A randomized clinical trial of home-based telepsychiatric outpatient care via videoconferencing: design, methodology, and implementation

Background Healthcare providers are continuously challenged to find innovative, cost-effective alternatives and to scale up existent services to meet the growing demand upon mental health care delivery. Due to continuous advances in technologies, telepsychiatry has become an effective tool for psychiatric care. In 2012, the Institute of Psychiatry of the University of São Paulo Medical School started a randomized clinical trial of home-based telepsychiatric outpatient care via videoconferencing. Objective The objective of this article is to describe the design, methodology and implementation of a pilot project, which aimed to verify the applicability and efficiency of psychiatric attendance via Internet-based videoconferencing in a resource-constrained environment. Methods The project consisted of a 12 months follow-up study with a randomized clinical trial, which compared various quality indicators between home-based telepsychiatric aftercare via videoconferencing and face-to-face aftercare. Results The final sample comprised 107 outpatients (53 in the telepsychiatry group and 54 in the control group). Among 1,227 realized consultations, 489 were held by videoconferencing. Satisfaction with the aftercare by videoconferencing and the medication delivery was high among patients. Attending psychiatrists were satisfied with the assistance by videoconferencing. Discussion The experiences during this pilot project have overall been very positive and psychiatric outpatient care by videoconferencing seems viable to treat patients even in a resource-constrained environment

An overview of the spindle assembly checkpoint status in oral cancer

Abnormal chromosome number, or aneuploidy, is a common feature of human solid tumors, including oral cancer. Deregulated spindle assembly checkpoint (SAC) is thought as one of the mechanisms that drive aneuploidy. In normal cells, SAC prevents anaphase onset until all chromosomes are correctly aligned at the metaphase plate thereby ensuring genomic stability. Significantly, the activity of this checkpoint is compromised in many cancers. While mutations are rather rare, many tumors show altered expression levels of SAC components. Genomic alterations such as aneuploidy indicate a high risk of oral cancer and cancer-related mortality, and the molecular basis of these alterations is largely unknown. Yet, our knowledge on the status of SAC components in oral cancer remains sparse. In this review, we address the state of our knowledge regarding the SAC defects and the underlying molecular mechanisms in oral cancer, and discuss their therapeutic relevance, focusing our analysis on the core components of SAC and its target Cdc20.CESPU [02-GCQF-CICS-2011N, 01-GCD-CICS-09; 02-GCD-CICS-09, 05-GCD-CICS-2011]; Fundacao para a Ciencia e a Tecnologia (FCT) [CEQUIMED-PEst-OE/SAU/UI4040/2011]

Effect of Tumor Necrosis Factor Inhibitor Therapy on Osteoclasts Precursors in Rheumatoid Arthritis

Objective. Tumor necrosis factor (TNF) increases circulating osteoclast (OC) precursors numbers by promoting their proliferation and differentiation. The aim of this study was to assess the effect of TNF inhibitors (TNFi) on the differentiation and activity of OC in rheumatoid arthritis (RA) patients. Methods. Seventeen RA patients treated with TNFi were analyzed at baseline and after a minimum follow-up period of 6 months. Blood samples were collected to assess receptor activator of nuclear factor kappa-B ligand (RANKL) surface expression on circulating leukocytes and frequency and phenotype of monocyte subpopulations. Quantification of serum levels of bone turnover markers, in vitro OC differentiation assays, and qRT-PCR for OC specific genes was performed. Results. After TNFi therapy, patients had reduced RANKL surface expression in B-lymphocytes and the frequency of circulating classical CD14(bright) CD16-monocytes was decreased. Serum levels of sRANKL, sRANKL/OPG ratio, and CTX-I were reduced in RA patients after TNFi treatment. Moreover, after exposure to TNFi, osteoclast differentiation and activity were decreased, as well as the expression of TRAF6 and cathepsin K. Conclusion. We propose that TNFi arrests bone loss and erosion, through two pathways: direct reduction of osteoclast precursor numbers and inhibition of intracellular signaling pathways acting through TRAF6.Peer reviewe

Life-long environmental enrichment counteracts spatial learning, reference and working memory deficits in middle-aged rats subjected to perinatal asphyxia

Continuous environmental stimulation induced by exposure to enriched environment (EE) has yielded cognitive benefits in different models of brain injury. Perinatal asphyxia results from a lack of oxygen supply to the fetus and is associated with long lasting neurological deficits. However, the effects of EE in middle aged rats suffering perinatal asphyxia are unknown. Therefore, the aim of the present study was to assess whether life long exposure to EE could counteract the cognitive and behavioral alterations in middle aged asphyctic rats. Experimental groups consisted of rats born vaginally (CTL), by cesarean section (C+), or by C+ following 19 min of asphyxia at birth (PA). At weaning, rats were assigned to standard (SE) or enriched environment (EE) for 18 months. During the last month of housing, animals were submitted to a behavioral test battery including Elevated Plus Maze, Open Field, Novel Object Recognition and Morris water maze (MWM). Results showed that middle aged asphyctic rats, reared in SE, exhibited an impaired performance in the spatial reference and working memory versions of the MWM. EE was able to counteract these cognitive impairments. Moreover, EE improved the spatial learning performance of middle aged CTL and C+ rats. On the other hand, all groups reared in SE did not differ in locomotor activity and anxiety levels, while EE reduced locomotion and anxiety, regardless of birth condition. Recognition memory was altered neither by birth condition nor by housing environment. These results support the importance of environmental stimulation across the lifespan to prevent cognitive deficits induced by perinatal asphyxia.Fil: Galeano, Pablo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Bioquimicas de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas (i); ArgentinaFil: Blanco, Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Bioquimicas de Buenos Aires; Argentina. Instituto de Investigaciones Bioquímicas de Málaga; España. Universidad de Malaga; EspañaFil: Logica Tornatore, Tamara Maite Ayelén. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas (i); ArgentinaFil: Romero, Juan Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas (i); ArgentinaFil: Holubiec, Mariana Ines. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas (i); ArgentinaFil: Rodríguez de Fonseca, Fernando. Universidad de Malaga; EspañaFil: Capani, Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas (i); Argentin

Isolation of a laccase-coding gene from the lignin-degrading fungus Phlebia brevispora BAFC 633 and heterologous expression in Pichia pastoris

Aims: Isolate and characterize a laccase-encoding gene (lac I) of Phlebia brevispora BAFC 633, as well as cloning and expressing cDNA of lac I in Pichia pastoris. And to obtain a purified and characterized recombinant laccase to analyse the biotechnological application potential. Methods and Results: Lac I was cloned and sequenced, it contains 2447 pb obtained by PCR and long-distance inverse PCR. Upstream of the structural region of the laccase gene, response elements such as metals, antioxidants, copper, nitrogen and heat shock were found. The coding region consisted of a 1563-pb ORF encoding 521 amino acids. Lac I was functionally expressed in P. pastoris and it was shown that the gene cloned using the α-factor signal peptide was more efficient than the native signal sequence, in directing the secretion of the recombinant protein. Km and highest kcat/Km values towards ABTS, followed by 2,6-dimethylphenol, were similar to other laccases. Lac I showed tolerance to NaCl and solvents, and nine synthetic dyes could be degraded to different degrees. Conclusions: Lac I-encoding gene could be successfully sequenced having cis-acting elements located at the regulatory region. It was found that lac I cDNA expressed in P. pastoris using the α-factor signal peptide was more efficient than the native signal sequence. The purified Lac I exhibited high tolerance towards NaCl and various solvents and degraded some recalcitrant synthetic dyes. Significance and Impact of the Study: The cis-acting elements may be involved in the transcriptional regulation of laccase gene expression. These results may provide a further insight into potential ways of optimizing fermentation process and also open new frontiers for engineering strong promoters for laccase production. The Lac I stability in chloride and solvents and broad decolorization of synthetic dyes are important for its use in organic synthesis work and degradation of dyes from textile effluents respectively.Fil: Fonseca, Maria Isabel. Universidad Nacional de Misiones. Facultad de Ciencias Exactas, Químicas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Molina, Melisa Antonella. Universidad Nacional de Misiones. Facultad de Ciencias Exactas, Químicas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Winnik, D. L.. Universidad Nacional de Misiones. Facultad de Ciencias Exactas, Químicas y Naturales; ArgentinaFil: Busi, María Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario. Centro de Estudios Fotosintéticos y Bioquímicos. Universidad Nacional de Rosario. Facultad de Ciencias Bioquímicas y Farmacéuticas. Centro de Estudios Fotosintéticos y Bioquímicos; ArgentinaFil: Fariña, Julia Ines. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Planta Piloto de Procesos Industriales Microbiológicos; ArgentinaFil: Villalba, Laura. Universidad Nacional de Misiones. Facultad de Ciencias Exactas, Químicas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Zapata, Pedro Dario. Universidad Nacional de Misiones. Facultad de Ciencias Exactas, Químicas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Anti-TNF drugs for chronic uveitis in adults : a systematic review and meta-analysis of randomized controlled trials

Copyright © 2019 Leal, Rodrigues, Sousa, Duarte, Romão, Marques-Neves, Costa and Fonseca. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Background: We aimed to assess efficacy and safety of anti-tumor necrosis factor (TNF) drugs for adult chronic non-infectious uveitis (NIU). Methods: CENTRAL, MEDLINE, and EMBASE, were searched from inception to January 2019. Double-masked randomized placebo-controlled trials, assessing any anti-TNF vs. best medical intervention/standard of care in adults with chronic NIU were considered. The PRISMA and SAMPL guidelines were followed. The risk of bias was assessed using the Cochrane risk of bias tool. Overall quality of the evidence was assessed according to GRADE. PROSPERO registration: #CRD42016039068. The primary efficacy and safety outcomes were preservation of visual acuity (VA) and withdrawals due to adverse events, respectively. Meta-analysis of efficacy analysis was not performed due to significant clinical heterogeneity between studies' population and interventions. Results: A total of 1,157 references were considered and 3 studies were included. The overall risk of bias was moderate. In active NIU, adalimumab group showed an increased likelihood of VA preservation (risk ratio (RR) 1.75, 95%CI 1.32 to 2.32, n = 217), whereas the etanercept group did not (RR 0.81, 95%CI 0.57 to 1.14, n = 20). In inactive NIU, adalimumab was associated with increased likelihood of VA preservation (RR 1.31, 95%CI 1.12 to 1.53, n = 226). The rate of adverse events did not differ between anti-TNF and control arms (RR 1.03, 95%CI 0.94 to 1.13, n = 410). Conclusions: There is high quality evidence that adalimumab decreases the risk of worsening VA in active and inactive NIU and very low quality evidence that the risk of etanercept worsening VA in inactive NIU is not different from placebo. Moderate quality evidence suggests that anti-TNF agents are not different from placebo on the risk of study withdrawal.This project received a research grant from a non-profit and scientific organization, Portuguese Society of Ophthalmology (Sociedade Portuguesa de Oftalmologia). UID/BIM/50005/2019, project funded by Fundação para a Ciência e a Tecnologia (FCT)/Ministério da Ciência, Tecnologia e Ensino Superior (MCTES) through Fundos do Orçamento de Estado (Portuguese State Funding).info:eu-repo/semantics/publishedVersio

Acylethanolamides and endocannabinoid signaling system in dorsal striatum of rats exposed to perinatal asphyxia

Endocannabinoids (eCBs) and acylethanolamides (AEs) have lately received more attention due to their neuroprotective functions in neurological disorders. Here we analyze the alterations induced by perinatal asphyxia (PA) in the main metabolic enzymes and receptors of the eCBs/AEs in the dorsal striatum of rats. To induce PA, we used a model developed by Bjelke et al. (1991). Immunohistochemical techniques were carried out to determine the expression of neuronal and glial markers (NeuN and GFAP), eCBs/AEs synthesis and degradation enzymes (DAGLα, NAPE-PLD and FAAH) and their receptors (CB1 and PPARα). We found a decrease in NAPE-PLD and PPARα expression. Since NAPE-PLD and PPARα take part in the production and reception of biochemical actions of AEs, such as oleoylethanolamide, these results may suggest that PA plays a key role in the regulation of this system. These data agree with previous results obtained in the hippocampus and encourage us to develop further studies using AEs as potential neuroprotective compounds.Fil: Holubiec, Mariana Ines. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; ArgentinaFil: Romero, Juan Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Bioquímicas de Buenos Aires. Fundación Instituto Leloir. Instituto de Investigaciones Bioquímicas de Buenos Aires; ArgentinaFil: Blanco, Eduardo. Universidad de Málaga; España. Universidad de Lleida; EspañaFil: Logica Tornatore, Tamara Maite Ayelén. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; ArgentinaFil: Suarez, Juan. Universidad de Málaga; EspañaFil: Rodríguez de Fonseca, Fernando. Universidad de Málaga; EspañaFil: Galeano, Pablo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Bioquímicas de Buenos Aires. Fundación Instituto Leloir. Instituto de Investigaciones Bioquímicas de Buenos Aires; ArgentinaFil: Capani, Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; Argentina. Universidad Argentina "John F. Kennedy"; Argentina. Universidad de Chile; Chil

Femtosecond-laser direct writing for spatially localized synthesis of PPV

Poly(p-phenylenevinylene), or PPV, is a polymer of great technological relevance due to its electroluminescence properties, which have been exploited in organic light emitting diodes, flexible displays and other optoelectronic devices. Although PPV is a material of foremost importance for many applications, its synthesis on the nano/microscale cannot be achieved through the standard method that uses heating of a precursor polymer. This paper shows how direct laser writing with femtosecond pulses can be employed for the synthesis of PPV in pre-determined regions, allowing a novel approach towards the precise fabrication of complex polymeric microcircuits. The physical-chemical phenomena involved in the conversion of the precursor into PPV are shown to be related to a two-photon induced thermal process, which is confined to the focal volume, resulting in the controlled synthesis of PPV

O funcionamento familiar em famílias com filhos adultos com deficiência: estudo descritivo-correlacional

Background: the presence of a child with a disability is an overwhelming challenge. Each family is unique, with its own needs, and promoting healthy family functioning is essential for the individual and collective health of its members. Objectives: characterize families with an adult child with disabilities and understand their family functioning. Methodology: correlational descriptive study, non-probabilistic convenience sample, of forty families whose children attend an institution in the district of Guarda. Data collected through a questionnaire, subject to descriptive and inferential statistics (Nonparametric Mann-Whitney and Kruskal-Wallis U tests). Results: the majority of the sample consists of children aged between 31 and 45 years, similarly distributed by sex. Most families have balanced levels of family functioning. The female gender positively influences the cohesion and communication subscale and the male gender the dismembered and chaotic subscale. Families with younger children are related to higheraverages on the tangled subscale, as well as those with physical disabilities. Conclusion: the existence of a disability interferes with family functioning, with differences regarding the sex and age of the disabled child. The family nurse, a decisive element in the diagnostic approach, develops strategies and creates multidisciplinary programs aimed at these families.Marco contextual: la presencia de un niño con una discapacidad es un desafío abrumador. Cada familia es única, con sus propias necesidades, y promover un funcionamiento familiar saludable es fundamental para la salud individual y colectiva de sus miembros. Objetivos: caracterizar familias con un hijo adulto con discapacidad y comprender su funcionamiento familiar. Metodología: estudio descriptivo correlacional, muestra no probabilística por conveniencia, de cuarenta familias cuyos hijos asisten a una institución del distrito de Guarda. Datos recolectados a través de un cuestionario, sujeto a estadística descriptiva e inferencial (pruebas U no paramétricas de Mann-Whitney y Kruskal-Wallis). Resultados: la mayoría de la muestra está compuesta por niños con edades comprendidas entre 31 y 45 años, igualmente distribuidos por sexo. La mayoría de las familias tienen niveles equilibrados de funcionamiento familiar. El género femenino influye positivamente en la subescala cohesión y comunicación y el género masculino en la subescala desmembrado y caótico. Las familias con niños más pequeños se relacionan con promedios más altos en la subescala de enredados, así como aquellas con discapacidades físicas. Conclusión: la existencia de una discapacidad interfiere en el funcionamiento familiar, existiendo diferencias en cuanto al sexo y edad del hijo discapacitado. La enfermera de familia, elemento decisivo en el abordaje diagnóstico, desarrolla estrategias y crea programas multidisciplinares dirigidos a estas familias.Enquadramento: a presença de um filho com deficiência é um desafio avassalador. Cada família é única, com necessidades próprias e promover um funcionamento familiar saudável é essencial para a saúde individual e coletiva dos seus membros. Objetivos: caraterizar as famílias com filho adulto com deficiência e compreender o funcionamento familiar das mesmas. Metodologia: estudo descritivo correlacional, amostra não probabilística por conveniência, de quarenta famílias cujos filhos frequentam uma instituição do distrito da Guarda. Dados recolhidos através de questionário, sujeitos a estatística descritiva e inferencial (testes não paramétricos U de Mann-Whitney e Kruskal-Wallis). Resultados: a generalidade da amostra é constituída por filhos com idades entre 31 e 45 anos, semelhantemente distribuídas por sexo. A maioria das famílias apresenta níveis de funcionamento familiar equilibrados. O sexo feminino influencia positivamente a subescala coesão e comunicação e o masculino a desmembrada e caótica. Às famílias com filhos mais novos estão relacionadas a médias superiores na subescala emaranhada, bem como nos que apresentam deficiência física. Conclusão: a existência de uma deficiência interfere no funcionamento familiar, com diferenças quanto ao sexo e idade do filho com deficiência. O enfermeiro de família, elemento decisivo na abordagem diagnóstica, elabora estratégias e cria programas multidisciplinares direcionados a estas famílias

Atividade antioxidante dos extratos etanólicos e dos óleos essenciais de Xylopia aromática e Piper nigrum / Antioxidant activity of ethanolic extracts and essential oils from Xylopia aromatica and Piper nigrum

Xylopia aromatica é conhecida como pimenta-de-macaco, pertence à família Annonaceae, e já no século XIX, o naturalista Saint-Hilaire a considerava com potencial de uso alimentício, pois seu sabor era similar à pimenta-do-reino. A pimenta-do-reino é um condimento, que também é utilizado para conservação de carnes e extração de óleo essencial. Assim, objetivou-se com essa pesquisa comparar o teor, atividade antioxidante e composição química dos óleos essenciais de frutos de pimenta-de-macaco e pimenta-do-reino (branca e preta). A pimenta-de-macaco (PM) foi coletada em áreas do Cerrado, e as pimentas do reino branca (PB) e preta (PP) adquiridas no comércio local. Os frutos foram triturados e a extração do óleo essencial realizada pelo método de hidrodestilação utilizando aparelho de Clevenger. O teor de óleo foi determinado com base na massa de óleo extraída (g) por 100 g de frutos. A atividade antioxidante foi avaliada por meio do sequestro do radical livre 2,2-difenil-1-picrilhidrazila (DPPH), e os resultados expressos em porcentagem de capacidade de redução de DPPH. O delineamento estatístico utilizado foi o inteiramente casualizado, sendo três tratamentos (PM, e PB e PP), com seis repetições. As análises cromatográficas foram realizadas em cromatógrafo a gás, Agilent Technologies (GC 7890A), acoplado ao detector espectrômetro de massas (MS 5975C) dotado de coluna capilar HP-5 MS. As análises estatísticas foram realizadas no programa estatístico R. A PM apresentou rendimento de óleo essencial de 0,35 %, enquanto que as PP e PB apresentaram rendimento de 0,98 %, e 1,08 %, respectivamente. A capacidade de redução de DPPH foi de 21,13% para PM, e 12,68% e 5,48% para as PP e PB, respectivamente. Na análise química dos óleos essenciais, considerando compostos que representavam mais de 1% de abundância no óleo da PM, foram detectados 82 compostos, enquanto que nas PP e PB foram detectados 57 e 47 respectivamente. O composto mais abundante na PM (29,5%) e PB (39,7%) foi o Limoneno, já na PP (11,2%) este foi segundo composto com maior abundância, sendo o Cariofileno (46,2%) o principal para a PP. Diante dos resultados a pimenta-de-macaco apresenta rendimento de óleo menor que as pimentas do reino branca e preta, no entanto, sua capacidade de redução de DPPH é maior que as demais pimentas avaliadas, tendo também maior número de compostos detectados