Dados de mundo real: o impacto econômico da inclusão de antineoplásicos orais para as operadoras de saúde no Sistema de Saúde Suplementar do Brasil / Real world data: the economic impact of including oral antineoplastic agents for health care providers in the Brazilian Supplementary Health System

Objetivo: Avaliar o incremento mensal do custo por beneficiário da incorporação das terapias antineoplásicas orais se aprovado o PL nº 6.330/2019. Métodos: As características clínicas e dos medicamentos utilizados em pacientes em tratamento oncológico foram coletadas da base de dados de mundo real Auditron®, plataforma de avaliações de solicitações de pré-autorização de procedimentos médicos. Com base nas características dos pacientes, foram avaliadas as possibilidades de uso dos medicamentos antineoplásicos orais, conforme as diretrizes da NCCN e ESMO. O cálculo do custo incremental foi realizado utilizando o número total de pacientes diagnosticados com uma neoplasia específica e o número de pacientes aptos a receber antineoplásicos orais. Foi utilizada lista de preços CMED para cálculo dos custos de aquisição de medicamentos. Resultados: O custo incremental da incorporação de 34 drogas antineoplásicas orais em 2019 foi de R$ 5.362.642.580 (R$ 3.944.321.786- R$ 6.483.413.466), representando impacto mensal de R$ 9,50 por beneficiário. O custo incremental da incorporação de 21 drogas antineoplásicas orais em 2021 era de R$ 2.028.538.791 (R$ 1.485.919.710-R$ 3,016,407,794), representando impacto mensal de R$ 3,59 por beneficiário. Conclusão: A incorporação das drogas antineoplásicas orais acarretariam um baixo incremento mensal por beneficiário.

Objective: To evaluate the monthly increase in the cost per member of incorporating all oral neoplastic therapies if approved the bill 6,330/2019. Methods: The clinical characteristics and medications used by patients undergoing cancer treatment were collected from the real-world Auditron® database, a platform for evaluating requests for pre-authorization of medical procedures. Based on the characteristics of each patient, the possibility of using oral antineoplastic drugs according to the NCCN and ESMO guidelines was evaluated. The incremental cost calculation was performed using the total number of patients diagnosed with a specific neoplasm and the number of patients eligible to receive oral anticancer drugs. CMED price list was used to calculate drug acquisition costs. Results: The incremental cost of incorporating 34 neoplastic drugs in 2019 was R$ 5,362,642,580 (R$ 3,944,321,786- R$ 6,483,413,466), representing a monthly impact of R$ 9.50 per member. The incremental cost of incorporating 21 neoplastic drugs in 2021 was R$ 2,028,538,791 (R$ 1,485,919,710-R$ 3,016,407,794), representing a monthly impact of R$ 3.59 per beneficiary. Conclusion: The incorporation of oral anticancer drugs in the coverage of health plans following international and national treatment guidelines would result in a low monthly increase in the cost per beneficiary.

In vitro stability of various enzymes by proline from H2O2 mediated oxidative damage

Plants under stress need to favour certain pathways so as to survive the stress period. Protection of specific enzymes by proline and other osmolytes could be one such mechanism to favour some pathways/processes. Therefore, the influence of osmolyte proline on conformational changes of various proteins caused by hydrogen peroxide (H2O2) was studied by intrinsic and extrinsic fluorescence emissions. H2O2 caused conformational change in proteins. Results indicated that for Alcohol dehydrogenase (AD) and Glutamate dehydrogenase (GD) enzymes, H2O2 induced conformational change was high and that for Glucose 6-phosphate dehydrogenase (G6PDH) and Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) was low. Fluorescence and far-UV, CD measurements of catalase demonstrated that the H2O2 stabilized the protein secondary structure at low concentrations but destabilized it at higher concentrations. Intrinsic and ANS fluorescence results showed that proline at a concentration of 1.0 M prompted a reduction in the H2O2-induced exposed hydrophobic surfaces of studied enzymes, to different degrees which suggests its differential protective effect. Furthermore, SDS-PAGE studies revealed that proline was not able to reduce or inhibit the H2O2 mediated aggregation of GAPDH.

A New and Practical Method to Locate Point ANS - A Cephalometric Study.

Diagnosis and treatment planning in skeletal discrepancy and disorders requires radiographic assessment. Disturbance in growth and development alters the morphologic build-up of bony structures, which makes evaluation difficult. Out of these skeletal landmarks Point ANS is seen affected in many conditions like cleft lip and palate, Binders Syndrome, Down’s Syndrome, nasomaxillary hypoplasia, etc., wherein maxilla is mostly affected. Surgical intervention if required needs exact evaluation of point ANS. The purpose of the present study is thus to revisit Point ANS to aid in the cephalometric evaluation in cases where location of Point ANS is difficult; thus, making treatment planning easy. METHODS50 lateral cephalograms were evaluated by taking reference of skeletal landmarks and linear measurements were done. RESULTSLinear measurements from Point Ptm’-Ba’, Ba’-ANS’, ANS’-A were found to be proportionally equal with a ratio of 1:1:1. CONCLUSIONSLinear distance of Point ANS to N perpendicular (ANS’) line was approximately half of the linear distance of Point Ba’-A, while Point ANS is placed approximately 5±2 mm ahead of the line N perpendicular.

Is the newly defined r2cha2ds2-vasc score a predictor for late mortality in patients undergoing transcatheter aortic valve replacement?

Abstract Objective: To assess the performance of the modified R2CHA2DS2-VASc score for predicting mid-to-long-term mortality (> 30 days) in patients undergoing transcatheter aortic valve replacement (TAVR). Methods: Data of 78 patients who underwent TAVR were retrospectively reviewed. R2CHA2DS2-VASc score was compared with the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II or ES II) and the transcatheter valve therapytranscatheter aortic valve replacement (TVT-TAVR) risk score. Results: The mean follow-up period was 17.4±9.9 months (maximum 37 months). Early mortality (first 30 days) was observed in 10 (12.8%) patients, whereas mid-to-long-term mortality (> 30 days) was observed in 26 (33.3%) patients. Non-survivors had higher values of R2CHA2DS2-VASc, ES II, and TAVR scores than survivors (P<0.001, P<0.001, and P=0.001, respectively). Analysis of Pearson's correlation revealed that R2CHA2DS2-VASc score was moderately correlated with ES II and TAVR scores (r=0.51, P<0.001; r=0.44, P=0.001, respectively). Pairwise comparisons of R2CHA2DS2-VASc (area under the curve [AUC]: 0.870, 95% confidence interval [CI]: 0.776-0.964; P<0.001), ES II (AUC: 0.801, 95% CI: 0.703-0.899; P<0.001), and TAVR scores (AUC: 0.730, 95% CI: 0.610-852; P=0.002) showed similar accuracy for predicting mortality. R2CHA2DS2-VASc score is an independent predictor of mortality in multivariable Cox regression analysis. A cutoff value of six for R2CHA2DS2-VASc score showed a sensitivity of 74% and a specificity of 89% for predicting mid-to-long-term mortality. Conclusion: R2CHA2DS2-VASc score, easily calculated from clinical parameters, is associated with prediction of mid-to-longterm mortality in patients undergoing TAVR.

Study of Exchange Transfusion by Reconstituted Blood in Hemolytic Disease of Fetus & New Born

Introduction: In newborns with hemolytic disease of fetusand newborn, exchange transfusion is one of the treatments.The main objective of this study was to review and establishthe practice of exchange transfusion with reconstituted bloodin neonates and to observe fall of bilirubin and also rise inhemoglobin and its comparison with related studies.Material and methods: Total 31 neonates with hemolyticdisease of fetus and newborn were included in thisstudy and exchange transfusion was carried out to treathyperbilirubinemia. Exchange transfusion with O Rh negativecells suspended in AB plasma were done for neonates havingRh hemolytic disease of fetus and newborn and O Rh positivecells suspended in AB plasma were used for exchangetransfusion to ABO hemolytic disease of fetus and newborn.The pre and post exchange transfusion blood samples weretested for serum bilirubin and hemoglobin.Result: Out of the 31 cases, 20 were of Rhesus (Rh) hemolyticdisease of fetus and newborn, while ABO and other bloodgroups constituted 08 and 03 hemolytic disease of fetus andnewborn cases respectively. The average post-exchange fallin serum indirect bilirubin was (53.47%) and average rise inhemoglobin level was 3.06 gm/dl in all 31 cases.Conclusion: The reconstituted blood is immunologically muchsafer and better than whole blood for purpose of exchangetransfusion in hemolytic disease of fetus and newborn becauseof its superiority in minimizing transfusion reactions and inachieving all the therapeutic effects of exchange transfusionin better way

Differences of acupuncture and moxibustion on heart rate variability in-deficiency syndrome:a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To observe the improvement of acupuncture and moxibustion on symptoms of-deficiency syndrome as well as their differences on the parameters of heart rate variability (HRV).</p><p><b>METHODS</b>Thirty patients with-deficiency syndrome and 15 healthy volunteers were recruited. Thirty patients with-deficiency syndrome were randomly assigned into an acupuncture group and a moxibustion group, 15 cases in each one. Fifteen healthy volunteers were allocated as a healthy control group. Patients in the acupuncture group and healthy control group were treated with acupuncture while patients in the moxibustion group were treated with moxibustion. Guanyuan (CV 4) and Zusanli (ST 36) were chosen for treatment, once every other day, for totally 10 times. All the patients were evaluated with-deficiency assessment scale (QDAS) and HRV parameters before treatment, after 4th treatment and after all treatment. The correlation was analyzed between QDAS and HRV parameters, and HRV parameters were compared among the three groups before treatment, after 4th treatment and after all treatment.</p><p><b>RESULTS</b>Compared before treatment, the scores of QDAS were decreased in the acupuncture group and the moxibustion group after 4th treatment and after all treatment (all<0.05); after all treatment the score of QDAS in the moxibustion group was lower than that in the acupuncture group (<0.05). The HRV parameters of-deficiency syndrome were significantly lower than those of healthy volunteers with higher correlation with QDAS. Compared before treatment, the mean heart rate was decreased after treatment (<0.05), while total HRV and low frequency were increased in the moxibustion group (both<0.05). The mean heart rate in the healthy control group was increased after treatment (<0.05). The differences of HRV parameters before and after treatment were not significant in the acupuncture group (all>0.05).</p><p><b>CONCLUSIONS</b>Total HRV can reflect the severity of-deficiency syndrome. Both acupuncture and moxibustion can improve symptoms of-deficiency patients, which is superior in moxibustion. The possible mechanism is likely to be related with improved sustainable activation of autonomic nervous system.</p>

Estudio densitométrico de diez años de remodelación femoral tras la implantación de un vástago anatómico / Étude densitométrique de dix ans d'un remodelage fémoral après implantation d'une tige anatomique / A Ten-Year sensitometric study of femoral remodeling after implantation of an anatomical stem

Introducción: la absorciometría dual con rayos X es comúnmente utilizada para cuantificar la remodelación ósea periprotésico, normalmente en seguimientos a corto plazo. Objetivo: determinar los patrones de remodelado producidos por vástago anatómico, mediante la cuantificación de cambios en la densidad mineral ósea en las 7 zonas de Gruen, durante el seguimiento, así como analizar la influencia de otros factores en el remodelado óseo. Métodos: se realizó un estudio prospectivo (10 años de seguimiento) a un grupo de 39 pacientes a los que se implantó una prótesis total de cadera no cementada. Se utilizó la cadera sana contralateral como control. Para cuantificar la remodelación femoral periprotésica se utilizó la absorciometría dual con rayos X en las 7 zonas de Gruen. Las mediciones de masa ósea se realizaron a los 15 días, 1, 3 y 10 años tras la intervención en la cadera no operada y a los 15 días, 1, 3, 5 y 10 años de la operación en la cadera protetizada. Se analizó también la influencia de otros factores en el remodelado óseo (sexo, índice de masa corporal y masa ósea preoperatoria). Resultados: se halló un descenso de la densidad mineral ósea del 7 por ciento en la zona 1 de Gruen y del 24,1 por ciento en la zona 7 de Gruen al final del décimo año. El sexo, el índice de masa corporal y la masa ósea preoperatoria no fueron estadísticamente relevantes en su influencia sobre el remodelado óseo. Conclusión: la remodelación ósea periprotésica depende en su mayor parte del implante, no se halló correlación con sexo, índice de masa corporal o masa ósea preoperatoria(AU)

Introduction: Dual X-ray absorptiometry is commonly used to quantify periprosthetic bone remodeling, usually for short-term follow up. Objective: determine patterns of remodeling caused by anatomical stem, by quantifying changes in bone mineral density in the 7 Gruen zones during follow up and analyze the influence of other factors in bone remodeling. Methods: a prospective study (10 year follow-up) was performed to a group of 39 patients undergoing uncemented total hip prosthesis. The healthy hip was used as control. Dual X-ray absorptiometry in Gruen zones 7 was used to quantify the femoral periprosthetic remodeling. Bone mass measurements were performed at 15 days, 1, 3 and 10 years after surgery on the non-operated hip, and at 15 days, 1, 3, 5 and 10 years of operation in the prosthetic hip. The influence of other factors in bone remodeling (sex, body mass index, and preoperative bone mass) was also analyzed. Results: 7 percent of decrease in bone mineral density was found in Gruen zone 1 and 24.1 percent was found in Gruen zone 7 at the end of the tenth year of follow up. Sex, body mass index and preoperative bone density were not statistically significant in its influence on bone remodeling. Conclusions: periprosthetic bone remodeling depends mainly on the implant. No correlation has been found with sex, body mass index and preoperative preoperative bone density(AU)

Introduction: l'absorptiométrie biphotonique à rayons X est fréquemment utilisée pour évaluer le remodelage osseux péri-prothétique, notamment par des suivis à court terme. Objectif: le but de cette étude est de déterminer les standards du remodelage osseux péri-prothétique produits par une tige anatomique, et d'analyser également l'influence d'autres facteurs sur le remodelage osseux. Méthodes: une étude prospective (suivi de 10 ans) d'un groupe de 39 patients, ayant subi une implantation de prothèse de hanche sans ciment, a été réalisée. Afin d'évaluer le remodelage fémoral périprothétique, on a effectué une absorptiométrie biphotonique à rayons X dans les 7 zones de Gruen. On a mesuré la DMO de la hanche non-opérée aux 15 jours et 1, 3, et 10 ans après la chirurgie, ainsi que la DMO de la hanche opérée aux 15 jours et 1, 3, 5, et 10 ans après la chirurgie. On a également analysé le retentissement d'autres facteurs (sexe, indice de masse corporelle, densité osseuse préopératoire) sur le remodelage osseux. Résultats: à la fin de la dixième année, on a trouvé une perte de la DMO de 7 pourcent dans la zone 1, et de 24.1 pourcent dans la zone 7. Le sexe, l'indice de masse corporelle et la masse osseuse préopératoire n'ont pas statistiquement influé sur le remodelage osseux. Conclusions: le remodelage osseux péri-prothétique dépend notamment de l'implant ; on n'a pas trouvé de corrélation avec le sexe, l'indice de masse corporelle ou la densité osseuse préopératoire(AU)

Measurement of the effect of Isha Yoga on cardiac autonomic nervous system using short-term heart rate variability.

Background: Benefi cial effects of Yoga have been postulated to be due to modulation of the autonomic nervous system. Objective: To assess the effect of Isha Yoga practices on cardiovascular autonomic nervous system through short-term heart rate variability (HRV). Design of the Study: Short-term HRV of long-term regular healthy 14 (12 males and 2 females) Isha Yoga practitioners was compared with that of age- and gender-matched 14 (12 males and 2 females) non-Yoga practitioners. Methods and Materials: ECG Lead II and respiratory movements were recorded in both groups using Polyrite during supine rest for 5 min and controlled deep breathing for 1 minute. Frequency domain analysis [RR interval is the mean of distance between subsequent R wave peaks in ECG], low frequency (LF) power, high frequency (HF) power, LF normalized units (nu), HF nu, LF/HF ratio] and time domain analysis [Standard Deviation of normal to normal interval (SDNN), square of mean squared difference of successive normal to normal intervals (RMSSD), normal to normal intervals which are differing by 50 ms (NN50), and percentage of NN50 (pNN50)] of HRV variables were analyzed for supine rest. Time domain analysis was recorded for deep breathing. Results: Results showed statistically signifi cant differences between Isha Yoga practitioners and controls in both frequency and time domain analyses of HRV indices, with no difference in resting heart rate between the groups. Conclusions: Practitioners of Isha Yoga showed well-balanced benefi cial activity of vagal efferents, an overall increased HRV, and sympathovagal balance, compared to non-Yoga practitioners during supine rest and deep breathing.

To evaluate the involvement of autonomic nervous system during pre and post menstrual phases in young women.

Background: During reproductive life, Women undergo many types of behavioural and hormonal changes, which influence various functions of body. ANS provides physiological adaptive background for these changes. The main aim of this study is to carry out autonomic function tests during various phases of menstrual cycle. Method: Different Methods were used to evaluate sympathetic and Parasympathetic activity. This study was carried out in two different phases of menstrual cycle viz. premenstrual phase (late luteal phase-LL) and post menstrual phase (early follicular phase –EF). Results: The autonomic function tests and heart rate variables were recorded and data was tabulated for Statistical evaluation with student paired “t” test. P 0.05 was considered as statistically significant. The tests for sympathetic activity were compared during pre and post menstrual phases. It was observed that pulse rate, blood pressure and cold pressor test were statistically more significant (p<0.01), while orthostatic variation in arterial blood pressure was statistically significant (p<0.05) in premenstrual phase as compared to post menstrual phase of menstrual cycle. For parasympathetic activity it was observed that heart rate response, expiratory: inspiratory ratio and valsalva ratio were statistically not significant (p>0.05) in both pre and post menstrual phases of menstrual cycle. Conclusion: In this study the responses to various sympathetic tests were significantly altered in premenstrual phase as compare to that of postmenstrual phase, reflecting the significant increase in the sympathetic activity. These changes may be due to gonadal steroids imbalance during post menstrual phase (EF) and premenstrual phase (LL) of menstrual cycle which in turn affects HPA axis and ANS significantly. Significant increased sympathetic activity responses indicate an augmented stress system.

Effects of Posture and Acute Sleep Deprivation on Heart Rate Variability

PURPOSE: In our previous study to investigate autonomic nervous system (ANS) activity due to radio frequency (RF) radiation using heart rate variability (HRV), drowsiness was observed in approximately half of all subjects. Therefore, the usage of HRV with unwanted drowsiness could falsely indicate the effects of RF radiation by mobile phones on the ANS. The objective of this study was to determine which posture is appropriate for accurate HRV analysis for provocation study. MATERIALS AND METHODS: A total of 52 healthy subjects (25 males and 27 females) participated in this experiment. We measured the number of times a subject showed drowsiness or sleep deprivation due to awakening, and analyzed HRV six times over 30 minutes in sitting and recumbent postures, using power spectrum. RESULTS: We employed the ratio of low frequency power to high frequency power (LFP/HFP) to analyze the changes in the ANS. The number of sleep deprivation occurrences in the sitting posture was significantly less than that in the recumbent posture (p<0.01), resulting in smaller increase of LFP/HFP. Although LFP/HFP of the two postures varied with time without any provocation, it was more stable in sitting than in recumbent postures. CONCLUSION: A sitting posture is preferable to a recumbent posture for analyzing HRV, because of decreased drowsiness and sleep deprivation, thereby decreasing variation of LFP/HFP during experiment. Considering the drowsiness, it is also recommended that any experiment should be completed within 15 minutes, if possible.

Effect of the Yu-tone music to reduction of fear emotion / 中华行为医学与脑科学杂志

Objective To explore the effect of the Yu-tone music to reduction of fear emotion. Methods 72 undergraduate students listened to Yu-tone Music or had a rest for ten minutes after elicitation of fear emotion by film clip;and measured from autonomic nerves system include skin conduction,BVP amplitude,heart rate,respiration,finger temperature and self-report subjective experience. Result 1.Compared with silence[(0.96±1.64)1/Ω,(0.85±1.73)min-1,(4.48±43.54)μV,(-5±15.37)min-1],music was associated with a significantly decreased skin resistance,respiration rate,heart rate and myoelectricity after fear emotion[(2.04±2.22)1/Ω,(0.09±1.79)min-1,(8.47±26.24) μV,(1.57±20.88) min-1,P <0.01,P <0.01,P <0.01,P <0.05]; 2.Compared with silence[(-0.37±2.71)μV, (0.13±1.16) ℃ ],music was enlarged BVP amplitude and skin temperature[(-0.53±3.8)μV,(-0.02±0.87)℃],but there was no significant difference( P ＞0.05,P ＞0.05).Conclusion Music advance the restore of negative emotion,and reduce excitability of the sympathetic and improve function of the parasympathetic nervous systems. Simultaneously,music significantly enhance the feelings of happiness as well as quietness of positive emotion.

Guerra, formação do estado e identidade nacional nas franjas do mundo Atlântico / Guerre, formation de l'état et identité nationale dans lês franges du monde Atlantique / War, state formation, and national identity on the fringes of the Atlantic world

This paper deals with the impact of war on state formation in Ireland and England, focusing on the period from 1590 to 1691, the key turning point for the future development of the state in both countries. War played a vital role, but in a number of different ways, including in the ideological sphere, in a complex process, rather than simply causing a long-term expansion in army size and subsequent growth of the state. The author further emphasizes the dynamic nature of the state itself.

Dans cet article, on étudie l'impact de la guerre sur la formation de l'État en Irlande et en Angleterre, surtout dans la période de 1590 à 1691, période-clé pour le développement de l'État dans ces deux pays. La guerre y a joué un rôle très important sous plusieurs formes, et en particulier dans la sphère idéologique, au long d'un processus très complexe, au-delà de son rôle d'expansion et d'augmentation des armées et de sa conséquence, la croissance de l'État, dont il faut souligner la nature dynamique.

Saúde suplementar no Brasil: o papel da Agência Nacional de Saúde Suplementar na regulação do setor / Suplemental health in Brazil: the role of the National Agency of Suplemental Health in the sector's regulation

Este artigo procurou contextualizar a saúde suplementar no Brasil, bem como a estruturação e a regulação do setor, utilizando uma análise da literatura e uma visão crítica sobre o assunto. A construção de um sistema de saúde suplementar acarretou disputas entre os diferentes setores envolvidos e o avanço ocorreu ao longo de muitos anos, culminando na criação da Agência Nacional de Saúde Suplementar (ANS) e sua posterior implementação. À ANS coube promover a defesa do interesse público na assistência suplementar à saúde e regular as operadoras setoriais, inclusive em suas relações com os prestadores de serviço e consumidores, contribuindo para o desenvolvimento das ações de saúde. Com o número de beneficiários ultrapassando os 40 milhões, a ANS é uma realidade e uma necessidade no setor no Brasil. A ANS possui excelentes possibilidades com a criação, verificação e divulgação de indicadores da qualidade da promoção e dos cuidados integrais da saúde, e a busca pela qualificação das operadoras de seguros de saúde impulsiona a regulação. Por outro lado, há uma necessidade premente de que a ANS atue mais diretamente nas relações conturbadas entre as operadoras de planos de saúde, os prestadores de serviços e os beneficiários mediando as tensões e contribuindo ativamente para a melhoria do sistema de saúde como um todo.

This paper aimed to contextualize the Supplemental Health in Brazil, as well as the organization and regulation of this sector, based on literature analysis and on a critical view of the subject. The construction of a supplemental health system took many years and disputes among the several sectors, and the progress came after many years, culminating with the creation of the National Agency of Supplemental Health (ANS) and its later implementation. ANS was in charge of defending the public interest in the supplemental health care and to regulate the sectorial operators, also in their relations with services rendering and consumers, helping develop health actions. Since the number of beneficiaries exceeds 40 million people, the National Agency of Supplemental Health is a reality and a necessity for the Brazilian health sector. ANS's possibilities are excellent with the creation, verification and spreading of quality, promotion and integral health care indicators, and the search for operators' qualification stimulates regulation. On the other hand, it is needed that ANS acts more directly in the confusing relations among health plans operators, services rendering and beneficiaries, mediating tensions and contributing to the improvement of health care system as a whole.

Effect of patient's breathing pattern on the stress changes in third molar extraction

PURPOSE: Heart rate variability(HRV) is the clinical consequence of various influences of the autonomic nervous system(ANS) on heart beat. HRV can estimate the potential physiologic rhythm from the interval between consecutive beats (RR interval or HRV data). It is known as RSA which represents respiration-related HR rhythmic oscillation. Previous studies demonstrated a specific breathing pattern (0.1Hz, 6breaths/min) to improve a physiological body condition related to the stress. In this paper, the level of stress would be evaluated in terms of three phases of the dental treatment, combined with 6breaths/min. METHODS: These phases include before, during and after tooth extraction or anesthesia or something.36 patients'stresses were assessed using HRV stress analyzer in each phase in Kangdong Sacred Heart Hospital, and Chuncheon Sacred Heart Hospital, Hallym University Medical Center from Jun. to Sept. of 2007. HRV 5-min data collected were analyzed in time-domain and frequency-domain to evaluate the activity of autonomic nervous system (ANS) which represents the level of stress. RESULTS: All HRV parameters including HF (high frequency), LF (low frequency) and LF/HF ratio showned a significant change affecting the ANS balance. There was a 6.4% difference between R(LF/HF)s on general breathing pattern for balance of Autonomic nervous system, but on controlled breathing pattern, 0.1Hz, was made narrow till 1.4%. The activity of ANS has increased by 1.4% on general breathing pattern, and by 2.9% on controlled breathing pattern, 0.1Hz. CONCLUSION: After analysis of preoperative stress changes and effect of breathing pattern of 0.1 Hz on the stress in 36 patients who have undergone third molar extraction, following was concluded. In the preoperative stage, the sympathetic change was the greatest after the anesthetic injection, and stress was relieved by controlling the breathing pattern to a frequency of 0.1Hz.