El cuerpo: ausente con aviso

El irónico título se basa en la tradicional forma de cuantificar al 'cuerpo presente' en el aula o participando de una clase. No es casual que los responsables de este texto hayan sacado de los convencionalismos el camino de 'enseñar' para comprender que no sería suficiente el abordaje de estos nuevos cuerpos, niños, adolescentes, medios de comunicación e intereses, sin profundizar en el origen de dichas consecuencias, habiendo atravesado un largo camino dotado de ineficiencias, de desgano pero, por sobre todo, de falta de competencia (entendida como desarrollo de capacidades cualitativas) y desembocando en la necesidad de nuevo maestro. El cuerpo esta ausente porque el saber/aprender, se asocian a la concentración (a la 'quietud') pero lo incomprensible es que lo esté en un área que pretende estudiarlo puntualmente. No solo no existe porque nada se hace para comprender por qué hace, sino porque no se dice. Trataremos de-mostrar que saber del cuerpo es situarnos, valorarnos, respetarnos, ayudarnos, representarnos, liberarnos. Que movernos significa corrernos del lugar del que todo lo sabe, que la sociedad insiste en otorgarle a los maestros y transformarnos en un simple canal para el flujo de conocimientos y saberes. “Vivir en armonía con LO PRIMERO, LO HONDO, LO PRIMERO QUE ME TRAJO Y LO ULTIMO QUE VA A DEJARME: MI CUERPO.”Facultad de Humanidades y Ciencias de la Educació

El cuerpo: ausente con aviso

El irónico título se basa en la tradicional forma de cuantificar al 'cuerpo presente' en el aula o participando de una clase. No es casual que los responsables de este texto hayan sacado de los convencionalismos el camino de 'enseñar' para comprender que no sería suficiente el abordaje de estos nuevos cuerpos, niños, adolescentes, medios de comunicación e intereses, sin profundizar en el origen de dichas consecuencias, habiendo atravesado un largo camino dotado de ineficiencias, de desgano pero, por sobre todo, de falta de competencia (entendida como desarrollo de capacidades cualitativas) y desembocando en la necesidad de nuevo maestro. El cuerpo esta ausente porque el saber/aprender, se asocian a la concentración (a la 'quietud') pero lo incomprensible es que lo esté en un área que pretende estudiarlo puntualmente. No solo no existe porque nada se hace para comprender por qué hace, sino porque no se dice. Trataremos de-mostrar que saber del cuerpo es situarnos, valorarnos, respetarnos, ayudarnos, representarnos, liberarnos. Que movernos significa corrernos del lugar del que todo lo sabe, que la sociedad insiste en otorgarle a los maestros y transformarnos en un simple canal para el flujo de conocimientos y saberes. “Vivir en armonía con LO PRIMERO, LO HONDO, LO PRIMERO QUE ME TRAJO Y LO ULTIMO QUE VA A DEJARME: MI CUERPO.”Facultad de Humanidades y Ciencias de la Educació

Video-thoracoscopic pericardial drainage in the treatment of pericardial effusions

OBJECTIVES: To assess efficacy and safety of videothoracoscopic pericardial drainage in the treatment and diagnostic of pericardial effusion through 26 cases review. METHODS: From April 2005 to December 2007, 26 patients with pericardial effusion underwent a video-thoracoscopic pericardial window. Median age was 48.2 years old. Dyspnea was the most frequent symptom followed by thoracic pain. The procedure was performed in lateral decubitus, under general anesthesia and selective intubation with the aid of three trocars. RESULTS: Procedure accomplish was feasible in 25 cases. One conversion occurred. In 61.53% of the cases the procedure was able to modify the initial diagnosis. Microbiology and tissue culture were negative in all cases. Neoplasia was present in nine cases, tuberculosis in two, aspergillosis in one, postoperative heart surgeries in three; lupus in two, uremia in one and idiopathy in eight. Associated pleuropulmonary procedures were performed in four cases. No deaths related to the procedure occurred. One late recurrence was recorded. CONCLUSION: The procedure is feasible, safe, reproducible and allowed an etiologic diagnostic. Specific treatment could be initiated in some cases. The intervention could possibly be the new gold standard treatment of pericardial effusion in selected patients.OBJETIVOS: Analisar a eficácia e a segurança da drenagem pericárdica videotoracoscópica no tratamento e diagnóstico etiológico dos derrames pericárdicos por meio da revisão de 26 casos. MÉTODOS: De abril de 2005 a dezembro de 2007, 26 pacientes com derrame pericárdico foram submetidos ao procedimento. A média etária foi de 48,2 anos. O sintoma mais comum foi dispnéia, seguida por dor torácica. O procedimento foi realizado em decúbito lateral, sob anestesia geral e intubação seletiva, com o auxílio de três trocateres. RESULTADOS: A realização do procedimento foi possível em 25 casos. Ocorreu uma conversão. Em 61,53% dos casos, o procedimento foi capaz de alterar o diagnóstico inicial. Culturas e microbiologia foram negativas em todos os casos. Achados compatíveis com neoplasia estavam presentes em nove casos, tuberculose em dois, aspergilose em um, pós-cirúrgico em três, lúpico em dois, urêmico em um e oito idiopáticos. Em quatro casos, procedimentos pleuropulmonares concomitantes foram realizados. Não ocorreram óbitos relacionados ao procedimento. Ocorreu uma recidiva. CONCLUSÃO: O procedimento demonstrou ser seguro, reprodutível e eficaz, capaz de fornecer diagnóstico etiológico e mudar o curso terapêutico de alguns pacientes. O procedimento pode se tornar o padrão-ouro em doentes selecionados.UNIFESP-EPMUNIFESP, EPMSciEL

Pharmacokinetics and pharmacodynamics of thiopurines in an in\ua0vitro model of human hepatocytes: Insights from an innovative mass spectrometry assay

AIM: To apply an innovative LC-MS/MS method to quantify thiopurine metabolites in human hepatocytes and to associate them to cytotoxicity. METHODS: Immortalized human hepatocytes (IHH cells) were treated for 48 and 96 h, with 1.4 7 10-4 M azathioprine and 1.1 7 10-3 M mercaptopurine, concentrations corresponding to the IC50 values calculated after 96 h exposure in previous cytotoxicity analysis. After treatments, cells were collected for LC-MS/MS analysis to quantify 11 thiopurine metabolites with different level of phosphorylation and viable cells were counted by trypan blue exclusion assay to determine thiopurines in vitro effect on cell growth and survival. Statistical significance was determined by analysis of variance (ANOVA). RESULTS: Azathioprine and mercaptopurine had a significant time-dependent cytotoxic effect (p-value ANOVA = 0.012), with a viable cell count compared to controls of 55.5% and 67.5% respectively after 48 h and 23.7% and 36.1% after 96 h; no significant difference could be observed between the two drugs. Quantification of thiopurine metabolites evidenced that the most abundant metabolite was TIMP, representing 57.1% and 40.3% of total metabolites after 48 and 96 h. Total thiopurine metabolites absolute concentrations decreased over time: total mean content decreased from 469.9 pmol/million cells to 83.6 pmol/million cells (p-value ANOVA = 0.0070). However, considering the relative amount of thiopurine metabolites, TGMP content significantly increased from 11.4% cells to 26.4% (p-value ANOVA = 0.017). A significant association between thiopurine effects and viable cell counts could be detected only for MeTIMP: lower MeTIMP concentrations were associated with lower cell survival (p-value ANOVA = 0.011). Moreover, the ratio between MeTIMP and TGMP metabolites directly correlated with cell survival (p-value ANOVA = 0.037). CONCLUSION: Detailed quantification of thiopurine metabolites in a human hepatocytes model provided useful insights on the association between thioguanine and methyl-thioinosine nucleotides with cell viability

Off-pump transapical balloon-expandable aortic valve endoprosthesis implantation

OBJECTIVE: The aortic valve replacement is a routine procedure, and involves replacement of the native valve/prosthesis. In most of the patients who undergo such procedure the risk is acceptable, but in some cases, such risk can justify contraindication. The minimally invasive transcatheter aortic valve implantation without cardiopulmonary bypass (CPB) has been shown to be viable, with lower morbidity and mortality. The aim of this study was to develop a catheter-mounted aortic bioprosthesis for implantation without CPB. METHODS: After developing in animals, three patients with high EuroSCORE underwent implantation. Case 1: patients with bioprosthesis dysfunction; Case 2: severe aortic stenosis; Case 3: dysfunction of aortic bioprosthesis. After minithoracotomy and under echocardiographic and fluoroscopic control, a balloon catheter was placed on aortic position and inflated. After, a second balloon with valved endoprosthesis was positioned and released under high ventricular rate. Echocardiographic and angiographic controls were performed and the patients were referred to ICU. RESULTS: In the first case, implantation without CPB was possible with appropriate results. The patient evolved with improvement of ventricular function. After, this patient developed bronchopneumonia, tracheoesophageal fistula and died due to mediastinitis. Autopsy confirmed proper valve positioning and leaflets preservation. The second case showed the device migration after inflation of the balloon, with the need for urgent median sternotomy, CPB and conventional valve replacement. This patient evolved well and was discharged from the ICU on the 14th postoperative day without complications. This patient developed respiratory infection, septic shock and died on the 60th postoperative day. The patient from the third case underwent successful implantation. CONCLUSION: The off-pump transapical implantation of catheter-mounted bioprosthesis was shown to be a feasible procedure. Technical details and learning curve require further discussion.OBJETIVO: A troca valvar aórtica é procedimento rotineiro, envolve substituição da valva nativa/prótese. Na maioria destes pacientes o risco é aceitável, porém, em alguns casos, o risco predito pode justificar contra-indicação. O implante de valva aórtica minimamente invasivo transcateter e sem circulação extracorpórea (CEC) tem se mostrado viável, com menor morbi-mortalidade. O objetivo deste trabalho foi desenvolver bioprótese aórtica, montada em cateter, para implante sem CEC. MÉTODOS: Após desenvolvimento em animais, três pacientes com EuroSCORE elevado foram submetidos ao implante. Caso 1: portador de bioprótese com disfunção; Caso 2: estenose aórtica grave; Caso 3: disfunção de bioprótese aórtica. Após minitoracotomia e sob controle ecocardiográfico e fluoroscópico, cateter-balão foi posicionado sobre posição aórtica e insuflado. Após, segundo cateter-balão, com endoprótese valvada, foi posicionado e liberado sob alta frequência ventricular. Controles angiográficos e ecocardiográficos foram realizados e pacientes encaminhados para UTI. RESULTADOS: No primeiro caso foi possível implante sem CEC com resultados adequados. Evoluiu com melhora da função ventricular. Cursou com broncopneumonia, fístula traqueo-esofágica e óbito por mediastinite. Necropsia confirmou bom posicionamento valvar e preservação dos folhetos. O segundo caso apresentou migração do dispositivo após insuflação do balão, necessidade de esternotomia mediana de urgência, CEC e troca valvar convencional. O paciente evoluiu bem, recebendo alta da UTI 14 dias após procedimento e sem complicações. Cursou com infecção respiratória, choque séptico e óbito no 60º pós-operatório. O terceiro caso foi submetido a implante com sucesso. CONCLUSÃO: O implante de bioprótese transapical montada em cateter sem CEC mostrou ser procedimento factível. Detalhes técnicos e a curva de aprendizado demandam discussão.UNIFESPUNIFESPSciEL

Multicentric Case-Control Study on Azathioprine Dose and Pharmacokinetics in Early-onset Pediatric Inflammatory Bowel Disease

BACKGROUND: Early-onset inflammatory bowel disease (IBD) is generally aggressive, with a high probability of complications and need of surgery. Despite the introduction of highly effective biological drugs, treatment with azathioprine continues to be important even for early-onset IBD; however, in these patients azathioprine response seems to be reduced. This study evaluated azathioprine doses, metabolite concentrations, and their associations with patients' age in children with IBD treated at 6 tertiary pediatric referral centers. METHODS: Azathioprine doses, metabolites, and clinical effects were assessed after at least 3 months of therapy in 17 early-onset (age 12 and <18 yrs, controls) patients with IBD. Azathioprine dose was titrated on therapeutic efficacy (response and adverse effects). Azathioprine metabolites and thiopurine methyltransferase activity were determined by high-performance liquid chromatography with ultra violet-vis detection (HPLC-UV) methods. RESULTS: Frequency of patients in remission was similar among early-onset and control groups, respectively (82% and 84%, P value = 0.72). Early-onset patients required higher doses of azathioprine (median 2.7 versus 2.0 mg\ub7kg\ub7d, P value = 1.1 7 10). Different doses resulted in comparable azathioprine active thioguanine nucleotide metabolite concentrations (median 263 versus 366 pmol/8 7 10 erythrocytes, P value = 0.41) and methylmercaptopurine nucleotide concentrations (median 1455 versus 1532 pmol/8 7 10 erythrocytes, P value = 0.60). Lower ratios between thioguanine nucleotide metabolites and azathioprine doses were found in early-onset patients (median 98 versus 184 pmol/8 7 10 erythrocytes\ub7mg\ub7kg\ub7d, P value = 0.017). Interestingly, early-onset patients presented also higher thiopurine methyltransferase activity (median 476 versus 350 nmol methylmercaptopurine/mg hemoglobin/h, P-value = 0.046). CONCLUSIONS: This study demonstrated that patients with early-onset IBD present increased inactivating azathioprine metabolism, likely because of elevated activity of the enzyme thiopurine methyltransferase

5-Aminoimidazole-4-carboxamide ribonucleotide-transformylase and inosine-triphosphate-pyrophosphatase genes variants predict remission rate during methotrexate therapy in patients with juvenile idiopathic arthritis

For children with juvenile idiopathic arthritis (JIA) who fail to respond to methotrexate, the delay in identifying the optimal treatment at an early stage of disease can lead to long-term joint damage. Recent studies indicate that relevant variants to predict methotrexate response in JIA are those in 5-aminoimidazole-4-carboxamide ribonucleotide-transformylase (ATIC), inosine-triphosphate-pyrophosphatase (ITPA) and solute-liquid-carrier-19A1 genes. The purpose of the study was, therefore, to explore the role of these candidate genetic factors on methotrexate response in an Italian cohort of children with JIA. Clinical response to methotrexate was evaluated as clinical remission stable for a 6-month period, as ACRPed score and as change in Juvenile Arthritis Disease score. The most relevant SNPs for each gene considered were assayed on patients' DNA. ITPA activity was measured in patients' erythrocytes. Sixty-nine patients with JIA were analyzed: 52.2 % responded to therapy (ACRPed70 score), while 37.7 % reached clinical remission stable for 6 months. ATIC rs2372536 GG genotype was associated with improved clinical remission (adjusted p value = 0.0090). For ITPA, rs1127354 A variant was associated with reduced clinical remission: (adjusted p value = 0.028); this association was present even for patients with wild-type ITPA and low ITPA activity. These preliminary results indicate that genotyping of ATIC rs2372536 and ITPA rs1127354 variants or measuring ITPA activity could be useful to predict methotrexate response in children with JIA after validation by further prospective studies on a larger patient cohort

Glucocorticoid pharmacogenetics in pediatric idiopathic nephrotic syndrome

Idiopathic nephrotic syndrome represents the most common type of primary glomerular disease in children: glucocorticoids (GCs) are the first-line therapy, even if considerable interindividual differences in thepir efficacy and side effects have been reported. Immunosuppressive and anti-inflammatory effects of these drugs are mainly due to the GC-mediated transcription regulation of pro- and anti-inflammatory genes. This mechanism of action is the result of a complex multistep pathway that involves the glucocorticoid receptor and several other proteins, encoded by polymorphic genes. Aim of this review is to highlight the current knowledge on genetic variants that could affect GC response, particularly focusing on children with idiopathic nephrotic syndrome

Zero degree Cherenkov calorimeters for the ALICE experiment

International audienceThe collision centrality in the ALICE experiment will be determined by the Zero Degree Calorimeters (ZDCs) that will measure the spectator nucleons energy in heavy ion collisions. The ZDCs detect the Cherenkov light produced by the fast particles in the shower that cross the quartz fibers, acting as the active material embedded in a dense absorber matrix. Test beam results of the calorimeters are presented