Prevalence of comorbid obstructive sleep apnea and metabolic syndrome: syndrome Z and maxillofacial surgery implications.

PURPOSE: To determine the prevalence of the recently identified syndrome Z (SZ), which is the co-occurrence of obstructive sleep apnea (OSA; hypoxia, systemic and pulmonary hypertension, nocturnal arrhythmias) and metabolic syndrome (MetS; increased abdominal girth, hypertriglyceridemia, decreased high-density lipoprotein, hypertension, increased fasting glucose), which places the surgical patient at heightened risk of perioperative complications (myocardial infarction, stroke, pneumonia, wound infection). MATERIALS AND METHODS: Electronic medical records of 296 male veterans were assessed for the presence of SZ using the American Academy of Sleep Medicine definition of OSA and a modified Adult Treatment Panel III definition of MetS, where obesity was defined by a body mass index of at least 30 kg/m(2) rather than by waist circumference. RESULTS: SZ was diagnosed in 59% of patients. These individuals commonly exhibited severe OSA and least commonly mild OSA. The more severe the OSA, the more likely (60%) that patients manifested moderate (4 risk markers) or severe (5 risk markers) MetS. Furthermore, with increasing apnea-hypopnea index values, the more severe were the MetS elements. CONCLUSIONS: The results of this study demonstrate the high prevalence rate of MetS in patients with OSA seeking treatment. Given the risk of perioperative complications, it is suggested that all patients scheduled for maxillofacial surgical procedures to treat OSA be evaluated for SZ.

Effects of two different training programs with same workload on throwing velocity by experienced water polo players.

To investigate the effects of two different strength-training programs with the same workload (impulse) on throwing velocity in water polo, 30 water polo players (M age = 17.1 yr., SD = 4.9; M mass = 71.2 kg, SD = 14.7; M height = 1.75 m, SD = 0.09 m) were randomly divided in two groups based upon throwing performance with water polo ball. The medicine-ball training group performed 3 x 6 reps with a 3-kg medicine ball, while the combination training group completed 1 x 9 repetitions with the 3-kg medicine ball, followed by 3 x 14 repetitions with a water polo ball. Both groups trained eight weeks twice per week in addition to their regular water polo training. Throwing velocity was measured with a Doppler radar gun before and after the training period. Testing included throws with a water polo ball on land and in water, as well as with 1-kg and 3-kg medicine balls on land. Statistically significant increases were found in mean peak throwing velocity with the water polo, 1-kg, and 3-kg medicine balls after training. No differences between the groups were found, except in throwing velocity with water polo on land, with a statistically significantly larger increase for the combination training group (+7.6%) than the medicine-ball training group (+3.4%). These findings indicate that after training with the same workload (impulse), increases in throwing velocity in water polo are similar and suggesting workload may be a critical variable for training results.

Practice of in-vitro fertilization: a case study from Finland.

In 1978 the first human IVF-baby was born. Today IVF is a standard procedure in the treatment of infertility in industrialized Western countries. In this study we analyzed how IVF reached an established position as a medical innovation in Finland, how IVF-care was organized between 1991-1993, and which kind of women used IVF-services and delivered a child as a result. The data sources were interviews with practicing IVF-physicians, a survey of Finnish IVF-clinics, telephone interviews with a sample of the adult population, and data of mothers from the Finnish Birth Registry. IVF in Finland followed the four stages of a medical innovation from a promising report into a standard procedure. Key factors in the introduction of IVF-methods were the work of andrologists', and later, IVF-physicians' associations, the approval of the method by head gynecologists in university clinics and among other colleagues, and later, the increase in IVF-services without regulatory government policy. IVF has become increasingly available in private clinics because pioneer physicians have established such services. In principle there was no social discrimination in having IVF, because it was available almost free of charge in public clinics. But the costs and availability of private clinics created unequal access to IVF services. IVF-women were more often upper-class white collar employees living in southern Finland than women in the control group. IVF has been a routine treatment option of infertility since the end of the 1980s. It has provided a medical technology solution to infertility. The supply and demand of IVF has increased and its indications have widened in the treatment of infertility. This is the inner logic of a successful technology: after the developmental processes of a revolutionary innovation, the use of technology escalates rapidly and the barriers for its use decrease.

Long-term globular adiponectin administration improves adipose tissue dysmetabolism in high-fat diet-fed Wistar rats.

Adiponectin administration to obese or type 2 diabetic patients is still far off, due to its expensive costs and absence of studies demonstrating the effectiveness of its chronic administration. We performed long-term globular adiponectin administration, testing its usefulness in improving adipose tissue metabolism. Adiponectin (98 υg/day) was administered through a subcutaneous minipump with continued release (28 days) to Wistar rats fed a high-fat diet. Adiponectin decreased body weight and adipocyte size, while decreasing circulating leptin levels. More, adiponectin was able to increase IkappaBalpha and PPARgamma levels and to prevent high-fat diet-induced impairment of insulin signalling, especially in epididymal adipose tissue. This resulted in improved glucose profile. High-fat diet caused an impairment of lipolysis in epididymal adipose tissue, which was partially restored by adiponectin treatment. Long-term globular adiponectin administration was able to improve pathways of insulin signalling and lipid storage in adipose tissue of high-fat diet-fed rats, contributing to a better metabolic profile.

Clinical control in the dual diagnosis of obstructive sleep apnea syndrome and rhinitis: a prospective analysis.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) and allergic rhinitis (AR) are common coexisting disorders. Upper airway, specifically nasal resistance, is thought to increase during exacerbations of AR and nonallergic rhinitis (NAR), as well as in OSAS. The study objective was to determine if a correlation exists between clinical control of rhinitis and OSAS. METHODS: This prospective study followed 43 patients with concurrent OSAS and AR or NAR. OSAS was diagnosed by polysomnography, and AR or NAR was diagnosed by history, skin testing, serum-specific IgE, and total IgE levels. Measurements of control of OSAS included the Epworth Sleepiness Scale (ESS) survey and compliance with continuous positive airway pressure (CPAP) device. Measurements of rhinitis control included Assessment of Nasal Symptom Severity and Assessment of Nonnasal Symptom Severity (NSS refers to both) and Global Assessment of Nasal and Nonnasal Symptom Severity surveys (GSS). Higher NSS scores correlate with more rhinitis symptoms, whereas higher GSS scores correlate with less symptoms. RESULTS: All patients completed the study. There was a positive correlation between ESS and NSS scores (p < 0.001), inverse correlation between ESS and GSS scores (p < 0.001), inverse correlation between CPAP compliance and NSS scores (p < 0.001), and positive correlation between CPAP compliance and GSS scores (p < 0.001). There was no statistically significant difference between the AR, NAR, and AR/NAR groups. CONCLUSION: Our study showed a statistically significant positive correlation between clinical control of rhinitis symptoms and clinical control of OSAS. This study emphasizes the importance of achieving concurrent optimal control of both OSAS and AR/NAR.

In vitro evaluation of the schistosomicidal potential of Eremanthus erythropappus (DC) McLeisch (Asteraceae) extracts.

Eremanthus erythropappus (DC) McLeisch, a plant popularly known as Candeia (Asteraceae), has high therapeutic potential. In this study, the in vitro schistosomicidal potentials of the ethanolic, dichloromethane and hexane extract of branches were evaluated. Couples of worms obtained from the infected mice were cultured in RPMI supplemented with foetal bovine serum and antibiotics. Four pairs of adult worms were exposed to increasing concentrations of each extract and examined by light microscope. The extracts at 100 and 200 µg mL(-1) had schistosomicidal activity, as demonstrated by the analysis of several aspects such as tegument darkening, absence of motility, incapacity of adhesion in culture plate and absence of egg in culture medium. At 50 and 75 µg mL(-1), the dichloromethane and hexane extracts were highly effective. The results suggest that these extracts could be useful in the development of new schistosomicidal drugs.

Avaliação da atividade antioxidante e inibição da tirosinase do extrato das folhas do jatobá (Hymenaea stigonocarpa Mart. ex Hayne) / Determination of total phenol, antioxidant activity and inhibition by tyrosinase extract of jatobá (Hymenaea stigonocarpa Mart. ex Hayne) leaves

Espécies de Jatobá (Hymenaea stigonocarpa Mart. ex Hayne) são tradicionalmente utilizadas para o tratamento de diversas doenças. Estudos quimiotaxonômicos têm relacionado o gênero Hymenaea como fonte potencial de compostos fenólicos, taninos, flavonoides, os quais apresentam atividade antioxidante, sendo assim substâncias potencialmente inibidoras da tirosinase, enzima responsável por defeitos da pigmentação da pele. Existem cerca de 15 espécies no gênero Hymenaea, das quais 13 ocorrem no Brasil. Assim, este trabalho foi realizado para avaliar os fenóis, a atividade antioxidante, a capacidade de quelação dos íons cobre, e a capacidade de inibição da tirosinase do extrato das folhas da espécie H. Stigonocarpa. O material botânico (folhas), foi colhido nas árvores da área de cerrado de preservação ambiental do campus universitário FESURV - Universidade de Rio Verde - GO, seco em estufa de circulação forçada a 42°C por 2 dias, seguindo para a obtenção dos extratos hexânico e etanólico. A determinação do conteúdo fenólico realizada através do reativo Folin Ciocalteau demonstrou ser o extrato bruto etanólico (EBE) o que apresentou a maior concentração dessa classe (235,7 mg equivalente de ácido gálico por grama de EBE). Na avaliação da atividade captadora de radical, empregando o radical livre DPPH, novamente o extrato etanólico demonstrou atividade antioxidante mais elevada (IC50 = 19 ± 0,1 ppm). Para o procedimento de quelação de íons cobre, o extrato bruto etanólico não demonstrou tal capacidade. Quanto a inibição da enzima tirosinase, o extrato bruto etanólico, após 30 e 60 minutos, apresentou inibição de 38 e 48%, respectivamente.

The jatobá species, also known as Brazilian cherry, are traditionally used for the treatment of various diseases. Chemotaxonomic studies have described the Hymenaea genus as a potential source of phenolic compounds, tannins and flavonoids, which have antioxidant activity, thus being potential inhibitors of tyrosinase, which is the enzyme responsible for skin pigmentation defects. There are approximately 15 species in the genus Hymenaea of which 13 are found in Brazil. This study was conducted to evaluate the phenols, the antioxidant activity, the ability to chelate copper ions and the ability to inhibit tyrosinase of the extract of the H. Stigonocarpa leaves. The plant material (leaves) was harvested from trees in the savannah (Brazilian Cerrado) area of environmental preservation of the FESURV campus - University of Rio Verde - state of Goiás, dried in a forced circulation oven at 42° C for 2 days and subjected to extraction with hexane (hexane crude extract) and extraction with absolute ethanol (ethanol crude extract). When determining the phenolic content performed with the Folin-Ciocalteu reagent, we found that the crude ethanol extract (CEE) presented the highest concentration (235.7 mg gallic acid equivalent per gram of CEE). In the evaluation of radical scavenging activity, using the DPPH free radical, the ethanol extract again showed higher antioxidant activity (IC50 = 19 ± 0.1 ppm). For the procedure for chelation of copper ions, the crude ethanol extract tested showed no such ability. For the process of inhibiting the tyrosinase enzyme, the crude ethanol extract tested after 30 and 60 minutes presented inhibition of 38 and 48%, respectively.

Avaliação in vitro do potencial antimicrobibiano do decoto de cascas de romã (Punica granatum L. ) sobre amostras de saliva de escolares / In vitro assessment of the antimicrobial effects of pomegranate (Punica granatum L.) peel decoction on saliva samples

Existem vários esforços para o desenvolvimento de produtos capazes de reduzir ou eliminar os microrganismos patogênicos presentes na cavidade oral. A literatura relata uma série de efeitos adversos associados ao uso contínuo destes produtos, dentre eles vômitos, diarreia e o escurecimento da dentina. A indução da resistência microbiana é um dos fatores de destaque relacionado ao uso destes produtos. Neste trabalho, o decocto de romã (Punica granatum L.), obtido a partir das cascas do fruto, foi utilizado para avaliação de seu potencial antimicrobiano sobre cepas de Pseudomonas aeruginosa, Candida albicans e Enterococcus faecalis, sendo ativos contra os dois primeiros microrganismos. A aplicação do decocto sobre os microrganismos presentes em amostras de saliva de crianças mostrou halos de inibição semelhantes ao obtido com a solução de clorexidina a 0,12%. A atividade antimicrobiana do decocto de romã aponta esta preparação como uma fonte em potencial para o desenvolvimento de produtos de uso oral...

Several products have been developed to eliminate or reduce potential pathogenic microorganisms of the oral microbiome. The continuous use of these synthetic products can result in side effects such as vomiting, diarrhea, darkening of the teeth and the induction of microbial resistance. Pomegranate (Punica granatum) peel decoction was tested to assess its antimicrobial activity. In vitro analysis showed the decoction had antimicrobial activity against strains of Pseudomonas aeruginosa and Candida albicans, but none was detected against Enterococcus faecalis. When tested on saliva samples from children, the decoction showed great potential in reducing the load of microorganisms, the inhibition haloes produced with saliva samples being similar to those of the antimicrobial control (0.12% chlorhexidine). The pomegranate peel decoction in water could thus provide a promising source for developing solutions for use against oral diseases...

Avaliação da atividade antioxidante e inibitória da tirosinase das folhas de Dipteryx alata Vogel (Baru) / Antioxidant and inhibitory action on tyrosinase from Dipteryx alata Vogel (Baru) leaves

Nos últimos anos, uma quantidade substancial de evidências tem indicado o papel chave dos radicais livres e outros oxidantes como grandes responsáveis pelo envelhecimento e pelas doenças degenerativas associadas ao mesmo. Por outro lado, substâncias fenólicas são reconhecidamente detentoras de pronunciada atividade antioxidante, muitas vezes envolvidas em tratamentos de pigmentação que resultam em hiperpigmentação ou hipopigmentação cutânea. Para o tratamento desses problemas de pigmentação vários produtos cosméticos e farmacêuticos são utilizados, porém, não são totalmente eficazes ou seguros, o que justifica a intensa pesquisa na busca de novos agentes ativos, principalmente àqueles envolvidos na melanogênese, como a tirosinase. Considerando que algumas substâncias obtidas de plantas apresentam essa atividade, a flora brasileira constitui-se uma importante fonte de pesquisa de novas substâncias. Assim, este trabalho foi realizado para avaliar os fenóis (método de Folin-Ciocalteau), a atividade antioxidante (CE50) (método de seqüestro do radical livre DPPH), a capacidade de quelação dos íons cobre, e a capacidade de inibição da tirosinase do extrato das folhas da espécie Dipteryx alata Vogel. Os resultados de fenóis totais mostraram uma concentração de 112,3 mg EAG.g-1 no extrato etanólico e 45 mg EAG.g-1 no extrato hexânico. A capacidade antioxidante dos extratos indica que o extrato etanólico, em comparação ao hexânico e ao BHT, possui maior teor de compostos antioxidantes, apresentando os respectivos valores sobre a quantidade de extrato necessária para decrescer a concentração inicial de DPPH em 50%: 52,9 ± 1,3 ppm, 169,1 ± 2,3 ppm, e 181± 6 ppm. Já a capacidade de quelação dos íons cobre mostrou que o extrato etanólico possui capacidade de quelação insignificante. No ensaio de inibição da tirosinase o extrato etanólico demonstrou um percentual de inibição da enzima de 42% após uma hora.

In recent years, a substantial amount of evidence has shown the key role of free radicals and other oxidants as largely responsible for aging and associated degenerative diseases. On the other hand, phenolic substances are known to hold pronounced antioxidant activity, often involved in pigmentation treatments, which result in skin hyperpigmentation or hypopigmentation. For the treatment of these pigmentation problems several cosmetic and pharmaceutical products have been used; however, they are not fully effective or safe, which justifies intense research to find new active agents, especially those involved in melanogenesis such as tyrosinase. Considering that some substances obtained from plants have this activity, the Brazilian flora constitutes an important source of research for new substances. Thus, this study was conducted to evaluate the phenols (Folin-Ciocalteau assay), the antioxidant activity (EC50) (DPPH free radical scavenging assay), the chelation capability of copper ions, and the inhibition capability of tyrosinase from leaf extract of the species Dipteryx alata Vogel. Results for total phenols showed concentration of 112.3 mg GAE.g-1 in ethanol extract and 45 mg GAE.g-1 in hexane extract. The antioxidant capacity of extracts indicates that ethanol extract, compared to hexane extract and BHT, has higher content of antioxidant compounds, showing the respective values of the necessary amount of extract to decrease the initial DPPH concentration by 50%: 52.9 ± 1.3 ppm, 169.1 ± 2.3 ppm and 181 ± 6 ppm. On the other hand, the chelation capacity of copper ions showed that the ethanol extract has insignificant chelation capacity. In the tyrosinase inhibition test, the ethanol extract had 42% enzyme inhibition after one hour.

Idiopathic pulmonary fibrosis: evaluation with positron emission tomography.

BACKGROUND: The pathogenesis of interstitial lung disease remains under investigation, but may be related to increased inflammatory or cellular activity. This activity may be detectable with physiologic imaging. OBJECTIVES: We investigated the role of physiologic imaging using (18)F-2-fluoro-2-deoxy-D-glucose ((18)FDG)-positron emission tomography (PET) scans in idiopathic pulmonary fibrosis (IPF). METHODS: Seven male patients with histologically confirmed IPF underwent (18)FDG-PET scans. Scans were analyzed qualitatively and interpreted as positive or negative. Patients also underwent pulmonary function tests and computed tomography (CT) scans. RESULTS: The average total lung capacity was 71 +/- 22% predicted (mean +/- SD) and diffusing capacity for carbon monoxide was 44 +/- 14% predicted. All had changes consistent with IPF on chest CT and 2 patients had ground glass attenuation. Six of seven patients (86%) had a positive (18)FDG-PET scan. Changes in the (18)FDG-PET scan were seen in 1 patient corresponding to changes in clinical status. CONCLUSIONS: Our findings suggest that (18)FDG-PET scans may be helpful in the evaluation of IPF. Increased activity suggests active disease and changes in response to therapy.

Pulmonary hypertension in men with thyrotoxicosis.

Thyrotoxicosis has a myriad of respiratory symptoms including dyspnea. Pulmonary hypertension may contribute to the respiratory symptoms of thyrotoxicosis, but is often unrecognized. We describe 3 male patients with thyrotoxicosis and associated pulmonary hypertension. Case reports of an additional 15 patients are also reviewed. In patients with thyrotoxicosis and pulmonary hypertension, treatment of thyrotoxicosis alone is associated with improvement in pulmonary hypertension. Previous reports have consisted of mostly female patients, but we report 3 men. When all cases are considered, the typical patient is female (10/14 = 71%), middle-aged (48 years), with mean pulmonary artery systolic pressures improving from 56 to 32 mm Hg with treatment. Autoantibodies were detected in 10/14 (71%) patients. The response to treatment (medical or surgical) of thyrotoxicosis supports the hypothesis that hyperthyroidism is either a cause of pulmonary hypertension, or a factor that may unmask pulmonary hypertension. Recognition is important since treatment and response are very different compared to other patients with pulmonary hypertension. This association may not be readily considered in men, since most reports have been of women.

In-vitro fertilization pregnancies and perinatal health in Finland 1991-1993.

In 1993, in Finland at least 0.7% of all pregnancies ending in birth were assisted by in-vitro fertilization (IVF). The purpose of this study was to compare IVF mothers with other mothers, and the perinatal health and health care costs of IVF infants to those of other infants. The main source of information was the Medical Birth Register for 1991-1993 (n = 19,1712 pregnancies, of which 1015 were started by IVF). IVF mothers were more often older, married and primiparas. They started antenatal care earlier, had more visits than other mothers and more than 50% were hospitalized during their pregnancy. Every fourth IVF pregnancy was a multiple one. Both IVF singletons and multiples had poorer health than other infants. The new practice of implanting fewer embryos than before was introduced in 1992-1993, and a 50% decrease in triplet rate was found. At the same time, a somewhat better outcome for IVF newborns was found. However, every fourth child was still preterm or weighed < 2500 g. The health care costs for one IVF newborn from induction of pregnancy until the age of 7 days was 5.4-fold compared to other newborns. The subsequent health of IVF children has to be further studied to more fully assess the health impact of IVF.

Physiological effects of whole cottonseed in the diet of lactating dairy cows.

With 32 lactating Holstein cows we evaluated physiological effects of gossypol and cyclopropenoid fatty acids in diets containing 18.5% whole cottonseed (dry matter) based on corn, corn silage, and soybean meal. All cows consumed a control diet for the first 2 wk of lactation and then were assigned to either control or whole cottonseed diet for the remainder of their lactation. Milk production, milk fat and protein percentages, and daily dry matter intake were measured. Dry matter intakes were less for cows consuming the whole cottonseed diet, but net energy intake was similar for all diets. Milk fat from cows consuming whole cottonseed contained detectable concentrations of cyclopropene fatty acids. Total lipid in plasma, total serum cholesterol, serum gossypol, and apparent liver gossypol concentrations were greater in cows fed whole cottonseed. Gossypol and cyclopropenoid fatty acids appeared to be absorbed from the gut of cows fed whole cottonseed. Small amounts of gossypol in serum and liver tissue and small amounts of cyclopropene fatty acids in adipose tissue lipids and milk fat indicate a need to elucidate the significance of these physiologically active compounds in the human diet and their biological effects on lactating dairy cows.

Efeitos farmacológicos e toxicológicos do extrato de Posoqueria acutifolia Mart. (Rubiaceae) em roedores / Pharmacological and toxic effects of Posoqueria acutifolia Mart. (Rubiaceae) extract in rodents

O presente trabalho investigou os efeitos farmacológicos e toxicológicos do extrato metanólico dos galhos de Posoqueria acutifolia. Foram realizados os testes de contorções abdominais, formalina, placa quente, edema de pata e pleurisia, bem como para a toxicidade aguda. As doses de 100, 200 e 400 mg/kg inibiram as contorções abdominais. No teste da formalina, a dose de 400 mg/kg reduziu o tempo de lambida da primeira fase, enquanto este efeito foi observado nas doses de 200 e 400 mg/kg sobre a segunda fase. O tempo de permanência sobre aplaca quente aumentou na dose de 400 mg/kg, embora a dose de 200 mg/kg também tenha tido efeito significativo após 90 minutos de tratamento. Houve uma redução do edema de pata, do volume do exsudato e da migração leucocitária nas doses testadas. O extrato testado não foi tóxico nas doses avaliadas. Portanto, o extrato metanólicode P. acutifolia exibe efeitos analgésico e antiinflamatório, o que poderia estar relacionado a seu uso na medicina popular

In the present study, the pharmacological and toxic effects on mice of methanol extract of branches of the Brazilian tree Posoqueria acutifolia were investigated. The tests carried out were acetic acid induced writhing, paw licking induced by formalin, hot plate, paw edema and pleurisy, as well as in acute toxicity test. Doses of 100, 200 and 400 mg/kg inhibited the abdominal contortions. In the formalin test, the first phase of paw licking was shortened at the dose of 400 mg/kg, while the second phase was significantly affected by 200 and 400 mg/kg. The time of reaction to the hot plate increased with 400 mg/kg, although 200 mg/kg had a significant effect after 90 min of treatment. All doses of the methanolic extract reduced the paw edema, the volume of the exsudate and the leukocyte migration. The tested extract showed low acute toxicity to mice. It was concluded that (or thus) the methanol extract of P. acutifolia branches possess analgesic and antiinflammatory activity, which could justify the popular medicinal application of this plant.

Enfermedad de las Vías Aéreas Pequeñas

Se realizó una revisión sobre Las Enfermedades Pulmonares Obstructivas (EPOC) que constituyen en la actualidad un serio problema clínico y epidemiologico en todo el mundo. Se analizó la Etiopatogénia, fisiopatología de la enfermedad.(AU)