Reliability and discriminatory power of methods for dental plaque quantification

OBJECTIVE: This in situ study evaluated the discriminatory power and reliability of methods of dental plaque quantification and the relationship between visual indices (VI) and fluorescence camera (FC) to detect plaque. MATERIAL AND METHODS: Six volunteers used palatal appliances with six bovine enamel blocks presenting different stages of plaque accumulation. The presence of plaque with and without disclosing was assessed using VI. Images were obtained with FC and digital camera in both conditions. The area covered by plaque was assessed. Examinations were done by two independent examiners. Data were analyzed by Kruskal-Wallis and Kappa tests to compare different conditions of samples and to assess the inter-examiner reproducibility. RESULTS: Some methods presented adequate reproducibility. The Turesky index and the assessment of area covered by disclosed plaque in the FC images presented the highest discriminatory powers. CONCLUSION: The Turesky index and images with FC with disclosing present good reliability and discriminatory power in quantifying dental plaque.

Novel inactivating mutations in the GH secretagogue receptor gene in patients with constitutional delay of growth and puberty

Background: A limited number of mutations in the GH secretagogue receptor gene (GHSR) have been described in patients with short stature. Objective: To analyze GHSR in idiopathic short stature (ISS) children including a subgroup of constitutional delay of growth and puberty (CDGP) patients. Subjects and methods: The GHSR coding region was directly sequenced in 96 independent patients with ISS, 31 of them with CDGP, in 150 adults, and in 197 children with normal stature. The pharmacological consequences of GHSR non-synonymous variations were established using in vitro cell-based assays. Results: Five different heterozygous point variations in GHSR were identified (c.-6 G>C, c.251G>T (p.Ser84Ile), c.505G>A (p.Ala169Thr), c.545 T>C (p.Val182Ala), and c.1072G>A (p.Ala358Thr)), all in patients with CDGP. Neither these allelic variants nor any other mutations were found in 694 alleles from controls. Functional studies revealed that two of these variations (p.Ser84Ile and p. Val182Ala) result in a decrease in basal activity that was in part explained by a reduction in cell surface expression. The p.Ser84Ile mutation was also associated with a defect in ghrelin potency. These mutations were identified in two female patients with CDGP (at the age of 13 years, their height SDS were -2.4 and -2.3). Both patients had normal progression of puberty and reached normal adult height (height SDS of -0.7 and -1.4) without treatment. Conclusion: This is the first report of GHSR mutations in patients with CDGP. Our data raise the intriguing possibility that abnormalities in ghrelin receptor function may influence the phenotype of individuals with CDGP.

Constitutional Haploinsufficiency of Tumor Suppressor Genes in Mentally Retarded Patients With Microdeletions in 17p13.1

Chromosome microdeletions or duplications are detected in 10-20% of patients with mental impairment and normal karyotypes. A few cases have been reported of mental impairment with microdeletions comprising tumor suppressor genes. By array-CGH we detected 4 mentally impaired individuals carrying de novo microdeletions sharing an overlapping segment of similar to 180 kb in 17p13.1. This segment encompasses 18 genes, including 3 involved in cancer, namely KCTD11/REN, DLG4/PSD95, and GPS2. Furthermore, in 2 of the patients, the deletions also included TP53, the most frequently inactivated gene in human cancers. The 3 tumor suppressor genes KCTD11, DLG4, and GPS2, in addition to the GABARAP gene, have a known or suspected function in neuronal development and are candidates for causing mental impairment in our patients. Among our 4 patients with deletions in 17p13.1, 3 were part of a Brazilian cohort of 300 mentally retarded individuals, suggesting that this segment may be particularly prone to rearrangements and appears to be an important cause (similar to 1%) of mental retardation. Further, the constitutive deletion of tumor suppressor genes in these patients, particularly TP53, probably confers a significantly increased lifetime risk for cancer and warrants careful oncological surveillance of these patients. Constitutional chromosome deletions containing tumor suppressor genes in patients with mental impairment or congenital abnormalities may represent an important mechanism linking abnormal phenotypes with increased risks of cancer. Copyright (C) 2009 S. Karger AG, Basel

PAIN IN FIBROMYALGIA AND DISCRIMINATIVE POWER OF THE INSTRUMENTS: VISUAL ANALOG SCALE, DOLORIMETRY AND THE MCGILL PAIN QUESTIONNAIRE

Objective: The aim of this study was to verify the discriminative power of the most widely used pain assessment instruments. Methods: The sample consisted of 279 subjects divided into Fibromyalgia Group (FM- 205 patients with fibromyalgia) and Control Group (CG-74 healthy subjects), mean age 49.29 +/- 10.76 years. Only 9 subjects were male, 6 in FM and 3 in CG. FM were outpatients from the Rheumatology Clinic of the University of Sao Paulo - Hospital das Clinicas (HCFMUSP); the CG included people accompanying patients and hospital staff with similar socio-demographic characteristics. Three instruments were used to assess pain: the McGill Pain Questionnaire (MPQ), the Visual Analog Scale (VAS), and the Dolorimetry, to measure pain threshold on tender points (generating the TP index). In order to assess the discriminative power of the instruments, the measurements obtained were submitted to descriptive analysis and inferential analysis using ROC Curve - sensibility (S), specificity (S I) and area under the curve (AUC) - and Contingence tables with Chi-square Test and odds ratio. Significance level was 0.05. Results: Higher sensibility, specificity and area under the curve was obtained by VAS (80%, 80% and 0.864, respectively), followed by Dolorimetry (S 77%, S177% and AUC 0.851), McGill Sensory (S 72%, S167% and AUC 0.765) and McGill Affective (S 69%, S1 67% and AUC 0.753). Conclusions: VAS presented the higher sensibility, specificity and AUC, showing the greatest discriminative power among the instruments. However, these values are considerably similar to those of Dolorimetry.

ON THE COMPOSITE OF THREE IRREDUCIBLE MORPHISMS IN THE FOURTH POWER OF THE RADICAL

We study here the nonzero composite of three irreducible morphisms between indecomposable modules lying in the fourth power of the radical.

Local power of some tests in exponential family nonlinear models

In this paper we obtain asymptotic expansions up to order n(-1/2) for the nonnull distribution functions of the likelihood ratio, Wald, score and gradient test statistics in exponential family nonlinear models (Cordeiro and Paula, 1989), under a sequence of Pitman alternatives. The asymptotic distributions of all four statistics are obtained for testing a subset of regression parameters and for testing the dispersion parameter, thus generalising the results given in Cordeiro et al. (1994) and Ferrari et al. (1997). We also present Monte Carlo simulations in order to compare the finite-sample performance of these tests. (C) 2010 Elsevier B.V. All rights reserved.

Digital control and integration of a 192 MW wind farm with doubly fed induction generator into the Brazilian power system

This paper reports on design of digital control for wind turbines and its relation to the quality of power fed into the Brazilian grid on connecting to it a 192 MW wind farm equipped with doubly fed induction generators. PWM converters are deployed as vector controlled regulated current voltage sources for their rotors, for independent control of both active and reactive power of those generators. Both speed control and active power control strategies are analyzed, in the search for maximum efficiency of conversion of wind kinetic energy into electric power and enhanced quality of delivered power. (C) 2009 Elsevier B.V. All rights reserved.

Central chemoreceptors and neural mechanisms of cardiorespiratory control

The arterial partial pressure (P CO2) of carbon dioxide is virtually constant because of the close match between the metabolic production of this gas and its excretion via breathing. Blood gas homeostasis does not rely solely on changes in lung ventilation, but also to a considerable extent on circulatory adjustments that regulate the transport of CO2 from its sites of production to the lungs. The neural mechanisms that coordinate circulatory and ventilatory changes to achieve blood gas homeostasis are the subject of this review. Emphasis will be placed on the control of sympathetic outflow by central chemoreceptors. High levels of CO2 exert an excitatory effect on sympathetic outflow that is mediated by specialized chemoreceptors such as the neurons located in the retrotrapezoid region. In addition, high CO2 causes an aversive awareness in conscious animals, activating wake-promoting pathways such as the noradrenergic neurons. These neuronal groups, which may also be directly activated by brain acidification, have projections that contribute to the CO2-induced rise in breathing and sympathetic outflow. However, since the level of activity of the retrotrapezoid nucleus is regulated by converging inputs from wake-promoting systems, behavior-specific inputs from higher centers and by chemical drive, the main focus of the present manuscript is to review the contribution of central chemoreceptors to the control of autonomic and respiratory mechanisms.

Calibration of the dietary data obtained from the Brazilian center of the Natural History of HPV Infection in Men study: the HIM Study

The objective of this study was to estimate the regressions calibration for the dietary data that were measured using the quantitative food frequency questionnaire (QFFQ) in the Natural History of HPV Infection in Men: the HIM Study in Brazil. A sample of 98 individuals from the HIM study answered one QFFQ and three 24-hour recalls (24HR) at interviews. The calibration was performed using linear regression analysis in which the 24HR was the dependent variable and the QFFQ was the independent variable. Age, body mass index, physical activity, income and schooling were used as adjustment variables in the models. The geometric means between the 24HR and the calibration-corrected QFFQ were statistically equal. The dispersion graphs between the instruments demonstrate increased correlation after making the correction, although there is greater dispersion of the points with worse explanatory power of the models. Identification of the regressions calibration for the dietary data of the HIM study will make it possible to estimate the effect of the diet on HPV infection, corrected for the measurement error of the QFFQ.

Um enfoque sanitário sobre a demanda judicial de medicamentos

No Brasil, apesar dos avanços da assistência farmacêutica, permanecem falhas na garantia do acesso dos cidadãos aos medicamentos pelo Estado. Nos últimos anos, vem crescendo a reivindicação de medicamentos por parte do cidadão via sistema judiciário. Os objetos dessas solicitações são tanto os medicamentos em falta na rede pública como aqueles ainda não incorporados pelo Sistema Único de Saúde. Este fenômeno pode ser analisado sob diferentes perspectivas, inclusive a sanitária, entendida aqui como os desfechos sobre a saúde dos indivíduos que demandam estes medicamentos. O presente texto busca discutir as principais características das demandas judiciais frente aos seguintes aspectos: o uso racional de medicamentos, o uso de evidências científicas para a indicação terapêutica proposta e o quanto as demandas se justificam diante do conceito de acesso adotado pelo campo da assistência farmacêutica. Ponderações podem ser feitas no sentido de minimizar os riscos à saúde dos demandantes de medicamentos por via judicial, sobretudo quando o objeto da ação são medicamentos não pertencentes às listas de fornecimento público, ou com uso off label, ou desprovidos de registro no país. Considera-se que o Judiciário, a partir do fornecimento de medicamentos, busca garantir a saúde dos demandantes, e assim a dignidade da pessoa humana. Cabe ressaltar que este objetivo só será atingido quando a garantia da saúde estiver associada aos aspectos que certificam a segurança do paciente, inclusive no uso de medicamentos.

Calibração dos dados dietéticos obtidos no centro brasileiro do estudo Natural History of HPV Infection in Men: o Estudo HIM

O objetivo foi estimar as regressões de calibração dos dados dietéticos mensurados pelo questionário quantitativo de freqüência alimentar (QQFA) utilizado no Natural History of HPV Infection in Men: o Estudo HIM. Uma amostra de 98 indivíduos do estudo HIM respondeu, por meio de entrevista, a um QQFA e três recordatórios de 24 horas (R24h). A calibração foi feita por meio de análise de regressão linear, tendo os R24h como variável dependente e o QQFA como variável independente. Idade, índice de massa corporal, atividade física, renda e escolaridade foram utilizadas como variáveis de ajuste nos modelos. As médias geométricas dos R24h e do QQFA corrigido pela calibração são estatisticamente iguais. Os gráficos de dispersão entre os instrumentos demonstraram aumento da correlação após a correção dos dados, porém observa-se maior dispersão dos pontos de acordo com a piora do poder explicativo dos modelos. A identificação das regressões de calibração dos dados dietéticos do estudo HIM permitirá a estimativa do efeito da dieta sobre a infecção por HPV, corrigida pelo erro de medida do QQFA

Influence of Laser Photobiomodulation on Collagen IV During Skeletal Muscle Tissue Remodeling After Injury in Rats

Objective: The aim of the present study was to determine the effect of GaAlAs low-level laser therapy (LLLT) on collagen IV remodeling of the tibialis anterior (TA) muscle in rats after cryolesion. Background: Considerable interest exists in skeletal muscle regeneration in situations such as repair after exercise-induced muscle injury, after muscle transplantation, in muscular dystrophy, exercise-induced muscle injury, and the recovery of strength after atrophy due to disuse. A number of studies have demonstrated the potential of LLLT in facilitating the muscle-healing process; however, no consensus is found in the literature regarding the best laser-irradiation parameters. Methods: Adult male Wistar rats (n = 45) were used and randomly divided into three groups: control (n = 5); nontreated cryolesioned group (n = 20), and LLLT-cryolesioned group (n = 20). The cryolesioned groups were analyzed at 1, 7, 14, and 21 days after the injury procedure. Laser irradiation was performed 3 times per week on the injured region by using the GaAlAs laser (660 nm; beam spot of 0.04 cm(2), output power of 20 mW, power density of 500 mW/cm(2), and energy density of 5 J/cm(2), for 10 sec). The muscles were removed, frozen, cryosectioned, and then stained with hematoxylin-eosin for the visualization of general morphology or used for immunohistochemical analysis of collagen IV. Results: It was demonstrated that LLLT promotes an increase in collagen IV immunolabeling in skeletal muscle in the first 7 days after acute trauma caused by cryoinjury, but does not modify the duration of the tissue-repair process. Even with LLLT, the injured muscle tissue needs similar to 21 days to achieve the same state of organization as that in the noninjured muscle. Conclusion: The collagen IV content is modulated in regenerating skeletal muscle under LLLT, which might be associated with better tissue outcome, although the histologic analysis did not detect tissue improvement in the LLLT group.

Investigation of mast cells in human gingiva following low-intensity laser irradiation

Objective: The aims of the present study were to investigate the effect of low-intensity laser irradiation on the total number of mast cells as well as the percentage of degranulation in human gingiva. Blood vessel dilation was also evaluated. Background Data: It has been proposed that low-intensity laser irradiation can ameliorate pain, swelling, and inflammation. In periodontal tissue, mast cells may influence either the destructive events or the defense mechanism against periodontal disease via secretion of cytokines and through cellular migration to improve the healing process. Mast cells play an important role in the inflammatory process. Methods: Twenty patients with gingival enlargement indicated for gingivectomy were selected. Gingival fragments were obtained from each patient and divided into three different groups before surgery. One fragment was removed without any irradiation. The two others were submitted to punctual irradiation with an energy density of 8 J/cm(2) at an output power of 50 mW at 36 Hz for 36 sec before gingivectomy. Nondegranulated and degranulated mast cells were counted in five areas of the gingival fragment connective tissue. Major and minor diameters of the blood vessels were also measured. Results: Both red and infrared radiation promoted a significant increase in mast cell degranulation compared to controls; however, no statistically significant differences (p > 0.05) were observed between the irradiated groups. No significant differences among the groups were observed regarding blood vessel size. Conclusion: The results suggests that red and infrared wavelengths promote mast cell degranulation in human gingival tissue, although no dilation of blood vessels was observed. The effects of premature degranulation of mast cells in human tissue and the laser radiation protocol applied in this study encourage further investigations to extend these results into clinical practice.

Spatial patterns in the brood combs of Nannotrigona testaceicornis (Hymenoptera: Meliponinae): male clusters

Genetic models of sex and caste determination in eusocial stingless bees suggest specific patterns of male, worker and gyne cell distribution in the brood comb. Conflict between queen and laying workers over male parentage and center-periphery gradients of conditions, such as food and temperature, could also contribute to non-random spatial configuration. We converted the positions of the hexagonal cells in a brood comb to Cartesian coordinates, labeled by sex or caste of the individuals inside. To detect and locate clustered patterns, the mapped brood combs were evaluated by indexes of dispersion (MMC, mean distance of cells of a given category from their centroid) and eccentricity (DMB, distance between this centroid and the overall brood comb centroid) that we developed. After randomizing the labels and recalculating the indexes, we calculated probabilities that the original values had been generated by chance. We created sets of binary brood combs in which males were aggregated, regularly or randomly distributed among females. These stylized maps were used to describe the power of MMC and DMB, and they were applied to evaluate the male distribution in the sampled Nannotrigona testaceicornis brood combs. MMC was very sensitive to slight deviations from a perfectly rounded clump; DMB detected any asymmetry in the location of these compact to fuzzy clusters. Six of the 82 brood combs of N. testaceicornis that we analyzed had more than nine males, distributed according to variations in spatial patterns, as indicated by the two indexes.