Terapia alternativa para o treinamento dos músculos respiratórios utilizando o breath stacking / Alternative therapy for respiratory muscle training using breath stacking

Objetivo: Avaliar a efetividade da técnica de breath-stacking como método de treinamento dos músculos ventilatórios. Métodos: Trinta e oito jovens saudáveis foram incluídos no estudo. A pressão respiratória máxima foi avaliada em cmH2O em um manovacuômetro digital. O sistema de breath-stacking (máscara facial conectada a um tubo T acoplado a uma válvula unidirecional inspiratória) foi o método utilizado para gerar a sobrecarga ao longo de 12 sessões do programa de treinamento da muscular (4 sessões/semana). Resultados: Ambas pressões inspiratórias e expiratórias máximas aumentaram significativamente após o treino dos músculos ventilatórios. O pico de pressão positiva aumentou significativamente ao final do programa. Conclusão: O breath-stacking gera sobrecarga suficiente para os músculos ventilatórios promovendo aumento consistente das pressões respiratórias máximas quando utilizado em um protocolo de treino da musculatura ventilatória. A técnica foi bem tolerada, mas permanece a necessidade de testes em situações clínicas que envolvam fraqueza muscular e outras disfunções orgânicas.

Effects of Transcutaneous Electrical Nerve Stimulation on Pain, Pulmonary Function, and Respiratory Muscle Strength After Posterolateral Thoracotomy: A Randomized Controlled Trial.

PURPOSE: To evaluate the effects of transcutaneous electrical nerve stimulation (TENS) compared to placebo TENS and a control group on pain, pulmonary function, respiratory muscle strength, and analgesic medications in the postoperative period of thoracotomy in an Intensive care unit (ICU). METHODS: Patients who had undergone posterolateral thoracotomy were randomly allocated to receive TENS during ICU stay, or placebo TENS, or into the control group. All groups received conventional physiotherapy. We analysed the intensity of pain, pulmonary function, respiratory muscle strength, and use of analgesia medications. Outcomes were evaluated before surgery, immediately after, 24 and 48 h after ICU admission. RESULTS: Forty-five patients were included. Regarding pain perception, there was no difference between groups (p = 0.172), but there was a significant reduction in pain intensity for patients receiving TENS after first physiotherapy session compared to baseline (4.7 ± 3.2 vs 3.3 ± 2.6; p < 0.05). All groups had a decrease in forced vital capacity (FVC) after surgery (p < 0.001). There was no difference between the groups regarding the use of analgesic medications, but a higher intake of morphine and acetaminophen were observed for the control (p = 0.037) and placebo group (p = 0.035), respectively. CONCLUSION: The use of TENS provides a little benefit of pain (in the first 12 h) but failed to demonstrate any improvement in the recovery of ICU patients after 48 h of posterolateral thoracotomy. TRIAL REGISTRATION: NCT02438241.

Segurança e potenciais benefícios da fisioterapia em adultos submetidos ao suporte de vida com oxigenação por membrana extracorpórea: uma revisão sistemática / Safety and potential benefits of physical therapy in adult patients on extracorporeal membrane oxygenation support: a systematic review

RESUMO O avanço científico e tecnológico associado à atuação de equipes multidisciplinares nas unidades de terapia intensiva tem aumentado a sobrevida de pacientes críticos. Dentre os recursos de suporte de vida utilizados em terapia intensiva, está a oxigenação por membrana extracorpórea. Apesar das evidências aumentarem, faltam dados para demonstrar a segurança e os benefícios da fisioterapia concomitante ao uso da oxigenação por membrana extracorpórea. Esta revisão reúne as informações disponíveis sobre a repercussão clínica da fisioterapia em adultos submetidos à oxigenação por membrana extracorpórea. A revisão incluiu as bases MEDLINE®, PEDro, Cochrane CENTRAL, LILACS e EMBASE, além da busca manual nas referências dos artigos relacionados até setembro de 2017. A busca resultou em 1.213 registros. Vinte estudos foram incluídos, fornecendo dados de 317 indivíduos (58 no grupo controle). Doze estudos não relataram complicações durante a fisioterapia. Fratura da cânula durante a deambulação, trombo na cânula de retorno e hematoma na perna em um paciente cada foram relatados por dois estudos, dessaturação e vertigens leves foram relatadas em dois estudos. Por outro lado, foram feitos relatos de melhora na condição respiratória/pulmonar, capacidade funcional e força muscular, com redução de perda de massa muscular, incidência de miopatia, tempo de internação e mortalidade dos pacientes que realizaram a fisioterapia. Analisando o conjunto das informações disponíveis, pode-se observar que a fisioterapia, incluindo a mobilização precoce progressiva, ortostase, deambulação e técnicas respiratórias, executada de forma simultânea à oxigenação por membrana extracorpórea, é viável, relativamente segura e potencialmente benéfica para adultos em condição clínica extremamente crítica.

Abstract Scientific and technological advances, coupled with the work of multidisciplinary teams in intensive care units, have increased the survival of critically ill patients. An essential life support resource used in intensive care is extracorporeal membrane oxygenation. Despite the increased number of studies involving critically ill patients, few studies to date have demonstrated the safety and benefits of physical therapy combined with extracorporeal membrane oxygenation support. This review identified the clinical outcomes of physical therapy in adult patients on extracorporeal membrane oxygenation support by searching the MEDLINE®, PEDro, Cochrane CENTRAL, LILACS, and EMBASE databases and by manually searching the references of the articles published until September 2017. The database search retrieved 1,213 studies. Of these studies, 20 were included in this review, with data on 317 subjects (58 in the control group). Twelve studies reported that there were no complications during physical therapy. Cannula fracture during ambulation (one case), thrombus in the return cannula (one case), and leg swelling (one case) were reported in two studies, and desaturation and mild vertigo were reported in two studies. In contrast, improvements in respiratory/pulmonary function, functional capacity, muscle strength (with reduced muscle mass loss), incidence of myopathy, length of hospitalization, and mortality in patients who underwent physical therapy were reported. The analysis of the available data indicates that physical therapy, including early progressive mobilization, standing, ambulation, and breathing techniques, together with extracorporeal membrane oxygenation, is feasible, relatively safe, and potentially beneficial for critically ill adult patients.

Safety and potential benefits of physical therapy in adult patients on extracorporeal membrane oxygenation support: a systematic review. / Segurança e potenciais benefícios da fisioterapia em adultos submetidos ao suporte de vida com oxigenação por membrana extracorpórea: uma revisão sistemática.

Scientific and technological advances, coupled with the work of multidisciplinary teams in intensive care units, have increased the survival of critically ill patients. An essential life support resource used in intensive care is extracorporeal membrane oxygenation. Despite the increased number of studies involving critically ill patients, few studies to date have demonstrated the safety and benefits of physical therapy combined with extracorporeal membrane oxygenation support. This review identified the clinical outcomes of physical therapy in adult patients on extracorporeal membrane oxygenation support by searching the MEDLINE®, PEDro, Cochrane CENTRAL, LILACS, and EMBASE databases and by manually searching the references of the articles published until September 2017. The database search retrieved 1,213 studies. Of these studies, 20 were included in this review, with data on 317 subjects (58 in the control group). Twelve studies reported that there were no complications during physical therapy. Cannula fracture during ambulation (one case), thrombus in the return cannula (one case), and leg swelling (one case) were reported in two studies, and desaturation and mild vertigo were reported in two studies. In contrast, improvements in respiratory/pulmonary function, functional capacity, muscle strength (with reduced muscle mass loss), incidence of myopathy, length of hospitalization, and mortality in patients who underwent physical therapy were reported. The analysis of the available data indicates that physical therapy, including early progressive mobilization, standing, ambulation, and breathing techniques, together with extracorporeal membrane oxygenation, is feasible, relatively safe, and potentially beneficial for critically ill adult patients.

O avanço científico e tecnológico associado à atuação de equipes multidisciplinares nas unidades de terapia intensiva tem aumentado a sobrevida de pacientes críticos. Dentre os recursos de suporte de vida utilizados em terapia intensiva, está a oxigenação por membrana extracorpórea. Apesar das evidências aumentarem, faltam dados para demonstrar a segurança e os benefícios da fisioterapia concomitante ao uso da oxigenação por membrana extracorpórea. Esta revisão reúne as informações disponíveis sobre a repercussão clínica da fisioterapia em adultos submetidos à oxigenação por membrana extracorpórea. A revisão incluiu as bases MEDLINE®, PEDro, Cochrane CENTRAL, LILACS e EMBASE, além da busca manual nas referências dos artigos relacionados até setembro de 2017. A busca resultou em 1.213 registros. Vinte estudos foram incluídos, fornecendo dados de 317 indivíduos (58 no grupo controle). Doze estudos não relataram complicações durante a fisioterapia. Fratura da cânula durante a deambulação, trombo na cânula de retorno e hematoma na perna em um paciente cada foram relatados por dois estudos, dessaturação e vertigens leves foram relatadas em dois estudos. Por outro lado, foram feitos relatos de melhora na condição respiratória/pulmonar, capacidade funcional e força muscular, com redução de perda de massa muscular, incidência de miopatia, tempo de internação e mortalidade dos pacientes que realizaram a fisioterapia. Analisando o conjunto das informações disponíveis, pode-se observar que a fisioterapia, incluindo a mobilização precoce progressiva, ortostase, deambulação e técnicas respiratórias, executada de forma simultânea à oxigenação por membrana extracorpórea, é viável, relativamente segura e potencialmente benéfica para adultos em condição clínica extremamente crítica.

Thiol/disulfide status regulates the activity of thiol-containing kinases related to energy homeostasis in rat kidney

ABSTRACT Considering that thiol-containing enzymes like kinases are critical for several metabolic pathways and energy homeostasis, we investigated the effects of cystine dimethyl ester and/or cysteamine administration on kinases crucial for energy metabolism in the kidney of Wistar rats. Animals were injected twice a day with 1.6 µmol/g body weight cystine dimethyl ester and/or 0.26 µmol/g body weight cysteamine from the 16th to the 20th postpartum day and euthanized after 12 hours. Pyruvate kinase, adenylate kinase, creatine kinase activities and thiol/disulfide ratio were determined. Cystine dimethyl ester administration reduced thiol/disulfide ratio and inhibited the kinases activities. Cysteamine administration increased the thiol/disulfide ratio and co-administration with cystine dimethyl ester prevented the inhibition of the enzymes. Regression between the thiol/disulfide ratio, and the kinases activities were significant. These results suggest that redox status may regulate energy metabolism in the rat kidney. If thiol-containing enzymes inhibition and oxidative stress occur in patients with cystinosis, it is possible that lysosomal cystine depletion may not be the only beneficial effect of cysteamine administration, but also its antioxidant and thiol-protector effect.

Thiol/disulfide status regulates the activity of thiol-containing kinases related to energy homeostasis in rat kidney.

Considering that thiol-containing enzymes like kinases are critical for several metabolic pathways and energy homeostasis, we investigated the effects of cystine dimethyl ester and/or cysteamine administration on kinases crucial for energy metabolism in the kidney of Wistar rats. Animals were injected twice a day with 1.6 µmol/g body weight cystine dimethyl ester and/or 0.26 µmol/g body weight cysteamine from the 16th to the 20th postpartum day and euthanized after 12 hours. Pyruvate kinase, adenylate kinase, creatine kinase activities and thiol/disulfide ratio were determined. Cystine dimethyl ester administration reduced thiol/disulfide ratio and inhibited the kinases activities. Cysteamine administration increased the thiol/disulfide ratio and co-administration with cystine dimethyl ester prevented the inhibition of the enzymes. Regression between the thiol/disulfide ratio, and the kinases activities were significant. These results suggest that redox status may regulate energy metabolism in the rat kidney. If thiol-containing enzymes inhibition and oxidative stress occur in patients with cystinosis, it is possible that lysosomal cystine depletion may not be the only beneficial effect of cysteamine administration, but also its antioxidant and thiol-protector effect.

Expiratory rib cage compression in mechanically ventilated adults: systematic review with meta-analysis. / Manobra de compressão torácica expiratória em adultos ventilados mecanicamente: revisão sistemática com metanálise.

OBJECTIVE:: To review the literature on the effects of expiratory rib cage compression on ventilatory mechanics, airway clearance, and oxygen and hemodynamic indices in mechanically ventilated adults. METHODS:: Systematic review with meta-analysis of randomized clinical trials in the databases MEDLINE (via PubMed), EMBASE, Cochrane CENTRAL, PEDro, and LILACS. Studies on adult patients hospitalized in intensive care units and under mechanical ventilation that analyzed the effects of expiratory rib cage compression with respect to a control group (without expiratory rib cage compression) and evaluated the outcomes static and dynamic compliance, sputum volume, systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, peripheral oxygen saturation, and ratio of arterial oxygen partial pressure to fraction of inspired oxygen were included. Experimental studies with animals and those with incomplete data were excluded. RESULTS:: The search strategy produced 5,816 studies, of which only three randomized crossover trials were included, totaling 93 patients. With respect to the outcome of heart rate, values were reduced in the expiratory rib cage compression group compared with the control group [-2.81 bpm (95% confidence interval [95%CI]: -4.73 to 0.89; I2: 0%)]. Regarding dynamic compliance, there was no significant difference between groups [-0.58mL/cmH2O (95%CI: -2.98 to 1.82; I2: 1%)]. Regarding the variables systolic blood pressure and diastolic blood pressure, significant differences were found after descriptive evaluation. However, there was no difference between groups regarding the variables secretion volume, static compliance, ratio of arterial oxygen partial pressure to fraction of inspired oxygen, and peripheral oxygen saturation. CONCLUSION:: There is a lack of evidence to support the use of expiratory rib cage compression in routine care, given that the literature on this topic offers low methodological quality and is inconclusive.

Manobra de compressão torácica expiratória em adultos ventilados mecanicamente: revisão sistemática com metanálise / Expiratory rib cage compression in mechanically ventilated adults: systematic review with meta-analysis

RESUMO Objetivo: Revisar na literatura os efeitos da manobra de compressão torácica expiratória sobre a mecânica ventilatória, a desobstrução brônquica, e os índices de oxigenação e hemodinâmica de pacientes adultos ventilados mecanicamente. Métodos: Foi realizada uma revisão sistemática com metanálise de ensaios clínicos randomizados nas bases de dados MEDLINE (via PubMed), EMBASE, Cochrane CENTRAL, PEDro e LILACS. Foram incluídos estudos com pacientes adultos, internados em unidades de terapia intensiva, ventilados mecanicamente, que comparavam os efeitos da manobra de compressão torácica expiratória com grupo controle (sem manobra de compressão torácica expiratória) e que avaliaram os seguintes desfechos: complacência estática e dinâmica, volume de secreção depurado, pressão arterial sistólica, pressão arterial diastólica, pressão arterial média, frequência cardíaca, saturação periférica de oxigênio e relação entre pressão arterial de oxigênio e fração inspirada de oxigênio. Foram excluídos estudos experimentais com animais e estudos com dados incompletos. Resultados: A estratégia de busca resultou em 5.816 estudos, sendo incluídos apenas três estudos randomizados com crossover, totalizando 93 pacientes. No desfecho de frequência cardíaca, observou-se redução a favor da manobra de compressão torácica expiratória, comparada com o grupo controle [-2,81bpm (IC95%: -4,73 a 0,89; I2: 0%)]. Na complacência dinâmica, não foi observada diferença significativa entre os grupos [-0,58mL/cmH2O (IC95%: -2,98 a 1,82; I2: 1%)]. Nas variáveis, pressão arterial sistólica e pressão arterial diastólica após avaliação descritiva, foram encontradas diferenças significativas, entretanto, para variáveis volume de secreção, complacência estática, relação pressão arterial de oxigênio por fração inspirada de oxigênio e saturação periférica de oxigênio, não foram encontradas diferenças entre os grupos. Conclusão: Faltam evidências que sustentem o uso da manobra de compressão torácica expiratória na rotina assistencial, pois a literatura sobre o tema é de baixa qualidade metodológica e inconclusiva.

ABSTRACT Objective: To review the literature on the effects of expiratory rib cage compression on ventilatory mechanics, airway clearance, and oxygen and hemodynamic indices in mechanically ventilated adults. Methods: Systematic review with meta-analysis of randomized clinical trials in the databases MEDLINE (via PubMed), EMBASE, Cochrane CENTRAL, PEDro, and LILACS. Studies on adult patients hospitalized in intensive care units and under mechanical ventilation that analyzed the effects of expiratory rib cage compression with respect to a control group (without expiratory rib cage compression) and evaluated the outcomes static and dynamic compliance, sputum volume, systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, peripheral oxygen saturation, and ratio of arterial oxygen partial pressure to fraction of inspired oxygen were included. Experimental studies with animals and those with incomplete data were excluded. Results: The search strategy produced 5,816 studies, of which only three randomized crossover trials were included, totaling 93 patients. With respect to the outcome of heart rate, values were reduced in the expiratory rib cage compression group compared with the control group [-2.81 bpm (95% confidence interval [95%CI]: -4.73 to 0.89; I2: 0%)]. Regarding dynamic compliance, there was no significant difference between groups [-0.58mL/cmH2O (95%CI: -2.98 to 1.82; I2: 1%)]. Regarding the variables systolic blood pressure and diastolic blood pressure, significant differences were found after descriptive evaluation. However, there was no difference between groups regarding the variables secretion volume, static compliance, ratio of arterial oxygen partial pressure to fraction of inspired oxygen, and peripheral oxygen saturation. Conclusion: There is a lack of evidence to support the use of expiratory rib cage compression in routine care, given that the literature on this topic offers low methodological quality and is inconclusive.

Alternative Physical Therapy Protocol Using a Cycle Ergometer During Hospital Rehabilitation of Coronary Artery Bypass Grafting: a Clinical Trial

ABSTRACT OBJECTIVE: To compare the efficacy of a cycle ergometer-based exercise program to a standard protocol on the increment of the maximum distance walked during the six-minute walk test in the postoperative rehabilitation of patients submitted to coronary artery bypass grafting. METHODS: A controlled clinical trial pilot, blinded to the outcome, enrolled subjects who underwent coronary artery bypass grafting in a hospital from Southern Brazil. Subjects were designated for the standard physical rehabilitation protocol or to an alternative cycle ergometer-based protocol through simple random sampling. The primary outcome was the difference in the maximum distance walked in the six-minute walk test before and after the allocated intervention. RESULTS: Twenty-four patients were included in the analysis, 10 in the standard protocol and 14 in the alternative protocol group. There was an increment in the maximum distance walked in both groups, and borderline superiority in the intervention group comparing to the control group (312.2vs. 249.7; P=0.06). CONCLUSION: There was an increase in the maximum distance walked in the alternative protocol compared to the standard protocol. Thus, it is postulated that the use of a cycle ergometer can be included in physical rehabilitation in the hospital phase of postoperative coronary artery bypass grafting. However, randomized studies with larger sample size should be conducted to assess the significance of these findings.

Alternative Physical Therapy Protocol Using a Cycle Ergometer During Hospital Rehabilitation of Coronary Artery Bypass Grafting: a Clinical Trial.

OBJECTIVE: To compare the efficacy of a cycle ergometer-based exercise program to a standard protocol on the increment of the maximum distance walked during the six-minute walk test in the postoperative rehabilitation of patients submitted to coronary artery bypass grafting. METHODS: A controlled clinical trial pilot, blinded to the outcome, enrolled subjects who underwent coronary artery bypass grafting in a hospital from Southern Brazil. Subjects were designated for the standard physical rehabilitation protocol or to an alternative cycle ergometer-based protocol through simple random sampling. The primary outcome was the difference in the maximum distance walked in the six-minute walk test before and after the allocated intervention. RESULTS: Twenty-four patients were included in the analysis, 10 in the standard protocol and 14 in the alternative protocol group. There was an increment in the maximum distance walked in both groups, and borderline superiority in the intervention group comparing to the control group (312.2 vs. 249.7; P=0.06). CONCLUSION: There was an increase in the maximum distance walked in the alternative protocol compared to the standard protocol. Thus, it is postulated that the use of a cycle ergometer can be included in physical rehabilitation in the hospital phase of postoperative coronary artery bypass grafting. However, randomized studies with larger sample size should be conducted to assess the significance of these findings.

The effect of exercise on the oxidative stress induced by experimental lung injury.

AIM: The effects of physical exercise on oxidative stress parameters and immunocontent of NF-кß/p65 in lung of rats submitted to lung injury, as well as its possible protective effect on the changes in the alveolar-capillary barrier (total cell count, lactate dehydrogenase and total protein) in the bronchoalveolar lavage fluid (BALF) and the inflammatory infiltration in the pulmonary parenchyma were evaluated. MAIN METHODS: Wistar rats were submitted to two months of physical exercise and after this period, lung injury was induced by intratracheal instillation of lipopolysaccharide (dose of 100 µg/100 g body weight). Twelve hours after injury, the animals were sacrificed and lung and BALF were collected. KEY FINDINGS: Results showed an increase in reactive species production, lipid peroxidation, oxidative damage to protein, as well as in nitrite levels and NF-кß/p65 immunocontent in lung of rats submitted to lung injury. Physical exercise was able to totally prevent the increase in reactive species, nitrite levels and NF-кß/p65 immunocontent, but partially prevented the damage to protein. Superoxide dismutase and catalase were not changed in lung injury group, but the activities of these enzymes were increased in lung injury plus exercise group. Non-enzymatic antioxidant capacity, glutathione content and glutathione peroxidase were decreased and exercise totally prevented such effects. Rats subjected to lung injury presented an increase in total cell, lactate dehydrogenase and total protein; exercise partially prevented the increase in lactate dehydrogenase. SIGNIFICANCE: These findings suggest that physical exercise may prevent, at least partially, the oxidative damage caused by experimental lung injury, suggesting that exercise may have an important role as protector in this condition.

Antioxidant effect of cysteamine in brain cortex of young rats.

Cysteamine is a cystine-depleting drug used in the treatment of cystinosis, a metabolic disorder caused by deficiency of the lysosomal cystine carrier. As a result, cystine accumulates within lysosomes in many tissues and organs, including the nervous system. Studies with cystine dimethyl ester loaded cells suggest that cystine might induce apoptosis through oxidative stress. Our objective was to investigate the effects of co-administration of cysteamine with the oxidant cystine dimethyl ester on several parameters of oxidative stress in the brain cortex of rats. Animals were injected with 1.6 micromol/g cystine dimethyl ester and/or 0.26 micromol/g body weight cysteamine. Cystine dimethyl ester induced lipoperoxidation, protein carbonylation, and stimulated superoxide dismutase, glutathione peroxidase and catalase activities, probably through the formation of free radicals. Cysteamine prevented those effects, possibly increasing cellular thiol pool and acting as a scavenger of free radicals. These results suggest that the antioxidant effect of cysteamine may be important in the treatment of cystinosis.

Effects of cysteamine on oxidative status in cerebral cortex of rats.

Cystinosis is a systemic genetic disease caused by a lysosomal transport deficiency accumulating cystine in most tissues. Tissue damage depends on cystine accumulation, but the mechanisms of this damage are still obscure. Cysteamine administration depletes cystine accumulated, increasing survive of affected patients. Studies performed in fibroblasts of cystinotic patients suggest that apoptosis is enhanced in this disease. Considering that oxidative stress is a known apoptosis inducer, our main objective was to investigate a possible antioxidant effect of cysteamine on several parameters of oxidative stress in the brain of young rats. Animals received three subcutaneous injections at 3-h intervals of a buffered solution (pH 7.4) of 10 mg/kg body weight cysteamine and were sacrificed 1 h after the last injection. Cysteamine decreased lipoperoxidation and glutathione peroxidase activity, and increased the carbonyl content of proteins and catalase activity. In vitro studies showed that cysteamine reduced lipoperoxidation, 2',7'-dihydrodichlorofluorescein oxidation, carbonyl content of proteins and catalase activity, and increased glutathione peroxidase activity. These results suggest that cysteamine may act as a scavenger of superoxide free radicals and hydrogen peroxide. Therefore, it is possible that cysteamine may extend life of cystinotic patients acting not only as a cystine depleting drug, but also as a free radical scavenger, reducing cell damage by apoptosis.

Evaluation of renal enzymuria and cellular excretion as an marker of acute nephrotoxicity due to an overdose of paracetamol in Wistar rats.

INTRODUCTION: The present study was conducted to determine whether the urinary levels of excreted enzymes, gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), aspartate (AST) and alanine aminotransferases (ALT), can efficiently indicate, within 24 h, an acute nephrotoxicity due to an overdose of paracetamol (PAR). METHODS: A baseline urine was collected from the experimental group. Thereafter, blood collected from the orbital sinus (1.0 ml) and paracetamol (650 mg/kg of body weight) was administered by gavage. After the drug administration, animals were returned to the metabolic cages and then urine was collected in the next 22 h. Blood and urine collection was performed at time 0+24 h (T(24)), as well as at times 48 and 72 h (T(48) and T(72)). After the last urine and blood collection, the rats were killed and the kidneys removed and prepared for histological examination. Plasma creatinine and urinary levels of creatinine (to determinate glomerular filtration rate-GFR), GGT, ALP, LDH, ALT and AST were measured. Kidney tissues were stained with hematoxylin and eosin stain for histological assessment. RESULTS: Urinary levels of GGT, ALP and LDH enzymes were significantly higher (P<0.05) at T(24) when compared to the levels at T(0) and returned to basal levels at T(48) and T(72). The number of urinary epithelial cells at T(24) was significantly higher when compared to the control time (T(0)) (P<0.001). The GFR was significantly reduced 24, 48 and 72 h after the drug administration. CONCLUSION: The number of urinary epithelial cells and urinary enzymes levels are a simple and low cost procedure that is available and can help in the detection of renal acute lesions.

Proline reduces creatine kinase activity in the brain cortex of rats.

Type II hyperprolinemia is an inherited disorder caused by a deficiency of delta 1-pyrroline-5-carboxilic acid dehydrogenase, whose biochemical hallmark is proline accumulation in plasma and tissues. Although neurological symptoms occur in most patients, the neurotoxicity of proline is still controversial. The main objective of the present study was to investigate the effect of acute and chronic administration of proline on creatine kinase activity of brain cortex of Wistar rats. Acute treatment was performed by subcutaneous administration of one injection of proline to 22-day-old rats. For chronic treatment, proline was administered twice a day from the 6th to the 21st postpartum day. The results showed that creatine kinase activity was significantly inhibited in the brain cortex of rats subjected to acute proline administration. In contrast, this activity was increased in animals subjected to chronic administration. We also measured the in vitro effect of proline on creatine kinase activity in cerebral cortex of 22-day-old nontreated rats. Proline significantly inhibited creatine kinase activity. Considering the importance of creatine kinase forthe maintenance of energy homeostasis in the brain, it is conceivable that an alteration of this enzyme activity in the brain may be one of the mechanisms by which proline might be neurotoxic.

Effect of proline on creatine kinase activity in rat brain.

Type II Hyperprolinemia is an inherited disorder caused by a deficiency of delta1-pyrroline-5-carboxilic acid dehydrogenase, whose biochemical hallmark is proline accumulation in plasma and tissues. Although neurologic symptoms occur in most patients, the neurotoxicity of proline is still controversial. The main objective of this study was to investigate the effect of acute and chronic administration of proline on creatine kinase activity in the homogenates of cerebellum and midbrain from Wistar rats. Acute treatment was performed by subcutaneous administration of one injection of proline to 22-day-old rats. For chronic treatment, proline was administered four times a day from the 6th to the 21st postpartum day. The results showed that creatine kinase activity was significantly inhibited in the cerebellum and midbrain of rats subjected to acute proline administration. In contrast, this activity was increased in animals subjected to chronic administration. We also measured the in vitro effect of proline on creatine kinase activity in the same cerebral structures of 22-day-old nontreated rats. Proline significantly inhibited creatine kinase activity. Considering the importance of creatine kinase for the maintenance of energy homeostasis in the brain, it is conceivable that an alteration of this enzyme activity in the brain may be one of the mechanisms by which proline might be neurotoxic.

Hyperphenylalaninemia reduces creatine kinase activity in the cerebral cortex of rats.

Phenylketonuria (PKU) is a metabolic disorder accumulating phenylalanine (Phe) and its metabolites in plasma and tissues of the patients. Considering that phenylalanine is the main neurotoxic metabolite, and brain energy homeostasis seems to be affected in phenylketonuria, our main objective was to investigate the effect of acute and chronic hyperphenylalaninemia (HPA) on creatine kinase (CK) activity in brain cortex of Wistar rats. Hyperphenylalaninemia was induced by subcutaneous administration of 5.2 micromol phenylalanine + 2.4 micromol alpha-methylphenylalanine (phenylalanine hydroxylase (PAH) inhibitor)/g of body weight. We also investigated the in vitro effect of phenylalanine and/or alpha-methylphenylalanine on creatine kinase activity in the brain cortex of non-treated rats. The results showed that phenylalanine significantly inhibited creatine kinase activity in vitro and reduced the enzyme activity in vivo. Considering the importance of creatine kinase for the maintenance of energy homeostasis in brain, if this enzyme inhibition also occurs in phenylketonuric patients, it is possible that creatine kinase inhibition may be one of the mechanisms by which phenylalanine is neurotoxic in phenylketonuria.

Capitalismo versus socialismo: a representação social da sociedade alternativa

O estudo discute qual a Representação Social da 'sociedade alternativa' construída por estudantes universitários de uma universidade pública e outra particular de Porto Alegre, Brasil. O referencial teórico que dá suporte a esta investigação é a teoria das Representações Sociais e o da Ideologia. Através da técnica dos grupos focais, investigou-se o que representam os modelos político-econômico-sociais do capitalismo e do socialismo para avaliarmos as possibilidades de construção de alternativas sociais mais justas e mais humanas. Os dados analisados provêm de quatro grupos focais. A partir de duas categorias estimuladas, o capitalismo e o socialismo, foi possível identificar as categorias nucleares emergentes do discurso que, por sua vez, conduziram ao campo representacional da 'sociedade alternativa'. Pelas associações de idéias subjacentes ao discurso, foi possível compreendermos o papel da história e das mediações ideológicas nas construções das Representações Sociais dos sujeitos (AU)