AVALIAÇÃO DA INFLUÊNCIA DO TIPO FACIAL NOS TAMANHOS DOS ESPAÇOS AÉREOS NASO E BUCOFARÍNGE

A variação nos tamanhos dos espaços aéreos naso e bucofaríngeo ocorre devido a fatores genéticos e/ou ambientais. A diminuição no tamanho do espaço aéreo nasofaríngeo, causada pela hipertrofia da tonsila faríngea, tem sido associada a alterações no padrão normal de crescimento craniofacial e a efeitos deletérios na oclusão. O objetivo do presente trabalho é avaliar se há variação nos tamanhos dos espaços aéreos naso e bucofaríngeo de acordo com o padrão de crescimento craniofacial, assim como avaliar a correlação entre os tamanhos dos espaços e o índice VERT, além de verificar um possível dimorfismo sexual. Na mensuração dos espaços, utilizou-se telerradiografias laterais de 90 pacientes, divididos em três grupos de acordo com o padrão de crescimento craniofacial, determinado por meio do índice VERT de Ricketts. Os pacientes da amostra, com idades entre 9 e 16 anos, apresentavam padrão respiratório nasal, sem qualquer tipo de obstrução. Não foi observada variação estatisticamente significante nos tamanhos dos espaços aéreos naso e bucofaríngeo, quando comparados os três tipos faciais. Também não foi encontrada correlação entre os tamanhos dos espaços aéreos e os valores do índice VERT de Ricketts dos pacientes e não foi observado dimorfismo sexual. XII

Characterising the central mechanisms of sensory modulation in human swallowing motor cortex

Objective: Pharyngeal stimulation can induce remarkable increases in the excitability of swallowing motor cortex, which is associated with short-term improvements in swallowing behaviour in dysphagic stroke patients. However, the mechanism by which this input induces cortical change remains unclear. Our aims were to explore the stimulus-induced facilitation of the cortico-bulbar projections to swallowing musculature and examine how input from the pharynx interacts with swallowing motor cortex. Methods: In 8 healthy subjects, a transcranial magnetic stimulation (TMS) paired-pulse investigation was performed comprising a single conditioning electrical pharyngeal stimulus (pulse width 0.2 ms, 240 V) followed by cortical TMS at inter-stimulus intervals (ISI) of 10-100 ms. Pharyngeal sensory evoked potentials (PSEP) were also measured over the vertex. In 6 subjects whole-brain magnetoencephalography (MEG) was further acquired following pharyngeal stimulation. Results: TMS evoked pharyngeal motor evoked potentials were facilitated by the pharyngeal stimulus at ISI between 50 and 80 ms (Δ mean increase: 47±6%, P<0.05). This correlated with the peak latency of the P1 component of the PSEP (mean 79.6±8.5 ms). MEG confirmed that the equivalent P1 peak activities were localised to caudolateral sensory and motor cortices (BA 4, 1, 2). Conclusions: Facilitation of the cortico-bulbar pathway to pharyngeal stimulation relates to coincident afferent input to sensorimotor cortex. Significance: These findings have mechanistic importance on how pharyngeal stimulation may increase motor excitability and provide guidance on temporal windows for future manipulations of swallowing motor cortex. © 2004 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Instability of CTG Repeats is Governed by the Position of a DNA Base Lesion through Base Excision Repair

Trinucleotide repeat (TNR) expansions and deletions are associated with human neurodegeneration and cancer. However, their underlying mechanisms remain to be elucidated. Recent studies have demonstrated that CAG repeat expansions can be initiated by oxidative DNA base damage and fulfilled by base excision repair (BER), suggesting active roles for oxidative DNA damage and BER in TNR instability. Here, we provide the first evidence that oxidative DNA damage can induce CTG repeat deletions along with limited expansions in human cells. Biochemical characterization of BER in the context of (CTG)20 repeats further revealed that repeat instability correlated with the position of a base lesion in the repeat tract. A lesion located at the 59-end of CTG repeats resulted in expansion, whereas a lesion located either in the middle or the 39-end of the repeats led to deletions only. The positioning effects appeared to be determined by the formation of hairpins at various locations on the template and the damaged strands that were bypassed by DNA polymerase b and processed by flap endonuclease 1 with different efficiency. Our study indicates that the position of a DNA base lesion governs whether TNR is expanded or deleted through BER.

Inter-relação entre lesão cervical não cariosa e comprometimento periodontal: diagnóstico, tratamento e previsibilidade - estudo clínico prospectivo e laboratorial

The coexistence of gingival recession (GR) with root coverage indication and non-carious cervical lesions (LCNC) generates the need for a protocol that respects and promotes health of dental and periodontal tissues and allows treatment predictability. The main objectives of this theses were: (1) verify, through clinical evaluations, the connective tissue graft for root coverage on direct and indirect restorations made of ceramic resin; (2) analyze the influence of the battery level of the LED curing unit in the composite resin characteristics; (3) assess the influence of restorative materials, composite resin and ceramics, on the viability of gingival fibroblasts from primary culture. Nine patients with good oral hygiene and occlusal stability diagnosed with LCNCs the anterior teeth including premolars associated with gingival recession (class I and II of Miller) and only gingival recession were selected. After initial clinical examination, occlusal adjustment was performed and the patients had their teeth randomized allocated on direct composite resin restoration of LCNC, polishing and GR treatment with connective tissue graft and advanced coronally flap CR group (n = 15); and indirect ceramic restoration of the LCNC's and GR treatment (CTG+CAF) Group C (n = 15). The GR presented teeth with no clinically formed LCNCs cavity were treated using (CTG+CAF) being the control group (n = 15). Sorption and solubility tests, analysis of the degree of conversion and diametral tensile strength were performed in composite resin samples (n = 10) photoactivated by 100, 50 and 10% battery charge LED unit. The viability of fibroblasts on composite resin, ceramics and dentin disks (n = 3) was examined. Clinical follow-up was performed for three months. The data obtained at different stages were tabulated and subjected to analysis for detection of normal distribution and homogeneity. The results showed that: the LED unit with 10% battery affects the characteristics of the composite resin; restorative materials present biocompatibility with gingival fibroblasts; and the association of surgical and restorative treatment of teeth affected by NCCL and GR presents successful results at 3-month follow-up.

L'étude du "cross-talk" des voies de synthèse des prostaglandines E₂ et des leucotriènes B₄ dans le fonctionnement altéré des ostéoblastes sous-chondraux humains arthrosiques

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

When static meets dynamic: Comparing cone-beam computed tomography and acoustic reflection for upper airway analysis

INTRODUCTION: Upper airway measurement can be important for the diagnosis of breathing disorders. Acoustic reflection (AR) is an accepted tool for studying the airway. Our objective was to investigate the differences between cone-beam computed tomography (CBCT) and AR in calculating airway volumes and areas. METHODS: Subjects with prescribed CBCT images as part of their records were also asked to have AR performed. A total of 59 subjects (mean age, 15 ± 3.8 years) had their upper airway (5 areas) measured from CBCT images, acoustic rhinometry, and acoustic pharyngometry. Volumes and minimal cross-sectional areas were extracted and compared with software. RESULTS: Intraclass correlation on 20 randomly selected subjects, remeasured 2 weeks apart, showed high reliability (r >0.77). Means of total nasal volume were significantly different between the 2 methods (P = 0.035), but anterior nasal volume and minimal cross-sectional area showed no differences (P = 0.532 and P = 0.066, respectively). Pharyngeal volume showed significant differences (P = 0.01) with high correlation (r = 0.755), whereas pharyngeal minimal cross-sectional area showed no differences (P = 0.109). The pharyngeal volume difference may not be considered clinically significant, since it is 758 mm3 for measurements showing means of 11,000 ± 4000 mm3. CONCLUSIONS: CBCT is an accurate method for measuring anterior nasal volume, nasal minimal cross-sectional area, pharyngeal volume, and pharyngeal minimal cross-sectional area.

L'étude du "cross-talk" des voies de synthèse des prostaglandines E₂ et des leucotriènes B₄ dans le fonctionnement altéré des ostéoblastes sous-chondraux humains arthrosiques

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Oxidative DNA Damage Modulates Trinucleotide Repeat Instability Via DNA Base Excision Repair

Trinucleotide repeat (TNR) expansion is the cause of more than 40 types of human neurodegenerative diseases such as Huntington’s disease. Recent studies have linked TNR expansion with oxidative DNA damage and base excision repair (BER). In this research, we provided the first evidence that oxidative DNA damage can induce CAG repeat deletion/contraction via BER. We found that BER of an oxidized DNA base lesion, 8-oxoguanine in a CAG repeat tract, resulted in the formation of a CTG hairpin at the template strand. DNA polymerase β (pol b) then skipped over the hairpin creating a 5’-flap that was cleaved by flap endonuclease 1 (FEN1) leading to CAG repeat deletion. To further investigate whether BER may help to shorten an expanded TNR tract, we examined BER in a CAG repeat hairpin loop. We found that 8-oxoguanine DNA glycosylase removed the oxidized base located in the loop region of the hairpin leaving an abasic site. Apurinic/apyrimidinic (AP) endonuclease 1 then incised the 5’-end of the abasic site leaving a nick in the loop. This further converted the hairpin into an intermediate with a 3’-flap and a 5’-flap. As a 5’-3’ endonuclease, FEN1 cleaved the 5’-flap, whereas a 3’-5’ endonuclease, Mus81/Eme1, removed the 3’-flap. The coordination between FEN1 and Mus81/Eme1 ultimately resulted in removal of a CAG repeat hairpin attenuating or preventing TNR expansion. To further explore if pol β bypass of an oxidized base lesion, 5’,8-cyclodeoxyadenosine, may affect TNR instability, we examined pol β DNA synthesis in bypassing this base lesion and found that the lesion preferentially induced TNR deletion during BER and Okazaki fragment maturation. The repeat deletion was mediated by the formation of a loop in the template strand induced specifically by the damage. Pol β then skipped over the loop structure creating a 5’-flap that was efficiently removed by FEN1 leading to repeat deletion. Our study demonstrates that pol β-mediated BER plays an important role in mediating TNR deletion and removing a TNR hairpin to prevent TNR expansion. Our research provides a molecular basis for further developing BER as a target for prevention and treatment of neurodegenerative diseases caused by TNR expansion.

DEVELOPMENT OF AN ADJUSTABLE SUTURE TECHNIQUE FOR TRABECULECTOMY

This research presents a new design of an adjustable suture that could provide a better intraocular pressure (IOP) control in the post treatment of trabeculectomy surgery and limit associated complication with the current suturing techniques. A better control in tension suture brings a great deal of advantages to this surgical technique compared with the traditional adjustable suture. A length adjustment can be added in advance to a 10-0 nylon suture which enables suture tension to be released during the postoperative period of trabeculectomy surgery. This adjustment has a D-ring geometry made of 10-0 nylon suture adhered to a 10-0 nylon surgical suture which is used to close the scalar flap. The D ring was adhered with about 180 microdroplet of Loctite 4311that was found to form a strong joint to connect the D ring to the main 10-0 nylon suture and strong enough to carry the added tension instead after cutting the central suture between the two joints of the D ring. The geometry of adjustment is the key factor of maintaining the IOP at the normal range and keeping the scleral flap tight enough and secure so that aqueous humor continues to percolate under the subconjunctiva. It has been found that a 365, and 450 µm length extensions can release suture tension postoperatively and relieve the intraocular pressure within the eye by 33, and 66% respectively. The fabrication process of the new adjustable suture was divided into two steps: fabrication of micro jig and forming microdroplets. A micro jig was fabricated in order to form and bond a precise length extension to the new design of the adjustable suture. In addition, a new liquid separation technique has been followed in this study in order to generate micro adhesive droplets as small as 50µm for bonding the new adjustable suture structure.

Optimising power take-off of an oscillating wave surge converter using high fidelity numerical simulations

Oscillating wave surge converters are a promising technology to harvest ocean wave energy in the near shore region. Although research has been going on for many years, the characteristics of the wave action on the structure and especially the phase relation between the driving force and wave quantities like velocity or surface elevation have not been investigated in detail. The main reason for this is the lack of suitable methods. Experimental investigations using tank tests do not give direct access to overall hydrodynamic loads, only damping torque of a power take off system can be measured directly. Non-linear computational fluid dynamics methods have only recently been applied in the research of this type of devices. This paper presents a new metric named wave torque, which is the total hydrodynamic torque minus the still water pitch stiffness at any given angle of rotation. Changes in characteristics of that metric over a wave cycle and for different power take off settings are investigated using computational fluid dynamics methods. Firstly, it is shown that linearised methods cannot predict optimum damping in typical operating states of OWSCs. We then present phase relationships between main kinetic parameters for different damping levels. Although the flap seems to operate close to resonance, as predicted by linear theory, no obvious condition defining optimum damping is found.

Calcaneus-navicular coalition associated to flatfoot in a child. A case report

Tarsal coalition (a congenital fibrous, cartilaginous or bony connection between two bones) often leads to a flatfoot deformity in children. Usually it presents with recurrent ankle sprains or insidious onset of a painful rigid flatfoot and movement limitation of midtarsal and subtalar joints. Clinical diagnosis is confirmed by X-rays, computed axial tomography and nuclear magnetic resonance. The anteater nose sign is caused by a tubular elongation of the anterior process of the calcaneus that approaches or overlaps the tarsal scaphoid (navicular) and resembles the nose of an anteater on a lateral foot or ankle radiograph. The treatment of this union is primarily symptomatic but if the pain persists must be surgical .

Aumento de coroa clínica

O sorriso não se baseia apenas em factores dentários relacionados com a cor, a forma ou o alinhamento dos dentes na arcada, mas implica também a presença de tecidos periodontais saudáveis e com um contorno gengival harmónico. Este trabalho tem como objectivo abordar as diversas técnicas de aumento de coroa clínica, enunciar as vantagens e indicações das mesmas, bem como comparar as técnicas cirúrgicas com as ortodônticas. Para tal foi realizada uma pesquisa bibliográfica recorrendo aos motores de busca da Pubmed e b-on, utilizando como palavras-chave: crown lengthening, biological width, crown lengthening AND surgery e crown lengthening AND orthodontic extrusion. Dos 539 artigos encontrados, foram seleccionados 28 que correspondiam aos critérios de inclusão por nós estabelecidos. Critérios de inclusão: meta-análises, ensaios clínicos randomizados e revisões sistemáticas publicadas em Português, Inglês e Espanhol nos últimos 12 anos. De acordo com a literatura, podemos verificar que o aumento de coroa clínica está indicado em várias situações clínicas tais como: cáries infra-gengivais, fracturas radiculares, resolução de alguns problemas estéticos, como o sorriso gengival, principalmente em casos de erupção passiva alterada e assimetrias das margens gengivais. Este aumento pode ser realizado por técnicas cirúrgicas (gengivectomia e retalho de reposicionamento apical), técnicas ortodônticas (extrusão ortodôntica com ou sem fibrotomia) ou através da combinação de ambas.

Tração de caninos superiores inclusos

Hoje em dia o médico dentista depara-se frequentemente com situações de inclusão canina. Sendo o canino um dente fundamental para o desenvolvimento harmonioso da estética dentária, facial e da função mastigatória, torna-se importante estudar abordagens que solucionem esta condição. Várias abordagens multidisciplinares têm sido desenvolvidas com recurso à Ortodontia, Cirurgia, Periodontia e Dentisteria. O objetivo desta revisão bibliográfica é o estudo e comparação de duas técnicas cirúrgicas de exposição de caninos inclusos maxilares: técnica aberta e técnica fechada. A técnica aberta consiste na exposição do canino, isolamento da área cirúrgica recorrendo a um cimento periodontal e posterior instalação de um acessório com vista à tração ortodôntica. Na técnica fechada a exposição cirúrgica e a instalação do acessório de tração são executados na mesma consulta, procedendo-se de seguida ao fecho e sutura do retalho. A escolha da técnica tem por base critérios como a localização vestíbulo-palatina, a quantidade de gengiva aderida presente na área de inclusão, posição mésio-distal e vertical da coroa do canino. Existe controvérsia entre os autores no que toca à escolha da técnica cirúrgica a utilizar. Nesse sentido são expostas as vantagens, desvantagens, indicações e protocolos de cada técnica, de modo a obter um melhor entendimento do tema. Existem também diversas opções em relação à escolha do dispositivo de tração ortodôntica a utilizar. Na década de 60 começou por se utilizar a técnica do laço de fio de aço, no entanto a manifestação de problemas periodontais decorrentes da sua utilização, bem como a evolução dos sistemas adesivos levaram ao desenvolvimento de acessórios de colagem direta e o uso de correntes metálicas.

Técnicas de alongamento coronário

Introdução: O alongamento coronário é um procedimento que pode envolver, ou não, técnicas cirúrgicas, e que tem como principal objetivo aumentar o tamanho da coroa clínica, assim como devolver a estética, a forma e a função às arcadas dentárias. Este procedimento realiza-se, ou por motivos estéticos ou motivos restauradores. Ultimamente, os motivos estéticos têm vindo a ganhar importância e são eles que, muitas da vezes, levam os pacientes às consultas de medicina dentária. O sorriso gengival é um desses motivos, e pode ser causado, entre outras razões por, uma erupção passiva alterada ou/e um excesso vertical maxilar. Estas são as etiologias que serão descritas neste trabalho. O aumento coronário realiza-se, também, quando há a necessidade de reabilitar um dente, quer seja com resinas compostas ou com coroas. Este, deve sempre respeitar os limites biológicos do periodonto, nomeadamente o espaço biológico. A invasão deste espaço pode por em risco a manutenção da saúde do periodonto e a viabilidade do tratamento a longo prazo, por isto, preconiza-se que deve ser deixado um espaço de 3mm, desde a crista óssea até a margem restauradora. As técnicas de alongamento coronário enumeradas e definidas ao longo desta tese são: a gengivectomia, o retalho apicalmente posicionado e a erupção dentária forçada. Cada uma delas possui as suas indicações e contra-inidcaçoes. A gengivectomia é realizada quando não há necessidade de recontorno ósseo, pelo contrário, quando essa necessidade existe opta-se pelo retalho apicalmente posicionado. A erupção forçada é uma alternativa ao alongamento cirúrgico e aplica-se, normalmente a dentes não restauráveis mas com estrutura dentária sã abaixo do da crista óssea. Um ótimo diagnóstico é o essencial para a escolha da técnica de aumento coronário que melhor se adequa a cada caso. Objetivo: O objetivo desta revisão bibliográfica tem por base a pesquisa das técnicas de alongamento coronário, começando por perceber a anatomia do periodonto, as alterações que nele acontecem antes e depois dos procedimentos de alongamento coronário, a descrição e a comparação dos mesmos. Materiais e métodos: Para a realização desta revisão foram utilizados os principais motores de busca de dados científicos como a PubMed, B-on, Medline, Scielo, Google Académico e ainda o repositório on-line da Universidade Fernando Pessoa. Foram utilizadas as seguintes palavras chaves: “altered passive eruption”, “gingivectomy”, “gingivoplasty”, “apically repositioned flap”, “surgical crown lengthening”, “biologic width”, “mucogengival junction”, “forced eruption”, “prostethic dentistry”, “gummy smile”, resultando num pesquisa de 45 artigos e duas obras literarátias de interesse. Conclusões: Foi possível concluir que existem varias técnicas de alongamento coronário, cada uma adequada a cada caso e verificou-se que existem vários motivos pelo qual se realiza essa técnica.

Oculo-auriculo-vertebral spectrum: a review of the literature and genetic update

Oculo-auriculo-vertebral spectrum (OAVS, OMIM 164 210) is a developmental disorder primarily involving structures derived from the first and second pharyngeal arches during embryogenesis. The phenotype is clinically heterogeneous and is typically characterised by abnormal development of the ear, mandible anomalies and defects of the vertebral column. OAVS may occur as a multiple congenital abnormality, and associated findings include anomalies of the eye, brain, heart, kidneys and other organs and systems. Both genetic and environmental factors are thought to contribute to this craniofacial condition, however, the mechanisms are still poorly understood. Here, we present a review of the literature on OAVS, discussing what is known about the aetiology, candidate loci, possible mechanisms and the range of clinical features that characterise this condition. We also comment on some important aspects of recurrence risk counselling to aid clinical management.