Alcoholic neuropathy associated with chronic alcohol intake.

Alcoholic neuropathy (AN), a debilitating condition that mainly affects chronic alcohol drinkers, is thought to cause lesions in the peripheral nervous system leading to sensory, autonomic, and motor dysfunctions. Despite many studies, the pathogenesis of these lesions is still not completely understood. We investigated few aspects on the development of alcohol-induced peripheral neuropathy, by assessing sensory, motor and autonomic functions, as well as stereological analysis of axonal fibers and myelin sheath of the sciatic nerve. Twelve male Wistar rats were divided into Control group and Alcohol group that was submitted to Two Bottle-Choice Paradigm of intermittent and voluntary alcohol solution intake (20%; v/v) during eight weeks. At the end of treatment, three different sensorium-motor tests were applied - Tactile Sensitivity, Thermal Sensitivity, and Functional Observational Battery (FOB). Quantitative morphometric analysis of sciatic nerve structures was performed by stereological method. Alcohol concentration in the blood was measured to analyze possible correlation between availability of alcohol in the blood and the magnitude of the peripheral nerve lesion. Our data showed a peripheral effect of chronic alcohol intake associated with hyperalgesia and a process of demyelination with a strong correlation with alcohol consumption. This process was associated with increased tactile sensitivity, with behavioral reflexes such as locomotor hyperactivity, changes in gait and balance, and autonomic reflexes such as piloerection.

Controversias en cirugía: colelitiasis y coledocolitiasis ¿Exploración de vías biliares laparoscópica más colecistectomía laparoscópica (cirugía en un paso) o CPRE y colecistectomía laparoscópica (cirugía en dos pasos)? / Controversies in surgery: Cholelithiasis and choledocholithiasis - Laparoscopic bile duct exploration plus laparoscopic cholecystectomy (one-step surgery) or ERCP and laparoscopic cholecystectomy(two-step surgery)?

Introducción. La colelitiasis tiene una prevalencia del 15 % y el 21 % tendrá coledocolitiasis al momento de la colecistectomía, con 50 % de probabilidad de presentar complicaciones asociadas. Desde el advenimiento de la colecistectomía laparoscópica, el abordaje de la coledocolitiasis ha sido endoscópico, usualmente en un tiempo diferente al vesicular, sin embargo, los avances en laparoscopia han permitido explorar la vía biliar común por la misma vía, pudiendo realizar ambos procedimientos en el mismo tiempo de forma segura. Métodos. Se realizó una búsqueda de la literatura existente con relación al enfoque para el manejo de la colecisto-coledocolitasis en un paso comparado con dos pasos. Resultados. Existe evidencia que demuestra mayor efectividad del abordaje en dos pasos, con CPRE y posterior colecistectomía laparoscópica, sobre el abordaje en un paso, especialmente en la tasa de fuga biliar y de cálculos retenidos. El enfoque en un paso con exploración de vías biliares y colecistectomía laparoscópica en el mismo tiempo es seguro, con alta tasa de éxito, baja incidencia de complicaciones, menor estancia hospitalaria y costos. Conclusión. El abordaje laparoscópico en un solo paso es un procedimiento seguro y eficaz para el manejo de la colecisto-coledocolitiasis, con el beneficio de estancia hospitalaria menor, sin embargo, se requieren habilidades técnicas avanzadas en cirugía laparoscópica. En nuestro medio ya existe una infraestructura para el manejo híbrido con CPRE y colecistectomía laparoscópica, pudiéndose realizar ambos en el mismo tiempo, para reducir estancia y costos.

Introduction. Cholelithiasis has a prevalence of 15%, and 21% will have choledocholithiasis at the time of cholecystectomy, with a 50% probability of presenting associated complications. Since the advent of laparoscopic cholecystectomy, the approach to choledocholithiasis has been endoscopic, normative at a different time than the gallbladder; however, advances in laparoscopy have made it possible to explore the common bile duct by the same route, being able to perform both procedures in a single time safely. Methods. A search of the existing literature was performed regarding the one-step approach compared to the two-step approach for the management of cholelithiasis and choledocholithiasis. Results. There is evidence that demonstrates greater effectiveness of the two-step approach with ERCP and subsequent laparoscopic cholecystectomy over the one-step approach, especially in the rate of bile leak and the incidence of retained stones. The one-step approach with bile duct exploration and laparoscopic cholecystectomy at the same time is safe, with a high success rate, low incidence of complications, shorter hospital stay, and lower costs. Conclusion. The one-step laparoscopic approach is a safe and effective procedure for the management cholelithiasis and concomitant choledocholithiasis, with the benefit of a shorter hospital stay; however, advanced technical skills in laparoscopic surgery are required. In our environment there is already an infrastructure for hybrid management with ERCP and laparoscopic cholecystectomy, both of which can be performed at the same time to reduce hospital stay and costs.

Clozapine prevented social interaction deficits and reduced c-Fos immunoreactivity expression in several brain areas of rats exposed to acute restraint stress.

In the present study, we evaluate the effect of acute restraint stress (15 min) of male Wistar rats on social interaction measurements and c-Fos immunoreactivity (c-Fos-ir) expression, a marker of neuronal activity, in areas involved with the modulation of acute physical restraint in rats, i.e., the paraventricular nucleus of the hypothalamus (PVN), median raphe nucleus (MnR), medial prefrontal cortex (mPFC), cingulate prefrontal cortex (cPFC), nucleus accumbens (NaC), hippocampus (CA3), lateral septum (LS) and medial amygdala (MeA). We considered the hypothesis that restraint stress exposure could promote social withdrawal induced by the activation of the hypothalamic-pituitary-adrenocortical (HPA) axis, and increase c-Fos expression in these limbic forebrain areas investigated. In addition, we investigated whether pretreatment with the atypical antipsychotic clozapine (5 mg/kg; I.P.) could attenuate or block the effects of restraint on these responses. We found that restraint stress induced social withdrawal, and increased c-Fos-ir in these areas, demonstrating that a single 15 min session of physical restraint of rats effectively activated the HPA axis, representing an effective tool for the investigation of neuronal activity in brain regions sensitive to stress. Conversely, pretreatment with clozapine, prevented social withdrawal and reduced c-Fos expression. We suggest that treatment with clozapine exerted a preventive effect in the social interaction deficit, at least in part, by blocking the effect of restraint stress in brain regions that are known to regulate the HPA-axis, including the cerebral cortex, hippocampus, hypothalamus, septum and amygdala. Further experiments will be done to confirm this hypothesis.

High and fluctuating levels of ovarian hormones induce an anxiogenic effect, which can be modulated under stress conditions: Evidence from an assisted reproductive rodent model.

Elevated levels of endogenous ovarian hormones are conditions commonly experienced by women undergoing assisted reproductive technologies (ART). Additionally, infertility-associated stress and treatment routines are factors that together may have a highly negative impact on female emotionality, which can be aggravated when several cycles of ART are needed to attempt pregnancy. This study aimed to investigate the effect of high and fluctuating levels of gonadal hormones induced by repeated ovarian stimulation on the stress response in rodents. To mimic the context of ART, female rats were exposed to an unpredictable chronic mild stress (UCMS) paradigm for four weeks. During this time, three cycles of ovarian stimulation (superovulation) (150 IU/Kg of PMSG and 75 IU/Kg of hCG) were applied, with intervals of two estrous cycles between them. The rats were distributed into four groups: Repeated Superovulation/UCMS; Repeated Superovulation/No Stress; Saline/UCMS; and Saline/No Stress. Anxiety-like and depressive-like behaviors were evaluated in a light-dark transition box and by splash test, respectively. Corticosterone, estradiol, progesterone, and biometric parameters were assessed. Data were analyzed using a two-way Generalized Linear Model (GzLM). Our results showed that repeated ovarian stimulation exerts by itself an expressive anxiogenic effect. Surprisingly, when high and fluctuating levels of ovarian hormones were combined with chronic stress, anxiety-like behavior was no longer observed, and a depressive-like state was not detected. Our findings suggest that females subjected to emotional overload induced by repeated ovarian stimulation and chronic stress seem to trigger the elaboration of adaptive coping strategies.

Agenesia esternal total: reconstrucción esternal con placas absorbibles y pericardio bovino en un paciente de 4 años / Total sternal cleft: sternal reconstruction with absorbable plaques and bovine pericardium in a 4-year-old patient

La agenesia esternal es una rara malformación del desarrollo embrionario del esternón, que puede estar o no relacionado con otras anomalías congénitas. Se presenta el caso de un paciente de 4 años de edad con agenesia esternal total, que fue llevado a reconstrucción de la pared torácica anterior con material protésico absorbible y pericardio bovino, logrando la adecuada estabilidad de la pared torácica y la corrección de la función de la misma, con una evolución satisfactoria después de dos años de seguimiento

Sternal cleft is a rare malformation of the embryonic development of the sternum, which may or may not be related to other congenital anomalies. We present the case of a 4-year-old patient with total sternal cleft, who underwent reconstruction of the anterior chest wall with absorbable prosthetic material and bovine pericardium, achieving adequate stability and correction of the function of the chest wall, with a satisfactory evolution after two years of follow-up

Effect of chronic alcohol intake on motor functions on the elderly.

Alcohol use disorder (AUD) is a chronic and progressive disease influenced by genetic, psychosocial, and environmental factors. The consequences of alcohol consumption involve alterations in neural circuits of emotion and cognition, as well as in the motor planning circuit. Furthermore, during the natural aging process, several biochemical and functional alterations are also observed with neurological consequences. Thus, considering the consequences of chronic alcohol consumption on neural systems and natural aging process, we aimed to analyze the degree of motor and functional impairment in elderly with chronic alcohol consumption. Sixty elderly underwent an analysis of alcohol consumption profile (Alcohol Use Disorders Identification Test - AUDIT) that divided them into a control group (CON) and an alcohol group (ALC). The analysis of quality of life was performed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), the analysis of motor function was performed using the Borg Scale, the Six-Minute Walk Test (6MWT) and the Motor Scale for Elderly (MSE). We were able to conclude that the misuse of alcohol by the elderly promotes significant physical limitations. These limitations result in a worsening of functional capacity of walking and various dimensions of motor ability: fine motor skill, global coordination, balance, body scheme, spatial organization, temporal organization, and general motor aptitude. Besides the physical limitations caused by alcohol use, the quality of life in their physical, mental, and social aspects was reduced. Thus, actions are required to help the elderly understand these losses and exercise control over alcohol misuse.

Association between polymorphism in gene related to the dopamine circuit and motivations for drinking in patients with alcohol use disorder.

The development of alcohol use disorder (AUD) is influenced by genetic, psychological, and social factors. However, the identification of the load of each of these factors and the association between them is still debatable. This study aimed to explore the load of the association between AUD and polymorphisms in genes of the dopaminergic system, as well as with drinking triggers. The study comprised 227 inpatients with AUD and 174 controls. The pattern and motivations for drinking were evaluated using the Alcohol Use Disorders Identification Test (AUDIT) and the Inventory of Drinking Situations (IDS). Analyses of genetic variation in genes encoding dopaminergic were performed using next generation sequencing. We observed an significant association between a polymorphism in DDC (rs11575457) and AUD. Positive reinforcement factors as urges/temptations to drink and pleasant emotion, in isolation, were the significantly related elements to drinking. In addition, negative (physical discomfort) and positive reinforcement factors (testing personal control; pleasant time with others) significantly reinforced the interaction with DDC genetic variant for increased odds of an individual presenting AUD. These results indicated a complex relationship between the dopaminergic system and the drug-seeking behavior profiles.

A single ovarian stimulation, as performed in assisted reproductive technologies, can modulate the anxiety-like behavior and neuronal activation in stress-related brain areas in rats.

Infertility affects about 8 to 12% of couples of childbearing age around the world, and is recognized as a global public health issue by the WHO. From a psychosocial perspective, infertile individuals experience intense psychological distress, related to emotional disorders, which have repercussions on marital and social relationships. The symptoms persist even after seeking specialized treatment, such as assisted reproductive technologies (ART). While the stress impact of ART outcome has been comprehensively studied, the role of supraphysiological concentrations of gonadal hormones on stress response, remains to be elucidated. This study aimed to evaluate the effect of a single ovarian stimulation on the stress response in rats. To mimic the context of ART in rodents, female rats were submitted to the superovulation (150 UI/kg of PMSG and 75 UI/kg of hCG) and then to psychogenic stress (restraint stress for 30 min/day, repeated for three days). Anxiety-like behavior was evaluated in the elevated plus-maze, and neuronal activation in the stress-related brain areas assessed by Fos protein immunoreactivity. Corticosterone, estradiol, progesterone and corpora lutea were quantified. Data were analyzed using Generalized Linear Model (GzLM). Our findings indicate anxiolytic-like and protective effects of supraphysiological concentrations of gonadal hormones induced by a single ovarian stimulation on stress response. An activation of hypothalamus-pituitary-adrenal response inhibitory pathways, with participation of the prefrontal cortex, basomedial amygdala, lateral septum, medial preoptic area, dorsomedial and paraventricular hypothalamus, was detected.

Controversias en cirugía: Erradicación del Helicobacter pylori ¿Terapia a todos o según indicaciones usuales? / Controversies in surgery: Eradication of Helicobacter pylori. Therapy for all or according to usual indications?

La infección por Helicobacter pylori (H. pylori), es la infección bacteriana crónica más frecuente de la raza humana, afecta al 50 % de la población mundial y, por lo menos, al 80 % de la población colombiana. Esta bacteria es re-conocida desde hace más de 15 años como un carcinógeno tipo I. De acuerdo con las indicaciones del Consenso de "Maastricht V" esta infección debe ser buscada y tratada en los pacientes con úlcera péptica activa, linfoma MALT (por sus siglas en inglés, mucosa associated lymphoid tissue), cáncer gástrico temprano, púrpura que presenten síntomas dispépticos crónicos y usuarios crónicos de AINES. Debido al papel que tiene en la fisiopatología del cáncer gástrico, nace la iniciativa de realizar una búsqueda activa del H. pylori y erradicarlo en todas las personas, incluyendo aquellas asintomáticas en países con alta incidencia de esta neoplasia. Existen diversas publicaciones alrededor del mundo que así lo sugieren, mostrando resultados con impacto positivo en el curso y progresión de la enfermedad, sobre todo en las etapas más tempranas de la infección. Sin embargo, otros autores resaltan la creciente problemática de la resistencia bacteriana, y demuestran que el peso estadístico y los diferentes análisis de los estudios disponibles en la actualidad tienen poca validez para dar una recomendación extendida al paciente asintomático. Se cuestiona que tal vez, estamos utilizando las estrategias inadecuadas para manejar una situación de salud pública, ya que estamos enfocados en impactar a cada individuo con terapias antibióticas complejas, en vez de a la población en general con políticas de salud pública

Helicobacter pylori (H. pylori) infection is the most frequent chronic bacterial infection in humans, affecting 50% of the world population, and at least 80% of the Colombian population. This bacteria has been recognized for more than 15 years as a type I carcinogen. According to the indications of the "Maastricht V" consensus, this infection should be sought and treated in patients with: active peptic ulcer, MALT lymphoma (for its acronym Mucosa associated lymphoid tissue), early gastric cancer, purpura who present with chronic dyspeptic symptoms and chronic users of NSAIDs. Due to the role it plays in the pathophysiology of gastric cancer, the initiative was born to carry out an active search for H. pylori and eradicate it in all people, including those asymptomatic in countries with a high incidence of this neoplasia.There are various publications around the world that suggest the effectiveness of this treatment and the positive impact on the course and progression of the disease, especially in the earliest stages of the infection, since the more advanced stages have less encouraging results regarding progression to malignancy. However, other authors highlight the growing problem of bacterial resistance that we are currently facing and demonstrate that the sta-tistical weight and the different analyzes of the currently available studies have little validity to give an extended recommendation to the asymptomatic patient. It is suggested that perhaps inappropriate strategies to manage this public health situation are being used, since we are focused on impacting each individual with complex antibiotic therapies, instead of the general population with public health policies

Chronic intermittent ethanol administration differentially alters DeltaFosB immunoreactivity in cortical-limbic structures of rats with high and low alcohol preference.

BACKGROUND: The role of specific cerebral areas involved in alcohol use disorder, such as the amygdala, hippocampus and prefrontal cortex, has emerged as a subject of interest over recent years. Nevertheless, the role played by these regions is frequently confounded by different variables, among them are the patterns of alcohol consumption presented by the subjects. OBJECTIVES: The present study verified the effects of chronic voluntary ethanol intake (20 sessions) on DeltaFosB immunoreactivity (DeltaFosB-ir) in the amygdala, hippocampus and prefrontal cortex of rats showing high and low preference for ethanol. METHODS: DeltaFosB-ir induced by chronic voluntary ethanol intake with a two-bottle intermittent access to 20% ethanol model in male Wistar rats was measured. Three groups of animals were analyzed: control (n = 6), low preference (n = 8) and high preference (n = 8) for ethanol, the latter two categorized from their pattern of voluntary consumption of the alcohol solution. RESULTS: Ethanol intake in high-preference rats increased DeltaFosB-ir in the central amygdala, CA1 and CA3 regions of the hippocampus and decreased DeltaFosB-ir in the prelimbic cortex and anterior cingulate cortex. On the other hand, in low preference rats, chronic voluntary ethanol intake decreased DeltaFosB-ir in the medial amygdala, basolateral amygdala, dentate gyrus and anterior cingulate cortex. CONCLUSIONS: The present results suggest that different alcohol intake patterns are associated with a specific pattern of DeltaFosB-ir in brain structures that play a key role in controlling behavior and decision making, that is the amygdala, the hippocampus and the prefrontal cortex.

Behavioral and stereological analysis of the prefrontal cortex of rats submitted to chronic alcohol intake.

Alcohol consumption has been identified as a causal factor promoting changes in different molecular and cellular mechanisms resulting in neurodegeneration. This process is specific to certain brain regions and its effects on different areas of the brain can result in a variety of deleterious consequences. The prefrontal cortex (PFC) appears to be particularly sensitive to alcohol-induced neurodegeneration; this region is quite complex, as it is responsible for high order mental processes such as decision making. Thus, it is important to have precise and unbiased data of neuronal morphology parameters to understand the real effects of alcohol on the PFC. This study aimed to investigate alcohol-induced neurodegeneration in the PFC by utilizing behavioral and stereological methods. In the first phase of the study, we utilized eighteen animals, six controls and twelve alcohol-treated, that were submitted to voluntary chronic alcohol ingestion for four or eight weeks. Their brains were analyzed by design-based stereology methods to assess number and volume parameters regarding neuronal integrity in regions of the PFC (prelimbic - PL, infralimbic - IL and anterior cingulate - ACC). In the second phase of the study, six animals were utilized as controls and eight animals were submitted to the same alcohol ingestion protocol and to a behavioral decision-making test. In conclusion, our findings indicate that chronic alcohol consumption promotes a decrease in volume in the prelimbic and in the anterior cingulate, a decrease of mean neuronal volume in the anterior cingulate cortex and a decrease of total volume of neurons in the IL area. We did not observe changes in decision-making behavior in either of the two periods of alcohol intake. This shows that morphological changes occur in specific regions of the prefrontal cortex, a noble area of cognitive functions, induced by chronic alcohol consumption.

Chronic corticosterone increases ΔFOSB and CRFR1 immunoreactivity in brain regions that modulate aversive conditioning.

Previous studies showed that chronic treatment with corticosterone facilitates elevated T-maze (ETM) inhibitory avoidance and a step-down avoidance task, responses that have been used to investigate aversive conditioning and memory processes. On the other hand, chronic corticosterone does not alter ETM escape from the open arms. The purpose of the present study was to further investigate the effects of chronic corticosterone treatment (200 mg pellets, 21-day release) in an animal model of anxiety that does not involve aversive conditioning: the light/dark transition model. We also investigated the pattern of ΔFosB immunoreactivity (ΔFosB-ir) in different brain regions. To examine how treatment with chronic corticosterone interferes with CRFR1 expression we measured CRFR1 in the same brain structures that exhibited increased ΔFosB-ir. Results showed that chronic treatment with corticosterone did not alter behavioral measurements performed in the light/dark transition model. On the other hand, ΔFosB-ir was increased in several structures that modulate aversive conditioning: the cingulate cortex, the ventro and dorsolateral septum, the amygdala, the paraventricular, dorsomedial and ventromedial hypothalamus, the periaqueductal grey matter, the dorsal raphe, and the median raphe nucleus. Chronic treatment with corticosterone also increased CRFR1-immunoreactivity in the ventrolateral septum, central amygdala, dorsomedial hypothalamus, ventral region of the dorsal raphe and median raphe. These results contribute to a better understanding of the behavioral and neurobiological alterations induced by chronic exposure to glucocorticoids.

Effects of Low-level Laser Therapy on Muscle Repair in Rats with Chronic Alcohol Intake

ABSTRACT This study aimed to investigate the effects of low-level laser therapy (LLLT) on muscle repair in rats with chronic alcohol intake. Thirty male Wistar rats were distributed into three groups: injured tibialis anterior (TA) muscle without treatment (IC); chronic ingestion of alcohol plus injured TA muscle (AI); and chronic ingestion of alcohol plus injured TA plus LLLT (AIL). Each group was divided into two different subgroups, and rats were sacrificed on days 3 and 7 post-injury. Morphological features in the injured areas were similar with or without alcohol intake (IC and AI); however, LLLT promoted a decrease in the number of inflammatory cells and destroyed zones, as well as improved tissue organization (AIL). In general, alcohol intake caused a decrease in myogenic regulatory factors (MyoD and myogenin) and vascular endothelial growth factor in the AI group. Moreover, LLLT promoted recovery of these factors to the same level as in animals without alcohol intake (IC and AIL). LLLT was able to increase the expression of myogenic and vascular growth factors and stimulate skeletal muscle regeneration in rats with chronic alcohol intake.

Lactulose decreases neuronal activation and attenuates motor behavioral deficits in hyperammonemic rats.

Lactulose is a nonabsorbable disaccharide commonly used in clinical practice to treat hepatic encephalopathy. However, its effects on neuropsychiatric disorders and motor behavior have not been fully elucidated. Male Wistar rats were bile-duct ligated, and 3 weeks after surgery, treated with lactulose administrated by gavage (1.43 or 3.57 g/kg), once a day for seven days. Plasma levels of ammonia, aspartate aminotransferase, total bilirubin, and creatinine were quantified and histopathological analysis of the livers was performed. Locomotor activity measurements were performed in an open field. The expression of water channel aquaporin-4 was investigated and the analysis of Fos protein immunoreactivity was used to evaluate the pattern of neural activation in brain areas related to motor behavior. Bile-duct ligated rats showed hyperammonemia, loss of liver integrity and function, impaired locomotor activity, reduced aquaporin-4 protein expression, and neuronal hyperactivity. Lactulose treatment was able to reduce ammonia plasma levels, despite not having an effect on biochemical parameters of liver function, such as aspartate aminotransferase activity and total bilirubin levels, or on the cirrhotic hepatic architecture. Lactulose was also able to reduce the locomotor activity impairments and to mitigate or reverse most changes in neuronal activation. Lactulose had no effect on reduced aquaporin-4 protein expression. Our findings confirm the effectiveness of lactulose in reducing hyperammonemia and neuronal hyperactivity in brain areas related to motor behavior, reinforcing the importance of its clinical use in the treatment of the symptoms of cirrhosis-associated encephalopathy.

Alcohol consumption increases locomotion in an open field and induces Fos-immunoreactivity in reward and approach/withdrawal-related neurocircuitries.

Drug addiction is a chronically relapsing disorder characterized by compulsion to seek and take the drug, loss of control in limiting intake and, eventually, the emergence of a negative emotional state when access to the drug is prevented. Both dopamine and corticotropin-releasing factor (CRF)-mediated systems seem to play important roles in the modulation of alcohol abuse and dependence. The present study investigated the effects of alcohol consumption on anxiety and locomotor parameters and on the activation of dopamine and CRF-innervated brain regions. Male Wistar rats were given a choice of two bottles for 31 days, one containing water and the other a solution of saccharin + alcohol. Control animals only received water and a solution of 0.2% saccharin. On the 31st day, animals were tested in the elevated plus-maze and open field, and euthanized immediately after the behavioral tests. An independent group of animals was treated with ethanol and used to measure blood ethanol concentration. Results showed that alcohol intake did not alter behavioral measurements in the plus-maze, but increased the number of crossings in the open field, an index of locomotor activity. Additionally, alcohol intake increased Fos-immunoreactivity (Fos-ir) in the prefrontal cortex, in the shell region of the nucleus accumbens, in the medial and central amygdala, in the bed nucleus of the stria terminalis, in the septal region, and in the paraventricular and dorsomedial hypothalamus, structures that have been linked to reward and to approach/withdrawal behavior. These observations might be relevant to a better understanding of the behavioral and physiological alterations that follow alcohol consumption.

Peer mentoring program in an interprofessional and interdisciplinary curriculum in Brazil.

The Federal University of São Paulo, Baixada Santista Campus was founded in 2006 with five degree-granting programs in physical education, physiotherapy, nutrition, psychology, and occupational therapy. The guiding principle behind the programs' educational mission was centered on the development of health care professionals capable of working in interdisciplinary teams with an emphasis on holistic patient care. This pedagogical structure required peer-mentoring programs in order to integrate different areas of knowledge and to improve learning strategies among new generations of students. The authors' objective in the present report is to discuss the strategies and activities of the peer-mentoring program in histophysiology and gross anatomy in an interdisciplinary and interprofessional curriculum. Evaluations by students, mentors and professors are presented, along with a statistical analysis of variance comparing student performance in the module assessments according to their participation in the peer-mentoring activities. The results demonstrated that students who participated in peer-mentoring activities enjoyed a higher rate of academic success than those who did not participate. In addition, student and mentor evaluations of the peer mentoring program were highly positive. The program enabled mentors to gain a deeper knowledge of the subjects addressed in the learning modules, as well as to develop intrinsic teaching skills during their time as mentors. In short, the authors believe that the peer-mentoring program has been validated for its effectiveness in raising student academic performance.

Increase in medial frontal cortex ERK activation following the induction of apomorphine sensitization.

Repeated high dose injections of the direct acting D1/D2 agonist apomorphine (APO) induces context specific behavioral sensitization. We assessed the effects of 2.0 mg/kg APO on open-field locomotor responses of rats over a 30 min period following either single or five daily APO injections. Acute injections increased locomotor activity, which was markedly increased in rats given 5 daily APO injections. This progressive increase in locomotion during the repeated APO treatments is indicative of behavioral sensitization. Immediately following the open-field test for the acute and the fifth apomorphine injection, the animals were euthanized and their brain tissue was prepared for immunohistochemistry. ERK immunoreactive nuclei in the medial prefrontal cortex (PFC), nucleus accumbens (NAcc), amygdala (AMYG) and lateral hypothalamus (LH) were quantified. The acute apomorphine injections increased ERK in all brain areas as compared to vehicle. Following the fifth apomorphine injection, ERK significantly increased in the PFC, decreased in the amygdala but was unchanged in the LH and NAcc. The selective increase in ERK activity in the PFC associated with behavioral sensitization, points to a possible pivotal role of the dopamine projection to the medial frontal cortex in the mediation of neural plasticity, considered to underlie the sensitization processes induced by dopaminergic drugs.

Physical therapy and psychological intervention normalize cortisol levels and improve vitality in women with endometriosis.

There is as yet no effective treatment for endometriosis. The objective of this study was to evaluate the effectiveness of submitting women with endometriosis and chronic pelvic pain to a therapeutic protocol involving physical and psychological therapy. Twenty-six female volunteers were submitted to a treatment protocol consisting of 2.5-h sessions, once a week for 10 weeks. We applied a Visual Analogue Scale, the Perceived Stress Questionnaire (PSQ), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Morning, afternoon, and evening levels of cortisol were determined in saliva samples. The PSQ scores were significantly lower after treatment, whereas the scores for the SF-36 vitality and physical functioning domains were significantly higher. Salivary cortisol levels were higher after treatment in the samples collected in the morning, but not in those collected in the afternoon or evening. The post-treatment cortisol levels were similar to those reported for healthy women. There were positive correlations between vitality, role emotional, social functioning, and mental health, and negative correlations to perceived stress. In conclusion, the physical and psychological intervention protocol applied in this study to women suffering of endometriosis was effective in reducing perceived stress, normalizing cortisol levels, increasing vitality and improving physical functioning.

Fatores que levam ao sucesso da anestesia Pterigomandibular / Factors that lead to the success of the Pterygomandibular anesthesia

As técnicas anestésicas para os nervos alveolar inferior, bucal e lingual possuem algum insucesso na clínica diária, porque as diretrizes para o local de penetração da agulha podem não causar o acesso adequado do anestésico ao nervo, devido às variações anatômicas das estruturas de referência, e variações na posição do nervo e estruturas vizinhas. As variações nas técnicas e no uso de agulhas anestésicas longas ou curtas também tem importância para alcançar a anestesia. Neste trabalho, nos propusemos a analisar as variações anatômicas da posição do forame da mandíbula, o uso de agulhas longas ou curtas, as duas principais técnicas para a anestesia dos nervos alveolar inferior, bucal e lingual, com dados clínicos obtidos a partir de um questionário. Este estudo foi dividido em três partes: análise em osso seco da posição do forame da mandíbula, relação da posição do nervo alveolar inferior na altura do forame da mandíbula e o comprimento das agulhas odontológicas, e um questionário clínico padrão. A partir dos dados recolhidos, concluímos que o forame da mandíbula em adultos pode possuir uma posição acima da altura da penetração da agulha, o que dificulta o acesso do anestésico ao nervo alveolar inferior. Nas mandíbulas infantis isto não ocorre, porque o forame sempre está mais inferior ao local de penetração da agulha. Agulhas curtas são eficazes quase sempre. A técnica de bloqueio do nervo alveolar inferior é eficaz para a anestesia dos nervos alveolar inferior, bucal e lingual, sendo a técnica de escolha, em detrimento da Gow-Gates.

The anesthetic techniques for the nerves alveolar inferior, buccal and lingual possess some failure in the daily clinic, because the lines of direction for the place of penetration of the needle can not cause the adequate access of the anesthetic to the nerve, which had to the anatomical variations of the structures of reference, and neighboring variations in the position of the nerve and structures. The variations in the techniques and the use of long or short anesthetic needles also have importance to reach the anesthesia. In this work, in we considered them to analyze the anatomical variations of the position of the foramen of the jaw, the use of long or short needles, the two main techniques for the anesthesia of the nerves alveolar inferior, buccal and lingual, with gotten clinical data from a questionnaire. This study it was divided in three parts: analysis in dry bone of the position of the foramen of the jaw, relation of the position of the inferior alveolar nerve in the height of the foramen of the jaw and the length of the odontologic needles, and a clinical questionnaire standard. From the collected data, we conclude that the foramen of the jaw in adults can possess a position above of the height of the penetration of the needle, what it makes it difficult the access of the anesthetic to the inferior alveolar nerve. In the infantile jaws this does not occur, because the foramen always is more inferior to the place of penetration of the needle. Short needles are efficient almost always. The technique of blockade of the inferior alveolar nerve is efficient for the anesthesia of the nerves alveolar inferior, buccal and lingual, being the choice technique, in detriment of the Gow-Gates.

Prevalência de lesão dos nervos alveolar inferior, bucal e lingual em procedimentos operatórios / Prevalence of lesions in the inferioralveolar, buccal and lingual nerves caused by surgical procedures

Os nervos alveolar inferior, lingual e bucal em seu trajeto estão próximos à região cirúrgica dos dentes terceiros molares inferiores. A literatura apresenta trabalhos que relatam a prevalência de lesão nos nervos alveolar inferior e lingual neste tipo de procedimento, porém não relata sobre a lesão no nervo bucal. Não existe consenso quanto a percentagem de lesão nervosa, tendo incidência variável entre vários trabalhos. Assim, nos propusemos a estudar as relações anatômicas destes três nervos com o dente terceiro molar inferior e a coletar dados clínicos da incidência de lesão. A relação do nervo alveolar inferior com o terceiro molar inferior foi analisada através de radiografias periapicais. A relação dos nervos lingual e bucal com o dente foi analisada através de peças cadavéricas. Os dados clínicos foram levantados através de questionário distribuído a cirurgiões dentistas. Os resultados obtidos foram: com relação ao nervo alveolar inferior, 40% das radiografias mostraram proximidade entre o terceiro molar inferior e o canal mandibular; com relação ao nervo lingual, obtivemos uma distância média de 21 mm com relação ao rebordo alveolar dos terceiros molares inferiores; o nervo bucal apresentou uma distância média de 11 mm da porção distal do terceiro molar inferior, superiormente a linha oblíqua da mandíbula; com relação aos dados clínicos, os profissionais participantes da pesquisa relataram uma incidência de 6% na lesão do nervo alveolar inferior e 3,5% na lesão do nervo lingual, com 0% na lesão do nervo bucal, durante a extração de terceiros molares inferiores.

The inferior alveolar, lingual and buccal nerves in its passage are next to the surgical region of third molar inferiors. Literature presents works that tell the prevalence of injury in the nerves inferior alveolar and lingual in this type of procedure, however does not tell on the injury in the buccal nerve. Does not exist consensus in the percentage of nervous injury, having changeable incidence between some works. So we propose to study the anatomical relations of these three nerves with the tooth third molar inferior and to collect clinical data of the injury incidence. The relation of the inferior alveolar nerve with the third molar inferior was analyzed through periapicais x-rays. The relation of the nerves lingual and buccal with the tooth was analyzed through body parts. The clinical data had been raised through distributed questionnaire to dentists. The gotten results had been: with regard to the inferior alveolar nerve, 40% of the x-rays had shown to proximity between the third molar inferior and the mandibular canal; with regard to the lingual nerve, we got a average of 21 mm with regard to the alveolar rim of the third molar inferiors; the buccal nerve presented a distance measured of 11 mm of the distal portion of the third molar inferior, superior the oblique line of the jaw; with regard to the clinical data, the participant professionals of the research had told an incidence of 6% in the injury of inferior alveolar nerve and 3.5% in the injury of the lingual nerve, with 0% in the injury of the buccal nerve, during the extration of third molar inferiors.