade de ganhos ortopédicos não mais está presente e a opção não cirúrgica é o tratamento ortodôntico compensatório, por meio de expansão dentoalveolar do arco maxilar. O objetivo deste trabalho foi descrever os resultados de expansão dentoalveolar, obtidos utilizando-se o arco auxiliar de expansão em TMA (tungstênio, molibdênio e alloy), a partir de medidas lineares e angulares obtidas, bem como a integridade da cortical óssea vestibular desta área. Foi realizado um estudo retrospectivo de análise de tomografias computadorizadas, contidas na documentação ortodôntica de 13 pacientes tratados em uma clínica particular, realizadas antes e após a realização desta mecânica de expansão dentoalveolar. Para esta expansão, estes pacientes foram submetidos à instalação de um sobre-arco utilizado por vestibular como um arco auxiliar, sendo justaposto e unido ao fio de nivelamento principal (0,017x0,025 Termoativado) em cinco pontos, sendo 2 pontos nas entradas do tubo dos primeiros molares, 2 pontos entre os pré-molares e 1 ponto entre os incisivos centrais, por meio de fio de amarrilho 0,010 aço. Os resultados apresentaram ganhos estatisticamente significantes para aumento da distância das cúspides ao plano vertical mediano de todos os dentes medidos, bem como aumento da inclinação vestibular destes. A cortical óssea demonstrou adaptação, tendo deslocamento na mesma direção do movimento dentário, porém em menor quantidade. O aumento transversal das distâncias inter-dentárias também apresentou aumentos significativos e condizentes com a literatura. Desta forma, o arco auxiliar de expansão demonstrou-se eficiente para expansão dentoalveolar no paciente adulto, por meio de aumento da inclinação vestibular, com deslocamento dentário maior que o movimento de crista óssea, apresentado ganhos transversais significantes. / The Maxillary constriction is a developmental disorder present in various types of malocclusion, from the most simple and pure transverse changes to the most severe forms, causing vertical and sagittal problems. This malocclusion diagnosis is often simplified in the presence or not of posterior crossbite, which can be uni or bilateral. However, a complete evaluation must include not only the dental arch form changes, but also the subsequent occlusal modifications, such as sagittal relationships of Class II or III malocclusions and vertical discrepancies. Maxillary constriction treatment can be performed by rapid maxillary expansion, using orthopedic forces when there is still craniofacial growth. In adults, the possibility of orthopedic changes is no longer present and the non-surgical option is compensatory orthodontic treatment with dentoalveolar expansion, when the disorder magnitude allows. The objective of this study was to evaluate the effects of dentoalveolar expansion, obtained with a TMA (tungsten and molybdenum alloy) auxiliary expansion archwire, by means of linear and angular measurements, and the integrity of the buccal cortical bone in the posterior area. A retrospective analysis of CT scans, of orthodontic records of 13 patients treated at a private clinic, performed immediately before and after the auxiliary expansion archwire, was used. For the expansion, the patients underwent installation of a secondary arch combined with the primary archwire (0.017x0.025-inch heatactivated Ni-Ti), ligated in five points. Two points in the first molar tube entries, 2 points between the premolars and 1 point between the central incisors, with a 0.010- inch steel ligature wire. The results showed statistically significant transverse increase and buccal inclination for all teeth. The cortical bone showed adaptability and displacement in the same direction of tooth movement, but in smaller amounts. Thus, the auxiliary expansion arch wire proved to be effective to correct dentoalveolar constriction in adult patients, by increasing the buccal dental inclination with larger displacements than the bone crest adaptation and with significant transverse gains.