Expressão de metaloproteinases de matriz e PCNA em úlceras de córnea profundas, induzidas em coelhos, tratadas com plasma rico em plaquetas / Expression of matrix metalloproteinases and PCNA in deep corneal ulcers induced in rabbits, treated with platelet-rich plasma

O objetivo deste estudo foi avaliar a influência do plasma rico (PRP) e pobre (PPP) em plaquetas na proliferação celular e expressão de metaloproteinases de matriz (MMPs), durante a reparação de úlceras corneais profundas. Foram utilizadas 45 coelhas, distribuídas em 3 grupos (G) experimentais (n=15), designados como grupos PRP (GR), PPP (GP) e Controle (GC), de acordo com o tratamento. Todos os animais foram submetidos à indução cirúrgica unilateral de úlcera corneal. No GR e GP, o sangue autólogo foi centrifugado, utilizando-se protocolo padronizado, e foram confeccionados os colírios de PRP e PPP, e instilados cinco vezes ao dia. No GC, foi utilizado colírio lubrificante. Cada grupo foi subdividido (n=5), segundo o momento final de avaliação, sendo 4 (M4), 7 (M7) e 30 dias (M30). As córneas dos animais foram processadas para avaliação morfológica e imuno-histoquímica para PCNA, MMP1, MMP2, MMP9, MT1-MMP e TIMP1. No M4, os níveis de MMP2 foram maiores no GP e GR, sendo que, no M7, esse comportamento foi observado apenas no GP. No M30, no GR, verificou-se maior número de células epiteliais e marcação para MMP1 que o GP. No GR, a proliferação celular foi maior no M4 que nos demais momentos, e a marcação para MMP2 foi maior no M4 que no M30. O PRP estimula a proliferação celular na fase inicial (M4) do tratamento quando comparado aos demais momentos, diferentemente dos demais tratamentos. O uso de colírios de plasma rico e pobre em plaquetas influencia a expressão de metaloproteinases de matriz envolvidas no processo de reparação corneal.

The aim of this study was to evaluate the influence of platelet-rich (PRP) and poor (PPP) plasma in cell proliferation and matrix metalloproteinases (MMPs) expression during the repair of deep corneal ulcers. Forty-five female rabbits were distributed in 3 experimental groups (G) (n = 15), referred to as PRP (GR), PPP (GP) and Control (GC) groups, in accordance with the treatment. All animals underwent surgical induction of unilateral corneal ulcer. PRP and PPP eye drops were made by using centrifuged blood through standardized protocol, and instilled five times a day. In GC, lubricant eye drops were used. Each group was subdivided (n = 5) according to the final time point, 4 (M4), 7 (M7) and 30 days (M30). The animals' corneas were processed for morphological and immunohistochemical analysis for PCNA, MMP1, MMP2, MMP9, MT1-MMP and TIMP1. In M4, the levels of MMP2 were higher in GP and GR, and in M7, this behavior was only observed in the GP. In M30, more epithelial cells and MMP1 expression were found in GR than GP. In GR, cell proliferation was higher in M4 than at other time points and MMP2 expression was higher in M4 than M30. The PRP stimulates cell proliferation in the early phase (M4) of treatment when compared to other time points, different from other treatments. The use of eye drops of platelet-rich and poor plasma influences the expression of matrix metalloproteinases involved in the corneal repair process.

The cost of care of systemic lupus erythematosus (SLE) in the UK: annual direct costs for adult SLE patients with active autoantibody-positive disease.

OBJECTIVES: The aim of the Systemic LUpus Erythematosus Cost of Care In Europe (LUCIE) study was to evaluate the annual direct medical costs of managing adults with active autoantibody-positive disease on medication for SLE in secondary care. This paper presents the UK analyses only. METHODS: A cost-of-illness study was conducted from the perspective of the National Health Service. Health resource utilization data were retrieved over a two-year period from four centres in England and unit cost data were taken from published sources. RESULTS: At baseline, 86 patients were included, 38 (44.2%) had severe SLE and 48 (55.8%) had non-severe SLE. The mean (SD) SELENA-SLEDAI score was 7.7 (5.7). The mean (SD) annual direct medical cost of was estimated at £3231 (£2333) per patient and was 2.2 times higher in patients with severe SLE compared with patients with non-severe SLE (p < 0.001). Multivariate model analyses showed that renal disease involvement (p = 0.0016) and severe flares (p = 0.0001) were associated with higher annual direct costs. CONCLUSIONS: Improvement of the overall stability of SLE and early intervention to minimize the impact of renal disease may be two approaches to mitigate the long-term direct cost of managing SLE patients in the UK.

Uso do plasma rico em plaquetas no reparo de úlceras de córnea profundas induzidas em coelhos. Avaliação clínica e histomorfométrica / Use of platelet-rich plasma in the treatment of deep corneal ulcers induced in rabbits. Clinical and histomorphometric evaluation

Avaliou-se e comparou-se, clinicamente, por meio de histopatologia e morfometria, o processo de reparação corneana de úlceras experimentais induzidas em coelhos, com o uso de plasma rico em plaquetas (PRP) sob a forma de colírio ou tampão. Foram utilizados 60 coelhos, constituindo-se quatro grupos experimentais de 15 animais cada, designados grupo plaqueta (GP), grupo tampão (GT), grupo controle (GC) e grupo controle amniótica (GA). Os grupos experimentais foram subdivididos em três subgrupos (M4, M7, M30), de acordo com o período final de avaliação, aos quatro, sete e 30 dias, respectivamente. Não houve diferenças entre os tratamentos utilizados quanto aos sinais relacionados à sensibilidade ocular, quemose e secreção ocular. Os grupos tratados com PRP, na forma de tampão ou colírio, apresentaram menor opacidade corneana do que os animais tratados apenas com membrana amniótica no momento final de avaliação. Quanto à presença da úlcera corneana, os grupos tratados com PRP apresentaram menor ulceração corneana em relação aos demais grupos. No exame histomorfométrico, verificou-se maior epitelização corneana na fase inicial da lesão no tratamento à base de colírio de plasma rico em plaquetas. O uso da membrana amniótica promoveu espessamento do epitélio e estroma corneano, com sinergismo dela quando associada ao plasma rico em plaquetas.

The repair process induced corneal ulcer in rabbits using platelet-rich plasma in the form of eyedrop or clot was clinically evaluated and compared. Sixty rabbits were divided into four groups of 15 animals, denominated platelet group (PG), clot group (CLG), control group (CG), and amniotic control group (AG). Experimental groups were then subdivided into three groups (M4, M7, M30), corresponding to the end of the evaluation period. There were no differences between treatments regarding ocular sensitivity, chemosis and ocular secretion. The groups treated with PRP either as eyedrop or a clot showed less opacity than the animals treated only with amniotic membrane at the moment of the final evaluation. The presence of corneal ulcers in the groups treated with PRP showed lower intensity than the other groups. Histomorphometric examination showed that corneal epithelization in the initial phase of the lesion was greater when using PRP. The use of amniotic membrane promoted corneal epithelial and stromal thickness, as well as synergism when associated to PRP.

Uso do colírio de Citrus lemon em úlceras de córnea induzidas em coelhos / Use of Citrus lemon eyedrops in corneal ulcers induced in rabbits

Avaliaram-se e compararam-se clinicamente os efeitos de colírios de Citrus lemon (CL) na reparação de úlcera corneal superficial. Foram utilizadas 50 coelhas, distribuídas em cinco grupos experimentais de 10 animais cada. Após a indução da úlcera, três grupos foram tratados com colírios de CL, nas concentrações de 1,5% (GL1,5), 3% (GL3) e 5% (GL5). Um quarto grupo foi tratado com Tween 80 a 8%, diluente utilizado na produção dos colírios de CL, e o quinto grupo, controle, recebeu substituto da lágrima. Os grupos foram distribuídos em dois subgrupos de cinco animais; assim, o primeiro (M1) foi avaliado após 24 horas, e o segundo (M5) após cinco dias. Não houve diferença entre os tratamentos quanto aos sinais clínicos secreção, hiperemia conjuntival, quemose e opacidade corneal. A extensão da úlcera corneal diminuiu, de forma significativa, em todos os grupos no M5, com exceção do GL3, o qual apresentou menor mediana quanto à extensão no M1. O colírio de óleo essencial de Citrus lemon pode ser utilizado no tratamento de ceratites ulcerativas superficiais, sem induzir irritação conjuntival, favorecendo a reepitelização corneal.

The aim of this study was to clinically evaluate and compare the effects of Citrus lemon (CL) eye drops in the repair of superficial corneal ulcers. Fifty female rabbits were used, constituting five experimental groups with 10 animals each. After ulcer induction, three groups were treated with CL eye drops, at 1.5% (GL1, 5), 3% (GL3) and 5% (GL5) concentrations. Another group was treated with Tween 80 8% solvent used in the production of CL eye drops, and the control group received tear substitute. The experimental groups were divided into two subgroups (five animals). The first (M1) was evaluated after 24 hours and the second (M5) after five days. There was no difference between treatments for clinical signs of secretion, conjunctival hyperemia, chemosis and corneal opacity. The extension of corneal ulcer significantly decreased in all groups in M5, the exception was GL3, which had a lower median of extension in the M1. The eye drops made of Citrus lemon essential oil can be used in the treatment of superficial ulcerative keratitis, without inducing conjunctival irritation, favoring corneal reepithelialization.

The impact of follicular lymphoma on health-related quality of life.

BACKGROUND: The purpose of this study was to determine whether there was a relationship between disease activity and health functioning, as measured by a range of patient-reported outcome (PRO) measures in patients with follicular lymphoma (FL). PATIENTS AND METHODS: A total of 222 patients with FL were recruited from eight sites across the UK and they completed a number of PRO measures. The participants were analyzed across five disease states: 'active disease-newly diagnosed', 'active disease-relapsed', 'partial response', 'complete response' and 'disease free'. The relationship between these disease states and their level of health functioning was assessed as well as the relationship between being 'on' or 'off' chemotherapy and disease state. RESULTS: In terms of health-related quality of life (HRQoL), participants in the relapsed category had the lowest mean physical well-being, emotional well-being, functional well-being and social well-being score. In a regression analysis, the 'active disease-relapsed' group acted as a significant predictor for each PRO variable. In addition, the remission group acted as a significant predictor of high anxiety scores as measured by the Hospital Anxiety and Depression Scale. CONCLUSION: The results of this study demonstrate that various aspects of patient-reported health outcomes differ according to disease state in patients with FL. For those patients who have relapsed, they are more likely to experience worse HRQoL and other patient-reported health outcomes than patients newly diagnosed, in partial or complete remission or when completely disease free.