Insight into inflammation involvement in varicocele: A narrative review.

BACKGROUND: Varicocele is one of the main causes of male infertility. Although the pathophysiology mechanism of varicocele is very well described and understood, there are some unanswered questions that remains unknown. Some studies have previously described the state of testicular inflammation and sperm in animal models, especially the mouse model, and the seminal plasma of men with varicocele, with or without changes in semen parameters. METHODS OF STUDY: This review intended to verify the role of inflammatory mechanism in varicocele, using clinical studies as well as animal model studies on the effect of inflammation caused by varicocele on the function of testicular somatic and germ cells. RESULTS: In-vivo studies confirmed whether anti-inflammatory molecules could treat the semen of men with varicocele and rats with varicocele. The use of different anti-inflammatory agents in mouse model studies provided a new perspective for future clinical studies to investigate the effect of concurrent treatment with surgery to improve surgical outcomes. CONCLUSION: Similar to animal model studies, previously conducted clinical trials have demonstrated the effectiveness of anti-inflammatory therapy in varicocele patients. However, clinical trials using anti-inflammatory are needed to be conducted agents to evaluate different aspects of this therapeutical approach in varicocele patients.

Risk and prevalence of oral cancer in patients with different types of lupus erythematosus: a systematic review and meta-analysis.

OBJECTIVE: The objective of this study was to assess the risk and prevalence of oral cancer in patients with systemic lupus erythematosus (SLE) or discoid lupus erythematosus (DLE). STUDY DESIGN: The review included observational cohort and cross-sectional studies that investigated the incidence or prevalence of oral cancer in adults with confirmed diagnoses of SLE or DLE. Studies were selected based on predefined eligibility criteria, including the use of specific diagnostic criteria for SLE and DLE. After searches in PubMed/MEDLINE, EMBASE, Scopus, Web of Science, LILACS, and LIVIVO databases and gray literature for relevant studies, the selection process was conducted by independent reviewers. RESULTS: A total of 5,545 articles were identified. After screening, 8 studies met the inclusion criteria. The pooled risk estimate indicated a significantly increased risk of oral cancer in patients with SLE (risk ratio = 2.69; 95% confidence interval, 1.75 to 4.16; I2 = 0%; P = .78) compared with the general population. The pooled prevalence of oral cancer in patients with DLE was 10% (95% ci, 0.03 to 0.13; I2 = 59%; P = .12). CONCLUSIONS: This review provides evidence supporting an elevated risk for individuals with SLE or DLE developing oral cancer. The findings highlight the importance of monitoring oral mucosa in patients with these conditions.

Pregnancy and postpartum experiences of women undergoing hemodialysis: a qualitative study / Experiências de gravidez e puerpério de mulheres em hemodiálise: um estudo qualitativo

ABSTRACT Introduction: There are particularities of chronic kidney disease (CKD) in women and their treatment. The biology of women exposes them to greater risk factors for CKD and both pregnancy and the postpartum period place an additional burden on renal health. Pregnancy complications may cause or worsen CKD. Objective: To explore the experiences of women with CKD undergoing hemodialysis in relation to their reproductive history. Methods: This study consisted of clinical-qualitative design with semi-structured individual interviews and open-ended questions. The sample selection was intentional and according to the theoretical saturation criterion. The data analysis was carried out based on the seven steps of the clinical-qualitative content analysis and validated by Nvivo11. This study was conducted in a public hemodialysis clinic of the Brazilian National Health System. Results: Twelve women undergoing hemodialysis were interviewed. The results from the analysis revealed three categories: 1) Association of pregnancy with CKD; 2) Nebulosity in relation to diagnosis and reproductive history 3) Being a woman undergoing hemodialysis. Conclusion: Our study showed the importance of considering the specificities of CKD in women, suggesting that these issues are important for diagnosis and treatment adherence. Consideration of reproductive life history allows the health of women undergoing hemodialysis to be promoted holistically, including aspects of mental health.

Resumo Introdução: Existem particularidades da doença renal crônica (DRC) em mulheres e seu tratamento. A biologia das mulheres as expõe a fatores de risco mais elevados para DRC e tanto a gravidez quanto o puerpério implicam um ônus adicional à saúde renal. Complicações na gestação podem causar ou piorar a DRC. Objetivo: Explorar as experiências de mulheres com DRC submetidas à hemodiálise em relação ao seu histórico reprodutivo. Métodos: Este estudo consistiu em desenho clínico-qualitativo com entrevistas individuais semiestruturadas e questões abertas. A seleção da amostra foi intencional e de acordo com o critério de saturação teórica. A análise de dados foi realizada com base nos sete passos da análise clínico-qualitativa de conteúdo e validada pelo Nvivo11. Este estudo foi realizado em uma clínica pública de hemodiálise do Sistema Único de Saúde brasileiro. Resultados: Foram entrevistadas 12 mulheres em hemodiálise. Os resultados da análise revelaram três categorias: 1) Associação da gravidez com DRC; 2) Nebulosidade em relação ao diagnóstico e à história reprodutiva; 3) Ser mulher e fazer hemodiálise. Conclusões: Nosso estudo mostrou a importância de considerar as especificidades da DRC em mulheres, sugerindo que estas questões são importantes para o diagnóstico e a adesão ao tratamento. A consideração do histórico de vida reprodutiva permite promover de forma holística a saúde das mulheres submetidas à hemodiálise, incluindo aspectos de saúde mental.

Role of Cystathionine ß-Synthase and 3-Mercaptopyruvate Sulfurtransferase in the Regulation of Proliferation, Migration, and Bioenergetics of Murine Breast Cancer Cells.

Cystathionine ß-synthase (CBS), CSE (cystathionine γ-lyase) and 3-mercaptopyruvate sulfurtransferase (3-MST) have emerged as three significant sources of hydrogen sulfide (H2S) in various forms of mammalian cancer. Here, we investigated the functional role of CBS' and 3-MST's catalytic activity in the murine breast cancer cell line EO771. The CBS/CSE inhibitor aminooxyacetic acid (AOAA) and the 3-MST inhibitor 2-[(4-hydroxy-6-methylpyrimidin-2-yl)sulfanyl]-1-(naphthalen-1-yl)ethan-1-one (HMPSNE) were used to assess the role of endogenous H2S in the modulation of breast cancer cell proliferation, migration, bioenergetics and viability in vitro. Methods included measurements of cell viability (MTT and LDH assays), cell proliferation and in vitro wound healing (IncuCyte) and cellular bioenergetics (Seahorse extracellular flux analysis). CBS and 3-MST, as well as expression were detected by Western blotting; H2S production was measured by the fluorescent dye AzMC. The results show that EO771 cells express CBS, CSE and 3-MST protein, as well as several enzymes involved in H2S degradation (SQR, TST, and ETHE1). Pharmacological inhibition of CBS or 3-MST inhibited H2S production, suppressed cellular bioenergetics and attenuated cell proliferation. Cell migration was only inhibited by the 3-MST inhibitor, but not the CBS/CSE inhibitor. Inhibition of CBS/CSE of 3-MST did not significantly affect basal cell viability; inhibition of 3-MST (but not of CBS/CSE) slightly enhanced the cytotoxic effects of oxidative stress (hydrogen peroxide challenge). From these findings, we conclude that endogenous H2S, generated by 3-MST and to a lower degree by CBS/CSE, significantly contributes to the maintenance of bioenergetics, proliferation and migration in murine breast cancer cells and may also exert a minor role as a cytoprotectant.

"Tratamento precoce", antivacinação e negacionismo: quem são os Médicos pela Vida no contexto da pandemia de COVID-19 no Brasil? / "Early Treatment", Anti-Vaccination, and Denialism: who are the Doctors for Life in the COVID-19 pandemic context in Brazil?

Resumo O artigo pretende identificar quem são os "Médicos pela Vida" (MPV), suas informações acadêmicas e profissionais, quais as premissas utilizadas para a defesa do "tratamento precoce" e da negação das vacinas contra COVID-19 e qual a representatividade de seus discursos no contexto da prática médica no Brasil. A análise baseia-se na lista de 276 profissionais médicos catalogados no site dos MPV e em informações acadêmicas e profissionais coletadas nos sites do Conselho Federal de Medicina e da Plataforma Lattes, do Conselho Nacional de Desenvolvimento Científico e Tecnológico. A análise do conteúdo aponta para a centralidade das especialidades da Homeopatia e Acupuntura na população de MPV quando comparada ao conjunto dos especialistas do Brasil. A adesão significativa de homeopatas e acupunturistas ao movimento dos MPV pode iluminar a compreensão sobre racionalidades médicas específicas, permitindo distinguir quais categorias e ideias acerca dos processos de saúde e doença estão em disputa. Conclui-se que, para além de descrever a problemática, é preciso estabelecer suas correlações com um conjunto de acontecimentos, práticas, decisões políticas, encadeamentos econômicos, compartilhamento de crenças e uma corrente de processos que configuram seu caráter inegavelmente social.

Abstract The article aims to identify who the "Doctors for Life" are, their academic and professional information, which assumptions have been mobilized for the defense of "early treatment" and the denial of vaccines for COVID-19, and the representativeness of their discourses in the medical practice context in Brazil. The analysis is based on a list of 276 doctors' names, cataloged from their website, and on academic and professional information obtained through research on the Federal Medical Conseil website and the Scientific and Technological Development Nacional Council platform. The content analysis points to the centrality of the medical specialties of homeopathy and acupuncture in the population of Doctors for Life when compared to the set of specialist doctors in Brazil. The significant accession of homeopaths and acupuncturists to the Doctors for Life movement can clarify the understanding of specific medical rationalities, allowing us to distinguish which categories and ideas about the health-disease process are in dispute. It is concluded that, more than describing the problem, it is needed to establish its correlations with a group of events, practices, political decisions, economic linkages, shared beliefs, and a chain of processes that configure its undeniably social characteristics.

Early physicians' mortality in Espírito Santo: a decade trend.

Introduction: Mortality data make it possible to develop indicators to guide the planning of health promotion and prevention actions in order to reduce mortality from preventable causes. However, there are no publications on physicians' mortality in the state of Espírito Santo, Brazil. Objectives: To describe mortality distribution and potential years of life lost from 2006 to 2015 among physicians who lived in Espírito Santo. Methods: This is a descriptive study of secondary data from the Mortality Information System of the Brazilian Ministry of Health. The distribution of socio-demographic variables and of basic cause of death was studied by absolute and relative frequencies. Potential years of life lost in each death were considered the years remaining from age at death up to the age limit of 70 years. Results: There were 20 deaths of female physicians (14.5%) and 118 (85.5%) of male physicians, with predominance of whites (87.9%) and married (56%) individuals. The main causes of death were neoplasms (39.1%), diseases of the circulatory system (19.6%), and external causes (19.6%). The majority of female and male deaths occurred from 60 to 69 years, but average death was significantly lower among women compared to men (respectively 58.3 and 67.0 years). Potential years of life lost totaled 1,226 years, with a mean of 14.6, which was greater in women (20.4) compared to men (13.4). Conclusions: Mortality trends observed in the general population were also present among physicians in Espírito Santo. However, contrary to the general population pattern, average death age was lower in women. Early mortality caused many lost years of life, especially among women.

Effects of the PARP Inhibitor Olaparib on the Response of Human Peripheral Blood Leukocytes to Bacterial Challenge or Oxidative Stress.

Prior studies demonstrate the activation of poly-(ADP-ribose) polymerase 1 (PARP1) in various pathophysiological conditions, including sepsis. We have assessed the effect of olaparib, a clinically used PARP1 inhibitor, on the responses of human peripheral blood leukocytes (PBMCs) obtained from healthy volunteers in response to challenging with live bacteria, bacterial lipopolysaccharide (LPS), or oxidative stress (hydrogen peroxide, H2O2). The viability of PBMCs exposed to olaparib or to the earlier generation PARP inhibitor PJ-34 (0.1-1000 µM) was monitored using Annexin V and 7-aminoactinomycin D. To evaluate the effects of olaparib on the expression of PARP1 and its effects on protein PARylation, PBMCs were stimulated with Staphylococcus aureus with or without olaparib (1-10 µM). Changes in cellular levels of nicotinamide adenine dinucleotide (NAD+) and adenosine triphosphate (ATP), as well as changes in mitochondrial membrane potential (MMP), were measured in PBMCs exposed to H2O2. Bacterial killing was evaluated in PBMCs and polymorphonuclear leukocytes (PMNs) incubated with S. aureus. Cytokine production was measured in supernatants using a cytometric bead array. Reactive oxygen species (ROS), nitric oxide (NO) production, and phagocytic activity of monocytes and neutrophils were measured in whole blood. For ROS and NO production, samples were incubated with heat-killed S. aureus; phagocytic activity was assessed using killed Escherichia coli conjugated to FITC. Olaparib (0.1-100 µM) did not adversely affect lymphocyte viability. Olaparib also did not interfere with PARP1 expression but inhibits S. aureus-induced protein PARylation. In cells challenged with H2O2, olaparib prevented NAD+ and ATP depletion and attenuated mitochondrial membrane depolarization. LPS-induced production of TNF-α, MIP-1α, and IL-10 by PBMCs was also reduced by olaparib. Monocytes and neutrophils displayed significant increases in the production of ROS and NO after stimulation with S. aureus and phagocytic (E. coli) and microbicidal activity, and these responses were not suppressed by olaparib. We conclude that, at clinically relevant concentrations, olaparib exerts cytoprotective effects and modulates inflammatory cytokine production without exerting adverse effects on the cells' ability to phagocytose or eradicate pathogens. The current data support the concept of repurposing olaparib as a potential experimental therapy for septic shock.

Quality of Life of Pregnant Women with Systemic Lupus Erythematosus / Qualidade de vida de mulheres grávidas com lúpus eritematoso sistêmico

Abstract Objective To assess the quality of life (QoL) of pregnant women with systemic lupus erythematosus (SLE) treated at a high-risk prenatal outpatient clinic during the third trimester of gestation. Methods An observational descriptive study was performed in a high-risk prenatal outpatient clinic. Women in the third trimester of pregnancy and undergoing antenatal care between July 2017 and July 2019 answered the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, consisting of 26 questions divided into 4 domains (physical, psychological, social and environmental). Results We interviewed 50 pregnant women with a mean gestational age of 30 weeks (standard deviation [SD]: 10 weeks) who were diagnosed with SLE. The average age of the participants was 30 years (SD: 14.85), and the average time since the diagnosis of SLE was of 9.06 years (SD: 6.8 years). Most participants had a partner, did not plan their pregnancy (76%), and did not use contraception prior to pregnancy (80%). The score of each domain ranges from 0 (the worst score) to 100 (the best score). The means ± SDs of the scores of the participants on each domain were: physical - 52.21 ± 18.44); psychological - 64.17 ± 18.56); social - 66.33 ± 27.09); and environmental - 64.56 (18.53). The means ± SDs of the general QoL, and health-related QoL items were of 70.50 ± 24.06 and 70.00 ± 30.72 respectively. Conclusion The physical domain presented the lowest scores compared with the other three domains. Pregnant women with SLE had high overall QoL scores, and their health-related QoL scores were also relatively high.

Resumo Objetivo Investigar a qualidade de vida (QV) de gestantes com lúpus eritematoso sistêmico (LES), em acompanhamento ambulatorial pré-natal de alto risco, durante o terceiro trimestre de gestação. Métodos Foi realizado um estudo observacional descritivo em ambulatório de prénatal de alto risco. Asmulheres emacompanhamento pré-natal no terceiro trimestre de gravidez entre julho de 2017 e julho de 2019 responderam ao questionário abreviado de Qualidade de Vida da Organização Mundial de Saúde (abbreviated World Health Organization Quality of Life, WHOQOL-BREF, em inglês), composto por 26 questões divididas em 4 domínios (físico, psicológico, social e ambiental). Resultados Foram entrevistadas 50 gestantes com diagnóstico de LES e média de 30 semanas de idade gestacional (desvio padrão [DP]: 10 semanas). A idade média das participantes foi de 30 anos (DP: 14,85), e o tempomédio desde o diagnóstico de lúpus foi de 9,06 anos (DP=15,55 anos). Amaioria das participantes tinha companheiro, não havia planejado a gravidez (76%), e não fazia uso de anticoncepcional antes da gravidez (80%). A pontuação em cada domínios varia de 0 (pior pontuação) a 100 (melhor pontuação). As médias± DPs das pontuações das participantes em cada domínios foram: físico - 52,21± 18,44; psicológico - 64,17± 18,56; social - 66,33± 27,09; e ambiental -64,56± 18,53). As médias± DPs dos itens relativos à QV geral e à QV relacionada à saude foram de 70,50± 24,06) e 70,00± 30,72, respectivamente. Conclusão O domínio físico apresentou as menores pontuações em comparação com os outros três domínios. Mulheres grávidas com LES tiveram pontuação alta no item de QV geral, e a pontuação no item de QV relacionada à saúde também foi relativamente alta.

Análise de impacto orçamentário dos inibidores de PARP no tratamento de manutenção em primeira linha de pacientes com câncer de ovário avançado, gBRCA mutado, sob a perspectiva do sistema de saúde suplementar brasileiro / Budget impact analysis of PARP inhibitors in the first line maintenance treatment of patients with advanced, gBRCA mutated, ovarian cancer, from the perspective of the Brazilian supplementary health system

Objetivo: O presente artigo visa disponibilizar aos gestores da saúde dados sobre o impacto orçamentário da incorporação dos inibidores de PARP (iPARPs) para o tratamento de primeira linha de manutenção de câncer de ovário avançado, gBRCA mutado, sob a perspectiva do sistema de saúde suplementar. Métodos: Adotou-se o método epidemiológico, tendo como comparador a vigilância ativa em um horizonte temporal de cinco anos. Foram considerados apenas os custos de tratamento medicamentoso na análise, utilizando o pressuposto conservador de que os custos da vigilância ativa são nulos. Além disso, construiu-se uma análise de sensibilidade determinística. Resultados: O impacto orçamentário dos iPARPs na população-alvo em todo o sistema foi de R$ 78,1 milhões em cinco anos acumulados. A análise de sensibilidade apontou que o resultado doimpacto orçamentário varia de R$ 54,6 milhões a R$ 101,6 milhões. A taxa de difusão da tecnologia e os parâmetros epidemiológicos foram os que exerceram a maior influência na variabilidade dos resultados. Conclusão: Os dados sugerem que a incorporação dos iPARPs na população selecionada gera um impacto orçamentário gerenciável.

Objective: The objective was to calculate the budget impact of PARP inhibitors (iPARPs) incorporation for the first-line maintenance treatment of advanced mutated gBRCA ovarian cancer from the perspective of the supplementary health system. Methods: We adopted the epidemiological method, with active surveillance as the comparator in a time horizon of five years. We considered only drug treatment's cost, using a conservative approach in which the costs with active surveillance are null. In addition, we developed a deterministic sensitivity analysis. Results: The budget impact of iPARPs on the target population was R$ 78.1 million in five years. The sensitivity analysis showed that the result of the budget impact ranges from R$ 54.6 million to R$ 101.6 million. The market share evolution and the epidemiological parameters had the highest impact on the result's variability. Conclusion: These data suggest that the incorporation of iPARPs in the selected population generates a manageable budget impact

Optimizing a Deep Residual Neural Network with Genetic Algorithm for Acute Lymphoblastic Leukemia Classification.

Acute lymphoblastic leukemia (ALL) is the most common childhood cancer worldwide, and it is characterized by the production of immature malignant cells in the bone marrow. Computer vision techniques provide automated analysis that can help specialists diagnose this disease. Microscopy image analysis is the most economical method for the initial screening of patients with ALL, but this task is subjective and time-consuming. In this study, we propose a hybrid model using a genetic algorithm (GA) and a residual convolutional neural network (CNN), ResNet-50V2, to predict ALL using microscopy images available in ALL-IDB dataset. However, accurate prediction requires suitable hyperparameters setup, and tuning these values manually still poses challenges. Hence, this paper uses GA to find the best hyperparameters that lead to the highest accuracy rate in the models. Also, we compare the performance of GA hyperparameter optimization with Random Search and Bayesian optimization methods. The results show that GA optimization improves the accuracy of the classifier, obtaining 98.46% in terms of accuracy. Additionally, our approach sheds new perspectives on identifying leukemia based on computer vision strategies, which could be an alternative for applications in a real-world scenario.

Condicionantes de gênero na produção de demandas de mulheres de meia-idade / Condicionantes de género en la producción de demandas de mujeres de mediana edad / Gender constraints in the production of demands by middle-aged women

Resumo Objetivo Analisar condicionantes de gênero presentes em demandas de saúde de mulheres de meia-idade oriundas do seu cotidiano. Métodos Estudo de abordagem qualitativa do tipo Pesquisa Convergente Assistencial. A pesquisa foi realizada com dois grupos de participantes: mulheres de meia-idade e profissionais da saúde. No total, participaram 13 mulheres de meia-idade e 18 profissionais de saúde. A produção do material empírico se deu por meio de oficinas de reflexão e entrevistas nos meses de maio e junho de 2017. A análise dos dados foi realizada por meio da técnica de análise de discurso. Resultados Os resultados conformaram duas categorias empíricas em que convergem a posição dos dois grupos de participantes: Atributos de gênero definindo demandas emocionais na meia-idade e o corpo como instrumento do fazer e demandante de cuidado na meia-idade. As experiências de vida relatadas são marcadas por trabalho doméstico e cuidado da família e expressam sobrecargas emocionais e físicas acumuladas ao longo dos anos. Profissionais de saúde revelam escuta sensível às demandas das mulheres, contudo questões estruturais, ligadas à organização da atenção dificultam práticas mais resolutivas. Conclusão Os resultados revelaram que o cotidiano de mulheres de meia idade define demandas para o cuidado vinculadas a atributos de gênero, incorporados ao cotidiano de modo naturalizado. Sem responsabilidades compartilhadas no ambiente familiar, há sobrecarga física e emocional que suscitam cuidados. Os serviços de saúde reconhecem, mas há somente ações pontuais para demandas de ordem biológica e nenhuma proposta sistematizada para um trabalho com mulheres que abram caminhos ao empoderamento.

Resumen Objetivo Analizar condicionantes de género presentes en demandas de salud de mujeres de mediana edad originarias de su cotidiano. Métodos Estudio de abordaje cualitativo del tipo Investigación Convergente Asistencial. La investigación se realizó con dos grupos de participantes: mujeres de mediana edad y profesionales de la salud. En la totalidad, participaron 13 mujeres de mediana edad y 18 profesionales de salud. La producción del material empírico se realizó a través de talleres de reflexión y encuestas en los meses de mayo y de junio de 2017. El análisis de los datos se realizó por medio de la técnica de análisis de discurso. Resultados Los resultados conformaron dos categorías empíricas en las que convergen la posición de los dos grupos de participantes: Atributos de género definiendo demandas emocionales en la mediana edad y el cuerpo como instrumento del quehacer y que demandan cuidado en la mediana edad. Las experiencias de vida relatadas están marcadas por el trabajo doméstico y el cuidado con la familia y expresan sobrecargas emocionales y físicas acumuladas a lo largo de los años. Profesionales de la salud revelan una escucha sensible a las demandas de las mujeres, sin embargo, cuestiones estructurales, relacionadas con la organización de la atención dificultan las prácticas más resolutivas. Conclusión Los resultados revelaron que el cotidiano de mujeres de mediana edad definen demandas con el cuidado vinculadas a atributos de género, incorporados al cotidiano de modo naturalizado. Sin responsabilidades compartidas en el ambiente familiar, hay una sobrecarga física y emocional que suscitan cuidados. Los servicios de salud reconocen, pero existen solamente acciones puntuales para demandas de orden biológico y ninguna propuesta sistematizada para un trabajo con mujeres que abran caminos hacia el empoderamiento.

Abstract Objective To analyze gender conditions present in middle-aged women's health demands from their daily lives. Methods This is a study with a qualitative approach of the Convergent Care Research type. The survey was conducted with two groups of participants: middle-aged women and health professionals. In total, 13 middle-aged women and 18 health professionals participated. The production of empirical material took place through reflection workshops and interviews in May and June 2017. Data analysis was performed using the discourse analysis technique. Results The results formed two empirical categories in which the position of the two groups of participants converge: Gender attributes defining emotional demands in middle age; The body as an instrument of doing and demanding care in middle age. The reported life experiences are marked by housework and family care and express emotional and physical burdens accumulated over the years. Health professionals reveal sensitive listening to women's demands; however, structural issues related to the organization of care hinder more resolving practices. Conclusion The results revealed that the daily life of middle-aged women defines demands for care linked to gender attributes, incorporated into daily life in a naturalized way. Without shared responsibilities in the family environment, there is a physical and emotional burden that prompts care. The health services recognize this, but there are only punctual actions for demands of a biological order and no systematic proposal for working with women that open paths to empowerment.

Uso de máquinas 3D e cortadores a laser em simulação aplicada à educação médica / Use of 3D printers and laser cutters for simulation in medical education

Introdução: As impressões tridimensionais (3D) têm obtido relevância em diversas áreas do conhecimento, especialmente na medicina. Com o advento da tecnologia, cada vez mais escolas médicas têm adotado o uso de prototipagem de estruturas humanas para aprimorar o treinamento dos estudantes, uma vez que a simulação produz um ambiente livre de riscos, no qual os alunos podem dominar com sucesso as habilidades relevantes para a prática clínica.Métodos: O projeto foi estruturado a partir da pesquisa dos softwares de impressão; seleção dos segmentos anatômicos a serem impressos; análise de materiais para a confecção; estudo aprofundado das caixas de simulação usadas no treinamento em videocirurgia e, por fim, realização de um treinamento dos estudantes interessados no desenvolvimento das habilidades cirúrgicas.Resultados: Por meio da impressão 3D,foram confeccionadas peças anatômicas para o ensino em anatomia, além de peças de silicone para treinamento de suturas manuais e videolaparoscópicas. O cortador a laser foi utilizado para fabricar caixas pretas, principalmente para simulações de cirurgia laparoscópica.Conclusão: A utilização de materiais 3D no ensino médico tem se mostrado altamente promissora, com aumento da curva de aprendizado dos alunos envolvidos e ótima relação custo-benefício. Contudo, o acesso a essa tecnologia ainda é restrito no Brasil, o que dificulta a expansão do método para todas as escolas médicas nacionais.

Introduction: Three-dimensional (3D) printing has become relevant in several areas of knowledge, especially Medicine. With the advent of technology, medical schools started using prototypes of human structures to improve student training, given that simulation provides a risk-free environment where students can successfully master relevant skills for clinical practice.Methods: The present study consisted of research about printing software, selection of anatomical segments for printing, analysis of printing materials, study of simulation boxes used in video-assisted surgery training, and training of students interested in developing surgical skills.Results: 3D printing was used to fabricate anatomical models for teaching anatomy and silicone models for manual and video-assisted laparoscopic suture training. Laser cutters were used to manufacture black boxes, mainly for laparoscopy simulation. Conclusion: The use of 3D printing in medical education is highly promising, with an improved learning curve among students and an excellent benefit-cost ratio. However, access to this technology is still limited in Brazil, which makes it difficult to expand the method to all national medical schools.

Elaboration of a Low-Cost Aquatic Ergometric Bicycle / Elaboração de uma Bicicleta Ergométrica Aquática de Baixo Custo

After a visit to a hydrotherapy laboratory, limited resources for use in lower limbs were noted. For this reason, the goal is to design a water bike from low-cost material. The process took place in three phases: (1) project carried out, (2) prototype construction and (3) bicycle construction. The confection was divided into six parts; the materials used were polyvinyl chloride (PVC) tubes for the construction of sewer system. In addition to PVC materials, other products were used: two plastic pedals; a gel saddle, a seat post, two cranksets, a pipe clamp, a central shaft, two industrial bearings, three 40-millimeter aluminum cylinders and four suction cups. The final product was measured 69 centimeters (cm) in width, 59.05 cm in length; as the seat can be adjusted, the height varies. The prototype ranges from 73 to 102 cm in height and supports up to 85 kilograms (kg). It is concluded that although there is a limitation as to the design of the final product due to the limited formats of the PVC connections and as to the adaptations that must be made so that the final product can support a considerable weight, it is feasible to make a low-cost water exercise bike using PVC as the main material that can be used in the pool. It is noteworthy, however, that this product will still be tested to ascertain functionality as for equipment for clinical practice. (AU)

Após a visita em um laboratório de hidroterapia denotou-se a limitação de recursos para membros inferiores. Devido a isso, o objetivo é elaborar uma bicicleta aquática de material de baixo custo. O processo se deu em três fases: (1) design realizado, (2) produção do protótipo e a (3) construção da bicicleta. A confecção foi dividida em seis partes; os materiais utilizados foram tubos de Policloreto de vinila (PVC) para esgoto predial. Além de materiais de PVC foram utilizados outros produtos: dois pedais de plástico; um selim de gel, um canote, dois pedivelas, uma braçadeira de tubo, um eixo central, dois rolamentos industriais, três cilindros de alumínios 40 milímetros e quatro ventosas. O produto final teve como medida 69 centímetros (cm) de largura, 59,05 cm de comprimento; como o banco pode ser regulado, a altura varia. o protótipo varia entre 73 a 102 cm de altura e suporta até 85 quilogramas. Conclui-se então que embora haja limitação quanto ao design do produto final por conta dos limitados formatos das conexões de PVC e quanto à adaptações que devem ser feitas para que o produto final consiga suportar um peso considerável, é viável a confecção de uma bicicleta ergométrica aquática de baixo custo utilizando o PVC como material principal e que pode ser utilizada na piscina. Destaca-se, entretanto, que este produto ainda será testado para averiguar a funcionalidade quanto equipamento para a prática clínica. (AU)

Long-term supplementation with phenolic compounds from jaboticaba (Plinia jaboticaba (Vell.) Berg) reduces adiposophaty and improves glucose, lipid, and energy metabolism.

Obesity is a critical public health problem worldwide that has been associated to non-communicable diseases (NCD), such as type 2 diabetes (T2DM), non-alcoholic fatty lipid diseases (NAFLD) and inflammatory diseases. Polyphenols from several food sources have been studied as one option against these health problems. Sabara jaboticaba (Plinia jaboticaba (Vell.) Berg) is a Brazilian berry rich in ellagic acid derivatives and anthocyanins. Here we investigated the effects of a phenolic-rich extract from Sabara jaboticaba (PEJ) in a diet-induced obesity animal model. PEJ at two doses, 50 mg gallic acid equivalent (GAE)/kg body weight (BW) and 100 mg GAE/kg BW, were administered by daily gavage to obese C57BL/6J mice for 14 weeks. PEJ prevented the excessive body weight and adiposity, adipocyte hypertrophy, inflammation, hyperglycemia, glucose intolerance, insulin resistance, hypercholesterolemia, and hepatic lipid accumulation, as well as increased energy expenditure. In conclusion, polyphenols from Sabara jaboticaba presented several powerful therapeutic properties relevant for fighting obesity and associated health problems.

Phenolic compounds from jaboticaba (Plinia jaboticaba (Vell.) Berg) ameliorate intestinal inflammation and associated endotoxemia in obesity.

Jaboticaba (Plinia jaboticaba (Vell.) Berg) is a Brazilian native fruit belonging to the Myrtaceae family. Previously it was demonstrated that phenolic-rich extracts from jaboticaba (PEJ) possess health-beneficial properties in diet-induced obesity; however, whether PEJ modulates the obesity-associated intestinal inflammatory status remains unclear. Thus, male C57BL/6J obese mice were fed a high-fat-sugar (HFS) diet and received PEJ at two doses, 50 mg gallic acid equivalent (GAE)/kg body weight (BW) (PEJ1 group), and 100 mg GAE/kg BW (PEJ2 group), or water (HFS group) by oral gavage for 14 weeks. PEJ groups presented a reduced body weight gain and adiposity and were protected against insulin resistance and dyslipidemia. In addition, PEJ prevented metabolic endotoxemia linked to an attenuation of the HFS diet-induced intestinal inflammation via down-regulation of pro-inflammatory mediators such as tumor necrosis factor (TNF-α), membrane transporter toll-like receptor-4 (TLR-4) and nuclear factor-κB (NF-κB) in the colon. These anti-inflammatory effects appear to be involved, at least in part, with an inhibition of the colonic inflammasome pathway of obese mice.

Polyphenols of cambuci (Campomanesia phaea (O. Berg.)) fruit ameliorate insulin resistance and hepatic steatosis in obese mice.

Polyphenols from cambuci (CBC) (Campomanesia phaea (O. Berg.)), a Brazilian native fruit, were investigated on therapeutic actions mitigating insulin resistance and hepatic steatosis in high-fat-sucrose diet (HFS) induced obese mice. For this, C57BL/6J mice fed with a obesogenic and diabetogenic HFS diet were administered with either water or two CBC doses (36 or 74 mg gallic acid equivalent (GAE)/kg body weight) by gavage from week 6 to week 14 (end-point) of HFS feeding. CBC reduced body weight gain, inflammation, hepatic steatosis, hyperglycemia, glucose intolerance, and insulin resistance in liver and skeletal muscle of obese mice, and such effects were associated with activation of Akt and AMPK in these tissues. In conclusion, polyphenols from CBC show important therapeutic actions ameliorating obesity-associated complications.

Análise Crítica Sobre Medicamentos Prescritos para o Uso Problemático de Crack / Critical Analysis of Prescriptions Medicines for Problematic Crack Use

Resumo Estudo de abordagem descritiva, exploratória e retrospectiva que analisou prontuários de pacientes em tratamento pelo uso problemático de crack. Foram levantadas as prescrições, as interações medicamentosas e o perfil sociodemográfico destes pacientes. Foram feitas revisões de literaturas narrativas para verificar quais medicamentos apresentam maiores potenciais terapêuticos e para caracterizar o perfil dos usuários; dados dos prontuários e da literatura foram triangulados. Os resultados sugerem que os medicamentos utilizados no tratamento do uso problemático de crack são limitados, os medicamentos utilizados na prática não possuem evidências de eficácia, há interações relevantes nas prescrições e o perfil sociodemográfico desses usuários é semelhante com a literatura. Estudos adicionais são desejáveis para buscar um tratamento medicamentoso eficaz para o uso problemático de crack.

Abstract A descriptive, exploratory and retrospective study that analyzed medical records of the patients under treatment for crack use; prescriptions and medicines interactions were collected, and the sociodemographic profile of these patients. Revisions of narrative literatures were conducted to verify which medicines have the greatest therapeutic potentials and to characterize the profile of the crack users; data from the medical records and the literature were triangulated. The results suggest: medicines prescribed in the treatment of the crack use are limited, medicines used in practice don't have evidence of efficacy, there are relevant interactions in the prescriptions, and the sociodemographic profile of these users is similar with the literature. Additional studies are desirable to seek effective medicine treatment for crack use.

The role of jaboticaba (Plinia jaboticaba (VELL. ) Berg) phenolic compounds in obesity-associated intestinal inflammation / O papel dos compostos fenólicos da jabuticaba (Plinia jaboticaba (VELL. ) Berg) na inflamação intestinal associada à obesidade

Jaboticaba (Plinia jaboticaba (Vell.) Berg) is a Brazilian native fruit belonging to the Myrtaceae family. Previously it was demonstrated that phenolicrich extracts from jaboticaba (PEJ) possess health-beneficial properties in dietinduced obesity; however, whether PEJ modulates the obesity-associated intestinal inflammatory status remains unclear. The objective of the present study was to evaluate the effect of PEJ on intestinal inflammation associated with obesity induced by a high-fat-sucrose (HFS) diet. Thus, forty male C57BL/6J mice were distributed into two groups: negative control (CH, 10 animals), fed standard diet AIN96M and water ad libitum; and positive control (HFS, 30 animals), fed HFS diet and water ad libitum induced to obesity for an initial period of 14 weeks. After this period, the HFS group was redistributed in three groups of 10 animals each, and continuously fed HFS diet for another 14 weeks: HFS group received daily gavages of water, PEJ1 group received PEJ at the dose of 50 mg of gallic acid equivalent (GAE)/kg body weight (BW and PEJ2 group received PEJ at the dose of 100 mg GAE/kg BW. Feed intake and body mass were monitored weekly, and fasting glucose biweekly. The initial period of obesity-induction demonstrated that the HFS diet was efficient to promote a significant body weight gain and fasting hyperglycemia when compared to the negative control group (CH). At the end of the experiment the animals were euthanized under anesthesia and their organs and tissues were collected. The major classes of phenolic compounds found in PEJ were ellagitannins, anthocyanins including cyanidin and delphinidin glycosides, proanthocyanidins, and free ellagic acid. PEJ-treated animals presented a reduced body weight gain, adiposity and demonstrated significant reversion of insulin resistance and dyslipidemia. In addition, the inflammatory profile of colon demonstrated that PEJ prevented metabolic endotoxemia linked to an attenuation of the HFS diet-induced intestinal inflammation via downregulation of pro-inflammatory mediators such as tumor necrosis factor (TNF-ß), membrane transporter toll-like receptor-4 (TLR-4) and nuclear factor-κB (NF-κB) in the colon. These anti-inflammatory effects appear to be involved, at least in part, with an inhibition of the colonic inflammasome pathway of obese mice. Collectively, our data reveals that PEJ exerts a direct anti-inflammatory effect in obesity-associated intestinal inflammation and this outcome is linked to an amelioration of metabolic endotoxemia in obese mice

A jabuticaba (Plinia jaboticaba (Vell.) Berg) é uma fruta nativa brasileira pertencente à família Myrtaceae. Anteriormente, foi demonstrado que extratos ricos em fenólicos de jabuticaba (PEJ) possuem propriedades benéficas à saúde na obesidade induzida por dieta; no entanto, se o PEJ modula o estado inflamatório intestinal associado à obesidade ainda não está claro. O objetivo do presente estudo foi avaliar o efeito do PEJ na inflamação intestinal associada à obesidade induzida por uma dieta rica em sacarose (HFS). Assim, quarenta camundongos C57BL / 6J machos foram distribuídos em dois grupos: controle negativo (CH, 10 animais), alimentados com dieta padrão AIN96M e água ad libitum; e controle positivo (HFS, 30 animais), alimentado com dieta HFS e água ad libitum induzida à obesidade por um período inicial de 14 semanas. Após este período, o grupo HFS foi redistribuído em três grupos de 10 animais cada, e continuamente alimentado com dieta HFS por mais 14 semanas: o grupo HFS recebeu gavagens diárias de água, o grupo PEJ1 recebeu PEJ na dose de 50 mg de ácido gálico equivalente (GAE) / kg de peso corporal (pc) e o grupo PEJ2 recebeu PEJ na dose de 100 mg GAE / kg pc. O consumo de ração e a massa corporal foram monitorados semanalmente e a glicemia de jejum quinzenal. O período inicial de indução da obesidade demonstrou que a dieta HFS foi eficiente em promover significativo ganho de peso corporal e hiperglicemia de jejum quando comparada ao grupo controle negativo (HC). Ao final do experimento os animais foram submetidos à eutanásia sob anestesia e seus órgãos e tecidos coletados. As principais classes de compostos fenólicos encontrados em PEJ foram elagitaninos, antocianinas incluindo cianidina e delfinidina glicosiladas, proantocianidinas e ácido elágico livre. Os animais tratados com PEJ apresentaram redução do ganho de peso corporal, adiposidade e reversão significativa da resistência à insulina e dislipidemia. Além disso, o perfil inflamatório do cólon demonstrou que o PEJ evitou a endotoxemia metabólica ligada a uma atenuação da inflamação intestinal induzida pela dieta de HFS por meio da regulação negativa de mediadores pró-inflamatórios, como o fator de necrose tumoral (TNF-), transportador de membrana toll- como o receptor 4 (TLR-4) e o fator nuclear B (NF-B) no cólon. Esses efeitos anti-inflamatórios parecem estar envolvidos, pelo menos em parte, com uma inibição da via do inflamassoma colônico de camundongos obesos. Coletivamente, nossos dados revelam que o PEJ exerce um efeito anti-inflamatório direto na inflamação intestinal associada à obesidade e esse resultado está relacionado com uma melhora da endotoxemia metabólica em camundongos obesos

Temporal processing skills in people who stutter / Habilidades do processamento temporal em pessoas que gaguejam

ABSTRACT Purpose: to investigate the auditory skills of temporal resolution and ordering in people who stutter. Methods: an observational, cross-sectional, analytical, and comparative research between study and control groups conducted at a speech-language-hearing teaching clinic of an academic institution, comprising people who stutter (who attended a public outreach program) and volunteers without communicative disorders, for 13 months. The procedures used were auditory perception anamnesis, acoustic immittance, and pure-tone and speech audiometry to discharge hearing changes. The participants who met the eligibility criteria had their resolution and ordering skills assessed with the Gaps-in-Noise, Random Gap Detection, Pitch Pattern Sequence, and Duration Pattern Sequence tests and the data obtained were entered into a spreadsheet for descriptive and inferential statistical analyses. Results: the study group presented changes in temporal resolution and ordering. A statistically significant difference was also verified comparing the assessment findings of the study and control groups, in all the assessment tests. Conclusion: temporal resolution and ordering changes were observed in the people presented with stuttering, regardless of sex or chronological age.

RESUMO Objetivo: investigar as habilidades auditivas de resolução e ordenação temporal em pessoas que gaguejam. Métodos: estudo observacional transversal analítico e comparativo entre o grupo estudo e o controle. Realizado numa Clínica-Escola de Fonoaudiologia de uma instituição de ensino com pessoas que gaguejam atendidos em projeto de extensão universitária, bem como por voluntários sem distúrbio de comunicação, no período de 13 meses. Os procedimentos realizados foram anamnese de percepção auditiva, imitanciometria, audiometria tonal e vocal para descartar alteração na audição. Para os participantes que atenderam aos critérios de elegibilidade, realizou-se a avaliação das habilidades de resolução e ordenação com os seguintes testes: Gaps in Noise; Random Gap Detection Test; Pitch Pattern Sequence; e Duration Pattern Sequence. Após a realização dos testes descritos acima, os dados obtidos foram alocados em planilha digital para análise estatística descritiva e inferencial. Resultados: o grupo estudo apresentou alteração nas habilidades de resolução e ordenação temporal. Verificou-se, também, a diferença estatisticamente significante nos achados avaliativos dos grupos estudo e controle, quando comparados, para todos os testes realizados nas avaliações. Conclusão: observou-se alteração das habilidades de resolução e ordenação temporal nos indivíduos com gagueira, independentemente do gênero ou idade cronológica.