Long-term lung inflammation is reduced by estradiol treatment in brain dead female rats

OBJECTIVES: Lung transplantation is limited by the systemic repercussions of brain death (BD). Studies have shown the potential protective role of 17β-estradiol on the lungs. Here, we aimed to investigate the effect of estradiol on the long-lasting lung inflammatory state to understand a possible therapeutic application in lung donors with BD. METHODS: Female Wistar rats were separated into 3 groups: BD, subjected to brain death (6h); E2-T0, treated with 17β-estradiol (50 μg/mL, 2 mL/h) immediately after brain death; and E2-T3, treated with 17β-estradiol (50 μg/ml, 2 ml/h) after 3h of BD. Complement system activity and macrophage presence were analyzed. TNF-α, IL-1β, IL-10, and IL-6 gene expression (RT-PCR) and levels in 24h lung culture medium were quantified. Finally, analysis of caspase-3 gene and protein expression in the lung was performed. RESULTS: Estradiol reduced complement C3 protein and gene expression. The presence of lung macrophages was not modified by estradiol, but the release of inflammatory mediators was reduced and TNF-α and IL-1β gene expression were reduced in the E2-T3 group. In addition, caspase-3 protein expression was reduced by estradiol in the same group. CONCLUSIONS: Brain death-induced lung inflammation in females is modulated by estradiol treatment. Study data suggest that estradiol can control the inflammatory response by modulating the release of mediators after brain death in the long term. These results strengthen the idea of estradiol as a therapy for donor lungs and improving transplant outcomes.

Perspectives of bilateral thoracic sympathectomy for treatment of heart failure

Surgical neuromodulation therapies are still considered a last resort when standard therapies have failed for patients with progressive heart failure (HF). Although a number of experimental studies have provided robust evidence of its effectiveness, the lack of strong clinical evidence discourages practitioners. Thoracic unilateral sympathectomy has been extensively studied and has failed to show significant clinical improvement in HF patients. Most recently, bilateral sympathectomy effect was associated with a high degree of success in HF models, opening the perspective to be investigated in randomized controlled clinical trials. In addition, a series of clinical trials showed that bilateral sympathectomy was associated with a decreased risk of sudden death, which is an important outcome in patients with HF. These aspects indicates that bilateral sympathectomy could be an important alternative in the treatment of HF wherein pharmacological treatment barely reaches the target dose.

Efeitos da morte cerebral na microvasculatura pulmonar em um modelo experimental de doador de pulmão / Brain death effects on lung microvasculature in an experimental model of lung donor

RESUMO Objetivo A morte cerebral (MC) desencadeia alterações hemodinâmicas e inflamatórias importantes, comprometendo a viabilidade dos órgãos empregados em transplantes. Para compreender melhor as alterações microcirculatórias nos pulmões de doadores com MC, o presente estudo investigou a microcirculação pulmonar em um modelo de roedor com MC via microscopia intravital. Métodos Ratos Wistar machos foram anestesiados e ventilados mecanicamente. Eles foram submetidos a trepanação e a MC induzida por meio do aumento da pressão intracraniana. Os ratos do grupo Sham (SH), utilizado como controle, foram submetidos apenas à trepanação. Em ambos os grupos, foram monitorados o O2 expiratório e o CO2, e, após 3 horas, foi realizada a toracotomia e criada uma janela para observar a superfície pulmonar usando o sistema de microscopia intravital. As expressões pulmonares das moléculas de adesão intercelular (ICAM)-1 e da óxido nítrico-sintase endotelial (eNOS) foram avaliadas por imuno-histoquímica, e as citocinas foram medidas em amostras pulmonares. Resultados Três horas após os procedimentos cirúrgicos, a perfusão pulmonar foi de 73% no grupo SH. Por outro lado, os animais com MC apresentaram uma importante diminuição na perfusão do órgão para 28% (p = 0,036). O comprometimento microcirculatório pulmonar após a indução de MC foi associado a um aumento do número de leucócitos recrutados para o tecido pulmonar, além de uma redução na expressão de eNOS e um aumento na expressão de ICAM-1 nas células endoteliais do pulmão. Os ratos com MC apresentaram valores mais elevados de O2 expiratório e valores mais baixos de CO2 em comparação com os animais SH após 3 horas de monitorização. Conclusões Os dados apresentados demonstraram que a MC desencadeia uma importante hipoperfusão e inflamação nos pulmões, comprometendo a microcirculação pulmonar do doador.

ABSTRACT Objective Brain death (BD) triggers important hemodynamic and inflammatory alterations, compromising the viability of organs suitable for transplantation. To better understand the microcirculatory alterations in donor lungs caused by BD. The present study investigated the pulmonary microcirculation in a rodent model of BD via intravital microscopy. Methods Male Wistar rats were anaesthetized and mechanically ventilated. They were trepanned and BD was induced through the increase in intracranial pressure. As control group, sham-operated (SH) rats were trepanned only. In both groups, expiratory O2 and CO2 were monitored and after three hours, a thoracotomy was performed, and a window was created to observe the lung surface using an epi-fluorescence intravital microscopy. Lung expression of intercellular adhesion molecule (ICAM)-1 and endothelial nitric oxide synthase (eNOS) was evaluated by immunohistochemistry, and cytokines were measured in lung samples. Results Three hours after the surgical procedures, pulmonary perfusion was 73% in the SH group. On the other hand, BD animals showed an important decrease in organ perfusion to 28% (p = 0.036). Lung microcirculatory compromise after BD induction was associated with an augmentation of the number of leukocytes recruited to lung tissue, and with a reduction in eNOS expression and an increase in ICAM-1 expression on lung endothelial cells. BD rats showed higher values of expiratory O2 and lower values of CO2 in comparison with SH animals after three hours of monitoring. Conclusion Data presented showed that BD triggers an important hypoperfusion and inflammation in the lungs, compromising the donor pulmonary microcirculation.

Querendo fazer o que deve ser feito, mas fazendo somente o possível: o profissional de saúde frente à detecção precoce do câncer de mama / Willing to do what should be done, but doing only the possible: the health professional facing breast cancer early detection

O câncer de mama é a principal causa de morte por câncer nas mulheres em todo o mundo. No Brasil, a maioria dos tumores de mama é descoberta em estágios avançados, em grande parte dos casos pela própria mulher. As políticas públicas reforçam que a detecção seja feita em estágios iniciais, o que resulta em melhor resposta ao tratamento, menores custos e prognóstico mais favorável para a mulher. O estudo tem como objetivos: Identificar os significados atribuídos à detecção precoce do câncer de mama pelos profissionais de saúde, Descrever as ações de profissionais de saúde com relação à detecção precoce do câncer de mama em sua atuação profissional na Rede Básica de Saúde e Analisar o processo de interação dos profissionais de saúde com a detecção precoce do câncer de mama a partir de suas ações no âmbito da Rede Básica de Saúde. O estudo de natureza qualitativa, do tipo descritivo-exploratório, teve como referencial teórico-metodológico o Interacionismo Simbólico e a Grounded Theory, que subsidiaram uma interpretação da ação e das relações dos profissionais de saúde em busca da detecção precoce do câncer de mama, baseados na definição e interpretação de significados por eles atribuídos. Dos resultados emergiram quatro categorias: Querendo detectar o nódulo precocemente, Refletindo sobre o que é ideal no atendimento à Saúde da Mulher e as falhas dos profissionais de saúde, Percebendo e enfrentando as dificuldades da Atenção Primária para a detecção precoce do câncer de mama e Construindo a identidade profissional através de sua formação e interpretando a própria atuação profissional. Evidenciou-se que o profissional de saúde sabe que o ideal é detectar nódulos impalpáveis ou pequenos e entendem que fazem a sua parte ao solicitar exames de imagem, realizar Exame Clínico das Mamas, rastrear a partir dos grupos de maior risco e orientar a mulher quanto ao cuidado de si. Acreditam que há fatores que dificultam a realização de ações que consideram ideais, tornando-se obstáculos para a detecção precoce. A formação profissional influencia pois, a graduação e a pós-graduação não são suficientes para todo conhecimento que esperam obter, além de possuírem uma formação baseada no modelo tecnocrático, mais voltada ao tratamento do que preventiva, que não os prepara para uma perspectiva ampliada da saúde. O processo de interação do profissional com a detecção precoce indicou que há elementos que dependem dele e outros fora de seu controle, e embora queira fazer o ideal muitas vezes faz somente o que é possível. Apesar das adversidades da Atenção Primária à Saúde, o profissional precisa ter consciência do seu papel pelo funcionamento das políticas de saúde e não negligenciar o cuidado ou transferir a responsabilidade de suas ações. A detecção precoce do câncer de mama depende, também, do seu comprometimento em ser um bom rastreador e da vontade de dar algo a mais.

Breast cancer is the leading cause of cancer death in women around the world. In Brazil, most breast tumors are discovered in advanced stages, in most cases by the woman herself. Public policies reinforce detection in the early stages, which results in a better response to treatment, lower costs and a more favorable prognosis for women. The objectives of this study are: To identify the meanings attributed to breast cancer early detection by health professionals; To describe the health professionals' actions on breast cancer early detection in the context of their professional performance at the Basic Health Network; and to analyze their interaction process with the breast cancer early detection from their actions in the scope of the Basic Health Network. The qualitative study, a descriptive-exploratory type, had the Symbolic Interactionism and The Grounded Theory as theoretical-methodological reference, which subsidized an interpretation of the action and relationships of health professionals in pursuit for acting on breast cancer early detection, based on the definition and interpretation of meanings attributed by them. From results, four categories emerged: Willing to early detect the nodule, reflecting on what is ideal for Women's Healthcare of and the failures of health professionals, Realizing and facing the difficulties of Primary Care for breast cancer early detection and Building the professional identity through their training and interpreting their own professional performance. It was evidenced that the health professional knows that the ideal is to detect small or impalpable nodules and understand that they do their part when requesting imaging tests, perform Clinical Breast Examination, screening groups at highest risk and guiding woman about self care. They believe that there are factors that make it difficult to perform actions that they consider to be ideal, becoming obstacles to early detection. The professional training is influential since undergraduate and postgraduate courses are not enough for all the knowledge they hope to achieve, as well as having a training based on the technocratic model, more treatment than preventive oriented, which does not prepare them for an extended perspective of health. The process of professional interaction with early detection indicated that there are elements that depend on them and others outside of their control, and although they want to do the ideal often they do only what is possible. Despite the Primary Health Care adversities, professionals must be aware about their role for health policies performance and not neglect care or transfer responsibility for their actions. The breast cancer early detection also depends on their commitment of being a good screening professional and their will to give something more.

Social reintegration of drug-addicted individuals living in therapeutic communities / Reinserção social de dependentes químicos residentes em comunidades terapêuticas / Reinserción social de dependientes químicos residentes en comunidades terapéuticas

The study aimed to characterize actions and activities aimed at social reintegration of drug-addicted living in therapeutic communities. Forty-three communities were evaluated in the state of Goiás, with the use of a semi-structured questionnaire. Data were analyzed using descriptive statistics and the results showed that these communities have resident preparation mechanisms for therapeutic discharge and referral to the labor market. However, few activities are developed for inclusion in the labor market. Family’s involvement in treatment of residents is stimulated with joint visits and activities. Although the relevant work of communities, help from public policies is needed for social assistance to contribute to the reintegration of these individuals in society.

O estudo teve por objetivo caracterizar as ações e atividades voltadas para a reinserção social de dependentes químicos residentes em comunidades terapêuticas. Foram avaliadas 43 comunidades, localizadas no estado de Goiás, com a utilização de um questionário semiestruturado. Os dados foram analisados por meio de estatística descritiva e os resultados apontaram que essas comunidades apresentam mecanismos de preparo do residente para a alta terapêutica e encaminhamento ao mercado de trabalho. Entretanto, desenvolvem poucas atividades para a inserção no mercado de trabalho. O envolvimento da família no tratamento dos residentes é estimulado com visitas e atividades conjuntas. Conclui-se que embora o trabalho das comunidades seja relevante, ainda carece de ajuda de políticas públicas de assistência social que contribuam com a reinserção desses indivíduos na sociedade.

El estudio tuvo por objetivo caracterizar las acciones y actividades vueltas para la reinserción social de dependientes químicos residentes en comunidades terapéuticas. Fueron evaluadas 43 comunidades, localizadas en el estado de Goiás, con la utilización de un cuestionario semiestructurado. Los datos fueron analizados por medio de estadística descriptiva y los resultados apuntaron que esas comunidades presentan mecanismos de preparo del residente para la alta terapéutica y encaminamiento al mercado de trabajo. Mientras, desarrollan pocas actividades para la inserción en el mercado de trabajo. El envolvimiento de la familia en el tratamiento de los residentes es estimulado con visitas y actividades conjuntas. Se concluye que aunque el trabajo de las comunidades sea relevante, aún carece de ayuda de políticas públicas de asistencia social que aporten con la reinserción de eses individuos en la sociedad.

Woman experiencing gynecologic surgery: coping with the changes imposed by surgery / A mulher que vivencia as cirurgias ginecológicas: enfrentando as mudanças impostas pelas cirurgias / La mujer que experimenta las cirugías ginecológicas: enfrentando los cambios impuestos por la cirugía

ABSTRACT Objectives: to describe the feelings and perceptions resulting from gynecologic surgery by women and analyze how they experience the changes caused by the surgery. Method: a qualitative, descriptive and exploratory study, which had Symbolic Interactionism and Grounded Theory as its theoretical framework. Participants of the study: 13 women submitted to surgery: Total Abdominal Hysterectomy, Total Abdominal Hysterectomy with bilateral Adnexectomy, Wertheim-Meigs surgery, Oophorectomy, Salpingectomy, Mastectomy, Quadrantectomy and Tracheloplasty. Individual interviews were conducted, recorded and analyzed according to the comparative analysis technique of the Grounded Theory. Results: from the data two categories emerged - Perceiving a different body and feeling as a different person and; building the meaning of mutilation. The changes experienced make women build new meanings and change the perception of themselves and their social environment. From the interaction with their inner self, occurred a reflection on relationships, the difference in their body and themselves, the functions it performs and the harm caused by the surgery. Conclusions: the participants felt like different women; the mutilation developed in concrete feelings, due the loss of the organ, and in abstract, linked to the impact of social identity and female functionality. The importance of the nurse establishing a multidimensional care, to identify the needs that go beyond the biological body is perceived.

RESUMO Objetivos: descrever as sensações e percepções advindas das cirurgias ginecológicas pelas mulheres e analisar como elas vivenciam as mudanças geradas pelas cirurgias. Método: estudo qualitativo, descritivo-exploratório, que teve o Interacionismo Simbólico e Grounded Theory como referencial teórico-metodológico. Participaram 13 mulheres submetidas às cirurgias: Histerectomia Total Abdominal, Histerectomia Total Abdominal com Anexectomia bilateral, cirurgia de Wertheim-Meigs, Ooforectomia, Salpingectomia, Mastectomia, Quadrantectomia e Traqueloplastia. Realizadas entrevistas individuais em profundidade, gravadas e analisadas segundo a técnica de análise comparativa da Grounded Theory. Resultados: a partir dos dados emergiram duas categorias - Percebendo um corpo diferente e sentindo-se uma pessoa diferente e Construindo o significado de mutilação. As mudanças vivenciadas fazem as mulheres construírem novos significados e mudar a percepção de si e do seu meio social. A partir da interação consigo mesmas e com este meio, ocorreu a reflexão sobre relacionamentos, a diferença no corpo e em si, nas funções que desempenha e sobre a mutilação provocada pela cirurgia. Conclusões: as participantes sentiram-se mulheres diferentes; a mutilação sentida desdobrou-se em concreta, pela perda do órgão, e abstrata, vinculada ao impacto na identidade social e funcional feminina. Percebe-se a importância da enfermeira estabelecer um cuidado multidimensional, que identifique as necessidades que vão além do corpo biológico.

RESUMEN Objetivos: describir las sensaciones y percepciones que surgen de la cirugía ginecológica para las mujeres y analizar cómo experimentan los cambios generados por la cirugía. Método: estudio cualitativo, descriptivo-exploratorio, que tenía el Interaccionismo Simbólico y la Grounded Theory como marco teórico y metodológico. Los sujetos fueron 13 mujeres sometidas a cirugía: Histerectomía abdominal total, Histerectomía Abdominal Total con Anexectomía bilateral, cirugía Wertheim-Meigs, Ooforectomía, Salpingectomía, Mastectomía, Cuadrantectomía y Traqueloplastia. Se realizaron entrevistas individuales en profundidad, registradas y analizadas de acuerdo con la técnica de análisis comparativo de la Grounded Theory. Resultados: a partir de los datos surgieron dos categorías - Darse cuenta de un cuerpo diferente y sentirse una persona diferente y Construyendo el significado de la mutilación. Los cambios experimentados hacen que las mujeres construyan nuevos significados y cambien la percepción de si misma y el entorno social. A partir de la interacción con ella misma y por este medio se produjo la reflexión sobre las relaciones, la diferencia en el cuerpo y en sí, las funciones que realiza y la mutilación causada por la cirugía. Conclusiones: las participantes se consideraron diferentes mujeres; la mutilación sentida se desarrolló en concreto, por la pérdida del órgano, y abstracta, ligada al impacto en la identidad social y funcional femenina. Percibimos la importancia de la enfermera de establecer una atención multidimensional, para identificar las necesidades que van más allá del cuerpo biológico.

Serviços de saúde e comunidades terapêuticas: há uma relação em prol do dependente químico? / Health services and therapeutic communities: is there a relationship for the drug-dependent patient?

O uso de droga é um dos principais problemas de saúde pública em todo o mundo. Para o auxílio no tratamento aos dependentes químicos existem no Brasil alguns serviços, dentre eles se encontram as comunidades terapêuticas que são instituições não governamentais que devem funcionar de forma articulada com a atenção básica de saúde e com os Centros de Atenção Psicossocial (CAPS). O objetivo deste estudo foi analisar o relacionamento entre as Comunidades Terapêuticas com os serviços de atenção à saúde. Foram pesquisadas 43 comunidades localizadas no município de Goiânia-GO, sua região metropolitana e também a cidade de Anápolis-GO. O trabalho de campo foi realizado por meio da aplicação do questionário. Todas as comunidades visitadas faziam uso do Sistema Único de Saúde (SUS) e, na contramão desse constante uso, identificou-se que não há uma relação efetiva entre as comunidades e os CAPS. As comunidades possuem o direito e o dever de proporcionar aos residentes o acesso ao SUS garantidos por lei. Já o CAPS como instituição de serviço voltado para o tratamento e reinserção social dos usuários de drogas serviria como um pilar, juntamente, com as comunidades no auxílio ao dependente químico. A relação entre os serviços de saúde e as comunidades pesquisadas se apresenta, em princípio, a favor dos dependentes químicos. No entanto, há a necessidade de haver uma maior interlocução entre os serviços de saúde, principalmente os CAPS e as comunidades visando a reabilitação integral dos residentes.

One of the main problems in public health is the use of illicit drugs. Several services are an aid in the treatment of illicit drugdependent people among which may be mentioned the therapeutic communities. They are non-governmental organizations which function together with the Basic Health Care and with Centers for Psychosocial Care (SAPS). Current analysis deals with the relationship between therapeutic communities and Health Services available at the National Health Service (SUS). Forty-three communities were researched in the municipality of Goiânia GO Brazil, the metropolitan region and the city of Anápolis GO Brazil. Field work was undertaken with a questionnaire. All communities visited use SUS services, but there is no relationship between the communities and CAPS. Communities have the right and the duty to provide resident people access to SUS, which is warranted by law. As a service institution for the treatment and social reinsertion of illicit drug users, CAPS is an important institution for communities in their aid for the drug user. The relationship between health service and communities is primarily for drug dependent people. However, greater interlocution must exist between the communities and CAPS for the integral rehabilitation of residents.

Resgatando o cuidado de enfermagem como prática de manutenção da vida: concepções de Collière / Rescatando el cuidado de enfermería como práctica de mantenimiento de la vida: concepciones de Collière / Restoring nursing care as the practice of maintaining life: Collière planning

Trata-se de um estudo descritivo, mediante revisão sistemática de comunicação cientifica, com o objetivo de identificar práticas de enfermagem que refletem o modelo de cuidado que se propõe a assegurar a manutenção da vida conforme proposto pela enfermeira Françoise Collière. As buscas ocorreram no mês de outubro de 2009, através de pesquisa avançada na Biblioteca Virtual de Saúde, quando foram identificados 14 artigos, sendo nove na base de dados LILACS e cinco na MEDLINE. A análise possibilitou a classificação dos resultados em duas categorias: Cuidados centrados no modelo biomédico, tecnicista e Cuidados que transcendem a técnica. Entender o cuidado em sua totalidade torna-se ainda mais difícil quando reduzido apenas à utilização de técnicas que visam somente cuidados biológicos, cuidados curativos através de procedimentos de enfermagem. Muitas vezes, a enfermeira, por estar inserida no modelo biomédico da assistência, acaba por negligenciar a arte do cuidado para o qual foi formada.

This descriptive study used systematic review of scientific communications to identify nursing practices reflecting the model of care that aims to ensure the maintenance of life, as proposed by the nurse Françoise Collière. Advanced search of Brazil’s Biblioteca Virtual de Saúde (virtual health library) in October 2009 identified 14 articles, 9 in LILACS and 5 in MEDLINE. Analysis enabled the results to be classified into two categories: health focused on the technicist biomedical model, and care that goes beyond technique. It becomes even more difficult to understanding care as a whole when restricted to the use of techniques directed only to biological, curative care through nursing procedures. Often, nurses immersed in the biomedical model of care come to neglect the art of care for which they were trained.

Este es un estudio descriptivo, mediante revisión sistemática de la comunicación científica, a fin de identificar las prácticas de enfermería que reflejan el modelo de cuidado que tiene por objeto garantizar el mantenimiento de la vida en la forma propuesta por la enfermera Françoise Collière. Las búsquedas se llevaron a cabo en octubre de 2009, por medio de investigación avanzada en la Biblioteca Virtual de Salud, cuando fueron identificados 14 artículos, siendo nueve en LILACS y cinco en MEDLINE. El análisis permitió la clasificación de los resultados en dos categorías: cuidados centrados en el modelo biomédico, tecnicista y cuidados que van más allá de la técnica. Entender el cuidado en su totalidad se vuelve aún más difícil cuando sólo se limita a la utilización de técnicas destinadas a cuidados biológicos, cuidados curativos a través de procedimientos de enfermería. A menudo, la enfermera, por estar inserta en el modelo biomédico de asistencia, pasa por alto el arte del cuidado para lo cual fue formada.

Enfrentando mudanças e valorizando a vida: uma referência para a enfermeira no cuidado à mulher submetida à cirurgia ginecológica / Facing changes and appreciating life: a reference for the nurse in the care for women undergoing gynecological surgery

Diversos estudos que abordam as repercussões das cirurgias ginecológicas na vida da mulher apontam para uma relação existente com aspectos subjetivos, em virtude da construção social da identidade feminina, indicando que a perda de órgãos ginecológicos pode interferir na maneira da mulher se perceber e se relacionar com o mundo. O presente estudo tem como objeto o processo de interação da mulher no contexto das cirurgias ginecológicas. Para isso foram formulados os objetivos: Descrever os significados da cirurgia ginecológica para a mulher submetida a este procedimento e Analisar o processo de interação da mulher com ela mesma e com o seu núcleo social a partir dos significados por ela atribuídos à cirurgia ginecológica, considerando o fenômeno da mutilação. O estudo de natureza qualitativa, do tipo descritivo-exploratório, teve como referencial teórico-metodológico o Interacionismo Simbólico e a Grounded Theory, que subsidiaram uma interpretação da ação e das relações das mulheres no contexto da cirurgia ginecológica e da mutilação, baseados na definição e interpretação de significados por elas atribuídos. Dos resultados emergiram quatro categorias: Investigando a doença e decidindo aceitar a cirurgia, A passagem pela cirurgia: vivendo o processo de resolução do problema, Enfrentando as mudanças impostas pela cirurgia e Valorizando a vida. Evidenciou-se que ao receber o diagnóstico da doença, a mulher interage com dúvidas, medos, a busca por informação e pelos benefícios da cirurgia, e por fim decide aceitá-la. Ao passar pela cirurgia, vivencia incômodos, complicações, compreende que perdeu uma parte do corpo e procura conformar-se, tentando crer que foi o único caminho...

Several studies that approach the repercussions of gynecological surgery on women’s lives indicate a relationship with subjective aspects, due to the social construction of the female identity, pointing out that the loss of gynecological organs may interfere in the way women perceive themselves and connects with the world. The object of this study is the process of interaction of women in the context of gynecological surgeries. To do so, the following objectives were devised: To describe the meanings of gynecological surgery for women undergoing such procedure and to analyze the process of interaction with women to themselves and with their social environment from the meanings attributed by her to gynecological surgery, considering the phenomenon of mutilation. This descriptive, exploratory study of qualitative nature had the Symbolic Interactionism and the Grounded Theory as theoretical-methodological references, thus supporting an interpretation of the action and relationships of women in the context of gynecological surgery, and mutilation, based on the definition and interpretation of meaning attributed by them. Four categories emerged from the results: Investigating the disease and deciding to accept the surgery; Undergoing the surgery: coping with the problem resolution process; Facing the changes posed by the surgery; and Appreciating life. It was evident that, when women are faced with the diagnosis, they interact with doubt, fear, search for information and the benefits of the surgery, and finally decides to accept it. After undergoing the surgery, they cope with discomfort, complications, they understand that they have lost a part of their bodies and seek resignation, trying to believe that it was the only way left...

Effect of aerobic training on EEG alpha asymmetry and depressive symptoms in the elderly: a 1-year follow-up study

The effect of physical exercise on the treatment of depressive elderly adults has not been investigated thus far in terms of changes in cortical hemispheric activity. The objective of the present study was to identify changes in depressive symptoms, quality of life, and cortical asymmetry produced by aerobic activity. Elderly subjects with a diagnosis of major depressive disorder (DSM-IV) were included. Twenty patients (70 percent females, 71 ± 3 years) were divided into an exercise group (pharmacological treatment plus aerobic training) and a control group (undergoing pharmacological treatment) in a quasi-experimental design. Pharmacological treatment was maintained stable throughout the study (antidepressants and anxiolytics). Subjects were evaluated by depression scales (Beck Depression Inventory, Hamilton Depression Rating Scale, Montgomery-Asberg Depression Rating Scale) and the Short Form Health Survey-36, and electroencephalographic measurements (frontal and parietal alpha asymmetry) before and after 1 year of treatment. After 1 year, the control group showed a decrease in cortical activity on the right hemisphere (increase of alpha power), which was not observed in the exercise group. The exercise group showed a significant decrease of depressive symptoms, which was not observed in the control group. This result was also accompanied by improved treatment response and remission rate after 1 year of aerobic exercise associated with treatment. This study provides support for the effect of aerobic training on alpha activity and on depressive symptoms in elderly patients. Exercise facilitates the treatment of depressive elderly adults, leading to clinical and physical improvement and protecting against a decrease in cortical activity.

A repercussão da histerectomia na vida de mulheres em idade reprodutiva / Repercussion of a hysterectomy in women’s life while in reproductive age

Estudo qualitativo, do tipo descritivo-exploratório, cujo método foi a História de Vida. O objetivo foi identificar e analisar a repercussão da histerectomia na vida da mulher em idade reprodutiva. Foram entrevistadas doze mulheres em pós-operatório de histerectomia. O cenário foi o ambulatório de ginecologia de um hospital especializado na assistência à mulher e à criança, no Riode Janeiro, entre julho e outubro de 2006. Foi realizada análise temática, emergindo duas categorias: “Vida pré: ligada à doença” e “Vida pós: adaptação”. Algumas mulheres referiram uma influência benéfica da histerectomia, trazendo a resolução de problemas, com uma conotação de cura. Porém, para outras significou uma difícil perda. Fatores como sexualidade, sensação de vazio e questões ligadas à reprodução geraram dúvidas no imaginário das mulheres. Considerar estes fatores é fundamental para aimplementação de uma assistência específica e que atenda as necessidades desta clientela.

Attenuation and immunogenicity of recombinant yellow fever 17D-dengue type 2 virus for rhesus monkeys

A chimeric yellow fever (YF)-dengue serotype 2 (dengue 2) virus was constructed by replacing the premembrane and envelope genes of the YF 17D virus with those from dengue 2 virus strains of Southeast Asian genotype. The virus grew to high titers in Vero cells and, after passage 2, was used for immunogenicity and attenuation studies in rhesus monkeys. Subcutaneous immunization of naive rhesus monkeys with the 17D-D2 chimeric virus induced a neutralizing antibody response associated with the protection of 6 of 7 monkeys against viremia by wild-type dengue 2 virus. Neutralizing antibody titers to dengue 2 were significantly lower in YF-immune animals than in YF-naive monkeys and protection against challenge with wild-type dengue 2 virus was observed in only 2 of 11 YF-immune monkeys. An anamnestic response to dengue 2, indicated by a sharp increase of neutralizing antibody titers, was observed in the majority of the monkeys after challenge with wild-type virus. Virus attenuation was demonstrated using the standard monkey neurovirulence test. The 17D-D2 chimera caused significantly fewer histological lesions than the YF 17DD virus. The attenuated phenotype could also be inferred from the limited viremias compared to the YF 17DD vaccine. Overall, these results provide further support for the use of chimeric viruses for the development of a new live tetravalent dengue vaccine.

Effect of passive stretching on the immobilized soleus muscle fiber morphology

The aim of the present study was to determine the effect of stretching applied every 3 days to the soleus muscle immobilized in the shortened position on muscle fiber morphology. Eighteen 16-week-old Wistar rats were used and divided into three groups of 6 animals each: a) the left soleus muscle was immobilized in the shortened position for 3 weeks; b) during immobilization, the soleus was stretched for 40 min every 3 days; c) the non-immobilized soleus was only stretched. Left and right soleus muscles were examined. One portion of the soleus was frozen for histology and muscle fiber area evaluation, while the other portion was used to identify the number and length of serial sarcomeres. Immobilized muscles (group A) showed a significant decrease in weight (44 ± 6 percent), length (19 ± 7 percent), serial sarcomere number (23 ± 15 percent), and fiber area (37 ± 31 percent) compared to the contralateral muscles (P < 0.05, paired Student t-test). The immobilized and stretched soleus (group B) showed a similar reduction but milder muscle fiber atrophy compared to the only immobilized group (22 ± 40 vs 37 ± 31 percent, respectively; P < 0.001, ANOVA test). Muscles submitted only to stretching (group C) significantly increased the length (5 ± 2 percent), serial sarcomere number (4 ± 4 percent), and fiber area (16 ± 44 percent) compared to the contralateral muscles (P < 0.05, paired Student t-test). In conclusion, stretching applied every 3 days to immobilized muscles did not prevent the muscle shortening, but reduced muscle atrophy. Stretching sessions induced hypertrophic effects in the control muscles. These results support the use of muscle stretching in sports and rehabilitation.

Effect of one stretch a week applied to the immobilized soleus muscle on rat muscle fiber morphology

We determined the effect of stretching applied once a week to the soleus muscle immobilized in the shortened position on muscle fiber morphology. Twenty-six male Wistar rats weighing 269 ± 26 g were divided into three groups. Group I, the left soleus was immobilized in the shortened position for 3 weeks; group II, the soleus was immobilized in the shortened position and stretched once a week for 3 weeks; group III, the soleus was submitted only to stretching once a week for 3 weeks. The medial part of the soleus muscle was frozen for histology and muscle fiber area evaluation and the lateral part was used for the determination of number and length of serial sarcomeres. Soleus muscle submitted only to immobilization showed a reduction in weight (44 ± 6 percent, P = 0.002), in serial sarcomere number (23 ± 15 percent) and in cross-sectional area of the fibers (37 ± 31 percent, P < 0.001) compared to the contralateral muscles. The muscle that was immobilized and stretched showed less muscle fiber atrophy than the muscles only immobilized (P < 0.05). Surprisingly, in the muscles submitted only to stretching, fiber area was decreased compared to the contralateral muscle (2548 ± 659 vs 2961 ± 806 µm², respectively, P < 0.05). In conclusion, stretching applied once a week for 40 min to the soleus muscle immobilized in the shortened position was not sufficient to prevent the reduction of muscle weight and of serial sarcomere number, but provided significant protection against muscle fiber atrophy. In contrast, stretching normal muscles once a week caused a reduction in muscle fiber area.

Efeitos de um implante de acetato de nomegestrol, um derivado de 19-nor-progesterona, na função tireoidiana / Effects of an implant of nomegestrol acetate, a 19-nor-progesterone derivative, on thyroid function

Este estudo foi realizado para avaliar tri-iodotironina (T3), tiroxina (T4), hormônio estimulante da tireóide (TSH), T3 uptake, T3 livre e T4 livre em usuárias do implante de acetato de nomegestrol (Uniplant). Dezoito voluntárias em idade reprodutiva, que desejavam fazer anticoncepção, foram recrutadas para o estudo e investigadas antes do início do tratamento. Amostras de sangue foram obtidas antes da inserção do implante, para análises hormonais. Em seguida, amostras de sangue foram colhidas 3,6,12 e 24 meses após a inserção do Uniplant. Todas as pacientes usaram contraceptivo não hormonal por um período mínimo de 6 meses, antes da inserção do implante. Os resultados observados no estudo mostraram que não houve diferença significante na tri-iodotironina (T3), tiroxina (T4) e hormônio estimulante da tireóide (TSH), durante dois anos de uso do Uniplant. Nenhuma diferença significante foi encontrada nos níveis de T3 livre, durante dois anos de uso do Uniplant. Um decréscimo significante foi abservado no T3 uptake (p<0,05) no 24º mês e no T4 livre (p<0,05) no 3º mês de uso do Uniplant. todas as alterações observadas no estudo foram inconsistentes e todos os níveis estavam dentro dos limites normais.

A new model for the immobilization of the rat hind limb

An alternative device for the immobilization of the hind limb of the rat was developed to study the effects of chronic disuse on the soleus and tibialis anterior muscles, maintained for 3 weeks in the shortening and the stretching positions, respectively. The proposed device is made of steel mesh and cotton materials, and has some advantages when compared to cast or plaster cast: it is cheaper, lighter (12 g or 4 percent of the body weight of the rat) and the same unit can be easily adjusted and used several times in the same animal or in animals of similar size. Immobilization is also useful to restrain the movements of the hip, knee, and ankle joints. Male rats (291 ± 35 g and aged 14 ± 2 weeks) were used to develop and test the model. The soleus muscle of 18 rats was maintained in a shortened position for 21 consecutive days and lost 19 ± 7 percent of its length (P = 0.008) and 44 ± 6 percent of its weight (P = 0.002) compared to the contralateral intact muscle. No difference (P = 0.67) was found in the stretched tibialis anterior of the same hind limb when compared to the contralateral muscle. No ulcer, sore or foot swelling was observed in the animals. Immobilization was effective in producing chronic muscle disuse in the hind limbs of rats and is an acceptable alternative to the traditional methods of immobilization such as cast or plaster cast

An investigation of the conformation of peptide-T and its D-Ala analog by NMR and molecular dynamics simulations.

Peptide-T (ASTTTNYT) and its D-Ala analog (D-ASTTTNYT-NH2) have been designed to block the adsorption of HIV to CD4 receptors on T-cell lymphocytes, thus inhibiting viral infectivity. The conformation of these important peptides has been investigated by 2D-NMR and molecular dynamics simulations. The NMR studies in DMSO show that the peptides exist in solution as a mixture of conformations. beta-Turns and non-specific folded conformations are present in a small proportion in the ensemble of conformations, which is largely dominated by more or less extended structures. This result is in line with molecular dynamics simulations where beta-turns were found to occur with a low frequency and with energies 10 to 17 kcal/mole higher than the global minimum structure. Our findings differ from previous reports on the conformation of peptide-T determined by NMR.

NMR and molecular dynamics studies of tachykinins: conformation of the C-terminal pentapeptide of substance P(SP7-11).

Substance P belongs to the tachykinin family of neuropeptides which exhibit diverse pharmacological activity. The conformation of Phe1-Phe2-Gly3-Leu4-Met5-NH2 the C-terminal pentapeptide of substance P (SP7-11) has been studied by NMR and molecular dynamics (MD) methods. NMR studies were carried out both in DMSO-d6 and 95% H2O. Based on the observed chemical shifts, 3JNH alpha coupling constants, temperature coefficients of chemical shifts of NH resonances and the pattern of inter- and intraresidue NOE's, a predominantly extended backbone conformation has been deduced for the peptide in both DMSO and H2O. MD calculations carried out in vacuo indicate that the global minimum energy conformation of the molecule is folded with an intramolecular hydrogen bond between the protonated N-terminal and the C-terminal CONH2 group. The simulation shows that beta-turns are energetically unfavourable, while alpha-helices are seen to be unstable for the peptide. gamma-Bends at either Gly3 or Leu4 are the most preferred ones. Simulations carried out in DMSO as well as in water show a preference for a nearly extended conformation.

Molecular mechanics calculations of opioid ligands of the 4-arylpiperidine class.

Molecular mechanics calculations have been carried out on N-methyl-4-phenyl-4-piperidinols substituted at 2,3-, 2,5- and 2,6-positions with methyl groups. Besides the alcohols, their esters and methiodides were also studied. The molecular mechanics conformations have been compared with conformations determined experimentally by NMR or X-ray diffraction.

1H NMR investigation of the interaction of berberine and sanguinarine with DNA.

Interaction of the alkaloids, berberine and sanguinarine with calf thymus DNA has been studied by 1H NMR. All proton resonances of the two compounds have been assigned using 2D-COSY, NOESY and ROESY spectra. Berberine has been found to partially intercalate into DNA, while sanguinarine shows normal intercalation and also binds more firmly to DNA. The NMR experiments indicate that sanguinarine is more potent than berberine in its activity.