Levels of bioavailable, and free forms of 25(OH)D after supplementation with vitamin D3 in primary hyperparathyroidism.

The 25 hydroxyvitamin D [25(OH)D] is the major metabolite for ascertaining vitamin D status, which circulates bound to a specific carrier (vitamin D-binding protein - VDBP). A portion that circulates unbound vary according to the VDBP genotype. This study evaluates the behavior of different forms of 25(OH)D, before and after supplementation with 14,000 IU of vitamin D3, weekly for 12 weeks, in individuals with primary hyperparathyroidism and controls. Fifty-six patients with active primary hyperparathyroidism (PHPT) and 64 paired controls (CTRL), not taking vitamin D3 for the last three months, were enrolled. The genetic isotypes of VDBP were determined to calculate bioavailable and free 25(OH)D. A p < 0.05 was considered significant. There were no statistical differences in free, bioavailable, and total 25(OH)D levels between PHPT and CTRL groups at baseline. The distribution of VDBP haplotypes 1s/1s, 1f/1f, 1s/1f, 2/2, 1s/2, and 1f/2 was similar between groups. After supplementation, all three forms of 25(OH)D proportionally increased within each group, although the percentage increment was lower in the PHPT group (p < 0.05). Total 25(OH)D is better correlated with PTH in the PHPT group than bioavailable and free 25(OH)D (r = -0.41; p < 0.05). The concentrations of total, free, and bioavailable 25(OH)D were similar in both PHPT and CTRL groups, and all forms increased proportionally after supplementation, although this increment percentage was higher in the CTRL group, with a subsequent reduction of PTH and AP. Total 25(OH)D correlated better with PTH than other forms, suggesting no advantages in measuring free or bioavailable 25(OH)D in these situations.

Two-year risedronate treatment for osteoporosis in patients with esophageal varices: a non-randomized clinical trial.

BACKGROUND: Bisphosphonates are the mainstay of osteoporosis treatment, but their use for patients with esophageal varices has been avoided due to the risk of esophagitis, which may cause variceal bleeding. Since most clinical trials assessing osteoporosis treatment last 2-3 years, this study aimed to evaluate a 2-year risedronate treatment for patients with esophageal varices and liver cirrhosis. METHODS: The study received Institutional Review Board approval, and the sample was divided into two groups according to bone mineral density (BMD). Cirrhosis severity and endoscopic findings at baseline were similar between the groups. The intervention group had 51 patients with osteoporosis, who received oral risedronate 35 mg weekly plus calcium and vitamin D supplements. The control group had 51 patients with osteopenia, receiving only the supplements. Scheduled esophagogastroduodenoscopies and BMD measurements were carried out. RESULTS: The adjusted esophagitis risk was higher in the intervention group; however, none of the subjects had digestive bleeding. Lumbar spine BMD increased in the intervention group (- 3.06 ± 0.71 to - 2.33 ± 0.90; p < 0.001) and in the control group (- 1.38 ± 0.77 to - 1.10 ± 1.05; p = 0.012). Femoral neck BMD did not change in the intervention group (- 1.64 ± 0.91 to - 1.71 ± 0.95; p = 0.220), but tended to decrease in the control group (- 1.00 ± 0.74 to - 1.09 ± 0.82; p = 0.053). CONCLUSION: Oral risedronate was effective and did not cause gastrointestinal bleeding in cirrhotic patients with esophageal varices under endoscopic surveillance.

Autoeficácia de puérperas em amamentar: estudo longitudinal / Autoeficacia de puérperas en la lactancia materna: estudio longitudinal / Self-efficacy of puerperal women in breastfeeding: a longitudinal study

Resumo Objetivo avaliar a autoeficácia de puérperas, ao longo do período puerperal, quanto ao potencial em amamentar. Método estudo longitudinal, do tipo painel, realizado de maio a dezembro de 2015, em Alojamento Conjunto de maternidade de referência de Fortaleza, Ceará, Brasil, delimitado em quatro momentos. O primeiro ocorreu por contato presencial na maternidade e os três contatos subsequentes foram realizados por meio telefônico aos dois, quatro e seis meses pós-parto. A amostra foi de 66 puérperas. Resultados observou-se aumento da mediana dos escores da escala de autoeficácia em amamentar ao longo dos meses. A maioria das puérperas apresentou nível elevado de autoeficácia, entretanto, a prática do aleitamento materno exclusivo apresentou declínio progressivo, chegando a 17,9% aos seis meses. Conclusão e implicações para a prática as puérperas participantes apresentaram aumento progressivo dos escores da escala de autoeficácia ao longo do tempo, mantendo níveis de elevada e média autoeficácia em amamentar. Logo, este estudo pode direcionar novas pesquisas de intervenção, bem como subsidiar a prática holística dos profissionais que apoiam a amamentação.

Resumen Objetivo evaluar la autoeficacia de puérperas a lo largo del puerperio en cuanto a su potencialidad para amamantar. Método estudio longitudinal del tipo panel, realizado de mayo a diciembre de 2015, en el Alojamiento Conjunto de una maternidad de referencia en Fortaleza, Ceará, delimitado en cuatro momentos. El primero ocurrió por contacto presencial en la maternidad y los tres contactos posteriores se realizaron telefónicamente a los dos, cuatro y seis meses posparto. La muestra fue de 66 puérperas. Resultados hubo un aumento en la mediana de puntuaciones de la escala de autoeficacia para lactancia materna a lo largo de los meses. La mayoría de las puérperas mostró un alto nivel de autoeficacia, sin embargo, la práctica de lactancia materna exclusiva mostró un declive progresivo llegando al 17,9% a los seis meses. Conclusión e implicaciones para la práctica Las puérperas mostraron un aumento progresivo en los puntajes de la escala de autoeficacia a lo largo del tiempo, manteniendo niveles de autoeficacia alta y media en la lactancia materna. Por lo tanto, este estudio puede orientar nuevas investigaciones de intervención, así como subsidiar la práctica holística de los profesionales que apoyan la lactancia materna.

Abstract Objective to evaluate the self-efficacy of puerperal women throughout the puerperal period regarding their potential to breastfeed. Method longitudinal panel study was performed from May to December 2015 in postpartum rooms of a reference maternity hospital in Fortaleza (Ceará State, Brazil). The study was separated into four moments: the first occurred through a face-to-face meeting at the maternity hospital, and the three subsequent encounters were made by telephone two, four, and six months postpartum. The sample was composed of 66 puerperal women. Results there was an increase in the mean scores of the self-efficacy scale for breastfeeding throughout the months, and most puerperal women showed a high self-efficacy level, although the practice of exclusive breastfeeding showed a progressive decline and reached 17.9% at six months. Conclusions and implications for practice The puerperal women showed progressively higher self-efficacy scores over time, maintaining high and medium self-efficacy levels in breastfeeding. Therefore, this study can direct new intervention research and subsidize the holistic practice of professionals who support breastfeeding.

Effect of Carnosine or ß-Alanine Supplementation on Markers of Glycemic Control and Insulin Resistance in Humans and Animals: A Systematic Review and Meta-analysis.

There is growing evidence that supplementation with carnosine, or its rate-limiting precursor ß-alanine, can ameliorate aspects of metabolic dysregulation that occur in diabetes and its related conditions. The purpose of this systematic review and meta-analysis was to evaluate the effect of carnosine or ß-alanine supplementation on markers of glycemic control and insulin resistance in humans and animals. We performed a systematic search of 6 electronic databases up to 31 December 2020. Primary outcomes were changes in 1) fasting glucose, 2) glycated hemoglobin (HbA1c), and 3) 2-h glucose following a glucose-tolerance test. A set of additional outcomes included fasting insulin and homeostatic model assessment of ß-cell function (HOMA-ß) and insulin resistance (HOMA-IR). We assessed risk of bias using the Cochrane risk of bias (RoB) 2.0 (human studies) and the Systematic Review Center for Laboratory Animal Experimentation (SYRCLE) RoB (animal studies) tools; and used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess certainty. We used Bayesian hierarchical random-effects models, with informative priors for human data and noninformative priors for animal data. Inferences were made on posterior samples generated by Hamiltonian Markov Chain Monte Carlo using 90% credible intervals (90% CrI) and calculated probabilities. Twenty studies (n = 4 human, n = 16 rodent) were included, providing data for 2 primary outcomes (fasting glucose and HbA1c) and 3 additional outcomes (fasting insulin, HOMA-ß, and HOMA-IR). The model provides evidence that supplementation decreases fasting glucose [humans: mean difference (MD)0.5 = -0.95 mmol · L-1 (90% CrI: -2.1, 0.08); rodent: MD0.5 = -2.26 mmol · L-1 (90% CrI: -4.03, -0.44)], HbA1c [humans: MD0.5 = -0.91% (90% CrI: -1.46, -0.39); rodents: MD0.5 = -1.05% (90% CrI: -1.64, -0.52)], HOMA-IR [humans: standardized mean difference (SMD)0.5 = -0.41 (90% CrI: -0.82, -0.07); rodents: SMD0.5 = -0.63 (90% CrI: -1.98, 0.65)], and fasting insulin [humans: SMD0.5 = -0.41 (90% CrI: -0.77, -0.07)]. GRADE assessment showed our certainty in the effect estimate of each outcome to be moderate (human outcomes) or very low (rodent outcomes). Supplementation with carnosine or ß-alanine may reduce fasting glucose, HbA1c, and HOMA-IR in humans and rodents, and fasting insulin in humans; both compounds show potential as therapeutics to improve glycemic control and insulin resistance. This review was registered at PROSPERO as CRD42020191588.

The effect of carnosine or ß-alanine supplementation on markers of glycaemic control and insulin resistance in human and animal studies: a protocol for a systematic review and meta-analysis.

BACKGROUND: Diabetes is a major public health issue and there is a need to develop low-cost, novel interventions to prevent or reduce disease progression. Growing evidence shows that supplementation with carnosine, or its rate-limiting precursor ß-alanine, can ameliorate aspects of the metabolic dysregulation that occurs in diabetes. There is, however, a need to develop a better understanding of the magnitude of effect and the factors associated with positive outcomes. The purpose of this systematic review and meta-analysis is to evaluate the effect of carnosine or ß-alanine supplementation on markers of glycaemic control and insulin resistance in humans and animals. METHODS: We will perform a systematic search for randomised and non-randomised controlled trials. Studies will be retrieved by searching electronic databases, clinical trial registers, author review, and cross-referencing. Primary outcomes include changes in (i) fasting glucose, (ii) glycated haemoglobin, and (iii) 2-h glucose following a glucose tolerance test. A set of additional outcomes includes other markers of glycaemic control and insulin resistance. Risk of bias (RoB) will be assessed using the Cochrane RoB 2.0 tool (human studies) and the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) RoB tool (animal studies). Confidence in the cumulative evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. All meta-analyses will be conducted within a Bayesian framework, providing a flexible modelling approach to account for uncertainty in model parameters and underlying structures within the data. DISCUSSION: By including all available human and animal data, we will provide the most comprehensive overview on the topic to date. The results will have implications for those working in prediabetes, diabetes, and metabolic health in general and may lead to the development of new treatment approaches. DISSEMINATION: Study results will be presented at a professional conference and published in a peer-reviewed journal. SYSTEMATIC REVIEW REGISTRATION: CRD42020191588.

Development of an Educational Protocol Based on a Nursing Team's Knowledge of Pulse Therapy in Adolescents in Brazil.

The aim of this study was to assess the knowledge of nursing teams that care for hospitalized adolescents undergoing glucocorticoid infusion and to develop an educational protocol for nursing care during pulse therapy. This descriptive, exploratory study with a qualitative approach was developed in a unit specializing in adolescent health at a university hospital in the state of Rio de Janeiro, Brazil. The instrument used for data collection was a semistructured interview conducted in a private room on the unit. The main results indicated that nursing knowledge was focused on the need to evaluate hemodynamic parameters, the care required during infusion therapy, and the complications resulting from the treatment. Educational material was developed to support a holistic view of the adolescent undergoing pulse therapy. Based on information received from the nursing team, it was determined that, although the team performed all the technical aspects of the infusion procedure well, their care did not address specific needs of the adolescent patient, guidance on infection prevention, or hemodynamic evaluation. After evaluating the nursing team's experience, knowledge, and perceptions, the researchers were able to develop appropriate protocols to guide care for hospitalized adolescents undergoing glucocorticoid infusion therapy.

Insulin does not stimulate ß-alanine transport into human skeletal muscle.

To test whether high circulating insulin concentrations influence the transport of ß-alanine into skeletal muscle at either saturating or subsaturating ß-alanine concentrations, we conducted two experiments whereby ß-alanine and insulin concentrations were controlled. In experiment 1, 12 men received supraphysiological amounts of ß-alanine intravenously (0.11 g·kg-1·min-1 for 150 min), with or without insulin infusion. ß-Alanine and carnosine were measured in muscle before and 30 min after infusion. Blood samples were taken throughout the infusion protocol for plasma insulin and ß-alanine analyses. ß-Alanine content in 24-h urine was assessed. In experiment 2, six men ingested typical doses of ß-alanine (10 mg/kg) before insulin infusion or no infusion. ß-Alanine was assessed in muscle before and 120 min following ingestion. In experiment 1, no differences between conditions were shown for plasma ß-alanine, muscle ß-alanine, muscle carnosine and urinary ß-alanine concentrations (all P > 0.05). In experiment 2, no differences between conditions were shown for plasma ß-alanine or muscle ß-alanine concentrations (all P > 0.05). Hyperinsulinemia did not increase ß-alanine uptake by skeletal muscle cells, neither when substrate concentrations exceed the Vmax of ß-alanine transporter TauT nor when it was below saturation. These results suggest that increasing insulin concentration is not necessary to maximize ß-alanine transport into muscle following ß-alanine intake.

Fitotoxicidade in vitro de extratos de Mikania laevigata Schultz Bip. ex de Baker sobre Lactuca sativa L. e Bidens pilosa L. / In vitro phytotoxicity of Mikania laevigata Schultz Bip. ex Baker extracts on Lactuca sativa L. and Bidens pilosa L

Extratos vegetais possuem metabólitos secundários que podem atuar como bioherbicidas com a vantagem de promoverem menores riscos ao ambiente. Mikania laevigata pertence à família Asteraceae e possui a cumarina 1,2-benzopirona como marcador químico, capaz de inibir ou estimular a germinação e crescimento de plantas adjacentes. Diante do exposto, objetivou-se avaliar a fitotoxicidade dos extratos aquoso e etanólico de M. laevigata sobre Lactuca sativa (alface) e Bidens pilosa (picão preto). Foram testadas cinco concentrações (0,1; 1,0; 1,5; 2,0 e 3,0 mg.mL-1) dos extratos, aquoso e etanólico, em experimentos separados, e água destilada como controle. Para isso, foram avaliados a porcentagem de germinação, o índice de velocidade de germinação, o crescimento inicial e os teores de peróxido de hidrogênio (H2O2) e do malonaldeido (MDA). Na presença do extrato etanólico, as espécies (alface e picão preto) reduziram 85 e 90% da germinação, respectivamente. O comprimento da radícula, na menor concentração dos extratos, não foi afetado. Entretanto, na concentração de 2,0 mg.mL-1, as reduções foram de 85%, para alface, e 65%, para picão preto. O aumento do teor de H2O2 foi dose dependente, ou seja, conforme o aumento da concentração dos extratos maior a produção de peróxido, seguido do aumento do MDA para alface e picão preto. As plântulas cultivadas na concentração de 3 mg.mL-1 do extrato etanólico sofreram necrose, impossibilitando as análises subsequentes. Os extratos da M. laeviagata nas concentrações 2,0 e 3,0 mg.mL-1 demonstraram fitointoxicação com aumento do estresse oxidativo nas espécies alface e picão preto.

Plant extracts have secondary metabolites that can act as bioherbicides, with the advantage of being more environmentally friendly. Mikania laevigata belongs to the family Asteraceae and has coumarin 1,2-benzopyrone as a chemical marker, which is capable of inhibiting or stimulating the germination and growth of adjacent plants. Thus, the objective of this work was to evaluate the phytotoxicity of aqueous and ethanolic extracts of M. laevigata on Lactuca sativa (lettuce) and Bidens pilosa (beggarticks). Five concentrations (0.1, 1.0, 1.5, 2.0 and 3.0 mg.mL-1) of aqueous and ethanolic extracts were tested in separate experiments, with distilled water as the control. Germination percentage, germination speed index, initial growth and the content of hydrogen peroxide (H2O2) and malonaldehyde (MDA) were evaluated. In the presence of the ethanolic extract, germination of the species (lettuce and beggarticks) was reduced by 85% and 90%, respectively. Radicle length, for the lowest concentration of the extracts, was not affected. However, at a concentration of 2.0 mg.mL-1 the reductions were 85% for lettuce and 65% for beggarticks. The increase of H2O2 content depended on the dose, where the greater the concentration of the extracts, the greater the production of peroxide, followed by an increase in MDA for lettuce and beggarticks. Seedlings grown in a concentration of 3.0 mg.mL-1 of the ethanolic extract were subjected to necrosis, making subsequent analyses impossible. The M. laeviagata extracts at concentrations of 2.0 and 3.0 mg.mL-1 demonstrated phytotoxicity, with increased oxidative stress in lettuce and beggarticks.

Safety and efficacy of risedronate for patients with esophageal varices and liver cirrhosis: a non-randomized clinical trial.

Despite the high prevalence of osteoporosis in liver cirrhosis, the indication of bisphosphonates for patients with esophageal varices has been avoided due to risk of digestive mucosal damage. Therefore, this study aimed to evaluate the safety profile of risedronate treatment for patients with osteoporosis, liver cirrhosis and esophageal varices with low risk of bleeding. A total of 120 patients were allocated into two groups according to their bone mineral density measured by dual-energy X-ray absorptiometry. In the intervention group, 57 subjects with osteoporosis received oral risedronate at 35 mg weekly plus daily calcium and vitamin D supplementation. In the control group, 63 subjects with osteopenia received only calcium and vitamin D. The groups received the treatment for one year and underwent surveillance endoscopies at six and 12 months, as well as a control dual-energy X-ray absorptiometry after a 12-month follow-up. The study received Institutional Review Board approval. The groups had not only comparable Model for End-stage Liver Disease score and esophageal varices degree, but also similar incidence of digestive adverse effects. A significant improvement was achieved in the intervention group in the lumbar spine T score (p < 0.001). The results suggest that risedronate may be safely used in liver cirrhosis and esophageal varices with low bleeding risk under endoscopic surveillance, thus allowing bone mass recovery.

Effect of low-level laser therapy and zoledronic acid on bone repair process.

This study aimed to evaluate, through histomorphometric analysis, the bone repair process in the tibia of rats treated with zoledronic acid and submitted to 808-nm low-level laser therapy (LLLT) by using arsenide aluminum gallium laser. For this purpose, 20 rats were used and distributed according to treatment: group 1-saline administration; group 2-treated with LLLT; group 3-treated with zoledronic acid; and group 4-treated with zoledronic acid and LLLT. The zoledronic acid was administered at a dose of 0.035 mg/kg every 2 weeks for 8 weeks. Subsequently, bone defects of 2 mm were prepared in the tibias of all groups. The bone defects in groups 2 and 4 were irradiated with LLLT in the immediate post-operative period. After 14 and 28 days of application, the animals were submitted and euthanized for histomorphometric analysis. The results were submitted to statistical analysis (α = 5%), and the intragroup comparison was performed using the t test. On the other hand, for intergroup comparison, the ANOVA test was performed, and to the groups presenting statistically significant difference, the Student-Newman-Keuls test was used. In intergroup comparison, group 1 (mean ± SD= 45.2 ± 18.56%) showed a lower bone formation compared with groups 2 (64.13 ± 3.51%) (p = 0.358) and 4 (15.2 ± 78.22%) (p = 0.049), at the 14-day period. Group 3 (20.99 ± 7.42%) also presented a lower amount of neoformed bone tissue, with statistically significant difference when compared with groups 1 (p = 0.002), 2, and 4 (p ≤ 0,001). After 28 days, group 1 presented a lower amount of neoformed bone tissue compared with the other groups, with p = 0.020. Thus, it was concluded that LLLT associated with zoledronic acid is effective for stimulating bone formation in surgically created defects in rats, at the periods studied.

Which of the branched-chain amino acids increases cerebral blood flow in hepatic encephalopathy? A double-blind randomized trial.

Branched-chain amino acids increase the brain perfusion of patients with hepatic encephalopathy (HE), but the amino acid and the mechanisms involved are still unknown. This study compared brain perfusion and clinical improvement during leucine or isoleucine supplementation. After randomization, 27 subjects with cirrhosis and HE received leucine or isoleucine supplements for one year. Brain single Photon Emission Computed Tomography (SPECT) and dynamic brain scintigraphy (DBS) were performed pretreatment and at 1, 8 and 12 months of supplementation. Brain perfusion was increased only in the isoleucine group at 8 months of treatment by both SPECT and DBS (p < 0.001 and p = 0.05, respectively) and by SPECT at the 12th month (p < 0.05). This was associated with hepatic encephalopathy improvement at 8 and 12 months (p = 0.008 and 0.004, respectively), which was not observed in the leucine group (p = 0.313 and 0.055, respectively). Isoleucine supplementation achieved a better impact on brain perfusion restoration in HE.

Production of biogas (methane and hydrogen) from anaerobic digestion of hemicellulosic hydrolysate generated in the oxidative pretreatment of coffee husks.

Ozone pretreatment of coffee husks (CH) was evaluated to generate hydrolysates for biogas production and to preserve cellulose of the solid phase for 2G ethanol production. Pretreatment variables included liquid-to-solid ratio (LSR), pH and specific applied ozone load (SAOL). Considering single-stage anaerobic digestion (AD), the highest methane production (36 NmL CH4/g CH) was achieved with the hydrolysate generated in the experiment using LSR 10 mL/g, pH 11 and SAOL 18.5 mg O3/g CH, leading to 0.064 kJ/g CH energy recovery. Due to the presence of toxic compounds in the hydrolysate, the addition of powdered activated carbon (4 g/L) to the reactor enhanced biogas production, leading to 86 NmL CH4/g CH yield and 0.58 kJ/g CH energy recovery. When two-stage AD was applied, methane production resulted in 49 NmL CH4/g CH, with additional 19 NmL H2/g CH production, resulting in a net 0.26 kJ/g CH energy recovery.

Diagnosis and Management of Cirrhosis-Related Osteoporosis.

Management of cirrhosis complications has greatly improved, increasing survival and quality of life of the patients. Despite that, some of these complications are still overlooked and scarcely treated, particularly those that are not related to the liver. This is the case of osteoporosis, the only cirrhosis complication that is not solved after liver transplantation, because bone loss often increases after immunosuppressant therapy. In this review, the definitions of bone conditions in cirrhotic patients are analyzed, focusing on the more common ones and on those that have the largest impact on this population. Risk factors, physiopathology, diagnosis, screening strategies, and treatment of osteoporosis in cirrhotic patients are discussed, presenting the more striking data on this issue. Therapies used for particular conditions, such as primary biliary cirrhosis and liver transplantation, are also presented.

Terapia nutricional nas doenças inflamatórias intestinais: artigo de revisão / Nutrition therapy in inflammatory bowel diseases: review article

OBJECTIVE: This article aims to discuss the role of nutrition therapy in Inflammatory Bowel Diseases according to its indications, contraindications, and the as main results obtained with prebiotics, probiotics, symbiotics and other nutritional interventions. Data source: We performed a literature review using the databases Pubmed, Scielo and Lilacs. Data synthesis: Inflammatory Bowel Diseases are chronic illnesses that affect primarily the gastrointestinal tract and are divided in two most common forms of presentation: Crohn's Disease and Ulcerative Colitis. The chronic inflammation can cause intestinal lesions, anorexia, nutrients malabsorption, oxidative stress and higher energy consumption, increasing the risk of malnutrition. Nutritional status is directly associated with the disease severity and malnutrition is a serious complication of inflammatory bowel diseases that worsens the patients' prognosis. Nutritional therapy is used to prevent or treat the malnutrition, to correct macro and micronutrients deficits and to reverse some of the metabolic and pathological consequences of these diseases. In the majority of patients, the nutrition therapy has an adjuvant role combined to medical or surgical treatments, but in some specific situations it can be the main treatment. CONCLUSIONS: Despite the benefits of nutritional therapy, more meta-analysis and double-blind controlled studies about these diseases are required to assure the good results obtained in some of the published trials.

OBJETIVO: O objetivo do artigo é discutir o papel da Terapia Nutricional nas Doenças Inflamatórias Intestinais de acordo com suas indicações e contraindicações, bem como os principais resultados com prebióticos, probióticos, simbióticos e outras intervenções nutricionais nessas doenças. Fonte dos dados: Foi realizada busca por artigos nas bases de dados: Pubmed, Scielo e Lilacs. Síntese dos dados: Doenças Inflamatórias Intestinais são doenças crônicas que acometem principalmente o trato gastrointestinal e se dividem em duas formas mais comuns de apresentação: Doença de Crohn e Retocolite Ulcerativa. A inflamação crônica pode causar lesões intestinais, anorexia, má absorção de nutrientes, estresse oxidativo e aumento do gasto energético, aumentando o risco de desnutrição. O estado nutricional está diretamente associado com a gravidade da doença e a desnutrição é uma complicação que piora o prognóstico do paciente. A terapia nutricional é utilizada para impedir ou corrigir a desnutrição, repor deficiências de macro e micronutrientes e reverter parte das consequências metabólicas patológicas dessas doenças. Na maior parte dos pacientes, a terapia nutricional atua como coadjuvante combinada ao tratamento clínico ou cirúrgico, mas em algumas situações específicas pode ser o principal tratamento. CONCLUSÃO: Apesar dos vários benefícios atingidos pelo uso da terapia nutricional, mais metanálises e estudos randomizados duplo cegos ainda são necessários para comprovar os efeitos de suplementos específicos, garantindo, dessa maneira, resultados positivos na sua aplicação

Ingestão proteica na encefalopatia hepática: panorama atual / Protein intake in hepatic encephalopathy: current concepts

Hepatic encephalopathy is a severe complication of cirrhosis and comprises a complexand multifactorial pathophysiology. However, ammonia exchange between different tissues still deserves attention in relation to neurological alterations. Hepatic encephalopathy treatment remains focused on the trigger factor correction and the ammonia formation. Therefore, it was believed that high-proteic diets could lead to hepatic encephalopathy through the accumulation of nitrogen compounds in the gastrointestinal tract, which could increase production and absorption of ammonia.Currently, it is known that proteic restriction is harmful to cirrhotic patients, but it isstill utilized. Malnutrition is highly prevalent among cirrhotic individuals with hepatic encephalopathy, thus indicating a nutritional risk which is clearly related to higher mortality rates. Furthermore, there is an increase in the protein needs of these patients and also a relationship between the loss of lean mass and hyperammonaemia. For these and other factors herein discussed, today's global guidelines recommend the ingestion of higher protein levels for patients with hepatic encephalopathy

A encefalopatia hepática é uma complicação grave da cirrose e envolve uma fisiopatologia complexa e multifatorial. Entretanto, a influência da amônia nos diferentes tecidos ainda merece atenção no que se refere às manifestações neuropatológicas. O tratamento da encefalopatia hepática permanece focado na correção do distúrbio desencadeante e na diminuição da formação da amônia a partir do cólon. Por conta disso, acreditava-se que dietas ricas em proteínas poderiam desencadear a encefalopatia hepática por meio do aporte de nitrogênio no trato gastrointestinal, podendo aumentar a produção e a absorção da amônia. Atualmente, sabe-se que a restrição proteica é prejudicial para portadores de cirrose, embora ainda utilizada. A desnutrição é prevalente entre indivíduos cirróticos com encefalopatia hepática, indicando um estado nutricional de risco que está nitidamente relacionado às maiores taxas de mortalidade. Além disso, há um aumento nas necessidades proteicas desses pacientes e uma relação entre a perda de massa magra e a hiperamoniemia. Com base em tais fatores, os guidelines atuais mundiais recomendam dieta hiperproteica para pacientes com encefalopatia hepática.

Avaliação da resistência ao cisalhamento da zircônia após diferentes tratamentos de superfície / Evaluation of shear bond strength of zirconia after different surface treatments

Cerâmicas de alto conteúdo cristalino, como a zircônia policristalina tetragonal estabilizada por ítrio (Y-TZP), apresentam ótimas propriedades mecânicas quando comparadas às cerâmicas convencionais, sendo cada vez mais empregadas como materiais restauradores indiretos. Entretanto, seu sucesso também depende da formação de uma união confiável com os agentes de cimentação. Porém, o aumento do conteúdo cristalino modificou as características de adesão entre cerâmica e cimento resinoso, não existindo um protocolo de cimentação bem estabelecido na literatura. Portanto, este estudo teve como objetivo avaliar o efeito na resistência ao cisalhamento de diferentes tratamentos de superfície sobre a zircônia, utilizando dois cimentos resinosos, assim como avaliar as possíveis diferenças no modo das fraturas. Cento e vinte amostras retangulares de zircônia foram incluídas em resina acrílica e divididas em 12 grupos (n=10), de acordo com os tratamentos de superfície e os cimentos (Panavia F e Rely X U100). Para cada cimento, os grupos experimentais foram formados da seguinte maneira: RU e Pa - controle (sem nenhum tratamento de superfície); ApRU e ApPa (aplicação do Alloy Primer); MzRU e MzPa (aplicação do Metal/Zircônia Primer); JatRU e JatPa (jateamento com partículas de óxido de alumínio de 50µm); JatApRU e JatApPa (jateamento e aplicação de Alloy Primer); JatMzRU e JatMzPa (jateamento e aplicação do Metal/Zircônia Primer). Os corpos de prova foram armazenados em água destilada à temperatura de 37°C por 24 horas, antes do teste de cisalhamento em uma máquina de ensaio universal (EMIC). Os valores foram submetidos primeiro a ANOVA a um critério (resistência ao cisalhamento) e teste de Tukey (p 0,05), independente do tratamento e do sistema de cimentação. Em seguida, ANOVA a dois critérios (tratamento de superfície e sistema de cimentação) e o teste de Tukey foram aplicados para observar com maior precisão a interação entre cimento e tratamento de superfície...

High crystalline content ceramics, such as yttria stabilized tetragonal zirconia polycrystal (Y-TZP), show great mechanical properties when compared to conventional ceramics, being increasingly used as indirect restorative materials. However, its success also depends on the reliable bond formation with luting agents. Though, the high crystalline content modified the adhesiveness between ceramic and resin cement although there isnt any cementing protocol established in literature. Therefore, the purpose of this study was to evaluate the effect of the shear bond strength after different surface treatments on the zirconia, using two resin cements and to evaluate possible differences in fracture modes. One hundred and twenty rectangular samples of zirconia were embedded in acrylic resin and divided into 12 groups (n=10) according to the surface treatments and the cements (Panavia F and RelyX U100). For each cement, the experimental groups were formed as follow: RU and Pa - control (no surface treatment); ApRU and ApPa (application of Alloy Primer); MzRU e MzPa (application of Metal/Zirconia Primer); JatRU and JatPa (air abrasion with 50µm Al2O3 particles); JatApRU and JatApPa (air abrasion and application of Alloy Primer); JatMzRU and JatMzPa (air abrasion and application of Metal/Zirconia Primer). The specimens were stored in distilled water at 37°C for 24 hours prior to the shear bond strength test in a universal testing machine (EMIC). The data were first analyzed by one-way ANOVA (shear bond strength) and Tukey test (p<0.05), regardless of the treatment and the luting system. Then two-way ANOVA (surface treatment and luting system) and the Tukey test were applied in order to observe more accurately the interaction between cement and surface treatments.The results presented were: RU 11.71a, ApRU 21.49b,e, MzRU 30.38c,d, JatRU 34.40c, JatApRU 30.66c,d, JatMzRU 38.06c, Pa 11.35a, ApPa 11.98a, MzPa 11.46a, JatPa 33.50c, JatApPa 23.14b,d,e, JatMzPa 18.66a,e...