Non-linear Optical Responses of Low-Density Lipoprotein are Associated with Intima-Media Thickness of Carotid Artery in Athletes.

We investigated the association between the degree of oxidative modification of LDL particles by non-linear optical response of LDL (Z-scan technique) and the presence of subclinical atherosclerosis in different segments of the carotid artery. We recruited high-intensity athlete runners (n = 44) and controls (n = 51) to participate in the study. The carotid intima-media thickness (cIMT), interleukin 10 (IL-10), TNF-alpha, and the non-linear optical responses of LDL particle (Z-scan) were assessed. In athletes, the mean cIMT differed between genders, with higher values observed in female athletes compared to male athletes (P < 0.05). Higher mean values for cIMT were seen in the right carotid arteries of female athletes as compared to female controls (P < 0.05). Higher levels of TNF-alpha and IL-10 were found in athletes (P < 0.05). Yet, ΔΓpv (transmittance curve) of Z-scan in athletes was higher than in the non-athletes, indicating less oxidation in LDL particles of athletes (P < 0.05). There was an inverse association between the ΔΓpv and cIMT in the right internal carotid segments (ß = -0.163, P < 0.05) in all subjects, and between the VO2max and the mean cIMT (ß = -0.003, P < 0.05) in male subjects. The present study shows that the Z-scan technique enabled to detect less oxidative modifications in LDL particles from athletes. This effect was associated with cIMT in a gender-dependent mode.

Declínio cognitivo, independência funcional e sintomas depressivos em idosos com hanseníase / Cognitive impairment, functional independence and depressive symptoms in elderly people with prior history of leprosy

Os problemas decorrentes da hanseníase podem causar transtornos psiquiátricos e comprometer o desempenho do indivíduo na execução das atividades cotidianas, especialmente no idoso. O objetivo deste estudo foi verificar as associações entre funcionabilidade, sintomas depressivos e aspectos cognitivos em idosos com história pregressa de hanseníase. Trata-se de estudo descritivo transversal. Foram aplicados os seguintes instrumentos de avaliação: Anamnese, Grau de Incapacidades da Organização Mundial da Saúde (GI-OMS), Questionário de Atividades Funcionais de Pfeffer, Escala de Depressão Geriátrica-15, Mini-Exame do Estado Mental e o Índice de Barthel. Quanto aos resultados, foram avaliados 90 idosos que tiveram a doença e a maioria pertencia ao gênero masculino (75,6%) e com baixa escolaridade (42,2%); eram casados/união consensual (58,9%) e apresentaram GI-OMS 1 ou 2 (83,3%). A idade variou entre 60 e 92 anos e a média foi 68,9 (DP7,3). Quanto aos problemas de saúde, houve um predomínio das doenças cardíacas (42,2%). A maioria deles apresentou independência funcional na execução das atividades de vida diária-AVDs (80%) e nas atividades instrumentais de vida diárias-AIVDs (83,3%); 30% apresentou sintomas depressivos e 52,2%, declínio cognitivo. Houve associação significativa entre sintomas depressivos e AVDs (p=0,048), sintomas depressivos e AIVDs (p=0,0111). Conclui-se que a maior parte dos idosos apresentou deficiências físicas, declínio cognitivo, e essas condições não interferiram significativamente na manifestação de sintomas depressivos e na independência funcional. A maioria dos idosos que apresentou independência funcional tinha menor chance de desenvolver sintomas depressivos, embora uma parcela significativa desta casuística demonstrou sintomas depressivos.

The problems caused by leprosy can cause psychiatric disorders and compromise the individual’s performance in execution of daily activities, especially in the aged. The aim of this study was to investigate possible associations between functionality, depressive symptoms and cognitive in aged with history of leprosy. This is a cross-sectional descriptive study. They were applied the following assessment instruments: Anamnesis, “World Health Organization leprosy disability grading system” (WHO-DG), Pfeffer’s Functional Activities Questionnaire, 15-item Geriatric Depression Scale, Mini-Mental State Examination and the Barthel Index. They were evaluated 90 aged who had the disease and the most of the patients were male (75.6%) and had low education (42.2%); married or live with partner (58.9%) and classified as WHO-DG 1 or 2 (83.3%). The ages ranged from 60 to 92 years, with a mean age of 68.9 (SD: 7.3). About the health problems, there was a predominance of heart disease (42.2%). The most of them had functional independence in the performance of activities of daily living (ADL) (80%) and in instrumental activities of daily living I (ADL) (83.3%); 30% had depressive symptoms and 52,2% cognitive decline. There was a significant association between depressive symptoms and ADL (p=0.48), depressive symptoms and IADL (p=0.111). It follows that the most aged patients had physical disabilities, cognitive decline, and these conditions did not influence significantly in the manifestation of depressive symptoms and functional independence. The most of seniors patients showed funcional independence had lower chance of developing depressive symptoms, although a significant portion of this subjects, showed depressive symptoms.

Supervised physical exercise improves endothelial function in patients with systemic lupus erythematosus.

OBJECTIVE: The objective of this study was to evaluate the effect of supervised physical exercise on endothelial function, ergospirometric test variables and disease activity in SLE patients. METHODS: We conducted a prospective study in which women with SLE who were available to perform physical exercise were allocated to the exercise group (EG) to practise supervised physical exercise for 1 h three times per week for 16 weeks. Those who were not available for this activity were allocated to the control group (CG). Intervention consisted of walking at a heart rate corresponding to the ventilatory 1 threshold obtained from ergospirometry and monitored by a frequency meter. At baseline (T0) and after 16 weeks (T16), patients were assessed for endothelial function by brachial artery (flow-mediated dilation), ergospirometry and disease activity (SLEDAI). Statistical analysis was performed through normality tests, Student's t-test and non-parametric tests for data with non-normal distribution. P < 0.05 was considered significant. RESULTS: Eighteen patients were allocated in the EG and 20 in the CG. After 16 weeks there was an increase in FMD in the EG [6.3 (6.7)% vs 14.1 (9.1)%, P = 0.006] without a change in the CG [8.4 (8.2)% vs 9.4 (5.7)%, P = 0.598]. Regarding the ergospirometric test, we found improvement in exercise tolerance [12.3 (2.4) vs 13.4 (2.6) min, P = 0.027], maximum speed [7.7 (1.0) vs 8.3 (1.2) km/h, P = 0.027] and threshold speed [5.6 (0.7) vs 6.1 (0.9) km/h, P = 0.005] in the EG without a difference in the CG. There was no difference in the SLEDAI score in both groups. CONCLUSION: Physical exercise is a useful strategy to improve endothelial function and aerobic capacity without worsening disease activity in SLE patients. TRIAL REGISTRATION; ClinicalTrials.gov (http://www.clinicaltrials.gov), NCT01712529.

Imbalance between endothelial progenitors cells and microparticles in HIV-infected patients naive for antiretroviral therapy.

BACKGROUND: Cardiovascular events have been reported among HIV-infected patients following antiretroviral therapy. However, the role of HIV itself in determining vascular damage is less described. Chronic inflammatory state might impair some regulatory endothelium properties leading to its activation, apoptosis or erosion. OBJECTIVES: To evaluate the balance between endothelial progenitor cells and microparticles in HIV-infected antiretroviral drug-naive patients. DESIGN: A case-control study comparing HIV-infected patients (n = 35) with sex-matched and age-matched healthy controls (n = 33). METHODS: Endothelial progenitor cells populations expressing CD34, CD133 and KDR were quantified by flow cytometry. Endothelial-derived microparticles, expressing CD51, and platelet-derived microparticles, expressing CD31/CD42, were also measured. Endothelial function was estimated by flow-mediated dilation. RESULTS: Lower percentages of endothelial progenitor cells (CD34/KDR) were observed in HIV-infected individuals compared with controls (0.02 vs. 0.09%, P = 0.045). In addition, endothelial microparticles concentration was higher in HIV-infected individuals (1963 vs. 436 microparticles/µl platelet-poor plasma, P = 0.003), with similar number of platelet-derived microparticles among groups. Furthermore, flow-mediated dilation was lower among HIV-infected individuals compared with controls [mean (SEM): 10 (1) and 16% (2), respectively; P = 0.03]. CONCLUSION: Our findings suggest an imbalance between endothelial progenitor cells mobilization and endothelial apoptosis. The alteration in the turnover of endothelial cells may contribute to cardiovascular events in HIV-infected patients.

Clinical crown lengthening in the esthetic zone.

Periodontal surgical procedures consisting of gingival flaps and osseous recontouring are indicated for crown lengthening of several contiguous teeth in the esthetic zone; both in cases where restorations are required and in cases where no restorations are planned, such as in patients with excessive gingival display due to altered passive eruption. Forced tooth eruption via orthodontic extrusion is the technique of choice when clinical crown lengthening is necessary on isolated teeth in the esthetic zone.

Replacement of a fractured upper central incisor with an implant-supported crown: a step-by-step approach to achieve acceptable esthetics.

Implant-supported restorations in the upper anterior segment need to meet biological, functional, and esthetic requirements to be successful. Bone availability and soft-tissue characteristics in the area of implant placement are crucial for achieving maximum success. This article describes the steps involved in replacing a fractured upper central incisor with an implant-supported crown. Using surgical techniques involving extraction socket preservation/augmentation and connective tissue grafting, ideal positioning of the implant was possible and gingival contours were idealized. With this multiple step treatment, the final restoration met biological and functional requirements and its esthetic results were maximized.

Tumores do mediastino em crianças / Mediastinal tumors in children

INTRODUÇAO: Os tumores mediastinais na criança compreendem um grupo heterogêneo de lesões com origem embrionária distinta. Podem apresentar-se como cistos benignos ou lesões malignas. OBJETIVO: Descrever os procedimentos diagnósticos, tratamento e evolução de uma série de crianças e adolescentes com tumores do mediastino. MÉTODO: Análise retrospectiva de vinte crianças com tumores de mediastino, no período de julho de 1996 a julho de 2002 no Hospital de Clínicas de Porto Alegre. Todos os pacientes foram submetidos a algum procedimento cirúrgico, seja diagnóstico, terapêutico ou ambos. RESULTADOS: Doze meninos e oito meninas foram estudados. A idade média no momento do diagnóstico foi de seis anos e oito meses, variando entre três meses e 16 anos. Quatorze tumores (70%) ocorreram no mediastino anterior, sendo os mais comuns os linfomas de Hodgkin e não-Hodgkin; seis tumores (30%) ocorreram no mediastino posterior, sendo o neuroblastoma o mais freqüente. Nos tumores anteriores, a abordagem cirúrgica mais comum foi a toracotomia anterior de Chamberlain; nos posteriores, a toracotomia póstero-lateral. No período de seguimento ocorreram seis óbitos, todos sem nenhuma relação com o procedimento cirúrgico. CONCLUSAO: Os tumores mediastinais em crianças são responsáveis por morbimortalidade. No mediastino anterior foram mais comuns os linfomas; no posterior, os tumores de origem neural. A cirurgia é um passo importante no diagnóstico e tratamento dessas lesões.

[Bronchoscopic removal of foreign body from airway through tracheotomy or tracheostomy]. / Remoção de corpo estranho da via aérea de criança por broncoscopia através de traqueotomia ou traqueostomia.

OBJECTIVE: Most foreign bodies in the airway are removed by respiratory endoscopy. Rarely, the removal of the foreign body has to be performed through endoscopic control by tracheotomy or tracheostomy. This article reports three cases of foreign body removal in children performed by tracheal opening. DESCRIPTION: Retrospective review of records with report of three cases of children who aspirated foreign bodies into the airway. In the first case, there was rupture of the tracheostomy tube, with aspiration of its distal portion. Endoscopic removal was performed by tracheostomy. The second child aspirated a pen cap. It could not be removed by endoscopy because it would not pass through the subglottic region. Cervical tracheotomy was performed and the foreign body was removed with endoscopic control. In the last case, the foreign body was in the left main bronchus. It was removed by bronchoscopy through tracheostomy opening. All children presented good outcome after the endoscopic procedure. The trachea of the patient submitted to tracheotomy was sutured after the foreign body removal. Tracheostomy was not necessary. In the children with previous tracheostomy, the tube was put back after the foreign body removal. COMMENTS: Most foreign bodies in the airway of children can be removed by endoscopy. When the foreign body is too large to pass through the subglottic region, or so sharp that it can injure the airway, the use of tracheotomy or tracheostomy is indicated.

Remoçäo de corpo estranho da via aérea de criança por broncoscopia através de traqueotomia ou traqueostomia / Bronchoscopic removal of foreign body from airway through tracheotomy or tracheostomy

OBJETIVO: a maioria dos corpos estranhos aspirados para a via aérea é removida através de endoscopia respiratória. Em situações raras, a retirada deste material tem que ser realizada sob controle endoscópico, através de traqueotomia ou traqueostomia. A seguir, relatamos casos de crianças cuja remoçäo de corpos estranhos aspirados para a via aérea foi realizada por abertura traqueal. DESCRIÇÄO: revisäo retrospectiva de prontuários, com relato de três crianças que aspiraram corpos estranhos para a via aérea. A primeira apresentou ruptura da cânula de traqueostomia, com aspiraçäo da porçäo distal da mesma. Foi realizada remoçäo endoscópica através do traqueostoma. A segunda aspirou tampa de caneta, que näo conseguia ser removida endoscopicamente, pois a mesma trancava e näo passava na regiäo subglótica. Foi realizado, entäo, traqueotomia cervical e remoçäo do corpo estranho sob controle endoscópico. A terceira apresentou corpo estranho aspirado para o brônquio principal esquerdo (palito de madeira), que foi removido através de broncoscopia, realizada pelo orifício da traqueostomia. Todas as crianças toleraram o procedimento endoscópico, com remoçäo do corpo estranho. No paciente em que foi realizada traqueotomia, a traquéia foi suturada após retirada do corpo estranho, näo havendo necessidade de realizaçäo de traqueostomia. Nas crianças com traqueostomia prévia, a mesma foi recolocada após a retirada do corpo estranho. COMENTARIOS: uma minoria dos corpos estranhos aspirados para a via aérea de criança näo pode ser removido somente por endoscopia. Quando o corpo estranho é demasiadamente largo que näo passa na regiäo subglótica, ou pontiagudo que possa traumatizar a via aérea, a remoçäo pode ser realizada por endoscopia, através de traqueotomia ou traqueostomia.