O objetivo deste estudo foi correlacionar as alterações causadas pela doença de Chagas no sistema nervoso autônomo e a possibilidade destas alterações provocarem disfunção erétil. Foram incluídos 60 pacientes, do sexo masculino, entre 40 e 70 anos, sendo 30 com a forma digestiva da doença de Chagas e 30 como grupo controle negativos para tripanossomíase; foram utilizados o questionário auto-aplicável do Índice Internacional de Função Erétil (IIFE) e o algoritmo de pontuação para análise e interpretação do questionário.Os resultados obtidos neste estudo comprovaram que a doença de Chagas não afetou a função erétil dos pacientes, que não há diferença significativa se a lesão é do esôfago ou de esôfago e cólon e que a doença de Chagas não deve ser considerada um fator de risco para a disfunção erétil / The objective of this study was to correlate the alterations caused by the Chagas'disease in the autonomous nervous system and the possibility of these alterations they provoke erectile dysfunction. Sixty men - between 40 and 70 years-old - were selected for the stydy: 30 men with the digestive form of the Chagas'disease and 30 of them had negative serologic findings for T. Cruzi. It was used the questionnaire of the International Index of Erectile Function (IIEF) and the punctuation algorithm for interpretation of the questionnaire. The results this study they proved that the Chagas'disease didn't affect the patients' erectile function, that there is not significant difference if the lesion is of esophagus or esophagus and colon and Chagas'disease should not be considered a risk factor for the erectile dysfunction

PURPOSE: A recent study suggested that updated spectacles could increase fall rate in frail older people. The authors hypothesized that the increased risk may be due to changes in spectacle magnification. The present study was conducted to assess the effects of spectacle magnification on step negotiation. METHODS: Adaptive gait and visual function were measured in 10 older adults (mean age, 77.1 +/- 4.3 years) with the participants' optimal refractive correction and when blurred with +1.00, +2.00, -1.00, and -2.00 DS lenses. Adaptive gait measurements for the leading and trailing foot included foot position before the step, toe clearance of the step edge, and foot position on the step. Vision measurements included visual acuity, contrast sensitivity, and stereoacuity. RESULTS: The blur lenses led to equal decrements in visual acuity and stereoacuity for the +1.00 and -1.00 DS and the +2.00 and -2.00 DS lenses. However, they had very different effects on step negotiation compared with the optimal correction. Positive-blur lenses led to an increased distance of the feet from the step, increased vertical toe clearance and reduced distance of the leading heel position on the step. Negative lenses led to the opposite of these changes. CONCLUSIONS: The step negotiation changes did not mirror the effects of blur on vision, but were driven by the magnification changes of the lenses. Steps appear closer and larger with positive lenses and farther away and smaller with negative ones. Magnification is a likely explanation of the mobility problems some older adults have with updated spectacles and after cataract surgery.

INTRODUÇÃO: O transtorno afetivo bipolar (TAB) e o transtorno obsessivocompulsivo (TOC) estão entre as dez condições médicas mais incapacitantes. No entanto, suas bases neurobiológicas são ainda desconhecidas. Os estudos postmortem podem dar uma boa contribuição para o entendimento da fisiopatologia desses transtornos, pois permitem a comparação das alterações celulares, citoarquitetônicas e moleculares com as manifestações clínicas, além de auxiliarem numa melhor compreensão dos achados dos estudos de neuroimagem. OBJETIVOS: Comparar a densidade neuronal, volume e número total de neurônios do córtex orbitofrontal (COF) e suas sub-regiões: antero-medial (AM), médio-orbitofrontal (MO) e antero-lateral (AL) entre casos psiquiátricos e controles; Verificar se há diferenças de densidade neuronal, volume e número total de neurônios do COF entre os casos de TAB e casos de TOC e controles. MÉTODOS E CASUÍSTICA: 17 encéfalos de indivíduos acima de 50 anos foram coletados, diagnosticados e submetidos a análises estereológicas, sendo três indivíduos acometidos por TAB, sete indivíduos acometidos por TOC e sete controles saudáveis pareados por idade, gênero e hemisfério cerebral analisado. Um hemisfério foi fixado por perfusão com formalina 20% e processado para estudos neuroestereológicos, enquanto o outro teve as 45 regiões de interesse dissecadas e congeladas a -80ºC para futuros estudos moleculares. RESULTADOS: O COF e suas sub-regiões apresentaram menor densidade neuronal no grupo total de casos vs. controles (p < 0,05). No entanto, não houve diferença em relação ao volume. A subregião MO apresentou um número menor de neurônios nos casos que em controles (p < 0,05). Curiosamente, na análise de densidade neuronal das camadas corticais, apenas a camada IV não apresentou diferença estatisticamente significante entre casos e controles. CONCLUSÕES: Nossos achados mostram que alterações no COF podem estar envolvidas com a fisiopatologia do TOC ou TAB, e indicam que podem haver interações entre elas e, além disso, concordam com estudos de imagem funcional e de atividades cerebrais na região MO que nos faz refletir que além de uma perda neuronal, há também uma hipoativação e uma redução funcional. Estudos com um número maior de amostras e com diferenciação celular poderão trazer novas contribuições para o entendimento da fisiopatologia desses transtornos neuropsiquiátricos / INTRODUCTION: Bipolar disorder (BD) and obsessive compulsive disorder (OCD) are within the ten medical condition promoving incapacity worldwide. To date, their neuropathological substrates are yet to be disclosed. Postmortem studies designed to estimate cytoarchitectonic and molecular changes for clinical and imaging correlation, have the potencial to undercover pathophysiological aspects of these conditions. OBJECTIVE: Objective: To compare neuronal density, volume and total neuron number of orbitofrontal cortex (OFC) as a whole and divided by sub-regions: anteromedial (AM), medio-orbitofrontal (MO) and antero-lateral (AL) among BD, OCD and matched controls. METHODS: We used 17 postmortem brains sourced from the Psy- BBBABSG. All the subject were older than 50 years and were classified based on clinical evaluation in BD, OCD and healthy control. Subjects were matched by age, gender and brain hemisphere. One hemisphere were perfusion fixed with 20% formalin and used for neuroestereological studies. The second hemisphere had ROIs dissected and snap frozen for future molecular studies. OUTCOMES: Neuron density in OFC and the sub-regions were decreased in cases vs. controls (p < 0,05). This result was observed in cortical layers analyses with exception of layer IV. We did not observed significant changes in volume. The MO sub-region had reduced total neuron number in cases than in controls (p < 0,05). CONCLUSION: Ours results suggest that OFC changes may be part of BD and OCD pathogenesis. These results go in line with functional imaging findings. Further studies with a higher number of cases and adressing specific neuron types are needed

Introdução: a hipótese deste estudo é de que a Pressão inspiratória máxima, Pressão de oclusão traqueal e sua razão podem predizer a evolução do desmame da ventilação mecânica em uma população mista de Terapia Intensiva. Métodos: A Pi Max , P 0.1 e a razão P 0.1 / Pi Max foram mensuradas em setenta pacientes consecutivos , intubados ou traqueostomizados, e ventilados mecanicamente, que preencheram os critérios para desmame da ventilação mecânica. Após a mensuração da Pi Max, P 0.1 e ainda da freqüência respiratória e volume corrente em litros com o cálculo da relação FR/VC e do produto P 0.1 x FR/VC, os pacientes foram submetidos a um teste de respiração espontânea. Os pacientes que toleraram o teste de respiração espontânea e não precisaram retornar para a ventilação mecânica no período de 24 horas foram considerados desmamados. A sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo, diagnóstico de acurácia e a área sob a curva ROC (receiver operating characteristic curve) foram calculadas. Resultados: Os valores médios da P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC e P 0.1 x FR /VC foram de 2,49±1,2, -34,6±13, 0,07±0,01, 75,4±33 e 184,6±123 respectivamente para os pacientes desmamados e 4,36± 2,0, -32,1±11,0 , 0,15± 0,09, 148,4± 42 e 652,9± 358 para os não desmamados da ventilação mecânica. Todos os índices distinguiram entre os pacientes desmamados e não desmamados, à exceção da Pi Max. A sensibilidade para a P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC e P 0.1 x FR /VC foi de 78,85, 65,38, 80,77, 82,69, 88,46 respectivamente. A especificidade para a P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC e P 0.1 x FR /VC foi de 72,2, 38,8, 72,2, 83,3, 72,2 respectivamente. Os valores preditivos positivos para a P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC e P 0.1 x FR /VC foram respectivamente 89,1, 75,5, 89,3, 93,4 e 90,2. Os valores preditivos negativos para a P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC e P 0.1 x FR /VC foram respectivamente de 54,1, 28,0, 56,5, 62,5 e 68,4. O diagnóstico de acurácia para a P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC e P 0.1 x FR /VC foi respectivamente de 77,1, 58,5, 78,5, 82,8 e 84,2. As áreas abaixo da curva ROC para a P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC e P 0.1 x FR /VC foram respectivamente 0,76± 0,06, 0,52±0,08 , 0,78±0,06, 0,90±0,04 e 0,84±0,05. A comparação da áreas abaixo da curva ROC mostrou que os melhores índices foram a relação FR/VC, o produto P 0.1 x FR/VC e a relação P 0.1 / Pi Max não havendo diferença estatística entre eles. A pior área abaixo da curva ROC foi do índice Pi Max. Os índices de desmame da ventilação mecânica P 0.1, Pi Max e P 0.1/ Pi Max não foram diferentes estatisticamente entre os pacientes intubados e traqueostomizados. Conclusão: os melhores índices foram a relação FR/VC, o produto P 0.1 x FR/VC e a relação P 0.1 / Pi Max não havendo diferença estatística entre eles. / Introduction: We hypothesized that maximal inspiratory pressure (Pi Max), airway tracheal occlusion pressure (P 0.1) and its ratio (P 0.1/Pi Max) can be used to predict weaning outcome in a mixed ICU mechanically ventilated patients. Methods: Pi Max, P 0.1 and P 0.1 / Pi Max ratio were measured in seventy consecutive intubated or tracheostomized, mechanically ventilated patients, who fulfilled weaning criteria. After these measurements of Pi Max, P0.1, respiratory rate and expiratory tidal volume (L) with the calculation of f / Vt ratio and the product P0.1x f / Vt , the patients were submitted to a spontaneous breathing trial (SBT) . Those who were able to sustain the SBT and had no need to return to mechanical ventilation in the following 24 hours were considered weaned. The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and Receiver- operating-characteristics (ROC) curves for this population were calculated. Results: The mean value of P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC e P 0.1 x FR /VC were 2,49 ±1,2, -34,6± 13, 0,07± 0,01, 75,4±33 and 184,6±123 respectively for the weaned patients and 4,36± 2,0, -32,1±11,0 , 0,15± 0,09, 148,4± 42 e 652,9± 358 for the not weaned patients. All the indexes distinguished between the weaned and not weaned patient, except for the Pi Max. The sensitivity for the P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC and P 0.1 x FR /VC were respectively 78,85, 65,38, 80,77, 82,69, 88,46. The specificity for P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC and P 0.1 x FR /VC were 72,2, 38,8, 72,2, 83,3, 72,2 respectively. The positive predictive value for P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC and P 0.1 x FR /VC were respectively 89,1, 75,5, 89,3, 93,4 e 90,2. The negative predictive value for P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC and P 0.1 x FR /VC were respectively 54,1, 28,0, 56,5, 62,5 e 68,4. The diagnostic accuracy for P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC and P 0.1 x FR /VC were respectively 77,1, 58,5, 78,5, 82,8 e 84,2. The area under the ROC curves for P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC and P 0.1 x FR /VC were respectively 0,76± 0,06, 0,52±0,08 , 0,78±0,06, 0,90±0,04 e 0,84±0,05. The comparison among the areas under the ROC curves showed that the best weaning indexes were f / Vt ratio, the product P 0.1 x f / Vt and the P0.1/ Pi Max ratio with no statistic differences among them. The Pi Max presented the smaller area under the ROC curve. The weaning indexes P 0.1, Pi Max e P 0.1/ Pi Max were not statistically different between intubated or tracheostomized patients. Conclusion: The best weaning indexes were f/Vt ratio , the product P 0.1 x f/Vt and the P 0.1 / Pi Max ratio with no statistically difference among them.

Os movimentos mandibulares utilizados na fala modificam os espaços para viabilizar as diversas posturas articulatórias próprias de cada som. As disfunções temporomandibulares podem acarretar alterações gerais nos movimentos mandibulares devido à modificação nas condições musculares e articulares. A eletrognatografia, exame computadorizado utilizado para complementar o diagnóstico dessas disfunções, permite delinear e registrar de maneira objetiva os movimentos mandibulares, determinando sua amplitude e velocidade. Assim, o objetivo desse estudo foi verificar a caracterização dos movimentos mandibulares na fala para o Português Brasileiro, em indivíduos com disfunções temporomandibulares e em indivíduos assintomáticos, por meio de eletrognatografia computadorizada, analisando possíveis interferências dessas disfunções quanto à: velocidade de abertura e fechamento mandibular; amplitude vertical, anteroposterior e lateral desses movimentos. Para tanto, 135 participantes adultos foram divididos em dois grupos: GI com 90 participantes com disfunções temporomandibulares e GII com 45 participantes assintomáticos. Foi realizada ainda verificação desses movimentos com base nos graus de dor, utilizando-se escala numérica, sendo: zero para ausência de dor, 1 para dor leve, 2 para dor moderada e 3 para dor grave. Os movimentos mandibulares foram observados na nomeação seqüencial de figuras balanceadas quanto à ocorrência dos fonemas da língua. Os registros foram obtidos com eletrognatografia computadorizada (BioEGN - sistema BioPak) por meio da captação dos sinais de um magneto sem interferir na oclusão e na extensão dos movimentos. A análise dos resultados mostrou diferenças estatisticamente significantes entre as médias dos valores obtidas para os dois grupos quanto à amplitude de abertura e amplitude de retrusão, e entre as médias de velocidade tanto de abertura quanto de fechamento mandibular na fala. Não foram encontradas diferenças estatisticamente significantes entre os resultados obtidos para os dois grupos quanto à presença e amplitude dos desvios em lateralidade durante a fala. Constatou-se predomínio de desvios bilaterais para GII e de desvios unilaterais para GI com diferenças estatisticamente significantes. Quanto aos diferentes graus de dor, verificou-se que as diferenças apontadas como significantes para amplitude de abertura e para velocidade de fechamento mandibular, ocorrem entre o grau zero e todos os outros graus de dor. Para velocidade de abertura mandibular na fala, foi obtida diferença estatisticamente significante entre grau zero e grau três. Constatou-se que os movimentos mandibulares na fala são discretos, com componente antero-posterior e desvios em lateralidade. A presença de disfunções temporomandibulares acarreta redução das amplitudes máximas de abertura e de retrusão mandibular, predomínio de desvios unilaterais e também redução da velocidade tanto de abertura quanto de fechamento dos movimentos mandibulares durante a fala. Os diferentes graus de dor parecem não determinar maior redução de amplitude máxima e de velocidade desses movimentos. Esse estudo possibilitou descrever os três limites dimensionais dos movimentos mandibulares na fala para o Português Brasileiro, assim como as médias dos valores máximos de velocidade de abertura e fechamento durante esses movimentos, para os dois grupos de indivíduos investigados / The mandibular movements used in speech modify the spaces to make possible the different articulatory postures proper to each sound. The temporomandibular dysfunctions can arise general modifications in the mandibular movements due to the modification in the muscular and articular conditions. The electrognathography, a computerized exam used to complement the diagnosis of those dysfunctions, allows to delineate and record in an objective way the mandibular movements, determining their range and speed. Thus, the goal of this study was to check the characterization of mandibular movements in speech for Brazilian Portuguese, in individuals with temporomandibular dysfunctions and in asymptomatic individuals, through computerized electrognathography, analyzing possible interferences of those dysfunctions as for the following issues: mandibular opening and closing speed; vertical, anteroposterior and lateral range of those movements. For such, 135 adult subjects were divided in two groups: GI with 90 participants with temporomandibular dysfunctions and GII with 45 asymptomatic participants. Those movements were also checked based on pain degrees, using numeric scale, namely: zero for pain absence, 1 for light pain, 2 for moderate pain and 3 for severe pain. Mandibular movements were observed in the sequential nomination of balanced figures as for the occurrence of tong phonemes. The records were obtained with computerized electrognathography (BioEGN - BioPak system) through the reception of signals from a magneto without interfering in the occlusion and movement extension. The analysis of such results showed statistically significant differences between the averages of the values obtained for the two groups as for the opening and retrusion range, and between the averages of speed both for mandibular opening as well as for mandibular closing in speech. Statistically significant differences were not found among the results obtained for the two groups as for the presence and range of the deviations in laterality during the speech. Prevalence of bilateral deviations was verified for GII and of unilateral deviations for GI with statistically significant differences. As for the different pain degrees, the differences indicated as significant for opening range and mandibular closing speed were verified to occur between zero degree and all other pain degrees. For mandibular opening speed in speech, statistically significant differences were obtained between zero degree and three degree. Mandibular movements in speech were verified to be discreet, with anteroposterior component and deviations in laterality. The presence of temporomandibular dysfunctions arises reduction of the maximum mandibular opening and retrusion ranges, prevalence of unilateral deviations and also speed reduction both concerning opening as well as closing of mandibular movements during speech. The different pain degrees do not seem to determine larger reduction of maximum range and speed as for such movements. This study made possible to describe the three dimensional thresholds of mandibular movements in speech for Brazilian Portuguese, as well as the averages concerning the maximum values of opening and closing speed during those movements, for the two groups of investigated individuals

Introdução: a hipótese deste estudo é de que a Pressão inspiratória máxima, Pressão de oclusão traqueal e sua razão podem predizer a evolução do desmame da ventilação mecânica em uma população mista de Terapia Intensiva. Métodos: A Pi Max , P 0.1 e a razão P 0.1 / Pi Max foram mensuradas em setenta pacientes consecutivos , intubados ou traqueostomizados, e ventilados mecanicamente, que preencheram os critérios para desmame da ventilação mecânica. Após a mensuração da Pi Max, P 0.1 e ainda da freqüência respiratória e volume corrente em litros com o cálculo da relação FR/VC e do produto P 0.1 x FR/VC, os pacientes foram submetidos a um teste de respiração espontânea. Os pacientes que toleraram o teste de respiração espontânea e não precisaram retornar para a ventilação mecânica no período de 24 horas foram considerados desmamados. A sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo, diagnóstico de acurácia e a área sob a curva ROC (receiver operating characteristic curve) foram calculadas. Resultados: Os valores médios da P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC e P 0.1 x FR /VC foram de 2,49±1,2, -34,6±13, 0,07±0,01, 75,4±33 e 184,6±123 respectivamente para os pacientes desmamados e 4,36± 2,0, -32,1±11,0 , 0,15± 0,09, 148,4± 42 e 652,9± 358 para os não desmamados da ventilação mecânica. Todos os índices distinguiram entre os pacientes desmamados e não desmamados, à exceção da Pi Max. A sensibilidade para a P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC e P 0.1 x FR /VC foi de 78,85, 65,38, 80,77, 82,69, 88,46 respectivamente. A especificidade para a P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC e P 0.1 x FR /VC foi de 72,2, 38,8, 72,2, 83,3, 72,2 respectivamente. Os valores preditivos positivos para a P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC e P 0.1 x FR /VC foram respectivamente 89,1, 75,5, 89,3, 93,4 e 90,2. Os valores preditivos negativos para a P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC e P 0.1 x FR /VC foram respectivamente de 54,1, 28,0, 56,5, 62,5 e 68,4. O diagnóstico de acurácia para a P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC e P 0.1 x FR /VC foi respectivamente de 77,1, 58,5, 78,5, 82,8 e 84,2. As áreas abaixo da curva ROC para a P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC e P 0.1 x FR /VC foram respectivamente 0,76± 0,06, 0,52±0,08 , 0,78±0,06, 0,90±0,04 e 0,84±0,05. A comparação da áreas abaixo da curva ROC mostrou que os melhores índices foram a relação FR/VC, o produto P 0.1 x FR/VC e a relação P 0.1 / Pi Max não havendo diferença estatística entre eles. A pior área abaixo da curva ROC foi do índice Pi Max. Os índices de desmame da ventilação mecânica P 0.1, Pi Max e P 0.1/ Pi Max não foram diferentes estatisticamente entre os pacientes intubados e traqueostomizados. Conclusão: os melhores índices foram a relação FR/VC, o produto P 0.1 x FR/VC e a relação P 0.1 / Pi Max não havendo diferença estatística entre eles. / Introduction: We hypothesized that maximal inspiratory pressure (Pi Max), airway tracheal occlusion pressure (P 0.1) and its ratio (P 0.1/Pi Max) can be used to predict weaning outcome in a mixed ICU mechanically ventilated patients. Methods: Pi Max, P 0.1 and P 0.1 / Pi Max ratio were measured in seventy consecutive intubated or tracheostomized, mechanically ventilated patients, who fulfilled weaning criteria. After these measurements of Pi Max, P0.1, respiratory rate and expiratory tidal volume (L) with the calculation of f / Vt ratio and the product P0.1x f / Vt , the patients were submitted to a spontaneous breathing trial (SBT) . Those who were able to sustain the SBT and had no need to return to mechanical ventilation in the following 24 hours were considered weaned. The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and Receiver- operating-characteristics (ROC) curves for this population were calculated. Results: The mean value of P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC e P 0.1 x FR /VC were 2,49 ±1,2, -34,6± 13, 0,07± 0,01, 75,4±33 and 184,6±123 respectively for the weaned patients and 4,36± 2,0, -32,1±11,0 , 0,15± 0,09, 148,4± 42 e 652,9± 358 for the not weaned patients. All the indexes distinguished between the weaned and not weaned patient, except for the Pi Max. The sensitivity for the P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC and P 0.1 x FR /VC were respectively 78,85, 65,38, 80,77, 82,69, 88,46. The specificity for P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC and P 0.1 x FR /VC were 72,2, 38,8, 72,2, 83,3, 72,2 respectively. The positive predictive value for P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC and P 0.1 x FR /VC were respectively 89,1, 75,5, 89,3, 93,4 e 90,2. The negative predictive value for P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC and P 0.1 x FR /VC were respectively 54,1, 28,0, 56,5, 62,5 e 68,4. The diagnostic accuracy for P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC and P 0.1 x FR /VC were respectively 77,1, 58,5, 78,5, 82,8 e 84,2. The area under the ROC curves for P 0.1 , Pi Max, P 0.1 / Pi Max, FR / VC and P 0.1 x FR /VC were respectively 0,76± 0,06, 0,52±0,08 , 0,78±0,06, 0,90±0,04 e 0,84±0,05. The comparison among the areas under the ROC curves showed that the best weaning indexes were f / Vt ratio, the product P 0.1 x f / Vt and the P0.1/ Pi Max ratio with no statistic differences among them. The Pi Max presented the smaller area under the ROC curve. The weaning indexes P 0.1, Pi Max e P 0.1/ Pi Max were not statistically different between intubated or tracheostomized patients. Conclusion: The best weaning indexes were f/Vt ratio , the product P 0.1 x f/Vt and the P 0.1 / Pi Max ratio with no statistically difference among them.

Ng Sin Man. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 120-135). / Abstracts in English and Chinese. / Acknowledgements --- p.i / Abbreviations --- p.iii / Abstract --- p.vi / 撮要 --- p.ix / Publications --- p.xi / Table of contents --- p.xiii / Chapter Chapter 1 --- General Introduction / Chapter 1.1 --- Allergic Diseases and Allergic Inflammation --- p.1 / Chapter 1.1.1 --- Prevalence of Allergic Diseases --- p.1 / Chapter 1.1.2 --- Common Allergic Diseases: Allergic Asthma --- p.1 / Chapter 1.1.3 --- Common Allergic Diseases: Atopic Dermatitis --- p.2 / Chapter 1.1.4 --- Allergic Inflammation --- p.3 / Chapter 1.2 --- The Inflammatory Leukocytes: Mast Cells and Eosinophils --- p.6 / Chapter 1.2.1 --- Characteristics of Mast Cells --- p.6 / Chapter 1.2.2 --- Mast Cells Distribution --- p.8 / Chapter 1.2.3 --- Mast Cells Subtypes --- p.8 / Chapter 1.2.4 --- HMC-1 Cells --- p.9 / Chapter 1.2.5 --- Characteristics of Eosinophils --- p.12 / Chapter 1.3 --- Adhesion Molecules in Allergic Diseases --- p.15 / Chapter 1.3.1 --- Adhesion Molecules and Leukocyte Migration --- p.15 / Chapter 1.3.2 --- Selectin --- p.17 / Chapter 1.3.3 --- Intermolecular Adhesion Molecules --- p.17 / Chapter 1.3.4 --- Integrin --- p.18 / Chapter 1.4 --- Cytokines and Chemokines in Allergic Diseases --- p.18 / Chapter 1.4.1 --- IL-6 --- p.20 / Chapter 1.4.2 --- CXCL1 --- p.21 / Chapter 1.4.3 --- CXCL8 --- p.21 / Chapter 1.4.3 --- CCL2 --- p.22 / Chapter 1.5 --- Intercellular Signal Transduction Pathways in Inflammation --- p.24 / Chapter 1.5.1 --- RAS-RAF-mitogen-activated Protein Kinases --- p.24 / Chapter 1.5.2 --- Janus Kinase/ Signal Transducers and Activators of Transcriptions Pathway --- p.27 / Chapter 1.5.3 --- Nuclear Factor-KB Pathway --- p.29 / Chapter 1.5.4 --- Phosphoinositide 3-Kinase Pathway --- p.31 / Chapter 1.6 --- Aims and Scope of the Study --- p.33 / Chapter Chapter 2 --- Materials and Methods / Chapter 2.1 --- Materials --- p.35 / Chapter 2.1.1 --- HMC-1 Cell Line --- p.35 / Chapter 2.1.2 --- Human Buffer Coat --- p.35 / Chapter 2.1.3 --- Human Mast Cell Chymase and TLR ligands --- p.35 / Chapter 2.1.4 --- Media and Reagents for Cell Culture --- p.36 / Chapter 2.1.5 --- Reagents and Buffers for Purification of Human Eosinophils --- p.37 / Chapter 2.1.6 --- Reagents and Buffers for Flow Cytmetry --- p.38 / Chapter 2.1.7 --- Reagents and Buffers for Total RNA Extraction --- p.41 / Chapter 2.1.8 --- Reagents and Buffers for Reverse Transcription-Polymerase Chain Reaction (RT-PCR) --- p.42 / Chapter 2.1.9 --- Reagents and Buffers for Agarose Gel Electrophoresis --- p.45 / Chapter 2.1.10 --- Reagents and Buffers for Sodium Dodecyl Sulfate -polyacrylamide Gel Electrophoresis (SDS-PAGE) --- p.46 / Chapter 2.1.11 --- Reagents and Buffers for Western Blot Analysis --- p.48 / Chapter 2.1.12 --- Chemotactic Migration --- p.51 / Chapter 2.1.13 --- Signaling Transduction Inhibitors and Protein Synthesis Inhibitors --- p.51 / Chapter 2.2 --- Methods --- p.52 / Chapter 2.2.1 --- HMC-1 Cell Cultures --- p.52 / Chapter 2.2.2 --- Purification of Buffy Coat Eosinophils by MACS and Eosinophil Culture --- p.52 / Chapter 2.2.3 --- Total Cellular RNA Extraction --- p.53 / Chapter 2.2.4 --- RT-PCR --- p.54 / Chapter 2.2.5 --- Agarose Gel Electrophoresis --- p.55 / Chapter 2.2.6 --- Flow Cytometry Analysis --- p.55 / Chapter 2.2.7 --- Protein Array Analysis of Cytokine Release --- p.57 / Chapter 2.2.8 --- Quantitative Analysis ofCXCLl --- p.58 / Chapter 2.2.9 --- Total Protein Extraction --- p.58 / Chapter 2.2.10 --- SDS-PAGE --- p.58 / Chapter 2.2.11 --- Western Blot Analysis --- p.59 / Chapter 2.2.12 --- Chemotactic Migration Analysis --- p.60 / Chapter 2.2.13 --- Statistical Analysis --- p.60 / Chapter Chapter 3 --- Effects of Mast Cell Derived Chymase on Human Eosinophils and the Signaling Mechanisms: Implication in Allergic Inflammation / Chapter 3.1 --- Introduction --- p.61 / Chapter 3.2 --- Results --- p.65 / Chapter 3.2.1 --- Effects of Chymase on Eosinophil Survival --- p.65 / Chapter 3.2.2 --- Effects of Chymase on the Adhesion Molecule Expression of Eosinophils --- p.68 / Chapter 3.2.3 --- Effects of Chymase on the Chemokinetic Properties on Eosinophils --- p.71 / Chapter 3.2.4 --- Effects of Chymase on the Release of Chemokines and IL-6 from Eosinophils --- p.73 / Chapter 3.2.5 --- Signal Transduction Mechanism Involved in Regulating Chymase-induced Effects on Eosinophils --- p.78 / Chapter 3.3 --- Discussion --- p.71 / Chapter Chapter 4 --- TLR-mediated Effects and Signal Transduction Mechanism of HMC-1 Cells / Chapter 4.1 --- Introduction --- p.92 / Chapter 4.2 --- Results --- p.97 / Chapter 4.2.1 --- Expression of Adhesion Molecules on HMC-1 Cells --- p.95 / Chapter 4.2.2 --- TLR Expression Profile on HMC-1 Cells --- p.97 / Chapter 4.2.3 --- Effects of TLR ligands on HMC-1 Cell Adhesion Molecule Expressions --- p.99 / Chapter 4.2.4 --- TLR7-induced Phosphorylation of ERK and Effects of PD98059 on TLR7-induced ERK Phosphorylation --- p.104 / Chapter 4.2.5 --- Effect of TLR7 Ligand on HMC-1 Cells Cytokine Release --- p.108 / Chapter 4.3 --- Discussion --- p.110 / Chapter Chapter 5 --- Conclusions and Future Perspectives / Chapter 5.1 --- Conclusions --- p.115 / Chapter 5.2 --- Future Perspectives --- p.117 / References --- p.120 / Appendix --- p.136

Cerebral ischemia is the principal cause of morbidity and mortality worldwide. In addition to neuronal loss associated with hypoxic-ischemic damage, cerebral ischemia is characterized by a neuromicrovascular injury. Nitrative stress and lipid peroxidation increase in hypoxic-ischemic damages and play an essential role in neuromicrovascular injury leading to cerebral ischemia. We hypothesized that newly described lipid peroxidation products, termed trans-arachidonic acids (TAA), could be implicated in the pathogenesis of hypoxia-ischemia by affecting the cerebral vasomotricity and microvascular integrity. / The effects of TAA on neuromicrovascular tone were tested ex vivo by monitoring the changes in vascular diameter of rat cerebral pial microvessels. Four isomers of TAA, namely 5 E-AA, 8E-AA, IIE-AA and 14 E-AA induced an endothelium-dependent vasorelaxation. Possible mechanisms involved in TAA-induced vasorelaxation were thoroughly investigated. Collectively, data enclosed revealed that TAA induce cerebral vasorelaxation through the interactive activation of BKCa channels with heme oxygenase-2. This interaction leads to generation of carbon monoxide which in turn activates soluble guanylate cyclase and triggers vasorelaxation. / Chronic effects of TAA on microvascular integrity were examined by generating a unilateral hypoxic-ischemic (HI) model of cerebral ischemia on newborn rat pups. Our HI model showed microvascular degeneration as early as 24h post-HI, preceded by an increase in cerebral TAA levels. HI-induced microvascular lesions were dependent on nitric oxide synthase activation and ensued TAA formation. Although the molecular mechanisms leading to TAA-induced microvascular degeneration were, in part uncovered for the retina, the primary site of action of TAA remains unknown. We demonstrated that TAA binds and activates GPR40 receptor, a newly described free fatty acid receptor. Importantly, GPR40 receptor knock-out prevents TAA-induced reduction in cerebral microvascular density and limits HI-induced brain infarct.

Decorin, is an extracellular matrix proteoglycan with important biological functions. Decorin deficiency affects collagen fibrillogenesis, airway mechanics, airway-parenchymal interdependence, and airway smooth muscle proliferation and apoptosis. We questioned whether decorin deficiency would alter allergen-induced asthma in a mouse model. Decorin-/- and decorin+/+ mice (C57Bl/6) were sensitized and challenged with ovalbumin. Control animals received saline. Responsiveness was assessed at baseline and after delivery of increasing concentrations of methacholine. Histological analyses were also performed. Decorin deficiency resulted in more modest hyperresponsiveness. Respiratory resistance and elastance along with tissue damping and tissue elastance, were increased in ovalbumin decorin +/+ and decorin-/-, but more so in decorin+/+ . Airway resistance was increased in ovalbumin decorin+/+ only. Inflammation and collagen staining within the airway wall, were increased in ovalbumin decorin+/+ mice only; whereas biglycan was significantly increased in ovalbumin decorin-/- mice only. These results reflect the role of decorin in the development of allergen-induced asthma.

INTRODUÇÃO: O transtorno afetivo bipolar (TAB) e o transtorno obsessivocompulsivo (TOC) estão entre as dez condições médicas mais incapacitantes. No entanto, suas bases neurobiológicas são ainda desconhecidas. Os estudos postmortem podem dar uma boa contribuição para o entendimento da fisiopatologia desses transtornos, pois permitem a comparação das alterações celulares, citoarquitetônicas e moleculares com as manifestações clínicas, além de auxiliarem numa melhor compreensão dos achados dos estudos de neuroimagem. OBJETIVOS: Comparar a densidade neuronal, volume e número total de neurônios do córtex orbitofrontal (COF) e suas sub-regiões: antero-medial (AM), médio-orbitofrontal (MO) e antero-lateral (AL) entre casos psiquiátricos e controles; Verificar se há diferenças de densidade neuronal, volume e número total de neurônios do COF entre os casos de TAB e casos de TOC e controles. MÉTODOS E CASUÍSTICA: 17 encéfalos de indivíduos acima de 50 anos foram coletados, diagnosticados e submetidos a análises estereológicas, sendo três indivíduos acometidos por TAB, sete indivíduos acometidos por TOC e sete controles saudáveis pareados por idade, gênero e hemisfério cerebral analisado. Um hemisfério foi fixado por perfusão com formalina 20% e processado para estudos neuroestereológicos, enquanto o outro teve as 45 regiões de interesse dissecadas e congeladas a -80ºC para futuros estudos moleculares. RESULTADOS: O COF e suas sub-regiões apresentaram menor densidade neuronal no grupo total de casos vs. controles (p < 0,05). No entanto, não houve diferença em relação ao volume. A subregião MO apresentou um número menor de neurônios nos casos que em controles (p < 0,05). Curiosamente, na análise de densidade neuronal das camadas corticais, apenas a camada IV não apresentou diferença estatisticamente significante entre casos e controles. CONCLUSÕES: Nossos achados mostram que alterações no COF podem estar envolvidas com a fisiopatologia do TOC ou TAB, e indicam que podem haver interações entre elas e, além disso, concordam com estudos de imagem funcional e de atividades cerebrais na região MO que nos faz refletir que além de uma perda neuronal, há também uma hipoativação e uma redução funcional. Estudos com um número maior de amostras e com diferenciação celular poderão trazer novas contribuições para o entendimento da fisiopatologia desses transtornos neuropsiquiátricos / INTRODUCTION: Bipolar disorder (BD) and obsessive compulsive disorder (OCD) are within the ten medical condition promoving incapacity worldwide. To date, their neuropathological substrates are yet to be disclosed. Postmortem studies designed to estimate cytoarchitectonic and molecular changes for clinical and imaging correlation, have the potencial to undercover pathophysiological aspects of these conditions. OBJECTIVE: Objective: To compare neuronal density, volume and total neuron number of orbitofrontal cortex (OFC) as a whole and divided by sub-regions: anteromedial (AM), medio-orbitofrontal (MO) and antero-lateral (AL) among BD, OCD and matched controls. METHODS: We used 17 postmortem brains sourced from the Psy- BBBABSG. All the subject were older than 50 years and were classified based on clinical evaluation in BD, OCD and healthy control. Subjects were matched by age, gender and brain hemisphere. One hemisphere were perfusion fixed with 20% formalin and used for neuroestereological studies. The second hemisphere had ROIs dissected and snap frozen for future molecular studies. OUTCOMES: Neuron density in OFC and the sub-regions were decreased in cases vs. controls (p < 0,05). This result was observed in cortical layers analyses with exception of layer IV. We did not observed significant changes in volume. The MO sub-region had reduced total neuron number in cases than in controls (p < 0,05). CONCLUSION: Ours results suggest that OFC changes may be part of BD and OCD pathogenesis. These results go in line with functional imaging findings. Further studies with a higher number of cases and adressing specific neuron types are needed