Effect of modified citrus pectin on galectin-3 inhibition in cisplatin-induced cardiac and renal toxicity.

This study evaluated the effect of pharmacological inhibition of galectin 3 (Gal-3) with modified citrus pectin (MCP) on the heart and kidney in a model of cisplatin-induced acute toxicity. Male Wistar rats were divided into four groups (n = 6/group): SHAM, which received sterile saline intraperitoneally (i.p.) for three days; CIS, which received cisplatin i.p. (10 mg/kg/day) for three days; MCP, which received MCP orally (100 mg/kg/day) for seven days, followed by sterile saline i.p. for three days; MCP+CIS, which received MCP orally for seven days followed by cisplatin i.p. for three days. The blood, heart, and kidneys were collected six hours after the last treatment. MCP treatment did not change Gal-3 protein levels in the blood and heart, but it did reduce them in the kidneys of the MCP groups compared to the SHAM group. While no morphological changes were evident in the cardiac tissue, increased malondialdehyde (MDA) levels and deregulation of the mitochondrial oxidative phosphorylation system were observed in the heart homogenates of the MCP+CIS group. Cisplatin administration caused acute tubular degeneration in the kidneys; the MCP+CIS group also showed increased MDA levels. In conclusion, MCP therapy in the acute model of cisplatin-induced toxicity increases oxidative stress in cardiac and renal tissues. Further investigations are needed to determine the beneficial and harmful roles of Gal-3 in the cardiorenal system since it can act differently in acute and chronic diseases/conditions.

Lack of Annexin A1 Exacerbates Inflammatory Response in Acute Endometritis Model.

Annexin A1 (AnxA1) is a glucocorticoid-inducible protein and an important endogenous modulator of inflammation. However, its effect in the endometrial microenvironment is poorly explained. This study aimed to evaluate the role of endogenous AnxA1 in an endometritis mouse model induced by lipopolysaccharide (LPS). Female C57BL/6 wild-type (WT) and AnxA1-/- mice were divided into two groups: SHAM and LPS. To induce endometritis, mice received a vaginal infusion of 50 µL of LPS (1 mg/mL) dissolved in phosphate-buffered saline. After 24 h, the mice were euthanized, and blood and uteri samples were collected. The endometrium inflammatory scores were significantly increased in the LPS-treated group. AnxA1-/- mice from the LPS group demonstrated a significant increase in the number of degranulated mast cell levels compared to AnxA1-/- SHAM mice. The Western blotting analysis revealed that a lack of AnxA1 promoted the upregulation of NLRP3 and pro-IL-1ß in the acute endometritis animal model compared to WT LPS animals. LPS-induced endometritis increased the number of blood peripheral leukocytes in both WT and AnxA1-/- mice compared with SHAM group mice (p < 0.001). AnxA1-/- mice also showed increased plasma levels of IL-1ß (p < 0.01), IL-6, IL-10, IL-17, and TNF-α (p < 0.05) following LPS-induced endometritis. In conclusion, a lack of endogenous AnxA1 exacerbated the inflammatory response in an endometritis model via NLRP3 dysregulation, increased uterine mast cell activation, and plasma pro-inflammatory cytokine release.

Sustainable production of bioemulsifiers, a critical overview from microorganisms to promising applications.

Microbial bioemulsifiers are molecules of amphiphilic nature and high molecular weight that are efficient in emulsifying two immiscible phases such as water and oil. These molecules are less effective in reducing surface tension and are synthesized by bacteria, yeast and filamentous fungi. Unlike synthetic emulsifiers, microbial bioemulsifiers have unique advantages such as biocompatibility, non-toxicity, biodegradability, efficiency at low concentrations and high selectivity under different conditions of pH, temperature and salinity. The adoption of microbial bioemulsifiers as alternatives to their synthetic counterparts has been growing in ongoing research. This article analyzes the production of microbial-based emulsifiers, the raw materials and fermentation processes used, as well as the scale-up and commercial applications of some of these biomolecules. The current trend of incorporating natural compounds into industrial formulations indicates that the search for new bioemulsifiers will continue to increase, with emphasis on performance improvement and economically viable processes.

The role of annexin A1-derived peptide Ac2-26 on liver and kidney injuries induced by cisplatin in rats.

AIMS: In this study we evaluated the effect of pharmacological treatment with AnxA1-derived peptide Ac2-26 in an experimental model of toxicity induced by cisplatin. MAIN METHODS: Male rats were divided into Sham (control), Cisplatin (received intraperitoneal injections of 10 mg/kg/day of cisplatin for 3 days) and Ac2-26 (received intraperitoneal injections of 1 mg/kg/day of peptide, 15 min before cisplatin) groups. KEY FINDINGS: After 6 h of the last dose of cisplatin, an acute inflammatory response was observed characterized by a marked increase in the number of neutrophils and GM-CSF, IL-ß, IL-6, IL-10 and TNF-α plasma levels. These findings were associated with increased AnxA1 protein levels in liver and kidneys, as well as positive AnxA1/Fpr2 circulating leukocytes. Treatment with Ac2-26 produced higher levels of GM-CSF, corroborating the high numbers of neutrophils, and the anti-inflammatory cytokine IL-4. Ac2-26 preserved the morphology of liver structures and increased Fpr1 expression, preventing the damage caused by cisplatin. In the kidneys, Ac2-26 caused downregulation of renal Fpr1 and Fpr2 levels and abrogated the increased levels of the CLU and KIM-1 biomarkers of kidney damage induced by cisplatin. However, no effect of peptide treatment was detected in cisplatin-induced kidney morphology injury. SIGNIFICANCE: Despite activation of the anti-inflammatory AnxA1/Fpr axis during cisplatin administration, treatment with Ac2-26 did not efficiently prevent its deleterious effects on the liver and kidneys.

Pharmacological treatment with annexin A1-derived peptide protects against cisplatin-induced hearing loss.

Cisplatin is an antineoplastic agent widely used, and no effective treatments capable of preventing cisplatin-induced ototoxicity and neurotoxicity in humans have yet been identified. This study evaluated the effect of the anti-inflammatory annexin A1 (AnxA1)-derived peptide Ac2-26 in a cisplatin-induced ototoxicity model. Wistar rats received intraperitoneal injections of cisplatin (10 mg/kg/day) for 3 days to induce hearing loss, and Ac2-26 (1 mg/kg) was administered 15 min before cisplatin administration. Control animals received an equal volume of saline. Hearing thresholds were measured by distortion product otoacoustic emissions (DPOAE) before and after treatments. Pharmacological treatment with Ac2-26 protected against cisplatin-induced hearing loss, as evidenced by DPOAE results showing similar signal-noise ratios between the control and Ac2-26-treated groups. These otoprotective effects of Ac2-26 were associated with an increased number of ganglion neurons compared with the untreated cisplatin group. Additionally, Ac2-26 treatment produced reduced immunoreactivity on cleaved caspase 3 and phosphorylated ERK levels in the ganglion neurons, compared to the untreated group, supporting the neuroprotective effects of the Ac2-26. Our results suggest that Ac2-26 has a substantial otoprotective effect in this cisplatin-induced ototoxicity model mediated by neuroprotection and the regulation of the ERK pathway.

EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT FOR POSTCARDIOTOMY SHOCK: SINGLE CENTER EXPERIENCE.

OBJECTIVES: We aim to report our experience on venoarterial extracorporeal membrane oxygenation (VA-ECMO) for postcardiotomy shock (PCS). METHODS: Single center, retrospective study of all patients on VA-ECMO for PCS, from November 2006 to July 2019. Pediatric and adult patients were analysed separately. Primary outcomes were survival to discharge and one-year survival. RESULTS: Twenty-nine patients were included. Pediatric group (group PED) (62%, n=18): mean age 1,3±2,1 years and 39% male. Adults (group AD) (38%, n=11): mean age 55,6±15,9 years and 64% male. Indications in group PED were complex congenital heart surgery (94%) and heart transplant (6%), with 27% being reoperations; in group AD valvular surgery (45%), aortic surgery (21%), coronary artery bypass grafting (18%) and pulmonary endarterectomy (9%); 45% were reoperations. ECMO support was initiated intraoperatively due to failure to wean from cardiopulmonary bypass in 28% of group PED and 73% of group AD. Central cannulation was performed in all pediatric patients and 82% adults. Bleeding was the most common complication in both groups (group PED 39%, group AD 45%). Mean ECMO support time was respectively 6,2±4,9 and 6,2± 3,6 days for group PED and group AD. Weaning rate was 44% in group PED (with 2 patients bridged to LVAD) and 45% in group AD. Survival to discharge as well as one-year survival were both 28% in group PED and 18% in group AD. CONCLUSION: Despite low survival and high complication rates, VA ECMO support provides a survival benefit in refractory cases, with a dismal prognosis, that would otherwise die.

Effects of soy isoflavones extract on the lipid profile and uterus in ovariectomized rats.

AIM: Although soy isoflavones (ISO) have been shown to relief postmenopausal symptoms, it remains inconclusive whether ISO can improve lipid-profile without uterotrophic effects under estrogen-deficiency. Thus, we investigated the effects of ISO on lipid-profile and uterus of ovariectomized (Ovx) rats. MATERIALS AND METHODS: Twenty-five adult rats were Ovx or Sham-operated (Sham) and assigned into five groups: Sham and Ovx groups, administered with vehicle solutions; Ovx-E, treated with 10 µg/kg of 17ß-Estradiol; Ovx-ISO, treated with 200 mg/kg of ISO; Ovx-E + ISO, treated with estradiol + ISO combined. After fifty days of treatments, rats were euthanized and uterine horns were processed for histomorphometry or to collagen fibers and glycosaminoglycans evaluations. Blood samples were collected to evaluate levels of triglycerides, total cholesterol (TC) and its fractions (HDL/VLDL). Data were subjected to statistical analysis (p < .05). RESULTS: Uterus weight was lower in Ovx group than the Sham and Ovx-E groups, whereas it was similar between Ovx and Ovx-ISO groups. Histomorphometry showed atrophic uterus in Ovx and Ovx-ISO groups, whereas uterotrophic effects were noticed in Ovx-E and Ovx-E + ISO groups. Collagen fibers-birefringence was higher in Sham, Ovx, and Ovx-ISO groups than in Ovx-E and Ovx-E + ISO groups. Sulfated glycosaminoglycans content was similar among Sham, Ovx, and Ovx-ISO groups, while it was higher in estrogen-treated groups; total glycosaminoglycans content was similar among groups. TC and HDL was higher in Ovx-ISO group, whereas VLDL and triglycerides levels was higher in Ovx-E + ISO group and similar among other groups. CONCLUSION: Soy isoflavones at 200 mg/kg have slight beneficial effects on lipid-profile without uterotrophic effects in Ovx rats.

Histomorphometric and immunohistochemical changes in interstitial cells and ovarian follicles of rats with polycystic ovaries treated with clomiphene citrate.

OBJECTIVE: To evaluate the histomorphometric and immunohistochemical changes in interstitial cells and ovarian follicles of rats treated with clomiphene citrate during and after induction of permanent estrus. METHODS: Twenty four adult-female rats with regular estrous cycle were equally divided into three groups: (1) GCtrl-at estrous phase. (2) GPCOS-at permanent-estrous phase. (3) GCC-PCOS rats, which remained exposed to 60 days of continuous illumination and treated with Clomiphene Citrate. After that, the animals were euthanized, and the ovaries were removed and processed for paraffin embedding. Sections were stained with H.E. for histomorphometry or subjected to immunohistochemistry for Ki-67 and cleaved caspase-3 detections. RESULTS: The GPCOS showed lack of corpus luteum and several ovarian cysts, as well as interstitial-like cells. The presence of corpus luteum and a significant increase in primary and antral follicles were observed in GCC, which also showed a decrease in the number of ovarian cysts and in the area occupied by interstitial-like cells, as well as a decrease in nuclear volume of interstitial cells. The percentage of cell proliferation was significantly higher in granulosa cells of the GCC. On the other hand, the percentage of apoptosis was significantly higher in the granulosa cells of GPCOS than the GCC. CONCLUSION: The ovaries of rats treated with clomiphene citrate showed a decrease in the number of cysts, an increase in the number of ovarian follicles, the presence of corpus luteum along with a decrease in the nuclear volume in the area occupied by interstitial cells.

Bioimpedance Vector Patterns Changes in Response to Swimming Training: An Ecological Approach.

BACKGROUND AND AIM: Monitoring bioelectric phase angle (PhA) provides important information on the health and the condition of the athlete. Together with the vector length, PhA constitutes the bioimpedance vector analysis (BIVA) patterns, and their joint interpretation exceeds the limits of the evaluation of the PhA alone. The present investigation aimed to monitor changes in the BIVA patterns during a training macrocycle in swimmers, trying to ascertain if these parameters are sensitive to training load changes across a 13-week training period. METHODS: Twelve national and international level swimmers (four females; eight males; 20.9 ± 1.9 years; with a competitive swimming background of 11.3 ± 1.8 years; undertaking 16-20 h of pool training and 4-5 h of dry-land training per week and 822.0 ± 59.0 International Swimming Federation (FINA) points) were evaluated for resistance (R) and reactance (Xc) using a single frequency phase sensitive bioimpedance device at the beginning of the macrocycle (M1), just before the beginning of the taper period (M2), and just before the main competition of the macrocycle (M3). At the three-time assessment points, swimmers also performed a 50 m all-out first stroke sprint with track start (T50 m) while time was recorded. RESULTS: The results of the Hotelling T2 test showed a significant vector displacement due to simultaneous R and Xc changes (p < 0.001), where shifting from top to bottom along the major axis of the R-Xc graph from M1 to M2 was observed. From M2 to M3, a vector displacement up and left along the minor axis of the tolerance ellipses resulted in an increase in PhA (p < 0.01). The results suggest a gain in fluid with a decrease in cellular density from M1 to M2 due to decrements in R and Xc. Nevertheless, the reduced training load characterizing taper seemed to allow for an increase in PhA and, most importantly, an increase of Xc, thus demonstrating improved cellular health and physical condition, which was concomitant with a significant increase in the T50 m performance (p < 0.01). CONCLUSIONS: PhA, obtained by bioelectrical R and Xc, can be useful in monitoring the condition of swimmers preparing for competition. Monitoring BIVA patterns allows for an ecological approach to the swimmers' health and condition assessment without resorting to equations to predict the related body composition variables.

The influence of phytoestrogens or estrogens on the proliferation of the rat endocervical mucosa.

OBJECTIVE: Although estrogen therapy is widely used against post-menopausal symptoms, it can present adverse effects, including endometrial cancer. Soy isoflavones are considered a possible alternative to estrogen therapy. However, there are still concerns whether isoflavones exert trophic effects on the uterine cervix. To evaluate the histomorphometric and immunohistochemical alterations in the uterine cervix of ovariectomized rats treated with soy isoflavones (Iso). METHODS: Fifteen adult Wistar rats were ovariectomized (Ovx) and divided into three groups: Group I (Ovx), administered with vehicle solution; Group II (OVX-Iso), administered with concentrated extract of Iso (150 mg/kg) by gavage; and Group III (OVX-E2), treated with 17ß-estradiol (10 µg/kg), subcutaneously. After 30 days of treatments, the uterine cervix was fixed in 10% formaldehyde and processed for paraffin-embedding. Sections were stained with Hematoxylin and eosin for morphological and morphometric studies or subjected to immunohistochemistry for detections of Ki-67 and vascular endothelial growth factor-A (Vegf-A). The data obtained were subjected to statistical analysis (p ≤ 0.05). RESULTS: We noted an atrophic uterine cervix in GI, whereas it was more voluminous in GII and even more voluminous in GIII. The thickness of the cervical mucosa was significantly higher in GIII, as compared to GI and GII. The cell proliferation (Ki-67) was significantly elevated in the estradiol and isoflavones treated groups, whereas Vegf-A immunoexpression was significantly higher in GIII, as compared to groups GII and GI. CONCLUSIONS: Soy isoflavones cause less trophic and proliferative effects in the uterine cervix of rats as compared to estrogen.

The influence of phytoestrogens or estrogens on the proliferation of the rat endocervical mucosa

SUMMARY INTRODUCTION Although estrogen therapy is widely used against post-menopausal symptoms, it can present adverse effects, including endometrial cancer. Soy isoflavones are considered a possible alternative to estrogen therapy. However, there are still concerns whether isoflavones exert trophic effects on the uterine cervix. OBJECTIVES To evaluate the histomorphometric and immunohistochemical alterations in the uterine cervix of ovariectomized rats treated with soy isoflavones (Iso). METHODS Fifteen adult Wistar rats were ovariectomized (Ovx) and divided into three groups: Group I (Ovx), administered with vehicle solution; Group II (OVX-Iso), administered with concentrated extract of Iso (150 mg/kg) by gavage; and Group III (OVX-E2), treated with 17β-estradiol (10 µg/kg), subcutaneously. After 30 days of treatments, the uterine cervix was fixed in 10% formaldehyde and processed for paraffin-embedding. Sections were stained with Hematoxylin and eosin for morphological and morphometric studies or subjected to immunohistochemistry for detections of Ki-67 and vascular endothelial growth factor-A (Vegf-A). The data obtained were subjected to statistical analysis (p ≤ 0.05). RESULTS We noted an atrophic uterine cervix in GI, whereas it was more voluminous in GII and even more voluminous in GIII. The thickness of the cervical mucosa was significantly higher in GIII, as compared to GI and GII. The cell proliferation (Ki-67) was significantly elevated in the estradiol and isoflavones treated groups, whereas Vegf-A immunoexpression was significantly higher in GIII, as compared to groups GII and GI. CONCLUSIONS Soy isoflavones cause less trophic and proliferative effects in the uterine cervix of rats as compared to estrogen.

RESUMO INTRODUÇÃO Embora a terapia estrogênica seja amplamente utilizada contra sintomas pós-menopausais, ela pode apresentar efeitos adversos, incluindo câncer de mama e endometrial. Assim, as isoflavonas da soja são consideradas uma alternativa possível à terapia estrogênica. No entanto, ainda há controvérsias se estes compostos exercem efeitos tróficos significativos no colo do útero. OBJETIVOS Avaliar as alterações histomorfométricas e imuno-histoquímicas no colo do útero de ratas ovariectomizadas tratadas com isoflavonas da soja (iso). MÉTODOS Quinze ratas Wistar adultas foram ovariectomizadas bilateralmente (Ovx) e separadas em três grupos: Grupo I (Ovx) - veículo (propilenoglicol); Grupo II (Ovx-Iso) - receberam extrato concentrado de Iso (150 mg/kg) e Grupo III (Ovx-E2) - tratado com 17β-estradiol (10 µg/kg); as soluções foram administradas via gavagem por 30 dias consecutivos. Posteriormente, os colos uterinos foram retirados, fixados em formaldeído a 10% tamponado e processados para inclusão em parafina. Cortes (4 µm) foram coradas com hematoxilina e eosina para estudo morfológico e morfométricos, enquanto outros foram submetidos à imuno-histoquímica para detecção de Ki-67 e do fator de crescimento endotelial vascular-A (Vegf-A). Os dados obtidos foram submetidos à análise estatística (p≤0,05). RESULTADOS Observamos a presença de colo uterino atrófico no GI (Ovx), sendo este mais volumoso no GII (Ovx+Iso) e ainda mais volumoso no GIII (Ovx+E2). A espessura da mucosa cervical foi significativamente maior no GIII (Ovx-E2), em comparação ao GI (Ovx) e ao GII (Ovx-Iso). A proliferação celular (Ki-67) foi significativamente mais elevada nos grupos tratados com estradiol e isoflavonas, enquanto a imunoexpressão de Vegf-A foi significativamente maior no GIII (Ovx-E2), em comparação ao GII (Ovx-Iso) e ao GI (Ovx-E2). CONCLUSÕES As isoflavonas da soja causam menos efeitos tróficos e proliferativos no colo do útero de ratas em comparação ao estrogênio.

Therapeutic expectations: Dentistry relies less on dental plaque as a major etiological factor. OR On the dental needs of young orthodontic patients (12-20 years old).

In Brazilian cities and states governed efficiently with wealth ethically administered, carious and periodontal diseases have prevalence rates similar to those found in socially developed European countries. This shift in reality, noticed over the last 15 years, reflects on changes in the etiological factors related to patients' major expectations and needs--especially young and orthodontic patients--which turn out to be a result of dental trauma, malocclusion, facial aspect, dental agenesis and iatrogenesis. Under such conditions, patients begin to appreciate the value of tooth position, color and shape, their smile and function: details become relevant. Carious and periodontal diseases remain an issue, not only from a preventive prospect, but also from a curative one. Nevertheless, it should be noted that changes and development are inevitable, and we should be prepared to contribute to the wellbeing of people, particularly regarding their novel needs and expectations.

Therapeutic expectations: Dentistry relies less on dental plaque as a major etiological factor OR On the dental needs of young orthodontic patients (12-20 years old)

In Brazilian cities and states governed efficiently with wealth ethically administered, carious and periodontal diseases have prevalence rates similar to those found in socially developed European countries. This shift in reality, noticed over the last 15 years, reflects on changes in the etiological factors related to patients' major expectations and needs - especially young and orthodontic patients - which turn out to be a result of dental trauma, malocclusion, facial aspect, dental agenesis and iatrogenesis. Under such conditions, patients begin to appreciate the value of tooth position, color and shape, their smile and function: details become relevant. Carious and periodontal diseases remain an issue, not only from a preventive prospect, but also from a curative one. Nevertheless, it should be noted that changes and development are inevitable, and we should be prepared to contribute to the wellbeing of people, particularly regarding their novel needs and expectations.

A cárie e a doença periodontal em cidades e estados brasileiros com gestão eficiente e ética dos recursos apresenta índices de prevalência semelhantes aos de países europeus mais desenvolvidos socialmente. Essa mudança de realidade, percebida ao longos dos últimos 15 anos, reflete na mudança dos agentes etiológicos relacionados às principais expectativas e necessidades dos pacientes - especialmente os jovens e ortodônticos -, as quais passam a ser decorrentes do traumatismo dentário, má oclusão, aspecto facial, agenesias dentárias, iatrogenias. Nessa nova condição, passam a valorizar a posição, cor e forma dos dentes, seu sorriso e suas funções: os detalhes passam a ser relevantes. Ainda devemos nos preocupar com a cárie e doença periodontal, inclusive nos seus aspectos curativos e não mais apenas preventivos, mas devemos perceber que as mudanças e evoluções são inevitáveis, e nos preparar para contribuir para o bem das pessoas quanto às suas novas necessidades e expectativas.

Characterization of non-technical skills in paediatric cardiac surgery: communication patterns.

OBJECTIVES: The management of non-technical skills in complex surgical domains, such as paediatric cardiac surgery, is being recognized as a major factor for both performance and safety. Communication patterns are very relevant for safety and were analysed in this human-factor observational study. METHODS: One behaviour observer taped and video-recorded the communication patterns for 10 consecutive paediatric open-heart cases, at a university institution, performed by variable, informal teams. Records were analysed for communication frequency, direction, type, content and pattern on the one hand, and on the other hand for factors influencing communication. RESULTS: A total of 10 167 communication flows were read, with an average of 1017 ± 170.9 per procedure over an average duration of 136.15 ± 19.52 min. The frequency of communication was maximal between the main surgeon and the scrub nurse (16% of all communications), followed by the main surgeon to the first surgical assistant (13.8%) and the main surgeon to the perfusionist (12.4%). Communication between the main surgeon and the anaesthetist was not more than 5%. Types of communication varied from requests, questions, answers, statements, informations and explanations, and being different for distinct staff roles: the main surgeon to the scrub nurse involved 84.2% requests, the main surgeon to the first surgical assistant 59.9% statements and the perfusionist to the main surgeon 65.4% answers. Communication patterns varied, being 'closed-loop' (with feedback and double-check) only between the main surgeon and the perfusionist, and mostly open among other team members. Communication-disturbing factors such as noise, technology-related events, resource-based problems and supervisory and training-related issues were also found. CONCLUSIONS: Communication is very frequent in paediatric cardiac surgery and shows a complex pattern. There is room for improvement, namely by a more formal and standardized communication flow structure that can be achieved with the help of behavioural, technological and organizational initiatives.

Linfoma não Hodgkin primário de mama: relato de caso / Primary breast lymphoma: case report

Linfomas primários da mama são infrequentes, com incidência variando entre 0,04% e 0,53% de todas as doenças malignas da mama, e compreendem 2,2% de todos os linfomas extranodais. Para ser considerado linfoma primário da mama, deve preencher alguns requisitos já estabelecidos. As publicações de casos estão aumentando provavelmente pelo uso mais frequente da imunoistoquímica no esclarecimento diagnóstico, e anticorpo monoclonal já está sendo incluso no arsenal terapêutico, melhorando o prognóstico. Relatou-se um caso de linfoma não Hodgkin primário da mama que preencheu os requisitos necessários, discutindo os aspectos clínicos, histopatológicos, imunoistoquímicos, exames de imagem e tratamento.

Primary breast lymphomas are not frequent having an incidence between 0,04% and 0,53 % of all malignant breast diseases and englobe 2,2% of all extra nodal lymphomas. To be considered a primary breast lymphoma, it must fulfill some requisites previously established. The publications of cases are increasing in number, probably due to the more frequent use of immunohistochemistry in the diagnostic enlightenment and monoclonal antibody, being already included in the therapeutical arsenal to improve prognostics. We report here a case of a primary non-Hodgkin breast lymphoma that fulfilled all the necessary requisits, discussing the clinical, histopathologic, immunohistochemical aspects, image exams and treatment.

Glucocorticoid receptors, in vitro steroid sensitivity, and cytokine secretion in idiopathic nephrotic syndrome.

BACKGROUND: Glucocorticoids (GC) represent the mainstay of treatment of idiopathic nephrotic syndrome (INS) and might be involved in the pathogenesis of the disease. We evaluated basal secretion of cortisol, number and affinity of glucocorticoid receptors, dexamethasone (Dex)-mediated inhibition of concanavalin-A (Con-A)-stimulated peripheral blood mononuclear cell (PBMC) proliferation, and cytokine secretion in patients with INS. METHODS: Blood and saliva were obtained from 20 INS patients in relapse and 11 control patients. Cortisol concentrations were measured by radioimmunoassay. PBMC were isolated for binding and in vitro GC sensitivity assays. Cytokines were measured in supernatants of PBMC culture by enzyme-linked immunosorbent assay (ELISA). RESULTS: Salivary cortisol concentrations were similar in INS patients and control patients. Density and affinity of GC receptors were similar in steroid-sensitive (SS) patients and control, whereas in steroid-resistant (SR) patients they were variable. Lymphocyte proliferation after Con-A stimulation was inhibited by Dex in a dose-dependent manner in control and SS patients. Control and all clinically SS patients were steroid-sensitive by in vitro test, but control patients significantly presented more suppression of PBMC proliferation compared with SS patients. Basal- and Con-A-stimulated interleukin (IL)-6, IL-10, interferon (IFN)-gamma, and tumor necrosis factor (TNF)-alpha levels were similar in control and INS patients, and all cytokines but IL-10 were significantly inhibited by Dex 10-6 mol/L. In SR patients, cytokine secretion remained elevated after treatment with high doses of Dex. CONCLUSION: Abnormalities of number and affinity of the GC receptor and altered secretion of cytokines may be involved in tissue sensitivity to GC in INS patients.

[Anterior urethral valves]. / Válvula de uretra anterior.

OBJECTIVE: To discuss clinical signs, diagnostic tools and therapeutics of anterior urethral valves, an obstructive anomaly of the urinary system in males. DESCRIPTION: Signs of urinary tract obstruction were identified on pre-natal ultrasound in two male fetuses and the diagnosis of anterior urethral valves was made through post-natal evaluation. As an initial treatment, vesicostomy was performed in both patients. Later, the valves were fulgurated using an endoscopic procedure. During the follow-up period both patients presented normal renal function. COMMENTS: Anterior urethral valves are a rare form of urethral anomaly that must be ruled out in boys with pre-natal ultrasound indicating infravesical obstruction. Vesicostomy used as an initial treatment rather than transurethral fulguration may prevent potential complications that can occur due to the small size of the neonatal urethra.\par

Immunogenetic features of steroid-sensitive nephrotic syndrome and focal segmental glomerulosclerosis in brazilian patients of the northeast region of the State of Säo Paulo

Steroid-sensitive nephrotic syndrome (SSNS) and focal segmental glomerulosclerosis (FSGC) share immunologic and pathogenetic features. We studied 93 Brazilian patients (46 with SSNS and 47 with FSGC) and 104 control subjects with the objective of characterizing the immunogenetic profile of these varieties of idiopathic nephrotic syndrome. HLA-A, -B, and -DR antigens were typed using a complement-dependent microlymphocytotoxicity assay. No significantly association was observed with HLA-A or -B antigens in either group; however, HLA-B7 and -B12 antigens were increased in SSNS patients. HLA-DR7, -DR1 and the combination of HLA-DR1/DR7 antigens were significantly increased in the total group of patients with SSNS compared to controls or to FGSC patients. The study of only Caucasoid individuals revealed the HLA-DR7 antigen remained significantly increased in SSNS patients. The HLA-B7/DR7 haplotype was significantly increased in both SSNS and FSGC patients. Although the Brazilian population is highly miscigenated, the same antigen (HLA-DR7) which confers susceptibility to SSNS in other Caucasian population is still prevalent in this series

Valor da relaçäo proteína/creatinina, em amostras únicas de urina para semi-qualificaçäo da proteinúria, em crianças com nefrose / Protein/creatinine ratio in single urine samples for the semiquantitation of proteinuria in children with nephrosis

Objetivo: Estimar semi-quantitativamente a proneteinúria de pacientes nefróticos, apartir de amostras únicas de urina, pelo uso do valor da relaçäo proteína/creatinina e determinar sua correlaçäo com o valor da proteinúria de 24 horas. Métodos: Foram analisadas 30 amostras de urina de 24 horas e 30 amostras únicas de urina obtidas de 20 crianças com nefrose, acompanhadas pelo Serviço de Nefrologia Pediátrica do Hospital das Clínicas da Faculdade de Medicina de Ribeiräo Preto - USP. A proteinúria foi dosada, nas urinas de 24 horas e nas amostras únicas de urina, pelo método turbidimétrico com o ácido sulfossalicílico a 3 por cento. A creatinina urinária foi dosada pelo método de Hare, modificado por Haugen e Blegen, adaptado para microtécnica. Resultados: Foi observada excelente correlaçäo entre o valor da proteinúria em amostra de urina de 24 horas e o valor da proteinúria determinada pela relaçäo proteína/creatinina em amostra única de urina, analisada por regressäo linear, antes (r= 0,82; p< 0,001) e após a transformaçäo logarítmica dos dados (r= 0,93; p< 0,001). Todos os pacientes com proteinúria em níveis fisiológicos (menor que 0,1 g/m²/dia) apresentaram relaçäo proteína/creatinina menor que 0,1 g/m²/dia) . Todos com proteinúria de 24 horas maciça (maior que 1 g/m²/dia) apresentaram relaçäo proteína/creatinina maior que 1,0(mg/mg). Os pacientes com proteinúria intermediária (entre 0,1 e 1,0 g/m²/dia) apresentaram relaçäo proteína/creatinina distribuída nos três níveis...