Task force of the Brazilian Society of Otology - evaluation and management of peripheral facial palsy.

OBJECTIVE: To review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults. METHODS: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on peripheral facial palsy were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS: The topics were divided into 2 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve. CONCLUSIONS: Peripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy.

miR-431 secreted by human vestibular schwannomas increases the mammalian inner ear's vulnerability to noise trauma.

Introduction: Vestibular schwannoma (VS) is an intracranial tumor that arises on the vestibular branch of cranial nerve VIII and typically presents with sensorineural hearing loss (SNHL). The mechanisms of this SNHL are postulated to involve alterations in the inner ear's microenvironment mediated by the genetic cargo of VS-secreted extracellular vesicles (EVs). We aimed to identify the EV cargo associated with poor hearing and determine whether its delivery caused hearing loss and cochlear damage in a mouse model in vivo. Methods: VS tissue was collected from routinely resected tumors of patients with good (VS-GH) or poor (VS-PH) pre-surgical hearing measured via pure-tone average and word recognition scores. Next-generation sequencing was performed on RNA isolated from cultured primary human VS cells and EVs from VS-conditioned media, stratified by patients' hearing ability. microRNA expression levels were compared between VS-PH and VS-GH samples to identify differentially expressed candidates for packaging into a synthetic adeno-associated viral vector (Anc80L65). Viral vectors containing candidate microRNA were infused to the semicircular canals of mice to evaluate the effects on hearing, including after noise exposure. Results: Differentially expressed microRNAs included hsa-miR-431-5p (enriched in VS-PH) and hsa-miR-192-5p (enriched in VS-GH). Newborn mice receiving intracochlear injection of viral vectors over-expressing hsa-miR-431-GFP, hsa-miR-192-GFP, or GFP only (control) had similar hearing 6 weeks post-injection. However, after acoustic trauma, the miR-431 group displayed significantly worse hearing, and greater loss of synaptic ribbons per inner hair cell in the acoustically traumatized cochlear region than the control group. Conclusion: Our results suggest that miR-431 contributes to VS-associated hearing loss following cochlear stress. Further investigation is needed to determine whether miR-431 is a potential therapeutic target for SNHL.

Brazilian Society of Otology task force - Vestibular Schwannoma ‒ evaluation and treatment.

OBJECTIVE: To review the literature on the diagnosis and treatment of vestibular schwannoma. METHODS: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS: The topics were divided into 2 parts: (1) Diagnosis - audiologic, electrophysiologic tests, and imaging; (2) Treatment - wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. CONCLUSIONS: Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.

Physical capacity, body composition and immune-inflammatory markers are associated with risk of cardiovascular disease in sedentary people living with HIV.

BACKGROUND: People living with HIV (PLHIV) are experiencing a high level of non-HIV-related disease mainly related to cardiovascular system however the factors associated with this scenario are widely discussed and indefinite so far. The purpose was to investigate the association of physical capacities, body composition, and immune-inflammatory markers with the Framingham risk score (FRS) in PLHIV. METHODS: Volunteers were recruited and data on age, the time of HIV infection diagnosis and the time of HAART use were collected. The volunteers performed upper limb strength (ULS), lower limb strength (LLS) and cardiorespiratory fitness (VO2peak) tests, body composition evaluation, and blood collection to immune-inflammatory marker markers and the FRS was calculated. Partial age- and sex-adjusted correlation was used to verify associations between factors and multiple linear regression analysis was performed to identify an independent association of FRS and the variables. RESULTS: 113 PLHIV met the eligible criteria and were observed a negative correlation between CD4+ (r=-0.615), time of HIV infection diagnosis (r=-0.237), time of HAART use (r=-0.239), ULS (r=-0.274), LLS (r=-0.213), and VO2peak (r=-0.207) with FRS. There was a positive correlation between fibrinogen and FRS (r=0.363; P<0.001). The TCD4+ count cells were significantly associated with FRS (P=0.001). CONCLUSIONS: Environmental and biological HIV-related factors are inversely associated with FRS while immune-inflammation markers have a positive association.

Protective effects of a chemically characterized extract from solanum torvum leaves on acetaminophen-induced liver injury.

Distinct parts of Solanum torvum Swartz. (Solanaceae) are popularly used for a variety of therapeutic purposes. This study determined the phytochemical composition of a phenolic fraction of S. torvum leaf aqueous extract and investigated its antioxidant and liver-protective properties. A phenolic compound-enriched fraction, or phenolic fraction (STLAE-PF) of an infusion (STLAE) of S. torvum leaves, was tested in vitro (antagonism of H2O2 in cytotoxicity and DCF assays with HepG2/C3A cells), and in vivo for antioxidant activity and protective effects against acetaminophen (APAP)-induced liver injury in mice. Thirty-eight compounds (flavonoids, esters of hydroxycinnamic acid, and chlorogenic acid isomers) were tentatively identified (high-performance liquid chromatography coupled to high-resolution electrospray mass spectrometry) in the STLAE-PF fraction. In vitro assays in HepG2/C3A cells showed that STLAE-PF and some flavonoids contained in this phenolic fraction, at noncytotoxic levels, antagonized in a concentration-dependent manner the effects of a powerful oxidant agent (H2O2). In C57BL/6 mice, oral administration of STLAE (600 and 1,200 mg/kg bw) or STLAE-PF (300 mg/kg bw) prevented the rise in serum transaminases (ALT and AST), depletion of reduced glutathione (GSH) and elevation of thiobarbituric acid reactive species (TBARs) levels in the liver caused by APAP (600 mg/kg bw, i.p.). The hepatoprotective effects of STLAE-PF (300 mg/kg bw) against APAP-caused liver injury were comparable to those of N-acetyl-cysteine (NAC 300 or 600 mg/kg bw i.p.). These findings indicate that a phenolic fraction of S. torvum leaf extract (STLAE-PF) is a new phytotherapeutic agent potentially useful for preventing/treating liver injury caused by APAP overdosing.

Brazilian Society of Otology task force - Vestibular Schwannoma - evaluation and treatment

Abstract Objective: To review the literature on the diagnosis and treatment of vestibular schwannoma. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: (1) Diagnosis - audiologic, electrophysiologic tests, and imaging; (2) Treatment - wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. Conclusions: Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.

Effects of Two Different Exercise Training Programs Periodization on Anthropometric and Functional Parameters in People Living with HIV: A Randomized Clinical Trial.

The purpose of this study was to investigate the effects of two different exercise training programs periodization on anthropometric and functional parameters in people living with HIV (PLHIV). This was a randomized clinical trial that involved participants (n = 31) living with HIV aged over 18 years and undergoing antiretroviral therapy which were randomized to periodized exercise training (PET; n = 13), non-periodized exercise training (NPET; n = 13), or control group (CON; n = 15). The PET and NPET groups performed 12 weeks of combined training while the CON group maintained the usual activities. Before and after 12 weeks of intervention were measured body composition and perimeters, muscle strength, Short Physical Performance Battery (SPPB) and Timed Up and Go (TUG) test time. Results: The PET and NPET groups increased fat-free mass (p < 0,001), right (p < 0,001) and left thigh perimeter (p < 0,001), muscle strength (p < 0,001), handgrip force (p < 0,001), and reduced the fat mass (p < 0,001), neck perimeter (p < 0,001), chair stand (p < 0,001), and time-up and go test time (p < 0,001) compared to CON. Furthermore, PET was significantly different to increase right thigh and muscle strength (p < 0,05) compared to NPET. Conclusion: Both exercise training periodization protocols were effective to improve body composition and functional outcomes; however, seems that PET presents better results compare to NPET in PLHIV.

Daily Undulating Periodization Is More Effective Than Nonperiodized Training on Maximal Strength, Aerobic Capacity, and TCD4+ Cell Count in People Living With HIV.

ABSTRACT: Soares, VL, Soares, WF, Zanetti, HR, Neves, FF, Silva-Vergara, ML, and Mendes, EL. Daily undulating periodization is more effective than nonperiodized training on maximal strength, aerobic capacity, and TCD4+ cell count in people living with HIV. J Strength Cond Res 36(6): 1738-1748, 2022-The aim of this study was to evaluate the effects of daily undulating periodization (DUP) and nonperiodized training (NPT) programs on maximal muscle strength, body composition, aerobic capacity, muscle power, and immune markers in people living with HIV (PLWHIV). A total of 41 PLWHIV were randomly assigned to control (CON [n = 15]), DUP (n = 13), and NPT (n = 13) groups. The DUP and NPT groups performed combined training 3 times a week on nonconsecutive days during 12 weeks, whereas the CON group was asked to maintain their current level of activity. After the 12-week training program, DUP produced greater gains in muscle strength (except for bench press), V̇o2peak, and muscle power than NPT (p < 0.05). Compared to CON, the training groups showed significantly (p < 0.05) increased muscle strength (DUP = 31.0 ± 13.9 kg; NPT = 17.7 ± 9.2 kg; CON = -0.3 ± 1.5 kg), fat-free mass (DUP = 1.9 ± 1.5 kg; NPT = 1.4 ± 1.9 kg; CON = -0.1 ± 1.2 kg), and metabolic equivalent (DUP = 2.3 ± 1.3; NPT = 1.8 ± 1.9), and decreased body fat mass (DUP = -2.1 ± 1.6 kg; NPT = -1.4 ± 1.5 kg; CON = 0.1 ± 0.2) and functional aerobic impairment (DUP = -35.9 ± 17.0%; NPT = -25.8 ± 22.0%; CON = 0.8 ± 3.0%). There was an increase in TCD4+ cells only in the DUP group (p < 0.05). The training effect generally provided a positive correlation between change in leg press strength (r = 0.393, p < 0.05), triceps pulley strength (r = 0.417, p < 0.05), lat pull-down strength (r = 0.459, p < 0.05), and muscle power (r = 0.324, p < 0.05) with changing CD4 + lymphocyte count. Daily undulating periodization protocol showed to be safe, applicable, and more efficient for increasing strength, aerobic capacity, and TCD4+ cells compared to NPT in PLWHIV.

Effects of resistance training on muscle strength, body composition and immune-inflammatory markers in people living with HIV: a systematic review and Meta-analysis of randomized controlled trials.

Purpose: The purpose of this review is to evaluate the effect of resistance training (RT) as a unique intervention on muscle strength, body composition, and immune-inflammatory markers in people living with HIV (PLHIV).Methods: The searches were conducted in seven databases and included published randomized clinical trials that assessed the effect of RT vs. no exercise on muscle strength, body composition, and immune-inflammatory markers in PLHIV until June 2021. Random effects meta-analyses of mean differences (MD) and their 95% confidence intervals (CI) were performed, and the effect size was estimated by Hedges' g test.Results: Seven RCTs were included (n= 258 PLHIV) and the study duration lasted between six and 24 weeks. In comparison to no exercise, RT improved muscle strength in bench press (MD 10.69 kg, 95%IC 3.44 to 17.93, p= 0.004, g =2.42) and squat (MD 22.66 kg, 95%IC 7.82 to 37.50, p= 0.003, g = 3.8) exercises, lean body mass (MD 2.96 kg, 95%CI 0.98 to 4.94, p= 0.003, g = 1.99), fat body mass(MD -2.67 kg; 95%CI -4.95 to -0.39, p= 0.02, g=-0.99), body fat percentage (MD -3.66%, 95%CI -6.04 to -1.29, p= 0.003, g=-1.99) and CD4+ cells count(MD 100.15 cells/mm3, 95%CI 12.21 to 188.08, p = 0.03, g = 2.91) in PLHIV. There was no effect of RT on IL-6 (MD -1.18 pg/mL, 95%CI -3.71 to 1.35, p = 0.36, g = 0.001) and TNF-α (MD -4.76 pg/mL, 95%CI -10.81 to 1.29, p = 0.12, g=-1.3) concentrations in PLHIV. Conclusions: RT as a unique intervention improves muscle strength, body composition and CD4+ count cells in PLHIV.

Impacto do déficit de investimentos para o tratamento da doença de chagas no Brasil: revisão narrativa / Impact of the investment deficit for the treatment of chagas disease in Brazil: narrative review / Impacto del déficit de inversión para el tratamiento de la enfermedad de Chagas en Brasil: revisión narrativa

Objetivo: discutir sobre o impacto do déficit de investimentos para o tratamento da Doença de Chagas no Brasil. Método: trata-se de uma revisão narrativa da literatura realizada nas seguintes bases de dados: SCIELO, LILACS, BIREME e MEDLINE. A amostra final foi composta por 27 artigos científicos publicados entre o período de 2000 a 2020. Resultados: o Brasil é um dos países com maior prevalência de pacientes portadores da doença, porém pouco se avançou em pesquisas nessa área, de modo a repercutir em um baixo incentivo e investimento dos governantes e da indústria farmacêutica para a Doença de Chagas, tendo em vista a doença ser de progressão lenta e o diagnóstico e o tratamento serem tardios. Conclusão: fica evidente a falta de investimento e políticas públicas que possibilitem o diagnóstico e o tratamento precoce da doença tendo como conseqüência um déficit na qualidade de vida dos pacientes.(AU)

Objective: to discuss the impact of the investment deficit for the treatment of Chagas Disease in Brazil. Method: This is a narrative review of the literature conducted in the following databases: SCIELO, LILACS, BIREME and MEDLINE. The final sample consisted of 27 scientific articles published between 2000 and 2020. Results: Brazil is one of the countries with the highest prevalence of patients with the disease, but little progress has been made in research in this area, so as to have a low incentive and investment from governments and the pharmaceutical industry for Chagas Disease, in view of the disease being of slow progression and the diagnosis and treatment are late. Conclusion: it is evident the lack of investment and public policies that make possible the diagnosis and early treatment of the disease with the consequence of a deficit in the quality of life of the patients.(AU)

Objetivo: discutir el impacto del déficit de inversión para el tratamiento de la enfermedad de Chagas en Brasil. Método: se trata de una revisión narrativa de la literatura realizada en las siguientes bases de datos: SCIELO, LILACS, BIREME y MEDLINE. La muestra final consistió en 27 artículos científicos publicados entre 2000 y 2020. Resultados: el Brasil es uno de los países con mayor prevalencia de pacientes con la enfermedad, pero se ha avanzado poco en la investigación en esta área, para tener un bajo incentivo e inversión de los gobiernos y de la industria farmacéutica para la enfermedad de Chagas, considerando que la enfermedad es de progresión lenta y el diagnóstico y tratamiento son tardíos. Conclusión: es evidente la falta de inversión y de políticas públicas que permitan el diagnóstico y tratamiento precoz de la enfermedad con el consiguiente déficit en la calidad de vida de los pacientes.(AU)

Viability of microencapsulated Lactobacillus acidophilus by complex coacervation associated with enzymatic crosslinking under application in different fruit juices.

The objective of this study was to produce microcapsules containing Lactobacillus acidophilus LA-02 by complex coacervation followed by crosslinking with transglutaminase and to evaluate the effect of their addition on different fruit juices, as well as the probiotic viability of L. acidophilus and its effect on fruit juices during storage. To this end, L. acidophilus was microencapsulated by complex coacervation, followed by crosslinking with transglutaminase at different concentrations. Probiotics, in their free and microencapsulated forms, were added to orange juice and apple juice at concentrations of 10% and 30%. The obtained microcapsules were characterized in terms of morphology. The viability of probiotics and the effects of their addition on fruit juices were assessed and the juices characterized (with respect to pH and total soluble solids) during 63 days of storage at 4 °C. Orange juice proved to be more suitable for the addition of probiotics, and the survival of probiotics was directly related to pH. The microcapsules had a protective effect on L. acidophilus, prolonging their survival, and the crosslinking process proved to be adequate and promising, ensuring probiotic viability. Thus, the complex coacervation process associated with induced enzymatic crosslinking provided protection for L. acidophilus in different fruit juices, showing an adequate methodology for adding probiotics to this adverse food matrix, guaranteeing the survival of L. acidophilus for up to 63 days, and generating products with innovative and promising probiotic appeal.

Umbelliferone esters with antibacterial activity produced by lipase-mediated biocatalytic pathway.

OBJECTIVE: The present report describes the enzymatic acylation of umbelliferone with different vinyl esters as acyl donors biocatalyzed by the commercial lipase Novozym® 435, and the investigation for their antibacterial activity against ATCC and clinical strains isolated from hospital infection sites. RESULTS: The umbelliferone esters (1-5) were synthesized through the acylation reaction of 7-hydroxy-2H-chromen-2-one with different long chain vinyl esters catalyzed by the lipase Novozym 435. The reaction conditions were: 10% Novozym 435; tetrahydrofuran:acetone (3:1) for the reactions with acetate, propionate and butyrate vinyl esters 50-90% conversion, and (9:1) for decanoate and laurate vinyl esters 10-15% conversion; acyl donor/umbelliferone molar ratio of 10:1 and 60 °C. All the umbelliferone esters were characterized NMR and (HRMS). The antibacterial activity of the products were tested using the broth microdilution method in order to determine the minimum inhibitory concentration (MIC). The results displayed by 7-laurate and 7-decanoate-umbelliferone esters showed the highest antibacterial potential, with 1 mM inhibitory activity for ATCC 33591, a methicillin and oxacillin resistant Staphylococcus aureus strain. They were also able to inhibit gram-negative bacterial strains, such as Pseudomonas aeruginosa (MIC 0.5 mM) and Klebsiella pneumoniae (MIC 1 mM). In addition, 7-laurate- and 7-decanoate-umbelliferone esters were able to inhibit all clinical strains (MIC 1 mM; except 7-laurate-umbelliferone in which MIC 0.5 mM against 55a). CONCLUSIONS: This is the first study performing the biocatalysis of umbelliferone followed by the purification of the products and the antibacterial evaluation.

Cytokine Levels in Inner Ear Fluid of Young and Aged Mice as Molecular Biomarkers of Noise-Induced Hearing Loss.

Sensorineural hearing loss (SNHL) is the most common sensory deficit worldwide, frequently caused by noise trauma and aging, with inflammation being implicated in both pathologies. Here, we provide the first direct measurements of proinflammatory cytokines in inner ear fluid, perilymph, of adolescent and 2-year-old mice. The perilymph of adolescent mice exposed to the noise intensity resulting in permanent auditory threshold elevations had significantly increased levels of IL-6, TNF-α, and CXCL1 6 h after exposure, with CXCL1 levels being most elevated (19.3 ± 6.2 fold). We next provide the first immunohistochemical localization of CXCL1 in specific cochlear supporting cells, and its presumed receptor, Duffy antigen receptor for chemokines (DARC), in hair cells and spiral ganglion neurons. Our results demonstrate the feasibility of molecular diagnostics of SNHL using only 0.5 µL of perilymph, and motivate future sub-µL based diagnostics of human SNHL based on liquid biopsy of the inner ear to guide therapy, promote hearing protection, and monitor response to treatment.

Very late hepatic arterial thrombosis manifesting as central biliary necrosis: A rare presentation.

Hepatic artery thrombosis should always be considered on a liver graft recipient with mild and nonspecific symptoms, even after a decade of the transplantation.

Extending compound identification for molecular network using the LipidXplorer database independent method: A proof of concept using glycoalkaloids from Solanum pseudoquina A. St.-Hil.

INTRODUCTION: Molecular networks are now established as the method of choice for tandem mass spectrometry dereplication and similarity-based structure elucidation. Node identification can be used to start the propagation of the structure elucidation of unknown compounds progressively. OBJECTIVE: To demonstrate the capabilities of using the LipidXplorer data results along with molecular networking to identify nodes and aid sequential structure elucidation of unknown compounds. MATERIAL AND METHODS: Molecular fragmentation query language (MFQL) files were written to identify glycoalkaloids based on known structures described for Solanum species. A dataset generated from liquid chromatography-high resolution mass spectrometry (LC-HRMS) analysis of Solanum pseudoquina sample were submitted to dereplication on both LipidXplorer software and Global Natural Products Social Molecular Network (GNPS) online system. The resulting attribute table from GNPS calculations was merged with the LipidXplorer results and this merged file was used for network visualisation in Cytoscape. Nodes in the molecular network were labelled using the LipidXplorer identifiers, thus assisting the structure elucidation of unidentified compounds. RESULTS: The combination of the LipidXplorer glycoalkaloids list and GNPS analysis was used in Cytoscape to label nodes in the molecular network. The analysis of the network using these labelled starting points triggered the structure elucidation of closely related nodes leading to the identification of 30 compounds using the LipidXplorer output and four purified and structure elucidated compounds, including a new glycoalkaloids identified as 3-O-(ß-d-xylopyranosyl)-(20R,25S)-22,26-epimino-16-acetyl-cholesta-5,22(N)-diene. CONCLUSION: A significant compound identification completely based on molecular formula and fragmentation queries was achieved. This new and effective approach could help researches to expand the identification rate of compounds in dereplication studies using molecular networks.

Chemical profile, liver protective effects and analgesic properties of a Solanum paniculatum leaf extract.

BACKGROUND/AIM: Solanum paniculatum L. (Solanaceae) is a plant native to South America where it is used in traditional medicine for different therapeutic indications. This study evaluated the chemical composition and the hepatoprotective and analgesic activities of S. paniculatum leaf extracts. MATERIAL AND METHODS: The chemical profile of an ethyl acetate partition (SPOE) of a S. paniculatum leaf infusion (SPAE) was analysed by high performance liquid chromatography coupled to high-resolution electrospray mass spectrometry (HPLC-ESIMS). Liver protective effects of SPAE (600 and 1200 mg/kg bw, po), or SPOE (300 mg/kg bw, po) were evaluated in a C57BL/6 mouse model of acetaminophen (AP, 600 mg/kg bw, ip) hepatotoxicity by measuring alanine (ALT) and aspartate (AST) aminotransferase activity in the serum, and reduced glutathione (GSH), and thiobarbituric acid reactive species (TBARs) levels in the hepatic tissue. RESULTS: HPLC-ESIMS analysis of the SPOE fraction tentatively identified 35 flavonoids, esters of hydroxycinnamic acid and isomers of chlorogenic acid. SPAE (600 and 1200 mg/kg bw) and SPOE (300 mg/kg bw) antagonized the rise in ALT and AST, and the depletion of GSH, and elevation of TBARs levels in the liver caused by AP. The liver protective effects of SPOE (300 mg/kg bw) against AP-induced liver toxicity mimicked those of N-acetyl-cysteine (NAC 300 or 600 mg/kg bw ip). The mouse writhing assay showed that SPOE (300 mg/kg bw po) has anti-nociceptive effects comparable to those of AP (180 mg/kg bw po). CONCLUSION: This study suggests that an extract of S. paniculatum leaves (SPOE), rich in phenolic compounds, is a promising herbal drug to prevent and treat AP poisoning and presents analgesic properties as well.

Neuroblastoma infantil: características clínicas, tratamento e prognóstico / Infant neuroblastoma: clinical characteristics, treatment and prognosis

Introdução: O neuroblastoma é a mais prevalente neoplasia abdominal pediátrica com um impacto de 15% da mortalidade total por causa oncológica nessa população. Este trabalho tem como objetivo estabelecer os critérios que levam à suspeição, diagnóstico e tratamento deste tumor. Métodos: Elaborado estudo de revisão bibliográfica entre as principais fontes científicas, realizando uma análise comparativa entre os artigos estudados, desconsiderando informações defasadas ou artigos com baixo impacto científico. Resultados: Este trabalho conseguiu reunir as principais informações acerca do neuroblastoma, possibilitando que este artigo sirva como fonte de estudo para profissionais da saúde. Conclusão: Deve-se suspeitar do diagnóstico de neuroblastoma quando a anamnese e o exame físico estiverem associados ao efeito de massa e a síndromes paraneoplásicas. Apesar do neuroblastoma ser uma doença de métodos diagnósticos e tratamento há muito estabelecidos, novos protocolos de estadiamento têm surgido, aderindo novas informações acerca de fatores de risco e predisposições genéticas.

Introduction: Neuroblastoma is the most prevalent abdominal neoplasia among pediatric patients, with an impact of 15% of total mortality of oncologic causes in this population. This article aims to identify the criteria that leads to the suspicion, diagnosis and treatment of the tumor. Methods: We reviewed works in several databases, while doing a comparative analysis of the chosen articles, excluding outdated or with low scientific impact information. Results: This article has managed to summarize the main information about neuroblastoma, allowing it to serve as a go-to source for health professionals. Conclusion: The diagnosis of neuroblastoma should be suspected when anamnesis and physical examination are associated with mass effect and paraneoplastic syndromes. Despite neuroblastoma being a disease with diagnostic methods and treatment long established, new protocol of staging have been emerging, adding new information about risk factors and genetic predispositions.

A importância pratica da cinesioterapia em grupo na qualidade de vida de idosos / The importance of kinesiotherapy group practice on the quality of life of the elderly

Analisar o efeito da cinesioterapia em grupo sobre a qualidade de vida, adesão e desistência do programa, capacidade funcional, equilíbrio e marcha de idosas sedentárias. Método: Estudo experimental, amostra de idosas com média de idade de 69,83 (±7,76), que foram submetidas a um protocolo de cinesioterapia e randomizadas em três grupos (N=48), cinesioterapia em grupo (CG), cinesioterapia individual (CI) e controle (C); durante 12 semanas. A qualidade de vida foi avaliada por meio do questionário SF-36, e as variáveis de equilíbrio e marcha através do teste de Tinetti. Utilizando os procedimentos estatísticos descritivos (média e desvio padrão) e o teste de Wilcoxon, admitindo-se o nível de significância de p < 0, 05. Resultados: Taxa de permanência: CG:n=9; GI:n=10; C:n=8 ;Teste de Tinetti:Grupo CG: escore total 9.26 X 13.1; Grupo GI 11.37 X 14.5. Não houve melhora no grupo C. SF-36: média de escores: (CG) Dor: 33.2 X 70.7; Aspectos emocionais 33.3 X 66.6; (GI) Capacidade funcional: 64 X 85.5; Aspectos emocionais: 77.7 X 88; Limitação funcional: 72.5X 100. Não houve melhora estatisticamente significativas no grupo C. Conclusão: Não foram encontradas diferenças expressivas em relação a taxa de desistência entre a dinâmica em grupo e a dinâmica individual no programa de cinesioterapia, no entanto os grupos experimentais apresentaram diferenças significativas com os testes, antes e pós intervenção, para melhora nos aspectos emocionais, melhora de limitações físicas, redução de dor, melhora no equilíbrio e marcha, mostrando assim eficácia e importância dessa atividade

Analyze the effect of group kinesiotherapy on quality of life, adherence and discontinuation of the program, functional ability, balance and gait of sedentary elderly women. Method: Experimental study, with a sample of elderly women over the age of 60 years (N=30). They were submitted to a kinesiotherapy protocol for twelve weeks after being randomized into three groups: collective kinesiotherapy (CK), individual kinesiotherapy (IK), and control group (CG). Quality of life with SF-36 survey, and the variables of balance and gait with Tinetti test were assessed. Descriptive statistical procedures and the Wilcoxon test were applied to evaluate the effect intra group and the Kruskal-wallis test for analyzing the variance between groups, with significance of p<0.05. Results: Adherence were: CK, n=10; IK, n=10; and CG, n=10. Tinetti test (before x after): CK total score, 9.26 X 13.1; IK total score, 11.37X14.5. There was not improvement in CG. SF-36 (mean scores, before x afer): CK Pain, 33.2 X 70.7; CK Emotional wellbeing 33.3X66.6; IK Functional capacity: 64X 85.5; IK Emotional aspects: 77.7 X 88; IK Functional limitation: 72.5X 100. There were no statistically significant changes in CG. Conclusion: We found no expressive differences regarding the kinesiotherapy program discontinuation between the intervention groups. However, both groups presented significant differences after the interventions in improvement of the emotional aspects, improvement of physical impairments, pain reduction, improvement of balance and gait, what evidences the efficacy and the relevance of this activity

Extracellular vesicles derived from human vestibular schwannomas associated with poor hearing damage cochlear cells.

BACKGROUND: Vestibular schwannoma (VS) is a tumor of the vestibular nerve that transmits balance information from the inner ear to the brain. Sensorineural hearing loss occurs in 95% of patients with these tumors, but the cause of this loss is not well understood. We posit a role of VS-secreted extracellular vesicles (EVs) as a major contributing factor in cochlear nerve damage. METHODS: Using differential centrifugation, we isolated EVs from VS cell line HEI-193 and primary cultured human VS cells from patients with good hearing or poor hearing. The EVs were characterized using a Nanosight device and transmission electron microscopy and by extracting their RNA content. The EVs' effects on cultured murine spiral ganglion cells and organotypic cochlear cultures were studied using a transwell dual-culture system and by direct labeling of EVs with PKH-67 dye. EV-induced changes in cochlear cells were quantified using confocal immunohistochemistry. Transfection of VS cells with a green fluorescent protein-containing plasmid was confirmed with reverse transcription PCR. RESULTS: Human VS cells, from patients with poor hearing, produced EVs that could damage both cultured murine cochlear sensory cells and neurons. In contrast, EVs derived from VS cells from patients with good hearing did not damage the cultured cochlear cells. CONCLUSIONS: This is the first report on EVs derived from VSs and on the capacity of EVs from VSs from patients with hearing loss to selectively damage cochlear cells, thereby identifying a potential novel mechanism of VS-associated sensorineural hearing loss.

Activation of TRAIL-DR5 pathway promotes sensorineural degeneration in the inner ear.

Tumor necrosis factor (TNF) family cytokines are important mediators of inflammation. Elevated levels of serum TNF-α are associated with human sensorineural hearing loss via poorly understood mechanisms. We demonstrate, for the first time, expression of TNF-related apoptosis-inducing ligand (TRAIL) and its signaling death receptor 5 (DR5) in the murine inner ear and show that exogenous TRAIL can trigger hair cell and neuronal degeneration, which can be partly prevented with DR5-blocking antibodies.