Three-dimensional kinematic evaluation of scapulohumeral rhythm after reverse shoulder arthroplasty: a systematic review and meta-analysis.

Background: The movement of the arm relative to the trunk results from 3-dimensional (3D) coordinated movements of the glenohumeral (GH) and scapulothoracic (ST) joints and dictates the scapulohumeral rhythm (SHR). Alterations in SHR increase joint overload and may lead to low functional scores, pain, and failures in patients undergoing reverse total shoulder arthroplasty (RSA). The goal of this systematic review and meta-analysis was to examine 3D SHR kinematics after RSA and compare it to that of asymptomatic shoulders. Methods: A systematic review and meta-analysis of articles in English were performed using PubMed, Embase, Cochrane Library, and SciELO. Additional studies were identified by searching bibliographies. Search terms included "Reverse shoulder arthroplasty", "3D", and "scapula". It was selected cross-sectional studies that reported SHR with 3D motion analysis systems in patients who underwent RSA and asymptomatic controls. Two authors independently performed the extraction of articles using predefined data fields, including study quality indicators. Results: Data from four studies were included in quantitative analysis, totaling 48 shoulders with RSA and 63 asymptomatic shoulders. Pooled analyses were based on random-effects model (DerSimonian-Laird). A statistically smaller SHR ratio was observed in the RSA group than that in the control group (P < .00001), meaning a greater contribution of ST joint in relation to GH joint for arm elevation. The standardized mean difference was -1.16 (95% confidence interval: -1.64, -0.67). A sensitivity analysis with three more studies that had imputed data on control group did not change the direction of the effect. The standardized mean difference on sensitivity analysis was -0.60 (P = .03; 95% confidence interval: -1.13, -0.06). It was detected as "not important heterogeneity" within the comparison (I2: 22%). Chi-square was not statistically significant (Chi2: 3.85), and I2 was 22%. Tau2 was not zero (Tau2: 0.05). Sensitivity analysis showed an I2 of 74%, which might represent substantial heterogeneity, Chi-square was not statistically significant (Chi2: 23.01), and Tau2 was not zero (Tau2: 0.37). Conclusion: This study found that RSA shoulders have an increased contribution of ST joint during arm elevation, compared with asymptomatic shoulders. More movement in ST joint in proportion to GH joint increases GH joint contact forces, which could lead to component loosening or other complications. Further studies should address the clinical implications of this kinematic finding.

Treatment of chronic locked posterior dislocation of the shoulder with the modified McLaughlin procedure.

BACKGROUND: Locked posterior dislocation of the shoulder (LPDS) is a challenging condition for the orthopedic surgeon. The problem with cases of chronic LPDS is that they may result in worse clinical outcomes because the size of the reverse Hill-Sachs lesion and cartilage damage can increase over time. Multiple treatment strategies have been reported in the literature for the treatment of chronic cases. The purpose of this study was to report our experience with the modified McLaughlin technique for the treatment of chronic LPDS and evaluate the mid- and long-term functional outcomes. METHODS: This was a retrospective single-center study including a consecutive series of 10 patients who underwent the modified McLaughlin procedure for the treatment of chronic LPDS. The time between dislocation and treatment ranged from 6 weeks to 14 months (mean, 20.9 weeks). Postoperative imaging and functional evaluation were performed with a minimum of 2 years' follow-up (range, 24-110 months). Functional outcomes were assessed by means of a visual analog scale score for pain and patient satisfaction regarding the operation, the Constant-Murley score, and the University of California, Los Angeles shoulder rating scale. RESULTS: The mean follow-up period was 59.4 months (range, 24-110 months). Range of motion improved significantly after surgery: Mean forward flexion improved from 71° ± 5° to 126°± 37° (P < .001), mean external rotation improved from 7°± 7° to 52° ± 18° (P = .012), and mean internal rotation improved from gluteal region ± 1 vertebral level to L1 ± 4 vertebral levels (P = .001). Functional outcome measures demonstrated significant improvements: The mean Constant-Murley score improved from 22 ± 2.4 (range, 20-26) to 65 ± 21.5 (P < .001); the mean University of California, Los Angeles score improved from 9.8 ± 1.3 (range, 8-12) to 27 ± 9.7 (P < .001); and the mean visual analog scale score improved from 4.6 ± 0.8 (range, 3-6) to 2.4 ± 2.3 (P < .001). Of the patients, 8 (80%) were satisfied with the procedure. The 2 remaining cases had a delay from injury to diagnosis > 6 months and evolved with poor functional outcomes and severe glenohumeral degenerative joint disease. There were no cases of recurrent dislocation, infection, or neurologic injury during the follow-up. CONCLUSION: Our study findings demonstrated that the modified McLaughlin procedure showed good results over a 2-year minimum follow-up period. The clinical outcomes of this procedure are worse when there is a delay from injury to diagnosis > 6 months.

Superior Capsular Reconstruction using the Long Head of the Biceps Tendon: The Biceps Loop Technique.

Irreparable rotator cuff tears can be treated in several ways. Superior capsular reconstruction has been reported as an excellent option, particularly for the young and active patients. We propose capsule reconstruction using the long head of the biceps tendon in a modified way. After its tenotomy at the musculotendinous junction, the long head is rerouted through a humeral bone tunnel and attached to a suture anchor in the posterior aspect of the superior glenoid rim. Further investigation is required, but this modified technique appears promising.

Incidence and Risk Factors of the Complications Related to the Latarjet Surgery.

Objective The Latarjet procedure is a well-accepted treatment of shoulder instability. This technique is associated with a unique set of complications with overall rates of up to 30%. The purpose of the present study was to investigate the incidence and risk factors associated with complications after open Latarjet procedure. Methods We retrospectively reviewed 102 patients submitted to open Latarjet procedure. Complications were divided into three types: clinical; graft-related; and screw-related. All of the patients were submitted to radiography and computed tomography (CT). The risk factors analyzed were gender, age, previous surgery, epilepsy, experience of the surgeon. Results A total of 102 consecutive patients (108 cases) underwent the Latarjet procedure. The mean age was 33.7 years old (18 to 61 years old), with 88 males and 14 females. The overall complication rate was 21.2%, being 12% clinical-related, 7.4% graft-related, and 2.7% screw-related. The most frequent were anterior apprehension (eight cases) and lateral overhang of the graft in six patients. Computed tomography scan at a minimum of 6 months was performed in 79 cases (73%), and graft union occurred in 75 patients (94.9%). There were no cases of instability in the remaining four cases of nonunion. Ten patients (9.2%) required revision surgery. The risk factors associated with complications were epilepsy ( p = 0.0325), experience of the surgeon ( p = 0.0499) and patients ≥ 40 years old at the time of the surgery ( p = 0.0151). There was no correlation with gender and previous surgery. Conclusion The complication rate following the Latarjet procedure was 21.2%, with 9% requiring revision surgery. Epilepsy, age > 40 years old and experience of the surgeon were risk factors.

Incidence and Risk Factors of the Complications Related to the Latarjet Surgery / Incidência e fatores de risco das complicações da cirurgia de Latarjet

Abstract Objective The Latarjet procedure is a well-accepted treatment of shoulder instability. This technique is associated with a unique set of complications with overall rates of up to 30%. The purpose of the present study was to investigate the incidence and risk factors associated with complications after open Latarjet procedure. Methods We retrospectively reviewed 102 patients submitted to open Latarjet procedure. Complications were divided into three types: clinical; graft-related; and screw-related. All of the patients were submitted to radiography and computed tomography (CT). The risk factors analyzed were gender, age, previous surgery, epilepsy, experience of the surgeon. Results A total of 102 consecutive patients (108 cases) underwent the Latarjet procedure. The mean age was 33.7 years old (18 to 61 years old), with 88 males and 14 females. The overall complication rate was 21.2%, being 12% clinical-related, 7.4% graft-related, and 2.7% screw-related. The most frequent were anterior apprehension (eight cases) and lateral overhang of the graft in six patients. Computed tomography scan at a minimum of 6 months was performed in 79 cases (73%), and graft union occurred in 75 patients (94.9%). There were no cases of instability in the remaining four cases of nonunion. Ten patients (9.2%) required revision surgery. The risk factors associated with complications were epilepsy (p = 0.0325), experience of the surgeon (p = 0.0499) and patients ≥ 40 years old at the time of the surgery (p = 0.0151). There was no correlation with gender and previous surgery. Conclusion The complication rate following the Latarjet procedure was 21.2%, with 9% requiring revision surgery. Epilepsy, age ≥ 40 years old and experience of the surgeon were risk factors.

Resumo Objetivo A cirurgia de Latarjet é bem estabelecida para o tratamento da instabilidade anterior do ombro. Apresenta complicações específicas com taxas de até 30%. Nosso objetivo é avaliar a incidência e os fatores de risco associados às complicações após a cirurgia de Latarjet. Métodos Analisamos retrospectivamente 102 pacientes submetidos ao procedimento. Dividimos as complicações em três tipos: clínicas, relacionadas ao enxerto e relacionadas aos implantes. Todos os pacientes foram submetidos a radiografias e tomografia computadorizada (TC). Os fatores de risco analisados foram gênero, idade, cirurgia prévia, epilepsia e experiência do cirurgião. Resultados Um total de 102 pacientes consecutivos (108 casos) foram avaliados. A média de idade foi 33,7 anos (18 a 61 anos), com 88 homens e 14 mulheres. A taxa de complicações foi de 21,2%, sendo 12% clínicas, 7,4% relacionadas ao enxerto e 2,7% relacionadas ao implante. As mais frequentes foram apreensão anterior (oito casos) e posicionamento lateral do enxerto, em seis casos. A TC foi realizada com o mínimo de 6 meses em 79 casos (73%), evidenciando a consolidação do enxerto em 75 pacientes (94.9%). Nenhum caso de não união apresentou instabilidade. Dez pacientes (9.2%) precisaram de cirurgia de revisão. Os fatores de risco relacionados às complicações foram epilepsia (p = 0.0325), experiência do cirurgião (p = 0.0499) e pacientes ≥ 40 anos (p = 0.0151). Não houve correlação com gênero e cirurgia prévia. Conclusão A taxa de complicações após a cirurgia de Latarjet foi de 21,2%, com 9% necessitando de revisão cirúrgica. Epilepsia, idade ≥ 40 anos e experiência do cirurgião foram fatores de risco.

Arthroscopic Fixation of a Large Osteochondral Fragment From the Glenoid After First Episode Dislocation.

Osteochondral lesions of the glenoid are not so uncommon after traumatic cases of shoulder dislocation and can be a challenge to the shoulder surgeon because of the technical difficulty and the potential to progression to shoulder arthritis. An all-arthroscopic technique of fixation of a large osteochondral fragment is used to allow optimal visualization and reduction, minimize the morbidity of the open approach, and provide good functional results.

Dietary breadth of the animal protein consumed by riverine communities in the Tapajós National Forest, Brazil.

In small-scale human settlements, the acquisition of animal protein is strictly related to subsistence activities, and yours dietary habits are determined by the availability and the selectivity permitted by the diversity of these resources. This study analyzed the consumption of animal protein sources in seven traditional riverine communities of the Tapajos National Forest, located in Eastern Brazilian Amazonia, considering fish, game meat and domestic animals. The analysis of animal protein consumption was based on the assumptions of the diet breadth model and the Optimal Foraging Theory. We compared diet breadths between communities and between rainy and dry seasons. The study focused on seven traditional riverside communities, six of them distributed along the right bank of the Tapajos River and one on the right bank of the Cupari River. Data collection was performed in four fields trips, two in the rainy season (May and July) and two in the dry season (September and November) in 2010. Data were collected through semi-structured interviews where the informant mentioned the source of animal protein consumed in the last three meals and which would be consumed at the next meal, if possible. We carried out a total of 470 interviews, where we documented 1 512 meals, and in only 12% of the meals there was no consumption of any animal protein source. The fish was consumed in 60.4% of the meals, being the most important source of animal protein consumed, differing significantly from other protein sources (X2=23.79, df=5, p<0.001). A total of 11 species of wild animals and 46 species of fish were consumed. The choice in the consumption of game meat consisted on Tayassu pecari, Hydrochoerus hidrochaeris and Cuniculus paca, while the preference for fish consumption included Plagioscion spp., Astronotus spp., Cichla spp. and Leporinus spp.. The Simpson index did not vary significantly between the rainy and dry season (N=6, t=1.25, p=0.267) or between communities (N=6, t=-5, p=0.42), although SLo Francisco das Chagas have significantly higher consumption of game meat (X2=370.41, df=25, p<0.001). Fishing is an activity of paramount importance to these communities, and factors that lead to decreased availability of fish may lead to subsequent increase in hunting pressure. For the conservation of preserve of both wildlife natural resources and practices of subsistence of riverine communities of the Tapajós National Forest, it is necessary to ensure the maintenance of fish stocks and the protection of the Tapajós River areas large enough to maintain viable populations of wild animals and more tolerant to hunting and habitat loss.

Dietary breadth of the animal protein consumed by riverine communities in the Tapajós National Forest, Brazil

In small-scale human settlements, the acquisition of animal protein is strictly related to subsistence activities, and yours dietary habits are determined by the availability and the selectivity permitted by the diversity of these resources. This study analyzed the consumption of animal protein sources in seven traditional riverine communities of the Tapajos National Forest, located in Eastern Brazilian Amazonia, considering fish, game meat and domestic animals. The analysis of animal protein consumption was based on the assumptions of the diet breadth model and the Optimal Foraging Theory. We compared diet breadths between communities and between rainy and dry seasons. The study focused on seven traditional riverside communities, six of them distributed along the right bank of the Tapajos River and one on the right bank of the Cupari River. Data collection was performed in four fields trips, two in the rainy season (May and July) and two in the dry season (September and November) in 2010. Data were collected through semi-structured interviews where the informant mentioned the source of animal protein consumed in the last three meals and which would be consumed at the next meal, if possible. We carried out a total of 470 interviews, where we documented 1 512 meals, and in only 12% of the meals there was no consumption of any animal protein source. The fish was consumed in 60.4% of the meals, being the most important source of animal protein consumed, differing significantly from other protein sources (χ²=23.79, df=5, p<0.001). A total of 11 species of wild animals and 46 species of fish were consumed. The choice in the consumption of game meat consisted on Tayassu pecari, Hydrochoerus hidrochaeris and Cuniculus paca, while the preference for fish consumption included Plagioscion spp., Astronotus spp., Cichla spp. and Leporinus spp.. The Simpson index did not vary significantly between the rainy and dry season (N=6, t=1.25, p=0.267) or between communities (N=6, t=5, p=0.42), although São Francisco das Chagas have significantly higher consumption of game meat (χ²=370.41, df=25, p<0.001). Fishing is an activity of paramount importance to these communities, and factors that lead to decreased availability of fish may lead to subsequent increase in hunting pressure. For the conservation of preserve of both wildlife natural resources and practices of subsistence of riverine communities of the Tapajós National Forest, it is necessary to ensure the maintenance of fish stocks and the protection of the Tapajós River areas large enough to maintain viable populations of wild animals and more tolerant to hunting and habitat loss.

En pequeños asentamientos rurales, la adquisición de proteína animal está estrechamente relacionada con actividades de subsistencia, y su hábitos alimentares son determinados por la disponibilidad y diversidad de estos recursos. Este estudio examinó el consumo de pescado, caza y animales domésticos en siete comunidades tradicionales ribereñas de la Floresta Nacional do Tapajós, ubicadas en la Amazonia oriental Brasileña. La análisis se basa en los supuestos de modelos de la amplitud de la dieta y la teoría de forrajeo óptimo, se comparó la amplitud de dieta en siete comunidades ribereñas en periodo seco y lluvioso. La recolección de datos se realizó en cuatro viajes, dos en la temporada de lluvias y dos en la estación seca en el 2010, mediante entrevistas semi-estructuradas. El pescado fue consumido en el 60.4% de las comidas, siendo la fuente de proteína animal más consumida. Un total de 11 especies de animales silvestres y 46 especies de pescado fueron documentadas y la preferencia en el consumo cayó sobre T. pecari, C. paca y Hydrochoerus hidrochaeris y la preferencia por el consumo de pescado cayó sobre Plagioscion spp. Astronotus spp., Cichla spp. y Leporinus spp.

Lack of kinin B1 receptor potentiates leptin action in the liver.

Kinins B1 and B2 receptors (B1R and B2R) are classically associated with inflammation, but our group has recently demonstrated new roles for B1R in metabolism using a knockout model (B1 (-/-)). B1 (-/-) mice display improvement on leptin and insulin sensitivity and is protected from high fat diet (HFD)-induced obesity. Here, we evaluate the hepatic effects of the B1R ablation and its role on hepatic function. Despite no expression of hepatic B1R, HFD-induced hepatic lipid accumulation was lower than in control animals. B1 (-/-) mice also presented lower hepatic lipogenesis and SCD1 protein content in the liver. When stimulated with exogenous leptin, B1 (-/-) mice exhibited increased hepatic pJAK2. Similarly, leptin signaling was enhanced in the liver of ob/ob-B1 (-/-) mice, as demonstrated by increased levels of pSTAT3 compared to ob/ob. Plasma concentrations of intercellular adhesion molecule 1, fetuin A, leukemia inhibitory factor, tissue inhibitor of metalloprotease-1, resistin, and oncostatin M were reduced in B1 (-/-). Finally, B1 (-/-) mice have increased gene expression of hepatic B2 receptor, but no difference in leptin receptor expression. Our results show that B1 (-/-) mice are protected from non-alcoholic fatty liver disease (NAFLD) after HFD treatment. Since B1R expression was not observed in the liver after HFD, we propose that the cross talk between the adipose tissue and the liver, mainly through leptin, is an important factor contributing to the observed results. Besides that, several other inflammatory mediators already correlated with NAFLD or liver function were found to be altered in our model. Taken together, our data suggest that B1R plays an important role in hepatic steatosis development.

Kinin B1 receptor in adipocytes regulates glucose tolerance and predisposition to obesity.

BACKGROUND: Kinins participate in the pathophysiology of obesity and type 2 diabetes by mechanisms which are not fully understood. Kinin B(1) receptor knockout mice (B(1) (-/-)) are leaner and exhibit improved insulin sensitivity. METHODOLOGY/PRINCIPAL FINDINGS: Here we show that kinin B(1) receptors in adipocytes play a role in controlling whole body insulin action and glucose homeostasis. Adipocytes isolated from mouse white adipose tissue (WAT) constitutively express kinin B(1) receptors. In these cells, treatment with the B(1) receptor agonist des-Arg(9)-bradykinin improved insulin signaling, GLUT4 translocation, and glucose uptake. Adipocytes from B(1) (-/-) mice showed reduced GLUT4 expression and impaired glucose uptake at both basal and insulin-stimulated states. To investigate the consequences of these phenomena to whole body metabolism, we generated mice where the expression of the kinin B(1) receptor was limited to cells of the adipose tissue (aP2-B(1)/B(1) (-/-)). Similarly to B(1) (-/-) mice, aP2-B(1)/B(1) (-/-) mice were leaner than wild type controls. However, exclusive expression of the kinin B(1) receptor in adipose tissue completely rescued the improved systemic insulin sensitivity phenotype of B(1) (-/-) mice. Adipose tissue gene expression analysis also revealed that genes involved in insulin signaling were significantly affected by the presence of the kinin B(1) receptor in adipose tissue. In agreement, GLUT4 expression and glucose uptake were increased in fat tissue of aP2-B(1)/B(1) (-/-) when compared to B(1) (-/-) mice. When subjected to high fat diet, aP2-B(1)/B(1) (-/-) mice gained more weight than B(1) (-/-) littermates, becoming as obese as the wild types. CONCLUSIONS/SIGNIFICANCE: Thus, kinin B(1) receptor participates in the modulation of insulin action in adipocytes, contributing to systemic insulin sensitivity and predisposition to obesity.

Intracellular proteolysis of kininogen by malaria parasites promotes release of active kinins.

BACKGROUND: The malaria burden remains a major public health concern, especially in sub-Saharan Africa. The complex biology of Plasmodium, the apicomplexan parasite responsible for this disease, challenges efforts to develop new strategies to control the disease. Proteolysis is a fundamental process in the metabolism of malaria parasites, but roles for proteases in generating vasoactive peptides have not previously been explored. RESULTS: In the present work, it was demonstrated by mass spectrometry analysis that Plasmodium parasites (Plasmodium chabaudi and Plasmodium falciparum) internalize and process plasma kininogen, thereby releasing vasoactive kinins (Lys-BK, BK and des-Arg9-BK) that may mediate haemodynamic alterations during acute malaria. In addition, it was demonstrated that the P. falciparum cysteine proteases falcipain-2 and falcipain-3 generated kinins after incubation with human kininogen, suggesting that these enzymes have an important role in this process. The biologic activity of peptides released by Plasmodium parasites was observed by measuring ileum contraction and activation of kinin receptors (B1 and B2) in HUVEC cells; the peptides elicited an increase in intracellular calcium, measured by Fluo-3 AM fluorescence. This effect was suppressed by the specific receptor antagonists Des-Arg9[Leu8]-BK and HOE-140. CONCLUSIONS: In previously undescribed means of modulating host physiology, it was demonstrated that malaria parasites can generate active kinins by proteolysis of plasma kininogen.

B1 and B2 kinin receptor participation in hyperproliferative and inflammatory skin processes in mice.

BACKGROUND: Kinins are released during dermal injury and inflammation and seem to contribute to the pathogenesis of cutaneous diseases. OBJECTIVE: Participation of kinins in skin inflammatory process was evaluated using knockout mice and non-peptide kinin receptor antagonists. METHODS: Chronic skin inflammation was induced by multiple applications of TPA in mice ear. RESULTS: The B(2) knockout mice (B(2)(-/-)) showed a significant increase of ear weight (23 ± 10%) and epidermal cellular hyperproliferation and acanthosis formation upon histological analysis when compared with wildtype mice. Also, evaluation of PCNA levels by Western blot and immunohistochemistry confirmed the increase in the epidermis hyperproliferation in the ear skin of B(2)(-/-) mice. In contrast, no modification in these parameters was detected in B(1) knockout mice (B(1)(-/-)). However, mice lacking both kinin receptors (B(1)B(2)(-/-)) presented a considerable reduction of epidermis thickness and in PCNA levels. Following the establishment of skin inflammation (5th day of TPA application) treatment with the non-peptide antagonists SSR 240612 (B(1) receptor antagonist), FR 173657 (B(2) receptor antagonist), or SSR 240612 plus FR 173657 topically applied, caused a significant inhibition of ear weight (20 ± 5%, 34 ± 4% and 32 ± 6%, respectively). In the histological analysis, the antagonists produced a reduction in epidermal hyperplasia and acanthosis formation; but the treatment with a combination of the two antagonists did not increase efficacy. CONCLUSION: Kinin receptors seem to be involved in the control of the keratinocyte hyperproliferative process, and non-peptide kinin receptor antagonists may be useful tools in the treatment of hyperproliferative skin disorders.

Predisposition to atherosclerosis and aortic aneurysms in mice deficient in kinin B1 receptor and apolipoprotein E.

Kinin B1 receptor is involved in chronic inflammation and expressed in human atherosclerotic lesions. However, its significance for lesion development is unknown. Therefore, we investigated the effect of kinin B1 receptor deletion on the development of atherosclerosis and aortic aneurysms in apolipoprotein E-deficient (ApoE(-/-)) mice. Mice deficient both in ApoE and in kinin B1 receptor (ApoE(-/-)-B(1)(-/-)) were generated and analyzed for their susceptibility to atherosclerosis and aneurysm development under cholesterol rich-diet (western diet) and angiotensin II infusion. Kinin B1 receptor messenger RNA (mRNA) expression was significantly increased in ApoE(-/-) mice after Western-type diet. Although no difference in serum cholesterol was found between ApoE(-/-)-B(1)(-/-) and ApoE(-/-) mice under Western-type diet, aortic lesion incidence was significantly higher in ApoE(-/-)-B(1)(-/-) after this treatment. In accordance, we observed increased endothelial dysfunction in these mice. The mRNA expression of cyclic guanosine monophosphate-dependent protein kinase I, CD-11, F4/80, macrophage colony-stimulating factor, and tumor necrosis factor-alpha were increased in the aorta of double-deficient mice following Western-type diet, whereas the levels of peroxisome proliferator-activated receptor gamma protein and the activity of matrix metalloproteinase-9 activity were decreased. In addition to the increased atherosclerotic lesions, the lack of kinin B(1) receptor also increased the incidence of abdominal aortic aneurysms after angiotensin II infusion. In conclusion, our results show that kinin B(1) receptor deficiency aggravates atherosclerosis and aortic aneurysms under cholesterolemic conditions, supporting an antiatherogenic role for the kinin B(1) receptor.

Kinin B1 receptor deficiency leads to leptin hypersensitivity and resistance to obesity.

OBJECTIVE: Kinins mediate pathophysiological processes related to hypertension, pain, and inflammation through the activation of two G-protein-coupled receptors, named B(1) and B(2). Although these peptides have been related to glucose homeostasis, their effects on energy balance are still unknown. RESEARCH DESIGN AND METHODS: Using genetic and pharmacological strategies to abrogate the kinin B(1) receptor in different animal models of obesity, here we present evidence of a novel role for kinins in the regulation of satiety and adiposity. RESULTS: Kinin B(1) receptor deficiency in mice (B(1)(-/-)) resulted in less fat content, hypoleptinemia, increased leptin sensitivity, and robust protection against high-fat diet-induced weight gain. Under high-fat diet, B(1)(-/-) also exhibited reduced food intake, improved lipid oxidation, and increased energy expenditure. Surprisingly, B(1) receptor deficiency was not able to decrease food intake and adiposity in obese mice lacking leptin (ob/ob-B(1)(-/-)). However, ob/ob-B(1)(-/-) mice were more responsive to the effects of exogenous leptin on body weight and food intake, suggesting that B(1) receptors may be dependent on leptin to display their metabolic roles. Finally, inhibition of weight gain and food intake by B(1) receptor ablation was pharmacologically confirmed by long-term administration of the kinin B(1) receptor antagonist SSR240612 to mice under high-fat diet. CONCLUSIONS: Our data suggest that kinin B(1) receptors participate in the regulation of the energy balance via a mechanism that could involve the modulation of leptin sensitivity.

Introdução do cuidado continuado aos pacientes portadores de hipertensão arterial sistêmica na Unidade Básica de Saúde São Lucas - Uberlândia, Minas Gerais

A presente proposta de intervenção surge como tentativa de enfrentamento do problema da hipertensão arterial sistêmica (HAS) em adultos com idade entre 30 e 40 anos atendidos no Programa Saúde da Família da Unidade Básica de Saúde São Lucas na cidade de Uberlândia - Minas Gerais. A HAS é uma condição clínica multifatorial que se caracteriza por altos níveis da pressão arterial, ligada ao aparecimento de doenças do coração, como exemplo o infarto do miocárdio e insuficiência cardíaca. Pode causar ainda acidente vascular cerebral, insuficiência renal, cegueira, amputação de membros e, até mesmo, óbito do indivíduo hipertenso. Por desenvolver-se, na maioria das vezes, de maneira crônica e assintomática, o diagnóstico e tratamento da hipertensão arterial sistêmica são comumente negligenciados, devendo ser propostas ações resolutivas e pertinentes para a sua redução e controle e, consequentemente, das diversas patologias a ela associadas. Para tanto, foi realizada uma proposta de intervenção baseada em uma revisão narrativa da literatura de publicações dos últimos 10 anos, obtidas através da Biblioteca Virtual em Saúde (BVS), Pubmed, RIMA, SciELO e EBSCO. Assim, tendo em vista que o controle da hipertensão arterial demanda diferentes ações a nível individual e coletivo e que principalmente deve pautar em proporcionar empoderamento para que o usuário tenha um cuidado continuado, a presente proposta de intervenção pode contribuir para o controle desse problema na comunidade assistida.