O uso da estimulação elétrica nervosa transcutânea na disfunção temporomandibular

JUSTIFICATIVA E OBJETIVOS: A disfunção temporomandibular (DTM) é um termo que descreve um grupo de doenças que afetam funcionalmente o aparelho mastigatório, particularmente a musculatura mastigatória e a articulação temporomandibular (ATM). Tem etiologias múltiplas e tratamentos específicos, entre os quais a estimulação elétrica nervosa transcutânea (TENS). O objetivo deste artigo é o de revisar a literatura científica sobre o uso da TENS em pacientes com DTM. CONTEÚDO: Estudos epidemiológicos mostram que aproximadamente 75% da população apresentam algum sinal de DTM, enquanto 33% possuem ao menos um sintoma. Sempre que possível deve-se tratar a causa da dor, caso não se consiga estabelecer a sua etiologia, inicia-se com procedimentos menos invasivos e reversíveis, especialmente nos casos de dor e disfunção muscular. A terapia com TENS consiste na administração de corrente elétrica na superfície cutânea, de modo a relaxar os músculos hiperativos e promover o alívio da dor. CONCLUSÃO: Embora existam controvérsias quanto ao uso de TENS para o controle da dor crônica, seu uso na dor muscular mastigatória continua relevante. Entretanto, é fundamental o diagnóstico preciso para evitar uso inadequado. São necessários ainda estudos randomizados controlados que incluam amostras selecionadas para homogeneizar o uso de TENS em pacientes com DTM.

Atividade muscular da mastigação na anquilose temporomandibular

Purpose: due to the presence of major masticatory dysfunction in patients with temporomandibular joint (TMJ) ankylosis, this study analyzed mouth opening and EMG activity of masticatory muscles in order to detect changes in these parameters after surgical release of mandible ankylosis. Method: in 7 patients with temporomandibular ankylosis, between 7 and 30 years (median = 9 years), the distance was measured as interincisal maximum active (DIMA) and we recorded the electromyographic activity (EMG) of masseter and temporal muscles during voluntary isometric contraction (VIC) and chewing, comparing the data before and after surgery using the Wilcoxon test. Results: higher values were observed for DIMA after surgery (p=0.0277), the asymmetry index showed no difference between the two evaluated periods for both studied muscles, the values of the EMG during VIC decreased after surgery for the right (p=0.0179) and left (p=0.0179) masseter but not for the temporal muscle, there were no changes in EMG values for the studied muscles during mastication. Conclusion: the surgical release of TMJ ankylosis resulted in an increase of mouth opening and decreased amplitude of action potentials generated during maximum isometric voluntary contraction of the masseter muscle on both sides, this did not change the asymmetry index of the masseter and temporal as well as the electromyographic activity of the temporal muscle bilaterally during isometric contraction and masseter and temporal muscles during mastication.

Utilidade clínica da angiografia coronariana em pacientes com disfunção ventricular esquerda

FUNDAMENTO: A realização da angiografia coronariana na insuficiência cardíaca sem etiologia definida é frequentemente justificada para avaliação diagnóstica de cardiopatia isquêmica. Porém, o benefício clínico dessa estratégia não é conhecido. OBJETIVO: Avaliar a prevalência de cardiopatia isquêmica mediante critérios angiográficos em pacientes com insuficiência cardíaca e fração de ejeção reduzida sem etiologia, assim como o seu impacto na decisão terapêutica. MÉTODOS: Foram avaliados pacientes ambulatoriais consecutivos com insuficiência cardíaca e disfunção sistólica, que tiveram a angiografia coronariana indicada para esclarecimento etiológico da cardiopatia, no período de 1º de janeiro de 2009 a 31 de dezembro de 2010. Os pacientes com diagnóstico de doença arterial coronariana, sorologia positiva para doença de Chagas, cardiopatia congênita, valvopatia grave ou pacientes submetidos a transplante cardíaco foram excluídos da análise. A amostra foi dividida em dois grupos conforme a indicação do cateterismo. Grupo-1: Sintomáticos em razão de angina ou insuficiência cardíaca refratária. Grupo-2: Presença de > 2 fatores de risco para doença arterial coronariana RESULTADOS: Cento e sete pacientes foram incluídos para análise, sendo 51 (47,7%) pacientes pertencentes ao Grupo-1 e 56 (52,3%), ao Grupo-2. A prevalência de cardiopatia isquêmica foi de 9,3% (10 pacientes), e todos pertenciam ao Grupo-1 (p = 0,0001). Durante o seguimento, apenas 4 (3,7%) tiveram indicação de revascularização miocárdica; 3 (2,8%) pacientes apresentaram complicações relacionadas ao procedimento. CONCLUSÃO: Em nosso trabalho, a realização da angiografia coronariana em pacientes com insuficiência cardíaca e disfunção sistólica sem etiologia, apesar de embasada pelas atuais diretrizes, não evidenciou benefício quando indicada apenas pela presença de fatores de risco para doença arterial coronariana.

Topology Verification for Isosurface Extraction

The broad goals of verifiable visualization rely on correct algorithmic implementations. We extend a framework for verification of isosurfacing implementations to check topological properties. Specifically, we use stratified Morse theory and digital topology to design algorithms which verify topological invariants. Our extended framework reveals unexpected behavior and coding mistakes in popular publicly available isosurface codes.

Interactive quadrangulation with reeb atlases and connectivity textures

Creating high-quality quad meshes from triangulated surfaces is a highly nontrivial task that necessitates consideration of various application specific metrics of quality. In our work, we follow the premise that automatic reconstruction techniques may not generate outputs meeting all the subjective quality expectations of the user. Instead, we put the user at the center of the process by providing a flexible, interactive approach to quadrangulation design. By combining scalar field topology and combinatorial connectivity techniques, we present a new framework, following a coarse to fine design philosophy, which allows for explicit control of the subjective quality criteria on the output quad mesh, at interactive rates. Our quadrangulation framework uses the new notion of Reeb atlas editing, to define with a small amount of interactions a coarse quadrangulation of the model, capturing the main features of the shape, with user prescribed extraordinary vertices and alignment. Fine grain tuning is easily achieved with the notion of connectivity texturing, which allows for additional extraordinary vertices specification and explicit feature alignment, to capture the high-frequency geometries. Experiments demonstrate the interactivity and flexibility of our approach, as well as its ability to generate quad meshes of arbitrary resolution with high-quality statistics, while meeting the user's own subjective requirements.

Obstrução de vias lacrimais associada ao tratamento radioiodoterápico de carcinoma de tireoide

OBJETIVO: Descrever uma série de pacientes portadores de obstrução do sistema lacrimal associado à radioiodoterapia para tratamento de carcinoma de tireoide, revisar os dados clínicos e a resposta ao tratamento cirúrgico desta rara complicação. MÉTODOS: Foi realizada uma análise retrospectiva dos achados oftalmológicos de pacientes com histórico de carcinoma de tireoide previamente submetidos à tireoidectomia e à RIT que foram encaminhados para cirurgia de vias lacrimais. RESULTADOS: Dezessete pacientes com carcinoma de tireoide tratados com tireoidectomia e RIT apresentaram obstrução do ducto nasolacrimal sintomática após período médio de 13,2 meses do tratamento do câncer. Onze pacientes tiveram epífora bilateral, 8 com mucocele de saco lacrimal. A idade dos pacientes variou entre 30 e 80 anos, sendo 10 com idade menor ou igual a 49 anos. A dose cumulativa média de radioiodo administrada foi de 571 mCi (variação entre 200-1200 mCi). Sintomas de obstrução nasal e aumento de glândulas salivares ocorreram em 53% dos pacientes. Todos os pacientes foram submetidos à dacriocistorrinostomia. Observou-se ainda que nos 3 pacientes mais jovens houve maior sangramento intraoperatótio e dilatação de saco lacrimal. A resolução completa da epífora e da dacriocistite ocorreu em 82,4%, e foi parcial em 17,6% (3 pacientes mantiveram queixa unilateral após a correção da obstrução bilateralmente). O seguimento médio foi de 6 meses (intervalo: 2-24 meses). CONCLUSÕES: Alta dose cumulativa de radioiodo, disfunção nasal e de glândulas salivares estão associadas à obstrução das vias lacrimais. Observa-se uma maior porcentagem de pacientes mais jovens apresentando quadro de dacriocistite quando comparado à dacrioestenose idiopática. A absorção de iodo radioativo pela mucosa do ducto nasolacrimal com subsequente inflamação, edema e fibrose parece ter relação direta com a obstrução do ducto nasolacrimal. O conhecimento desta complicação é importante para o estudo e abordagem correta desses pacientes.

Advances in primary immunodeficiency diseases in Latin America: epidemiology, research, and perspectives

Primary immunodeficiencies (PIDs) are genetic disorders of the immune system comprising many different phenotypes. Although previously considered rare, recent advances in their clinical, epidemiological, and molecular definitions are revealing how much we still need to learn about them. For example, geographical and ethnic variations as well as the impact of certain practices influence their frequency and presentation, making it necessary to consider their study in terms of regions. The Latin American Society for Immunodeficiencies was established as an organization dedicated to provide scientific support for basic and clinical research and to develop tools and educational resources to promote awareness in the medical community. Initiatives such as these are positively influencing the way PIDs are tackled in these countries, as shown by recent reports and publications. This paper provides a historical compilation and a current view of the many issues faced by scientists studying these diseases in these countries, highlighting the diverse scientific contributions and offering a promising perspective for the further developments in this field in Latin America.

A scheme for synchronizing clocks connected by a packet communication network

Consider a communication system in which a transmitter equipment sends fixed-size packets of data at a uniform rate to a receiver equipment. Consider also that these equipments are connected by a packet-switched network, which introduces a random delay to each packet. Here we propose an adaptive clock recovery scheme able of synchronizing the frequencies and the phases of these devices, within specified limits of precision. This scheme for achieving frequency and phase synchronization is based on measurements of the packet arrival times at the receiver, which are used to control the dynamics of a digital phase-locked loop. The scheme performance is evaluated via numerical simulations performed by using realistic parameter values. (C) 2011 Elsevier By. All rights reserved.

Predicted preoperative maximal static respiratory pressures in adult cardiac surgeries: evaluation of two formulas

Objectives: Cardiac surgery (CC) determines systemic and pulmonary changes that require special care. What motivated several studies conducted in healthy subjects to assess muscle strength were the awareness of the importance of respiratory muscle dysfunction in the development of respiratory failure. These studies used maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) values. This study examined the concordance between the values predicted by the equations proposed by Black & Hyatt and Neder, and the measured values in cardiac surgery (CS) patients. Methods: Data were collected from preoperative evaluation forms. The Lin coefficient and Bland-Altman plots were used for statistical concordance analysis. The multiple linear regression and analysis of variance (ANOVA) were used to produce new formulas. Results: There were weak correlations of 0.22 and 0.19 in the MIP analysis and of 0.10 and 0.32 in the MEP analysis, for the formulas of Black & Hyatt and Neder, respectively. The ANOVA for both MIP and MEP were significant (P <0.0001), and the following formulas were developed: MIP = 88.82 - (0.51 x age) + (19.86 x gender), and MEP = 91.36 -(030 x age) + (29.92 x gender). Conclusions: The Black and Hyatt and Neder formulas predict highly discrepant values of MIP and MEP and should not be used to identify muscle weakness in CS patients.

A new local variety of Crepidomanes minutum (Hymenophyllaceae) in the Mascarene Archipelago (Indian Ocean) and a new record for Mauritius

Crepidomanes minutum (Hymenophyllaceae) is here identified and recorded from Mauritius for the first time. The Mauritian specimens, in addition to those of La Reunion observed at low to middle elevations, are easily distinguished from populations observed outside the Mascarene Archipelago by their dwarfed size and rarity of the stipe proliferation that usually characterizes this species. We thus describe a new variety in this species for the Mascarene Islands.

Chronic Stress Improves the Myocardial Function without Altering L-type Ca+2 Channel Activity in Rats

Background: Chronic stress is associated with cardiac remodeling; however the mechanisms have yet to be clarified. Objective: The purpose of this study was test the hypothesis that chronic stress promotes cardiac dysfunction associated to L-type calcium Ca2+ channel activity depression. Methods: Thirty-day-old male Wistar rats (70 - 100 g) were distributed into two groups: control (C) and chronic stress (St). The stress was consistently maintained at immobilization during 15 weeks, 5 times per week, 1h per day. The cardiac function was evaluated by left ventricular performance through echocardiography and by ventricular isolated papillary muscle. The myocardial papillary muscle activity was assessed at baseline conditions and with inotropic maneuvers such as: post-rest contraction and increases in extracellular Ca2+ concentration, in presence or absence of specific blockers L-type calcium channels. Results: The stress was characterized for adrenal glands hypertrophy, increase of systemic corticosterone level and arterial hypertension. The chronic stress provided left ventricular hypertrophy. The left ventricular and baseline myocardial function did not change with chronic stress. However, it improved the response of the papillary muscle in relation to positive inotropic stimulation. This function improvement was not associated with the L-type Ca2+ channel. Conclusion: Chronic stress produced cardiac hypertrophy; however, in the study of papillary muscle, the positive inotropic maneuvers potentiated cardiac function in stressed rats, without involvement of L-type Ca2+ channel. Thus, the responsible mechanisms remain unclear with respect to Ca2+ influx alterations. (Arq Bras Cardiol 2012;99(4):907-914)

Chk1 phosphorylation of Metnase enhances DNA repair but inhibits replication fork restart

Chk1 both arrests replication forks and enhances repair of DNA damage by phosphorylating downstream effectors. Although there has been a concerted effort to identify effectors of Chk1 activity, underlying mechanisms of effector action are still being identified. Metnase (also called SETMAR) is a SET and transposase domain protein that promotes both DNA double-strand break (DSB) repair and restart of stalled replication forks. In this study, we show that Metnase is phosphorylated only on Ser495 (S495) in vivo in response to DNA damage by ionizing radiation. Chk1 is the major mediator of this phosphorylation event. We had previously shown that wild-type (wt) Metnase associates with chromatin near DSBs and methylates histone H3 Lys36. Here we show that a Ser495Ala (S495A) Metnase mutant, which is not phosphorylated by Chk1, is defective in DSB-induced chromatin association. The S495A mutant also fails to enhance repair of an induced DSB when compared with wt Metnase. Interestingly, the S495A mutant demonstrated increased restart of stalled replication forks compared with wt Metnase. Thus, phosphorylation of Metnase S495 differentiates between these two functions, enhancing DSB repair and repressing replication fork restart. In summary, these data lend insight into the mechanism by which Chk1 enhances repair of DNA damage while at the same time repressing stalled replication fork restart. Oncogene (2012) 31, 4245-4254; doi:10.1038/onc.2011.586; published online 9 January 2012

Evaluation of the effects of hyperbaric oxygen therapy for spinal cord lesion in correlation with the moment of intervention

Study design: Experimental, controlled, animal study. Objectives: To evaluate the functional effect of hyperbaric oxygen therapy administered shortly, one day after, and no intervention (control) in standardized experimental spinal cord lesions in Wistar rats. Setting: Sao Paulo, Brazil. Methods: In all, 30 Wistar rats with spinal cord lesions were divided into three groups: one group was submitted to hyperbaric oxygen therapy beginning half an hour after the lesion and with a total of 10 one-hour sessions, one session per day, at 2 atm; the second received the same treatment, but beginning on the day after the lesion; and the third received no treatment (control). The Basso, Beattie and Bresnahan scales were used for functional evaluation on the second day after the lesion and then weekly, until being killed 1 month later. Results: There were no significant differences between the groups in the functional analysis on the second day after the lesion. There was no functional difference comparing Groups 1 and 2 (treated shortly after or one day after) in any evaluation moment. On the 7th day, as well as on the 21st and 28th postoperative days, the evaluation showed that Groups 1 and 2 performed significantly better than the control group (receiving no therapy). Conclusion: Hyperbaric chamber therapy is beneficial in the functional recovery of spinal cord lesions in rats, if it is first administered just after spinal cord injury or within 24 h. Spinal Cord (2012) 50, 502-506; doi: 10.1038/sc.2012.16; published online 6 March 2012