Crucial neuroprotective roles of the metabolite BH4 in dopaminergic neurons.

Dopa-responsive dystonia (DRD) and Parkinson's disease (PD) are movement disorders caused by the dysfunction of nigrostriatal dopaminergic neurons. Identifying druggable pathways and biomarkers for guiding therapies is crucial due to the debilitating nature of these disorders. Recent genetic studies have identified variants of GTP cyclohydrolase-1 (GCH1), the rate-limiting enzyme in tetrahydrobiopterin (BH4) synthesis, as causative for these movement disorders. Here, we show that genetic and pharmacological inhibition of BH4 synthesis in mice and human midbrain-like organoids accurately recapitulates motor, behavioral and biochemical characteristics of these human diseases, with severity of the phenotype correlating with extent of BH4 deficiency. We also show that BH4 deficiency increases sensitivities to several PD-related stressors in mice and PD human cells, resulting in worse behavioral and physiological outcomes. Conversely, genetic and pharmacological augmentation of BH4 protects mice from genetically- and chemically induced PD-related stressors. Importantly, increasing BH4 levels also protects primary cells from PD-affected individuals and human midbrain-like organoids (hMLOs) from these stressors. Mechanistically, BH4 not only serves as an essential cofactor for dopamine synthesis, but also independently regulates tyrosine hydroxylase levels, protects against ferroptosis, scavenges mitochondrial ROS, maintains neuronal excitability and promotes mitochondrial ATP production, thereby enhancing mitochondrial fitness and cellular respiration in multiple preclinical PD animal models, human dopaminergic midbrain-like organoids and primary cells from PD-affected individuals. Our findings pinpoint the BH4 pathway as a key metabolic program at the intersection of multiple protective mechanisms for the health and function of midbrain dopaminergic neurons, identifying it as a potential therapeutic target for PD.

Esquizofrenia, modelo biomédico e a cobertura da mídia / Schizophrenia, the biomedical model and media coverage

RESUMO A esquizofrenia, marcada por alterações significativas na percepção da realidade e, em muitos casos, pelo declínio social e ocupacional, continua sendo um desafio etiológico e terapêutico. A despeito de décadas em investigações científicas sobre suas possíveis causas, apenas modestos avanços foram alcançados. Atualmente, as pesquisas indicam que a esquizofrenia é uma condição complexa e que sua etiologia é multifatorial. No entanto, o modelo biomédico em saúde mental, caracterizado pela ideia de que transtornos mentais são doenças do cérebro, frequentemente procura delimitar a esquizofrenia aos seus aspectos biológicos, menosprezando a influência do ambiente. A concepção de transtornos mentais como doenças cerebrais tem repercutido na população em geral, que, em parte, é informada sobre o tema a partir da divulgação científica pela mídia tradicional. O objetivo do artigo é analisar como as causas da esquizofrenia têm sido divulgadas pela mídia impressa. Para tanto, a partir de uma Análise de Discurso Crítica, foi conduzida uma busca no acervo digital dos três maiores jornais brasileiros, de maneira a evidenciar quem é convocado a falar sobre a esquizofrenia e quais as principais explicações causais divulgadas ao público. Os resultados mostram um domínio do discurso biomédico e um enfoque em aspectos genéticos e neuroquímicos da esquizofrenia.

ABSTRACT Schizophrenia, marked by significant alterations in the perception of reality and, in many cases, by social and occupational decline, remains an etiological and therapeutic challenge. Despite decades of scientific investigation into its possible causes, only modest progress has been made. Today, research indicates that schizophrenia is a complex condition and that its etiology is multifactorial. However, the biomedical model of mental health, characterized by the idea that mental disorders are brain diseases, often seeks to delimit schizophrenia to its biological aspects, underestimating the influence of the environment. The conception of mental disorders as brain diseases has had an impact on the general population, which, in part, is informed about the subject from scientific dissemination by the traditional media. The objective of the article is to analyze how the causes of schizophrenia have been publicized by the print media. For this purpose, based on a Critical Discourse Analysis, a search was conducted in the digital collection of the three largest Brazilian newspapers, in order to highlight who is invited to talk about schizophrenia and what are the main causal explanations disclosed to the public. The results show a dominance of the biomedical discourse and a focus on genetic and neurochemical aspects of schizophrenia.

X-ray tube operators can be exposed to equal or higher scattered radiation doses to the hand as cassette holders during diagnostic radiographic procedures of the equine vertebral column and limbs.

OBJECTIVE: The objectives of this study were to investigate scattered radiation doses to the hands of equine workers holding the cassette and the x-ray tube by hand, for both limb and vertebral column studies, and to compare the scattered radiation attenuation of lead with radiation protection lead-free gloves. Radiation doses to the hands of the cassette holder in the primary beam were also investigated. SAMPLE: A whole-body horse cadaver. PROCEDURES: A portable x-ray unit was used to simulate 6 radiographic study types in the horse cadaver. Doses were measured with no shielding and, for cassette holders, with the ion chamber enclosed in a lead glove and a lead-free glove. Thirty exposures were performed for each study view and condition (n = 1,920). RESULTS: Mean scattered doses to x-ray unit operators were higher than doses to cassette holders for ungula (hoof), thoracic vertebrae, and lumbar vertebrae studies, whereas doses to cassette holders were higher than doses to x-ray tube operators for studies of the metacarpophalangeal joint (fetlock) and tarsus (hock). Doses did not differ for the stifle joint. Mean percentage decrease in scattered radiation dose was 99.58% with lead gloves and 98.9% with lead-free gloves. CLINICAL RELEVANCE: X-ray tube operators can be exposed to equal or higher scattered radiation doses to the hand as cassette holders. Lead-free hand shielding should only be considered as an alternative to lead gloves if their lighter weight increases frequency of use by workers.

Evaluation of Long-Term Results of Oberlin Surgery in Obstetric Brachial Paralysis.

Objective To evaluate elbow flexion in children with obstetric brachial plexus paralysis submitted to Oberlin transfer. Methods Retrospective study with 11 patients affected by paralysis due to labor who did not present spontaneous recovery from elbow flexion until 12 months of life, operated between 2010 and 2018. Results The children were operated between 5 and 12 months of life, with a mean of 7.9 months, and the mean follow-up time was 133.2 months, ranging from 37 to 238 months. Six patients (54.5%) presented a degree of muscle strength ≥ 3, measured by the strength scale of the Medical Research Council (MRC) and, according to the active movement scale (AMS), 5 patients obtained a score of ≥ 5. A negative correlation was identified between the AMS and the Narakas classification (r = -0.509), as well as between the strength scale (MRC) and the Narakas classification (r = -0.495). A strong positive correlation was observed (r = 0.935) between the AMS and the MRC demonstrating that the higher the score on the movement scale, the higher the score on the muscle strength scale. Conclusion The Oberlin surgery is a possible option for recovery of elbow flexion in children with neonatal plexopathy, demonstrating, however, very heterogeneous results, even in the long-term follow-up.

Acute ischemic stroke and COVID-19 pandemic in Brazil: a comparative study of frequency and risk factors before and during SARS-CoV-2 era.

BACKGROUND: COVID-19 pandemic directly impacted the request for hospital care and medical assistance for several diseases worldwide, as occurred with acute ischemic stroke. The present study sought to compare the incidence and severity of acute ischemic stroke (AIS), in addition to sociodemographic, clinical, and radiological characteristics of patients hospitalized in the prepandemic (2018-2019) and pandemic (2020-2021) eras. METHODS: An incidence case-control, observational, and analytical research was carried out in the Stroke Unit of Hospital Governador Celso Ramos, Florianopolis, Santa Catarina, Brazil, including 171 patients admitted with acute ischemic stroke from April 2018 to April 2019 (prepandemic era) and 148 patients between January 2020 and January 2021 (during pandemic). RESULTS: The mean incidence of AIS hospital admissions was significantly lower in the pandemic period (CI 95%, 0.2 to 5.6; p = 0.04), being lower in the lockdown periods and when the incidence of new COVID-19 cases increased. Besides, referring to AIS severity, the mean areas of AIS were larger during the pandemic period (p < 0.01), especially in August, September, December, and January (p < 0.05). Sociodemographic and clinical variables did not show any difference between the two periods of the study. CONCLUSIONS: Hospital admissions for AIS decreased in the COVID-19 pandemic, mostly during months of higher incidences of new COVID-19 cases. When the incidence of admissions diminished, an increase in the severity of AIS was observed, characterized by larger areas. These findings might contribute to other similar referral centers in managing public policies related to stroke.

Evaluation of Long-Term Results of Oberlin Surgery in Obstetric Brachial Paralysis / Avaliação dos resultados a longo prazo da cirurgia de Oberlin na paralisia braquial obstétrica

Abstract Objective To evaluate elbow flexion in children with obstetric brachial plexus paralysis submitted to Oberlin transfer. Methods Retrospective study with 11 patients affected by paralysis due to labor who did not present spontaneous recovery from elbow flexion until 12 months of life, operated between 2010 and 2018. Results The children were operated between 5 and 12 months of life, with a mean of 7.9 months, and the mean follow-up time was 133.2 months, ranging from 37 to 238 months. Six patients (54.5%) presented a degree of muscle strength ≥ 3, measured by the strength scale of the Medical Research Council (MRC) and, according to the active movement scale (AMS), 5 patients obtained a score of ≥ 5. A negative correlation was identified between the AMS and the Narakas classification (r = -0.509), as well as between the strength scale (MRC) and the Narakas classification (r = -0.495). A strong positive correlation was observed (r = 0.935) between the AMS and the MRC demonstrating that the higher the score on the movement scale, the higher the score on the muscle strength scale. Conclusion The Oberlin surgery is a possible option for recovery of elbow flexion in children with neonatal plexopathy, demonstrating, however, very heterogeneous results, even in the long-term follow-up.

Resumo Objetivo Avaliar a flexão do cotovelo em crianças portadoras de paralisia obstétrica do plexo braquial submetidas à transferência de Oberlin. Métodos Estudo retrospectivo com 11 pacientes acometidos por paralisia decorrente do trabalho de parto e que não apresentaram recuperação espontânea da flexão do cotovelo até os 12 meses de vida, operados entre 2010 e 2018. Resultados As crianças foram operadas entre os 5 e 12 meses de vida, com média de 7,9 meses e o tempo médio de seguimento foi de 133,2 meses, variando de 37 a 238 meses. Seis pacientes (54,5%) apresentaram grau de força muscular ≥ 3, medido pela escala de força do Medical Research Council (MRC), e, pela escala de movimentação ativa (Active Momement Scale [AMS]), 5 pacientes obtiveram pontuação ≥ 5. Foi identificada correlação negativa entre a AMS e a classificação de Narakas (r = -0,509), bem como entre a MRC e a classificação de Narakas (r = -0,495). Já entre a AMS e a MRC, foi observada forte correlação positiva (r = 0,935), demonstrando que quanto maior a pontuação na escala de movimento, maior será a pontuação na escala de força muscular. Conclusão A cirurgia de Oberlin apresenta-se como uma opção possível para a recuperação da flexão do cotovelo em crianças com plexopatia neonatal; no entanto, demonstra resultados bastante heterogêneos, mesmo no seguimento a longo prazo.

Survey of self-reported radiation safety practices among North American veterinary technicians involved in equine radiography using portable x-ray equipment.

OBJECTIVES: To describe self-reported radiation safety practices by equine veterinary technicians in North America and identify factors associated with these practices. SAMPLE: 154 equine technicians. PROCEDURES: An electronic questionnaire regarding radiation safety practices during the use of portable x-ray equipment was sent to 884 members of the American Association of Equine Veterinary Technicians and Assistants. Data were summarized, and various factors were evaluated for associations with reported safety practices. RESULTS: 221 of 884 (25.0%) questionnaires were completed, including 154 by equine technicians who had been involved in equine radiography as x-ray tube operators, cassette holders, or both in the previous year. Lead apron use was suboptimal, reported as "always" for 80.0% (104/130) of tube operators and 83.1% (123/148) of cassette holders. Approximately 20% of participants never wore thyroid shields, and approximately 90% never wore lead eyeglasses. Almost 50% of participants did not have lead eyeglasses available. Although > 55% of participants always held the x-ray equipment by hand, 58.4% (73/125) of tube operators and 25.0% (35/140) of cassette holders never wore gloves. Cassette holders wore lead gloves and personal radiation dose-monitoring devices significantly more frequently than did tube operators. CONCLUSIONS AND CLINICAL RELEVANCE: Compliance of North American equine technicians with radiation safety recommendations by the National Council on Radiation Protection and Measurements was suboptimal. Improvements in radiation safety training and education, strengthening the connection between academic institutions and private practices, and greater availability and requirement of personal protective equipment use by senior clinicians and employers might aid in improving safety practices.

Pilot Randomized Control Trial: Efficacy of a Group-Based Psychosocial Program for Youth with PTSD in the Brazilian Favelas.

The study aimed to evaluate Teaching Recovery Techniques (TRT) delivered to Brazilian youth who experienced drug violence in one Favela. Thirty children, 8 to 14 years, were randomly assigned to TRT (n = 14) or to a treatment as usual group (n = 16) involving boxing/martial arts. Youth received five 90-min sessions over successive weeks. Standardized measures assessed Posttraumatic Stress and Depression at 2 weeks pre and post-test. An exploratory assessment of posttraumatic growth was also utilized. An interview with group leaders explored perceptions of delivering TRT within the favela. Medium effect sizes were found for PTSD and Depression, and a small effect size for posttraumatic growth. Group leaders emphasized understanding the favela context for program adaptation. In conclusion, TRT was found to be effective for children with PTSD and Depression who experienced drug violence in a Brazilian favela. TRT is recommended for future delivery. Larger scale RCTs are needed in Brazilian favelas.

Use of non-invasive stimulation in movement disorders: a critical review.

BACKGROUND: Noninvasive stimulation has been widely used in the past 30 years to study and treat a large number of neurological diseases, including movement disorders. OBJECTIVE: In this critical review, we illustrate the rationale for use of these techniques in movement disorders and summarize the best medical evidence based on the main clinical trials performed to date. METHODS: A nationally representative group of experts performed a comprehensive review of the literature in order to analyze the key clinical decision-making factors driving transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in movement disorders. Classes of evidence and recommendations were described for each disease. RESULTS: Despite unavoidable heterogeneities and low effect size, TMS is likely to be effective for treating motor symptoms and depression in Parkinson's disease (PD). The efficacy in other movement disorders is unclear. TMS is possibly effective for focal hand dystonia, essential tremor and cerebellar ataxia. Additionally, it is likely to be ineffective in reducing tics in Tourette syndrome. Lastly, tDCS is likely to be effective in improving gait in PD. CONCLUSIONS: There is encouraging evidence for the use of noninvasive stimulation on a subset of symptoms in selected movement disorders, although the means to optimize protocols for improving positive outcomes in routine clinical practice remain undetermined. Similarly, the best stimulation paradigms and responder profile need to be investigated in large clinical trials with established therapeutic and assessment paradigms that could also allow genuine long-term benefits to be determined.

Impaired dopamine metabolism is linked to fatigability in mice and fatigue in Parkinson's disease patients.

Fatigue is a common symptom of Parkinson's disease that compromises significantly the patients' quality of life. Despite that, fatigue has been under-recognized as symptom, its pathophysiology remains poorly understood, and there is no adequate treatment so far. Parkinson's disease is characterized by the progressive loss of midbrain dopaminergic neurons, eliciting the classical motor symptoms including slowing of movements, muscular rigidity and resting tremor. The dopamine synthesis is mediated by the rate-limiting enzyme tyrosine hydroxylase, which requires tetrahydrobiopterin as a mandatory cofactor. Here, we showed that reserpine administration (1 mg/kg, two intraperitoneal injections with an interval of 48 h) in adult Swiss male mice (8-10 weeks; 35-45 g) provoked striatal depletion of dopamine and tetrahydrobiopterin, and intolerance to exercise. The poor exercise performance of reserpinized mice was not influenced by emotional or anhedonic factors, mechanical nociceptive thresholds, electrocardiogram pattern alterations or muscle-impaired bioenergetics. The administration of levodopa (100 mg/kg; i.p.) plus benserazide (50 mg/kg; i.p.) rescued reserpine-induced fatigability-like symptoms and restored striatal dopamine and tetrahydrobiopterin levels. Remarkably, it was observed, for the first time, that impaired blood dopamine metabolism inversely and idependently correlated with fatigue scores in eighteen idiopathic Parkinson's disease patients (male n = 13; female n = 5; age 61.3 ± 9.59 years). Altogether, this study provides new experimental and clinical evidence that fatigue symptoms might be caused by the impaired striatal dopaminergic neurotransmission, pointing to a central origin of fatigue in Parkinson's disease.

Self-reported radiation safety behaviors among veterinary specialists and residents performing fluoroscopic procedures on small animals.

OBJECTIVE: To describe the radiation safety behaviors of veterinary specialists performing small animal fluoroscopic procedures and examine potential risk factors for these behaviors, including knowledge of radiation risk and training regarding machine operating parameters. SAMPLE: 197 veterinary specialists and residents in training. PROCEDURES: An electronic questionnaire was distributed to members of the American Colleges of Veterinary Internal Medicine (subspecialties of cardiology and small animal internal medicine), Veterinary Radiology, and Veterinary Surgery. RESULTS: The overall survey response rate was 6% (240/4,274 email recipients). Of the 240 respondents, 197 (82%) had operated an x-ray unit for a small animal fluoroscopic procedure in the preceding year and fully completed the questionnaire. More than 95% of respondents believed that radiation causes cancer, yet approximately 60% of respondents never wore hand or eye protection during fluoroscopic procedures, and 28% never adjusted the fluoroscopy machine operating parameters for the purpose of reducing their radiation dose. The most common reasons for not wearing eye shielding included no requirement to wear eyeglasses, poor fit, discomfort, and interference of eyeglasses with task performance. Respondents who had received training regarding machine operating parameters adjusted those parameters to reduce their radiation dose during procedures significantly more frequently than did respondents who had not received training. CONCLUSIONS AND CLINICAL RELEVANCE: On the basis of the self-reported suboptimal radiation safety practices among veterinary fluoroscopy users, we recommend formal incorporation of radiation safety education into residency training programs. All fluoroscopy machine operators should be trained regarding the machine operating parameters that can be adjusted to reduce occupational radiation exposure.

Evolução das manifestações clínicas de pacientes com doença de parkinson / Evolution of clinical manifestations of parkinson's disease patients

Objetivos: Avaliar o perfil clínico e epidemiológico dos pacientes parkinsonianos acompanhados no ambulatório de Distúrbios do Movimento do Hospital Governador Celso Ramos utilizando-se escaladas validadas. Métodos: Estudo longitudinal onde foram incluídos 167 pacientes consecutivos, em diferentes estágios da doença de Parkinson, atendidos no ambulatório de distúrbios do movimento do HGCR e reavaliados 20 pacientes em consulta, 5 anos após a primeira. Aplicou-se questionário e avaliou-se o primeiro sintoma motor cardinal entre as associações independentes e entre os escores de sintomas neurológicos motores avaliados através da escala UPDRS-MDS e Schwab and England Activities of Daily Living Scale. Resultados: Tremor foi o primeiro sintoma motor percebido mais frequentemente pelos pacientes (64,9%), dor foi a primeira queixa de 5,2% dos pacientes. A idade de início do primeiro sintoma foi inversamente proporcional à escolaridade. Quanto maior a pontuação nas escalar UPDRS-MDS ­ III (p=0,004) e Schwab and England Activities of Daily Living Scale (p=0,001) maior a tendência a inatividade. Conclusão: A doença de Parkinson geralmente é percebida por seus sintomas motores clássicos, entretanto, uma série de sintomas não motores iniciam e acompanham a evolução da doença conforme mostra a piora do perfil ao longo de 5 anos.

Objectives: To evaluate symptoms, establish a profile for the Parkinsonian patient of HGCR's Movement Disorders's Service. Method: Longitudinal study. 167 consecutive patients, in different stages of Parkinson's disease, and treated at HGCR movement disorders service were inclueded. 20 of them were reevaluated after 5 yers. A questionnaire was administered and the first cardinal motor symptoms was evaluated and associated with independent associations and with the scores of neurological symptoms measured by UPDRS-MDS and through the Schwab and England Activities of Daily Living Scale. Results: Tremor was the first motor symptom perceived most frequently by patients (64.9%), pain was the first complaint of 5,2% of patients. The age of onset of the first symptom was inversely proportional to schooling. The higher the scores in the UPDRS-MDS-III scale (p=0,004) and the Schwab and England Activities of the Daily Living Scale (p = 0,001) the greater the tendency to inactivity. Conclusion: Parkinson's disease is usually noticed by its classic motor symptoms, however, a series of non-motor symptoms begin and accompany the disease's progression. This study evaluated the profile of the clinical and epidemiological patients attending our service and showed important clinical worsening in the evolution of 5 years of disease.

Effects of shoulder distraction on canine shoulder arthroscopy.

OBJECTIVE: To evaluate the use of the Leipzig distractor during canine shoulder arthroscopy. STUDY DESIGN: Experimental, ex vivo. SAMPLE POPULATION: Paired shoulder joints from 15 large breed canine cadavers. METHODS: Standard lateral shoulder arthroscopy was performed with or without the use of the Leipzig distractor (n = 15 each). Joint space width, procedure time, and visibility and palpability of the intra-articular structures were assessed during the arthroscopy. After the arthroscopic evaluation, each shoulder joint was disarticulated to assess the area and number of iatrogenic articular cartilage injury (IACI) lesions. Sites around the distraction device were assessed for the presence of iatrogenic injury. RESULTS: With shoulder distraction, median joint space width was 4 mm larger (P = .01), IACI area was 9.5 mm2 lower (P = .003), and there were two fewer total number of IACI lesions (P = .004) compared with nondistracted shoulders. The mean total surgery time was 93 seconds shorter (P = .01) in distracted shoulders. Although distraction was associated with increased visibility of the supraglenoid tubercle (P = .015), no significant differences were found for other intra-articular structures for their visibility and palpability. Unexpected lesions at the sites around the distraction device were not encountered. CONCLUSION: Use of the distraction device decreased the area and incidence of IACI lesions and shortened the arthroscopy time. However, no improvement was found in the visibility or palpability of the intra-articular structures. CLINICAL SIGNIFICANCE: Although additional clinical studies are required to evaluate the effect of the distraction device on pathologic articular conditions and intraoperative manipulation, the use of a shoulder distraction device might improve the outcomes of shoulder arthroscopy by decreasing IACI and arthroscopy time.

A 7-min video training intervention improves worker short-term radiation safety behavior during small animal diagnostic radiography.

Although manual restraint for small animal diagnostic radiography is common, worker protection is often not optimized, particularly for hands and eyes. Radiation safety training videos generally include hours of material on content other than personal protective equipment (PPE), have limited content, if any, on reducing dose to the lens of the eye, and are presented at the level of veterinary professionals. The objectives of this prospective, observational study were to develop a short, open access video training intervention at the layperson level, focused on proper use of PPE, and to test the effectiveness of the training video in changing behavior of workers. The use of PPE, optimal head position, and body position relative to the source of scattered radiation were compared before and after the video training was completed by workers. Results of unconditional and multivariable analyses were similar. In final multivariable analysis, workers wore gloves correctly more frequently (odds ratio [OR] = 2.09; 95% confidence interval [CI], 1.68-2.59; P < .001) and wore eyewear more frequently (OR = 1.85; 95% CI, 1.23-2.78; P = .003) after completing the training intervention. Workers also had an optimal head position more frequently (OR = 1.27; 95% CI, 1.03-1.58; P = .03) and stood straight or leaned back more frequently (OR = 1.85; 95% CI, 1.48-2.23; P < .001) after completing the training. The video training developed in this study is an effective tool that can be incorporated into a radiation protection program to improve worker radiation safety behaviors during manual restraint for small animal diagnostic radiography.

After Experimental Trypanosoma cruzi Infection, Dying Hepatic CD3+TCRαß+B220+ T Lymphocytes Are Rescued from Death by Peripheral T Cells and Become Activated.

The unusual phenotype of CD3+ T lymphocyte expressing B220, a marker originally attributed to B lymphocytes, was first observed in the liver of Fas/Fas-L-deficient mice as a marker of apoptotic T lymphocytes. However, other CD3+B220+ T lymphocyte populations were later described in the periphery as functional cytotoxic or regulatory cells, for example. Then, in this work, we studied whether hepatic CD3+B220+ T lymphocytes could play a role in experimental Trypanosoma cruzi infection. In control and infected mice, we observed two subpopulations that could be discerned based on CD117 expression, which were conventional apoptotic CD3+B220+(CD117-) and thymus-independent CD3+B220+CD117+ T lymphocytes. Regardless of CD117 expression, most B220+ T lymphocytes were 7AAD+, confirming this molecule as a marker of dying T cells. However, after infection, we found that around 15% of the CD3+B220+CD117+ hepatic population became B220 and 7AAD negative, turned into CD90.2+, and upregulated the expression of CD44, CD49d, and CD11a, a phenotype consistent with activated T lymphocytes. Moreover, we observed that the hepatic CD3+B220+CD117+ population was rescued from death by previously activated peripheral T lymphocytes. Our results extend the comprehension of the hepatic CD3+B220+ T lymphocyte subpopulations and illustrate the complex interactions that occur in the liver.

Difficulties in activities of daily living are associated with stigma in patients with Parkinson's disease who are candidates for deep brain stimulation

Objective: Parkinson's disease (PD) is often accompanied by stigma, which could contribute to a worse prognosis. The objective of this study is to identify the variables associated with stigma in PD patients who are candidates for deep brain stimulation (DBS). Methods: We investigated sociodemographic and clinical variables associated with stigma in a sample of 54 PD patients indicated for DBS. The independent variables were motor symptoms assessed by the Movement Disorder Society‐sponsored revision of the Unified Parkinson Disease Rating Scale (MDS-UPDRS III), depressive symptoms measured by the Hospital Anxiety and Depression Scale, age, disease duration and the presence of a general medical condition. The Mobility, Activities of daily living and Emotional well-being domains of the 39-item Parkinson's Disease Questionnaire (PDQ-39) were also investigated as independent variables, and the Stigma domain of the PDQ-39 scale was considered the outcome variable. Results: After multiple linear regression analysis, activities of daily living remained associated with the Stigma domain (B = 0.42 [95%CI 0.003-0.83], p = 0.048). The full model accounted for 15% of the variance in the Stigma domain (p = 0.03). Conclusions: Although causal assumptions are not appropriate for cross-sectional studies, the results suggest that ADL difficulties could contribute to greater stigma in PD patients with refractory motor symptoms who are candidates for DBS.

Difficulties in activities of daily living are associated with stigma in patients with Parkinson's disease who are candidates for deep brain stimulation.

OBJECTIVE: Parkinson's disease (PD) is often accompanied by stigma, which could contribute to a worse prognosis. The objective of this study is to identify the variables associated with stigma in PD patients who are candidates for deep brain stimulation (DBS). METHODS: We investigated sociodemographic and clinical variables associated with stigma in a sample of 54 PD patients indicated for DBS. The independent variables were motor symptoms assessed by the Movement Disorder Society-sponsored revision of the Unified Parkinson Disease Rating Scale (MDS-UPDRS III), depressive symptoms measured by the Hospital Anxiety and Depression Scale, age, disease duration and the presence of a general medical condition. The Mobility, Activities of daily living and Emotional well-being domains of the 39-item Parkinson's Disease Questionnaire (PDQ-39) were also investigated as independent variables, and the Stigma domain of the PDQ-39 scale was considered the outcome variable. RESULTS: After multiple linear regression analysis, activities of daily living remained associated with the Stigma domain (B = 0.42 [95%CI 0.003-0.83], p = 0.048). The full model accounted for 15% of the variance in the Stigma domain (p = 0.03). CONCLUSIONS: Although causal assumptions are not appropriate for cross-sectional studies, the results suggest that ADL difficulties could contribute to greater stigma in PD patients with refractory motor symptoms who are candidates for DBS.

A importância de Hans Prinzhorn para a reforma psiquiátrica no Brasil / The importance of Hans Prinzhorn for psychiatric reform in Brazil

RESUMO A autonomia do campo artístico-cultural com relação ao campo psiquiátrico é uma tendência que vem sendo fortalecida na reforma psiquiátrica brasileira, tendo como precursores históricos Osório César e Nise da Silveira. Com a assistência sendo deslocada do hospital para o território, novas questões surgem. O artigo explora o papel pioneiro de Hans Prinzhorn para a abordagem das relações entre a arte e a loucura, apresentando os principais fundamentos da sua obra.

ABSTRACT The autonomy of the artistic-cultural field with regard to the psychiatric field is a trend that has been strengthened in the Brazilian psychiatric reform, having as historical precursors Osório César and Nise da Silveira. With assistance moving from the hospital to the territory, new issues arise. The article explores the pioneering role of Hans Prinzhorn to address the relationship between art and madness, presenting the main fundamentals of his work.

Brief hospitalization protocol for pressure ulcer surgical treatment: outpatient care and one-stage reconstruction.

OBJECTIVE: to evaluate a brief hospitalization protocol for the treatment of pressure ulcers, proposed by the Complex Wound Group of Clinical Hospital of University of Sao Paulo Medical School, particularly in regard to selection of patients, hospitalization time, cutaneous covering, complications and sore recurrence. METHODS: retrospective cohort of 20 consecutive patients with 25 pressure lesions Grade IV. All patients were ambulatorily prepared and were hospitalized for surgical one time procedure for pressure lesion closing. RESULTS: in total, 27 flaps were performed to close 25 wounds. Three patients showed minor dehiscence (11.1%). There was no recurrence during the post-surgical follow-up period. No patient suffered a new surgery and no flap showed partial or total necrosis. Median time of hospitalization was 3.6 days (2-6 days) and median follow-up was 91 months (2-28 months). All patients maintained their lesions closed, and there was no recurrence during follow-up. CONCLUSION: the brief hospitalization protocol was considered adequate for the resolution of pressure wounds, showing an average time of hospitalization of 3.6 days and rate of minor surgical wound dehiscence of 11.1%.

Brief hospitalization protocol for pressure ulcer surgical treatment: outpatient care and one-stage reconstruction / Protocolo de internação breve para tratamento cirúrgico de lesões por pressão: preparo ambulatorial e cobertura em tempo único

ABSTRACT Objective: to evaluate a brief hospitalization protocol for the treatment of pressure ulcers, proposed by the Complex Wound Group of Clinical Hospital of University of Sao Paulo Medical School, particularly in regard to selection of patients, hospitalization time, cutaneous covering, complications and sore recurrence. Methods: retrospective cohort of 20 consecutive patients with 25 pressure lesions Grade IV. All patients were ambulatorily prepared and were hospitalized for surgical one time procedure for pressure lesion closing. Results: in total, 27 flaps were performed to close 25 wounds. Three patients showed minor dehiscence (11.1%). There was no recurrence during the post-surgical follow-up period. No patient suffered a new surgery and no flap showed partial or total necrosis. Median time of hospitalization was 3.6 days (2-6 days) and median follow-up was 91 months (2-28 months). All patients maintained their lesions closed, and there was no recurrence during follow-up. Conclusion: the brief hospitalization protocol was considered adequate for the resolution of pressure wounds, showing an average time of hospitalization of 3.6 days and rate of minor surgical wound dehiscence of 11.1%.

RESUMO Objetivo: avaliar o protocolo de internação breve para tratamento de lesões por pressão, em vigência no Grupo de Feridas Complexas do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, com ênfase na seleção do paciente, no tempo de internação, na cobertura cutânea realizada, nas complicações e nas recidivas das lesões. Métodos: coorte retrospectiva de 20 pacientes consecutivos com 25 lesões por pressão Grau IV. Todos os pacientes foram preparados em ambulatório e foram internados para fechamento cirúrgico da lesão por pressão em cirurgia única. Resultados: no total foram confeccionados 27 retalhos para cobertura de 25 feridas abordadas. Foram verificados três casos (11,1%) de deiscências menores. Não foi observada recidiva no período de seguimento pós-operatório. Nenhum paciente foi reoperado e nenhum retalho sofreu necrose parcial ou total. O tempo de internação médio foi de 3,6 dias (dois a seis dias) e o seguimento foi de 9,1 meses, em média, oscilando entre dois e 18 meses. Todos os pacientes permaneceram com a lesão fechada e nenhum deles apresentou recidiva da lesão durante o seguimento. Conclusão: o protocolo de internação breve para resolução de lesões por pressão foi considerado adequado, com curto tempo de internação e baixos índices de deiscência de ferida cirúrgica.