Neuromodulation approaches for the treatment of major depression: challenges and recommendations from a working group meeting

The use of neuromodulation as a treatment for major depressive disorder (MDD) has recently attracted renewed interest due to development of other non-pharmacological therapies besides electroconvulsive therapy (ECT) such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS), and vagus nerve stimulation (VNS). METHOD: We convened a working group of researchers to discuss the updates and key challenges of neuromodulation use for the treatment of MDD. RESULTS: The state-of-art of neuromodulation techniques was reviewed and discussed in four sections: [1] epidemiology and pathophysiology of MDD; [2] a comprehensive overview of the neuromodulation techniques; [3] using neuromodulation techniques in MDD associated with non-psychiatric conditions; [4] the main challenges of neuromodulation research and alternatives to overcome them. DISCUSSION: ECT is the first-line treatment for severe depression. TMS and tDCS are strategies with a relative benign profile of side effects; however, while TMS effects are comparable to antidepressant drugs for treating MDD; further research is needed to establish the role of tDCS. DBS and VNS are invasive strategies with a possible role in treatment-resistant depression. In summary, MDD is a chronic and incapacitating condition with a high prevalence; therefore clinicians should consider all the treatment options including invasive and non-invasive neuromodulation approaches.

Porcine skin as a source of biodegradable matrices: alkaline treatment and glutaraldehyde crosslinking

In this work, the modifications promoted by alkaline hydrolysis and glutaraldehyde (GA) crosslinking on type I collagen found in porcine skin have been studied. Collagen matrices were obtained from the alkaline hydrolysis of porcine skin, with subsequent GA crosslinking in different concentrations and reaction times. The elastin content determination showed that independent of the treatment, elastin was present in the matrices. Results obtained from in vitro trypsin degradation indicated that with the increase of GA concentration and reaction time, the degradation rate decreased. From thermogravimetry and differential scanning calorimetry analysis it can be observed that the collagen in the matrices becomes more resistant to thermal degradation as a consequence of the increasing crosslink degree. Scanning electron microscopy analysis indicated that after the GA crosslinking, collagen fibers become more organized and well-defined. Therefore, the preparations of porcine skin matrices with different degradation rates, which can be used in soft tissue reconstruction, are viable.

Mechanical, thermal and morphological properties of glutaraldehyde crosslinked bovine pericardium followed by glutamic acid treatment

Major problems with valve bioprostheses are associated with progressive structural deterioration and calcification, directly associated with the use of glutaraldehyde (GA). This work describes the effects of GA processing and borate/glutamic acid buffer treatment on the mechanical, thermal and morphological properties of 0.5% GA crosslinked bovine pericardium (BP). The results showed that while the treatment of 0.5% GA crosslinked BP with borate/glutamic acid significantly improves the mechanical properties, it had no visible effect on surface morphology. Better surface preservation was only achieved for BP pre-treated with a lower GA concentration followed by the conventional treatment (0.5% GA). Improvements in mechanical properties probably arises from structural changes probably involving the depolymerization of polymeric GA crosslinks and an increase electrostatic interaction due to covalent binding of glutamic acid to free carbonyl groups (Schiff base).The results indicate that the treatment GA crosslinked BP with borate/glutamic acid buffer may be an attractive procedure for the manufacture of heart valve bioprostheses.

Photodynamic antimicrobial chemotherapy (PACT) for the treatment of malaria, leishmaniasis and trypanosomiasis

A photodynamic effect occurs when photosensitiser molecules absorb light and dissipate the absorbed energy by transferring it to biological acceptors (usually oxygen), generating an excess of reactive species that are able to force cells into death pathways. Several tropical diseases present physiopathological aspects that are accessible to the application of a photosensitiser and local illumination. In addition, disease may be transmitted through infected blood donations, and many of the aetiological agents associated with tropical diseases have been shown to be susceptible to the photodynamic approach. However, there has been no systematic investigation of the application of photoantimicrobial agents in the various presentations, whether to human disease or to the disinfection of blood products or even as photo-insecticides. We aim in this review to report the advances in the photoantimicrobial approach that are beneficial to the field of anti-parasite therapy and also have the potential to facilitate the development of low-cost/high-efficiency protocols for underserved populations.

Effect of experimental heat treatment on mechanical properties of resin composites

The aim of this study was to verify the influence of an experimental heat treatment (170��C/10 min) using a casting furnace on the mechanical properties (hardness and flexural strength) of 2 commercial direct resin composites (TPH Spectrum and Filtek P60) compared to a commercial indirect resin system (BelleGlass). Heat treatment temperature was determined after thermal characterization by thermogravimetry (TG) and differential scanning calorimetry (DSC). Data was analyzed by ANOVA and Tukey's test at 5% significance level. There was statistical significance for the main factor heat treatment (p=0.03) and composite (p=0.02), for flexural strength. For Knoop hardness, only the main factor composite was statistically significant (p=0.00). P60 presented higher hardness than TPH. No statistically significant correlation between mechanical properties tested was detected. Based on these results, it was possible to conclude that heat treatment influenced flexural strength of direct composites, while it was not observed for hardness. The association of direct composites with a simple post-cure heat treatment may be an alternative for current indirect composite systems, although more studies are needed to verify other properties of the composites for this application.

Nutritional aspects of the prevention and treatment of osteoporosis

Osteoporosis is a global health problem characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture. Nutrition plays a critical role in reducing the risk of osteoporosis through its effect on all of these fragility factors, especially on the development and maintenance of bone mass. An adequate calcium, vitamin D and protein intake resulted in reduced bone remodeling, better calcium retention, reduced age-related bone loss, and reduced fracture risk. Recent evidence indicates that a healthy dietary pattern including dairy products (mainly fat free), fruit and vegetables and adequate amounts of meat, fish and poultry is positively related to bone health. Furthermore, mineral and vitamin supplementation should be closely monitored by health professionals since it could have adverse effects and be insufficient to ensure optimal protection of bone health.

An��lise colorim��trica e espectrosc��pica do muco de carac��is terrestres Achatina sp alimentados com ra����o diferenciada

Foram estudados os efeitos da adi����o de plantas medicinais de princ��pios cicatrizantes (Centelha asi��tica, Papa��na e Confrei) na ra����o controle de carac��is terrestres, para se avaliar a interfer��ncia destas plantas na composi����o do muco glicoprot��ico. Foram utilizados 80 carac��is terrestres Achatina sp, baseados em um peso homog��neo (49 e 40 g e idade m��dia de 10 e 19 meses para Achatina fulica e Achatina monochromatica, respectivamente). Os animais foram distribu��dos aleatoriamente em oito grupos experimentais: controle Achatina fulica (FC) e Achatina monochromatica (MC), centelha asi��tica Achatina fulica (FCe) e Achatina monochromatica (MCe), papa��na Achatina fulica (FPa) e Achatina monochromatica (MPa) e confrei Achatina fulica (FCo) e Achatina monochromatica (MCo). ��gua e ra����o foram fornecidos ad libitum. Ao final de 150 dias de tratamento, os animais foram submetidos �� t��cnica de extra����o do muco glicoprot��ico, por meio do est��mulo manual da gl��ndula podal, respons��vel pela secre����o deste muco. Esta metodologia considerou o bem-estar dos animais, uma vez que os mesmos n��o foram sacrificados e retornaram ao seu sistema de cria����o. Os mucos foram analisados por meio de testes colorim��tricos e espectrosc��picos, que constataram altera����es semelhantes, por��m apresentaram varia����o significativa em sua composi����o glicoprot��ica.

Nutrional aspects of the prevention and treatment of osteoporosis

A osteoporose �� um problema de sa��de global, caracterizada por baixa massa ��ssea e deteriora����o da microarquitetura do tecido ��sseo, com consequente aumento da fragilidade ��ssea e suscetibilidade a fraturas. A nutri����o desempenha um papel fundamental na redu����o do risco de osteoporose por seu efeito sobre todos os fatores relacionados �� fragilidade ��ssea, principalmente no desenvolvimento e na manuten����o da massa ��ssea. Uma adequada ingest��o de c��lcio, vitamina D e prote��na leva �� redu����o da remodela����o ��ssea, �� maior reten����o de c��lcio, �� redu����o da perda ��ssea relacionada �� idade e �� redu����o do risco de fraturas. Evid��ncias recentes indicam que uma alimenta����o saud��vel, incluindo a ingest��o de produtos l��cteos (principalmente os desnatados), frutas e verduras, e uma quantidade adequada de carnes, peixes e aves, est�� relacionada positivamente com a sa��de ��ssea. Al��m disso, a suplementa����o de vitaminas e minerais deve ser monitorada de perto, por profissionais de sa��de, uma vez que pode ter efeitos adversos e ser insuficiente para assegurar uma eficaz prote����o �� sa��de ��ssea

Evaluation of timing and responses to physiotherapeutic treatment

In several treatment regimens, the recognition of chronobiology contributes to the therapeutic process through the effective use of temporization protocols. The purpose of the present study was to evaluate the relationship between the tic treatment and the time of day when such treatment was performed, as well as the chronotype of orthopedic and rheumatologic patients in a clinical physiotherapy school. The population studied was treated in the morning and evening periods. The patients were divided into three groups of pathologies with similar treatments, which were as follows: syndrome of shoulder impact (n=33), knee artrosis (n=17), and lombalgia (n=23). At the end of ten treatment sessions, data concerning pain, percentage of subjective improvement, chronotype and age were compared. At the end of the study, it was observed that the time of day when treatment was performed influenced the results of individuals treated in the evenings but had no influence on the individuals treated in the morning. In addition, the evening schedule was the most well suited for intermediate individuals.

Efficacy of sweet solutions for analgesia in infants between 1 and 12 months of age: a systematic review

Objective To compare the efficacy of oral sweet solutions to water or no treatment in infants aged 1-12 months during immunisation. Methods Randomised controlled trials (RCTs) were retrieved through internet searches or manual searches of reference lists. Search terms included newborn, infant, pain, sucrose and alternative names for sweet solutions. Summary estimates with 95% CIs were calculated and included relative risk (RR), risk difference (RD) and number needed to treat to benefit (NNTB) for dichotomous outcomes, and weighted mean differences (WMD) for continuous outcomes. Where pooling of results was not possible, a narrative summary of study results is presented. Results Of the 695 studies identified, 14 RCTs with 1674 injections met the inclusion criteria. Sucrose or glucose, compared to water or no treatment decreased crying during or following immunisation in 13 of the 14 studies. Infants receiving 30% glucose (three trials, 243 infants) had a decreased RR in crying incidence following immunisation (typical RR 0.80, 95% CI 0.69 to 0.93; RD -0.17, 95% CI -0.29 to -0.05; NNTB 6, 95% CI 3 to 20). With sucrose or glucose, there was a 10% WMD reduction in proportion of crying time (95% CI - 18 to - 2) and a 12 s reduction in crying duration (95% CI - 23 to -0.7 s). An optimal dose of sucrose or glucose could not be ascertained due to the varied volumes and concentrations used. Conclusion Infants aged 1-12 months administered sucrose or glucose before immunisation had moderately reduced incidence and duration of crying. Healthcare professionals should consider using sucrose or glucose before and during immunisation.

Influence of Annealing Heat Treatment and Cr, Mg, and Ti Alloying on the Mechanical Properties of High-Silicon Cast Iron

The influence of annealing on the mechanical properties of high-silicon cast iron for three alloys with distinct chromium levels was investigated. Each alloy was melted either with or without the addition of Ti and Mg. These changes in the chemical composition and heat treatment aimed to improve the material's mechanical properties by inhibiting the formation of large columnar crystals, netlike laminae, precipitation of coarse packs of graphite, changing the length and morphology of graphite, and rounding the extremities of the flakes to minimize the stress concentration. For alloys with 0.07 wt.% Cr, the annealing reduced the impact resistance and tensile strength due to an enhanced precipitation of refined carbides and the formation of interdendritic complex nets. Annealing the alloys containing Ti and Mg led to a decrease in the mechanical strength and an increase in the toughness. Alloys containing approximately 2 wt.% Cr achieved better mechanical properties as compared to the original alloy. However, with the addition of Ti and Mg to alloys containing 2% Cr, the chromium carbide formation was inhibited, impairing the mechanical properties. In the third alloy, with 3.5 wt.% of Cr additions, the mechanical strength improved. The annealing promoted a decrease in both hardness and amount of iron and silicon complex carbides. However, it led to a chromium carbide formation, which influenced the mechanical characteristics of the matrix of the studied material.

Health services performance for TB treatment in Brazil: a cross-sectional study

Background: Researches to evaluate Primary Health Care performance in TB control in Brazil show that different cities aggregate local specificities in the dynamics of coping with the disease. This study aims to evaluate health services' performance in TB treatment in cities across different Brazilian regions. Methods: This cross-sectional study was conducted in five cities that are considered priorities for TB control in Brazil: Itaborai (ITA), Ribeirao Preto (RP) and Sao Jose do Rio Preto (SJRP) in the Southeast; Campina Grande (CG) and Feira de Santana (FS) in the Northeast. Data were collected through interviews with 514 TB patients under treatment in 2007, using the Primary Care Assessment Tool adapted for TB care in Brazil. Indicators were constructed based on the mean response scores (Likert scale) and compared among the study sites. Results: ""Access to treatment"" was evaluated as satisfactory in the Southeast and regular in the Northeast, which displayed poor results on 'home visits' and 'distance between treatment site and patient's house'. ""Bond"" was assessed as satisfactory in all cities, with a slightly better performance in RP and SJRP. ""Range of services"" was rated as regular, with better performance of southeastern cities. 'Health education', 'DOT' and 'food vouchers' were less offered in the Northeast. ""Coordination"" was evaluated as satisfactory in all cities. ""Family focus"" was evaluated as satisfactory in RP and SJRP, and regular in the others. 'Professional asking patient's family about other health problems' was evaluated as unsatisfactory, except in RP. Conclusions: Two types of obstacles are faced for health service performance in TB treatment in the cities under analysis, mainly in the Northeast. The first is structural and derives from difficulties to access health services and actions. The second is organizational and derives from the way health technologies and services are distributed and integrated. Incentives to improve care organization and management practices, aimed at the integration of primary, secondary and tertiary services, can contribute towards a better performance of health services in TB treatment.