Mitral valve prolapse and anxiety disorders

We investigated whether there is an association between anxiety disorders and mitral valve prolapse. We compared mitral valve prolapse prevalence in individuals with panic disorder (n=41), social anxiety disorder (n=89) and in healthy controls (n=102) in an attempt to overcome the biases of previous studies. Our results show no associations between panic disorder or social anxiety disorder and mitral valve prolapse, regardless of the diagnostic criteria employed, and that the relationship between these conditions seems not to be clinically relevant.

Isoproterenol induces primary loss of dystrophin in rat hearts: correlation with myocardial injury

The mechanism of isoproterenol-induced myocardial damage is unknown, but a mismatch of oxygen supply vs. demand following coronary hypotension and myocardial hyperactivity is the best explanation for the complex morphological alterations observed. Severe alterations in the structural integrity of the sarcolemma of cardiomyocytes have been demonstrated to be caused by isoproterenol. Taking into account that the sarcolemmal integrity is stabilized by the dystrophin-glycoprotein complex (DGC) that connects actin and laminin in contractile machinery and extracellular matrix and by integrins, this study tests the hypothesis that isoproterenol affects sarcolemmal stability through changes in the DGC and integrins. We found different sensitivity of the DGC and integrin to isoproterenol subcutaneous administration. Immunofluorescent staining revealed that dystrophin is the most sensitive among the structures connecting the actin in the cardiomyocyte cytoskeleton and the extracellular matrix. The sarcomeric actin dissolution occurred after the reduction or loss of dystrophin. Subsequently, after lysis of myofilaments, gamma-sarcoglycan, beta-dystroglycan, beta 1-integrin, and laminin alpha-2 expressions were reduced followed by their breakdown, as epiphenomena of the myocytolytic process. In conclusion, administration of isoproterenol to rats results in primary loss of dystrophin, the most sensitive among the structural proteins that form the DGC that connects the extracellular matrix and the cytoskeleton in cardiomyocyte. These changes, related to ischaemic injury, explain the severe alterations in the structural integrity of the sarcolemma of cardiomyocytes and hence severe and irreversible injury induced by isoproterenol.

Influence of aging, tidal volume, and respiratory rate on Doppler echocardiographic indices of diastolic function in normal male subjects: A quantitative evaluation

Background: Although the influence of respiration on ventricular filling, as evaluated by Doppler technique, and the evaluation of diastolic velocities of mitral valve annulus (MVA), as measured by Doppler tissue imaging (DTI), can provide valuable information for the study of left ventricular (LV) diastolic function, the concomitant effects of aging, tidal volume (TV), and respiratory rate (RR) on these velocities have not been quantitatively investigated. Methods: We evaluated 12 normal male volunteers (Group I) aged 20-26 years (mean: 22.8) and 8 normal subjects aged 41 to 54 years old (mean: 45.9) (Group II). Using DTI we measured peak early (E-a) and late (A(a)) velocities of longitudinal axis expansion at lateral and medial MVA. Doppler mitral and tricuspid flow velocities were measured: peak early (E) and late (A) inflow velocity, early (E-i) and late (A(i)) flow integral, and deceleration time of peak early mitral flow velocity (DT). Respiratory cycles were simultaneously recorded at RR of 9, 12, 15, and 18 cycles/min and TV of 600 and 900 mL during respiration (RESP). Results and conclusions: (1) E, A, and A(i) in MV had negligible change during respiration, but E-i was significantly reduced during inspiration; (2) DT reduced slightly with inspiration, but the change was significant only with TV of 900 mL; (3) an important increase of E in right ventricular flow was observed during inspiration; (4) variations of RR and TV did not significantly influence right and left ventricular inflow in normal subjects, in the conditions of this investigation; (5) a significant increase of E-a at medial MVA was documented during inspiration only in young subjects; (6) a significant decrease of A(a) at medial MVA was observed during inspiration in both groups of volunteers; (7) RR and TV did not influence MVA velocities in young and adult subjects; (8) a consistent reduction in E-a and a significant increase in A(a) were observed with increasing age; (9) these changes were more conspicuous and consistent than those documented in ventricular filling when young and middle-age men are compared, suggesting that the DTI is more sensitive to detect changes in diastolic function; and (10) in addition, these data suggest that, for evaluation of diastolic function, in clinical context, it is not necessary to control rigorously RR or TV.

Electrocardiographic Alterations During Endosseous Implant Placement Performed with Local Anesthetic Agents

Purpose: The purpose of this study was to analyze electrocardiographic alterations during dental implant surgeries when local anesthetic agents were used. Materials and Methods: Twenty implants were placed in 18 healthy patients. An electrocardiogram and Wincardio software were used to gather recordings from 12 static leads every 2 minutes, continuously record coronary artery (D2) derivations, and automatically measure the following electrocardiographic parameters: heart rate, duration and amplitude of the P wave, PR segment duration, ST segment deviation, QRS complex duration, and duration of the RR, QT, and corrected QT (QTc) intervals. Results: Analysis of variance of the values obtained at the different stages showed significant differences (P < .05) for the heart rate and for the duration of the RR and QT intervals. The heart rate increased during the anesthesia, incision, and bone drilling stages, reaching a peak during drilling. Duration of the RR and QT intervals decreased during the incision and drilling stages. Among the electrocardiographic parameters individually assessed, several altered values were found for the duration of the P wave, the QRS complex, and the QT and QTc intervals. Sinusal tachycardia and bradycardia, sinusal arrhythmia, supraventricular extrasystole, ventricular extrasystole, and T-wave inversion were detected. Conclusion: Dental implant placement surgery may induce electrocardiographic alterations. The most frequently found arrhythmias were extrasystole and sinusal tachycardia. The anesthesia, incision, and bone drilling stages exhibited the highest heart rate values and the shortest durations of the RR and QT intervals. INT J ORAL MAXILLOFAC IMPLANTS 2009;24:412-418

Miniplates as skeletal anchorage for treating mandibular second molar impactions

Mandibular second molar impactions can be difficult to correct and might require surgery. A young man with an impacted mandibular right second molar was treated with a miniplate, which provided anchorage to upright the tooth. Although other devices are available, this technique appears to be predictable and quick, and has few side effects.

Effect of a bleaching agent on abrasion of resin-based restoratives

Purpose: To evaluate the effect of a 10% carbamide peroxide-containing bleaching agent on brushing abrasion of esthetic restorative materials. Methods: Using a randomized complete block design, 150 specimens (n = 15) measuring 3 x 3 x 2 mm were fabricated into acrylic resin cylinders, using one of the restorative materials: a microfilled resin composite (At), a hybrid resin composite (Ch), a flowable resin composite (Wa), a resin-modified glass-ionomer cement (Fj) and a polyacid-modified resin composite (Dy). The bleaching agent or artificial saliva (control) was applied for 2 hours/day. After that, 120 brushing strokes were simulated automatically and the samples were kept in artificial saliva. Such bleaching/brushing cycle was performed daily for 21 days. Wear depth was assessed using profilometry. Results: Bleaching did not show significant effect on wear depth. There was a significant difference among the restorative materials. Tukey`s test showed that (Al=Ch) < (Wa) < (Fj) and that Dy was only different from Fj. (Am J Dent 2009;22:171-174).

Effect of a 10% carbamide peroxide on wear resistance of enamel and dentine: In situ study

Objectives: This triple-blind, 2 x 2 crossover in situ study, was undertaken to verify whether the wear resistance of enamel and root dentine would be affected by bleaching with a 10% carbamide peroxide agent and a placebo agent. Methods: Thirty slabs of each. substrate (2 mm x 3 mm x 2 mm) were selected for each phase, after flattening and polishing procedures and microhardness test. After a 7-day lead-in period, one specimen of each substrate was randomly bonded on the facial surface of each one of 30 subject`s upper second premolars. The volunteers received instructions on how to perform toothbrushing and application of gel in the tray. Fifteen volunteers bleached their maxillary arch with a 10% carbamide peroxide bleaching agent for a 2-week period, while the remainders used a placebo agent. After a 1-week washout period, a new set of enamel and root dentine slabs were bonded to the premolars and volunteers were crossed over to the alternate agent for 14 days. The resistance of enamel and root dentine to wear following bleaching, toothbrushing and intraoral exposure was measured with a profilometer, using reference areas. Results: For enamel, ANOVA did not demonstrate significant difference between wear provided by placebo and bleaching agent (p = 0.3713), but higher wear depth was observed for bleached root dentine (p = 0.0346). Conclusions: While overnight bleaching caused no alteration in wear resistance of enamel, root dentine showed increased tissue loss. (C) 2008 Elsevier Ltd. All rights reserved.

Bleaching Agents with Varying Concentrations of Carbamide and/or Hydrogen Peroxides: Effect on Dental Microhardness and Roughness

To evaluate the effect of low and highly concentrated bleaching agents on microhardness and surface roughness of bovine enamel and root dentin. According to a randomized complete block design, 100 specimens of each substrate were assigned into five groups to be treated with bleaching agents containing carbamide peroxide (CP) at 10% (CP10); hydrogen peroxide (HP) at 7.5% (HP7.5) or 38% (HP38), or the combination of 18% of HP and 22% of CP (HP18/CP22), for 3 weeks. The control group was left untreated. Specimens were immersed in artificial saliva between bleaching treatments. Knoop surface microhardness (SMH) and average surface roughness (Ra) were measured at baseline and post-bleaching conditions. For enamel, there were differences between bleaching treatments for both SMH and Ra measurements (p = 0.4009 and p = 0.7650, respectively). SMH significantly increased (p < 0.0001), whereas Ra decreased (p = 0.0207) from baseline to post-bleaching condition. For root dentin, the group treated with CP10 exhibited the significantly highest SMH value differing from those groups bleached with HP18/CP22, HP7.5, which did not differ from each other. Application of HP38 resulted in intermediate SMH values. No significant differences were found for Ra (p = 0.5975). Comparing the baseline and post-bleaching conditions, a decrease was observed in SMH (p < 0.0001) and an increase in Ra (p = 0.0063). Bleaching agents with varying concentrations of CP and/or HP are capable of causing mineral loss in root dentin. Enamel does not perform in such bleaching agent-dependent fashion when one considers either hardness or surface roughness evaluations. Bleaching did not alter the enamel microhardness and surface roughness, but in root dentin, microhardness seems to be dependent on the bleaching agent used.

Rinossinusite crônica em pacientes infectados pelo vírus da imunodeficiência humana: avaliação clínica e radiológica

O advento dos inibidores de protease, aumentando a sobrevida dos pacientes infectados com HIV aumentou a procura destes pacientes por médicos otorrinolaringologistas, já que 40% a 70% deles podem apresentar alguma alteração otorrinolaringológica. OBJETIVIVOS: Objetivamos, nesse estudo, comparar os achados radiológicos e sintomatologia nasossinusal entre pacientes infectados com HIV e pacientes com AIDS, com rinossinusite crônica. A literatura sobre o assunto é revisada e discutida. FORMA DE ESTUDO: clínico prospectivo com coorte transversal. CASUÍSTICA E MÉTODOS: Prospectivamente, 39 pacientes em uso de drogas antiretrovirais foram divididos em 2 grupos: pacientes com diagnóstico de AIDS (grupo I) e aqueles apenas infectados pelo HIV (grupo II). Estes grupos foram comparados clinicamente, quanto à contagem de células CD4+ e avaliação tomográfica dos seios paranasais. RESULTADOS: Os pacientes dos grupos I e II apresentaram média de células CD4+ de 118 cél/10-9l e 377 cél/10-9l, respectivamente. Na comparação dos achados tomográficos pelo sistema de Lund e Mackay, o grupo I apresentou escore médio de 12 e o grupo II apresentou média de escore de 5,63 (p<0,001), sendo a febre e a secreção pós-nasal mais prevalente no grupo I (p<0,001). CONCLUSÃO: A prevalência da sinusite crônica nos pacientes infectados pelo HIV foi de 12%. Os sintomas da rinossinusite foram similares nos pacientes sem AIDS e com AIDS, com exceção da presença de febre. Os pacientes com AIDS apresentaram alterações radiológicas mais extensas do que os pacientes HIV positivos.

Papel da técnica endoscópica no tratamento cirúrgico do papiloma invertido nasossinusal

O papiloma invertido nasossinusal é uma neoplasia benigna com potencial de malignização e elevados índices de recidiva pós-operatória. Existe muito debate na literatura a respeito da melhor via de acesso cirúrgico: externa ou endoscópica endonasal. OBJETIVO: Demonstrar a eficácia da via endoscópica endonasal no tratamento do papiloma invertido nasossinusal. FORMA DO ESTUDO: Clínico retrospectivo. CASUÍSTICA E MÉTODO: Revisão de prontuário dos pacientes operados por papiloma invertido no HC/FMUSP entre janeiro de 1994 e abril de 2004. RESULTADOS: Vinte e oito pacientes traziam todas as informações estudadas, havendo nove casos de recidiva pós-operatória (32,1%), sendo um caso operado via endoscópica e oito pela via externa. DISCUSSÃO: A classificação proposta por Krouse para estadiamento do papiloma invertido nasossinusal auxilia no planejamento cirúrgico e também permite padronização para comparação de resultados pós-operatórios. A via endoscópica endonasal apresentou menor índice de recidiva tumoral que a via externa ao se comparar casos com o mesmo estadiamento tumoral. CONCLUSÃO: O uso do endoscópio no intra-operatório é uma importante ferramenta para se obter sucesso no tratamento do papiloma invertido nasossinusal.

Vitória da Alemanha constitucional e de direito social!

O poder judicial é hoje independente na RFA, sendo ainda o direito baseado no direito romano, com algumas referências germânicas. O Tribunal Federal Constitucional é uma instituição sagrada que prima pela reverência absoluta ao Estado de Direito social e controla a constitucionalidade. Existe ainda o Tribunal de Justiça Federal e os Tribunais Federais do Trabalho, o Social Federal, o Federal das Finanças e o Administrativo Federal. O sistema penal alemão é destinado à recuperação do criminoso. O Völkerstrafgesetzbuch/“Código Penal Internacional” dá aos tribunais alemães jurisdição universal caso a acusação por um tribunal do país onde o crime foi praticado, ou por um tribunal internacional, não for possível. Abstract: The judiciary is independent today in the Germany, still being the right based on Roman law with some Germanic references. The Federal Constitutional Court is a sacred institution that excels in absolute reverence for the rule of law and social controls constitutionality. There is also the Federal Court of Justice and the Federal Courts of Labor, the Federal Social, the Federal Finance Administration and the Federal. The German penal system is aimed at the criminal recovery. The Völkerstrafgesetzbuch / "International Criminal Code" gives German courts universal jurisdiction if prosecution by a court of the country where the crime was committed, or by an international court, is not possible.

Absorption of primary macronutrients and soybean growth at different compactation densities and moisture levels in a silt loam soil

ABSTRACT Soybean cultivation is increasing rapidly in the region of Alto Vale do Itajaí, State of Santa Catarina, where there is a predominance of silt soils. The objective of this work was to evaluate the content of primary macronutrients in shoots and shoot and root vegetative growth of soybean (Glicine max L. Merrill) grown in a silt-loam soil under different compactation densities and moisture levels. A randomized block design in a 4x4 factorial arrangement was used, with four compactation densities: 1.00; 1.20; 1.40 and 1.60 Mg m-3, and four soil moisture levels: 0.130; 0.160; 0.190 and 0.220 kg kg-1 and four replications. Each pot consisted of the overlapping of three 150-mm PVC rings, where soil was maintained in the higher and lower part of the pot with a density of 1.00 Mg m-3 and in the intermediate ring, the compactation densities were increased. Values of soil density higher than 120 Mg m-3 negatively affected N, P and K uptake by soybean plants, as well as the plant mass of the shoots and roots. The higher levels of soil moisture reduced the compaction effect and promoted better absorption of P and K.

Controle e coerção: a pedagogia do olhar na espacialidade do teatro e das organizações

Este ensaio aborda o tema da coerção e do controle, amplamente tratado no campo dos estudos críticos em Administração, privilegiando o espaço físico. Porém o faz numa perspectiva alternativa: toma a evolução histórica da espacialidade teatral e estabelece analogias com a espacialidade nas organizações. Para tanto, são analisados o anfiteatro grego, o teatro de Roma, os palcos medievais, o palco italiano e, adicionalmente, a sala de cinema. O objetivo é argumentar que no espaço físico controla-se, pedagogicamente, o olhar do indivíduo para que propósitos políticos, econômicos e culturais sejam realizados. Tal acontece tanto pelo emprego de modos coercitivos e diretos de controle quanto de modos normativos, mais sutis.

A relação público-privada no SUS: um olhar sobre a assistência ambulatorial de média e alta complexidade na região de saúde da Baixada Cuiabana em Mato Grosso

O artigo objetiva discutir a relação público-privada na assistência ambulatorial de média e alta complexidade no SUS, na região da Baixada Cuiabana (MT). No Brasil, as imbricações entre os setores público e privado na saúde e suas consequências são complexas e ainda pouco estudadas. Este é um estudo quantitativo e descritivo, com base em dados secundários de Sistemas de Informação do SUS, referentes à estrutura, à produção e aos gastos desse tipo de assistência. Os resultados apontam que o número de estabelecimentos, a produção e o volume de recursos se concentram em Cuiabá, tendo o setor privado/filantrópico como principal provedor. Conclui-se que tal fato possa sugerir que esse setor detenha poder político e de pressão sobre o SUS, tanto na negociação de seus contratos quanto na prestação de serviços ambulatoriais mais bem remunerados.

Acompanhamento dos trabalhos de reabilitação de edifícios da Baixa-Chiado

O trabalho em apreço aborda o acompanhamento das intervenções de reabiblitação de vários edifícios na zona histórica da Baixa-Chiado. O interesse por este tipo de trabalho ocorreu devido à necessidade de complementar a diversificada experiência profissional adquirida na Amoníaco de Portugal, com responsabilidade na Inspecção e Diagnóstico, bem como na reabilitação e reforço de estrutura e, ainda, em conservação e restauro em edifícios recentes. A realização deste estágio na Unidade de Projecto Baixa-Chiado visou adquirir competências no processo de reabilitação de edifícios antigos, tendo em vista a observação e caracterização construtiva, diagnóstico, propostas de intervenção, com elaboração dos respectivos projectos, sua aprovação, licenciamento, implementação e acompanhamento de obra. A actividade desenvolvida no âmbito deste estágio recaiu também na visita regular a edifícios antigos e às obras em curso nos mesmos, acompanhando a sua evolução e analisando as soluções construtivas utilizadas. Destas visitas regulares foram colhidos elementos preponderantes para a caracterização do estado de conservação dos respectivos edifícios, com vista a encontrar a melhor solução para a sua reabilitação. Estes elementos foram recolhidos através da realização de vistorias e de outros tipos de levantamentos, designadamente, de arquitectura, topográficos, entre outros, e aompanhamento de alguns ensaios. Com estes tipos de levantamentos descobriram-se várias patologias nos diferentes edifícios, quer nas zonas exteriores, quer nas interiores dos mesmos. Essas anomalias foram, na generalidade, detectadas e posteriormente eliminadas. Noutras situações, em que se optou por demolir o interior dos edifícios mantendo as fachadas (zonas classificadas), constatou-se que houve necessidade de erguer estruturas de contenção e travamento provisórias para garantir a segurança da respectiva edificação e dos edifícios adjacentes. Também se efectuou uma abálise de custos de construção por unidade de área, quer para edifícos a reabilitar, quer para obras de intervenção mais profunda.