Estudio microtomográfico de la porosidad en la cementación de postes de fibra / Microtomographic study of the porosity in the cementation of fiber posts

El objetivo de este estudio fue evaluar con microto-mografía los poros existentes entre el cemento de resina, poste de fibra y paredes del conducto en los distintos tercios radiculares en premolares inferio-res. Se utilizaron 15 premolares inferiores unirra-diculares humanos recientemente extraídos. Se les realizó el tratamiento endodóntico, y se obturó con conos de gutapercha y cemento endodóntico a base de resina. Una vez desobturados se procedió a la ce-mentación de los postes. Cada muestra se posicionó en un accesorio personalizado y se escaneó utilizan-do un Microtomógrafo. Con el software CTAn v.1.12 (Bruker-microCT) se analizaron las microtomografías para obtener el volumen de interés (VOI) que permi-tió calcular el área de superficie (mm2) y volumen de cada poro (mm3) entre la dentina y el poste a nivel co-ronal, medio y apical. Los datos fueron analizados me-diante las pruebas estadísticas de Friedman o ANOVA de medidas repetidas. El volumen de los poros entre los tres tercios radiculares mediante la prueba de Friedman, encontró una diferencia global significativa (F = 30,00; p < 0,05). El tercio en donde los poros presentaron un mayor volumen (mm3) fue el tercio coronal (mediana: 0,29250), seguido por los tercios medio (mediana: 0,03200), y apical (mediana: 0,00140). La comparación de la superficie de los poros entre los 3 tercios brindó un resultado análogo al de la comparación del volumen. La mayor superficie (mm2) correspondió al tercio coronal (media ± DE = 1,66377 ± 0,27175), seguido por los tercios medio (media ± DE = 1,16210 ± 0,20343) y apical (media ± DE = 0,41074 ± 0,12641). La microtomografía permitió realizar un análisis cuantitativo y cualitativo de los poros en toda la muestra, sin deterioro de la misma. Se puede concluir que el tercio coronal presenta más poros que el tercio apical con la técnica de cementación utilizada. En cuanto a la superficie y volumen de los poros, los resultados encontrados son similares a los reporta-dos por diversos autores (AU)

The aim of this study was to evaluate with microtomography the existing pores between the resin cement, fiber post and canal walls in the different in thirds of the canal, in single-root lower premolars. Fifteen recently extracted human single root lower premolars were used, endodontically treated, and filled with gutta-percha cones and resin-based endodontic cement. Once unfilled, the posts were cemented. Each sample was positioned on a custom fixture and scanned using a Microtomograph. Each sample was evaluated using CTAn v.1.12 software (Bruker-microCT) to obtain the surface area (mm2), volume of interest (mm3) of each pore between dentin and post at the coronal, middle and apical levels. Data were analyzed using Friedman's tests or repeated measures ANOVA. The volume of the pores between the three root thirds using the Friedman test, a significant global difference was found (F = 30.00; p < 0.05). The third in which the pores presented a greater volume (mm3) was the coronal third (means: 0.29250), followed by the middle (means: 0.03200) and apical (means: 0.00140) thirds. The comparison of the pore surface between the 3 thirds gave an analogous result to that of the volume comparison. The largest surface area (mm2) corresponded to the coronal third (mean ± SD 1.66377 ± 0.27175), followed by the middle (mean ± 1.16210 ± 0.20343) and apical (mean ± 0.41074 ± 0.12641) thirds.Microtomography allowed a quantitative and qualitative analysis of the pores in the entire sample without deterioration. It can be concluded that the coronal third has more pores than the apical third with the cementation technique used. Regarding the surface and volume of the pores, the results found are similar to those reported by various authors (AU)

Resistencia adhesiva de postes de fibra a los diferentes tercios del conducto radicular / Adhesive resistance of fiber posts to different thirds of the root canal

En los últimos años resulta de elección la utilización de postes de fib ra en la rehabilitación de piezas endodónticamente tratadas. La adhesión entre poste, agente cementante y dentina radicular permitiría lograr una retención de la estructura dentro de las paredes del conducto. El objetivo de este estudio fue comparar la resistencia adhesiva en los tercios cervical, medio y apical, entre la dentina del conducto radicular y el cemento adhesivo utilizado en la cementación de postes de fibra. Se utilizaron 30 premolares inferiores uniradiculares humanos, recientemente extraídos, se realizaron los tratamientos endodónticos, se desobturaron y realizaron las preparaciones con la fresa conformadora número 3 para la cementación de postes White Post DC especial número 3 con cemento Paracore utilizando el protocolo adhesivo del mismo sistema. Las muestras fueron incluidas en acrílico cristal, cortadas en forma perpendicular al eje mayor de la pieza con una máquina de corte y por último se procedió a medir los valores de adhesión de los postes a la superficie interna de los conductos en los tres tercios con la prueba push-out mediante una máquina de ensayo universal. Los resultados arrojaron que las resistencias (media +- DE, MPa) en los tercios cervical, medio y apical, fueron 8,74 +- 3,12, 9,38 +- 2,29 y 11,11 +- 2,95, respectivamente. En el tercio apical se registró mayor resistencia. Considerando las limitaciones de esta investigación, se puede concluir que la cementación de postes de fibra con cementos resinosos, presenta mayores valores en el tercio apical y menores en el tercio cervical del conducto radicular con técnica de Push-out (AU)

¿Tienen los Hábitos de Vida y de Alimentación Impacto en la Calidad Seminal? / Do Lifestyle and Eating Habits have an Impact on Seminal Quality?

En los últimos años, se ha reportado en la literatura científica un declive en la calidad seminal. La significancia biológica de ese evento podría estar relacionada con la reducción en la fertilidad masculina o con el aumento del riesgo de enfermedades en la descendencia. La occidentalización en el estilo de vida, caracterizado por el aumento del peso corporal, el sedentarismo, el uso de cigarrillo, la ingesta de alimentos ricos en grasas y sodio y la reducción en la ingesta de alimentos fuente de fibras y antioxidantes, pudieran estar implicados en esos resultados. A su vez, cambios en el estilo de vida, que conduzcan a una reducción de peso corporal, de la ingesta de grasa y sodio, a un mejor estado antioxidante y a un aumento de la ingesta de fibra, se han asociado a mejores parámetros seminales. Por lo tanto, la alimentación basada en plantas o vegetariana, podría ser una estrategia válida para mejorar el estado nutricional y la salud masculina.

In recent years, a decline in seminal quality has been reported in the scientific literature. The biological significance of this event could be related to the reduction in male fertility or the increased risk of diseases in the offspring. Westernization in lifestyle, characterized by increased body weight, sedentary lifestyle, cigarette use, intake of foods high in fat and sodium and reduced intake of food sources of fiber and antioxidants, may be involved in these changes. Modifications in lifestyle, which lead to a reduction in body weight, fat and sodium intake, a better antioxidant status and an increase in fiber intake, have been associated with better seminal parameters. Therefore, plant-based or vegetarian food could be a valid strategy to improve nutritional status and male health.

An Update on Hypertriglyceridemia-Induced Acute Pancreatitis / 대한내과학회지

Hypertriglyceridemia a major cause of acute pancreatitis, accounting for up to 10% of all cases. The pathophysiological mechanism of hypertriglyceridemia-induced acute pancreatitis (HTGP) is presumed to involve the hydrolysis of triglycerides by pancreatic lipase resulting in an excess of free fatty acids and elevated chylomicrons, which are thought to increase plasma viscosity and induce ischemia and inflammation in pancreatic tissue. Although the clinical course of HTGP is similar to other forms of acute pancreatitis, the clinical severity and associated complications are significantly higher in patients with HTGP. Therefore, an accurate diagnosis is essential for treatment and prevention of disease recurrence. At present, there are no approved guidelines for the management of HTGP. Different treatment modalities such as apheresis/plasmapheresis, insulin, heparin, fibric acids, and omega-3 fatty acids have been successfully implemented to reduce serum triglycerides. Following acute phase management, lifestyle modifications including dietary adjustments and drug therapy are important for the long-term management of HTGP and the prevention of relapse. Additional studies are required to produce generalized and efficient treatment guidelines for HTGP.

Triglyceride-Rich Lipoproteins and Novel Targets for Anti-atherosclerotic Therapy

Although elevated serum low-density lipoprotein-cholesterol (LDL-C) is without any doubts accepted as an important risk factor for cardiovascular disease (CVD), the role of elevated triglycerides (TGs)-rich lipoproteins as an independent risk factor has until recently been quite controversial. Recent data strongly suggest that elevated TG-rich lipoproteins are an independent risk factor for CVD and that therapeutic targeting of them could possibly provide further benefit in reducing CVD morbidity, events and mortality, apart from LDL-C lowering. Today elevated TGs are treated with lifestyle interventions, and with fibrates which could be combined with omega-3 fatty acids. There are also some new drugs. Volanesorsen, is an antisense oligonucleotid that inhibits the production of the Apo C-III which is crucial in regulating TGs metabolism because it inhibits lipoprotein lipase (LPL) and hepatic lipase activity but also hepatic uptake of TGs-rich particles. Evinacumab is a monoclonal antibody against angiopoietin-like protein 3 (ANGPTL3) and it seems that it can substantially lower elevated TGs levels because ANGPTL3 also regulates TGs metabolism. Pemafibrate is a selective peroxisome proliferator-activated receptor alpha modulator which also decreases TGs, and improves other lipid parameters. It seems that it also has some other possible antiatherogenic effects. Alipogene tiparvovec is a nonreplicating adeno-associated viral vector that delivers copies of the LPL gene to muscle tissue which accelerates the clearance of TG-rich lipoproteins thus decreasing extremely high TGs levels. Pradigastat is a novel diacylglycerol acyltransferase 1 inhibitor which substantially reduces extremely high TGs levels and appears to be promising in treatment of the rare familial chylomicronemia syndrome.

Effect of Fenofibrate Medication on Renal Function / 가정의학회지

BACKGROUND: Fibrates are widely used to treat hypertriglyceridemia, a risk factor for arteriosclerosis, but these compounds have been associated with renal dysfunction. This study aimed to investigate the effects of fibrates on renal function in relatively healthy adult subjects with no cardiovascular diseases. METHODS: This retrospective study included 558 outpatients who were prescribed 160 mg fenofibrate (fenofibrate group) or 10 mg atorvastatin (control group) between August 2007 and October 2015. The groups were randomly matched using propensity scores at a 1:1 ratio. Serum creatinine levels and estimated glomerular filtration rates before and after treatment were compared between the two groups. RESULTS: Patients in the fenofibrate group showed greater changes in serum creatinine levels than those in the control group (9.73%±9.83% versus −0.89%±7.37%, P<0.001). Furthermore, 55.1% of patients in the fenofibrate group, but only 6.1% of those in the control group, exhibited a serum creatinine level increase ≥0.1 mg/dL (P<0.001). The fenofibrate group showed significantly greater declines in the estimated glomerular filtration rate than the control group (−10.1%±9.48% versus 1.42%±9.42%, P<0.001). Moreover, 34.7% of the fenofibrate group, but only 4.1% of the control group, exhibited an estimated glomerular filtration rate decrease ≥10 mL/min·1.73 m² (P<0.001). CONCLUSION: Fenofibrate treatment resulted in increased serum creatinine levels and reduced estimated glomerular filtration rates in a primary care setting. Therefore, regular renal function monitoring should be considered essential during fibrate administration.

Chemical degradation kinetics of fibrates: bezafibrate, ciprofibrate and fenofibrate

ABSTRACT Fibrates are drugs used for the treatment of hypertriglyceridemia and for the prevention of atherosclerosis. Three drugs in the fibrate class, ciprofibrate, fenofibrate and bezafibrate, were chosen for this study because their raw materials are readily available and because scientific publications on these compounds is limited. To evaluate their intrinsic stability, the drugs were exposed to a test condition (temperature, oxidation, UV light exposure, hydrolysis at different pH values and metal ions in solution) and then were subjected to analysis by HPLC. The samples were run on a C18 column, with a flow rate of 1.0 mL min-1 in a mobile phase consisting of methanol: 0.01 % phosphoric acid v/v (80:20), with variable detection wavelengths in the UV spectra. The analysis methodology showed satisfactory performance parameters. The three drugs were very unstable, degrading in each of the conditions evaluated. The test conditions of acid and basic hydrolysis showed the most significant degradation. The results demonstrated that the drugs in this class are unstable. Based on these experimentally determined degradation kinetics, it is easy to understand and emphasize the importance of the lack of liquid dosage forms on the market for fibrates because of their instability.

Efecto del ciprofibrato sobre el metabolismo del colesterol HDL y la capacidad antioxidante plasmática en el ratón / Effect of ciprofibrate on HDL cholesterol metabolism and plasma anti-oxidant capacity in mice

Antecedentes: Las dislipidemias, ya sea un aumento en los niveles de colesterol LDL y/o una disminución en las cifras de colesterol HDL, son muy relevantes para el desarrollo de la enfermedad cardiovascular ateroesclerótica, siendo el colesterol HDL bajo la dislipidemia más frecuente en la población chilena. Con respecto al colesterol HDL bajo y los tri -glicéridos elevados, los fibratos, agonistas del receptor nuclear PPAR-a que modula la transcripción de genes involucrados en el metabolismo de lípidos, representan una importante alternativa de manejo farmacológico de las dislipidemias. Sin embargo, estudios clínicos recientes no han sido concluyentes con respecto a su beneficio real sobre el control de la ateroesclerosis cuando se usan combinados con estatinas. Objetivo: Evaluar el impacto de la administración de fibratos sobre el metabolismo del colesterol HDL y la función antioxidante del plasma usando el ratón como modelo experimental. Metodología: Los ratones de la cepa C57BL/6 fueron tratados con ciprofibrato al 0,2% en dieta control durante 7 días. Luego del tratamiento, se analizaron los niveles de colesterol plasmático y triglicéridos, la expresión hepática de proteínas claves involucradas en el metabolismo de colesterol HDL, el contenido de colesterol hepático, la secreción de colesterol biliar y el daño oxidativo y la función antioxidante plasmática. Resultados: El tratamiento con ciprofibrato disminuyó significativamente los niveles de triglicéridos plasmáticos y la expresión hepática del receptor de HDL SR-BI, efecto que se correlacionó con un aumento en el tamaño de las partículas de HDL, pero no en los niveles de colesterol HDL. Además, el ciprofibrato disminuyó los niveles proteicos de los transportadores de colesterol ABCG1 y ABCG8, aunque no modificó ABCA1, en conjunto con una reducción del contenido hepático de colesterol y un aumento en la secreción de colesterol hacia la bilis. Finalmente, el uso de este hipolipemiante mejoró la función antioxidante del plasma, aunque se detectó un aumento en el daño nitrosativo de las proteínas plasmáticas. Conclusión: Este estudio ha permitido obtener nueva información sobre el efecto metabólico y funcional de la administración de fibratos en ratones, lo cual podría ayudar comprender los resultados de estudios clínicos recientes que han usado esta clase de hipolipemiantes en humanos.

Background: Increased serum levels of LDL cholesterol and/or decreased values of HDL cholesterol are very relevant for atherosclerotic cardiovascular disease. Low HDL cholesterol is the most prevalent dyslipidemia in the Chilean population. Regarding reduced HDL cholesterol and high triglyceride levels, fibrates, nuclear receptor PPAR-a agonists that modulate transcription of genes involved in lipid metabolism, represent an important alternative for pharmacological management of dyslipidemia. However, recent clinical studies have been inconclusive with respect to their real benefit on atherosclerosis when used in combination with statins. Aim: To evaluate the impact of fibrate administration on HDL cholesterol metabolism and antioxidant plasma functionality using the mouse as experimental model. Methodology: Using wild-type C57BL/6 mice, ciprofibrate was administered at 0.2% in chow diet for 7 days. After treatment, plasma cholesterol and triglycerides levels, hepatic expression of key proteins involved in HDL cholesterol metabolism, liver cholesterol content, biliary cholesterol secretion, and plasma oxidative damage and antioxidant function were analyzed. Results: Ciprofibrate treatment significantly decreased plasma triglycerides levels and hepatic HDL receptor SR-BI expression. This latter finding was associated with increased HDL particle size, without changes in HDL cholesterol levels. Furthermore, ci-profibrate decreased hepatic expression of cholesterol transporters ABCG1 and ABCG8, but not ABCA1, which correlated with reduced liver cholesterol content and increased biliary cholesterol secretion. Fina-lly, fibrate therapy improved plasma antioxidant func-tion, even though increased nitrosative plasma protein damage was detected. Conclusion: This study has provided new information on metabolic and functional effects derived from fibrate use in mice and it may help to better understand recent clinical findings using this lipid-lowering drug class in humans.

Hypertriglyceridemia and Cardiovascular Diseases: Revisited

Residual cardiovascular risk and failure of high density lipoprotein cholesterol raising treatment have refocused interest on targeting hypertriglyceridemia. Hypertriglyceridemia, triglyceride-rich lipoproteins, and remnant cholesterol have demonstrated to be important risk factors for cardiovascular disease; this has been demonstrated in experimental, genetic, and epidemiological studies. Fibrates can reduce cardiovascular event rates with or without statins. High dose omega-3 fatty acids continue to be evaluated and new specialized targeting treatment modulating triglyceride pathways, such as inhibition of apolipoprotein C-III and angiopoietin-like proteins, are being tested with regard to their effects on lipid profiles and cardiovascular outcomes. In this review, we will discuss the role of hypertriglyceridemia, triglyceride-rich lipoproteins and remnant cholesterol on cardiovascular disease, and the potential implications for treatment stargeting hypertriglyceridemia.

Prevalence, Treatment Pattern and Resource Use in Patients with Mixed Dyslipidemia Using Lipid Modifying Agents in Korea (PRIMULA): An Observational Study

OBJECTIVE: Limited information is available on the effectiveness of lipid-modifying therapy (LMT) for low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) in the Korean population. The objective of this study was to describe the prevalence of different types of lipid disorders in Korean patients using LMT. METHODS: Eight hundred seventy-one dyslipidemia patients, who were LMT-naive for >1 year prior to retrospective enrollment, were included for analysis. Serum levels of LDL-C, HDL-C, TG and total cholesterol (TC) were assessed after >1 year of LMT. We also analyzed the therapeutic effects of LMT in the subjects with high cardiovascular risk factors (n=629), atherosclerotic cardiovascular disease (ASCVD) (n=296) or diabetes without ASCVD (n=316). RESULTS: The rates of elevated LDL-C without other abnormal lipids levels, elevated TG or decreased HDL-C (with normal LDL-C levels) and high LDL-C combined with elevated TG and/or decreased HDL-C were 33.4%, 13.0% and 53.6%, respectively. After at least one year on LMT (statin alone: 81%, statin and cholesterol absorption inhibitor: 10%, fibrates alone: 3%, others: 3%), 61% of patients had at least one lipid abnormality, with 3.4% failing to reach the therapeutic LDL-C target level or a normal level of HDL-C and TG. After LMT, 64.9% of patients with high cardiovascular risk factors, 64.5% of those with ASCVD or and 64.2% of those with diabetes without ASCVD also had at least one lipid abnormality. CONCLUSION: Approximately two-thirds of patients did not reach the target or normal lipid profile after taking LMT, irrespective of combining disease and high cardiovascular risk factors. Tight lipid control is required, especially in patients with dyslipidemia and high cardiovascular risk factors or comorbid diseases.

Onychomatricoma: a tumor unknown to dermatologists

A sixty-one year old white female was referred to the Dermatology Department to treat an ingrown nail in the inner corner of the left hallux. Examination of the entire nail unit showed the presence of xanthonychia in the outer corner besides thickening and increase in the transverse curvature of the nail plate. Dermoscopy and nuclear magnetic resonance of the free edge of the nail plate detected characteristic signs of onychomatricoma, a diagnosis that was later confirmed by anatomopathological exam.

Update on the Pharmacologic Agents for Dyslipidemia / 임상당뇨병

Although statins have demonstrated consistent and strong effects on cardiovascular prevention, non-statin drugs have failed to show additional clinical benefit. Consequently, statins are currently recommended as first-line therapy in dyslipidemia. On the contrary, non-statin drugs are indicated in limited cases in which statins are not sufficiently effective or intolerable. A recent trial on ezetimibe provides evidence supporting further prescription of this agent. Proprotein convertase subtilisin-kexin type 9 inhibitors have strong low-density lipoprotein-cholesterol-lowering effects and were just approved in Western countries. However, results of clinical outcomes are not yet available. Other non-statin lipid-modifying agents have their own roles and limitations. Thus, it is important to have correct knowledge on these agents for optimal treatment of dyslipidemic patients.

Combination pharmacotherapy in lipid management

Latest guidelines on lipid management recommend statins as the first-line therapy. Because limited evidence is available on cardiovascular outcomes with varying statin-nonstatin combinations, recommendation levels for these regimens have been weak. However, a recent trial has demonstrated the additive effect of the statin-ezetimibe combination. The statin-fibrate combination has shown an effect in certain subgroups and on diabetic microangiopathy. Recent trials using the statin-niacin combination have been largely negative, whereas the statin-omega-3 fatty acids combination demonstrated a positive effect only in one study. Identifying the benefits and limitations of each combination is important for the best possible management of patients.

GINSENG, GREEN TEA OR FIBRATE: valid options for nonalcoholic steatohepatitis prevention? / Ginseng, chá verde ou fibrato: opções válidas para prevenção da esteatohepatite não alcoólica?

Objectives Panax ginseng, Camellia sinensis and bezafibrate were compared for their lipid-lowering, antioxidant and anti-inflammatory properties as potential agents to prevent nonalcoholic fatty liver disease and its progression to nonalcoholic steatohepatitis. Methods Fifty Wistar rats were randomized into five groups: G1 (feed with standard diet); G2 (feed with high-fat diet with 58% of energy from fat); G3 (high-fat diet + standardized Panax ginseng extract at 100 mg/kg/day); G4 (high-fat diet + standardized Camellia sinensis extract at 100 mg/kg/day); and G5 (high-fat diet + bezafibrate at 100 mg/kg/day), given by gavage. The animals were sacrificed eight weeks later and blood was collected for glucose, insulin, cholesterol, triglycerides, AST, ALT, alkaline phosphatase and gamma-glutamyl transferase determinations. The score system for nonalcoholic fatty liver disease was used to analyse the liver samples. Results and conclusions High-fat diet resulted in a significant increase in animal body weight, biochemical changes and enzymatic elevations. Steatosis, inflammation and hepatocellular ballooning scores were significant high in this group. The biochemical and histological variables were statistically similar in the bezafibrate group and control group. Treatment with Panax ginseng extract prevented obesity and histological features of nonalcoholic steatohepatitis (steatosis and inflammation) compared to high-fat diet. Camellia sinensis showed a less effective biochemical response, with small reduction in steatosis and inflammation but lower ballooning scores. .

Objetivos Panax ginseng, Camellia sinensis e bezafibrato foram comparados por suas propriedades hipolipemiantes, antioxidantes e anti-inflamatórias, como potenciais agentes capazes de prevenir a doença hepática gordurosa não alcoólica e sua progressão para esteato-hepatite não alcoólica. Métodos Cinqüenta ratos Wistar foram distribuídos aleatoriamente em cinco grupos: G1 (alimentados com dieta padrão); G2 (alimentados com dieta hipercalórica com 58% de energia a partir de gordura); G3 (dieta rica em gordura + extrato padronizado Panax ginseng em 100 mg / kg / dia); G4 (dieta rica em gordura + extrato de Camellia sinensis padronizado a 100 mg / kg / dia); e G5 (dieta rica em gordura + bezafibrato, a 100 mg / kg / dia), administrado via oral. Os animais foram sacrificados após oito semanas e o sangue foi coletado para determinação da glicose, insulina, colesterol, triglicérides, AST, ALT, fosfatase alcalina e gama-glutamil transferase. O sistema NAS de pontuação para doença hepática gordurosa não alcoólica foi utilizado para analisar as amostras de fígado. Resultados e conclusões A dieta hipercalórica resultou em um aumento significativo no peso corporal dos animais, associado a alterações bioquímicas e elevações enzimáticas. Os escores de esteatose, inflamação e balonização hepatocelular foram significativamente mais elevados neste grupo. As variáveis bioquímicas e histológicas foram estatisticamente semelhantes entre os grupos bezafibrato e controle. O uso do extrato do Panax ginseng esteve associado a um menor ganho de peso dos animais, em média, bem como a menores índices nos escores de esteato-hepatite (esteatose e inflamação) em comparação com o grupo apenas alimentado com dieta hipercalórica. No grupo ...

Brazilian Portuguese version of the Patient Competency Rating Scale (PCRS-R-BR): semantic adaptation and validity / Versão em português brasileiro da Patient Competency Rating Scale (PCRS-R-BR): adaptação semântica e validade

This study describes the adaptation of a revised Brazilian version of the Patient Competency Rating Scale (PCRS-R-BR), which focuses on executive, mnemonic, and attention functions. Evidence of content-based and external validity is also reported. The cross-cultural adaptation was conducted in five phases: 1) translations and back translations; 2) item analysis by authors; 3) classification by experts; 4) revisions and reformulations by authors; 5) pilot study with a sample of patients with mild and moderate/severe traumatic brain injury (TBI). Data were analyzed descriptively, and the PCRS-R-BR scores of groups with mild vs. moderate/severe TBI were compared using the Mann-Whitney test. Patients and their relatives were divided into groups and compared using repeated-measures analysis. The results of the PCRS-R-BR questionnaire for relatives and discrepancy scores of patients with moderate/severe TBI revealed significantly more impairment than that found in the group of patients with mild TBI. There were significant differences between item and total scores of both groups of patients and relatives. Results indicated a high level of item content agreement between experts. This study found initial evidence of PCRS-R-BR content-based and external validity when the questionnaire was applied to patients with mild and moderate/severe TBI and their relatives.

O presente artigo teve como objetivo apresentar a adaptação transcultural e evidências de validade externa e de conteúdo da versão brasileira revisada da Patient Competency Rating Scale (PCRS-R-BR), com foco nas funções executivas, mnemônicas e atencionais. A adaptação transcultural incluiu cinco fases: 1) tradução e retrotradução; 2) análise de itens por autores; 3) análise de especialistas; 4) revisões e reformulações dos autores; 5) estudo piloto em pacientes com traumatismo cranioencefálico (TCE) leve e moderado/grave. Os dados foram analisados descritivamente e os pacientes com TCE leve e moderado/grave foram comparados nos escores da PCRS-R-BR pelo teste Mann-Whitney. Os pacientes e familiares foram comparados por grupo através da análise de medidas repetidas. Os pacientes com TCE moderado/grave tiveram maior prejuízo que os pacientes com TCE leve no formulário da PCRS-R-BR dos familiares e no escore de discrepância entre pacientes e familiares. Os resultados indicam bons e altos níveis de concordância entre especialistas frente aos componentes avaliados pelos itens. Esse estudo apresentou evidências iniciais de validade de conteúdo da PCRS-R-BR para pacientes com TCE leve e moderado/severo e seus familiares.

Normalization of the levels of inflammatory molecules in Mycobacterium smegmatis-infected U937 cells by fibrate pretreatment

BACKGROUND: Tuberculosis (TB) is a respiratory tract disease caused by Mycobacterium tuberculosis infection. M. tuberculosis exploits immune privilege to grow and divide in pleural macrophages. Fibrates are associated with the immune response and control lipid metabolism through glycolysis with ß-oxidation of fatty acids. RESULTS: In this study, we investigated the effect of fibrate pretreatment on the immune response during M. smegmatis infection in U937 cells, a human leukemic monocyte lymphoma cell line. The protein expression of tumor necrosis factor α (TNF-α), an inflammatory marker, and myeloid differentiation primary response gene 88 (MyD88), a toll like receptor adaptor molecule, in the infected group increased at 1 and 6 h after M. smegmatis infection of U937 cells. Acetyl coenzyme A acetyl transferase-1 (ACAT-1), peroxisome proliferator-activated receptor-α (PPAR-α), TNF-α, and MyD88 decreased in U937 cells treated with fibrates at 12 and 24 h after treatment. More than a 24 h pretreatment with fibrate resulted in similar expression levels of ACAT-1 and PPAR-α between infected vehicle control and infected groups which were pretreated with fibrate for 24 h. However, upon exposure to M. smegmatis, the cellular expression of the TNF-α and MyD88 in the infected groups pretreated with fibrate for 24 h decreased significantly compared to that in the infected vehicle group. CONCLUSION: These results suggest that fibrate pretreatment normalized the levels of inflammatory molecules in Mycobacterium smegmatis-infected U937 cells. Further studies are needed to confirm the findings on pathophysiology and immune defense mechanism of U937 by fibrates during M. tuberculosis infection.

Fenofibrate Therapy and Change of Renal Function: Management, What and How? / 대한내과학회지

Fenofibrate is one of PPAR-alpha (peroxisome proliferator activated receptor alpha) agonists. Fenofibrate decreases effectively triglyceride and increases high density lipoprotein cholesterol level through the effect on lipoprotein lipase, hepatic production and degradation of lipoproteins. Fenofibrate was recommended as the drug for hypertriglyceridemia treatment in European guideline released in 2011. But American heart association guideline in 2013 did not recommend non-statin therapy including fibrate for the prevention of atherosclerotic cardiovascular disease. But fenofibrate is still considered as the important drug for the management of atherogenic dyslipidemia especially in patients with metabolic syndrome and diabetes to reduce the residual risk after statin therapy from the evidence of many studies. Fibrates including bezafibrate, gemfibrozil, and fenofibrate increased serum creatinine level in several studies. But the mechanism of change in renal function is not clear till now. And the reversibility of renal function with drug discontinuation is dependent on the kinds of fibrate. Fenofibrate increased serum creatinine level, decreased albuminuria and renal function was reversible with the drug discontinuation in large clinical trials. In these days renal function change with fenofibrate therapy in Korean patients with hypertriglyceridemia was investigated. Fenofibrate treatment for 2 months increased serum creatinine level significantly and old age was associated with the change of renal function in multivariate analysis. Short-term therapy significantly increased serum creatinine level even within normal range, and this change may be important in some groups especially old age.

Refocusing Peroxisome Proliferator Activated Receptor-alpha: A New Insight for Therapeutic Roles in Diabetes

Although glucose-lowering treatment shows some risk lowering effects in cardiovascular diseases, risks of macrovascular and microvascular complications have still remained, and development of new therapeutic strategies is needed. Recent data have shown that peroxisome proliferator activated receptor-alpha (PPAR-alpha) plays a pivotal role in the regulation of lipid homeostasis, fatty acid oxidation, cellular differentiation, and immune response such as inflammation or vascularization related to diabetic complication. This review will re-examine the metabolic role of PPAR-alpha, summarize data from clinical studies on the effect of PPAR-alpha agonist in diabetes, and will discuss the possible therapeutic role of PPAR-alpha activation.