RESUMO
BACKGROUND AND OBJECTIVE: Ultraviolet (UV)-irradiated 7-dehydrocholesterol (7-DHC) and vitamin E (VitE)-coated titanium (Ti) implants have a beneficial effect on bone cells. Human gingival fibroblasts (HGFs) are the most abundant cells in periodontal tissues and are involved in the wound healing and repair. The objective of this study was to evaluate the response of HGFs to Ti implants coated with UV-irradiated 7-DHC and VitE, for improved soft-tissue integration of dental implants. MATERIAL AND METHODS: Ti surfaces were coated with 7-DHC and VitE, irradiated with UV light and incubated for 48 h at 23°C to allow cholecalciferol (D3 ) synthesis from 7-DHC onto the Ti surface. HGFs were cultured on the modified surfaces and the influence of the coating on these cells was evaluated through the analysis of: (i) biocompatibility; (ii) the mRNA levels of genes involved in the composition and turnover of the extracellular matrix, the inflammatory response, periodontal bone resorption and wound healing; and (iii) the levels of MMP-1 and TIMP-1 proteins. RESULTS: We found a beneficial effect of UV-irradiated 7-DHC:VitE-coated Ti implants on HGFs. Besides being biocompatible with HGFs, the UV-irradiated 7-DHC and VitE coating increased the levels of collagen III α1 and fibronectin mRNAs. and decreased the level of interleukin-8 mRNA. TIMP-1 was increased at both mRNA and protein levels in HGFs cultured on UV-irradiated 7-DHC:VitE-coated Ti implants. Finally, the UV-irradiated 7-DHC and VitE coating decreased the level of RANKL mRNA in HGFs. CONCLUSION: UV-irradiated 7-DHC:VitE-coated Ti implants have a positive effect on HGFs in vitro by reducing the inflammatory response and extracellular matrix breakdown.
Assuntos
Materiais Revestidos Biocompatíveis/farmacologia , Implantes Dentários , Fibroblastos/efeitos dos fármacos , Gengiva/efeitos dos fármacos , Titânio/química , Raios Ultravioleta , Vitamina D/farmacologia , Vitamina E/farmacologia , Adulto , Perda do Osso Alveolar/terapia , Diferenciação Celular/efeitos dos fármacos , Células Cultivadas , Colágeno Tipo III/análise , Desidrocolesteróis/farmacologia , Desidrocolesteróis/efeitos da radiação , Feminino , Fibroblastos/química , Fibronectinas/análise , Expressão Gênica , Humanos , Interleucina-8/análise , Masculino , Metaloproteinase 1 da Matriz/análise , Pessoa de Meia-Idade , Ligante RANK/análise , RNA Mensageiro/análise , Propriedades de Superfície , Inibidor Tecidual de Metaloproteinase-1/análise , Vitamina D/efeitos da radiação , Vitamina E/efeitos da radiação , CicatrizaçãoRESUMO
OBJECTIVES: To investigate biological changes in alveolar bone occurring during orthodontic relapse. MATERIALS AND METHODS: Rat maxillary first molars were moved mesially for 10 days. After orthodontic tooth movement (OTM), appliances were removed, and the molars were allowed to relapse for one, three, five, seven, 14 or 21 days. Changes in 3D morphometric parameters of bone located mesial to the first molars were evaluated by micro-CT. Total RNA was isolated from the same bone site, and real-time RT-PCR was used to measure the expression of bone formation and resorption markers. RESULTS: One day after appliance removal, the molars relapsed to a mean 73% of the achieved OTM and then steadily relapsed to 93% at 21 days. Tissue mineral density and per cent bone volume increased over the experimental period. Inversely, there was a decrease in total porosity. Gene expression of OCN, Coll-I and ALP decreased during OTM, whilst as the molars relapsed showed tended to increase. Gene expression of RANKL and TRAP increased during OTM. Changes in mRNA expression of H(+)-ATPase were minor. By 21 days post-appliance removal, the remodelling process in rats appeared to have returned to control levels. CONCLUSIONS: Bone tissue reactions on a molecular level are similar during OTM and orthodontic relapse. These findings validate the importance of immediate retention following active OTM.
Assuntos
Processo Alveolar/química , Maxila/química , Técnicas de Movimentação Dentária , Fosfatase Ácida/análise , Fosfatase Alcalina/análise , Animais , Biomarcadores/análise , Densidade Óssea/fisiologia , Reabsorção Óssea/metabolismo , Colágeno Tipo I/análise , Subunidade alfa 1 de Fator de Ligação ao Core/análise , Imageamento Tridimensional/métodos , Isoenzimas/análise , Masculino , Dente Molar/patologia , Tamanho do Órgão , Osteocalcina/análise , Osteogênese/fisiologia , Porosidade , ATPases Translocadoras de Prótons/análise , Ligante RANK/análise , Ratos , Ratos Wistar , Recidiva , Fosfatase Ácida Resistente a Tartarato , Fatores de Tempo , Microtomografia por Raio-X/métodosRESUMO
OBJECTIVES: The objective of this study was to demonstrate a successful binding of Doxy hyclate onto a titanium zirconium alloy surface. METHODS: The coating was done on titanium zirconium coins in a cathodic polarization setup. The surface binding was analyzed by SEM, SIMS, UV-vis, FTIR and XPS. The in vitro biological response was tested with MC3T3-E1 murine pre-osteoblast cells after 14 days of cultivation and analyzed in RT-PCR. A rabbit tibial model was also used to confirm its bioactivity in vivo after 4 and 8 weeks healing by means of microCT. RESULTS: A mean of 141 µg/cm(2) of Doxy was found firmly attached and undamaged on the coin. Inclusion of Doxy was documented up to a depth of approximately 0.44 µm by tracing the (12)C carbon isotope. The bioactivity of the coating was documented by an in vitro study with murine osteoblasts, which showed significantly increased alkaline phosphatase and osteocalcin gene expression levels after 14 days of cell culture along with low cytotoxicity. Doxy coated surfaces showed increased bone formation markers at 8 weeks of healing in a rabbit tibial model. SIGNIFICANCE: The present work demonstrates a method of binding the broad spectrum antibiotic doxycycline (Doxy) to an implant surface to improve bone formation and reduce the risk of infection around the implant. We have demonstrated that TiZr implants with electrochemically bound Doxy promote bone formation markers in vitro and in vivo.
Assuntos
Desenvolvimento Ósseo/efeitos dos fármacos , Implantes Dentários , Doxiciclina/química , Células 3T3 , Animais , Doxiciclina/farmacologia , Técnicas In Vitro , Camundongos , Coelhos , Propriedades de Superfície , Microtomografia por Raio-XRESUMO
OBJECTIVES: The aim of this study was to evaluate the influence of different titanium zirconium (TiZr) alloy surfaces on primary human gingival fibroblasts (HGF) for improved soft tissue integration of dental implants. METHODS: TiZr polished, machined and machined+HCl/H2SO4 acid-etched surfaces were modified by cathodic polarization and/or HNO3/HF acid etching. Contact angle of surfaces was measured. The influence of modified TiZr surfaces on HGF was evaluated through the analysis of cell number, morphology, recovery after a wound (wound healing assay) and the expression of several genes, including matrix metalloproteinase-1 (MMP1) and metallopeptidase inhibitor-1 (TIMP1). RESULTS: Modification of TiZr surfaces decreased its hydrophilicity. Hydride implementation on TiZr surfaces via cathodic polarization increased TIMP1 expression and decreased MMP1/TIMP1 mRNA ratio. Cathodic polarization of machined surfaces promoted cell attachment. Cells on machined and machined+cathodic polarization surfaces grew aligned to the microgrooves whereas on all polished surfaces they grew randomly. Acid etching of polished and machined surfaces did not improve HGF function. CONCLUSIONS: Hydride implementation on TiZr machined surfaces may be used as new dental implant material for improved soft tissue integration. CLINICAL SIGNIFICANCE: Enhancing dental implant surfaces' bioactivity by hydride implementation may promote soft tissue attachment and sealing around the implant and reduce peri-implantitis related to ECM-destruction compared with conventional machined surfaces.
Assuntos
Ligas/química , Ligas Dentárias/química , Implantes Dentários , Planejamento de Prótese Dentária , Gengiva/citologia , Condicionamento Ácido do Dente/métodos , Adulto , Contagem de Células , Técnicas de Cultura de Células , Proliferação de Células , Forma Celular , Células Cultivadas , Polimento Dentário/métodos , Feminino , Fibroblastos/fisiologia , Humanos , Ácido Clorídrico/química , Ácido Fluorídrico/química , Teste de Materiais , Metaloproteinase 1 da Matriz/análise , Inibidores de Metaloproteinases de Matriz/análise , Ácido Nítrico/química , Polarografia , Ácidos Sulfúricos/química , Propriedades de Superfície , Inibidor Tecidual de Metaloproteinase-1/análise , MolhabilidadeRESUMO
BACKGROUND AND OBJECTIVE: Gingival fibroblasts are responsible for the constant adaptation, wound healing and regeneration of gingival connective tissue. New titanium-zirconium (TiZr) abutment surfaces have been designed to improve soft tissue integration and reduce implant failure compared with titanium (Ti). The aim of the present study was first to characterize a primary human gingival fibroblast (HGF) model and secondly to evaluate their differential response to Ti and TiZr polished (P), machined (M) and machined + acid-etched (modMA) surfaces, respectively. MATERIAL AND METHODS: HGF were cultured on tissue culture plastic or on the different Ti and TiZr surfaces. Cell morphology was evaluated through confocal and scanning electron microscopy. A wound healing assay was performed to evaluate the capacity of HGF to close a scratch. The expression of genes was evaluated by real-time RT-PCR, addressing: (i) extracellular matrix organization and turnover; (ii) inflammation; (iii) cell adhesion and structure; and (iv) wound healing. Finally, cells on Ti/TiZr surfaces were immunostained with anti-ITGB3 antibodies to analyze integrin ß3 production. Matrix metalloproteinase-1 (MMP1) and inhibitor of metallopeptidases-1 (TIMP1) production were analyzed by enzyme-linked immunosorbent assays. RESULTS: On tissue culture plastic, HGF showed no differences between donors on cell proliferation and on the ability for wound closure; α-smooth muscle actin was overexpressed on scratched monolayers. The differentiation profile showed increased production of extracellular matrix components. Ti and TiZr showed similar biocompatibility with HGF. TiZr increased integrin-ß3 mRNA and protein levels, compared with Ti. Cells on TiZr surfaces showed higher MMP1 protein than Ti surfaces, although similar TIMP1 protein production. In this in vitro experiment, P and M surfaces from both Ti and TiZr showed better HGF growth than modMA. CONCLUSION: Taking into account the better mechanical properties and bioactivity of TiZr compared with Ti, the results of the present study show that TiZr is a potential clinical candidate for soft tissue integration and implant success.
Assuntos
Materiais Dentários/química , Fibroblastos/fisiologia , Gengiva/fisiologia , Titânio/química , Zircônio/química , Condicionamento Ácido do Dente/métodos , Actinas/análise , Materiais Biocompatíveis/química , Adesão Celular/fisiologia , Técnicas de Cultura de Células , Proliferação de Células , Forma Celular/fisiologia , Células Cultivadas , Corrosão Dentária/métodos , Polimento Dentário/métodos , Proteínas da Matriz Extracelular/análise , Gengiva/citologia , Humanos , Integrina beta3/análise , Teste de Materiais , Metaloproteinase 1 da Matriz/análise , Microscopia Eletrônica de Varredura , Propriedades de Superfície , Inibidor Tecidual de Metaloproteinase-1/análiseRESUMO
In the quest for improved bone growth and attachment around dental implants, chemical surface modifications are one possibility for future developments. The biological properties of titanium based materials can be further enhanced with methods like anodic polarization to produce an active rather than a passive titanium oxide surface. Here we investigate the formation of hydroxide groups on sand blasted and acid etched titanium and titanium-zirconium alloy surfaces after anodic polarization in an alkaline solution. X-ray photoelectron spectroscopy shows that the activated surfaces had increased reactivity. Furthermore the activated surfaces show up to threefold increase in OH(-) concentration in comparison to the original surface. The surface parameters Sa, Sku, Sdr and Ssk were more closely correlated to time and current density for titanium than for titanium-zirconium. Studies with MC3T3-E1 osteoblastic cells showed that OH(-) activated surfaces increased mRNA levels of osteocalcin and collagen-I.
Assuntos
Oxigênio/química , Titânio/química , Células 3T3 , Animais , Materiais Biocompatíveis/química , Diferenciação Celular , Proliferação de Células , Colágeno Tipo I/metabolismo , Implantes Dentários , Radical Hidroxila , Camundongos , Osteoblastos/citologia , Osteocalcina/metabolismo , Espectroscopia Fotoeletrônica , Propriedades de SuperfícieRESUMO
The aim of this study was to investigate the effect of TiO2 scaffold (SC) coated with an alginate hydrogel containing a proline-rich peptide (P2) on osteoblast proliferation and differentiation in vitro. Peptide release was evaluated and a burst release was observed during the first hours of incubation, and then progressively released overtime. No changes were observed in the cytotoxicity after 48 h of seeding MC3T3-E1 cells on the coated and uncoated TiO2 SC. The amount of cells after 7 days was higher on uncoated TiO2 SC than on alginate-coated TiO2 SC, measured by DNA content and scanning electron microscope imaging. In addition, while lower expression of integrin beta1 was detected for alginate-coated TiO2 SC at this time point, similar gene expression was observed for other integrins, fibronectin-1, and several osteoblast differentiation markers. After 21 days, gene expression of integrin beta3, fibronectin-1, osterix, and collagen-I was increased in alginate-coated compared to TiO2 SC. Moreover, increased gene expression of integrin alpha8, bone morphogenetic protein 2, interleukin-6, and collagen-I was found on P2 alginate-coated TiO2 SC compared to alginate-coated TiO2 SC. In conclusion, our results indicate that alginate-coated TiO2 SC can act as a matrix for delivery of proline-rich peptides increasing osteoblast differentiation. © 2012 Wiley Periodicals, Inc. J Biomed Mater Res Part A, 2013.
Assuntos
Alginatos/farmacologia , Materiais Revestidos Biocompatíveis/farmacologia , Hidrogel de Polietilenoglicol-Dimetacrilato/farmacologia , Osteoblastos/citologia , Peptídeos/farmacologia , Alicerces Teciduais/química , Titânio/farmacologia , Sequência de Aminoácidos , Animais , Biomarcadores/metabolismo , Adesão Celular/efeitos dos fármacos , Adesão Celular/genética , Contagem de Células , Diferenciação Celular/efeitos dos fármacos , Linhagem Celular , Proliferação de Células/efeitos dos fármacos , Meios de Cultura , Regulação da Expressão Gênica/efeitos dos fármacos , Ácido Glucurônico/farmacologia , Ácidos Hexurônicos/farmacologia , L-Lactato Desidrogenase/metabolismo , Camundongos , Dados de Sequência Molecular , Osteoblastos/efeitos dos fármacos , Osteoblastos/metabolismo , Peptídeos/química , Domínios Proteicos Ricos em Prolina , RNA Mensageiro/genética , RNA Mensageiro/metabolismoRESUMO
Vitamin D plays a central role in bone regeneration, and its insufficiency has been reported to have profound negative effects on implant osseointegration. The present study aimed to test the in vitro biological effect of titanium (Ti) implants coated with UV-activated 7-dehydrocholesterol (7-DHC), the precursor of vitamin D, on cytotoxicity and osteoblast differentiation. Fourier transform infrared spectroscopy confirmed the changes in chemical structure of 7-DHC after UV exposure. High-pressure liquid chromatography analysis determined a 16.5±0.9% conversion of 7-DHC to previtamin D(3) after 15min of UV exposure, and a 34.2±4.8% of the preD(3) produced was finally converted to 25-hydroxyvitamin D(3) (25-D(3)) by the osteoblastic cells. No cytotoxic effect was found for Ti implants treated with 7-DHC and UV-irradiated. Moreover, Ti implants treated with 7-DHC and UV-irradiated for 15min showed increased 25-D(3) production, together with increased ALP activity and calcium content. Interestingly, Rankl gene expression was significantly reduced in osteoblasts cultured on 7-DHC-coated Ti surfaces when UV-irradiated for 15 and 30min to 33.56±15.28% and 28.21±4.40%, respectively, compared with the control. In conclusion, these findings demonstrate that UV-activated 7-DHC is a biocompatible coating of Ti implants, which allows the osteoblastic cells to produce themselves active vitamin D, with demonstrated positive effects on osteoblast differentiation in vitro.
Assuntos
Diferenciação Celular/efeitos dos fármacos , Desidrocolesteróis/efeitos da radiação , Osteoblastos/citologia , Próteses e Implantes , Ligante RANK/genética , Titânio/farmacologia , Raios Ultravioleta , Fosfatase Alcalina/metabolismo , Animais , Calcificação Fisiológica/efeitos dos fármacos , Calcificação Fisiológica/genética , Contagem de Células , Diferenciação Celular/genética , Linhagem Celular , Forma Celular/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Colecalciferol/farmacologia , Materiais Revestidos Biocompatíveis/farmacologia , Regulação da Expressão Gênica/efeitos dos fármacos , Regulação da Expressão Gênica/efeitos da radiação , Camundongos , Oxigenases de Função Mista/genética , Oxigenases de Função Mista/metabolismo , Osteoblastos/efeitos dos fármacos , Osteoblastos/enzimologia , Osteoblastos/efeitos da radiação , Ligante RANK/metabolismo , Espectroscopia de Infravermelho com Transformada de Fourier , Fatores de TempoRESUMO
Polyproline-rich synthetic peptides have previously been shown to induce bone formation and mineralization in vitro and to decrease bone resorption in vivo. Alginate hydrogel formulations containing these synthetic peptides (P2, P5, P6) or Emdogain® (EMD) were tested for surface coating of bone implants. In an aqueous environment, the alginate hydrogels disclosed a highly compact structure suitable for cell adhesion and proliferation. Lack of cytotoxicity of the alginate-gel coating containing peptides was tested in MC3T3-E1 cell cultures. In the present study, relative mRNA expression levels of integrin alpha 8 were induced by P5 compared to untreated alginate gel, and osteopontin mRNA levels were increased after 21 days of culture by treatment with synthetic peptides or EMD compared to control. Further, in agreement with previous results when the synthetic peptides were administered in the culture media, osteocalcin mRNA was significantly upregulated after long-term treatment with the formulated synthetic peptides compared to untreated and EMD alginate gel. These results indicate that the alginate gel is a suitable carrier for the delivery of synthetic peptides, and that the formulation is promising as biodegradable and biocompatible coating for bone implants.
Assuntos
Alginatos , Substitutos Ósseos/química , Osteoblastos/citologia , Peptídeos/química , Células 3T3 , Sequência de Aminoácidos , Animais , Sequência de Bases , Adesão Celular , Diferenciação Celular/efeitos dos fármacos , Proliferação de Células , Materiais Revestidos Biocompatíveis/química , Proteínas do Esmalte Dentário/química , Proteínas do Esmalte Dentário/farmacologia , Ácido Glucurônico , Ácidos Hexurônicos , Hidrogéis , Cadeias alfa de Integrinas/genética , Teste de Materiais , Camundongos , Microscopia Eletrônica de Varredura , Dados de Sequência Molecular , Osteoblastos/efeitos dos fármacos , Osteoblastos/metabolismo , Osteopontina/genética , Peptídeos/farmacologia , RNA Mensageiro/genética , RNA Mensageiro/metabolismoRESUMO
This study investigates the effect of fluoride surface modification on the surface properties of polycrystalline ceramic TiO(2) and the biological response of murine osteoblast cells to fluoride-modified TiO(2) in vitro. Fluoride concentrations up to 9 at.% were detected and the fluoride was found to bind to the surface in a ligand exchange reaction between surface hydroxyl groups and the fluoride anions from the HF. No significant changes in the surface topography were detected. In vitro experiments were performed in order to evaluate the biological response of the MC3T3-E1 cells to the fluoride-modified ceramic TiO(2) surfaces. No difference in the lactate dehydrogenase (LDH) activity was seen in comparison to unmodified samples, apart from the highest fluoride concentration (â¼9 at.%) which was found to be more toxic to the cells. Real-time PCR analysis showed no conclusive evidence for the fluoride-induced promotion of osteoblast differentiation as no significant increase in the collagen-1, osteocalcin, or BMP-2 mRNA levels was detected on the fluoride-modified ceramic TiO(2) surfaces apart from one group, which showed an elevated osteocalcin level and higher number of cells. Since the observed grain boundary corrosion is also anticipated to reduce the mechanical properties of ceramic TiO(2), this surface modification method may not be an ideal method for improving the osteogenic response of ceramic TiO(2) scaffolds.
Assuntos
Materiais Biocompatíveis/química , Fluoretos/farmacologia , Osteoblastos/citologia , Titânio/química , Células 3T3 , Animais , Diferenciação Celular , Cerâmica , Técnicas In Vitro , L-Lactato Desidrogenase/metabolismo , Ligantes , Camundongos , Microscopia de Força Atômica/métodos , Osteoblastos/efeitos dos fármacos , Reação em Cadeia da Polimerase em Tempo Real/métodos , Propriedades de Superfície , Difração de Raios XAssuntos
Injúria Renal Aguda/induzido quimicamente , Antimetabólitos Antineoplásicos/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Febre/induzido quimicamente , Antagonistas do Ácido Fólico/efeitos adversos , Leucemia de Células B/tratamento farmacológico , Metotrexato/efeitos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Doença Aguda , Injúria Renal Aguda/tratamento farmacológico , Antimetabólitos Antineoplásicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Febre/tratamento farmacológico , Antagonistas do Ácido Fólico/administração & dosagem , Furosemida/uso terapêutico , Predisposição Genética para Doença , Heterozigoto , Humanos , Leucovorina/uso terapêutico , Masculino , Metotrexato/administração & dosagem , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Mutação de Sentido Incorreto , gama-Glutamil Hidrolase/uso terapêuticoRESUMO
Control of mitochondrial biogenesis in brown adipose tissue (BAT), as part of the thermogenesis program, is a complex process that requires the integration of multiple transcription factors to orchestrate mitochondrial and nuclear gene expression. Despite the knowledge of the role of sex hormones on BAT physiology, little is known about the effect of these hormones on the mitochondrial biogenic program. The aim of this study was to determine the effect of testosterone, 17beta-estradiol, and progesterone on the expression of nuclear factors involved in the control of mitochondrial biogenesis and thermogenic function such as ppargamma, pgc1alpha, nrf1, gabpa, and tfam, and also an inhibitor of PI3K-Akt pathway, recently found to be involved in the control of mitochondrial recruitment (pten). For this purpose, an in vitro assay using cell-cultured brown adipocytes was used to address the role of steroid hormones, progesterone, testosterone, and 17beta-estradiol on the mRNA expression of these factors by real-time PCR. Thus 17beta-estradiol seemed to exert a dual effect, activating the PI3K-Akt pathway by inhibiting pten mRNA expression and also inhibiting nrf1 and tfam mRNA expression. Progesterone seemed to positively stimulate mitochondriogenesis and BAT differentiation by increasing the mRNA expression of the gabpa-tfam axis and ppargamma, respectively, but also exerted a negative output by increasing pten mRNA levels. Finally, testosterone inhibited the transcription of pgc1alpha, the master factor involved in UCP1 expression and mitochondrial biogenesis. In conclusion, our results support the idea that sex hormones have direct effects on different mediators of the mitochondriogenesis program.
Assuntos
Adipócitos Marrons/efeitos dos fármacos , Adipócitos Marrons/metabolismo , Estradiol/farmacologia , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/metabolismo , Progesterona/farmacologia , Testosterona/farmacologia , Animais , Células Cultivadas , Relação Dose-Resposta a Droga , Feminino , Expressão Gênica/efeitos dos fármacos , Masculino , Camundongos , Ratos , Ratos Wistar , Caracteres Sexuais , Transdução de Sinais/efeitos dos fármacos , Termogênese/efeitos dos fármacosRESUMO
OBJECTIVE: Electronic prescribing is considered a basic measure for the prevention and reduction of medications errors. The goal of this survey was to assess the incidence of errors occurring with electronic versus standard prescription. METHOD: A prospective, sequential, open-label study to assess errors with electronic prescribing as compared to traditional manual prescribing in two public hospitals in Balearic Islands. Errors regarding medication, diet and/or nursing orders were assesses along four process stages: medical prescription, pharmacy transcription/validation, nursing transcription, and dispensation. RESULTS: With manual prescription 1,576 errors/18,539 therapy orders (8.50%) were identified, whereas with electronic prescription 827 errors/18,885 therapy orders (4.38%) were detected, which represents a relative risk reduction by 48% and an absolute risk reduction by 4.12% (p < 0.0001). Pharmacy transcription/validation errors decreased (1.73 vs. 0.13%, p < 0.0001), as did nursing transcription errors (2.54 vs. 0.81%, p < 0.0001) and dispensation errors (2.13 vs. 0.96%, p < 0.0001); however, the number of prescription errors increased (2.10 vs. 2.40%, p = 0.0401). CONCLUSIONS: Electronic prescription is a powerful tool, and one that in this work was shown to decrease medication-, diet-, and nursing care-related errors in a highly significant way; however, it should be developed and maintained in order to achieve safety and effectiveness as required by drug usage.
Assuntos
Prescrições de Medicamentos/normas , Sistemas de Registro de Ordens Médicas/normas , Erros de Medicação/estatística & dados numéricos , Humanos , Erros de Medicação/classificação , Estudos ProspectivosRESUMO
A probable case of hypersensitivity reaction to Total Parenteral Nutrition (TPN) in a 55 years old patient diagnosed with gastric adenocarcinoma is presented. Onset of TPN infusion coincides with the time of the onset of a disseminated pruritic cutaneous eruption that repeats after a second exposure to nutrition. The likely causes of this hypersensitivity reaction are analyzed.
Assuntos
Hipersensibilidade/etiologia , Nutrição Parenteral Total/efeitos adversos , Nutrição Parenteral/efeitos adversos , Prurido/etiologia , Algoritmos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Sex hormones play an important role in adipose tissue metabolism by activating specific receptors that alter several steps of the lipolytic and lipogenic signal cascade in depot- and sex-dependent manners. However, studies focusing on steroid receptor status in adipose tissue are scarce. In the present study, we analyzed steroid content [testosterone (T), 17beta-estradiol (17beta-E2), and progesterone (P4)] and steroid receptor mRNA levels in different rat adipose tissue depots. As expected, T levels were higher in males than in females (P = 0.031), whereas the reverse trend was observed for P4 (P < 0.001). It is noteworthy that 17beta-E2 adipose tissue levels were higher in inguinal than in the rest of adipose tissues for both sexes, where no sex differences in 17beta-E2 tissue levels were noted (P = 0.010 for retroperitoneal, P = 0.005 for gonadal, P = 0.018 for mesenteric). Regarding steroid receptor levels, androgen (AR) and estrogen receptor (ER)alpha and ERbeta densities were more clearly dependent on adipose depot location than on sex, with visceral depots showing overall higher mRNA densities than their subcutaneous counterparts. Besides, expression of ERalpha predominated over ERbeta expression, and progesterone receptor (PR-B form and PR-A+B form) mRNAs were identically expressed regardless of anatomic depot and sex. In vitro studies in 3T3-L1 cells showed that 17beta-E2 increased ERalpha (P = 0.001) and AR expression (P = 0.001), indicating that estrogen can alter estrogenic and androgenic signaling in adipose tissue. The results highlighted in this study demonstrate important depot-dependent differences in the sensitivity of adipose tissues to sex hormones between visceral and subcutaneous depots that could be related to metabolic situations observed in response to sex hormones.
Assuntos
Tecido Adiposo/metabolismo , Hormônios Esteroides Gonadais/sangue , Receptores de Esteroides/metabolismo , Células 3T3-L1 , Tecido Adiposo/citologia , Animais , Estradiol/sangue , Estradiol/farmacologia , Receptor alfa de Estrogênio/genética , Receptor alfa de Estrogênio/metabolismo , Receptor beta de Estrogênio/genética , Receptor beta de Estrogênio/metabolismo , Feminino , Expressão Gênica/efeitos dos fármacos , Expressão Gênica/fisiologia , Masculino , Camundongos , Tamanho do Órgão , Progesterona/sangue , Progesterona/farmacologia , RNA Mensageiro/análise , Ratos , Ratos Wistar , Receptores Androgênicos/genética , Receptores Androgênicos/metabolismo , Receptores de Progesterona/genética , Receptores de Progesterona/metabolismo , Receptores de Esteroides/genética , Caracteres Sexuais , Testosterona/sangue , Testosterona/farmacologiaRESUMO
OBJECTIVE: To assess the impact of pharmaceutical intervention on the use of sequential therapy (ST) with fluoroquinolones. METHODS: A prospective comparative study of pharmaceutical intervention in two stages: observational stage and intervention stage for ST promotion. RESULTS: In all, 250 patients receiving intravenous therapy with fluoroquinolones (113 with levofloxacin and 137 with ciprofloxacin) were studied, with 76 and 70 patients, respectively, being eligible for a pharmaceutical intervention program to promote ST. Pharmaceutical intervention showed a decreased duration of intravenous therapy and increased duration of oral therapy for both drugs, as well as decreased medication-related costs, all in a statistically significant manner. DISCUSSION: ST promotion provides an opportunity to expand the role of hospital pharmacists and to optimize fluoroquinolone-based therapy, which results in decreased intravenous treatments and provides a more cost-effective option.
Assuntos
Fluoroquinolonas/administração & dosagem , Serviço de Farmácia Hospitalar/métodos , Administração Oral , Idoso , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/economia , Esquema de Medicação , Feminino , Fluoroquinolonas/economia , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Serviço de Farmácia Hospitalar/economia , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Estudos ProspectivosRESUMO
OBJECTIVE: To clinically assess effectiveness of therapeutic interchange from glibenclamide to gliclazide in the hospital setting. METHODS: An open-label prospective, randomized study with two groups of patients: a reference group (patients still receiving their previous outpatient regimen of glibenclamide) and an interchange group (patients with gliclazide substituted for glibenclamide according to a hospital-approved interchange protocol). The efficacy endpoint used was blood glucose at 3 and 6 days post-intervention. A patient with blood glucose < 200 mg/L was considered clinically controlled, and blood glucose changes < or > 30 mg/dL were considered significant. RESULTS: One hundred and sixteen patients were randomized. Blood glucose on the day before the intervention was 177.9 mg/dL +/- 63.4 in the reference group versus 171.3 mg/dL +/- 52.1 in the interchange group (p = 0.92). Mean blood glucose during the first 3 days post-intervention was 156.1 mg/dL +/- 47.5 and 177.7 mg/dL +/- 36.0 (p = 0.14) in the reference and interchange groups, respectively; and mean values for the first 6 days post-intervention were 142.1 mg/dL +/- 36.0 and 172.8 mg/dL +/- 28.2, respectively (p = 0.01). The overall analysis of blood glucose levels showed a better control in the reference group versus baseline values, which was not seen in the interchange group, where blood glucose remained stable and similar to baseline. In no case were 3-day and 6-day blood glucose mean levels above 200 mg/dL, which may be considered acceptable within the hospital setting. CONCLUSIONS: Therapeutic interchange may be safely performed with no clinical impairment, but better controls were achieved in the reference group.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Gliclazida/administração & dosagem , Hipoglicemiantes/administração & dosagem , Compostos de Sulfonilureia/administração & dosagem , Administração Oral , Idoso , Glicemia , Diabetes Mellitus Tipo 2/sangue , Esquema de Medicação , Feminino , Humanos , Masculino , Estudos Prospectivos , Resultado do TratamentoRESUMO
The brown adipose tissue (BAT) thermogenic response to diet-induced obesity and cold has been found to be gender dependent. In the present work, we aimed to investigate the effects of the main physiological male and female sex hormones, i.e. testosterone, progesterone and 17-beta-estradiol, on the expression of uncoupling protein I (UCP1)--the main mediator of BAT thermogenesis--and on UCP2 and lipid accumulation in rodent brown adipocytes differentiated in culture. Testosterone-treated cells showed fewer and smaller lipid droplets than control cells and a dose-dependent inhibition of UCP1 mRNA expression, under adrenergic stimulation by norepinephrine (NE). These effects were reverted by the androgen receptor antagonist flutamide, suggesting they are dependent, at least in part, on the androgen receptor. Progesterone- and 17-beta-estradiol-treated cells showed more and larger lipid droplets and progesterone stimulated NE-induced UCP1 mRNA expression at the lower concentration tested, but not at higher concentrations, suggesting that for brown adipocytes, this hormone is dose dependent. 17-beta-Estradiol did not have any remarkable effect either on UCP1 or UCP2 mRNA expression. Interestingly, the specific progesterone receptor antagonist RU486 induced UCP1 and UCP2 mRNAs, including UCP1 mRNA expression in non-NE-treated brown adipocytes, suggesting a profound effect of this antiprogestagen on brown adipocyte thermogenic capacity. Thus, are conclude that testosterone, 17-beta-estradiol, progesterone and RU486 have distinct actions on brown adipocytes, thus modulating UCP1 and UCP2 mRNA expression and/or lipid accumulation, and that sex hormones are factors that may explain in part the gender-dependent BAT thermogenic response.
Assuntos
Tecido Adiposo Marrom/fisiologia , Proteínas de Transporte/genética , Proteínas de Membrana/genética , Progesterona/farmacologia , RNA Mensageiro/genética , Testosterona/farmacologia , Transcrição Gênica/efeitos dos fármacos , Tecido Adiposo Marrom/citologia , Tecido Adiposo Marrom/efeitos dos fármacos , Animais , Sequência de Bases , Células Cultivadas , Primers do DNA , Estradiol/farmacologia , Regulação da Expressão Gênica/efeitos dos fármacos , Canais Iônicos , Masculino , Camundongos , Camundongos Endogâmicos , Mifepristona/farmacologia , Proteínas Mitocondriais , Norepinefrina/farmacologia , Proteína Desacopladora 1RESUMO
Gender-related differences in the brown adipose tissue (BAT) response to overfeeding rats on a cafeteria diet were studied by assessing the balance between the expression of beta-adrenoceptors (beta1-, beta2-, beta3-AR) and alpha2A-AR and their relation to the expression of uncoupling proteins (UCP1, UCP2, UCP3). Cafeteria diet feeding for 15 days, which involved a similar degree of hyperphagia in both sexes, led to a greater body weight excess in females than in males and a lower activation of thermogenesis. Gender-related differences were found for different adrenoceptor expression and protein levels, which might explain, in part, sex differences in the thermogenic parameters. The lower expression of alpha2A-AR in females than in males could be responsible for the higher expression of UCP1 and thermogenic capacity under non-hyperphagic conditions. However, in a situation of high adrenergic stimulation--as occurs with overfeeding--as there is a preferential recruitment of the beta3-AR by noradrenaline compared with other adrenergic receptors, the higher levels of beta3-AR in males rats than in females could be responsible for the greater thermogenic capacity and the lesser weight gain in males. Thus, the alpha2/beta3 balance in BAT could be a key in the thermogenic control.