Avaliação transversal dos maxilares em pacientes submetidos à adenoidectomia: análise em modelos de gesso

Pós-graduação em Odontologia - FOA

Effect of the interfacial area measurement parameters on the push-out strength between fiber post and dentin

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

Organochlorine contaminants in albatrosses and petrels during migration in South Atlantic Ocean

Albatrosses and petrels (Procellariiformes) are migratory oceanic birds of considerable conservational interest. Polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) were assessed in the subcutaneous fat, liver and muscle of 100 birds belonging to eight species of Procellariiformes collected during their migration period in southern Brazil, one of the most important feeding areas for these species. Although the profiles of PCBs and OCPs were similar among the individuals, with predominance of penta, hexa and heptachlorobiphenyls and p'p-DDE, organochlorine concentrations exhibited a high degree of intra-species variability. The influence of body condition during the migration period in the distribution of organochlorine contaminants was also evaluated, showing that it is a significant factor in the variation and redistribution of these compounds in the tissues of these birds. The intense use of lipid reserves associated to the contamination from organochlorine compounds could be a troubling factor for seabirds with extended breeding periods and that spend most of their lives at sea migrating long distances, such as most of Procellariiformes. Studies on contamination are necessary to improve the knowledge of the threats to these birds and their populations as well as to contribute with information about persistent organic pollutants in the South Atlantic marine environment.

Relationships between running economy and mechanics in middle-distance runners

Running economy (RE), i.e. the oxygen consumption at a given submaximal speed, is an important determinant of endurance running performance. So far, investigators have widely attempted to individuate the factors affecting RE in competitive athletes, focusing mainly on the relationships between RE and running biomechanics. However, the current results are inconsistent and a clear mechanical profile of an economic runner has not been yet established. The present work aimed to better understand how the running technique influences RE in sub-elite middle-distance runners by investigating the biomechanical parameters acting on RE and the underlying mechanisms. Special emphasis was given to accounting for intra-individual variability in RE at different speeds and to assessing track running rather than treadmill running. In Study One, a factor analysis was used to reduce the 30 considered mechanical parameters to few global descriptors of the running mechanics. Then, a biomechanical comparison between economic and non economic runners and a multiple regression analysis (with RE as criterion variable and mechanical indices as independent variables) were performed. It was found that a better RE was associated to higher knee and ankle flexion in the support phase, and that the combination of seven individuated mechanical measures explains ∼72% of the variability in RE. In Study Two, a mathematical model predicting RE a priori from the rate of force production, originally developed and used in the field of comparative biology, was adapted and tested in competitive athletes. The model showed a very good fit (R2=0.86). In conclusion, the results of this dissertation suggest that the very complex interrelationships among the mechanical parameters affecting RE may be successfully dealt with through multivariate statistical analyses and the application of theoretical mathematical models. Thanks to these results, coaches are provided with useful tools to assess the biomechanical profile of their athletes. Thus, individual weaknesses in the running technique may be identified and removed, with the ultimate goal to improve RE.

Statistical methods for analysis and processing of medical ultrasound: applications to segmentation and restoration

In this thesis two major topics inherent with medical ultrasound images are addressed: deconvolution and segmentation. In the first case a deconvolution algorithm is described allowing statistically consistent maximum a posteriori estimates of the tissue reflectivity to be restored. These estimates are proven to provide a reliable source of information for achieving an accurate characterization of biological tissues through the ultrasound echo. The second topic involves the definition of a semi automatic algorithm for myocardium segmentation in 2D echocardiographic images. The results show that the proposed method can reduce inter- and intra observer variability in myocardial contours delineation and is feasible and accurate even on clinical data.

Parameter estimation in a growth model for a biological population

The motivating problem concerns the estimation of the growth curve of solitary corals that follow the nonlinear Von Bertalanffy Growth Function (VBGF). The most common parameterization of the VBGF for corals is based on two parameters: the ultimate length L∞ and the growth rate k. One aim was to find a more reliable method for estimating these parameters, which can capture the influence of environmental covariates. The main issue with current methods is that they force the linearization of VBGF and neglect intra-individual variability. The idea was to use the hierarchical nonlinear model which has the appealing features of taking into account the influence of collection sites, possible intra-site measurement correlation and variance heterogeneity, and that can handle the influence of environmental factors and all the reliable information that might influence coral growth. This method was used on two databases of different solitary corals i.e. Balanophyllia europaea and Leptopsammia pruvoti, collected in six different sites in different environmental conditions, which introduced a decisive improvement in the results. Nevertheless, the theory of the energy balance in growth ascertains the linear correlation of the two parameters and the independence of the ultimate length L∞ from the influence of environmental covariates, so a further aim of the thesis was to propose a new parameterization based on the ultimate length and parameter c which explicitly describes the part of growth ascribable to site-specific conditions such as environmental factors. We explored the possibility of estimating these parameters characterizing the VBGF new parameterization via the nonlinear hierarchical model. Again there was a general improvement with respect to traditional methods. The results of the two parameterizations were similar, although a very slight improvement was observed in the new one. This is, nevertheless, more suitable from a theoretical point of view when considering environmental covariates.

Optimierung der Pharmakotherapie schizophrener Patienten durch objektive Symptomerfassung und Therapeutisches Drug Monitoring

Der Erfolg einer Schizophrenie-Behandlung ist zum größten Teil abhängig vom Ansprechen des Patienten auf seine antipsychotische Medikation. Welches Medikament und welche Dosis bei einem individuellen Patienten wirksam sind, kann derzeit erst nach mehrwöchiger Behandlung beurteilt werden. Ein Grund für variierendes Therapieansprechen sind variable Plasmakonzentrationen der Antipsychotika. Ziel dieser Arbeit war es, zu untersuchen, in wieweit der Therapieerfolg zu einem frühen Zeitpunkt der Behandlung durch objektive Symptomerfassung vorhersagbar ist und welche Faktoren die hohe Variabilität der Antipsychotikaspiegel im Blut beeinflussen. rnEine 18-monatige naturalistische klinische Studie an schizophrenen Patienten wurde durchgeführt, um folgende Fragen zu beantworten: Kann man das Therapieansprechen prädizieren und welche Instrumente sind dafür geeignet? Die Psychopathologie wurde anhand zweier Messskalen (Brief Psychiatric Rating Scale, BPRS und Clinical Global Impressions, CGI) wöchentlich ermittelt, um die Besserung der Krankheitssymptome im Verlauf von 8 Wochen zu bewerten. Therapiebegleitend wurden noch die Serum-Konzentrationen der Antipsychotika gemessen. Objektive Symptomerfassung durch BPRS oder CGI waren als Messinstrumente geeignet, Therapieansprechen vorherzusagen. Bezogen auf den Behandlungsbeginn war eine Verminderung der Symptome hoch prädiktiv für späteres Therapieversagen oder -ansprechen. Eine Verminderung um mehr als 36,5% auf der BPRS Skala in Woche 2 wurde als signifikanter Schwellenwert für Nichtansprechen ermittelt. Patienten, deren Symptombesserung unterhalb des Schwellenwertes lag, hatten eine 11,2-fach höhere Wahrscheinlichkeit, am Ende der Studie nicht auf ihre medikamentöse Therapie anzusprechen als die Patienten, die sich um mindestens 36,5% verbesserten. Andere Faktoren, wie Alter, Geschlecht, Dauer der Erkrankung oder Anzahl der stationären Aufenthalte hatten keinen Einfluss auf die Prädiktion des Therapieansprechens. Therapeutische Antipsychotika-Spiegel übten einen positiven Einfluss auf die Ansprechrate aus. Bei Patienten mit therapeutischen Spiegeln war das Ansprechen rascher und die Ansprechrate größer als unter denjenigen deren Spiegel außerhalb der therapeutisch üblichen Bereiche lag. rnEine wichtige Voraussetzung für den Einsatz von TDM ist das Vorhandensein einer präzisen, reproduzierbaren, zeit- und kostensparenden analytischen Methode zur quantitativen Bestimmung der untersuchten Substanzen. Die Entwicklung und Validierung einer solchen geeigneten Methode wurde für den Nachweis von Haloperidol vorgenommen. Eine HPLC-Methode mit Säulenschaltung erwies sich für TDM geeignet. rnBasierend auf den Ergebnissen der eigenen klinischen Studie zur Response Prädiktion wurde untersucht, welche Faktoren die Variabilität der Pharmakokinetik von Antipsychotika beeinflussen. Die Variabilität der Pharmakokinetik ist ein Grund für fehlendes oder unzureichendes Ansprechen. Es wurde zum einen der Einfluss der galenischen Formulierung auf die Freisetzung und zum anderen der Einfluss von entzündlichen Prozessen auf die Metabolisierung eines Antipsychotikums untersucht. Dazu wurden Patientendaten retrospektiv ausgewertet.rnDie Analyse von 247 Serumspiegeln von Patienten, die mit Paliperidon in OROS®Formulierung, einer neu eingeführten Retardform, behandelt wurden, zeigte, dass die intraindividuelle Variabilität der Talspiegel (Vk) von Paliperidon 35% betrug. Er war damit vergleichbar wie für nicht retardiertes Risperidon 32% (p=n.s.). Die Retardierung hatte demnach keinen Varianz mindernden Effekt auf die Talspiegel des Antipsychotikums. Der Wirkstoff-Konzentrations-Bereich lag bei 21-55 ng/ml und entsprach ebenfalls nahezu dem therapeutischen Bereich von Risperidon (20-60 ng/ml). rnEntzündliche Prozesse können die Metabolisierung von Medikamenten verändern. Dies wurde bisher für Medikamente nachgewiesen, die über CYP1A2 abgebaut werden. Durch die eigene Analyse von 84 Patienten-Serumspiegeln konnte festgestellt werden, dass die Metabolisierung von Quetiapin während eines entzündlichen Prozesses beeinträchtigt war, wahrscheinlich durch Hemmung von CYP3A4. Dies sprach dafür, dass auch Wirkstoffe, die über CYP3A4 abgebaut werden, während eines entzündlichen Prozesses im Körper in ihrer Pharmakokinetik beeinträchtigt sein können. Aus diesem Grund sollte während einer Infektion unter der Therapie mit Quetiapin besonders auf die Nebenwirkungen geachtet werden und der Serumspiegel sollte in dieser Zeit überwacht werden, um den Patienten vor eventuellen Nebenwirkungen oder sogar Intoxikationen zu schützen. rnDie Befunde dieser Arbeit zeigen, dass bei einer Behandlung schizophrener Patienten mit Antipsychotika die Messung der Psychopathologie zur Vorhersage des Therapieansprechens und die Messung der Blutspiegel zur Identifizierung von Faktoren, die die pharmakokinetische Variabilität bedingen, geeignet sind. Objektive Symptomerfassung und Therapeutisches Drug Monitoring sind demnach Instrumente, die für die Steuerung der antipsychotischen Pharmakotherapie genutzt werden sollten.rn

Ottimizzazione del consumo dei grassi durante esercizio fisico: studio di un test per il target mirato di allenamento individuale

Il primo studio ha verificato l'affidabilità del software Polimedicus e gli effetti indotti d'allenamento arobico all’intensità del FatMax. 16 soggetti sovrappeso, di circa 40-55anni, sono stati arruolati e sottoposti a un test incrementale fino a raggiungere un RER di 0,95, e da quel momento il carico è stato aumentato di 1 km/ h ogni minuto fino a esaurimento. Successivamente, è stato verificato se i valori estrapolati dal programma erano quelli che si possono verificare durante a un test a carico costante di 1ora. I soggetti dopo 8 settimane di allenamento hanno fatto un altro test incrementale. Il dati hanno mostrato che Polimedicus non è molto affidabile, soprattutto l'HR. Nel secondo studio è stato sviluppato un nuovo programma, Inca, ed i risultati sono stati confrontati con i dati ottenuti dal primo studio con Polimedicus. I risultati finali hanno mostrato che Inca è più affidabile. Nel terzo studio, abbiamo voluto verificare l'esattezza del calcolo del FatMax con Inca e il test FATmaxwork. 25 soggetti in sovrappeso, tra 40-55 anni, sono stati arruolati e sottoposti al FATmaxwork test. Successivamente, è stato verificato se i valori estrapolati da INCA erano quelli che possono verificarsi durante un carico di prova costante di un'ora. L'analisi ha mostrato una precisione del calcolo della FatMax durante il carico di lavoro. Conclusione: E’ emersa una certa difficoltà nel determinare questo parametro, sia per la variabilità inter-individuale che intra-individuale. In futuro bisognerà migliorare INCA per ottenere protocolli di allenamento ancora più validi.

Impaired performance on the rapid visual information processing task (RVIP) could be an endophenotype of schizophrenia

The aim of the present study was to investigate whether healthy first-degree relatives of schizophrenia patients show reduced sensitivity performance, higher intra-individual variability (IIV) in reaction time (RT), and a steeper decline in sensitivity over time in a sustained attention task. Healthy first-degree relatives of schizophrenia patients (n=23) and healthy control subjects (n=46) without a family history of schizophrenia performed a demanding version of the Rapid Visual Information Processing task (RVIP). RTs, hits, false alarms, and the sensitivity index A' were assessed. The relatives were significantly less sensitive, tended to have higher IIV in RT, but sustained the impaired level of sensitivity over time. Impaired performance on the RVIP is a possible endophenotype for schizophrenia. Higher IIV in RT, apparently caused by impaired context representations, might result in fluctuations in control and lead to more frequent attentional lapses.

Investigation of different apple cultivars by high resolution magic angle spinning NMR. A feasibility study

(1)H HR-MAS NMR spectroscopy was applied to apple tissue samples deriving from 3 different cultivars. The NMR data were statistically evaluated by analysis of variance (ANOVA), principal component analysis (PCA), and partial least-squares-discriminant analysis (PLS-DA). The intra-apple variability of the compounds was found to be significantly lower than the inter-apple variability within one cultivar. A clear separation of the three different apple cultivars could be obtained by multivariate analysis. Direct comparison of the NMR spectra obtained from apple tissue (with HR-MAS) and juice (with liquid-state HR NMR) showed distinct differences in some metabolites, which are probably due to changes induced by juice preparation. This preliminary study demonstrates the feasibility of (1)H HR-MAS NMR in combination with multivariate analysis as a tool for future chemometric studies applied to intact fruit tissues, e.g. for investigating compositional changes due to physiological disorders, specific growth or storage conditions.

How reliable is Ki-67 immunohistochemistry in grade 2 breast carcinomas? A QA study of the Swiss Working Group of Breast- and Gynecopathologists

Adjuvant chemotherapy decisions in breast cancer are increasingly based on the pathologist's assessment of tumor proliferation. The Swiss Working Group of Gyneco- and Breast Pathologists has surveyed inter- and intraobserver consistency of Ki-67-based proliferative fraction in breast carcinomas. Methods Five pathologists evaluated MIB-1-labeling index (LI) in ten breast carcinomas (G1, G2, G3) by counting and eyeballing. In the same way, 15 pathologists all over Switzerland then assessed MIB-1-LI on three G2 carcinomas, in self-selected or pre-defined areas of the tumors, comparing centrally immunostained slides with slides immunostained in the different laboratoires. To study intra-observer variability, the same tumors were re-examined 4 months later. Results The Kappa values for the first series of ten carcinomas of various degrees of differentiation showed good to very good agreement for MIB-1-LI (Kappa 0.56–0.72). However, we found very high inter-observer variabilities (Kappa 0.04–0.14) in the read-outs of the G2 carcinomas. It was not possible to explain the inconsistencies exclusively by any of the following factors: (i) pathologists' divergent definitions of what counts as a positive nucleus (ii) the mode of assessment (counting vs. eyeballing), (iii) immunostaining technique, and (iv) the selection of the tumor area in which to count. Despite intensive confrontation of all participating pathologists with the problem, inter-observer agreement did not improve when the same slides were re-examined 4 months later (Kappa 0.01–0.04) and intra-observer agreement was likewise poor (Kappa 0.00–0.35). Conclusion Assessment of mid-range Ki-67-LI suffers from high inter- and intra-observer variability. Oncologists should be aware of this caveat when using Ki-67-LI as a basis for treatment decisions in moderately differentiated breast carcinomas.

Quantifying the periodicty of Inter Movement Intervals of Leg Movements

ims: Periodic leg movements in sleep (PLMS) are a frequent finding in polysomnography. Most patients with restless legs syndrome (RLS) display PLMS. However, since PLMS are also often recorded in healthy elderly subjects, the clinical significance of PLMS is still discussed controversially. Leg movements are seen concurrently with arousals in obstructive sleep apnoea (OSA) may also appear periodically. Quantitative assessment of the periodicity of LM/PLM as measured by inter movement intervals (IMI) is difficult. This is mainly due to influencing factors like sleep architecture and sleep stage, medication, inter and intra patient variability, the arbitrary amplitude and sequence criteria which tend to broaden the IMI distributions or make them even multi-modal. Methods: Here a statistical method is presented that enables eliminating such effects from the raw data before analysing the statistics of IMI. Rather than studying the absolute size of IMI (measured in seconds) we focus on the shape of their distribution (suitably normalized IMI). To this end we employ methods developed in Random Matrix Theory (RMT). Patients: The periodicity of leg movements (LM) of four patient groups (10 to 15 each) showing LM without PLMS (group 1), OSA without PLMS (group 2), PLMS and OSA (group 3) as well as PLMS without OSA (group 4) are compared. Results: The IMI of patients without PLMS (groups 1 and 2) and with PLMS (groups 3 and 4) are statistically different. In patients without PLMS the distribution of normalized IMI resembles closely the one of random events. In contrary IMI of PLMS patients show features of periodic systems (e.g. a pendulum) when studied in normalized manner. Conclusions: For quantifying PLMS periodicity proper normalization of the IMI is crucial. Without this procedure important features are hidden when grouping LM/PLM over whole nights or across patients. The clinical significance of PLMS might be eluded when properly separating random LM from LM that show features of periodic systems.

A multiplex PCR for the simultaneous detection and genotyping of the Echinococcus granulosus complex.

Echinococcus granulosus is characterized by high intra-specific variability (genotypes G1-G10) and according to the new molecular phylogeny of the genus Echinococcus, the E. granulosus complex has been divided into E. granulosus sensu stricto (G1-G3), E. equinus (G4), E. ortleppi (G5), and E. canadensis (G6-G10). The molecular characterization of E. granulosus isolates is fundamental to understand the spatio-temporal epidemiology of this complex in many endemic areas with the simultaneous occurrence of different Echinococcus species and genotypes. To simplify the genotyping of the E. granulosus complex we developed a single-tube multiplex PCR (mPCR) allowing three levels of discrimination: (i) Echinococcus genus, (ii) E. granulosus complex in common, and (iii) the specific genotype within the E. granulosus complex. The methodology was established with known DNA samples of the different strains/genotypes, confirmed on 42 already genotyped samples (Spain: 22 and Bulgaria: 20) and then successfully applied on 153 unknown samples (Tunisia: 114, Algeria: 26 and Argentina: 13). The sensitivity threshold of the mPCR was found to be 5 ng Echinoccoccus DNA in a mixture of up to 1 µg of foreign DNA and the specificity was 100% when template DNA from closely related members of the genus Taenia was used. Additionally to DNA samples, the mPCR can be carried out directly on boiled hydatid fluid or on alkaline-lysed frozen or fixed protoscoleces, thus avoiding classical DNA extractions. However, when using Echinococcus eggs obtained from fecal samples of infected dogs, the sensitivity of the mPCR was low (<40%). Thus, except for copro analysis, the mPCR described here has a high potential for a worldwide application in large-scale molecular epidemiological studies on the Echinococcus genus.

Time of emergence of trends in ocean biogeochemistry

For the detection of climate change, not only the magnitude of a trend signal is of significance. An essential issue is the time period required by the trend to be detectable in the first place. An illustrative measure for this is time of emergence (ToE), that is, the point in time when a signal finally emerges from the background noise of natural variability. We investigate the ToE of trend signals in different biogeochemical and physical surface variables utilizing a multi-model ensemble comprising simulations of 17 Earth system models (ESMs). We find that signals in ocean biogeochemical variables emerge on much shorter timescales than the physical variable sea surface temperature (SST). The ToE patterns of pCO2 and pH are spatially very similar to DIC (dissolved inorganic carbon), yet the trends emerge much faster – after roughly 12 yr for the majority of the global ocean area, compared to between 10 and 30 yr for DIC. ToE of 45–90 yr are even larger for SST. In general, the background noise is of higher importance in determining ToE than the strength of the trend signal. In areas with high natural variability, even strong trends both in the physical climate and carbon cycle system are masked by variability over decadal timescales. In contrast to the trend, natural variability is affected by the seasonal cycle. This has important implications for observations, since it implies that intra-annual variability could question the representativeness of irregularly sampled seasonal measurements for the entire year and, thus, the interpretation of observed trends.

Volumetric analysis of lung nodules in computed tomography (CT): comparison of two different segmentation algorithm softwares and two different reconstruction filters on automated volume calculation.

BACKGROUND A precise detection of volume change allows for better estimating the biological behavior of the lung nodules. Postprocessing tools with automated detection, segmentation, and volumetric analysis of lung nodules may expedite radiological processes and give additional confidence to the radiologists. PURPOSE To compare two different postprocessing software algorithms (LMS Lung, Median Technologies; LungCARE®, Siemens) in CT volumetric measurement and to analyze the effect of soft (B30) and hard reconstruction filter (B70) on automated volume measurement. MATERIAL AND METHODS Between January 2010 and April 2010, 45 patients with a total of 113 pulmonary nodules were included. The CT exam was performed on a 64-row multidetector CT scanner (Somatom Sensation, Siemens, Erlangen, Germany) with the following parameters: collimation, 24x1.2 mm; pitch, 1.15; voltage, 120 kVp; reference tube current-time, 100 mAs. Automated volumetric measurement of each lung nodule was performed with the two different postprocessing algorithms based on two reconstruction filters (B30 and B70). The average relative volume measurement difference (VME%) and the limits of agreement between two methods were used for comparison. RESULTS At soft reconstruction filters the LMS system produced mean nodule volumes that were 34.1% (P < 0.0001) larger than those by LungCARE® system. The VME% was 42.2% with a limit of agreement between -53.9% and 138.4%.The volume measurement with soft filters (B30) was significantly larger than with hard filters (B70); 11.2% for LMS and 1.6% for LungCARE®, respectively (both with P < 0.05). LMS measured greater volumes with both filters, 13.6% for soft and 3.8% for hard filters, respectively (P < 0.01 and P > 0.05). CONCLUSION There is a substantial inter-software (LMS/LungCARE®) as well as intra-software variability (B30/B70) in lung nodule volume measurement; therefore, it is mandatory to use the same equipment with the same reconstruction filter for the follow-up of lung nodule volume.