The Impact of Short and Long-Term Exercise on the Expression of Arc and AMPARs During Evolution of the 6-Hydroxy-Dopamine Animal Model of Parkinson's Disease.

The loss of nigral dopaminergic neurons typical in Parkinson's disease (PD) is responsible for hyperexcitability of medium spiny neurons resulting in abnormal corticostriatal glutamatergic synaptic drive. Considering the neuroprotective effect of exercise, the changes promoted by exercise on AMPA-type glutamate receptors (AMPARs), and the role of activity-regulated cytoskeleton-associated protein (Arc) in the AMPARs trafficking, we studied the impact of short and long-term treadmill exercise during evolution of the unilateral 6-hydroxy-dopamine (6-OHDA) animal model of PD. Wistar rats were divided into sedentary and exercised groups, with and without lesion by 6-OHDA and followed up to 4 months. The exercised groups were subjected to a moderate treadmill exercise 3×/week. We measured the proteins tyrosine hydroxylase (TH), Arc, GluA1, and GluA2/3 in the striatum, substantia nigra, and motor cortex. Our results showed a higher reduction of TH expression in all sedentary groups when compared to all exercised groups in striatum and substantia nigra. In general, larger changes occurred in the striatum in the first and third months after training. After 1 month of exercise, there was significant increase of GluA2/3 with concomitant reduction of GluA1 and Arc. As a balanced system, these changes were reversed in the third month, showing an increase of Arc and GluA1 and decrease of GluA2/3. Similar results for GluAs and Arc were observed in the motor cortex of the exercised animals. These modifications may be relevant for corticostriatal circuits in PD, since the exercise-dependent plasticity can modulate GluAs expression and maybe neuronal excitability.

Supplemented vs. unsupplemented human milk on bone mineralization in very low birth weight preterm infants: a randomized clinical trial.

UNLABELLED: Very low birth weight preterm newborns weighing less than 1500 g were randomized to receive human milk supplemented with FM 85® or not. They have similar bone mineral content (BMC) at baseline, but, at the end of study, BMC was increasingly higher in the FM 85® group. INTRODUCTION: The purpose of this study is to evaluate the effectiveness of a human milk supplement (FM 85®; Nestlé, Vevey, Switzerland) developed for the purpose of improving nutrition, including bone mineralization, in very low birth weight preterm newborns. METHODS: Preterm infants weighing less than 1500 g at birth admitted to the neonatal intensive care unit of a university hospital were studied. During hospitalization, they were fed at least 50 % of human milk. Newborns with ≥20 days of age were randomly assigned to the intervention group (n = 19) to receive human milk supplemented with FM 85® or to a control group (n = 19) to receive human milk only. Anthropometric measurements, whole-body bone densitometry (DXA), and biochemical tests were performed at study entry and at the end of the study (shortly before discharge when the infant had reached 2000 g). RESULTS: There were no start- or end-of-study differences between the two groups, except for daily increase in length (p = 0.010). At baseline, both groups had similar BMC: 5.49 ± 3.65 vs. 4.34 ± 2.98 g (p = 0.39) for the intervention and control group, respectively. However, at the end of the study, BMC was higher in the intervention group: 10.3 ± 4.71 vs. 6.19 ± 3.23 g (p = 0.003). The mean increase in BMC during the observation period was 4.90 ± 4.46 g for the intervention group and 1.86 ± 3.17 g for the control group (p = 0.020). Serum alkaline phosphatase levels were higher in the control group (720 ± 465 vs. 391 ± 177 IU/L; p = 0.007). CONCLUSIONS: Our data suggest that supplementation of human milk with FM 85® leads to improved bone mineralization in very low birth weight preterm newborns.

Intramuscular midazolam versus intravenous diazepam for treatment of seizures in the pediatric emergency department: a randomized clinical trial.

AIM: To compare the therapeutic efficacy of intramuscular midazolam (MDZ-IM) with that of intravenous diazepam (DZP-IV) for seizures in children. DESIGN: Randomized clinical trial. SETTING: Pediatric emergency department. PATIENTS: Children aged 2 months to 14 years admitted to the study facility with seizures. INTERVENTION: Patients were randomized to receive DZP-IV or MDZ-IM. MAIN MEASUREMENTS: Groups were compared with respect to time to treatment start (min), time from drug administration to seizure cessation (min), time to seizure cessation (min), and rate of treatment failure. Treatment was considered successful when seizure cessation was achieved within 5min of drug administration. RESULTS: Overall, 32 children (16 per group) completed the study. Intravenous access could not be obtained within 5min in four patients (25%) in the DZP-IV group. Time from admission to active treatment and time to seizure cessation was shorter in the MDZ-IM group (2.8 versus 7.4min; p<0.001 and 7.3 versus 10.6min; p=0.006, respectively). In two children per group (12.5%), seizures continued after 10min of treatment, and additional medications were required. There were no between-group differences in physiological parameters or adverse events (p=0.171); one child (6.3%) developed hypotension in the MDZ-IM group and five (31%) developed hyperactivity or vomiting in the DZP-IV group. CONCLUSION: Given its efficacy and ease and speed of administration, intramuscular midazolam is an excellent option for treatment of childhood seizures, enabling earlier treatment and shortening overall seizure duration. There were no differences in complications when applying MDZ-IM or DZP-IV.

Cytogenetic comparison of tree frogs of the genus Aplastodiscus and the Hypsiboas faber group (Anura, Hylidae).

Four species of Aplastodiscus and two species of Hypsiboas were cytogenetically compared. Aplastodiscus perviridis, A. cochranae, H. albomarginaus, and H. faber had 2n = 24 chromosomes, while A. albosignatus and A. leucopygius had 2n = 20 and 2n = 18 chromosomes, respectively. Aplastodiscus perviridis and A. cochranae had identical karyotypes, as indicated by their chromosomal morphology, the location of the nucleolus organizer region (NOR) on chromosome pair 12, and the heterochromatin pattern. The NOR-bearing chromosomes of A. albosignatus and A. leucopygius (pair 9) were very similar in size and morphology (metacentric) when compared to A. perviridis and A. cochranae (pair 12) and to H. faber (pair 11); the NOR of these chromosomes also occurred in the same region, suggesting that these chromosomes are homologous. Although H. albomarginatus differs from the other species with regard to the location of its NOR on pair 2, this species had the same diploid number and a chromosomal morphology similar to that of A. perviridis and A. cochranae. Chromosomal differentiation among the species appears to have occurred by reduction in chromosome number.

NOR dispersion, telomeric sequence detection in centromeric regions and meiotic multivalent configurations in species of the Aplastodiscus albofrenatus group (Anura, Hylidae).

In the present study, we examined the chromosome number and morphology, heterochromatin pattern, and location of the nucleolar organizer region (NOR) and telomeric sequences in Aplastodiscus albofrenatus, A. arildae, A. ehrhardti and A. eugenioi in order to cytogenetically characterize the Aplastodiscus albofrenatus group. The 4 species analyzed in this study had diploid numbers of 2n = 22 and very similar chromosome morphology. These species could be differentiated based on the distribution and amount of heterochromatin and the location of the nucleolar organizer region (NOR). Six of the 8 A. albofrenatus individuals had an NOR polymorphism previously unknown in anurans since only one of the homologs of pairs 1 and 7 was stained. In the other 2 specimens, the NOR occurred on both homologs of pair 7. In A. ehrhardti, pairs 6 and 10 were stained by the AgNOR technique, but only pair 6 was confirmed by in situ hybridization. The NOR was located on pair 10 in A. arildae and on pair 7 in A. eugenioi. In A. albofrenatus and A. arildae, multivalent rings involving NOR-containing chromosomes were observed during prophase I of meiosis. The telomeric probe identified the telomeres in all species and also centromeric regions in the chromosomes of A. albofrenatus and A. arildae, which were coincident with centromeric heterochromatin. The conserved chromosomal morphology seen mainly in the first 7 pairs among species of the A. albofrenatus group suggests that all of these species probably originated from a common ancestral karyotype and that chromosomal rearrangements resulted in karyotype differentiation, with changes in NOR location, as well as telomeric and heterochromatin dispersal.

Accidental asphyxia due to closing of a motor vehicle power window.

Injuries and deaths among children left unattended in motor vehicles are frequent and the rates are increasing. Injuries associated with motor vehicle power windows usually affect children, in particular children under 6 years of age. This case report is about a child who was asphyxiated because of a motor vehicle power window closing. She was rapidly resuscitated and recovered fully. A brief review of the literature, epidemiology, and preventive measures to avoid this type of injury is also presented.

Hiperglicemia e uso da insulina na criança criticamente enferma / Hyperglycemia and use of the insulin in critically ill child

O objetivo deste trabalho é descrever sobre mecanismos da hiperglicemia e resistência à insulina na sepse grave e choque séptico, suas repercurssões em morbimortalidade nas Unidades de Tratamento Intensivo Pediátrico, assim como resultados e segurança do uso da insulina. Realizou-se revisão bibliográfica no banco de dados Medline no período de 1998 a 2005, utilizando os termos insulina, hiperglicemia, sepse e choque séptico. Estudos em adultos, relatam benefícios em mortalidade e morbidade com controle glicêmico estrito e uso de insulina. Os trabalhos envolvendo pacientes pediátricos, na maioria retros, apontam para resultados semelhantes. Os riscos de hipoglicemia não parecem significativos. Embora ainda não se disponha de evidências adequadas, parece prudente oferecer, aos pacientes pediátricos, controle glicêmico e uso de insulina quando necessário. Sugere-se protocolo clínico de controle glicêmico e uso da insulina nestes pacientes.

Haemophilus paragallinarum secretes metalloproteases.

Haemophilus paragallinarum secretes metalloproteases into different culture media lacking serum. Secreted proteins, concentrated by precipitation with 70% ammonium sulphate ((NH(4))(2)SO(4)) or methanol, displayed proteolytic activity at >100 kDa molecular mass in 10% polyacrylamide gels co-polymerized with porcine gelatin (0.1%). They were active in a broad pH range (4-9); pH 7.5 being the optimum. Protease activity was inhibited by 20 mmol EDTA/L and reactivated by calcium. The proteolytic activity was heat-stable at 40, 50, and 60 degrees C, but its activity diminished at 70 degrees C or higher. Secreted proteins partially degraded chicken immunoglobulin G (IgG) and cross-reacted with a polyclonal serum against a high molecular mass protease secreted by Actinobacillus pleuropneumoniae. Extracellular proteases could play a role in infectious coryza caused by H. paragallinarum.

Direct action of the biocide carbendazim on phenolic metabolism in tobacco plants.

In view of the essential role of phenolic compounds in the development of pathogen resistance in plants, and given the influence that fungicides exert over phenolic metabolism, the aim of the present study was to determine the effect of the application of different rates of fungicide on the metabolism of phenolic compounds in tobacco plants (Nicotiana tabacum L. cv. Tennessee 86). The fungicide applied was carbendazim, with a purity of 100%, at three different rates: 1.3 mM (carb(1)), 2.6 mM (this being the recommended concentration, carb(2)), and 5.2 mM (carb(3)). The control treatment was without carbendazim. The results in relation to control plants indicate that the application of carb(1) in tobacco plants not afflicted by damaging biotic and abiotic agents boosts phenolic accumulation. Therefore, in the case of carbendazim, the application of 50% less (carb(1), 1.3 mM) than the recommended dosage (carb(2), 2.6 mM) of this fungicide could be more effective, because the foliar accumulation of phenolics presented at carb(1) may imply an increased resistance of plants to pathogen infection. On the other hand, we found an inhibition of the phenolic oxidation by the application of carbendazim, principally at carb(3). These results suggest that the excessive application of carbendazim (5.2 mM) could be harmful for healthy plants, because, on inhibiting phenolic metabolism (biosynthesis and oxidation), such treatment would also sharply reduce the capacity of these plants to respond against pathogen attack.

Resistance to cold and heat stress: accumulation of phenolic compounds in tomato and watermelon plants.

Tomato plants, Lycopersicon esculentum L. cv. Tmknvf(2), and watermelon plants, Citrullus lanatus [Thomb.] Mansf. cv. Dulce maravilla, were grown for 30 days at different temperatures (15, 25 and 35 degrees C). We analysed soluble phenolics, enzymatic activities (phenylalanine ammonia-lyase, polyphenol oxidase and peroxidase), and dry weight. The impact of the three temperatures was different in tomato and watermelon. Our results indicate that heat stress in tomato plants occurred at 35 degrees C, while chilling stress occurred in watermelon plants at 15 degrees C. Thermal stress in both plants caused: (1) decreased shoot weight; (2) accumulation of soluble phenolics; (3) highest phenylalanine ammonia-lyase activity; and (4) lowest peroxidase and polyphenol oxidase activity. These results indicate that thermal stress induces the accumulation of phenolics in the plant by activating their biosynthesis as well as inhibiting their oxidation. This could be considered an acclimation mechanism of the plant against thermal stress.

[Exogenous surfactant treatment for severe acute viral bronchiolitis: case report] / Uso de surfactante exógeno no tratamento da bronquiolite viral grave: relato de caso.

OBJECTIVE: To describe the possible clinical and laboratory effects of exogenous surfactant instillation into the tracheal tube of a child with severe acute bronchiolitis undergoing mechanical ventilation. CASE REPORT: a 2-month-old girl with clinical diagnosis of acute viral bronchiolitis underwent mechanical ventilation. She required high positive inspiratory peak pressure (35 to 45 cmH(2)O) and high inspiratory fraction of oxygen (FiO(2) = 0.9), but showed no clinical response or improvement in the arterial blood gas analysis. An exogenous surfactant (Exosurf(R), Glaxo - 50 mg/kg) was used to facilitate the use of a less aggressive ventilatory strategy. RESULTS: Four hours after surfactant administration, it was possible to reduce the positive peak inspiratory pressure (PIP) from 35 to 30 cmH(2)O, and FiO(2) from 0.9 to 0.6; and to increase the positive end-expiratory pressure (PEEP) from 6 to 9 cmH(2)O. During this period the paO(2)/FiO(2) ratio increased from 120 to 266. At the end of 24 hours, FiO(2) could be reduced to 0.4. DISCUSSION: Surfactant inactivation may be a decisive factor in the unfavorable evolution of some severe cases of acute bronchiolitis. The tracheal instillation of exogenous surfactant, in these cases, allows us to adopt less aggressive ventilatory strategies, and promotes rapid clinical responses.

[Short-term effects of prone positioning on the oxygenation of pediatric patients submitted to mechanical ventilation] / Efeito a curto prazo da posição prona na oxigenação de crianças em ventilação mecânica.

OBJECTIVE: To analyze the short-term effects of prone positioning on the oxygenation of mechanically-ventilated children suffering from severe hypoxemia. MATERIALS AND METHODS: A prospective, nonrandomized trial (each patient as his/her own control) was conducted between July 1998 and July 1999. Mechanically-ventilated children with peak inspiratory pressure greater than or equal to 30 cm H(2)O, FiO(2) greater than or equal to 0.5, and PaO(2)/FiO(2) ratio less than or equal to 200 were included in the study. Each patient was kept in the prone position for two hours, returning to the supine position after this period. Oxygenation was assessed by means of PaO(2)/FiO(2) in the supine position (one hour before prone positioning), one hour after prone positioning, and one hour after returning to the supine position. Patients who presented an increase of at least 20 in PaO(2)/FiO(2) were considered responsive. The results were compared by Student t-test, Friedman test, chi-square test, Fishers exact test, and confidence interval. RESULTS: Eighteen children (10 males), whose mean age was 11.5 -/+11.5 months, with initial PaO(2)/FiO(2) of 96.06 -/+ 41.78, participated in the study. After one hour in the prone position, 27.7% of the patients (5/18) improved their PaO(2)/FiO(2) ratio (P=0.045). Six of these patients presented reduced lung compliance (four of them had acute respiratory distress syndrome); and twelve patients showed increased airway resistance (six of them presented bronchiolitis). No significant difference was observed between these two groups (reduced lung compliance x increased airway resistance) in terms of age, sex, duration of ventilation prior to change in position, peak inspiratory pressure, FiO(2), severity of hypoxemia, and outcome. CONCLUSION: Prone positioning during mechanical ventilation of children with severe hypoxemia may improve the PaO(2)/FiO(2) ratio in the first hour.

[Randomized clinical trial of intravenous magnesium sulfate versus salbutamol in early management of severe acute asthma in children] / Estudo controlado do uso endovenoso de sulfato de magnésio ou de salbutamol no tratamento precoce da crise de asma aguda grave em crianças.

OBJECTIVE: To study the efficacy of intravenous magnesium sulfate and intravenous salbutamol in the treatment of severe asthma in children. METHODS: Randomized, double-blind, placebo-controlled clinical trial, including children above 2 years of age with severe acute asthma admitted to the observation ward of the Pediatric Intensive Care Unit of Hospital São Lucas. All patients received conventional treatment (oxygen, corticoids, beta-adrenergics) on admission, and later received one of the following solutions: a) IVMg (50 mg/kg); b) intravenous salbutamol (1 micro g/kg); c) saline solution. Clinical assessments, electrolyte concentration, and arterial blood gas analyses were recorded before intravenous infusion and one hour after that. RESULTS: Fifty patients participated in this study (of whom 53% were females, mean age = 4.5 years). There were no significant differences among the three groups. The group that received IVMg presented lower blood pressure during administration, which reached normal levels one hour afterwards, along with an increase in serum magnesium (P<0,001) and serum pH, and reduction of PaCO(2). The group that received intravenous salbutamol had lower respiratory rate (P=0.05) and higher blood pressure (P=0.01), and one hour after administration, these patients showed decreased respiratory rate (P=0.02); lower levels of serum potassium (P=0.009); higher pH, and reduced PaCO(2). This group required fewer nebulizations (P=0.009), fewer nebulizations per day (P<0.001) and less oxygen therapy than the IVMg and placebo groups. Acidosis was more persistent (P<0.01) in the placebo group. No difference as to the length of hospital stay was observed in any of the three groups. Artificial ventilation was necessary in 10% of the patients. CONCLUSIONS: The early intravenous administration of magnesium sulfate, especially salbutamol, achieved a rapid clinical response with excellent prognosis and no significant side effects.

[Congenital syphilis: an emerging emergency also in Brazil] / Sífilis congênita: uma emergência emergente também no Brasil.

OBJECTIVE: To highlight to the fact that some newborns are not identified as having congenital syphilis, and will present to an emergency room within a few months with a severe disease. METHOD: Review of the charts concerning 3 patients with congenital syphilis, as well as review of the literature using Medline and Lilacs databases, covering the period from 1988 to 1999. RESULTS: We describe the case of 3 infants whose diagnosis of congenital syphilis was only established after the neonatal period, when they presented to the emergency room and were admitted to the pediatric intensive care unit. The first patient had neurosyphilis and nephrotic syndrome, the second had neurosyphilis, and the third had hepatitis. We discuss the clinical aspects of the cases, and comment on other clinical manifestations of congenital syphilis that should be within the purview of pediatric emergency medicine. We analyze the reasons for the failure to diagnose syphilis at birth, and describe some risk factors for gestational syphilis. CONCLUSIONS: Considering the rising incidence of syphilis in Brazil, and the possibility that the congenital infections are not recognized at birth, emergency physicians must keep a high degree of suspicion and an awareness of maternal risk factors, prenatal serology pitfalls, as well as of the several clinical presentations of congenital syphilis that can develop in the first months of life.

Cytogenetics of two species of Paratelmatobius (Anura: Leptodactylidae), with phylogenetic comments.

In this paper we provide a cytogenetic analysis of Paratelmatobius cardosoi and Paratelmatobius poecilogaster. The karyotypes of both species showed a diploid number of 24 chromosomes and shared some similarity in the morphology of some pairs. On the other hand, pairs 4 and 6 widely differed between these complements. These karyotypes also differed in their NOR number and location. Size heteromorphism was seen in all NOR-bearing chromosomes of the two karyotypes. In addition, both karyotypes showed small centromeric C-bands and a conspicuous heterochromatic band in the short arm of chromosome 1, although with a different size in each species. The P. cardosoi complement also showed other strongly stained non-centromeric C-bands, with no counterparts in the P. cardosoi karyotype. Chromosome staining with fluorochromes revealed heterogeneity in the base composition of two of the non-centromeric C-bands of P. cardosoi. Comparison of the chromosomal morphology of these Paratelmatobius karyotypes with that of P. lutzii showed that the P. poecilogaster karyotype is more similar to that of P. lutzii than P. cardosoi. These cytogenetic results agree with the proposed species arrangements in the P. cardosoi and P. lutzii groups based on morphological and ecological data.

[Shock therapy in children] / Tratamento do choque na criança.

OBJECTIVE: Review the theoretical bases of the therapeutic approach for volumetric resuscitation of the infant in shock and the evolutionary process that take to the pharmacological support to the circulationMETHODS: References were obtained from computerized searches on the National Library of Medicine (Medline), recent review articles and personal files. RESULTS: Shock and septic shock is the leading cause of mortality in critically ill patients. The septic shock is an extremely complex disease process leading to progressive multiple organ failure. Its presentation may be subtle or catastrophic. Successful management depends on an understanding of the pathophysiology of the syndrome, allowing rapid, appropriate resuscitation. Treatment often requires aggressive correction of volume deficit, maintenance of adequate perfusion pressure with inotropic and vasopressor, mechanical ventilation and others therapies. CONCLUSIONS: The management of the shock in children presents a challenge for the pediatrician. Hemodynamic and respiratory instability should be anticipated. Management requires multisystemic and careful intervention.

[Acid-base balance disorders] / Distúrbios do equilíbrio ácido-básico.

OBJECTIVE: Review the theoretical bases on the maintenance of the acid-basic balance, the pathophysiology of the disturbances and its therapeutics in the child.METHODS: References were obtained from computerized searches on the National Library of Medicine (Medline), recent review articles and personal files.RESULTS: Acid-basic disturbances are frequently found in critical ill children. Their pathophysiology and main causes are a complex and multifactorial process. The management depends on precocious diagnosis and of the understanding of the base cause. The treatment should be adjusted for each disturbance and its base cause. Frequently it requests an aggressive correction and continuous monitoring.CONCLUSIONS: The knowledge of the physiology of the acid-basic balance as well as the understanding of the pathophysiology of the main disturbances associated to the clinical situations represent a challenge for the pediatrician. The management of acid-basic balance demands appropriate and careful intervention.