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The terminal complement inhibitor eculizumab was shown to improve myasthenia gravis-related symptoms in the 26-week, phase 3, randomized, double-blind, placebo-controlled REGAIN study (NCT01997229). In this 52week sub-analysis of the open-label extension of REGAIN (NCT02301624), eculizumab's efficacy and safety were assessed in 11 Japanese and 88 Caucasian patients with anti-acetylcholine receptor antibody-positive refractory generalized myasthenia gravis. For patients who had received placebo during REGAIN, treatment with openlabel eculizumab resulted in generally similar outcomes in the Japanese and Caucasian populations. Rapid improvements were maintained for 52 weeks, assessed by change in score from open-label extension baseline to week 52 (mean [standard error]) using the following scales (in Japanese and Caucasian patients, respectively): Myasthenia Gravis Activities of Daily Living (−2.4 [1.34] and − 3.3 [0.65]); Quantitative Myasthenia Gravis (−2.9 [1.98] and − 4.3 [0.79]); Myasthenia Gravis Composite (−4.5 [2.63] and − 4.9 [1.19]); and Myasthenia Gravis Quality of Life 15-item questionnaire (−8.6 [5.68] and − 6.5 [1.93]). Overall, the safety of eculizumab was consistent with its known safety profile. In this interim sub-analysis, the efficacy and safety of eculizumab in Japanese and Caucasian patients were generally similar, and consistent with the overall REGAIN population.

Objective To assess whether eculizumab, a terminal complement inhibitor, improves patient‐ and physician‐reported outcomes (evaluated using the myasthenia gravis activities of daily living profile and the quantitative myasthenia gravis scale, respectively) in patients with refractory anti‐acetylcholine receptor antibody‐positive generalized myasthenia gravis across four domains, representing ocular, bulbar, respiratory, and limb/gross motor muscle groups. Methods Patients with refractory anti‐acetylcholine receptor antibody‐positive generalized myasthenia gravis were randomized 1:1 to receive either placebo or eculizumab during the REGAIN study (NCT01997229). Patients who completed REGAIN were eligible to continue into the open‐label extension trial (NCT02301624) for up to 4 years. The four domain scores of each of the myasthenia gravis activities of daily living profile and the quantitative myasthenia gravis scale recorded throughout REGAIN and through 130 weeks of the open‐label extension were analyzed. Results Of the 125 patients who participated in REGAIN, 117 enrolled in the open‐label extension; 61 had received placebo and 56 had received eculizumab during REGAIN. Patients experienced rapid improvements in total scores and all four domain scores of both the myasthenia gravis activities of daily living profile and the quantitative myasthenia gravis scale with eculizumab treatment. These improvements were sustained through 130 weeks of the open‐label extension. Interpretation Eculizumab treatment elicits rapid and sustained improvements in muscle strength across ocular, bulbar, respiratory, and limb/gross motor muscle groups and in associated daily activities in patients with refractory anti‐acetylcholine receptor antibody‐positive generalized myasthenia gravis.

Introdução: Os psicoestimulantes são drogas que aumentam o estado de alerta e concentração dos seus usuários e são usados principalmente no tratamento de TDAH e narcolepsia. Entretanto, o uso dessas substâncias como potenciadores cognitivos tem crescido exponencialmente na busca por um rendimento melhor nos estudos ou no trabalho. Nesse cenário, algumas questões são levantadas a respeito dos efeitos nocivos para os usuários de psicoestimulantes. Objetivo: avaliar a prevalência do uso de psicoestimulantes e correlacionar com a utilização de outras substâncias, de modo a entender as causas e as consequências do uso indiscriminado do metilfenidato. Material e método: Revisão bibliográfica de livros, artigos e publicações sobre o tema e análise de pesquisas realizadas sobre o uso do metilfenidato para melhor compreensão do assunto. Resultados: Estudos mostraram que os principais motivos da utilização do metilfenidato são melhorar a atenção e aumentar o estado de vigília durante o consumo de álcool e de outras drogas. Conclusão: O uso indiscriminado de potenciadores cognitivos em longo prazo pode alterar vias noradrenérgicas e dopaminérgicas, predispondo transtornos obsessivos compulsivos e aditivos.Descritores: Estimulantes do Sistema Nervoso Central; Metilfenidato; Transtorno da Personalidade Compulsiva.ReferênciasOutram SM. The use of methylphenidate among students: the future of enhancement? J Med Ethics. 2010;36(4):198-202.Freese L, Signor L, Machado C, Ferigolo M, Barros HMT. Non-medical use of methylphenidate: a review. Trends Psychiatry Psychother. 2012;34(2):110-15.Ortega F, Barros D, Caliman L, Itaborahy C, Junqueira L, Ferreira CP. A Ritalina no Brasil: produções, discursos e práticas. Interface Comum Educ Saúde. 2010;14(34):499-510.Itaborahy C. A Ritalina no Brasil: uma década de produção, divulgação e consumo [dissertação]. Rio de Janeiro: Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro; 2009.Urban KR, Gao WJ. Performance enhancement at the cost of potential brain plasticity: neural ramifications of nootropic drugs in the healthy developing brain. Front Syst Neurosci. 2014;8:38.Bassols AM, Sordi AO, Eizirik CL, Seeger GM, Rodrigues GS, Reche M. Prevalência de estresse em uma amostra de estudantes do curso de medicina da Universidade Federal do Rio Grande do Sul. Rev HCPA. 2008; 28(3):153-57.Pereira DS, Souza RS, Buaiz V, Siqueira MM. Uso de substâncias psicoativas entre universitários de medicina da Universidade Federal do Espírito Santo. J bras psiquiatr. 2008;57(3):188-95.Barros D, Ortega F. Metilfenidato e aprimoramento cognitivo farmacológico: representações sociais de universitários. Saúde Soc. 2011;20(2):350-62.Cruz TC, Barreto Junior EPDS, Gama MLM, Maia LCDM, Melo Filho MJXD, Manganotti Neto O et al. Uso não prescrito de metilfenidato entre estudantes de medicina da Universidade Federal da Bahia. Gazeta Méd Bahia. 2011;81(1):3-6.Cesar ELR, Wagner GA, Castaldelli-Maia JM, Silveira CM, Andrade AG, Oliveira LG. Uso prescrito de cloridrato de metilfenidato e correlatos entre estudantes universitários brasileiros. Rev Psiq Clín. 2012;39(6):183-88.Carneiro SG, Prado AST, Araújo ECJ, Moura HC, Strapasson JF, Rabelo NF et al. O uso não prescrito de metilfenidato entre acadêmicos de Medicina. Cadernos UniFOA: Edição Especial Ciênc da Saúde e Biol. 2013:53-9.Pasquini NC. Uso de metilfenido (mfd) por estudantes universitários com intuitode “turbinar” o cérebro. Rev Biol Farm. 2013;9(2):107-13.Mota JS, Pessanha FF, Prevalência do uso de metilfenidato por universitários de Campos dos Goytacazes, RJ. Vértices. 2014;16(1):77-86.Silveira RR, Lejderman B, Ferreira PEMS, Rocha GMP. Patterns of non-medical use of methylphenidate among 5th and 6th year students in a medical school in southern Brazil. Trends Psych Psychother. 2014; 36(2):101-06.Affonso RS, Lima KS, Oyama YM, Deuner MC, Garcia DR, Barboza LL et  al.  O  uso  indiscriminado  do  cloridrato  de  metilfenidato  como  estimulante  por estudantes da área da saúde da Faculdade Anhanguera de Brasília (FAB). Infarma. 2016;28(3):166-72.Wille ARF, Salvi JO. Prevalência do uso de metilfenidato em acadêmicos de um centro universitário em Ji-Paraná, Rondônia. BJSCR. 2018;24(3):13-9.Tolentino JEF, Silva Neto JP. O uso off label de metilfenidato entre estudantes de medicina para aprimoramento do desempenho acadêmico. CCS 2019;30(1): Ahead of Print - AOF)Lima RF. Compreendendo os mecanismos atencionais. Ciência e Cognição. 2005;6:113-22.Rotta NT, Ohlweiler L, Riesgo RS. Transtorno da aprendizagem: abordagem neurobiológica e multidisciplinar. São Paulo: Artmed; 2016.Stahl SM. Psicofarmacologia – bases neurocientíficas e aplicações práticas. Guanabara Koogan; 2014.Brunton LL, Chabner BA, Knollmann BC. As bases farmacológicas da terapêutica de Goodman & Gilman. 12. ed. Porto Alegre: AMGH Editora; 2002.Gillick BT, Zirpel L. Neuroplasticity: an appreciation from synapse to system. Arch phys med rehabil. 2012;93(10):1846-55.Gomes KM, Souza RP, Inácio CG, Valvassori SS, Réus GZ, Martins MR et al. Avaliação do ciclo claro e escuro no comportamento relacionado à ansiedade e à depressão em ratos de diferentes cidades após tratamento crônico com hidrocloridrato de metilfenidato. Rev bras psiquiatr. 2011;33(1):55-8.

The human body does not have time sensing receptors; thus, there is no association between time and sensory-specific systems 1 . We have receptors under the skin for sensing touch, temperature, pain, pressure, and vibration. In addition, we have proprioceptors in muscles and tendons, which continuously generate action potentials to the central nervous system with information about the length and tension of muscles; this signaling allows us to make accurate movements. We also have highly specialized sensory systems, such as vision, hearing, olfaction, and gustation, which provide us with environmental information. Although we are not endowed with time receptors 2,3 , our brains have an inherent ability to process time through the functions of neuronal mechanisms and neurotransmitters.We carry watches to know the hour precisely, but we do not need similar devices to determine whether it is cold or whether a sound is loud or soft. Similarly, our perception of time refers to subjective experience and depends on an internal clock. The subjective duration of events may be based on brain units that accumulate over time 4,5,6,7 . It is commonly said that "time passes faster" in older people 8 , which may be due to central dopamine-related mechanisms and memory 9,10 . This study aimed to estimate the passage of time in different age groups, to test the truth of this saying. METHODThis study included 233 healthy subjects, including 129 women. Three groups were formed according to age: Group 1 comprised 86 subjects, aged 15-29 years; the mean age was 22.4 years. Group 2 comprised 76 subjects, aged 30-49 years; the mean age was 38.9 years. Group 3 comprised 71 subjects, aged 50-89 years; the mean age was 59.7 years. Each of the participants was asked to count mentally with eyes closed the passage of 120 s (2 min). When the participant ABSTRACTOur internal clock system is predominantly dopaminergic, but memory is predominantly cholinergic. Here, we examined the common sensibility encapsulated in the statement: "time goes faster as we get older". Objective: To measure a 2 min time interval, counted mentally in subjects of different age groups. Method: 233 healthy subjects (129 women) were divided into three age groups: G1, 15-29 years; G2, 30-49 years; and G3, 50-89 years. Subjects were asked to close their eyes and mentally count the passing of 120 s. Results: The elapsed times were: G1, mean = 114.9 ± 35 s; G2, mean = 96.0 ± 34.3 s; G3, mean = 86.6 ± 34.9 s. The ANOVA-Bonferroni multiple comparison test showed that G3 and G1 results were significantly different (P < 0.001). Conclusion: Mental calculations of 120 s were shortened by an average of 24.6% (28.3 s) in individuals over age 50 years compared to individuals under age 30 years.Keywords: time perception; age; timing; aging. RESUMONosso sistema de relógio interno é predominantemente dopaminérgico, mas a memória é predominantemente colinérgica. Neste estudo, examinamos a assertiva comum que "o tempo passa mais rápido para pessoas mais velhas". Objetivo: Medir o int...

No abstract

Comparing results from jitter studies performed with voluntary and electrical activation is difficult to perform quantitatively, particularly in complex signals as seen in reinnervation. High jitter values in individual spikes in these multispike signals can be missed with both activation methods, which introduces a bias towards more normal values.With voluntary activation, triggering on a spike from an abnormal end-plate in multispike potentials will overestimate individual jitter values and the number of abnormal jitter values.With electrical stimulation, artefactually-increased jitter may be caused by subliminal stimulation, which causes uncertainty at the stimulation point. Electrical stimulation also may activate many axons, causing signal summation, with erroneous or impossible jitter estimation.Awareness of such pitfalls can improve the correct performance and interpretation of jitter recordings. Quantitative comparisons of results can be made between studies in reinnervated muscle performed with the same activation method, but not between results obtained with different activation methods.

ResumoO presente trabalho relatou um caso clínico de meningioma na tenda cerebelar, evidenciando seus aspectos clínicos, imaginológicos e histopatológicos, com o intuito de ampliar o conhecimento do médico generalista, favorecendo o diagnóstico e o tratamento da doença. O caso relatado foi de um paciente do sexo masculino na sétima década de vida, que permaneceu com a lesão durante 4 meses após apresentar os primeiros sinais e sintomas. O diagnóstico definitivo foi realizado com auxílio de ressonância magnética e, imediatamente, a opção terapêutica instituída foi a ressecção completa da lesão. Mediante tal relato, pode-se concluir que a investigação clínica é essencial mesmo em pacientes fora do grupo de maior incidência da lesão, sendo que o conhecimento das principais características da doença facilita o diagnóstico precoce e, consequentemente, antecipa o tratamento adequado, resultando no melhor prognóstico do paciente. Descritores: Meningioma; Neoplasias Meníngeas; Neoplasias de Tecido Nervoso. AbstractThe present study reported a clinical case of meningioma in the cerebellar tent, evidencing its clinical, imaging and histopathological aspects, in order to broaden the knowledge of the general practitioner, favoring the diagnosis and treatment of the disease. The case reported was of a male patient in the seventh decade of life, who remained with the lesion for 4 months after presenting the first signs and symptoms. The definitive diagnosis was made with the aid of magnetic resonance imaging, and immediately, the therapeutic option instituted was the complete resection of the lesion. By means of such a report, it can be concluded that clinical investigation is essential even in patients outside the group with a higher incidence of the injury, and knowledge of the main characteristics of the disease facilitates early diagnosis and, consequently, anticipates appropriate treatment, resulting in better prognosis for patients. Descriptors: Meningioma; Meningeal Neoplasms; Neoplasms, Nerve Tissue. ResumenEste estudio informó un caso de meningioma en la tienda del cerebelo, mostrando su clínica, las imágenes y los aspectos histopatológicos, con el fin de ampliar los conocimientos de la medicina general, favoreciendo el diagnóstico y tratamiento de la enfermedad. Presentamos el caso de un paciente varón de en la séptima década de la vida, que se quedó con la lesión durante 4 meses después de presentar los primeros signos y síntomas. El diagnóstico final se hizo con la ayuda de resonancia magnética y de inmediato la opción de terapia era una resección completa de la lesión. A tal cuenta, se puede concluir que la investigación clínica es esencial incluso en pacientes más allá de la mayor incidencia de grupo lesión, con el conocimiento de las características principales de la enfermedad facilita el diagnóstico temprano y, por consiguiente, se anticipa el tratamiento apropiado, lo que resulta en mejor pronóstico. Descriptores: Meningioma; Neoplasias Meníngeas; Neoplasias de Tejido Nervioso. INTRODUÇÃOO meningioma é uma n...