This article continues our presentation of the Brazilian Psychiatric Association guidelines for the management of patients with suicidal behavior, with a focus on screening, intervention, postvention, prevention, and promotion. For the development of these guidelines, we conducted a systematic review of the MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, Web of Science, and SciELO databases for research published from 1997 to 2020. Systematic reviews, clinical trials, and cohort/observational studies on screening, intervention, and prevention in suicidal behavior were included. This project involved 14 Brazilian psychiatry professionals and 1 psychologist selected by the Psychiatric Emergencies Committee of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. Publications were evaluated according to the 2011 Oxford Center for Evidence-Based Medicine (OCEBM) Levels of Evidence Classification. Eighty-five articles were reviewed (of 5,362 initially collected and 755 abstracts on the drug approach). Forms of screening, intervention, and prevention are presented. The intervention section presents evidence for psychotherapeutic and drug interventions. For the latter, it is important to remember that each medication is effective only for specific groups and should not replace treatment protocols. We maintain our recommendation for the use of universal screening plus intervention. Although the various studies differ in terms of the populations evaluated and several proposals are presented, there is already significant evidence for certain interventions. Suicidal behavior can be analyzed by evidence-based medicine protocols. Currently, the best strategy is to combine several techniques through the Safety Plan. Nevertheless, further research on the topic is needed to elucidate some approaches with particular potential for intervention and prevention. Systematic review registry number: CRD42020206517

Suicide is a global public health problem that causes the loss of more than 800,000 lives each year, principally among young people. In Brazil, the average mortality rate attributable to suicide is approximately 5.23 per 100,000 population. Although many guidelines have been published for the management of suicidal behavior, to date, there are no recent guidelines based on the principles of evidence-based medicine that apply to the reality of suicide in Brazil. The objective of this work is to provide key guidelines for managing patients with suicidal behavior in Brazil. This project involved 11 Brazilian psychiatry professionals selected by the Psychiatric Emergencies Committee (Comissão de Emergências Psiquiátricas) of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. For the development of these guidelines, 79 articles were reviewed (from 5,362 initially collected and 755 abstracts). In this review, we present definitions, risk and protective factors, assessments, and an introduction to the Safety Plan. Systematic review registry number: CRD42020206517

RESUMEN Este trabajo describe los efectos del probiótico Saccharomyces cerevisiae sobre el área, número de criptas de Lieberkühn en duodeno y yeyuno, y producción de moco en ambas secciones intestinales de pollos de engorde. Fueron empleados los tejidos de un total de 27 individuos clasificados en un grupo control GC (n=12) y un grupo suplementado con probióticos GP (n=15). Los resultados revelaron que los grupos suplementados con el S. cerevisiae presentaron una mayor amplitud del área de las criptas en duodeno (p= 0,0119) y yeyuno (p= 0,0355), menor número de criptas por milímetro en duodeno (p= 0,0420) y mayor producción de moco en duodeno respecto al grupo control (p= 0,0185), mientras que en yeyuno no se observaron diferencias significativas. Se concluyó que el uso de Saccharomyces cerevisiae aumentó el tamaño del área de las criptas en ambas secciones intestinales y aumentó la producción de moco en duodeno; lo cual, al aumentar la superficie de absorción intestinal, seguramente podría resultar en mejoras de los parámetros productivos.

ABSTRACT This work describes the effects of the probiotic Saccharomyces cerevisiae on the area, number of Lieberkühn crypts in the duodenum and jejunum, and mucus production in both intestinal sections. Tissues from a total of 27 individuals were used, classified in control group - GC (n = 12) and group supplemented with probiotics - GP (n = 15). The results revealed that the group supplemented with S. cerevisiae presented a greater area of the crypts in the duodenum (p = 0.0119) and jejunum (p = 0.0355), less number of crypts per millimeter in the duodenum (p = 0.0420) and higher mucus production in the duodenum compared to the control group (p = 0.0185), while in the jejunum no significant differences were observed. It was concluded that the use of Saccharomyces cerevisiae increased the size of the crypt area in both intestinal sections and increased mucus production in the duodenum; which by increasing the intestinal absorption surface could surely result in improvements in the productive parameters.

Resumo O concreto é um material que apresenta efeitos diferidos no tempo, que estão associados aos fenômenos de fluência e retração. A modelagem numérica da fluência não é trivial, pois depende da idade do concreto no instante de aplicação do carregamento, o que torna necessário armazenar a história de carga para posterior aplicação do princípio da superposição dos efeitos. Contudo, um problema formulado em elementos finitos possui muitos pontos de integração, tornando esse armazenamento impossível. A Teoria da Solidificação, juntamente com o algoritmo incremental desenvolvido por Bazant e Prasannan ([1], [2]), permitem resolver esse problema. Esse artigo apresenta a adaptação desse algoritmo em um programa de elementos finitos (ANSYS), considerando a fluência e, também a retração, conforme formulado pelo Código Modelo CEB-FIP 1990 [3]. Os resultados comprovam que as deformações previstas por esta adaptação estão em conformidade com a solução analítica dada pelo CEB-FIP MC90, incluindo situações em que as cargas são aplicadas ao longo de diferentes idades do concreto.

Abstract Concrete is a material that presents time-delayed effects associated with creep and shrinkage phenomena. The numerical modeling of the creep is not trivial because it depends on the age of the concrete at the time of loading, which makes necessary to store the history of loads to apply the principle of superposition. However, a problem formulated in finite elements has many points of integration, making this storage impossible. The Theory of Solidification, together with incremental algorithm developed by Bazant e Prasannan ([1], [2]), solves this problem. Therefore, this paper presents the adaptation of this algorithm to a finite element commercial software (ANSYS) considering the creep, according to the CEB-FIP Model Code 1990 [3]. The results demonstrate that the deformations provided by this adaptation are in accordance with the analytical solution given by the CEB-FIP MC90, including cases where the loads are applied at different ages of the concrete.

Resumo O sensoriamento remoto e geoprocessamento de imagens se constituem em ferramentas fundamentais para a obtenção e manutenção de registros das ações humanas no espaço ao longo do tempo subsidiando diagnósticos no uso do solo, na interferência ambiental e no desenvolvimento local. A microbacia do Arroio Schmidt, localizada na bacia do Rio dos Sinos, no Rio Grande do Sul, apresenta situação ambiental semelhante a da maioria dos pequenos cursos d'agua que drenam áreas rurais e urbanas no sul do Brasil: práticas agrícolas e urbanização que não reconhecem a área ciliar com a remoção da cobertura vegetal original desrespeitando a aptidão do uso dos solos, remoção de áreas úmidas, uso intenso da água para diversas atividades e falta de controle e monitoramento no lançamento de efluentes entre outros, deterioram a qualidade deste importante ambiente. O objetivo deste trabalho é a caracterização física da Microbacia do Arroio Schmidt (Bacia do Rio dos Sinos) identificando elementos como uso e ocupação do solo, pedologia, geologia, climatologia, extensão e localização da Microbacia entre outros, a fim de instrumentalizar uma ferramenta auxiliar de gestão ambiental integrada de bacias hidrográficas. Através da aplicação do geoprocessamento no processo de obtenção dos mapas de uso e ocupação do solo, pedológico e geológico e uso de dados climatológicos da estação climatológica de Campo Bom-RS, visita a campo, revisão bibliográfica e de periódicos, dados públicos disponíveis, foi realizada a caracterização física da microbacia hidrográfica do Arroio Schmidt, visando a gestão ambiental integrada desta microbacia. Da área total da microbacia hidrográfica do Arroio Schmidt (23,92 km2) observou-se quanto à geologia que 23,7% são Colúvios, Fácies Gramado 22,6% e Formação Botucatu 53,7%. Principais tipos de solos da microbacia: Argissolos 97,4% e os Planossolos que ocupam apenas 2,6%. O uso e ocupação do solo é caracterizado por área úmida (0,5%), Mata Nativa (12,83%), Mata Nativa + Antrópico Rural + Vegetação Secundária + Silvicultura (43,81%), Antrópico Urbano/Área Urbana (39,85%) e ainda Antrópico Urbano/Áreas de expansão (3,01%). Precipitação média anual de 1337 mm, temperaturas máximas entre 10,5°C e 41,6°C e as mínimas entre –1,8°C e 26°C, Ventos fracos, eventualmente passam de 5 m/s. A realização da avaliação ambiental nesta microbacia é fundamental na gestão ambiental e territorial. No entanto, estas avaliações não ocorrem em todas as microbacias e, quando ocorrem, não apresentam a frequência adequada para permitir o monitoramento contínuo a fim de modelar e prever cenários objetivando a adoção de medidas de médio e longo prazo para a proteção ambiental.

Remote sensing and geoprocessing are essential tools for obtaining and maintaining records of human actions on space over the course of time; these tools offer the basis for diagnoses of land use, environmental interference and local development. The Schmidt stream watershed, located in the Sinos River basin, in southern Brazil, has an environmental situation similar to that of the majority of small streams draining rural and urban areas in southern Brazil: agricultural and urbanization practices do not recognize the riparian area and there is removal of original vegetation, disregarding the suitability of land use; removal of wetlands; intensive water use for various activities; and lack of control and monitoring in the discharge of wastewater, among other factors, deteriorate the quality of this important environment.This article aims to achieve a physical characterization of the Schmidt stream watershed (Sinos river basin) identifying elements such as land use and occupation, soil science, geology, climatology, extent and location of watershed, among others, so as to serve as the basis for a tool that helps in the integrated environmental management of watersheds. By applying geographic information system - GIS to the process of obtaining maps of land use and occupation, pedologicaland geological, and using climatological data from the Campo Bom meteorological station, field visit, review of literature and journals, and publicly available data, the physical characterization of the Schmidt stream watershed was performed, with a view to the integrated environmental management of this watershed. Out of the total area of the Schmidt stream watershed (23.92 km2), in terms of geology, it was observed that 23.7% consist of colluvial deposits, 22.6% consist of grass facies, and 53.7% consist of Botucatu formation. Major soil types of the watershed: 97.4% Argisols and only 2.6% Planosols. Land use and occupation is characterized by wetland (0.5%), Native Forest (12.83%), Native Forest + Rural Anthropic + Secondary Vegetation + Forestry (43.81%), Urban Anthropic/Urban Area (39.85%), and also Urban Anthropic/Expansion areas (3.01%). Mean annual rainfall is 1337 mm, maximum temperatures range from 10.5°C to 41.6°C and minimum temperatures range from –1.80°C and 26°C, weak winds, occasionally over 5 m/s. Conducting an environmental assessment in this watershed is essential for environmental and land management. However, these assessments are not conducted in all watersheds and, when they are, their frequency is not sufficiency to allow for continuous monitoring, in order to model and predict scenarios, with a view to adopt medium and long-term measures for environmental protection.

Células tronco mesenquimais (CTMs) são células progenitoras multipotentes que têm a capacidade de se diferenciar em todas as linhagens de origem mesodérmica, como, cartilagem, ossos, e adipócitos. CTMs têm sido identificadas em diferentes fases do desenvolvimento, incluindo a idade adulta e em diferentes tecidos, tais como medula óssea, tecido adipose e cordão umbilical. Estudos recentes têm mostrado que as CTMs possuem a capacidade de migrar para locais de lesões. Nesse sentido, uma característica importante das CTMs são os seus efeitos imunomodulatórios e anti-inflamatórios. Por exemplo, há evidências que as CTMs podem regular o sistema imune por inibição da proliferação de células T e B. O interesse clínico no uso das CTMs tem aumentado consideravelmente nos últimos anos, especialmente devido às características ideais destas células para a medicina regenerativa. Terapias com CTMs têm mostrado resultados promissores em doenças neurodegenerativas, além de regular a inflamação, elas podem promover outros efeitos benéficos, tais como, crescimento neuronal, diminuição de radicais livres e reduzir a apoptose. No entanto, apesar de muitas pesquisas das CTMs em doenças neurodegenerativas, o mecanismo de ação das CTMs ainda não estão completamente esclarecidos, o que dificulta o desenvolvimento de tratamentos eficazes. Por outro lado, estudos em modelos de doenças psiquiátricas são escassos, apesar dos resultados promissores utilizando terapias com CTMs nesta área.

Mesenchymal stem cells (MSCs) are multipotent progenitor cells that have the capacity to differentiate into all lineages of mesodermal origin, e.g., cartilage, bone, and adipocytes. MSCs have been identified at different stages of development, including adulthood, and in different tissues, such as bone marrow, adipose tissue and umbilical cord. Recent studies have shown that MSCs have the ability to migrate to injured sites. In this regard, an important characteristic of MSCs is their immunomodulatory and anti-inflammatory effects. For instance, there is evidence that MSCs can regulate the immune system by inhibiting proliferation of T and B cells. Clinical interest in the use of MSCs has increased considerably over the past few years, especially because of the ideal characteristics of these cells for regenerative medicine. Therapies with MSCs have shown promising results neurodegenerative diseases, in addition to regulating inflammation, they can promote other beneficial effects, such as neuronal growth, decrease free radicals, and reduce apoptosis. Notwithstanding, despite the vast amount of research into MSCs in neurodegenerative diseases, the mechanism of action of MSCs are still not completely clarified, hindering the development of effective treatments. Conversely, studies in models of psychiatric disorders are scarce, despite the promising results of MSCs therapies in this field as well.

Objective: To evaluate the influence of environmental enrichment (EE) on memory, cytokines, and brain-derived neurotrophic factor (BDNF) in the brain of adult rats subjected to experimental pneumococcal meningitis during infancy. Methods: On postnatal day 11, the animals received either artificial cerebrospinal fluid (CSF) or Streptococcus pneumoniae suspension intracisternally at 1 × 106 CFU/mL and remained with their mothers until age 21 days. Animals were divided into the following groups: control, control + EE, meningitis, and meningitis + EE. EE began at 21 days and continued until 60 days of age (adulthood). EE consisted of a large cage with three floors, ramps, running wheels, and objects of different shapes and textures. At 60 days, animals were randomized and subjected to habituation to the open-field task and the step-down inhibitory avoidance task. After the tasks, the hippocampus and CSF were isolated for analysis. Results: The meningitis group showed no difference in performance between training and test sessions of the open-field task, suggesting habituation memory impairment; in the meningitis + EE group, performance was significantly different, showing preservation of habituation memory. In the step-down inhibitory avoidance task, there were no differences in behavior between training and test sessions in the meningitis group, showing aversive memory impairment; conversely, differences were observed in the meningitis + EE group, demonstrating aversive memory preservation. In the two meningitis groups, IL-4, IL-10, and BDNF levels were increased in the hippocampus, and BDNF levels in the CSF. Conclusions: The data presented suggest that EE, a non-invasive therapy, enables recovery from memory deficits caused by neonatal meningitis.

OBJETIVO: Hidrocloridrato de metilfenidato é a medicação preferida para o tratamento e manutenção do transtorno de atenção e hiperatividade. No entanto, os efeitos do tratamento crônico com hidrocloridrato de metilfenidato em diferentes idades e ciclos sobre o comportamento relacionado à ansiedade e à depressão ainda não está claro. Neste contexto, o presente estudo teve como objetivo avaliar os efeitos do tratamento com hidrocloridrato de metilfenidato sobre o comportamento relacionado à ansiedade e à depressão em diferentes idades e no ciclo claro e escuro. MÉTODO: Foram utilizados ratos Wistar machos jovens e adultos que receberam uma vez ao dia (ciclo claro e escuro) hidrocloridrato de metilfenidato (2mg/kg) ou salina com injeção intraperitoneal, durante 28 dias. Após duas horas da última injeção, os animais foram submetidos ao testes de labirinto em cruz elevada e natação forçada. RESULTADOS: A fase do ciclo claro e escuro foi um fator significativo para o comportamento relacionado à ansiedade. Além disso, não houve interação significativa entre os ciclos claro e escuro, idade e metilfenidato no comportamento relacionado à ansiedade e à depressão, mas foi observada uma interação significativa entre ciclo claro e escuro e idade no teste de natação forçada. CONCLUSÃO: Nossos resultados mostraram que a idade e o ciclo claro e escuro são moduladores significativos de ambos os comportamentos quanto do tratamento com hidrocloridrato de metilfenidato.

OBJECTIVE: Methylphenidate hydrochloride is the most widely used medication for treatment and management of attention-deficit hyperactivity disorder. However, the chronic effects of methylphenidate hydrochloride on anxiety- and depressive-like rat behaviors remain poorly investigated. In this context, the present study evaluated the effects of treatment with methylphenidate hydrochloride on anxiety- and depressive-like behaviors using young and adult rats during the light and the dark cycle. METHOD: Male Wistar rats (25 or 60 days old) received a once-daily (in either the light or dark cycle) methylphenidate hydrochloride (2mg/kg) or saline intraperitoneal injection for 28 days. We performed elevated plus maze and forced swimming test two hours after the last injection. RESULTS: The light/dark cycle was a significant factor in the anxiety-like behaviors; however, no significant interaction between all three factors (cycle, age and methylphenidate hydrochloride) was found. Nevertheless, we observed a nominally significant interaction between the light/ dark cycle and age in the forced swimming test. CONCLUSION: Our results have shown that age and the light/dark cycle are more significant modulators of anxiety- and depressive-like behaviors than methylphenidate hydrochloride treatment.

Objectives: It has been demonstrated that abdominal high-pressure and the use of C02 pneumoperitoneum induce changes of the cardiovascular and respiratory systems, attributable to two factors: changes of the cardiac output(CO) and hypercarbia. Other modifications derived from these facts include changes of the systemic vascular resistances (SVR), blood pressure (BP), central venous pressure (CVP), vascular changes like modifications of the renal blood flow (RBF), carotid flow (CF), portal flow, and hepatic artery flow (HAF). Our objective is to analyze the hemodynamic modifications induced by pneumoperitoneum on renal blood flow, carotid flow, portal flow and hepatic artery flow in a porcine experimental model. Methods: We compared two groups of pigs: CONTROL group (n = 10) and LAPAROSCOPIC group (n = 10), undergoing open or laparoscopic nephrectomy respectively. In every case, catheters were inserted into the right external jugular vein and femoral artery and cardiac output, CVP, blood pressure and systemic vascular resistances (calculated as RVS = (BP/CVP)x 80/CO); these measurements were taken at the following times: baseline, 5, 30, 60 min. and postoperatively. Renal blood flow, carotid flow, portal flow and hepatic artery flow were registered by means of an electromagnetic probe around the vessel 30 minutes after the start of surgery. Results: Comparative analysis shows: an increase of cardiac output in the laparoscopic group, the difference which was maximal at 30 minutes (4.33 + 0.73 vs. 8 .54+ 1.26 l/min., p < 0,001); a descent of the systemic vascular resistances (1118.81+ 302.52 vs. 663.37+ 81.45 dynes .s.cm5, p <0.001) and an increase of blood pressure (66.5+ 11.52 vs. 80.25+ 2.49 mm Hg in the laparoscopic group. Flow analysis showed an increase of the carotid artery flow (125.73+ 41.69 vs. 291.7+ 51.52 ml/min., p <0.001) and a decrease of portal flow (973.67+ 131.70 vs. 546.83+ 217.53 ml/min., p = 0.001) and hepatic artery flow (278.00+ 94.71 vs. 133.33+ 112.32 ml/min., p = 0.03) in the laparoscopic group. There were no significant differences in renal blood flow with the volume expansion used. Conclusions: Laparoscopic nephrectomy conditions an increase of carotid flow, probably secondary to the increase of cardiac output, and also a diminishment of hepatic perfusion, both arterial and portal. Nevertheless, volume expansion and the limitation of intra-abdominal pressure to 12 mm Hg enable to maintain similar renal blood flow in both groups.

Objetivo: Se ha demostrado que la hiperpresión abdominal y la utilización del neumoperitoneo con CO2, provocan cambios en los aparatos cardiovascular y respiratorio, atribuibles a dos factores: alteraciones en el gasto cardiaco (GC) e hipercarbia. Otras alteraciones derivadas de estos hechos son los cambios en las resistencias vasculares sistémicas (RVS), la tensión arterial (TA), la presión venosa central (PVC), cambios vasculares como las alteraciones en el flujo sanguíneo renal (FSR), flujo carotídeo (FAC), flujo portal (FP) y flujo de la arteria hepática (FAH). Nuestro objetivo es analizar las modificaciones hemodinámicas producidas por el neumoperitoneo sobre los FSR, FC, FP y FAH en modelo experimental porcino. Métodos: Se analizan comparativamente dos grupos de cerdos, un grupo CONTROL (N=10) y grupo LAPAROSCÓPICO (N=10), a los que se les realiza una nefrectomía abierta o laparoscópica respectivamente. En ambos grupos se canaliza la vena yugular externa derecha y la arteria femoral y se monitoriza el GC, la PVC, la TA, las RVS (calculada mediante la fórmula RVS=(TA-PVC)*80/GC); estas determinaciones se realizan en los momentos: basal, 5, 30, 60 minutos y postcirugía. Mediante sonda electromagnética alrededor del vaso, se registran los FSR, FC, FP y FAH a los 30 minutos de iniciada la intervención quirúrgica. Resultados: El análisis comparativo de ambos grupos demuestra un aumento del GC en el grupo laparoscópico, cuya diferencia fue máxima a los 30 minutos (4,33 + 0,73 vs 8,54 + 1,26 l/min, p< 0,001); un descenso de las RVS (1118,81 + 302,52 vs 663,37 + 81,45 dinas x s x cm-5 p<0,001) y un aumento de la TA del grupo laparoscópico (66,5 + 11,52 vs 80,25 + 2,49 mm Hg, p= 0,004). El análisis de los flujos demostró un aumento del FAC (125,73 + 41,69 vs 291,70 + 51,52 ml/min, p<0,001) y una disminución del FP (973,67+ 131,70 vs 546,83+ 217,53 ml/min, p= 0,001) y del FAH (278,00 + 94,71 vs 133,33+112,32 ml/min, p=0,03) en el grupo laparoscópico. No existieron diferencias significativas en el FSR con la expansión de la volemia utilizada. Conclusiones: La nefrectomia laparoscópica condiciona un aumento del FC, posiblemente secundario al aumento del gasto cardiaco, así como un descenso de la perfusión hepática, tanto arterial como portal. Sin embargo, la expansión de la volemia y la reducción de la PIA a 12 mmHg permiten mantener el FSR semejante en ambos grupos.

O jundiá (Rhamdia quelen, Quoy & Gaimard) é uma espécie endêmica da América do Sul. Por ser adaptada ao frio do inverno e ter um crescimento rápido durante os meses quentes, o jundiá é uma espécie adequada para aqüicultura no sul da América do Sul. Muitos aspectos da fisiologia reprodutiva, larvicultura, hematologia, fisiologia da resposta ao estresse, têm sido recentemente estudados. Os ovócitos utilizados neste estudo foram obtidos pela extrusão de fêmeas após indução hormonal. Logo após a hidratação, foram transferidos para incubadoras cônicas de vidro com capacidade para 50 L, com fluxo de água constante e controlado. Amostras de ovos fertilizados foram colocadas em placas de Petri e examinadas através de estereomicroscópio. Os ovos eram esféricos, demersais e não-adesivos, com espaço perivitelino definido e córion resistente. Os estágios de clivagem ocorreram durante as 3,5 primeiras horas. Após a eclosão, as larvas foram transferidas para incubadoras de fibra de vidro de 200 l. Os primeiros sinais de movimento embrionário foram observados 21 h após a fertilização, e a eclosão das larvas ocorreu 30,5 h após a fertilização. Estes resultados podem servir como base para muitos estudos, objetivando o conhecimento da ontogenia completa do jundiá, e para aplicação em estudos ecotoxicológicos.

The jundiá (Rhamdia quelen, Quoy & Gaimard) is an endemic South American fish species. Because this species supports cold winters and grows faster during warm months, it has begun to be viewed as an ideal species for fish production in southern South America. In the present study, jundiá oocytes used were obtained by extrusion from females after hormone injection. Soon after hydration, the eggs were transferred to 50 L conic glass incubators, with constant and controlled water influx. Samples of fertilized eggs were transferred to Petri dishes and, examined under a stereoscopic microscope, were spherical, demersal, and non-adhesive with defined perivitelline space and resistant chorion. Cleavage stages occurred during the first 3.5 h. After hatching, larvae were transferred to 200 L glass fiber incubators. First signs of embryo movement were observed 21 h after fertilization; larval eclosion occurred 30.5 h after fertilization. Present findings may provide a basis for studies aimed at determining the complete ontogeny of jundiá and may be useful in eco-toxicological studies.

OBJECTIVE: Sacral root neuromodulation is an effective technique for the treatment of Chronic Micturition Dysfunction (CMD) refractory to conventional therapy. New indications such as chronic pelvic pain and interstitial cystitis are currently making their way within the urologic setting. Several groups of gastric surgeons are now choosing this technique for the management of rectal diseases (constipation, sphincter dysfunction). This paper contributes our experience in the treatment of patients with CMD and the comparative results at one year from implant in all patients. MATERIAL AND METHODS: From December 1998 through July 2003, 18 neuromodulation definite implants were performed. The main indication was CMD in 62.5% patients. Follow up of patients was done at one month and three months, and every six months thereafter. Follow up is conducted through a micturition diary and QoL questionnaire. Electrode implant in the first 16 patients was achieved by open surgery. The next 2 patients had the electrode placed by a percutaneous technique using the "Tined Lead" kit. RESULTS: Results at one year after implant were compared in all patients. The total number of neuromodulation implants placed was 18, 14 (77.7%) of which were women and 4 (22.3%) men. Mean age was 52.56 years. Implant indication was CMD in 72.2% patients, mixed incontinence (urinary and faecal) in 22.1%, and interstitial cystic disease in 5.5%. Symptoms improvement at one year from implant, as determined by a micturition diary and QoL questionnaire was 76.4%. Clinical improvement was greater in patients with urgency symptoms than in patients with predominance of voiding symptoms.

OBJETIVO: La neuromodulacion de raíces sacras es una técnica eficaz para el tratamiento de la Disfunción Miccional Crónica (DMC), refractaria a tratamientos convencionales. En la actualidad están surgiendo nuevas indicaciones en el ámbito urológico, como el dolor pélvico crónico y la cistitis intersticial. Diversos grupos de cirujanos digestivos están optando por esta técnica para el tratamiento de patología rectal (estreñimiento, disfunción esfinteriana). Este trabajo aporta nuestra experiencia en el tratamiento de pacientes con DMC y los resultados comparativos al año del implante de todos los pacientes. MATERIAL Y MÉTODOS: Desde diciembre de 1998 a julio del 2003 hemos realizados 18 implantes definitivos de neuromodulacion. La indicación principal fue la DMC, en un 62,5% de los pacientes. El seguimiento de los pacientes lo realizamos al mes, tres meses, y posteriormente cada seis meses. Este se realiza mediante diario miccional y cuestionario de calidad de vida. El implante del electrodo en los 16 primeros pacientes se ha realizado mediante cirugía abierta, mientras que los 2 siguientes se ha colocado el electrodo mediante técnica percutánea, utilizando el kit "Tined Lead". RESULTADOS: Comparamos resultados al año del implante en todos los pacientes. Se han realizado 18 implantes de neuromodulación de los cuales 14 (77,7%) han sido en mujeres y 4 (22,3%) en varones. La edad media es de 52,56 años. La indicación del implante en un 72,2% de los pacientes fue por DMC, un 22,1% por incontinencia mixta (urinaria y fecal), y un 5,5% fue por cistopatía intersticial. La mejoría de los síntomas al año del implante, medidos por el calendario miccional y el cuestionario de calidad de vida fue de 76,4%. La mejoría clínica fue mayor en los pacientes con síntomas de urgencia, que los pacientes con predominio de la sintomatología de vaciado.

Objective: To evaluate the pattern of erythropoietin (EPO) and some proinflammatory cytokines in the anemia of chronic disorders (ACD) secondary to infection Methods: Sequential determination in serum of interleukin-1 beta (IL-1β), necrosis tumoral factor alpha (TNF-α), gamma interferon (IFN-γ), interleukin-6 (IL-6), and erythropoietin (EPO) in 25 patients with chronic bacterial infectious diseases and ACD criteria. We evaluated the relationship of these mediators with the anemia and the iron metabolism.Results: Serum EPO levels significatively decreassed compared with initial values, and the last control was in normal rank (18.04 ± 19.10 vs. 8.56 ± 4.72 UI/mL; p < 0.001; normal rank: 4-15 mUI/mL). In the first control, there was a negative and non significative correlation between the EPO levels and the hemoglobin concentration (r = -0.115, NS), reaching significance in the last control (r = -0.446; p < 0.05). There was negative correlation between the hematocrit and TNF-α levels (r = 0.467; p <0.05) and between the haemoglobin values and the log of serum TNF-α (r = 0.424; p <0.001). An inverse correlation between the IL-6 levels and both, the hemoglobin concentration and the serum iron was found, and there was a direct correlation between this cytokine values and the EPO levels.Conclussions: Blunted response of erythopoietin and the action of TNF may contribute to the pathogenesis of ACD secondary to infection. Positive correlation between IL-6 and EPO suggest a proerythropoietic action of IL-6 in response to the anemia.

Objetivo: Evaluar el comportamiento de la eritropoyetina (EPO) y determinadas citocinas proinflamatorias en la anemia de trastornos crónicos (ATC) de origen infeccioso. Métodos: Determinación secuencial en suero mediante enzimoinmunoanálisis de interleucina-1 beta (IL-1β), factor de necrosis tumoral alfa (TNF-α), interferσn gamma (IFN-γ), interleucina-6 (IL-6) y eritropoyetina (EPO) en 25 pacientes con enfermedades de origen bacteriano, curso clínico prolongado y criterios de ATC. Se analizó la relación de estos mediadores con la anemia y con el metabolismo del hierro.Resultados: Los niveles de EPO experimentaron un descenso significativo respecto al nivel inicial, normalizándose en el control tardío (18,04 ± 19,10 vs 8,56 ± 4,72 UI/mL; p < 0,001; rango normal: 4-15 mUI/mL). Inicialmente, existía correlación inversa no significativa entre los niveles de EPO y la concentración de hemoglobina (r = - 0,115, NS), alcanzándose significación estadística en el control tardío (r = -0,446; p < 0,05). Existía correlación inversa entre el hematocrito y los niveles del TNF-α (r = 0,467; p < 0,05) y entre la hemoglobina y la transformación logarítmica del TNF-α (r = 0,424; p < 0,001). La IL-6 mostró correlación inversa con la hemoglobina (r = 0,366; p < 0,05) y con la sideremia (r = -0,614; p < 0,001), mientras que se correlacionó directamente con los niveles de la EPO (r = 0,297; p < 0,05).Conclusiones: Una deficiente respuesta de la eritropoyetina y la acción del TNF pueden implicarse en la patogenia de la ATC de origen infeccioso. La correlación positiva entre la IL-6 y la EPO sugiere una implicación proeritropoyética de la primera en respuesta a la anemia.

We evaluated the effects of infusions of the NMDA receptor antagonist D,L-2-amino-5-phosphonopentanoic acid (AP5) into the basolateral nucleus of the amygdala (BLA) on the formation and expression of memory for inhibitory avoidance. Adult male Wistar rats (215-300 g) were implanted under thionembutal anesthesia (30 mg/kg, ip) with 9.0-mm guide cannulae aimed 1.0 mm above the BLA. Bilateral infusions of AP5 (5.0 µg) were given 10 min prior to training, immediately after training, or 10 min prior to testing in a step-down inhibitory avoidance task (0.3 mA footshock, 24-h interval between training and the retention test session). Both pre- and post-training infusions of AP5 blocked retention test performance. When given prior to the test, AP5 did not affect retention. AP5 did not affect training performance, and a control experiment showed that the impairing effects were not due to alterations in footshock sensitivity. The results suggest that NMDA receptor activation in the BLA is involved in the formation, but not the expression, of memory for inhibitory avoidance in rats. However, the results do not necessarily imply that the role of NMDA receptors in the BLA is to mediate long-term storage of fear-motivated memory within the amygdala.

Intra-amygdala infusion of the non-N-methyl-D-aspartate (NMDA) receptor antagonist 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX) prior to testing impairs inhibitory avoidance retention test performance. Increased training attenuates the impairing effects of amygdala lesions and intra-amygdala infusions of CNQX. The objective of the present study was to determine the effects of additional training on the impairing effects of intra-amygdala CNQX on expression of the inhibitory avoidance task. Adult female Wistar rats bilaterally implanted with cannulae into the border between the central and the basolateral nuclei of the amygdala were submitted to a single session or to three training sessions (0.2 mA, 24-h interval between sessions) in a step-down inhibitory avoidance task. A retention test session was held 48 h after the last training. Ten minutes prior to the retention test session, the animals received a 0.5-µl infusion of CNQX (0.5 µg) or its vehicle (25% dimethylsulfoxide in saline). The CNQX infusion impaired, but did not block, retention test performance in animals submitted to a single training session. Additional training prevented the impairing effect of CNQX. The results suggest that amygdaloid non-NMDA receptors may not be critical for memory expression in animals given increased training.

Male Wistar rats were trained in one-trial step-down inhibitory avoidance using a 0.4-mA footshock. At various times after training (0, 1.5, 3, 6 and 9 h for the animals implanted into the CA1 region of the hippocampus; 0 and 3 h for those implanted into the amygdala), these animals received microinfusions of SKF38393 (7.5 µg/side), SCH23390 (0.5 µg/side), norepinephrine (0.3 µg/side), timolol (0.3 µg/side), 8-OH-DPAT (2.5 µg/side), NAN-190 (2.5 µg/side), forskolin (0.5 µg/side), KT5720 (0.5 µg/side) or 8-Br-cAMP (1.25 µg/side). Rats were tested for retention 24 h after training. When given into the hippocampus 0 h post-training, norepinephrine enhanced memory whereas KT5720 was amnestic. When given 1.5 h after training, all treatments were ineffective. When given 3 or 6 h post-training, 8-Br-cAMP, forskolin, SKF38393, norepinephrine and NAN-190 caused memory facilitation, while KT5720, SCH23390, timolol and 8-OH-DPAT caused retrograde amnesia. Again, at 9 h after training, all treatments were ineffective. When given into the amygdala, norepinephrine caused retrograde facilitation at 0 h after training. The other drugs infused into the amygdala did not cause any significant effect. These data suggest that in the hippocampus, but not in the amygdala, a cAMP/protein kinase A pathway is involved in memory consolidation at 3 and 6 h after training, which is regulated by D1, ß, and 5HT1A receptors. This correlates with data on increased post-training cAMP levels and a dual peak of protein kinase A activity and CREB-P levels (at 0 and 3-6 h) in rat hippocampus after training in this task. These results suggest that the hippocampus, but not the amygdala, is involved in long-term storage of step-down inhibitory avoidance in the rat.