Nasal septum-derived chondroprogenitor cells control mandibular condylar resorption consequent to orthognathic surgery: a clinical trial.

Condylar resorption is an aggressive and disability form of temporomandibular joint (TMJ) degenerative disease, usually non-respondent to conservative or minimally invasive therapies and often leading to surgical intervention and prostheses implantation. This condition is also one of the most dreaded postoperative complications of orthognathic surgery, with severe cartilage erosion and loss of subchondral bone volume and mineral density, associated with a painful or not inflammatory processes. Because regenerative medicine has emerged as an alternative for orthopedic cases with advanced degenerative joint disease, we conducted a phase I/IIa clinical trial (U1111-1194-6997) to evaluate the safety and efficacy of autologous nasal septal chondroprogenitor cells. Ten participants underwent biopsy of the nasal septum cartilage during their orthognathic surgery. The harvested cells were cultured in vitro and analyzed for viability, presence of phenotype markers for mesenchymal stem and/or chondroprogenitor cells, and the potential to differentiate into chondrocytes, adipocytes, and osteoblasts. After the intra-articular injection of the cell therapy, clinical follow-up was performed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and computed tomography (CT) images. No serious adverse events related to the cell therapy injection were observed during the 12-month follow-up period. It was found that autologous chondroprogenitors reduced arthralgia, promoted stabilization of mandibular function and condylar volume, and regeneration of condylar tissues. This study demonstrates that chondroprogenitor cells from the nasal septum may be a promise strategy for the treatment of temporomandibular degenerative joint disease that do not respond to other conservative therapies.

The Key Digital Tool Features of Complex Telehealth Interventions Used for Type 2 Diabetes Self-Management and Monitoring With Health Professional Involvement: Scoping Review.

BACKGROUND: Therapeutic education and patient self-management are crucial in diabetes prevention and treatment. Improving diabetes self-management requires multidisciplinary team intervention, nutrition education that facilitates self-management, informed decision-making, and the organization and delivery of appropriate health care services. The emergence of telehealth services has provided the public with various tools for educating themselves and for evaluating, monitoring, and improving their health and nutrition-related behaviors. Combining health technologies with clinical expertise, social support, and health professional involvement could help persons living with diabetes improve their disease self-management skills and prevent its long-term consequences. OBJECTIVE: This scoping review's primary objective was to identify the key digital tool features of complex telehealth interventions used for type 2 diabetes or prediabetes self-management and monitoring with health professional involvement that help improve health outcomes. A secondary objective was to identify how these key features are developed and combined. METHODS: A 5-step scoping review methodology was used to map relevant literature published between January 1, 2010 and March 31, 2022. Electronic searches were performed in the MEDLINE, CINAHL, and Embase databases. The searches were limited to scientific publications in English and French that either described the conceptual development of a complex telehealth intervention that combined self-management and monitoring with health professional involvement or evaluated its effects on the therapeutic management of patients with type 2 diabetes or prediabetes. Three reviewers independently identified the articles and extracted the data. RESULTS: The results of 42 studies on complex telehealth interventions combining diabetes self-management and monitoring with the involvement of at least 1 health professional were synthesized. The health professionals participating in these studies were physicians, dietitians, nurses, and psychologists. The digital tools involved were smartphone apps or web-based interfaces that could be used with medical devices. We classified the features of these technologies into eight categories, depending on the intervention objective: (1) monitoring of glycemia levels, (2) physical activity monitoring, (3) medication monitoring, (4) diet monitoring, (5) therapeutic education, (6) health professional support, (7) other health data monitoring, and (8) health care management. The patient-logged data revealed behavior patterns that should be modified to improve health outcomes. These technologies, used with health professional involvement, patient self-management, and therapeutic education, translate into better control of glycemia levels and the adoption of healthier lifestyles. Likewise, they seem to improve monitoring by health professionals and foster multidisciplinary collaboration through data sharing and the development of more concise automatically generated reports. CONCLUSIONS: This scoping review synthesizes multiple studies that describe the development and evaluation of complex telehealth interventions used in combination with health professional support. It suggests that combining different digital tools that incorporate diabetes self-management and monitoring features with a health professional's advice and interaction results in more effective interventions and outcomes.

Targeting SmCB1: Perspectives and Insights to Design Antischistosomal Drugs.

Neglected tropical diseases (NTDs) are prevalent in tropical and subtropical countries, and schistosomiasis is among the most relevant diseases worldwide. In addition, one of the two biggest problems in developing drugs against this disease is related to drug resistance, which promotes the demand to develop new drug candidates for this purpose. Thus, one of the drug targets most explored, Schistosoma mansoni Cathepsin B1 (SmCB1 or Sm31), provides new opportunities in drug development due to its essential functions for the parasite's survival. In this way, here, the latest developments in drug design studies targeting SmCB1 were approached, focusing on the most promising analogs of nitrile, vinyl sulphones, and peptidomimetics. Thus, it was shown that despite being a disease known since ancient times, it remains prevalent throughout the world, with high mortality rates. The therapeutic arsenal of antischistosomal drugs consists only of praziquantel, which is widely used for this purpose and has several advantages, such as efficacy and safety. However, it has limitations, such as the impossibility of acting on the immature worm and exploring new targets to overcome these limitations. SmCB1 shows its potential as a cysteine protease with a catalytic triad consisting of Cys100, His270, and Asn290. Thus, design studies of new inhibitors focus on their catalytic mechanism for designing new analogs. In fact, nitrile and sulfonamide analogs show the most significant potential in drug development, showing that these chemical groups can be better exploited in drug discovery against schistosomiasis. We hope this manuscript guides the authors in searching for promising new antischistosomal drugs.

Hospitalization is associated with handgrip strength decline in older adults: a longitudinal study.

BACKGROUND: Hospitalization episodes in older people are considered critical events because they act in a complex interaction among immobilization effects. AIM: The purpose of this study was to evaluate the effects of hospitalization on older adults' handgrip strength (HGS) and to identify factors related to its performance on the test. METHODS: A cohort study was conducted in a hospital in Natal, Brazil, and enrolled all patients aged 60 years and older between January 2014, and April 2015. Cognitive (Leganés Cognitive Test) and functional status (Katz Index, Lawton Scale and Functional limitation Nagi), physical performance (HGS and gait speed) and depressive symptom assessment (GDS-15) were evaluated at admission and discharge time, as well as information about health and functional status prior to hospitalization. Linear Mixed Models were used to create a predictive model for handgrip strength. RESULTS: A total of 1168 hospitalized older adults were evaluated. A significant decrease in HGS means was observed between admission and discharge time for men (28.12 ± 10.35 and 20.22 ± 14.08 Kgf, p < 0.01) and for women (19.18 ± 7.87 and 14.88 ± 9.79 Kgf, p < 0.01). Undergoing surgery and basal values of the Katz Index were associated with worse HGS performance at discharge. CONCLUSION: A significant decline in handgrip strength during the hospitalization period was observed, which was more pronounced in men. Performing surgery during hospitalization was an important factor for HGS decline in men and women. This study reinforces the importance of early mobilization and muscle strength loss prevention protocols in hospitalized older patients.

SPPB as a predictor of functional loss of hospitalized older adults / A SPPB como preditora da perda da capacidade funcional de idosos hospitalizados

Abstract Introduction: Immobility is associated with adverse outcomes such as loss of functional capacity and longer hospitalization. Objective: To assess intra-hospital mobility at admission as a predictor of loss of functional capacity during older adults´ hospitalization. Methods: A prospective cohort study was conducted, and personal and hospital related risk factors were assessed at admission and discharge. To determine whether Short Physical Performance Battery (SPPB) on admission could predict loss of functional capacity during hospitalization, a ROC curve was performed and area under the curve (AUC) was calculated. Binary logistic regression models were used to identify predictors of loss of functional capacity. Model 1 contained only SPPB. Model 2 SPPB was matched with age, sex, instrumental activity of daily living (IADL), cognition, depression and surgery. Data were entered into SPSS version 18.0. Results: 1,191 patients were included with a mean age of 70.02 (± 7.34). SPPB cutoff point of 6.5 (sensitivity 62%, specificity 54%) identified 593 (49.8%) patients at risk for functional loss. In logistic regression, SPPB alone showed prediction of functional loss (p < 0.001, OR 1.8, 95% CI = 1.5-2.5) between admission and discharge. Model 1 explained between 22 to 32% of the variation in functional capacity. In Model 2, three variables contributed to the loss. SPPB 6.5 increased 1.8 times (95% CI = 1.3-2.4), being a woman increased 1.4 times (95% CI = 1.0-1.8) and not having surgery increased 2 times (95% CI = 1.4-2.8) the chance of having functional loss during hospitalization. Conclusion: SPPB is a good instrument to predict loss of functional capacity in hospitalized older adults.

Resumo Introdução: A imobilidade está associada a resultados adversos, como perda da capacidade funcional e maior tempo de hospitalização. Objetivo: Avaliar a mobilidade intra-hospitalar na admissão como preditor de perda da capacidade funcional durante a hospitalização de idosos. Métodos: Um estudo de coorte prospectivo foi conduzido e os fatores de risco pessoais e relacionados ao hospital foram avaliados na admissão e alta. Para determinar se o Short Physical Performance Balance (SPPB) na admissão poderia prever a perda de capacidade funcional durante a internação, uma curva ROC foi realizada e a área sob a curva (AUC) foi calculada. Modelos de regressão logística binária foram usados para identificar preditores de perda de capacidade funcional. O modelo 1 continha apenas SPPB. O modelo 2 SPPB foi pareado com idade, sexo, atividades instrumentais da vida diária (AIVD), cognição, depressão e cirurgia. Os dados foram inseridos no SPSS versão 18.0. Resultados: Foram incluídos 1.191 pacientes com idade média de 70,02 (± 7,34). O ponto de corte do SPPB de 6,5 (sensibilidade 62%, especificidade 54%) identificou 593 (49,8%) pacientes com risco de perda funcional. Na regressão logística, o SPPB sozinho mostrou predição de perda funcional (p < 0,001, OR 1,8, IC 95% = 1,5-2,5) entre a admissão e a alta. O modelo 1 explicou entre 22 a 32% da variação da capacidade funcional. No Modelo 2, três variáveis contribuíram para a perda. SPPB 6,5 aumentou 1,8 vezes (IC 95% = 1,3-2,4), ser mulher aumentou 1,4 vezes (IC 95% = 1,0-1,8) e não ter operado aumentou 2 vezes (IC 95% = 1,4-2,8) a chance de ter perda funcional durante a hospitalização. Conclusão: O SPPB é um bom instrumento para predizer a perda da capacidade funcional em idosos hospitalizados.

PAX7 gene polymorphism in muscular temporomandibular disorders as potentially related to muscle stem cells.

BACKGROUND: Temporomandibular disorders (TMD) are a group of painful and debilitating disorders, involving the masticatory muscles and/or the temporomandibular joint (TMJ). Chronic TMD pain can be associated with genetic changes in the key muscle development genes. OBJECTIVE: To evaluate the association between polymorphisms in the PAX7 (paired box 7) gene and masticatory myalgia in patients with temporomandibular disorders (TMD). MATERIALS AND METHODS: This is a case-control study. Patients with TMD were divided into two groups: (a) presence of muscular TMD (n = 122) and (b) absence of muscular TMD (n = 49). Genomic DNA was obtained from saliva samples from all participants to allow for genotyping single nucleotide polymorphisms in PAX7 (rs766325 and rs6659735). Over-representation of alleles was tested using chi-square or Fisher's exact tests. Values of p < 0.05 were considered to be statistically significant. RESULTS: Individuals without muscular TMD were less likely to have the PAX7 rs6659735 GG genotype (p = 0.03). No associations were found for PAX7 rs766325. CONCLUSIONS: Alterations in PAX7 may influence muscular pathophysiology and individuals with TMD and the rs6659735 homozygous genotype (GG) are seemingly associated with muscular involvement of the disorder. No associations were found in the region rs766325.

Trajectories and Predictors of Functional Capacity Decline in Older Adults From a Brazilian Northeastern Hospital.

BACKGROUND AND PURPOSE: Older adults face increased risk of loss of functional capacity both before and during hospitalization, so identifying older adults at risk for loss in functional capacity during hospitalization would help researchers and clinicians make informed decisions. This study aims to evaluate functional changes from preadmission (baseline) until discharge of hospitalized older adults and identify predictors of loss in functional capacity. METHODS: This is a prospective cohort study conducted at a tertiary care hospital in Natal, Brazil, and enrolled all consecutive patients aged 60 years and older between January 1, 2014, and April 30, 2015. Independent variables included personal characteristics, instrumental activities of daily living (IADL) (evaluated by the Lawton and Brody scale), cognition (evaluated by the Leganés cognitive test), depression (assessed by the Geriatric Depression Scale-15), and in-hospital mobility (evaluated by the Short Physical Performance Battery). The dependent variable functional capacity was assessed by the Katz scale. These instruments were applied at 2 different times: upon admission (within first 24 hours) and at discharge (12-24 hours before). Functional trajectories were defined as the course of functioning from preadmission until discharge using functional capacity data. A multivariate analysis with generalized estimating equation estimated the longitudinal changes in functional capacity. RESULTS AND DISCUSSION: The final sample consisted of 1191 older adults and 53.9% were less than 70 years of age. Regarding changes in functional capacity, 52.5% of the older adults presented worse functional capacity at discharge than at baseline. Being dependent for IADL instrumental daily living activities, the presence of depressive symptoms, low levels of cognition, and in-hospital mobility were risk factors for greater loss in functional capacity during a hospitalization event. CONCLUSION: Hospitalization events may be catastrophic for functional capacity in older adults in Brazil. Functional, cognitive, and emotional status and in-hospital mobility must be carefully assessed at hospital admission and monitored during hospitalization. Effective strategies for preventing loss in functional capacity in older people must improve in the Brazilian hospital system.

Human mesenchymal stromal/stem cells recruit resident pericytes and induce blood vessels maturation to repair experimental spinal cord injury in rats.

Angiogenesis is considered to mediate the beneficial effects of mesenchymal cell therapy in spinal cord injury. After a moderate balloon-compression injury in rats, injections of either human adipose tissue-derived stromal/stem cells (hADSCs) or their conditioned culture media (CM-hADSC) elicited angiogenesis around the lesion site. Both therapies increased vascular density, but the presence of hADSCs in the tissue was required for the full maturation of new blood vessels. Only animals that received hADSC significantly improved their open field locomotion, assessed by the BBB score. Animals that received CM-hADSC only, presented haemorrhagic areas and lack pericytes. Proteomic analyses of human angiogenesis-related factors produced by hADSCs showed that both pro- and anti-angiogenic factors were produced by hADSCs in vitro, but only those related to vessel maturation were detectable in vivo. hADSCs produced PDGF-AA only after insertion into the injured spinal cord. hADSCs attracted resident pericytes expressing NG2, α-SMA, PDGF-Rß and nestin to the lesion, potentially contributing to blood vessel maturation. We conclude that the presence of hADSCs in the injured spinal cord is essential for tissue repair.

Evaluation of the Adjuvant Effect of Antimicrobial Photodynamic Therapy in the Treatment of Periodontal Disease: Literature Review / Avaliação do Efeito Adjuvante da Terapia Fotodinâmica Antimicrobiana no Tratamento da Doença Periodontal: Revisão de Literatura

Antimicrobial Photodynamic Therapy (aPDT) is a promising approach with several clinical applications, including the treatment of periodontal diseases, by acting as an adjuvant to the conventional treatment of periodontal disease by allowing reduction of periodontopathogens, with no systemic side effects and minimal possibilities of bacterial resistance. Objective: To verify, through the scientific literature, the effectiveness of Antimicrobial Photodynamic Therapy associated with conventional periodontal treatment. Methodology: The literature review was conducted in the MEDLINE databases - PubMed, Scopus and Web of Science. The articles were selected through the analysis of titles and abstracts published in the period from 2007 to 2018. Selected articles were published in their entirety and with free or controlled access, of the type clinical trial on the subject, without restriction of languages. The terms used were: "Periodontal diseases"; "Chronic Periodontitis" and "Photochemotherapy." Results: 84 articles were found, and 20 clinical trials that met the inclusion criteria were analyzed. There were different clinical protocols for the association of aPDT with the conventional treatment of periodontal disease. a number of different clinical outcomes were found for each of the proposed clinical protocols. Conclusion: Considering the clinical trials investigated, conflicting results regarding the efficacy of aPTD as an adjuvant treatment of the conventional treatment of periodontal disease are observed. and lack of standardization of clinical parameters and protocols. (AU)

A terapia fotodinâmica antimicrobiana (aPDT) é uma abordagem promissora com várias aplicações clínicas, incluindo o tratamento das doenças periodontais, ao atuar como um adjuvante ao tratamento convencional da doença periodontal por permitir redução de periodontopatógenos, com ausência de efeitos sistêmicos colaterais e mínimas possibilidades de resistência bacteriana. O objetivo deste estudo é verificar, por meio da literatura científica, a eficácia da terapia fotodinâmica antimicrobiana associada ao tratamento periodontal convencional. A revisão de literatura foi conduzida nas bases de dados MEDLINE ­ PubMed, Scopus e Web of Science. Os artigos foram selecionados através da análise de títulos e de resumos publicados no período de 2007 a 2018. Foram selecionados artigos publicados na íntegra e com acesso livre e gratuito, ou controlado, do tipo ensaio clínico sobre o tema, sem restrição de idiomas. Os termos utilizados foram: Periodontal diseases; Chronic Periodontitis e Photochemotherapy. Foram encontrados 84 artigos, e 20 ensaios clínicos que atenderam os critérios de inclusão, foram analisados. Observou-se diferentes protocolos clínicos para a associação da aPDT com o tratamento convencional da doença periodontal. Também foram encontrados diferentes desfechos clínicos para cada um dos protocolos clínicos propostos. Conclusão: Considerando os ensaios clínicos pesquisados, observa-se resultados conflitantes frente à eficácia da aPDT como tratamento adjuvante do tratamento convencional da doença periodontal. Observa-se, ainda, uma produção literária escassa e a falta de uma padronização dos parâmetros e dos protocolos clínicos. (AU)

Percepção dos residentes sobre prevenção de quedas no programa de residência multiprofissional em saúde / Percepción de los residentes sobre la prevención de caídas en la residencia de varios profesionales en programa de salud

O estudo teve como objetivo desvelar a percepção dos residentes sobre prevenção de quedas no Programa de Residência Multiprofissional em Saúde para estabelecer melhoria de processos assistenciais em um Hospital Universitário. Realizou-se uma pesquisa qualitativa, descritiva- exploratória, com os residentes do primeiro ano dos programas de cardiologia e terapia intensiva do adulto. Para a coleta de informações, optou-se pela técnica de grupo focal, onde as conversas foram gravadas e transcritas na íntegra, e a análise de conteúdo por BARDIN. Evidenciou-se com os relatos dos participantes, o conhecimento sobre as estratégias de prevenção de quedas, a integração dos profissionais de saúde e a construção de propostas de ações de mudanças na incorporação de atividades multiprofissionais. Concluiu-se com a percepção dos residentes, a necessidade de educação permanente em saúde, o trabalho em equipe no cuidado integral ao usuário e a revisão periódica de protocolos para promover a redução de quedas

Evaluation of Oral Mucositis Occurrence in Oncologic Patients under Antineoplastic Therapy Submitted to the Low-Level Laser Coadjuvant Therapy.

Low-level laser therapy has been widely used in treating many conditions, including oral mucositis. The purpose of this study was to evaluate the occurrence of oral mucositis in patients undergoing antineoplastic therapy submitted to preventive and therapeutic treatment with low-level laser therapy. This cross-sectional study was carried out with 51 children and adolescents of both sexes with malignant neoplasias who developed oral mucositis and underwent low-level laser therapy. Data were collected on sex, age, type and degree of neoplasia, region affected, and remission time. 64.7% of the patients were male and were between 3 and 6 years of age (39.2%). Acute lymphoid leukemia was the most frequent neoplasm (37.3%). Regarding the maximum oral mucositis, grade 2 (41.2%) was predominant, with jugal mucosa (29.9%) and tongue (17.7%) being the most affected regions. The majority of cases presented lesion remission time between 4 and 7 days (44.0%). Most patients were young, male, and diagnosed with acute lymphoid leukemia. Predominance of grade 2 oral mucositis was observed, with jugal mucosa and tongue being the most affected regions, with the majority of cases presenting lesion remission time between 4 and 7 days. Low-level laser therapy has been shown to be an essential therapy in the prevention and treatment of these lesions, since it is a non-invasive and low-cost method.

Temporomandibular joint regeneration: proposal of a novel treatment for condylar resorption after orthognathic surgery using transplantation of autologous nasal septum chondrocytes, and the first human case report.

BACKGROUND: Upon orthognathic mandibular advancement surgery the adjacent soft tissues can displace the distal bone segment and increase the load on the temporomandibular joint causing loss of its integrity. Remodeling of the condyle and temporal fossa with destruction of condylar cartilage and subchondral bone leads to postsurgical condylar resorption, with arthralgia and functional limitations. Patients with severe lesions are refractory to conservative treatments, leading to more invasive therapies that range from simple arthrocentesis to open surgery and prosthesis. Although aggressive and with a high risk for the patient, surgical invasive treatments are not always efficient in managing the degenerative lesions. METHODS: We propose a regenerative medicine approach using in-vitro expanded autologous cells from nasal septum applied to the first proof-of-concept patient. After the required quality controls, the cells were injected into each joint by arthrocentesis. Results were monitored by functional assays and image analysis using computed tomography. RESULTS: The cell injection fully reverted the condylar resorption, leading to functional and structural regeneration after 6 months. Computed tomography images showed new cortical bone formation filling the former cavity space, and a partial recovery of condylar and temporal bones. The superposition of the condyle models showed the regeneration of the bone defect, reconstructing the condyle original form. CONCLUSIONS: We propose a new treatment of condylar resorption subsequent to orthognathic surgery, presently treated only by alloplastic total joint replacement. We propose an intra-articular injection of autologous in-vitro expanded cells from the nasal septum. The proof-of-concept treatment of a selected patient that had no alternative therapeutic proposal has given promising results, reaching full regeneration of both the condylar cartilage and bone at 6 months after the therapy, which was fully maintained after 1 year. This first case is being followed by inclusion of new patients with a similar pathological profile to complete an ongoing stage I/II study. TRIAL REGISTRATION: This clinical trial is approved by the National Commission of Ethics in Medical Research (CONEP), Brazil, CAAE 12484813.0.0000.5245, and retrospectively registered in the Brazilian National Clinical Trials Registry and in the USA Clinical Trials Registry under the Universal Trial Number (UTN) U1111-1194-6997 .

Instruments to evaluate mobility capacity of older adults during hospitalization: A systematic review.

Independent mobility is a key factor in predicting morbidity and determining hospital discharge readiness for older patients. The main objective was identify and appraise relevant instruments for the measurement of mobility of hospitalized geriatric patients. A systematic review was performed in two consecutive steps. Based on the definition of mobility of the International Classification of Functioning (ICF). Step 1 identified mobility measurement instruments used to assess patients 60 years of age and over hospitalized in acute care or intensive geriatric rehabilitation unit. Aim of the instrument, coverage of mobility construct, applicability (format, training required, administration time and use of assistive devices) were extracted. For each included instrument, Step 2 identified and appraised articles reporting about their measurement properties. Consensus-based Standards for the selection of health status Measurement INstruments (COSMIN) was used by two independent reviewers to critically appraise and compare the measurement properties. Step 1 resulted in 6350 articles, of which 28 articles reported about 17 different instruments. Step 2 retained 11 instruments with 70 articles reporting about their measurement properties in various settings. Judgement-based instruments (n=5) covered the ICF mobility construct more broadly than performance-based measures (n=6). Our results showed that 3 instruments (DEMMI, SPPB and Tinetti scale) had the most extensive and robust measurement properties, and from those, SPPB and DEMMI covered the mobility construct more broadly but SPPB had the longest administration (10-15min). Conclusion SPPB presents the best balance between mobility coverage, measurement properties and applicability to acute care or intensive geriatric rehabilitation unit.

DNA damage and postural balance in multiple sclerosis patients / Dano ao DNA e equilíbrio postural de portadores de Esclerose Múltipla

Abstract Introduction: Multiple Sclerosis (MS) is a chronic inflammatory disease characterized by infiltration of inflammatory cells on the Central Nervous System (CNS). There is evidence that cumulative DNA damage can contribute to various mechanisms underlying MS lesions. Changes in postural balance are frequent observations in subjects with MS. Objective: Evaluated the DNA damage index (DDI)) and postural balance in patients with MS. Methods: A case-control study was conducted with 28 subjects matched for sex, age, and body mass index, divided into MS group and control. The DDI was assessed by comet assay and postural balance through recording the body oscillations of the center of pressure (COP), in the anterior-posterior and lateral middle directions. Results: Showed higher DDI in MS patients (21.3 ± 4.8) than controls (7.9 ± 6.1). Significant differences between groups were also noted in postural control parameters. The wider ranges of postural sway were observed in the MS group. The associations between DDI and postural control parameters showed weak, but significant correlations. No associations were found between DDI and time of diagnosis of MS. Conclusion: People with MS had higher DDI and larger body oscillations than healthy individuals.

Resumo Introdução: A Esclerose Múltipla (EM) é uma doença inflamatório crônica caracterizada pela infiltração de células inflamatórias no Sistema Nervoso Central (SNC). Há evidencias de que danos cumulativos ao DNA possam contribuir para vários mecanismos subjacentes às lesões da EM. As alterações no equilíbrio postural são observações frequentes nos sujeitos com EM. Objetivo: Este estudo avaliou os índices de dano ao DNA (ID) e equilíbrio postural em portadores de Esclerose Múltipla (EM). Métodos: Um estudo de caso-controle foi conduzido com 28 sujeitos pareados por sexo, idade e índice de massa corporal, divididos em grupo EM e controle. O ID foi avaliado pelo ensaio cometa e o equilibro postural através do registro das oscilações corporais relativas ao deslocamento centro de pressão (COP) nas direções antero posterior e médio lateral. Resultados: Maiores ID em portadores de EM (21,3 ± 4,8) do que controles (7,9 ± 6,1). Diferenças significativas entre os grupos também foram percebidas nos parâmetros do controle postural. As maiores amplitudes de oscilação foram observadas no grupo EM para ambas as direções. As associações entre o ID e parâmetros do controle postural apresentaram correlações fracas e significativas. Não foram encontradas associações entre ID e tempo de diagnóstico de EM. Conclusão: Portadores de EM apresentaram maior ID e maiores oscilações corporais do que controles saudáveis.

Human mesenchymal cells from adipose tissue deposit laminin and promote regeneration of injured spinal cord in rats.

Cell therapy is a promising strategy to pursue the unmet need for treatment of spinal cord injury (SCI). Although several studies have shown that adult mesenchymal cells contribute to improve the outcomes of SCI, a description of the pro-regenerative events triggered by these cells is still lacking. Here we investigated the regenerative properties of human adipose tissue derived stromal cells (hADSCs) in a rat model of spinal cord compression. Cells were delivered directly into the spinal parenchyma immediately after injury. Human ADSCs promoted functional recovery, tissue preservation, and axonal regeneration. Analysis of the cord tissue showed an abundant deposition of laminin of human origin at the lesion site and spinal midline; the appearance of cell clusters composed of neural precursors in the areas of laminin deposition, and the appearance of blood vessels with separated basement membranes along the spinal axis. These effects were also observed after injection of hADSCs into non-injured spinal cord. Considering that laminin is a well-known inducer of axonal growth, as well a component of the extracellular matrix associated to neural progenitors, we propose that it can be the paracrine factor mediating the pro-regenerative effects of hADSCs in spinal cord injury.

Satisfação e qualidade de vida no trabalho: percepção dos profissionais de enfermagem no âmbito hospitalar / Life satisfaction and quality at work: perception of the nursery professionals in the health area

Introdução: Por ocupar um lugar central na vida do homem e dependendo da forma como é executado e organizado, o trabalho demanda ações, no sentido de suprir as necessidades dos trabalhadores, as quais podem gerar sentimentos de satisfação ou insatisfação. Neste sentido, quanto maior for o sentimento de satisfação do indivíduo com o seu trabalho, melhor será seu empenho em garantir um serviço de qualidade que irá repercutir positivamente em sua vida, contribuindo com a melhoria da qualidade de vida. O ambiente hospitalar apresenta aspectos muito específicos como à excessiva carga de trabalho, o contato direto com situações limite, o que corrobora no elevado nível de tensão e altos riscos para si e para os outros onde o profissional de enfermagem é bastante prejudicado. Objetivos: Os objetivos do presente estudo são: identificar os fatores de satisfação ou insatisfação no trabalho dos profissionais de enfermagem em âmbito hospitalar e analisar se tais fatores interferem na qualidade de vida dos profissionais de enfermagem. Método: Trata-se de uma pesquisa exploratório-descritiva de natureza quantitativa, a qual foi realizada no Hospital Universitário Lauro Wanderley e Hospital de Trauma Senador Humberto Lucena, ambos situados no município de João Pessoa- PB. Foram utilizados dois questionários semiestruturados que sofreram tratamento estatístico para análise de dados. Resultados: Os resultados demonstraram que os profissionais de enfermagem dos hospitais estudados que lidam diretamente com a assistência no ambiente hospitalar não vivenciam o bem-estar no ambiente de trabalho.

Introduction: For occupying a central position in men s lives and depending on the way it s executed and organized, work requires action, on the matter of supplying the workers needs, which can generate feelings of satisfaction or dissatisfaction. On this point of view, the bigger is the feeling with his work, the better his effort in completing a good service will reverberate in his life, contributing to his life quality. The in hospital environment presents very specific aspects, like work excess, direct contact with limit situations which corroborates the high level of tension and high risks for himself and for the others where the professional of nursery is highly harmed. Goals: The goals of the current study are: identifying the factors of satisfaction and dissatisfaction in the work of nursery professional in the hospital environment and analyse if those factors interfere on the nursery professionals life quality. It s about an exploring, describing nature research which was made in the Lauro Wanderley University Hospital and Senador Humberto Lucena Trauma Hospital, both in João Pessoa city. Method: Two semi-structured questionnaires were utilized, which had statistic treatment for data analysis. Results: The results reveal that the nursery professionals of the studied hospital, which deal directly with assistance in hospital environment, do not experience welfare in work ambient.

Fatores sociais e melhoria da qualidade de vida dos idosos: revisão sistemática / Social factors and the improvement of the quality of life of the elderly: a systematic review

Objetivo: identificar na produção científica nacional os aspectos sociais pertinentes à melhoria da qualidadede vida dos idosos. Método: estudo bibliométrico decorrente da revisão sistemática em 54 periódicos da Basede dados LILACS e da Biblioteca virtual SCIELO com os descritores sociologia or idoso or qualidade de vida, apartir da questão > A análise se deu a partir de duas categoriastemáticas e dez subcategorias. Resultados: constatou-se que as abordagens se concentraram nos aspectosfísicos/funcionais e patológicos dos idosos sendo escassas as pesquisas com abordagem no contexto socialrelacionadas à qualidade de vida. Conclusão: Assim, fazem-se necessários estudos de promoção da cidadaniapara uma maior longevidade, de práticas alternativas e complementares para envelhecer com saúde, doaumento dos projetos de ressocialização e de uma conscientização política direcionada para a melhoria daqualidade de vida dessa população.

Efeito da equoterapia na estabilidade postural de portadores de esclerose múltipla: estudo preliminar / Effect of hippotherapy on the postural stability of patients with multiple sclerosis: a preliminary study / Efecto de la hipoterapia en la estabilidad postural de portadores de esclerosis múltiple: estudio preliminar

OBJETIVO: Este estudo se propôs a verificar se a estimulação por meio da equoterapia é capaz de desencadear alterações no controle postural de portadores de esclerose múltipla (EM). MÉTODO: Fizeram parte deste estudo 11 portadores de EM divididos em Grupo Intervenção (GI) e Grupo Controle (GC). O GI foi inserido num programa de hipoterapia durante 4 meses, sendo conduzidas 2 sessões semanais com duração de 50 minutos cada. A estabilidade postural foi avaliada utilizando uma plataforma de força (para calcular o deslocamento do centro de pressão (COP), durante 30 segundos, em postura ereta quasi-estática, com olhos abertos e fechados, antes e após o treinamento com equoterapia. O tratamento estatístico foi feito através do ANOVA e Post hoc de Tukey com p<0,05. RESULTADOS: A amplitude de oscilação anteroposterior reduziu significativamente no GI após a estimulação, enquanto o GC manteve um comportamento inalterado entre as avaliações. Em ambos os grupos, a estabilidade postural foi reduzida com a supressão da informação visual. CONCLUSÕES: A adaptação funcional proporcionada pela equoterapia foi capaz de melhorar a estabilidade postural dos portadores de EM. Os resultados corroboram a literatura que suporta o uso da equoterapia como uma intervenção em potencial nas desordens de controle postural em portadores de EM.

OBJECTIVE: This study intended to identify the effects of hippotherapy on the postural control of multiple sclerosis (MS) patients. METHODS: Eleven MS patients were separated into two groups: Intervention Group (IG) and Control Group (CG). Hippotherapy consisted of two 50-minute sessions each week for four months. Postural stability was evaluated before and after hippotherapy using a force plate to calculate the center of pressure (COP), when subjects stood still for 30 seconds, with eyes open and closed. Statistical analysis was performed by ANOVA and post hoc Tukey tests, p<0.05. RESULTS: Hippotherapy significantly reduced the amplitude of oscillation in the anteroposterior direction in IG while CG remained unaltered. In both groups postural stability was reduced after the suppression of visual information. CONCLUSIONS: Hippotherapy induced functional adaptations that resulted in better postural stability of subjects with MS. This study corroborates literature supporting the use of hippotherapy as a possible intervention for balance disorders in patients with MS.

OBJETIVO: El objetivo de éste estudio fue identificar los efectos de la hipoterapia sobre el control postural en pacientes con esclerosis múltiple (EM). MÉTODO: Hicieron parte de este estudio 11 portadores de EM divididos en Grupo Intervención (GI) y Grupo Control (GC). El GI fue insertado en un programa de hipoterapia durante cuatro meses, siendo realizadas dos sesiones semanales con duración de 50 minutos cada una. La estabilidad postural fue evaluada utilizando una plataforma de fuerza (para calcular el desplazamiento del centro de presión (COP), durante 30 segundos en postura erecta casi-estática, con ojos abiertos y cerrados, antes y después del entrenamiento con hipoterapia. El tratamiento estadístico fue realizado a través de ANOVA y Post hoc de Tukey con p<0,05. RESULTADOS: la amplitud de oscilación antero-posterior se redujo significativamente en el GI después de la estimulación, mientras que el GC mantuvo un comportamiento sin cambios entre las evaluaciones. En ambos grupos la estabilidad postural fue reducida con la supresión de la información visual. CONCLUSIONES: la adaptación funcional proporcionada por la hipoterapia fue capaz de mejorar la estabilidad postural de los portadores de EM. Los resultados corroboran la literatura que soporta el uso de la hipoterapia como una potencial intervención en los desordenes del control postural en portadores de EM.

Mães doadoras: motivos e sentimentos subjacentes à doação / Donor mothers: motives and feelings underlying donation / Las madres donantes: motivos y sentimientos subyacentes de la donación / Mères donateurs: motivations et les sentiments qui sous-tendent la donation

Este trabalho visou compreender as motivações e os sentimentos que estão subjacentes ao discurso da mãe que doa o filho, bem como as repercussões desse ato em sua vida. A pesquisa foi realizada com seis mulheres na faixa etária entre 22 e 40 anos, com escolaridade e nível socioeconômicos baixos, que doaram, no mínimo, dois filhos. Elas responderam a uma entrevista, composta de questões que atendiam aos objetivos da pesquisa e dados sócios demográficos. Constataram-se as condições de pobreza material e emocional que permeiam as vidas dessas mães, impedindo-as de terem um desenvolvimento emocional equilibrado que lhes possibilitem maternar. As motivações que as levaram a doar os filhos estão relacionadas, além do contexto de carência, à imaturidade e à falta de apoio familiar e do parceiro. Igualmente, detectaram-se sentimentos de tristeza, remorso e culpa que derivam do ato da doação, a par de, racionalmente, elas acharem que fizeram o melhor pelos filhos. No que se refere às repercussões da doação na vida dessas mães, constatou-se que, mesmo tendo vislumbrado um recomeço de vida após o ato, todas mostraram marcas emocionais e somáticas que podem estar relacionadas ao mesmo. Conclui-se que a motivação para o ato de doar um filho é contextualizada e individual, dependendo de fatores sociais, porém muito mais dos intrapsíquicos. Trata-se de um assunto complexo, necessitando, portanto, que se observem as peculiaridades de cada caso e os fatores a eles subjacentes.(AU)

This paper aims the understanding of motivations and feelings that underlie the discourse of mothers who donates a child, as well as the repercussions of this act in her life. Participated in this research six women aged between 22 and 40 years, with low education and socioeconomic levels, who have donated, at least, two children. They were interviewed and answered questions about their social demographic data and about the issues of this research. Their economic and emotional poverty conditions that permeate their lives were verified. These conditions restrained them from achieving an emotionally balanced development that would have enabled them to act as mothers. The motivations that led to donate the children are related to their immaturity, together with the lack of family support and the of the children's father, as well as social-economic difficulties. Moreover, it was also found feelings of sadness, regret and guilt derived from the donation act, together with the fact that, in rational terms, they think they did the best decision regarding to their children. With regard to the repercussions of the donation in their life, it was found that even having glimpsed a resumption of life after the act, all showed emotional and physical inscriptions related to it. In conclusion, the motivation for children donation is a contextualized and individual decision, depending on social factors, but mostly on intra-psychic ones. This is, undoubtly, a complex issue, requiring, therefore, the observation of the peculiarities of each case and the factors underlying them.(AU)

Este trabajo dirigido a comprender las motivaciones y sentimientos que subyacen en el discurso de la madre quien dona al hijo, así como las repercusiones de este acto en su vida. La encuesta fue realizada con seis mujeres de edades comprendidas entre 22 y 40 años, con baja escolaridad y bajo nivel socioeconómico, que han donado a al menos dos hijos. Respondieron a una entrevista, compuesta por cuestiones que cumplían con los objetivos de la investigación y datos socios demográficos. Se constató la pobreza material y emocional que impregnan la vida de estas madres y que restringen la posibilidad de tener un desarrollo emocional equilibrado que las permitan maternar. Las motivaciones que llevaron a donar a los niños se relacionan, así como el contexto de la escasez, a la inmadurez y falta de apoyo familiar y de la pareja. También, fueron constatados sentimientos de tristeza, remordimiento y culpa que se derivan de la donación, aparte de, racionalmente, pensaren que hicieran lo mejor para los niños. Con respecto a las repercusiones de la donación en la vida de estas madres, se encontró que incluso haber vislumbrado una reanudación de la vida después del acto, muestran marcas emocionales y corporales que pueden estar relacionados con él. Parece que la motivación para el acto de donación de un niño es contextualizada y individual, dependiendo de factores sociales, pero mucho más de los intra-psíquicos. Se trata de una cuestión compleja, que requiere, por lo tanto, observar las peculiaridades de cada caso y los factores que subyacen a ellos.(AU)

Cette étude se propose à comprendre les motivations et les sentiments sous-jacents au discours de la mère biologique qui donne son fils à l'adoption, aussi bien que les répercussions de cet acte dans leurs vies. Les accompagnements psychologiques de ces mères, dans la maternité, dévoilent, certaines fois, une rationalisation de telle motivation. Implicitement, nous pourrions entendre ce qui supposément serait de l'ordre du désir. Nous avons interviewé six mères entre 22 et 40 ans, ayant une scolarité et niveau socio-économique moins privilégiés, qui ont donné au moins deux enfants à l'adoption. Nous avons fait un entretien semi- directif avec chaque mère concernée. Il a été analysé, à partir d'une perspective psychanalytique, les contenus verbal et non-verbal du discours des génitrices, dans l'intention d'identifier les possibles motivations et sentiments liés à l'acte de donner son fils. Nous avons constaté les conditions de pauvreté matérielle et émotionnelle qui sont présentes dans les vies de ces mères, empêchant ainsi un développement émotionnel équilibré qui rend possible lematernage. Ces femmes ont vécu une enfance marquée par des privations, violences, carences, incompréhensions et abandon. Le contexte économique et familial au moment de la gestation était défavorable à l'équilibre psychique. De plus, les grossesses étaient vécues en tant que prématurée. En ce qui concerne les motifs qui facilitent le don, nous avons souligné l'immaturité comme cause première, aussi bien que le manque de support familial et du père de l'enfant. A l'égard des sentiments vécus après le don, nous avons identifié la culpabilité, la tristesse, l'angoisse, le chagrin et le regret. Nous avons également remarqué des sentiments d'incapacité et d'insuffisance comme incitatifs inconscients au don. Quant aux répercussions du don dans la vie de ces mères, il a été constaté le fait que malgré l'intention de recommencer la vie après le don, ces mères se montrent amères, fatiguées, insatisfaites et malheureuses. Cette étude a conclu que la motivation de l'acte de donner un fils est à la fois contextualisée et individuelle, dépendant ainsi de facteurs sociaux et, principalement, intrapsychiques. Il s'agit d'un sujet complexe, impossible de produire des généralisations. Il faut observer les singularités de chaque cas et les facteurs sous-jacents.(AU)