A Agência Nacional de Saúde e a política de saúde mental no contexto do sistema suplementar de assistência à saúde: avanços e desafios

O presente estudo trata das políticas de saúde mental conduzidas pela Agência Nacional de Saúde Suplementar - ANS, no cenário da assistência dispensada pelos planos privados de assistência à saúde. Dessa forma, analisa o modelo de regulação econômica e assistencial do setor suplementar, a forma de atuação da ANS como organismo regulador e o tratamento dispensado à assistência à saúde mental nos normativos emanados pela Agência. Concluiu-se que, apesar de avanços como a obrigatoriedade de cobertura para todas as doenças listadas na CID-10, a inclusão do tratamento das tentativas de suicídio e das lesões autoinfligidas, o atendimento por uma equipe multiprofissional, a ampliação do número de sessões com psicólogo, com terapeuta ocupacional e de psicoterapia, e a inclusão do hospital-dia na rede credenciada da operadora, a assistência à saúde mental ainda é pouco normatizada pelos regramentos vigentes no sistema de atenção à saúde suplementar, existindo muitas lacunas a serem preenchidas. A regulamentação dos mecanismos de coparticipação e franquia, a coparticipação crescente como limitador da internação psiquiátrica sem o repensar em uma rede substitutiva e a limitação do número de sessões de psicoterapia de crise são alguns dos desafios colocados para a ANS, no sentido de que esta cumpra realmente o seu papel institucional de promoção da defesa do interesse público na assistência suplementar à saúde.

O hemograma nas anemias microcíticas e hipocrômicas: aspectos diferenciais

O diagnóstico diferencial das anemias microcíticas é clinicamente importante. Na tentativa de tornar esse diagnóstico menos oneroso e mais eficiente, o uso de parâmetros dos contadores automáticos tem sido sugerido. O objetivo deste estudo foi avaliar a eficiência diagnóstica de alguns parâmetros do hemograma na diferenciação das anemias microcíticas. Foram comparados os parâmetros hematológicos de 395 pacientes portadores de anemia ferropriva, anemia de doença crônica ou talassemia menor. O número de hemácias apresentou os maiores valores combinados de sensibilidade e especificidade na diferenciação dessas anemias. Em conclusão, a contagem de hemácias pode ser útil no diagnóstico diferencial de anemias microcíticas.

Dor crônica refratária de tornozelo controlada com radiofrequência pulsada: relato de caso

JUSTIFICATIVA E OBJETIVOS: A radiofrequência (RF) é uma corrente alternada com frequência de oscilação de 500.000 Hz, que tem sido usada com sucesso no tratamento de algumas morbidades que cursam com dor crônica. O objetivo deste relato de caso foi mostrar o uso bem sucedido da RF pulsátil do nervo sural para o tratamento de dor crônica no tornozelo. RELATO DO CASO: Paciente do sexo feminino, 60 anos, que há 5 anos apresentava dor em tornozelo direito, refratária ao tratamento com opioides, anti-inflamatório não esteroides (AINES), dipirona, antidepressivos e anticonvulsivantes, fisioterapia, infiltrações localizadas, acupuntura e palmilha. A paciente foi submetida a aplicação de RF pulsátil de nervo sural direito. O local da inserção da agulha foi na linha entre o tendão de Aquiles e maléolo lateral, região inicial de tendão de Aquiles e final dos músculos sóleo e gastrocnêmio. A estimulação sensitiva para identificação do nervo sural foi com 0,5 volts e 50 Hz. A corrente pulsátil foi aplicada durante 140 segundos com 45 volts com temperatura de até 42º C. Foram realizadas duas aplicações, ocorrendo melhora de cerca de 80% da dor, permitindo que a paciente pudesse deambular ou permanecer em pé, sem maiores dificuldades. CONCLUSÃO: A RF pulsátil do nervo sural pode ser uma opção para o controle das dores crônicas em tornozelo.

A Agência Nacional de Saúde Suplementar - ANS: onze anos de regulação dos planos de saúde

Trata-se de um trabalho com objetivo de apresentar os principais resultados alcançados pela regulação dos planos de saúde exercida pela Agência Nacional de Saúde Suplementar, autarquia instituída para promover o equilíbrio das relações entre operadoras e consumidores, tornando o mercado de planos de saúde mais eficiente. Como avanços mais significativos oriundos da regulação do setor podem ser citados: as barreiras à entrada e à saída das operadoras no mercado, a ampliação das coberturas assistenciais contratuais, o monitoramento e o controle dos reajustes, a indução a práticas de promoção da saúde e à qualificação do setor, e a possibilidade da portabilidade de carências. Como desafios a serem enfrentados, podem ser apontados: o monitoramento da qualidade da assistência prestada, a renúncia fiscal, a existência dos cartões de desconto, a operação de empresas como operadoras de planos de saúde sem o registro na ANS e a adoção de alguns mecanismos nocivos de regulação assistencial pelas operadoras de planos de saúde.

Results from the HST/COS FUV detector "lifetime move"

We describe the planning, implementation, and initial results of the first planned move of the default position of spectra on the Hubble Space Telescope's Cosmic Origins Spectrograph (COS) Far Ultraviolet (FUV) cross-delay line detector. This was motivated by the limited amount of charge that can be extracted from the microchannel plate due to gain sag at any one position. Operations at a new location began on July 23, 2012, with a shift of the spectrum by +3.5"(corresponding to ~ 41 pixels or ~ 1 mm) in a direction orthogonal to the spectral dispersion. Operation at this second "lifetime position" allows for spectra to be collected which are not affected by detector artifacts and loss of sensitivity due to gain sag. We discuss programs designed to enable operations at the new lifetime position; these include determinations of operational high voltage, measuring walk corrections and focus, confirming spectrum placement and aperture centering, and target acquisition performance. We also present results related to calibration of the new lifetime position, including measurements of spectral resolution and wavelength calibration, flux and flat field calibration, carryover of time-dependent sensitivity monitoring, and operations with the Bright Object Aperture (BOA).

Pyloric Brunner’s gland hamartoma with atypical hyperplasia

Brunner’s gland hamartoma (BGH) is an extremely rare benign digestive tumor, generally located in the duodenal bulb. We report the case of a 51-year-old asymptomatic man with a large pedunculated BGH arising from the pylorus. It was successfully removed en bloc by endoscopic resection.

Optimierung von Transformationsprotokollen und Entwicklung von SSR-Markern für das Kolumnarwachstum beim Apfel

Ziel war es, molekularbiologische Untersuchungen zum Kolumnarwachstum des Apfels durchzuführen. Anhand Sequenzdaten des ‘Golden Delicious’ Genoms (Velasco et al. 2010) wurden drei neue SSR Marker entwickelt. Sie konnten bei untersuchten Geisenheimer Nachkommenschaften zuverlässig den Kolumnarwuchs auf DNA-Ebene detektieren. Zusätzlich wurden von Bai et al. (2012) veröffentlichte Marker untersucht. Die von Bai et al. (2012) gefundenen Grenzen des co-Lokus konnten in dieser Arbeit anhand der Geisenheimer Nachkommenschaften nicht bestätigt werden. Die „linke“ Begrenzung der co-Region wird nach Untersuchungen dieser Arbeit am ehesten von dem Marker Mdo.chr10.11 (Moriya et al. 2012) bei 18,757 Mbp definiert. Die „rechte“ Begrenzung der co-Region wird vermutlich von den Markern Co04R13 (Baldi et al. 2012) und C1753-3520 (Bai et al. 2012) bei 18,905 Mbp definiert, wodurch die potentielle co-Region auf 148 kb auf Chromosom 10 eingegrenzt werden könnte. Für Funktionsanalysen möglicher Kandidatengene des co-Gens wurde ein Agrobakterien-vermitteltes Transformationssystem für die Geisenheimer Apfelselektionen ‘A 14’ und ‘Procats 28’ adaptiert. Zusätzlich wurde der bereits in der Literatur als transformierbar beschriebene Genotyp ‘Jonagold’ (Viss et al. 2003) transformiert. Bei Transformationen der Apfelselektion ‘A 14’ gelang es, transgene Zellen an den Explantaten, am Kallusgewebe und an den Regeneraten zu erzeugen. Bei Transformationen von ‘Jonagold’ wurde ein fast vollständig transgenes Regenerat erzeugt.

An overlapping kinase and phosphatase docking site regulates activity of the retinoblastoma protein

The phosphorylation state and corresponding activity of the retinoblastoma tumor suppressor protein (Rb) are modulated by a balance of kinase and phosphatase activities. Here we characterize the association of Rb with the catalytic subunit of protein phosphatase 1 (PP1c). A crystal structure identifies an enzyme docking site in the Rb C-terminal domain that is required for efficient PP1c activity toward Rb. The phosphatase docking site overlaps with the known docking site for cyclin-dependent kinase (Cdk), and PP1 competition with Cdk-cyclins for Rb binding is sufficient to retain Rb activity and block cell-cycle advancement. These results provide the first detailed molecular insights into Rb activation and establish a novel mechanism for Rb regulation in which kinase and phosphatase compete for substrate docking.

Delayed osteoblast differentiation and altered inflammatory response around implants placed in incisor sockets of type 2 diabetic rats

Objective: Central to the process of osseointegration is the recruitment of mesenchymal progenitor cells to the healing site, their proliferation and differentiation to bone synthesising osteoblasts. The process is under the control of pro-inflammatory cytokines and growth factors. The aim of this study was to monitor these key stages of osseointegration and the signalling milieu during bone healing around implants placed in healthy and diabetic bone. Methods: Implants were placed into the sockets of incisors extracted from the mandibles of normal Wistar and diabetic Goto-Kakizaki rats. Mandibles 1-12 weeks post-insertion of the implant were examined by histochemistry and immunocytochemistry to localise the presence of Stro-1- positive mesenchymal progenitor cells, proliferating cellular nuclear antigen proliferative cells, osteopontin and osteocalcin, macrophages, pro-inflammatory cytokines interleukin (IL)-1 , IL-6, tumour necrosis factor (TNF)- and tumour growth factor (TGF)- 1. Image analysis provided a semi-quantification of positively expressing cells. Results: Histological staining identified a delay in the formation of mineralised bone around implants placed in diabetic animals. Within the diabetic bone, the migration of Stro-1 mesenchymal cells in the healing tissue appeared to be unaffected. However, in the diabetic healing bone, the onset of cell proliferation and osteoblast differentiation were delayed and subsequently prolonged compared with normal bone. Similar patterns of change were observed in diabetic bone for the presence of IL-1 , TNF- , macrophages and TGF- 1. Conclusion: The observed alterations in the extracellular presence of pro-inflammatory cytokines, macrophages and growth factors within diabetic tissues that correlate to changes in the signalling milieu, may affect the proliferation and differentiation of mesenchymal progenitor cells in the osseointegration process. To cite this article: Colombo JS, Balani D, Sloan AJ, St Crean J, Okazaki J, Waddington RJ. Delayed osteoblast differentiation and altered inflammatory response around implants placed in incisor sockets of type 2 diabetic rats Clin. Oral Impl. Res22, 2011; 578-586 doi: 10.1111/j.1600-0501.2010.01992.x.

Metabolic imaging allows early prediction of response to vandetanib

The RET (rearranged-during-transfection protein) protooncogene triggers multiple intracellular signaling cascades regulating cell cycle progression and cellular metabolism. We therefore hypothesized that metabolic imaging could allow noninvasive detection of response to the RET inhibitor vandetanib in vivo.

A novel allele of FILAMENTOUS FLOWER reveals new insights on the link between inflorescence and floral meristem organization and flower morphogenesis

Background The Arabidopsis FILAMENTOUS FLOWER (FIL) gene encodes a YABBY (YAB) family putative transcription factor that has been implicated in specifying abaxial cell identities and thus regulating organ polarity of lateral organs. In contrast to double mutants of fil and other YAB genes, fil single mutants display mainly floral and inflorescence morphological defects that do not reflect merely a loss of abaxial identity. Recently, FIL and other YABs have been shown to regulate meristem organization in a non-cell-autonomous manner. In a screen for new mutations affecting floral organ morphology and development, we have identified a novel allele of FIL, fil-9 and characterized its floral and meristem phenotypes. Results The fil-9 mutation results in highly variable disruptions in floral organ numbers and size, partial homeotic transformations, and in defective inflorescence organization. Examination of meristems indicates that both fil-9 inflorescence and floral meristems are enlarged as a result of an increase in cell number, and deformed. Furthermore, primordia emergence from these meristems is disrupted such that several primordia arise simultaneously instead of sequentially. Many of the organs produced by the inflorescence meristems are filamentous, yet they are not considered by the plant as flowers. The severity of both floral organs and meristem phenotypes is increased acropetally and in higher growth temperature. Conclusions Detailed analysis following the development of fil-9 inflorescence and flowers throughout flower development enabled the drawing of a causal link between multiple traits of fil-9 phenotypes. The study reinforces the suggested role of FIL in meristem organization. The loss of spatial and temporal organization of fil-9 inflorescence and floral meristems presumably leads to disrupted cell allocation to developing floral organs and to a blurring of organ whorl boundaries. This disruption is reflected in morphological and organ identity aberrations of fil-9 floral organs and in the production of filamentous organs that are not perceived as flowers. Here, we show the role of FIL in reproductive meristem development and emphasize the potential of using fil mutants to study mersitem organization and the related effects on flower morphogenesis.