Efetividade do clareamento dent��rio com per��xido de carbamida a 10% e avalia����o dos efeitos adversos sobre o esmalte dent��rio

The aim of the present study was to assess the effectiveness and adverse effects on dental enamel caused by nightguard vital bleaching with 10% carbamide peroxide. This was accomplished through the interaction of researchers from different areas such as dentistry, materials engineering and physics. Fifty volunteers took part in the doubleblind randomized controlled clinical trial. They were allocated to an experimental group that used Opalescence PF 10% (OPA) and a control group that used a placebo gel (PLA). Fragments of human dental enamel from the vestibular surface of healthy premolars, extracted for orthodontic reasons, were fixed to the vestibular surface of the first upper molars of the volunteers for in situ observation. Bleaching was performed at night for 21 days. The observation periods included Baseline (BL), T0 (21 days), T30 (30 days after treatment) and T180 (180 days after treatment, only for the OPA group). Tooth color was assessed by comparing it with the Vita�� scale and by the degree of satisfaction expressed by the volunteer. We also assessed adverse clinical effects, dental sensitivity and gingival bleeding. The study of adverse effects on enamel was conducted in vivo and in situ, using the DIAGNOdent�� laser fluorescence device to detect mineral loss. Scanning electron microscopy (SEM) was used to check for superficial morphological alterations, energy dispersive spectrophotometry (EDS) to semiquantitatively assess chemical composition using the Ca/P ratio, and the x-ray diffraction (XRD) technique to observe alterations in enamel microstructure. The results showed that nightguard vital bleaching with 10% carbamide peroxide was effective in 96% of the cases, versus 8% for the PLA group. Dental sensitivity was present in 36% (9/25) of the cases. There was no significant association between gingival bleeding and the type of gel used (p = 1.00). In vivo laser fluorescence analysis showed no difference in values for the control group, whereas in the OPA group there was a statistically significant difference between baseline values in relation to the subsequent periods (p<0.01), with lower mean values for post-bleaching times. There was a significant difference between the groups for times T0 and T30. Micrographic analysis showed no enamel surface alterations related to the treatment performed. No significant alteration in Ca/P ratio was observed in the OPA group (p = 0.624) or in the PLA group (p = 0.462) for each of the observation periods, nor between the groups studied (p=0.102). The XRD pattern for both groups showed the presence of three-phase Hydroxyapatite according to JCPDS files (9-0432[Ca5(PO4)3(OH)], 18-0303[Ca3(PO4)2.xH2O] and 25-0166[Ca5(PO4)3(OH, Cl, F)]). No other peak associated to other phases was found, independent of the group analyzed, which reveals there was no disappearance, nucleation or phase transformation. Neither was there any alteration in peak pattern location. With the methodology and protocol used in this study, nightguard vital bleaching with 10% carbamide peroxide proved to be an effective and safe procedure for dental enamel

Efeitos do alcal��ide ind��lico caulerpina, obtido de alga do g��nero caulerpa, em modelo de colite experimental murina

As doen��as inflamat��rias intestinais s��o enfermidades onde a toler��ncia e homeostase da resposta inflamat��ria est��o comprometidas, gerando les��es teciduais e favorecendo o surgimento de neoplasias. H�� dois importantes exemplos de doen��as inflamat��rias intestinais, a colite ulcerativa, foco do modelo desse estudo, e a doen��a de Crohn. Os medicamentos utilizados no tratamento dessas doen��as desencadeiam diversos efeitos adversos; al��m disso, em alguns pacientes, eles n��o s��o eficazes. Os extratos de algas t��m demonstrado v��rias atividades biol��gicas, entre elas a atividade anti-inflamat��ria. Os extratos das algas do g��nero Caulerpa foram utilizados em v��rios estudos, onde modelos inflamat��rios foram analisados, entre eles o modelo de colite ulcerativa. A utiliza����o do extrato metan��lico da C. mexicana como terap��utica nesse modelo atenuou o quadro clinico desenvolvido pelos animais. Sendo assim, o presente estudo teve como objetivo analisar a a����o terap��utica da Caulerpina (CLP), extra��da da C. racemosa, no modelo murino de colite ulcerativa. Camundongos C57BL/6 machos foram expostos a uma solu����o de Dextrana Sulfato de S��dio (DSS) a 3% por sete dias. A partir do primeiro dia de exposição ao DSS os animais foram tratados em dias alternados com a CLP nas doses de 4 e 40 mg/kg e com a dexametasona (3 mg/kg) por via oral. O desenvolvimento da doen��a foi analisado atrav��s do ��ndice de atividade da doen��a (IAD), que leva em considera����o a perda de peso corporal, a consist��ncia e a presen��a de sangue nas fezes. Ap��s a eutan��sia, o c��lon foi removido e mensurado, e amostras do tecido col��nico foram destinadas a an��lise histol��gica e �� cultura para dosagem de citocinas. Os n��veis de citocinas no sobrenadante da cultura do c��lon foram mensurados por ELISA. O tratamento com a CLP (4 mg/kg) desencadeou significativa melhora quanto �� perda de peso corporal e ao IAD, e atenuou o encurtamento do c��lon em resposta ao DSS. Tal dose foi capaz de reduzir os n��veis de citocinas pr��-inflamat��rias analisadas (TNF-&#61537;, IFN-&#61543;, IL-6, IL-17), mas n��o teve efeito significativo nas citocinas anti-inflamat��rias IL-10 e TGF-&#61538;. O tratamento com a CLP (40 mg/kg) n��o foi eficaz quanto a perda de peso e ao IAD, al��m de n��o ter atenuado a redu����o do c��lon em resposta ao DSS. Essa dose conseguiu reduzir os n��veis das citocinas pr��-inflamat��rias, por��m n��o os n��veis de IL-6. O tratamento com a dexametasona obteve melhora discreta quanto �� perda de peso corporal e ao IAD, por��m n��o atenuou a redu����o do c��lon em resposta ao DSS. Esse tratamento tamb��m conseguiu reduzir todas as citocinas pr��-inflamat��rias testadas. Deste modo a CLP (4 mg/kg) demonstrou ser uma alternativa promissora no tratamento da colite ulcerativa, em raz��o dos seus efeitos ben��ficos sobre par��metros cl��nicos, morfol��gicos e moleculares do modelo em estudo

Efeitos do potencial probi��tico Enterococcus faecium 32 e de sua associa����o com o extrato da alga marinha Caulerpa mexicana no tratamento de colite experimental murina

Ulcerative colitis comprising an inflammatory bowel disease, whose most severe consequence is the development of intestinal neoplasia. The drugs currently used to treat the disease trigger a variety of serious adverse effects and are not effective in many cases. Recent studies demonstrated the effectiveness of natural products for the treatment of inflammatory processes. Seaweed extracts and their purified products have shown protective effects in models of inflammation and the association of traditional therapies with probiotics has significantly improved the clinical symptoms of ulcerative colitis. Therefore, the aims of this study include evaluating the potential effects of the use of probiotic strain Enterococcus faecium 32 (Ef32), the methanolic extract of the green seaweed Caulerpa mexicana (M.E.) and their concomitant administration in a murine model of colitis induced by dextran sodium sulfate (DSS). Accordingly, C57BL /6 mice were pretreated orally with Ef32 (109 CFU/ml) for seven days. In the seven days following, the colitis was induced by administration of 3% DSS (w/v) diluted in the animals drinking water. During this period, animals were treated daily with Ef32 and the M.E. (2.0 mg/kg) every other day by intravenous route. The development of colitis was monitored by the disease activity index (DAI), which takes into account the loss of body weight, consistency and presence of blood in stools. After euthanasia, the colon was removed, its length measured and tissue samples were destined for histological analysis and culture for cytokine quantification. The levels of cytokines in the culture supernatant of the colon were measured by ELISA. The treatments with the probiotic Ef32 or the M.E. alone or the combination of these two substances provoked significant improvement as to weight loss and DAI, and prevented the shortening of the colon in response to DSS. The isolated treatments triggered a slight improvement in intestinal mucosal tissue damage. However, their combination was able to completely repair the injury triggered by DSS. The association was also able to reduce the levels of all the cytokines analyzed (IFN-&#947;, IL-4, IL-6, IL-12, IL-17A and TNF-&#945;). On the other hand, the treatment with Ef32 did not interfere with the levels of TNF-&#945;, whereas treatment with M.E. did not alter the levels of IL-6. Moreover, the treatment with Ef32 not interferes in TNF-&#945; levels, whereas treatment with M.E. did not alter the levels of IL-6. Therefore, the potential probiotic Ef32 and M.E. and especially when these samples were associated proved promising alternatives in the treatment of ulcerative colitis as demonstrated in an experimental model because of its beneficial effects on morphological and clinical parameters, and by reducing the production of proinflammatory cytokines of Th1, Th2 and Th17

Efeitos da azilsartana sobre a doen��a periodontal em um modelo experimental com ratos wistar

Periodontal diseases, highly prevalent disease in worldwide population, manifest primarily in two distinct entities: plaque-induced gingivitis and periodontitis. Periodontitis is a chronic inflammatory disease characterized of different levels of collagen, cementum, and alveolar bone destruction. Recent experimental studies demonstrated anti-inflammatory and antirreabsortive effect of antihypertensive agents of the angiotensin II receptor blockers class on periodontal disease. The aim of this study was to evaluate the effects of azilsartan (AZT), a potent inhibitor of the angiotensin II receptor which has minimal adverse effects on bone loss, inflammation, and the expression of matrix metallo proteinases (MMPs), receptor activator of nuclear factor kB ligand (RANKL), receptor activator of nuclear factor kB (RANK), osteoprotegerin (OPG), cyclooxygenase-2 (COX-2), and cathepsin K in periodontal tissue in a rat model of ligature-induced periodontitis. Male Wistar albino rats were randomly divided into 5 groups of 20 rats each: (1) nonligated, water; (2) ligated, water; (3) ligated, 1 mg/kg AZT; (4) ligated, 5 mg/kg AZT; and (5) ligated, 10 mg/kg AZT. All groups were treated with water or AZT for 10 days. Periodontal tissues were analyzed by morphometric exam, histopathology and immunohistochemical detection of MMP-2, MMP-9, COX-2, RANKL, RANK, OPG, and cathepsin K. Levels of IL-1b, IL-10, TNF-a, myeloperoxidase (MPO), and glutathione (GSH) were determined by ELISA. Treatment with 5 mg/kg AZT resulted in reduced MPO (p��0.05) and IL-1b (p��0.05) levels and increased in Il-10 levels (p��0.05). It was observed a reduced expression of MMP-2, MMP-9, COX-2, RANK, RANKL, cathepsin K, and a increased expression of OPG in the animals subjected to experimental periodontitis and threated with AZT (5 mg/kg). Conclusions: These findings suggest an anti-inflammatory and anti-reabsortive effects of AZT on ligature-induced periodontitis in rats.

Queilite act��nica: express��o imuno-histoqu��mica da cox-2 e avalia����o do diclofenaco s��dico gel como uma terapia alternativa

Actinic cheilitis (AC) is a potentially malignant disorder which affects the lip vermilion and results from chronic exposure to sunlight. Currently, it is not possible to predict which cases of AC may progress to squamous cell carcinoma, and therefore, some biomolecular markers have been researched. Cyclooxygenase 2 (COX-2) is an enzyme associated with inflammatory response which is overexpressed in oral cancer; however, little is known about the role of this protein in actinic cheilitis. About the treatment of this lesion, currently available therapeutic modalities to AC may cause cytotoxic effects and deleterious results to patients. Therefore, the aim of this study was to evaluate the immunoexpression of COX-2 in AC of different risks of malignant transformation and analyse, through clinical follow-up, the efficacy of diclofenac sodium 3% gel in the treatment of this condition. Epithelial immunoexpression of COX-2 was analysed semi-quantitatively in 90 cases of AC classified as low risk (n = 55) and high risk (n = 35) of malignant transformation, in which the scores were assigned: (0) 0 to 5% of positive cells - Negative; (1) 6 to 30% of positive cells - Low expression; (2) 31 to 100% of positive cells - High expression. The chi-square test of Pearson was conducted to verify possible associations between immunoexpression of COX-2 and histologic grade of actinic cheilitis. The weighted kappa coefficient denoted a good interobserver agreement (0.677). Nineteen patients diagnosed with AC were instructed to perform topical application of the gel three times a day for a period of 90 days. In each biweekly visit, a follow-up record was accomplished through digital photographs and after treatment was completed, two researchers analysed all the images to assess clinical aspects of the lip. Furthermore, tolerability to the drug and patient satisfaction after treatment were evaluated. COX-2 was overexpressed in 74.4% of AC cases. Both low and high-risk groups revealed predominance of score 3, followed by scores 2 and 1. There was no significant association (p = 0.315) between COX-2 expression and histological grading. Among the total number of participants of this clinical study, ten showed total remission of all clinical features of the lesion and three had partial improvement of these characteristics. One participant presented worsening of the clinical condition. In five cases, the treatment was discontinued due to development of mild adverse effects at the site of gel application. Regarding analysis of satisfaction and tolerability to the drug, most patients were fully satisfied with the therapy (n = 11) and reported that the drug was not irritating to the lips (n = 9). Our study demonstrates that high expression of COX-2 is common in AC; however, this protein was not associated with malignant transformation risk of the analysed cases. Topical application of diclofenac sodium 3% gel provided a convenient and well tolerated approach in most cases, and may be a promising alternative for the treatment of actinic cheilitis.

Avalia����o da atividade antimal��rica e citot��xica de plantas medicinais dos Biomas Caatinga e Amaz��nico

Resistance of Plasmodium falciparum to the usual antimalarials, as well as their adverse effects and high cost, has led to the search of new drugs against malaria. Several of these have been developed from medicinal plants based on ethnopharmacology, including the most widely used antimalarials today: quinine and artemisinin. In the present study schizonticide activity of extracts and fractions of a number of medicinal plants from the Caatinga and Amazon biomes were assessed based on ethnopharmacological and chemosystematic information. These included Ximenia americana, Maytenus rigida, Sideroxylon obtusifolium, Stryphnodendro coriaceum, Bowdichia virgiliodes, Schinopis brasiliensis and Picrolemma sprucei, the last, an Amazon species. Antimalarial tests of blood schizonticides were conducted in Swiss mice infected with P. berghei and in vitro against P. falciparum. In vitro cytotoxicity studies were carried out using HeLa, CHO, 3T3, Raw and HEPG2 cell lines. Except for X. americana, all species exhibited in vivo or in vitro antimalarial activity, inhibiting parasitic growth by up to 79%. Extracts exhibited moderate toxicity with dosedependent kinetics. In this sense, ethnopharmacological and chemosystematic approaches were shown to be useful and promising tools in the search of new drugs. These findings represent a significant contribution to scientific knowledge of the antimalarial potential of Brazilian flora, thereby opening perspectives for the development of new antimalarials

Significados e percep����es de pu��rperas sobre as s��ndromes hipertensivas da gravidez e parto prematuro

Hypertensive syndromes in pregnancy (HSP) are configured as one of the major complications in the pregnancy and postpartum period and can lead premature newborn and subsequent hospitalization of the newborn to the Neonatal Intensive Care Unit (NICU). This study aimed to analyze the perceptions, meanings and feelings of mothers on the hypertensive syndromes in pregnancy and premature obstetric labor. The research was qualitative and has a theoretical methodological the Social Representations Theory(SRT) in the approach to the Central Nucleus Theory. The study included 70 women, mean age 29 years, predominantly school to high school, most of them married or in consensual union, primiparous and prevalence of cesarean delivery occurred between 32 and 37 weeks of pregnancy.The data were collected from may to december 2008 in the Maternity School Janu��rio Cicco in Natal , and obtained through the following instruments for data collection: questionnaire including questions about socio-demographic status; the Free Words Association Test (FWAT) and and verbalized mental image construction used three stimuli: such as pregnancy with high blood pressure, preterm birth and NICU, and interview with the following guiding question: what it meant for you to have a pregnancy with high blood pressure and consequently the birth of a premature baby? Data analysis was performed using multi-method obtained from the data processing by EVOC (Ensemble Programmes Permettant L 'Analyze des ��vocations) and ALCESTE (Analyse Lexicale par Contexte d'un Ensemble de Segment de Texte) and thematic analysis in categories. The results will be presented in four thematic units under the following representative universes: HSP, prematurity as a result of HSP, NICU and the social representations of mothers on the hypertensive disorder of pregnancy sequenced premature birth and hospitalization of the child in the NICU. The results obtained by multimethod analyses showed similar constructions and point to death as the central nucleus and negative aspects, coping strategies, need of care, knowledge about the disease, fragility and meanings of the NICU as peripheral elements. It is considered that the perceptions, meanings and feelings of puerperal women in relation to HSPs and to premature delivery are a negative social representation, with representational elements that may have influenced the adverse effects on the disease and its consequences. We suggest action on the peripheral elements of this representation, with adequate orientation, early diagnosis, effective conduct, receptive attitude on the part of the team, health promotion measures and effective public policies, in order to improve the care provided to puerperal women, making them feel welcome and minimizing their suffering

Micropart��culas polim��ricas �� base de xilana e Eudragit�� S-100 contendo mesalazina visando �� libera����o c��lon-espec��fica

Colon-specific drug delivery systems have attracted increasing attention from the pharmaceutical industry due to their ability of treating intestinal bowel diseases (IBD), which represent a public health problem in several countries. In spite of being considered a quite effective molecule for the treatment of IBD, mesalazine (5-ASA) is rapidly absorbed in the upper gastrointestinal tract and its systemic absorption leads to risks of adverse effects. The aim of this work was to develop a microparticulate system based on xylan and Eudragit�� S- 100 (ES100) for colon-specific delivery of 5-ASA and evaluate the interaction between the polymers present in the systems. Additionaly, the physicochemical and rheological properties of xylan were also evaluated. Initially, xylan was extracted from corn cobs and characterized regarding the yield and rheological properties. Afterwards, 10 formulations were prepared in different xylan and ES100 weight ratios by spray-drying the polymer solutions in 0.6N NaOH and phosphate buffer pH 7.4. In addition, 3 formulations consisting of xylan microcapsules were produced by interfacial cross-linking polymerization and coated by ES100 by means of spray-drying in different polymer weight ratios of xylan and ES100. The microparticles were characterized regarding yield, morphology, homogeneity, visual aspect, crystallinity and thermal behavior. The polymer interaction was investigated by infrared spectroscopy. The extracted xylan was presented as a very fine and yellowish powder, with mean particle size smaller than 40&#956;m. Regarding the rheological properties of xylan, they demonstrated that this polymer has a poor flow, low density and high cohesiveness. The microparticles obtained were shown to be spherical and aggregates could not be observed. They were found to present amorphous structure and have a very high thermal stability. The yield varied according to the polymer ratios. Moreover, it was confirmed that the interaction between xylan and ES100 occurs only by means of physical aggregation

Nanopart��ulas de magnetita com oxacilina obtida por moagem de alta energia para aplica����es biom��dicas

The drug targeting has been the subject of extensive studies in order to develop site-specific treatments that minimize side effects and become more effective anticancer therapy. Despite considerable interest in this class, drugs like antibiotics also have limitations, and have been neglected. Using new pharmaceutical technologies, the use of magnetic vectors appear as promising candidate for drug delivery systems in several studies. Small magnetic particles bound to the drug of interest can be modulated according to the orientation of a magnet outside the body, locating and holding in a specific site. In this work, we propose the use of High Energy Milling (HEM) for synthesis of a magnetic vector with characteristics suitable for biomedical applications by intravenous administration, and for the formation of an oxacillin-carrier complex to obtain a system for treating infections caused by Staphylococcus aureus. The results of the variation of milling time showed that the size and structural properties of the formed material change with increasing milling time, and in 60 hours we found the sample closest to the ideal conditions of the material. The vector-drug system was studied in terms of structural stability and antimicrobial activity after the milling process, which revealed the integrity of the oxacillin molecule and its bactericidal action on cultures of Staphylococcus aureus ATCC

Prepara����o e caracteriza����o de complexos multicomponentes contendo ciclodextrinas com metotrexato

Conselho Nacional de Desenvolvimento Cient��fico e Tecnol��gico

Efeito da adi����o de colesterol e ecdisona na produ����o in vitro do baculov��rus spodoptera frugiperda MNPV

Among the pests that attack corn crop in Brazil, there is Spodoptera frugiperda (JE Smith, 1797) (Lepidoptera: Noctuidae), known as fall armyworm, which is the major corn pest. Due to genetic instability during serial passage of baculoviruses in insect cell culture, the viral bioinseticides in vitro production development is the greatest challenge for mass production of this bioproduct. Successive passages of virus using extracellular viruses (BVs), necessary during viral bioinseticides production scaling up, leads to the appearance of aberrant forms of virus, a process so called as "passage effect ". The main consequence of passage effect is the production of occlusion bodies (OB) decrease, preventing its production using in vitro process. In this study, it was carried out a serial passage of baculovirus Spodoptera frugiperda multiple nucleopolyhedrovirus, isolate 18, using Sf21 cells. A decrease in the production of occlusion bodies from 170 to 92 in the third to fourth passage was observed. A factorial experimental design (22) was employed to verify the influence of two input variables, concentration of the hormone 20 - hydroxyecdysone (CH) and cholesterol (CC) on the values of response variables (volumetric and the specific OB production) of the process, seeking to define the optimum operating ranges trying to reverse or minimize the passage effect. The result indicated a negative influence of the cholesterol addition and positive effect in the hormone supplementation which the optimum range found for the concentrations studied were 8 to 10&#956;g/mL and 5 to 6.5 mg / mL, for cholesterol and hormone concentrations respectively. New experiments were performed with addition of hormone and cholesterol in order to check the influence of these additives on the OB production independently. While the best result obtained from the factorial experiment was 9.4 x 107 OB/mL and 128.4 specific OB/cell, with the addition of only 6&#956;g/mL 20-hydroxyecdysone these concentrations increased to 1.9 x 108 OB/mL and 182.9 OB/cell for volumetric and specific OB production, respectively. This result confirms that the addition of the hormone 20-hydroxyecdysone enhances the SfMNPV in vitro production process performance using Sf21 cells

S��ndrome da fragilidade e fatores associados em idosos comunit��rios do munic��pio de Santa Cruz RN

The frailty in the elderly is characterized by decreased physiological reserves, and is associated with increased risk of disability and high vulnerability to morbidity and mortality. This study is part of a multicentric project on Frailty in Elderly Brazilians (REDE FIBRA). Aims: to investigate characteristics, prevalence and associated factors related to frailty. Metodology: We interviewed 391 elderly patients aged 65 years, selected randomly. Data collection was performed using a multidimensional questionnaire containing information about socio-demographic and clinical variables. To characterize the frail elderly, was considered the phenotype proposed by Fried. Data were analyzed using descriptive statistics, bivariate analysis (&#967; ��) and binary logistic regression. Results: The prevalence of frailty was 17.1%. In the final model of multivariate analysis, was obtained as factors associated with frailty: advanced chronological age (p <0.001), have comorbidity (p <0.035), show dependence on performing basic activities of daily living (p <0.010) and instrumental (p <0.003) and have poor perception of health status (p <0030). Conclusions: The factors associated with frailty suggest a predictive model helping to understand the syndrome, guiding actions that minimize adverse effects on the aging process

Exerc��cios respirat��rios para asma: revis��o sistem��tica com metan��lise

Introdu����o: A asma se tornou um problema de sa��de p��blica devido aos seus grandes custos em cuidados de sa��de. Os exerc��cios respirat��rios constituem uma interven����o n��o farmacol��gica de baixo custo e baixo risco que vem sendo utilizada por fisioterapeutas em diferentes pa��ses no tratamento de pacientes asm��ticos. Objetivo: Avaliar a efic��cia dos exerc��cios respirat��rios no tratamento de pacientes adultos com asma nos seguintes desfechos: qualidade de vida, sintomas da asma, n��mero de exacerba����es agudas, epis��dios de hospitaliza����o, mensura����es fisiol��gicas (fun����o pulmonar e capacidade funcional), n��mero de consultas m��dicas, n��mero de faltas no trabalho devido a exacerba����es da doen��a, avalia����o subjetiva do paciente em rela����o �� interven����o. M��todo: Revis��o sistem��tica de estudos controlados randomizados com metan��lise realizada em parceria com a Colabora����o Cochrane. As seguintes bases de dados foram consultadas: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, e PsycINFO, al��m de busca manual em revistas da ��rea e em resumos de congressos. Os seguintes termos foram utilizados: (breath*) and (exercise* or retrain* or train* or re-educat* or educat* or physiotherap* or "physical therap*" or "respiratory therapy" or buteyko ). As listas de refer��ncias dos estudos selecionados e registros de ensaios cl��nicos tamb��m foram consultados. A sele����o dos estudos e a avalia����o do risco de vi��s dos estudos inclu��dos foram realizadas de maneira independente por dois revisores. O software Review Manager foi utilizado para an��lise dos dados, no qual o modelo de efeito fixo foi utilizado. As vari��veis cont��nuas foram expressas como diferen��a de m��dia ponderada com um intervalo de confian��a de 95%. A heterogeneidade dos resultados dos estudos inclu��dos foi realizada por meio da an��lise dos Forest plots. O teste qui-quadrado (Chi2) com um P valor de 0.10 foi utilizado para indicar signific��ncia estat��stica. O ��ndice de heterogeneidade (I2) foi implementado com um valor acima de 50% como um n��vel substancial de heterogeneidade. Resultados: 13 estudos envolvendo 906 pacientes est��o atualmente inclu��dos na revis��o. Os seguintes desfechos foram mensurados pelos estudos inclu��dos: qualidade de vida, sintomas da asma, n��mero de exacerba����es agudas e fun����o pulmonar. Os estudos relataram uma melhora na qualidade de vida, sintomas da asma e n��mero de exacerba����es agudas. Seis dos onze estudos que avaliaram fun����o pulmonar mostraram uma diferen��a significativa favor��vel aos exerc��cios respirat��rios. N��o houve relato de efeitos adversos. Devido �� heterogeneidade substancial encontrada entre os estudos, metan��lise foi poss��vel apenas para sintomas da asma, a qual incluiu dois estudos e mostrou uma diferen��a significativa favor��vel aos exerc��cios respirat��rios. A avalia����o do risco de vi��s foi prejudicada devido ao relato incompleto de aspectos metodol��gicos pela maioria dos estudos inclu��dos. Conclus��o: Embora os resultados encontrados pelos estudos inclu��dos demonstraram individualmente que os exerc��cios respirat��rios podem ser importantes no tratamento da asma, n��o h�� evid��ncia conclusiva nesta revis��o para suportar ou refutar a efic��cia desta interven����o no tratamento de pacientes asm��ticos. Este fato foi devido ��s diferen��as metodol��gicas entre os estudos inclu��dos e �� aus��ncia de relato de aspectos metodol��gicos por parte da maioria dos estudos inclu��dos. N��o h�� dados dispon��veis em rela����o aos efeitos dos exerc��cios respirat��rios nos seguintes desfechos: epis��dios de hospitaliza����o, n��mero de consultas m��dicas, n��mero de faltas no trabalho devido a exacerba����es da doen��a, e avalia����o subjetiva do paciente em rela����o �� interven����o

Proposta de Interven����o para Auxiliar a Reabilita����o Motora e Cognitiva de Pacientes com Acidente Vascular Cerebral

Stroke is the leading cause of combined motor and cognitive disability worldwide. The rehabilitation of stroke patients is mostly directed towards motor recovery through the training of the affected member under supervision of a Physical Therapist. In the present study we introduce a new approach for both cognitive and motor therapy, which relies on motor imagery of the upper limbs and working memory training. This therapy should be utilized as an adjuvant to physical therapy. Ten individuals (5 men and 5 women) were selected for the pilot study, all of them in the acute phase of the first ischemic stroke episode. The control group had 5 individuals who were submitted to physical therapy only, whilst the other 5 patients in the experimental group also performed the cognitive and motor training with a video game specially built for this study. Two patients left the experimental group before the end. Total training lasted for 9 weeks, 2 times a week, for half an hour. Patients reported they enjoyed playing the game, even though it required a lot of mental effort, according to them. Plus, they considered it had a beneficial influence in their activities of daily living. No side effects were reported. Preliminary results suggest there is a difference between groups in cognitive and upper limb motor evaluation following the intervention. It is important to notice that our conclusions are limited due the small sample number. Overall, this work is supported by other studies in literature focused in rehabilitation with motor imagery and working memory and indicate a continuity of the research, increasing total training hours

Estudo da descelulariza����o tecidual na produ����o de arcabou��os biol��gicos para enxertos

The regeneration of bone defects with loss of substance remains as a therapeutic challenge in the medical field. There are basically four types of grafts: autologous, allogenic, xenogenic and isogenic. It is a consensus that autologous bone is the most suitable material for this purpose, but there are limitations to its use, especially the insufficient amount in the donor. Surveys show that the components of the extracellular matrix (ECM) are generally conserved between different species and are well tolerated even in xenogenic recipient. Thus, several studies have been conducted in the search for a replacement for autogenous bone scaffold using the technique of decellularization. To obtain these scaffolds, tissue must undergo a process of cell removal that causes minimal adverse effects on the composition, biological activity and mechanical integrity of the remaining extracellular matrix. There is not, however, a conformity among researchers about the best protocol for decellularization, since each of these treatments interfere differently in biochemical composition, ultrastructure and mechanical properties of the extracellular matrix, affecting the type of immune response to the material. Further down the arsenal of research involving decellularization bone tissue represents another obstacle to the arrival of a consensus protocol. The present study aimed to evaluate the influence of decellularization methods in the production of biological scaffolds from skeletal organs of mice, for their use for grafting. This was a laboratory study, sequenced in two distinct stages. In the first phase 12 mice hemi-calvariae were evaluated, divided into three groups (n = 4) and submitted to three different decellularization protocols (SDS [group I], trypsin [Group II], Triton X-100 [Group III]). We tried to identify the one that promotes most efficient cell removal, simultaneously to the best structural preservation of the bone extracellular matrix. Therefore, we performed quantitative analysis of the number of remaining cells and descriptive analysis of the scaffolds, made possible by microscopy. In the second stage, a study was conducted to evaluate the in vitro adhesion of mice bone marrow mesenchymal cells, cultured on these scaffolds, previously decellularized. Through manual counting of cells on scaffolds there was a complete cell removal in Group II, Group I showed a practically complete cell removal, and Group III displayed cell remains. The findings allowed us to observe a significant difference only between Groups II and III (p = 0.042). Better maintenance of the collagen structure was obtained with Triton X-100, whereas the decellularization with Trypsin was responsible for the major structural changes in the scaffolds. After culture, the adhesion of mesenchymal cells was only observed in specimens deccelularized with Trypsin. Due to the potential for total removal of cells and the ability to allow adherence of these, the protocol based on the use of Trypsin (Group II) was considered the most suitable for use in future experiments involving bone grafting decellularized scaffolds