RESUMO
PURPOSE: Despite endoscopic sinus surgery (ESS) being the standard best treatment for chronic rhinosinusitis with nasal polyps (CRSwNP), there still remains a high recurrence rate of nasal polyps after ESS. The aim of this study was to analyze the impact of ESS in the treatment of CRSwNP and identify possible predictors for revision surgery. METHODS: We conducted a cross-sectional retrospective study of patients with CRSwNP submitted to ESS between the years 2013 and 2021. RESULTS: We analyzed 517 cases, of which 15.1% were submitted to revision ESS. The presence of hyposmia/anosmia, asthma, intolerance/allergy to non-steroid inflammatory drugs, non-steroidal anti-inflammatory drug exacerbated respiratory disease, and bilateral polyposis were more frequent in patients who needed revision surgery. Initial values of peripheral eosinophilia and Lund-Mackay scores were significantly higher in this sub-group of patients. Lund-Mackay score was the only independent risk factor for revision surgery. CONCLUSIONS: Factors like peripheral eosinophilia and Lund-Mackay score were associated with a higher probability of revision ESS. Applying these concepts to the clinical practice could help predict the evolution of patient's pathology in the post-operative period and identify in advance those cases that may need a multidisciplinary approach.
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Eosinofilia , Pólipos Nasais , Rinite , Sinusite , Humanos , Estudos Retrospectivos , Pólipos Nasais/complicações , Pólipos Nasais/cirurgia , Estudos Transversais , Rinite/complicações , Rinite/cirurgia , Sinusite/complicações , Sinusite/cirurgia , Endoscopia , Doença CrônicaRESUMO
BACKGROUND: Pulmonary hypertension (PH) is a marker of poor outcome in mitral stenosis (MS), which improves after percutaneous mitral valvuloplasty (PMV). However, mechanical interventions for relief of valve obstruction often but not always reduce pulmonary pressures. This study aimed to assess the parameters associated with abnormal pulmonary artery pressure (PAP) response immediately after a successful PMV, and also its impact on long-term outcome. METHODS: A total of 181 patients undergoing PMV for rheumatic MS were prospectively enrolled. Invasive hemodynamic and echocardiographic measures were examined in all patients. Abnormal PAP response was defined as the mean PAP (mPAP) values unchanged at the end of the procedure. Long-term outcome was a composite endpoint of death, mitral valve replacement, repeat PMV, new onset of atrial fibrillation (AF), or stroke. RESULTS: The mean age was 44.1 ± 12.6 years, and 157 patients were women (86.7%). In the overall population, mPAP decreased from 33.4 ± 13.1 mmHg pre to 27.6 ± 9.8 mmHg post (p < 0.001). Following PMV, 52 patients (28.7%) did not have any reduction of mPAP immediately after the PMV. Multivariable analysis adjusting for baseline values of PAP and mitral valve area revealed that AF (Odds ratio [OR] 2.7, 95% [confidence interval] CI 1.3 to 6.7), maximum mitral valve leaflets displacement (OR 0.8, 95% CI 0.7 to 0.9), and post-procedural left ventricular compliance (OR 0.7, 95% CI 0.5 to 0.9) were predictors of a lack of improvement in mPAP. During a median follow-up of 4.4 years, the endpoint was reached in 56 patients (31%). The pulmonary pressure response to PMV was not an independent predictor of long-term events. CONCLUSIONS: In patients with MS undergoing PMV, pulmonary pressures may not reduce immediately after the procedure, despite adequate opening of the valve. Abnormal PAP response can be predicted from baseline clinical and valvular characteristics as well as post-procedural left ventricular compliance. The lack of any immediate reduction in mPAP is not associated with long-term adverse outcomes.
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Valvuloplastia com Balão , Estenose da Valva Mitral , Adulto , Valvuloplastia com Balão/efeitos adversos , Ecocardiografia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/terapia , Artéria Pulmonar/diagnóstico por imagem , Resultado do TratamentoRESUMO
PURPOSE: The authors aim to review available reports regarding laryngeal candidiasis and describe the existing evidence on the demographics, clinical manifestations, diagnosis, therapeutic options, and outcomes of this infection. METHODS: A review of articles on laryngeal candidiasis was conducted using PubMed® database from its inception through July 2019. RESULTS: Patients were mainly females presenting with complaints of dysphonia and associated gastroesophageal reflux history or inhaled corticosteroids use; although local predisposing factors were common, most patients were immunocompetent. The main anatomical affected subsite was the glottis with the presence of leukoplastic lesions. The diagnostic approach remains controversial, since some authors recommend prompt lesion biopsy and others rely on empirical antifungal treatment that showed effective results regarding symptoms and lesions resolution. CONCLUSION: Laryngeal Candida infection is thought to be a rare condition, with limited available literature. The correct diagnosis is difficult for the otolaryngologist and a high level of suspicion is required. The authors emphasize the need to include this condition into the differential diagnosis in patients with predisposing factors presenting with suspected lesions. In addition, the conservative diagnostic approach with antifungal treatment seems to provide effective outcomes, although comparative clinical studies between diagnostic options are lacking.
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Candidíase , Disfonia , Doenças da Laringe , Laringe , Adolescente , Candidíase/diagnóstico , Candidíase/tratamento farmacológico , Feminino , Rouquidão , Humanos , Doenças da Laringe/diagnóstico , Doenças da Laringe/diagnóstico por imagem , Masculino , OtorrinolaringologistasRESUMO
BACKGROUND: Secondary rhinoplasty often involves the addition of autogenous graft material to add volume, structure, support and to camouflage cartilage and bone grafts. A variety of fascias have been used to camouflage, wrap and give "fill" in secondary rhinoplasty. The posterior auricular fascia is a source of material ideal for such purposes, and its quantity, anatomical structure and ease of harvest with minimal donor site morbidity make it a versatile and attractive autogenous graft. METHODS: The clinical records of patients receiving autogenous posterior auricular fascial grafts were reviewed. There were two main uses of this graft material, one was to cover the tip reconstruction in secondary rhinoplasties under thin tip skin. This is a camouflage graft. The second use is for fill and augmentation, especially for the nasal dorsum and as an interpostitional graft between the dorsum and the tip. CONCLUSION: The posterior auricular fascial graft has many potential uses in secondary rhinoplasties and is readily harvested as a generous graft concurrent to conchal cartilage harvest and with a concealed scar behind the ear. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Pavilhão Auricular/cirurgia , Fáscia/transplante , Reoperação/métodos , Rinoplastia/métodos , Pavilhão Auricular/transplante , Estética , Feminino , Sobrevivência de Enxerto , Humanos , Cartilagens Nasais/cirurgia , Satisfação do Paciente , Rinoplastia/efeitos adversos , Estudos de Amostragem , Coleta de Tecidos e Órgãos/métodos , Transplante Autólogo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The pectoralis muscle sling has proven to be a suitable alternative technique for long-term results in breast parenchyma suspension. Although the pectoralis muscle sling has been subjectively observed to reduce the bottoming-out effect with a bipedicled muscle flap (muscular loop), there has not been a study to objectively or numerically prove it. OBJECTIVES: This study aimed to radiologically evaluate the influence of a pectoralis muscle sling in supporting the chest wall-based flap after a vertical breast-reduction technique. METHODS: Twenty-one female patients underwent a vertical breast reduction with the chest wall-based flap and were randomly divided into two subgroups. Ten patients were in subgroup (S), which consisted of patients with a muscle sling. Eleven patients without the muscle sling technique were assigned as a control group (C). Periodic radiological examinations were performed at 1, 3, 6, and 12 months and then at 10 years postoperatively to analyze the breast flap and any migration with respect to three titanium clips placed intraoperatively on the chest wall parenchyma flap. RESULTS: Patients in subgroup S had a significantly higher difference in migration of the chest wall-based flaps between the first day and 10 years postoperatively when compared with patients in subgroup C (P < .001), as shown by the distances measured between titanium clip locations. CONCLUSIONS: After 10 years of follow-up, there were changes in chest wall-based flap bottoming-out in patients in whom a pectoralis major muscle sling was utilized compared with those patients without it. Thus, a pectoralis major muscle sling seems to provide greater and longer-lasting support to the flap position on the patient's chest. LEVEL OF EVIDENCE: 2 Therapeutic.
Assuntos
Mama/cirurgia , Mamoplastia/métodos , Músculos Peitorais/cirurgia , Retalhos Cirúrgicos , Adulto , Idoso , Pontos de Referência Anatômicos , Mama/diagnóstico por imagem , Feminino , Humanos , Estudos Longitudinais , Mamoplastia/efeitos adversos , Pessoa de Meia-Idade , Músculos Peitorais/diagnóstico por imagem , Retalhos Cirúrgicos/efeitos adversos , Fatores de Tempo , Resultado do TratamentoRESUMO
Chronic wounds remain a significant medical and financial burden in hospitals of today. A major factor in the transition from an acute to a chronic wound is its bacterial bioburden. Developments in molecular techniques have shown that chronic wounds remain colonised by many species of bacteria and that the bacteria within these chronic wounds exist in two forms. Treatments of chronic wounds have maintained a challenging field and significant ongoing research is being conducted. With the development of an in vitro wound model, we applied topical negative pressure (TNP) dressings to a spectrum of common bacterial biofilms found in chronic wounds and studied the synergistic efficacy between the application of TNP and silver-impregnated foam against these biofilms. This synergistic response was seen within the laboratory strains of staphylococcal biofilms over a 3-day treatment period but lost following the 5 days of treatment. However, combining topical pressure dressings and silver foam lead to a synergistic inactivation in Pseudomonas species over both 3-day and 5-day treatments.
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Bandagens , Biofilmes , Tratamento de Ferimentos com Pressão Negativa , Compostos de Prata/farmacologia , Biofilmes/efeitos dos fármacos , Contagem de Colônia Microbiana , Humanos , Técnicas In Vitro , Microscopia Eletrônica de Varredura , Modelos Biológicos , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/fisiologia , Staphylococcus/efeitos dos fármacos , Staphylococcus/fisiologiaRESUMO
AIMS: Intestinal metaplasia (IM), which results from de-novo expression of CDX2, and dysplasia are precursor lesions of gastric cancer that are associated with an increased risk for cancer development. There is much evidence suggesting a role for the transcription factor SOX2 in gastric differentiation. The aim of this study was to attempt to establish the relationship of SOX2 with CDX2 and with the differentiation reprogramming that characterizes gastric carcinogenesis, to assess their involvement in IM and dysplasia. METHODS AND RESULTS: Characterization of gastric (SOX2, MUC5AC, and MUC6) and intestinal (CDX2 and MUC2) markers in normal gastric mucosa, in 55 foci of IM and in 26 foci of dysplasia, was performed by immunohistochemistry. SOX2 was expressed in the normal gastric mucosa, in the presumptive stem cell compartment, and was maintained in 7% of the complete (MUC5AC-negative) and 85% of the incomplete (MUC5AC-positive) IM subtypes. Twelve per cent of the dysplastic lesions expressed SOX2, and the association with MUC5AC was lost. CDX2 was present in all IMs and dysplastic lesions. CONCLUSIONS: SOX2 is associated with gastric differentiation in incomplete IM and is lost in the progression to dysplasia, whereas CDX2 is acquired de novo in IM and maintained in dysplasia. This suggests that the balance between gastric and intestinal differentiation programmes impacts on the gastric carcinogenesis cascade progression.
Assuntos
Proteínas de Homeodomínio/metabolismo , Mucosa Intestinal/patologia , Lesões Pré-Cancerosas/patologia , Fatores de Transcrição SOXB1/metabolismo , Neoplasias Gástricas/patologia , Fator de Transcrição CDX2 , Diferenciação Celular/fisiologia , Humanos , Imuno-Histoquímica , Mucosa Intestinal/metabolismo , Metaplasia/metabolismo , Metaplasia/patologia , Lesões Pré-Cancerosas/metabolismo , Neoplasias Gástricas/metabolismoRESUMO
BACKGROUND: Gastric dysplasia is classified as adenomatous/type I (intestinal phenotype) and foveolar or pyloric/type II (gastric phenotype) according to morphological (architectural and cytological) features. The immunophenotypic classification of dysplasia, based on the expression of the mucins, CD10 and CDX2, recognizes the following immunophenotypes: intestinal (MUC2, CD10, and CDX2); gastric (MUC5AC and/or MUC6, absence of CD10, and absent or low expression of CDX2); hybrid (gastric and intestinal markers); and null. METHODS: Sixty-six cases of nonpolypoid epithelial dysplasia of the stomach were classified according to morphological features (histotype and grade) and immunophenotype. Immunohistochemical staining was performed with antibodies against MUC2, MUC5AC, MUC6, CD10, CDX2, chromogranin, synaptophysin, Ki-67, and TP53. HER2 alterations were analyzed by immunohistochemistry and silver-enhanced in situ hybridization. RESULTS: By conventional histology, dysplasia was classified as adenomatous/intestinal (n = 42; 64 %) and foveolar or pyloric/gastric (n = 24; 36 %) and graded as low grade (n = 37; 56 %) or high grade (n = 29; 44 %). Immunophenotypic classification showed intestinal (n = 22; 33.3 %), gastric (n = 25; 37.9 %), hybrid (n = 17; 25.8 %), or null (n = 2; 3.0 %) phenotypes. In 20 cases a coexistent intramucosal carcinoma was identified. The intestinal immunophenotype was shown to be significantly associated with low-grade dysplasia (p = 0.001), high expression of CDX2 (p = 0.015), TP53 (p = 0.034), synaptophysin (p = 0.003), and chromogranin (p < 0.0001); the gastric immunophenotype was significantly associated with high-grade dysplasia (p = 0.001), high Ki-67 proliferative index (p = 0.05), and coexistence of intramucosal carcinoma (p = 0.013). HER2 amplification was observed in 3 cases, typed as gastric or hybrid. CONCLUSIONS: Epithelial nonpolypoid dysplasia of the stomach with gastric immunophenotype shows features of biological aggressiveness and may represent the putative precursor lesion in a pathway of gastric carcinogenesis originated de novo from the native gastric mucosa, leading to gastric-type adenocarcinoma.
Assuntos
Biomarcadores Tumorais/análise , Mucosa Gástrica/patologia , Lesões Pré-Cancerosas/patologia , Gastropatias/patologia , Adulto , Idoso , Feminino , Humanos , Imuno-Histoquímica , Imunofenotipagem , Hibridização In Situ , Masculino , Pessoa de Meia-IdadeRESUMO
Human beings lead largely sedentary lives. From an evolutionary perspective, such lifestyle is not beneficial to health. Exercise can promote many enabling pathways, particularly through circulating exerkines, to optimize individual health and quality of life. Such benefits might explain the protective effects of exercise against aging and noncommunicable diseases. Nevertheless, the miRNA-mediated molecular mechanisms and exerkine interorgan crosstalk that underlie the beneficial effects of exercise remain poorly understood. In this mini review, we focused on the exerkine, irisin, mainly produced by muscle contraction during adaptation to exercise and its beneficial effects on body homeostasis. Herein, the complex role of irisin in metabolism and inflammation is described, including its subsequent effects on thermogenesis through browning to control obesity and improve glycemic regulation for diabetes mellitus control, its potential to improve cognitive function (via brain derived neurotrophic factor), and its pathways of action and role in aging.
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Fibronectinas , Músculo Esquelético , Humanos , Fibronectinas/metabolismo , Músculo Esquelético/metabolismo , Qualidade de Vida , Anti-Inflamatórios/metabolismo , Envelhecimento , OxirreduçãoRESUMO
BACKGROUND: A growing body of evidence implicates subclinical (biofilm) infection around breast implants as an important cause of capsular contracture (CC). OBJECTIVES: The authors use an in vivo porcine model to investigate the potential of antibiotic-impregnated mesh as a prophylactic measure against biofilm formation and CC. METHODS: A total of 28 implants (14 untreated controls, 14 treated with antibiotic mesh) were inserted into 5 adult female pigs. All implants and pockets were inoculated with a human clinical strain of Staphylococcus epidermidis. The implants were left in situ for 16 weeks and then analyzed for contracture using both Baker grading and applanation tonometry. The presence of biofilm infection was assessed by subsequent microbiological analysis of implants and capsules. RESULTS: One untreated implant had extruded and was excluded from analysis. The tissue surrounding the 13 untreated control implants had Baker Grade III/IV CC, whereas no CC was identified around the 14 antibiotic mesh-treated implants. This difference was highly significant (P < .001). Tonometry findings were consistent with the Baker assessments. Although bacterial biofilm was detected on all implants and capsules, the biofilms on the antibiotic-treated implants and surrounding capsules were generally single-layered or isolated in contrast to the multilayer biofilms found on untreated implants and capsules. CONCLUSIONS: Based on the findings from this study of a porcine model, the use of antibiotic-impregnated mesh reduces bacterial access to breast implants at the time of surgical insertion and may subsequently protect against subclinical infection and CC.
Assuntos
Antibacterianos/administração & dosagem , Biofilmes , Implantes de Mama/microbiologia , Contratura Capsular em Implantes/prevenção & controle , Animais , Antibacterianos/uso terapêutico , Modelos Animais de Doenças , Feminino , Contratura Capsular em Implantes/microbiologia , Manometria , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/prevenção & controle , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/prevenção & controle , Staphylococcus epidermidis/isolamento & purificação , SuínosRESUMO
Contamination with Arsenic, a toxic metalloid, is increasing in the marine environment. Additionally, global warming can alter metalloids toxicity. Polychaetes are key species in marine environments. By mobilizing sediments, they play vital roles in nutrient and element (including contaminants) cycles. Most studies with marine invertebrates focus on the effects of metalloids on either adults or larvae. Here, we bring information on the effects of temperature increase and arsenic contamination on the polychaete Hediste diversicolor in different growth stages and water temperatures. Feeding activity and biochemical responses-cholinesterase activity, indicators of cell damage, antioxidant and biotransformation enzymes and metabolic capacity-were evaluated. Temperature rise combined with As imposed alterations on feeding activity and biochemical endpoints at different growth stages. Small organisms have their antioxidant enzymes increased, avoiding lipid damage. However, larger organisms are the most affected class due to the inhibition of superoxide dismutase, which results in protein damage. Oxidative damage was observed on smaller and larger organisms exposed to As and temperature of 21 °C, demonstrating higher sensibility to the combination of temperature rise and As. The observed alterations may have ecological consequences, affecting the cycle of nutrients, sediment oxygenation and the food chain that depends on the bioturbation of this polychaete.
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Arsênio , Poliquetos , Poluentes Químicos da Água , Animais , Arsênio/análise , Poluentes Químicos da Água/metabolismo , Poliquetos/metabolismo , Estresse Oxidativo , Antioxidantes/metabolismoRESUMO
Polypharmacology is a new trend in amyotrophic lateral sclerosis (ALS) therapy and an effective way of addressing a multifactorial etiology involving excitotoxicity, mitochondrial dysfunction, oxidative stress, and microglial activation. Inspired by a reported clinical trial, we converted a riluzole (1)-rasagiline (2) combination into single-molecule multi-target-directed ligands. By a ligand-based approach, the highly structurally integrated hybrids 3-8 were designed and synthesized. Through a target- and phenotypic-based screening pipeline, we identified hit compound 6. It showed monoamine oxidase A (MAO-A) inhibitory activity (IC50 = 6.9 µM) rationalized by in silico studies as well as in vitro brain permeability. By using neuronal and non-neuronal cell models, including ALS-patient-derived cells, we disclosed for 6 a neuroprotective/neuroinflammatory profile similar to that of the parent compounds and their combination. Furthermore, the unexpected MAO inhibitory activity of 1 (IC50 = 8.7 µM) might add a piece to the puzzle of its anti-ALS molecular profile.
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Esclerose Lateral Amiotrófica , Fármacos Neuroprotetores , Esclerose Lateral Amiotrófica/tratamento farmacológico , Humanos , Indanos , Ligantes , Fármacos Neuroprotetores/farmacologia , Fármacos Neuroprotetores/uso terapêutico , Riluzol/farmacologia , Riluzol/uso terapêuticoRESUMO
Most malignant tumors of the penis are squamous cell carcinomas (SCC), being divided in 2 groups, one human papillomavirus (HPV)-related and another non-HPV-related, with lymphoepithelioma-like carcinoma (LELC) being one of the rarest HPV-related SCC. In this article, we report a case of a 50-year-old man who presented testicular swelling and pain for the past 3 months. A penile mass was identified, and the patient was submitted to a total penectomy. The penectomy specimen showed an ulcerated lesion at the glans reaching the cavernous bodies. Microscopic examination showed undifferentiated epithelial cells with syncytial growth pattern mix with a dense lymphoplasmacytic infiltrate, consistent with LELC. The tumor cells expressed p16 and all 3 different clones of PDL1 (22C3, SP263, and SP142). The patient is alive and well with a follow-up of 3 months. To our knowledge, this is the third LELC of the penis reported in literature and the first case reported with PDL1 expression.
Assuntos
Carcinoma/diagnóstico , Infecções por Papillomavirus/diagnóstico , Neoplasias Penianas/diagnóstico , Biomarcadores Tumorais/análise , Biópsia , Carcinoma/patologia , Carcinoma/virologia , Inibidor p16 de Quinase Dependente de Ciclina/análise , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Neoplasias Penianas/patologia , Neoplasias Penianas/virologia , Pênis/patologia , Pênis/virologiaRESUMO
BACKGROUND: The ageing process implies several physiological and psychological changes that hence affect the general health, mood states, and quality of life of older persons. Exercise and adequate nutrition are renowned non-pharmacological strategies that significantly delay and alleviate the adverse consequences of the ageing process. This study aimed to evaluate the effects of branched-chain amino acid (BCAA) supplementation and a multicomponent exercise program (ME) on the physical frailty and mood states of older persons. METHODS: 35 participants (women and men; 83 ± 3 years old) from residential care homes were submitted to a 40-week exercise-washout-retraining intervention (16 weeks of the elastic band based exercise and/or supplementation, 8 weeks of washout, and 16 weeks of multicomponent exercise and/or resupplementing), with or without BCAA supplementation. The experimental groups were: (i) ME plus BCAA supplementation (ME+BCAA); (ii) ME; (iii) BCAA supplementation (BCAA), and (iv) control group (CG). Fried's phenotype was used to assess frailty prevalence. Geriatric Depression Scale (GDS), Profile of Mood State (POMS), Mini-Mental State Examination (MMSE), were used to access mental health and cognition. The Short Physical Performance Battery (SPPB) was used to access functional capacity. Salivary testosterone levels (ST) were also determined to access the anabolic effects of the intervention. RESULTS: Exercise was effective in improving functional capacity and prevented the increase in frailty that occurred in the non-exercising CG, where the frailty scores increased over time (p < 0.01). BCAAs supplement alone had no impact on functional fitness, but in a short time (16 weeks) contributed to diminishing frailty and combined with exercise may have the potential to reduce the effect of a detraining period on functional capacity. Salivary testosterone levels correlated with handgrip strength and could be a useful indicator of susceptibility to frailty. No effects were found for mood states, cognition, and depression. CONCLUSION: This study showed that a long-term exercise program, independent of being multicomponent or strength elastic band-based, was effective in improving functional capacity and prevented an increase in frailty in frail and pre-frail older persons living in residential care homes.
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Aminoácidos de Cadeia Ramificada , Idoso Fragilizado , Idoso , Idoso de 80 Anos ou mais , Suplementos Nutricionais , Terapia por Exercício , Feminino , Força da Mão , Humanos , Masculino , Saúde Mental , Qualidade de VidaRESUMO
This review outlines the various factors associated with unhealthy aging which includes becoming frail and dependent. With many people not engaging in recommended exercise, facilitators and barriers to engage with exercise must be investigated to promote exercise uptake and adherence over the lifespan for different demographics, including the old, less affluent, women, and those with different cultural-ethnic backgrounds. Governmental and locally funded public health messages and environmental facilitation (gyms, parks etc.) can play an important role. Studies have shown that exercise can act as a conductor to balance oxidative stress, immune and endocrine functions together to promote healthy aging and reduce the risk for age-related morbidities, such as cardiovascular disease and atherosclerosis, and promote cognition and mood over the lifespan. Like a classic symphony orchestra, consisting of four groups of related musical instruments - the woodwinds, brass, percussion, and strings - the aging process should also perform in harmony, with compassion, avoiding the aggrandizement of any of its individual parts during the presentation. This review discusses the wide variety of molecular, cellular and endocrine mechanisms (focusing on the steroid balance) underlying this process and their interrelationships.
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Fragilidade , Idoso , Exercício Físico , Feminino , Idoso Fragilizado , Hormônios , Humanos , Inflamação , Estresse Oxidativo , EsteroidesRESUMO
Acute vestibular syndrome is most often caused by vestibular neuritis or stroke, although demyelinating diseases may be responsible for 4% of all AVS episodes. The authors present the case of a previously healthy 17-year-old female patient complaining of spontaneous vertigo and right-sided hearing loss. Otoneurological examination suggested a peripheral vestibular cause and video head impulse test revealed a reduced vestibulo-ocular reflex gain. The presence of sensorineural hearing loss raised the suspicion of a central cause and prompted imaging evaluation. A brain MRI evidenced demyelinating lesions in the right middle cerebellar peduncle and the patient was ultimately diagnosed with Multiple Sclerosis.
Assuntos
Cerebelo/diagnóstico por imagem , Perda Auditiva Neurossensorial/diagnóstico , Labirintite/diagnóstico , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Esclerose Múltipla Recidivante-Remitente/diagnóstico , Neuronite Vestibular/diagnóstico , Doença Aguda , Adolescente , Audiometria de Tons Puros , Audiometria da Fala , Diagnóstico Diferencial , Feminino , Teste do Impulso da Cabeça , Perda Auditiva Neurossensorial/etiologia , Humanos , Imageamento por Ressonância Magnética , Esclerose Múltipla Recidivante-Remitente/complicações , Náusea/etiologia , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/etiologia , Reflexo Vestíbulo-Ocular , Vertigem/etiologia , Neuronite Vestibular/etiologia , Vômito/etiologiaRESUMO
Plastic debris has been reaching the world's oceans since it started being used. Multiple studies have been addressing the effects of microplastics in various organisms but, despite the increased scientific awareness, there is still a significant gap in knowledge when it comes to small-sized plastic particles of sizes below 100 nm. The aim of this study was to understand the effect of waterborne 100 nm polystyrene nanoplastics (PS NPs) on the marine polychaeta Hediste diversicolor, a keystone species in intertidal and coastal environments, in terms of behavior, neurotransmission, oxidative status, energy metabolism and oxidative damage. Results of PS NPs characterization showed an aggregation along the time and with increasing concentrations. Results also revealed a considerable impact of PS NPs on ecologically relevant endpoints like cholinesterase (ChE) and burrowing, but no increases in most of the parameters associated with oxidative stress. Protein carbonylation was found to be more sensitive to PS NPs effects than lipid peroxidation. Behavioral alterations induced by PS NPs may affect nutrient cycling and (endo-)benthic fauna. The data revealed in this study highlighted the potential consequences of NPs to benthic organisms and the need for further studies.
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Poliquetos , Poluentes Químicos da Água , Animais , Estresse Oxidativo , Plásticos , PoliestirenosRESUMO
An approximate analytical solution to Johanson's rolling theory is derived. It is shown that the solution yields a single dimensionless parameter invariant in process scale-up or equipment transfer, which relates the densification factor with process parameters (roll force and gap), geometric parameters (roll diameter and width) and material properties. It is shown that, to a first approximation, the model prediction does not depend on the nip angle evading the need to powder rheometry measurements such as wall friction and internal shear angle. The model is benchmarked against data obtained from pilot-scale roller compactors from different manufacturers as well as literature data from Nesarikar. The model yields good ribbon density predictions even when calibrating material properties from uniaxial die compression.
Assuntos
Composição de Medicamentos , Fricção , Tamanho da Partícula , Pós , Pressão , ComprimidosRESUMO
INTRODUCTION: Epidemiologic studies demonstrate that obesity and diabetes increase the prevalence of urinary lithiasis. Most of these studies did not stratify the chemical composition of calculi and the physiological mechanisms responsible for this increased risk are not well understood. This study aims to investigate the relation between the metabolic syndrome and the composition of the urinary calculi. MATERIAL AND METHODS: Observational and retrospective study of all urinary calculi analysis performed at the Centro Hospitalar do Tâmega e Sousa, Portugal - from January 2009 to September 2015. Calculi were analyzed by infrared spectroscopy. RESULTS: 302 analyses of urinary calculi were identified. Metabolic syndrome was diagnosed in 20.5% of patients. A total of 7 different mineral compounds were identified: 51.6% (N = 156) contained calcium oxalate, 41% (N = 124) calcium phosphate, 37.7% (N = 114) uric acid, 22.1% (N = 67) ammonium urate, 9.6% (N = 29) ammonium magnesium phosphate, 6.3% (N = 19) sodium urate and 1.3% (N = 4) contained cystine. Patients with metabolic syndrome presented a higher proportion of uric acid calculi (66.1% vs. 0%, p <0.001) and ammonium urate calculi (38.7% vs. 17%, p = 0.001). Patients without metabolic syndrome had a higher proportion of calcium oxalate calculi (58.8% vs. 24.2%, p <0.001) and calcium phosphate (46.7% vs. 19.4%, p <0.001). CONCLUSIONS: There is a statistically significant relation between metabolic syndrome and uric acid and ammonium urate calculi. Metabolic syndrome may be considered risk factor for this calculi and the diagnosis and treatment of this syndrome must be considered for urolithiasis prevention. Further studies are needed to better the understanding of physiological mechanisms underlying this relationship to improve our strategy of prevention of urinary lithiasis.
RESUMO
Primary mesenchymal chondrosarcoma of the kidney is extremely rare, with only nine cases reported in the English literature. We report a new case of this disease. A 35-year-old man, presented with flank pain, episodic gross hematuria and a painless palpable mass in left abdominal quadrant. Computed tomography scan identified a left renal tumor with 20 cm, with no evidence of regional or metastatic spread disease. The patient underwent radical nephrectomy. The immunohistopathological diagnosis was mesenchymal chondrosarcoma of the kidney. At 18 months of follow-up, there was no evidence of recurrence or distant metastasis. Primary renal chondrosarcoma is so rare that its prognosis is unknown. Disease recurrence is unpredictable and when it is detected, the prognosis is poor. The radical nephrectomy with complete resection of the tumor with wide resection free margins is recommended, and the patients need long-term and close surveillance, with particular attention to local recurrence and uncommon sites of metastization.