Synovial features of patients with rheumatoid arthritis and psoriatic arthritis in clinical and ultrasound remission differ under anti-TNF therapy: a clue to interpret different chances of relapse after clinical remission?

OBJECTIVE: To define the synovial characteristics of patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in clinical and ultrasound remission achieved by combination therapy with methotrexate (MTX) and tumour necrosis factor (TNF) blockers. METHODS: Patients with RA in remission (n=25) (disease activity score (DAS)<1.6 for at least 6 months), patients with RA in low disease activity (LDA) (n=10) (1.6

Microvascular impairment is associated with insulin resistance in euglycemic mild hypertensives.

BACKGROUND: Hypertension and diabetes are significantly associated with insulin resistance (IR), which could affect the vasodilatory capacity and microcirculation. The aim of the study was to verify whether IR is associated with a reduced microvascular blood flow in normoglycemic mild hypertensives. METHODS: Eighty-four untreated grade-1 hypertensives were equally divided, according to the IR homeostasis model assessment (HOMA) index, into three groups: IR-Low = 2.16 +/- 0.09 vs. IR-Medium = 3.77 +/- 0.09 vs. IR-High = 7.08 +/- 0.68 (P < 0.001) with similar sex distribution, office systolic blood pressure (SBP)/diastolic blood pressure (DBP) and history of hypertension. They underwent ambulatory blood pressure monitoring (ABPM) and a laboratory stress session, during which blood pressure (BP), heart rate (HR), and skin blood flow (Laser Doppler) were taken on the forehead (LDF) and the hand (LDH), where the neuroadrenergic control of the microvascular blood flow is higher. Reactivity was calculated as "area-under-the-curve" (AUC) during arithmetic and cold pressor tests. Postischemic LDH served as the index of endothelial microcirculatory damage. RESULTS: ABPM confirmed the diagnosis of hypertension, but IR-High patients showed a reduced nighttime BP fall. They also demonstrated reduced LDH-AUC and LDF-AUC although BP-AUC and HR-AUC reactivity were similar. Postischemic LDH was lower in the IR-High group (P < 0.05), and the postischemic LDH change was progressively impaired in both IR-Medium and IR-High patients (P < 0.001). LDH-AUC (-0.305, P = 0.007) and postischemic LDH at 30 s (-0.217, P = 0.059) and 60 s (-0.248, P = 0.030) during hyperemia were associated with HOMA. Multiple regression analysis, with HOMA as the dependent variable, showed that BMI (beta = 0.336, P < 0.001) and LDH (beta = -0.239, P < 0.001), LDH-AUC (beta = -0.296, P < 0.01) and postischemic LDH change (beta = -0.321, P < 0.001) entered the equation. CONCLUSIONS: The findings suggest that IR is associated with functional microvascular constrictive impairment in normoglycemic mild hypertensives.

Influência do ângulo entre a crista óssea e a superfície radicular na profundidade do sulco gengival clínico / Influence of the angle between the bone crest and root surfaces in the depth of the clinical gingival sulcus

Foi desenvolvido projeto de pesquisa clínica e radiográfica para avaliar a influência do ângulo formado entre a superfície dental e a crista óssea na determinação da profundidade de sondagem do sulco gengival e complementarmente no comportamento da margem gengival por vestibular de dentes molares inferiores inclinados para mesial. Para tanto foram incluídos 30 sítios mesiais e 30 distais no grupo teste, com igual número de sítios controles de molares inferiores com inclinação normal. Nos dentes que forneceram esses sítios também foi feita a determinação da profundidade do sulco gengival na região vestibular central do dente, identificando-se a qualidade e quantidade de gengiva ceratinizada, respectivamente pela metodologia de Kan et al. (2010) e pela mensuração com sonda periodontal da distância da margem gengival à junção mucogengival. Foram incluídos pacientes periodontal e sistemicamente saudáveis, excluindo-se pacientes que tivessem sido submetidos a procedimentos ósseos regenerativos prévios nas áreas de interesse, diabéticos relutantes ao controle médico, usuários de drogas e/ou álcool, portadores de alterações sistêmicas que interfiram no metabolismo ósseo (como por exemplo, osteoporose e hiperparatireoidismo). Os exames foram realizados por examinador competente, devidamente calibrado. Para análise radiográfica as imagens foram transferidas para o computador, realizando-se as mensurações dos ângulos interessados com o programa de computador MB-Ruler Pro (MB-Software solutions). A análise estatística foi realizada no programa GraphPad Prism versão 5.03 para Windows (GraphPad, Usa). Os resultados obtidos em linhas gerais mostraram que houve influência significativa do ângulo entre a superfície dental e a crista óssea (p > 0,0001) na determinação do sulco gengival proximal em áreas de dentes inclinados, porém não há essa influência na profundidade de sondagem do sulco gengival por vestibular para áreas com...

A clinical and radiographic research project was developed to assess the influence of the angle formed between the tooth surface and the alveolar bone crest in determining the probing depth of the gingival sulcus and complementary also to evaluate the behavior of the buccal gingival margin of mesially inclined molars. Therefore, 30 mesial and 30 distal sites of inclined lower molars were included in the test group, with an equal number of sites of lower molars with normal inclination in the control group. In addition in all the teeth of both test and control groups the depth of the clinical gingival sulcus at the central buccal region of the tooth was assessed by measuring with a periodontal probe, identifying the quality of the keratinized gingiva through the methodology of Kan et al. (2010) and determining the width of keratinized gingiva by measuring the distance from the free gingival margin to the mucogingival junction. The study was done in systemic and periodontally healthy individuals, excluding patients who had undergone bone-regenerative procedures in the areas of interest, diabetics reluctant to medical control, alcohol and / or drug users, and individuals suffering from systemic conditions that might interfere with bone metabolism (like osteoporosis and hyperparathyroidism). The examinations were performed by a competent and properly calibrated examiner. The radiographic images were then transferred to a computer in order to analyze the measurements of the involved angles with the computer program MB-Ruler Pro (MB-Software solutions). Statistical analysis was performed using GraphPad Prism version 5.03 for Windows (GraphPad, Usa). The results in general showed that there was significant influence of the angle between the tooth surface and the alveolar bone crest on the depth of the gingival sulcus in proximal areas of inclined teeth (p > 0,0001), but there was no such influence in the probing...