Modulation of Immune Response by RAGE and TLR4 Signalling in PBMCs of Diabetic and Non-Diabetic Patients

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Estudo comparativo da inclinação do plano oclusal de modelos para cirurgia ortognática montados em dois tipos de articuladores semi-ajustáveis

Purpose: The aim of this study was to compare occlusal plane angulation measured in two different types of semi-adjustable articulators with that obtained on the lateral cephalometric radiograph. Materials and Methods: 20 patients due to undergo orthognathic surgery had dental casts mounted in two different types of semi-adjustable articulators through face bow transfer from the position of the maxilla and occlusal recording to the mandible. After mounting, the inclination of the occlusal plane in the articulators was measured and compared with the inclination measured at on both articulators and compared with the inclination measured on the lateral cephalometric radiographs and between the articulators themselves. The results obtained werestatistically analyzed. Results: Mean angulation values for the Bio Art (7.55º) and Kavo (-5.70º) articulators differ by 13.25º, which is statistically significant (p=0.00). When individually compared to the lateral cephalometric radiograph (5.075º), the Bio Art articulator showed more similar angulation values, with a difference of 2.475º, while the Kavo articulator presented a difference of 10.775º. Conclusion: Neither of the models of semi-adjustable articulators accurately reproduced the inclination of the maxillary occlusal plane of patients with dentofacial deformities; the difference between the two articulators tested and the lateral cephalometric radiograph was lower for the Bio Art than for the Kavo articulator.

Can an LED-laser hybrid light help to decrease hydrogen peroxide concentration while maintaining effectiveness in teeth bleaching?

The aim of this study was to compare the bleaching efficacy of 35% hydrogen peroxide and 15% hydrogen peroxide with nitrogen-doped titanium dioxide catalysed by an LED-laser hybrid light. We studied 70 patients randomized to two groups. Tooth shade and pulpal sensitivity were registered. Group 1: 15% hydrogen peroxide with nitrogen-doped titanium dioxide. Group 2: 35% hydrogen peroxide. Both groups were activated by an LED-laser light. No significant differences were seen in shade change immediately, one week or one month after treatment (p > 0.05). Differences were seen in pulpal sensitivity (p < 0.05). The use of an LED-laser hybrid light to activate 15% hydrogen peroxide gel with N_TiO2 permits decreasing the peroxide concentration with similar aesthetic results and less pulpal sensitivity than using 35% hydrogen peroxide for bleaching teeth.

The effect of chlorhexidine on plaque index and mutans streptococci in orthodontic patients: A pilot study

Aim: The purpose of this study was to assess chlorhexidine effects on plaque index and salivary levels of mutans streptococci (MS) when used as the immersion solution for removable orthodontic appliances and added to their acrylic resin composition. Methods: Forty-five patients (6 to 12 years old) were randomly assigned into three groups with 15 patients each. Group I (control)—without orthodontic appliances disinfection; Group II—removable orthodontic appliances which had been immersed in 0.12% chlorhexidine digluconate overnight (8 hours), and Group III—orthodontic appliances in which 0.12% chlorhexidine digluconate solution had been incorporated into their resin composition. Saliva was collected for quantification of MS and evaluation of plaque index was performed before and after installation of orthodontic appliance at 0, 2, 4, 6, 8, and 10 weeks. Data were analyzed by using analysis of variance. Results: Number of MS colonies in saliva and plaque index showed no statistically differences among groups at the different periods (p > 0.05). Conclusions: It could be concluded that chlorhexidine incorporation into the acrylic resin of removable orthodontic appliances at 0.12% concentration and immersion of the appliance into 0.12% chlorhexidine solution were not effective in reducing plaque index and the number of MS in saliva.

Pharyngeal airway space cephalometric evaluation in transverse maxillary deficient patients after SARME

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Identificação de funções de transferência de ordem fracionária utilizando como entrada um degrau

Pós-graduação em Engenharia Elétrica - FEIS

Quality of life index in autoimmune bullous dermatosis patients

Background: Autoimmune bullous dermatoses are complex diseases triggered by autoantibodies action against epidermal antigens or the dermoepidermal junction. Blisters and vesicles that evolve with erosion areas characterize them. Although rare, they present high morbidity, affecting the quality of life of patients.Objectives: To assess the magnitude of autoimmune bullous dermatoses on life quality of patients treated in a public university service in countryside of Brazil. Methods: This cross-sectional study was based on an inquiry with autoimmune bullous dermatoses patients assisted at outpatient university referral service. Elements related to quality of life were evaluated by the Dermatology Life Quality Index, as well as clinical and demographic data. Results: The study evaluated 43 patients with pemphigus foliaceus, 32 with pemphigus vulgaris, 6 with bullous pemphigoid and 3 with dermatitis herpetiformis. The average age was 48 +/- 16 years and 34 (40%) were female. The median score (p25-p75) of the Dermatology Life Quality Index was 16 (9-19), classified as "severe impairment" of life quality, in which the greater impact was related to symptoms and feelings, daily and leisure activities. Conclusions: Autoimmune bullous dermatoses inflict severe impairment of quality of life for patients followed by a public outpatient clinic in the countryside of Brazil.

The involvement of TLR2 and TLR4 in cytokine and nitric oxide production in visceral leishmaniasis patients before and after treatment with anti-leishmanial drugs

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Modulation of immune response by RAGE and TLR4 signalling in PBMCs of diabetic and non-diabetic patients

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Incorporating priorities for waiting customers in the hypercube queuing model with application to an emergency medical service system in Brazil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Activation of monocytes and cytokine production in patients with peripheral atherosclerosis obliterans

Background: Arterial peripheral disease is a condition caused by the blocked blood flow resulting from arterial cholesterol deposits within the arms, legs and aorta. Studies have shown that macrophages in atherosclerotic plaque are highly activated, which makes these cells important antigen-presenting cells that develop a specific immune response, in which LDLox is the inducing antigen. As functional changes of cells which participate in the atherogenesis process may occur in the peripheral blood, the objectives of the present study were to evaluate plasma levels of anti-inflammatory and inflammatory cytokines including TNF-alpha, IFN-gamma, interleukin-6 (IL-6), IL-10 and TGF-beta in patients with peripheral arteriosclerosis obliterans, to assess the monocyte activation level in peripheral blood through the ability of these cells to release hydrogen peroxide (H(2)O(2)) and to develop fungicidal activity against Candida albicans (C. albicans) in vitro.Methods: TNF-alpha, IFN-gamma, IL-6, IL-10 and TGF-beta from plasma of patients were detected by ELISA. Monocyte cultures activated in vitro with TNF-alpha and IFN-gamma were evaluated by fungicidal activity against C. albicans by culture plating and Colony Forming Unit (CFU) recovery, and by H(2)O(2) production.Results: Plasma levels of all cytokines were significantly higher in patients compared to those detected in control subjects. Control group monocytes did not release substantial levels of H(2)O(2) in vitro, but these levels were significantly increased after activation with IFN-gamma and TNF-alpha. Monocytes of patients, before and after activation, responded less than those of control subjects. Similar results were found when fungicidal activity was evaluated. The results seen in patients were always significantly smaller than among control subjects. Conclusions: The results revealed an unresponsiveness of patient monocytes in vitro probably due to the high activation process occurring in vivo as corroborated by high plasma cytokine levels.

Analysis of the feasibility of early hospital discharge after autologous hematopoietic stem cell transplantation and the implications to nursing care

Autologous hematopoietic stem cell transplantation is a conduct used to treat some hematologic diseases and to consolidate the treatment of others. In the field of nursing, the few published scientific studies on nursing care and early hospital discharge of transplant patients are deficient. Knowledge about the diseases treated using hematopoietic stem cell transplantation, providing guidance to patients and caregivers and patient monitoring are important nursing activities in this process. Guidance may contribute to long-term goals through patients' short-term needs. To analyze the results of early hospital discharge on the treatment of patients submitted to autologous transplantation and the influence of nursing care on this conduct. A retrospective, quantitative, descriptive and transversal study was conducted. The hospital records of 112 consecutive patients submitted to autologous transplantation in the period from January to December 2009 were revisited. Of these, 12 patients, who remained in hospital for more than ten days after transplantation, were excluded from the study. The medical records of 100 patients with a median age of 48.5 years (19-69 years) were analyzed. All patients were mobilized and hematopoietic stem cells were collected by leukapheresis. The most common conditioning regimes were BU12Mel100 and BEAM 400. Toxicity during conditioning was easily managed in the outpatient clinic. Gastrointestinal toxicity, mostly Grades I and II, was seen in 69% of the patients, 62% of patients had diarrhea, 61% of the patients had nausea and vomiting and 58% had Grade I and II mucositis. Ten patients required hospitalization due to the conditioning regimen. Febrile neutropenia was seen in 58% of patients. Two patients died before Day +60 due to infections, one with aplasia. The median times to granulocyte and platelet engraftment were 12 days and 15 days, respectively, with median red blood cell and platelet transfusions until discharge of three and four units, respectively. Twenty-three patients required rehospitalization before being discharged from the outpatient clinic. The median time to granulocyte engraftment was 12 days and during the aplasia phase few patients were hospitalized or suffered infections. The toxicity of the conditioning was the leading cause of rehospitalization. The nursing staff participated by providing guidance to patients and during the mobilization, transplant and outpatient follow-up phases, thus helping to successfully manage toxicity.

Icodextrin reduces insulin resistance in non-diabetic patients undergoing automated peritoneal dialysis: results of a randomized controlled trial (STARCH)

Insulin resistance is a common risk factor in chronic kidney disease patients contributing to the high cardiovascular burden, even in the absence of diabetes. Glucose-based peritoneal dialysis (PD) solutions are thought to intensify insulin resistance due to the continuous glucose absorption from the peritoneal cavity. The aim of our study was to analyse the effect of the substitution of glucose for icodextrin on insulin resistance in non-diabetic PD patients in a multicentric randomized clinical trial. This was a multicenter, open-label study with balanced randomization (1:1) and two parallel-groups. Inclusion criteria were non-diabetic adult patients on automated peritoneal dialysis (APD) for at least 3 months on therapy prior to randomization. Patients assigned to the intervention group were treated with 2L of icodextrin 7.5%, and the control group with glucose 2.5% during the long dwell and, at night in the cycler, with a prescription of standard glucose-based PD solution only in both groups. The primary end-point was the change in insulin resistance measured by homeostatic model assessment (HOMA) index at 90 days. Sixty patients were included in the intervention (n = 33) or the control (n = 27) groups. There was no difference between groups at baseline. After adjustment for pre-intervention HOMA index levels, the group treated with icodextrin had the lower post-intervention levels at 90 days in both intention to treat [1.49 (95% CI: 1.23-1.74) versus 1.89 (95% CI: 1.62-2.17)], (F = 4.643, P = 0.03, partial η(2) = 0.078); and the treated analysis [1.47 (95% CI: 1.01-1.84) versus 2.18 (95% CI: 1.81-2.55)], (F = 7.488, P = 0.01, partial η(2) = 0.195). The substitution of glucose for icodextrin for the long dwell improved insulin resistance measured by HOMA index in non-diabetic APD patients.

Spironolactone is secure and reduces left ventricular hypertrophy in hemodialysis patients

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Sepsis and AKI in clinical emergency room patients: the role of urinary NGAL

Few studies have investigated the predictive properties of urinary (u) NGAL as an AKI marker in septic population. This study evaluated the efficacy of uNGAL as predictor of AKI and death in septic patients admitted to the clinical emergency room (ER). We prospectively studied patients with sepsis admitted to the ER. Urine was analyzed for NGAL within the first 24 hours after admission (classified as NGAL1), between 24 and 48 h (NGAL2), and at moment of AKI diagnosis (NGAL3). Among 168 septic patients admitted to ER, 72% developed AKI. The uNGAL and its relationship with creatinine (Cr) were high in septic patients but statistically higher in those with sepsis and AKI. The uNGAL1 and uNGAL2, as well as uNGAL1/uCr1 and uNGAL2/uCr2, were good predictors for AKI (AUC-ROC 0.73, 0.70, 0.77, and 0.84, resp.). The uNGAL1 and uNGAL1/uCr1 were poor predictors for death (AUC-ROC 0.66 and 0.68, resp.), whereas uNGAL2 and uNGAL2/uCr2 were better predictors (AUC-ROC 0.70 and 0.81, resp.). The uNGAL is highly sensitive but nonspecific predictor of AKI and death in septic patients admitted into ER.