Bj-PRO-10c, as an allosteric regulator of argininosuccinate synthase, is a potential therapy for neuroblastoma metastasis.

Cancer is a global public health issue. Neuroblastoma (NB) originates from any tissue of the sympathetic nervous system, and the most affected site is the abdomen. The adrenal gland is the primary site in 38% of cases. Approximately 50% of patients have metastatic disease at diagnosis, and bone marrow is often affected. Metastatic disease is characterized by the spreading of cancer cells that are frequently resistant to chemotherapy and radiotherapy from the primary tumor to other specific parts of the body and is responsible for 90% of cancer-related deaths. Increasing evidence has indicated that nitric oxide (NO) signaling is implicated in the pathophysiology of many types of cancer, particularly in tumorigenesis and cancer progression. However, the effect of NO on metastasis cannot be easily classified as prometastatic or antimetastatic. An understanding at the molecular level of the role of NO in cancer will have profound therapeutic implications for the diagnosis and treatment of disease. Here, the proline-rich decapeptide isolated from Bothrops jararaca venom (Bj-PRO-10c) that enhances and sustains the generation of NO was used to unravel the role of metabolic NO in steps of metastasis. Bj-PRO-10c showed an antimetastatic effect, mainly by interfering with actin cytoskeleton rearrangement, controlling cell proliferation, and decreasing the seeding efficiency of NB in metastatic niches. Therefore, we proposed that an approach for controlled NO induction with the right molecular strategies can hopefully inhibit metastasis and increase the lifespan of NB patients.

Medo do parto: uma revisão das intervenções baseadas na Terapia Cognitivo-Comportamental / Fear of childbirth: a review of interventions based on Cognitive Behavioral Therapy / Miedo al parto: una revisión de intervenciones basadas en Terapia Cognitivo-Conductual

O medo do parto vaginal é bastante comum e pode ter impactos relevantes na saúde materno-infantil. O objetivo deste estudo foi investigar de que forma a Terapia Cognitivo-Comportamental (TCC) tem sido aplicada em casos de medo do parto e avaliar a eficácia dessas intervenções. Realizou-se uma revisão sistemática da literatura através das bases de dados BVS Brasil, Scopus e PubMed, no período de fevereiro de 2019 a abril de 2019. Após a análise dos critérios de inclusão e exclusão, um total de oito textos completos constituíram a amostra final. Técnicas terapêuticas como a reestruturação cognitiva, a exposição e a atenção plena demonstraram ser relevantes para a elaboração de uma percepção menos catastrófica do parto e para o desenvolvimento de maior confiança nas próprias habilidades de enfrentamento do trabalho de parto. Conclui-se que as intervenções em TCC apresentam potencial benefício para o tratamento do medo do parto.

Fear of childbirth is a very common phenomenon among women and may significantly impact maternal-infant health. The goal of this study is to investigate how Cognitive Behavioral Therapy (CBT) has been applied in cases of fear of childbirth and assess the efficacy of such interventions. A systematic review of these practices was made using the BVS Brazil, Scopus, and PubMed databases, from February to April 2019. After analyzing the inclusion and exclusion criteria, a total of six full studies were selected as the final sample for this research. Therapeutic techniques such as cognitive restructuring, exposure, and mindfulness have proven to be important means of developing a less catastrophic perception of childbirth along with greater self-confidence in the abilities to cope with labor. The review led to the conclusion that CBT does have the potential to treat fear of childbirth.

El miedo al parto es muy común y puede afectar significativamente la salud materno-infantil. El objetivo de este estudio fue investigar cómo se ha aplicado la Terapia Cognitivo-Conductual (TCC) en casos de miedo al parto y evaluar la eficacia de las intervenciones. Se realizó una revisión sistemática a través de las bases de datos BVS Brasil, Scopus y PubMed, de febrero a abril de 2019. Después de analizar los criterios de inclusión y exclusión, un total de seis textos completos constituyeron la muestra final. Las técnicas terapéuticas como la reestructuración cognitiva, la exposición y la atención plena demostraron ser relevantes para la elaboración de una percepción menos catastrófica del parto y para el desarrollo de una mayor confianza en las capacidades propias para enfrentar el parto. La revisión llevó a la conclusión de que la TCC tiene potencial benéfico para tratar el miedo al parto.

Rastreio de câncer na prática clínica: recomendações para a população de risco habitual / Cancer screening in clinical practice: recommendations for average risk population

Objetivo: Compilar as evidências da literatura e as recomendações das principais sociedades médicas mundiais para o rastreamento populacional de câncer, contextualizando com a relevância epidemiológica de cada subtipo da doença. Métodos: Trata-se de revisão narrativa da literatura, realizada por levantamento na base de dados PubMed® e consulta aos posicionamentos de instituições governamentais e sociedades médicas nas áreas específicas. Resultados: O rastreamento populacional sistemático foi recomendado apenas para as neoplasias de mama, colo do útero e colorretal, utilizando-se métodos, idade e periodicidade específicos. O rastreio do câncer de próstata mostrou-se controverso, e o pulmonar e o hepático recomendados apenas em tabagistas com alta carga tabágica e cirróticos, respectivamente. Não houve evidência para se recomendar atualmente o rastreamento sistemático da população geral para as neoplasias de pele, tireoide, esôfago, estômago, pâncreas, ovário, endométrio, bexiga, rins, dentre outras. Conclusão: O exame periódico de saúde do paciente saudável abrangeu a prevenção e o rastreamento do câncer para redução de morbidade e mortalidade pela doença, e a estratificação das evidências atuais teve o potencial de melhorar o direcionamento dos esforços, aumentando a cobertura, havendo maior benefício e reduzindo riscos e custos de exames desnecessários.

Objective: To gather evidence from the literature, and recommendations of the main medical societies worldwide for the population screening of cancer, contextualizing with the epidemiological relevance of each subtype of the disease. Methods: This is a narrative review of the literature, carried out through research on PubMed® database, and consultation to the governmental institutions and medical societies' opinions in specific areas. Results: Systematic population screening was recommended only for breast, cervix and colorectal cancers, using specific methods, age and periodicity. Prostate cancer screening showed to be controversial, and pulmonary and hepatic screening are recommended only in heavy smokers and cirrhotic patients, respectively. Currently, there is no evidence to recommend the screening of the general population for neoplasms of skin, thyroid, esophagus, stomach, pancreas, ovary, endometrium, bladder, and kidneys. Conclusion: The periodic health screening of the healthy patient covered the prevention and screening for cancer to reduce morbidity and mortality from the disease; the stratification of current evidence has the potential to improve the direction of efforts, broadening coverage, with more benefit, and reducing risks and costs of unnecessary tests.

Kinin and Purine Signaling Contributes to Neuroblastoma Metastasis.

Bone marrow metastasis occurs in approximately 350,000 patients that annually die in the U.S. alone. In view of the importance of tumor cell migration into the bone marrow, we have here investigated effects of various concentrations of stromal cell-derived factor-1 (SDF-1), bradykinin- and ATP on bone marrow metastasis. We show for first time that bradykinin augmented chemotactic responsiveness of neuroblastoma cells to SDF-1 and ATP concentrations, encountered under physiological conditions. Bradykinin upregulated VEGF expression, increased metalloproteinase activity and induced adhesion of neuroblastoma cells. Bradykinin augmented SDF-1-induced intracellular Ca2+ mobilization as well as resensitization and expression of ATP-sensing P2X7 receptors. Bradykinin treatment resulted in higher gene expression levels of the truncated P2X7B receptor compared to those of the P2X7A full-length isoform. Bradykinin as pro-metastatic factor induced tumor proliferation that was significantly decreased by P2X7 receptor antagonists; however, the peptide did not enhance cell death nor P2X7A receptor-related pore activity, promoting neuroblastoma growth. Furthermore, immunodeficient nude/nude mice transplanted with bradykinin-pretreated neuroblastoma cells revealed significantly higher metastasis rates compared to animals injected with untreated cells. In contrast, animals receiving Brilliant Blue G, a P2X7 receptor antagonist, did not show any specific dissemination of neuroblastoma cells to the bone marrow and liver, and metastasis rates were drastically reduced. Our data suggests correlated actions of kinins and purines in neuroblastoma dissemination, providing novel avenues for clinic research in preventing metastasis.

Effectiveness of first-wave protease inhibitors in hepatitis C virus genotype 1 infection: a multicenter study in Brazil.

INTRODUCTION: In 2013, combination therapy using peginterferon, ribavirin, and boceprevir or telaprevir was introduced to treat hepatitis C virus genotype 1 infection in Brazil. The effectiveness of this therapy in four Brazilian regions was evaluated. METHODS: Clinical and virological data were obtained from patients of public health institutions in five cities, including sustained virological response (SVR) and side effects. Patients with advanced fibrosis (F3/4), moderate fibrosis (F2) for > 3 years, or extra-hepatic manifestations were treated according to Ministry of Health protocol. Treatment effectiveness was verified by using bivariate and multivariate analysis; p-values of < 0.05 were considered significant. RESULTS: Of 275 patients (64.7% men; average age, 57 years old), most (61.8%) were treatment-experienced; 53.9% had subgenotype 1a infection, 85.1% had advanced fibrosis, and 85.5% were treated with telaprevir. SVR was observed in 54.2%. Rapid virological response (RVR) was observed in 54.6% of patients (data available for 251 patients). Overall, 87.5% reported side effects and 42.5% did not complete treatment. Skin rash, severe infection, and death occurred in 17.8%, 2.5%, and death in 1.4% of cases, respectively. SVR was associated with treatment completion, RVR, and anemia. CONCLUSIONS: The effectiveness of hepatitis C virus triple therapy was lower than that reported in phase III clinical trials, possibly owing to the prioritized treatment of patients with advanced liver fibrosis. The high frequency of side effects and treatment interruptions observed supported the decision of the Brazilian authorities to suspend its use when safer and more effective drugs became available in 2015.

Effectiveness of first-wave protease inhibitors in hepatitis C virus genotype 1 infection: a multicenter study in Brazil

Abstract INTRODUCTION: In 2013, combination therapy using peginterferon, ribavirin, and boceprevir or telaprevir was introduced to treat hepatitis C virus genotype 1 infection in Brazil. The effectiveness of this therapy in four Brazilian regions was evaluated. METHODS: Clinical and virological data were obtained from patients of public health institutions in five cities, including sustained virological response (SVR) and side effects. Patients with advanced fibrosis (F3/4), moderate fibrosis (F2) for > 3 years, or extra-hepatic manifestations were treated according to Ministry of Health protocol. Treatment effectiveness was verified by using bivariate and multivariate analysis; p-values of < 0.05 were considered significant. RESULTS: Of 275 patients (64.7% men; average age, 57 years old), most (61.8%) were treatment-experienced; 53.9% had subgenotype 1a infection, 85.1% had advanced fibrosis, and 85.5% were treated with telaprevir. SVR was observed in 54.2%. Rapid virological response (RVR) was observed in 54.6% of patients (data available for 251 patients). Overall, 87.5% reported side effects and 42.5% did not complete treatment. Skin rash, severe infection, and death occurred in 17.8%, 2.5%, and death in 1.4% of cases, respectively. SVR was associated with treatment completion, RVR, and anemia. CONCLUSIONS: The effectiveness of hepatitis C virus triple therapy was lower than that reported in phase III clinical trials, possibly owing to the prioritized treatment of patients with advanced liver fibrosis. The high frequency of side effects and treatment interruptions observed supported the decision of the Brazilian authorities to suspend its use when safer and more effective drugs became available in 2015.

O curso de aprimoramento para enfermeiras obstétricas: desenvolvendo e ampliando o poder de agir de um coletivo profissional no seu meio de trabalho / The course of improvement for obstetrical nurses: developing and expanding the power to act of a professional collective in their work environment

Para a mudança de modelo na atenção obstétrica o Ministério da Saúde tem investido na formação e capacitação de enfermeiras (os) obstétricas (os) e uma das modalidades trata-se de um curso de capacitação de curto prazo intitulado de Curso de Aprimoramento para Enfermeiros Obstétricos. Este estudo teve como objetivo analisar o Curso de Aprimoramento para Enfermeiras (os) Obstétricas (os) como articulador da transformação das situações reais de trabalho no âmbito da assistência ao parto. Trata-se de um recorte de uma pesquisa avaliativa com abordagem qualitativa em que se utilizou o referencial conceitual da "Clínica da Atividade" de Yves Clot (2010). Os sujeitos do estudo foram enfermeiras (os) obstétricas (os) de quatro regiões do Brasil inseridos em maternidades e que se enquadraram nos critérios de inclusão do estudo, totalizando 64 participantes. Para a coleta de dados utilizou-se uma ficha de identificação e foram realizados oito grupos focais. A análise de dados foi realizada pela análise de conteúdo direta, utilizando-se o software MAXQDA© versão 2018. O material gravado dos grupos focais foi transcrito e analisado por meio do software, sistematizado e categorizado para compor o banco de dados, considerando opiniões recorrentes, dissensos e consensos das participantes. Foram construídas quatro categorias de análise guiadas pelo refencial teórico: a) sentimentos e expectativas do curso em relação ao poder de agir do enfermeiro; b) a autonomia do enfermeiro obstétrico para o fortalecimento do gênero profissional; c) o cuidado como chave propulsora para a mudança; d) o curso como articulador do coletivo no trabalho. A primeira foi construída a partir dos sentimentos referidos pelas (os) aprimorandas (os) relativos ao Curso e vivência no campo de prática, bem como suas expectativas. A segunda categoria refere-se a autonomia da (o) enfermeira (o) obstétrica (o) e foi definida devido às inúmeras vezes que o termo "autonomia do enfermeiro" foi utilizado pelas (os) aprimorandas (os) durante a discussão nos grupos focais. A terceira categoria demostra a retomada do significado do cuidar em enfermagem pelas (os) aprimorandas (os) a partir da vivência no campo de prática do Curso servindo de inspiração para a mudança pessoal e profissional. A quarta e última categoria dá ênfase aos planos de ação/intervenção nos processos de assistência ao parto e nascimento, elaborado no final da primeira etapa do curso pelas (os) aprimorandas (os), juntamente com os pesquisadores, refletindo os enfrentamentos necessários para mudanças de atitude e práticas no âmbito do cuidado, formação e gestão. Por meio deste estudo, pode-se inferir que o Curso de Aprimoramento para enfermeiras (os) obstétricas (os) foi importante para a reafirmação do gênero profissional e um articulador da transformação das situações reais de trabalho no âmbito da assistência ao parto. Espera-se, assim, que este trabalho contribua para a criação de outros cursos para profissionais de enfermagem, utilizando esta modelagem metodológica de modo que suas repercussões possam potencializar a prática da (o) enfermeira (o) obstétrica (o) de forma autônoma, fortalecendo assim, o protagonismo dessas profissionais nas transformações das situações reais de trabalho.(AU)

In order to change the model in obstetric care, the Ministry of Health has invested in the training and qualification of obstetrical nurses and one of the modalities is a short-term training course, titled an Improvement Course for Obstetric Nurses. This study aimed to analyze the Course of Improvement for Obstetric Nurses as an articulator of the transformation of real work situations in the field of childbirth care. It is a cut of an evaluative research with a qualitative approach in which the conceptual reference of the "Clinic of the Activity" of Yves Clot (2010) was used. Participants were professional obstetrician nurses from four regions of Brazil inserted in maternity hospitals and who met the inclusion criteria of the study, totaling 64 participants. For data gathering, an identification card was used and eight focal groups were performed. The analysis of the data was performed through the direct content analysis using the software MAXQDA © version 2018. The recorded material of the focus groups was transcribed and analyzed through the software, systematized and categorized to compose the database, considering recurrent opinions, dissent and consensus of the participants. Four categories of analysis were constructed guided by the theoretical reference: a) feelings and expectations of the course in relation to the nurse's power to act; b) the autonomy of the obstetric nurse to strengthen the professional gender; c) care as the driving force for change; d) the course as articulator of the collective at work. The first category reveals the feelings, expectations and meanings that the experience in other daily work that has served as a model for childbirth and childbirth care has for the obstetric nurses in training. The first one was built based on the participants's feelings about the course and their experiences in the field of practice, as well as their expectations. The second category refers to the autonomy of the obstetric nurse and was defined because of the several times that the term "nurse´s autonomy" was used by the obstetrics nurses in training during the discussion in the focus groups. The third category shows the resumption of the meaning of care in nursing by obstetrician nurses in training, from the experience of practice of the Course serving as inspiration for personal and professional change. The fourth and last category emphasizes action / intervention plans in childbirth and childbirth care processes, elaborated at the end of the first stage of the course by the learners, together with the researchers, reflecting the confrontations that will be necessary for changes in attitudes and practices in care, training and management. Through this study, it can be inferred that the course of improvement for obstetrical nurses was important for the reaffirmation of the professional gender and an articulator of the transformation of the real work situations in delivery assistance. Therefore, it is hoped that this work will contribute to the creation of other courses for nursing professionals, using this methodology so that its repercussions can potentialize the practice of the obstetric nurse in an autonomous way, thus strengthening the role of these professionals in the transformation of real work situations.(AU)

Adaptation of a cognitive-behavioral protocol for generalized anxiety disorder patientswith low educational attainment / Adaptação de um protocolo cognitivo comportamental para pacientes com transtorno de ansiedade generalizada com baixo nível educacional / Adaptación de un protocolo cognitivo-conductual de trastornos de ansiedad generalizada para pacientes con bajo nivel educativo

This article reports the experience of treating low-income patients with a primary diagnosis of generalized anxiety disorder (GAD) in a public hospital in Rio de Janeiro, Brazil. At the start of the project for outpatient treatment, which included the application of a cognitive model for GAD treatment, we observed that the majority of patients presented low educational level, which made it hard for them to understand key aspects of the cognitive-behavioral based treatment offered. Therefore, important adaptations to the treatment protocol were made necessary, including the way techniques were presented and applied, the therapeutic approach used, and even the duration of sessions. Since variations of cognitive therapy are increasingly being applied in hospital outpatient clinics in countries worldwide, the objective of this article is to present the adaptations performed and promote a discussion on the possible solutions for the difficulties faced in applying clinical psychology practice among patients with low educational and socioeconomic levels. This is a clinical study presenting an illustrative case, where adaptations to the treatment protocol were essential for the positive outcome of the case. It is concluded that, with the scope of treatment in mind, the therapist must be attentive to the client's demands and particularities in order to achieve therapeutic success.(AU)

Este artigo relata a experiência de tratamento de pacientes de baixa renda com diagnóstico primário de transtorno de ansiedade generalizada (TAG) em hospital público no Rio de Janeiro, Brasil. A ideia inicial do projeto era tratamento ambulatorial, com aplicação de um modelo cognitivo para o tratamento de TAG; porém, observamos que a maioria dos pacientes apresentou baixo nível educacional, o que tornava difícil sua compreensão dos principais aspectos do tratamento cognitivo-comportamental oferecido. Assim, foram feitas adaptações no protocolo de tratamento, incluindo a forma como as técnicas foram apresentadas e aplicadas, a abordagem terapêutica utilizada e a duração das sessões. Considerando que variações de terapias cognitivas são cada vez mais aplicadas em ambulatórios hospitalares em todo o mundo, o objetivo deste artigo é apresentar as adaptações realizadas e discutir possíveis soluções para as dificuldades enfrentadas na prática clínica com pacientes com baixo nível educacional e socioeconômico. Trata-se de um estudo clínico, com apresentação de um caso ilustrativo. Os resultados obtidos foram positivos e mostraram que as adaptações no protocolo foram essenciais para o sucesso terapêutico. Conclui-se que, tendo em mente o escopo do tratamento, o terapeuta deve estar atento às demandas e particularidades do cliente a fim de obter sucesso terapêutico.(AU)

Este artículo reporta la experiencia del tratamiento de pacientes de bajos recursos con diagnóstico primario de Trastorno de Ansiedad Generalizada (TAG) en hospitales públicos de Rio de Janeiro, Brasil. La idea original era el tratamiento ambulatorio con aplicación de un modelo cognitivo para el TAG. No obstante, el bajo nivel educativo presentado por la mayoría de los pacientes hace que les resulte difícil la comprensión de los principales aspectos del tratamiento cognitivo-conductual ofrecido. Adaptaciones fueron entonces realizadas en el protocolo de tratamiento, incluyendo cómo las técnicas fueron introducidas y aplicadas, el enfoque terapéutico utilizado y la duración de las sesiones. Dado que variantes de la terapia cognitiva son cada vez más aplicadas en la atención ambulatoria hospitalaria de todo el mundo, el objetivo de este artículo es presentar las adaptaciones realizadas y analizar posibles soluciones a las dificultades encontradas en la práctica de la psicología clínica con pacientes con bajo nivel educativo y socioeconómico, a partir de un caso ilustrativo. Los resultados obtenidos, positivos, indican que las adaptaciones realizadas fueron fundamentales para el éxito de la terapia. Podemos concluir que el terapeuta debe estar atento a las demandas y particularidad del cliente a fin de que la terapia sea exitosa.(AU)

Adaptation of a cognitive-behavioral protocol for generalized anxiety disorder patientswith low educational attainment / Adaptação de um protocolo cognitivo comportamental para pacientes com transtorno de ansiedade generalizada com baixo nível educacional / Adaptación de un protocolo cognitivo-conductual de trastornos de ansiedad generalizada para pacientes con bajo nivel educativo

This article reports the experience of treating low-income patients with a primary diagnosis of generalized anxiety disorder (GAD) in a public hospital in Rio de Janeiro, Brazil. At the start of the project for outpatient treatment, which included the application of a cognitive model for GAD treatment, we observed that the majority of patients presented low educational level, which made it hard for them to understand key aspects of the cognitive-behavioral based treatment offered. Therefore, important adaptations to the treatment protocol were made necessary, including the way techniques were presented and applied, the therapeutic approach used, and even the duration of sessions. Since variations of cognitive therapy are increasingly being applied in hospital outpatient clinics in countries worldwide, the objective of this article is to present the adaptations performed and promote a discussion on the possible solutions for the difficulties faced in applying clinical psychology practice among patients with low educational and socioeconomic levels. This is a clinical study presenting an illustrative case, where adaptations to the treatment protocol were essential for the positive outcome of the case. It is concluded that, with the scope of treatment in mind, the therapist must be attentive to the client's demands and particularities in order to achieve therapeutic success.

Este artigo relata a experiência de tratamento de pacientes de baixa renda com diagnóstico primário de transtorno de ansiedade generalizada (TAG) em hospital público no Rio de Janeiro, Brasil. A ideia inicial do projeto era tratamento ambulatorial, com aplicação de um modelo cognitivo para o tratamento de TAG; porém, observamos que a maioria dos pacientes apresentou baixo nível educacional, o que tornava difícil sua compreensão dos principais aspectos do tratamento cognitivo-comportamental oferecido. Assim, foram feitas adaptações no protocolo de tratamento, incluindo a forma como as técnicas foram apresentadas e aplicadas, a abordagem terapêutica utilizada e a duração das sessões. Considerando que variações de terapias cognitivas são cada vez mais aplicadas em ambulatórios hospitalares em todo o mundo, o objetivo deste artigo é apresentar as adaptações realizadas e discutir possíveis soluções para as dificuldades enfrentadas na prática clínica com pacientes com baixo nível educacional e socioeconômico. Trata-se de um estudo clínico, com apresentação de um caso ilustrativo. Os resultados obtidos foram positivos e mostraram que as adaptações no protocolo foram essenciais para o sucesso terapêutico. Conclui-se que, tendo em mente o escopo do tratamento, o terapeuta deve estar atento às demandas e particularidades do cliente a fim de obter sucesso terapêutico.

Este artículo reporta la experiencia del tratamiento de pacientes de bajos recursos con diagnóstico primario de Trastorno de Ansiedad Generalizada (TAG) en hospitales públicos de Rio de Janeiro, Brasil. La idea original era el tratamiento ambulatorio con aplicación de un modelo cognitivo para el TAG. No obstante, el bajo nivel educativo presentado por la mayoría de los pacientes hace que les resulte difícil la comprensión de los principales aspectos del tratamiento cognitivo-conductual ofrecido. Adaptaciones fueron entonces realizadas en el protocolo de tratamiento, incluyendo cómo las técnicas fueron introducidas y aplicadas, el enfoque terapéutico utilizado y la duración de las sesiones. Dado que variantes de la terapia cognitiva son cada vez más aplicadas en la atención ambulatoria hospitalaria de todo el mundo, el objetivo de este artículo es presentar las adaptaciones realizadas y analizar posibles soluciones a las dificultades encontradas en la práctica de la psicología clínica con pacientes con bajo nivel educativo y socioeconómico, a partir de un caso ilustrativo. Los resultados obtenidos, positivos, indican que las adaptaciones realizadas fueron fundamentales para el éxito de la terapia. Podemos concluir que el terapeuta debe estar atento a las demandas y particularidad del cliente a fin de que la terapia sea exitosa.

Effectiveness of hand and Mtwo TM Instruments in preparing oval-shaped root canals: in vitro study

Objective: This study evaluated through stereomicroscopy the effectiveness of hand and rotary instrumentation techniques, either isolated or combined, in the preparation of oval-shaped root canals. Materials and method: Thirty single-rooted human mandibular incisors were selected. After endodontic access and coronal preflaring, teeth were mounted in a modified Bramante muffle and then sectioned transversely at 3 and 6 mm from the root apex. Images of each section were made under a stereomicroscope at 30× magnification. Teeth were reassembled in the muffle and divided into three groups (n=10) according to the root canal preparation technique: GI - rotary preparation with Mtwo™ basic sequence (10/.04; 15/.05; 20/.06; 25/.06), followed by Mtwo™ complementary instruments (30/.05; 35/.04; 40/.04); GII - rotary preparation with Mtwo™ basic sequence, complemented by hand instruments (#30, #35 and #40); GIII - hand instrumentation using the conventional technique (#10 to #40). All instruments were used in brushing motion. The muffles were separated again so that new images of each section could be obtained. The following parameters were evaluated in pre- and postoperative images: root canal area; perimeter; mesiodistal (MD) and buccolingual (BL) diameters; and mesial (M) and distal (D) wall thickness. Next, the values measured in post- and preoperative images were subtracted for comparison of experimental groups. Data were analyzed using the Kruskal-Wallis test (α=0.05). Results: No significant difference between groups was observed for all parameters. Conclusion: There was no difference among hand, rotary, or combined instrumentation; all techniques were able to increase root canal area, perimeter, and diameter in MD and BL directions. Moreover, the amount of dentin wear on proximal root canal walls was similar for all tested groups. Keywords: Endodontics. Microscopy. Root canal preparation. Root canal therapy. Stereomicroscopy.

Terapia cognitivo-comportamental e coaching cognitivo-comportamental: como as duas práticas se integram e se diferenciam / Cognitive-behavioural therapy and cognitive-behavioural coaching: differences and similarities between the two approaches

O coaching cognitivo-comportamental (CCC) é um processo estruturado de estabelecimento e alcance de metas que se fundamenta sobre o princípio cognitivo-comportamental, que pressupõe que não são os eventos em si que deflagram respostas emocionais e comportamentais, mas a interpretação que os indivíduos apresentam sobre eles. Nesse sentido, o CCC é um processo de identificação e desbloqueio de padrões cognitivos que dificultam a realização e o alcance de objetivos vinculado a planos de ação para a mudança comportamental, tendo sido descrito como método eficaz para o alcance de resultados na vida profissional e pessoal. No entanto, a interface dessa prática com a terapia cognitivo-comportamental (TCC) tem sido pouco investigada no Brasil. Assim, este artigo tem como objetivo discutir algumas das principais semelhanças e diferenças entre essas duas práticas. Pretende-se, com essa discussão, contribuir para o fortalecimento da prática profissional fundamentada sobre a abordagem cognitivo-comportamental para além do contexto clínico no nosso país, tendo em vista que o CCC visa atuar com clientes que não preencham critérios diagnósticos para transtornos mentais ou que simplesmente almejam alcançar uma experiência de viver mais plena e dotada de significado(AU)

Cognitive-behavioral coaching (CBC) is a structured process of goal establishment and attainment that is grounded on the cognitive-behavioral principle that emotional and behavioral responses are not triggered by events per se but by the individual's interpretation of them. In this respect, the CBC is a process of identifying and unblocking cognitive patterns that difficult goal achievement, tagged to action plans targeting behavioral change. CBC has been described as an effective method for achieving results in both professional and personal dimensions of life. However, the interface of this practice with CBT has been little investigated in Brazil. Thus, the present article aims at attempting to bridge this gap by presenting and discussing some of the main similarities and differences between these two practices. It is intended that this discussion will contribute towards the strengthening of cognitive-behavioral-grounded practices beyond the clinical context in our country, with patients who do not fulfill diagnostic criteria for mental disorders or with those who simply aim at developing a more purposeful experience of living(AU)

Percepção dos indivíduos com hipertensão arterial sobre sua doença e adesão ao tratamento medicamentoso na estratégia de saúde da família / Perception of individuals with hypertension regarding their disease and medication adherence in the family health strategy program / Percepción de los individuos con hipertensión arterial sobre su enfermedad y adhesión al tratamiento medicamentoso en la estrategia de salud de la familia

O enfrentamento da cronicidade da Hipertensão Arterial envolve vários fatores,entre eles, a percepção da doença e sua adesão ao tratamento medicamentoso que são fundamentais para nortear a avaliação e intervenção dos profissionais de saúde envolvidos na sua assistência. O objetivo deste artigo é analisar a percepção dos indivíduos com hipertensão sobre a doença e sua adesão ao tratamento medicamentoso na Estratégia de Saúde Família (ESF). Trata-se de estudo exploratório, com abordagem qualitativa, desenvolvido na ESF do município de Recife. Participaram do estudo indivíduos com hipertensão cadastrados na ESF, sorteados aleatoriamente. Foi aplicada uma entrevista semiestruturada. Na análise dos dados foram utilizados os métodos de avaliação de adesão: pela autopercepção do usuário, adesão percebida pelo pesquisador e análise de conteúdo. Os resultados apontam que a percepção sobre a hipertensão envolvia sintomas de agravamento da doença; ficou demonstrada a dificuldade dos hipertensos em adotar medidas de controle, que exijam engajamento, persistência e compreensão acerca do seu adoecimento. Conclui-se que é necessária, na avaliação da adesão ao tratamento, a análise dos processos de abordagem ao usuário. O cuidado deve levar em conta os sentidos e significados que envolvam uma doença que não tem cura e, portanto, exige, por maior tempo, persistência tanto do usuário quanto dos serviços de saúde.

Coping with chronic hypertension involves the perception of patients regarding the disease and their compliance with drug treatment. These are fundamental aspects to the assessment and intervention of healthcare professionals. The aim of the present study was to analyze the perception of individuals with hypertension regarding the disease and medication adherence. An exploratory study with a qualitative approach was carried out in Recife, Brazil.Patients with hypertension registered with the Family Health Strategy Program of the Brazilian public healthcare system were randomly selected to participate in the study. A semi-structured interview was administered. The assessment of compliance with treatment was based on discourse content, the self-perception of the patients, the perception of the researcher and content analysis. The results reveal the difficulty patients with high blood pressure have in adopting control measures, which require persistence and an understanding of the disease.Perceptions regarding hypertension involved the aggravation of the disease. The analysis of compliance with treatment should take into account the perception of patients regarding a disease that has no cure and therefore requires greater persistence on the part of both the patient and healthcare services.

El enfrentamiento de la cronicidad de la Hipertensión Arterial envuelve varios factores, entre ellos, la percepción de la enfermedad y su adhesión al tratamiento medicamentoso, que son fundamentales para guiar la evaluación e intervención de los profesionales de salud envueltos en su asistencia. El objetivo de este artículo es analizar la percepción de los individuos con hipertensión sobre la enfermedad y su adhesión al tratamiento medicamentoso en la Estrategia de Salud de la Familia (ESF). Se trata de estudio exploratorio, con enfoque cualitativo, desarrollado en la ESF del município de Recife. Participaron del estudio individuos con hipertensión registrados en la ESF y sorteados de forma aleatoria. Fue aplicada una entrevista semiestructurada. En el análisis de los datos fueron utilizados los métodos de evaluación de adhesión: por la autopercepción del usuario, adhesión percibida por el investigador y por el análisis de contenido. Los resultados indican que la percepción sobre la hipertensión envolvia síntomas de agravamiento de la enfermedad; quedó demostrada la dificultad de los hipertensos en adoptar medidas de control, que exijan compromiso, persistencia y comprensión acerca de su enfermedad. Se concluye que es necesario el análisis de los procesos de abordaje al usuario en la evaluación de la adhesión al tratamiento. El cuidado debe llevar en cuenta los sentidos y significados que envuelvan una enfermedad que no tiene cura y, por lo tanto exige mayor tiempo y persistencia, tanto del usuario cuanto de los servicios de salud.

Current concept of anxiety: implications from Darwin to the DSM-V for the diagnosis of generalized anxiety disorder.

This article proposes a revision of the historical evolution of the concepts of generalized anxiety disorder (GAD). Currently, Darwin's evolutionary theory is the hegemonic paradigm for modern science and influences research on mental disorders. Throughout the 20th Century, the editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association) have changed the diagnostic criteria for GAD, reflecting the prevailing psychiatric understanding of this disorder. The prevalence and symptoms of major depression and GAD show the fragility of the categorical conception of these conditions. Differences in cultural views towards anxiety disorders also suggest that anxiety cannot have a uniform definition. This article provides contributions for reflecting future guidelines concerning the diagnostic criteria for GAD in DSM-V.

On-line preconcentration and determination of Zn in natural water samples employing a styrene-divinylbenzene functionalized resin and flame atomic absorption spectrometry.

In this work, flame atomic absorption spectrometry (FAAS) was used as a detector for the determination of zinc in natural water samples with a flow-injection system coupled to solid-phase extraction (SPE). In order to promote the on-line preconcentration of zinc from samples a minicolumn packed with 35 mg of a styrene-divinylbenzene resin functionalized with (S)-2-[hydroxy-bis(4-vinylphenyl)methyl]pyrrolidine-1-carboxylic acid ethyl esther was utilized. The system operation was based on Zn(II) ion retention at pH 9.5 +/- 0.5 in such a minicolumn with analyte elution, at the back flush mode, with 1 mol L(-1) HCl directly to the FAAS nebulizer. The influence of the chemical (sample pH, buffer concentration, HCl eluent concentration and effect of the ionic strength) and flow (sample and eluent flow rates and preconcentration time) parameters that could affect the performance of the system were investigated as well as the possible interferents. At the optimum conditions, for 2 min of preconcentration time (9.9 ml of sample volume), the developed methodology presented a detection limit of 1.1 microg L(-1), a RSD of 3.5% at 10 microg L(-1) and an analytical throughput of 24 h(-1). Whereas, for 4 min of the preconcentration time (19.8 ml of sample volume) a detection limit of 0.98 microg L(-1), a RSD of 6.5% at 5 microg L(-1) and a sampling frequency of 13 h(-1) are reported.

Synthesis and application of a functionalized resin for flow injection/F AAS copper determination in waters.

This paper reports the development of a new strategy for low-level determination of copper in water samples by using a flow-injection system coupled to solid-phase extraction (SPE) using flame atomic absorption spectrometry (F AAS) as detector. In order to preconcentrate copper from samples, a minicolumn packed with a styrene-divinylbenzene resin functionalized with (S)-2-[hydroxy-bis-(4-vinyl-phenyl)-methyl]-pyrrolidine-1-carboxylic acid ethyl ester was used and the synthesis procedure is described. System operation is based on the on-line retention of Cu(II) ions at pH 9.0+/-0.2 in a such minicolumn with posterior analyte elution with 2moll(-1) HCl directly to the F AAS nebulizer. The influence of several chemical (sample pH, buffer concentration, HCl eluent concentration and effect of the ionic strength) and flow (sample and eluent flow rates and preconcentration time) variables that could affect the performance of this system were investigated as well as the possible interferents. At optimized conditions, for 2min of preconcentration time (13.2ml of sample volume), the system achieved a detection limit of 1.1mugl(-1), a R.S.D. 1% at 20muggl(-1) and an analytical throughput of 25h(-1), whereas for 4min of preconcentration time (26.4ml of sample volume), a detection limit of 0.93mugl(-1), a R.S.D. 5.3% at 5mugl(-1) and a sampling frequency of 13h(-1) were reported.