Spatial-temporal pattern of colorectal cancer mortality in a Northeastern Brazilian State.

Colorectal cancer (CRC) is one of the most common cancer types worldwide. Its increasing mortality trends, especially in emerging countries, are a concern. The aim of this study was to analyse mortality trends and spatial patterns of CRC in the state of Sergipe, Brazil, from 1990 to 2019. Trends were calculated using data from the Online Mortality Atlas and Joinpoint Regression Program 4.8.0.1. Spatial analyses were performed using the empirical Bayesian model and Moran indices calculated by TerraView 4.2.2 between 1990 to 1999, 2000 to 2009 and 2010 to 2019. A total of 1585 deaths were recorded during the study period, with 58.42% among females. Trends were increasing and constant for both sexes and all age groups studied. The highest mean annual percent change was 6.2 {95% Confidence interval (CI) 3.4;9.0} for males aged +65 years and 4.5 (95% CI 3.2;5.8) for females aged 50-64 years. There was positive spatial autocorrelation for both sexes in all periods studied when using the Moran index for Bayesian rates. In summary, a consistent trend of increasing colorectal cancer (CRC) mortality has been observed overall. Nevertheless, an altered spatial distribution among males has emerged over the studied period.

Two-year real-world outcome data from a single tertiary centre shows reduced ustekinumab persistence in a non-bio-naïve Crohn's disease cohort with penetrating disease, -ostomies and sarcopenia.

Background: Ustekinumab was approved in 2016 for the treatment of moderate-severe Crohn's disease (CD). Clinical trials and real-world studies have suggested ustekinumab to be a safe and effective treatment; however, studies to date infrequently use imaging techniques to predict response to biologics in CD. Objectives: We assessed the 2-year real-world effectiveness and safety of ustekinumab in a tertiary CD cohort with the use of novel imaging techniques. Design: Retrospective cohort study. Methods: Retrospective data were collected between 2016 and 2021. Study end points included ustekinumab persistence, biological and/or clinical response and remission at 12, 18 and 24 months. Statistical analysis included demographic and inferential analyses. Results: In all, 131 CD patients [57.3% female, median age of 26.0 (21.0-37.0)] were included. Patients were non-bio naïve, and the majority received ustekinumab as third- or fourth-line treatment. At 24 months, 61.0% (80/131) persisted with ustekinumab [52.7% (69/131) steroid free]. Clinical response was reported in 55.2% (37/67), clinical remission in 85.7% (57/67), biological response in 46.8% (22/47) and biological remission in 31.9% (15/47) of patients at 24 months. The low outcome numbers were attributable to missing data. Improvements in routine disease markers, including C-reactive protein and Harvey-Bradshaw Index, were also reflected in magnetic resonance imaging-derived disease scores. The presence of penetrating CD, an -ostomy and sarcopenia were all predictors of poorer ustekinumab outcomes (p < 0.05). Conclusion: Ustekinumab is effective in non-bio-naïve CD patients with non-stricturing, non-penetrating disease with an unremarkable safety profile but may be less effective in those with penetrating disease, -ostomies and sarcopenia.

Influence of the Dose and Frequency of Administration of Tramadol on Analgesia, Hematological, Biochemical Parameters, and Oxidative Status of Cats Undergoing Ovariohysterectomy.

This study aimed to evaluate the effects of the repeated administration of tramadol subcutaneously on postoperative analgesia, liver, kidneys, and oxidative status in the postoperative period of cats undergoing ovariohysterectomy. Thirty-seven cats were randomly assigned to 5 groups, according to the postoperative analgesic treatment: NaCl 0.9%, GC; tramadol at 2 mg/kg, T2B (q12h) and T2T (q8h); or 4 mg/kg, T4B (q12h) and T4T (q8h). Oxidative status was assessed at baseline, 12 hours and 24 hours after the final administration of tramadol by the activity of superoxide dismutase (SOD), catalase (CAT), myeloperoxidase (MPO), butyrylcholinesterase (BuChE), and lipoperoxidation (MDA). Total blood count, serum biochemistry and urinalysis were compared between baseline and 12 hours posttramadol. Postoperative pain was evaluated by applying the Glasgow Feline Composite Measure Pain Scale at baseline, 3 (T3), 6 (T6), 8 (T8), 12 (T12), 24 (T24) e 36 (T36) hours after extubation. No side effects were observed. Tramadol increased SOD activity while CAT varied among groups in all time points but not over time. MDA levels increased from baseline to 12 hours in all groups but T4T. MPO activity decreased from baseline to 24 hours in some groups, including GC. Creatinine and phosphatase alkaline decreased in T2T, T4B, and T4T at 12 hours. Higher pain scores were observed from T3 to T8, except for GC. Rescue analgesia was administered only at T3. No difference in pain scores was observed from T8 onwards. Based on the findings, it is suggested that tramadol at 2 mg/kg every 8 hours is recommended for postoperative analgesia of cats undergoing ovariohysterectomy.

Evaluation of biocidal properties of biodegradable nanofiber filters and their use in face masks.

Due to the recent coronavirus-2019 pandemic, several studies have emerged looking for new materials, especially with biocidal characteristics. Thus, the present research investigates the antibacterial properties of biodegradable cellulose acetate (CA) / cetylpyridinium bromide (CPB) electrospun nanofibers, their aerosol filtration, and the possible use as a filter media of surgical face masks. Then, samples of these nanofibers were produced over a nonwoven substrate, using different volumes of polymeric solution during the electrospinning process. The evaluation of the antibacterial properties of the nanofibers was performed for Escherichia coli and Staphylococcus aureus using quantitative methods. The aerosol filtration performance was evaluated in these samples for NaCl nanoparticles (from 7-300 nm) and with 8 mL min-1 of air flow rate. The results show that the single use of the surfactant has antibacterial properties from a concentration of 39 µg mL-1 of solution. The nanofibers presented a reduction of 100% for both bacteria. Air filtration tests showed 126.03 and 207.73 Pa cm-² of pressure drops and 63 and 77% of aerosol filtration efficiency (FE) for samples with 0.13 and 0.15 mL, respectively. Regarding the nanofiber produced with 0.35 mL, the value obtained was 115.13 ± 33.64 Pa cm-2 and 3.15% of particle penetration. These breathability values are higher than those required for the surgical face mask standard, indicating that improvements in the porosity and thickness are necessary to meet the Brazilian requirements. However, the nanofibers could be applied as filter media for indoor air conditioning systems due to their FE and biocidal properties.

A severidade da cárie na primeira infância aumenta atividade da SOD sensível ao KCN, reduz proteínas carboniladas e aumenta a biodisponibilidade do óxido nítrico na saliva / The severity of caries increases the activity of SOD sens KCN, reduces carbonylated proteins and increases the bioavailability of nitric oxide in saliva

O objetivo deste estudo foi avaliar se a progressão da severidade das lesões de cárie alteraria as atividades das isoformas da superóxido dismutase (SOD), sensível ou não ao cianeto de potássio (KCN), a carbonilação de proteínas e a biodisponibilidade do óxido nítrico (NO) salivar. Amostras de saliva, não estimulada, foram coletadas de crianças (1 a 3 anos) em uma creche municipal de Birigui, SP, Brasil. As crianças foram divididas em 4 grupos (n=30/grupo) de acordo com os critérios do ICCMSTM, sendo o grupo A (livres de cárie), grupo B (cárie inicial), grupo C (cárie moderada) e grupo D (cárie extensa). A atividade enzimática da SOD sensível ao KCN e da SOD insensível ao KCN (SOD sens KCN e SOD ins KCN, respectivamente) foram determinadas pelo método de oxidação do pirogalol. O método da carbonilação da proteína foi utilizado para determinar o dano oxidativo (DO), baseado no método alcalino de DNPH (2,4- Dinitrofenilhidrazina). A biodisponibilidade de NO salivar foi quantificada pelo método de Griess. Os dados foram analisados pelo teste de ANOVA e pós-teste de StudentNewman-Keuls (α = 0,05), e pela correlação de Pearson e Spearman. Os resultados demostraram que a progressão das lesões de cárie aumentou a atividade da SOD sens KCN, mas não alterou a atividade da SOD ins KCN, reduziu a carbonilação de proteína, e aumentou a biodisponibilidade do NO salivar. Em conclusão, os dados deste estudo mostraram que a progressão da cárie aumenta a atividade da SOD sens KCN que, possivelmente, reduz o dano oxidativo e favorece a biodisponibilidade de NO salivar. Embora exista um aumento da defesa antioxidante enzimática e da biodisponibilidade de NO, a progressão da cárie nestas condições se daria quando os fatores extrínsecos estiverem prevalecendo aos fatores de defesa antioxidante da saliva e ação antibacteriana do NO. Com isso, podemos reforçar a importância do acompanhamento odontológico preventivo da cárie desde a primeira infância para que sejam reduzidos os fatores de risco da cárie e prevaleça a defesa antioxidante salivar e ação antibacteriana do NO(AU)

The aim of this study was to assess whether caries progression alters the activity of superoxide dismutase (SOD) isoforms, protein carbonylation (a biomarker of oxidative damage) and the bioavailability of nitric oxide (NO) in children's saliva. Saliva samples, not stimulated, were collected from children (1 to 3 years old) in a municipal day care center in Birigui, SP, Brazil. The children were divided into 4 groups (n=30/group), according to the ICCMSTM criteria, being group A (caries free), group B (initial caries), group C (moderate caries) and group D (extensive caries). The enzymatic activity of potassium cyanide (KCN)- sensitive superoxide dismutase (SOD) and KCN-insensitive SOD (SOD sens KCN and SOD ins KCN, respectively) were determined by the pyrogallol oxidation method. The protein carbonylation method based on the alkaline method of DNPH (2,4- Dinitrophenylhydrazine) was used to determine oxidative damage (OD). Salivary nitric oxide (NO) bioavailability was quantified by the Griess method. Data were analyzed by ANOVA and Student-Newman-Keuls post-test (α = 0.05), and by Pearson and Spearman correlation. The results showed that with the progression of caries, there was an increase in SOD sens KCN activity, with no change in SOD ins KCN activity, a reduction in protein carbonylation, and an increase in salivary NO bioavailability. We can conclude that the greater the severity of caries, the greater the activity of SOD sens KCN, which leads to less oxidative damage and greater bioavailability of NO. However, it is possible that in the stages of greater caries severity, the antibacterial action of NO is superimposed by external cariogenic factors, favoring the process of demineralization and enamel and dentin damage. Thereby, we understand that the clinical dental care of children in early childhood is a key factor for controlling cariogenic factors and keeping in balance with the antioxidant defense and antibacterial action of NO in saliva(AU)

Trends in the incidence and mortality of colorectal cancer in a brazilian city.

OBJECTIVES: This study was conducted to analyze the trends in colorectal cancer (CRC) incidence and mortality in the city of Aracaju, Sergipe State, Brazil, between 1996 and 2015 with Joinpoint Regression Program 4.7.0.0 and to identify the geographical distribution of CRC in the municipality. RESULTS: A total of 1322 cases of CRC and 467 CRC-related deaths during the study period were included. In total, 40% of the incident cases and 43% of the deaths occurred in men, while 60% of the incident cases and 57% of the deaths occurred in women. Males who were 20 to 44 years old had the most significant trend in growth. Among women, those in the group aged 45 to 64 years had the highest observed annual percent change (APC). In both sexes, mortality was stable. Regarding the geographic distribution, there were constant hotspots in the northeast region of the municipality. This study showed a significant increase in incidence, mainly in young men between 20 and 44 years of age, but stable mortality in Aracaju.

Evaluation of buccal damage associated with acute inhalation exposure to 2,4-dichlorophenoxyacetic acid (2,4-D) in mice.

BACKGROUND: The herbicide dichlorophenoxyacetic acid (2,4-D) is one of the most widely used crop spraying products in the world. Some pesticides induce the degranulation of mast cells and increase allergic responses. This is the first study to evaluate the damage to the oral mucosa after an experimental simulation of environmental inhalation exposure to the 2,4-D herbicide. The aim of this study was evaluate the possible oral damage caused by acute inhalation exposure to the herbicide 2,4-D. RESULTS: There was a difference between the exposure concentrations in relation to tissue congestion intensity (p = 0.002) and mast cell counts (p = 0.002), a difference in the evaluation of the interaction between the exposure concentrations and nebulization time in the dorsum epithelium thickness (p = 0.013), and a significant correlation between the epithelial thickness and the number of nucleoli organizing regions on the dorsum of the tongue (p = 0.048). CONCLUSIONS: Even after acute exposure, the herbicide 2,4-D had the potential to damage the oral epithelium, especially at higher doses.

Quality of life of patients with inflammatory bowel disease using immunobiological therapy / Qualidade de vida de pacientes com doença inflamatória intestinal em uso de terapia imunobiológica

ABSTRACT Objectives: To assess the quality of life of patients diagnosed with inflammatory bowel disease (IBD) using immunobiological therapy and to relate the general and domain scores of the Inflammatory Bowel Disease Questionnaire (IBDQ) to the immunobiological drug in use and the clinical and sociodemographic variables. Methods: This was a descriptive observational cross-sectional study, conducted from June to September 2018 in a tertiary hospital in Sergipe, which included 47 patients with a diagnosis of Crohn's disease. The IBDQ questionnaire was applied together with a sociodemographic questionnaire, and the clinical data and the history of the disease were analyzed. Results: Female, mixed-race, married patients from the countryside of the state of Sergipe, Brazil, who had never undergone any intestinal surgery, represented most of the study participants. 24 patients were on infliximab and 23 were on adalimumab. Variables such as gender, type of immunobiological drug and duration of its use, and association of therapy with other medications were shown to statistically significantly influence the report quality of life (p-value < 0.05). Conclusion: Further studies with larger samples are necessary to allow a more accurate delimitation of the impact of clinical and sociodemographic variables on the quality of life of patients with inflammatory bowel disease.

RESUMEN Objectivos: Avaliar a qualidade de vida de pacientes diagnosticados com doença inflamatória intestinal (DII) em uso de terapia imunobiológica e relacionar o escore geral e por domínios do "Inflammatory Bowel Disease Questionnaire" (IBDQ) com o imunobiológico em uso e as variáveis clínicas e sociodemográficas. Métodos: Estudo observacional descritivo analítico transversal, realizado no período de junho a setembro de 2018, em hospital terciário de Sergipe, que incluiu 47 pacientes com diagnóstico de Doença de Crohn. Foi aplicado o questionário IBDQ, associado a um questionário sociodemográfico e analisados os dados clínicos e da história da doença. Resultados: Pacientes do sexo feminino, pardos, casados, procedentes do interior de Sergipe e que nunca foram submetidos a nenhuma cirurgia intestinal representaram a maioria dos participantes do estudo. 24 pacientes estavam em uso de Infliximabe e 23 em uso de Adalimumabe. Variáveis como o gênero, tipo de imunobiológico e duração de seu uso e associação da terapêutica com outras medicações mostraram influenciar a qualidade de vida relatada, com significância estatística (p-valor < 0,05). Conclusão: Novos estudos com amostras maiores são necessários para que se possa permitir uma delimitação mais acurada do impacto de variáveis clínicas e sociodemográficas na qualidade de vida dos pacientes com doença inflamatória intestinal.

Therapeutic potential of laminin-biodritin microcapsules for type 1 diabetes mellitus.

Pancreatic islet microencapsulation constitutes an attractive therapy for type 1 diabetes mellitus; however, long-term ß-cell function remains a major problem. Loss of extracellular matrix interactions during islet isolation dramatically affects ß-cell viability. We have previously shown beneficial effects of laminin (LN) in human islet cultures. Herein, we investigated whether LN could improve the outcome of transplantation after islet microencapsulation in Biodritin, an alginate-based material. To test LN-Biodritin stability, microcapsules were subjected to different types of in vitro stress. Focusing on biocompatibility, empty microcapsules were coincubated with the RAW 264.7 macrophage cell line for up to 24 h, and empty beads were implanted IP in mice and retrieved for analyses after 7 and 30 days. Upon culturing for 48 h, mRNA, protein levels, and caspase 3 activity were evaluated in islets microencapsulated with LN-Biodritin. Mice rendered diabetic by streptozotocin injection were transplanted with microencapsulated islets, followed by assessment of body weight, glycemia, and graft function (evaluated by OGTT). Graft efficiency was observed upon microencapsulated islet explantation. The results obtained showed that LN-Biodritin microcapsules were as stable and biocompatible as Biodritin. Modulation of mRNA and protein levels suggested protection against apoptosis and islet stress. Mice transplanted with LN-Biodritin microencapsulated islets presented a better outcome at 198 days postsurgery. Graft explantation led animals to hyperglycemia. In conclusion, LN-Biodritin constitutes a very promising biomaterial for islet transplantation.

Suspeição de depressão segundo escala geriátrica em umaequipe da estratégia saúde da família / Geriatric Scale-Defined Depression Suspicion in the Family Health Strategy Setting

Objetivo: determinar a frequência da suspeição de depressãoem idosos de uma Equipe de Saúde da Família de umacidade do Sul de Minas baseado em Escala Geriátrica com30 questões. Métodos: Pesquisa de campo, do tipo quantitativo,com estudo de perfil populacional, com 289 idososde ambos os sexos, maiores de 60 anos e com autonomia deresposta. O desfecho analisado foi a suspeita de depressãoidentificada por Escala de Depressão Geriátrica (EDG-30).Os dados foram coletados e foram calculadas as proporçõesde acordo com os fatores determinantes como: sexo, faixaetária, comorbidades (presença e tipo), estado civil, cor dapele e internações hospitalares no último ano. Resultados:Neste estudo, foi verificado o predomínio de suspeiçãode depressão entre pacientes do sexo feminino e entreaqueles que tiveram comorbidades associadas. Observou-setambém prevalência de viúvos entre os pacientes suspeitosde depressão. A cor branca foi predominante tanto parasuspeitos como não suspeitos de depressão. Quanto àsmedicações em uso, houve apenas significância entre osusuários de anti-hipertensivos. Conclusão: Os dados conferemimportância em se diagnosticar e tratar precocementea depressão a fim de promover qualidade de vida aos indivíduosafetados, sem prejuízo de suas atividades cotidianas.

Use of assisted reproductive technology to separate sperm from human immunodeficiency virus infected men resulting in pregnancy among serodiscordant couples.

Due to HIV care improvement, discordant couples more frequently seek help in order to conceive their own biological child. Besides the advance of antiretroviral therapy, unprotected intercourse is not a complete safe option, carrying a low but still present risk of HIV transmission. We report 10 serodiscordant couples in whom the male partner is HIV positive, submitted to sperm washing and intrauterine insemination. The procedure resulted in four pregnancies and no HIV transmission to mother or child was observed. Techniques of assisted reproduction can help HIV discordant couples to conceive biological offspring and is a safer option than unprotected intercourse.

Use of assisted reproductive technology to separate sperm from human immunodeficiency virus infected men resulting in pregnancy among serodiscordant couples

Due to HIV care improvement, discordant couples more frequently seek help in order to conceive their own biological child. Besides the advance of antiretroviral therapy, unprotected intercourse is not a complete safe option, carrying a low but still present risk of HIV transmission. We report 10 serodiscordant couples in whom the male partner is HIV positive, submitted to sperm washing and intrauterine insemination. The procedure resulted in four pregnancies and no HIV transmission to mother or child was observed. Techniques of assisted reproduction can help HIV discordant couples to conceive biological offspring and is a safer option than unprotected intercourse.

IIhotas pancreáticas humanas viáveis para o transplante através do aumento da massa de células e do imunoisolamento com microcápsulas biocompatíveis / Obtention of human pancreatic islets for transplantation through an increase in cell mass and an immunoisolation with biocompatible microcapsules

O transplante de ilhotas pancreáticas humanas representa uma estratégia promissora para a cura do diabetes mellitus tipo 1 (DM1) mas a aplicação a todos os pacientes diabéticos ainda é impraticável devido à limitada disponibilidade de ilhotas ou células β e à necessidade de utilização de drogas imunossupressoras pelo paciente transplantado. O tratamento com imunossupressores após o transplante de ilhotas pode ser abolido quando se realiza o microencapsulamento das ilhotas pancreáticas. Neste trabalho investigou-se um novo biomaterial, Biodritina (alginato/sulfato de condroitina) adequado ao microencapsulamento que gelifica na presença de íons de cálcio ou bário. A biocompatibilidade das microcápsulas tem sido avaliada segundo o grau de pureza do alginato utilizado na sua confecção. Amostras de alginato comercial purificado foram analisadas, comprovando-se a presença de impurezas (polifenóis, endotoxinas, proteínas) em níveis elevados, que impedem sua aplicação clínica. Optou-se, portanto pela utilização do alginato comercial ultrapurificado nos experimentos descritos neste trabalho. Das formulações de biomateriais avaliadas, as microcápsulas de bário-Biodritina apresentaram o melhor desempenho em testes de estabilidade físico-química...

Antinociceptive effect and acute toxicity of the essential oil of Hyptis fruticosa in mice.

The essential oil of the Hyptis fruticosa leaves was analyzed by GC/MS and evaluated for antinociceptive property as well as acute toxicity in mice. The essential oil, at doses of 100, 200, and 400 mg/kg (s.c.), produced significant inhibition of acetic acid-induced writhing, but did not manifest a significant effect in hot-plate test. There was no acute toxicity at doses up to 5 g/kg. Bicyclogermacrene, 1,8-cineole, alpha-pinene, and beta-caryophyllene were the major compounds detected in the essential oil.

Avaliação do efeito antinociceptivo e da toxicidade aguda do extrato aquoso da Hyptis fruticosa Salmz. ex Benth / Evaluation of the analgesic effect and acute toxicity of the aqueous extract of Hyptis fruticosa (Salmz. ex Benth.)

Este trabalho descreve o efeito antinociceptivo e a toxicidade aguda do extrato aquoso das folhas da Hyptis fruticosa Salmz. ex Benth. (Lamiaceae). O extrato aquoso liofilizado, administrado por via oral, reduziu as contorções abdominais induzidas por ácido acético (200, 400 e 500 mg/kg) e o tempo de reação dos animais na primeira fase do teste da formalina (100 mg/kg e 400 mg/kg). No teste da placa quente, o extrato aquoso aumentou o tempo de latência ao calor (100 e 200 mg/kg) tendo este efeito sido revertido pelo antagonista opióide naloxona (5 mg/kg; i.p.). No ensaio de toxicidade aguda, não foi detectada a morte de nenhum animal após tratamento com doses de até 5 g/kg (v.o.) do extrato. Em conclusão, os resultados obtidos indicam que o extrato aquoso da Hyptis fruticosa apresenta efeito antinociceptivo em camundongos e não apresenta toxicidade aguda nas doses testadas.

The antinociceptive effect and the acute toxicity of Hyptis fruticosa leaves were evaluated through the administration of its aqueous extract in mice. The extract, administered orally (200, 400, and 500 mg/kg), reduced the nociceptive response in the writhing test as well as in the early phase of the formalin test (100 and 400 mg/kg) and it increased the latency time in the hot plate test (100 and 200 mg/kg). The antinociceptive effect was reversed by naloxone (5 mg/kg, i.p.). Moreover, no animal deaths were observed in doses up to 5 g/kg. In conclusion, the aqueous extract of Hyptis fruticosa showed no acute toxicity at the evaluated doses and revealed antinociceptive effect in mice. Such effects are possibly associated with the opioid system activation.

Antinociceptive effect of Hyptis pectinata leaves extracts.

Oral administration of hexanes, chloroform, and ethyl acetate extracts of the leaves of Hyptis pectinata significantly reduced the number of writhing induced by acetic acid and increased the response to thermal stimuli in hot-plate test. Such effect was completely reversed by the opioid antagonist naloxone.

Síndromes hiperandrogênicas / Hyperandrogenic syndromes

As síndromes hiperandrogênicas, especialmente a Síndrome dos Ovários Policísticos e a Hiperplasia Congênita da Supra-Renal, fazem parte do dia-a-dia de todo ginecologista. As manifestações clínicas do hiperandrogenismo, como acne, hirsutismo, irregularidade menstrual, estão entre as principais queixas das mulheres no menacme. Daí a importância de se conhecer bem a fisiopatologia destas doenças, seu diagnóstico, tratamento e implicações reprodutivas. Este artigo de revisão descreve resumidamente e de forma atualizada os aspcetos mais importantes das duas síndromes hiperandrogênicas mais frequentes na prática clínica, a Síndrome dos Ovários Policísticos (SOP) e a Hiperplasia Congênita da Supra-Renal (HCSR), além de algumas perspectivas futuras em relação ao manejo destas patologias

First efficacy and safety results with the antibody containing leukocyte inhibition module in cardiac surgery patients with neutrophil hyperactivity.

Systemic administration of immune modulating antibodies may play an important role in reducing neutrophil hyperactivity, for example, in patients undergoing cardiac surgery with extracorporeal circulation or in trauma patients. However, this strategy has extremely high costs and is often associated with severe adverse effects. We developed the Leukocyte-Inhibition-Module (LIM), an extracorporeal circulation (ECC) device housing a polyurethane matrix with covalently bound Fas (CD95; APO-1) stimulating antibodies to rapidly prevent neutrophil hyperactivation. A feasibility study with 14 patients undergoing cardiac surgery with the use of immunogenic ECC without (n = 5) and with (n = 9) LIM (venous line) was performed. Our data show that the usually observed ECC associated perioperative increase in neutrophils (control) was prevented by LIM (p = 0.023). Moreover, the increase of the proinflammatory markers tumor necrosis factor (TNF)-alpha and polymorphonuclear elastase was limited by LIM (p = 0.038 and p = 0.002). In both groups, no significant changes in liver enzymes or in clotting were detected after surgery, and up to 12 months follow up, no unusual complications were reported. This study shows for the first time to our knowledge the feasibility, efficacy, and safety of a new cost effective, immune management strategy in patients with aberrant immune activation by exposing the blood stream to immobilized agonistic anti-Fas antibodies.

Atualização no manejo da hiperprolactinemia / Actual management of hyperprolactinemia

A hiperprolactinemia é uma condição freqüente que afeta mulheres na vida reprodutiva. A regulação da produção de prolactina é feita através da ação inibitória de um neurotransmissor, a dopamina, e por outras substâncias como endorfinas, peptídeo vasoativo intestinal, ácido gama butírico e hormônio liberador de tireotrofina. Geralmente as manifestações clínicas são distúrbios do ciclo menstrual, amenorréia, galactorréia e infertilidade. Um importante aumento fisiológico em seus níveis ocorre na gravidez, após exercícios, estresse físido ou psicológico, refeições e estimulação da parede torácica. Muitos medicamentos também são capazes de aumentar os níveis de prolactina. Outras causas incluem doenças endócrinas, como hipotireoidismo primário, insuficiência adrenal, síndrome dos ovários policísticos e doenças hipotálamo-hipofisárias. Os tumores funcionantes da hipófise, os prolactinomas, são causas comuns de hiperprolactinemia. O manejo dos prolactinomas mudou da cirurgia transesfenoidal para a terapia farmacológica na maioria dos casos. Quando nenhuma causa de hiperprolactinemia pode ser identificada, o diagnóstico é de hiperprolactinemia idiopática ou de macroprolactinemia. O diagnóstico e o tratamento da hiperprolactinemia, o manejo dos prolactinomas e da macroprolactinemia são discutidos