Sleep bruxism and its associations with insomnia and OSA in the general population of Sao Paulo.

Sleep bruxism (SB) is characterized by recurrent masticatory muscle activity during sleep with occasional tooth grinding. SB can be concomitant with sleep apnea although its association with insomnia is understudied. STUDY OBJECTIVE: Assess the strength of the associations between SB, insomnia and sleep apnea in a general population. METHODS: Data from the 2007 EPISONO general population study (n = 1042; Sao Paulo, Brazil) were reused for the present analyses. The data was collected from polysomnography (PSG) and from a questionnaire. SB could only be assessed as "possible" with self-report questionnaires, but as "definitive" with both self-reports and PSG. Logistic regression and decision tree analyses were performed. RESULTS: Logistic regression analyses revealed that being male, overweight, obese, having an apnea/hypopnea index (AHI) above 30 and insomnia syndrome are among risk factors for SB (prevalence ratio (PR): 1.5-3.3). A high AHI and insomnia syndrome had similar PRs, 2.7 and 2.8, respectively. Decision tree analysis showed that insomnia syndrome contributed to the predictive accuracy of SB self-report (88%). A similar estimate (91%) was observed with SB PSG data. Correspondence analysis illustrated three age profiles in participants: (1) good sleepers aged 20-35 years, (2) females aged 35-50 years with SB and concomitant insomnia syndrome, and (3) participants aged ≥ 50 years with obesity and sleep apnea. CONCLUSIONS: Insomnia is likely a condition associated with SB, especially in middle-age females, while sleep apnea seems age and gender dependent. Such overlap may influence the treatment decision to achieve best outcomes. CLINICAL TRIAL REGISTRATION: EPISONO study; Clinical trials.gov ID # NCT00596713.

[Preoperative fasting : state of the art]. / Intérêt du jeûne préopératoire : mise au point.

Inhalation of gastric content is a significant risk factor for perioperative complications. Preoperative fasting reduces this risk. The preanesthesia fasting time is variable and is subject to recommendations from different scientific societies. The clinician can identify some risk factors for inhalation during the preoperative anesthetic consultation. On the day of the procedure, the gastric ultrasound allows quantitative or semi-quantitative assessment of the gastric content. In that way, the anesthesiologist can adapt the anesthesia, in particular by using a so-called rapid sequence induction and esophageal compression.

L'inhalation du contenu gastrique représente un important facteur de risque peropératoire. Le jeûne préopératoire permet de limiter ce risque. La durée du jeûne est variable selon les patients et les circonstances. Elle est soumise à des recommandations par différentes sociétés savantes. La consultation pré-anesthésique permet d'identifier certains facteurs de risque d'inhalation. Le jour de l'intervention, l'échographie de l'estomac permet de guider l'évaluation quantitative ou semi-quantitative du contenu gastrique. La stratégie anesthésique est ainsi adaptée à la balance bénéfice-risque, notamment en utilisant une induction dite «en séquence rapide¼ et une compression oesophagienne lors des interventions chirurgicales en urgence.

Critical Issues in Dental and Medical Management of Obstructive Sleep Apnea.

This critical review focuses on obstructive sleep apnea (OSA) and its management from a dental medicine perspective. OSA is characterized by ≥10-s cessation of breathing (apnea) or reduction in airflow (hypopnea) ≥5 times per hour with a drop in oxygen and/or rise in carbon dioxide. It can be associated with sleepiness and fatigue, impaired mood and cognition, cardiometabolic complications, and risk for transportation and work accidents. Although sleep apnea is diagnosed by a sleep physician, its management is interdisciplinary. The dentist's role includes 1) screening patients for OSA risk factors (e.g., retrognathia, high arched palate, enlarged tonsils or tongue, enlarged tori, high Mallampati score, poor sleep, supine sleep position, obesity, hypertension, morning headache or orofacial pain, bruxism); 2) referring to an appropriate health professional as indicated; and 3) providing oral appliance therapy followed by regular dental and sleep medical follow-up. In addition to the device features and provider expertise, anatomic, behavioral, demographic, and neurophysiologic characteristics can influence oral appliance effectiveness in managing OSA. Therefore, OSA treatment should be tailored to each patient individually. This review highlights some of the putative action mechanisms related to oral appliance effectiveness and proposes future research directions.

Potential transfer of aquatic organisms via ballast water with a particular focus on harmful and non-indigenous species: A survey from Adriatic ports.

Ballast water discharges may cause negative impacts to aquatic ecosystems, human health and economic activities by the introduction of potentially harmful species. Fifty untreated ballast water tanks, ten in each port, were sampled in four Adriatic Italian ports and one Slovenian port. Salinity, temperature and fluorescence were measured on board. Faecal indicator bacteria (FIB), phyto- and zooplankton were qualitatively and quantitatively determined to identify the species assemblage arriving in ballast water. FIB exceeded the convention standard limits in 12% of the sampled tanks. Vibrio cholerae was not detected. The number of viable organisms in the size groups (minimum dimension) <50 and ≥10 µm and ≥50 µm resulted above the abundances required from the Ballast Water Management Convention in 55 and 86% of the samples, respectively. This is not surprising as unmanaged ballast waters were sampled. Some potentially toxic and non-indigenous species were observed in both phyto- and zooplankton assemblages.

[Neisseria meningitidis urethritis: Two case reports]. / Urétrite à Neisseria meningitidis : deux cas.

BACKGROUND: Neisseria meningitidis (NM) is a commensal bacteria present in the oropharyngeal flora that causes invasive infections. There have been rarer reports of presence in the genital region. Herein, we present two cases of acute NM urethritis. PATIENTS AND METHODS: Two men aged 30 and 31years, one of whom is homosexual and seropositive for HIV infection, presented urethral discharge which was diagnosed as acute urethritis. The unit through samples indicated the presence of NM of serogroups B and C. One of the antibiotic sensitivity tests revealed intermediate susceptibility to penicillin G and to amoxicillin. DISCUSSION: The clinical presentation of acute NM urethritis is non-specific, because of which urethral samples should be taken wherever acute urethritis is suspected. NM urethritis is infrequent and primarily affects men who have sex with men (MSM). Its current increase is due to unprotected oral-genital sexual practices. Due to the emergence of resistance to NM, antibiotic susceptibility testing should be carried out routinely to ensure appropriate therapy and prophylaxis. Cases of invasive serogroup C meningococcal infections have been recorded within the MSM population with hypothetical sexual port of entry. Thus, the French High Public Health Authority recommends vaccination against meningitis C in this population.

Polysomnographic study of the prevalence of sleep bruxism in a population sample.

The goal of the current study was to estimate the prevalence of sleep bruxism (SB) in the general population using a representative sample of 1,042 individuals who answered questionnaires and underwent polysomnography (PSG) examinations. After PSG, the individuals were classified into 3 groups: absence of SB, low-frequency SB, and high-frequency SB. The results indicated that the prevalence of SB, indicated by questionnaires and confirmed by PSG, was 5.5%. With PSG used exclusively as the criterion for diagnosis, the prevalence was 7.4% regardless of SB self-reported complaints. With questionnaires alone, the prevalence was 12.5%. Of the 5.5% (n = 56) with confirmed SB, 26 were classified as low-frequency SB, and 30 as high-frequency. The episodes of SB were more frequent in stage 2 sleep, and the phasic bruxism events were more frequent than tonic or mixed events in all sleep stages in individuals with SB. A positive association was observed between SB and insomnia, higher degree of schooling, and a normal/overweight body mass index (BMI). These findings demonstrate the prevalence of SB in a population sampled by PSG, the gold standard methodology in the investigation of sleep disorders, combined with validated questionnaires.

Phenotypic and genetic diversity of coexisting Listonella anguillarum, Vibrio harveyi and Vibrio chagassi recovered from skin haemorrhages of diseased sand smelt, Atherina boyeri, in the Gulf of Trieste (NE Adriatic Sea).

AIMS: This study identified and characterized coexisting Vibrios associated with haemorrhagic skin lesion bearing sand smelt fishes (Atherina boyeri) in north-eastern Adriatic Sea. METHODS AND RESULTS: Bacteria were isolated from external skin lesions of four samples, and representative morphotypes grown on thiosulfate-citrate-bile salt-sucrose agar were isolated. In total 25 isolates, presumptively assigned to Vibrio genus, were biochemically characterized and were grouped in 10 phenotypic profiles. Phenotypes were heterogeneously distributed among the diseased sand smelt analysed; only one phenotype was recovered from all the samples. Sequencing of 16S rRNA was performed to identify representatives of all phenotypes. Phylogenetic analysis using the neighbour-joining method revealed six isolates clustered within the Vibrio harveyi group, three clustered with known Vibrio chagasii strains and three clustered with Listonella anguillarum. CONCLUSIONS: Vibrios with a broad phenotypic variability were found in the external lesions of diseased A. boyeri. In total three species of Vibrio were identified: V. harveyi showed the wider phenotypical and ribotypical heterogeneity while L. anguillarum shared similar biochemical characteristics with typical strains. SIGNIFICANCE AND IMPACT OF THE STUDY: Previously unreported coexistence of potential pathogenic species colonizing diseased A. boyeri has ecological as well as epidemiological significance.

Is ceramic-on-ceramic squeaking phenomenon reproducible in vitro? A long-term simulator study under severe conditions.

Clinical and in vitro studies on ceramic hip prostheses correlate cup implant position with hip noise, ceramic wear, or ceramic liner damage. A ceramic cup malposition could lead to edge load, ceramic head wear, and squeaking. A noise of a ceramic hip could also be correlate with implant instability and liner damage. Aim of this study was to investigate the long-term wear behavior of 12 commercial alumina-on-alumina bearings under severe conditions: different angles of inclination (23 degrees, 45 degrees, and 63 degrees) and the addition of third body particles (titanium and alumina powder) to address the effective role of cup position and ceramic particles on wear and hip noise. The study was performed using a 12-stations hip joint wear simulator (Shore Western, Monrovia) under bovine calf serum used as lubricant. Wear was evaluated by gravimetric method and the piezo-spectroscopic technique was used to evaluate the residual stress of the ceramic components and correlate this to the weight loss. After eight million cycles, we found that the inclination of the cup (63 degrees in this study) was the most disadvantaged and it was correlated with a hip noise. Gravimetric measurements showed higher wear than the other configurations and these results were in agreement with the Photoluminescence investigation. In particular, the results obtained in this work revealed a residual stress state greater not only with respect to the other angles of inclination but also to two retrieved alumina acetabular cups with a 10 years follow-up.

Tribology and total hip joint replacement: current concepts in mechanical simulation.

Interest in the rheology and effects of interacting surfaces is as ancient as man. This subject can be represented by a recently coined word: tribology. This term is derived from the Greek word "tribos" and means the "science of rubbing". Friction, lubrication, and wear mechanism in the common English language means the precise field of interest of tribology. Wear of total hip prosthesis is a significant clinical problem that involves, nowadays, a too high a number of patients. In order to acquire further knowledge on the tribological phenomena that involve hip prosthesis wear tests are conducted on employed materials to extend lifetime of orthopaedic implants. The most basic type of test device is the material wear machine, however, a more advanced one may more accurately reproduce some of the in vivo conditions. Typically, these apparatus are called simulators, and, while there is no absolute definition of a joint simulator, its description as a mechanical rig used to test a joint replacement, under conditions approximating those occurring in the human body, is acceptable. Simulator tests, moreover, can be used to conduct accelerated protocols that replicate/simulate particularly extreme conditions, thus establishing the limits of performance for the material. Simulators vary in their level of sophistication and the international literature reveals many interpretations of the design of machines used for joint replacement testing. This paper aims to review the current state of the art of the hip joint simulators worldwide. This is specified through a schematic overview by describing, in particular, constructive solutions adopted to reproduce in vivo conditions. An exhaustive commentary on the evolution and actually existing simulation standards is proposed by the authors. The need of a shared protocol among research laboratories all over the world could lead to a consensus conference.

Analysis of transcription of the Col6a1 gene in a specific set of tissues suggests a new variant of enhancer region.

The region extending from -5.4 to -3.9 kilobase pairs from the transcription start site of the Col6a1 gene has been previously shown to contain sequences activating tissue-specific transcription in articular cartilage, intervertebral disks, subepidermal, and vibrissae mesenchyme and peripheral nervous system (Braghetta, P., Fabbro, C., Piccolo, S., Marvulli, D., Bonaldo, P., Volpin, D., and Bressan, G. M. (1996) J. Cell Biol. 135, 1163-1177). Analysis of expression of deletions of this region in transgenic mice has identified the 383-base pair fragment E-L as the most active sequence of the region. Linker-scanning mutagenesis analysis of segment E-J, which spans the 5' 245 base pairs of E-L and is sufficient for high frequency expression in articular cartilage, showed that all the mutations reduced transcription considerably, suggesting that the integrity of the entire cluster of elements is necessary for enhancer activity. Electrophoretic mobility shift assays with nuclear extracts derived from various sources showed that fragment E-J binds numerous transcription factors (at least 22). These factors are present in most cells, expressing and nonexpressing alpha1(VI) collagen mRNA, but in different relative proportions, and none of them appears to be cell type-specific. Several lines of evidence indicate that sequence elements of the enhancer may have different functional roles in various cells. The data configure the -5.4/-3.9 region of the Col6a1 gene as a new type of tissue-specific enhancer, characterized by a variety of tissues supporting its activation and by the dependence of its function only on ubiquitous transcription factors. This type of enhancer is postulated to be particularly important for genes such as those of the extracellular matrix, which are often expressed with broad tissue specificity.

Cell type-specific transcription of the alpha1(VI) collagen gene. Role of the AP1 binding site and of the core promoter.

Analysis of the chromatin of different cell types has identified four DNase I-hypersensitive sites in the 5'-flanking region of the alpha1(VI) collagen gene, mapping at -4.6, -4.4, -2.5, and -0.1 kilobase (kb) from the RNA start site. The site at -2.5 kb was independent from, whereas the other three sites could be related to, alpha1(VI) mRNA expression. The site at -0.1 kb was present in cells expressing (NIH3T3 and C2C12) but absent in cells not expressing (EL4) the mRNA; the remaining two sites were apparently related with high levels of mRNA. DNase I footprinting and gel-shift assays with NIH3T3 and C2C12 nuclear extracts have located a binding site for transcription factor AP1 (activator protein 1) between nucleotides -104 and -73. When nuclear extracts from EL4 lymphocytes were used, the AP1 site-containing sequence was bound by proteins not related to AP1. The existence of the hypersensitive site at -0.1 kb may be related to the binding of AP1 and of additional factors to the core promoter (Piccolo, S., Bonaldo, P., Vitale, P., Volpin, D., and Bressan, G. M. (1995) J. Biol. Chem. 270, 19583-19590). The function of the AP1 binding site and of the core promoter in the transcriptional regulation of the Col6a1 gene was investigated by expressing several promoter-reporter gene constructs in transgenic mice and in cell cultures. The results indicate that regulation of transcription of the Col6a1 gene by different cis-acting elements (core promoter, AP1 binding site and enhancers) is not completely modular, but the final output depends on the specific interactions among the three elements in a defined cell type.

Alternative splicing of VWFA modules generates variants of type VI collagen alpha 3 chain with a distinctive expression pattern in embryonic chicken tissues and potentially different adhesive function.

Type VI collagen, a ubiquitous extracellular cell adhesion molecule, is formed by heterotrimeric monomers which associate into dimers and tetramers and assemble into larger oligomers constituting the 100 nm-long periodic microfilaments of connective tissues. One distinctive structural characteristic of type VI collagen is represented by an alpha 3 chain with a much larger molecular mass compared to the other two chains and with an extensive size heterogeneity, exemplified by the separation into up to five polypeptides in SDS-PAGE. There is evidence that the alpha 3(VI) mRNA can undergo alternative splicing of three VWFA modules at the 5'-end, potentially resulting in the expression of protein variants. Here we report that alternative splicing of alpha 3(VI) mRNA in chicken embryo did not result in the absolute predominance of a particular alpha 3(VI) form in any tissue; instead, the expression of variants including exons A9, A8 and A6 increased with age. In addition, these variants had a more restricted tissue distribution pattern compared to variants including only constitutive exons: A9+ were the rarest and were present almost exclusively in skin and skeletal muscle; A6+ were expressed in several of the examined tissues with local variations; A8+ had intermediate levels and were less widely distributed than A6+ variants. Quantitative densitometric scanning of immunoblots of type VI collagen purified from gizzard and stained with VWFA module-specific antibodies indicated that the polymorphic migration pattern of alpha 3(VI) polypeptides is contributed by concurrent or independent splicing of two exons (A8 and A6) and probably by processing and/or proteolysis at the N- and C-terminus. Three exon-specific recombinant polypeptides were examined in cell adhesion assays, and A6 appeared to be the most active, particularly at low substrate concentrations. The adhesion to the recombinant modules was not abrogated by EDTA nor by mAbs against the integrin beta 1 or alpha 2 subunits. Over all, these results suggest that the splicing of the alpha 3(VI) mRNA and the tissue distribution pattern of type VI collagen variants, apart from promoting cell adhesion to different extents, might also affect additional structural as well as functional properties of this molecule, including microfilament formation and interaction with other extracellular matrix molecules.

Tissue-specific expression of promoter regions of the alpha1(VI) collagen gene in cell cultures and transgenic mice.

Cis-acting regions regulating transcription of the alpha1(VI) collagen chain have been investigated in vitro by transfection of promoter-CAT (where CAT is chloramphenicol acetyltransferase) constructs in different types of cultured cells and in vivo in transgenic mice carrying the same CAT constructs or minigenes derived from the fusion of genomic and cDNA sequences in which small deletions of the collagenous domain had been engineered. 215 bp of 5'-flanking sequence showed promoter activity in vitro, yet were not expressed in any tissue of six transgenic lines, indicating that this fragment contains the basal promoter, but not activator sequences. Constructs with 0.6 and 1.4 kb of the 5'-flanking region produced significantly higher CAT activity in transfected cells and were expressed in tissues of about 30% of transgenic lines. Although CAT activity was totally unrelated to the pattern of expression of the alpha1(VI) mRNA, these results suggest the presence of an activator(s) between -0.2 and -0.6 kb from the transcription start site. When the promoter size was increased to 5.4 or 6.5 kb, CAT activity was stimulated severalfold relative to the construct p1.4CAT and p4.0CAT in NIH3T3 fibroblasts and chick embryo chondroblasts. This stimulation was, however, not observed in C2C12 myoblasts. Transgenic mice generated with 6.5CAT construct or minigenes, containing 6.2 kb of promoter, exhibited very high levels of expression, which was similar to the relative amount alpha1(VI) mRNA in the majority of tissues, with the exception of lung, adrenal gland and uterus. CAT activity in tissues was 100-1000-fold higher than that measured in transgenic mice with shorter promoter (0.6 or 1.4 kb). Since expression of minigenes was determined by RNase protection assay, the levels of mRNA per transgene copy were compared to those of the chromosomal gene and found to be always less than one quarter. These data suggest that the region -4.0/-5.4 contains an important activator(s) sequence which induces transcription in several, but not all, type VI collagen-producing tissues. Finally, analysis with the longest promoter fragment (7.5 kb) revealed a complex effect of the region -6.5/-7.5 on alpha1(VI) chain transcription. The sequence was inhibitory in NIH3T3 cells, indifferent in myoblasts and activating in chondroblasts in vitro, whereas transgenic animals generated with 7.5CAT construct produced a pattern of expression comparable to that of 6.5CAT and minigenes. During postnatal development transcription from both the endogenous gene and the transgenes decreased. However, the ratio of transgene/chromosomal gene expression was not constant, but varied in a way dependent on the tissue. This observation suggests that the fragment studied contains key sequences for the age-dependent regulation of the alpha1(VI) gene. No phenotypic alterations were induced by the presence of mutations in the minigenes.

Distinct regions control transcriptional activation of the alpha1(VI) collagen promoter in different tissues of transgenic mice.

To identify regions involved in tissue specific regulation of transcription of the alpha1(VI) collagen chain, transgenic mice were generated carrying various portions of the gene's 5'-flanking sequence fused to the E. coli beta-galactosidase gene. Analysis of the transgene expression pattern by X-gal staining of embryos revealed that: (a) The proximal 0.6 kb of promoter sequence activated transcription in mesenchymal cells at sites of insertion of superficial muscular aponeurosis into the skin; tendons were also faintly positive. (b) The region between -4.0 and -5.4 kb from the transcription start site was required for activation of the transgene in nerves. It also drove expression in joints, in intervertebral disks, and in subepidermal and vibrissae mesenchyme. (c) The fragment comprised within -6.2 and -7.5 kb was necessary for high level transcription in skeletal muscle and meninges. Positive cells in muscle were mostly mononuclear and probably included connective tissue elements, although staining of myoblasts was not ruled out. This fragment also activated expression in joints, in intervertebral disks, and in subepidermal and vibrissae mesenchyme. (d) beta-Galactosidase staining in vibrissae induced by the sequences -4.0 to -5.4 and -6.2 to -7.5 was not coincident: with the latter sequence labeled nuclei were found mainly in the ventral and posterior quadrant, and, histologically, in the outer layers of mesenchyme surrounding and between the follicles, whereas with the former the remaining quadrants were positive and expressing cells were mostly in the inner layers of the dermal sheath. (e) Other tissues, notably lung, adrenal gland, digestive tract, which produce high amounts of collagen type VI, did not stain for beta-galactosidase. (f) Central nervous system and retina, in which the endogenous gene is inactive, expressed the lacZ transgene in most lines. The data suggest that transcription of alpha1(VI) in different tissues is regulated by distinct sequence elements in a modular arrangement, a mechanism which confers high flexibility in the temporal and spatial pattern of expression during development.