Anti-SSA Ro52 and anti-Ro60 autoantibodies: association with clinical phenotypes.

OBJECTIVES: Anti-SSA autoantibodies can be differentiated according to their antigenic target proteins as anti-Ro60 (60 kDa) or anti-Ro52 (52 kDa). Anti-SSA(Ro60) antibodies are clearly associated with connective tissue diseases (CTD), but the clinical significance of anti-SSA(Ro52) antibodies remains unclear. The aim of the present study was to analyse the disease phenotype of patients with anti-Ro52 and/or anti-Ro60 antibodies. METHODS: A multicentre, cross-sectional study was carried out of positive anti-Ro52 and/or Ro60 antibodies patients followed at 10 Rheumatology centres from January 2018 until December 2021. Patients were categorised into 3 groups: group 1 (Ro52+/Ro60-); group 2 (Ro52-/Ro60+); group 3 (Ro52+/Ro60+). Antinuclear antibodies were evaluated by indirect immunofluorescence assay and further screened for anti-extractable nuclear antigen (ENA) antibodies. Demographicsand clinical data were compared between the 3 groups, by patients' medical chart review. Univariate analysis was performed and subsequently logistic regression was used to identify intergroup differences and calculate the odds ratio with a 95% confidence interval (95% CI). RESULTS: We included 776 patients [female: 83.1%; median age: 59 (46-71) years]. Groups 1, 2, and 3 comprised 31.1%, 32.6%, and 36.3% of the patients, respectively. Anti-Ro52 antibody alone was more frequently associated with non-rheumatic diseases, older age, and men (p<0.05). Among patients with CTD, the diagnosis of systemic lupus erythematosus is 3 and 2 times more prevalent in groups 2 and 3, respectively, than in group 1 [OR 2.8 (95% CI 1.60, 4.97), p<0.001; OR 2.2 (95% CI 1.28, 3.86), p<0.01]. In group 2, the diagnosis of undifferentiated CTD is more frequent than in the other groups. Group 1 was more frequently associated with inflammatory myositis than group 2 [OR 0.09 (95% CI 0.01, 0.33), p<0.001] or group 3 [OR 0.08 (95% CI 0.01, 0.29), p<0.001]. Group 1 was also more frequently associated with arthritis (p<0.01), interstitial lung disease (p<0.01), and myositis (p<0.01). CONCLUSIONS: Anti-Ro52+ antibody alone is frequently found in patients with non-rheumatic diseases. In addition, anti-Ro52+ antibody is also prevalent in patients with CTD and associated with clinical phenotypes that are different from anti-Ro60+ antibody.

Development of a Biomechanical Device for Parameter Quantification Associated with the Sit-to-Stand Movement.

The "sit-to-stand" (STS) movement is essential during activities of daily living (ADL). In individuals with physical-motor diseases, its execution and repetition increases activity levels, which is crucial for a good motor rehabilitation process and daily training. Interestingly, there are no sit-to-stand devices that allow a quantitative assessment of the key variables that happen during STS, and there is a need to come up with a new device. This work presents a developed biomechanical support device that measures the force of the upper limbs during the STS movement, aiming to motivate and encourage people undergoing physical therapy in the lower limbs. The device uses two instrumented beams and allows real-time visualization of both arms' applied force and it records the data for post-processing. The device was tested with a well-defined protocol on a group of 34 healthy young volunteers and an elderly group of 16 volunteers from a continuing care unit. The system showed robust strength and stiffness, good usability, and a user interface that acquired and recorded data effectively, allowing one to observe force-time during the execution of the movement through the application interface developed and in recording data for post-processing. Asymmetries in the applied forces in the STS movement between the upper limbs were identified, particularly in volunteers of the continuing care unit. From the application and the registered data, it can be observed that volunteers with motor problems in the lower limbs performed more strength in their arms to compensate. As expected, the maximum average strength of the healthy volunteers (both arms: force = 105 Newton) was higher than that of the volunteers from the continuing care unit (right arm: force = 54 Newton; left arm: force = 56 Newton). Among others, moderate correlations were observed between weight-applied and height-applied forces and there was a moderately high correlation between the Sequential Clinical Assessment of Respiratory Function (SCAR-F score) and time to perform the movement. Based on the obtained results, the developed device can be a helpful tool for monitoring the evaluation of a patient with limitations in the upper and lower limbs. In addition, the developed system allows for easy evolution, such as including a barometric platform and implementing serious games that can stimulate the execution of the STS movement.

Effect of fructooligosaccharide on endothelial function in CKD patients: a randomized controlled trial.

BACKGROUND: Microbiota-derived uremic toxins have been associated with inflammation that could corroborate with endothelial dysfunction (ED) and increase cardiovascular risk in patients with chronic kidney disease (CKD). This trial aimed to evaluate the effect of the prebiotic fructooligosaccharide (FOS) on endothelial function and arterial stiffness in nondialysis CKD patients. METHODS: In a double-blind controlled trial, 46 nondiabetic CKD patients were randomized to receive 12 g/day of FOS or placebo (maltodextrin) for 3 months. Total p-cresyl sulfate (PCS) and indoxyl sulfate by high-performance liquid chromatography, urinary trimethylamine N-oxide by mass spectrometry, C-reactive protein, interleukin-6 (IL-6), serum nitric oxide and stroma-derived factor-1 alfa were measured at baseline and at the end of follow-up; endothelial function was assessed through flow-mediated dilatation (FMD) and arterial stiffness by pulse wave velocity (PWV). RESULTS: The mean (± standard deviation) age of the study participants was 57.6 ± 14.4 years, with an estimated glomerular filtration rate of 21.3 ± 7.3 mL/min/1.73 m2. During the follow-up, regarding the inflammatory markers and uremic toxins, there was a significant decrease in IL-6 levels (3.4 ± 2.1 pg/mL versus 2.6 ± 1.4 pg/mL; P = 0.04) and a trend toward PCS reduction (55.4 ± 38.1 mg/L versus 43.1 ± 32.4 mg/L, P = 0.07) only in the prebiotic group. Comparing both groups, there was no difference in FMD and PWV. In an exploratory analysis, including a less severe ED group of patients (FMD ≥2.2% at baseline), FMD remained stable in the prebiotic group, while it decreased in the placebo group (group effect P = 0.135; time effect P = 0.012; interaction P = 0.002). CONCLUSIONS: The prebiotic FOS lowered circulating levels of IL-6 in CKD patients and preserved endothelial function only in those with less damaged endothelium. No effect of FOS in arterial stiffness was observed.

Is Strength Training as Effective as Aerobic Training for Depression in Older Adults? A Randomized Controlled Trial.

BACKGROUND: This study aimed to compare the effects of aerobic training (AT), strength training (ST) and low-intensity exercise in a control group (CG) as adjunct treatments to pharmacotherapy for major depressive disorder (MDD) in older persons. METHODS: Older persons clinically diagnosed with MDD (n = 27) and treated with antidepressants were blindly randomized into three groups: AT, ST and a CG. All patients were evaluated prior to and 12 weeks after the intervention. RESULTS: Compared with the CG, the AT and ST groups showed significant reductions in depressive symptoms (treatment -response = 50% decrease in the pre- to postintervention assessment) through the Hamilton Depression Rating Scale (AT group: χ2, p = 0.044) and Beck Depression Inventory (ST group: χ2, p = 0.044). CONCLUSION: Adding AT or ST with moderate intensity to the usual treatment promoted a greater reduction of MDD symptoms.

Cell sheets of human dental pulp stem cells for future application in bone replacement.

OBJECTIVES: To analyze the potential of human dental pulp stem cells (hDPSCs) for maintaining their undifferentiated status and osteogenic differentiation capacity when arranged in cell sheets (CSs) for future application in bone replacement. MATERIALS AND METHODS: CSs were formed after being induced for 10-15 days by clonogenic medium containing additional vitamin C (20 µg/ml). The cell viability of hDPSC4s in the CSs was followed until 96 h using the Live/Dead® assay. The cells of the CSs were enzymatically dissociated and then compared with the original hDPSC4s. The two cell types were characterized immunophenotypically by flow cytometry using specific mesenchymal stem cell-associated markers (CD105, CD146, CD44, STRO-1, and OCT3/4) and non-associated markers (CD34, CD45, and CD14). Osteogenic differentiation was analyzed with the Alizarin red assay. RESULTS: Living cells were observed until 96 h in the CSs. Both cell types exhibited osteogenic differentiation and expressed the specific undifferentiated MSC-associated markers. Cells spontaneously detached from the CSs attached and proliferated at the bottom of the culture dishes. CONCLUSIONS: Cells in the hDPSC4s cell sheets survived for at least 96 h. Moreover, the cells in the cell sheets retained their stemness and their osteogenic differentiation potential. CLINICAL RELEVANCE: Cell sheets of hDPSCs could be employed as natural tri-dimensional structures for treating bone loss. This technique would be useful particularly for critical bone defects or any type of bone defects in patients carrying diseases that impair bone regeneration, such as diabetes mellitus, medication-related osteonecrosis of the jaw (MRONJ), and osteoporosis.

Conventional Drilling Versus Piezosurgery for Implant Site Preparation: A Meta-Analysis.

The aim of this study was to evaluate if the stability of dental implants varies between dental implants placed by piezosurgery compared with those placed by conventional drilling. An electronic search in MEDLINE, SCOPUS, and the Cochrane Library was undertaken until August 2016 and was supplemented by manual searches and by unpublished studies at OpenGray. Only randomized controlled clinical trials that reported implant site preparation with piezosurgery and with conventional drilling were considered eligible for inclusion in this review. Meta-analyses were performed to evaluate the impact of piezosurgery on implant stability. Of 456 references electronically retrieved, 3 were included in the qualitative analysis and quantitative synthesis. The pooled estimates suggest that there is no significant difference between piezosurgery and conventional drilling at baseline (weighted mean differences [WMD]: 2.20; 95% confidence interval [CI]: -5.09, 9.49; P = .55). At 90 days, the pooled estimates revealed a statistically significant difference (WMD: 3.63; 95% CI: 0.58, 6.67, P = .02) favoring piezosurgery. Implant stability may be slightly improved when osteotomy is performed by a piezoelectric device. More randomized controlled clinical trials are needed to confirm these findings.

First trimester prediction of HELLP syndrome.

OBJECTIVE: The aim of this study was to evaluate first-trimester maternal characteristics and biomarkers in pregnancies that subsequently develop HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. METHOD: Maternal history, biochemical, and biophysical parameters were compared between women who developed HELLP, preeclampsia (PE) without HELLP and controls. After determination of significant variables through univariate analysis a first-trimester prediction model was obtained by applying logistic regression analysis. Performance of the model was evaluated. RESULTS: Twenty participants with HELLP were compared with 147 patients that developed PE without HELLP and 2810 controls. Women with HELLP were more likely Caucasian, nulliparous and presented a higher mean arterial pressure (MAP) when compared with controls. As opposing to women who developed HELLP, women who developed PE without HELLP were more likely of African-American origin and presented an even higher first-trimester MAP. Enrollment biochemical and biophysical parameters were similar between HELLP and PE or controls. Ethnicity, nulliparity, history of previous PE, history of previous HELLP syndrome, and first-trimester MAP were primary risk factors. A prediction rule for HELLP syndrome had an area under the curve of 0.80, with 75% sensitivity for 79% specificity. CONCLUSION: The majority of pregnancies that develop HELLP syndrome can be predicted in the first trimester. © 2015 John Wiley & Sons, Ltd.

Heart rate variability indexes as a marker of chronic adaptation in athletes: a systematic review.

BACKGROUND: Regular exercise promotes functional and structural changes in the central and peripheral mechanisms of the cardiovascular system. Heart rate variability (HRV) measurement provides a sensitive indicator of the autonomic balance. However, because of the diversity of methods and variables used, the results are difficult to compare in the sports sciences. Since the protocol (supine, sitting, or standing position) and measure (time or frequency domain) are not well defined, the aim of this study is to investigate the HRV measures that better indicates the chronic adaptations of physical exercise in athletes. METHOD: PubMed (MEDLINE), Web of Science, SciELO (Scientific Electronic Library), and Scopus databases were consulted. Original complete articles in English with short-term signals evaluating young and adult athletes, between 17 and 40 years old, with a control group, published up to 2013 were included. RESULTS: Selected 19 of 1369 studies, for a total sample pool of 333 male and female athletes who practice different sports. The main protocols observed were the supine or standing positions in free or controlled breathing conditions. The main statistical results found in this study were the higher mean RR, standard deviation of RR intervals, and high frequency in athletes group. In addition, the analyses of Cohen's effect size showed that factors as modality of sport, protocol used and unit of measure selected could influence this expected results. CONCLUSION: Our findings indicate that time domain measures are more consistent than frequency domain to describe the chronic cardiovascular autonomic adaptations in athletes.

Physical exercise and clinically depressed patients: a systematic review and meta-analysis.

OBJECTIVE: The aim of this meta-analysis is to evaluate the effect of aerobic training and strength training as a treatment for depression in patients diagnosed with major depressive disorder. METHODS: PubMed (Medline), ISI knowledge (Institute for Scientific Information), SciELO (Scientific Electronic Library) and Scopus databases were consulted from January 1970 to September 2011. Data were collected on variables as follows: total number of patients (pre- and postintervention), age, randomized (yes or no), diagnostic criteria, assessment instruments, and the percentage of remission and treatment response. Subsequently, we collected information on time intervention, intensity, duration, frequency, method of training (aerobic training and strength training) and type of supervision. Standardized mean differences were used for pooling continuous variables as endpoint scores. Binary outcomes, such as proportion of remission (no symptoms) and at least 50% reduction of initial scores (response), were pooled using relative risks. Random effects models were used that take into account the variance within and between studies. RESULTS: Ten articles were selected and subdivided by their interventions, controlled training modality and levels of intensity. As there was no statistically significant difference between the two types of intervention (strength or aerobic training), we combined data which finally showed a 0.61 (95% CI: -0.88 to -0.33) standard deviation reduction in the intervention group compared to the control group. When the analysis was restricted only to those studies that used the Hamilton scale (n = 15), we observed a reduction of 3.49 points compared with the control group. CONCLUSION: Despite the heterogeneity of the studies, the present meta-analysis concluded that physical exercise improves the response to treatment, especially aerobic training. However, the efficacy of exercise in the treatment of depression was influenced by age and severity of symptoms.

Science mapping analysis of maxillofacial reconstruction over the last four decades.

PURPOSE: This paper aims to provide a bibliometric analysis of the maxillofacial reconstruction literature over 40 years and to compare the data with previous studies. METHODS: A bibliographical search for oral and maxillofacial surgery literature in maxillofacial reconstruction was conducted on Wef of Science. A graphic representation of authorship and keywords was created with VOSviewer. Mendeley and Microsoft Excel were used for tabulation and data visualization. Some statistical tests were performed with a 95 % confidence interval, which was considered significant. RESULTS: A total of 7417 articles from specialized journals were included in the study. These articles received 138,493 citations from 63,390 other studies, with an average citation count of 18.67, and a very high H-index. A total of 2375 specific keywords were analyzed, covering a wide range of topics, with two noteworthy MeSH keywords that have recently gained prominence. A total of 33 journals were included in the study, with a mean Impact Factor of 2.404, indicating a relatively high influence in the subject area. CONCLUSION: The high h-index reflects abundant and high-quality literature on maxillofacial reconstruction, with the United States leading in publication quantity. Emerging topics in maxillofacial reconstruction were discussed. These areas shape the discipline, driving advancements and offering opportunities for researchers and clinicians to contribute to progress and improve patient outcomes.

Incised valleys drive distinctive oceanographic processes and biological assemblages within rhodolith beds.

Continental shelves encompass gently sloped seascapes that are highly productive and intensively exploited for natural resources. Islands, reefs and other emergent or quasi-emergent features punctuate these shallow (<100 m) seascapes and are well known drivers of increased biomass and biodiversity, as well as predictors of fishing and other human uses. On the other hand, relict mesoscale geomorphological features that do not represent navigation hazards, such as incised valleys (IVs), remain poorly charted. Consequently, their role in biophysical processes remains poorly assessed and sampled. Incised valleys are common within rhodolith beds (RBs), the most extensive benthic habitat along the tropical and subtropical portions of the mid and outer Brazilian shelf. Here, we report on a multi-proxy assessment carried out in a tropical-subtropical transition region (~20°S) off Eastern Brazil, contrasting physicochemical and biological variables in IVs and adjacent RBs. Valleys interfere in near bottom circulation and function as conduits for water and propagules from the slope up to the mid shelf. In addition, they provide a stable and structurally complex habitat for black corals and gorgonians that usually occur in deeper water, contrasting sharply with the algae-dominated RB. Fish richness, abundance and biomass were also higher in the IVs, with small planktivores and large-bodied, commercially important species (e.g. groupers, snappers and grunts) presenting smaller abundances or being absent from RBs. Overall, IVs are unique and vulnerable habitats that sustain diverse assemblages and important ecosystem processes. As new IVs are detected by remote sensing or bathymetric surveys, they can be incorporated into regional marine management plans as conservation targets and priority sites for detailed in situ surveys.

Two-Dimensional Blue Native/SDS Polyacrylamide Gel Electrophoresis for Analysis of Brazilian Bothrops Snake Venoms.

Viperidae snakes are the most important agents of snakebites in Brazil. The protein composition of snake venoms has been frequently analyzed by means of electrophoretic techniques, but the interaction of proteins in venoms has barely been addressed. An electrophoretic technique that has gained prominence to study this type of interaction is blue native polyacrylamide gel electrophoresis (BN-PAGE), which allows for the high-resolution separation of proteins in their native form. These protein complexes can be further discriminated by a second-dimension gel electrophoresis (SDS-PAGE) from lanes cut from BN-PAGE. Once there is no study on the use of bidimensional BN/SDS-PAGE with snake venoms, this study initially standardized the BN/SDS-PAGE technique in order to evaluate protein interactions in Bothrops atrox, Bothrops erythromelas, and Bothrops jararaca snake venoms. Results of BN/SDS-PAGE showed that native protein complexes were present, and that snake venom metalloproteinases and venom serine proteinases maintained their enzymatic activity after BN/SDS-PAGE. C-type lectin-like proteins were identified by Western blotting. Therefore, bidimensional BN/SDS-PAGE proved to be an easy, practical, and efficient method for separating functional venom proteins according to their assemblage in complexes, as well as to analyze their biological activities in further details.

Poly-ε-caprolactone/poly(rotaxane) seeded with human dental pulp stem cells or osteoblasts promotes angiogenesis: a chorioallantoic membrane assay.

Biomaterials used for tissue regeneration should ideally provide a favorable environment for cell proliferation and differentiation. Angiogenesis is crucial for supplying oxygen and nutrients necessary for cellular survival at implantation sites. The aim of this study was to evaluate the overall angiogenesis response of a poly ε-caprolactone/poly (rotaxane) blend (poly-blend) carried by human dental pulp stem cells (hDPSCs) or osteoblasts (OB) seeded in the chorioallantoic membranes (CAM) of fertilized chicken eggs on embryonic day 7. They were classified into the following intervention groups: (a) poly(polymeric blend disks free of cells); (b) hDPSC seeded onto CAM; (c) poly/hDPSC (where hDPSCs were seeded onto poly-blend); (d) poly/OB (where osteoblasts were seeded onto poly); (e) OB (where hDPSCs differentiated into osteoblasts were seeded onto CAM); and (f) a negative control when a sterilized silicone ring free of cells or polymer was inserted into CAM. On embryonic day 14, the quantitative and qualitative characteristics of the blood vessels in the CAMs were analyzed macroscopically and microscopically. Macroscopic examination showed that the Poly/hDPSC samples exhibited an increased medium vessel density. Additionally, microscopic observations showed that the Poly/hDPSC group and poly alone resulted in a large lumen area of vascularization. Thus, poly ε-caprolactone/poly (rotaxane) did not impair angiogenesis. Furthermore, poly-blend carried by stem cells of dental pulp origin shows a better vasculogenic potential, which is essential for regenerative therapies.

Factors Associated With Violence Against Women and Facial Trauma of a Representative Sample of the Brazilian Population: Results of a Retrospective Study.

STUDY DESIGN: Violence against women is a challenge in public health. It involves women of all ages, socioeconomic statuses, cultures, and religions. OBJECTIVE: The objective of this study was to perform an epidemiological survey of facial trauma among women who experienced physical aggression by an intimate partner. METHODS: Electronic medical records from a public tertiary referral hospital for trauma in the Brazilian state of Espírito Santo were analyzed between 2013 and 2018. RESULTS: Patients were most commonly between 20 and 29 years of age (33.9%), and 50% of the patients were of mixed race. When separated by days of the week, facial trauma was most commonly inflicted on Sundays (24.2%) and on Saturdays (22.6%). Of the 62 women included in the study, 47 had facial fractures, and 7 had more than 1 concomitant fracture. Forty of the total fractures (72.7%) were on the middle and upper thirds of the face, while 15 fractures (27.3%) were on the lower third of the face. The most commonly observed signs and symptoms of these injuries were edema (56.5%), periorbital ecchymosis (35.5%), deviated nasal dorsum (22.6%), and hematoma (16.1%). CONCLUSIONS: Facial trauma may be considered an important marker of attempted femicide. Health care professionals must be aware of and attentive to this correlation, since many cases of attempted femicide go unnoticed or are attributed to another etiology.

Two-dimensional blue native/SDS polyacrylamide gel electrophoresis for analysis of Brazilian Bothrops snake venoms

Viperidae snakes are the most important agents of snakebites in Brazil. The protein composition of snake venoms has been frequently analyzed by means of electrophoretic techniques, but the interaction of proteins in venoms has barely been addressed. An electrophoretic technique that has gained prominence to study this type of interaction is blue native polyacrylamide gel electrophoresis (BN-PAGE), which allows for the high-resolution separation of proteins in their native form. These protein complexes can be further discriminated by a second-dimension gel electrophoresis (SDS-PAGE) from lanes cut from BN-PAGE. Once there is no study on the use of bidimensional BN/SDS-PAGE with snake venoms, this study initially standardized the BN/SDS-PAGE technique in order to evaluate protein interactions in Bothrops atrox, Bothrops erythromelas, and Bothrops jararaca snake venoms. Results of BN/SDS-PAGE showed that native protein complexes were present, and that snake venom metalloproteinases and venom serine proteinases maintained their enzymatic activity after BN/SDS-PAGE. C-type lectin-like proteins were identified by Western blotting. Therefore, bidimensional BN/SDS-PAGE proved to be an easy, practical, and efficient method for separating functional venom proteins according to their assemblage in complexes, as well as to analyze their biological activities in further details.

Aneurisma do seio de valsava associado a fistula aortocavitária: relato de caso Kirschbaum, Marcelo / Valsava sinus aneurysm associated with aortocavitary fistula: case report

INTRODUÇÃO: Aneurisma do Seio de Valsalva é uma condição rara, geralmente congênita, primeiramente descrita em 1839 e tratada com sucesso pela primeira vez em 1950 por Morrow e col. Tem a incidência de 0,14% a 0,96% dos pacientes submetidos a cirurgia cardíaca de acordo com alguns estudos realizados em instituições de referência. De acordo com um estudo realizado por Takach et al., sua incidência em 50 anos de experiência foi de 0,14% dos casos submetidos a cirurgia cardíaca na instituição. Nesta casuística acometeu predominantemente homens, podendo ser assintomáticos ou oligossintomáticos, cursando com quadro de insuficiência cardíaca (IC), podendo cursar com piora súbita dos sintomas, decorrente geralmente de ruptura e formação de fístula com alguma cavidade cardíaca, sendo o ventrículo direito é a cavidade mais frequentemente acometida. O tratamento da condição é cirúrgico. DESCRIÇÃO DO CASO A.C.L., 37 anos, masculino, sem doenças crônicas, histórico de tromboembolismo pulmonar (TEP) em novembro/2017, o paciente foi admitido com quadro de insuficiência cardíaca e rápida piora da classe funcional. Realizou Angiotomografia de tórax não evidenciando novo evento tromboembólico, seguido de ecocardiograma transtorácico que revelou disfunção sistólica biventricular com achado de aneurisma roto de seio coronariano e refluxo aórtico importante, hipertensão pulmonar moderada e derrame pericárdico difuso. Procedida a realização de complementação transesofágica, que confirmou a rotura do anel com formação de fístula comunicando com ventrículo esquerdo medindo 22 por 11 mm, com refluxo de grau importante e forame oval patente (FOP) e trombo em apêndice atrial esquerdo. Ressonância cardíaca revelou aneurisma de seio coronariano esquerdo com fistulização para cavidade, achado também evidenciado em angiotomografia de aorta. Paciente submetido a cirurgia de troca de válvula aórtica por prótese biológica com reconstrução de raiz de aorta e fechamento do FOP, associado a remoção de trombo e exclusão de auriculeta esquerda, com boa evolução pós operatória e apresentando melhora importante da sintomatologia, recebendo alta para seguimento ambulatorial. CONCLUSÃO: Aneurisma de seio de Valsava é uma alteração congênita rara que pode cursar fistula aorto-cavitária levando a um quadro grave de IC que, se não identificado, pode evoluir de maneira desfavorável. (AU)

Aliança terapêutica: estabelecimento, manutenção e rupturas da relação / Therapeutic Alliance: establishment, maintenance and disruption of relationship / Alianza terapéutica: establecimiento, mantenimiento y rupturas de la relación

A Aliança Terapêutica (AT) tem sido apontada como importante sinalizador de resultados em psicoterapia. Este artigo teórico apresenta dois temas de pesquisa relacionados à AT. São eles: características pessoais do paciente e do terapeuta associadas à manutenção da AT na terapia, segundo a obra de Corbella e Botella, e fatores associados ao abandono precoce do tratamento, servindo para identificar, evitar e restaurar a AT, através da contribuição de Safran e Muran. A compreensão do desenvolvimento da formação da AT, bem como os fatores que podem influenciá-la de forma positiva, permite que o terapeuta fortaleça o vínculo e estruture um trabalho voltado para a necessidade do paciente(AU)

Therapeutic Alliance (TA) has been identified as an important indicator of results in psychotherapy. This theoretical article presents two important research's topics related to TA: patient's and therapist's personal characteristics, which are associated to establishment and maintenance of TA in therapy, according to Corbella's and Botella's studies, and factors associated with early abandonment of treatment, aiding to identify, prevent and restore AT through contributions of Safran and Muran. Understanding development of AT, as well as the factors that can influence in a positive way, it allows to strengthen therapeutic relationship and to structure a treatment directed to patient's needs(AU)

La alianza terapéutica (AT) se ha identificada como un importante indicador de resultados en la psicoterapia. Este artículo teórico presenta dos importantes temas de investigación relacionados con la AT. Ellos son: características personales del paciente y del terapeuta asociados con el mantenimiento de la AT en la terapia, de acuerdo con el trabajo de Corbella y Botella, y los factores asociados con el abandono terapéutico temprano, que sirve para identificar, prevenir y restaurar la AT a través de la contribución de Safran y Muran. La comprensión del desarrollo de la formación de la AT, así como los factores que pueden influir de manera positiva, permite al terapeuta fortalecer el vínculo y estructurar el trabajo hacia la necesidad del paciente(AU)

Aliança terapêutica: estabelecimento, manutenção e rupturas da relação / Therapeutic alliance: establishment, maintenance and disruption of relationship / Alianza terapéutica: establecimiento, mantenimiento y rupturas de la relación

A Aliança Terapêutica (AT) tem sido apontada como importante sinalizador de resultados em psicoterapia. Este artigo teórico apresenta dois temas de pesquisa relacionados à AT. São eles: características pessoais do paciente e do terapeuta associadas à manutenção da AT na terapia, segundo a obra de Corbella e Botella, e fatores associados ao abandono precoce do tratamento, servindo para identificar, evitar e restaurar a AT, através da contribuição de Safran e Muran. A compreensão do desenvolvimento da formação da AT, bem como os fatores que podem influenciá-la de forma positiva, permite que o terapeuta fortaleça o vínculo e estruture um trabalho voltado para a necessidade do paciente.

Therapeutic Alliance (TA) has been identified as an important indicator of results in psychotherapy. This theoretical article presents two important research's topics related to TA: patient's and therapist's personal characteristics, which are associated to establishment and maintenance of TA in therapy, according to Corbella's and Botella's studies, and factors associated with early abandonment of treatment, aiding to identify, prevent and restore AT through contributions of Safran and Muran. Understanding development of AT, as well as the factors that can influence in a positive way, it allows to strengthen therapeutic relationship and to structure a treatment directed to patient's needs.

La alianza terapéutica (AT) se ha identificada como un importante indicador de resultados en la psicoterapia. Este artículo teórico presenta dos importantes temas de investigación relacionados con la AT. Ellos son: características personales del paciente y del terapeuta asociados con el mantenimiento de la AT en la terapia, de acuerdo con el trabajo de Corbella y Botella, y los factores asociados con el abandono terapéutico temprano, que sirve para identificar, prevenir y restaurar la AT a través de la contribución de Safran y Muran. La comprensión del desarrollo de la formación de la AT, así como los factores que pueden influir de manera positiva, permite al terapeuta fortalecer el vínculo y estructurar el trabajo hacia la necesidad del paciente.