Respiratory mechanics do not always mirror pulmonary histological changes in emphysema

OBJECTIVE: To verify the accordance of functional and morphometric parameters during the development of emphysema. METHODS: BALB/c mice received a nasal drop of either papain or saline solution and were studied after 1, 3, 15, 28, and 40 days. Functional parameters, such as airway resistance, tissue damping, and tissue elastance, were analyzed. To evaluate the structural changes and possible mechanisms involved in this disease, we measured the mean linear intercept, the volume proportions of elastic and collagen fibers, the number of macrophages, the numbers of cells expressing metalloprotease 12 and 8-isoprostane in lung parenchyma. RESULTS: We only observed decreases in tissue elastance and tissue damping on the 28th day, with a concomitant increase in the mean linear intercept, indicating the presence of emphysema. However, only the mean linear intercept values remained increased until the 40th day. The volume proportion of collagen fibers was increased from the 15th day to the 40th day, whereas the volume proportion of elastic fibers was only increased on the 40th day. The number of macrophages increased beginning on the 1st day. The expression of metalloproteinase 12 was increased from the 3rd day until the 40th day. However, 8-isoprostane expression was only increased on the 1st and 3rd days. CONCLUSIONS: In this study, morphometric parameters were found to be more reliable for detecting the presence of emphysema than the functional parameters measured by respiratory mechanics. Further investigations are necessary to understand how the extracellular matrix remodeling observed in the lung parenchyma could be involved in this process

Medical students’ quality of life: does the learning environment matter?

Introdução: A qualidade de vida e a saúde mental dos estudantes de medicina podem afetar o seu desempenho acadêmico, suas habilidades e atitudes com pacientes. Evidências recentes confirmam a importância do ambiente educacional como um dos determinantes da saúde mental e qualidade de vida. Este estudo teve o objetivo de avaliar diferentes aspectos da qualidade de vida dos estudantes de medicina brasileiros em todos os anos do curso. Casuística e Métodos: Estudo transversal de abrangência nacional, com a utilização de questionário validado de qualidade de vida específico para o estudante da área da saúde (Veras-q). Resultados: De uma amostra aleatória de 1.650 estudantes, em 22 escolas médicas de diferentes regiões do país, 1.350 (81,8%) participaram do estudo. Os coeficientes de alfa Cronbach dos domínios do Veras-q variaram entre 0,77 e 0,82. Estudantes do sexo feminino apresentaram menores escores de qualidade de vida nos domínios físico, psicológico e uso do tempo, quando comparadas a seus colegas do sexo masculino (p<0,05; d<0,5). A percepção de qualidade de vida relacionada ao ambiente de ensino também foi menor entre estudantes dos últimos anos do curso (p<0,001; f<0,25), principalmente entre as mulheres (p<0,001; f=0,22). Conclusões: Estudantes do sexo feminino apresentaram pior percepção de qualidade de vida do que seus colegas do sexo masculino. Estudantes dos anos mais avançados do curso, principalmente as mulheres, apresentaram pior percepção de qualidade de vida no domínio ambiente de ensino quando comparados aos estudantes dos anos iniciais. Este estudo demonstra o impacto do ambiente educacional na qualidade de vida dos estudantes de Medicina e sugere que intervenções institucionais que aprimorem o ambiente, estimulem a formação de redes de suporte e promovam o bem-estar dos estudantes devem ser implementadas e avaliadas.Introduction: Medical students’ quality of life and mental health may affect their academic performance and their attitudes towards medical care. Recent evidence shows a preponderant role of the learning environment in the quality of life of medical students. This study aimed to assess Brazilian medical students’ quality of life throughout all years of medical school. Methods: Cross-sectional multi-centric study with the use of a quality of life questionnaire, validated for specific use among health sciences students (Veras-q). RESULTS: From a random sample of 1,650 students, 1,350 (81.8%) participated in the study. Cronbach’s alpha coefficients for Veras-q domains ranged from 0.77 to 0.82. Female students had lower scores on physical, psychological and time management domains of quality of life compared to male students (p<0.05; d<0.5). Perceptions of quality of life on the learning environment were also lower among students in the final years of medical school (p<0.001; f<0.25), especially among female students (p<0.001; f= 0.22). CONCLUSIONS: Female students showed worse perception of quality of life than their male counterparts. Students from more advanced years of medical school, especially women, also showed lower perception of quality of life in the learning environment domain. Institutional interventions directed to students at higher risk of low quality of life should be implemented and evaluated in further studies. This study demonstrates the impact of the learning environment on medical students’ quality of life, suggesting that institutional interventions designed to improve students’ well being such as the supporting networks must be adequately implemented and assessed

Effects of Anti-IL-17 on Inflammation, Remodeling, and Oxidative Stress in an Experimental Model of Asthma Exacerbated by LPS

Inflammation plays a central role in the development of asthma, which is considered an allergic disease with a classic Th2 inflammatory profile. However, cytokine IL-17 has been examined to better understand the pathophysiology of this disease. Severe asthmatic patients experience frequent exacerbations, leading to infection, and subsequently show altered levels of inflammation that are unlikely to be due to the Th2 immune response alone. This study estimates the effects of anti-IL-17 therapy in the pulmonary parenchyma in a murine asthma model exacerbated by LPS. BALB/c mice were sensitized with intraperitoneal ovalbumin and repeatedly exposed to inhalation with ovalbumin, followed by treatment with or without anti-IL-17. Twenty-four hours prior to the end of the 29-day experimental protocol, the two groups received LPS (0.1 mg/ml intratracheal OVA-LPS and OVA-LPS IL-17). We subsequently evaluated bronchoalveolar lavage fluid, performed a lung tissue morphometric analysis, and measured IL-6 gene expression. OVA-LPS-treated animals treated with anti-IL-17 showed decreased pulmonary inflammation, edema, oxidative stress, and extracellular matrix remodeling compared to the non-treated OVA and OVA-LPS groups (p < 0.05). The anti-IL-17 treatment also decreased the numbers of dendritic cells, FOXP3, NF-kappa B, and Rho kinase 1-and 2-positive cells compared to the non-treated OVA and OVA-LPS groups (p < 0.05). In conclusion, these data suggest that inhibition of IL-17 is a promising therapeutic avenue, even in exacerbated asthmatic patients, and significantly contributes to the control of Th1/Th2/Th17 inflammation, chemokine expression, extracellular matrix remodeling, and oxidative stress in a murine experimental asthma model exacerbated by LPS.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)National Council of Scientific and the Technological Development (CNPq)Laboratory of Medical InvestigationsUniv Sao Paulo, Sch Med, Dept Med Sci, Sao Paulo, Brazil|Hosp Sirio Libanes, Sao Paulo, BrazilUniv Fed Sao Paulo, Inst Biomed Sci, Dept Biol Sci, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Biol Sci, Sao Paulo, BrazilUniv Fed Sao Paulo, Inst Biomed Sci, Dept Biol Sci, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Biol Sci, Sao Paulo, BrazilFAPESP: 2013/17944-1Laboratory of Medical Investigations: LIM-20 FMUSPWeb of Scienc