Sarcoid optic neuropathy.

A 45-year-old woman presented with sudden complete vision loss in her left eye and retroorbital pain worsened by eye movements. A previous milder episode of vision loss had occurred in the same eye 1 year before, with complete recovery after high-dose intravenous methylprednisolone. She had no light perception in the left eye with a swollen optic disc, but with a normal right optic disc. There were no systemic manifestations or infections. MR scan of the brain showed extensive enlargement and enhancement of the left optic nerve and optic chiasm. After excluding infections and autoimmune markers, a left optic nerve biopsy confirmed non-caseating granulomas, leading to a diagnosis of neurosarcoidosis.

Spontaneous intracranial hypotension: from cerebral venous thrombosis to neurosurgical treatment: a case series experience from a Brazilian tertiary health care center.

BACKGROUND: Spontaneous intracranial hypotension (SIH) is a secondary cause of headache and an underdiagnosed disease. The clinical presentation can be highly variable. It typically presents with isolated classic orthostatic headache complaints, but patients can develop significant complications such as cerebral venous thrombosis (CVT). OBJECTIVE: To report 3 cases of SIH diagnosis admitted and treated in a tertiary-level neurology ward. METHODS: Review of the medical files of three patients and description of clinical and surgical outcomes. RESULTS: Three female patients with SIH with a mean age of 25.6 ± 10.0 years old. The patients had orthostatic headache, and one of them presented with somnolence and diplopia because of a CVT. Brain magnetic resonance imaging (MRI) ranges from normal findings to classic findings of SIH as pachymeningeal enhancement and downward displacement of the cerebellar tonsils. Spine MRI showed abnormal epidural fluid collections in all cases, and computed tomography (CT) myelography could determine an identifiable cerebrospinal fluid (CSF) leak in only one patient. One patient received a conservative approach, and the other two were submitted to open surgery with laminoplasty. Both of them had uneventful recovery and remission in surgery follow-up. CONCLUSION: The diagnosis and management of SIH are still a challenge in neurology practice. We highlight in the present study severe cases of incapacitating SIH, complication with CVT, and good outcomes with neurosurgical treatment.

ANTECEDENTES: Hipotensão intracraniana espontânea (HIE) é uma causa secundária de cefaleia e uma doença subdiagnosticada. A apresentação clínica pode ser muito variável. Tipicamente, se apresenta com queixas isoladas de cefaleia ortostática clássica, porém pode evoluir com complicações significativas como trombose venosa cerebral (TVC). OBJETIVO: Relatar 3 casos de diagnóstico de hipotensão intracraniana espontânea manejados em uma enfermaria de neurologia de nível terciário. MéTODOS: Revisão dos prontuários de três pacientes e descrição dos resultados clínicos e cirúrgicos. RESULTADOS: Três pacientes do sexo feminino com média de idade de 25.6 ± 10.0 anos. As pacientes apresentavam cefaleia ortostática e uma delas apresentou sonolência e diplopia devido a TVC. A ressonância magnética (RM) do encéfalo varia de achados normais até achados clássicos de HIE como realce paquimeníngeo e deslocamento inferior das tonsilas cerebelares. A RM da coluna mostrou coleções anormais de líquido epidural em todos os casos e a mielografia por tomografia computadorizada (TC) foi capaz de determinar fístula liquórica identificável em apenas uma paciente. Uma paciente recebeu abordagem conservadora e as outras duas foram submetidas a cirurgia aberta com laminoplastia. Ambas tiveram recuperação e remissão sem intercorrências no seguimento cirúrgico. CONCLUSãO: O diagnóstico e manejo da hipotensão intracraniana ainda são desafios na prática neurológica. Destacamos no presente estudo casos graves, complicação com TVC e bons resultados com tratamento neurocirúrgico.

Spontaneous intracranial hypotension: from cerebral venous thrombosis to neurosurgical treatment: a case series experience from a Brazilian tertiary health care center / Hipotensão intracraniana espontânea: de trombose venosa cerebral ao tratamento cirúrgico: uma série de casos de um centro terciário de saúde brasileiro

Abstract Background Spontaneous intracranial hypotension (SIH) is a secondary cause of headache and an underdiagnosed disease. The clinical presentation can be highly variable. It typically presents with isolated classic orthostatic headache complaints, but patients can develop significant complications such as cerebral venous thrombosis (CVT). Objective To report 3 cases of SIH diagnosis admitted and treated in a tertiary-level neurology ward. Methods Review of the medical files of three patients and description of clinical and surgical outcomes. Results Three female patients with SIH with a mean age of 25.6 ± 10.0 years old. The patients had orthostatic headache, and one of them presented with somnolence and diplopia because of a CVT. Brain magnetic resonance imaging (MRI) ranges from normal findings to classic findings of SIH as pachymeningeal enhancement and downward displacement of the cerebellar tonsils. Spine MRI showed abnormal epidural fluid collections in all cases, and computed tomography (CT) myelography could determine an identifiable cerebrospinal fluid (CSF) leak in only one patient. One patient received a conservative approach, and the other two were submitted to open surgery with lamino-plasty. Both of them had uneventful recovery and remission in surgery follow-up. Conclusion The diagnosis and management of SIH are still a challenge in neurology practice. We highlight in the present study severe cases of incapacitating SIH, complication with CVT, and good outcomes with neurosurgical treatment.

Resumo Antecedentes Hipotensão intracraniana espontânea (HIE) é uma causa secundária de cefaleia e uma doença subdiagnosticada. A apresentação clínica pode ser muito variável. Tipicamente, se apresenta com queixas isoladas de cefaleia ortostática clássica, porém pode evoluir com complicações significativas como trombose venosa cerebral (TVC). Objetivo Relatar 3 casos de diagnóstico de hipotensão intracraniana espontânea manejados em uma enfermaria de neurologia de nível terciário. Métodos Revisão dos prontuários de três pacientes e descrição dos resultados clínicos e cirúrgicos. Resultados Três pacientes do sexo feminino com média de idade de 25.6 ± 10.0 anos. As pacientes apresentavam cefaleia ortostática e uma delas apresentou sonolência e diplopia devido a TVC. A ressonância magnética (RM) do encéfalo varia de achados normais até achados clássicos de HIE como realce paquimeníngeo e deslocamento inferior das tonsilas cerebelares. A RM da coluna mostrou coleções anormais de líquido epidural em todos os casos e a mielografia por tomografia computadorizada (TC) foi capaz de determinar fístula liquórica identificável em apenas uma paciente. Uma paciente recebeu abordagem conservadora e as outras duas foram submetidas a cirurgia aberta com laminoplastia. Ambas tiveram recuperação e remissão sem intercorrências no seguimento cirúrgico. Conclusão O diagnóstico e manejo da hipotensão intracraniana ainda são desafios na prática neurológica. Destacamos no presente estudo casos graves, complicação com TVC e bons resultados com tratamento neurocirúrgico.

O que as revisões sistemáticas Cochrane dizem sobre o uso das 10 novas práticas de medicina integrativa incorporadas ao Sistema Único de Saúde / What systematic reviews allows the doctor to use the 10 new practices of integrated medicine to the Unified Health System

Contexto: O Ministério da Saúde do Brasil anunciou, em março de 2018, uma expansão das políticas para práticas integrativas em saúde dentro do Sistema Único de Saúde (SUS), incorporando 10 novos tipos de práticas integrativas à lista de procedimentos disponíveis no sistema público de saúde brasileiro. Objetivo: Identificar, sintetizar e avaliar criticamente evidências de revisões sistemáticas Cochrane sobre as novas práticas de medicina integrativa inseridas no SUS. Métodos: Revisão de revisões sistemáticas conduzida pela Disciplina de Medicina Baseada em Evidências, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), sobre as seguintes intervenções: apiterapia, aromaterapia, bioenergética, constelação familiar, terapia de florais, cromoterapia, geoterapia, hipnoterapia, imposição de mãos e ozonioterapia. Resultados: Foram incluídas 16 revisões sistemáticas: 4 sobre apiterapia, 4 sobre aromaterapia, 6 sobre hipnoterapia e 2 sobre ozonioterapia. Não foram encontradas revisões sistemáticas Cochrane referentes aos temas bioenergética, constelação familiar, cromoterapia, geoterapia, terapia de florais ou imposição de mãos. A única evidência de alta qualidade encontrada nessas revisões foi sobre o potencial benefício da apiterapia, especificamente para o uso de curativos de mel para cura parcial de feridas por queimadura, para redução de tosse entre crianças com tosse aguda e para prevenção de reações alérgicas a picadas de insetos. Conclusão: Exceto por alguns usos específicos da apiterapia (mel para lesões por queimadura e para tosse aguda e do veneno de abelhas para reações alérgicas às picadas de insetos), o uso das 10 práticas integrativas recentemente incorporadas ao SUS não é embasado por evidências de revisões sistemáticas Cochrane.

Schizencephaly: A Review of 734 Patients.

BACKGROUND: Schizencephaly is a rare congenital cerebral malformation associated with serious neurological manifestations. The number of studies regarding schizencephaly is limited. METHODS: We conducted a literature review and extracted data from the case reports. Of 199 articles retrieved, 156 articles (734 patients) met our inclusion criteria. RESULTS: Patient characteristics included microcephaly (41.5% of patients), seizures (74.1%), bilateral cleft (41.4%), open lip (61.3%), septo-optic dysplasia (69.1%), and ventricular dilation (60.5%). The majority of clefts were in the frontal and parietal lobes. When these potential association factors were assessed by univariate logistic regression microcephaly (OR = 21.75, P < 0.001), corpus callosum agenesis (OR = 9, P < 0.001), motor impairments (OR = 6.21, P < 0.001), and bilateral clefts (OR = 6.31, P < 0.001) seems to have the strongest association, but also age at diagnosis <10 years (OR = 1.05, P < 0.001), right (OR = 1.85, P = 0.001) or left (OR = 2.71, P < 0.001) side clefts and septum pellucidum (OR = 3.7, P = 0.002) agenesis were associated with neurocognitive dysfunctions. CONCLUSIONS: We describe novel findings with practical implications for predicting neurocognitive outcomes in patients with schizencephaly. Most patients had neurological impairments including motor (90.0%) or cognitive (77.5%) dysfunctions. Bilateral clefts, motor impairment, microcephaly, and corpus callosum agenesis were strongly associated with neurocognitive impairment. A lack of large cohorts of patients with schizencephaly prevented comparison of our results; most previous studies are case reports or small case series.

What do Cochrane systematic reviews say about new practices on integrative medicine?

ABSTRACT BACKGROUND: This study identified and summarized all Cochrane systematic reviews (SRs) on the effects of ten integrative practices that were recently added to the Brazilian public healthcare system (SUS). DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp). METHODS: Review of Cochrane SRs on the following interventions were identified, summarized and critically assessed: apitherapy, aromatherapy, bioenergetics, family constellation, flower therapy, chromotherapy, geotherapy, hypnotherapy, hand imposition or ozone therapy. RESULTS: We included a total of 16 SRs: 4 on apitherapy, 4 on aromatherapy, 6 on hypnotherapy and 2 on ozone therapy. No Cochrane SR was found regarding bioenergetics, family constellation, chromotherapy, clay therapy, flower therapy or hand imposition. The only high-quality evidence was in relation to the potential benefit of apitherapy, specifically regarding some benefits from honey dressings for partial healing of burn wounds, for reduction of coughing among children with acute coughs and for preventing allergic reactions to insect stings. CONCLUSION: Except for some specific uses of apitherapy (honey for burn wounds and for acute coughs and bee venom for allergic reactions to insect stings), the use of ten integrative practices that have recently been incorporated into SUS does not seem to be supported by evidence from Cochrane SRs.

The Importance of Student Leagues on Medical Training in Neurosurgery and Residency Choice

Introdução Distúrbios neurológicos e neurocirúrgicos são altamente prevalentes no Brasil. O atendimento inicial é realizado por médicos generalistas, o que demonstra a importância dos estudos práticos e teóricos em neurologia e neurocirurgia nos cursos de graduação em medicina. Objetivos Descrever a escolha da especialidade médica dos formandos da Liga Acadêmica de Neurocirurgia da Escola Paulista de Medicina (LNC-EPM) e mapear a composição dos cursos de neurologia e/ou neurocirurgia e a presença de ligas acadêmicas dessas disciplinas nas escolas médicas do Brasil. Métodos Levantamento pessoal ou por rede social com todos os membros da liga de neurocirurgia da EPM de 2007 a 2015 quanto a conclusão do curso e a residência escolhida. Envio de um formulário online para todas as escolas médicas cadastradas no Conselho Federal de Medicina (CFM). Resultados e Discussão Cinquenta e sete graduandos de medicina já participaram da LNC-EPM, sendo que 45 já concluíram a graduação, 6 fizeram neurocirurgia e 5 neurologia. Conseguimos respostas de 128 das 173 escolas médicas cadastradas no CFM. Um total de 91% das escolas respondeu que possuem curso de neurologia estruturado. Esses cursos dividem-se em: 32 exclusivamente teóricos, com 12 abordando a neurocirurgia; 84 teórico-práticos, com 51 abordando a neurocirurgia. Apenas 19% das faculdades apresentam curso próprio estruturado de neurocirurgia, sendo que metade destes é apenas teórico. Um total de 66% das universidades tem liga acadêmica das disciplinas citadas. Conclusão Nota-se que a presença de ligas acadêmicas de neurologia e neurocirurgia em 66% das escolas médicas brasileiras é, muitas vezes, usada para suprir conhecimento teórico-prático que deveria ser abordado na graduação. Infelizmente, apenas 9,5% das escolas tem curso teórico-prático próprio de neurocirurgia na grade curricular, um fato que é preocupante devido à alta prevalência das doenças neurológicas na população.

Manifestações paranoicas na ausência de psicose / Manifestations paranoids in the absence of psychosis / Manifestaciones paranoicas en la ausencia de psicosis / Manifestations paranoïaques en l'absence de psychose

Manifestações paranoicas podem ocorrer mesmo na ausência de psicose. A proposta deste trabalho é discutir como isso é possível. Como método de trabalho, realizamos pesquisa bibliográfica, na qual recorremos a leituras e releituras de obras de Freud e de Lacan, bem como de autores contemporâneos da Psicanálise, como Charles Melman e Marcel Czermak. Para tanto, partimos da noção de Verwerfung como mecanismo atrelado à estrutura psicótica, na medida em que o Nome-do-pai pode não ser instaurado para o falante e permanecer forcluído. Bem como tratamos também da Bejahung, a simbolização primitiva. Apresentamos a constituição do Eu como propriamente paranoica, pois possui uma base rivalitária que põe em jogo uma agressividade (nem sempre) latente, que podemos apreender nas manifestações tipicamente paranoicas que um sujeito pode apresentar, mesmo que não se possa constatar uma psicose. Trata-se de um funcionamento inerente ao próprio psiquismo e decorre do fato de que nosso eu - função imaginária - é fundado sobre uma base em que nos apreendemos primeiramente no outro. Por fim, discorremos acerca do que é a paranoia e como se manifestam fenômenos paranoicos de modo a contribuir para uma escuta na clínica para além do encerramento dos funcionamentos paranoicos somente no campo da psicose. Os mecanismos imaginários constitutivos do eu não podem ser tomados isoladamente como critério para a identificação da estrutura. Podemos encontrar situações em que manifestações paranoicas ocorrem mesmo na ausência de psicose.

Paranoid manifestations may occur even in the absence of psychosis. This paper aims to discuss how it is possible. As a method of work, we carried out a bibliographical research, in which we used readings and re-readings of Freud and Lacan works, as well as contemporary authors of Psychoanalysis, such as Charles Melman and Marcel Czermak. To do so, we begin with Verwerfung notion as a mechanism attached to the psychotic structure, insofar as the parent-name may not be established for the speaker and remain foreclosed. In addition, Bejahung, dealing the primitive symbolization. We present the constitution of the I as properly paranoid because it has a rivalry base that puts at stake a (not always) latent aggressiveness that we can perceive in the typically paranoid manifestations that a subject can present, even if a psychosis cannot be verified. It is an operation inherent in one's own psyche and derives from the fact that one's self-an imaginary function-is founded on a basis in which one first apprehends the other. Finally, we discuss what paranoia is and how paranoid phenomena manifest themselves in order to contribute to a listening in the clinic beyond the closure of paranoid functions only in the field of psychosis. The imaginary constitutive mechanisms of the self cannot be taken in isolation as a criterion for the identification of the structure. We can find situations in which paranoid manifestations occur even in the absence of psychosis.

Manifestaciones paranoicas pueden ocurrir en ausencia de psicosis. La propuesta de este trabajo es discutir como eso es posible. Como método de trabajo realizamos investigación bibliográfica donde recurrimos a lecturas y relecturas de obras de Freud y Lacan, así como de autores contemporáneos del psicoanálisis, como Charles Melman y Marcel Czermark. Para eso, partimos de la noción de Verwerfung como mecanismo ligado a la estructura psicótica, a la medida en que el Nombre-del-padre puede no ser establecido para el hablante y seguir forcluido. Bien como tratamos también de la Bejahung, el simbolismo primitivo. Presentamos la constitución del Yo como propiamente paranoica, porque posee una base 'rivalitaria' que pone en cuestión una agresividad (no siempre) latente, que podemos aprender de las manifestaciones típicamente paranoicas que un sujeto puede presentar, aunque no se pueda constatar una psicosis. Se trata de un funcionamiento inherente al propio psiquismo y viene del hecho de que nuestro yo - función imaginaria - es fundado sobre una base en la cual nos asimilamos mentalmente primero en el otro. Finalmente, hablamos acerca de lo que es paranoia y como se manifiestan fenómenos paranoicos solamente en el campo de la psicosis. Los mecanismos Los mecanismos imaginarios constitutivos del yo no pueden ser tomados por separado como criterio para identificación de la estructura. Podemos encontrar situaciones donde manifestaciones paranoicas ocurren en la ausencia de psicosis.

Les manifestations paranoïaques peuvent arriver même en l'absence de psychose Ce travail a l'objectif d'analyser comme cela arrive. Comme méthode de travail, on a effectué des recherches bibliographiques. Donc, on a utilisé des lectures et relectures des œuvres de Freud et de Lacan, ainsi que des auteurs contemporains de la psychanalyse, comme Charles Melman et Marcel Czermak. À cette fin, on a utilisé la notion de Verwerfung comme un mécanisme lié à la structure psychotique, dans la mesure où le Nom du Père ne peut pas être établi pour le parleur et ni rester en forclusion. On traite aussi de la Bejahung, la symbolisation primitive. on présente la constitution du Moi comme paranoïaque, car il y a un base rivalitaire qui met en scène une agression (pas toujours) latente, ce qu'on peut saisir chez les manifestations typiquement paranoïaques q'un sujet peut présenter, même si ne soit pas possible constater de la psychose. Il s'agit d'un fonctionnement inhérent au psychisme et découle du fait que notre Moi - fonction imaginaire - est fondé sur une base sur laquelle on nous saisi tout d'abord dans l'autre. Finalement, on parle sur ce qui est de la paranoïa et comment les phénomènes paranoïaques se manifestent afin de contribuer à une écoute clinique au-delà de la fermeture des fonctionnement paranoïaque le domaine dans de la psychose . Les mécanismes de l'imaginaires constitutifs du Moi ne peuvent pas être pris isolément comme critère pour l'identification de la structure. Nous pouvons trouver des situations dans lesquelles des manifestations paranoïaques se produisent même en l'absence de psychose.

A Technical Guide for Fiber Tract Dissection of the Internal Capsule.

AIM: Dissection of white fibers is important in identifying detailed neuroanatomical relationships. With tractrography it is possible to transport and apply this knowledge in a practical way to treat many diseases involving the white matter. MATERIAL AND METHODS: The Klingler method, subsequently disseminated by Türe with slight modifications was used. RESULTS: We review some historical aspects of white fibers and provide a guide for dissection of the internal capsule. The removal of gray matter allowed us to obtain a view of the white matter. We removed all U-shaped fibers to expose the insular cortex. The cortex of the insular lobe was removed, which exposed the extreme capsule. The removal of the claustrum exposed the external capsule, which covers the lentiform nucleus, specifically the putamen. During dissection, removing some fibers of the external capsule produced windows in which the putamen could be medially visualized. Since the internal capsule lies medial to the lentiform nucleus, it was necessary to remove the nucleus in order to expose the internal capsule. We identified five regions of the internal capsule: the anterior limb, genu, posterior limb, and sublenticular and retrolenticular parts. Finally, we determined that the fibers of the corona radiata condense into the internal capsule at the level of the superior border of the lentiform nucleus. CONCLUSION: Knowledge gained with the cadaveric fiber dissection technique can be applied in microsurgical practice and can be used to evaluate the surgical treatment for different tumors and vascular malformations.

What do Cochrane systematic reviews say about probiotics as preventive interventions?

ABSTRACT BACKGROUND: Probiotics have been used for a range of clinical situations and their use is strongly encouraged by the media worldwide. This study identified and summarized all Cochrane systematic reviews about the preventive effects of probiotics in clinical practice. DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp). METHODS: We included all Cochrane reviews on any probiotics when they were used as preventive interventions and compared with no intervention, placebo or any other pharmacological or non-pharmacological intervention. RESULTS: 17 Cochrane systematic reviews fulfilled our inclusion criteria and were summarized in this report. None of the reviews included in the present study provided high-quality evidence for any outcome. The benefits from use of probiotics included decreased incidence of antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea; decreased incidence of upper respiratory tract infections and duration of episodes; decreased need for antibiotics and absences from school due to colds; and decreased incidence of ventilator-associated pneumonia. Probiotics seem to decrease the incidence of gestational diabetes mellitus, birthweight, risk of vaginal infection and incidence of eczema. CONCLUSION: Despite the marketing and the benefits associated with probiotics, there is little scientific evidence supporting the use of probiotics. None of the reviews provided any high-quality evidence for prevention of illnesses through use of probiotics. More trials are needed to gain better knowledge of probiotics and to confirm when their use is beneficial and cost-effective.

Is the omega sign a reliable landmark for the neurosurgical team? An anatomical study about the central sulcus region / O sinal do ômega é um reparo anatômico confiável para a equipe neurocirúrgica? Estudo anatômico sobre a regiāo do sulco central

ABSTRACTThe central sulcus region is an eloquent area situated between the frontal and parietal lobes. During neurosurgical procedures, it is sometimes difficult to understand the cortical anatomy of this region.Objective Find alternative ways to anatomically navigate in this region during neurosurgical procedures.Method We analyzed eighty two human hemispheres using a surgical microscope and completed a review of the literature about central sulcus region.Results In 68/82 hemispheres, the central sulcus did not reach the posterior ramus of the lateral sulcus. A knob on the second curve of the precentral gyrus was reliably identified in only 64/82 hemispheres.Conclusion The morphometric data presented in this article can be useful as supplementary method to identify the central sulcus region landmarks.

RESUMOA região do sulco central é uma área eloquente posicionada entre os lobos frontal e parietal. Durante procedimentos neurocirúrgicos, em algumas ocasiões, torna-se difícil compreender a anatomia cortical desta região.Objetivo Encontrar métodos alternativos para uma navegaçāo anatômica desta regiāo durante procedimentos neurocirúrgicos.Método Analisamos oitenta e dois hemisférios humanos usando um microscópio cirúrgico, além de fazer uma revisão da literatura.Resultados Em 68/82 hemisférios, o sulco central não atingiu o ramo posterior do sulco lateral. Uma dilatação na segunda curva do giro precentral foi encontrada em apenas 64/82 hemisférios.Conclusão Os dados morfométricos apresentados neste artigo podem ser úteis como método suplementar para identificação dos reparos anatômicos na região do sulco central.

Priming mesenchymal stem cells boosts stem cell therapy to treat myocardial infarction.

Cardiovascular diseases are the number one cause of death globally and are projected to remain the single leading cause of death. Treatment options abounds, although efficacy is limited. Recent studies attribute discrete and ephemeral benefits to adult stem cell therapies, indicating the urge to improve stem cell based-therapy. In this study, we show that priming mesenchymal stem cells (MSC) towards cardiomyogenic lineage enhances their beneficial effects in vivo as treatment option for acute phase myocardial infarction. MSC were primed using cardiomyogenic media for 4 days, after which peak expression of key cardiomyogenic genes are reached and protein expression of Cx-43 and sarcomeric α-actinin are observed. MSC and primed MSC (pMSC) were characterized in vitro and used to treat infarcted rats immediately after left anterior descending (LAD) occlusion. Echocardiography analysis indicated that MSC-treated myocardium presented discrete improvement in function, but it also showed that pMSC treatment lead to superior beneficial results, compared with undifferentiated MSC. Seven days after cell injection, MSC and pMSC could still be detected in the myocardium. Connexin-43 expression was quantified through immunoblotting, and was superior in pMSC, indicating that this could be a possible explanation for the superior performance of pMSC therapy.

Beneficial effects of long-term administration of an oral formulation of Angiotensin-(1-7) in infarcted rats.

In this study was evaluated the chronic cardiac effects of a formulation developed by including angiotensin(Ang)-(1-7) in hydroxypropyl ß-cyclodextrin (HPßCD), in infarcted rats. Myocardial infarction (MI) was induced by left coronary artery occlusion. HPßCD/Ang-(1-7) was administered for 60 days (76 µg/Kg/once a day/gavage) starting immediately before infarction. Echocardiography was utilized to evaluate usual cardiac parameters, and radial strain method was used to analyze the velocity and displacement of myocardial fibers at initial time and 15, 30, and 50 days after surgery. Real-time PCR was utilized to evaluate the fibrotic signaling involved in the remodeling process. Once-a-day oral HPßCD/Ang-(1-7) administration improved the cardiac function and reduced the deleterious effects induced by MI on TGF-ß and collagen type I expression, as well as on the velocity and displacement of myocardial fibers. These findings confirm cardioprotective effects of Ang-(1-7) and indicate HPßCD/Ang-(1-7) as a feasible formulation for long-term oral administration of this heptapeptide.

The cardiac expression of Mas receptor is responsive to different physiological and pathological stimuli.

The Mas protooncogene encodes a G protein-coupled receptor that has been described as a functional receptor for the cardioprotective fragment of the renin-angiotensin system (RAS), Angiotensin (Ang)-(1-7). The aim of this current study was to evaluate the responsiveness of Mas expression in hearts during different physiological and pathological conditions in rats. Physical training was considered a physiological condition, while isoproterenol-induced hypertrophy, myocardial infarction and DOCA-salt model of hypertension were used as pathological models of heart injury. The expression of Mas was analyzed by western blotting. Although swim-trained rats presented significant cardiac hypertrophy, our physical training protocol was unable to induce changes in the expression of Mas. On the other hand, cardiac hypertrophy and damage elicited by isoproterenol treatment led to a reduction in Mas expression. Myocardial infarction also significantly decreased the expression of Mas after 21 days of myocardial ischemia. Additionally, Mas expression levels were increased in hearts of DOCA-salt rats. Our present data indicate that Mas expression is responsive to different pathological stimuli, thereby suggesting that Mas receptor is involved in the homeostasis of the heart, as well as in the establishment and progression of cardiac diseases.