Caryocar brasiliense induces vasorelaxation through endothelial Ca2+/calmodulin and PI3K/Akt/eNOS-dependent signaling pathways in rats

ABSTRACT Caryocar brasiliense Cambess., Caryocaraceae (pequi) is a typical Brazilian Cerrado tree. A previous study showed that the butanolic fraction of pequi leaves promotes endothelium-dependent relaxation mediated by nitric oxide and that it causes reversible hypotension in rats. In the present study, we investigated the cell signaling pathways associated with the butanolic fraction-induced nitric oxide release, and we characterized the chemical composition of its fraction. Vascular reactivity tests, a western blotting analysis, and a chemiluminescence assay were used to investigate the signaling pathways involved in the vasorelaxant effect of the butanolic fraction. Electrospray Ionization Fourier Transform Ion Cyclotron Resonance Mass Spectrometry was used to characterize the butanolic fraction chemical composition. Vasorelaxation was mediated through the activation of the calmodulin and phosphatidylinositol 3-kinase (PI3K)/Akt signaling pathways, leading to subsequent endothelial nitric oxide synthase phosphorylation and nitric oxide production, as evidenced by western blotting and chemiluminescence assays, respectively. The chemical characterization of the butanolic fraction revealed the presence of 72 oxygenated compounds, whose molecular formulae are compatible with phenolic compounds, suggesting a potential contribution of these compounds for the butanolic fraction vasorelaxant effect. These findings show that the calmodulin and phosphatidylinositol 3-kinase (PI3K)/Akt signaling pathways are involved in the butanolic fraction-induced endothelial nitric oxide synthase activation and are promoted by polyphenol compounds present in the C. brasiliense leaves.

Fractional Flow Reserve-Guided Strategy in Acute Coronary Syndrome. A Systematic Review and Meta-Analysis / Estratégia Guiada por Reserva de Fluxo Fracionada na Síndrome Coronária Aguda: Revisão Sistemática Metanálise

Abstract Background: There are limited data on the prognosis of deferral of lesion treatment in patients with acute coronary syndrome (ACS) based on fractional flow reserve (FFR). Objectives: To provide a systematic review of the current evidence on the prognosis of deferred lesions in ACS patients compared with deferred lesions in non-ACS patients, on the basis of FFR. Methods: We searched Medline, EMBASE, and the Cochrane Library for studies published between January 2000 and September 2017 that compared prognosis of deferred revascularization of lesions on the basis of FFR in ACS patients compared with non-ACS patients. We conducted a pooled relative risk meta-analysis of four primary outcomes: mortality, cardiovascular (CV) mortality, myocardial infarction (MI) and target-vessel revascularization (TVR). Results: We identified 7 studies that included a total of 5,107 patients. A pooled meta-analysis showed no significant difference in mortality (relative risk [RR] = 1.44; 95% CI, 0.9-2.4), CV mortality (RR = 1.29; 95% CI = 0.4-4.3) and TVR (RR = 1.46; 95% CI = 0.9-2.3) after deferral of revascularization based on FFR between ACS and non-ACS patients. Such deferral was associated with significant additional risk of MI (RR = 1.83; 95% CI = 1.4-2.4) in ACS patients. Conclusion: The prognostic value of FFR in ACS setting is not as good as in stable patients. The results demonstrate an increased risk of MI but not of mortality, CV mortality, and TVR in ACS patients.

Resumo Fundamento: Existem dados limitados sobre o prognóstico do adiamento do tratamento das lesões em pacientes com síndrome coronária com base na reserva de fluxo fracionada (FFR). Objetivos: Realizar uma revisão sistemática da evidência atual sobre o prognóstico do adiamento do tratamento de lesões em pacientes com SCA com base na FFR, comparando-o com o prognóstico em pacientes sem SCA. Métodos: Pesquisamos as bases de dados do Medline, EMBASE, e Cochrane Library por estudos publicados entre janeiro de 2000 e setembro de 2017 que compararam o prognóstico do adiamento da revascularização das lesões com base na FFR em pacientes com SCA em comparação a pacientes sem SCA. Conduzimos uma metanálise do risco relativo de quatro desfechos primários: mortalidade, mortalidade cardiovascular, infarto do miocárdio (IM) e revascularização do vaso-alvo (TVR). Resultados: Identificamos sete estudos que incluíram um total de 5107 pacientes. A metanálise mostrou que não houve diferença quanto à mortalidade [risco relativo (RR) = 1,44; IC95%, 0,9-2,4), mortalidade cardiovascular (RR = 1,29; IC95% = 0,4-4,3) e TVR (RR = 1,46; IC95% = 0,9-2,3) após adiamento da revascularização com base na FFR entre pacientes com SCA e pacientes sem SCA. Tal adiamento foi associado com risco adicional de IM (RR = 1,83; IC95% = 1,4-2,4) em pacientes com SCA. Conclusão: O valor prognóstico da FFR na SCA não é tão bom como em pacientes estáveis. Os resultados mostram um risco aumentado de IM, mas não de mortalidade, mortalidade cardiovascular, e TVR em pacientes com SCA.

Adherence to antiretroviral therapy and correlation with adverse effects and coinfections in people living with HIV/AIDS in the municipality of Goiás State

Abstract INTRODUCTION: Acquired immunodeficiency syndrome is an advanced stage of a human immunodeficiency virus infection. The antiretroviral therapy aims to improve the life quality of HIV patients and a good adherence is essential for a better prognosis. This study aimed to evaluate the adherence of human immunodeficiency virus/acquired immunodeficiency syndrome patients to antiretroviral therapy recommended by the Brazilian health system in Anápolis/Goiás, and correlate the level of adherence with sociodemographic data and clinical-laboratory variables. METHODS Adherence to antiretroviral therapy was assessed using the Questionnaire for Evaluation of Adherence to Antiretroviral Therapy. The sociodemographic data were collected using a standardized questionnaire and the clinical-laboratory records were reviewed. RESULTS: Among 220 patients included, 59% (129/220) were men and the average age was 41 years. Infection was acquired primarily through sexual contact (92%, 202/220), and 69% (152/220) of the patients were heterosexual. Approximately 86% (188/220) of the patients had good or strict adherence to antiretroviral therapy. In our study, the use of illicit drugs was associated with low adherence to antiretroviral therapy (p=0.0004), and no significant association was observed between adherence levels and other sociodemographic data (p>0.05). The logistic regression indicated that adverse effects (p=0.0018) and sexual orientation (p=0.0152) were associated with the level of adherence to antiretroviral therapy. Patients with good or strict adherence had higher CD4+T lymphocyte count (p<0.0001) and undetectable viral load (p<0.0001). Patients with low adherence (14%, 32/220) had higher frequency of adverse events (p=0.0009). The frequency of coinfections was 25% (55/220), with syphilis and tuberculosis being the most common coinfections. CONCLUSIONS: Adherence was related to use of illicit drugs, adverse effects, and sexual orientation.

Financial cost of the admissions for simultaneous pancreas-kidney transplant in a Brazilian Hospital

PURPOSE: To perform a cost analysis of simultaneous pancreas-kidney transplantation (SPKT) in a Brazilian hospital. METHODS: Between January 2008 and December 2011, 105 consecutive SPKTs at the Hospital of Kidney and Hypertension in Sao Paulo were evaluated. We evaluated the patient demographics, payment source (public health system or supplementary system), and the impact of each hospital cost component. The evaluated costs were corrected to December 2011 values and converted to US dollars. RESULTS: Of the 105 SPKT patients, 61.9% were men, and 38.1% were women. Eight patients died, and 97 were discharged (92.4%). Eighty-nine procedures were funded by the public health system. The cost for the patients who were discharged was $18.352.27; the cost for the deceased patients was $18.449.96 (p = 0.79). The FOR for SPKT during this period was positive at $5,620.65. The costs were distributed as follows: supplies, 36%; administrative costs, 20%; physician fees, 15%; intensive care unit, 10%; surgical center, 10%; ward, 9%. CONCLUSION: Mortality did not affect costs, and supplies were the largest cost component. .

Produção e qualidade de botões de rosa c v. Vega cultivados sob plásticos de cobertura com diferentes anos de uso / Production and quality of floral buds for rose cv. Vega (Rosa SP.) cultivated under plastic with different years of use

Objetivou-se, neste trabalho, avaliar a produção e qualidade de botões de rosa cultivar Vega ( Rosa sp. ), cultivada sob cobertura plástica com diferentes anos de uso. Para tanto foram selecionados 15 vãos de estufas com plásticos colocados em 1998, 1999, 2002, 2003, e testemunha (sem uso anterior), com três repetições, avaliados por duas maneiras: na primeira os frutos foram colhidos através de uma poda (como procedimento do cultivo comercial); na segunda foi realizada uma poda rasa em uma área de 1 m² para poder acompanhar o crescimento da haste floral desde o início da formação até a fase de botão floral. No primeiro caso foram realizadas 4 coletas ao longo do período do experimento, nas quais foram coletadas 4 hastes florais por tratamento, totalizando 60 flores por data de coleta. No segundo caso foi avaliado o aparecimento dos botões florais dos novos brotos em quatro datas até a formação das hastes florais comerciais, e então coletadas 13 hastes florais por tratamento. Não houve diferença estatística entre os anos de uso dos plásticos de 1998, 1999, 2002 e 2003 nas variáveis: comprimento, diâmetro e comprimento dos botões florais, massa fresca e seca das pétalas, para as condições e cultivar analisados. Com isso o produtor ganha um período maior de utilização do plástico gerando um custo menor, sem perdas na produção.

The aim of this study was to evaluate the production and quality of floral buds of rose cv. Vega (Rosa sp.) cultivated underneath a plastic film used as greenhouse covering, with different years of use. In order to evaluate the bud production and quality, 15 greenhouse gaps with plastic covering dating from 1998, 1999, 2002, 2003, were selected; and the control covering (never used before) with three replications each. Two types of evaluation were made for this analysis: the first one, the fruits were harvested by means of pruning (as the commercial use standard procedure); in the second evaluation a clear cut pruning was conducted in an area of 1m² with the purpose of determining the development of the flower buds from the pruning to the commercial flower stalk. On the first evaluation, 4 harvestings were conducted during the entire experiment period, in which 4 flower stalks per treatments were collected, totaling 60 flowers per collecting date. On the second evaluation, floral buds emerging on new shoots were determined in four different dates until commercial flower stalks complete formation was achieved, then 13 flower stalks per treatment were collected. There was no statistical difference among the plastic films with different years of use regarding stalk length and diameter, flower bud diameter and length, dry and fresh petal mass under the analyzed conditions and cultivars, translating into a larger period of plastic covering use without loss in the production at a low production cost.

O rato como modelo experimental do diabetes - estudo clínico-laboratorial / The rat as a model to experimental diabetes - a clinical and laboratory study

Em 90 ratos da raça Wistar, divididos igualmente em três grupos experimentais - grupo normal (GC), grupo diabético (GD) e grupo diabético tratado (GT) - foram estudados parâmetros clínicos (comportamento, atividade, aspecto geral, peso, ingestäo hídrica e diurese) e bioquímicos (glicemia de jejum e glicose urinária). O diabetes foi induzido por aloxana e o tratamento feito com insulina associada a hipoglicemiante oral (acarbose). As observaçöes foram efetuadas em cinco momentos experimentais: 1, 3, 6, 9 e 12 meses após a induçäo do diabetes, e os resultados submetidos a análise de variância, adotando-se o nível de significância de 5 por cento. Os ratos de GD tiveram peso inferior e diurese mais elevada cem relaçäo aos do GC e do GT. A ingestäo hídrica do GD foi semelhante à do GT. Os níveis de glicemia do GD foram sempre superiores aos do GC, enquanto o GT teve glicemia semelhante ao GC, exceto nas dosagens de 3 e 9 meses. Os níveis de glicose urinária do GD e do GT foram semelhantes entre si e superiores aos do GC.

Megacolon congenito no recem-nascido.Diagnostico e tratamento. / Congenital megacolon in the newborn infant. Diagnosis and treatment

Os autores apresentam sua experiencia no tratramento do megacolon congenito do recem-nascido na Disciplina de Cirurgia Pediatrica da Escola Paulista de Medicina. Sao feitas consideracoes a respeito do historico da molestia, do quadro clinico e dos principais metodos propedeuticos utilizados para o diagnostico da patologia, ou seja, o exame radiologico, a manometria anorretal e a biopsia com coloracao histoquimica para pesquisa da atividade da enzima acetil-colinesterase. Os autores apresentam a conduta adotada em 46 casos de sua casuistica

Invaginacao colo-colica cronica. Apresentacao de um caso. / Chronic colonic intussusception. Report of a case

Os autores apresentam um caso de invaginacao colo-colica-cronica (30 dias), devido a um polipo juvenil do colo descendente. Tecem comentarios sobre a incidencia, quadro clinico, radiologico e tratamento desta patologia