Commotio cordis: Another cardiac arrest "sine materia". The 1707 early report and interpretation by G.M. Lancisi.

Sudden death by commotio cordis is rare. It is the consequence of a blunt trauma of the chest overlying the heart. The mechanism is a cardiac arrest by ventricular fibrillation in the absence of grossly or microscopically apparent myocardial injury. It has been reproduced in animals. The first historical case was reported by Giovanni Maria Lancisi in his book "De Subitaneis Mortibus'' published in 1707. Sudden death occurred in a man receiving a powerful blow under the xiphoid cartilage. Lancisi advanced the hypothesis of acute heart failure by a diastolic stand still ("death in diastole'').

Motivação acadêmica e autoestima contingente: relação com satisfação de vida, esperança e otimismo / Academic motivation and contingent self-esteem: investigating the relation with life satisfaction, hope and optimism / Motivacón académica y autoestima contingente: relación con la satisfaccíon de la vida, la esperanza y el optimismo

Este estudo investigou em uma amostra de estudantes de universidades públicas e privadas a relação entre o tipo de motivação para os estudos (intrínseca ou externa) com autoestima e personalidade, otimismo, esperança e satisfação de vida. Os resultados indicaram associação entre os domínios de competência acadêmica, competição e aparência com Motivação Extrínseca no âmbito acadêmico. Além disso, houve associação significativa do fator neuroticismo com o domínio Aprovação de Outros. As mulheres apresentaram escores mais elevados em domínios de contingência externa. Foram realizadas análises de regressão e o domínio Aprovação de Outros demonstrou maior poder de explicação (35,9%), seguido pelo de Competência Acadêmica (28,4%) e Aparência (25,5%). Esses achados estão de acordo com a literatura, indicando que quando a autoestima se apoia em contingências externas pode haver menor motivação para os estudos. Os achados indicam a necessidade de estratégias de intervenção que propiciem ambientes que oportunizem o interesse intrínseco para a aprendizagem nas universidades. (AU)

Motivation for learning is fundamental and closely related to external and internal factors and to the extent to which they interrelate. Accordingly, self-esteem can be an indicator of how the individual deals with the environment and with internal pressure, especially when this is based on external contingencies. This study sought to investigate, in a sample of university students, the relationship of the type of motivation with self-esteem and characteristics such as personality, optimism, hope, and life satisfaction. In the study sample, an association was found between extrinsic motivation in the academic environment and the contingency domains of academic competence, competition, and appearance. We concluded that the findings are in line with the literature and indicate the need for intervention strategies in higher education, aiming to promote an environment that is more favorable to the intrinsic interest in studying. (AU)

La motivación para el aprendizaje es fundamental y está estrechamente relacionada con factores extrínsecos e intrínsecos y cómo estos se interrelacionan. En este sentido, la autoestima puede ser un indicador de cómo el individuo trata con el medio ambiente y con las presiones internas, especialmente cuando depende de contingencias externas como una forma de mantener el autoestima elevado. Este estudio tuvo como objetivo investigar en una muestra de estudiantes universitarios la relación del tipo de motivación para los estudios (intrínseca o extrínseca) con autoestima y características tales como personalidad, optimismo, esperanza y satisfacción con la vida. La muestra del estudio presentó una asociación entre los dominios de competencia académica, competición y apariencia con la motivación extrínseca en el campo académico. Se concluye que los resultados respaldan la literatura vigente, lo que indica la necesidad de estrategias de intervención en el ámbito de la educación superior para promover un ambiente más propicio para el interés intrínseco para el aprendizaje en las universidades. (AU)

O uso de escalas psicológicas para avaliar autoestima / The use of psychological scales to assess self-esteem / El uso de escalas psicológicas para evaluar autoestima

A autoestima é amplamente explorada em pesquisa. Dois estudos foram conduzidos para identificar o uso das escalas de autoestima em publicações científicas. O primeiro analisou artigos científicos publicados em quatro periódicos tradicionais no campo da avaliação psicológica no Brasil. A escala mais utilizada foi a Escala de Autoestima de Rosenberg (RSES), referida em 68% dos casos. Além disso, houve predomínio da avaliação global da autoestima. O segundo estudo avaliou publicações disponíveis no Portal de Periódicos CAPES/MEC. Notou-se um aumento de publicações com escalas de autoestima a partir da década de 1990; a RSES foi novamente a mais citada (64%). Atenta-se para a importância de explorar diferentes instrumentos de avaliação, contemplando diferentes domínios e situações que influenciam diretamente os níveis de autoestima. Acima de tudo, detectou-se uma notável ausência de informação sobre as propriedades psicométricas das escalas utilizadas. (AU)

Self-esteem has been widely investigated in research. Two studies were performed to identify the use of self-esteem scales in scientific publications. The first study analyzed papers published in four traditional journals in the field of psychological assessment in Brazil. The most used scale was the Rosenberg Self-Esteem Scale (RSES), cited by 68% of the papers. In addition, assessment of global self-esteem predominated. The second study assessed publications available in the Portal de Periódicos CAPES/MEC database. There was an increase in publications citing self-esteem scales during the 1990's; the RSES was again the most cited (64%). We highlight the relevance of exploring different assessment instruments, including different domains and situations that directly influence self-esteem levels. More importantly, we detected a remarkable absence of information on the psychometric properties of the scales used. (AU)

La autoestima es ampliamente estudiada en investigación científica. Se realizaron dos estudios para identificar el uso de las escalas de autoestima en publicaciones científicas. El primero analizó artículos científicos publicados en cuatro periódicos tradicionales en el campo de la evaluación psicológica en Brasil. La escala más utilizada fue la Escala de Autoestima de Rosenberg (RSES), empleada por 68% dos casos. Además, prevaleció la evaluación global de autoestima. El segundo estudio evaluó publicaciones disponibles en el Portal de Periódicos CAPES/MEC. Se identificó un aumento de publicaciones con escalas de autoestima a partir de la década de 1990; la RSES fue nuevamente la más citada (64%). Se enfatiza la importancia de explorar diferentes instrumentos de evaluación, contemplando diferentes dominios y situaciones que influyen directamente en los niveles de autoestima. Sobre todo, se detectó una notable ausencia de información sobre las propiedades psicométricas de las escalas utilizadas. (AU)

Satisfaction of basic needs and its repercussion in the course of development / Satisfação de necessidades básicas e sua repercussão no curso do desenvolvimento / Satisfacción de necesidades básicas y su repercusión en el curso del desarrollo

Self-determination Theory (SDT) has an organismic and dialectical framework for the study of personality growth and development. From SDT's perspective, individuals are prone to develop towards an active and integrative way. Therefore, there are three basic needs that must be satisfied: autonomy, relatedness and competence. Through the association between personal characteristics and the satisfaction of needs development and integration will be allowed. This paper will discuss SDT precepts and how the satisfaction of these needs reverberates throughout development. (AU)

A Teoria da Autodeterminação (TAD) é uma teoria organísmica e dialética que considera os indivíduos como ativos no processo de desenvolvimento, com potencial para o crescimento e integração. Para tanto é fundamental que três necessidades básicas sejam satisfeitas: autonomia, relação e competência. É através do interjogo das características pessoais e dos nutrientes dados pelo meio que irá permitir ou não o bom desenvolvimento e integração. Este trabalho propõe-se a discutir os preceitos da TAD e a forma como a satisfação dessas necessidades repercute ao longo do desenvolvimento. (AU)

La Teoría de la Autodeterminación (TAD) es una teoría organicista y dialéctica que considera como individuos activos en el proceso de desarrollo, con un potencial de crecimiento e integración. Por lo tanto, es esencial que se cumplan tres necesidades básicas: autonomía, relación y competencia. Es a través de la interacción de las características personales y los datos de los nutrientes a través que va a permitir o no permitir el desarrollo y la integración con éxito. Este trabajo tiene como objetivo discutir los preceptos del TAD y como la forma de satisfacer esas necesidades reverbera a lo largo del desarrollo. (AU)

Should the annular tendon of the eye be named 'annulus of Zinn' or 'of Valsalva'?

The annular tendon is commonly named 'annulus of Zinn', from the German anatomist and botanist Johann Gottfried Zinn (1727-1759) who described this structure in his Descriptio anatomica oculi humani (Anatomical Description of the Human Eye, 1755). This structure, however, had been previously discovered not by Zinn, but by Antonio Maria Valsalva (1666-1723) some decades before the publication of Zinn, in his Dissertatio anatomica prima and Dissertatio anatomica altera (First and Second Anatomical Dissertations), inside Valsalva's Opera omnia published in 1740. We advance that this structure could be re-named such as 'annulus of Valsalva-Zinn' because Valsalva, even making a mistake in its functional interpretation, first described this anatomical structure. Likewise, Valsalva, with his discovery, advanced a revolutionary idea for that time on the usefulness of anatomy for clinic and pathology.

Pentraxin 3 and complement cascade activation in the failure of arteriovenous fistula.

OBJECTIVE: Pentraxin-3 (PTX3) has been suggested to play a role in the development of vascular pathology. Stenosis of arteriovenous fistula (AVF) leading to its failure is the major cause of morbidity in hemodialysis patients. To date, little is known on the pathogenesis of AVF stenosis. The aim of the present study was to investigate the potential role of PTX3 in this setting. METHODS AND RESULTS: A sample of venous wall was collected at the time of AVF formation in 44 patients with end stage renal disease. Ten patients developed AVF stenosis and from these patients a second portion of the venous wall was obtained during surgical revision of the AVF. Confocal laser scanning microscopy demonstrated that PTX3 immunostaining, hardly detectable in native AVF, was significantly increased in failed AVF, showing a specific co-localization with endothelial cell markers. Circulating mononuclear cells isolated at the time of AVF revision presented a significantly higher PTX3 mRNA expression than those collected during AVF creation. Interestingly, a significant deposition of C5b-9 on endothelial cells, co-localizing with PTX3, was observed in stenotic AVF. CONCLUSION: The present study demonstrates for the first time a close association between PTX3 deposition and complement activation at the endothelial cell level in failed AVF and suggests a role for PTX3 in modulating innate immunity in the pathogenesis of AVF stenosis.

Local activation of interleukin 6 signaling is associated with arteriovenous fistula stenosis in hemodialysis patients.

BACKGROUND: Vascular access failure is the main cause of morbidity in hemodialysis patients. Stenosis of the arteriovenous fistula (AVF) is similar histologically to atherosclerosis. Recent studies showed that interleukin 6 (IL-6) has a key role in the pathogenesis of atherosclerosis by binding 2 specific receptors, gp80 and gp130. When activated, gp130 interacts with a tyrosine kinase, Janus kinase (JAK2), which then activates a transcription factor, signal transducers and activators of transcription (STAT3), directly turning on several proinflammatory genes. The aim of this study is to evaluate gp130 expression and JAK2/STAT3 activation within stenotic AVFs. METHODS: 44 patients undergoing surgery for AVF creation were enrolled; 10 of them had AVF failure with histologically proven AVF stenosis (wall-lumen ratio > 1). A venous fragment of the AVFs was collected during creation and revision of the vascular access. gp130 and gp80 expression, as well as JAK/STAT activation, were evaluated by means of confocal microscopy. Peripheral-blood mononuclear cells were isolated at the time of AVF creation and revision. RESULTS: gp130 protein expression, barely detectable in native AVFs, was strikingly increased within the venous branch of stenotic AVFs. The signaling subunit of the IL-6 receptor broadly colocalized with gp80, the IL-6-binding subunit. gp130-expressing cells were mainly CD34(+), suggesting that this receptor is expressed primarily by neovasculature endothelial cells. At the same time, a significant increase in phosphorylation of JAK2/STAT3 was observed in endothelial cells of stenotic AVFs. Interestingly, peripheral-blood mononuclear cells isolated at the time of AVF failure presented strikingly greater IL-6 expression compared with dialysis age-matched controls. CONCLUSION: IL-6 receptor activation may have a role in the pathogenesis of AVF failure in hemodialysis patients and may represent a potential therapeutic target in this setting.

Coagulation cascade activation causes CC chemokine receptor-2 gene expression and mononuclear cell activation in hemodialysis patients.

Priming of the coagulation cascade during hemodialysis (HD) leads to the release of activated factor X (FXa). The binding of FXa to its specific receptors, effector protease receptor-1 (EPR-1) and protease-activated receptor-2 (PAR-2), may induce the activation of peripheral blood mononuclear cells (PBMC) and promote a chronic inflammatory state that is responsible for several HD-related morbidities. In the attempt to elucidate the mechanisms underlying the coagulation-associated inflammation in HD, 10 HD patients were randomized to be treated subsequently with a cellulose acetate membrane (CA) and Ethylen-vinyl-alcohol (EVAL), a synthetic membrane that has been shown to reduce FXa generation. At the end of each experimental period, surface FXa and thrombin receptors (EPR-1 and PAR-1, -2, and -4) and CCR2 (monocyte chemoattractant protein-1 receptor) gene expression in isolated PBMC were examined. the ability of dialytic membranes to activate protein-tyrosine kinases and the stress-activated kinase JNK and to modulate the generation of terminal complement complex (TCC) was also investigated. EPR-1 and PAR-2 and -4 mRNA expression, barely detectable in normal PBMC, were significantly upregulated in HD patients, particularly in those who were treated with CA. A striking increase of tyrosine-phosphorylated proteins and JNK activation was observed at the end of HD only in CA-treated patients. Simultaneously, an increased gene expression for both splicing isoforms of CCR2, A and B, only in PBMC from CA-treated patients was demonstrated. The increased CCR-2 mRNA abundance was followed by a significant increase in its protein synthesis. The high expression of CCR2 was associated with an increased generation of plasma TCC and a significant drop in leukocyte and monocyte count. By contrast, EVAL treatment slightly lowered TCC generation and normalized leukocyte count. In vitro FXa induced CCR2 A and B expression and JNK activation in freshly isolated PBMC. FXa-induced CCR2 mRNA expression was completely abolished by JNK and tyrosine kinase inhibition. In conclusion, these data suggest that subclinical clotting activation may cause an increased CCR2 gene and protein expression on uremic PBMC, contributing to HD-related chronic microinflammation. The use of the less coagulation-activating membrane, EVAL, may reduce PBMC activation through the modulation of the stress-activated kinase JNK.

In vivo modulation of soluble "antagonistic" IL-6 receptor synthesis and release in ESRD.

Soluble gp130 (sgp130) is a soluble circulating receptor of IL-6 with "antagonistic" biologic activity. It is generated independently by either shedding of the extracellular domain of membrane gp130 or alternative mRNA splicing. This study was addressed to clarify the mechanisms underlying sgp130 synthesis and release in patients who undergo regular dialysis treatment (RDT) using dialytic membranes with different biocompatibility. Two groups of RDT patients were enrolled: 11 patients who were treated with cellulosic membranes (C) and 10 patients who were treated with synthetic membranes (S). Ten healthy subjects constituted the control group. Serum samples and peripheral blood mononuclear cells (PBMC) were harvested in all groups (before dialysis in RDT patients). PBMC were cultured for 24 h in the absence or presence of LPS. The serum levels of sgp130 were significantly higher in C group than in control and S patients (C, 603.1 +/- 89.9; control, 396 +/- 49.5; S, 423.4 +/- 27.7 ng/ml; P < 0.01). PBMC from C patients, in the absence of any mitogenic stimulation, released a significantly greater amount of sgp130 as compared with S and control groups (C, 532.6 +/- 161.2; S, 332.4 +/- 148.6; control, 341.4 +/- 125.4 pg/ml; P < 0.01). The sgp130 release was positively correlated with the release of both IL-6 (r = 0.336, P < 0.05) and sIL-6R receptor (r = 0.324, P < 0.05). A significantly higher gp130 gene expression was also observed in unstimulated PBMC from C patients when compared with control and S groups. It is interesting that the expression of the 85-bp exon characteristic of the alternative splicing mRNA for sgp130 was low in all groups. Finally, confocal microscopy analysis showed an increased expression of gp130 on cell surface in unstimulated PBMC from C patients as compared with control and S groups. Our results demonstrate that in patients on RDT with C membranes, the synthesis and release of sgp130 "antagonistic" receptor is significantly increased. This release is seemingly due to a shedding of membrane-bound gp130 receptor. The increased sgp130 release may partially counteract the inflammatory effects caused by IL-6.