Hypoxie transitoire en relation avec les activités rythmiques des muscles de la mastication chez les patients atteints du bruxisme du sommeil

Study Objectives: Sleep bruxism (SB) is a repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible occurring during sleep. SB is scored, from electromyographic traces, as rhythmic masticatory muscle activity (RMMA). Most RMMA occurred during sleep in association with sleep arousal. Since not all RMMA episodes were associated with sleep arousal we hypothesized that some event could be observed in relation to small fluctuations of the oxygen level resulting in mild desaturation/hypoxia. Methods: Sleep laboratory or home recordings from 22 SB (teeth grinding) patients were analyzed from our data bank. A total of 143 RMMA/SB episodes were classified in 4 categories: (i) no arousal & no body movement; (ii) arousal + & no body movement; (iii) no arousal & body movement +; (iv) arousal + & body movement +. Minimum blood oxygen levels were assessed from finger oxymetry signal: 1) during the baseline period before RMMA, i.e., an average of 7 s before RMMA onset (-20 s to -14 s); 2) during RMMA, i.e. a window of 15 s corresponding to -5 s before the onset until +10 s after the episode. For all episodes, the minimum oximetry values were compared for each patient. Results: There was a significant variation of blood oxygen level over time (p=0.001) with a statistically significant transient hypoxia during RMMA at time (+7),(+8) and (+9) s. The variation over time was similar among the 4 groups (non significant group*time interaction p=0.10) and no overall difference was observed between groups (p=0.91). Of the 22 subjects, 6 subjects (27%) remained equal or had a slight increase in SaO2 (+8) s after the RMMA/SB onset compared to baseline (-20 s to -14) s, 10 subjects (45%) showed a small decrease in SaO2 (>0 to <1%) and 6 others (27%) had a decrease of 1-1.8%. Conclusions: These preliminary findings suggest that in some SB patients, RMMA episodes are potentially triggered by minor transient hypoxia. Key words: sleep bruxism, oximetry, desaturation, hypoxia, rhythmic masticatory muscle activity

Proposition de combinaisons optimales de contractions volontaires maximales isométriques pour la normalisation de 12 muscles de l'épaule

Afin d’être représentatif d’un niveau d’effort musculaire, le signal électromyographique (EMG) est exprimé par rapport à une valeur d’activation maximale. Comme l’épaule est une structure articulaire et musculaire complexe, aucune contraction volontaire isométrique (CVMi) proposée dans la littérature ne permet d’activer maximalement un même muscle de l’épaule pour un groupe d’individus. L’objectif de ce mémoire est de développer une approche statistique permettant de déterminer les CVMi optimales afin de maximiser les niveaux d’activation d’un ensemble de muscles de l’épaule. L’amplitude du signal EMG de 12 muscles de l’épaule a été enregistrée chez 16 sujets alors qu’ils effectuaient 15 CVMi. Une première approche systématique a permis de déterminer les 4 CVMi parmi les 15 qui ensemble maximisent les niveaux d’activation pour les 12 muscles simultanément. Ces 4 contractions ont donné des niveaux d’activation supérieurs aux recommandations antérieures pour 4 muscles de l’épaule. Une seconde approche a permis de déterminer le nombre minimal de CVMi qui sont nécessaires afin de produire un niveau d’activation qui n’est pas significativement différent des valeurs d’activation maximales pour les 16 sujets. Pour 12 muscles de l’épaule, un total de 9 CVMi sont requises afin de produire des valeurs d’activation qui sont représentatives de l’effort maximal de tous les sujets. Ce mémoire a proposé deux approches originales, dont la première a maximisé les niveaux d’activation qui peuvent être produits à partir d’un nombre fixe de CVMi tandis que la deuxième a permis d’identifier le nombre minimal de CVMi nécessaire afin de produire des niveaux d’activation qui ne sont pas significativement différentes des valeurs d’activation maximales. Ces deux approches ont permis d’émettre des recommandations concernant les CVMi nécessaires à la normalisation de l’EMG afin de réduire les risques de sous-estimer l’effort maximal d’un ensemble d’individus.

Effets du port continu de coquilles correctrices Invisalign® sur l’articulation temporo-mandibulaire et les muscles du complexe facial.

INTRODUCTION : L’articulation temporo-mandibulaire (ATM) est un système articulaire excessivement complexe. L'étiologie des désordres temporo-mandibulaires (DTM) est encore incertaine et le lien de cause à effet des traitements orthodontiques en tant que facteur de risque est une question qui a longuement été discutée. Cette étude clinique prospective vise à évaluer les effets à long terme du port continu de coquilles correctrices Invisalign® sur l’ATM et les muscles du complexe facial. MATÉRIELS ET MÉTHODES : L'étude incluait 43 adolescents et adultes âgés entre 13 et 51 ans (25 femmes et 18 hommes). Deux d'entre eux ont été exclus en raison de mauvaise coopération causant l’arrêt du traitement orthodontique. Les effets dans le temps des coquilles sur l'ATM et les muscles du complexe facial ont été évalués en utilisant l’examen du Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Le nombre de contractions musculaires durant le sommeil a été mesuré objectivement par enregistrements électromyographiques (EMG) et la fréquence de grincement et de serrement des dents à l’éveil a été rapportée subjectivement par les patients à l’aide de questionnaires. Des mesures répétées ont été effectuées aux temps suivants: avant le début du traitement pour les données contrôles (T1), deux semaines (T2), et six mois (T3) après le début du traitement. Les données numériques ont été analysées par l’analyse de variance (ANOVA) en mesures répétées et la méthode de Brunner-Langer, alors que les données nominales ont été évaluées par le test de Cochran-Mantel-Haenszel. Les résultats ont été considérés significatifs si p < 0.05. RÉSULTATS ET DISCUSSION : Le nombre de contractions musculaires par heure (index) durant le sommeil et leur durée moyenne n’ont pas été statistiquement différents entre les trois nuits d’enregistrement EMG (Brunner Langer, p > 0.005). Cependant, 67 % des participants ont rapporté avoir eu du grincement ou du serrement des dents la nuit au T2 et 64 % au T3 comparativement à 39 % au T1, ce qui était une augmentation significative (Cochran-Mantel-Haenszel, p = 0.0112). Quarante-quatre pour cent des patients ont signalé du grincement ou du serrement des dents pendant le jour au T1, tandis qu'un pourcentage nettement plus élevé de 66 % en a rapporté au T2 et 61 % au T3 (Cochran-Mantel-Haenszel, p = 0.0294). Au T1, 12 % des sujets ont indiqué qu'ils se sont réveillés avec une douleur musculaire, comparativement à 29 % au T2, ce qui était une augmentation significative (Cochran-Mantel-Haenszel, p = 0.0347). Au T2, il y avait une réduction significative des mouvements maximaux de la mandibule dans toutes les directions (ANOVA en mesures répétées, p < 0,05). De plus, il y a eu une augmentation significative du nombre de sites douloureux et de l'intensité de la douleur à la palpation de l'ATM et des muscles faciaux avec l'évaluation du RDC/TMD au T2 en comparaison aux T1 et T3 (Brunner Langer, p < 0,05). CONCLUSION : La présente étude n’a révélé aucun effet des coquilles sur l’activité oro-faciale durant le sommeil au fil du temps mesurée objectivement à l’aide des enregistrements EMG, mais une augmentation significative de la fréquence du grincement et du serrement des dents rapportée subjectivement par les patients au moyen des questionnaires aux T2 et T3. Au T2, il y avait une augmentation significative des symptômes de l'ATM et des muscles du complexe oro-facial, mais ces symptômes sont retournés au niveau initial avec le temps.

Étude des interactions interhémisphériques entre les représentations des muscles de l'épaule et du tronc dans le cortex moteur primaire.

Après un accident vasculaire cérébral (AVC), 30% des personnes ont une atteinte de la fonction motrice du membre supérieur. Un des mécanismes pouvant intervenir dans la récupération motrice après un AVC est la réorganisation des interactions interhémisphériques. À ce jour, la plupart des études se sont intéressées aux interactions entre les représentations des muscles de la main. Or la réalisation de mouvements de la main nécessite une coordination précise des muscles proximaux de l’épaule et le maintien d’une stabilité assurée par les muscles du tronc. Cependant, il existe peu d’informations sur le contrôle interhémisphérique de ces muscles. Ainsi, l’objectif de cette étude était de caractériser les interactions entre les représentations corticales des muscles proximaux (Deltoïde antérieur (DA)), et axiaux (Erecteur spinal (ES L1)) chez le sujet sain et de les comparer avec les interactions interhémisphériques entre les représentations des muscles distaux (1er interosseux dorsal (FDI)). Deux techniques de stimulation magnétique transcrânienne ont été utilisées pour évaluer ces interactions. La stimulation du cortex moteur ipsilatéral évoque une période de silence ipsilatérale (iSP)-reflétant l’inhibition interhémiphérique-dans le FDI et le DA. Dans ES L1, l’iSP est précédée d’une facilitation. Le paradigme de l’impulsion pairée démontre aussi la présence d’inhibition interhémisphérique dans les trois muscles. Ces résultats suggèrent un patron distinct d’interactions réciproques entre les représentations des muscles distaux, proximaux et axiaux qui peut être expliqué à la fois par des changements d’excitabilité au niveau cortical et sous-cortical. Ces résultats pourraient servir de bases normatives afin d’évaluer les changements survenant suite à un AVC.

ADRENERGIC RECEPTOR GENE EXPRESSION DURING PANCREATIC REGENERATION AND INSULIN SECRETION IN RATS –

In the present study, the changes in the brain EPI (Epinephrine), adrenergic receptors and the receptor gene expression were investigated during pancreatic regeneration and insulin secretion. The changes in the pancreatic islet EPI and adrenergic receptors were also studied in the pancreatectomised rats. The regulatory function of EPI in association with Epidermal growth factor (EGF) and glucose were investigated in rat islet cultures. In vitro studies were carried out using antagonists for adrenergic receptor subtypes to see their involvement in the islet DNA synthesis. The mechanism by which the peripheral EPI regulate insulin secretion was also investigated by studying the nuclear binding proteins in the pancreatic islets during pancreatic regeneration and diabetes. The study reveals that EPI can regulate the pancreatic islet cell proliferation by controlling the insulin synthesis and secretion. The brain adrenergic receptor gene expression and functional correlation regulate the pancreatic adrenergic receptors. The functional balance of α and β-adrenergic receptors controls the insulin secretion and pancreatic β-cell proliferation, which will have immense clinical significance in the treatment of Diabetes mellitus.

Hypothalamic 5-HT functional regulation through 5-HTIA and 5-HT2c receptors during pancreatic regeneration

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Decreased 5-HT2C receptor binding in the cerebral cortex and brain stem during pancreatic regeneration in rats

The purpose of this study was to investigate the role of central 5-HT2C receptor binding in rat model of pancreatic regeneration using 60-70% pancreatectomy. The 5-HT and 5-HT2c receptor kinetics were studied in cerebral cortex and brain stem of sham operated, 72 h pancreatectomised and 7 days pancreatectomised rats. Scatchard analysis with [3H] mesulergine in cerebral cortex showed a significant decrease (p < 0.05) in maximal binding (B^,ax) without any change in Kd in 72 h pancreatectomised rats compared with sham. The decreased Bmax reversed to sham level by 7 days after pancreatectomy. In brain stem , Scatchard analysis showed a significant decrease (p < 0.01) in Bax with a significant increase (p < 0.01) in Kd. Competition analysis in brain stem showed a shift in affinity towards a low affinity. These parameters were reversed to sham level by 7 days after pancreatectomy. Thus the results suggest that 5-HT through the 5-HT2C receptor in the brain has a functional regulatory role in the pancreatic regeneration. (Mol Cell Biochem 272: 165-170, 2005)

Enhanced /3-adrenergic receptors in the brain and pancreas during pancreatic regeneration in weanling rats

Adrenergic stimulation has an inyortant role in the pancreatic It-cell proliferation and insulin secretion. In the present study. we have investigaled how sympathetic system mgulales the panrrealic n I rnerui nr ht an:ilyiing I'pinephi inn 1111 ), Norepinephrinc (NE) and /1-adrenergic receptor changes in the brain as (%eli is in the I swirls. Fill and NII showed a significant decrease in the brain regions, pancreas and plasma :rt 72Ius iller partial prurcrealectonty. We observed an increase in the circulating insulin levels at 72 hrs. Scatchard analysis using I CHI propranolol showed a significant increase in the number of loth the low affinity and high affinity t-adrenergic receplors in cerebral cortex and hypothalamus of partially pancreatectornised rats during peak DNA synthesis. The affinity of the receptors decrea,ed significantly in the low and high affinity receptors of cerebral cortex and the high affinity hypothalamic receptors. In file brain stein, low affinity receptors were increased significantly during regeneration whereas there was no change in the high affinity receptors. The pancreatic ff-adrenergic receptors were also up regulated at 72 firs after partial panerealectony. In vitro studies showed that /i-adrenergic receptors are positive regulators of islet cell proliferation and insulin secretion. Thus our results suggest that the t-adrenergic receptors are functionally enhanced during pancreatic regeneration, which in turn increases pancreatic ft-cell proliferation an(hilisulin secretion in wean hug rats.

Decreased a2-adrenergic receptor in the brain stem and pancreatic islets during pancreatic regeneration in weanling rats

Sympathetic stimulation inhibits insulin secretion. a2-Adrenergic receptor is known to have a regulatory role in the sympathetic function. We investigated the changes in the a2-adrenergic receptors in the brain stein and pancreatic islets using [3H]Yohimbine during pancreatic regeneration in weanling rats. Brain stem and pancreatic islets of experimental rats showed a significant decrease (p<0.001) in norepinephrine (NE) content at 72 h after partial pancreatectomy. The epinephrine (EPI) content showed a significant decrease (p<0.001) in pancreatic islets while it was not detected in brain stem at 72 h after partial pancreatectomy. Scatchard analysis of [3H]Yohimbine showed a significant decrease (p<0.05) and Kd at 72 h after partial pancreatectomy in the brain stem. In the pancreatic islets, Scatchard analysis of [3H]Yohimbine showed a signiinfiBca'nnatx decrease (p<0.001) in B,nax and Kd (p<0.05) at 72 h after partial pancreatectomy. The binding parameters reversed to near sham by 7 days after pancreatectomy both in brain stein and pancreatic islets. This shows that pancreatic insulin secretion is influenced by central nervous system inputs from the brain stem. In vitro studies with yohimbine showed that the a2-adrenergic receptors are inhibitory to islet DNA synthesis and insulin secretion. Thus our results suggest that decreased a2-adrenergic receptors during pancreatic regeneration functionally regulate insulin secretion and pancreatic 13-cell proliferation in weanling rats.

Decreased (x1-Adrenergic Receptor Binding in the Cerebral Cortex and Brain Stem during Pancreatic Regeneration in Rats

purpose of this study was to investigate the role of brain al-adrenergic receptor binding in the rat model of pancreatic regeneration using 60-70% pancre:dectorny. The a, -adrenergic receptors kinetics was studied in the cerebral cor:cx and brain stem of sham operated . 72 It pan- crea(ectoinised and 7 days pancreatectomised rats. Scar chard analysis with I `I I lprazocin in cerebral cartes and brain stein showed a significant decrease (/' < 0.01). (P < 0.05) in maximal binding ( 1),,,,,) with it significant decrease (P < 0.001 ), ( P < 0.01) in the K,,in 72 It pancreatecto- raised rats compared with sham , respectively . Competition analysis in cerebral cortex and brain stem showed it shift in affinity during pancreatic regeneration . The sympathetic activity was decreased as indicated by the significantly de- increased norepinephrine level in the plasma (P < 0.001), cerebral cortex (P < 0.01) and brain stem (P < 0.001) of 72 h pancreatectomised rats compared to sham . Thus, from our results it is suggested that the central a, -adrenergic receptors have a functional role in the pancreatic regenera- Lion mediated through the sympathetic pathway.

Kinetic Parameters of Thymidine Kinase and DNA Synthesis During Liver Regeneration: Role Ofthyroid Hormones

The role of thyroid hormones in DNA synthesis and in the activity of Thymidille kinase (TK), a key regulatory enzyme of DNA synthesis was studied in proliferating hepatocytes in vivo. Liver regeneration after partial hepatectomy was used as a model for controlled cell division in rats having different thyroid status - euthyroid, hypothyroid and 3,3',5'-triiodo-L-thyronine (T))-heated hypothyroid. Partial hepatectomy caused a significant elevation of DNA synthesis (p<0.01) in all the three groups compared to their sham-operated counterparts. Hypothyroid liepatectomised animals showed significantly lower (p<0.01) level of DNA synthesis than euthyroid hepatectomised animals. A single subcutaneous close of 1'3 to hypothyroid shamoperated animals resulted in a significant increase (p<0.01) of DNA synthesis in the intact liver. 17tis was comparable to the level of DNA synthesis occurring in regenerating liver of euthyroid animals. In hypothyroid hepatectomised animals, "1'3 showed an additive effect on l)NA synthesis and this group exhibited maximum level of DNA synthesis (p<0.0I ). Studies of the kinetic parameters of TK show that the Michelis-Menten constant, (K111) of TK for thymidine was altered by the thyroid status. K11 increased significantly (p<0.01) in untreated hypothyroid animals when compared to the euthyroid rats. '13 treatment of hypothyroid animals reversed this effect and this group showed the lowest value for K111 (p<0.01). Thus our results indicate that thyroid hormones can influence DNA synthesis during liver regeneration and they may regulate the activity of enzymes such as 17rymidine kinase which are important for DNA synthesis and hence cell division.

Alterations in the muscarinic M I and M3 receptor gene expression in the brain stem during pancreatic regeneration and insulin secretion in weanling rats

Muscarinic M1 and M3 receptor changes in the brain stem during pancreatic regeneration were investigated. Brain stem acetylcholine esterase activity decreased at the time of regeneration . Sympathetic activity also decreased as indicated by the norepinephrine (NE) and epinephrine (EPI) content of adrenals and also in the plasma. Muscarinic Ml and M3 receptors showed reciprocal changes in the brain stem during regeneration. Muscairnic M1 receptor number decreased at time of regeneration without any change in the affinity. High affinity M3 receptors showed an increase in the number. The affinity did not show any change . The number of low affinity receptors decreased with decreased Kd at 72 hours after partial pancreatectomy. The Kd reversed to control value with a reversal of the number of receptors to near control value . Gene expression studies also showed a similar change in the mRNA level of Ml and M3 receptors . These alterations in the muscarinic receptors regulate sympathetic activity and maintain glucose level during pancreatic regeneration. Central muscarinic M1 and M3 receptor subtypes functional balance is suggested to regulate sympathetic and parasympathetic activity, which in turn control the islet cell proliferation and glucose homeostasis.

Increased 5-HT2C Receptor Binding in the Brain Stem And Cerebral Cortex During Liver Regeneration And Hepatic Neoplasia In Rats

In the present study, serotonin 2C (5-HT2c) receptor binding parameters in the brainstem and cerebral cortex were investigated during liver generation after partial hepatectomy (PH) and N-nitrosodiethylamine (NDEA) induced hepatic neoplasia in male Wistar rats. The serotonin content increased significantly (p<0.01) in the cerebral cortex after PH and in NDEA induced hepatic neoplasia. Brain stem serotonin content increased significantly (p<0.05) after PH and (p<0.001) in NDEA induced hepatic neoplasia. The number and affinity of the 5-HT2c receptors in the crude synaptic membrane preparations of the brain stem showed a significant (p<0.001) increase after PH and in NDEA induced hepatic neoplasia. The number and affinity of 5-HT2c receptors increased significantly (p<0.001) in NDEA induced hepatic neoplasia in the crude synaptic membrane preparations of the cerebral cortex. There was a significant (p<0.01) increase in plasma norepinephrine in PH and (p<0.001) in NDEA induced hepatic neoplasia, indicating sympathetic stimulation. Thus, our results suggest that during active hepatocyte proliferation 5-HT2c receptor in the brain stem and cerebral cortex are up-regulated which in turn induce hepatocyte proliferation mediated through sympathetic stimulation.

Decreased GyBAA Receptor Function in the Brain Stem during Pancreatic Regeneration in Rats

Gamma amino outyric acid is a major inhibitory neurotrarsr titter in the central nervous system. In the preset study sv, Have investigate(' the alteration of GABA receptor, In t he hrain stem of rats during pancreatic regeneration. Three groups of rats were used for the study: sham operated, 72 It and 7 days partially pancreatectonnsea. GABA was (juan- (ified by [H]GABA receptor iispiacement method. GABA receptor kin: 10, pat at i et•ers were studied by using the binding of F'.](iAhA as ligand to the Triton X-100 treated me,i1,;-:mes a1,J displacement with unlabelled GABA. GhRA,v receptor activity was studied by using the [` -1 h3cuculline and displacement with unlabellecV euculline. ;.\13A content significantly decreased (1' < (1.(101 ) it, 0-e brain stern during the regeneration of pancreas. 'I hl, high affinity (IAI3A receptor binding sho?:ed it sigii'f cant decrease in 131„.,\ (P < 11.01) and K,I 1).05) n 72 h and 7 days after partial pancreatee 'timv. ";:flhicuculline hin(Iing showed it signih eat, 'le ( r(, :,e in /Jn1,s and K,I (P < 0.001) in 72 h pa^.rcreaw,, mised rats when compared with sham wt--tt' as P,n and K,I reversed to near sham after 7 da,s of pancreatectomv. The results sugge,) that GAB A throur,r; ('GABA receptors in brain Atcem has a regulatory uie during active regeneration of pancreas which will have inunense clinical significance in the treatment of cliahetcs.