Detection of epithelial apoptosis in pelvic ileal pouches for ulcerative colitis and familial adenomatous polyposis

<p>Abstract</p> <p>Background</p> <p>Ileal pouch-anal anastomosis (IPAA) is the surgical procedure of choice for patients with refractory ulcerative colitis (UC) and for familial adenomatous polyposis (FAP) with many rectal polyps. Pouchitis is one of the more frequent complications after IPAA in UC patients; however, it is rare in FAP.</p> <p>Objective</p> <p>Evaluate pro-apoptotic activity in endoscopically and histological normal mucosa of the ileal pouch in patients with UC and FAP.</p> <p>Methods</p> <p>Eighteen patients (nine with UC and nine with FAP) with J pouch after total rectocolectomy were studied. Biopsies were obtained from the mucosa of the pouch and from normal ileum. The specimens were snap-frozen and the expressions of Bax and Bcl-2 were determined by immunoblot of protein extracts and by immunohistochemistry analysis. FADD, Caspase-8, APAF-1 and Caspase-9 were evaluated by immunoprecipitation and immunoblot.</p> <p>Results</p> <p>Patients with UC had significantly higher protein levels of Bax and APAF-1, Caspase-9 than patients with FAP, but were similar to controls. The expressions of Bcl-2 and FADD, Caspase-8 were similar in the groups. Immunohistochemistry for Bax showed less intensity of immunoreactions in FAP than in UC and Controls. Bcl-2 immunostaining was similar among the groups.</p> <p>Conclusion</p> <p>Patients with FAP present lower levels of pro-apoptotic proteins in all methods applied, even in the absence of clinical and endoscopic pouchitis and dysplasia in the histological analysis. These findings may explain a tendency of up-regulation of apoptosis in UC patients, resulting in higher rates of progression to pouchitis in these patients, which could correlate with mucosal atrophy that occurs in inflamed tissue. However, FAP patients had low pro-apoptotic activity in the mucosa, and it could explain the tendency to low cell turn over and presence of adenomas in this syndrome.</p

5-azacytidine improves the osteogenic differentiation potential of aged human adipose-derived mesenchymal stem cells by DNA demethylation

The therapeutic value of adipose-derived mesenchymal stem cells (Ad-MSCs) for bone regeneration is critically discussed. A possible reason for reduced osteogenic potential may be an age-related deterioration of the Ad-MSCs. In long term in vitro culture, epigenomic changes in DNA methylation are known to cause gene silencing, affecting stem cell growth as well as the differentiation potential. In this study, we observed an age-related decline in proliferation of primary human Ad-MSCs. Decreased Nanog, Oct4 and Lin28A and increased Sox2 gene-expression was accompanied by an impaired osteogenic differentiation potential of Ad-MSCs isolated from old donors (>60 a) as compared to Ad-MSCs isolated from younger donors (<45 a). 5-hydroxymethylcytosine (5 hmC) and 5-methylcytonsine (5 mC) distribution as well as TET gene expression were evaluated to assess the evidence of active DNA demethylation. We observed a decrease of 5 hmC in Ad-MSCs from older donors. Incubation of these cells with 5-Azacytidine induced proliferation and improved the osteogenic differentiation potential in these cells. The increase in AP activity and matrix mineralization was associated with an increased presence of 5 hmC as well as with an increased TET2 and TET3 gene expression. Our data show, for the first time, a decrease of DNA hydroxymethylation in Ad-MSCs which correlates with donor-age and that treatment with 5-Azacytidine provides an approach which could be used to rejuvenate Ad-MSCs from aged donors

Risco de tração excessiva nas lesões tipo distração-flexão da coluna cervical baixa Risk of excessive traction on distraction-flexion-type injuries of the low cervical spine

O estudo em questão visa avaliar a relação entre risco e benefício do uso de tração com halo craniano como alternativa para estabilização nas fraturas-luxações por mecanismo de distração-flexão tipo IV de Allen e Ferguson, considerando a natureza da lesão, seu extenso dano ligamentar e o risco de apresentar distração excessiva e conseqüente lesão da medula espinhal. Para tanto, realizamos uma análise retrospectiva no IOT-HC-FMUSP envolvendo um período de 10 anos, quando 34 casos foram diagnosticados como fratura-luxação por distração-flexão da coluna cervical baixa, sendo 12 deles do tipo IV. Todos foram submetidos à tração esquelética com halo craniano num momento inicial. Durante o controle radiográfico seqüencial, observou-se distração excessiva em sete casos, mesmo com baixo peso inicial (4 kg). Em dois pacientes houve surgimento de nistagmo. Em todos os casos a tração foi retirada e seguiu-se normalização do quadro clínico.<br>This study aims to evaluate the risk/ benefit ratio in the use of traction with cranial halo as an alternative to stabilize fractures-dislocations by Allen & Ferguson's type IV- distraction-flexion mechanism, considering the nature of the injury, its extensive ligament damage and the risk of presenting excessive distraction and resultant spinal cord injury. Thus, we performed a retrospective analysis at IOT-HC-FMUSP comprising a period of 10 years, when 34 cases were diagnosed as fractures-dislocations due to distraction-flexion of the low cervical spine, of which 12 were IV-type. All individuals have been submitted to skeletal traction with cranial halo at an early phase. During sequential X-ray management, an excessive distraction was seen in seven cases, even with initial light weight (4 kg). In two patients, the onset of nistagmus was seen. In all cases, traction was removed, which was followed by stabilization of the clinical picture

Rotulagem de suplementos vitamínicos e minerais: uma revisão das normas federais Labeling of vitamin and mineral supplements: a revision of the federal normative regulations

Os produtos à base de vitaminas e minerais têm tido a oferta e o consumo crescentes no Brasil. As diferenças nas dosagens oferecidas ao consumidor em cada produto são o parâmetro para sua classificação como suplementos alimentares ou como medicamentos, de acordo com a legislação sanitária brasileira. Entretanto, este limite entre os conceitos é confuso e pouco claro. Considerando o risco gerado pelo consumo desavisado de tais produtos, e visando facilitar a interpretação e a consolidação das normas que tratam dos produtos à base de vitaminas e minerais e fundamentar a dissertação de mestrado, foram realizados levantamento bibliográfico e avaliação de todo o arcabouço jurídico relacionado à sua rotulagem. Concluiu-se que a normatização é extensa, complexa e de difícil entendimento, com muitas normas de hierarquias diferentes tendo interface com o assunto e que as normas não estão consolidadas, levando a dificuldades de interpretação pelos comerciantes, profissionais de saúde e consumidores e ainda a falhas na aplicação por parte dos órgãos fiscalizadores do Estado. Foram também apresentadas propostas para auxiliar a correção das falhas explicitadas pelo estudo.<br>In Brazil, there is a steadily increasing offer and demand for products on the basis of vitamins and minerals. According to Brazilian law, the differences in the dosages offered to the consumer in each product are the parameter for its classification as alimentary supplement or medicament. The limit between these two concepts, however, is confusing and lacks clearness. Considering the risk posed by imprudent consumption of such products and seeking to facilitate the interpretation and consolidation of the norms dealing with vitamin and mineral products as well as to create the basis for a master's degree dissertation, a bibliographical survey and evaluation of the entire juridical basis regarding the labeling of these products was conducted. It was concluded that the normative regulations are extensive, complex and of difficult understanding, with a great number of norms dealing with the same subject issued by different authorities. These norms are not consolidated leading to difficult interpretation by retailers, health professionals and consumers and even to failures in the application of these norms by the control authorities. Suggestions are made for helping to correct the failures identified in the study

Estudo comparativo dos procedimentos percutâneos orientados por métodos de imagem no tratamento das coleções hepáticas A comparative study of image-guided percutaneous procedures for the treatment of liver abscesses

OBJETIVO: Verificar e comparar a eficácia da punção aspirativa e da drenagem percutânea, orientadas por métodos de imagem, no tratamento das coleções hepáticas. MATERIAIS E MÉTODOS: Foram encaminhados, ao nosso setor, 52 pacientes para tratamento percutâneo de coleções abdominais. Destes, 17 apresentavam coleções hepáticas, sendo 13/17 não-complexas e 4/17, complexas (multiloculadas, múltiplas ou associadas a fístulas). Foram submetidas a punção aspirativa 7/17 coleções (41,2%) e a drenagem percutânea, 10/17 (58,8%). Considerou-se como sucesso do método a resolução completa da coleção, com melhora clínica e laboratorial do paciente. RESULTADOS: O sucesso do procedimento ocorreu em 82,4% dos casos. Nas coleções submetidas exclusivamente a punção aspirativa, obteve-se sucesso em 57,1%, enquanto nas submetidas a drenagem percutânea o sucesso foi de 100%. O índice de sucesso no grupo submetido a punção aspirativa foi de 75% nas coleções menores que 100 ml, e de 33,3% naquelas entre 100 e 250 ml. Houve sucesso com a punção aspirativa em 75% das coleções não-complexas e em 25% das complexas. CONCLUSÃO: A drenagem percutânea é mais eficaz que a punção aspirativa no tratamento das coleções hepáticas. A punção aspirativa talvez possa ser empregada como alternativa válida nas coleções de menor volume e não-complexas.<br>OBJECTIVE: To determine and compare the efficacy of percutaneous needle aspiration and percutaneous catheter drainage, both guided by imaging methods, for the treatment of liver abscesses. MATERIALS AND METHODS: From 52 patients referred to our service for percutaneous treatment of abdominal abscesses, 17 presented liver abscesses, 13 of which were considered noncomplex and four were considered complex (multiloculated, multiple or associated to fistulas). Percutaneous needle aspiration was performed in 7/17 patients and 10/17 patients were submitted to percutaneous catheter drainage. The method used was considered successful when there was complete abscess resolution with both clinical and laboratorial improvement. RESULTS: The procedures were successful in 82.4% of all cases. In the group submitted to percutaneous needle aspiration the rate of success was 57.1% and in the group submitted to percutaneous catheter drainage the rate of success was 100%. Successful treatment was achieved in 75% of the patients submitted to percutaneous needle aspiration for abscesses smaller than 100 ml, but in only 33.3% of the patients with abscesses between 100 and 250 ml. There was complete resolution of the abscesses with percutaneous needle aspiration in 75% of the simple abscesses and in 25% of the complex abscesses. CONCLUSION: Percutaneous catheter drainage is more effective than percutaneous needle aspiration for the treatment of liver abscesses. Needle aspiration may probably be used as a valid alternative for smaller and noncomplex abscesses