Although it is suggested that a dysfunctional stress response system may be associated with posttraumatic stress disorder (PTSD) the neurobiological underpinnings are not well established, especially in children. There is also limited research on how treatment for PTSD may impact associated physiology. Respiratory sinus arrhythmia (RSA) is a reliable measure of parasympathetic stress reactivity, and both resting RSA and RSA reactivity are physiological indicators related to children’s emotion functioning and regulation. The present study examined if pretreatment resting RSA levels predicted RSA reactivity at pretreatment and the trajectory of resting RSA, RSA reactivity, resting heart period (HP) and HP reactivity after Cognitive Behavioral Therapy (CBT). Forty-nine children who experienced at least 1 traumatic event and presented with PTSD symptoms were assessed for psychological measures, RSA and HP at pretreatment, post treatment and a 3-month follow up. At pretreatment, lower resting RSA was associated with increased RSA withdrawal. Analysis with repeated measures mixed models indicated that lower resting pretreatment RSA and lower RSA withdrawal increased during CBT, and individuals with higher resting RSA and RSA withdrawal decreased during CBT, so that those at the extreme ends of higher and lower indices converged in the middle by the end of treatment. These data suggest an optimal moderate range for resting RSA and RSA reactivity. There were also significant gender differences on RSA reactivity after CBT. Lower pretreatment resting RSA predicted lower resting heart period (higher heart rate) across all time points but did not change with CBT. Pretreatment resting RSA did not predict HP reactivity. Post hoc analysis also revealed that PTSD symptoms were significantly reduced after CBT but this change was not associated with pretreatment resting RSA levels. Overall, these results suggest that children may change physiologically after CBT and the direction of the changes may depend on initial resting RSA levels. / acase@tulane.edu

Perseverative cognition is the repetitive cognitive representation of a stressor, which includes the concepts of worry and rumination. These thoughts delay post-stress cardiovascular recovery, which may lead to an increased risk for cardiovascular disease. This may be due to the negative emotional content of perseverative cognition or because it involves cognitive effort. The aim of this study was to identify the unique influences of negative emotional content and cognitive effort during recovery. Participants (N = 120) were given a demanding task purportedly as a measure of intelligence and then given false negative feedback. Immediately following, participants engaged in one of four recovery instruction conditions: think about task performance, perform a cognitive load task, watch a distracting video, or remain quietly seated. EKG, impedance cardiography, and blood pressure were recorded throughout. Perseverative cognition and cognitive load both resulted in significantly less heart rate recovery compared to the distracting video. Higher test motivation and anxiety were related to more blunted reactivity and delayed recovery of respiratory sinus arrhythmia. Reduced recovery during perseverative cognition and cognitive effort indicate that the cognitive load produced by perseveration is the pernicious component that explains its link to increased risk for cardiovascular disease. Further, the relationship between motivation/anxiety and blunted reactivity and recovery suggest effort may be important in the link between perseverative cognition and cardiovascular disease.

Dental caries and periodontal disease are the major causes for tooth loss. While dental caries commonly involve the posterior teeth in both jaws, the teeth most commonly lost due to periodontal problems are the first and second molars in the maxilla. As a consequence, the upper posterior jaw is frequently edentulous. Implant therapy today is a predictable treatment modality for prosthetic reconstruction of edentulous patient. Insufficient amounts of bone, due to atrophy following loss of teeth or due to the presence of the maxillary sinus, can make it impossible to insert implants in the posterior maxilla. During the 1970s and 1980s, Tatum, Boyne and James and Wood and Moore first described maxillary sinus floor augmentation whereby, after the creation of a lateral access point, autologous bone grafts are inserted to increase crestal bone height and to create the necessary conditions for the insertion of implants. This surgical procedure requires a two-stage approach and a double surgical site: first, bone is harvested from a donor site and transplanted to the recipient site; then, after a proper healing period of between 4 to 6 months, the implants are inserted. This kind of bone reconstruction, even if well documented, has its limitations, not least in the creation of two different surgical sites and the consequent increased risk of morbidity. In 2004, Lundgren et al. described a new, simplified technique for the elevation of the sinus floor. The authors showed that by lifting the sinus membrane an empty space was created in which blood clot formations resulted in the establishment of new bone. The implants were placed simultaneously to function as “tent poles”, thus maintaining the sinus membrane in a raised position during the subsequent healing period. An essential prerequisite of this technique is to obtain optimal primary implant stability from the residual bone in the sinus floor. An extremely resorbed maxillary sinus floor, with, for example, less than 2-3 mm of poor quality residual bone, could impair implant insertion. The aims of the present research project were (i) to evaluate the donor site morbidity and the acceptance level of patients when a bone graft is harvested from the anterior iliac crest, (ii) to evaluate implant stability, new bone formation inside the maxillary sinus and marginal bone resorption around the implants in long term follow up when maxillary sinus floor augmentation is performed through sinus membrane elevation and without the addition of any grafting material, (iii) to investigate new bone formation inside the maxillary sinus, in experimental design, using a resorbable space-maker device in order to maintain elevation of the sinus membrane where there is too little bone to insert implants with good primary stability. In Paper I, 70 consecutively treated patients were retrospectively evaluated in terms of postoperative donor site morbidity and donor site complications. With regard to donor site morbidity, 74% of patients were free of pain within 3 weeks, whereas 26% had a prolonged period of pain lasting from a few weeks to several months. For 11% of patients there was still some pain or discomfort 2 years after the grafting surgery. Nevertheless, patients acceptance was high and treatment significantly improved oral function, facial appearance, and recreation/social activities and resulted in an overall improvement in the quality of life of formerly edentulous patients. In Paper I and III, some differently shaped space-making devices were tested on primates (tufted capuchin - Cebus apella) in two experimental models aimed at evaluating whether a two-stage procedure for sinus floor augmentation could benefit from the use of a space-making device to increase the bone volume and enable later implant installation with good primary stability, without the use of any grafting material. An histological examination of the specimens showed that it is possible to obtain bone formation in contact with both the Schneiderian membrane and the device. In most cases the device was displaced. The process of bone formation indicated that this technique is potentially useful for two-stage sinus floor augmentation. The lack of device stability within the sinus requires further improvement in space-makers if predictable bone augmentation is to be achieved. In Paper IV, a total of 84 patients were subjected to 96 membrane elevation procedures and the simultaneous placement of 239 implants. Changes of intra-sinus and marginal bone height in relation to the implants were measured in intraoral radiographs carried out during insertion after 6 months of healing, after 6 months of loading and then annually. Computerised tomography was performed pre-surgically and 6 months post-surgically. Resonance frequency analysis measurements were performed at the time of implant placement, at abutment connection and after 6 months of loading. The implant follow-up period ranged from a minimum of one to a maximum of 6 years after implant loading. All implants were stable after 6 months of healing. A total of three implants were lost during the follow-up period giving a survival rate of 98.7%. Radiography demonstrated an average of 5.3 ± 2.1 mm of intra-sinus new bone formation after 6 months of healing. RFA measurements showed adequate primary stability (implant stability quotient 67.4 ± 6.1) and small changes over time. In conclusion, harvesting bone from the iliac crest could result in temporary donor site morbidity, but in 11% of patients pain or discomfort was still present up to 2 years after surgery. However, patient satisfaction was good despite this slow or incomplete recovery, as showed by the quality of life questionnaire. Maxillary sinus membrane elevation without the use of bone grafts or bone substitutes results in predictable bone formation both in animal design, where the sinus membrane is supported by a resorbable device, and in clinical conditions, where the membrane is kept in the upper position by dental implants. This new bone formation is accompanied by a high implant survival rate of 98.7% over a follow-up period of up to 6 years. Intra-sinus bone formation remained stable in the long-term follow-up. It is suggested that the secluded compartment allowed bone formation in accordance with the principle of guided tissue regeneration. This technique reduces the risks of morbidity related to bone graft harvesting and eliminates the costs of grafting materials.

This mixed-method study investigated the effects of self-directed physiological monitoring on therapists anxiety. Ten therapists participated in a10-week physiological monitoring training sessions while monitoring respiratory sinus arrhythmia (RSA) and heart rate variability (HRV). The participants completed the state-trait anxiety inventory questionnaire after having a first, sixth, or tenth therapy session with a client. This was designed to monitor their state anxiety while working with clients. A series of paired sampled t-tests was conducted to assess changes in HRV, RSA, trait anxiety, and state anxiety. One significant result was found: the RSA of the therapist increased significantly. Correlations existed between the HRV of the therapist increasing and the trait anxiety of the therapist decreasing through RSA training sessions although they were not significant at the .05 level.

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Atrial fibrillation and atrial flutter are the most common sustained arrhythmias, however their underlying mechanisms are yet to be fully characterised. This thesis evaluates the electrophysiological and electroanatomical substrate of the atria in patients with these arrhythmias. Experimental studies of atrial fibrillation have demonstrated effective refractory period shortening and conduction slowing as a result of atrial fibrillation giving rise to the concept that "atrial fibrillation begets atrial fibrillation". However, cardioversion to prevent electrical remodelling does not prevent progression of disease, suggesting a "second factor" drives this process. Chapters 2 and 3 evaluate the atrial substrate in patients with "lone" atrial fibrillation. These studies demonstrate such patients, remote from an arrhythmic event, have prolongation of atrial refractoriness, conduction slowing, impairment of sinus node function, site-specific conduction delay, lower voltage and a greater proportion of complex electrograms compared to reference patients. These abnormalities constitute the "second factor" critical to the development and progression of atrial fibrillation. Atrial flutter has a close inter-relationship with atrial fibrillation and these rhythms frequently co-exist. Atrial fibrillation often occurs in patients with heart disease known to demonstrate abnormal atrial substrate; whether similar substrate exists in patients with atrial flutter to account for the co-existence of both arrhythmias is unknown. Chapters 4 and 5 evaluate the atrial substrate in patients with atrial flutter, remote from arrhythmia, demonstrating structural abnormalities characterised by loss of myocardial voltage, conduction slowing and impaired sinus node function, without reduction in atrial refractoriness. These findings implicate a common substrate as the cause of the close inter-relationship between these arrhythmias. There is a frequent association between atrial arrhythmia and sinus node disease for which several mechanisms have been postulated. In addition, there is a size discrepancy between the anatomical sinus node and the much larger functional sinus node complex. little is known about normal sinus node function or the effects of remodelling due to arrhythmia. Chapter 6 characterises sinus node activation to determine the nature and extent of the functional sinus node complex in patients with and without chronic atrial flutter. The functional sinus node complex demonstrates dynamic shifts in activation with preferential pathways of conduction to atrial myocardium. Patients with atrial flutter demonstrate lesser voltage, longer conduction times along preferential pathways and a smaller functional sinus node complex. These findings provide insights into the function of the human sinus node in health and disease. Sites of complex fractionated atrial electrograms and highest dominant frequency are implicated in maintaining atrial fibrillation. Chapter 7 determines the minimum recording duration that accurately characterises electrogram complexity and activation frequency. An electrogram duration of 5 seconds is required to accurately identify these sites. Chapter 8 evaluates the relationship between sites of fractionation and high frequency activation during atrial fibrillation. Greater fractionation and higher dominant frequency are seen in persistent atrial fibrillation and left atria. Preferential areas of high dominant frequency are observed in paroxysmal but not persistent atrial fibrillation. Areas of complex fractionated atrial electrograms are found adjacent to sites of high dominant frequency. / Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 2009

Abstract: The role of bacterial biofilms in patients with persistent CRS is of growing concern. The limited efficacy of some medical and surgical treatments for CRS illustrates the need for further progress in this area. The current treatments of chronic rhinosinusitis are concentrated on medical +/- surgical therapy. In this thesis, we consider two methods performed in chronic rhinosinusitis, endoscopic sinus surgery and long term low-dose macrolide therapy, and consider how they can affect bacterial biofilms. The effect of endoscopic sinus surgery on bacterial biofilms and the clinical impact of this condition on CRS patients may be far more profound than we can currently understand. To understand the impact of ESS on bacterial biofilms, we have performed the first prospective study to evaluate the effect of ESS on bacterial biofilms in patients with CRS and patients’ clinical outcomes after 3 months follow-up. We have shown that ESS results in a statistically significant improvement in QoL, subjective and objective outcome measures. In terms of bacterial biofilms, the mean OD630nm of isolates was significantly reduced after 3 months follow-up (p=0.043). No correlations between the reduction of bacterial biofilms with any of the objective, subjective and QoL outcomes were seen in our study. Macrolides have demonstrated their anti-inflamatory effects in the treatment of diffuse panbronchiolitis, asthma, cystis fibrosis and chronic rhinosinusitis. In recent years, there are a number of in vitro studies supporting the anti-biofilm effects of macrolide antibiotics, especially at sub-MICs level. These have shown that macrolides alter the outer membrane, lipopolysaccharide of biomass and inhibit the expression of other bacterial virulence factors which may disrupt the adherence of bacteria to form biofilms. Long term low dose macrolide therapy, therefore, may transform bacterial biofilms from the protected organized form into the plantonic form. In this thesis, we also report the first in vivo efficacy of long term low dose macrolides on bacterial biofilms in patients with CRS. Patients receiving oral macrolide showed significant improvements in subjective, objective and QoL scores following a 12 week course. Nasal swabs were taken from CRS patients at the first visit and 3 months after macrolide therapy. Using the microtiter biofilm assay, these swabs showed a reduction in the mean OD630nm of isolates in 8/12 patients. While it is well-known that bacterial biofilms are established in CRS patients, the relationship between the improvement of clinical symptoms and the severity of bacterial biofilm is less clear.

Diss. (sammanfattning) Uppsala : Univ., 2001. / Härtill 5 uppsatser.

Orientador: Frederico Canato Martinho / Banca: Márcia Carneiro Valera Garakis / Banca: Cláudio Antonio Talge Carvalho / Banca: Luiz Alexandre Thomaz / Banca: Maria Rachel Figueiredo Penalva Monteiro / Resumo: O conhecimento da posição topográfica dos ápices dentários em relação às corticais ósseas externas e estruturas anatômicas é de importância para a endodontia, sobretudo quando da instituição de técnicas com sobreinstrumentação. A tomografia computadorizada de feixe cônico (TCFC) permite uma análise tridimensional da localização do ápice radicular, estimando os riscos em relação a essas estruturas. Os objetivos desta pesquisa foram: a) aferir a medida linear entre os ápices radiculares de dentes posteriores e canino superiores e o seio maxilar e entre os ápices de dentes posteriores inferiores e o canal mandibular, relacionando os achados com gênero e idade; b) comparar as medições realizadas em tomografias entre ápices e estruturas anatômicas, com as realizadas em radiografias panorâmicas; c) verificar a proximidade dos ápices radiculares dos dentes superiores com a respectiva cortical óssea externa adjacente e dos ápices radiculares dos dentes inferiores com as corticais ósseas externas vestibular e lingual; d) verificar a ocorrência de fenestrações apicais, em todos os grupos dentais e e) classificar riscos de sobreinstrumentação baseando-se nas medidas lineares entre ápices radiculares e estruturas anatômicas/ corticais ósseas externas. Foram selecionados 800 TCFCs e 200 radiografias panorâmicas obtidas de pacientes com indicações diversas. Na TCFC, foram encontradas médias entre os ápices radiculares e o seio maxilar, variando de 0,37mm até 6,22mm, e na mandíbula, entre o... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: It is important to know the topographic position of dental root apices in relation to external cortical bones and adjacent anatomical structures for endodontics, mainly regarding the use of over-instrumentation techniques. Cone beam computed tomography (CBCT) allows for analysis of the root apex position and estimation of the risks in relation to these structures. The objectives of this study were: a) to assess the linear measurement between root apices of posterior teeth and upper canine and maxillary sinus as well as between apices of lower posterior teeth and mandibular canal according to gender and age; b) to compare tomographic measurements of apices and anatomical structures to those from panoramic radiographs; c) to verify the proximities of the root apices of upper teeth to corresponding adjacent cortical bones and of lower teeth to buccal and lingual cortical bones; d) to verify the occurrence of apical fenestrations in all dental groups; and e) to assess the risks of overinstrumentation based on linear measurements between root apices and anatomical structures/external cortical bones. A total of 800 tomographs and 200 panoramic radiographs were selected. CBCT images showed mean distances between root apices and maxillary sinus ranging from 0.37mm to 6.22mm and between root apices and mental foramen ranging from 2.81mm to 4.92mm. By comparing the tomographs to panoramic radiographs, over-estimation and sub-estimation were found in the maxillary and mandibular measurements, respectively (P < 0.01). The distances between each root apex and corresponding cortical bone were ranked according to distance, with the majority of the apices located less than 1 mm from the cortical bone in the maxilla and greater than 3mm in the mandible. Higher rates of fenestrations were found in the maxilla, whereas lingual bone plate was more affected in the mandible. ...(Resumo completo, clicar acesso eletrônico abaixo) / Doutor

Disruptive behavior problems are among the most commonly occurring forms of childhood psychopathology and show considerable stability beginning in early childhood. Investigations of the biological underpinnings of behavior problems have revealed that the influences of the parasympathetic branch of the autonomic nervous system on cardiac functions are central to self-regulation. Parasympathetic regulation of heart rate is indexed via respiratory sinus arrhythmia (RSA). Suppression of RSA during challenging emotional and cognitive tasks is associated with better emotional and behavioral functioning in preschoolers. However, the relationship between RSA suppression and preschool social functioning is still unclear. Further, direct relationships between behavior problems and RSA reactivity within command-based play tasks (i.e., child instructed to build 3 towers) with parents and other adults have yet to be examined. The present study experimentally evaluated the relationship between child RSA reactivity and adult (mother vs. staff) commands requiring child compliance during command-based play tasks in children ages 3-8 with and without disruptive behavior disorders (N=43). Child RSA suppression in response to commands was examined as a predictor of child command compliance during experimental play tasks and of general child behavior problems, and was compared across command-based interactions with mothers versus staff. Less RSA suppression in the context of mothers’ play-based commands was associated with more severe behavioral problems (p=.046). In the context of staff play-based commands, more RSA suppression was associated with more severe behavior problems (p=.009), an effect that was significant only among boys (p<.000). Further, greater child RSA suppression predicted greater compliance with mother-given commands (p=.017), but was unrelated to compliance with staff-given commands. The relationship between child RSA suppression and compliance with mother-given commands was moderated by child age, such that the effect of RSA suppression on child compliance was stronger for younger children than older children. Findings suggest that RSA reactivity to social demands, and the functional association between RSA suppression and behavioral compliance, vary by social context (i.e., mother vs. other adult command-givers) and identify child factors (i.e., age, gender) that influence these associations. This work may inform efforts to identify a biomarker of early childhood behavior problems.