The FKBP5 polymorphism rs1360780 is associated with lower weight loss after bariatric surgery: 26 months of follow-up.

BACKGROUND: Bariatric surgery is the most effective treatment choice for severe obesity. Recent literature indicates that FK506-binding protein 51 (FKBP51) could play a role in energy homeostasis, influencing adipogenesis and weight. OBJECTIVE: To evaluate if the presence of the T allele of the FKBP5 SNP rs1360780, associated with increased FKBP51 expression, could influence weight loss after bariatric surgery. SETTING: Hospital de Clínicas de Porto Alegre, Brazil. METHODS: Forty-two patients awaiting bariatric surgery were included, and the presence of the FKBP5 rs1360780 polymorphism was evaluated. During the postoperative period, a 26-month follow-up of weight loss was performed (n = 42, 36, 35, 35, and 30, from the first to fifth postoperative evaluation, respectively; loss to follow-up: 28.6%). RESULTS: Carriers of the T allele presented significantly lower weight loss compared with patients with the C/C genotype after the 12th to 14th month follow-up period. Differences in weight loss between genotypes ranged from 14.2% to 19.9% of excess weight loss (P = .045 and .004, respectively) and from 7.6% to 9.0% of total weight loss (P = .002 for both comparisons). Furthermore, carriers of the T allele also presented an earlier cessation of weight loss after surgery. CONCLUSION: The presence of the T allele of the FKBP5 SNP rs1360780 was associated with weight loss after bariatric surgery. Bariatric surgery can interact with genes involved in metabolic regulation, leading to different weight loss outcomes.

Asma de difícil controle em pediatria: desafio presente e futuro / Hard-to-control asthma and pediatrics: current and future challenges

Objetivos: fazer revisão dos aspectos epidemiológicos, clínicos, propedêuticos e do manejo terapêutico da asma de difícil controle. Fonte dos dados: pesquisa não sistemática nas bases de dados Medline e LILACS. Síntese dos dados: a asma de difícil controle (ADC) constitui-se em síndrome definida na ausência de controle da asma com doses de budesonida, ou equivalente, iguais ou superiores a 800 ?g por dia. Apesar da simplicidade dessa definição clínica, o manejo propedêutico e terapêutico envolve multiplicidade de fatores e os pacientes devem ser acompanhados por pneumopediatra e equipe multidisciplinar em centros de referência. É necessário confirmar o diagnóstico de asma, avaliar diagnósticos alternativos e/ou fatores agravantes, verificar a adesão, a presença de causas psicossociais e estabelecer o fenótipo da asma a partir de marcadores inflamatórios (invasivos e não invasivos). As pesquisas revelam que os diferentes fenótipos requerem tratamentos específicos, entretanto, a aplicação na prática clínica desse conhecimento fenotípico ainda requer mais estudos. Conclusões: a asma de difícil controle em criança ou adolescente pode estar relacionada a múltiplas causas e à existência de diferentes subgrupos de ADC e com diferentes fisiopatologias de base.

Objectives: To review the epidemiological, clinical, propaedeutic aspects as well as the treatment of hard-to-control asthma. Source of data : Non-systematic research on Medline and LILACS databases. Data summary: Hard-to-control asthma (HCA) is a syndrome defined as the lack of asthma control despite daily doses of budesonide or equivalent that are equal to or higher than 800 ?g. This clinical definition may sound simple, but preliminary handling and treatment involve multiple factors and patients should be followed up by a pediatric pulmonologist and a multidisciplinary team at specialist care centers. It is necessary to confirm the diagnosis, to assess alternative diagnoses and/or aggravating factors, assess compliance and existence of psychosocial causes, and to define the asthma phenotype based on inflammatory markers (both invasive and non-invasive). Studies show that different phenotypes demand different treatments; however, further studies are needed to investigate the actual application of this knowledge in the clinical practice. Conclusions: Hard-to-control asthma in children or adolescents can be related to multiple causes and the existence of different HCA subgroups with different pathophysiological grounds

Transmissão do psiquismo entre as gerações / The Psychic Transmission Between Generations

O debate sobre a transmissão do psiquismo entre gerações, embora presentedesde o início na obra de Freud, teve nos últimos anos um novo impulso napsicanálise, com vários trabalhos dedicados à articulação da realidade psíquicado sujeito singular com a realidade psíquica do grupo. O estudo dessesfenômenos pode enriquecer a compreensão do sofrimento psíquico, e oobjetivo deste trabalho é realizar uma revisão teórica sobre o tema da transmissãodo psiquismo entre as gerações, nas modalidades intergeracional etransgeracional, exemplificando-se com um caso clínico.(AU)

The debate about psychic transmission between generations has been present,in the work of Freud, since the beginning of psychoanalysis. But there hasbeen a renewal of interest about this subject in the last years, and many articleshave been dedicated to the understanding of the relationship between thepsychic reality of the singular person and that of his group. The study of thisphenomenon can enrich our comprehension of psychic suffering. So, theobjective of this work is to proceed a revision of the literature about this topic on its two modalities, intergenerational and transgenerational transmission.A clinical report is included as an illustration.

Transmissão do psiquismo entre as gerações / The psychic transmission between generations

O debate sobre a transmissão do psiquismo entre gerações, embora presentedesde o início na obra de Freud, teve nos últimos anos um novo impulso napsicanálise, com vários trabalhos dedicados à articulação da realidade psíquicado sujeito singular com a realidade psíquica do grupo. O estudo dessesfenômenos pode enriquecer a compreensão do sofrimento psíquico, e oobjetivo deste trabalho é realizar uma revisão teórica sobre o tema da transmissãodo psiquismo entre as gerações, nas modalidades intergeracional etransgeracional, exemplificando-se com um caso clínico.

The debate about psychic transmission between generations has been present,in the work of Freud, since the beginning of psychoanalysis. But there hasbeen a renewal of interest about this subject in the last years, and many articleshave been dedicated to the understanding of the relationship between thepsychic reality of the singular person and that of his group. The study of thisphenomenon can enrich our comprehension of psychic suffering. So, theobjective of this work is to proceed a revision of the literature about this topic on its two modalities, intergenerational and transgenerational transmission.A clinical report is included as an illustration.

Left atrial appendage assessment by second harmonic transthoracic echocardiography after an acute ischemic neurologic event.

Although second harmonic (sh) imaging is widely available in most contemporary ultrasound systems, its accuracy to evaluate left atrial appendage (LAA) morphology and function remains poorly characterized. We conducted a cross-sectional survey of patients with acute ischemic neurologic conditions (n = 51) who underwent both transesophageal and transthoracic echocardiography (TTE) to explore the performance of sh in LAA assessment. Doppler and LAA area evaluation by sh TTE were feasible in most patients (98%). We observed positive and significant associations between sh TTE and transesophageal echocardiography assessment of LAA peak emptying velocities (r = 0.63, P < .001) and LAA maximum area (r = 0.73, P < .001). In addition, all patients (n = 7) with LAA thrombus or spontaneous contrast had peak emptying velocities less than 50 cm/s on sh TTE (negative predictive value of 100%). In multivariate analysis, LAA peak emptying velocity remained independently associated with LAA thrombus or contrast. In conclusion, sh TTE can provide valuable and clinically relevant information of LAA morphology and dynamics.

Tracer studies in the rat demonstrate misdirected filtration and peritubular filtrate spreading in nephrons with segmental glomerulosclerosis.

In two genetic models of "classic" focal segmental glomerulosclerosis (FSGS), the Milan normotensive and the Fawn-hooded hypertensive rats, tracer studies were performed to test the hypothesis that misdirected glomerular filtration and peritubular filtrate spreading are relevant mechanisms that contribute to nephron degeneration in this disease. Two exogenous tracers, lissamine green and horse spleen ferritin, were administered by intravenous injection and subsequently traced histologically in serial kidney sections. In contrast to control rats, both tracers in kidneys of Milan normotensive and Fawn-hooded hypertensive rats with established FSGS were found to accumulate extracellularly at the following sites: (1) within tuft adhesions to Bowman's capsule and associated paraglomerular spaces, (2) at the glomerulotubular junction contained within extensions of the paraglomerular spaces onto the tubule, and (3) within subepithelial peritubular spaces eventually encircling the entire proximal convolution of an affected nephron. This distribution strongly suggests the existence of misdirected filtration into tuft adhesions to Bowman's capsule and subsequent spreading of the filtrate around the entire circumference of a glomerulus and, alongside the glomerulotubular junction, onto the outer aspect of the corresponding tubule. This leads to an interstitial response that consists of the formation of a barrier of sheet-like fibroblast processes around the affected nephron, which confines the filtrate spreading and, subsequently, the destructive process to the affected nephron. No evidence was found that either misdirected filtration and peritubular filtrate spreading themselves or the associated tubulo-interstitial process led to the transfer of the injury from an affected nephron to an unaffected nephron. It is concluded that in the context of FSGS development, misdirected filtration and peritubular filtrate spreading are important damaging mechanisms that underlie the extension of glomerular injury to the corresponding tubulointerstitium, thus leading finally to degeneration of both the glomerulus and the tubule of a severely injured nephron.