Molecular profile of driver genes in lung adenocarcinomas of Brazilian patients who have never smoked: implications for targeted therapies.

INTRODUCTION: Lung cancer in never-smoker (LCINS) patients accounts for 20% of lung cancer cases, and its biology remains poorly understood, particularly in genetically admixed populations. We elucidated the molecular profile of driver genes in Brazilian LCINS. METHODS: The mutational and gene fusion status of 119 lung adenocarcinomas from self-reported never-smoker patients, was assessed using targeted sequencing (NGS), nCounter, and immunohistochemistry. A panel of 46 ancestry-informative markers determined patients' genetic ancestry. RESULTS: The most frequently mutated gene was EGFR (49.6%), followed by TP53 (39.5%), ALK (12.6%), ERBB2 (7.6%), KRAS (5.9%), PIK3CA (1.7%), and less than 1% alterations in RET, NTRK1, MET∆ex14, PDGFRA, and BRAF. Except for TP53 and PIK3CA, all other alterations were mutually exclusive. Genetic ancestry analysis revealed a predominance of European (71.1%), and a higher African ancestry was associated with TP53 mutations. CONCLUSION: Brazilian LCINS exhibited a similar molecular profile to other populations, except the increased ALK and TP53 alterations. Importantly, 73% of these patients have actionable alterations that are suitable for targeted treatments.

Dammarane triterpenes targeting α-synuclein: biological activity and evaluation of binding sites by molecular docking.

Parkinson's disease (PD) is a neurodegenerative disorder that affects adult people whose treatment is palliative. Thus, we decided to test three dammarane triterpenes 1, 1a, 1b, and we determined that 1 and 1a inhibit ß-aggregation through thioflavine T rather than 1b. Since compound 1 was most active, we determined the interaction between α-synuclein and 1 at 50 µM (Kd) through microscale thermophoresis. Also, we observed differences in height and diameter of aggregates, and α-synuclein remains unfolded in the presence of 1. Also, aggregates treated with 1 do not provoke neurites' retraction in N2a cells previously induced by retinoic acid. Finally, we studied the potential sites of interaction between 1 with α-synuclein fibrils using molecular modelling. Docking experiments suggest that 1 preferably interact with the site 2 of α-synuclein through hydrogen bonds with residues Y39 and T44.

Alcohol Consumption Influences Clinical Outcome in Patients Admitted to a Referral Center for Liver Disease.

INTRODUCTION AND AIM: Excessive alcohol consumption is a public health concern worldwide and has been associated with high mortality rates. This study aimed to determine the prevalence of alcohol consumption and its influence on the prognosis of hospitalized cirrhotic patients in a tertiary care hospital. MATERIAL AND METHODS: We reviewed the medical records of all patients with hepatic cirrosis admitted between January 2009 and December 2014, in a referral center for liver disease in southern Brazil. Data on clinical outcomes, associated conditions, infections, and mortality were collected and compared between alcoholic and nonalcoholic patients. RESULTS: The sample consisted of 388 patients; 259 (66.7%) were men. One hundred fifty-two (39.2%) were classified as heavy use of alcohol. Most alcoholic patients were men (n = 144; 94.7%). Mean age was 55.6 ± 8.9 years. Hepatic decompensations and infections were more prevalent in alcoholic patient. Spontaneous bacterial peritonitis and respiratory tract infection accounted for most of the infections. Excessive alcohol consumption was associated with mortality (P = 0.009) in multivariate analysis. CONCLUSION: On the present study, the prevalence of heavy use of alcohol was high and associated with a poorer prognosis in hospitalized cirrhotic patients, increasing the risk of infection and death.

Melatonin reduces endoplasmic reticulum stress and autophagy in liver of leptin-deficient mice.

The sedentary lifestyle of modern society along with the high intake of energetic food has made obesity a current worldwide health problem. Despite great efforts to study the obesity and its related diseases, the mechanisms underlying the development of these diseases are not well understood. Therefore, identifying novel strategies to slow the progression of these diseases is urgently needed. Experimental observations indicate that melatonin has an important role in energy metabolism and cell signalling; thus, the use of this molecule may counteract the pathologies of obesity. In this study, wild-type and obese (ob/ob) mice received daily intraperitoneal injections of melatonin at a dose of 500 µg/kg body weight for 4 weeks, and the livers of these mice were used to evaluate the oxidative stress status, proteolytic (autophagy and proteasome) activity, unfolded protein response, inflammation and insulin signalling. Our results show, for the first time, that melatonin could significantly reduce endoplasmic reticulum stress in leptin-deficient obese animals and ameliorate several symptoms that characterize this disease. Our study supports the potential of melatonin as a therapeutic treatment for the most common type of obesity and its liver-associated disorders.

BYPASS VS. SLEEVE AND ITS EFFECTS IN NON-ALCOHOLIC FATTY LIVER DISEASE: WHAT IS THE BEST TECHNIQUE?

BACKGROUND: Strongly associated with obesity, non-alcoholic fatty liver disease is considered the hepatic manifestation of the metabolic syndrome. It presents as simple steatosis and steatohepatitis, which can progress to cirrhosis and its complications. Among the therapeutic alternatives is bariatric surgery. AIM: To compare the effect of the two most frequent bariatric procedures (sleeve and bypass) on liver disease regarding to epidemiological, demographic, clinical and laboratory parameters. METHODS: The results of intraoperative and 12 months after surgery liver biopsies were used. The NAFLD activity score (NAS) was used to assess and compare the stages of liver disease. RESULTS: Sixteen (66.7%) patients underwent Bypass procedure and eight (33.3%) Sleeve. It was observed that the variation in the NAFLD activity score was significantly greater in the Bypass group than in Sleeve (p=0.028) and there was a trend regarding the variation in fibrosis (p=0.054). CONCLUSION: Both surgical techniques were effective in improving the hepatic histology of most operated patients. When comparing sleeve and bypass groups, bypass showed better results, according to the NAS score.

Development and validation of an interactive educational technology on spotted fever.

OBJECTIVE: to develop and validate an interactive educational technology on spotted fever, to offer an innovative teaching method. METHOD: a methodological study that covered the following stages: analysis and diagnosis; instructional planning, didactic design, review, and validation and production of technology. RESULTS: the analysis and diagnosis were obtained from experiences in education and health activities for spotted fever. In the instructional planning, it was defined that the technology would be presented in the form of an Interactive Laboratory, with learning stations. The production of the Laboratory was carried out by a multidisciplinary team made up of a carpenter, an electrician, and a plastic artist, among others. The review and validation process was subdivided into two stages: appearance and content validation by professionals in the fields of biology, and education and semantic validation by students of the Nursing and Pedagogy courses. The results of the appearance and content validation showed a content validity index over 0.8 for the vast majority of the variables. In the semantic validation, the Laboratory was evaluated positively by the students. CONCLUSION: the trajectory followed for the construction of the Interactive Laboratory on spotted fever gave academic and scientific support to the product, offering an innovative educational resource with pedagogical potential that values significant learning.

High-Fructose Consumption Impairs the Redox System and Protein Quality Control in the Brain of Syrian Hamsters: Therapeutic Effects of Melatonin.

Although numerous studies have demonstrated the harmful effect of excessive fructose consumption at the systemic level, there is little information on its effects in the central nervous system. The purpose of the present work was to study the cellular alterations related to oxidative stress and protein quality control systems induced by a high-fructose diet in the brain of Syrian hamsters and their possible attenuation by exogenous melatonin. High-fructose intake induced type II diabetes together with oxidative damage, led to alterations of the unfolded protein response by activating the eIF2α branch, and impaired the macroautophagic machinery in the brain, favoring the accumulation of aggregates labeled for selective degradation and neurodegeneration markers such as ß-amyloid (1-42), tau-p-S199, and tau-p-S404. Melatonin attenuated the manifestation of type II diabetes and reduced oxidative stress, deactivated eIF2α, and decreased tau-p-S404 levels in the brain of animals fed a high-fructose diet.

Effects of decylubiquinone (coenzyme Q10 analog) supplementation on SHRSP.

Decylubiquinone treatment in vitro has demonstrated a potent inhibitor effect on reactive oxidative species production. However, the effectin vivo has not been demonstrated yet. Thus, rats SHRSP male were divided in two groups: treated and controls (n=6, each). The treated group received 10 mg/Kg(-)/body weight of decylubiquinone diluted in coconut oil by oral gavage during four weeks. Control rats just received the vehicle. Body weight, diuresis, food and water intake, systolic blood pressure, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, blood glucose levels and malondialdehyde were determined. There were a significant (p<0.05) reduction on systolic blood pressure, plasma malondialdehyde, total cholesterol and LDL-cholesterol in the treated group. Additionally, HDL-cholesterol also increased significantly. However, body weight, diuresis, food and water intake, blood glucose levels and triglycerides did not alter after treatment. Thus, decylubiquinone can be a new antihypertensive, hypolipidemic and antioxidant agent on the prevention and treatment of diseases linked to oxidative stress.

Cardiovascular Risk Factors in Children and Adolescents with Fontan Circulation

Abstract Background: Long-term outcomes of patients with Fontan circulation are uncertain regarding the prevalence and role of risk factors (RFs) such as increased body mass index (BMI), arterial hypertension, and hypercholesterolemia. Objectives: To describe the prevalence of RFs in patients with univentricular heart, with variable follow-up times. Methods: This mixed cohort study was performed with 66 patients, who underwent blood count, fasting blood glucose, C-reactive protein (CRP), and lipid profile tests; systolic/diastolic blood pressure (SBP/DBP) measurements; and anthropometric and sociodemographic data collection. Cardiovascular RFs among first-degree relatives and physical activity habits were also assessed. Prevalence was described using proportions, with a 95% confidence interval. Continuous variables (height, weight, age, SBP, DBP) were described as means and standard deviations (m±SD). Associations between RFs were assessed using chi-squared or Fisher's exact tests. Spearman's correlation was used for analyzing CRP and the presence of 2 or more RFs. The Shapiro-Wilk test was used to check for data normality. Statistical significance considered p<0.05. Results: In our population, 19.7% were overweight, mean SBP was 89.44±37.4, and mean DBP was 60.0±26.08. The most prevalent diseases in the interviewees' families were systemic arterial hypertension (30.3%), obesity (16.7%), and 2 or more cardiovascular RFs among first-degree relatives (13.8%). We observed a trend towards significance between the presence of 2 familial RFs and overweight, as well as a risk profile for cardiovascular disease. There was an association between the BMI percentile, the presence of 2 or more RFs (p<0.05), and CRP (p<0.01). Conclusions: Overweight is common in patients with univentricular heart, being related to more than 2 cardiovascular RFs among first-degree relatives; physical inactivity and changes in lipid profiles are also frequent.

Dilemas éticos durante a pandemia de covid-19 / Ethical dilemmas during the COVID-19 pandemic / Dilemas éticos durante la pandemia del covid-19

Resumo Este artigo objetiva refletir acerca dos dilemas éticos enfrentados pelos profissionais de saúde, pacientes e familiares durante a pandemia da covid-19. A pandemia irrompeu questões éticas na saúde, ocasionadas pela falta de recursos materiais, humanos e o medo do desconhecido. Pacientes e familiares também foram afetados pelo distanciamento na internação e no luto. Profissionais da saúde depararam com dilemas éticos que suscitam questões sobre o dever de assistir o paciente e a garantia da segurança pessoal, lidando com o desafio de agir com ética em meio à sobrecarga e à insegurança do contexto. A família e os pacientes enfrentam um cenário de adaptação do cuidar em saúde com a carência de tecnologias que permitam acolhimento diante da necessidade de distanciamento, inclusive no processo dos rituais de despedida dos finados. Assim, investimentos em saúde podem impulsionar mudanças no cuidado, em observância da justiça social e do respeito à dignidade humana.

Abstract This article aims to reflect on the ethical dilemmas faced by health professionals, patients and family members during the COVID-19 pandemic. The pandemic raised ethical issues in health caused by the lack of material and human resources and the fear of the unknown. Patients and family members were also affected by social distancing in hospitalization and mourning. Health profissionals faced ethical dilemmas that raise questions about the duty to assist patients and the guarantee of personal safety, dealing with the challenge of acting ethically amid work overload and insecurity of the context. The family and patients face a scenario of adaptation of health care with the lack of technologies that allow feelings of care in the face of the need for distancing, including in the process of farewell rituals of the late. Investments in health can thus drive changes in care, in compliance with social justice and respect for human dignity.

Resumen Este artículo reflexionó sobre los dilemas éticos que enfrentan los profesionales de la salud, los pacientes y familiares durante la pandemia del covid-19. La pandemia hizo estallar cuestiones éticas en salud, provocadas por la falta de recursos materiales y humanos, y el miedo a lo desconocido. Los pacientes y sus familias fueron afectados por el distanciamiento en la hospitalización y el duelo. Los profesionales de la salud afrontaron dilemas éticos en cuanto al deber de asistir al paciente y la garantía de seguridad personal, y el desafío de actuar éticamente durante la sobrecarga e inseguridad en ese contexto. Los pacientes y sus familias enfrentan una adaptación de la atención a la falta de tecnología para acogerles ante el distanciamiento, incluso en el proceso de despedida al difunto. Las inversiones en salud pueden promover cambios en la atención en observancia de la justicia social y el respeto a la dignidad humana.

Efetividade de um programa de educação de enfermagem em pessoas com diabetes tipo 2 na atenção primária: ensaio clínico randomizado

Objetivo: Avaliar a efetividade de um programa de educação de enfermagem em indivíduos com diabetes tipo 2, considerando a relação entre as atitudes psicológicas e as características sociodemográficas, assim como o controle glicêmico, atendidos pela Estratégia de Saúde da Família do município de Divinópolis, estado de Minas Gerais, Brasil. Material e Método: Ensaio clínico randomizado realizado com 278 pessoas com diabetes tipo 2 distribuídas em grupo intervenção e controle. As Equações de Estimação Generalizadas foram ajustadas para verificar se haveria mudanças das atitudes psicológicas ou hemoglobina glicada associadas às características sociodemográficas ou duração de diabetes. Resultados: Houve associação para atitudes psicológicas, educação e controle glicêmico. O grupo intervenção melhorou as atitudes psicológicas (p= 11,2; IC= 95%: 7,4-15,0). As pessoas que melhoraram as atitudes tiveram redução da hemoglobina glicada no grupo intervenção (7,9 ± 0,2 vs 7,4 ± 0,2; p< 0,001) e aumento no grupo controle. O grupo intervenção diminuiu a hemoglobina glicada ao final do programa (p= -0,9; IC= 95%: -1,4 -0,5). Conclusão: O grupo intervenção melhorou as atitudes psicológicas ao comparar com o grupo controle, exceto entre pessoas com menos de cinco anos de diagnóstico.

Objective: To evaluate the effectiveness of a nursing program in people with type 2 diabetes, considering the relationship between psychological attitudes and sociodemographic characteristics, as well as glycemic control in individuals with type 2 diabetes, assisted by the Family Health Strategy in the city of Divinópolis, State of Minas Gerais, Brazil. Material and Method: Randomized clinical trial carried out with 278 people with type 2 diabetes distributed in an intervention and a control group. The Generalized Estimating Equations were adjusted to control for changes in psychological attitudes or glycosylated hemoglobin associated with sociodemographic characteristics or duration of diabetes. Results: There was an association between psychological attitudes, education and glycemic control. The intervention group improved psychological attitudes (p = 11.21; CI = 95%: 7.4-15.0). People who improved attitudes had a reduction in glycosylated hemoglobin in the intervention group (7.9 ± 0.2 vs. 7.4 ± 0.2, p<0.001) and an increase in the control group. The intervention group decreased glycosylated hemoglobin at the end of the program (p = -0.9; 95% CI: -1.4; -0.5). Conclusion: The intervention group improved psychological attitudes when compared to the control group, except among people with less than five years of diagnosis.

Objetivo: Evaluar la efectividad de un programa de educación de enfermería en personas con diabetes tipo 2, considerando la relación entre las actitudes psicológicas y las características sociodemográficas y el control glicémico en individuos con diabetes tipo 2, atendidos en la Estrategia Salud de la Familia en la ciudad de Divinópolis, estado de Minas Gerais, Brasil. Material y Método: Ensayo clínico aleatorizado realizado con 278 personas con diabetes tipo 2 divididas en grupos de intervención y control. Las Ecuaciones de Estimación Generalizadas se ajustaron para comprobar si había cambios en las actitudes psicológicas o la hemoglobina glucosilada asociados con las características sociodemográficas o la duración de la diabetes. Resultados: Hubo una asociación para las actitudes psicológicas, la educación y el control glicémico. El grupo de intervención mejoró las actitudes psicológicas (p= 11,21; IC= 95%: 7,4-15,0). Las personas que mejoraron las actitudes tuvieron una reducción de la hemoglobina glucosilada en el grupo de intervención (7,9 ± 0,2 frente a 7,4 ± 0,2, p <0,001) y un aumento en el grupo de control. El grupo de intervención disminuyó la hemoglobina glucosilada al final del programa (p= -0,9; IC 95%: -1,4-0,5). Conclusión: El grupo de intervención mejoró las actitudes psicológicas en comparación con el grupo de control, excepto entre las personas con menos de cinco años de diagnóstico.

Overweight in elderly people induces impaired autophagy in skeletal muscle.

Sarcopenia is the gradual loss of skeletal muscle mass, strength and quality associated with aging. Changes in body composition, especially in skeletal muscle and fat mass are crucial steps in the development of chronic diseases. We studied the effect of overweight on skeletal muscle tissue in elderly people without reaching obesity to prevent this extreme situation. Overweight induces a progressive protein breakdown reflected as a progressive withdrawal of anabolism against the promoted catabolic state leading to muscle wasting. Protein turnover is regulated by a network of signaling pathways. Muscle damage derived from overweight displayed by oxidative and endoplasmic reticulum (ER) stress induces inflammation and insulin resistance and forces the muscle to increase requirements from autophagy mechanisms. Our findings showed that failure of autophagy in the elderly deprives it to deal with the cell damage caused by overweight. This insufficiently efficient autophagy leads to an accumulation of p62 and NBR1, which are robust markers of protein aggregations. This impaired autophagy affects myogenesis activity. Depletion of myogenic regulatory factors (MRFs) without links to variations in myostatin levels in overweight patients suggest a possible reduction of satellite cells in muscle tissue, which contributes to declined muscle quality. This discovery has important implications that improve the understanding of aged-related atrophy caused by overweight and demonstrates how impaired autophagy is one of the main responsible mechanisms that aggravate muscle wasting. Therefore, autophagy could be an interesting target for therapeutic interventions in humans against muscle impairment diseases.

Effects of alpha-tocopherol associated with lovastatin on brain tissue and memory function in SHRSPs.

Strokes are preceded by oxidative stress and inflammation, two processes linked to atherosclerosis and hypertension. Statins have been widely employed to control atherosclerosis; however, there could be neurological implications to its use­including cognitive impairment. Thus,we aimed to determine whether alpha-tocopherol is capable of reversing the neurological side effects of statins and enhancing its anti-inflammatory properties. To assess these effects, 15-week-old stroke-prone spontaneously hypertensive rats (SHRSPs) were divided into four groups (n = 6, each): alpha-tocopherol (AT), lovastatin (LoV), alpha-tocopherol + lovastatin (AT + LoV), and control (C).We administered 120 IU of alpha-tocopherol diluted in 0.1 ml of coconut oil,whereas the dose of lovastatin was administered at a ratio of 1 mg/kg of rat body weight. The control group received 0.1 ml coconut oil. All animals received the treatments via orogastric gavage.We assessed body weight, diuresis, food and water intake, oxidative stress (malondialdehyde levels), the total cellular injury marker (lactate dehydrogenase), short and long-term memory, cognition, and histopathological changes in the hippocampus. The results demonstrated that lovastatin treatment did not negatively affect the memory of our animal model. In fact, the animals treated with AT and LoV showed improvement in memory and cognition. Additionally, both treatments decrease lactate dehydrogenase and oxidative stress levels. Furthermore, our study also demonstrated hippocampal tissue preservation in the treated groups.

Development and validation of an interactive educational technology on spotted fever / Desenvolvimento e validação de tecnologia educacional interativa sobre febre maculosa / Desarrollo y validación de una tecnología educativa interactiva sobre fiebre maculosa

Objective: to develop and validate an interactive educational technology on spotted fever, to offer an innovative teaching method. Method: a methodological study that covered the following stages: analysis and diagnosis; instructional planning, didactic design, review, and validation and production of technology. Results: the analysis and diagnosis were obtained from experiences in education and health activities for spotted fever. In the instructional planning, it was defined that the technology would be presented in the form of an Interactive Laboratory, with learning stations. The production of the Laboratory was carried out by a multidisciplinary team made up of a carpenter, an electrician, and a plastic artist, among others. The review and validation process was subdivided into two stages: appearance and content validation by professionals in the fields of biology, and education and semantic validation by students of the Nursing and Pedagogy courses. The results of the appearance and content validation showed a content validity index over 0.8 for the vast majority of the variables. In the semantic validation, the Laboratory was evaluated positively by the students. Conclusion: the trajectory followed for the construction of the Interactive Laboratory on spotted fever gave academic and scientific support to the product, offering an innovative educational resource with pedagogical potential that values significant learning.

Objetivo: desenvolver e validar uma tecnologia educacional interativa sobre febre maculosa, para oferecer um método inovador de ensino. Método: estudo metodológico desenvolvido nas seguintes etapas: análise e diagnóstico; planejamento instrucional, desenho didático, revisão e validação e produção da tecnologia. Resultados: a análise e diagnóstico foram obtidos a partir de experiências em atividades de educação e saúde para febre maculosa. No planejamento instrucional, definiu-se que a tecnologia seria apresentada em forma de Laboratório Interativo, com estações de aprendizagem. A produção do Laboratório foi realizada por uma equipe multidisciplinar constituída por marceneiro, eletricista, artista plástico, dentre outros. O processo de revisão e validação foi subdividido em duas etapas: validação de aparência e conteúdo por profissionais das áreas de biologia e educação e validação semântica por alunos do curso de enfermagem e pedagogia. Os resultados da validação de aparência e conteúdo mostraram um índice de validade de conteúdo superior a 0,8 para a grande maioria das variáveis. Na validação semântica, o Laboratório foi avaliado de forma positiva pelos alunos. Conclusão: a trajetória percorrida para a construção do Laboratório Interativo sobre febre maculosa conferiu sustentação acadêmica e científica ao produto construído, oferecendo um recurso educativo inovador com potencial pedagógico que valoriza a aprendizagem significativa.

Objetivo: desarrollar y validar una tecnología educativa interactiva sobre fiebre maculosa, para ofrecer un método innovador de enseñanza. Método: estudio metodológico que recorrió las siguientes etapas: análisis y diagnóstico; planificación instructiva, diseño didáctico, revisión y validación y producción de la tecnología. Resultados: el análisis y el diagnóstico se obtuvieron a partir de experiencias en actividades de educación y salud para fiebre maculosa. En la planificación instructiva, se definió que la tecnología se presentaría en forma de Laboratorio Interactivo, con estaciones de aprendizaje. La producción del Laboratorio fue realizada por un equipo multidisciplinario constituido por un carpintero, un electricista y un artista plástico, entre otros. El proceso de revisión y validación se subdividió en dos etapas: validación de aspecto y contenido por profesionales de las áreas de biología y educación, y validación semántica por alumnos de las carreras de Enfermería y Pedagogía. Los resultados de la validación de aspecto y contenido mostraron un índice de validez de contenido superior a 0,8 para la gran mayoría de las variables. En la validación semántica, el Laboratorio fue evaluado de manera positiva por los alumnos Conclusión: la trayectoria recorrida para la construcción del Laboratorio Interactivo sobre fiebre maculosa dio sustentación académica y científica al producto construido, ofreciendo un recurso educativo innovador con potencial pedagógico que valora el aprendizaje significativo.

Bypass vs. sleeve and its effects in non-alcoholic fatty liver disease: what is the best technique? / Bypass vs. sleeve e seus resultados na doença hepática gordurosa não alcoólica: qual a melhor técnica?

ABSTRACT Background: Strongly associated with obesity, non-alcoholic fatty liver disease is considered the hepatic manifestation of the metabolic syndrome. It presents as simple steatosis and steatohepatitis, which can progress to cirrhosis and its complications. Among the therapeutic alternatives is bariatric surgery. Aim: To compare the effect of the two most frequent bariatric procedures (sleeve and bypass) on liver disease regarding to epidemiological, demographic, clinical and laboratory parameters. Methods: The results of intraoperative and 12 months after surgery liver biopsies were used. The NAFLD activity score (NAS) was used to assess and compare the stages of liver disease. Results: Sixteen (66.7%) patients underwent Bypass procedure and eight (33.3%) Sleeve. It was observed that the variation in the NAFLD activity score was significantly greater in the Bypass group than in Sleeve (p=0.028) and there was a trend regarding the variation in fibrosis (p=0.054). Conclusion: Both surgical techniques were effective in improving the hepatic histology of most operated patients. When comparing sleeve and bypass groups, bypass showed better results, according to the NAS score.

RESUMO Racional: Fortemente associada à obesidade, a doença hepática gordura não alcoólica é considerada a manifestação hepática da síndrome metabólica. Ela apresenta-se como esteatose simples e esteato-hepatite, podendo evoluir para cirrose e suas complicações. Entre as alternativas terapêuticas está a cirurgia bariátrica. Objetivo: Comparar o efeito sobre a doença hepática dos dois procedimentos bariátricos mais frequentes - sleeve e bypass - e comparar dados epidemiológicos, demográficos, parâmetros clínicos e laboratoriais. Métodos: Utilizou-se o resultado das biópsias hepáticas realizadas no intra-operatório e 12 meses após a operação. O NAFLD activity score foi utilizado para avaliar e comparar os estágios da doença hepática. Resultados: Dezesseis (66,7%) pacientes foram submetidos ao bypass e oito (33,3%) ao sleeve. Observou-se melhora significativa no IMC e glicemia nas duas técnicas cirúrgicas enquanto que os níveis de fosfatase alcalina, ferritina, Gama-GT e TGP reduziram com significância apenas no grupo bypass. A redução no NAFLD activity score foi significativamente maior no grupo bypass que no sleeve (p=0,040). Conclusão: Ambas as técnicas foram eficazes em promover a melhora da histologia hepática da maior parte dos pacientes operados. Quando comparadas o bypass apresentou melhores resultados.

Alpha-tocopherol in the brain tissue preservation of stroke-prone spontaneously hypertensive rats.

Oxidative stress has an important role in neuronal damage during cerebral ischemia and can lead to cognitive and behavioral impairment. Alpha-tocopherol, a powerful antioxidant, may be able to preserve neuronal tissue and circumvent neurological deficits. Thus, this study aimed to investigate the influence of alpha-tocopherol in the preservation of brain tissue and the maintenance of memory formation in stroke-prone spontaneously hypertensive rats (SHRSP). To achieve this aim, twenty-four 15-week-old male SHRSP rats were separated into the following four groups (n = 6 each) that received different treatments over a 4-week period: the alpha-tocopherol group, the control group, the L-NAME group, and the L-NAME + alpha-tocopherol group. We evaluated the physiological parameters (body weight, diuresis, and food and water intake), an oxidative stress marker (malondialdehyde levels), and neurological responses (the Morris Water Maze and Novel Objects Recognition tests). Afterwards, the brains were removed for histopathological analysis and quantification of the number of cells in the hippocampus. Statistically, the alpha-tocopherol group demonstrated better results when compared to all groups. The data indicated a reduction in oxidative stress and the preservation of neurological responses in groups treated with alpha-tocopherol. In contrast, the L-NAME group exhibited increased malondialdehyde levels, impairment of neurological responses, and several hippocampus tissue injuries. The others groups exhibited nerve tissue changes that were restricted to the glial nodes. No significant alterations were observed in the physiologic parameters. Based on these findings, we suggest that alpha-tocopherol can prevent stroke, preserve the structure of the hippocampus, and maintain both memory and cognition functions.

[Analysis of elderly outpatients in relation to nutritional status, sarcopenia, renal function, and bone density]. / Análise de idosos ambulatoriais quanto ao estado nutricional, sarcopenia, função renal e densidade óssea.

OBJECTIVES: To evaluate relationships between nutritional status, sarcopenia and osteoporosis in older women. SUBJECTS AND METHODS: We studied 44 women, 67-94 years, by mini-nutritional assessment (MAN), glomerular filtration corr. 1.73 m(2), body mass index (BMI), arm circumference and calf (CP and CB), bone mineral density and body composition, DXA (fat mass MG; lean MM). We gauge sarcopenia: IMM MM = MSS + MIS/height(2). We used the Pearson correlation coefficient, p < 0.05 as significant. RESULTS: MNA and IMM were positively correlated with BMI, CP, CB and MG. Age influenced negatively FG corr., BMI, FM, IMM and CP. Fourteen had a history of osteoporotic fractures. The lowest T-score was directly related to MAN and MG. CONCLUSIONS The aging caused the decline of FG, fat mass and muscle; the calf circumference, and brachial reflected nutritional status and body composition; and major influences on BMD were nutritional status and fat mass.

Alpha-tocopherol protects against memory impairment caused by L-NAME and modulates the injury marker and blood coagulant parameters.

Cerebrovascular disease studies have shown similarity between humans and spontaneously hypertensive rats stroke-prone rats in the development of spontaneous stroke and transitory ischemic attacks (TIA). In addition, nitric oxide (NO) suppression by L-arginine methyl ester (L-NAME) can precipitate several vascular diseases including TIA and strokes. On the other hand, alpha-tocopherol (AT) has been associated with beneficial effects on vascular disorders. Four groups were tested to evaluate AT effects on NO inhibition: AT, control (C), AT + L-NAME, and L-NAME. During 4 weeks, all groups had their physiologic parameters evaluated and were submitted to neurological tests. After the sacrifice of the animals, total L-lactate dehydrogenase, fibrinogen levels, and platelet counts were measured. Our results demonstrated improvement in memory function and sensory-motor function of the rats treated with AT. The AT treatment also demonstrated a significant difference on the injury identifier, fibrinogen levels, and platelet count between the treated groups and the L-NAME group. In conclusion, AT reversed damaging L-NAME neurological effects and could be considered as a possible protective agent in neurological diseases.

Effects of Vitamin K1 Supplementation on the Risk Factors to the Stroke and on Memory in Spontaneously Hypertensive Rats Stroke Prone (SHR-sp)

A number of risk factors have been associated to the stroke and many strategies have been proposed in order to control them as well. Vitamin K has been largely found in brain, which suggests a possible function at that tissue. This study aimed to evaluate the potential of this vitamin on the prevention of risk factors to stroke and on cognitive function on SHRSP rats. Twelve SHRSP males, 15 weeks old, were divided into two groups (n= 6 each), receiving the vehicle-coconut oil (control group) or 40 μg of phylloquinone (treated group) during 28 days. Biological parameters, systolic blood pressure and lipid profile were evaluated. Both groups were submitted to the neurological tasks. The data was treated by Student's t test and ANOVA one-way test being P<0.05 considered significant. The phylloquinone supplementation showed a statistically significant reduction in the treated group of all parameters of lipid profile and systolic blood pressure when compared to the control group. Neurological evaluation indicated a statistically significant improvement in the performance of long term memory tests in the treated group, without similar findings in the evaluation of short memory. In sum, phylloquinone supplementation was shown to modulated lipid profile and protect neuronal suffering in this model.

Pode um pai ser cuidadoso: crítica à teoria da paternidade em winnicott / Can a father be careful: critics toward the winnicott's theory fatherhood

Neste trabalho, fizemos umpercurso nos principais textos teóricos nos quais Winnicott aborda a função do pai. Recorremos também aos casos clínicos para localizar como essa função paterna é analisada na prática clínica. Na obra de Winnicott, a figura paterna aparece como coadjuvante ao trabalho de cuidado materno, muitas vezes atrelado a condições do ambiente e em diversas outras como um substituto que mimetiza características rigorosamente maternais. Percebemos em Winnicott uma clara aproximação entre os termos pai e homem, que contribuem para uma imagem normativa da família. A própria teoria winnicottiana pode ser utilizada para desconstruir o que consideramos uma dobra ideológica na obra do autor, por meio do confronto de seus próprios textos, como sugere a metodologia proposta por Laplanche, utilizada neste artigo. Tal desconstrução permite pensar, a partir dessa perspectiva, novos formatos familiares (homoafetivos e monoparentais, por exemplo) que aumentem o potencial criativo no relacionamento de um adulto com o bebê.

In this work we have done a journey in the major theoretical texts in which Winnicott discusses the father´s role. We also consulted clinical cases in order to find out how this paternal function is analyzed in the clinical practice. In Winnicott´s work, the father figure appears as a supporting to the maternal care work, often linked to environmental conditions and in several others as a substitute that mimics strictly maternal characteristics. We noticed in Winnicott's writings a clear rapprochement between the father and man terms, contributing to a normative representation of the family. The very Winnicott's theory can be used to deconstruct what we consider an ideological fold in the author's work, through the confrontation of his own texts, as suggested by the methodology proposed by Laplanche, used in this article. Such deconstruction allows us to think, from this perspective, about new family formats (homoaffective and single parent famil.