Radiotherapy Metastatic Prostate Cancer Cell Lines Treated with Gold Nanorods Modulate miRNA Signatures.

MicroRNA (miRNA) modulation has been identified as a promising strategy for improving the response of human prostate cancer (PCa) to radiotherapy (RT). Studies have shown that mimics or inhibitors of miRNAs could modulate the sensitivity of PCa cells to RT. In addition, pegylated gold nanoparticles have been studied as a therapeutic approach to treat PCa cells and/or vehicles for carrying miRNAs to the inside of cells. Therefore, we evaluated the capacity of hypofractionated RT and pegylated gold nanorods (AuNPr-PEG) to modulate the miRNA signature on PCa cells. Thus, RT-qPCR was used to analyze miRNA-95, miRNA-106-5p, miRNA-145-5p, and miRNA-541-3p on three human metastatic prostate cell lines (PC3, DU145, and LNCaP) and one human prostate epithelial cell line (HprEpiC, a non-tumor cell line) with and without treatment. Our results showed that miRNA expression levels depend on cell type and the treatment combination applied using RT and AuNPr-PEG. In addition, cells pre-treated with AuNPr-PEG and submitted to 2.5 Gy per day for 3 days decreased the expression levels of miRNA-95, miRNA-106, miRNA-145, and miRNA-541-3p. In conclusion, PCa patients submitted to hypofractionated RT could receive personalized treatment based on their metastatic cellular miRNA signature, and AuNPr-PEG could be used to increase metastatic cell radiosensitivity.

Harvesting the Power of Green Synthesis: Gold Nanoparticles Tailored for Prostate Cancer Therapy.

Biosynthetic gold nanoparticles (bAuNPs) present a promising avenue for enhancing bio-compatibility and offering an economically and environmentally responsible alternative to traditional production methods, achieved through a reduction in the use of hazardous chemicals. While the potential of bAuNPs as anticancer agents has been explored, there is a limited body of research focusing on the crucial physicochemical conditions influencing bAuNP production. In this study, we aim to identify the optimal growth phase of Pseudomonas aeruginosa cultures that maximizes the redox potential and coordinates the formation of bAuNPs with increased efficiency. The investigation employs 2,6-dichlorophenolindophenol (DCIP) as a redox indicator. Simultaneously, we explore the impact of temperature, pH, and incubation duration on the biosynthesis of bAuNPs, with a specific emphasis on their potential application as antitumor agents. Characterization of the resulting bAuNPs is conducted using ATR-FT-IR, TEM, and UV-Vis spectroscopy. To gain insights into the anticancer potential of bAuNPs, an experimental model is employed, utilizing both non-neoplastic (HPEpiC) and neoplastic (PC3) epithelial cell lines. Notably, P. aeruginosa cultures at 9 h/OD600 = 1, combined with biosynthesis at pH 9.0 for 24 h at 58 °C, produce bAuNPs that exhibit smaller, more spherical, and less aggregated characteristics. Crucially, these nanoparticles demonstrate negligible effects on HPEpiC cells while significantly impacting PC3 cells, resulting in reduced viability, migration, and lower IL-6 levels. This research lays the groundwork for the development of more specialized, economical, and ecologically friendly treatment modalities.

Metabolic Disruption of Gold Nanospheres, Nanostars and Nanorods in Human Metastatic Prostate Cancer Cells.

Nanomaterials offer a broad spectrum of applications in biomedicine. The shapes of gold nanoparticles could modulate tumor cell behavior. Spherical (AuNPsp), stars (AuNPst) and rods (AuNPr) shapes of polyethylene glycol coated-gold nanoparticles (AuNPs-PEG) were synthesized. Metabolic activity, cellular proliferation, and reactive oxygen species (ROS) were measured and the impact of AuNPs-PEG in metabolic enzymes function was evaluated by RT-qPCR in PC3, DU145, and LNCaP prostate cancer cells. All AuNPs were internalized, and the different morphologies of AuNPs showed to be an essential modulator of metabolic activity. For PC3 and DU145, the metabolic activity of AuNPs was found to rank in the following order from lowest to highest: AuNPsp-PEG, AuNPst-PEG, and AuNPr-PEG. Regarding LNCaP cells, the AuNPst-PEG were less toxic, followed by AuNPsp-PEG and AuNPr-PEG, but it seems not to be dose-dependent. The proliferation was lower in AuNPr-PEG in PC3 and DU145 cells but was stimulated around 10% in most conditions (0.001-0.1 mM) in LNCaP cells (not statistically significant). For 1 mM, LNCaP cells showed a significant decrease in proliferation only for AuNPr-PEG. The outcomes of the current study demonstrated that different AuNPs conformations influence cell behavior, and the correct size and shape must be chosen considering its final application in the field of nanomedicine.

Application of Gold Nanoparticles as Radiosensitizer for Metastatic Prostate Cancer Cell Lines.

More than 50% of all prostate cancer (PCa) patients are treated by radiotherapy (RT). Radioresistance and cancer recurrence are two consequences of the therapy and are related to dose heterogeneity and non-selectivity between normal and tumoral cells. Gold nanoparticles (AuNPs) could be used as potential radiosensitizers to overcome these therapeutic limitations of RT. This study assessed the biological interaction of different morphologies of AuNPs with ionizing radiation (IR) in PCa cells. To achieve that aim, three different amine-pegylated AuNPs were synthesized with distinct sizes and shapes (spherical, AuNPsp-PEG, star, AuNPst-PEG, and rods, AuNPr-PEG) and viability, injury and colony assays were used to analyze their biological effect on PCa cells (PC3, DU145, and LNCaP) when submitted to the accumulative fraction of RT. The combinatory effect of AuNPs with IR decreased cell viability and increased apoptosis compared to cells treated only with IR or untreated cells. Additionally, our results showed an increase in the sensitization enhancement ratio by cells treated with AuNPs and IR, and this effect is cell line dependent. Our findings support that the design of AuNPs modulated their cellular behavior and suggested that AuNPs could improve the RT efficacy in PCa cells.

Gentle Touch Therapy, Pain Relief and Neuroplasticity at Baseline in Fibromyalgia Syndrome: A Randomized, Multicenter Trial with Six-Month Follow-Up.

BACKGROUND: Fibromyalgia (FM) is considered a stress-related disorder characterized mainly by chronic widespread pain. Its pathogenesis is unknown, but cumulative evidence points at dysfunctional transmitter systems and inflammatory biomarkers that may underlie the major symptoms of the condition. This study aimed to evaluate pain scores (primary outcome), quality of life, inflammatory biomarkers and neurotransmitter systems in women with FM (secondary outcomes) subjected to gentle touch therapy (GTT) or placebo. METHODS: A total of 64 female patients with FM were randomly assigned to two groups, namely GTT (n = 32) or Placebo (n = 32). Clinical assessments were conducted at baseline and post-intervention with six-month follow-up. We measured serum catecholamines (dopamine), indolamines and intermediary metabolites (serotonin or 5-hydroxyindolacetic acid (5-HIAA)), as well as tetrahydrobiopterin (BH4), which is a cofactor for the synthesis of neurotransmitters and inflammatory biomarkers in women with FM. A group of healthy individuals with no intervention (control group) was used to compare biochemical measurements. Intervention effects were analyzed using repeated measures (RM) two-way ANOVA followed by Bonferroni post hoc test and mixed ANCOVA model with intention to treat. RESULTS: Compared to placebo, the GTT group presented lower pain scores and brain-derived neurotrophic factor (BDNF) levels without altering the quality of life of women with FM. Changes in BDNF had a mediating role in pain. Higher baseline serum BDNF and 5-HIAA or those with a history of anxiety disorder showed a higher reduction in pain scores across time. However, women with higher serum dopamine levels at baseline showed a lower effect of the intervention across the observation period revealed by an ANCOVA mixed model. CONCLUSIONS: In conclusion, lower pain scores were observed in the GTT group compared to the placebo group without altering the quality of life in women with FM. Reductions in BDNF levels could be a mechanism of FM pain status improvement. In this sense, the present study encourages the use of these GTT techniques as an integrative and complementary treatment of FM.

The Influence of miRNAs on Radiotherapy Treatment in Prostate Cancer - A Systematic Review.

In the last years, extensive investigation on miRNomics have shown to have great advantages in cancer personalized medicine regarding diagnosis, treatment and even clinical outcomes. Prostate cancer (PCa) is the second most common male cancer and about 50% of all PCa patients received radiotherapy (RT), despite some of them develop radioresistance. Here, we aim to provide an overview on the mechanisms of miRNA biogenesis and to discuss the functional impact of miRNAs on PCa under radiation response. As main findings, 23 miRNAs were already identified as being involved in genetic regulation of PCa cell response to RT. The mechanisms of radioresistance are still poorly understood, despite it has been suggested that miRNAs play an important role in cell signaling pathways. Identification of miRNAs panel can be thus considered an upcoming and potentially useful strategy in PCa diagnosis, given that radioresistance biomarkers, in both prognosis and therapy still remains a challenge.

Genetic and clinical aspects of paediatric pheochromocytomas and paragangliomas.

OBJECTIVE: Few and conflicting reports have characterized the genetics of paediatric pheochromocytomas and paragangliomas (PPGLs). This study aimed to investigate the clinical and genetic features of Brazilian children with PPGL. PATIENTS AND METHODS: This study included 25 children (52% girls) with PPGL. The median age at diagnosis was 15 years (4-19). The median time of follow-up was 145 months. The genetic investigation was performed by Sanger DNA sequencing, multiplex ligation-dependent probe amplification and/or target next-generation sequencing panel. RESULTS: Of the 25 children with PPGL, 11 (44%), 4 (16%), 2 (8%), 1 (4%) and 7 (28%) had germline VHL pathogenic variants, SDHB, SDHD, RET and negative genetic investigation, respectively. Children with germline VHL missense pathogenic variants were younger than those with SDHB or SDHD genetic defects [median (range), 12 (4-16) vs. 15.5 (14-19) years; P = .027]. Moreover, 10 of 11 cases with VHL pathogenic variants had bilateral pheochromocytoma (six asynchronous and four synchronous). All children with germline SDHB pathogenic variants presented with abdominal paraganglioma (one of them malignant). The two cases with SDHD pathogenic variants presented with head and neck paraganglioma. Among the cases without a genetic diagnosis, 6 and 2 had pheochromocytoma and paraganglioma, respectively. Furthermore, metastatic PPGL was diagnosed in four (16%) of 25 PPGL. CONCLUSIONS: Most of the paediatric PPGL were hereditary and multifocal. The majority of the affected genes belong to pseudohypoxic cluster 1, with VHL being the most frequently mutated. Therefore, our findings impact surgical management and surveillance of children with PPGL.

Association between early pulmonary complications after abdominal surgery and preoperative physical capacity.

Objective: To investigate whether early postoperative pulmonary complications after abdominal surgery are associated with a lower performance in preoperative six-minute walk test.Methods: A cross-sectional cohort study of 50 participants who underwent elective abdominal surgery and performed the six-minute walk test within 48 hours prior to surgery were conducted. Postoperative pulmonary complications up to the seventh postoperative day were obtained from medical records.Results: Overall, 25 participants developed postoperative pulmonary complications. The mean (standard deviation) preoperative walked distances of the participants with and without postoperative pulmonary complications were, respectively, 444.8 (81.3) meters and 498.3 (63.7) meters (p = .013). The incidence of postoperative pulmonary complications was greater in the participants with walked distance < 400 meters. The multivariable logistic regression model revealed a significant association between postoperative pulmonary complications and preoperative walked distance (Odds ratio = 0.978, p = .010) in participants who underwent intestinal, stomach, or bile tract resection. Conclusions: This study found a high incidence of postoperative pulmonary complications in abdominal surgery participants and an association between lower preoperative physical capacity and the risk of postoperative pulmonary complications in participants who underwent intestinal, stomach, and biliary tract resection.

Association between violence in childhood and increase in the body mass index among adolescents / Asociación entre violencia sufrida en la infancia y aumento del índice de masa corporal entre adolescentes / Associação entre violência na infância e aumento do índice de massa corporal entre adolescentes

ABSTRACT Objective: to analyze the association between violence in childhood and increase in the Body Mass Index among adolescents. Method: a cross-sectional study, conducted with 136 adolescents aged from 10 to 19 years old, monitored by a Multiprofessional Residency Program in Adolescents' Health, in health units from the municipality of Divinópolis-MG. The anthropometric assessment was conducted from March to June 2018; and information was collected referring to the socioeconomic level, demographic factors, food consumption, and physical activity of the participants. The variable related to violence in childhood was composed of five groups, obtained from a factorial analysis. Multiple regression models were used to identify the variables associated with the increase in Body Mass Index, with a significance level of 5%. Results: the prevalence of excess weight was 31.8%. The adolescents participating in the study consumed soft drinks (66.2%) and industrialized food products (66.9%) every week and ate in front of the TV every day (54.4%). The most prevalent type of abuse was emotional neglect, which affected 100% of the sample under study. An association was evidenced of physical neglect in childhood and intake of industrialized food products with the increase in the Body Mass Index z-score. Conclusion: violence in childhood and the consumption of industrialized food products were associated to the increase in Body Mass Index among adolescents. Investments in public policies for comprehensive promotion of health and protection of children and adolescents are imperious.

RESUMEN Objetivo: analizar la asociación entre violencia sufrida en la infancia y aumento del Índice de Masa Corporal entre adolescentes. Método: estudio transversal, realizado con 136 adolescentes de 10 a 19 años de edad, monitoreados por un Programa de Residencia Multiprofesional de la Salud del Adolescente, en unidades de salud del municipio de Divinópolis-MG. La evaluación antropométrica se realizó entre los meses de marzo y junio de 2018, y se recolectaron datos referentes al nivel socioeconómico, factores demográficos, consumo de alimentos y actividad física de los participantes. La variable relacionada con la violencia sufrida en la infancia estuvo compuesta por cinco bloques, que se obtuvieron a partir de un análisis factorial. Se emplearon modelos de regresión lineal múltiple para identificar las variables asociadas al aumento del Índice de Masa Corporal, con un nivel de significancia del 5%. Resultados: la prevalencia de exceso de peso fue del 31,8%. Los adolescentes que participaron del estudo ingerían refrescos (66,2%) y alimentos industrializados (66,9%) semanalmente, además de comer frente al televisor a diario (54,4%). El tipo de abuso más prevalente fue la negligencia emocional, que afectó al 100% de la muestra estudiada. Se hizo evidente la asociación de negligencia física sufrida en la infancia y consumo de alimentos industrializados con el aumento de la puntuación z del Índice de Masa Corporal. Conclusão: la violencia sufrida en la infancia y el consumo de alimentos industrializados presentaron una asociación con el aumento del Índice de Masa Corporal entre adolescentes. Es imperioso invertir en políticas públicas para promover la salud integral y proteger a los niños y adolescentes.

RESUMO Objetivo: analisar a associação entre violência na infância e aumento de Índice de Massa Corporal entre adolescentes. Método: estudo transversal, realizado com 136 adolescentes de 10 a 19 anos, em acompanhamento por um Programa de Residência Multiprofissional da Saúde do Adolescente, em unidades de saúde do município de Divinópolis-MG. Realizou-se, nos meses de março a junho de 2018, a avaliação antropométrica e coletaram-se informações referentes ao nível socioeconômico, a fatores demográficos, ao consumo alimentar e à atividade física dos participantes. A variável relativa à violência na infância foi composta por cinco blocos, obtidos a partir de uma análise fatorial. Modelos de regressão linear múltipla foram utilizados para identificação das variáveis associadas ao aumento do Índice de Massa Corporal, com um nível de significância de 5%. Resultados: a prevalência de excesso de peso foi de 31,8%. Os adolescentes do estudo ingeriam refrigerantes (66,2%) e alimentos industrializados (66,9%) semanalmente e se alimentavam em frente à TV diariamente (54,4%). O tipo de abuso mais prevalente foi a negligência emocional, acometendo 100% da amostra estudada. Evidenciou-se associação da negligência física na infância e do consumo de alimentos industrializados com o aumento do índice de escore z de Índice de Massa Corporal. Conclusão: A violência na infância e o consumo de alimentos industrializados associaram-se ao aumento de Índice de Massa Corporal entre adolescentes. Investimentos em políticas públicas para promoção da saúde integral e proteção de crianças e adolescentes são imperativos.

Ações Preventivas sobre Hepatites Virais: vivência de um projeto de extensão na Amazônia / Preventive Actions on Viral Hepatitis: experience of an extension project in the Amazon / Acciones preventivas sobre la hepatitis viral: experiencia de un proyecto de extensión en la Amazonía

Descrever a experiência dos discentes em um projeto de extensão intitulado "Ações Preventivas sobre Hepatites B e C na Escola Estadual Centro de Tempo Integral Professor Manuel Vicente Ferreira Lima", no município de Coari, Amazonas. Método: estudo descritivo do tipo de relato de experiência através de um projeto de extensão realizado por discentes do 5º e 8º períodos do Curso de Enfermagem do Instituto de Saúde e Biotecnologia-ISB da Universidade Federal do Amazonas-Ufam. Resultados: durante as atividades do projeto, constatou-se um baixo nível de conhecimentos dos participantes, principalmente relacionados a hepatite, uma vez que obtinham uma concepção errônea da doença, acerca da transmissão e da prevenção de hepatites B e C. Conclusão: o projeto teve papel fundamental na vida dos acadêmicos envolvidos, proporcionando-lhes informações valiosas para o enriquecimento de seus conhecimentos, além de apresentá-los como principais intermediadores da educação em saúde na sociedade.

Describe the experience of students in an extension project entitled "Preventive Actions on Hepatitis B and C in the State School Time Center Full Professor Manuel Vicente Ferreira Lima" in the city of Coari, Amazonas. Method: a descriptive study of the kind of experience reporting through an extension project carried out by students of 5 and 8 times of the Nursing Course at the Institute of Health and Biotechnology ISB-Federal University of Amazonas-Ufam. Results: During the project activities, there was a low level of knowledge of the participants, mainly related to hepatitis, once they obtained a misconception of the disease, about the transmission and prevention of hepatitis B and C. Conclusion: the project played a key role in the lives of students involved by providing them with valuable information to enrich their knowledge, and present them as key intermediaries of health education in society.

Describir la experiencia de los estudiantes en un proyecto de extensión titulado "Acciones preventivas sobre la hepatitis B y C en la Escuela Estatal Profesor Tiempo Completo Centro de Manuel Vicente Ferreira Lima" en la ciudad de Coari, Amazonas. Método: estudio descriptivo del tipo de informes experiencia a través de un proyecto de extensión realizado por los estudiantes de 5 y 8 momentos del curso de enfermería en el Instituto de Salud y Biotecnología ISB-Universidad Federal de Amazonas-Ufam. Resultados: durante las actividades del proyecto, hubo un bajo nivel de conocimiento de los participantes, principalmente relacionados con la hepatitis, una vez que obtuvieron una idea errónea de la enfermedad, aproximadamente la transmisión y la prevención de la hepatitis B y C. Conclusión: el proyecto desempeñó un papel clave en la vida de los estudiantes involucrados, proporcionándoles información valiosa para enriquecer sus conocimientos, y presentarlos como intermediarios clave de la educación para la salud en la sociedad.

Chlamydia trachomatis infection in women living in remote areas in Amazonas, Brazil-a self-collection screening experience.

Chlamydia trachomatis infection is the most common sexually transmitted bacterial infection among women. In Brazil, there is no organized screening program for C. trachomatis, and the actual prevalence of infection is unknown. This study aimed to determine the prevalence of C. trachomatis infection in women living in riverside communities in the Amazon, using self-collection employing the Evalyn® Brush and polymerase chain reaction. A total of 299 riverine women aged 18-81 years, mean age 35.7 (±12.8) years, predominantly agricultural workers, with low schooling and living with a partner, participated in this study. The prevalence of C. trachomatis infection was found to be 3.7% (95% CI 1.8-6.5), most of them being symptomatic. The mean age of the first sexual intercourse reported by women was 15.2 (±2.3) years, and the majority reported having had none or only one partner in the last 12 months, with very low adherence to consistent condom use (15.4%). Most women (98.3%) reported having approved using the vaginal self-collecting brush, and only 4.7% reported having difficulty in handling the brush. We consider that a vaginal self-collecting device is adequate for diagnosing C. trachomatis infection in women living in remote, hard-to-reach areas.

TP53 Arg72Pro polymorphism is associated with increased overall survival but not response to therapy in Portuguese/Caucasian patients with advanced cervical cancer.

Identification of mechanisms that influence the therapeutic response and survival in patients with cancer is important. It is known that the genetic variability of the host, including presence of genetic polymorphisms in genes involved in DNA damage response, serves a crucial role in the prognosis of these patients. The present hospital-based retrospective cohort study aimed to evaluate the influence of TP53 Arg72Pro (rs1042522) polymorphism in the clinical outcome of 260 Caucasian patients diagnosed with cervical cancer and treated with concomitant radiotherapy and chemotherapy. The polymorphism genotyping was assessed using allelic discrimination by quantiative polymerase chain reaction. The results indicate that the TP53 Arg72Pro polymorphism did not significantly impact the response to therapy (P=0.571) nor disease-free survival (P=0.081). However, the polymorphism did influence overall survival, as increased median survival time was observed for patients carrying Arg/Pro genotype when compared with patients with Arg/Arg and Pro/Pro genotypes (126 months vs. 111 months, respectively; P=0.047). To conclude, the present findings suggest that a pharmacogenomic profile based on the genetic background of patients, including the analysis of the TP53 genotypes, may individualize treatment nad assist in the selection of therapies that may improve clinical outcome and lower toxicity for the patients.

Avaliação da musculatura flexora dos artelhos de idosos institucionalizados e comunitários: aspectos biomecânicos, mobilidade e quedas / Evaluación de la musculatura flexora de los dedos del pie de personas mayores institucionalizadas y comunitarias: aspectos biomecánicos, movilidad y caídas / Assessment of the toes flexor musculature in institutionalized and community-dwelling older adults: biomechanical aspects, mobility and falls

RESUMO As mudanças morfológicas, biomecânicas e funcionais nos pés podem aumentar o risco de queda nos idosos. Os idosos institucionalizados apresentam menor mobilidade e maior risco de queda. O objetivo deste trabalho é verificar as relações das características dos pés com a mobilidade e quedas de idosos institucionalizados e ativos da comunidade. Participaram deste estudo 15 idosos institucionalizados e 15 idosos ativos da comunidade, que foram avaliados quanto à incidência de quedas e por meio do Timed Up and Go Test; presença de hálux valgo e pico de força muscular de flexores do hálux e dos artelhos pela plataforma de pressão. utilizou-se a análise de variância para comparar os grupos. Como resultado, os idosos comunitários apresentaram maior força muscular de flexores dos artelhos que os idosos institucionalizados (p<0,05) e melhor mobilidade funcional. Observou-se risco de queda nos idosos institucionalizados. O hálux valgo grau leve foi a deformidade mais comum. O teste de Pearson não mostrou correlação entre as variáveis analisadas e a incidência de quedas. Conclui-se que a força muscular de flexores dos artelhos é maior nos idosos comunitários, assim como a mobilidade funcional, quando comparados com idosos institucionalizados.

RESUMEN Las alteraciones morfológicas, biomecánicas y funcionales en los pies pueden aumentar el riesgo de caída en las personas mayores. Las que están institucionalizadas presentan menor movilidad y mayor riesgo de caída. El propósito de esta investigación es comprobar la relación entre las características de los pies con la movilidad y la caída de personas mayores institucionalizadas y activas en la comunidad. Del estudio, participaron 15 personas mayores institucionalizadas y 15 personas mayores activas en la comunidad, de las cuales se evaluaron la incidencia de caídas mediante el Timed Up and Go Test; la presencia de Hallux valgus y el punto máximo de fuerza muscular de los flexores del Hallux y de los dedos del pie mediante la plataforma de presión. Se utilizó el análisis de varianza para comparar los grupos. Los resultados demuestran que las personas mayores comunitarias presentaron una fuerza muscular de los flexores de los dedos del pie mayor que las institucionalizadas (p<0,05) y también una mejor movilidad funcional. En las personas mayores institucionalizadas se observó riesgo de caída. El Hallux valgus con deformidad leve fue la más común. El test de Pearson no demostró correlación entre las variables evaluadas y la incidencia de caídas. Se concluye que la fuerza muscular de los flexores de los dedos del pie es mayor en las personas mayores comunitarias, así como la movilidad funcional, en comparación a las institucionalizadas.

ABSTRACT Morphological, biomechanical and functional changes in the feet may increase the risk of fall in older adults. Institutionalized older adults have less mobility and greater risk of falling. The aim of this study is to check the relationship of the feet's characteristics with the mobility and falls of institutionalized or active community-dwelling older adults. A total of 15 institutionalized and 15 community-dwelling older adults participated in this study. They were assessed considering the incidence of falls and through the Timed Up and Go Test; presence of hallux valgus; and strength peak of the muscles of the hallux and toes measured by a pressure platform. The variance analysis was used to compare the groups. As a result, the community-dwelling older adults showed greater muscle strength of the toe flexor muscles than institutionalized older adults (p<0.05) and better functional mobility. We observed the risk of fall in institutionalized older adults. Hallux valgus of mild degree was the most common deformity. The Pearson's correlation coefficient showed no correlation between the analyzed variables and incidence of falls. We concluded that the strength of toe flexor muscles is greater in community-dwelling older adults, as well as the functional mobility, when compared with institutionalized older adults.

Relationship between clinical toxicities and ERCC1 rs3212986 and XRCC3 rs861539 polymorphisms in cervical cancer patients.

BACKGROUND: Several studies have suggested that there are single nucleotide polymorphisms (SNPs) that can be considered potential biomarkers in the prognosis and therapeutic response of cancer patients. The present study investigated the association between ERCC1 rs3212986 and XRCC3 rs861539 polymorphisms and clinical toxicities induced by chemoradiotherapy (CRT) in cervical cancer. METHODS: This hospital-based retrospective cohort study included 260 patients with cervical cancer, FIGO stages Ib2-IVa, who underwent CRT (cisplatin). Genetic polymorphisms analysis was performed by allelic discrimination with real-time polymerase chain reaction (RT-PCR). RESULTS: Our results indicated a link between ERCC1 rs3212986 and the onset of late gastrointestinal toxicity (p = 0.038). Furthermore, using a recessive model (AA vs. CC/CA), we found that patients carrying AA homozygous genotype presented a fourfold increased risk of developing late gastrointestinal toxicity when compared with patients with the C allele (odds ratio = 3.727, 95% confidence interval, 1.199-11.588; p = 0.017). No association was found regarding the XRCC3 rs861539 polymorphism and any clinical toxicity event. CONCLUSIONS: This is the first study evaluating the relationship between these polymorphisms and clinical toxicities in cervical cancer patients submitted to CRT with cisplatin. These results may contribute toward a better understanding of the influence of genetic polymorphisms in genes associated with DNA repair in the clinical response to CRT of patients with cervical cancer.

Vancomycin resistant Enterococcus spp (VRE): follow up during 9 years in a tertiary teaching hospital in southern Brazil

Introduction: Infection with vancomycin-resistant Enterococcus spp (VRE) has been a worldwide problem since mid 1980’s and, in Brazil, since 1996. This study was conducted to evaluate the experience with VRE in our institution. Methods: A prospective cohort study from 2000 to 2009 was conducted at Hospital São Lucas da PUCRS. All hospitalized patients with VRE positive culture were included and followed from their diagnosis until they were negative for VRE or their discharge. Only the first admission for each VRE positive patient was included. Pulsed field gel electrophoresis (PFGE) was performed to determine how VRE had spread. Results: A total of 315 cases of VRE were identified, 224 of which were isolated from rectal swabs. Vancomycin-resistant/ampicilin susceptible Enterococcus faecalis were identified in 312 isolates. PFGE was performed in 47 VRE isolates that presented an indistinguishable migratory profile. The median length of hospital stay and length of stay before VRE isolation were 46 days and 21 days, respectively; 52% of the patients were aged 60 and above. The annual distribution of the new VRE cases showed a clear decrease from 2000 to 2009. Discussion: This study shows a substantial VRE colonization (71%) with a homogenous pattern that emphasizes its transversal spread. Predominance of E. faecalis differs from the literature which largely describes a higher prevalence of vancomycin-resistant Enterococcus faecium. The follow up of VRE during 9 years in our institution highlighted the importance of continuous surveillance to prevent outbreaks in our hospital.

Pulmonary function and physical performance outcomes with preoperative physical therapy in upper abdominal surgery: a randomized controlled trial.

OBJECTIVE: Investigation of the effects of preoperative physical therapy on pulmonary function and physical performance before and after upper abdominal surgery. DESIGN: Non-blind randomized controlled trial. SETTING: Tertiary public hospital and private university, São Paulo state, Brazil. SUBJECTS: Thirty-two patients undergoing abdominal surgery. INTERVENTIONS: Patients were randomly assigned to receive physical therapy, with respiratory and global exercises, 2-3 weeks before surgery (treatment group; n = 16) or await operation without engaging in practicing (control group; n = 16). After surgery, a physical therapy protocol was administered to all subjects until the seventh postoperative day. MAIN MEASURES: Pulmonary function outcome variables were inspiratory and expiratory strength, respiratory muscle endurance and spirometry, and physical performance outcome variables were the functional independence measure and 6-minute walk test distance. Any postoperative pulmonary complications were recorded. RESULTS: There were no between-group differences at randomization. In the preoperative period, patients in the intervention group had higher inspiratory strength and respiratory muscle endurance than controls (88 cmH(2)O versus 64 cmH(2)O and 28 cmH(2)O versus 23 cmH(2)O, respectively; P <0 0.05). On the seventh postoperative day, in addition to inspiratory force and respiratory muscle endurance, the intervention group showed better results than controls in the functional independence measure score (118 versus 95) and 6-minute walk test distance (368.5 m versus 223 m), all P <0 0.05. Postoperative pulmonary complications occurred in 11 patients in the control group and five in the intervention group (P = 0.03). CONCLUSION: Preoperative physical therapy improved pulmonary function and physical performance in the pre- and postoperative periods among patients undergoing upper abdominal surgery.

Glasgow outcome scale at hospital discharge as a prognostic index in patients with severe traumatic brain injury / Escala de resultados de Glasgow por ocasião da alta hospitalar como indicador prognóstico em pacientes com traumatismo cranioencefálico grave

OBJECTIVE: Evaluate the Glasgow outcome scale (GOS) at discharge (GOS-HD) as a prognostic indicator in patients with traumatic brain injury (TBI). METHOD: Retrospective data were collected of 45 patients, with Glasgow coma scale <8, age 25±10 years, 36 men, from medical records. Later, at home visit, two measures were scored: GOS-HD (according to information from family members) and GOS LATE (12 months after TBI). RESULTS: At discharge, the ERG showed: vegetative state (VS) in 2 (4%), severe disability (SD) in 27 (60%), moderate disability (MD) in 15 (33%) and good recovery (GR) in 1 (2%). After 12 months: death in 5 (11%), VS in 1 (2%), SD in 7 (16%), MD in 9 (20%) and GR in 23 (51%). Variables associated with poor outcome were: worse GOS-HD (p=0.03), neurosurgical procedures (p=0.008) and the kind of brain injury (p=0.009). CONCLUSION: The GOS-HD was indicator of prognosis in patients with severe TBI.

OBJETIVO: Avaliar a escala de resultados de Glasgow (ERG) à alta hospitalar (ERG-ALTA) como indicador prognóstico em pacientes com traumatismo cranioencefálico (TCE). MÉTODO: Dados retrospectivos de 45 pacientes (36 homens), com escala de coma de Glasgow <8, idade 25±10 anos, foram coletados do prontuário médico. Posteriormente, em visita domiciliar, foram pontuadas duas medidas: ERG-ALTA (de acordo com informações de familiares) e ERG TARDIA (após 12 meses do TCE). RESULTADOS: Por ocasião da alta hospitalar, a ERG evidenciou: estado vegetativo (EV) em 2 (4%); incapacidade grave (IG) em 27 (60%), incapacidade moderada (IM) em 15 (33%) e boa recuperação (BR) em 1 (2%). Após 12 meses: morte em 5 (11%), EV em 1 (2%), IG em 7 (16%), IM em 9 (20%) e BR em 23 (51%). Variáveis associadas com má evolução foram: pior ERG-ALTA (p=0,03); procedimentos neurocirúrgicos (p=0,008) e o tipo de lesão cerebral (p=0,009). CONCLUSÃO: A ERG-ALTA foi indicador adequado de prognóstico tardio em pacientes com TCE grave.

Terapia rotacional: eixo longitudinal, em unidade de terapia intensiva / Rotational therapy: longitudinal axis, in the intensive care unit

Reunir e sumarizar os benefícios e protocolos da terapia rotacional na prevenção e no tratamento das complicações pulmonares de pacientes internados em terapia intensiva. Trata-se de uma revisão sistemática da literatura, na qual foram consultadas as bases de dados Lilacs, MedLine, Cochrane, Divisão Bibliotecária da Universidade de Stanford e o Banco de Dados de Evidência em Fisioterapia. Os ensaios clínicos randomizados publucados entre 2000 e 3008 foram incluídos na análise. Sete estudos foram selecionados, sendo um multicêntrico, totalizando 573 pacientes. O objetivo da intervenção foi a prevenção e o tratamento de complicações pulmonares em três e quatro ensaios, respectivamente. A terapia rotacional foi adotada na forma de terapia cinética em dois estudos, e a terapia de rotação lateral contínua, nos demais. Dentre os principais defechos, foram observados menor incidência de pneumonia (n=3), menor ocorrência e risco de desenvolver atelectasia lobar (n=1), melhora da razão PaO2/FiO2 em pacientes com lesão pulmonar aguda (n=1) e maior volume de escarro expelido (n=1). A terapia rotacional pode ser uma terapêutica coadjuvante no tratamento e na prevenção de complicações pulmonares, uma vez que se observou melhora clínica e fisiológica nos pacientes críticos. Outros estudos são necessários, entretanto, para confirmação desses resultados

Lesão pulmonar e ventilação mecânica em cirurgia cardíaca: revisão / Lung injury and mechanical ventilation in cardiac surgery: a review

A insuficiência respiratória após a cirurgia cardíaca com utilização da circulação extracorpórea pode ser resultante de inúmeros fatores relacionados às condições do sistema respiratório no pré, intra e pós-operatório. A finalidade desta revisão é discutir alguns dos fatores relacionados à lesão pulmonar observada no período pós-operatório de cirurgia cardíaca e quais os recursos ventilatórios têm sido propostos para minimizar e/ou tratar a hipoxemia dos pacientes.

Respiratory failure after cardiopulmonary bypass heart surgery can result from many pre-, intra- or postoperative respiratory system-related factors. This review was aimed to discuss some factors related to acute lung injury observed during the postoperative period of cardiac surgery and the mechanical ventilation modalities which should be considered to prevent hypoxemia.