Tarsoconjunctival flap in scleral necrosis: report of three cases / Retalho tarsoconjuntival em necrose escleral: relato de três casos

ABSTRACT To report a series of three cases (four eyes) of scleral necrosis after pterygium excision, in which the tarsoconjunctival flap technique was used as treatment. Three patients who progressed to scleral necrosis after surgical pterygium excision were selected. The first patient underwent excision using the bare sclera technique and developed scleral thinning in the immediate postoperative period. The second and third patients received beta irradiation and had late onset scleral necrosis. The tarsoconjunctival flap technique was performed by the same surgeon. Recovery was satisfactory from both anatomical and functional perspectives in all cases, and the technique was considered effective and safe. Although there are only few reports about this technique in the literature, it can be considered as a good alternative to treat scleral necrosis.

RESUMO O objetivo deste estudo foi relatar uma série de três casos (quatro olhos) de necrose escleral pós-exérese de pterígio, em que se utilizou como tratamento a técnica de retalho tarsoconjuntival. Foram selecionados três pacientes que evoluíram para necrose escleral após tratamento cirúrgico de exérese de pterígio: o primeiro caso após técnica de esclera nua, com evolução para afinamento escleral no pós-operatório imediato; o segundo e o terceiro fizeram uso de betaterapia e apresentaram necrose escleral tardiamente. A técnica de recobrimento tarsoconjuntival foi executada pelo mesmo cirurgião. A recuperação foi satisfatória em todos os casos, do ponto de vista anatômico e funcional, sendo eficiente e segura. Apesar das escassas menções na literatura, essa técnica pode ser considerada uma boa alternativa para tratamento da necrose escleral.

Advances of targeted protein degradation technology and its applications in diseases therapy / 生物工程学报

Targeted protein degradation (TPD) technology facilitates specific and efficient degradation of disease-related proteins through hijacking the two major protein degradation systems in mammalian cells: ubiquitin-proteasome system and lysosome pathway. Compared with traditional small molecule-inhibitors, TPD-based drugs exhibit the characteristics of a broader target spectrum. Compared with techniques interfere with protein expression on the gene and mRNA level, TPD-based drugs are target-specific, efficaciously rapid, and not constrained by post-translational modification of proteins. In the past 20 years, various TPD-based technologies have been developed. Most excitingly, two TPD-based therapeutic drugs have been approved by FDA for phase Ⅰ clinical trials in 2019. Despite of the early stage characteristics and various obstructions of the TPD technology, it could serve as a powerful tool for the development of novel drugs. This review summarizes the advances of different degradation systems based on TPD technologies and their applications in disease therapy. Moreover, the advantages and challenges of various technologies were discussed systematically, with the aim to provide theoretical guidance for further application of TPD technologies in scientific research and drug development.

Therapies for crohn's disease: a clinical update / Terapia farmacológica em portadores de doença de Crohn. Atualização clínica

ABSTRACT The main objectives of clinical therapy in Crohn's disease are clinical and endoscopic remission without the use of corticosteroids for long periods of time, prevention of hospitalization and surgery, and improvement of quality of life. The main limitation of drug therapy is the loss of response over the long term, which makes incorporation of new drugs to the therapeutic arsenal necessary. This review analyses the main drugs currently used in clinical treatment of Crohn's disease.

RESUMO Os principais objetivos da terapia clínica na doença de Crohn são a remissão clínica e endoscópica por tempo prolongado, sem o uso de corticosteroides, além de evitar hospitalizações e cirurgias, e melhorar a qualidade de vida. A principal limitação da terapêutica medicamentosa é a perda de reposta a longo prazo, o que faz com que a incorporação de novas drogas ao arsenal terapêutico seja necessária. Esta revisão aborda os principais medicamentos utilizados atualmente no tratamento clínico da doença de Crohn.

Uso do lítio no tratamento de Alzheimer / Use of lithium in Alzheimer's treatment

A doença de Alzheimer (DA) é a causa mais comum de demência em idosos. As principais lesões cerebrais encontradas nesses pacientes são placas neuríticas com depósitos extracelulares de proteína ß-amiloide e um emaranhado neurofibrilar localizado normalmente no citoplasma perinuclear e composto de proteínas Tau hiperfosforiladas. Nos estágios iniciais, nota-se deficiência da memória recente, lapsos de memória, confusão e queda no rendimento funcional em tarefas complexas. Apesar de todo o conhecimento de sua fisiopatogenia, ainda não foram descritas terapias completamente eficazes para seu tratamento, sendo que o tratamento de primeira escolha é feito com fármacos inibidores da colinesterase. Estudos sugerem que o tratamento crônico com lítio potencializa a sobrevivência de novas células induzida por enriquecimento ambiental no hipocampo, proporcionando um ambiente favorável para os estímulos ambientais exercerem um efeito protetor mais forte. Deste modo, o tratamento combinado com lítio e enriquecimento ambiental poderia constituir uma estratégia para promover a sobrevivência de novos neurônios e, assim, melhorar a função cognitiva na doença de Alzheimer, especialmente em estágio inicial.

Alzheimer's disease (AD) is the most common cause of dementia in the elderly. The two major brain lesions found in patients with Alzheimer's disease are neuritic plaques, which contain extracellular deposits of amyloid ß-protein and neurofibrillary tangle typically located in the perinuclear cytoplasm and composed of hyperphosphorylated Tau protein. In the early stages, the patient has a deficiency of recent memory, tends to commit lapses and to blur easily, besides presenting drop in its functional performance in complex tasks. Despite all the knowledge about the pathogenesis of Alzheimer's disease, have not yet been described completely effective therapies for the treatment of disease and the first choice of treatment is done with cholinesterase inhibitor drugs. Studies suggest that chronic treatment with lithium enhances the survival of new cells induced by environmental enrichment in the hippocampus, providing an environment conducive to environmental stimuli exert a stronger protective effect. Thus, combined treatment with lithium and environmental enrichment could be a strategy to promote the survival of new neurons and thus improve cognitive function in Alzheimer's disease, particularly in the initial stage.

Autophagy pathways and key drug targets in Parkinson's disease / 药学学报

Parkinson's disease (PD) is a common neurodegenerative disorder associated with aging. Great progresses have been made toward understanding the pathogenesis over the past decades. It seems that both genetic factors and environmental factors contribute to PD, while the precise pathogenesis still remains unknown. Recently, increasing evidence has suggested that autophagy dysregulation is closely related to PD. Dysregulation of the autophagic pathways has been observed in the brains of PD patients or in animal models of PD, and a number of PD-associated proteins, such as α-synuclein, Parkin and PINK1, were found to involve in autophagy, suggesting a link between autophagy and pathogenesis of PD. In this review, we summarized the role of PD-associated proteins in autophagy pathways. In addition, we described the efficacy of autophagy-modulating compounds in PD models and discussed promising strategies for PD therapy.

Celiac Disease: A Disorder Emerging from Antiquity, Its Evolving Classification and Risk, and Potential New Treatment Paradigms

Celiac disease is a chronic genetically based gluten-sensitive immune-mediated enteropathic process primarily affecting the small intestinal mucosa. The disorder classically presents with diarrhea and weight loss; however, more recently, it has been characterized by subclinical occult or latent disease associated with few or no intestinal symptoms. Diagnosis depends on the detection of typical histopathological biopsy changes followed by a gluten-free diet response. A broad range of clinical disorders may mimic celiac disease, along with a wide range of drugs and other therapeutic agents. Recent and intriguing archeological data, largely from the Gobleki Tepe region of the Fertile Crescent, indicate that celiac disease probably emerged as humans transitioned from hunter-gatherer groups to societies dependent on agriculture to secure a stable food supply. Longitudinal studies performed over several decades have suggested that changes in the prevalence of the disease, even apparent epidemic disease, may be due to superimposed or novel environmental factors that may precipitate its appearance. Recent therapeutic approaches are being explored that may supplement, rather than replace, gluten-free diet therapy and permit more nutritional options for future management.

Doença celíaca / Celiac disease

A doença celíaca (DC) é uma enteropatia caracterizada pela intolerância permanente ao glúten desencadeada por mecanismos autoimunes nos indivíduos geneticamente predispostos. A DC com seu quadro clínico típico e principalmente atípico tem se mostrado mais frequente do que se imaginava. Seu diagnóstico é baseado em suspeita clínica, exames sorológicos e biópsia intestinal. Devido à evolução dos marcadoressorológicos e revisão dos critérios diagnósticos, discute-se sobre a real necessidade da realização da biópsia intestinal em casos selecionados. O tratamento da DC continua sendo a dieta isenta de glúten.

Celiac disease (CD) is an enteropathy characterized by permanent intolerance to gluten triggered by autoimmune mechanisms in genetically predisposed individuals. The frequency of CD, with its typical clinical condition and mainly atypical, has been higher than expected. Its diagnosis is based on clinical suspicion, serologic tests, and intestinal biopsy. The evolution of the knowledge about serological markers and revision of thediagnostic criteria prompts questions about the real need of intestinal biopsy in selected cases. The treatment of CD remains the gluten-free diet.

Clinical characteristics of infantile malignant osteopetrosis with eye disease / 中华实验眼科杂志

Background Malignant osteopetrosis is an extremely rare dense bone disease,and sometimes features ocular disease and cranial nerve palsy.This disease received high attention because of its poor prognosis.And whether the eye manifestation improved after treatment is a problem for concern.Objective This study was to clarify the clinical manifestation,treatment and prognosis of malignant osteopetrosis associated with ocular disease.Methods A retrospective study was adopted.Two children with malignant osteopetrosis associated with eye symptoms were collected from Beijing Children Hospital.The systemic and ocular medical examinations were performed on the patients,including physical examination,hematology laboratory examination,abdominal B ultrasound and bone X ray radiography,external ocular examination,flash visual evoked potential (F-VEP) and CT of orbit.Bone marrow hematopoietic stem cell transplantation was employed and 5-year following-up was cinducted on the chidren.Results The children showed increased bone density,systemic bone sclerosis,basilar thickening,abnormalities of hematology indexes,anemia,hepatosplenomegaly,optical canal stenosis and abnormality of F-VEP P2 wave.In addition,optical disc pale,facial paralysis and paralytic esotropia were seen in a female child and alternating strabismus was found in another boy.After successful treatment,the systemic symptoms remitted in both children,but the eye findings remained unchanged in the female child during the follow-up duration.However,the strabismus diminished in the male child.The optical bone canal widening to 1.9 mm 1 year and 3.2 mm 5 years after treatment in the female child.Conclusions Strabismus and eye disease are the signs of malignant infantile osteopetrosis and reflections of the impairment of the central nervous system.The pathogenetic mechanism of malignant osteopetrosisrelated eye disease is below understanding now.Early bone marrow hematopoietic stem cell transplantation for malignant osteopetrosis can offer the best chance of long-term survival and improve the prognosis of eye diseases.

Pay attention to the research work of stem cells transplantation for retinal diseases / 中华实验眼科杂志

With the special organization structure and function,retina is thought to be a prime candidate for developing the cellular therapies.Many types of stem cells have been explored to use for the treatment of retinal diseases and exhibit significant potential for further clinical application.However,before these results are translated to a clinical setting,sufficient investigations are required,such as the selection of the type of stem cells,transplantation strategy,the mechanism of therapeutic effect and biological safety,and how to get high differentiation efficiency,clarify the best development phase before transplantation,and achieve effective functional and structural integration of stem cells in the retina,etc.

Study on chronotropic response in coronary disease with percutaneous coronary intervention / 中国医师杂志

Objecitve To investigate the changes of chronotropic response before and after percutaneous coronary intervention ( PCI)in patients with coronary disease .Methods A total of 339 patients with coronary disease was included in this study .All sub-jects underwent treadmill exercise test and coronary angiogram , and some patients underwent PCI if necessary .The parameters of chro-notropic response were recorded and analyzed , including ratio of the highest to predicted heart rates ( rHR) ,chronotropic response in-dex ( CRI) , and heart rate reserve ( HRR) .After coronary angiogram , the score of gensin was recorded and analyzed .Results There was significant difference in the parameter of CRI between unstable angina pectoris and silent myocardial ischemia groups ( P 40 ( t =2.567, 2.223, 2.062, all P <0.05).Conclusions Parameters (rHR, CRI, and HRR) had important clinical values in evaluating the changes of chronotropic response before and after PCI in patients with coronary disease with a negative correlation with the score of Gensin.

Antiplaquetários nas síndromes coronarianas agudas: revisão / Antiplatelet drugs for treating acute coronary syndromes: A review

As síndromes coronarianas agudas sem supradesnivelamento do segmento ST são causadas, na maioria das vezes, por instabilização ou ruptura da placa de ateroma, com consequente formação de trombo não oclusivo. A escolha adequada de antiplaquetários é fundamental no tratamento, com redução dos eventos isquêmicos e da mortalidade. O objetivo deste artigo é a revisão crítica atualizada dos principais agentes antiplaquetários disponíveis para uso no Brasil, os mecanismos de ação de cada droga, bem como suas indicações e contraindicações em pacientes com síndrome coronariana aguda sem supradesnivelamento do segmento ST. A aspirina, isoladamente, é capaz de reduzir eventos de forma significativa. Sua associação com derivados tienopiridínicos, principalmente com o clopidogrel, acarretou sinergismo de ação com importante redução de eventos adversos. Novas drogas surgiram, gerando redução de recorrência de infarto e aumento nas taxas de sangramento, tornando mais complexa a escolha de antiplaquetários. O prasugrel, na sala de hemodinâmica, é opção basicamente nos pacientes que não receberam clopidogrel e que se submetem à angioplastia precoce, com baixo risco de sangramento avaliado por escores. O ticagrelor é uma opção ao clopidogrel para pacientes submetidos a tratamento invasivo, com possível benefício adicional na mortalidade. A escolha de antiplaquetários deve ser individualizada, conforme as circunstâncias definidas no texto, conforme o perfil de risco hemorrágicoe também conforme o perfil de risco de morte ou infarto do paciente.

Acute coronary syndromes without ST segment elevation are usually caused by destabilization or rupture of the atheroma plaque and the subsequent formation of non-occlusive thrombus. The right choice of antiplatelet drugs is crucial for treatment and to reduce both ischemicevents and mortality. This paper provides an updated critical review of the main antiplatelet drugs available in Brazil, describing the mechanisms of action, indications and contraindications of each drug for patients with acute coronary syndrome without ST segment elevation.Aspirin alone is capable of reducing events significantly. Its association with thienopyridine derivatives, especially with clopidogrel leads to synergisms and meaningful reduction of adverse events. Choosing the most adequate antiplatelet drug has become increasingly difficultas new drugs have been developed, which have reduced infarction recurrence but increased bleeding rates. Prasugrel is basically an option for patients that have not been treated with clopidogrel and undergo angioplasty in early stages, with low risks of bleeding as assessedthrough scores. Ticagrelor is an alternative to clopidogrel for patients that have undergone invasive treatment. The choice of antiplatelet drugs should be individualized for each patient, according to circumstances herein described, and according to patients? death and bleeding risk rankings.

A importância da criação de rede de cuidado para o tratamento do IAM com supra de ST e a experiência da Unidade Coronariana do Hospital das Clínicas / UFMG / The importance of creating a health care network to treat myocardial infarction with ST segment elevation and the experience of the Coronary Unit of UFMG University Hospital

O infarto com supradesnivelamento do segmento ST (IAMCSST) é uma importante causa de morbimortalidade no Brasil. O tratamento ideal para o IAMCSST depende principalmente do diagnóstico precoce e da rápida seleção de estratégia de reperfusão apropriada. A angioplastia coronária percutânea (ICP) primária é a estratégia de escolha em hospitais com serviço de hemodinâmica. Em hospitais sem esse serviço, duas estratégias de reperfusão são possíveis: transferência para ICP primária ou terapia com trombolíticos. A ICP primária apresenta melhores resultados, com redução de eventos cardiovasculares, entretanto, essa vantagem pode ser perdida, dependendo do tempo de atraso para transferência. A criação de rede de cuidado para pacientes com IAMCSST é um desafio para nosso município e pretende possibilitar o acesso à terapia de reperfusão em tempo adequado, levando em consideração as condições clínicas do paciente e do sistema de saúde em que ele é atendido.

Myocardial infarction with ST segment elevation is one of the major causes of morbimortality in Brazil. The ideal treatment for the disease depends mostly on early diagnosis and choice of adequate reperfusion strategy. Primary percutaneous coronary angioplasty (PCI) is a strategywidely adopted in hospitals that provide cardiac services, whereas hospitals without such services usually adopt either transfer for PCI or therapy with thrombolytic drugs. Primary PCI usually provides better results, reducing cardiovascular events, but this may not be effective in the event of significant transference delay. The creation of a health care network for patients with the disease is a challenge in our Municipality that can provide access to reperfusion therapy as soon as possible considering both patients? clinical conditions and health insurance.

Influence of community and hospital comprehensive health management on life quality after PCI in elderly patients / 中国医师杂志

Objective To assess the influence of community and hospital comprehensive Health management on quality of life in aged patients with coronary artery disease (CAD) after PCI.Methods 147 patients with CAD after PCI were divided into experimental group(72 cases) and control group (75 cases) accordance with their residential community.In control group,community health education was introduced.While in experimental group,hospital and community comprehensive healthy education lasted for one year.Before and after invention,major adverse cardiac events (MACE) was recorded and generic quality of life inventory (CQOLI-74),self-rating anxiety scale (SAS),and self-rating depression scale (SDS) were carried out on the basis of giving unite guiding words.Results The observation items of the SAS(34±6 vs41 ±7,t =2.714,P ＜0.01)and SDS(35 ±7 vs 41 ±8,t =2.572,P ＜0.05)scores in experimental group were lower than those in control group.Meanwhile the body health dimension(63 ± 12 vs 59 ±11,t =5.935,P ＜0.01 ),psychological health dimension(64 ± 14 vs 58 ± 13,t =6.116,P ＜0.01 ),social function dimension(64 ± 11 vs 58 ± 10,t =6.157,P ＜0.01 ) were higher than those in control group,but the difference of the material life dimension and the MACE rate were not statistically significant( P ＞0.05).Conclusions Community and Hospital comprehensive health management is a practical and valuable strategy for palliating the depression and anxiety and improving quality of life after PCI in aged patients.

Anestesia no paciente cardiopata / Anesthesia in cardiac patients

O avanço da tecnologia permitiu que a propedêutica pré-operatória, a monitorização e a terapêutica se tornassem mais adequadas para os cardiopatas, que são, cada vez mais, submetidos aos mais complexos procedimentos cirúrgicos. A avaliação pré-anestésica é fundamental em todos os pacientes, no intuito de oferecer o melhor cuidado possível.A integração entre o anestesista, o cardiologista e o cirurgião é essencial para o sucesso no tratamento. Com o objetivo de se predizer o risco cardíaco e, mais importante que isto, formular estratégias para melhorar o estado clínico no pré-operatório, vários índices foram elaborados e reavaliados, apresentando boa correlação. O clínico envolvido no tratamento de pacientes cardiopatas deve conhecer as interações medicamentosas, exames pré-operatórios necessários e a conduta perioperatória adequada para cada situação específica.

The advancement of technology allowed the preoperative workup, monitoring and therapy to become more suitable for cardiac patients, who are increasingly undergoing the most complex surgical procedures. The pre-anesthetic evaluation is essential in all patients in order to provide the best possible care. The integration between the anesthesiologist, the cardiologist and surgeon is essential for a successful treatment. In order to predict cardiac risk and, more important than this, to formulate strategies to improve the preoperative clinical status, several indices have been prepared and reviewed, showing good correlation. The clinician involved in treating patients with heart disease should be aware of drug interactions, necessary preoperative tests and perioperative management appropriate for each specific situation.

Tratamento metabólico da doença da urina do xarope de bordo / Metabolic treatment of the maple syrup urine disease

Objetivo: relatar caso de doença da urina do xarope de bordo (leucinose) e demonstrar como obterem-se bons resultados com o tratamento metabólico da doença. Descrição do caso: recém-nascida, desenvolveu no quinto dia de vida dificuldade de sucção, prostração e alternação de hipotonia e hipertonia axial. Foi admitida com 12 dias de vida em unidade de tratamento intensivo com crises de hipertonia, opistótono, movimentos de pedalar e apneia. Foi submetida à CPAP nasal e instituído tratamento de suporte, com triagem infecciosa negativa. A cromatografia sanguínea de aminoácidos revelou aumento pronunciado de leucina (5.986,4 nmol/mL), isoleucina (488,1 nmol/mL) e valina (755,9 mmol/mL), sendo diagnosticada leucinose e iniciado o seu tratamento metabólico. Evoluiu com melhora neurológica, ganho de peso e redução dos níveis de leucina. Recebeu alta em boas condições. Comentários: houve queda mais lenta nos níveis de leucina do que o relatado na literatura, o que pode ser explicado pelo tempo necessário para conseguir-se a dieta especial (MSUD 1) e pelo fato da mistura de aminoácidos usada na nutrição parenteral conter leucina. Poder-se-ia alcançar controle bioquímico mais rápido se houvesse disponibilidade diária da análise sérica quantitativa de aminoácidos e mais agilidade na liberação dos resultados.

Objective: Case report of the maple syrup urine disease (leucinosis) and show how to get good results with the disease metabolic treatment. Case description: newborn developed in the 5th day of life difficulty poor sucking, prostration and alternating axial hypotonia and hypertonia, was admitted with 12 days of life in the intensive treatment unit, with attacks of hypertonia, opisthotonus, paddling movements and apnea. She underwent nasal CPAP and supportive care instituted, with negative infectious screening. The blood amino acid chromatography showed a pronounced increase of leucine(5.986,4 nmol/mL), isoleucine (488,1 nmol/mL) and valine (755,9 mmol/mL), with leucinosis diagnosis and started the metabolic treatment. Evolved with neurological improvement, weight gain and decreased the levels of leucine. She was discharged in good condition. Comments: there was a slower fall in levels of leucine than that reported in the literature, which can be explained by the time needed to get the specialdiet (MSUD 1) and because the mixture of amino acids used in the parenteral nutrition contain leucine. The biochemical control could be achieved faster if there was daily availability of the quantitative analysis of serum amino acids and more speed in the release of results.

Relation between three-dimensional and two-dimensional echocardiography and biochemical analysis in patients with ST-segment elevation myocardial infarction percutaneously treated / Relação entre a análise bioquímica e ecocardiográfica tridimensional e bidimensional em pacientes com infarto do miocárdio com supradesnivelamento do segmento ST tratados por via percutânea

Objective: The prognosis of patients with acute myocardial infarction depends on multiple features that can demonstrate myocardial injury degree (such as serum markers of cardiac necrosis), and also on adaptive mechanisms relative to the acute event. The aim of the study was to assess the relation between biochemical and echocardiographic findings from three-dimensional echocardiographic (3D Echo) analysis and echocardiographic two-dimensional (2D Echo) left ventricular ejection fraction in patients with ST-segment elevation acute myocardial infarction , submitted to primary percutaneous treatment. Methods: A prospective study with 2D Echo and 3D Echo of 23 patients (17 males, mean age of 57 ± 13 years) with ST-segment elevation acute myocardial infarction, primarily percutaneously treated (stent). Serum cardiac markers (creatine kinase MB, Troponin I and Myoglobin) and serum brain natriuretic peptide were compared to echocardiographic parameters (volumes, left ventricular ejection fraction and ventricular dyssynchrony index). The statistical analysis was performed using Pearson?s correlation coefficient, 95% CI, p < 0.05, linear regression equation and Bland & Altman test. Results: Pearsons correlation coefficient (r)relative to 3D left ventricular ejection fraction: 1- brain natriuretic peptide: r: - 0.7427, p < 0.0001; 2- creatine kinase MB: r: - 0.660, p = 0.001. Left ventricular ejection fraction 2D (r) : 1- brain natriuretic peptide: r: - 0.5478, p = 0.001; 2- creatine kinase MB: r: - 0.4800, p < 0.0277. Other associations were not significant. Conclusions: In this series, it was observed better correlation in regard to serum creatine kinase MB , brain natriuretic peptide and 3D Echo left ventricular ejection fraction, when compared to 2D Echo left ventricular ejection fraction.

Objetivo: O prognóstico dos pacientes portadores de infarto agudo do miocárdico depende de múltiplos aspectos que espelhem o grau de agressão ao miocárdio (como marcadores enzimáticos de necrose miocárdica), assim como dos mecanismos de adaptação ao evento agudo. O objetivo do estudo foi verificar a associação entre os achados bioquímicos e ecocardiográficos derivados da análise ecocardiográfica transtorácica tridimensional (ECO 3D) com a fração de ejeção do ventrículo esquerdo (ECO 2D) em pacientes acometidos por infarto agudo do miocárdio com supradesnivelamento do segmento ST, que tenham sido submetidos a tratamento primário percutâneo. Métodos: Estudo prospectivo com Eco 3D e 2D de 23 indivíduos (17 homens, 57 ± 13 anos), acometidos por infarto agudo do miocárdio com elevação do segmento ST, primariamente tratados com implante de stent coronariano. Foi feita a dosagem sérica de creatina cinase fração MB, Troponina I, Mioglobina e peptídeo atrial natriurético e comparada com os parâmetros ecocardiográficos (volumes, fração de ejeção do ventrículo esquerdo e índice de dissincronia ventricular). A análise estatística foi feita com a determinação do coeficiente de correlação (Pearson), IC = 95%, p < 0,05, com teste de regressão linear e teste de Bland & Altman. Resultados: Coeficiente de correlação (r) entre fração de ejeção do ventrículo esquerdo 3D: 1- peptídeo atrial natriurético: r: - 0,7427, p < 0,0001; 2- creatina cinase fração MB: r: -0,660, p = 0,001. fração de ejeção do ventrículo esquerdo 2D (r) : 1- peptídeo atrial natriurético: r: - 0,5478, p = 0,001; 2- creatina cinase fração MB: r: -0,4800, p < 0,0277. As demais associações entre os parâmetros ecocardiográficos e as dosagens séricas não foram significativas. Conclusões: Nesta série, foi observada correlação melhor entre a dosagem sérica de peptídeo atrial natriurético, de creatina cinase fração MB e a fração de ejeção do ventrículo esquerdo aferida por Eco 3D do que a correlação com a fração de ejeção do ventrículo esquerdo aferida por Eco 2D.

Empleo de antiinflamatorios no esteroideos (AINEs) como coadyuvante en el tratamiento de la enfermedad periodontal

Estudios previos han indicado que las drogas antiinflamatorias no esteroideas (AINEs) actúan en la modificación de la respuesta inflamatoria por parte del huésped. El propósito del presente trabajo es presentar una revisión bibliográfica relacionada con el empleo de los AINEs y su efectividad comprobada sobre la enfermedad periodontal. Se desarrollarán diversos aspectos dentro de los cuales se mencionarán la etiología y patogenia de la enfermedad periodontal, características de los AINEs, su clasificación, farmacocinética, farmacodinamia (haciendo énfasis en el mecanismo como antiinflamatorio), uso terapéutico, así como diferentes estudios experimentales sobre el uso de los mismos en animales y en pacientes con enfermedad periodontal.

This review presents information about nonsteroidal antiinflammatory drugs their clinical efficacy in the periodontal disease, doing emphasis on the indications, pharmaceutical preparations, classification and adverse effects which they can produce on the basis of scientific knowledge. This report describes the use of nonsteroidal antiinflammatory drugs as an adjunct to scaling and root planning in periodontal disease.

Persuasão como estratégia para modificar as crenças nos comportamentos de risco para a doença arterial coronariana / Persuasion as a strategy to modify beliefs in risk behaviors related to coronary arterial disease / La persuasión como estrategia para modificar creencias en comportamientos de riesgo para la enfermedad arterial coronaria

Considerando os preceitos da Teoria de Persuasão de Fotheringham e o Sistema de Crenças de Rokeach, buscou-se identificar quanto um material didático pedagógico é capaz de modificar as crenças que favorecem a adoção de comportamentos de prevenção de doença coronariana. Trata-se de um estudo quase-experimental cuja amostra foi de 200 sujeitos: 50% do sexo masculino, idade entre 30 e 73 anos; 34% com hipertensão grau I; 75% com 10% risco para DAC; e 34% com níveis aumentados de colesterol total. Foram emitidas 1 297 crenças nos comportamentos de fumar, ingerir bebida alcoólica, ingerir alimentos ricos em gordura em excesso, estresse, não controlar PA, não controlar o diabetes, ingerir sal e açúcar em excesso, não controlar o peso e não realizar atividades físicas. Dessas, 248 eram referentes a comportamentos envolvidos na determinação de escores de risco para desenvolvimento de doença arterial coronariana, assim distribuídas: crenças do tipo B (36,%), D (28%) e E (36%). Para a análise dos dados foi utilizado o teste Mcnemar ou Binomial e o teste x2. Após a exposição ao material didático, foram realizadas duas avaliações (pós-teste 1 e pós-teste 2). Os resultados foram estatisticamente significantes para a maioria dos comportamentos considerados, exceto no comportamento de controlar o diabetes e dosagem de glicemia. O referencial de crenças mostrou-se oportuno para explicar a dificuldade de obter adesão às recomendações terapêuticas e de prevenção, bem como a técnica da persuasão válida por maximizar o impacto dos riscos e influenciar no deslocamento de crenças.

The study aims to identify the extent to which didactic-pedagogic material can modify beliefs favoring the adoption of preventive behavior towards coronary artery disease (CAD). The premises of Fotheringham's Persuasion Theory and Rokeach's Beliefs System were taken into account. It is a quasi-experimental study with a sample of 200 participants, half of whom were men. Participants'age ranged from 30 to 73 years. Thirty four percent of the patients had hypertension level I and 75% had a 10% CAD risk. Total cholesterol levels were increased in 34% of the patients. In all, 1,297 beliefs in several behaviors were produced: smoking, alcohol consumption, excessive intake of high-fat food, stress, not controlling blood pressure, not controlling diabetes, excessive salt and sugar intake, not controlling weight and not exercising; of these, 248 were related to behaviors involved in the assessment of risk scores for coronary artery disease, distributed as follows: Type B (36%), D (28%) and E (36%) beliefs. McNemar's Binomial test and chi-square test were used for data analysis. After exposure to didactic material, two assessments took place (post-test 1 and post-test 2). The results concerning most of the behaviors under analysis were statistically significant, except those for diabetes control and blood glucose measurement. The beliefs reference framework was appropriate to explain the difficulty in achieving adherence to therapeutic and preventive recommendations and the persuasion technique was valid to maximize the impact of risks and influence the displacement of beliefs.

Considerando los preceptos de la Teoría de la Persuasión de Fotheringham y el Sistema de Creencias de Rokeach, se intentó identificar en qué grado un material didáctico pedagógico es capaz de modificar las creencias que favorecen la adopción de comportamientos de prevención de la enfermedad coronaria. Se trata de un estudio casi-experimental cuya muestra incluyó a 200 sujetos, el 50% del sexo masculino, con edad entre 30 y 73 años, el 34% con hipertensión grado I, el 75% con el 10% de riesgo para EAC, el 34% con niveles aumentados de colesterol total. Se emitieron 1297 creencias en los comportamientos de fumar, ingerir bebida alcohólica, ingerir alimentos ricos en grasas, estrés, no controlar PA, no controlar la diabetes, ingerir sal y azúcar en exceso, no controlar el peso y no realizar actividades físicas; entre ellas: 248 se refirieron a comportamientos involucrados en la determinación de scores de riesgo para el desarrollo de enfermedad arterial coronaria, distribuidas así: creencias tipo B (36%), D (28%) y E (36%). Para el análisis de datos se utilizaron el test Mcnemar o Binomial y el test x2. Tras la exposición al material didáctico se efectuaron dos evaluaciones (post-test 1; post-test 2). Los resultados fueron estadísticamente significativos para la mayoría de los comportamientos considerados, excepto para el comportamiento de controlar la diabetes y dosaje de glicemia. El referente de creencias se mostró oportuno para explicar la dificultad para obtener adhesión a las recomendaciones terapéuticas y de prevención y la técnica da persuasión válida por maximizar el impacto de los riesgos e influir en el desplazamiento de creencias.

Advance in Study of Neural Stem Cells Used for Treatment of Alzheimer's Disease (review) / 中国康复理论与实践

@#Alzheimer's disease (AD) is a common progressive degenerative disease of the central nervous system. It's also a main cause for dementia in presenium and senectitude. In the past few years, the discoveries in vitro expansion of neural stem cells (NSCs) indicate a new way for recovery and replacement of damaged neurons as well as reconstruction of the neural circuit, and offer a useful future therapy for AD. There are two main promising approaches in NSCs replacement therapy. They are endogenetic approach, inducing proliferation and differentiation of endogenetic NSCs, improving self-repair of central nervous system, and exogenous approach, ransplantation of exogenous tissue and promoting proliferation of endogenous NSCs. However, it may not become truth before the mechanism of NSCs' proliferation, migration, differentiation and it's integration with the host tissues to be elucidated.