Charakteristisch für Perlcellulose als Regenerat vom Typ Cellulose II sind sphärisch geformte, poröse Partikel mit einer hohen spezifischen Oberfläche und einer guten Bioverträglichkeit. Aufgrund ihrer Eigenschaften sind diese Cellulosemikropartikel besonders gut für medizinische Anwendungen geeignet. Im Mittelpunkt der Arbeit standen Herstellung, Charakterisierung und Modifizierung von Perlcellulosen mit Partikelgrößen von etwa 1 bis10 µm. Im Rahmen der Arbeit wurden zunächst sieben technische Cellulose-2,5-acetate mit vergleichbaren molekularen Eigenschaften auf ihre Eignung zur Herstellung von Perlcellulose nach dem in EP0750007 beschriebenen Acetatverfahren untersucht. Dabei erfolgte der Vergleich verschiedener Eigenschaften. Aus allen untersuchten Celluloseacetaten können Perlcellulosen synthetisiert werden. Als besonders geeignet erwies sich ein Produkt mit einer Molmasse von über 100.000, einem Verhältnis der Molmasse zur numerischen Molmasse von etwa 1,5 und einer guten Löslichkeit in Ethylacetat / Methanol (100:17,5). Die hergestellte Perlcellulose hat eine geringe Partikelgröße und eine relativ enge Größenverteilung. Damit erfüllt dieses Cellulose-2,5-acetat alle Anforderungen für die Synthese von Perlcellulose. Der entscheidende Verfahrensschritt zur Herstellung von Perlcellulose ist das Dispergieren der Emulsion mittels Inline-Ultraturrax. Die Partikelgrößenverteilung hängt im Wesentlichen von den Bedingungen während des Dispergierens ab. Im Rahmen der Arbeit gelang die reproduzierbare Herstellung von Cellulosemicrospheres mit einer Partikelgröße unter 5 µm. Für die Herstellung von Cellulosemikropartikeln mit definierten Eigenschaften ist neben den Synthesebedingungen auch die Charakterisierung der Perlcellulosen von entscheidender Bedeutung. Dafür wurden zunächst etablierte Verfahren verwendet (Partikelgrößenmessung, REM und Quecksilberporosimetrie). Parallel dazu erfolgte die Entwicklung bzw. Einführung neuer Methoden. Im Vordergrund stand die Untersuchung des Sedimentationsverhaltens der Perlcellulosen durch analytisches Zentrifugieren. Davon ausgehend konnte ein Verfahren zur Berechnung der Porosität aus dem Sedimentationsvolumen entwickelt werden. Zum Nachweis der kompletten Deacetylierung der Proben wurde die Ramanspektroskopie genutzt. Durch die Anwendung vorhandener und die Entwicklung neuer Methoden wird die genaue Einstellung von Eigenschaften der Perlcellulosen (z. B. Partikelgröße und deren Verteilung, Morphologie sowie Porosität) ermöglicht und deren Reproduzierbarkeit gewährleistet. Weitere Versuche hatten die Entwicklung von Endotoxinadsorbermaterial auf Basis von Perlcellulose und Polymyxin-B-sulfat (PMB) zum Ziel. Die Kopplung des PMB erfolgte meist nach Aktivierung der Proben mit Epichlorhydrin. Zunächst wurde die eingesetzte Epichlorhydrinmenge variiert, um das Optimum für die Aktivierung der Perlcellulosen zu finden. Weiterhin wurden unterschiedliche Mengen PMB angebunden und die Anbindung an nicht aktivierte Proben untersucht. Die Planung aller Versuche erfolgte jeweils nach Auswertung der an der Donau-Universität Krems durchgeführten Limulus- Amöbocyten- Lysat (LAL)-Tests. Mittels dieser Batchtests wurde die Wirksamkeit des Endotoxinadsorbermaterials sowohl im Vergleich zu unbehandeltem Blutplasma und als auch zu kommerziell erhältlichen Adsorbern auf Polystyrenbasis getestet. Endotoxinadsorber, die bei diesen Tests besonders gut bewertet wurden, konnten in einem up-scale- Versuch erstmals in größeren Mengen synthetisiert werden. Auch die direkte Herstellung von Endotoxinadsorbermaterial aus Perlcelluloseacetat konnte realisiert werden. Bei diesem neu entwickelten Verfahren erfolgen Deacetylierung und Aktivierung in einem Schritt. Damit kann die Herstellung vereinfacht werden. Zur Gewährleistung der Erstfehlersicherheit in extrakorporalen Blutreinigungssystemen sollen magnetisierte Perlcellulosepartikel als bioverträgliche Marker eingesetzt werden. Versuche zur Magnetisierung von Cellulosemikropartikeln während des Herstellungsprozesses zeigten, dass die Einbindung von Magnetit bei Erhalt der sphärischen Partikelstruktur prinzipiell auch auf diesem homogenen Syntheseweg möglich ist. / Bead cellulose is regenerated cellulose II characterized by spherically shaped, porous particles with a high specific surface and a good biocompatibility. Because of their properties these cellulose microspheres are especially suited for medical applications. The focus of this work was the synthesis, characterization and modification of bead cellulose with particle sizes between 1 to 10 µm. In the frame of this work seven technical cellulose-2.5-acetates were investigated with regard to their suitability for making bead cellulose according to the process described in EP0750007. These cellulose acetates have comparable molecular characteristics. Different properties were compared. Bead celluloses can be synthesized from all investigated cellulose acetates. A product with a molecular weight of more than 100,000 and with a ratio between molecular weight and numeric molecular weight of about 1.5 is special suited. This cellulose-2.5-acetate has a good solubility in ethyl acetate / methanol (100:17.5). The bead cellulose made from it has a low particle size and a relative narrow size distribution. Thus this cellulose acetate complies with the requirements for making bead cellulose. The most important process step for making bead cellulose is the dispersing of the emulsion using an inline-ultraturrax. The distribution of particle size depends mainly on the conditions during dispersing. A reproducible synthesis of cellulose microspheres with a particle size range below 5 µm was successfully achieved. In addition to determining conditions for manufacturing bead cellulose the characterization of the microspheres is essential to obtain bead cellulose with well defined properties. At first well-established methods of characterization were used (particle size measurement, SEM and mercury porosimetry). In parallel new methods were developed and implemented. The main focus was the investigation of sedimentation behaviour of bead cellulose using analytical centrifugation. Based on this knowledge of the sedimentation volume a new method to calculate the porosity was designed. Raman spectroscopy was used for detecting the complete deacetylation of the samples. By using well-established and newly developed methods properties of bead cellulose such as particle size and distribution, morphology and porosity can be accurately adjusted. In this way the reproducible synthesis of cellulose microspheres can be ensured. The aim of further experiments was to develop an endotoxin adsorber material based on a coupling of bead cellulose with Polymyxin B sulfate (PMB). The coupling with PMB was carried out after activation of the samples by using epichlorohydrin. At first the added epichlorohydrin amount was diversified in order to find the optimum for the activation of bead cellulose. Later the coupling of different amounts of PMB took place and the linking of PMB to non activated samples was investigated too. The planning of all experiments occurred after evaluation of Limulus amebocyte lysate (LAL) tests at Danube-University Krems. Using these batch tests the effectiveness of the endotoxin adsorber material was tested compared to untreated blood plasma as well as commercial available adsorbers based on polystyrene. Endotoxin adsorbers showing the best adsorption rate were then synthesized for the first time in larger quantities. Also the direct synthesis of endotoxin adsorber material based on bead cellulose acetate could be realized. Using this newly developed method, deacetylation and activation occur during the same step. This means manufacturing process can be simplified. Using magnetized bead cellulose as biocompatible marker particles is planned to achieve first fault safety in case of a membrane rupture during extracorporeal blood purification. Initial tests have shown that the magnetization of cellulose microspheres is possible during the manufacturing process. The incorporation of magnetite can be realized while keeping the spherical shape of the particles using this homogenous synthesis pathway.

Maturity-onset diabetes of the young (MODY), due to hepatocyte nuclear factor 1 alpha mutations (HNF1A-MODY), is the most common form of monogenic diabetes presenting in young adults. An accurate genetic diagnosis of HNF1A-MODY has therapeutic implications for the patients and their family members. However, the majority of people with HNF1A-MODY are not referred for genetic testing and remain misdiagnosed as type 1 or type 2 diabetes. As part of measures to address this misdiagnosis, over the last few years there have been efforts to define clinical features and biomarkers that can be used to identify those at high risk of HNF1A-MODY. Secreted hepatic proteins regulated by HNF1A are attractive candidates for diagnostic biomarkers that would be specific for this form of diabetes. Apolipoprotein M (apoM), C-reactive protein (CRP) and plasma glycan profile have all been investigated as biomarkers to improve selection of suspected MODY cases for genetic testing. In my thesis, I have addressed questions about the variation in apoM between different forms of diabetes and assessed the performance of hsCRP and plasma glycan profile to identify HNF1A-MODY in previously uninvestigated individuals with young-onset diabetes and in a non-European population. Additionally because CRP and plasma glycans are both important components of an acute inflammatory response, I examined the effect of haploinsufficiency of HNF1A in a standardised model of inflammation. When investigating apoM, I showed that serum apoM levels are lower in HNF1A-MODY than controls, and have demonstrated for the first time that serum apoM provides good discrimination between HNF1A-MODY and type 1 diabetes. CRP and plasma glycan profile both performed well in identifying HNF1A-MODY cases in unselected young adults with diabetes. The results also suggested that both biomarkers have value for assessing the functional impact of novel HNF1A variants. I went on to examine the use of a low CRP for selecting those at risk of HNF1A-MODY in South Asian subjects with young-onset diabetes. This study suggests that the overall population prevalence of HNF1A-MODY is similar in South Asians to Europeans, but that MODY represents a lower proportion of those with diabetes (due to the higher prevalence of type 2 diabetes in South Asians). The specific selection strategy employed in this study was not successful in identifying subjects at high risk of HNF1A-MODY (only 3% of those sequenced had mutations), suggesting that additional clinical and biochemical features will be required in addition to CRP to distinguish South Asians at high risk of HNF1A-MODY. Lastly, using endotoxaemia as a standardised model of acute inflammation for the first time in HNF1A-MODY, I have shown that despite low baseline levels, subjects with HNF1A-MODY had peak stimulated CRP levels comparable to non-diabetic controls. An attenuated cytokine response was observed in HNF1A-MODY, which requires further investigation. This is also the first report of inflammation-associated changes in plasma and white cell membrane glycan profile in diabetes. This research work adds substantially to current understanding of performance of HNF1A-MODY biomarkers, a critical step before their clinical translation. The work presented also provides novel insights into the regulation of the acute inflammatory response in HNF1A-MODY.

Este estudo clínico avaliou a quantidade de bactérias e endotoxinas, antes e após o tratamento endodôntico utilizando ativação ultrassônica de solução de hidróxido de cálcio e sua correlação com a indução de citocinas pró-inflamatórias por fibroblastos humanos. Vinte e três pacientes com dentes com periodontite apical primária foram submetidos ao tratamento endodôntico. O preparo químico-cirúrgico (PQC) foi realizado com instrumentos reciprocantes, utilizando NaOCl 2,5% durante o preparo e EDTA 17% para remoção do magma dentinário; complementado com a ativação ultrassônica de uma solução de hidróxido de cálcio. Os canais radiculares foram preenchidos com pasta de hidróxido de cálcio por 14 dias e obturados. Foram realizadas coletas microbiológicas dos canais antes (S1) e após o PQC (S2), após o protocolo de ativação ultrassônica (S3) e após a medicação intracanal (S4). As amostras foram analisadas por: PCR quantitativo (qPCR) utilizando iniciadores universais para quantificação de bactérias após extração de DNA; teste turbidimétrico de LAL para quantificação de endotoxinas; e ELISA para quantificação de citocinas (IL-1?, IL-6, CCL2) em cultura de fibroblastos humanos após indução com o conteúdo do canal radicular. Os dados foram analisados pelos seguintes testes estatísticos: teste de Wilcoxon e Q de Cochran para análise quantitativa de bactérias e endotoxinas; ANOVA e teste de Tukey, para quantificação dos níveis de citocinas; e teste de Pearson para correlação entre os níveis de endotoxinas e citocinas (todos com nível de significância de 5%). Bactérias e endotoxinas foram observadas em todas as amostras iniciais com uma mediana de 3,61 x 104 e 109 EU/ml, respectivamente. Após o preparo químico-cirúrgico, houve uma redução significativa (p <0,05) dos níveis de DNA bacteriano (mediana 7,84 x 103) e endotoxina (mediana 20,2 EU/ml). Entretanto, não houve redução de DNA bacteriano após as etapas seguintes. Com relação a endotoxina, houve redução significativa (p <0,05) após a medicação intracanal (9,58 EU/mL). Correlação positiva foi observado entre os níveis de endotoxina e a indução de citocinas pró-inflamatórias. Produção de IL-1?, IL-6, CCL2 foram observadas em todas as etapas do tratamento. Não houve diferença estatística dos níveis de IL-1 ? detectados nas diferentes amostras (p >0,05). Houve diminuição significativa de IL-6 e CCL-2 entre S1 e S2 (p <0,05). Entretanto, não houve redução dessas citocinas nas amostras S3 ou S4 em relação às amostras S2 (p >0,05). Conclui-se que o PQC foi eficaz na redução de bactérias e endotoxinas dos canais radiculares; enquanto a medicação intracanal influenciou apenas na redução de endotoxina. As amostras após o PQC induziram menores níveis de IL-6 e CCL-2 em fibroblastos humanos do que as amostras antes do tratamento endodôntico. Por outro lado, as demais etapas do tratamento não foram capazes de promover uma redução adicional dessas citocinas. / This clinical study analyzed bacteria and endotoxins levels before and after endodontic treatment using ultrasonic activation of a calcium hydroxide solution and an intracanal medication and its correlation with pro-inflammatory cytokines induction by human fibroblasts. Twenty-three patients with teeth with primary apical periodontitis were submitted to endodontic treatment. The root canal preparation of all the teeth was carried out with reciprocating files and 2.5% NaOCl during preparation; and 17% EDTA for smear layer removal, supplemented with the ultrasonic activation of a solution of calcium hydroxide. The root canals were medicated with calcium hydroxide for 14 days and then obturated. Microbiological sampling were performed before (S1) and after the root canal preparation (S2), after ultrasonic activation protocol (S3) and after intracanal medication (S4). The samples were analyzed by quantitative PCR (qPCR) using universal primers quantification of bacteria after DNA extraction; LAL turbidimetric test for detection and determination of endotoxin and ELISA for evaluate the cytokine production (IL-1?, IL-6, CCL2) by humam fibroblasts culture. Data was analyzed by Wilcoxon and Q cochran tests for the quantitative analysis of bacteria and endotoxins. ANOVA and tukey test, with significance level of 5%, were used for quantification of cytokine levels and Pearson\'s test for correlation between endotoxins and cytokine levels. Bacteria and endotoxins were observed in all initial samples with a median of 3.61 x 104 and 109 EU/ml respectively. After root canal preparation, there was a significant reduction (p<0,05) of bacterial DNA (median 7.84 x 103) and endotoxin (median 20.2 EU/ml). However, there was no reduction of bacterial DNA after following steps. Regarding endotoxin, there was a significant reduction (p <0.05) after intracanal medication (9.58 EU / mL), A positive correlation was observed between endotoxins and cytokine induction. Production of IL-1?, IL-6, CCL2 were observed in all stages of treatment.. There was no statistical difference between the presence of IL-1? in each step of the treatment (p >0.05). There was a significant decrease in the presence of the proinflammatory cytokine IL-6 and CCL-2 between the initial stage of endodontic treatment (S1) and the next step (S2) (p <0.05). However, in the following steps (S3 and S4) there was no reduction (p >0.05). It was concluded that the root canal preparation was effective in reducing bacteria and endotoxins, and intracanal medication only influenced in endotoxin reduction. Samples after the root canal preparation induced lower levels of IL-6 and CCL-2 in human fibroblasts than samples before endodontic treatment, whereas other stages of the endodontic treatment were not able to promote an additional reduction.

O hidrogênio molecular (H2) exerce efeito antioxidante, anti-apoptótico e antiinflamatório. Nesse estudo testamos a hipótese que o H2 modula as mudanças cardiovasculares, inflamatórias e termorregulatórias na inflamação sistêmica (IS) induzida por lipopolissacarídeo (LPS) em diferentes doses (0,1 ou 1,5 mg/kg, intravenoso, induzindo IS moderada ou severa) em ratos machos Wistar (250-300 g). LPS ou salina foi injetada imediatamente antes do início dos 360 minutos de inalação do H2 (2% H2, 21% O2, balanceado com nitrogênio) ou ar ambiente (21% O2, balanceado com nitrogênio). A temperatura corporal (Tc) foi mensurada por datalogger pré-implantados na cavidade peritoneal. O H2 não causou mudança nos parâmetros cardiovasculares, inflamatórios e na Tc dos ratos controle (tratados com salina). Durante a IS moderada o H2 reduziu o surgimento das citocinas pró-inflamatórias no plasma (TNF-? e IL-6) enquanto causou um aumento da IL-10 plasmática (citocina anti-inflamatória) e preveniu a febre. Durante a IS severa o H2 potencializou a hipotermia e preveniu a febre e a hipotensão. Além disso, o H2 causou uma redução no surgimento das citocinas pró-inflamatórias (TNF-? e IL-1? do plasma) e prostaglandina E2 [(PGE2), no plasma e no hipotálamo], e um aumento da IL-10 plasmática. Esses dados são consistentes com o entendimento que o H2 atenua a febre na IS moderada e durante a IS severa potencializa a hipotermia, previne a hipotensão e exerce um efeito antiinflamatório forte o suficiente para prevenir a febre alterando a sinalização febrigênica e alterando a produção hipotalâmica de PGE2 / Molecular hydrogen (H2) exerts anti-oxidative, anti-apoptotic, and anti-inflammatory effects. Here we tested the hypothesis that H2 modulates cardiovascular, inflammatory, and thermoregulatory changes in systemic inflammation (SI) induced by lipopolysaccharide (LPS) at different doses (0.1 or 1.5 mg/kg, intravenously, to induce mild or severe SI) in male Wistar rats (250-300 g). LPS or saline was injected immediately before the beginning of 360- minute inhalation of H2 (2% H2, 21% O2, balanced with nitrogen) or room air (21% O2, balanced with nitrogen). Deep body temperature (Tb) was measured by dataloggers preimplanted in the peritoneal cavity. H2 caused no change in cardiovascular, inflammatory parameters, and Tb of control rats (treated with saline). During mild SI, H2 reduced plasma surges of proinflammatory cytokines (TNF-? and IL-6) while caused an increase in plasma IL-10 (anti-inflammatory cytokine) and prevented fever. During severe SI, H2 potentiated hypothermia, and prevented fever and hypotension. Moreover, H2 caused a reduction in surges of proinflammatory cytokines (plasma TNF-? and IL-1?) and prostaglandin E2 [(PGE2), in plasma and hypothalamus], and an increase in plasma IL-10. These data are consistent with the notion that H2 blunts fever in mild SI, and during severe SI potentiates hypothermia, prevents hypotension and exerts anti-inflammatory effects strong enough to prevent fever by altering febrigenic signaling and ultimately down-modulating hypothalamic PGE2 production

O hidrogênio molecular (H2) exerce efeito antioxidante, anti-apoptótico e antiinflamatório. Nesse estudo testamos a hipótese que o H2 modula as mudanças cardiovasculares, inflamatórias e termorregulatórias na inflamação sistêmica (IS) induzida por lipopolissacarídeo (LPS) em diferentes doses (0,1 ou 1,5 mg/kg, intravenoso, induzindo IS moderada ou severa) em ratos machos Wistar (250-300 g). LPS ou salina foi injetada imediatamente antes do início dos 360 minutos de inalação do H2 (2% H2, 21% O2, balanceado com nitrogênio) ou ar ambiente (21% O2, balanceado com nitrogênio). A temperatura corporal (Tc) foi mensurada por datalogger pré-implantados na cavidade peritoneal. O H2 não causou mudança nos parâmetros cardiovasculares, inflamatórios e na Tc dos ratos controle (tratados com salina). Durante a IS moderada o H2 reduziu o surgimento das citocinas pró-inflamatórias no plasma (TNF-? e IL-6) enquanto causou um aumento da IL-10 plasmática (citocina anti-inflamatória) e preveniu a febre. Durante a IS severa o H2 potencializou a hipotermia e preveniu a febre e a hipotensão. Além disso, o H2 causou uma redução no surgimento das citocinas pró-inflamatórias (TNF-? e IL-1? do plasma) e prostaglandina E2 [(PGE2), no plasma e no hipotálamo], e um aumento da IL-10 plasmática. Esses dados são consistentes com o entendimento que o H2 atenua a febre na IS moderada e durante a IS severa potencializa a hipotermia, previne a hipotensão e exerce um efeito antiinflamatório forte o suficiente para prevenir a febre alterando a sinalização febrigênica e alterando a produção hipotalâmica de PGE2 / Molecular hydrogen (H2) exerts anti-oxidative, anti-apoptotic, and anti-inflammatory effects. Here we tested the hypothesis that H2 modulates cardiovascular, inflammatory, and thermoregulatory changes in systemic inflammation (SI) induced by lipopolysaccharide (LPS) at different doses (0.1 or 1.5 mg/kg, intravenously, to induce mild or severe SI) in male Wistar rats (250-300 g). LPS or saline was injected immediately before the beginning of 360- minute inhalation of H2 (2% H2, 21% O2, balanced with nitrogen) or room air (21% O2, balanced with nitrogen). Deep body temperature (Tb) was measured by dataloggers preimplanted in the peritoneal cavity. H2 caused no change in cardiovascular, inflammatory parameters, and Tb of control rats (treated with saline). During mild SI, H2 reduced plasma surges of proinflammatory cytokines (TNF-? and IL-6) while caused an increase in plasma IL-10 (anti-inflammatory cytokine) and prevented fever. During severe SI, H2 potentiated hypothermia, and prevented fever and hypotension. Moreover, H2 caused a reduction in surges of proinflammatory cytokines (plasma TNF-? and IL-1?) and prostaglandin E2 [(PGE2), in plasma and hypothalamus], and an increase in plasma IL-10. These data are consistent with the notion that H2 blunts fever in mild SI, and during severe SI potentiates hypothermia, prevents hypotension and exerts anti-inflammatory effects strong enough to prevent fever by altering febrigenic signaling and ultimately down-modulating hypothalamic PGE2 production

Este estudo clínico analisou os efeitos dos procedimentos endodônticos e da irrigação ultrassônica passiva (PUI) em bactérias e endotoxinas de canais radiculares. Cinquenta pacientes com dentes com periodontite apical primária foram divididos de forma randomizada em dois grupos: PUI (n=25) e irrigação convencional (IC) (n=25). O preparo químico-cirúrgico (PQC) foi realizado com instrumentos reciprocantes, utilizando-se NaOCl 2,5% durante o preparo; e EDTA 17%, para remoção do magma dentinário. Os canais radiculares foram preenchidos com pasta de hidróxido de cálcio por 14 dias e obturados. Foram realizadas coletas microbiológicas dos canais antes (S1) e após o PQC (S2), após os protocolos de irrigação (S3), após a medicação intracanal (S4) e após a reinstrumentação dos canais (S5). Durante o processamento das amostras, as coletas de 5 casos foram perdidas por fatores diversos. As amostras foram analisadas por PCR quantitativo para detecção e quantificação de bactérias e pelo teste turbidimétrico de LAL para detecção e determinação do nível de endotoxinas. Bactérias e endotoxinas foram observadas em 100% das amostras iniciais coletadas. Em ambos os grupos, houve diminuição significativa na concentração de endotoxinas entre uma etapa do tratamento e a etapa posterior (p<0,05). O mesmo foi observado quanto ao número de bactérias, exceto entre a remoção da medicação intracanal e a reinstrumentação antes da obturação (S5). A análise intergrupos demonstrou que, com relação às endotoxinas, não foram observadas diferenças significativas entre os grupos (p>0,05). Com relação à redução bacteriana, a PUI foi capaz de reduzir significativamente mais o número de bactérias do que a IC (p<0,05). A análise qualitativa dos resultados demonstrou que nenhuma das técnicas sobressaiu-se sobre a outra em relação à frequência de casos com leituras positivas, tanto para bactérias quanto para endotoxinas. Concluiu-se que a PUI foi mais eficaz do que a IC em reduzir o número de bactérias, mas não a quantidade de endotoxinas do canal radicular. Além disso, cada etapa do tratamento endodôntico foi capaz de reduzir tanto o número de bactérias quanto a quantidade de endotoxinas. / The aim of this clinical study was to compare the effects of passive ultrasonic irrigation (PUI) and intracanal medication with calcium hydroxide in bacteria and endotoxins from root canal. Fifty teeth with apical periodontitis were randomly divided into two groups according to the irrigation protocol: PUI (n = 25) and conventional irrigation (CI) (n = 25). The root canal preparation of all the teeth was carried out with reciprocating files and 2.5% NaOCl during preparation; and 17% EDTA for smear layer removal. The root canals were medicated with calcium hydroxide for 14 days. Microbiological sampling were performed before (S1) and after the preparation (S2) after irrigation protocols (S3), and after intracanal medication (S4 and S5). During the processing of the samples, five cases were lost for several factors. The samples were analyzed by real time PCR, for the detection and quantification of bacteria, and the turbidimetric LAL assay, for the detection and analysis of the endotoxin levels. Bacteria and endotoxins were observed in 100% of the initial samples. In both groups, there was a significant decrease in the concentration of endotoxins between one step and the subsequent step of treatment (p < 0.05). The same was observed for the number of bacteria, with the exception of the reinstrumentation after the removal of the medication (S5). The intergroup analysis showed no significant differences between groups in endotoxin reduction ( p > 0.05 ). PUI was able to reduce the number of bacteria significantly better than CI (p < 0.05). No significant statistical difference was observed between groups regarding the occurrence of cases wielding positive results for bacteria or endotoxin. It was concluded that PUI was more effective than CI in reducing the number of bacteria but not the amount of endotoxin in the root canal. Furthermore, each step of the endodontic therapy was effective in reducing both the number of bacteria as the amount of endotoxin.

Three main projects are included in this dissertation. Though seemingly broad in scope, this research afforded a unique opportunity for comprehensive study of urban and rural environmental inhalation exposures to endotoxin (lipopolysaccharide LPS) and the associated immune response. In the LA PM10 Endotoxin Study, ambient concentration of LPS in PM (particulate matter) was quantified through analysis of air samples collected in Southern California. Endotoxin concentrations measured were lower than recognized thresholds for adverse health effects in occupational exposures, but in the same range as for indoor effects. This study provides the first extensive characterization of endotoxin concentration across a large metropolitan area in relation to PM10 and other pollutant monitoring, and supports the need for studies of the role of endotoxin in childhood asthma in urban settings. The Mouse Whole Blood Assay (WBA) Study replicated LPS-induced airway inflammation in a laboratory model. Presently, there is a need for less invasive options for evaluating pulmonary responses to occupational exposures. The whole blood assay (WBA), which measures cytokine production of leukocytes after ex vivo stimulation with LPS, may be one such option. This study used an endotoxin-tolerance model to demonstrate the efficacy of the WBA as a biomarker of inhalation exposure to swine concentrated animal feeding operation (CAFO) dust and showed the utility of the WBA for assessing susceptibility to organic dust-induced lung inflammation. Finally, The Human WBA Study applied the WBA outside the controlled environment of the laboratory. This study utilized pulmonary function testing (PFT), symptom questionnaires and the WBA to evaluate inflammatory responses following an inhalation exposure to purified LPS in CAFO workers and controls. Subjects were stratified into response groups for analysis of WBA results based on PFT response. All subjects demonstrated significant WBA LPS-stimulant dose-responses for all 3 cytokines measured. This study demonstrated that LPS-induced pulmonary and WBA responses are variable among individuals and offered insight into the use of the WBA in future studies. Information gained from these studies provides much insight into urban endotoxin concentrations, the use of the WBA as a biomarker of pulmonary exposure in the rural environment, and offers possibilities for further research.

Cry3Aa is a 73 kDa protoxin toxic to insect larvae of Coleoptera order. It is processed to form a stable 65 kDa &amp / #61540 / -endotoxin by endogenous proteases. The first part of this study involved the determination of the patterns of biosynthesis of Coleoptera-specific &amp / #61540 / -endotoxin by a local isolate of Bacillus thuringiensis subsp. tenebrionis (Btt) in relation to its growth and sporulation. Among four different media compared (DSM, GYS, HCT and C2) Cry3Aa production was the highest in DSM, especially at 72nd h and 120th h of incubation. For improvement of Cry3Aa production, the effects of different carbon and nitrogen sources, inorganic phosphate and other mineral elements were tested. Increasing concentrations (5-10 g.L-1) of glucose or sucrose decreased the toxin yield probably by suppressing sporulation. Inorganic phosphate was found to have the most striking effect on toxin biosynthesis. 200 mM inorganic phosphate concentration resulted in 5 fold increase in Cry3Aa yield. Cry3Aa production was greatly reduced when various combinations of organic and inorganic nitrogen sources, especially ammonium sulphate and Casamino acids were replaced with Nutrient broth in DSM. The highest Cry3Aa production was obtained in the media containing 10-5-10-7 M MnCl2, 10-5 M FeSO4 and 5.10-4 M MgSO4, corresponding to their original concentrations in DSM. Decrease of iron concentration or its omission from the medium decreased the toxin yield. Toxin production capacity of our local isolate was compared with those of 30 different anti-Coleopteran Bt strains. Most of the strains producing this protein gave general protein banding patterns quite similar to that of our local isolate. Lastly, the cry3Aa gene of the Btt local isolate was PCR-amplified and cloned into the E. coli/Bacillus shuttle vector pNW33N. The recombinant plasmid was amplified in E. coli and the sequence of the cry3Aa was determined. Amino acid sequence deduced was found to be 97.4 %-99.2 % identical to the cry3Aa sequences (GenBank) of 10 different quaternary ranks. In this respect, the gene has to represent the 11th quaternary rank of the cry3Aa ones. The recombinant plasmid carrying cry3Aa gene was next used to transform Bs 168 as an intermediate host and low level of expression was seen.

Το αιμορραγικό shock (H/S) έχει δειχθεί πως προκαλεί οξειδωτικό stress (OS) σε διάφορους ιστούς λόγω της υπερπαραγωγής ελευθέρων ριζών οξυγόνου στη φάση της επαναιμάτωσης και επίσης σχετίζεται με την ανάπτυξη ενδοτοξιναιμίας. Επίσης, το είδος της καταστολής που χρησιμοποιείται στις Μονάδες Εντατικής Θεραπείας (ΜΕΘ) έχει επίπτωση στη νοσηρότητα και τη θνητότητα των ασθενών. Η κλονιδίνη, ένας α2-αδρενεργικός αγωνιστής, που έχει χρησιμοποιηθεί τόσο περιεγχειρητικά όσο και για καταστολή στη ΜΕΘ, φαίνεται πως ασκεί προστατευτική δράση σε μοντέλα ισχαιμίας/επαναιμάτωσης. Σκοπός: Σκοπός της παρούσας μελέτης ήταν η εκτίμηση της επίδρασης της προχορήγησης κλονιδίνης στο οξειδωτικό φορτίο στο έντερο, το ήπαρ και τους πνεύμονες και στην ανάπτυξη ενδοτοξιναιμίας στην πυλαία και συστηματική κυκλοφορία σε επίμυες που υποβλήθηκαν σε σημαντικού βαθμού H/S. Υλικό και Μέθοδος: Η μελέτη πραγματοποιήθηκε σε 64 επίμυες και αποτελείται από δύο σκέλη: ένα για τον προσδιορισμό του οξειδωτικού φορτίου και ένα για τη μέτρηση της ενδοτοξίνης. Σε κάθε σκέλος, τα ζώα μοιράστηκαν σε 4 ομάδες: (1) ομάδα ελέγχου (Sham), όπου τα ζώα καθετηριάστηκαν χωρίς να πραγματοποιηθεί αφαίμαξη, (2) ομάδα H/S (H/S) και δύο ομάδες στις οποίες προχορηγήθηκε κλονιδίνη, (ομάδα 3,Clonidine) και (ομάδα 4, Clonidine-H/S). Το H/S, διάρκειας μίας ώρας, στόχευε σε τιμές μέσης αρτηριακής πίεσης 30-40mmHg και ολοκληρώθηκε με επαναχορήγηση του απολεσθέντος αίματος. Τρεις ώρες μετά την αναζωογόνηση, το οξειδωτικό φορτίο εκτιμήθηκε με δύο μεθόδους: (α) τη μέτρηση των οργανικών υδροϋπεροξειδίων (LOOHs) και (β) τη μέτρηση της ρίζας του υπεροξειδίου (O2.-) στο έντερο, στο ήπαρ και τους πνεύμονες ενώ για τη μέτρηση της ενδοτοξίνης, ελήφθησαν δείγματα αίματος από την πυλαία φλέβα και την αορτή. Αποτελέσματα: Οι επίμυες που υπεβλήθησαν σε H/S παρουσίασαν στατιστικά σημαντική αύξηση του οξειδωτικού φορτίου σε όλα τα όργανα. Η προχορήγηση κλονιδίνης προκάλεσε μείωση της παραγωγής LOOHs μετά από H/S στο έντερο (Ρ<0.001), στο ήπαρ (Ρ<0.05) και τους πνεύμονες (Ρ<0.05), σε σχέση με την ομάδα H/S. Επίσης, η ομάδα Clonidine-H/S παρουσίασε μειωμένο ρυθμό παραγωγής του O2.- σε σχέση με την ομάδα H/S, στο έντερο (P< 0.001), στο ήπαρ (P< 0.001) και τους πνεύμονες (Ρ<0.005). Τέλος, όσον αφορά τα επίπεδα ενδοτοξίνης, βρέθηκαν στατιστικά σημαντικά αυξημένα μετά από H/S τόσο στην πυλαία (Ρ<0.05), όσο και στη συστηματική (Ρ<0.001) κυκλοφορία, ενώ η προχορήγηση κλονιδίνης οδήγησε σε μείωση της ενδοτοξίνης και στις δύο κυκλοφορίες (πυλαια: Ρ<0.05 και συστηματική: Ρ<0.001) σε σχέση με την ομάδα H/S. Συμπέρασμα: Στην παρούσα μελέτη βρέθηκε για πρώτη φορά ότι η κλονιδίνη ασκεί αντιοξειδωτική δράση στο έντερο, στο ήπαρ και στους πνεύμονες όταν χορηγείται προ του H/S, το οποίο, ως γνωστόν, προκαλεί σημαντικού βαθμού OS σε αυτά τα όργανα. Μάλιστα, αυτό εκτιμήθηκε για πρώτη φορά σε μοντέλο H/S με την εφαρμογή μιας νέας άμεσης και ποσοτικής μεθόδου προσδιορισμού του O2.-. Τα αποτελέσματα αυτά αποκτούν ιδιαίτερη σημασία, καθώς το επαγόμενο από σοβαρή αιμορραγία OS ενέχεται στην παθογένεια του MODS (Multiple Organ Dysfunction Syndrome). Επιπλέον, η κλονιδίνη περιόρισε την επαγόμενη από το H/S ενδοτοξιναιμία, γεγονός που μπορεί να αποδοθεί, τουλάχιστον μερικώς στην αντιοξειδωτική της δράση στον εντερικό βλεννογόνο. Αυτή η παρατηρούμενη μείωση της ενδοτοξιναιμίας, ενδέχεται να συμβάλλει με τη σειρά της στο μειωμένο OS στα όργανα. Αν και τα αποτελέσματα πειραματικών μελετών σε ζώα δεν μπορούν πάντα να αναχθούν σε συμπεράσματα που αφορούν τους ανθρώπους, αυτή η μελέτη συνηγορεί υπέρ της χρήσης της κλονιδίνης σαν συμπληρωματικό αναισθητικό παράγοντα εκλογής σε ασθενείς επιρρεπείς σε απώλεια αίματος, με στόχο την άμβλυνση των παθοφυσιολογικών επιπτώσεων του H/S που μπορούν να οδηγήσουν σε MODS. / Hemorrhagic shock (H/S) leads to the development of oxidative stress (OS) as a result of the excessive production of reactive oxygen species (ROS) in various tissues during reperfusion. Likewise, ischemia and ROS are believed to compromise the integrity of the intestinal barrier, resulting in endotoxemia. Moreover, it is now clear that the choice of sedation in ICU (Intensive Care Unit) patients affects their outcome. The a2-adrenergic agonist clonidine that is used as an adjunct to anesthesia, as well as in the ICU setting, has been shown to exert protective effects in models of ischemia/reperfusion injury. Aim of the study: To test the effect of clonidine pre-treatment of rats in the H/S-induced OS in the gut, liver and lung tissues and endotoxemia as well. Materials and Methods: The study consisted of two arms (64 rats): one for the measurement of the oxidative load in the organs and one for the measurement of endotoxin. Four animal groups (n=8 per group) were used for each arm (Sham, Clonidine, H/S and Clonidine-H/S group). The duration of Η/S was one hour, targeting to a mean arterial pressure of 30-40mmHg, at the end of wich rats were rescusitated by reinfusion of the shed blood. Three hours after rescusitation, the oxidative load was estimated with the measurement of lipid hydroperoxides (LOOHs) and superoxide radical (O2.- ) production in the liver, gut and lungs of the animals, while the levels of endotoxin were determined in both the systemic and portal circulation. Results: Rats subjected to H/S exerted increase in the oxidative load in all the tested organs. Clonidine pre-treatment resulted in a statistically significant reduction of LOOHs production after H/S in the gut (P < 0.001), liver and lungs of the rat (P < 0.05). Rats in the Clonidine-H/S group exhibited a statistically significant reduction (P< 0.001) in the production of O2.- in the gut and liver, and to a lesser extent in the lungs ( P < 0.05) compared to H/S group. H/S induced endotoxemia in the portal and systemic circulation, whereas clonidine pre-treatment reduced the amount of endotoxin detected both in the portal (P<0.05) and systemic (P<0.01) circulation compared to H/S. Conclusion: This study documents for the first time that clonidine pre-treatment prior to H/S results in a significant reduction of the OS observed in the gut, liver and lungs of the rat. Moreover, this antioxidant effect was estimated for the first time in a model of H/S with a new, direct and quantitative method of O2.- production. These results are of great value, since the H/S-induced OS is implicated in the pathogenesis of MODS (Multiple Organ Dysfunction Syndrome). Furthermore, clonidine prevented H/S induced endotoxemia in both portal and systemic circulations, probably due to its antioxidant effect on the intestinal epithelium. The reduced endotoxemia after clonidine pre-treatment may contribute to the decreased OS observed in the liver and lungs. Although laboratory results on animals should not be easily extrapolated to humans, we believe that clonidine merit consideration as an adjunctive sedative agent of choice in patients susceptible to develop H/S, as it may prevent the development of MODS, improving likewise their outcome.

Made available in DSpace on 2014-06-11T19:24:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-07-06Bitstream added on 2014-06-13T19:31:19Z : No. of bitstreams: 1 chung_a_me_sjc.pdf: 3221604 bytes, checksum: 5b16f37a62e8b9804f944b0be536c388 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A proposta deste trabalho foi detectar microrganismos e avaliar in vivo a ação do extrato glicólico de gengibre 20% (GENG), do hipoclorito de sódio 1% (NaOCl), da clorexidina gel 2% (CLX) como soluções irrigadoras e da medicação intracanal (MIC) de hidróxido de cálcio sobre microrganismos e endotoxinas em dentes com necrose pulpar e lesão periapical. Para isso 36 pacientes portadores de dente com necrose pulpar e lesão periapical visível radiograficamente foram submetidos ao tratamento endodôntico e divididos em 3 grupos (n=12), de acordo com a substância química auxiliar utilizada durante o preparo biomecânico: GENG; NaOCl ou CLX intercalado com solução salina fisiológica. Foram realizadas coletas do conteúdo do canal radicular com cones de papel absorvente após a abertura do dente, após a instrumentação e, após 14 dias da ação da MIC. Para todas as coletas foram realizados os seguintes testes: a) avaliação da atividade antimicrobiana pela contagem de UFC/mL e método molecular – PCR e; b) análise da quantidade de endotoxina verificada pelo lisado de amebócitos de Limulus. Os resultados foram submetidos à análise descritiva e estatística de Kruskal-Wallis e teste de Dunn. Os resultados mostraram presença de DNA bacteriano em todas as coletas, sendo que Parvimonas micra foi a espécie mais frequente. A instrumentação com as substâncias testadas reduziram significativamente microrganismos e endotoxinas dos canais radiculares. A utilização da MIC não foi capaz de potencializar os efeitos antimicrobianos nem sobre endotoxinas. Pôde-se concluir que o preparo biomecânico com GENG foi eficiente tanto em reduzir microrganismos quanto endotoxinas dos canais radiculares. A MIC de Ca(OH)2 não foi capaz de potencializar a neutralização de endotoxinas após PBM / The purpose of this study was to detect microorganisms and to evaluate in vivo the action of 20% ginger glycolic extract (GENG), 1% sodium hypochlorite (NaOCl) and 2% chlorhexidine gel (CLX) as irrigating solutions and intracanal medication (ICM) of calcium hydroxide on microorganisms and endotoxins in teeth with necrotic pulp and periapical lesions. Thirty six patients with tooth with pulp necrosis and radiographically visible periapical lesion were submitted to endodontic treatment and divided into 3 groups (n = 12), according to the auxiliary chemical substance used during the biomechanical preparation: GENG, NaOCl or CHX interspersed with saline solution. Samples of the root canal were taken with paper cones immediately after exposure of the canal, immediately after instrumentation and 14 days after MIC. For all samples were performed the following tests: a) evaluation of antimicrobial activity by counting the CFU / mL and molecular method - PCR and b) quantification of endotoxins verified by the Limulus amoebocyte lysate. The results showed the presence of bacterial DNA in all samples, and Parvimonas micra was the most frequent species. The instrumentation with all substances tested reduced significantly microorganisms and endotoxins from root canals. The use of ICM was not able to potentiate the antimicrobial effects either on endotoxins. It was concluded that biomechanical preparation with glycolic extract of ginger was effective in reducing microorganisms and endotoxins from root canals with no significant differences from NaOCl or chlorhexidine. The Ca(OH)2 ICM could not enhance the neutralization of endotoxins after biomechanical preparation