BackgroundThe inappropriate secretion of adipocytokines plays a critical role in chronic inflammatory states associated with obesity-linked type 2 diabetes and atherosclerosis. The pleiotropic actions of simvastatin and pioglitazone on epicardial adipose tissue (EAT) are unknown. This study assessed the anti-inflammatory actions of simvastatin and pioglitazone on EAT in patients with coronary artery disease (CAD) and metabolic syndrome (MS).MethodsA total of 73 patients with multivessel CAD who underwent elective bypass grafting were non-randomly allocated to one of four subgroups: Control (n = 17), simvastatin (20 mg/day, n = 20), pioglitazone (15 mg or 30 mg/day, n = 18), or simvastatin + pioglitazone (20 mg/day + 30 mg/day, respectively, n = 18); 20 valvar patients were also included. EAT samples were obtained during surgery. The infiltration of macrophages and lymphocytes and cytokines secretion were investigated using immunohistochemical staining and compared to plasma inflammatory biomarkers.ResultsSimvastatin significantly reduced plasma interleukin-6, leptin, resistin and monocyte chemoattractant protein-1 (p < 0.001 for all); pioglitazone reduced interleukin-6, tumoral necrose factor-alpha, resistin and matrix metalloproteinase-9 (p < 0.001 for all). Simvastatin + pioglitazone treatment further reduced plasmatic variables, including interleukin-6, tumoral necrose factor-alpha, resistin, asymmetric dimethylarginine and metalloproteinase-9 vs. the control group (p < 0.001). Higher plasma adiponectin and lower high sensitivity C-reactive protein concentrations were found simultaneously in the combined treatment group. A positive correlation between the mean percentage systemic and tissue cytokines was observed after treatments. T- and B-lymphocytes and macrophages clusters were observed in the fat fragments of patients treated with simvastatin for the first time.ConclusionsPioglitazone, simvastatin or combination treatment substantially reduced EAT and plasma inflammatory markers in CAD and MS patients. These tissue effects may contribute to the control of coronary atherosclerosis progression.
ResumoObjetivO. Relatar a extensão do conhecimento de pediatras de São Paulo sobre a diretriz. MétOdOs. Durante eventos de pediatria ou nos locais de trabalho, pediatras responderam um questionário contendo informações sobre o tempo de formação, local de trabalho, dedicação dentro da área de pediatria, atuação em área acadêmica e questões de múltipla escolha com informações retiradas da diretriz. As diferenças de expressão e associações foram consideradas significantes estatisticamente quando p<0,05. Todas as análises foram realizadas usando teste de Quiquadrado e teste de Quiquadrado de tendência linear por meio dos Softwares Primer of Biostatistics ou SPSS for Windows. ResultadOs. Dos 370 pediatras entrevistados, 65,7% afirmaram não ter tido conhecimento prévio da diretriz. O valor de corte para os acertos foi maior ou igual a 70% (maior ou igual a cinco questões corretas). Apenas 136 pediatras (36,7%) alcançaram tal valor e dentre esses não havia relação no conhecimento da diretriz quanto aos sexos (p=0,25). Dos 187 profissionais envolvidos em atividades acadêmicas, 45 (24%) acertaram o valor de corte e dos 183 não participantes de atividades acadêmicas, 23 (12,7%) acertaram maior ou igual a cinco questões (p<0,001). Pediatras do setor público apresentaram melhor conhecimento da prática preventiva da aterosclerose (46,1%; p=0,01). O desconhecimento da diretriz foi independente do tempo de formação. COnClusãO. A meta da diretriz de servir como referência para o estabelecimento de estratégias individuais e populacionais no controle dos fatores de risco para a aterosclerose desde a infância não foi alcançada na cidade de São Paulo. A divulgação mais adequada e cursos de educação médica continuada em que o conhecimento da diretriz se torne mais efetivo são sugeridos para corrigir tais achados.unitermos: Prevenção primária. Aterosclerose. Criança. Adolescente. Diretrizes para o planejamento em saúde. desCOnheCiMentO da diRetRiz de pRevençãO da ateROsCleROse na infânCia e adOlesCênCia pOR pediatRas eM sãO paulO
Cannabis sativa has a fascinating history and has been used by mankind for millennia. Many societies such as Greek, Roman, Chinese, African, Indian and Arabic take advantage of the plant's qualities, which are consumed as food, medicine, fuel, fibers or tobacco. The first reference found related to the therapeutic use of the plant data from 2700 B.C. and is present in the pharmacopoeia of the Chinese Emperor Shen-Nung, where this plant was recommended in the treatment of malaria, rheumatic pain, in irregular and painful menstrual cycles. The book “De Matéria Médica”, written by the doctor Pedânio Dioscórides considered thefounder of pharmacology, exposes Cannabis as one of the natural substances that can relieve inflammatory pain. In Brazil, African slaves brought a cannabis during the colonial period, around 1549. Then, its use spread quickly among black slaves and Indians, who started to cultivate it. Once the plant was popularized among French intellectuals and English doctors in the Indian imperial army, it started to be considered in our country as an excellent medicine for men, until it was suppressed by the police authorities in the 1930s. Only 60 years later important findings were highlighted around Cannabis with the System Endocannabinoid and its receptors, neurotransmitters such as anandamide and 2-AG, revolutionizing the understanding of molecular signaling that modulates pain and analgesia, inflammation, appetite, gastrointestinal motility and sleep cycles, immune cell activity and hormones among others.We are in front of a huge revolution in the therapeutic area, in which phytocabinoids represent one of the great therapeutic options of the century. We need a widespread disclosure that CBD is not marijuana and that its use for recreational purpose has nothing to do with the use of medical cannabis. Scientific research is seriously committed to the use of the substance in various pathologies. The role of information is absolute, being the main tool to clarify a society.
Um indivíduo pode mudar sua posição no espaço e aplicar forças mecânicas no ambiente porque há movimento de seus músculos (contração muscular) e geração de força. A partir de fenômenos elétricos, os potenciais de ação e as fibras musculares se contraem. O conhecimento dos processos fisiológicos que envolvem a unidade motora é o ponto fundamental para os estudos eletromiográficos. Pela eletromiografia, os fisioterapeutas podem avaliar a integridade neuromuscular de seus pacientes e, com isso, estabelecer o tratamento correspondente. O objetivo deste trabalho foi acompanhar as interações neuromusculares por meio da eletromiografia do músculo reto femoral saudável, para propor um protocolo experimental que vem demonstrar, na prática, toda a interação neuromuscular, auxiliando graduandos em fisioterapia a compreender a teoria da fisiologia do controle motor.
Introduction:Based on the assumptions of Group Analysis theorized by Burrow and Foulkes, in the Center for Mental Health of Casarano (Department of Mental Health of Lecce, Italy), it has been experienced the “Workshop of words, sounds and music”, with the aim to develop and empower the skills of the participants promoting the functional re-inclusion in the context of normal life.Methods:The work group has provided weekly meetings and involved 12 schizophrenic patients followed by the Mental Health Center of Casarano. It was stimulated the writing of songs first by lyrics and then by melody starting from individual and group introspective thoughts.Results:Several songs have been created by the participants and it was released a CD in the recording studio.Conclusions:It was possible to develop creative moments in which they could be expressed deep emotions that dwell in the individual lives of the protagonists stimulating at the same time socialization as an intrinsic part of the therapeutic process. This allowed the metaphorical language of the unconscious could be communicated to the conscious, resulting in a curative effect on psychosis. in this way, the pent-up energy from the disease has been usefully channeled in a group setting where each component has expressed a new access to mental regenerative sources.
Introduction:Most users of psychiatric services shows jointly clinical severity, disability and marginalization so complex that it can not be answered fully only within the same services.Objectives:Within the Mental Health Department of Lecce, in the Mental Health Center of Casarano it is started the Natural Social Network Project “One for all and all for one” aimed to provide a more adequate response to the needs of these patients.Methods:It will be identified patients with most psychosocial problems according to frequency of hospitalizations, emergency visits and rating scales (Brief Psychiatric Rating Scale, Life Skills Profile and Short Form 36 Health Survey). Then it will be identified with the patient a “facilitator”, or a person outside the CSM and longer fit into the everyday life of the patient (eg, relatives, friends, etc..). After that, the various parties involved (doctor, nurse, facilitator and user) agree an individual program based on which we make a psychoeducational path. The process will be checked quarterly with the presence of all the parties involved and monitored monthly or on the basis of needs.Results:After one trial year it is expected a substantial improvement by the patient in the satisfaction of his needs and more generally in his rehabilitation.
Tanto o estado de repouso fisiológico quanto o exercício representam um desafio para os sistemas de controle na manutenção da homeostasia. Em geral, os sistemas do corpo mantêm um estado estável durante as interações com o ambiente externo (como, por exemplo, mudar a posição do corpo, realizar atividade física), apesar de vários parâmetros fisiológicos variarem. Os parâmetros cardiovasculares são índices interessantes para estudar o equilíbrio do organismo e as ações em prol da homeostase. Para facilitar o estudo dos parâmetros cardiovasculares e suas influências, abordados na teoria da disciplina de Fisiologia Humana, elaborou-se um protocolo experimental que pode ser usado como referência durante as aulas práticas de fisiologia cardiovascular na graduação em Fisioterapia. O protocolo foi criado com a intenção de solidificar os conceitos da fisiologia vascular e cardíaca ao mostrar o comportamento das variáveis fisiológicas durante duas situações: o momento de repouso fisiológico e a situação de atividade física. Adicionalmente, este trabalho vem destacar a importância do conteúdo da disciplina básica no contexto do curso.
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