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Vol:10 Issue 4/2006



TABLE OF CONTENTS / CUPRINS





MEDICO-SURGICAL SECTION / SECTIUNEA MEDICO-CHIRURGICALE

NEWS IN MEDICAL TREATAMENT OF MÉNIERČ DISEASE

ACTUALITATI ĪN TRATAMENTUL MEDICAMENTOS AL BOLII MÉNIERČ

Aurelian Ioan Curca, Luminita Radulescu, Cristian Marius Mārtu



CONSIDERATIONS ON THE CLINICA LAND THERAPEUTICAL ASPECTS IN INFECTIOUS MONONUCLEOSIS

CONSIDERATII ASUPRA ASPECTELOR CLINICE SI TERAPEUTICE ĪN MONONUCLEOZA INFECTIOASA

Mihaela Catalina Luca, Carmen Dorobat, Carmen Manciuc, Eduard Nastase



ORO-MAXILLO-FACIAL SURGERY / CHIRURGIE ORO-MAXILO-FACIALA

THE COMPARATIVE ANALYSIS OF DIFFERENT SUTURE MATERIALS USED IN THE ORAL SURGERY

ANALIZA COMPARATIVA A UNOR MATERIALE DE SUTURA FOLOSITE ĪN CHIRURGIA ORALA

Mihaela Maftei, Maria Voroneanu



THE PSYCHOLOGIC AFFECTION DUE TO FACIAL MUTILLATION

AFECTAREA PSIHICA ĪN MUTILARILE FACIALE

Delia Bahrim, Camelia Ionascu



BIOMATERIALS. PROTHESIS TECHNOLOGY / BIOMATERIALE. TEHNOLOGIA PROTEZELOR

THE STUDY OF VARIATIONS OF THE BIOCHEMICAL PARAMETERS AT THE TESTED ANIMALS BY USING RED DEER ANTLER AS GUIDED TISSULAR REGENERATING MATERIAL

STUDIUL VARIATIILOR PARAMETRILOR BIOCHIMICI LA ANIMALELE OPERATE, FOLOSIND CORNUL DE CERB CA MATERIAL DE REGENERARE TISULARA GHIDATA

Paul Prodan, Silvia Mārtu



GNATOPROSTHETICS. IMPLANTOLOGY / GNATOPROTETICA. IMPLANTOLOGIE

ESTHETICS OF THE REMOVABLE PARTIAL DENTURES - CLINICAL CASE

ESTETICA ĪN PROTEZAREA MOBILIZABILA - CAZ CLINIC

Zaharia N. Agripina, Duta D. Mihaela



RESEARCH OVER THE EVOLUTION AND COMPLICATION OF THE OSSEOUS COMPONENT OF THE MANDIBULAE EDENTULOUS SPACES

CERCETARII PRIVIND EVOLUTIA SI COMPLICATIILE EDENTATIEI MANDIBULARE LA NIVELUL SUPORTULUI OSOS

Alina Jehac, Corina Cristescu, Vasile Burlui



NEWS IN THE STUDY OF THE MUSCULAR TONUS MECHANISM

ACTUALITATI ĪN STUDIUL MECANISMULUI TONUSULUI MUSCULAR

Laura Checherita, V. Burlui



ODONTOLOGY. PERIODONTOLOGY / ODONTOLOGIE. PARODONTOLOGIE

STUDY REGARDING DIGITAL RADIOGRAPHY ADVANTAGES IN DIAGNOSING OF EARLY DENTAL CARIES FOR LATERAL DENTAL GROUP

STUDIU PRIVIND AVANTAJELE RADIOGRAFIEI DIGITALE IN DIAGNOSTICAREA CARIILOR INCIPIENTE LA NIVELUL GRUPULUI DENTAR POSTERIOR

Avadanei Ciprian, Andrian Sorin, Iovan Gianina, Topoliceanu Claudiu, Hamburda Tudor, Lacatusu Stefan

Angela Ghiorghe, Topoliceanu C



GINGIVAL OVERGROWTHS IN PATIENTS WITH HAEMODIALYSIS AND THE RISK OF GINGIVAL BLEEDING

HIPERCRESTERILE GINGIVALE LA PACIENTII CU DIALIZA SI RISCUL DE SĀNGERARE GINGIVALA

Silvia Mārtu, Ramona Mocanu



SUDIES REGARDING THE INTERRELATION AND INTERDEPENDENCE BETWEEN PERIODONTAL DISEASE AND SISTEMIC DISEASIS

STUDII PRIVIND INTERRELATIA SI INTERDEPENDENTA BOALA PARODONTALA BOLI SISTEMICE

Silvia Mārtu, Pasarin Liliana, Solomon Sorina, Rudnic Ioana



PROMOTING HEALTH AND BEHAVIOURAL APPROACHES IN PREVENTING THE PERIODONTAL DISEASE

PROMOVAREA SANATATII SI ABORDARILE COMPORTAMENTALE ĪN PREVENTIA BOLII PARODONTALE

Sorina Solomon, Sonia Nanescu, Silvia Mārtu



GCF: POTENTIAL ENZYMATIC DIAGNOSTIC MARKERS IN PERIODONTAL DISEASE

FLUIDUL CREVICULAR: MARKERI ENZIMATICI CU POTENTIAL DE DIAGNOSTIC ĪN BOALA PARODONTALA

Liliana Foia, Vasilica Toma, Carmen Aanei, Didona Ungureanu, Florina Filip



INFLAMMATORY CELLULAR RESPONSE IN PERIODONTAL DISEASE

RASPUNSUL INFLAMATOR CELULAR ĪN BOALA PARODONTALA

Liliana Foia, Mihaela Zlei, Ungureanu Didona, Sonia Nanescu, Vasilica Toma, Silvia Mārtu



NEWS IN MEDICAL TREATAMENT OF MÉNIERČ DISEASE

Aurelian Ioan Curca1, Luminita Radulescu2, Cristian Marius Mārtu3

1PhD student, ORL Dept., Faculty of Dental Medicine, University of Medicine and Pharmacy "Gr. T. Popa" Iasi

2Lecturer, PhD., ORL Dept., Faculty of Dental Medicine, University of Medicine and Pharmacy "Gr. T. Popa" Iasi

3Student, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa" Iasi



Abstract



Ménierč disease (endolymphatic hydrops) is defined as episodic attacks of tinnitus, hearing loss, aural fullness, and vertigo lasting minutes to hours. The majority of authors said that Ménierč disease, and in particularly endolymphatic hydrops, are multicausal. Ménierč disease incidence is approximately 0,2/100 persons, and the hydrops is met in 6/100 persons, therefore it has to be something more involved in] on Ménierč disease ethiopathogenesis than a simple hydrops: the mechanisms are multiethiologic or other mechanisms which produced Ménierč disease exist. Currently therapeutical options for Ménierč disease pacients are: diet and lifestyle control, pharmacotherapy, surgical treatment, re-education and other therapeutical procedures.

Keywords: MENIERE, DRUGS, ENDOLYMPHATIC HYDROPS, ETIOLOGY





ACTUALITATI ĪN TRATAMENTUL MEDICAMENTOS AL BOLII MENIERE



Rezumat



Boala Ménierč (hidropsul endolimfatic) se defineste prin atacuri episodice de acufene, hipoacuzie, senzatie de presiune auriculara si vertij, cu durata de minute sau ore. Majoritatea autorilor afirma ca boala Ménierč, si īn particular hidropsul endolimfatic, sunt plurietiologice. Deoarece boala Ménierč are o incidenta de aproximativ 0,2/100 persoane, iar hidropsul este prezent īn 6/100 persoane, trebuie sa fie implicat īn etiopatogenia bolii Ménierč ceva mai mult decāt un simplu hidrops: mecanismele sunt plurietiologice sau exista si alte mecanisme care provoaca boala Ménierč. Optiunile terapeutice actuale pentru pacientii cu boala Ménierč sunt: controlul dietei si al stilului de viata, farmacoterapia, tratamentul chirurgical, reeducarea si alte procedee terapeutice.

Cuvinte cheie: MENIERE, MEDICAMENT, HIDROPS ENDOLIMFATIC, ETIOLOGIE





CONSIDERATIONS ON THE CLINICA LAND THERAPEUTICAL ASPECTS IN INFECTIOUS MONONUCLEOSIS

Mihaela Catalina Luca, Carmen Dorobat, Carmen Manciuc, Eduard Nastase

Clinic of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", Iasi



Abstract



The aim of the study is the analysis of the incidence and clinical-biological and therapeutic aspects of the mononucleosis cases, hospitalized in the Clinic of Infectious Diseases during 1st January 2004 - 31st December 2006. The 75 studied cases were unequal arranged in the 3 years of study with maximum incidence in 2004 (39%) and with the prevalence of the cases at the female sex (58%). The age of the patients varied between 5 and 30 years old, with the highest incidence at the 17-20 years group of age. Clinical manifestations were miscellaneous with fever and adenopathy in all cases, angina in 82%) cases and hepatosplenomegaly in 44% cases. The evolution was favorable under symptomatic and pathogenic therapy.

Key word: INFECTIOUS MONONUCLEOSIS, PAUL-BUNELL REACTION.





CONSIDERATII ASUPRA ASPECTELOR CLINICE SI TERAPEUTICE ĪN MONONUCLEOZA INFECTIOASA



Rezumat



Studiul īsi propune analiza incidentei, aspectelor clinico-biologice si terapeutice a cazurilor de mononucleoza infectioasa spitalizate īn Clinica Boli Infectioase lasi īn perioada 1 ianuarie 2004 - 31 decembrie 2006. Cele 75 cazuri luate īn studiu au fost repartizate īn mod neegal īn cei 3 ani de studiu, incidenta maxima fiind īn anul 2004 (39%), cu predominanta cazurior la sexul feminin (58%). Vārsta pacientilor a variat īntre 5 si 30 ani, cu incidenta maxima la grupa de vārsta 17-20 ani. Manifestarile clinice au fost polimorfe cu febra si adenopatii īn toate cazurile, angina īn 82% din cazuri si hepatosplenomegalie īn 44% cazuri, evolutia cazurilor fiind favorabila sub terapie patogenica si simptomatica.

Cuvinte cheie: MONONUCLEOZA INFECTIOASA, REACTIA PAUL-BUNELL.





THE COMPARATIVE ANALYSIS OF DIFFERENT SUTURE MATERIALS USED IN THE ORAL SURGERY

Mihaela Maftei1, Maria Voroneanu2

1PhD. student,U.M.F. "Gr. T. Popa" Iasi, Chirurgie Orala si Maxilo-Faciala

2Prof. PhD,U.M.F. "Gr. T. Popa" Iasi, Chirurgie Orala si Maxilo-Faciala.



Abstract



A great variety of suture materials is now available for usage in oral surgery, with the purpose of forwarding the healing process. The suture itself is the cause of new microscopically wounds in the already traumatized and perforated tissues. Placing a suture in gingival tissue induces an inflammatory response of a magnitude varying upon the suture material used. The study was conducted on a batch of 36 patients which underwent alveoloplastic dental extractions, in the Ambulatory of Oral and Maxilo-Facial Surgery Clinic of Iassy, during 7.01.2005-30.06.2006. We have divided the batch in 3 equal groups. The postextractional wounds were sutured with silk in the first group, polyester suture in the second group and nylon in the third group. We analyzed the gingival reaction to the suture material from clinical and morphopathological point of view. The study revealed that nylon was the most appropriate suture for the wound healing process. Because of its multifilament structure, silk delays the wound repairing, while polyester sutures slightly prolong the healing, inducing mild inflammation in the early stage of the process.

KEYWORDS: ALVEOLOPLASTIC DENTAL EXTRACTION, SUTURE, HEALING, INFLAMMATION





ANALIZA COMPARATIVA A UNOR MATERIALE DE SUTURA FOLOSITE ĪN CHIRURGIA ORALAINTERDISCIPLINARY APPROACH IN CHRONIC LUMBAR PAIN



REZUMAT



Pentru chirurgia orala este disponibila la ora actuala o mare varietate de produse pentru sutura, cu rolul de a potenta procesul de vindecare. Sutura īn sine este cauza a noi plagi microscopice la nivelul unor tesuturi dejatraumatizate si perforate. Utilizarea suturii la nivelul tesutului gingival induce un raspuns inflamator cu o amploare variabila īn functie de materialul de sutura utilizat. Studiul a fost realizat pe un lot de 36 de pacienti care au beneficiat de extractii alveolo-plastice īn Ambulatorul de Chirurgie Orala si Maxilo-Faciala Iasi, īn perioada 7.01.2005-30.06.2006. Lotul a fost īmpartit īn 3 grupuri egale. Īn cazul primului lot, sutura plagilor postextractionale s-a realizat cu matase, īn cel de-al doilea caz, s-a folosit poliester si īn cel de-al treilea caz, naylon. S-au analizat reactiile gingiei la materialul de sutura, din punct de vedere clinic si morfopatologic. Studiul a relevat ca naylonul a prezentat rezultatele cele mai bune. Datorita structurii multifilamentare, matasea īntārzie vindecarea plagii, pe cānd poliesterul īntārzie vindecarea prin inducerea unei reactii inflamatorii medii īn primele etape ale procesului de vindecare.

Cuvinte cheie: EXTRACTII ALVEOLO-PLASTICE, SUTURAA, VINDECARE, INFLAMATIE





THE PSYCHOLOGIC AFFECTION DUE TO FACIAL MUTILLATION

Delia Bahrim1, Camelia Ionascu2

1Assist., PhD, University of Medicine and Farmacy "Gr.T.Popa", Iasi, Faculty of Dental Medicine, Prostodontics Dept.

2Dr, Private practice, Iasi





Abstract



The present study aims to present the relations established between certain types of cranium and facial dismorphologies and the psychologic reactions of the suffering patients.

The objective of the research is to underline the fact that according to the patient's attitude and perception, he/she can be more or less receptive to the doctor's suggestions, recomandations and indicated treatment.

The correlations between these two elements have been studied by introducing and analysing certain criteria, such as, on the one hand, the causes of the dismorphology apparition, the length and the identity of the disease, the probability of treatment application and, on the other hand, the ways in which patients perceive their own illness and its effects.

The working method for this study was that of the questionnaire. The one used here was revised by Moss-Moris and it is based on three variables. The psychologic variable comprises the following subunities - patient perception of the consequences of their own disease, emotional representation, disease coherence and perceived causes of the disease. The next variable is social-demographic and it reffers to the patient's biologic gender, age, marital status and education level. The third variable reffers to the patient's medical state (pathologic category) and to his/her receptivity to the treatment and behaviour recomended by the doctor (medical compliance).

Keywords: PSYCHOLOGIC AFFECTION, FACIAL MUTILLATION, QUESTIONNAIRE, PSYCHOLOGIC EVALUATION





AFECTAREA PSIHICA ĪN MUTILARILE FACIALE



REZUMAT



Īn cadrul studiului de fata sunt prezentate relatiile care se stabilesc īntre anumite tipuri de dismorfii cranio-faciale si reactiile de ordin psihologic ale pacientilor.

Scopul cercetarilor este acela de a evidentia faptul ca īn functie de atitudinea si perceptia pacientului asupra afectiunii sale, acesta poate fi mai receptiv sau nu la sugestiile, recomandarile si tratamentul indicat de catre medicul curant.

Corelarile īntre cele doua elemente sunt studiate prin introducerea si analizarea anumitor criterii, cum ar fi, pe de o parte, cauzele aparitiei dismorfiei, durata si identitatea bolii, probabilitatea de aplicare a tratamentului si, pe de alta parte, modalitatile īn care pacientii percep propria boala si efectele acesteia.

Metoda de lucru īn cadrul studiului a fost cea a chestionarului. Forma acestuia a fost cea revizuita de Moss-Moris, care se bazeaza pe trei variabile. Cea de ordin psihologic cuprinde urmatoarele subunitati- perceperea de catre pacient a consecintelor propriei afectiuni, reprezentarea emotionala, coerenta bolii, cauzele percepute ale bolii. Urmeaza variabila de ordin socio-demografic, referitoare la genul biologic al pacientului, vārsta, starea civila si nivelul studiilor acestuia si variabila referitoare la statutul medical al pacientului (categoria patologica) si la receptivitatea acestuia la tratamentul si conduita recomandata (complianta medicala).

Cuvinte cheie: AFECTIUNE PSIHOLOGICA, MUTILARE FACIALA, CHESTIONAR, EVALUARE PSIHOLOGICA.





THE STUDY OF VARIATIONS OF THE BIOCHEMICAL PARAMETERS AT THE TESTED ANIMALS BY USING RED DEER ANTLER AS GUIDED TISSULAR REGENERATING MATERIAL

Paul Prodan1, Silvia Mārtu2

1Phd student, University of Medicine and Pharmacy "Gr.T.Popa" Iasi, Faculty of Dental Medicine, Periodontology Dept.

2Professor, University of Medicine and Pharmacy "Gr.T.Popa" Iasi, Faculty of Dental Medicine, Periodontology Dept.





ABSTRACT



Considering the red deer antler's rich content in biological active substances (BMP2, BMP4, IgF1, IgF2 si PDGF), this paper aims to analize the use of this material, after a prelimina-ry physio-chemical processing in order to obtain a biomaterial for the guided tissular regeneration (TGR). For this study, pigs were used as tested subjects, taking into account that these animals present biological similarities to the human body.

The variations of alkaline phosphatase were analised, as an indicator of osteogenesys, as well as the variations of Ca, P, Mg ions and the A/G ratio (albumine/globuline), concerning the dynamic of the possible immune reactions of biomaterial rejection.

Keywords: BIOCHEMISTRY, BIOMATERIAL, GUIDED TISSULAR REGENERATION





STUDIUL VARIATIILOR PARAMETRILOR BIOCHIMICI LA ANIMALELE OPERATE, FOLOSIND CORNUL DE CERB CA MATERIAL DE REGENERARE TISULARA GHIDATA



Rezumat



Tinānd cont de continutul bogat īn substante biologic active (BMP2, BMP4, IgF1, IgF2 si PDGF) al cornului de cerb, lucrarea de fata īsi propune analiza utilizarii acestuia dupa o prealabila prelucrare fizico-chimica īn scopul regenerarii tisulare ghidate (TGR). Īn studiul de fata s-au folosit ca si animale de experienta porcii, luānd īn considerare asemanarile biologice cu organismul uman.

Au fost urmarite variatiile fosfatazei alcaline, ca si indicator al osteogenezei, precum si variatiile ionilor de Ca, P, Mg si raportul A/G (albumina/globulina) privind dinamica eventualelor reactii imune de respingere a biomaterialului.

Cuvinte cheie: BIOCHIMIE, BIOMATERIAL, REGENERARE TISULARA GHIDATA





ESTHETICS OF THE REMOVABLE PARTIAL DENTURES - CLINICAL CASE

Zaharia N. Agripina1, Duta D. Mihaela2

1Assoc. Prof. Phd. "Ovidius" University Constanta, Faculty of Dental Medicine and Pharmacy, Discipline of Dental Prosthesis

2Lecturer Phd. "Ovidius" University Constanta, Faculty of Dental Medicine and Pharmacy, Discipline of Dental Prosthesis



Abstract



Abstract: Actually, esthetics is considered of primary importance in the mobile prosthetic treatment; therefore were created modern special attachments adapted for various clinical situations. The purpose of this scientific paper is proving the existence of a modern, esthetic hybrid treatment solution which combines fixed and mobile treatment, for the IInd class Kennedy with two modifications maxillary edentation as an alternative for the classic solution by a conventional clasp mobile denture.

Material and method: A young patient with IInd class Kennedy is treated by fixed partial metallo-ceramic prosthesis and a unimaxillary partial denture with MK1 attachement (Dental-Attachment GmbH).

Results: Using special attachments instead conventional clasp assemblies confers mobile prosthesis a special esthetics.

Discussions: Indications for special attachment systems are uniterminal, biterminal edentation, critical bone tissue, overdenture, fixed and mobile dentures, implant supported dentures. The contraindications are lack of manuality and oral hygiene. The hinge type attachments are chrome-cobalt systems, small, easy supported and hygienised by the patient.

Conclusions: The IInd class Kennedy with two modifications maxillary edentation using hybrid treatment (fixed and mobile with precise special attachments) must be considered an alternative modern esthetic method to conventional clasp prosthetic dentures.

Keywords: HINGE TYPE ATTACHMENT, EDENTATION, ESTHETIC.









ESTETICA ĪN PROTEZAREA MOBILIZABILA - CAZ CLINIC





Rezumat



Īn prezent, estetica este considerata de importanta majora īn tratamentul cu proteze mobilizabile; prin urmare au fost create sisteme speciale moderne adaptate situatiilor clinice diverse. Scopul acestui articol este demonstrarea existentei unei solutii moderne de tratament estetic care combina tratamentul fix si mobilizabil, pentru tratarea edentatiei clasa a II-a Kennedy cu 2 modificari la maxilar ca alternativa la rezolvarea clasica prin protezare mobilizabila cu crosete.

Material si metoda: Pacient tānar este restaurat hibrid printr-o proteza partiala fixa metalo-ceramica si o proteza partiala unimaxilara ancorata printr-un sistem de ancorare special tip balama MK1 (Dental-Attachment GmbH).

Rezultate: Utilizarea sistemelor speciale tip MK1 a conferit o estetica deosebita protezei partiale scheletate care are o dimensiune redusa, este confortabila, tolerata parodontal.

Discutii: Indicatiile sistemelor speciale tip balama sunt: edentatia uniterminala, biterminala, suport osos deficitar, supraprotezari, protezari fixe si mobilizabile, protezari pe implante; iar contraindicatiile: manualitatea si igiena deficitara a pacientului. Attachment-urile tip balama sunt realizate din crom-cobalt, mici, usor de suportat, de īndepartat si īntretinut de catre pacient.

Concluzii: Tratamentul edentatiilor de clasa a II-a Kennedy cu 2 modificari la maxilar folosind tratamentul hibrid trebuie considerat ca o metoda estetica posibila, moderna la protezele partiale clasice cu crosete.

Cuvinte cheie: ATTACHMENT, BALAMA, EDENTATIE





RESEARCH OVER THE EVOLUTION AND COMPLICATION OF THE OSSEOUS COMPONENT OF THE MANDIBULAE EDENTULOUS SPACES

Alina Jehac1, Corina Cristescu2, Vasile Burlui3

1Junior instructor, Phd," Gr.T.Popa" University Iasi, Faculty of Dental Medicine, Fixed Prosthodontics Dept..

2Assistant, Phd, "Gr.T.Popa" University Iasi, Faculty of Dental Medicine, Oral Implantology-Gnathology- Esthetic Dentistry Dept.

3Prof. Phd "Gr.T.Popa" University Iasi, Faculty of Dental Medicine, Oral Implantology-Gnathology- Esthetic Dentistry Dept.



ABSTRACT



The purpose of this study was that of analyzing the weight of the main changes induced from the level of implantar field through the evolution and complications of the edentation state, with a special accent on the alterations of the osseous field. For realizing this study we have investigated a group constituted of 179 patients, 93 women and 86 men, with ages between 18 and 72 years old who came in the Clinic of Gnatho-Prosthodontics Iasi. For investigation it was used the clinical exam, through descriptive and canonical methods and also paraclinical exams were used: gnathophotostatical exam on intra- and extraoral photography of face and profile, study models and radiological evaluation through OPT with markers. The study demonstrated that most of the investigated patients presented accentuated resoptions of the alveolar ridge, especially women from the group of age of more than 50 years old and also the significant increase of the mucosal resilience. It is justified therefore the increased necessity for interventions for optimizing the implantar mandibular field both through interventions on osseous structures and through interventions on soft tissues..





CERCETARII PRIVIND EVOLUTIA SI COMPLICATIILE EDENTATIEI MANDIBULARE LA NIVELUL SUPORTULUI OSOS



REZUMAT



Scopul acestui studiu a fost acela al analizei ponderii principalelor modificari induse de la nivelul cāmpului implantar mandibular prin evolutia si complicatiile starii de edentatie, cu un accent deosebit asupra modificarii cāmpului osos. Pentru realizarea acestui studiu am investigat un lot alcatuit din 179 pacienti, 93 femei si 86 barbati, cu vārste cuprinse īntre 18 si 72 ani, care s-au prezentat īn Clinica de Gnatoprotetica din Iasi. Pentru investigare s-au utilizat atāt examenul clinic, prin metodele descriptiva si canonica, cāt si examene paraclinice: examen gnatofotostatic pe fotografii intra si extraorale de fata si de profil, modele de studiu si evaluarea radiologica prin OPT cu markeri. Studiul a demonstrat ca mare parte dintre pacientii investigati prezentau resorbtii accentuate ale crestelor alveolare (mai ales femeile din grupa de vārsta peste 50 ani, precum si cresterea semnificativa a rezilientei fibromucoasei. Se justifica astfel necesarul crescut de interventii de optimizare a cāmpului implantar mandibular atāt prin interventii pe structuri osoase cāt si prin interventii asupra partilor moi.





NEWS IN THE STUDY OF THE MUSCULAR TONUS MECHANISM

Laura Checherita1, V. Burlui2

1Junior instructor,Phd, "Gr.T.Popa" University Iasi, Faculty of Dental Medicine, Oral Implantology-Gnathology- Esthetic Dentistry Dept.

2Professor, "Gr.T.Popa" University Iasi, Faculty of Dental Medicine, Oral Implantology-Gnathology- Esthetic Dentistry Dept.



ABSTRACT



The main role of the central nervous system is to control different activities of the organism, for example the contraction of skeletal muscles; these activities have the generic name of motor functions of the nervous system and the muscles are called effectors because they do activities dictated by nervous signals. The components of the nervous central system which assure the control of the skeletal muscles contraction create the somatic motor system unit. The nervous central system participates in creating the organism motion through some structures which contain: cortical areas, basal nucleus, cerebellum, cerebral trunk and spine. While the inferior levels, the spine and the cerebral trunk create instant answers, automatic, the superior level participates in creating controlled conscious motions. The majority of the control systems acts by revision actions both in negative or positive direction, for reestablishing and maintaining the homeostatic balance; any deviation activates one or more self-adjustments and control systems for reestablishing the equilibrium and going back to normal by negative feed-back reactions. When the opposite reactions deteriorate the disequilibrium created by the disturbator factor, it encourages the installation of a vicious circle; these determine pathological estates of different degrees.

Postural tonus as a semi-contraction of the muscles which assures the maintaining of the normal body position in repose and movement is the result of the dynamic equilibrium between the medullary afferent tonic circuits (neuromuscular spindle, Golgi tendon organ) and efferent (alpha motor neuron and gamma curl), permanently modulated by supra-medullary nervous formations. These interfere voluntary or neuro-reflex depending on subcortical influences (from cerebral trunk, basal nucleus, and cerebellum) or cortical influences. Neuro-spindle device and his reflex connections could constitute a cybernetic retro-control system for adapting proper length for optimal tonic muscle activity in which the intervention of a coupled mechanism, alpha gamma could play an essential role. In the regulation of the muscular tonus it has a great importance the gamma system, Renshaw circuit and some supra-medullary formations. The creating mechanism of the striated muscular tonus has a great complexity, practically there is no nervous formations which doesn't participate in the regulating or maintaining the tonus (Granit). No matter his more or less high level, simple or complex, each of these influencing mechanism of the muscular tonus know a final common path: the motoneurons to which all innervating impulses go to, finally.

Keywords: MUSCULAR TONUS, NEUROMUSCULAR ACTIVITY, TONUS MECHANISM.





ACTUALITATI ĪN STUDIUL MECANISMULUI TONUSULUI MUSCULAR



REZUMAT



Sistemul nervos central are ca principal rol controlul diverselor activitati ale organismului printre care si contractia muschilor scheletici, aceste achitati poarta numele generic de functii motorii ale sistemului nervos iar muschi sunt denumiti efectori īntrucāt efectueaza activitati dictate de semnalele nervoase. Componenetele SNC care asigura controlul contractiei musculaturii scheletice alcatuieste sistemul motor somatic. SNC participa la realizarea motricitatii organismului prin intermediul unor structuri ce cuprind.arii corticale, nuclei bazali, cerebel,trunchi cerebral si maduva spīnarii. Īn timp ce etajele inferioare maduva, trunchiul cerebral realizeaza raspunsuri instantanee, automate, etajele superioare participa la elaborarea unor miscari deliberate controlate. Majoritatea sistemelor de control actioneaza prin reactii corectoare de sens negativ sau pozitiv īn vederea restabilirii si mentinerii echilibrelor homeostazice; orice deviere īn plus sau īn minus pune īn stare de functiune unul sau mai multe sisteme de autoreglare si control īn vederea restabilirii echilibrului si revenirii la normal prin reactii de feed-hack negativ. Cānd reactiile inverse duc la agravarea dezechilibrului creeat de factorul perturbator se favorizeaza iīnstalarea unui cerc vicios acestea deteminand stari patologice de diferite grade.

Tonusul postura! ca stare de semicontractie a muschilor care asigura mentinerea pozitiei normale a corpului īn repaus si miscare este rezultatul echilibrului dinamic dintre circuitele tonigene aferente (fus neuromuscular,organ tendinos Golgi) si eferente (neuron moto alfa,bucla gama) medulare, modulate permanent de formatiunile nervoase supramedulare. Acestea īntervin fie neuro-reflex,fie voluntar,dupa cum este vorba de influente subcorticale (din trunchiul cerebral, nuclei bazali, cerebel) sau corticale. Dispozitivul neuro-fusal si conexiunile sale reflexe ar constitui un sistem de retrocontrol cibernetic pentru adaptarea lungimii corespunzatoare unei activitati tonice musculare optimale īn care interventia unui mecanism cuplat, alfa gamma ar juca un rol esential Īn reglarea tonusului muscular o importanta deosebita o are sistemul gama, circuitul Renshaw si unele formatiuni supramedulare. Mecanismul realizarii tonusului musculaturii striate este de o complexitate deosebita, astfel īncāt practic nu exista formatiune nervoasa care sa nu participe īn reglarea si mentinerea tonusului (Granit). Dar, indiferent de nivelul sau mai mult sau mai putin īnalt, mai simplu sau mai complex, fiecare din mecanismele de influentare a tonusului muscular cunoaste o cale fīnala comuna: motoneuronul, asupra careia se īndreapta, īn sfārsit, toate impulsurile cu semnificatie toni gena.

Cuvinte cheie: TONUS MUSCULAR, ACTIVITATE NEUROMUSCULARA, MECANISMUL TONUSULUI





STUDY REGARDING DIGITAL RADIOGRAPHY ADVANTAGES IN DIAGNOSING OF EARLY DENTAL CARIES FOR LATERAL DENTAL GROUP

Avadanei Ciprian1, Andrian Sorin2, Iovan Gianina3, Topoliceanu Claudiu4,Hamburda Tudor4, Lacatusu Stefan2

1Phd student, U.M.F."Gr.T.Popa" Iasi, ,Clinica Odontologie-Parodontologie,

2Prof. univ. Disciplina Cariologie, Facultatea Medicina Dentara, U.M.F."Gr.T.Popa" Iasi

3Assoc. Prof.,U.M.F."Gr.T.Popa" Iasi, Facultatea Medicina Dentara, Disciplina Cariologie,

4Asist. Phd. U.M.F."Gr.T.Popa" Iasi, Facultatea Medicina Dentara, Catedra Dentistica Conservativa



ABSTRACT



Introduction: The change of dental caries pattern determined an increase of uncavitated caries percent requiring complementary exams designed to diagnose caries in incipient stages. Radiography exam is one of the most used complementary method for diagnosing dental and periodontal structures diseases.

Materials and method: Our study aimed to compare conventional ortopantomography exam with digital radiography, regarding diagnosing potential of early dental caries. Our study group was represented by 16 patients with age between 18 and 25 years. All patients were from high cariogenic risk category. Every patient had an ortopantomography made in last three months in standard conditions at the same radiological laboratory. All digital radiographs were bite-wing radiographs, every bite-wing being centered on a lateral dental group (14-17, 24-27, 34-37, 44-47). The gold standard was represented by the information obtained during clinical examination and minimal invasive treatments.

Results: The results established the superiority of digital radiography for some categories of early dental caries and the similar rate of diagnosing between the two techniques for another category of early dental caries.

Conclusions: Digital radiography is especially useful in diagnosing approximal early caries in stages D1 and D2, allowing minimal invasive treatments or remineralising treatments. Although less used in current practice, digital radiograph exam will represent in close future an important diagnosing instrument for application of minimal invasive or remineralising treatments in operative dentistry





STUDIU PRIVIND AVANTAJELE RADIOGRAFIEI DIGITALE IN DIAGNOSTICAREA CARIILOR INCIPIENTE LA NIVELUL GRUPULUI DENTAR POSTERIOR





REZUMAT



Introducere: Odata cu schimbarea tiparului de carie, procentul cariilor necavitare a īnceput sa creasca facānd necesara utilizarea metodelor paraclinice īn scopul diagno-sticarii leziunilor carioase īn stadii incipiente. Examenul radiografic reprezinta una dintre cele mai utilizate metode paraclinice de diagnosticare a afectiunilor odonto-parodontale.

Material si metoda: Studiul nostru a urmarit sa compare, īn ceea ce priveste potentialul de diagnostic al cariilor dentare incipiente, un examen paraclinic utilizat si recomandat īn mod curent de catre practicienii stomatologi (ortopantomografia) cu un examen paraclinic mai putin utilizat īn practica curenta (radiografia digitala). Lotul inclus īn studiu a fost reprezentat de un numar de 16 pacienti cu vārste cuprinse īntre 18 si 25 de ani. Toti pacientii selectati au prezentat ortopantomografie efectuata īn ultimele 3 luni īn conditii standard la acelasi laborator radiologic dentar. Radiografiile digitale au fost efectuate īn conditii standard īn format bite-wing, fiecare radiografie bite-wing fiind centrata pe o hemiarcada (14-17, 24-27, 34-37, 44-47). Validarea leziunilor carioase diagnosticate radiologic s-a realizat prin intermediul examenului clinic si tratamentelor minim invazive aplicate.

Rezultate: Rezultatele obtinute au stabilit superioritatea radiografiei digitale īn ceea ce priveste diagnosticarea unor anumite categorii de carii dentare incipiente.

Concluzii: Examenul radiografic digital este deosebit de util īn detectarea cariilor proximale īn stadiile D1 si D2, permitānd astfel oprirea īn evolutie a acestora īn cazul aplicarii unor tratamente minim invazive sau prin remineralizare; rata de detectare a acestor doua categorii de carii proximale este net superioara examenului ortopantomografic. Desi mai putin utilizat īn practica curenta, examenul radiografic digital va reprezenta īn viitorul apropiat un instrument de diagnostic deosebit de important īn instituirea pe scara larga a tratamentelor minim invazive si neinvazive īn stomatologie.





GINGIVAL OVERGROWTHS IN PATIENTS WITH HAEMODIALYSIS AND THE RISK OF GINGIVAL BLEEDING

Silvia Mārtu1, Ramona Mocanu2

1Prof. PhD, U.M.Ph. "Gr.T. Popa", Iasi, Department of Periodontology,

2PhD. Student, U.M.Ph. "Gr.T. Popa", Iasi, Department of Periodontology



ABSTRACT



The treatment in the case of gingival overgrowths is frequently based on drug replacement, associated with the accurate control of bacterial plaque. When this treatment option fails, the surgical intervention of excessive tissue removal offers a satisfactory result on short term. Besides, before an eventual transplant the removal of any cause for infection is necessary, so that subsequently under the effect of immune suppressors, the immunity of the patient and resistance to infections are markedly reduced. A problem may that the infection increase the bleeding time and maked the haemorrhage difficult to control. We present the case of a patient of 39 years old, which addressed to the department of Periodontology for evaluation and treatment of gingival maxillar and mandibular overgrowths. She received haemodia-lysis three times a week from 20 months, due to a chronic renal insufficiency, secondary to a rapidly progressive glome-rulonephritis and she had to receive a renal transplant from her sister after three months. The patient presented an advanced periodontal disease, with mobility and periodontal pockets of 4-9 mm. For intervention, the general anaesthesia was realized and 18 teeth were extracted and at 6 teeth a Widman flap was realized and it was followed by a severe haemorrhage, which needed blood transfusions.

This study suggests that the patients with renal insufficiency who will undergo periodontal surgical treatment should be carefully evaluated before surgery, and the bleeding and coagulation times should be evaluated.

Key words: GINGIVAL OVERGROWTHS, RISK OF HAEMORRHAGE





HIPERCRESTERILE GINGIVALE LA PACIENTII CU DIALIZA SI RISCUL DE SĀNGERARE GINGIVALA



REZUMAT



Tratamentul īn cazul hipercresterilor medicamentoase este cel mai des axat pe inlocuirea medicamentului, asociat cu un control riguros al placii bacteriene. Cānd aceasta varianta de tratament esueaza, interventia chirurgicala de īndepartare a excesului de tesut ofera un rezultat satisfacator pe termen scurt. Īn plus, īnainte de un eventual transplant este necesara īndepartarea oricarei cauze de infectie, pentru ca ulterior sub efectul imunosupresoarelor imunitatea pacientului si rezistenta la infectii este mult mai mica. O problema ar fi aceea ca infectia creste timpul de sangerare si face hemoragia dificil de controlat. Prezentam cazul unei paciente de 39 de ani, care s-a adresat Departamentului de Parodontologie pentru evaluarea si tratarea hipercresterii gingivale maxilare si mandibulare. Pacienta primea dializa de trei ori pe saptamāna de 20 luni, din cauza insuficientei renale cronice, secundare glomerulonefritei rapid progresive si urma sa primeasca un transplant renal de la sora sa peste trei luni.

Pacienta prezenta boala parodontala avansata, cu mobilitate si pungi parodontale de 4 -9 mm. Pentru interventie s-a realizat anestezia generala, si s-au extras 18 dinti iar la 6 dinti s-a realizat lambou Widman si a fost urmata de o hemoragie puternica, care a necesitat transfuzii de sānge.

Acest studiu sugereaza ca pacientii cu insuficienta renala care sufera interventii chirurgicale parodontale ar trebui atent evaluati īnainte de operatie, iar timpul de sāngerare si de coagulare ar trebui atent masurati.

Cuvinte cheie: HIPERCRESTERI GINGIVALE, RISC DE HEMORAGIE





SUDIES REGARDING THE INTERRELATION AND INTERDEPENDENCE BETWEEN PERIODONTAL DISEASE AND SISTEMIC DISEASIS

Silvia Mārtu1, Pasarin Liliana2, Solomon Sorina3, Rudnic Ioana4

1Prof. PhD. University of Medicine and Pharmacy "Gr.T.Popa" Iasi, Faculty of Dental Medicine, Periodontology Dept.

2Assist. PhD, University of Medicine and Pharmacy "Gr.T.Popa" Iasi, Faculty of Dental Medicine, Periodontology Dept.

3Lecturer, PhD, University of Medicine and Pharmacy "Gr.T.Popa" Iasi, Faculty of Dental Medicine, Periodontology Dept

4Junior instr.Phd,University of Medicine and Pharmacy "Gr.T.Popa"Iasi, Faculty of Dental Medicine, Periodontology Dept



ABSTRACT



The recent studies which reported a positive association between indicators of poor dental health and outcomes of atherosclerosis. the association observed between atherosclerosis-induced disease and periodontal disease may be the result of etiologic factors common to both disease processes, such as lifestyle practices like cigarette smoking, and therefore coincidental. The oral cavity may serve as a reservoir for respiratory pathogen colonization and subsequent pneumonia. The approaches taken to reduce the numbers of bacterial pathogens in the oral cavity of subjects with high risk for pneumonia, seem to decrease the number of aspiration pneumonia cases in patients from the Intensive Care Units. In the last years it was also noticed an association between the periodontal disease and preterm birth.





STUDII PRIVIND INTERRELATIA SI INTERDEPENDENTA BOALA PARODONTALA BOLI SISTEMICE



REZUMAT



Majoritatea studiile recente au raportat o asociatie pozitiva dintre boala parodontala si boala cardiovasculara. Asocierea observata īntre boala indusa de ateroscleroza si boala parodontala ar putea fi rezultatul factorilor etiologici comuni ambelor procese patologice, cum ar fi practicile stilului de viata ca fumatul si de aceea coincidente. Cavitatea orala poate servi ca rezervor pentru colonizarea cu patogeni respirator si pneumonie consecutiva. Abordarile īncercate pentru a reduce numarul patogenilor din cavitatea orala la subiectii cu risc crescut de pneumonie par sa scada numarul cazurilor de pneumonie de aspiratie la pacientii internati īn sectiile de terapie intensiva. Īn ultimii ani s-a constatat si o asociere īntre boala parodontala si nasterea prematura.





PROMOTING HEALTH AND BEHAVIOURAL APPROACHES IN PREVENTING THE PERIODONTAL DISEASE

Sorina Solomon1, Sonia Nanescu2, Silvia Mārtu 3

1Lecturer, Phd, Department of Periodontology, U.M.Ph. "Gr. T. Popa", Iasi

2Phd. student, Department of Periodontology, U.M.Ph. "Gr. T. Popa", Iasi

3Prof. Phd., Department of Periodontology, U.M.Ph. "Gr. T. Popa", Iasi



ABSTRACT



Strong evidences are constantly accumulating about the causal important role in the periodontal disease of some predisposing systemic diseases, conditions and behavioural factors. The concept of activites for promoting health which would include: prevention services for health, communitarian work, development at organizational level, public health politics, measures for the health of the surrounding environment, economic and regulatory activities and programs of health education. There are two main prevention strategies: the first one relies on the strategy of increased risk, the second method of approach is the strategy at population level. The prevention should be started in childhood because the debut of the periodontal disease is in adolescence. This is sustained also by the fact that many causal factors for periodontits which can be prevented are connected to behaviour and lifestyle, which are mostly shaped in childhood and adolescence.

Key words: PREVENTION STRATEGIES, EDUCATION FOR HEALTH, PERIODONTAL DISEASE





PROMOVAREA SANATATII SI ABORDARILE COMPORTAMENTALE ĪN PREVENTIA BOLII PARODONTALE



REZUMAT



Se acumuleaza constant puternice dovezi cu privire la rolul cauzativ important pe care īl joaca īn boala parodontala o serie de boli sistemice predispozante, stari si factori comportamentali Conceptul de activitati de promovare a sanatatii includ: servicii de preventie pentru sanatate, munca comunitara, dezvoltare la nivel organizational, politici de sanatate publica, masuri de sanatate a mediului īnconjurator, activitati economice si regulatoare, si programe de educare pentru sanatate. Exista doua strategii principale de preventie: prima se bazeaza pe strategia riscului crescut, a doua metoda de abordare este strategia la nivel populational. Preventia trebuie īnceputa din copilarie deoarece debutul bolii parodontale este īn adolescenta. Aceasta este sustinuta si de faptul ca multi factori sistemici cauzatori ai parodontitei care pot fi preveniti sunt legati de comportament si de stilul de viata, care sunt modelate īn mare īn copilarie si adolescenta.

Cuvinte cheie: STRATEGII DE PREVENTIE, EDUCATIA PENTRU SANATATE, BOALA PARODONTALA





GCF: POTENTIAL ENZYMATIC DIAGNOSTIC MARKERS IN PERIODONTAL DISEASE

Liliana Foia1, Vasilica Toma2, Carmen Aanei3, Didona Ungureanu1, Florina Filip4

1Assoc. Prof. Phd.,Disciplina de Biochimie, UMF Gr. T. Popa, Iasi

2Asist. Phd., Disciplina de Pedodontie, UMF Gr. T. Popa, Iasi

3Asist. Phd., Disciplina de Imunologie, UMF Gr. T. Popa, Iasi

4Lecturer Phd., Disciplina de Medicina de Familie, UMF Gr. T. Popa, Iasi



ABSTRACT



Inflammation represents the central component of several chronic disorders, and seems that genetic variations of the inflammatory response can influence the future disease evolution in human. One of the most significant practical application of inflammatory disease modulation would reside in regulation of "key" gene expression, involved in these inflammatory disorder mediation. Periodontal alteration is the end result of immune inflammatory response, generated by bacterial accumulation upon dental surfaces adjacent to supra and subgingival tissues. There is an initial gingivitis-like bacterial-mediated inflammatory response, that can be held at this level, existing in some individuals as an independent, clinical condition, with no further progression.

Development of periodontitis is plurifactorial, with several contributors: bacterial infection, genetic susceptibility, metabolic response and anatomic modifications in the oral tissues, all of which have to be considered whenever one can diagnose periodontal disease. It is so less probable that one sigle biochemical parameter can express solely the diagnostic of such disorder. Nevertheless, tissular markers of the connective tissue (collagen, MPS, osteocalcin, osteonectin, fibronectin, enzymes) have significant values in metabolic response evaluation during the active course of disease, many of which possessing an elevated expression within GCF (gingival crevicular fluid)





FLUIDUL CREVICULAR: MARKERI ENZIMATICI CU POTENTIAL DE DIAGNOSTIC ĪN BOALA PARODONTALA



REZUMAT



Inflamatia reprezinta componenta centrala īn numeroase boli cronice severe, iar variatiile genetice ale raspunsului inflamator par sa influenteze evolutia bolilor īn populatia umana. Dealtfel, una din cele mai semnificative aplicatii practice ale modularii prin diferiti agenti ai bolilor inflamatorii, ar consta īn reglarea expresiei genelor "cheie" care mediaza aceste procese inflamatorii. Alterarea parodontiului apare ca rezultat al inductiei raspunsului imuno-inflamator, generat de acumularea bacteriilor pe suprafetele dentare adiacente tesuturilor supra- si sub-gingivale. Initial se instaleaza un raspuns inflamator de tip gingivita ca raspuns la actiunea agentilor bacterieni, care poate ramāne la acest stadiu, existānd la unii indivizi ca o conditie clinica independenta, fara progresie ulterioara (1).

Dezvoltarea parodontitei implica asocierea mai multor factori: infectia bacteriana, susceptibilitatea genetica, raspunsul metabolic si modificarile anatomice la nivelul tesuturilor orale, toate acestea necesitānd a fi luate in considerare atunci cānd diagnosticam conditia de boala parodontala. Avānd īn vedere natura plurivalenta a acestei boli, este foarte putin probabil ca expresia diagnosticului acesteia sa poata fi realizata printr-un singur parametru biologic. Totusi, un rol aparte īn aprecierea raspunsului metabolic īn cadrul procesului activ de boala, īl detin markerii tisulari ai tesutului conjunctiv (colagen, MPZ, osteocalcina, osteonectina, fibronectina, enzime), multi dintre acestia avānd o expresie semnificativa la nivelul fluidului gingival (2).





INFLAMMATORY CELLULAR RESPONSE IN PERIODONTAL DISEASE

Liliana Foia1, Mihaela Zlei2, Ungureanu Didona1, Sonia Nanescu3, Vasilica Toma4, Silvia Mārtu5

1Assoc.Prof. Phd. Dept of Biochemistry, UMF "Gr. T. Popa", Iasi

2Assist Phd., Dept of Immunology, UMF "Gr. T. Popa", Iasi

3 Phd. Student, UMF "Gr. T. Popa", Iasi, Dept. of Periodontology,

4Assist Phd., UMF"Gr. T. Popa", Iasi, Dept of Pedodoncy

5Prof. Phd., UMF "Gr. T. Popa", Iasi, Dept. of Periodontology



ABSTRACT



The predominant cellular population from the connective and epithelial tissues of gingiva is represented by polymorphonuclear cells (PMN). In the periodontal disease, this type of cells present in the crevicular fluid are functionally different from those of peripheral blood, having a reduced capacity of phagocytosis, a decreased activity of diacylglycerol kinases and an almost inexistent response to LXA4. As a marker of PMN presence in the crevicular fluid, there are high levels of ß-glucuronidases and alkaline phosphatases. In general, there is a reduction of CD4+ lymphocytes and an increase of CD8+ lymphocytes during periodontal disorders. Several studies have shown that there are more abundant Th2 cells than Th1 cells in different alterations of the periodontal tissues, the expression profile of cytokines in the gingival tissues with periodontal disease being type Tc2-like. There are hypothesis according to which, in the periodontal disease, the macrophages can have a deficiency of STAT6 with subsequent generation of excessive nitric oxide and a higher ability to induce CD4+ T cells.





RASPUNSUL INFLAMATOR CELULAR ĪN BOALA PARODONTALA



REZUMAT



Populatia celulara predominanta din tesutul conjunctiv si epitelial al gingiei este reprezentata de polimorfonucleare (PMN). Īn boala parodontala, acest tip de celule prezente īn fluidul crevicular sunt diferite functional de cele din sāngele periferic, avānd o capacitate de fagocitare mai redusa, activitate a kinazei diacilglicerolului mai scazuta si raspuns aproape inexistent la LXA4. Ca marker al prezentei PMN īn fluidul crevicular, exista nivele crescute ale ale ß-glucuronidazei si fosfatazei alcaline. Īn general, exista o reducere a limfocitelor T CD4+ si o crestere a limfocitelor TCD8+. Cāteva studii au aratat ca exista celule Th2 mai abundente decāt Th1 īn diferite ale afectarii tesuturilor parodontale, profilul de expresie al citokinelor īn tesuturile gingivale la pacientii cu boala parodontala fiind de tip Tc2-like. Exista ipoteze conform carora, īn boala parodontala, macrofagele pot avea o deficienta de STAT6 cu generarea consecutiva de oxid nitric īn exces si o abilitate mai mare de a induce celule T CD4+.







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