O cuidador de paciente com neoplasia cerebral maligna primária: os desafios do cuidado

Patients with primary malignant brain tumor endure several motor and cognitive dysfunctions, demanding the presence of a caregiver even more because the time necessary for their assistance increases considerably. Usually this task is performed by a family relative, whose activities include taking care of the patient’s personal hygiene, escorting them to medical appointments, managing their money and performing their housework. All of this overwhelms the caregiver both physical and psychologically. This bibliographic research intends to analyze the role in which a caregiver plays in the quality of life of those kinds of patients, the complications of such task, the caregivers’ needs and the daily life of those terminal patients. It was used CAPES, PubMed and Google Academic databases for researching articles related to family caregivers who assisted adult patients with primary malignant brain tumor. The study concluded that being a caregiver of patients in such conditions harms one’s quality of life, with consequences such as stress, insomnia, financial problems and lack of social support. Theirs needs include: having someone to talk to about the matter, attending programs for reducing stress and increasing their knowledge about the disease. In advanced phases of the condition, the patient shows great mobility problems, aphasia and regular seizures, which end up overwhelming the caregiver. The level of quality of life found was above other types of cancer’s caregivers. Therefore, they represent a group with special needs, which should be especially handled by health professionals.

Influência do treinamento aeróbico intradialítico no fluxo sanguíneo cerebral e o reflexo sobre a função cognitiva e qualidade de vida em pacientes renais crônicos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Ganho ponderal pós-gastrostomia em crianças com Paralisia Cerebral e Tetraplegia espástica

O objetivo deste estudo foi avaliar a evolução ponderal pós-gastrostomia em crianças com paralisia cerebral tipo tetra-plegia espástica. Mediante análise de variância para dados pareados, 33 crianças foram avaliadas nos momentos: 6 meses antes, à gastrostomia, 6 meses e 18-24 meses após. A mediana da idade à gastrostomia foi de 48,1 meses. 75,8% eram do gênero masculino. Houve ganho ponderal na comparação dos momentos: 6 meses antes, à gastrostomia e 6 meses após em relação a 18-24 meses após (p<0,001). Utilizando-se referencial específico de crescimento para paralisia cerebral, à gastrostomia e 18-24 meses após as crianças apresentavam percentil ≤10 (respectivamente, 52,4% e 33,3%) e >10 (respectivamente, 47,6% e 66,6%). As medianas do escore z do peso foram: 6 meses antes (-5,1), à gastrostomia (-5,0), 6 meses após (-4,7) e 18-24 meses após (-4,4), não havendo diferença significativa. Escore z ≤-2 foi observado em 75% das crianças 6 meses antes, 81,8% à gastrostomia, 75% 6 meses após e 64,5% 18-24 meses após. Na análise da mediana da idade, para as crianças com idade ≤ 48,1 meses não houve diferenças no escore z nos diferentes momentos. Para aquelas com idade >48,1 meses houve diferença significativa entre 6 meses antes e 18-24 meses após. Considerando as crianças mais (z≤-5,0) e menos (z>-5,0) comprometidas nutricionalmente, houve diferença significativa entre as mais comprometidas (p = 0,04) na comparação entre gastrostomia com 6 meses após e com 18-24 meses após. Este estudo demonstrou que 18-24 meses após a gastrostomia houve aumento ponderal para todas as crianças e aumento do escore z do peso naquelas com mais idade e mais comprometidas nutricionalmente.

Relação entre início da resposta faríngea e lateralização da lesão cerebral no acidente vascular encefálico

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Avaliação das principais infecções ocorridas em pacientes com acidente vascular cerebral

Pós-graduação em Enfermagem - FMB

Avaliação da teneurina-2 (Ten-2) nos astrócitos do córtex cerebral de ratos adultos após lesão mecânica. Estudo imuno-histoquímico e de expressão gênica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Paralisia cerebral: efeitos da escrita sobre a escrita

The aim of this research was to apprehend the effects of text reading in S.'s writing productions, a child in literacy process. S. is a child who can't speak or write by her own due to a dystonic quadriplegic CP. S. communicates with Blissymbols which were introduced in a school-clinic in São Paulo city when she was six years old. At the same time the literacy process took place and she indicated symbols, letters and numbers in a board by scanning. The teacher related S.'s difficulties concerning reading activities, so a weekly activity was proposed by the speech therapist in the classroom. The teacher and her assistant participated in the activity. A cutout of the activity involving a book reading when S. was between eight years and seven months old and nine years and one month old was analysed. The research was based in Borges (2006) grounded in The Brazilian Interactionism according to De Lemos (1992; 1995 and others) and proposes a literacy process among students from the first series in a regular school by the reading of different texts. The activity guided by the speech therapist took place side by side with the literacy program guided by the teacher and resulted in various S's text productions. The data was collected through film transcriptions from the activities in the classroom and from materials produced by S. through the reading of the chosen book. These data integrates NALíngua-CNPq databases coordinated by Dr. Alessandra Del Ré whose aim is to investigate the language acquisition process. S.'s reading and writing acquisition occurred in a singular way, affected by the using of Blissymbols that became S.'s speech modality: a written-speech with symbols and alphabetic writing

Avaliação da teneurina-2 (Ten-2) nos astrócitos do córtex cerebral de ratos adultos após lesão mecânica. Estudo imuno-histoquímico e de expressão gênica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Paralisia cerebral: efeitos da escrita sobre a escrita

The aim of this research was to apprehend the effects of text reading in S.'s writing productions, a child in literacy process. S. is a child who can't speak or write by her own due to a dystonic quadriplegic CP. S. communicates with Blissymbols which were introduced in a school-clinic in São Paulo city when she was six years old. At the same time the literacy process took place and she indicated symbols, letters and numbers in a board by scanning. The teacher related S.'s difficulties concerning reading activities, so a weekly activity was proposed by the speech therapist in the classroom. The teacher and her assistant participated in the activity. A cutout of the activity involving a book reading when S. was between eight years and seven months old and nine years and one month old was analysed. The research was based in Borges (2006) grounded in The Brazilian Interactionism according to De Lemos (1992; 1995 and others) and proposes a literacy process among students from the first series in a regular school by the reading of different texts. The activity guided by the speech therapist took place side by side with the literacy program guided by the teacher and resulted in various S's text productions. The data was collected through film transcriptions from the activities in the classroom and from materials produced by S. through the reading of the chosen book. These data integrates NALíngua-CNPq databases coordinated by Dr. Alessandra Del Ré whose aim is to investigate the language acquisition process. S.'s reading and writing acquisition occurred in a singular way, affected by the using of Blissymbols that became S.'s speech modality: a written-speech with symbols and alphabetic writing

Decompressive craniectomy and cerebral blood flow regulation in head injured patients: A case studied by perfusion CT

Previous studies have reported increased cerebral blood flow (CBF) velocity after decompressive craniectomy in traumatic brain injury (TBI) patients. A 27-year-old man presented with clinical and tomographic signs of cerebral herniation secondary to TBI. Prior to decompressive craniectomy, hemodynamic study by perfusion computed tomography (CT) indicated diffuse cerebral hyperperfusion. Following surgical decompression, the patient recovered neurologically and perfusion CT disclosed a decrease in the intensity of cerebral perfusion. The patient's blood pressure levels were similar at both pre- and postoperative perfusion CT examinations. This finding provides indirect evidence that decompressive craniectomy may improve mechanisms of CBF regulation in TBI, providing pathophysiological insights in the cerebral hemodynamics of TBI patients. This is the first report analyzing the hemodynamic changes through perfusion CT (PCT) in a patient with decompressive craniotomy due to TBI. (C) 2012 Elsevier Masson SAS. All rights reserved.

Calorie restriction increases cerebral mitochondrial respiratory capacity in a NO center dot-mediated mechanism: Impact on neuronal survival

Calorie restriction (CR) enhances animal life span and prevents age-related diseases, including neurological decline. Recent evidence suggests that a mechanism involved in CR-induced life-span extension is NO-stimulated mitochondrial biogenesis. We examine here the effects of CR on brain mitochondrial content. CR increased eNOS and nNOS and the content of mitochondria] proteins (cytochrome c oxidase, citrate synthase, and mitofusin) in the brain. Furthermore, we established an in vitro system to study the neurological effects of CR using serum extracted from animals on this diet. In cultured neurons, CR serum enhanced nNOS expression and increased levels of nitrite (a NO product). CR serum also enhanced the levels of cytochrome c oxidase and increased citrate synthase activity and respiratory rates in neurons. CR serum effects were inhibited by L-NAME and mimicked by the NO donor SNAP. Furthermore, both CR sera and SNAP were capable of improving neuronal survival. Overall, our results indicate that CR increases mitochondrial biogenesis in a NO-mediated manner, resulting in enhanced reserve respiratory capacity and improved survival in neurons. (C) 2012 Elsevier Inc. All rights reserved.

Study of cerebral gene expression densities using Voronoi analysis

As the available public cerebral gene expression image data increasingly grows, the demand for automated methods to analyze such large amount of data also increases. An important study that can be carried out on these data is related to the spatial relationship between gene expressions. Similar spatial density distribution of expression between genes may indicate they are functionally correlated, thus the identification of these similarities is useful in suggesting directions of investigation to discover gene interactions and their correlated functions. In this paper, we describe the use of a high-throughput methodology based on Voronoi diagrams to automatically analyze and search for possible local spatial density relationships between gene expression images. We tested this method using mouse brain section images from the Allen Mouse Brain Atlas public database. This methodology provided measurements able to characterize the similarity of the density distribution between gene expressions and allowed the visualization of the results through networks and Principal Component Analysis (PCA). These visualizations are useful to analyze the similarity level between gene expression patterns, as well as to compare connection patterns between region networks. Some genes were found to have the same type of function and to be near each other in the PCA visualizations. These results suggest cerebral density correlations between gene expressions that could be further explored. (C) 2011 Elsevier B.V. All rights reserved.

Pre, intra and post-ischemic hypothermic neuroprotection in temporary focal cerebral ischemia in rats: morphometric analysis

Objective: To evaluate the neuroprotection of mild hypothermia, applied in different moments, in temporary focal cerebral ischemia in rats. Methods: Rats was divided into Control (C), Sham (S), Ischemic-control(IC), Pre-ischemic Hypothermia (IH1), Intra-ischemic Hypothermia (IH2), and Post-ischemic Hypothermia (IH3) groups. Morphometry was performed using the KS400 software (Carl Zeiss (R)) in coronal sections stained by Luxol Fast Blue. Ischemic areas and volumes were obtained. Results: Statistically, blue areas showed difference for C vs. IC, IC vs. IH1 and IC vs. IH2 (p=0.0001; p=0.01; p=0.03), and no difference between C vs. S, IC vs. IH3 and IH vs. IH2 (p=0.39; p=0.85; p=0.63). Red areas showed difference between C vs. IC, IC vs. IH1 and IC vs. IH2 (p=0.0001; p=0.009; p=0.03), and no difference between C vs. S, IC vs. IH3 and IH1 vs. IH2 (p=0.48; p=0.27; p=0.68). Average ischemic areas and ischemic volumes showed difference between IC vs. IH1 and IC vs. IH2 (p=0.0001 and p=0.0011), and no difference between IC vs. IH3 and IH1 vs. IH2 (p=0.57; p=0.79). Conclusion: Pre-ischemic and intra-ischemic hypothermia were shown to be similarly neuroprotective, but this was not true for post-ischemic hypothermia.

Analysis of the NMDA in Focal Cerebral Ischemia in Rats

NMDAR (N-methyl-D-aspartate receptor) is one subtype of ionotrophic glutamate receptor which is extensively distributed in the central nervous system (CNS). In the mammalian CNS, NMDAR serves prominent roles in the pathophysiologic process of cerebral ischemia. This study aimed to investigate the pattern of expression of protein and gene of the excitatory neurotransmitter NMDAR in experimental focal cerebral ischemia and the hole of neuroprotection with hypothermia and ketoprofen. 120 rats were randomly divided into 6 groups (20 animals each): control - no surgery; sham - simulation of surgery; ischemic - focal ischemia for 1 hour, without reperfusion; ischemic + intraischemic hypothermia; ischemic + previous intravenous ketoprofen, and ischemic + hypothermia and ketoprofen. Ten animals from each experimental group were used to establish the volume of infarct. Transient focal cerebral ischemia was obtained in rats by occlusion of the middle cerebral artery with an intraluminal suture. The infarct volume was measured using morphometric analysis of infarct areas defined by triphenyl tetrazolium chloride and the patterns of expression of the protein and gene NMDA were evaluated by immunohistochemistry and quantitative real-time PCR, respectively. Increases in the protein and gene NMDA receptor in the ischemics areas were observed and these increases were reduced by hypothermia and ketoprofen. The increase in the NMDA receptor protein and gene expression observed in the ischemic animals was reduced by neuroprotection (hypothermia and ketoprofen). The NMDA receptor increases in the ischemic area suggests that the NMDA mediated neuroexcitotoxicity plays an important role in cell death and that the neuroprotective effect of both, hypothermia and ketoprofen is directly involved with the NMDA.

Phenylephrine-induced hypertension during transient middle cerebral artery occlusion alleviates ischemic brain injury in spontaneously hypertensive rats

Arterial hypertension is a major risk factor for ischemic stroke. However, the management of preexisting hypertension is still controversial in the treatment of acute stroke in hypertensive patients. The present study evaluates the influence of preserving hypertension during focal cerebral ischemia on stroke outcome in a rat model of chronic hypertension, the spontaneously hypertensive rats (SHR). Focal cerebral ischemia was induced by transient (1 h) occlusion of the middle cerebral artery, during which mean arterial blood pressure was maintained at normotension (110-120 mm Hg, group 1, n=6) or hypertension (160-170 mm Hg, group 2, n=6) using phenylephrine. T2-, diffusion- and perfusion-weighted MRI were performed serially at five different time points: before and during ischemia, and at 1, 4 and 7 days after ischemia. Lesion volume and brain edema were estimated from apparent diffusion coefficient maps and T2-weighted images. Regional cerebral blood flow (rCBF) was measured within and outside the perfusion deficient lesion and in the corresponding regions of the contralesional hemisphere. Neurological deficits were evaluated after reperfusion. Infarct volume, edema, and neurological deficits were significantly reduced in group 2 vs. group 1. In addition, higher values and rapid restoration of rCBF were observed in group 2, while rCBF in both hemispheres was significantly decreased in group 1. Maintaining preexisting hypertension alleviates ischemic brain injury in SHR by increasing collateral circulation to the ischemic region and allowing rapid restoration of rCBF. The data suggest that maintaining preexisting hypertension is a valuable approach to managing hypertensive patients suffering from acute ischemic stroke. Published by Elsevier B.V.