Exogenously induced brain activation regulates neuronal activity by top-down modulation: conceptualized model for electrical brain stimulation.

Physiological and exogenous factors are able to adjust sensory processing by modulating activity at different levels of the nervous system hierarchy. Accordingly, transcranial direct current stimulation (tDCS) may use top-down mechanisms to control the access for incoming information along the neuroaxis. To test the hypothesis that brain activation induced by tCDS is able to initiate top-down modulation and that chronic stress disrupts this effect, 60-day-old male Wistar rats (n = 78) were divided into control; control + tDCS; control + sham-tDCS; stress; stress + tDCS; and stress + sham-tDCS. Chronic stress was induced using a restraint stress model for 11 weeks, and then, the treatment was applied over 8 days. BDNF levels were used to assess neuronal activity at spinal cord, brainstem, and hippocampus. Mechanical pain threshold was assessed by von Frey test immediately and 24 h after the last tDCS-intervention. tDCS was able to decrease BDNF levels in the structures involved in the descending systems (spinal cord and brainstem) only in unstressed animals. The treatment was able to reverse the stress-induced allodynia and to increase the pain threshold in unstressed animals. Furthermore, there was an inverse relation between pain sensitivity and spinal cord BDNF levels. Accordingly, we propose the addition of descending systems in the current brain electrical modulation model.

Impact of vertical positioning on lung aeration among mechanically ventilated intensive care unit patients: a randomized crossover clinical trial.

OBJECTIVE: To assess the impact of different vertical positions on lung aeration in patients receiving invasive mechanical ventilation. METHODS: An open-label randomized crossover clinical trial was conducted between January and July 2020. Adults receiving invasive mechanical ventilation for > 24 hours and < 7 days with hemodynamic, respiratory and neurological stability were randomly assigned at a 1:1 ratio to the sitting position followed by passive orthostasis condition or the passive orthostasis followed by the sitting position condition. The primary outcome was lung aeration assessed using the lung ultrasound score (score ranges from 0 [better] to 36 [worse]). RESULTS: A total of 186 subjects were screened; of these subjects, 19 were enrolled (57.8% male; mean age, 73.2 years). All participants were assigned to receive at least one verticalization protocol. Passive orthostasis resulted in mean lung ultrasound scores that did not differ significantly from the sitting position (11.0 versus 13.7; mean difference, -2.7; [95%CI -6.1 to 0.71; p = 0.11). Adverse events occurred in three subjects in the passive orthostasis group and in one in the sitting position group (p = 0.99). CONCLUSION: This analysis did not find significant differences in lung aeration between the sitting and passive orthostasis groups. A randomized crossover clinical trial assessing the impact of vertical positioning on lung aeration in patients receiving invasive mechanical ventilation is feasible. Unfortunately, the study was interrupted due to the need to treat COVID-19 patients.ClinicalTrials.gov registry: NCT04176445.

Movilización temprana en el paciente sometido a terapia de reemplazo renal continua: ¿el riesgo sobrepasa los beneficios? / Early mobilization in continuous renal replacement therapy: does the risk outweigh the benefits? / Mobilização precoce do paciente em terapia de substituição renal contínua: o risco supera os benefícios?

Resumen: La movilización temprana (MT) del paciente crítico ingresado a la UCI ha demostrado grandes beneficios en poblaciones cada vez más heterogéneas; sin embargo, pacientes que se encuentran vinculados a dispositivos extracorpóreos como la terapia de reemplazo renal continua (TRRC) suelen estar confinados por periodos prolongados a inmovilización en cama debido a la percepción del personal sobre posibles eventos adversos relacionados al paciente (desaturación, inestabilidad hemodinámica, caídas, etc.) o al catéter (desinserción, hemorragia, embolismo) durante la sesión de fisioterapia. Sin embargo, la evidencia actual demuestra que de manera general, si se cuenta con un protocolo de MT adaptado a las necesidades específicas de los pacientes vinculados a TRRC y esto se acompaña de un equipo humano multidisciplinario calificado y coordinado, el paciente podría realizar actividades en cama, sentado, parado e inclusive deambular sin necesidad de interrumpir la TRRC, y aun así, el riesgo de eventos adversos es casi nulo, lo que nos permitiría continuar priorizando la vida del paciente, al mismo tiempo que le permitimos ejercer su derecho de vivirla dignamente a través del movimiento corporal.

Abstract: Early mobilization (EM) of the critically ill patient admitted to the ICU has shown great benefits in increasingly heterogeneous populations, however, patients who are linked to extracorporeal devices such as continuous renal replacement therapy (CRRT) are often confined to prolonged periods of bed immobilization due to the staff's perception of possible adverse events related to the patient (desaturation, hemodynamic instability, falls, etc.) or to the catheter (disinsertion, bleeding, embolism, etc.) during the physical therapy session. However, current evidence shows that, in general, this is an unfounded fear since, if there is a EM protocol adapted to the specific needs of patients linked to CRRT and this is accompanied by a qualified and coordinated multidisciplinary team, the patient could perform activities in bed, sitting, standing and even walking without interrupting CRRT, and even then, the risk of adverse events is almost nil, which would allow us to continue to prioritize the patient's life, while allowing them to exercise their right to live life with dignity through bodily movement.

Resumo: A mobilização precoce (MP) do paciente em estado crítico internado na UTI tem mostrado grandes benefícios em populações cada vez mais heterogêneas, porém, pacientes que estão vinculados a dispositivos extracorpóreos como a terapia renal substitutiva contínua (TRRC) costumam ficar confinados à imobilização no leito por períodos prolongados devido à percepção da equipe sobre possíveis eventos adversos relacionados ao paciente (dessaturação, instabilidade hemodinâmica, quedas, etc.) ou ao cateter (desinserção, hemorragia, embolia) durante a sessão de fisioterapia. No entanto, as evidências atuais mostram que, em geral, se houver um protocolo de MP adaptado às necessidades específicas dos pacientes vinculados a TRRC e este for acompanhado por uma equipe humanizada multidisciplinar qualificada e coordenada, o paciente poderá realizar atividades no leito, sentado, ficar em pé e até andar sem a necessidade de interromper o TRRC, e mesmo assim o risco de eventos adversos é quase zero, o que nos permitiria continuar priorizando a vida do paciente, ao mesmo tempo que permitimos que ele exerça seu direito de viver com dignidade através do movimento corporal.

Impact of vertical positioning on lung aeration among mechanically ventilated intensive care unit patients: a randomized crossover clinical trial / Impacto do posicionamento vertical na aeração pulmonar em pacientes de unidades de terapia intensiva ventilados mecanicamente: um estudo clínico transversal randomizado

ABSTRACT Objective: To assess the impact of different vertical positions on lung aeration in patients receiving invasive mechanical ventilation. Methods: An open-label randomized crossover clinical trial was conducted between January and July 2020. Adults receiving invasive mechanical ventilation for > 24 hours and < 7 days with hemodynamic, respiratory and neurological stability were randomly assigned at a 1:1 ratio to the sitting position followed by passive orthostasis condition or the passive orthostasis followed by the sitting position condition. The primary outcome was lung aeration assessed using the lung ultrasound score (score ranges from 0 [better] to 36 [worse]). Results: A total of 186 subjects were screened; of these subjects, 19 were enrolled (57.8% male; mean age, 73.2 years). All participants were assigned to receive at least one verticalization protocol. Passive orthostasis resulted in mean lung ultrasound scores that did not differ significantly from the sitting position (11.0 versus 13.7; mean difference, -2.7; [95%CI -6.1 to 0.71; p = 0.11). Adverse events occurred in three subjects in the passive orthostasis group and in one in the sitting position group (p = 0.99). Conclusion: This analysis did not find significant differences in lung aeration between the sitting and passive orthostasis groups. A randomized crossover clinical trial assessing the impact of vertical positioning on lung aeration in patients receiving invasive mechanical ventilation is feasible. Unfortunately, the study was interrupted due to the need to treat COVID-19 patients. ClinicalTrials.gov registry: NCT04176445

RESUMO Objetivo: Avaliar o impacto de diferentes posicionamentos verticais na aeração pulmonar em pacientes em ventilação mecânica invasiva. Métodos: Trata-se de ensaio clínico aberto, randomizado e transversal, realizado entre janeiro e julho de 2020. Adultos em ventilação mecânica invasiva por mais de 24 horas e menos de 7 dias com estabilidade hemodinâmica, respiratória e neurológica foram distribuídos aleatoriamente em uma proporção de 1:1 à postura sentada seguida da condição de ortostatismo passivo ou o ortostatismo passivo seguido de postura sentada. O desfecho primário foi a aeração pulmonar avaliada pelo lung ultrasound score. O escore varia de zero (melhor) a 36 (pior). Resultados: Foram selecionados 186 indivíduos; destes, 19 foram incluídos (57,8% do sexo masculino; média idade de 73,2 anos). Todos os participantes foram selecionados para receber pelo menos um protocolo de verticalização. O ortostatismo passivo resultou em escores médios de aeração pulmonar por ultrassonografia que não diferiram significativamente da postura sentada (11,0 versus 13,7; diferença média, -2,7; IC95% -6,1 a 0,71; p = 0,11). Ocorreram eventos adversos em três indivíduos no grupo ortostatismo passivo e em um no grupo postura sentada (p = 0,99). Conclusão: Esta análise não encontrou diferenças significativas na aeração pulmonar entre os grupos ortostatismo passivo e postura sentada. É factível conduzir um estudo clínico transversal randomizado para avaliar o impacto do posicionamento vertical na aeração pulmonar em pacientes em ventilação mecânica invasiva. Infelizmente, o estudo foi interrompido devido à necessidade de tratar pacientes com COVID-19. Registro ClinicalTrials.gov: NCT04176445

Hypoestrogenism alters mood: Ketamine reverses depressive-like behavior induced by ovariectomy in rats.

BACKGROUND: Estrogen deficiency is associated with the onset of depressive and anxiety symptoms, cognitive impairment, and adverse consequences. We investigated depressive-like behaviors in ovariectomized rats and ketamine's effect on this behavior. METHODS: Twenty-eight female Wistar adult rats were initially divided into two groups: ovariectomized (OVX) and sham surgery (SHAM). Hormonal status was verified by vaginal cytology, and the rats were subjected to a forced swimming (FS) test 18 days post-surgery, an open field (OF) test 28 days post-surgery, and an elevated plus maze (EPM) test 38 days post-surgery (Experiment 1). In addition, the effect of ketamine on depressive-like behavior of the female rats was evaluated (Experiment 2). RESULTS: OVX group exhibited anxiety-like behavior on EPM test (lower time spent and fewer entries in the open arms), without any difference in performance in the OF test. OVX rats showed depressive-like behavior (higher time of immobility) than SHAM rats in FS test. The SHAM group showed signs of hypoestrogenism (anestrus) at six months of age. Moreover, ketamine was able to reverse depressive-like behavior in the FS retest in both groups (OVX and SHAM). CONCLUSION: Similar to the literature, we showed the antidepressant effect of ketamine in depressive female rats which was induced by ovariectomy; including in female rats submitted to sham surgery that interestingly presented a premature menopausal.

Long-Lasting Effect of Transcranial Direct Current Stimulation in the Reversal of Hyperalgesia and Cytokine Alterations Induced by the Neuropathic Pain Model.

BACKGROUND: Neuropathic pain (NP) is caused by an insult or dysfunction in the peripheral or central nervous system (CNS), the main symptoms being mechanical allodynia and hyperalgesia. NP often shows insufficient response to classic analgesics and its management remains a challenge. Transcranial direct current stimulation (tDCS) is a non-invasive method of cerebral stimulation and represents a promising resource for pain management. OBJECTIVE/HYPOTHESIS: We investigated the effects of tDCS on the nociceptive response and on IL-1ß, IL-10, and TNF-α levels in CNS structures of rats with NP. METHODS: After induction of NP by chronic constriction injury (CCI) of the sciatic nerve, the rats received 20 min of bicephalic tDCS for 8 days. Hyperalgesia was assessed by the hot plate and von Frey tests and evaluated at baseline, 7 days, and 14 days after CCI surgery, and also immediately, 24 hours, and 7 days following tDCS treatment. The levels of IL-1ß, IL-10 and TNF-α in the cortex, spinal cord, and brainstem were determined by ELISA at 48 hours and 7 days post-tDCS. RESULTS: The CCI model provoked thermal and mechanical hyperalgesia until at least 30 days post-CCI; however, bicephalic tDCS relieved the nociceptive behavior for up to 7 days after treatment completion. CONCLUSIONS: Bicephalic tDCS is effective to promote antinociceptive behavior in neuropathic pain, which can be reflected by a spinal neuroimmunomodulation linked to pro- and anti-inflammatory cytokine levels observed in the long-term.

Knowledge about Systemic Arterial Hypertension in Employees of a Teaching Institution in the Metropolitan Region of Porto Alegre / RS / Conhecimento Sobre Hipertensão Arterial Sistêmica em Colaboradores de uma Instituição de Ensino da Região Metropolitana de Porto Alegre/RS

In occupational health actions that aimed at the clinical outcome of Hypertension (HBP) are directed in the form of informative lectures and prevalence data. The objective was to determine the level of knowledge of hypertension in employees of an educational institution in the metropolitan area of Porto Alegre / RS as a strategy for education and health promotion. Three meetings were held that consisted of evaluating the knowledge of hypertension, anthropometric data (IMC index) and physical activity level (IPAQ). Blood pressure (BP) was measured at each meeting. Statistical analysis was performed through the descriptive analysis of the variables: hypertension prevalence, blood pressure levels, level of knowledge about hypertension, mean±SD, percentage. It was considered statistically significant p <0.05. The sample consisted of 35 employees, 57.1% female and 42.9% were male. Five new hypertensive stage 1 were discovered, the classification of HBP, optimal n = 14 (40%), normal n = 11 (31.4%), borderline n = 3 (8.6%), hypertension stage 1 = n 7 (20%). In the field "concept" most employees did not associate the term "high pressure" with hypertension disease. As for the "risk factors" and "complications" 48.6% associated with nervousness hypertension and most participants believe that HBP leads to health complications. In the treatment 28.6% know the non-pharmacological treatment. The domain "prevention" returned 100% correct when it was inquired about the prevention of hypertension. Health education programs seek to facilitate access to information about the disease, aiming at prevention, better treatment adherence and quality of life. (AU)

Na saúde do trabalhador ações que visam o desfecho clínico de Hipertensão Arterial Sistêmica (HAS) são direcionadas na forma de palestras informativas e dados de prevalência. O objetivo foi verificar o nível de conhecimento de HAS em colaboradores de uma instituição de ensino na região metropolitana de Porto Alegre/RS como estratégia de educação e promoção em saúde. Foram realizados três encontros que consistia na avaliação do conhecimento em HAS, dados antropométricos (índice de Massa corporal) e nível de atividade física (IPAQ). A Pressão Arterial (PA) foi mensurada em cada encontro. A análise estatística foi realizada por meio da análise descritiva das variáveis: prevalência de HAS, níveis pressóricos, nível de conhecimento sobre HAS, média±DP, percentual. Foi considerado estatisticamente significativo p<0,05. A amostra foi composta de 35 colaboradores, 57,1% do sexo feminino e 42,9% do sexo masculino. Foram descobertos 5 novos hipertensos estágio 1, quanto à classificação de PA, ótima n=14 (40%), normal n= 11 (31,4%), limítrofe n=3 (8,6%), hipertensão estágio 1 n=7 (20%). No domínio "conceito" grande parte dos colaboradores não associou o termo "pressão alta" a doença HAS. Quanto aos "fatores de risco" e "complicações" 48,6% associa nervosismo a hipertensão e a maioria dos participantes acredita que a HAS leva a complicações na saúde. Já no tratamento 28,6% desconhecem o tratamento não farmacológico. O domínio "prevenção" obteve 100% de acertos quando indagamos sobre prevenção de HAS. Programas de educação em saúde buscam facilitar o acesso a informações sobre esta doença, buscando a prevenção, uma melhor adesão ao tratamento e qualidade de vida. (AU)

Obesity and chronic stress are able to desynchronize the temporal pattern of serum levels of leptin and triglycerides.

Disruption of the circadian system can lead to metabolic dysfunction as a response to environmental alterations. This study assessed the effects of the association between obesity and chronic stress on the temporal pattern of serum levels of adipogenic markers and corticosterone in rats. We evaluated weekly weight, delta weight, Lee index, and weight fractions of adipose tissue (mesenteric, MAT; subcutaneous, SAT; and pericardial, PAT) to control for hypercaloric diet-induced obesity model efficacy. Wistar rats were divided into four groups: standard chow (C), hypercaloric diet (HD), stress plus standard chow (S), and stress plus hypercaloric diet (SHD), and analyzed at three time points: ZT0, ZT12, and ZT18. Stressed animals were subjected to chronic stress for 1h per day, 5 days per week, during 80 days. The chronic exposure to a hypercaloric diet was an effective model for the induction of obesity and metabolic syndrome, increasing delta weight, Lee index, weight fractions of adipose tissue, and triglycerides and leptin levels. We confirmed the presence of a temporal pattern in the release of triglycerides, corticosterone, leptin, and adiponectin in naïve animals. Chronic stress reduced delta weight, MAT weight, and levels of triglycerides, total cholesterol, and leptin. There were interactions between chronic stress and obesity and serum total cholesterol levels, between time points and obesity and adiponectin and corticosterone levels, and between time points and chronic stress and serum leptin levels. In conclusion, both parameters were able to desynchronize the temporal pattern of leptin and triglyceride release, which could contribute to the development of metabolic diseases such as obesity and metabolic syndrome.