INTRODUÇÃO: A insuficiência respiratória acomete grande parte dos pacientes oncológicos levando a altos índices de mortalidade. A ventilação não invasiva (VNI) pode auxiliar seu manejo, mas seus efeitos ainda são pouco conhecidos sobre os mecanismos de defesa pulmonar. OBJETIVOS: Observar o efeito da VNI com máscara facial usando-se geradores de fluxo com pressão positiva contínua (CPAP) e ventilador microprocessado no modo pressão de suporte + pressão positiva ao final da expiração (PSV + PEEP), a fim de verificar impacto nas propriedades viscoelásticas do muco respiratório e o conforto proporcionado ao paciente. MÉTODOS: A VNI foi instalada após diagnóstico de insuficiência respiratória em dezenove pacientes, admitidos nas unidades de tratamento intensivo do Hospital A. C. Camargo, sendo nove submetidos ao CPAP e dez com PSV + PEEP. Foram colhidos antes e após uma hora de VNI: os dados clínicos, secreção nasal, gasometria, e o grau de conforto através de uma escala visual. As propriedades físicas do muco (transportabilidade in vitro, adesividade e wettabilidade ou hidrofobicidade) foram avaliadas respectivamente no palato de rã, máquina da tosse e ângulo de contato. RESULTADOS: Os grupos eram homogêneos entre si em relação à idade, sexo, tipo e estadiamento do tumor e SAPS II. Em relação às propriedades físicas do muco, houve um aumento da transportabilidade in vitro do muco nasal com o sistema PSV + PEEP (p = 0,04) e um aumento na wettabilidade no grupo CPAP (p = 0,06). Os dois sistemas foram eficazes em melhorar significativamente os sinais vitais, a PaO2/FiO2, o padrão e o conforto respiratório e em evitar a intubação traqueal nas primeiras 24 horas (p < 0,05). Entretanto, independentemente do tipo de sistema de VNI usado, foram encontrados altos índices de intubação endotraqueal e mortalidade no seguimento destes pacientes. CONCLUSÃO: As propriedades físicas do muco (transportabilidade in vitro e wettabilidade) se alteraram após uma hora de uso da VNI e parecem ser dependentes da temperatura e umidificação dentro da máscara. A VNI mostrou-se útil em reverter a insuficiência respiratória em pacientes selecionados, ou pelo menos em trazer conforto para pacientes hipoxêmicos que a princípio recusam a intubação endotraqueal / INTRODUCTION: Respiratory failure is a common situation among cancer patients leading to high rates of mortality. Noninvasive ventilation (NIV) can help its management, but its effects are still unknown regarding the pulmonary defense mechanisms. OBJECTIVES: Observe the effect of NIV with facial mask using a flow generator with continuous positive pressure (CPAP) and standard intensive care unit ventilator using pressure support ventilation + positive end expiratory pressure (PSV + PEEP), to verify impact on the physical properties of respiratory mucus and the comfort provided to the patient. METHODS: NIV was started after diagnosis of respiratory failure in nineteen patients, admitted in the intensive care unit of the A. C. Camargo Hospital. Nine patients were submitted to CPAP and ten to PSV + PEEP. Nasal mucus, blood gases, and the degree of comfort through a visual scale were accessed before and after one hour. The physical properties of nasal mucus (transportabilility in vitro, adhesivity and wettability or hydrofobicity) were evaluated respectively by frog palate, cough machine and contact angle. RESULTS: Groups had similar characteristics about age, sex, tumor and SAPS II score. Regarding the physical properties of the mucus, there was an increase in mucus transportability (by the frog palate model) with the system PSV + PEEP (p = 0.04) and an increase in the contact angle in the CPAP groupo (p = 0.06). The two systems were effective in improving the vital signs, the PaO2/FiO2, the respiratory pattern and comfort and avoiding endotracheal intubation in the first 24 hours (p < 0.05). However, regardless of the type of NIV system used, high rates of endotracheal intubation and mortality were found. CONCLUSION: The physical properties of the mucus (transportability in vitro and wettability) changed after an hour of use of the NIV as a result of temperature and humidification into the mask. NIV was useful in reversing the respiratory failure in selected patients, or at least in bringing comfort for those who refuse endotracheal intubation

O muco protege o corpo humano de partículas externas, mas também representa uma barreira para a entrega de controlada de medicamentos através de nanocarregadores. Para ultrapassar a barreira do muco e impedir mucoadesão, nanopartículas sólidas são normalmente revestidas com polímeros inertes, tais como o polietileno glicol (PEG). No entanto, trata-se de um procedimento relativamente complexa. Nesta tese, estudamos métodos para fabricar nanocarreadores com uma excepcional combinação de propriedades, incluindo uma boa capacidade de mucopenetração e uma grande capacidade de carga. Ao contrário dos métodos convencionais de revestimento, usamos um copolímero dibloco, que consiste em dois blocos hidrofóbicos e hidrofílicos, que se auto-organiza em polimerosomos sob hidratação. Devido à inércia do bloco hidrofílico, estes polimerosomos devem ser, por natureza, muco penetradores. Além disso, sua estrutura oca fornece os polimersomos para serem carregados com carga hidrofílica, enquanto a carga hidrofóbica pode ser transportada através da membrana. Por conta da utilização de um polímero hidrolisável na presença de ácido, ácido poli láctico (PLA) como a espinha dorsal copolímero, demonstramos que estes polimerosomos podem liberar o conteúdo, após aplicação do estímulos externo relacionado ao pH. Os experimentos de rastreamento de partículas demonstraram que os polimersomos se difundem mais rápido do que as partículas não revestidas, em muco de intestino de porco, e testes de biodistribuição apresentaram resultados encorajadores para a entrega localizada de fármacos de maneira mais homogênea, melhorando a biodisponibilidade e efeitos terapeuticos. Mais estudos relacionados ao aumento da eficiência de encapsulação e testes de efetividade in vivo no tratamento de doenças devem ser promovidos. Acreditarmos que combinação das vantagens relacionadas à estrutura vesicular dos polimerossomas, estabilidade, e muco penetração possibilitam o desenvolvimento de uma nova plataforma para a entrega controlada de medicamentos na mucosa. / Mucus protects the human body by trapping foreign particulates but also poses a barrier for drug delivery by slowing down the mobility of drug carriers. To design mucus penetrating carriers, solid particles are typically coated with inert polymers such as polyethylene glycol (PEG) to prevent mucoadhesion. However, the solid structure of these particles limits their loading capabilities and the process to coat them requires a complex synthesis. In this thesis we studied methods to fabricate nanocarriers with an exceptional combination of properties including a good mucus-penetration capability and loading capacity of hydrophilic and hydrophobic cargos. Unlike conventional coating methods, we use a diblock copolymer, consisting of both hydrophobic and hydrophilic blocks, which self-assembles into polymersomes under hydration. Because of the inertness of the hydrophilic block, these polymersomes should be mucus-penetrating by nature. Moreover, their hollow structure provides the polymersomes to be loaded with hydrophilic cargo, whereas hydrophobic cargo can be carried through the membrane. Importantly, by using a hydrolysable acid-catalyzed polymer (poly lactic acid, PLA) as the copolymer backbone, we demonstrate that these polymersomes can release contents upon application of external pH stimuli. Particle Tracking experiments demonstrated that polymersomes diffuse faster than uncoated particles in porcine intestine mucus, and biodistribution tests displayed encouraging results towards more homogeneous local drug-delivery, helping bioavailability as well as therapeutic efects. More studies related to the increase of encapsulation efficiency, and in vivo disease treatment tests should be promoted. Although we believe that combining the advantages of polymersome carrier, and tunning the membrane composition, this mucus-penetrating carrier we propose may provide as a new platform for mucosal drug delivery.

Orientador: Luiz Claudio Di Stasi / Resumo: A Doença Inflamatória Intestinal (DII) é uma doença inflamatória crônica e idiopática do intestino que inclui duas doenças distintas: a Doença de Crohn e a Retocolite Ulcerativa. Os pacientes acometidos pela DII podem sofrer de dor abdominal, diarreia e de outros sintomas socialmente inaceitáveis que comprometem sua qualidade de vida. Embora exista uma grande quantidade de fármacos destinados ao tratamento da DII, fatores como o alto custo de aquisição, os efeitos colaterais e o fato de uma parte dos pacientes não responderem inicialmente ao tratamento, têm despertado o interesse de pesquisadores na busca de novas abordagens de tratamento para a doença. Uma das alternativas é a utilização de produtos naturais com propriedades antioxidante e/ou imunomoduladora, assim como de produtos que possam modular a microbiota intestinal, prevenindo recidivas ou complementando o tratamento de pacientes acometidos pela DII. Com base nisso, estudos realizados por nosso grupo de pesquisa com a farinha de banana nanica verde (Musa sp AAA) demonstraram que a espécie apresentou um efeito anti-inflamatório intestinal. Considerando a similaridade química, a espécie Musa sp AAB (banana prata) foi selecionada para a realização do presente estudo. As bananas são ricas em fibras, amido resistente e fenóis, além de apresentarem alto valor nutricional por serem excelentes fontes de potássio, cálcio, fósforo e vitaminas A, B e C. De forma geral, as bananas apresentam atividades antidiarreica, antiulcero... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Inflammatory bowel disease (IBD) is a chronic and idiopathic inflammation of gastrointestinal tract that comprises two major disorders: Crohn's Disease and Ulcerative Colitis. Patients affected by IBD may suffer abdominal pain, diarrhea and other socially unacceptable symptoms that compromise their quality of life. Although there are a large number of drugs for the treatment of IBD, factors such as the high cost of acquisition, side effects and the fact that many patients do not respond initially to the available treatment, have aroused the interest of researchers to evaluate new therapeutic approaches to disease. One of these alternatives is the use of natural products with antioxidant and/or immunomodulatory properties, as well as products which can modulate the intestinal microbiota, preventing relapses or complementing patient treatments. Based on this, our research group conducted studies with green dwarf banana flour (Musa sp AAA) and demonstrated its intestinal anti-inflammatory effect. Bananas are rich in fiber, resistant starch and phenols, and have high nutritional value as they are excellent sources of potassium, calcium, phosphorus and vitamins A, B and C. Generally, bananas present antidiarrheal, antiulcerogenic, antimicrobial, hypoglycemic, antihypertensive, antihypertensive and diuretic activities. Indeed, Musa sp AAA variety increased the production of SCFAs probably because they produce prebiotic effects due to the presence of fibers and resistant starch in i... (Complete abstract click electronic access below) / Mestre

Submitted by LETICIA VILMA DOS SANTOS VIEIRA null (leticiavieir@hotmail.com) on 2017-09-22T15:22:13Z No. of bitstreams: 1 DISSERTAÇÃO_Letícia Vilma dos Santos Vieira.pdf: 2517417 bytes, checksum: 934c0060d04d2bb79afa7cb1c1f7b10a (MD5) / Approved for entry into archive by Monique Sasaki (sayumi_sasaki@hotmail.com) on 2017-09-27T18:54:34Z (GMT) No. of bitstreams: 1 vieira_lvs_me_araca.pdf: 2517417 bytes, checksum: 934c0060d04d2bb79afa7cb1c1f7b10a (MD5) / Made available in DSpace on 2017-09-27T18:54:34Z (GMT). No. of bitstreams: 1 vieira_lvs_me_araca.pdf: 2517417 bytes, checksum: 934c0060d04d2bb79afa7cb1c1f7b10a (MD5) Previous issue date: 2017-08-07 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Na inflamação alérgica, a histamina desencadeia papel crucial na indução de sintomas, tais como vasodilatação, broncoconstrição e produção de muco. O objetivo deste estudo foi investigar os efeitos da histamina na inflamação e no remodelamento das vias aéreas, avaliando para tanto a produção de muco e colágeno em modelo murino de inflamação pulmonar. Camundongos Balb/c machos de 20-25g foram estimulados, por via intratraqueal, com histamina em diferentes concentrações (10, 50 e 100 µM) e avaliados após 6, 24 e 48 horas. A partir dos dados resultantes do ensaio dose-resposta, foi realizado tratamento farmacológico, onde animais foram separados em 5 grupos (6 camundongos por grupo): Grupo 1 (PBS), controle não estimulado; Grupo 2 (Histamina), controle estimulado; Grupo 3 (Histamina + Loratadina); Grupo 4 (Histamina + Dexametasona) e Grupo 5 (Histamina + Dexametasona e Loratadina). Analisamos a migração de leucócitos no lavado broncoalveolar (LBA) e no tecido pulmonar. As alterações estruturais no tecido pulmonar e na traqueia foram avaliadas por análise histopatológica, bem como a produção de muco e deposição de colágeno usando Alcian blue/Periodic Acid Shiff e Tricômio de Masson, respectivamente. O sobrenadante do LBA e o tecido pulmonar foram coletados para quantificar os níveis SCF e CCL3 por ELISA de captura. A expressão gênica de Muc5ac, Gob-5, Col1a2 e receptores de histamina foi avaliada por RT-PCR em tempo real. Nossos resultados demonstram que a histamina induz inflamação das vias aéreas, com presença de infiltrado leucocitário no LBA e no tecido pulmonar. Além disso, os animais estimulados com histamina demonstraram aumento significativo na expressão gênica de Muc5ac, Gob-5 e Col1a2 no tecido pulmonar, produção SCF e CCL3 no LBA e pulmão, bem como apresentaram alterações estruturais na traqueia e no tecido pulmonar, tais como infiltrado leucocitário, presença de células caliciformes, produção de muco e depósito de colágeno. O pré-tratamento com dexametasona (DEX) inibiu a migração leucocitária no LBA e tecido pulmonar, e também diminuiu a expressão gênica de Muc5ac no tecido pulmonar, diminuiu a produção de SCF e CCL3 no LBA e pulmão, bem como reduziu a produção de muco e a deposição de colágeno no pulmão. Já o pré-tratamento com loratadina (LOR), bloqueador de H1, inibiu parcialmente a migração celular no LBA, mas não no tecido pulmonar, enquanto que a associação farmacológica entre DEX e LOR diminuiu significativamente a migração leucocitária tanto no LBA como no tecido pulmonar. Com base nos dados acima, sugere-se que a histamina induz inflamação das vias aéreas, promovendo a migração de leucócitos possivelmente através da produção de SCF e CCL3, bem como provoca alterações estruturais na traqueia e no tecido pulmonar, tais como produção de muco, deposição de colágeno, e esses efeitos tem a participação dos receptores H1 e H4. / In allergic inflammation, histamine exerts a crucial role in the induction of symptoms, such as vasodilation, bronchoconstriction and mucus production. The aim of this study was to investigate the effects of histamine in inflammation and airway remodeling, evaluating the mucus production and collagen in a murine model of pulmonary inflammation. Male Balb/c mice of 20-25g were challenged by intratracheal instillation of histamine at different concentrations (10, 50 and 100 μM) and evaluated after 6, 24 and 48 hours. From the data resulting from the dose-response assay, pharmacological treatment was performed, and animals were separated into 5 groups (6 mice per group): Group 1 (PBS), non-challenged control; Group 2 (Histamine), challenged control; Group 3 (Histamine + Loratadine); Group 4 (Histamine + Dexamethasone) and Group 5 (Histamine + Dexamethasone and Loratadine). We analyzed the recruitment of leukocytes in bronchoalveolar lavage (BAL) and lung tissue. Structural changes in lung tissue and trachea were assessed by histopathological analysis, as well as mucus production and collagen deposition using Alcian blue/Periodic Acid Shiff and Masson's Trichrome, respectively. BAL supernatant and lung tissue were collected for SCF and CCL3 levels quantification by capture ELISA. The gene expression of Muc5ac, Gob-5, Col1a2, and histamine receptors was evaluated by RT-PCR real time. Our results demonstrated that histamine induces airway inflammation, with presence of leukocyte infiltrate in BAL and lung tissue. In addition, histamine-challenged animals demonstrated a significant increase in the gene expression of Muc5ac, Gob-5 and Col1a2 in lung tissue, SCF and CCL3 production in BAL and lung, as well as structural changes in the trachea and lung tissue, such as leukocyte infiltrate, presence of goblet cell, mucus production and collagen deposition around the airways. Dexamethasone pre-treatment (DEX) inhibited leukocyte recruitment in BAL and lung tissue, decreased gene expression of Muc5ac in lung tissue, decreases SCF and CCL3 production in BAL and lung, as well as mucus production and collagen deposition in the lung. Already pre-treatment with loratadine (LOR), an H1 blocker, partially inhibited cell migration in BAL, but not in lung tissue, whereas the pharmacological association between DEX and LOR significantly reduced leukocyte recruitment in both the BAL and the lung tissue. Putting the above data together, we suggest that histamine induces airway inflammation, promoting the recruitment of leukocytes possibly through the production of SCF and CCL3, as well as causes structural changes in the trachea and lung tissue, such as mucus production, collagen deposition, and these effects might be mediated by H1 and H4 receptors.

INTRODUÇÃO: A insuficiência respiratória acomete grande parte dos pacientes oncológicos levando a altos índices de mortalidade. A ventilação não invasiva (VNI) pode auxiliar seu manejo, mas seus efeitos ainda são pouco conhecidos sobre os mecanismos de defesa pulmonar. OBJETIVOS: Observar o efeito da VNI com máscara facial usando-se geradores de fluxo com pressão positiva contínua (CPAP) e ventilador microprocessado no modo pressão de suporte + pressão positiva ao final da expiração (PSV + PEEP), a fim de verificar impacto nas propriedades viscoelásticas do muco respiratório e o conforto proporcionado ao paciente. MÉTODOS: A VNI foi instalada após diagnóstico de insuficiência respiratória em dezenove pacientes, admitidos nas unidades de tratamento intensivo do Hospital A. C. Camargo, sendo nove submetidos ao CPAP e dez com PSV + PEEP. Foram colhidos antes e após uma hora de VNI: os dados clínicos, secreção nasal, gasometria, e o grau de conforto através de uma escala visual. As propriedades físicas do muco (transportabilidade in vitro, adesividade e wettabilidade ou hidrofobicidade) foram avaliadas respectivamente no palato de rã, máquina da tosse e ângulo de contato. RESULTADOS: Os grupos eram homogêneos entre si em relação à idade, sexo, tipo e estadiamento do tumor e SAPS II. Em relação às propriedades físicas do muco, houve um aumento da transportabilidade in vitro do muco nasal com o sistema PSV + PEEP (p = 0,04) e um aumento na wettabilidade no grupo CPAP (p = 0,06). Os dois sistemas foram eficazes em melhorar significativamente os sinais vitais, a PaO2/FiO2, o padrão e o conforto respiratório e em evitar a intubação traqueal nas primeiras 24 horas (p < 0,05). Entretanto, independentemente do tipo de sistema de VNI usado, foram encontrados altos índices de intubação endotraqueal e mortalidade no seguimento destes pacientes. CONCLUSÃO: As propriedades físicas do muco (transportabilidade in vitro e wettabilidade) se alteraram após uma hora de uso da VNI e parecem ser dependentes da temperatura e umidificação dentro da máscara. A VNI mostrou-se útil em reverter a insuficiência respiratória em pacientes selecionados, ou pelo menos em trazer conforto para pacientes hipoxêmicos que a princípio recusam a intubação endotraqueal / INTRODUCTION: Respiratory failure is a common situation among cancer patients leading to high rates of mortality. Noninvasive ventilation (NIV) can help its management, but its effects are still unknown regarding the pulmonary defense mechanisms. OBJECTIVES: Observe the effect of NIV with facial mask using a flow generator with continuous positive pressure (CPAP) and standard intensive care unit ventilator using pressure support ventilation + positive end expiratory pressure (PSV + PEEP), to verify impact on the physical properties of respiratory mucus and the comfort provided to the patient. METHODS: NIV was started after diagnosis of respiratory failure in nineteen patients, admitted in the intensive care unit of the A. C. Camargo Hospital. Nine patients were submitted to CPAP and ten to PSV + PEEP. Nasal mucus, blood gases, and the degree of comfort through a visual scale were accessed before and after one hour. The physical properties of nasal mucus (transportabilility in vitro, adhesivity and wettability or hydrofobicity) were evaluated respectively by frog palate, cough machine and contact angle. RESULTS: Groups had similar characteristics about age, sex, tumor and SAPS II score. Regarding the physical properties of the mucus, there was an increase in mucus transportability (by the frog palate model) with the system PSV + PEEP (p = 0.04) and an increase in the contact angle in the CPAP groupo (p = 0.06). The two systems were effective in improving the vital signs, the PaO2/FiO2, the respiratory pattern and comfort and avoiding endotracheal intubation in the first 24 hours (p < 0.05). However, regardless of the type of NIV system used, high rates of endotracheal intubation and mortality were found. CONCLUSION: The physical properties of the mucus (transportability in vitro and wettability) changed after an hour of use of the NIV as a result of temperature and humidification into the mask. NIV was useful in reversing the respiratory failure in selected patients, or at least in bringing comfort for those who refuse endotracheal intubation

O tabagismo é um problema mundial de saúde pública e é considerado a principal causa de morte evitável no mundo associado com câncer de pulmão, doença pulmonar obstrutiva crônica e infarto agudo do miocárdio. O tabagismo induz alterações morfológicas e funcionais no sistema respiratório. O transporte mucociliar (TMC) é um dos principais mecanismos de defesa do sistema respiratório que pode ser alterado com a fumaça e outros produtos do cigarro. O objetivo desse estudo foi avaliar os efeitos do tabagismo e da cessação do tabagismo no TMC nasal, nas propriedades do muco e sobre marcadores inflamatórios. Trinta e três indivíduos tabagistas foram incluídos no estudo após concordância com o termo de consentimento livre e esclarecido. O recrutamento de voluntários foi realizado na Faculdade de Medicina da Universidade de São Paulo (FMUSP) e no Ambulatório de Cessação do Tabagismo da Disciplina de Pneumologia do Hospital das Clínicas da FMUSP. As variáveis desfecho foram o TMC nasal analisado por meio do teste de trânsito da sacarina, as propriedades do muco por meio do ângulo de contato e da transportabilidade da tosse por alto fluxo e a quantificação de células inflamatórias e concentração de interleucinas (IL)-6 e IL-8 em lavado nasal. Vinte cessadores (idade média: 51 anos, 9 do sexo masculino) foram avaliados no tempo basal do estudo, 1o mês, 3o mês e 12o mês de cessação do tabagismo e 13 tabagistas (média de idade: 52 anos, 6 do sexo masculino) foram avaliados no tempo basal e 12 meses após o basal. As características demográficas, hábito tabágico inicial e morbidades de tabagistas e de cessadores foram similares. No tempo basal do estudo, os tabagistas e cessadores apresentaram disfunção do TMC nasal (17,9 ± 10,1 min e 17,4 ± 7,7 min, respectivamente, p=0,880). A cessação do tabagismo induziu melhora significativa do TMC nasal no 1o mês, 3º mês e 12o mês em 63%, 76% e 85% dos indivíduos, respectivamente. Somente aos 12 meses, foi possível observar melhora na transportabilidade do muco por alto fluxo (~ 23%), porém com aumento do número de macrófagos (2x) em lavado nasal. Não observamos alterações no ângulo de contato do muco e nas concentrações de citocinas em lavado nasal. Concluímos que a cessação do tabagismo induz melhora rápida no TMC nasal, porém melhora nas propriedades do muco foi observada somente após 12 meses de cessação do tabagismo / Smoking is a health problem in the world. It is considered a main cause of preventable death and is associated with lung cancer, chronic obstructive pulmonary disease and myocardium infarction. Smoking induces morphological and functional changes in the respiratory system. Mucociliary clearance (MCC) is one of the main defense mechanisms of the respiratory system that can be affected by smoke and other cigarette products. The aim of this study was to assess the effects of smoking and smoking cessation on nasal MCC, mucus properties and inflammatory biomarkers. Thirty three smokers were included in this study after agreement with the written informed consent. Subject´s recruitment was performed at Faculdade de Medicina da Universidade de São Paulo (FMUSP) and Ambulatório de Cessação do Tabagismo da Disciplina de Pneumologia do Hospital das Clínicas da FMUSP. The outcome variables were nasal MCC evaluated by saccharin transit test, mucus properties using contact angle and mucus transportability by high airflow and quantification of inflammatory cells number and interleukin (IL)-6 and IL-8 in the nasal lavage fluid. Twenty volunteers in the smoking cessation program (mean age: 51 years, 9 male) were assessed at baseline, month 1, month 3 and month 12 after of the smoking cessation and 13 smokers (mean age: 52 years, 6 male) were assessed at baseline and 12 months after baseline. Demographic characteristics, smoking history and morbidities were similar between the two groups. At baseline, smokers showed impaired nasal MCC (17.9 ± 10.1 min and 17.4 ± 7.7 min, respectively, p=0.880). Smoking cessation significantly improved nasal MCC at 1 month, 3 months and 12 months in 63%, 76% and 85% of the subjects, respectively. Only after 12 months of smoking cessation, improvement in mucus transportability by high airflow (~ 23%) was observed, however, with increased number of macrophages (2-fold) in nasal lavage fluid. No changes were observed in mucus contact angle and cytokines concentrations in nasal lavage fluid. We concluded that smoking cessation induces rapid improvement in nasal MCC, however, improvement in mucus properties were observed only after 12 months of smoking cessation

Une grande part des muqueuses à l’intérieur du corps humain sont recouvertes de cils qui, par leurs mouvements coordonnés, conduisent à une circulation de la couche de fluide nappant la muqueuse. Dans le cas de la paroi interne des bronches, ce processus permet l’évacuation des impuretés inspirées à l’extérieur de l’appareil respiratoire.Dans cette thèse, nous nous intéressons aux effets du ou des cils sur le fluide, en nous plaçant à l’échelle du cil, et on considère pour cela les équations de Stokes incompressible. Due à la finesse du cil, une simulation directe demanderait un raffinement important du maillage au voisinage du cil, pour un maillage qui évoluerait à chaque pas de temps. Cette approche étant trop onéreuse en terme de coûts de calculs, nous avons considéré l’asymptotique d’un diamètre du cil tendant vers 0 et d’une vitesse qui tend vers l’infini : le cil est modélisé par un Dirac linéique de forces en terme source. Nous avons montré qu’il était possible de remplacer ce Dirac linéique par une somme de Dirac ponctuels distribués le long du cil. Ainsi, nous nous sommes ramenés, par linéarité, à étudier le problème de Stokes avec en terme source une force ponctuelle. Si les calculs sont ainsi simplifiés (et leurs coûts réduits), le problème final est lui plus singulier, ce qui motive une analyse numérique fine et l’élaboration d’une nouvelle méthode de résolution.Nous avons d’abord étudié une version scalaire de ce problème : le problème de Poisson avec une masse de Dirac en second membre. La solution exacte étant singulière, la solution éléments finis est à définir avec précaution. La convergence de la méthode étant dégradée dans ce cas-là, par rapport à celle dans le cas régulier, nous nous sommes intéressés à des estimations locales. Nous avons démontré une convergence quasi-optimale en norme Hs (s ě 1) sur un sous-domaine qui exclut la singularité. Des résultats analogues ont été obtenus dans le cas du problème de Stokes.Pour palier les problèmes liés à une mauvais convergence sur l’ensemble du domaine, nous avons élaboré une méthode pour résoudre des problème elliptiques avec une masse de Dirac ou une force ponctuelle en terme source. Basée sur celle des éléments finis standard, elle s’appuie sur la connaissance explicite de la singularité de la solution exacte. Une fois données la position de chacun des cils et leur paramétrisation, notre méthode rend possible la simulation directe en 3d d’un très grand nombre de cils. Nous l’avons donc appliquée au cas du transport mucociliaire dans les poumons. Cet outil numérique nous donne accès à des informations que l’on ne peut avoir par l’expérience, et permet de simuler des cas pathologiques comme par exemple une distribution éparse des cils. / Numerous mucous membranes inside the human body are covered with cilia which, by their coordinated movements, lead to a circulation of the layer of fluid coating the mucous membrane, which allows, for example, in the case of the internal wall of the bronchi, the evacuation of the impurities inspired outside the respiratory system.In this thesis, we integrate the effects of the cilia on the fluid, at the scale of the cilium. For this, we consider the incompressible Stokes equations. Due to the very small thickness of the cilia, the direct computation would request a time-varying mesh grading around the cilia. To avoid too prohibitive computational costs, we consider the asymptotic of a zero diameter cilium with an infinite velocity: the cilium is modelled by a lineic Dirac of force in source term. In order to ease the computations, the lineic Dirac of forces can be approached by a sum of punctual Dirac masses distributed along the cilium. Thus, by linearity, we have switched our initial problem with the Stokes problem with a punctual force in source term. Thus, we simplify the computations, but the final problem is more singular than the initial problem. The loss of regularity involves a deeper numerical analysis and the development of a new method to solve the problem.We have first studied a scalar version of this problem: Poisson problem with a Dirac right-hand side. The exact solution is singular, therefore the finite element solution has to be defined with caution. In this case, the convergence is not as good as in the regular case, and thus we focused on local error estimates. We have proved a quasi-optimal convergence in H1-norm (s ď 1) on a sub-domain which does not contain the singularity. Similar results have been shown for the Stokes problem too.In order to recover an optimal convergence on the whole domain, we have developped a numerical method to solve elliptic problems with a Dirac mass or a punctual force in source term. It is based on the standard finite element method and the explicit knowl- edge of the singularity of the exact solution. Given the positions of the cilia and their parametrisations, this method permits to compute in 3d a very high number of cilia. We have applied this to the study of the mucociliary transport in the lung. This numerical tool gives us information we do not have with the experimentations and pathologies can be computed and studied by this way, like for example a small number of cilia.

Dans le tractus gastro-intestinal, l'adhésion des bactéries commensales à l’épithélium permet leur maintien, ce qui aide à contrôler l’implantation de germes indésirables par des mécanismes de concurrence (effets nutritionnels, sites spécifiques d'adhésion ...). Bien que le rôle de la couche du mucus (principalement composée de glycoprotéines à haut poids moléculaire, appelées mucines) recouvrant la muqueuse soit connu et décrit depuis de nombreuses années, notamment pour sa fonction de barrière protectrice, l'intérêt pour décrypter les mécanismes précis d’interaction(s) avec le microbiote (bactéries commensales, pathogènes ou probiotiques) n’a que récemment émergé. Dans ce cadre, l'objectif de cette thèse, menée en collaboration entre le Laboratoire d’Ingénierie des Systèmes Biologiques et des Procédés de Toulouse et le Laboratoire d’Analyse et d’Architecture des Systèmes de Toulouse, est de caractériser in vitro le comportement muco-adhésif de Lactococcus lactis, le modèle des bactéries lactiques, en utilisant des approches de quantification multi-échelles (du niveau moléculaire à l’échelle multicellulaire) sur un large panel de souches naturelles et recombinantes. Une attention particulière est accordée au rôle des mucines, en utilisant le modèle PGM (mucine gastrique de porc ou « Pig Gastric Mucin »).La première partie du travail a porté sur la quantification à l'échelle de la cellule unique des interactions entre L. lactis et une surface abiotique (polystyrène) recouverte de PGM, en utilisant la microscopie à force atomique (AFM). La faisabilité de la méthode a tout d'abord été démontrée sur la souche modèle L. lactis ssp. cremoris MG1820. La couche de PGM a été caractérisée en utilisant des méthodes analytiques complémentaires (AFM, XPS - spectroscopie de photoélectrons induits par rayons X, QCM-D - Microbalance à Quartz à mesure de Dissipation...). En parallèle, les bactéries L. lactis ont été immobilisées sur la pointe AFM et utilisées comme « sonde de force », en considérant la souche naturelle IBB477 (L. lactis ssp. cremoris), d’origine laitière et présentant une forte persistance dans le tractus digestif du rat lors d’essais réalisés in vivo (collaboration avec l’Institut de Biochimie et de Biophysique de Varsovie, Pologne). Comparé aux conditions contrôle (i.e., surface de polystyrène sans PGM), les niveaux de force d'adhésion enregistrés entre L. lactis et PGM sont inférieurs, ceci en raison des répulsions électrostatiques, hydrophiles et stériques s’établissant entre la couche de PGM et la paroi cellulaire. La forme des courbes représentant l’évolution de la force au retrait en fonction de la distance est également différente. Une analyse détaillée souligne la contribution, conjointe et différente selon les souches testées, d’événements (i) non adhésifs, (ii) adhésifs non spécifiques (interactions électrostatiques, hydrophobes, de van der Waals) et (iii) adhésifs spécifiques (liaison de type ligand/récepteur). La contribution spécifique a ensuite été explorée plus finement en termes de constantes cinétiques d’association et de dissociation. Nous avons, par ailleurs, poursuivi notre exploitation de la biodiversité naturelle chez les lactocoques en étudiant la souche TIL448 (L. lactis ssp. lactis) d’origine végétale, en collaboration avec l’Institut MICALIS de Jouy-en-Josas. Nous avons ainsi démontré, pour la première fois chez L. lactis, le rôle combiné des protéines à domaine(s) MUB (« Mucus-Binding ») et des pili, à travers l'analyse approfondie des données AFM (force d'adhésion, répartition des événements adhésifs spécifiques/non spécifiques, distances d'interaction...). Le rôle des pili a été confirmé sur des souches recombinantes piliées (L. lactis ssp. lactis IL1403), toujours en partenariat avec l’Institut MICALIS de Jouy-en-Josas. En parallèle, en collaboration avec l’Unité de Glycobiologie Structurale et Fonctionnelle de Villeneuve d'Ascq, nous avons cherché à identifier les O-glycannes de PGM (fractions neutre et acide), impliqués dans le processus d'interaction avec la surface bactérienne. Pour confirmer l’ensemble des résultats obtenus à l'échelle de la cellule unique et en mode statique par AFM (effet anti-adhésif de PGM, comportement muco-adhésif différent selon les souches de L. lactis), la deuxième partie du travail a été consacrée à des expérimentations à l’échelle de l’ensemble de la population bactérienne, en conditions dynamiques (QCM-D, chambre à écoulement cisaillé). Nous avons évalué par QCM-D chez les souches IBB477 et MG1820 les propriétés viscoélastiques des dépôts bactériens, en relation avec le comportement bio-adhésif vis-à-vis de la couche de PGM. Les données obtenues par AFM et chambre à écoulement cisaillé sur ces mêmes souches ont été confrontées pour accéder plus finement au mode d’interaction avec PGM (densité de liaisons sur la surface bactérienne). Enfin, nous avons évalué chez IL1403 l’effet des pili sur la dynamique de détachement et d’orientation sous cisaillement contrôlé.En conclusion, la combinaison des échelles d'observation et d’analyse, aussi bien au niveau de la cellule unique qu’à celui de l’ensemble de la population bactérienne, nous permet désormais de disposer de nouvelles connaissances sur les mécanismes diversifiés d'interaction entre L. lactis et PGM, visant à une meilleure compréhension des fonctionnalités de cette bactérie au niveau du tractus gastro-intestinal / In the gastrointestinal tract, adhesion of commensal bacteria to epithelial cells allows their retention, which helps to control the implementation of unwanted germs through mechanisms of competition (nutritional effects, specific sites of adhesion ...). Indeed, bacterial adhesion to the intestinal epithelium seems to be important for the balance of intestinal microbiota. Although the role of the mucus layer lining the mucosa, which is mainly composed of large glycoproteins termed mucins, is known and described for many years, particularly for its protective barrier function, the interest for unraveling precise mechanisms of interaction with bacteria (commensal, pathogens or probiotics) has just recently emerged. In this framework, the aim of the PhD thesis was to characterize in vitro muco-adhesive behavior of Lactococcus lactis, the model of Lactic Acid Bacteria, using multi-scale approaches (from molecular to multicellular levels) on a large set of natural and recombinant strains. A particular attention was paid to the role of mucins, using the PGM model (Pig Gastric Mucin).The first part of the work was focused on the quantification at nanoscale of interactions between L. lactis and adsorbed PGM, using AFM. The feasibility of the method was first demonstrated on the reference strain MG1820. PGM coating was characterized using a complementary set of analytical methods (AFM, XPS, quartz crystal microbalance with dissipation monitoring…). In parallel, L. lactis cells were immobilized onto the AFM tip and used as a living force probe, considering the natural strain IBB477 (L. lactis subsp. cremoris), isolated from Polish artisanal dairy products and previously shown to display in vivo retention in the rat gut (collaboration with the Institute of Biochemistry and Biophysics of Warsaw, Poland). Compared to control conditions (i.e., no PGM coating), adhesion force levels recorded for PGM were lower, due to the interplay of electrostatic, hydrophilic and steric repulsions. The shape of retraction force-distance curves for L. lactis/PGM interactions was also different. The detailed analysis of curve shape highlighted the contribution of non-adhesive, non-specific (electrostatic, hydrophobic, van der Waals interactions) and specific adhesive events (ligand/receptor bonding), depending on the strain under study. Specific forces were analyzed in terms of dissociation/association kinetic constants.We then explored the natural biodiversity among lactococci by studying the natural strain of L. lactis (subsp. lactis) TIL448 from plant origin, in collaboration with MICALIS (Jouy-en-Josas). We demonstrated, for the first time for L. lactis, the combined role played by “MUB-like” domain-containing protein and pili, through the thorough analysis of AFM data (adhesion force, repartition of specific/non-specific adhesive events and distances of interaction…). The role of pili was also confirmed with recombinant piliated strains (L. lactis subsp. lactis IL1403), in partnership with MICALIS (Jouy-en-Josas). In parallel, in collaboration with the “Unité de Glycobiologie Structurale et Fonctionnelle de Villeneuve d'Ascq”, a first attempt was done to identify the O-glycans of PGM (neutral and acid fractions), involved in interactions with the bacterial surface.To confirm these results achieved at single-cell scale and under static mode by AFM (anti-adhesive of PGM, different muco-adhesive properties among several strains of L. lactis), the second part of the work was devoted to experiments at multicellular scale under dynamic conditions (quartz crystal microbalance with dissipation monitoring – QCM-D, shear stress flow chamber). We evaluated by QCM-D, for MG1820 and IBB477 strains, the viscoelastic properties of the cell layers, in relation with the bio-adhesive behavior towards PGM. The data obtained by AFM and shear stress flow chamber were combined to access more precisely to the interaction mode with PGM (density of bonds over the cell surface). Finally, using the recombinant piliated strain (IL1403), we focused on the effect of pili on detachment and re-orientation dynamics under shear flow

Problématique : Les connaissances théoriques et pratiques au sujet de la mise en charge immédiate d’implants non jumelés chez les édentés sont limitées. Objectifs : Cette étude avait pour but de : (1) déterminer le taux de survie implantaire de 2 implants non jumelés supportant une prothèse totale mandibulaire suite à une mise en charge immédiate, (2) évaluer les changements des niveaux osseux et de stabilité implantaire survenus sur ces 2 implants durant une période de 4 mois et les comparer à un implant témoin, et (3) décrire les complications cliniques associées à ce mode de mise en charge. Méthodologie : Chez 18 individus édentés (âge moyen de 62±7 ans), cette étude de phase I avec un design pré/post a évalué les résultats cliniques suivant la mise en charge immédiate (<48 heures) de 2 implants non jumelés par une prothèse totale mandibulaire. À l’aide de radiographies périapicales, de sondages osseux et d’analyses de la fréquence en résonnance, les niveaux osseux péri-implantaires (en mm) et les niveaux de stabilité implantairte (en ISQ) de ces 2 implants insérés dans la région parasymphysaire ont été évalués à la chirurgie (T0) et au suivi de 4 mois (T1). Un implant non submergé et sans mise en charge inséré dans la région de la symphyse mandibulaire a été utilisé comme témoin. Les données ont été analysées avec des modèles mixtes linéaires, la méthode de Tukey ajustée, l’analyse de variance de Friedman et des tests de rang signés de Wilcoxon. Résultats : De T0 à T1, 3 implants mis en charge immédiatement ont échoué chez 2 patients. Le taux de survie implantaire obtenu était donc de 91,7% (33/36) et, par patient, de 88,9% (16/18). Aucun implant témoin n’a échoué. Les changements osseux documentés radiologiquement et par sondage autour des implants mis en charge immédiatement étaient, respectivement, de -0,2 ± 0,3 mm et de -0,5 ± 0,6 mm. Les pertes d’os de support implantaire n’ont pas été démontrées statistiquement différentes entre les implants avec mise en charge immédiate et les témoins. Les niveaux moyens de stabilité implantaire ont augmenté de 5 ISQ indépendamment de la mise en charge. Les niveaux moyens d’ISQ n’ont pas été démontrés statistiquement différents entre les implants avec mise en charge immédiate et les témoins à T0 ou T1. Cinq des 18 patients n’ont expérimenté aucune complication clinique, alors que 9 en ont eu au moins deux. Hormis les échecs implantaires, aucune de ces complications n’a entraîné de changements au protocole. Conclusion : Les résultats à court terme suggèrent que : (1) le taux de survie implantaire suite au protocole immédiat est similaire à ceux rapportés lors d’un protocole de mise en charge conventionnel (2) les changements d’os de support implantaire et de stabilité ne sont pas différents comparativement à ceux d’un implant témoin, (3) un niveau élevé d’expérience clinique et chirurgicale est requis pour effectuer les procédures et pour gérer les complications associées. Ces résultats préliminaires devraient être confirmés dans une étude clinique de phase II. / Problem: There is a theoretical and practice knowledge gap in regard to immediate loading of unsplinted implants in edentulous individuals. Objectives: This study aimed to: (1) determine the implant survival rate of 2 unsplinted implants supporting a mandibular complete overdenture following an immediate loading protocol, (2) assess marginal bone level and implant stability changes of these immediately loaded implants in a 4-month period and compared them to a control implant, and (3) describe the clinical complications associated with this mode of loading. Methods: In 18 edentate individuals (mean age 62±7 years), this phase-I trial with a pre/post design assessed the clinical outcomes following the immediate loading (<48 hours) of 2 unsplinted implants supporting a mandibular overdenture. Periapical radiograhs, bone probing measurements and resonance frequency analysis were used to assess marginal bone losses and implant stability changes of these two implants inserted in the mandibular parasymphyseal region, at baseline (T0) and 4-month follow-up (T1). A non-submerged and non-loaded implant inserted in the mandibular symphysis was used as a control. Data were analyzed using linear mixed models, adjusted Tukey tests, Friedman’s analysis of variance and Wilcoxon signed-ranks tests. Results: From T0 to T1, 3 immediately loaded implants failed in 2 patients. This resulted in an implant survival rate of 91.7% (33/36), and, per patient, of 88.9% (16/18). No control implant failed. The marginal bone losses around loaded implants were -0.2 ± 0.3 mm for radiographic measurements and -0.5 ± 0.6 mm for probing measurements. There was no statistically significant difference between immediately loaded and control implants in regard to the supporting marginal bone losses. The implant stability levels increased of 5 ISQ units regardless of loading. There was no statistically significant difference in the mean ISQ levels between immediately loaded and control implants at T0 or T1. Five out of 18 patients experienced no clinical complication, while 9 of them had at least two. Apart from implant failures, none of these clinical complications led to changes in the protocol. Conclusion: The short-term results suggest that: (1) the implant survival rate following the immediate protocol is similar to those reported during a conventional loading protocol, (2) marginal implant supporting bone and stability changes are not different compared to those of a control implant, (3) a high level of clinical and surgical experience is required to perform the procedures and to manage the associated complications. These preliminary results should be confirmed in a phase II clinical trial.

Problématique : La majorité des études publiées sur la réhabilitation par mise en charge immédiate de deux implants non jumelés avec une prothèse totale mandibulaire de recouvrement n’ont rapporté que des mesures cliniques objectives et très peu ont évalué les mesures centrées sur le patient, et ce, avec des erreurs de mesure. Aucune étude n’a évalué les attentes des patients vis-à-vis d'un tel protocole. Objectifs : Évaluer les attentes, le niveau de satisfaction ainsi que la qualité de vie reliée à la santé bucco-dentaire des édentés complets suite à un protocole de mise en charge immédiate. Méthodologie : Cet essai clinique de phase 1 utilise un design pré-post afin d’évaluer les mesures centrées sur le patient. Dix-huit individus, complètement édentés et âgés en moyenne de 62,39 ± 7,65 ans, ont reçu une prothèse totale mandibulaire de recouvrement sur deux implants non jumelés suite à un protocole de mise en charge immédiate, conjointement à une prothèse totale conventionnelle maxillaire. Un instrument adapté pour mesurer leurs attentes à l’aide d’échelles visuelles analogues, le questionnaire « McGill Denture Satisfaction Instrument » ainsi que le questionnaire OHIP-20 ont été remis aux patients avant de procéder aux traitements (T0), ainsi qu’aux rendez-vous de suivi à 2 semaines (T1), 1 mois (T2) et 4 mois (T3). De plus, l’inventaire de personnalité révisé (NÉO PI-R) ainsi qu’un questionnaire sociodémographique ont été remplis par les participants. Les « change scores » ont été calculés puis des tests non paramétriques et des analyses de variances en mesures répétées suivies de comparaisons par paires ont été utilisés afin d’analyser les données recueillies. La taille d’effet a été estimée. Résultats : Les participants avaient différentes attentes par rapport à la mise en charge immédiate. Certains s’attendaient à un effet positif à court terme par rapport à leur apparence esthétique (83,3 %) et à leur vie sociale (55,7 %), alors que d’autres avaient des craintes envers leur confort (5,6 %), leur habileté à mastiquer (11,1 %) et à nettoyer leur prothèse inférieure (11,1 %). À 4 mois, le protocole de mise en charge immédiate avait rencontré la majorité des attentes des patients par rapport à l’esthétique (94.4 %), la mastication (83.3 %), la phonétique (61.1 %), le confort (94.4 %), l’hygiène (88.9 %) et leur vie sociale (88.9 %). Une amélioration statistiquement significative de la satisfaction en générale, du confort, de l’esthétique, de la stabilité de la prothèse inférieure et de l’habileté à mastiquer a été notée à 2 semaines (p<0,001). Également, les comparaisons par paires ont révélé une diminution statistiquement significative du score total de l’OHIP-20 (p < 0,001) de même que la majorité des domaines de l’OHIP (p < 0.01), sauf pour l’handicap social qui n’a diminué significativement qu’après 1 mois (p = 0.01). Ces changements (pour la satisfaction et la qualité de vie) sont restés stables au cours des suivis subséquents. Indépendamment des traits de personnalité et des variables sociodémographiques, le protocole immédiat a satisfait 94,4 % des participants et a amélioré leur qualité de vie avec une large magnitude d’effet (d = 1.9; p < 0.001). Bien que deux patients aient perdu des implants au cours du traitement, 100 % des participants étaient d’accord pour recommander cette procédure à leurs pairs. Conclusions: Le protocole de mise en charge immédiate semble satisfaire les patients quelles que soient leurs attentes. Le protocole MCI peut améliorer, à court terme, la qualité de vie des patients totalement édentés. Les résultats prometteurs de la phase 1 devraient être corroborés lors de la 2e phase de cette étude. / Statement of problem: Most published research on the immediate loading of a mandibular 2-implant overdenture has only reported on clinical outcomes. Few studies have evaluated patients centered-outcomes but with measurement errors. Consequently, there is a need to assess clinical and patient-reported outcomes in this regard. Objectives: To examine patients’ level of satisfaction, expectations and quality of life with regard to the implants’ immediate loading protocol in edentate individuals. Methods: This phase-I trial used a pre-post design to assess patient-centered outcomes in 18 edentate individuals (mean age 62.39 ± 7.65 years) who have received a 2-implant (unsplinted) mandibular overdenture through an immediate loading protocol. The McGill Denture Satisfaction Instrument, a VAS instrument assessing expectations and the OHIP-20 questionnaire were used to evaluate patients’ outcomes at baseline, 2 weeks, 1 and 4 months. Socio-demographic and personality trait data were obtained using the Revised NEO Personality Inventory and a self-administered questionnaire. Change scores were calculated and non-parametrical tests were used to analyse the data. Repeated measures ANOVAs and paired t-tests were also conducted, and effect size was estimated. Results: The participants had a wide range of expectations regarding the immediate loading protocol. Expectations included short-term positive impact on aesthetics (83.3 %) and social life (55.7 %). Other expectations included negative effects on comfort (5.6%), the ability to chew (11.1 %) and to clean their lower denture (11.1%). At 4 months, the immediate loading protocol had met most patients’ expectations regarding aesthetics (94.4%), the ability to chew (83.3%), ability to speak (61.1%), comfort (94.4%), the ability to clean their lower denture (88.9%) and their social life (88.9%). The statistical analysis showed an overall satisfaction increase with a median change score of 66 (range=7-98), 68 (range=7- 95), and 70 (range= 17- 99), at 2 weeks, 1 month and 4 months respectively. There was a statistically significant improvement in overall satisfaction, comfort, perceived aesthetics, stability of the overdenture, and ability to chew at 2 weeks (p < 0,001). Pairwise comparison (within-subjects comparisons) revealed significant decreases in total OHIP scores (P < 0.001), as well as fewer functional limitations, physical pain, psychological discomfort, physical disability, psychological disability, and handicap (P < 0.01) from baseline to 2 weeks, 1 month and 4 months follow-up. Social disability score decrease significantly only after 1 month follow-up (p = 0.01). These changes remained stable during subsequent follow-ups. The protocol satisfied 94.4% of the participants and improve their quality of life with an estimated effect size of 1.9 (p < 0.001), regardless of socio-demographic and personality profiles. There was 100% agreement among patients on recommending this procedure to their peers. Conclusions: Immediate loading of two unsplinted implants with a mandibular overdenture seemed to fulfill patients’ satisfaction regardless of their expectations and may improve oral health-related quality life of edentate individuals in short-term. Encouraging results from phase I should be confirmed and approved in Phase II clinical trials.