Insufficient choline intake during pregnancy: cohort study / Ingestão insuficiente de colina durante a gestação: estudo de coorte

ABSTRACT Objective To investigate the intake of choline during pregnancy and associated factors. Methods Cohort study with 353 pregnant women recruited from the primary health care network in an inland city of the State of São Paulo. In-house interviews were conducted in each of the gestational trimesters. In each of these points in time, a 24-hour dietary recall was collected. Subsequently, a new dietary recall collection was performed by telephone in the same trimester on a non-consecutive day, differentiating weekday versus weekend/holiday. Dietary intake data were included in the Nutrition Data System for Research software, and the habitual food intake throughout pregnancy was determined, with intra-individual variation correction in the MSM software. The influence of socioeconomic, obstetric and lifestyle factors, and of the actual diet, on choline intake during pregnancy was assessed using linear regression models, that were developed with the Stata software version 14.2, at a significance level of 95%. Results Choline intake (281.1±68.6 milligrams) was below the recommended adequate intake, and only energy was positively associated with this micronutrient intake. Conclusion Choline intake in the population studied fell far short of current recommendations, and only higher energy intake was found as a factor associated with a higher intake.

RESUMO Objetivo Investigar a ingestão de colina durante a gestação e fatores associados. Métodos Estudo de coorte com 353 gestantes recrutadas na rede de assistência primária à saúde de cidade paulista. Foram realizadas entrevistas presenciais, no domicílio, em cada um dos trimestres gestacionais. Em cada momento foi coletado um recordatório alimentar de 24 horas, seguido por nova coleta via telefone no mesmo trimestre, em dia não consecutivo, diferenciando dia de semana versus final de semana/feriado. Os dados de consumo alimentar foram incluídos no software Nutrition Data System for Research, sendo obtida a ingestão habitual, durante toda a gestação, com correção da variação intraindividual, no software MSM. A influência de fatores socioeconômicos, obstétricos, de estilo de vida e da própria dieta sobre a ingestão de colina na gestação foi avaliada por modelos de regressão linear, realizados no software Stata versão 14.2, ao nível de significância de 95%. Resultados A ingestão diária de colina (281,1±68,6 miligramas) mostrou-se abaixo do recomendado, sendo que apenas a energia mostrou-se como positivamente associada à ingestão desse micronutriente. Conclusão A ingestão de colina na população estudada ficou muito aquém das recomendações atuais, sendo que apenas a maior ingestão energética foi encontrada como fator associado à maior ingestão de colina.

Efeito da suplementação de colina protegida no perfil metabólico e intervalo entre parto e concepção de vacas leiteiras / Prepartum supplementation of protected choline on metabolic profile and interval between calving and conception of dairy cows

Durante o periparto, as vacas leiteiras são submetidas a uma grande demanda de energia, ao mesmo tempo em que reduzem sua ingestão de matéria seca. O balanço energético negativo, resultante dessa equação, acarreta severos transtornos metabólicos, à produção e, principalmente, à reprodução. O objetivo do presente estudo foi avaliar o efeito da colina protegida sobre os parâmetros metabólicos, o intervalo entre parto e concepção e a produção de leite em vacas no período de transição. Cinquenta e quatro vacas leiteiras foram divididas em três grupos: controle, suplementação com colina por 10 dias pré-parto (T10) e suplementação com colina por 20 dias pré-parto (T20). Após o parto, foram mensurados os teores de frutosamina, colesterol, ácidos graxos não esterificados (AGNE), beta-hidroxibutirato (BHB), aspartato aminotransferase (AST), gamaglutamiltransferase (GGT) e total de oxidantes (TOS), nos dias 10, 20 e 30. Ainda foram avaliadas produção de leite e intervalo entre parto e concepção. Não houve efeito da suplementação com colina sobre os parâmetros sanguíneos e a produção. O intervalo entre parto e concepção foi menor no grupo T20. A colina suplementada por 20 dias durante o pré-parto melhorou a performance reprodutiva de vacas leiteiras(AU)

During the periparturient dairy cows undergo a large energy demand, at the same time reducing their intake of dry matter. The negative energy balance resulting from this equation leads to severe metabolic disorders in production, and mainly in reproduction. The aim of this study was to evaluate the effect of protected choline on metabolic parameters, reproductive performance, and milk production in cows during the transition period. Fifty-four dairy cows were divided into three groups: control, supplementation with choline for 10 days prepartum (T10) and supplementation with choline for 20 days prepartum (T20). After delivery we measured fructosamine levels, cholesterol, non-esterified fatty acids (NEFA), beta-hydroxybutyrate (BHB), aspartate aminotransferase (AST), gamma glutamyltransferase (GGT), and total oxidant (TOS) on days 10, 20 and 30. We also evaluated milk production and interval between calving and conception. There was no effect of supplementation with choline on blood and production parameters. The interval between calving and conception was lower in the T20 group. Choline supplemented by 20 during the antepartum improved reproductive performance of dairy cows, although it did not change the metabolic profile.(AU)

Utilidad de la 18f-colina pet/tc en hiperparatiroidismo primario persistente o recurrente: experiencia inicial / Usefulness of 18f-choline pet / tc in persistent or recurrent primary hyperparathyroidism: initial experience

El hiperparatiroidismo persistente/recurrente representa un desafío en la localización del tejido paratiroideo hiperfuncionante. En esta subpoblación, los métodos convencionales ofrecen un menor rédito diagnóstico. La 18F-colina PET/TC podría ser una buena alternativa dada su mejor resolución espacial, capacidad de detectar glándulas ectópicas y la conjunción de la imagen molecular y anatómica. Sin embargo, la evidencia en este subgrupo de pacientes es escasa. Objetivo: evaluar la utilidad de la 18F-colina PET/TC como método de localización en el hiperparatiroidismo persistente o recurrente. Materiales y métodos: se analizaron los pacientes con 18F-colina PET/TC para hiperparatiroidismo entre diciembre de 2015 y enero de 2018 en un centro terciario de alto volumen. Se analizaron el número de lesiones, su localización, tamaño y el Standard Uptake Value máximo (SUV max) en las imágenes tempranas y tardías. Se compararon los resultados con los métodos convencionales. Resultados: 7 de 15 pacientes habían sido operados previamente (persistentes/recurrentes). La 18F-colina PET/TC detectó 6/7 casos (83,33%), la ecografía cervical 1/4 (25%) y el SPECT de paratiroides y la resonancia nuclear magnética 2/5 (40%). El SUV max obtenido fue variable, en la mitad de los casos a los 10 minutos y en los restantes a la hora; el tamaño promedio de las lesiones fue 8,61 mm (6-12 mm). Conclusiones: la 18F-colina PET/TC muestra una alta tasa de detección en los pacientes con hiperparatiroidismo persistente/recurrente. La combinación del comportamiento biológico del PET con los hallazgos morfológicos aportados por la TC con contraste endovenoso le ofrecería ventajas sobre otros estudios que podrían posicionarlo como método de primera línea en esta subpoblación. (AU)

Persistent or recurrent hyperparathyroidism represents a challenge regarding the localization of the hyper-functioning parathyroid tissue. In this subpopulation of hyperpharathyroid patients, conventional methods have a low diagnostic yield. The 18F-choline PET /CT could be a good alternative given its better spatial resolution, ability to detect ectopic glands, and the conjunction of the molecular and anatomical image. However, the evidence in this subgroup of patients is limited. Objective: to evaluate the utility of 18F-choline PET/ CT as a localization method in persistent or recurrent hyperparathyroidism. Materials and methods: patients with 18F-choline PET / CT for hyperparathyroidism between December 2015 and January 2018 in a high-volume tertiary center were included. The number of lesions, and their location, size, and maximum Standard Uptake Value (SUV) in the early and late images were analyzed. The results were compared to conventional methods. Results: 7 of 15 patients had been previously operated (persistent/recurrent). 18F-choline PET / CT detected 6/7 cases (83,33%), cervical ultrasound 1/4 (25%) and parathyroid SPECT and magnetic resonance 2/5 (40%). The maximum SUV was variable, one half at 10 minutes and the other half at 60 minutes; the average size of the lesions was 8.61 mm (6-12 mm). Conclusions: 18F-Choline PET / CT shows a high detection rate in patients with persistent / recurrent hyperparathyroidism. The combination of the biological behavior of PET with the morphological findings provided by CT with intravenous contrast would offer advantages over other studies that could position it as a first line method in this subpopulation. (AU)

Dramatic polarization in genitourinary expert opinions regarding the clinical utility of positron emission tomography (PET) imaging in prostate cancer

ABSTRACT Objectives: To ascertain the opinions of North American genitourinary (GU) experts regarding inclusion of technologies such as prostate - specific membrane antigen (PSMA) and C - 11 choline positron emission tomography (PET) into routine practice. Materials and Methods: A survey was distributed to North American GU experts. Questions pertained to the role of PSMA and C - 11 PET in PCa management. Participants were categorized as "supporters" or "opponents" of incorporation of novel imaging techniques. Opinions were correlated with practice patterns. Results: Response rate was 54% and we analyzed 42 radiation oncologist respondents. 17 participants (40%) have been in practice for > 20 years and 38 (90%) practice at an academic center. 24 (57%) were supporters of PSMA and 29 (69%) were supporters of C - 11. Supporters were more likely to treat pelvic nodes (88% vs. 56%, p < 01) and trended to be more likely to treat patients with moderate or extreme hypofractionation (58% vs. 28%, p = 065). Supporters trended to be more likely to offer brachytherapy boost (55% vs. 23%, p = 09), favor initial observation and early salvage over adjuvant radiation (77% vs. 55%, p = 09), and to consider themselves expert brachytherapists (69% vs. 39%, p = 09). Conclusions: There is a polarization among GU radiation oncology experts regarding novel imaging techniques. A correlation emerged between support of novel imaging and adoption of treatment approaches that are clinically superior or less expensive. Pre - existing biases among GU experts on national treatment - decision panels and leaders of cooperative group studies may affect the design of future studies and influence the adoption of these technologies in clinical practice.

3T magnetic resonance spectroscopy as a powerful diagnostic modality for assessment of thyroid nodules

ABSTRACT Objective: Magnetic resonance spectroscopy (MRS) is a powerful tool for structural studies of chemical compounds and biomolecules and also documented promising findings as a potential imaging technology in thyroid oncology. This prospective study was to ascertain the clinical significance of 3 Tesla MRS in the evaluation of patients with thyroid nodules (TNs) as an ancillary diagnostic technique for thyroid carcinoma. Materials and methods: Magnetic resonance spectroscopy at 3T at echo- times (TEs) 136 and 270 ms was carried out on 15 patients with total number of 32 TNs larger than 1 cm3, which all were surgically resected. Choline (Chol) to creatine (Cr) ratio was assessed at 136 and 270 TEs on each nodule and a receiver operating characteristic (ROC) curve was used to determine optimal cut-off point. The findings were compared with histopathology of thyroid specimens. Results: There were 23 benign and 9 malignant lesions (7 papillary and 2 follicular thyroid carcinomas). The mean values of Chol/Cr at 136 and 270 TEs was 2.28 ± 3.65 and 1.52 ± 1.67 respectively and the difference between benign and malignant nodules was only significant at 136 TEs. The study revealed that Chol/ Cr ratio cut-off point of 2.5 best correlates with histopathology results (sensitivity = 75%; specificity = 100%; PPV = 100%; NPV= 92%). Conclusion: This preliminary study showed that 3T magnetic resonance spectroscopy might be a specific modality for the evaluation of thyroid nodules in differentiation of benign from malignant thyroid tissue. However, a larger series would give much greater confidence that this state-of-the-art technology will worth pursuing in clinical practice.

Dynamic 11C-Choline PET / CT for the primary diagnosis of prostate cancer

ABSTRACT Objectives: To test the ability of dynamic 11C-PET / CT to discriminate cancerous tissue from background tissue in patients with localized prostate cancer. Materials and Methods: Twenty-four consecutive patients with prostate cancer were prospectively evaluated with dynamic 11C-choline PET / CT prior to radical prostatectomy. The PET / CT scan was divided into 18 sequences of 5 seconds each, followed by 9 sequences of 60 seconds each. Whole-mount sections of harvested prostates served as reference standards. Volumes of interest were positioned on the dynamic PET / CT images and the following quantitative variables were calculated: perfusion coefficient (K1), washout constant (K2), area under the curve (AUC) at 175 and 630 seconds, and average and maximum standardized uptake values (SUVavg, and SUVmax). Wilcoxon signed-ranks test was used to compare benign and cancerous areas of the prostate. Results: Areas of cancerous tissue were characterized by higher SUVavg and SUVmax than areas of benign tissue (3.67 ± 2.7 vs. 2.08 ± 1.3 and 5.91 ± 4.4 vs. 3.71 ± 3.7, respectively, P < 0.001), in addition to a higher K1 (0.95 ± 0.58 vs. 0.43 ± 0.24, P < 0.001) and greater cumulative tracer uptake, represented by the AUC at 175 and 630 seconds (P <0.001). No associations were found between dynamic parameters and preoperative prostate specific antigen level or Gleason score. Conclusions: In this pilot study, 11C-choline PET / CT demonstrated increased tracer uptake with higher values of static and dynamic parameters in areas of prostate cancer compared to areas of benign tissue. Larger studies are warranted to validate these results and examine the potential applicability of 11C-choline dynamic PET / CT for the diagnosis of prostate cancer.

Targeting personalized medicine in a non-Hodgkin lymphoma patient with 18F-FDG and 18F-choline PET/CT

Summary Early diagnosis and staging of non-Hodgkin lymphoma (NHL) is essential for therapeutic strategy decision. Positron emission tomography/computed tomography (PET/CT) with fluordeoxyglucose (FDG), a glucose analogue, labeled with fluor-18 (18F-FDG) has been used to evaluate staging, therapy response and prognosis in NHL patients. However, in some cases, 18F-FDG has shown false-positive uptake due to inflammatory reaction after chemo and/or radiation therapy. In this case report, we present a NHL patient evaluated with 18F-FDG and 18F-choline PET/CT scan imaging pre- and post-therapy. 18F-FDG and 18F-choline PET/CT were performed for the purpose of tumor staging and have shown intense uptake in infiltrative tissue as well as in the lymph node, but with some mismatching in the tumor. Post-treatment 18F-FDG and 18F-choline PET/ CT scans revealed no signs of radiotracer uptake, suggesting complete remission of the tumor. 18F-choline may be a complimentary tool for staging and assessment of therapeutic response in non-Hodgkin lymphoma, while non-18F-FDG tracer can be used for targeted therapy and patient management.

Efeito da suplementação com colina protegida sobre parâmetros bioquímicos, produção e reprodução de vacas leiteiras no periparto / Effect of protected choline supplementation on biochemical parameters, production, and reproduction of dairy cows in peripartum

Avaliou-se o efeito da suplementação com colina protegida sobre o perfil energético, as enzimas hepáticas e a reprodução de vacas leiteiras no periparto. Quinze vacas leiteiras foram divididas em dois grupos experimentais: oito receberam 80 gramas de colina protegida por 21 dias no pré-parto e por 40 dias no pós-parto e sete foram consideradas controle. Amostras de sangue foram coletadas nos dias 10, 20, 30 e 60 pós-parto para avaliação dos perfis energético e hepático. Aos 60 dias pós-parto, realizou-se exame ginecológico dos animais para avaliação da saúde reprodutiva. A suplementação com colina protegida não alterou os níveis de beta-hidroxibutirato (BHBA), ácidos graxos não esterificados (AGNE), frutosamina, fator de crescimento semelhante a glicose I (IGF-I), status oxidante total (TOS), aspartato aminotransferase (AST) e gamaglutamiltransferase (GGT) no pós-parto. Não houve diferença também quanto à produção de leite. Aos 60 dias pós-parto, vacas suplementadas com colina protegida apresentaram menor número de casos de endometrite que vacas do grupo controle. A suplementação de colina protegida não alterou o perfil bioquímico e a produção de leite, mas reduziu o número de casos de endometrite no pós-parto de vacas leiteiras.(AU)

The study aimed to evaluate the effect of supplementation with protected choline on the energy profile, liver enzymes and reproduction in dairy cows in peripartum. Fifteen cows were divided into two groups: 8 received 80 grams of protected choline for 21 days pre-partum and 40 days postpartum, and 7 were considered control. Blood samples were collected on days 10, 20, 30, and 60 postpartum to evaluate the energy and hepatic profiles. After 60 days postpartum a gynecological examination of animals for evaluation of reproductive health was done. The supplementation with choline protected did not alter the beta-hydroxybutyrate levels (BHBA), non-esterified fatty acids (NEFA), fructosamine, like growth factor glucose (IGF-I), total oxidant status (TOS), aspartate aminotransferase (AST) and glutamiltrasferase range (GGT) postpartum. There was no difference in milk production. After 60 days postpartum, cows fed protected choline had fewer cases of endometritis that cows in the control group. The protected choline supplementation did not alter the biochemical profile and milk production, but reduced the number of endometritis cases in postpartum dairy cows.(AU)

Betaína e Colina dietéticas relacionadas à homocisteína plasmática: estudo de base populacional, São Paulo, Brasil / Betaine and Choline Intakes are related to total plasma homocysteine: health survey of São Paulo, Brazil

Fundamentos: Elevadas concentrações de homocisteína plasmática (Hcyp) têm sido associadas ao risco aumentado de doenças cardiovasculares. A Hcyp pode ser diminuída por meio da remetilação à metionina, que usa folato ou betaína como doador do grupo metil.Objetivos: Avaliar a ingestão de betaína e colina e sua relação com a homocisteína em residentes do município de São Paulo. Métodos: Obtidos dados de 584 indivíduos, de ambos os sexos, a partir do estudo de base populacional ISA-SP 2008. Médias geométricas de Hcyp foram analisadas de acordo com tercis de ingestão de colina e betaína e foi aplicado teste de tendência.Resultados: Foram analisados 584 indivíduos: 222 (38,0%) homens e 362 (62,0%) mulheres, com média de idade 55,0±19,0 anos. A prevalência de hiper-homocisteinemia foi maior entre os homens (28,0%), idosos (21,0%) e indivíduos com menor renda familiar (21,0%). Cerca de 31,0% dos indivíduos com hiper-homocisteinemia apresentou deficiência de folato (<7,5 nmol/L) e 26,0%, deficiência de vitamina B12 (<200 pmol/L). Observou-se diminuição nas médias geométricas de homocisteína conforme aumento nos tercis de betaína em ambos os sexos,adultos, eutróficos e em todas as categorias de escolaridade. A colina esteve relacionada à Hcyp em ambos os sexos, indivíduos de maior renda familiar, não fumantes e consumidores de bebidas alcoólicas. Conclusões: Este estudo sugere a importância da ingestão de betaína por sua associação inversa com a concentração de Hcyp em adultos e idosos do município de São Paulo. A colina desempenhou papel protetor em subgrupos específicos da população.

Background: High concentrations of plasma homocysteine (Hcyp) have been associated with increased risk of cardiovascular diseases. Hcyp can be decreased by remethylation to methionine, which uses folate or betaine as a donor of the methyl group. Objectives: To evaluate the intake of betaine and choline and its relation to homocysteine in residents of the city of São Paulo. Methods: Data from 584 individual, of both sexes, from the population-based study ISA-SP 2008. Geometric averages of Hcyp were analyzed according to choline and betaine intake tertiles and trend test was applied. Results: The study analyzed 584 individuals: 222 (38.0%) men and 362 (62.0%) women, mean age 55.0 ± 19.0 years. The prevalence of hyperhomocysteinemia was higher among men (28.0%), the elderly (21.0%) and those with lower household income (21.0%). Approximately 31.0% of individual with hyperhomocysteinemia presented folate deficiency (<7.5 nmol/L) and 26.0% presented vitamin B12 deficiency (<200 pmol/L). There was a decrease in the geometric means of homocysteine according to an increase in betaine tertiles in both sexes, adults, normal and in all categories of education. Choline was related to Hcyp in both sexes, higherhousehold income individuals, non-smokers and alcohol consumers. Conclusions: This study suggests the importance of betaine intake due to its inverse relationship with the concentration of Hcyp in adults and elderly in the city of São Paulo. Choline played a protective role in specific subgroups of the population.

Pattern of Maxillofacial Fractures in Severe Multiple Trauma Patients: A 7-year Prospective Study

The incidence of facial trauma is high. This study has the primary objective of documenting and cataloging maxillofacial fractures in polytrauma patients. From a total of 1229 multiple trauma cases treated at the Emergency Room of the Santo Antonio Hospital - Oporto Hospital Center, Portugal, between August 2001 and December 2007, 251 patients had facial wounds and 209 had maxillofacial fractures. Aged ranged form 13 to 86 years. The applied selective method was based on the presence of facial wound with Abbreviated Injury Scale ≥1. Men had a higher incidence of maxillofacial fractures among multiple trauma patients (86.6%) and road traffic accidents were the primary cause of injuries (69.38%). Nasoorbitoethmoid complex was the most affected region (67.46%) followed by the maxilla (57.42%). The pattern and presentation of maxillofacial fractures had been studied in many parts of the world with varying results. Severe multiple trauma patients had different patterns of maxillofacial injuries. The number of maxillofacial trauma is on the rise worldwide as well as the incidence of associated sequelae. Maxillofacial fractures on multiple trauma patients were more frequent among males and in road traffic crashes. Knowing such data is elementary. The society should have a key role in the awareness of individuals and in prevention of road traffic accidents.

É alta a incidência de traumas na face. Este estudo teve por objetivo documentar e catalogar as fraturas maxilofaciais em pacientes com politraumatismos. De um total de 1229 casos de politraumatizados tratados na Sala de Emergência do Hospital de Santo António - Centro Hospitalar do Porto, Portugal, entre Agosto de 2001 e Dezembro de 2007, 251 pacientes tiveram ferimentos na face e 209 apresentaram fraturas maxilofaciais. As idades variaram de 13 a 86 anos. O método de seleção baseou-se na presença de ferimentos na face com Abreviated Injury Scale ≥1. Os homens apresentaram maior incidência de fraturas maxilofaciais (86,6%) entre os pacientes com múltiplos traumatismos na face e os acidentes de trânsito foram a causa principal dos traumatismos (69,38%). A região mais afetada foi o complexo naso-órbito-etmoidal (67,46%), seguido pela maxila (57,42%). O padrão e a apresentação das fraturas maxilofaciais tem sido estudado em muitas regiões do mundo com resultados variados. Pacientes com politraumatizados graves apresentaram padrões diferentes de traumatismos maxilofaciais. O número de traumatismos maxilofaciais tem aumentado à escala mundial, assim como a incidência das sequelas associadas. Entre os pacientes com traumatismos múltiplos, a maioria pertencia ao sexo masculino, assim como a causa mais frequente foram os acidentes automobilísticos. É elementar o conhecimento destes dados. A sociedade tem um papel primordial nos cuidados individuais e na prevenção dos acidentes de trânsito.

Some current challenges in research on air pollution and health / Desafíos actuales de la investigación sobre contaminación del aire y salud

This commentary addresses some of the diverse questions of current interest with regard to the health effects of air pollution, including exposure-response relationships, toxicity of inhaled particles and risks to health, multipollutant mixtures, traffic-related pollution, accountability research, and issues with susceptibility and vulnerability. It considers the challenges posed to researchers as they attempt to provide useful evidence for policy-makers relevant to these issues. This commentary accompanies papers giving the results from the ESCALA project, a multi-city study in Latin America that has an overall goal of providing policy-relevant results. While progress has been made in improving air quality, driven by epidemiological evidence that air pollution is adversely affecting public health, the research questions have become more subtle and challenging as levels of air pollution dropped. More research is still needed, but also novel methods and approaches to address these new questions.

Este comentario aborda algunos de los temas de interés actual en relación con los efectos de la contaminación del aire sobre la salud, tales como las relaciones exposición-respuesta, la toxicidad y riesgos para la salud de las partículas inhaladas, las mezclas de contaminantes múltiples, la contaminación relacionada con el tráfico, la investigación sobre responsabilidad, y los problemas de susceptibilidad y vulnerabilidad. Considera los retos que se presentan a los investigadores que intentan proporcionar evidencia para los responsables políticos en estas cuestiones. Este texto acompaña otros trabajos con resultados del proyecto ESCALA, un estudio en varias ciudades de América Latina que tiene como objetivo general proporcionar resultados relevantes para la política pública. Aunque ha habido avances para mejorar la calidad del aire, gracias a la evidencia epidemiológica de que la contaminación aérea está afectando negativamente a la salud pública, las preguntas de investigación se han vuelto más sutiles y difíciles a medida que los niveles de contaminación se reducen. Se necesita más investigación, pero también nuevos métodos y enfoques capaces de enfrentar estas preguntas.

Suplementação de colina em dietas para frangos de corte machos em fase de crescimento / Choline supplementation in diets for male broilers in the growing phase

Avaliaram-se os efeitos dos níveis de suplementação de colina em dietas para frangos de corte, de 22 a 40 dias de idade, sobre o desempenho, a composição de carcaças e fígados, bem como as características macroscópicas e histopatológicas dos fígados. O período de criação foi de um a 40 dias de idade, sendo que o período experimental foi de 22 a 40 dias de idade. Até o 21º dia de idade, todas as aves receberam a mesma ração à qual foram adicionados 400mg colina/kg. No 22º dia, os frangos foram distribuídos em cinco tratamentos, nos quais os níveis testados de suplementação de colina foram: zero, 400, 800, 1.200 e 1.600mg/kg, com seis repetições de 30 aves cada. As rações experimentais, formuladas à base de milho, farelo de soja e farinha de carne/ossos, foram isonutritivas, com exceção dos níveis de colina. O delineamento experimental foi o inteiramente ao acaso, e a estimativa da suplementação de colina foi avaliada pelos modelos de regressão. Os níveis de suplementação de colina apresentaram efeito linear pelo teste F (P<0,05) para o consumo de ração. Os demais parâmetros avaliados não sofreram influência da suplementação (P>0,05). O nível de 1.600mg colina/kg de ração resulta em maior consumo de ração de frangos de corte aos 40 dias de idade.

The effects of choline supplemental levels were evaluated in diets for broilers on performance, carcass and liver composition and liver histopathology characteristics from 22 to 40 days-old. The period of creation was one to 40 days of age, and the experimental period was 22 to 40 days-old. Until 21 days of age all birds received the same diet added to 400mg choline/kg. On day 22, broilers were allotted to five treatments (zero, 400, 800, 1200 and 1600 mg/kg), with six repetitions of 30 birds each. The experimental diets formulated based on corn, soybean meal and meat/bones meal were isonutritive, except for the choline levels. The experimental design was completely randomized and the estimation of choline supplementation was evaluated by regression models. The levels of choline supplementation showed a significant linear effect for the F test (P<0.05) for feed intake. The other evaluated parameters were not influenced by supplementation (P>0.05). The supplementation of 1600mg choline/kg in the diet results in higher feed intake of broilers at 40 days old.

Proton magnetic spectroscopy agreed better with magnetic resonance image to lateralization of epileptogenic zone than with surface electroencephalography / Espectroscopia de protons de hidrogenio na investigacao ambulatorial das epilepsias extra-temporais

Objective To analyze the agreement rate of proton magnetic spectroscopy with magnetic resonance image (MRI) and surface electroence-phalography (EEG) in extratemporal neocortical epilepsies. Methods A cross-sectional study, type series of cases included 33 patients, age range 13–59 years old, of both gender, presenting structural alteration identified by MRI (75.8%) or by neurophysiologic techniques (72.7%). The variables were alterations of N-acetyl-aspartate/choline, N-acetyl-aspartate/creatine, choline/creatine, and N-acetyl-aspartate/cho-line+creatine coefficient of asymmetry. Results Agreement rates of lateralization by coefficient of asymmetry of NAA/Cho, NAA/Cr, Co/Cr, and NAA/Cho+Cr with MRI, independent of alteration of surface EEG, were equal to 93.3, 57.9, 15.4, and 93.3%, respectively, modifying to 100, 33.3, 0, and 100%, in 16 patients, with lateralization agreement of MRI and surface EEG. Conclusion Proton magnetic spectroscopy agreed better with MRI to lateralization of epileptogenic zone than with surface EEG. .

Objetivo Analisar a taxa de concordância da espectroscopia de prótons de hidrogênio com imagem de ressonância magnética (IRM) e o eletrencefalograma (EEG) de superfície nas epilepsias neocorticais extratemporais. Métodos Estudo transversal, série de casos, incluiu 33 pacientes, com idade de 13 a 59 anos, de ambos os gêneros, apresentando alteração estrutural à IRM (75,8%) ou neurofisiológica à (72,7%). As variáveis estudadas foram as alterações dos coeficientes de assimetria de N-acetil-aspartato/colina, N-acetil-aspartato/crea-tina, Colina/Creatina e N-acetil-aspartato/colina+creatina. Resultados As taxas de concordância de lateralização dos coeficientes de assimetria de NAA/Co, NAA/Cr, Co/Cr e NAA/Co+Cr com a IRM, independentemente de alterações do EGG de superfície, passaram de 93,3, 57,9, 15,4, 93,3%, respectivamente, para 100, 33,3, zero, 100%, em 16 pacientes, mostrando concordância de lateralização entre IRM e EEG de superfície. Conclusão A espectroscopia de prótons de hidrogênio concordou melhor com a lateralização da zona epileptogênica pela IRM do que com o EEG de superfície. .

Magnetic resonance imaging study cannot individually distinguish individuals with mild cognitive impairment, mild Alzheimer's disease, and normal aging / Estudo por ressonância magnética não pode diferenciar individualmente os indivíduos com declínio cognitivo leve, doença de Alzheimer leve e envelhecimento normal

Objective: To evaluate the volumetric and spectroscopy aspects of hippocampus in patients with mild Alzheimer's disease (AD) and mild cognitive impairment (MCI). Methods: A series of patients older than 65 years and with memory deficit were studied. Results: The evocation of words test presented a significant reduction in the number of words recalled by the patients with MCI and mild AD as compared with the control group. Bilateral reduction of the hippocampus volume in the AD group was observed when compared to the control group. There were no statistical differences in the values of NAA/Cr, mI/Cr, Cho/Cr and mI/NAA between the groups. Conclusions: Magnetic resonance imaging study failed to individually distinguish patients with MCI, mild AD and normal aging. However, patients with mild AD presented loss of asymmetry between the right and left hippocampus, and a reduction in hippocampus volume. .

Objetivo: Avaliar volume e espectroscopia do hipocampo em pacientes com doença de Alzheimer leve e declínio cognitivo leve. Métodos: Foi estudada uma série de pacientes com 65 anos de idade ou mais, com déficit de memória. Resultados: O teste de evocação de palavras mostrou redução significativa no número de palavras lembradas pelos pacientes com declínio cognitivo leve e doença de Alzheimer leve, em comparação com o grupo controle. Foi observada redução bilateral do volume do hipocampo no grupo com doença de Alzheimer quando comparado com o grupo controle. Não houve diferença estatística nos valores de NAA/Cr, mI/Cr, Cho/Cr e mI/NAA entre os grupos. Conclusão: Estudo pela ressonância magnética não diferencia individualmente os pacientes com declínio cognitivo leve, doença de Alzheimer leve e envelhecimento normal. No entanto, pacientes com quadro leve de doença de Alzheimer apresentam perda de assimetria entre os hipocampos direito e esquerdo e redução no volume do hipocampo. .

Association between altered proton magnetic resonance spectroscopy (1H MRS) findings and clinical symptoms of schizophrenia

Objective: To assess the metabolic alterations of the thalamus in subjects with schizophrenia compared to healthy subjects and to investigate whether specific schizophrenic symptoms are associated with metabolic alterations measured by 1H MRS. Methods: This is a case-control study including patients with schizophrenia diagnosed usingthe Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition, DMS-IV and the Operational CriteriaChecklist for Psychotic Illness (OPCRIT). Proton magnetic resonance spectroscopy (1H MRS) was used to assess metabolite concentrations (N-acetylaspartate, choline, creatinine, myoionositol and lactacte) in the left and rightthalamus of 13 patients with schizophrenia and 13 healthy controls. Results: In this study, concentrations of specific metabolites in the thalamus, determined by 1H MRS, were similar for individuals with schizophrenia andcontrols. It was observed that cases with family history of schizophrenia and disorganized speech demonstrated areduction in the ratio of the metabolites NAA /Cho in the thalamic nuclei on the right side. However, those withorganized delusions, hallucinations and non-affective auditory hallucinations had an increase of metabolites on theright side compared to the left thalamus. Decreased thalamic metabolic activity in patients with positive symptomswas observed in contrast with those who had well-organized delusions and auditory non-affective hallucinations,core symptoms of schizophrenia. Conclusion: A lateralized thalamic involvement was verified, suggesting thatorganic and genetic factors compromise the right thalamus and that the disorganization associated with delusionsand hallucinations compromises the left thalamic nuclei. Further studies to investigate the correlation betweensymptoms and thalamic dysfunction are warranted. (Rev Neuropsiquiatr 2011;74:183-190).

Objetivo: Evaluar las alteraciones metabólicas del tálamo en personas con esquizofrenia comparándolas con controles sanos e investigar si los síntomas específicos de la esquizofrenia están vinculados a alteraciones metabólicas medidas por 1H MRS. Métodos: Se realizó la espectroscopía por resonancia magnética (1H-MRS) para estimar concentraciones de metabolitos (N-acetil- aspartato, colina creatinina, mioionositol y lactato) en el tálamo izquierdo y derecho de 13 pacientes con esquizofrenia y 13 controles. Resultados: Las concentraciones de metabolitos específicos en el tálamo fueron iguales para las personas con esquizofrenia y los controles. Se observó que los pacientes con historia familiar de esquizofrenia y aquellos que presentaban lenguaje desorganizado tenían una reducción de los metabolitos NAA/Co en los núcleos talámicos de la derecha. Sin embargo, en aquellos delirios ordenados, alucionaciones no afectivas y alucinaciones auditivas los metabolitos del lado derecho tuvieron cierto aumento con relación a los núcleos talámicos de la izquierda. Se encontró una reducción en la actividad metabólica talámica en los pacientes con síntomas positivos, al contrario de aquellos que presentaron delirios bien ordenados y alucinaciones auditivas no afectivas, los síntomas más nucleares de la esquizofrenia. Conclusión: Se verificó cierta lateralización del envolvimiento talámico, sugiriendo que los factores orgánicos y los genéricos comprometen el tálamo derecho y que la desorganización asociada a los delirios y alucionaciones compromete los núcleos talámicos de la izquierda. Más estudios son necesarios para investigar la validez de la correlación entre síntomas y disfunción talámica.

La regulación del transportador de colina de alta afinidad dependiente de AMPc/PKA no es mediada por dopamina en neuronas de retina / cAMP/PKA - dependent regulation of the high affinity choline transporter is not mediated by dopamine in retinal neurons

La actividad del transportador de colina de alta afinidad (HAChT) es considerado el paso limitante en la síntesis de acetilcolina (ACh) en el terminal colinérgico. Estudios recientes muestran que el HAChT contiene residuos de serina y treonina consensuales para la fosforilación por proteína kinasa A (PKA). Usando neuronas de retina de embrión de pollo se evaluó el efecto del segundo mensajero AMPc sobre la actividad del HAChT. El aumento de los niveles intracelulares de AMPc a través de la inhibición de la fosfodiesterasa, activación de la adenilato ciclasa o usando un análogo de AMPc resistente a la fosfodiesterasa disminuyó la actividad del HAChT entre 29 y 69%. Por otra parte, la activación de receptores de dopamina tipo-D1 aumenta los niveles de AMPc intracelular y activa PKA, sin embargo, el tratamiento con dopamina o con antagonistas de los receptores dopaminergicos D1 o D2 no induce cambios en la actividad del transportador

The high affinity choline transporter (HAChT) activity is considered to be the rate-limiting step in acetylcholine (ACh) synthesis in the cholinergic terminal. Recent studies show that HAChT contains consensus serine and threonine residues for protein kinase A (PKA) phosphorylation. Using chick retinal neurons evaluated the effects of the second messenger cAMP on the HAChT activity. The increase of the intracellular cAMP levels through phosphodiesterase inhibition, adenilatecyclase activation or using a phosphodiesterase-resistant cAMP analog decreased HAChT activity between 29 and 69%. Moreover, the activation of dopamine D1-type receptors increase the intracellular cAMP levels and activates PKA, however, the treatment with dopamine D1 or D2 receptor antagonists does not induce changes on transporter activity

Espectroscopia cerebral em candidatos a transplante hepático / Cerebral magnetic resonance spectroscopy in patients with hepatic encephalopathy: analysis before and after liver transplantation

OBJETIVOS: Determinar os níveis dos metabólitos (mio-inositol [MI], colina [Cho], glutamina [Glx], creatina [Cr] e N-acetilaspartato [NAA]) por meio da espectroscopia por ressonância magnética em portadores de hepatopatia crônica, antes e após o transplante hepático, correlacionando com a avaliação clínica. MÉTODOS: Foram estudados prospectivamente 25 pacientes portadores de hepatopatia crônica do Serviço de Transplante Hepático da Universidade Federal do Paraná por meio de avaliação clínica e espectroscópica. Trinta voluntários sadios formaram o grupo controle, sendo submetidos às mesmas avaliações. Dezesseis dos 25 pacientes também foram avaliados após o transplante. RESULTADOS: Antes do transplante hepático reduções significativas nos índices de MI/Cr e Cho/Cr e aumento significativo no índice de Glx/Cr foram observadas nos pacientes portadores de encefalopatia hepática comparados ao grupo controle. Os critérios quantitativos de Ross para diagnóstico espectroscópico da encefalopatia hepática (MI/Cr e Cho/Cr < média + 2 desvios padrão do grupo controle) demonstraram uma sensibilidade de 61,54 por cento, especificidade de 91,67 por cento e precisão de 76 por cento, sendo que a Cho/Cr foi o melhor parâmetro isolado. A espectroscopia após o transplante mostrou mudanças nos índices metabólicos comparados com o status pré-transplante. CONCLUSÃO: A espectroscopia permite um diagnóstico preciso da encefalopatia hepática. A melhora dos níveis metabólicos após o transplante hepático sugere um importante papel do MI e da Cho no desenvolvimento da encefalopatia hepática.

OBJECTIVES: To determine the metabolite levels (myo-inositol [MI], choline [Cho], glutamate [Glx], creatine [Cr] and N-acetylaspartate [NAA]) visible on magnetic resonance spectroscopy in patients with chronic hepatic failure, before and after liver transplantation and to correlate these data with results of neuropsychiatric tests and clinical findings. METHODS: Twenty five patients with chronic hepatic failure from the Liver Transplantation Unit of the Federal University of Parana were prospectively studied. Patients were submitted to clinical evaluation and magnetic resonance spectroscopy. Thirty healthy volunteers also submitted to the same evaluations. Sixteen of the 25 patients were evaluated after liver transplantation. RESULTS: Before liver transplantation, significant reductions in MI/Cr and Cho/Cr and a significant increase in Glx/Cr were observed in patients with hepatic encephalopathy compared with healthy subjects. The Ross's criteria for spectroscopic diagnosis of the hepatic encephalopathy (MI/Cr and Cho/Cr lower than 2 SD of controls) demonstrated a sensitivity of 61.54 percent, specificity of 91.67 percent and accuracy of 76 percent, further Cho/Cr was the best parameter. Spectroscopy after liver transplantation showed changes in the metabolite ratios compared with the pretransplantation status. CONCLUSION: Magnetic resonance spectroscopy permits an accurate diagnosis of hepatic encephalopathy. Improvement of metabolic ratios after liver transplantation suggests an important role of MI and Cho in the development of hepatic encephalopathy.