Is leaf fluctuating asymmetry related to plant and leaf size in Miconia albicans, a common Melastomataceae species? / A assimetria flutuante de folhas está relacionada ao tamanho da planta e da folha em um arbusto de savana neotropical?

Fluctuating asymmetry, defined as random differences between the two sides of a symmetrical structure, has been often related to development stress in both plants and animals. In plants, leaf fluctuating asymmetry has been related to stresses such as pollution and fire and may also be related to leaf growth and herbivory rates. We assessed whether leaf fluctuating asymmetry is related to plant and leaf size in Miconia albicans (Sw.) Triana (Melastomataceae), a common multi-stem Neotropical shrub, in a Brazilian savanna area. We collected 15 leaves from each of 70 individuals, and measured fluctuating asymmetry as the difference in area between the right and left sides of the leaves using the central vein as reference. To avoid spurious results due to measurement error, the division along the central vein was performed independently by three researchers. We also measured the basal area and height of each stem of the plant individuals. We used linear models to assess the relations between leaf fluctuating asymmetry, plant size and leaf size. No consistent relations were observed between leaf fluctuating asymmetry and plant size, as the analyses performed on the fluctuating asymmetry values obtained by the different researchers showed different results. However, relative fluctuating asymmetry values, obtained by dividing the fluctuating asymmetry by the total leaf area, tended to be smaller in larger leaves. It thus appears that, in the study species, fluctuating asymmetry is related to the developmental conditions faced by the individual leaves and not by the plant as a whole.

A assimetria flutuante, definida como diferenças aleatórias entre os dois lados de uma estrutura simétrica, tem sido frequentemente relacionada ao estresse de desenvolvimento em plantas e animais. Nas plantas, a assimetria flutuante foliar tem sido relacionada a estresses como poluição e fogo e também pode estar relacionada ao crescimento foliar e taxas de herbivoria. Nós avaliamos se a assimetria flutuante foliar está relacionada ao tamanho da planta e da folha em Miconia albicans (Sw.) Triana (Melastomataceae), um arbusto neotropical multicaule comum, em uma área de Cerrado. Coletamos 15 folhas de cada um dos 70 indivíduos e medimos a assimetria flutuante como a diferença de área entre os lados direito e esquerdo das folhas usando a nervura central como referência. Para evitar resultados espúrios devido ao erro de medição, a separação ao longo da nervura centra foi feita independentemente por três pesquisadoras/es. Também medimos a área basal e a altura de cada caule de cada planta. Usamos modelos lineares para avaliar as relações entre assimetria flutuante foliar, tamanho da planta e tamanho da folha. Não foram observadas relações consistentes entre a assimetria flutuante da folha e o tamanho da planta, pois as análises realizadas nos valores da assimetria flutuante obtidos pelas/os diferentes pesquisadoras/es mostraram resultados diferentes. No entanto, os valores de assimetria flutuante relativa, obtidos pela divisão da assimetria flutuante pela área foliar total, tenderam a ser menores nas folhas maiores. Assim, verifica-se que, na espécie estudada, a assimetria flutuante está relacionada às condições de desenvolvimento enfrentadas pelas folhas individuais e não pela planta como um todo.

Is leaf fluctuating asymmetry related to plant and leaf size in Miconia albicans, a common Melastomataceae species?

Fluctuating asymmetry, defined as random differences between the two sides of a symmetrical structure, has been often related to development stress in both plants and animals. In plants, leaf fluctuating asymmetry has been related to stresses such as pollution and fire and may also be related to leaf growth and herbivory rates. We assessed whether leaf fluctuating asymmetry is related to plant and leaf size in Miconia albicans (Sw.) Triana (Melastomataceae), a common multi-stem Neotropical shrub, in a Brazilian savanna area. We collected 15 leaves from each of 70 individuals, and measured fluctuating asymmetry as the difference in area between the right and left sides of the leaves using the central vein as reference. To avoid spurious results due to measurement error, the division along the central vein was performed independently by three researchers. We also measured the basal area and height of each stem of the plant individuals. We used linear models to assess the relations between leaf fluctuating asymmetry, plant size and leaf size. No consistent relations were observed between leaf fluctuating asymmetry and plant size, as the analyses performed on the fluctuating asymmetry values obtained by the different researchers showed different results. However, relative fluctuating asymmetry values, obtained by dividing the fluctuating asymmetry by the total leaf area, tended to be smaller in larger leaves. It thus appears that, in the study species, fluctuating asymmetry is related to the developmental conditions faced by the individual leaves and not by the plant as a whole.

Investigation of genetic susceptibility to Mycobacterium tuberculosis (VDR and IL10 genes) in a population with a high level of substructure in the Brazilian Amazon region.

OBJECTIVES: Tuberculosis (TB) is an infectious and contagious disease that has been very influential in human history and presents high rates of mortality. The objective of this study was to investigate the association of VDR, IL10, and SLC11A1 gene polymorphisms with susceptibility to the presence of Mycobacterium tuberculosis infection. METHODS: A total of 135 patients with confirmed TB and 141 healthy individuals were included in the analysis. Blood samples were collected for DNA extraction. Genotyping of the polymorphisms in the VDR and IL10 genes was performed by real-time PCR, and genotyping of the polymorphisms in the SLC11A1 gene by conventional PCR, followed by visualization in polyacrylamide gel. The genomic ancestry was obtained using an autosomal panel with 48 insertion/deletion ancestry-informative markers. RESULTS: Polymorphisms TaqI (TT, p=0.004), FokI (CC and CC+CT, p=0.012 and p=0.003, respectively), and BsmI (GG, p=0.008) in the VDR gene, as well as A-592C (GC+AG, p=0.001) in the IL10 gene, were significantly associated with susceptibility to TB In addition, high production of VDR combined with low production of IL10 showed protection for the TB group (p=0.035). CONCLUSIONS: The VDR polymorphisms may confer an increased risk and the IL10 haplotype may be a protection factor for the presence of M. tuberculosis infection in the Brazilian population.

Noninvasive prenatal testing: benefits and limitations of the available tests.

BACKGROUND: The „gold standard“ for prenatal diagnosis of aneuploidies is provided by the karyotype, which has high accuracy, but is dependent on invasive procedures, which generate risk of fetal loss. Different methodologies of development of noninvasive prenatal genetic tests (NIPT) for tracking aneuploidies, including sex chromosomes, have been made available for clinical use, for some microdeletions and triploids and for exclusion of paternity. These exams make use of three methodological tools: s-MPS, t-MPS and SNP. Genetic tests, despite the high cost, cover a broader range of clinical applications, have the advantage that can be performed early, with high accuracy, and low false positive rate. Type of article: Review. SETTING: Department of Obstetrics and Gynecology, Science College of Santa Casa of São Paulo (FSMSCSP), São Paulo-SP, Brazil. DESIGN AND METHODS: This study was a non-asystematic review, which searched PubMed / MEDLINE as a research source and aimed at the compilation of data, which allowed approaching the evolution, the technical and methodological advances of the available tests, the recognition of its benefits, limitations and future perspectives on NIPT. CONCLUSION: NIPT stand out for being applied earlier during the pregnancy with high accuracy and low false-positive rates, including a broad spectrum of clinical applications. The t-MPS is a recent technique used to evaluate aneuploidy that shows greater accuracy and lower cost than the s-MPS, but that is limited to being applied only to the most common aneuploidies. The SNP technique can search for more genetic conditions, besides presenting better accuracy.

Efficacy of carvacrol on Rhipicephalus (Boophilus) microplus engorged female ticks (Canestrini, 1887) (Acari: Ixodidae): effects on mortality and reproduction.

The activity of carvacrol was evaluated in R. microplus female ticks by estimating the mean lethal concentration (LC50) and the acaricidal efficacy. Ticks were subjected to the Adult Immersion Test (AIT) to calculate LC50. From this value, the AIT was performed again at the concentrations of 20%, 40%, 60%, 80% and 100% of the LC50. Two control groups were established: one treated with distilled water and one with the solvent (ethanol 50%). The following parameters were evaluated: female weight before oviposition, egg mass weight, pre-oviposition and incubation period, hatching percentage, egg production index, fecundity rate, estimated reproduction, reduction in oviposition and hatching, and product efficacy. The obtained LC50 was 20.11 mg/mL. Egg mass weight, egg production index, pre-oviposition and fecundity rates of groups treated with 80% and 100% of LC50 were statistically different when compared to control groups. The product efficacy in groups treated with 100% of LC50 was 61.10%.

Removal of iron ore slimes from a highly turbid water by DAF.

This paper addresses Dissolved Air Flotation (DAF) process variables, such as the flocculation parameters and the recycle water addition, as well as the pretreatment chemical variables (coagulation conditions), to determine the optimal values for the flotation of iron ore slimes found in a highly turbid water sample from the Gualaxo do Norte River, a tributary of the Doce River Basin in Minas Gerais, Brazil. This work was conducted using a flotatest batch laboratory-scale device to evaluate the effectiveness of DAF for cleaning the water polluted by the Samarco tailings dam leakage and determine the ability of DAF to reduce the water turbidity from 358 NTU to values below 100 NTU, aiming to comply with current legislation. The results showed that the four types of tested coagulants (PAC, ferric chloride, Tanfloc SG and Tanfloc SL) provided adequate conditions for coagulation, flocculation and flotation (in the range of 90-99.6% turbidity reduction). Although the process variables were optimized and low residual turbidity vales were achieved, results revealed that a portion of the flocs settled at the bottom of the flotatest columns, which indicated that the turbidity results represented removal caused by a combination of flotation and sedimentation processes simultaneously.

Accuracy of p57KIP2 compared with genotyping to diagnose complete hydatidiform mole: a systematic review and meta-analysis.

BACKGROUND: Distinguishing hydatidiform moles (HMs) from nonmolar specimens and the subclassification of HM are important because complete hydatidiform mole (CHM) is associated with an increased risk of development of gestational trophoblastic neoplasia. However, diagnosis based solely on morphology has poor inter-observer reproducibility. Recent studies have demonstrated that the use of p57KIP2 immunostaining improves diagnostic accuracy for CHM. OBJECTIVES: To evaluate the accuracy of p57KIP2 immunostaining compared with molecular genotyping for the diagnosis of CHM. SEARCH STRATEGY: Major databases were searched from inception to March 2017 using the terms 'hydatidiform mole', 'p57', and 'genotyping', with their variations, and the search limit for the relevant study design. SELECTION CRITERIA: Any cross-sectional study, case series, case-control study, cohort study, or clinical trial that evaluated the accuracy of p57KIP2 immunostaining for the diagnosis of CHM compared with genotyping was included. Case reports, narrative reviews, expert opinions, and animal testing were excluded. DATA COLLECTION AND ANALYSIS: Extracted accuracy data were tabulated and pooled using a hierarchical bivariate random effects model. MAIN RESULTS: Bivariate meta-analysis produced a summary sensitivity of 0.984 (95% CI: 0.916-1.000) and specificity of 0.625 (95% CI: 0.503-0.736) with significant heterogeneity for specificity (I2 = 71.8, chi-square P = 0.029). The pooled summary diagnostic odds ratio was 56.54 (95% CI: 11.03-289.74) with no heterogeneity (I2 = 0.00%, chi-square P = 0.67). The diagnostic performance of the test was high with an area under the curve of (AUC) 0.980. CONCLUSIONS: p57KIP2 immunostaining is accurate when diagnosing CHM. It can be used as an adjunct test in a combination algorithmic approach. TWEETABLE ABSTRACT: A meta-analysis to evaluate the accuracy of p57KIP2 compared with genotyping to diagnose CHM.

Clinical Evolution of Patients Using Ventricular Assist Devices as a Bridge for Transplantation.

OBJECTIVE: To evaluate the clinical evolution of patients with implantation of ventricular assist device (VAD) and identify the intervening factors for death. METHODS: This analytical, retrospective study was carried out in a public reference hospital in cardiopulmonary diseases located in northeastern Brazil. The study population encompassed the medical records of 16 patients who underwent VAD implantation. Data collection took place from January to August 2016, through the consultation of medical records. Descriptive analysis, odds ratio, and the Fisher's Exact, Wilcoxon, Friedman and t-tests were used to analyze the data. RESULTS: All patients experienced complications during the use of the device, with bleeding being the main cause (11 [68.8%]). There was a significant decrease in noradrenaline (P = .025), milrinone (Primacor; P = .007), and dobutamine (P = .046) flow rates with the clinical evolution of patients. Regarding hematologic parameters, the use of VAD promoted a significant improvement in hemoglobin (P < .001), hematocrit (P = .003), activated partial thromboplastin time (P = .013), and fibrinogen (P = .049) values at the 3 time points analyzed. Regarding the clinical outcome of the patients, the majority (10 [62.5%]) underwent cardiac transplantation. CONCLUSIONS: This study allowed for better knowledge of the clinical evolution of patients with VAD implantation, highlighting the benefits of this type of device as a bridge for heart transplantation.

Obesity and lower urinary tract dysfunction in children and adolescents: Further research into new relationships.

INTRODUCTION: Lower urinary tract dysfunction (LUTD) involves faults in the filling and emptying phases of bladder function in toilet-trained children with no previous infection or any other obvious pathology. Lower urinary tract dysfunction is associated with conditions such as vesicoureteral reflux, recurrent urinary infection, behavioral alterations and decreased quality of life. The literature suggests an association between LUTD and obesity; however, the association between each individual symptom and obesity has yet to be evaluated. OBJECTIVE: To evaluate the association between excess weight and LUTD in children and adolescents in a community-based sample. STUDY DESIGN: This cross-sectional study included 423 children and adolescents aged 5-17 years, and randomly selected in public places and schools between May and July 2015. The participants and their mothers completed the Dysfunctional Voiding Scoring System (DVSS) questionnaire, except for the questions on constipation and with the addition of a question on enuresis. They also completed the Rome III questionnaire, in which two positive responses defined the presence of constipation. Participants were classified as being of normal weight, overweight or obese, which was based on the BMI-for-age indicator. RESULTS: Mean age was 9.7 years (SD 2.9), with girls comprising 50.6% of the sample and adolescents 52.5%. The prevalence of LUTD was 7.1%, with 13.5% of participants being overweight and 12.1% obese (Figure). Constipation was present in 5.9% of participants and enuresis in 10.8%. In the multivariate analysis, three factors were independently and significantly associated with a positive DVSS: age <10 years (ß = 0.76; 95% CI: 0.34-1.18), constipation (ß = 1.79; 95% CI: 0.88-2.70) and obesity (ß = 0.89; 95% CI: 0.25-1.52). DISCUSSION: Only bladder filling symptoms were associated with obesity. This may be explained by the fact that both obese individuals and those with emptying symptoms were shown to have activation alterations in the same brain regions. One limitation of this study was the use of questionnaires alone to diagnose LUTD and constipation. CONCLUSION: Only the bladder-emptying symptoms of LUTD appear to be associated with obesity. This hypothesis may serve as a basis for future studies.

Metal fractionation in sludge from sewage UASB treatment.

This study evaluates the trace metal composition and fractionation in sludge samples from anaerobic sewage treatment plants from six cities in Brazil. Ten metals were evaluated: Ni, Mn, Se, Co, Fe, Zn, K, Cu, Pb and Cr. Specific methanogenic activity of the sludge was also evaluated using acetic acid as the substrate. Among the essential trace metals for anaerobic digestion, Se, Zn, Ni and Fe were found at a high percentage in the organic matter/sulfide fraction in all sludge samples analyzed. These metals are less available for microorganisms than other metals, i.e., Co and K, which were present in significant amounts in the exchangeable and carbonate fractions. Cu is not typically reported as an essential metal but as a possible inhibitor. One of the samples showed a total Cu concentration close to the maximal amount allowed for reuse as fertilizer. Among the non-essential trace metals, Pb was present in all sludge samples at similar low concentrations and was primarily present in the residual fraction, demonstrating very low availability. Cr was found at low concentrations in all sludge samples, except for the sludge from STP5; interestingly, this sludge presented the lowest specific methanogenic activity, indicating possible Cr toxicity.

Prevalence of hypertension and its associated factors in contaminated areas of the Santos-São Vicente Estuarine region and Bertioga, Brazil: 2006-2009.

In Brazil, cardiovascular diseases account for 33% of deaths and the prevalence of hypertension is of approximately 22%. The Santos and São Vicente Estuarine System is the most important example of environmental degradation by chemicals from industrial sources. The aim of the present study was to evaluate the prevalence of hypertension and its associated factors in the population of this estuary in the period 2006-2009. A cross-sectional study was conducted to assess the aforementioned prevalence of hypertension in the evaluated areas, as well as risk factors for this disease in four contaminated areas located in the Estuary, and one area outside Estuary, the city of Bertioga. Associations between categorical variables were tested using Pearson's chi-square test incorporating Yates' correction, or Fisher's exact test. Single and multiple logistic regression models were applied to evaluate the risk factors for hypertension. The highest prevalence of hypertension was found in Continental São Vicente (28.4%). The risk factors for hypertension were the following: living in Center of Cubatão (OR: 1.3; IC95%: 1.0 - 1.6) and Continental São Vicente (OR: 1.4; IC95%: 1.1 - 1.8); illiterate (OR: 1.9; IC95%: 1.1 - 3.2); living in the area for more than 20 years (OR: 1.2; IC95%: 1.0 - 1.5); group of people aged 36-60 years (OR: 3.9; IC95%: 3.3 - 4.6) and who have had past occupational exposure (OR: 1.3; IC95%: 1.1 - 1.6). Results indicate that living in contaminated areas, especially for a longer time, is a risk factor for hypertension.

Hormonal contraceptive use before hCG remission does not increase the risk of gestational trophoblastic neoplasia following complete hydatidiform mole: a historical database review.

OBJECTIVE: To re-evaluate the safety of hormonal contraceptives (HC) after uterine evacuation of complete hydatidiform mole (CHM). DESIGN: Historical database review. SETTING: Charing Cross Hospital Gestational Trophoblastic Disease Centre, London, United Kingdom. POPULATION: Two thousand four hundred and twenty-three women with CHM of whom 154 commenced HC while their human chorionic gonadotropin (hCG) was still elevated, followed between 2003 and 2012. METHODS: We compared time to hCG remission between HC users and nonusers. The relationship between HC use and gestational trophoblastic neoplasia (GTN) development was assessed. The relationship between HC use and a high International Federation of Gynecology and Obstetrics (FIGO) risk score was determined. MAIN OUTCOME MEASURES: Time to hCG remission, risk of developing postmolar GTN and proportion of women with high FIGO risk score. RESULTS: No relationship was observed between HC use with mean time to hCG remission (HC users versus non-users: 12 weeks in both, P = 0.19), GTN development (HC users versus non-users: 20.1 and 16.7%, P = 0.26) or high-risk FIGO score (HC users versus nonusers: 0% and 8%, P = 0.15). Moreover, no association between HC and GTN development was found, even when an age-adjusted model was used (OR = 1.37, 95% CI 0.91-2.08, P = 0.13). CONCLUSIONS: The use of current HC is not associated with development of postmolar GTN or delayed time to hCG remission. Therefore, HC can be safely used to prevent a new conception following CHM regardless of hCG level. TWEETABLE ABSTRACT: Non-concurrent cohort study to re-evaluate the safety of low dose HCs after uterine evacuation of CHM.

A two-day bladder diary for children: Is it enough?

INTRODUCTION: A bladder diary (BD) is a simple and non-invasive method of evaluating people with lower urinary tract symptoms (LUTS). Recently, the ICCS recommended a 48-h daytime frequency and volume chart (which does not need to be recorded on 2 consecutive days) to evaluate lower urinary tract (LUT) dysfunction. However, some studies on adults have demonstrated that a minimum of 3 days is required. It is believed that, to date, there are no studies in the literature that compare a 2-day BD with a 3-day BD. The advantages of a BD over a shorter period of time are the simplicity and possible better parent compliance. OBJECTIVE: The aim of this study was to evaluate if a 2-day BD is statistically and clinically comparable to a 3-day BD. STUDY DESIGN: A voiding diary was filled in over a 3-day period for 92 children (ages ranged from to 3-16 years, mean 7.9 ± 3.07) attending the present institution. By using the voiding diary, the following parameters were calculated: urination frequency, maximum and average volumes of urine (MVV and AVV) and fluid intake. The diary considered the 2 days as the first and second days of the 3-day diary. RESULTS: Out of the 92 children, eight (8.7%) did not properly complete the diary. The sample predominantly comprised females (n = 55, 59.8%). No differences were seen between 2-day and 3-day bladder diaries regarding fluid intake, maximum and average voided volume. The sensitivity, specificity, positive and negative predictive values of the 2-day bladder diary for detecting frequency were 83.4%, 91.7%, 80% and 93.2%, and for low bladder capacity they were 97.2%, 90.9%, 99% and 88%, respectively (Table). DISCUSSION: In a 2006 document, the ICCS recommended that a bladder diary be kept for 3 days, but in new documentation (2014) there is a reference stating that 2 days are enough. Bladder capacity is an important parameter in evaluating LUTS. Using a 2-day BD, the data showed that only a small percentage of reduced bladder capacity diagnosis would be lost. CONCLUSION: When using the 2-day diary, a 16% false negative rate for frequency should be expected. A 2-day bladder diary is sufficient to evaluate bladder capacity and fluid intake.

Prevalence of liver diseases as referred by people living in the Santos and São Vicente Estuary.

The Santos and São Vicente Estuary has suffered extensively over the years from irregular industrial deposits. The present study aimed to evaluate liver disease prevalence and potential associated risk factors in four of the Estuary's areas (Pilões and Água-Fria, Cubatão Center, Continental São Vicente, and Guarujá) and a reference area (Bertioga). This study consisted of a cross-sectional study design, in which a questionnaire was used to collect information in 820 households at each of the study areas. The proportion of total liver diseases, hepatitis, cirrhosis, and cancer (liver, biliary tract, and pancreas) per area were estimated. Pearson's chi-square test and two proportion differences test were applied in order to evaluate associations between disease occurrence and areas and to test differences between two proportions, respectively. Single and multiple logistic regression models were applied to assess associations between disease prevalence and the different study areas. Liver disease prevalence was 1.5 % among all inhabitants and 1.4 % among those without any type of exposure. Among those who reported the presence of liver disease, a higher percentage of the participants that reported hepatitis (27.7 %) or other liver disease (48.7 %) did not report occupational or alcohol exposures. Hepatitis (77.8 %) was the most reported disease, and a statistical association between living in Pilões and Água-Fria and the occurrence of hepatitis was observed (Pearson's χ (2): z = 18.1; p = 0.001). The consumption of locally-produced groceries (2.88; CI: 1.24-6.70) and water (5.88; CI: 2.24-15.45) were shown to be risk factors for the occurrence of liver disease. Thus, environmental exposure is still a public health problem present in the estuary region.

Involvement of oxidative stress in subacute toxicity induced by fumonisin B1 in broiler chicks.

Fumonisin B1 (FB1) is a mycotoxin produced by Fusarium spp. It has been reported to be a potential cause of liver cancer in rats and esophageal cancer in humans. The underlying mechanisms of FB1 toxicity are thought to be related to the inhibition of ceramide synthase, causing an accumulation of sphingosine (SO) and sphinganine (SA), which in turn may cause tissue functional impairment and the development of oxidative stress. Therefore, in this study, we investigate the effects of an FB1-contaminated diet on markers of oxidative stress in chick liver. A total of 24 male broiler chicks (Cobb 500) were fed a standard control diet or a diet contaminated with FB1 (100mg/kg) for 21 days, starting on postnatal day one. The feed and animals were weighed on days 0, 7, 14 and 21 to estimate the feed conversion ratio, and at 21 days, the liver weight and liver relative weight were determined. At the end of the experiment, samples of blood and liver were collected. The blood was used to quantify the SA/SO ratio, and the liver was used to determine the activity of antioxidant enzymes superoxide dismutase (SOD), catalase (CAT) and glutathione-S-transferase (GST); ascorbic acid levels (VitC), non-protein thiol (NPSH) levels and TBARS content were also determined. The FB1 diet increased the liver weight, liver relative weight, feed conversion and SA/SO ratio. Furthermore, hepatic TBARS levels, Vit C content and CAT activity were also increased. Conversely, the activities of SOD, GST and NPSH levels, in the liver were not altered by the mycotoxin-contaminated diet. In summary, we showed that subacute exposure of broiler chicks to FB1 induced liver oxidative stress concomitantly with SA/SO accumulation.

Efficacy of cognitive behavioral therapy in reducing psychiatric symptoms in patients with implantable cardioverter defibrillator: an integrative review

This article is a systematic review of the available literature on the benefits that cognitive behavioral therapy (CBT) offers patients with implanted cardioverter defibrillators (ICDs) and confirms its effectiveness. After receiving the device, some patients fear that it will malfunction, or they remain in a constant state of tension due to sudden electrical discharges and develop symptoms of anxiety and depression. A search with the key words “anxiety”, “depression”, “implantable cardioverter”, “cognitive behavioral therapy” and “psychotherapy” was carried out. The search was conducted in early January 2013. Sources for the search were ISI Web of Knowledge, PubMed, and PsycINFO. A total of 224 articles were retrieved: 155 from PubMed, 69 from ISI Web of Knowledge. Of these, 16 were written in a foreign language and 47 were duplicates, leaving 161 references for analysis of the abstracts. A total of 19 articles were eliminated after analysis of the abstracts, 13 were eliminated after full-text reading, and 11 articles were selected for the review. The collection of articles for literature review covered studies conducted over a period of 13 years (1998-2011), and, according to methodological design, there were 1 cross-sectional study, 1 prospective observational study, 2 clinical trials, 4 case-control studies, and 3 case studies. The criterion used for selection of the 11 articles was the effectiveness of the intervention of CBT to decrease anxiety and depression in patients with ICD, expressed as a ratio. The research indicated that CBT has been effective in the treatment of ICD patients with depressive and anxiety symptoms. Research also showed that young women represented a risk group, for which further study is needed. Because the number of references on this theme was small, further studies should be carried out.

Efficacy of cognitive behavioral therapy in reducing psychiatric symptoms in patients with implantable cardioverter defibrillator: an integrative review.

This article is a systematic review of the available literature on the benefits that cognitive behavioral therapy (CBT) offers patients with implanted cardioverter defibrillators (ICDs) and confirms its effectiveness. After receiving the device, some patients fear that it will malfunction, or they remain in a constant state of tension due to sudden electrical discharges and develop symptoms of anxiety and depression. A search with the key words "anxiety", "depression", "implantable cardioverter", "cognitive behavioral therapy" and "psychotherapy" was carried out. The search was conducted in early January 2013. Sources for the search were ISI Web of Knowledge, PubMed, and PsycINFO. A total of 224 articles were retrieved: 155 from PubMed, 69 from ISI Web of Knowledge. Of these, 16 were written in a foreign language and 47 were duplicates, leaving 161 references for analysis of the abstracts. A total of 19 articles were eliminated after analysis of the abstracts, 13 were eliminated after full-text reading, and 11 articles were selected for the review. The collection of articles for literature review covered studies conducted over a period of 13 years (1998-2011), and, according to methodological design, there were 1 cross-sectional study, 1 prospective observational study, 2 clinical trials, 4 case-control studies, and 3 case studies. The criterion used for selection of the 11 articles was the effectiveness of the intervention of CBT to decrease anxiety and depression in patients with ICD, expressed as a ratio. The research indicated that CBT has been effective in the treatment of ICD patients with depressive and anxiety symptoms. Research also showed that young women represented a risk group, for which further study is needed. Because the number of references on this theme was small, further studies should be carried out.

Impaired post exercise heart rate recovery in anabolic steroid users.

Previous study showed that muscle sympathetic nerve activity (MSNA) was augmented in anabolic steroids users (AASU). In the present study, we tested the hypothesis that the heart rate (HR) responses after maximal exercise testing would be reduced in AASU. 10 male AASU and 10 AAS nonusers (AASNU) were studied. Cardiopulmonary exercise was performed to assess the functional capacity and heart rate recovery. MSNA was recorded directly from the peroneal nerve by microneurography technique. Peak oxygen consumption (VO2) was lower in AASU compared to AASNU (43.66±2.24 vs. 52.70±1.68 ml/kg/min, P=0.005). HR recovery (HRR) at first and second minute was lower in AASU than AASNU (21±2 vs. 27±2 bpm, P=0.02 and 37±4 vs. 45±2 bpm, P=0.05, respectively). MSNA was higher in AASU than AASNU (29±3 vs. 20±1 bursts/min, P=0.01). Further analysis showed a correlation between HRR and MSNA (r=- 0.64, P=0.02), HRR at first minute and peak VO2 (r=0.70, P=0.01) and HRR at second minute and peak VO2 (r=0.62, P=0.02). The exacerbated sympathetic outflow associated with a lower parasympathetic activation after maximal exercise, which impairs heart rate recovery, strengthens the idea of autonomic imbalance in AASU.

Fenômeno lúcio. Relato de um caso exuberante com excelente resposta ao tratamento com poliquimioterapia multibacilar

O Fenômeno de Lúcio (FL) representa uma reação cutânea necrosante grave, que pode ocorrer na Hanseníase de Lúcio e em outras formas de Hanseníase Virchowiana. Manifesta-se 3-4 anos após o início da doença e é mais comum em pacientes não tratados ou recebendo dose inadequada de tratamento. Caracteriza-se por surtos de máculas eritematosas, ligeiramente infiltradas, que evoluem com necrose central e posterior ulceração. Sua fisiopatogenia é ainda desconhecida, porém é consenso que se trata fundamentalmente de um processo trombótico-oclusivo. Na histologia observa-se trombose de pequenos vasos da derme superior e média, resultando em ulceração da epiderme, infiltrado inflamatório com histiócitos espumosos, e numerosos bacilos, inclusive na parede dos vasos.