The immune system in Parkinson's disease: what we know so far.

Parkinson's disease (PD) is characterised neuropathologically by the degeneration of dopaminergic neurons in the ventral midbrain, the accumulation of α-synuclein (α-syn) aggregates in neurons, and chronic neuroinflammation. In the past two decades, in vitro, ex vivo and in vivo studies have consistently shown the involvement of inflammatory responses mediated by microglia and astrocytes, which may be elicited by pathological α-syn or signals from affected neurons and other cell types, and are directly linked to neurodegeneration and disease development. Besides the prominent immune alterations seen in the central nervous system (CNS), including the infiltration of T-cells into the brain, more recent studies have demonstrated important changes in the peripheral immune profile within both the innate and adaptive compartments, particularly involving monocytes, CD4+ and CD8+ T-cells. This review aims to integrate the consolidated understanding of immune-related processes underlying the pathogenesis of PD, focusing on both central and peripheral immune cells, neuron-glia crosstalk as well as the central-peripheral immune interaction during the development of PD. Our analysis seeks to provide a comprehensive view of the emerging knowledge of the mechanisms of immunity in PD and the implications of this for better understanding the overall pathogenesis of this disease.

The role of postoperative blood pressure management in early postoperative hemorrhage in awake craniotomy glioma patients.

Postoperative hemorrhage can severely affect the patients' neurological outcome after awake craniotomy. Higher postoperative blood pressure can increase the risk of postoperative hemorrhage. The aim of this study was to investigate the role of postoperative blood pressure and other common radiological and epidemiological features with the incidence of postoperative hemorrhage. In this retrospective analysis, we included patients who underwent awake surgery at our institution. We assessed the blood pressure both intra- and postoperatively as well as the heart rate for the first 12 h. We compared a cohort with postoperative hemorrhage, who required further treatment (surgical revision or intravenous antihypertensive therapy), with a cohort with no postoperative hemorrhage. We included 48 patients with a median age of 39 years. 9 patients (19%) required further treatment due to postoperative hemorrhage, which was surgery in 2 cases and intensive blood pressure measurements in 7 cases. However, with early treatment, no significant difference in Performance scores at follow-up could be found. Patients with postoperative hemorrhage showed significantly higher postoperative systolic blood pressure during the hours 3-12 (p < 0.05) as well as intraoperatively throughout the procedure (p < 0.05). In ROC and Youden Test, a strong impact of systolic blood pressure over 140mmHg during the early postoperative course could be shown. Postoperative hemorrhage is a rare but possible complication in awake surgery glioma patients. To avoid postoperative hemorrhage, treating physicians should aim strictly on systolic blood pressure of under 140mmHg for the postoperative course.

Identification of master regulator genes controlling pathogenic CD4+ T cell fate in inflammatory bowel disease through transcriptional network analysis.

Inflammatory bowel diseases (IBD) are a group of chronic inflammatory conditions of the gastrointestinal tract associated with multiple pathogenic factors, including dysregulation of the immune response. Effector CD4+ T cells and regulatory CD4+ T cells (Treg) are central players in maintaining the balance between tolerance and inflammation. Interestingly, genetic modifications in these cells have been implicated in regulating the commitment of specific phenotypes and immune functions. However, the transcriptional program controlling the pathogenic behavior of T helper cells in IBD progression is still unknown. In this study, we aimed to find master transcription regulators controlling the pathogenic behavior of effector CD4+ T cells upon gut inflammation. To achieve this goal, we used an animal model of IBD induced by the transfer of naïve CD4+ T cells into recombination-activating gene 1 (Rag1) deficient mice, which are devoid of lymphocytes. As a control, a group of Rag1-/- mice received the transfer of the whole CD4+ T cells population, which includes both effector T cells and Treg. When gut inflammation progressed, we isolated CD4+ T cells from the colonic lamina propria and spleen tissue, and performed bulk RNA-seq. We identified differentially up- and down-regulated genes by comparing samples from both experimental groups. We found 532 differentially expressed genes (DEGs) in the colon and 30 DEGs in the spleen, mostly related to Th1 response, leukocyte migration, and response to cytokines in lamina propria T-cells. We integrated these data into Gene Regulatory Networks to identify Master Regulators, identifying four up-regulated master gene regulators (Lef1, Dnmt1, Mybl2, and Jup) and only one down-regulated master regulator (Foxo3). The altered expression of master regulators observed in the transcriptomic analysis was confirmed by qRT-PCR analysis and found an up-regulation of Lef1 and Mybl2, but without differences on Dnmt1, Jup, and Foxo3. These two master regulators have been involved in T cells function and cell cycle progression, respectively. We identified two master regulator genes associated with the pathogenic behavior of effector CD4+ T cells in an animal model of IBD. These findings provide two new potential molecular targets for treating IBD.

Predictors of poor functional outcomes in adults with type I Chiari Malformation: Clinical and surgical factors assessed with the Chicago Chiari Outcome Scale over long-term follow-up.

OBJECTIVE: This study aimed to identify clinical and surgical features associated with poor long-term postoperative outcomes in patients diagnosed with Type I Chiari Malformation (CMI) treated with posterior fossa decompression with duroplasty (PFDD), with or without tonsillar coagulation. METHODS: This retrospective, single-center study included 107 adult patients with CMI surgically treated between 2010 and 2021. The surgical technique involved a midline suboccipital craniectomy, C1 laminectomy, durotomy, arachnoid dissection, duroplasty, and tonsillar coagulation until 2014, after which tonsillar coagulation was discontinued. Postoperative outcomes were assessed using the Chicago Chiari Outcome Scale (CCOS) at a median follow-up of 35 months. Clinical, surgical, and neuroimaging data were analyzed using the Wilcoxon signed-rank test, Cox regression analysis, and Kaplan-Meier survival curves to identify predictors of poor functional outcomes. RESULTS: Of the 107 patients (mean age 43.9 years, SD 13), 81 (75.5 %) showed functional improvement, 25 (23.4 %) remained unchanged, and 1 (0.9 %) experienced worsened outcomes. Cephalalgia, bilateral motor weakness, and bilateral paresthesia were the most frequent initial symptoms. Tonsillar coagulation was performed in 31 cases (28.9 %) but was clinically associated with higher rates of unfavorable outcomes. The Wilcoxon signed-rank test indicated that long-term follow-up CCOS was significantly higher than postoperative CCOS (Z = -7.678, p < 0.000). Multivariate Cox analysis identified preoperative bilateral motor weakness (HR 6.1, 95 % CI 1.9-18.9; p = 0.002), hydrocephalus (HR 3.01, 95 % CI 1.3-6.9; p = 0.008), and unilateral motor weakness (HR 2.99, 95 % CI 1.1-8.2; p = 0.033) as significant predictors of poor outcomes on a long-term follow-up. CONCLUSION: This study highlights the high rate of functional improvement in CMI patients following PFDD. Preoperative motor weakness and hydrocephalus were significant predictors of poor long-term outcomes. Tonsillar coagulation did not demonstrate a clear clinical benefit and may be associated with worse outcomes. Our findings suggest that careful preoperative assessment and selection of surgical techniques are crucial for optimizing patient outcomes.

Surgical outcomes in patients with acromegaly: Microscopic vs. endoscopic transsphenoidal surgery.

Transsphenoidal resection of growth hormone-secreting pituitary neuroendocrine tumors remains the first-line treatment for acromegaly. This can be performed through microsurgery or endoscopic surgery. For the past decades, endoscopic surgery has become the preferred technique in an increasing number of centers worldwide. However, whether it offers superior clinical outcomes has yet to be determined. In this paper, we performed a narrative review of the literature comparing both techniques in the treatment of acromegaly. We critically assessed available comparative studies from an objective perspective to determine their suitability for defining superiority of either technique. Available evidence displays substantial methodological variations and reports conflicting findings. Although endoscopic surgery provides a wider exposure and enhanced visibility of the surgical field, this does not consistently translate into better clinical outcomes, as most tumors are equally accessible through both techniques. Postoperative outcomes such as remission and complication rates are similar between both techniques. The management of acromegaly should be performed by experienced pituitary neurosurgeons, regardless of the approach. The involvement of a multidisciplinary team in a dedicated pituitary center is critical to ensure optimal outcomes.

Diagnostic Algorithm for Intracranial Lesions in the Emergency Department: Effectiveness of the Relative Brain Volume and Hounsfield Unit Value Measured by Perfusion Tomography.

Background Early treatment of intracranial lesions in the emergency department is crucial, but it can be challenging to differentiate between them. This differentiation is essential because the treatment of each type of lesion is different. Cerebral computed tomography perfusion (CTP) imaging can help visualize the vascularity of brain lesions and provide absolute quantification of physiological parameters. Compared to magnetic resonance imaging, CTP has several advantages, such as simplicity, wide availability, and reproducibility. Purpose This study aimed to assess the effectiveness of Hounsfield units (HU) in measuring the density of hypercellular lesions and the ability of CTP to quantify hemodynamics in distinguishing intracranial space-occupying lesions. Methods A retrospective study was conducted from March 2016 to March 2022. All patients underwent CTP and CT scans, and relative cerebral blood volume (rCBV) and HU were obtained for intracranial lesions. Results We included a total of 244 patients in our study. This group consisted of 87 (35.7%) individuals with glioblastomas (GBs), 48 (19.7%) with primary central nervous system lymphoma (PCNSL), 45 (18.4%) with metastases (METs), and 64 (26.2) with abscesses. Our study showed that the HUs for METs were higher than those for GB (S 57.4% and E 88.5%). In addition, rCBV values for PCNSL and abscesses were lower than those for GB and METs. The HU in PCNSL was higher than those in abscesses (S 94.1% and E 96.6%). Conclusion PCT parameters provide valuable information for diagnosing brain lesions. A comprehensive assessment improves accuracy. Combining rCBV and HU enhances diagnostic accuracy, making it a valuable tool for distinguishing between lesions. PCT's widespread availability allows for the use of both anatomical and functional information with high spatial resolution for diagnosing and managing brain tumor patients.

Disturbances in the IgG Antibody Profile in HIV-Exposed Uninfected Infants Associated with Maternal Factors.

Over the last 20 years, the incidence of vertical HIV transmission has decreased from 25%-42% to less than 1%. Although there are no signs of infection, the health of HIV-exposed uninfected (HEU) infants is notoriously affected during the first months of life, with opportunistic infections being the most common disease. Some studies have reported effects on the vertical transfer of antibodies, but little is known about the subclass distribution of these antibodies. We proposed to evaluate the total IgG concentration and its subclasses in HIV+ mothers and HEU pairs and to determine which maternal factors condition their levels. In this study, plasma from 69 HEU newborns, their mothers, and 71 control pairs was quantified via immunoassays for each IgG isotype. Furthermore, we followed the antibody profile of HEUs throughout the first year of life. We showed that mothers present an antibody profile characterized by high concentrations of IgG1 and IgG3 but reduced IgG2, and HEU infants are born with an IgG subclass profile similar to that of their maternal pair. Interestingly, this passively transferred profile could remain influenced even during their own antibody production in HEU infants, depending on maternal conditions such as CD4+ T-cell counts and maternal antiretroviral treatment. Our findings indicate that HEU infants exhibit an altered IgG subclass profile influenced by maternal factors, potentially contributing to their increased susceptibility to infections.

Circulating sex hormones in women with severe anxiety during pregnancy / Hormonas sexuales circulantes en mujeres con ansiedad severa durante el embarazo

Abstract Introduction Anxiety, mood- and stress-related behaviors are regulated by sex hormones in pregnant and non-pregnant women. Very scarce information exists about the role of sex steroids in pregnant women displaying high levels of anxiety. Objective To determine sex hormones serum levels in pregnant women exhibiting high levels of anxiety symptoms. Method The Hamilton Anxiety Rating Scale (HARS/ HAM-A) was used to assess the intensity of anxiety symptoms in third-trimester pregnant women. Two groups were included in the study, pregnant women exhibiting severe anxiety (ANX; HARS scores ≥ 25; n = 101) and healthy control subjects (CTRL; n = 40) displaying lower scores for anxiety (HARS scores ≤ 7). Estradiol (E2), progesterone (P4), and testosterone (T) serum levels were measured using a standard chemiluminescent immunoassay. Bivariate and partial correlations were performed to detect significant associations between groups, clinical measures, biochemical data, and HARS scores. Results The anxiety group (ANX) showed an increase in E2 and T serum levels (p < .001) compared to CTRL. Conversely, significantly lower P4 levels were found in the symptomatic group (p < .001) as compared to the CTRL hormone values. The P4:E2 index was significantly reduced in pregnant women with high levels of anxiety (p < .001). Negative correlations between anxiety (HARS) scores, P4 serum levels (p = .02), and P4:E2 ratio (p = .04) were found in the symptomatic group. Conversely, T serum levels displayed a positive association (p = .001) with high levels of anxiety symptoms in the same group, after adjusting our data by clinical confounders. Discussion and conclusion Serum levels of sex-steroid hormones are altered in pregnant women exhibiting severe anxiety.

Resumen Introducción La ansiedad, el estado de ánimo y el estrés están regulados por diversos esteroides sexuales. Existe poca información sobre el papel que juegan estos esteroides en mujeres embarazadas con niveles elevados de ansiedad. Objetivo Determinar los niveles séricos de hormonas sexuales en mujeres embarazadas con altos índices de síntomas de ansiedad con respecto a mujeres gestantes sanas. Método Determinación de la intensidad de síntomas ansiosos empleando la escala de Hamilton de Ansiedad (HAM-A) en 141 mujeres embarazadas en el tercer trimestre de gestación. Cuantificación de los niveles séricos de estradiol (E2), progesterona (P4) y testosterona (T) por inmunoensayo estándar. Aplicación de las correlaciones de Pearson para detectar asociaciones entre parámetros clínicos y valores hormonales entre los grupos de estudio. Resultados Las mujeres con ansiedad severa (ANX; n = 101; HAM-A ≥ 25) mostraron niveles séricos más altos de E2 y T (p < .001), así como niveles más bajos de P4 (p < .001) en relación con el grupo control (CTRL, n = 40, HAM-A < 7). Se detectó una disminución significativa en el índice P4:E2 en el grupo de ANX (p < .001) y se observaron correlaciones negativas y positivas entre los puntajes elevados de ansiedad con los niveles circulantes de P4 (p = .02), en la taza P4:E2 (p = .04) y en los niveles séricos de T (p = .001) respectivamente, al ajustar nuestros datos con variables confusoras. Discusión y conclusión Los niveles circulantes de los esteroides sexuales se encontraron alterados en mujeres con ansiedad severa.

Consecuencias inmunológicas de la infección materna por VIH en el recién nacido no infectado / Immunologic consequences of maternal HIV infection in the uninfected newborn

Resumen Con la implementación de estrategias de cuidado perinatal, la tasa de transmisión vertical del virus de inmunodeficiencia humana (VIH) ha disminuido considerablemente en el mundo. A pesar de no mostrar cargas virales, los infantes expuestos al VIH no infectados (ENI) cursan en sus primeros meses de vida con mayores tasas de morbimortalidad. Esto se relaciona con enfermedades infecciosas por microorganismos oportunistas y menor respuesta a las vacunas en comparación con infantes sin exposición al virus, lo que sugiere alteraciones en su sistema inmunitario. En esta revisión abordamos diferentes evidencias de alteraciones en las respuestas inmunitarias innatas y adaptativas de infantes ENI que pudieran explicar esta disfuncionalidad inmunitaria. Adicionalmente, este conocimiento ayuda a entender cómo se desarrolla el sistema inmunitario desde los primeros momentos de gestación que servirán para encontrar alternativas de manejo y terapias para el bienestar de los infantes con esta condición.

Abstract With the implementation of perinatal care strategies, the rate of vertical transmission of human immunodeficiency virus (HIV) has decreased considerably worldwide. Despite the absence of viral loads, infants exposed to HIV not infected during gestation have higher morbidity and mortality rates. This is found to be related to infectious diseases by opportunistic microorganisms and lower response to vaccines in their first months of life compared to non-HIV exposed infants, suggesting alterations in their immune system. In this review we address different evidence of alterations in the innate and adaptive immune responses of HIV exposed infants that could explain their immune dysfunctionality. Additionally, this knowledge helps to understand how the immune system develops from the early stages of gestation and will serve to find management alternatives and therapies for the welfare of the infants with this condition.

Allergens of the urushiol family promote mitochondrial dysfunction by inhibiting the electron transport at the level of cytochromes b and chemically modify cytochrome c1

BACKGROUND: Urushiols are pro-electrophilic haptens that cause severe contact dermatitis mediated by CD8+ effector T-cells and downregulated by CD4+ T-cells. However, the molecular mechanism by which urushiols stimulate innate immunity in the initial stages of this allergic reaction is poorly understood. Here we explore the sub-cellular mechanisms by which urushiols initiate the allergic response. RESULTS: Electron microscopy observations of mouse ears exposed to litreol (3-n-pentadecyl-10-enyl-catechol]) showed keratinocytes containing swollen mitochondria with round electron-dense inclusion bodies in the matrix. Biochemical analyses of sub-mitochondrial fractions revealed an inhibitory effect of urushiols on electron flow through the mitochondrial respiratory chain, which requires both the aliphatic and catecholic moieties of these allergens. Moreover, urushiols extracted from poison ivy/oak (mixtures of 3-n-pentadecyl-8,11,13 enyl/3-n-heptadecyl-8,11 enyl catechol) exerted a higher inhibitory effect on mitochondrial respiration than did pentadecyl catechol or litreol, indicating that the higher number of unsaturations in the aliphatic chain, stronger the allergenicity of urushiols. Furthermore, the analysis of radioactive proteins isolated from mitochondria incubated with 3H-litreol, indicated that this urushiol was bound to cytochrome c1. According to the proximity of cytochromes c1 and b, functional evidence indicated the site of electron flow inhibition was within complex III, in between cytochromes bL (cyt b566) and bH (cyt b562). CONCLUSION: Our data provide functional and molecular evidence indicating that the interruption of the mitochondrial electron transport chain constitutes an important mechanism by which urushiols initiates the allergic response. Thus, mitochondria may constitute a source of cellular targets for generating neoantigens involved in the T-cell mediated allergy induced by urushiols.

Smoking promotes exacerbated inflammatory features in dendritic cells of Chilean rheumatoid arthritis patients / El tabaco exacerba características inflamatorias en células dendríticas de pacientes chilenos con artritis reumatoide

ABSTRACT Background: The dual potential to promote tolerance or inflammation when facing self-antigens makes dendritic cells (DCs) fundamental players in autoimmunity. There is an association between smoking and DCs maturation in patients with rheumatoid arthritis (RA). However, ethnicity is a key factor in autoimmune disorders. Aim: To evaluate phenotypic and functional alterations of DCs obtained from Chilean patients with RA as compared to healthy controls (HC). In second term, to compare the inflammatory behaviour of DCs between smoker and non-smoker patients. Material and Methods: Monocyte-derived DCs and T-cells were obtained from blood samples isolated from 30 HC and 32 RA-patients, 14 of which were currently smokers and 18 non-smokers. Several maturation surface markers were evaluated in DCs, including HLA-DR, CD40, CD80, CD83 and CD86. Furthermore, autologous co-cultures of DCs and T-cells were carried out and then T-cell proliferation, and expansion of Th1, Th17 and Tregs were analysed. Results: Compared with HC, RA-patients displayed increased HLA-DR expression in DCs, which was manifested mainly in patients with moderate-to- high disease activity scores (DAS28). Furthermore, RA-patients presented a stronger Th17-expansion and a correlation between DAS28 and Th1-expansion. Both effects were mainly observed in patients in remission or with a low DAS28. Moreover, smoker RA-patients displayed enhanced HLA-DR and CD83 expression in DCs as well as an exacerbated Th17-expansion and a correlation between DAS28 and Th1-expansion. Conclusions: These findings suggest that smoking enhances the inflammatory behaviour of DCs and the consequent Th1 and Th17-mediated response in patients with RA

Introducción: El potencial dual que poseen para promover tolerancia o inflamación ante antígenos propios, hace de las células dendríticas (CDs) actores fundamentales en el desarrollo de autoinmunidad. Existe una asociación entre fumar y la maduración de las CDs en pacientes con artritis reumatoide (AR). No obstante, la etnicidad es un factor clave a considerar en desórdenes autoinmunes. Objetivos: Comparar las alteraciones fenotípicas y funcionales de las CDs obtenidas desde pacientes Chilenos con AR y controles sanos (CS). Además, analizamos las diferencias en el comportamiento inflamatorio que existe entre las CDs obtenidas de pacientes fumadores y CS. Materiales y Métodos: Se obtuvieron CDs derivadas de monocitos y células T desde muestras de sangre aisladas de 30 CS y 32 pacientes con AR, 14 de los cuales eran fumadores y 18 no fumadores. Se evaluaron marcadores de maduración en la superficie de las CDs: HLA-DR, CD40, CD80, CD83 y CD86. Además, se realizaron co-cultivos autólogos de células T y CDs, analizando la proliferación de células T, y la expansión de células Th1, Th17 y Tregs. Resultados: En comparación con los CS, los pacientes AR mostraron un aumento de la expresión de HLA-DR en las CDs, principalmente en los individuos con DAS28 moderado-alto. Los pacientes con AR presentaron una mayor expansión de células Th17 y una correlación entre el DAS28 y la expansión de células Th1, ambos efectos manifestados principalmente en los individuos con un DAS28 bajo o en remisión. Además, los pacientes con AR fumadores mostraron un aumento en la expresión de HLA-DR y CD83 en las CDs y una expansión de células Th17 exacerbada así como una correlación entre el DAS28 y la expansión de células Th1. Conclusiones: Nuestros resultados sugieren que fumar favorece el comportamiento inflamatorio de las CDs y en consecuencia la inducción de respuestas mediadas por células Th1 y Th17 en los pacientes Chilenos con AR.

Canonical correlation analysis applied to production and reproduction traits of meat type quails / Análise de correlações canônicas aplicada em características de produção e reprodução em codorna de corte

ABSTRACT: Data from 629 meat type quails were used to study association between two different sets of traits: egg production and reproduction. Traits related to reproduction were: body weight at 42 days (W42), average egg weight (AEW), age at sexual maturity (ASM); and production traits: number of eggs produced from 42 until 182th day considering intervals of 35 days each period (P1, P2, P3 and P4). Canonical correlations were used to describe the association between these two sets of traits. The canonical coefficients indicated that egg production and reproductive traits were moderately related (0.3475). The first partial period of production (P1) and age at sexual maturity were the most relevant traits among the analyzed variables. Results show that selecting animals with lower age at sexual maturity might lead to an increase on number of eggs produced until 77 days, although it might also lead to a decrease on egg weight. Breeding programs aiming to improve quails production should consider selection strategies to decrease age at sexual maturity and then, as correlated response, increased egg production might be observed.

RESUMO: Dados de 629 matrizes de codornas de corte foram utilizados para estudar a associação entre características de reprodução e produção de ovos. As características analisadas foram: peso corporal aos 42 dias (W42), peso médio de ovos (AEW) e idade à maturidade sexual (ASM), que compôs as características reprodutivas; e números de ovos produzidos a partir do 42o dia, divididos em intervalos de 35 dias cada (P1, P2, P3 e P4), que integrou o grupo de características de produção. Para análise de associação, foi utilizada a análise de correlação canônica entre os dois conjuntos de características. Os coeficientes canônicos indicaram que os conjuntos de características de produção de ovos e reprodutivas são dependentes, correlacionando-se moderadamente (0,3475). Entre as variáveis avaliadas, o primeiro período parcial de produção de ovos e a idade à maturidade sexual foram as mais importantes. Os resultados indicam que a seleção para menor idade à maturidade sexual resultaria em aumento no número de ovos produzidos até 77 dias de idade, embora essa seleção possa resultar em diminuição do peso de ovo. Conclui-se que a seleção de aves deve ser efetuada para menor maturidade sexual, pois, assim, estará selecionando também aves para maior produção de ovos.

Anticorpos policlonais em dietas com alta inclusão de concentrado para bovinos confinados / Polyclonal antibodies for feedlot cattle fed high-concentrate diets

Dentre as alternativas para substituir o uso de ionóforos classificados como antibiótico por alguns comitês, a utilização de anticorpos policlonais classificados como promotores de crescimento naturais tem se mostrado alternativa interessante e economicamente eficiente. Recentes estudos demonstraram pontos positivos na utilização desse aditivo em dietas com alta inclusão de ingredientes concentrados para bovinos confinados, traduzido por melhora de desempenho e saúde ruminal, em alguns casos, semelhantes à monensina sódica. No entanto, alguns pontos dessa nova tecnologia ainda devem ser elucidados, entre eles, a possível perda de atividade da forma sólida de apresentação do preparado e a diminuição do rendimento de carcaça encontrado em alguns estudos. Contudo, a presente revisão destaca a possibilidade de substituição da monensina sódica por anticorpos policlonais sem resultar em diminuição de desempenho e de rentabilidade para a bovinocultura de corte brasileira.

Among alternatives to replace ionophores, which are classified as antibiotics by some committees, the feeding of polyclonal antibodies have shown an interesting and economically efficient alternative. Recent studies have demonstrated some advantages of adding polyclonal antibodies into high-concentrate diets for feedlot cattle, showed by increased performance and ruminal health, in some cases similar to sodium monensin. However, there are blind spots of this innovated technology that still need to be elucidated, as example, if the dry form of the preparation is inactivated and decreased carcass-dressing percentage. All in all, this review demonstrates the possibility of replacing sodium monensin by this feed additive without negatively impacting animal performance and profit of cattle feeders in Brazil.

Tratamento endoscópico e complicações de corpos estranhos do trato digestivo superior: casuística de um hospital público / Endoscopic removal and complications of foreign bodies in upper digestive tract: experience of a public hospital

Introdução: a presença de Corpos Estranhos (CE) no trato digestivo superior se constitui em um dos principais motivos de atendimento em serviços de emergência em endoscopia. A ingestão de CE é um evento comum tanto em crianças quanto em adultos. Métodos: descrever os tipos de CE esôfago-gástricos mais encontrados durante a remoção endoscópica. Definir as características demográficas dos pacientes com CE atendidos no Serviço de Endoscopia e submetidos a procedimento endoscópico para sua retirada. Buscou-se ainda avaliar a incidência de complicações resultantes da impactação do CE ou da intervenção endoscópica e a taxa de tratamento cirúrgico. Foi realizada análise retrospectiva dos registros do pacientes submetidos à endoscopia digestiva para retirada de corpos estranhos no período entre março de 2007 e fevereiro de 2009. Resultados: foram avaliados retrospectivamente 43 pacientes admitidos na emergência do Hospital Público de Macaé com o quadro de impactação por corpo estranho em trato digestivo, com predomínio de homens, com média da idade. O tipo de CE mais frequente na casuística apresentada foi a moeda, predominante no subgrupo pediátrico. Em adultos e idosos, o CE preponderante foi o osso. O local de impactação de CE mais frequente foi o esôfago superior. A taxa de sucesso da retirada de CE foi de 95,3%.

Introduction: the presence of foreign bodies in the gastrointestinal tract is a major reason for care in emergency department. The impaction of foreign bodies is a common event in children, and also in adults. Methods: this study describes the types of foreign bodies most often found during endoscopic procedure. Define demographic patterns of the patients who underwent upper digestive endoscopy with the purpose of removing foreign bodies. To assess the incidence of complications resulting from impaction of the foreign bodies per se or those procedure related and the rate surgical treatment. It was performed a retrospective evaluation of medical records of these patients. Results: data of forty three patients admitted to the Emergency of Public Hospital of Macaé with impaction of foreign bodies in upper digestive tract, from march of 2007 to february of 2009. This analysis revealed a predominance of men, with a median age of 37.2 years. The most common foreign bodies encountered were coins, predominantly in the pediatric subgroup. In adults and elders, bones were the most frequent. The most frequent site of impaction was the upper esophagus. Foreign bodies were successfully removed in 95.3% of cases.

Médicos na atenção primária à saúde: as relações entre a formação e a prática do cuidado no cotidiano da APS: umestudo de caso a partir do PROVAB / Doctors in primary health care: the relationship between training and practice of care in the APS daily life: a case study from PROVAB

Este trabalho discute a prática do cuidado na Atenção Primária à Saúde (APS), articulando-a à formação dos médicos que a compõem no município do Rio de Janeiro. A ideia que conduz a investigação é que a formação tem implicações diretas no cuidado e este último provoca tensionamentos e aponta necessidades à formação. A discussão internacional vem considerando a APS o alicerce para a organização do sistema de saúde e, o Brasil, nesse processo, tem enfrentado muitos desafios. Foi grande a ampliação do mercado de trabalho na APS nos últimos anos, porém, ainda é pouco atrativo para os médicos. Além disso, há um déficit de profissionais se comparado a outros países com sistemas universais de saúde, o que torna a situação da APS ainda mais delicada, principalmente em áreas de maiores vulnerabilidades. Frente a este quadro, políticas de provimento vêm sendo articuladas, propostas e custeadas pelo Ministério da Saúde(MS), com vistas a aumentar o acesso à saúde da população. Destaca-se o Programa de Valorização da Atenção Básica (PROVAB). Além do provimento, tem objetivos formativos:exposição dos médicos aos espaços de trabalho da APS e especialização semipresencial. Este trabalho busca analisar e problematizar as relações entre processos de formação e as práticas do cuidado e, a partir delas, pensar se as mudanças propostas ao modelo atual de formação produzem impacto nas práticas do cuidado. O trabalho de campo consistiu na aplicação de 48questionários e em 05 entrevistas semidirigidas com médicos que estavam encerrando sua atuação no PROVAB. Os aspectos éticos foram contemplados, as entrevistas foram gravadas etodo o material foi transcrito e analisado.

Os questionários e as entrevistas abordaram as experiências em relação à realização da prática na APS, da supervisão presencial e da participação como aluno no Curso de Especialização em Saúde da Família na modalidade de EAD, suas representações sobre o cuidado e as ferramentas da APS. A pesquisa permitiu concluir que o PROVAB sensibiliza aqueles que dele participam, porém, a exposição desprotegida e quase solitária desses médicos ainda inexperientes a contextos tão complexos apresenta limitações e pode produzir efeitos contrários. E a supervisão tem papel central nesse processo. (AU)

This paper focuses on how primary health care is provided in Rio de Janeiro, taking into accountthe way physicians were trained. The idea behind the investigation is that professional medical education has direct implications for patient care and it causes tensions and points to needs interms of medical training. Several discussions worldwide consider primary care indispensableto the organization of the health systems and to improve the population's quality of life, andBrazil, in this process, has faced numerous challenges. There was a great expansion in the needfor health professionals in primary care, however this field of work still doesnt appeal to many physicians. Moreover, Brazil suffers from a deficit of health professionals compared to other countries with universal health care systems, which makes the situation even more delicate to primary care, especially in areas of greatest vulnerabilities. Given this situation, provision policies have been articulated, proposed and funded by the Brazilian Ministry of Health, in anattempt to meet the demands of increasing access to health care. Among these policies, the Programa de Valorização da Atenção Básica (PROVAB) stands out and is the focus of this study. In addition to improving provision, it also aims to qualify medical training, by exposing physicians to primary health care scenarios using blended learning strategies. Thus, this workaims to analyze and discuss the relationship between training and care practices and, from them, wonder whether the proposed changes to the current training model have an impact on care practices. The field work consisted of the application of 48 questionnaires and 05 semistructured interviews with physicians who were ending their period in the PROVAB. All ethical aspects were followed. The interviews were recorded and all the material was transcribed and analyzed.

Questionnaires and interviews covered the experiences regarding medical practice in PHC, the face-to-face supervision, the participation as a student in the online Family Health specialization program, their thoughts about care and the primary health care tools. The research concluded that the PROVAB sensitizes those who participate in it, however, unprotected and almost solitary exposure of such inexperienced doctors to so complex contexts has limitations and may produce adverse effects. And the supervision plays a central role in this process. (AU)

Estudio experimental sobre quimioterapia focalizada en riñón mediante arpón magnético y administración intravenosa de nanopartículas ferrocarbonosas / Research study on renal targeted chemotherapy with magnetic harpoons and intravenous administration of ferro-carbon nanoparticles

OBJETIVOS: El empleo de nanopartículas en el transporte de fármacos es actualmente uno de los temas de interés prioritario dentro del campo de la investigación biomédica. Nuestro objetivo es mostrar los resultados iniciales de un método inédito para focalizar en órganos sólidos nanopartículas ferro carbonosas quimioportadoras. Hemos obtenido y caracterizado diversos tipos de nanopartículas ferromagnéticas, y hemos estudiado su comportamiento in vitro e in vivo en animales de experimentación con dianas magnéticas intrarrenales implantadas laparoscópicamente. METODOS: Obtenemos mediante arco de plasma nanopartículas ferro carbonosas capaces de absorber y desorber doxorrubicina y mostrar excelente comportamiento en estudios reológicos in vitro. Bajo anestesia general insertamos mediante control laparoscópico en el riñón izquierdo de conejos de raza neozelandesa un microarpón magnético encapsulado en oro. En el mismo acto inyectamos por vía intravenosa diferentes dosis de distintos tipos de nanopartículas. Los diversos lotes de animales se sacrifican tras diferentes tiempos y se analizan histológicamente ambos riñones, bazo, hígado, pulmones y médula ósea. RESULTADOS: Tras haber seleccionado las nanopartículas más adecuadas para nuestros fines, hemos constatado en los estudios post-mortem diferencias significativas en la distribución de las nanopartículas, con cúmulos de las mismas en la diana magnética y en el parénquima renal circundante. No obstante, el sistema retículoendotelial retiene gran parte de la carga inyectada. CONCLUSIONES: Aunque nuestro sistema de focalización magnética resulta efectivo, deben ensayarse sistemas de blindaje temporal de las nanopartículas que les permita eludir la acción del sistema inmune (AU)

OBJECTIVES: The use of nanoparticules for drug transport is one of the topics with priority interest within the field of biomedical research. Our objective is to show the initial results of an innovative method to focalize drug carrier ferro-carbon nanoparticules to solid organs. We obtained and characterized various types of ferrous magnetic nanoparticules and studied their behaviour in vitro and in vivo in laboratory animals with intrarenal magnetic targets laparoscopically implanted. METHODS: Using a plasma arch we obtained ferro-carbon nanoparticules with the ability to absorb and deliver doxorubicin, showing an excellent behaviour in in vitro rheological studies. Under general anesthesia and control we inserted a gold covered magnetic microharpoon in the left kidney of New Zealand rabbits. At the same time we injected intravenously different doses of various types of nanoparticules. The animals were sacrified ofter pre-established times and pathologic studies of their kidneys, spleens, livers, lungs and bone marrow were carried out. RESULTS: After selection of the most adequafe nanoparticules for our purposes, we ascertained significant differences in the distribution of nanoparticules in postmortem studies, with accumulation in the magnetic target and surrounding renal parenchyma. Nevertheless, the reticuloendothelial system retains a great amount of the injected dose. CONCLUSIONS: Although our magnetic focalization system is effective, nanoparticule temporary protection systems should be tested to allow us avoid the action of the immune system (AU)

Os itinerários terapêuticos de usuários de Centros de Atenção Psicossocial para crianças e adolescentes (CAPS-i) do município de São Paulo / The therapeutic routes of users of psychosocial care centers for children and adolescents (CAPS-i) in the city of São Paulo

O presente estudo teve por objetivo investigar os itinerários terapêuticos de usuários de Centros de Atenção Psicossocial para crianças e adolescentes (CAPSi) do município de São Paulo. Os CAPSi são serviços da rede de saúde mental do Sistema Único de Saúde (SUS). Oferecem atendimentos interdisciplinares e comunitários às crianças e adolescentes com transtornos mentais graves. Para a investigação, foi realizada uma pesquisa qualitativa composta de 8 (oito) entrevistas qualitativas semi-dirigidas com os chamados cuidadores informais destes usuários. Em todos os casos, estes cuidadores informais foram as mães dos usuários. O referencial teórico adotado foi fundamentalmente a obra de Milton Santos, embora tenham sido feitas articulações com a concepção psicanalítica de sujeito. A técnica de tratamento dos dados foi a análise de conteúdo. Os entrevistados abordaram: a) a descoberta do problema com a saúde mental da criança e o início do itinerário, enfatizando os sintomas que chamaram à atenção para um problema com a saúde mental da criança e o momento entre estes sintomas e os primeiros passos do itinerário; b) os encaminhamentos e caminhadas na busca por profissionais e serviços, ressaltando-se o modelo biomédico, as distintas especialidades e os excessivos deslocamentos e dificuldades nesta busca; c) as relações entre as mães (cuidadores informais), as crianças e os serviços, destacando-se a incondicionalidade do amor materno e, simultaneamente, a angústia e solidão dessas mães na procura pelos distinto tratamentos; e d) a chegada ao CAPSi e, a partir daí, a mudança da lógica pela qual vinham sendo desenhados os itinerários até então. Através da análise das entrevistas articulada à bibliografia de referência, pôde-se perceber que as dificuldades e barreiras encontradas na busca pelos cuidados e tratamentos em saúde mental se referiam a diversos fatores: grande valorização das especialidades profissionais na procura por tratamento; prestadores de serviços muito...