Chronic stress is a major risk factor for neuropsychiatric conditions such as depression. Adult hippocampal neurogenesis (AHN) has emerged as a promising target to counteract stress-related disorders given the ability of newborn neurons to facilitate endogenous plasticity. Recent data sheds light on the interaction between cannabinoids and neurotrophic factors underlying the regulation of AHN, with important effects on cognitive plasticity and emotional flexibility. Since physical exercise (PE) is known to enhance neurotrophic factor levels, we hypothesised that PE could engage with cannabinoids to influence AHN and that this would result in beneficial effects under stressful conditions. We therefore investigated the actions of modulating cannabinoid type 2 receptors (CB2R), which are devoid of psychotropic effects, in combination with PE in chronically stressed animals. We found that CB2R inhibition, but not CB2R activation, in combination with PE significantly ameliorated stress-evoked emotional changes and cognitive deficits. Importantly, this combined strategy critically shaped stress-induced changes in AHN dynamics, leading to a significant increase in the rates of cell proliferation and differentiation of newborn neurons, overall reduction in neuroinflammation, and increased hippocampal levels of BDNF. Together, these results show that CB2Rs are crucial regulators of the beneficial effects of PE in countering the effects of chronic stress. Our work emphasises the importance of understanding the mechanisms behind the actions of cannabinoids and PE and provides a framework for future therapeutic strategies to treat stress-related disorders that capitalise on lifestyle interventions complemented with endocannabinoid pharmacomodulation.
Cannabinoids , Animals , Cannabinoids/pharmacology , Receptors, Cannabinoid , Exercise , Hippocampus , Neurogenesis/physiology , Antidepressive Agents/pharmacology
Erector spinae plane block has been recently described and it appears as a very promising regional analgesia technique. We report the first continuous erector spinae plane block performed in a pediatric patient for thoracic surgery. A 15-month-old boy, diagnosed with a paracardiac teratoma was scheduled for a tumor resection with a thoracotomy approach. After general anesthesia induction, a continuous erector spinae plane block at T5 level was performed with ropivacaine 0.2%. After surgery, a continuous thoracic interfascial infusion of ropivacaine 0.1% along with multimodal rescue analgesia was initiated. The patient tolerated the procedure well with no complications. It appears that this is a good alternative to thoracic epidural and paravertebral block, given the simple reproducibility and potential greater safety of this technique.
Analgesia/methods , Nerve Block/methods , Thoracotomy , Humans , Infant , Male
BACKGROUND: Donor-specific antibodies (DSAs) play a fundamental role in kidney transplantation. The identification of DSAs is an essential rejection parameter. PATIENTS AND METHODS: We evaluated a protocol in 237 patients receiving kidneys from living (LDs) and deceased donors (DDs). Recipients were classified as being at low (LR), medium (MR), high (HR), or strong (SR) risk of rejection based on Luminex panel reactive antibody (PRA)-single antigen beads (SABs). Grafts that survived for 1 year were evaluated. RESULTS: Of the 237 transplanted patients, 129 (54.43%) received a kidney from an LD and 108 (45.57%) from a DD. Of 95 LR recipients receiving kidneys from LDs, 2 patients lost the graft due to non-immunological causes. Of 34 MR recipients, 13 had rejection episodes, and 2 lost the graft by AMR and one by cellular rejection (CR). Of 108 recipients receiving a kidney from a DD, 59 (54.63%) were LR, 31 (28.70%) MR, 11 (10.19%) HR, and 7 (6.48%) SR. Twenty of all transplanted recipients lost their grafts; 4 were due to clinical causes, 4 by cellular rejection, and 12 by antibody-mediated rejection (AMR) with PRA-SAB mean fluorescent intensity of 530 to 12,591. One-year graft survival for LD transplanted LR and MR patients was 97.6% and 94.1%, respectively (P = .004). In DD recipients, the LR vs MR SD was P = .011, and for LR vs HR + SR it was P = .001. For MR vs HR+SR no SD was found (P = .323). CONCLUSION: Rejections were detected in 51 patients (21.52%). Graft failure occurred in 16 patients (6.75%). A total of 218 (91.98%) recipients maintained good kidney function after 1 year. This protocol based on fluxogram risk assessment of AMR provided fast and precise immunological evaluation of recipients and donors and stratification by immunological risk of AMR.
Graft Rejection/immunology , Histocompatibility Testing/methods , Kidney Transplantation , Renal Insufficiency/surgery , Adult , Antibodies/chemistry , Creatinine/blood , Female , Graft Survival , HLA Antigens/chemistry , Humans , Immunosuppressive Agents/therapeutic use , Kidney/pathology , Living Donors , Male , Middle Aged , Prospective Studies , Risk Factors , Treatment Outcome
Reduced aerobic capacity, as measured by maximal oxygen uptake, is a hallmark in cardiovascular diseases and strongly predicts poor prognosis and higher mortality rates in heart failure patients. While exercise capacity is poorly correlated with cardiac function in this population, skeletal muscle abnormalities present a striking association with maximal oxygen uptake. This fact draws substantial attention to the clinical relevance of targeting skeletal myopathy in heart failure. Considering that skeletal muscle is highly responsive to aerobic exercise training, we addressed the benefits of aerobic exercise training to combat skeletal myopathy in heart failure, focusing on the mechanisms by which aerobic exercise training counteracts skeletal muscle atrophy.
Exercise Therapy , Exercise Tolerance , Heart Failure/therapy , Muscle, Skeletal/physiopathology , Muscular Atrophy/therapy , Muscular Diseases/therapy , Animals , Heart Failure/complications , Heart Failure/pathology , Heart Failure/physiopathology , Humans , Muscle Contraction , Muscle, Skeletal/pathology , Muscular Atrophy/complications , Muscular Atrophy/pathology , Muscular Atrophy/physiopathology , Muscular Diseases/complications , Muscular Diseases/physiopathology , Myocardium/pathology , Oxygen Consumption , Recovery of Function , Treatment Outcome
PURPOSE: To assess ocular and otorhinolaryngologic manifestations and intellectual ability in patients with Möbius' syndrome. METHODS: Patients with Möbius' syndrome underwent prospective ophthalmic, genetic-clinical, and otorhinolaryngologic examinations as well as psychological evaluation. RESULTS: Sixteen patients with Möbius' syndrome between the ages of 8 months and 10.6 years underwent ocular examination. Esotropia was present in 12 (75%) patients and V-pattern in 8 (50%). Limited abduction was present in 30 (93.8%) eyes, and limited adduction was present in 21 (65.6%) eyes. The most frequent refractive error was compound hyperopic astigmatism (13 [40.6%] eyes). Eleven (68.8%) patients had lagophthalmos and 12 (75%) patients had bilateral epicanthus. Unilateral amblyopia was present in 2 (12.5%) patients. Clubfoot was the most common lower limb defect (7 [43.8%] patients). Cranial nerve impairments included paralysis of 7th nerve in all patients, paralysis of the 12th nerve in 13 patients, and paralysis of the 9th and 10th nerves in 3 patients. Evaluation of intellectual ability showed that 4 (25%) patients had normal intelligence. The mothers of 3 (18.8%) patients used misoprostol during the first trimester of pregnancy. CONCLUSION: Prominent ophthalmic features of Möbius' syndrome in this series were esotropia, V-pattern, abduction limitation, and compound hyperopic astigmatism. Intellectual assessment showed some degree of mental retardation in 75% of patients. Möbius' syndrome is associated with prenatal exposure to misoprostol.
Eye Diseases/diagnosis , Mobius Syndrome/diagnosis , Otorhinolaryngologic Diseases/diagnosis , Child , Child, Preschool , Diagnostic Techniques, Ophthalmological , Eye Diseases/etiology , Female , Humans , Infant , Intelligence Tests , Male , Mobius Syndrome/complications , Otorhinolaryngologic Diseases/etiology , Prospective Studies , Visual Acuity
A total of 83 clinical isolates of the Bacteroides fragilis group collected from two Brazilian hospitals during 1993 and 1994, were tested for susceptibility to six antimicrobial agents by using an agar dilution method. The species most frequently isolated was B. fragilis (63.8%), followed by B. thetaiotaomicron (15.6%), B. vulgatus (9.6%) and B. distasonis (7.2%). The various species of the B. fragilis group had different patterns of resistance; B. fragilis was the most susceptible species in both medical centers. All isolates were susceptible to metronidazole and chloramphenicol. The following resistance rates were observed: 89.1% (Penicillin G); 77.1% (tetracycline); 18% (clindamycin) and 7.2% (cefoxitin). These results reflect the value of identification of clinical important isolates and the periodic determination of B. fragilis group susceptibility patterns at each medical institution.
PURPOSE: To identify the most common ocular findings in a pediatric group of patients with Down's syndrome. METHODS: A total of 152 children with Down's syndrome between two months and 18 years of age prospectively underwent ocular examination, including visual acuity assessment, slit-lamp biomicroscopy, ocular motility, cycloplegic retinoscopy, and ophthalmoscopy. RESULTS: Ocular findings in decreasing prevalence were the following: upward slanting of the palpebral fissure with the outer canthus 2 mm or higher than the inner canthus (82%), epicanthal folds (61%), astigmatism (60%), iris abnormalities (52%), strabismus (38%), lacrimal system obstruction (30%), blepharitis (30%), retinal abnormalities (28%), hyperopia (26%), amblyopia (26%), nystagmus (18%), cataract (13%), and myopia (13%). Visual acuity was assessed, and the Teller acuity cards were the most useful method of examination. The patients younger than five years old had a higher prevalence of hyperopia than did those in other age groups; patients between five and 12 years old had a higher prevalence of astigmatism; and patients older than 12 years of age had more iris abnormalities, strabismus, and cataract. Myopia and myopic astigmatism were more common in the patients with cardiac malformations. CONCLUSION: The early diagnosis of the ocular abnormalities in patients with Down's syndrome, by using Teller acuity cards in assessing visual acuity facilitates the treatment of refractive errors, strabismus, and amblyopia and may minimize handicaps.
Down Syndrome/complications , Eye Diseases/epidemiology , Adolescent , Age Distribution , Brazil/epidemiology , Cataract/diagnosis , Cataract/epidemiology , Cataract/etiology , Child , Child, Preschool , Eye Diseases/diagnosis , Eye Diseases/etiology , Eyelid Diseases/diagnosis , Eyelid Diseases/epidemiology , Eyelid Diseases/etiology , Female , Fundus Oculi , Humans , Infant , Lacrimal Duct Obstruction/diagnosis , Lacrimal Duct Obstruction/epidemiology , Lacrimal Duct Obstruction/etiology , Male , Prevalence , Prospective Studies , Refractive Errors/diagnosis , Refractive Errors/epidemiology , Refractive Errors/etiology , Retinal Diseases/diagnosis , Retinal Diseases/epidemiology , Retinal Diseases/etiology , Visual Acuity
The efficacy of hydroxypropylmethylcellulose and sodium hyaluronate as adjuncts during adjustable strabismus surgery was evaluated experimentally. Fifteen randomized NZA rabbits underwent a bilateral 4-mm recession of the superior rectus followed by a 0.05 mL injection of submuscular hydroxypropylmethylcellulose 2% (HPMC) in one eye and sodium hyaluronate 1% (Healon) in the other eye. Five additional rabbits (10 eyes), used as controls, underwent the same procedure, but no viscoelastic was injected after surgery. The force needed to move the muscle 4 mm toward its original insertion was measured immediately and 24 hours after the operation, using a force gauge. The force needed to adjust the muscles increased 326.0%, 98%, and 124.7%, respectively in the control, Healon and HPMC groups (p < 0.001). No significant difference was found between the two viscoelastic substances. Histologic evaluation of the operation sites disclosed similar inflammation in both controls and viscoelastic groups (p = .5960).
Hyaluronic Acid/therapeutic use , Methylcellulose/analogs & derivatives , Strabismus/surgery , Suture Techniques , Animals , Chemotherapy, Adjuvant , Hypromellose Derivatives , Injections , Male , Methylcellulose/therapeutic use , Oculomotor Muscles/physiology , Oculomotor Muscles/surgery , Prospective Studies , Rabbits , Random Allocation
Treze dentre 55 pacientes em hemodialise (23,6%) foram submetidos a biopsia hepaticas antes e apos transplante renal e acompanhados, em media, por 18,3 meses, por serem HBaAg positivo (12 pacientes, 21,8%) e/ou terem disfuncao hepatica. A simples persistencia do HBsAg no soro se acompanhava, com frequencia, de biopsias normais ou com alteracoes inespecificas. Entretanto, quatro pacientes HBsAg positivos apresentaram hepatopatia fatal algum tempo apos o transplante: dois com cirrose comprovada, um com necrose submacica e outro, que se tornara etilista inveterado, com provavel cirrose. Um quinto paciente HBaAg positivo evoluiu para hepatite cronica ativa apos rejeicao do transplante. Embora a persistencia do HBsAg no soro indique sempre mau prognostico apos o transplante, parece ser a principal causa de hepatopatia em nosso grupo de renais cronicos e associa-se, por vezes, a disfuncao hepatica intensa e ate fatal
Adolescent , Adult , Middle Aged , Humans , Male , Female , Kidney , Liver Diseases , Postoperative Complications , Transplantation
O autor apresenta um projeto multidisciplinar em todas as suas etapas, realizado na cidade de Osasco, em 1975, com o objetivo de prevencao. Foram examinados 2.238 pre-escolares. O projeto apresentou o menor indice de intestabilidade encontrado na literatura, devido a um excelente preparo pedagogico da populacao alvo. Esse preparo e unico na literatura. Os resultados sao comentados e comparados com os dos demais autores. Apresentou-se a incidencia das ametropias, dos desvios oculares, da ambliopia e das patologias oculares encontradas
Infant , Child, Preschool , Child , Humans , Amblyopia , School Health Services , Vision Disorders , Vision Tests , Brazil
Foi realizado o estudo nutricional e da amplitude de acomodacao em escolares de faixa etaria media de 8 anos. Foram classificados do ponto de vista nutricional em eutroficos, desnutridos vigentes e pregressos. Posteriormente realizou-se a confrontacao das amplitudes de acomodacao dos mesmos
Child , Humans , Male , Female , Accommodation, Ocular , Nutrition Disorders , Anthropometry
Three women with extrinsic oculo-muscular distrophy were studied. In two patients the symptoms were began at 25 and another one at 56 year-old. Non myogenic features were observed: in case one there was familial otosclerosis. This patient had impossibility to beget children. Her first menstruation was observed at 19 and the last at 40 year-old, like to case 2, which was the only to have electrocardiographic alterations. Romberg's signal and profound hyporeflexia was obtained in case 3, whose family had a lot of member with cataract. Biopsy of the non ocular muscles was made too, in spite of patient's symptoms had been concerning to ocular muscles only. All of non ocular muscles had myogenic features. In electromyogram examination of non ocular muscles the myogenic features were observed too. Therefore, we believe in diffuse myogenic process in spite of ocular manifestation had been the only patient's complaints.
Blepharoptosis/genetics , Muscular Dystrophies/genetics , Ophthalmoplegia/genetics , Adult , Female , Humans , Middle Aged , Muscles/embryology , Muscles/pathology , Muscular Dystrophies/pathology , Oculomotor Nerve/pathology
Em 166 pacientes transplantados de rim, 4 casos de tuberculose foram constatados, uma incidencia de 2,4% bem superior a da populacao geral brasileira de 0,3%. Tres casos foram da forma extrapulmonar, surgida entre o 2o.e 4o.anos apos transplante, e um caso de forma pulmonar, surgida um mes apos cirurgia.O quadro observado consistiu de febre, tosse, anorexia, perda de peso hepatosplenomegalia, ascite e pericardite. Todos os pacientes apresentaram PPD nao reator, leucopenia e alteracoes das provas de funcao hepatica.O diagnostico foi feito atraves de biopsia hepatica em um caso e com tratamento de prova nos tres restantes. Um paciente faleceu em decorrencia a doenca
Adult , Humans , Male , Female , Transplantation , Tuberculosis , Immunosuppressive Agents , Kidney
O autor conceitua os exodesvios segundo os conceitos unanimes encontrados na literatura desde Landolt e Chavasse. Apresenta um levantamento de 150 pacientes com exodesvios, escolhidos aleatoriamente do fichario da Escola Paulista de Medicina. Os resultados levam a algumas conclusoes contraditorias a literatura
Humans , Exotropia
Sao relatados 3 casos de pacientes femininos com atrofia dos musculos oculares extrinsecos, sendo 2 de inicio provavel aos 25 anos e 1 aos 56 anos. No que se referem as intercorrencias nao miogenicas, no caso 1 havia otosclerose, comum na familia e incapacidade para engravidar. A menarca ocorreu aos 19 anos e a menopausa aos 40, o que igualmente ocorreu com o caso 2, este o unico a mostrar alteracoes eletrocardiograficas. No caso 3 havia sinal de Romberg e hiporreflexia profunda, sendo comum a incidencia de catarata congenita. Com relacao a patologia muscular, apesar das queixas serem praticamente restritas aos musculos extrinsecos oculares, procedemos a biopsia de outros musculos,alem dos oculares, evidenciando-se em todos acometimento do tipo miogenico, o mesmo ocorrendo na EMG. Acreditamos tratar-se de processo miogenico difuso, em que pese a dominancia das manifestacoes oculares
Ophthalmoplegia
