Wegener's granulomatosis in Finland in 1981-2000

Objectives: Wegener s granulomatosis (WG) is a vasculitis with a predilection for the airways and kidneys. An increasing incidence and improved prognosis of WG has been shown. The aim of this study was to evaluate the incidence, clinical presentation, diagnostic delay, risk of dialysis-dependent renal insufficiency and mortality of WG in 1981-2000. Patients and methods: Data was retrieved from the Finnish hospital discharge register and hospital case reports. Patients diagnosed with WG in 1981-2000 were included, and their demographic and clinical data recorded. The patients were crossed with the national kidney dialysis register and the national mortality statistics. Results: A total of 492 patients (243 ♂ , 249 ♀) were diagnosed at a mean age of 54 years (SD 18). The incidence increased from 1.9 to 9.3/ million/ year. The median diagnostic delay decreased from 17 to 4 months. Patients presented most often with symptoms of the ear, nose and throat (ENT) (45%), lung (36%), musculoskeletal system (22%) and kidney (11%). Initial lung involvement, constitutional symptoms, high erythrocyte sedimentation rate (ESR) and high ELK scores [(number of simultaneously involved organ groups (ENT, Lung, Kidney)] were associated with a shorter diagnostic delay. Medical treatment of WG patients remained similar in the 1980s and 1990s. Almost 90% of patients received cyclophosphamide (CYC) and more than 90% glucocorticoid medication at some point during the course of the disease. Eighty-four patients (17%) needed dialysis. Initial renal involvement and elevated serum creatinine values were related to an increased risk of dialysis-dependent kidney disease. In two-thirds of the patients, renal impairment was reversible. Dialysis became chronic (>3 months) in 32 patients (6.5%). Nineteen patients (3.9%) received a kidney transplant. Altogether 203 patients (99 men, 104 women) died before 30 June 2005. WG was the underlying cause of death in 37%. The crude one-year and five-year survival rates were 83.3% and 74.2%, respectively. The standardized mortality ratio was 3.43 (95% CI = 2.98 to 3.94). Older age and elevated creatinine level at diagnosis predicted shorter survival. ENT symptoms at presentation and treatment with CYC were associated with better outcome. There was no additional risk associated with male gender or with either of the decades (1981-1990 and 1991-2000) Conclusions: In 1981-2000, the incidence of WG increased ca. 4.5-fold and diagnostic delay decreased to ca. one-fourth, reflecting increased recognition of the disease and improved diagnostic means. WG patients are at great risk of developing dialysis-dependent renal insufficiency and an increased risk of dying. During the study period the treatment of WG did not change markedly, nor did the prognosis improve.

CINCINNATA in Antirrhinum majus directly modulates genes involved in cytokinin and auxin signaling

Mutations in the CINCINNATA (CIN) gene in Antirrhinum majus and its orthologs in Arabidopsis result in crinkly leaves as a result of excess growth towards the leaf margin. CIN homologs code for TCP (TEOSINTE-BRANCHED 1, CYCLOIDEA, PROLIFERATING CELL FACTOR 1 AND 2) transcription factors and are expressed in a broad zone in a growing leaf distal to the proliferation zone where they accelerate cell maturation. Although a few TCP targets are known, the functional basis of CIN-mediated leaf morphogenesis remains unclear. We compared the global transcription profiles of wild-type and the cin mutant of A. majus to identify the targets of CIN. We cloned and studied the direct targets using RNA in situ hybridization, DNA-protein interaction, chromatin immunoprecipitation and reporter gene analysis. Many of the genes involved in the auxin and cytokinin signaling pathways showed altered expression in the cin mutant. Further, we showed that CIN binds to genomic regions and directly promotes the transcription of a cytokinin receptor homolog HISTIDINE KINASE 4 (AmHK4) and an IAA3/SHY2 (INDOLE-3-ACETIC ACID INDUCIBLE 3/SHORT HYPOCOTYL 2) homolog in A. majus. Our results suggest that CIN limits excess cell proliferation and maintains the flatness of the leaf surface by directly modulating the hormone pathways involved in patterning cell proliferation and differentiation during leaf growth. 10.1111/(ISSN)1469-8137

五数苣苔(Bournea leiophylla)次生辐射对称花形成的分子机制和进化发育生物学研究

被子植物中，花对称性进化的一个重要方面就是从两侧对称向次生辐射对称的演化。唇形目是被子植物中以两侧对称花为主的类群，次生辐射对称花频繁发生。然而在分子发育水平上，除了模式植物金鱼草(Antirrhinum majus)和少数其他种外，从两侧对称花向次生辐射对称花演化的机制仍然是一个巨大的未被探索的领域。 在金鱼草和柳川鱼(Linaria vulgaris)中，腹部化反常整齐花的形成各自是由于CYC和LCYC的沉默所引起，这些基因沉默分别是由于转座子插入和DNA广泛甲基化所导致。在豆科(legumes)中，辐射对称花的形成是由于legCYC基因在所有五个花瓣均有表达，这相似于金鱼草中CYC基因同源异位表达所形成的背部化辐射对称花。然而，自然界中起源于不同的两侧对称花支系的许多次生辐射对称花好像并不是因为简单的花对称性基因功能丢失或者获得。因此，以模式植物突变体表型特征的分子机制作为研究出发点，通过对自然发生的次生辐射对称花进行详细研究探讨，有可能揭示两侧对称花向次生辐射对称花转变的新的演化途径，包括花对称性发育过程中不同基因的参与以及他们的表达在时间上的变化等。 苦苣苔科(Gesneriaceae)是唇形目(Lamiales sensu lato)其他类群的姊妹群, 以较弱的两侧对称花为特征，并拥有相当数量的次生辐射对称花种类;该科所拥有的辐射对称花属在唇形目所有科中占的比例最大。在苦苣苔科中，五数苣苔(Bournea leiophylla)是次生辐射对称花类群中具有两侧对称痕迹的代表类群，其花的发育过程显示出五数苣苔花经历了由花器官发育早期的两侧对称向成熟时期辐射对称的形态转变。这种发育模式暗示着五数苣苔的花可能起源于一个两侧对称花祖先;五数苣苔中控制花背腹非对称性的CYC类基因应该是有功能的，至少在花发育的早期是这样的。由于苦苣苔科和婆婆纳科(Veronicaceae)(金鱼草属于婆婆纳科)亲缘关系较近，而且CYC类基因的基本功能之一是导致背部雄蕊退化;因此五数苣苔中辐射对称花的形成很可能既不是由于CYC类基因失去，也不是因为CYC-类基因功能获得延伸或加强所致。在五数苣苔花发育过程中，从早期的两侧对称到成熟花的辐射对称的发育转变可能牵涉到TCP和MYB基因家族成员相互调节作用在时间和空间上的改变。因此，五数苣苔是探讨被子植物中次生辐射对称花新的进化途径的一个理想的候选材料。针对解决这一问题，我们对五数苣苔花进行了以下实验研究： 1 花器官发生过程的观察 成熟的五数苣苔花是辐射对称花，但是对花发育过程中花原基电镜扫描结果表明：在花器官起始和发育的早期，五数苣苔花是显著的两侧对称;但是随着进一步发育，这种两侧对称性逐步减弱，最后形成具有微弱两侧对称性痕迹的辐射对称花。 2 花对称性基因的克隆 我们应用RACE技术克隆得到了五数苣苔花对称性同源基因：BlDIV1、BlDIV2和BlRAD的翻译区全序列及其上下游非翻译区，得到了BlCYC1的3‘端翻译区和非翻译区序列。为了确定这些基因内含子的有无和位置，我们也从DNA中得到了相应同源基因的DNA序列，并且补全了BlCYC1的5‘端序列。同时也克隆到了一个没有在mRNA中得到的CYC同源基因BlCYC2。在该实验中我们第一次在金鱼草以外的类群中克隆得到了DIV和RAD的同源基因。 3 序列比较和分子系统发育分析 运用不同的比较软件和分子系统发育分析工具对五数苣苔的花对称性基因进行了比较和分析。结果表明：五数苣苔各种类型的花对称性基因和金鱼草的花对称基因在序列上是高度同源的，在分子系统发育上是非常近缘的。暗示着五数苣苔花对称性基因和金鱼草花对称性基因功能上的同源性。 4 花对称称性基因表达模式的分析 我们第一次运用组织原位杂交和RT-PCR技术对在金鱼草以外类群中所有已知类型花对称性同源基因的表达模式进行了实验研究。结果表明：五数苣苔花对称性基因的表达模式在花发育的早期类似于金鱼草;但是早期以后，BlCYC1和BlRAD被负调节，BlDIV的表达特异地在每个花瓣侧部边缘表达;这种表达结果和花的形态发生过程有很好的吻合。 上述研究表明：和金鱼草花对称基因的表达模式相比，五数苣苔三种类型花对称性基因在花发育过程中的时间和空间表达模式发生了改变;并且这种表达模式变化和五数苣苔花对称性由发育起始时期的两侧对称向成熟时期的辐射对称的转变是相互关联的。五数苣苔具有两侧对称性痕迹的辐射对称花和其他类群辐射对称花的比较显示：在五数苣苔中发育早期的两侧对称性应该是两侧对称性的遗迹;这是由于BlCYC1和BlRAD基因早期表达的保守性造成的。我们的结果揭示了一个新的花对称性演化路径：在花发育过程中，被CYC-like基因推动的RAD和DIV同源基因之间相互调节作用在时间和空间上的变化是花对称性从两侧对称向辐射对称转变或演化的基础;我们的发现还预示着：在一个调节网络的动态变化过程中，一个预先存在的两侧对称发育程序的修饰调节可能在被子植物次生辐射对称花多样性的形成中扮演重要角色。

基于TCP和MYB基因的表达模式，试探四数苣苔（Bournea sinensis）(苦苣苔科)中次生辐射对称花形成的进化发育途径

花对称性，作为花器官的一个基本而又非常重要的特征，它的进化发育过程，越来越吸引着科学家们的注意力。次生辐射对称花的形成也越来越受到关注。然而在分子发育水平上，除了模式植物金鱼草（Antirrhinum majus）和少数其他种外，次生辐射对称花演化的机制仍然是一个巨大的未被探索的领域。 在金鱼草和柳穿鱼（Linaria vulgaris）中，腹部化反常整齐花的形成各自是由CYC和LCYC基因沉默所致，二者基因沉默分别是由于转座子的插入和DNA广泛甲基化所导致;而在豆科（legumes）中，辐射对称花的形成是由于legCYC基因在五个花瓣上都有表达，这种情况和金鱼草中CYC基因同源异位表达所形成的背部化辐射对称花相似。然而，自然起源的两侧对称花支系中的次生辐射对称花的形成似乎并不是简单的花对称性基因功能丢失或获得。自然形成的次生辐射对称花究竟可能经历了怎样的进化途径？对此，我们选择了广义唇形目（Lamiales sensu lato）中苦苣苔科（Gesneriaceae）植物——四数苣苔（Bouenea sinensis）作为研究对象，通过和模式植物金鱼草的突变体中花对称性基因表达特征比较，结合其近缘种——五数苣苔（Bournea leiophylla）中DIVARICATA在时间和空间上的表达特征，试图揭示苦苣苔科中可能的两侧对称向次生辐射对称花转变的新的演化途径，以及在这种进化过程中所产生的可能的器官丢失或融合现象。 四数苣苔和五数苣苔同属于苦苣苔亚科（Cyrtandroideae）苦苣苔族（Trib.Ramondeae Eritsch）中的四数苣苔属（Bournea Oliv）。该属仅仅有两个种——四数苣苔和五数苣苔，它们都是次生辐射对称花类群中的典型代表，而且两者花发育过程都显示出了由腹部向背部顺序发生和生长的特征。然而和五数苣苔相比，四数苣苔花瓣和雄蕊数目分别少了一枚，拥有四枚花瓣（背部花瓣两枚、两侧花瓣两枚）和四枚雄蕊（背部雄蕊一枚、两侧雄蕊两枚、腹部雄蕊一枚）。从形态特征比较来看，很有可能是四数苣苔在次生辐射对称花形成的过程中，发生了腹部花瓣的丢失和两枚腹部雄蕊愈合成了一枚较大的腹部雄蕊。那么，我们推测在四数苣苔次生辐射对称花形成过程中，花对称性基因即CYC类和DIV类基因在分子水平上发生了变化，这种变化和四数苣苔中次生辐射对称花的形成有关。 基于上述考虑，我们开展了对四数苣苔中花对称性基因——BsCYCLOIDEA、BsDIVARICATA、BsRADALIS以及BsCYCLIND3四个基因共9个拷贝进行了在花组织中表达模式研究。我们在四数苣苔中共分离到了五个拷贝的CYC类基因，分别命名为BsCYC1C-1、BsCYC1C-2、BsCYC1D、BsCYC2A、BsCYC2B。这五个拷贝在保守的TCP区和R区保持了高度的同源性。BsDIV的两个拷贝BsDIV1、BsDIV2也是如此，在保守的两个区domain I、domain II，尤其是在那些螺旋和环结构处，保守性相当高。组织原位杂交结果显示，BsDIV在四数苣苔中的表达非常特别，在金鱼草和五数苣苔中该类基因的表达分两个不同时期，即早期表达和晚期特异性表达，BsDIV在四数苣苔中似乎没有早期表达模式或者在很早期就已经进入到了晚期的表达模式。它在四个花瓣的两侧边缘和四个雄蕊上均等表达，而且这种表达持续时间相对比较长。组织原位杂交结果也得到了RT-PCR结果的支持。有趣的是BsRAD的RT-PCR结果显示，BsRAD在晚期花瓣上只在背部表达，但是在雄蕊上的表达却和金鱼草中AmRAD在背部区域表达不同，它的表达从背部延伸到了两侧和腹部。BsRAD在花器官的第二轮和第三轮的表达显然发生了分化。这种现象可能暗示着BsRAD功能发生了分化。BsRAD和BsDIV在腹部雄蕊上精细的时间空间调控关系可能正是导致腹部雄蕊愈合的原因。RT-PCR结果并没有检测到BsCYC2在晚期花上的表达。原位杂交结果显示BsCYC2在第8期以后表达就基本消失了，从而验证了RT-PCR结果。BsCYC2在早期花原基和早期花器官上都是均匀表达，但在表达消失之前，它在花瓣裂片和花冠筒的分界处则有表达信号，BsCYC2可能和调控花冠筒高度有关。根据Almeida 和 Galego（2002）所说，花冠筒高度的改变依赖于CYC 、DIV基因和其它非主动生长决定因子之间的相互作用。BsCYC1C晚期的RT-PCR结果显示它在背部花瓣、背部雄蕊和两侧雄蕊上均有表达信号，但在腹部花瓣和雄蕊上则没有表达信号，这似乎和四数苣苔由腹部向背部顺序发育的形态特征相符合，说明BsCYC1C可能起到了抑制背部花瓣和背部雄蕊生长的作用。

A zebrafish forebrain-specific zinc finger gene can induce ectopic dlx2 and dlx6 expression

Identifcation of the earliest forebrain-specific markers should facilitate the elucidation of molecular events underlying vertebrate forebrain determination and specification. Here we report the sequence and characterization of fez (forebrain embryonic zinc finger), a gene that is specifically expressed in the embryonic forebrain of zebrafish. Fez encodes a putative nuclear zinc finger protein that is highly conserved in Drosophila, zebrafish, Xenopus, mouse, and human. In zebrafish, the expression of fez becomes detectable at the anterior edge of the presumptive neuroectoderm by 70% epiboly. During the segmentation period, its expression is completely restricted to the rostral region of the prospective forebrain. At approximately 24 h postfertilization, fez expression is mostly confined to the telencephalon and the anterior-ventral region of the diencephalon. Although fez expression is present in one-eyed pinhead (oep) and cyclops (cyc) zebrfish mutants, the pattern is altered. Forced expression of fez induces ectopic expression of dlx2 and dlx6, two genes involved in brain development. Knockdown of fez function using a morpholino-based antisense oligo inhibited dlx2 expression in the ventral forebrain. Our studies indicate that fez is one of the earliest markers specific for the anterior neuroectoderm and it may play a role in forebrain development by regulating Dlx gene expression. (C) 2001 Academic Press.

Appearance of the frequency-doubling stimulus at threshold.

PURPOSE. It has been argued that the threshold for detecting frequency-doubling (FD) technology perimeter stimuli differs from the threshold for perceiving spatial structure (pattern) in the same targets. Thresholds for perceiving spatial structure have typically been assessed using orientation-identification experiments. The authors investigated the influence of orientation, edge profile, and psychophysical method on the origin of the reported differences in detection and orientation-identification thresholds for FD gratings.

METHODS. Detection and orientation-identification thresholds were determined in 12 observers with the use of FD stimuli (0.25 cyc/deg, 25 Hz) presented centrally and at 15° eccentricity. Edge profile (square- and Gaussian-windowed) and orientation (horizontal, vertical, and oblique) were independently modified. Detection thresholds were also measured for spatially uniform flickering targets (25 Hz). Orientation-identification thresholds using a two-alternative forced choice (2-AFC) and a two-interval forced choice (2-IFC) method were also compared in five experienced observers.

RESULTS. Orientation-identification and detection thresholds did not significantly differ under any condition tested. Orientation-identification thresholds obtained with 2-AFC were not significantly different from those obtained with 2-IFC. Thresholds for spatially uniform flicker were significantly lower than for FD stimuli.

CONCLUSIONS. The authors found that orientation-identification and detection thresholds for FD gratings did not differ and argue that recent findings to the contrary arise from the inappropriate use of spatially uniform flicker targets as alternatives in 2-IFC experiments.

Postcolonial entanglements of Power, Race, Class and Privilege in Child and Youth Care Work Within a Brazilian Favela

This research assesses the various aspects of Child and Youth Care (CYC) work and how relationships between child or youth and care provider are limited and constricted within greater political, social and historical contexts. Specifically, this research takes place internationally in Rio de Janeiro, Brazil within a favela (slum) and unveils the entangled and complex relationship that I, not only as an ethnographer, but also as a CYC worker had with the many young people that I encountered. It will address a variety of theories that demonstrate the potentials of reproducing oppressive relationships, and argue that it is imperative for CYC workers to critically reflect on the greater contexts in which their work is situated in order to gain forces with those young people whom they are attempting to serve.

Deconstructing Child Youth Care: an autoethnographic exploration of physical restraints in children’s residential settings

This thesis is written through the front-line perspective of a child/youth worker who has experienced ‘rupture’ in her personal understanding of the Child Youth Care (CYC) practice. Using a collection of personal journal entries written about her individual experiences of CYC education, mentorship/training, front-line residential practice and frequently used interventions, this thesis takes the reader (and the writer) on a discovery of prominent discourses that exist within the residential CYC profession. Focusing on the use of physical restraints on children by residential Child/Youth Workers, this research project utilizes Deconstructive Discourse Analysis and Liberation Psychologies to illustrate a critical examination of power-knowledge and scientific/medical discourses in CYC practice. By focusing on Foucault’s concepts of disciplinary power, binary division and theory of panopticism, the writer seeks to explore a personal reflection and comprehension of how power is used to assert control over children/youth through mental health treatment and physical interventions.

Analyse des réponses neuronales du cortex visuel primaire du chat à la fréquence spatiale suite à des adaptations répétées

Les neurones du cortex visuel primaire (aire 17) du chat adulte répondent de manière sélective à différentes propriétés d’une image comme l’orientation, le contraste ou la fréquence spatiale. Cette sélectivité se manifeste par une réponse sous forme de potentiels d’action dans les neurones visuels lors de la présentation d’une barre lumineuse de forme allongée dans les champs récepteurs de ces neurones. La fréquence spatiale (FS) se mesure en cycles par degré (cyc./deg.) et se définit par la quantité de barres lumineuses claires et sombres présentées à une distance précise des yeux. Par ailleurs, jusqu’à récemment, l’organisation corticale chez l’adulte était considérée immuable suite à la période critique post-natale. Or, lors de l'imposition d'un stimulus non préféré, nous avons observé un phénomène d'entrainement sous forme d'un déplacement de la courbe de sélectivité à la suite de l'imposition d'une FS non-préférée différente de la fréquence spatiale optimale du neurone. Une deuxième adaptation à la même FS non-préférée induit une réponse neuronale différente par rapport à la première imposition. Ce phénomène de "gain cortical" avait déjà été observé dans le cortex visuel primaire pour ce qui est de la sélectivité à l'orientation des barres lumineuses, mais non pour la fréquence spatiale. Une telle plasticité à court terme pourrait être le corrélat neuronal d'une modulation de la pondération relative du poids des afférences synaptiques.

Apparent specific volumes and tastes of cyclamates, other sulfamates, saccharins and acesulfame sweeteners

Measurements of apparent specific volume (ASV) for a series of alternative sweeteners (cyclamates, sulfamates, saccharins, acesulfames and anilinomethanesulfonates) have been made. Taste data have been obtained for many of the new compounds unless the toxicity of the associated metals precluded this. Apparent molar volume (AMV), isentropic specific (IASC) and isentropic molar (IAMC) compressibilities were also measured. Sixteen metallic cyclamates cyc-C6H11NHSO3M and two phenylsulfamates ArNHSO3Na, namely 3.5-dimethyl- and 3,4-dimethoxyphenylsulfamates have been examined. When the ASVs for these are combined with those for 15 aliphatic, aromatic and alicyclic sulfamates from a previous study, many of the values are seen to fall into the region that was previously identified as being the "sweet area", i.e. the ASVs lay between similar to0.5 and similar to0.7 (a few sweet compounds fall below this range and it is suggested that it could be extended slightly to accommodate these). Interestingly, the anilinomethanesulfonates, ArNHCH2SO3Na (Ar = C6H5-, 3-MeC6H4- and 3-ClC6H4-) lie clearly in the sweet region but only one of them shows slight sweetness showing that the molecular structural change made (compared with the 'parent' sulfamate-NHSO3-) cannot be accommodated at the receptor site. (C) 2003 Elsevier Ltd. All rights reserved.

The construction of a juridical ontology

The need for the representation of both semantics and common sense and its organization in a lexical database or knowledge base has motivated the development of large projects, such as Wordnets, CYC and Mikrokosmos. Besides the generic bases, another approach is the construction of ontologies for specific domains. Among the advantages of such approach there is the possibility of a greater and more detailed coverage of a specific domain and its terminology. Domain ontologies are important resources in several tasks related to the language processing, especially in those related to information retrieval and extraction in textual bases. Information retrieval or even question and answer systems can benefit from the domain knowledge represented in an ontology. Besides embracing the terminology of the field, the ontology makes the relationships among the terms explicit. Copyright 2007 ACM.

Efeito do estresse térmico calórico na expressão de alguns genes relacionados à implantação e desenvolvimento inicial de embriões Nelore (Bos indicus) e Jersey (Bos taurus) produzidos in vitro

Pós-graduação em Ciências Biológicas (Farmacologia) - IBB

Expressão dos fatores de crescimento fibroblástico 17 e 18 (FGF-17 e FGF-18) em folículos antrais bovinos

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

Aptidão aeróbia e amplitude dos domínios de intensidade de exercício no ciclismo

INTRODUÇÃO: A determinação dos domínios de intensidade de exercício tem importantes implicações na prescrição do treino aeróbio e na elaboração de delineamentos experimentais. OBJETIVO: Analisar os efeitos do nível de aptidão aeróbia sobre a amplitude dos domínios de intensidade de exercício durante o ciclismo. MÉTODOS: Doze ciclistas (CIC), 11 corredores (COR) e oito indivíduos não treinados (NT) foram submetidos aos seguintes protocolos em diferentes dias: 1) teste progressivo para determinação do limiar de lactato (LL), consumo máximo de oxigênio (VO2máx) e sua respectiva intensidade (IVO2máx); 2) três testes de carga constante até a exaustão a 95, 100 e 110% IVO2máx para a determinação da potência crítica (PC); 3) testes até a exaustão para determinar a intensidade superior do domínio severo (Isup). As amplitudes dos domínios (moderado < LL; LL > pesado < PC; PC > severo < Isup) foram expressas como percentual da Isup (VO2). RESULTADOS: A amplitude do domínio moderado foi similar entre CIC (52 ± 8%) e COR (47 ± 4%) e significantemente maior no CIC em relação ao NT (41 ± 7%). O domínio pesado foi significantemente menor no CIC (17 ± 6%) em relação ao COR (27 ± 6%) e NT (27 ± 9%). Em relação ao domínio severo não foram encontradas diferenças significantes entre os CIC (31 ± 7%), COR (26 ± 5%) e NT (31 ± 7%). CONCLUSÃO: O domínio pesado de exercício é mais sensível a mudanças determinadas pelo nível de aptidão aeróbia, existindo a necessidade de que se atenda ao princípio da especificidade do movimento, quando se pretende obter um elevado grau de adaptação fisiológica.

Patient Education and Self-Care for the Management of Jaw Pain upon Awakening: A Randomized Controlled Clinical Trial Comparing the Effectiveness of Adding Pharmacologic Treatment with Cyclobenzaprine or Tizanidine

Aims: To compare the effectiveness of adding cyclobenzaprine, tizanidine, or placebo to patient education and a self-care management program for patients with myofascial pain and specifically presenting with jaw pain upon awakening. Methods: Forty-five patients with a diagnosis of myofascial pain based on the guidelines of the American Academy of Orofacial Pain participated in this 3-week study. The subjects were randomly assigned into one of three groups: placebo group, TZA group (tizanidine 4 mg), or CYC group (cyclobenzaprine 10 mg). Patients were evaluated for changes in pain intensity, frequency, and duration by using the modified Severity Symptoms Index and changes in sleep quality with the use of the Pittsburgh Sleep Quality Index. Data were analyzed by ANOVA and post-hoc or nonparametric statistical tests as appropriate. Results: All three groups had a reduction in pain symptoms and improvement of sleep quality based on a comparison of pretreatment and treatment scores. However, no significant differences among the groups were observed at the posttreatment evaluation. Conclusion: The use of tizanidine or cyclobenzaprine in addition to self-care management and patient education was not more effective than placebo for the management of patients with myofascial jaw pain upon awakening.