RESUMO
Abstract Adolescent idiopathic scoliosis is considered the most severe and common spinal deformity, affecting children and adolescents still in the neuropsychomotor development phase before they reach skeletal maturity. This study aimed to evaluate the surgical approach to adolescent idiopathic scoliosis (AIS), considering the results associated with the reduction of pathological curvature, pulmonary function, and repercussions on the quality of life of adolescents undergoing such treatment. Systematic literature review, with a quantitative and qualitative approach to the data collected, structured according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), carried out in the databases linked to the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Latin American and Caribbean Health Sciences Literature (LILACS). The total sample of the studies was 638 adolescents with AIS, with a mean age of 14.93 years ± 1.24. The mean correction of the main pathological curvature in the studies was 55.06% ± 12.24. In all of the selected studies using posterior spinal fusion to correct AIS, there was a significant reduction in pathological curvatures (> 49%), and the recurrence of curvature in none of the studies exceeded a pathological gain of more than 5%. As for lung function, the studies showed significant increases in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) in patients with severe AIS, and no pulmonary function losses were reported after surgery to correct AIS.
Resumo A escoliose idiopática do adolescente (EIA) é considerada a deformidade vertebral de maior gravidade e ocorrência, que acomete crianças e adolescentes ainda na fase de desenvolvimento neuropsicomotor, antes de atingirem a maturidade esquelética. Este estudo teve como objetivo avaliar a abordagem cirúrgica da EIA, considerando resultados associados à redução de curvatura patológica, função pulmonar e repercussões na qualidade de vida dos adolescentes submetidos a tal tratamento. Revisão Sistemática de literatura, com abordagem quanti-qualitativa dos dados coletados, cuja estruturação se deu conforme as orientações de Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) realizada nas bases de dados vinculadas à Medical Literature Analysis and Retrieval System Online (MEDLINE) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). A amostra total dos estudos foi de 638 adolescentes com EIA, com uma idade média de 14,93 anos ± 1,24. A correção média da curvatura patológica principal nos estudos foi de 55,06% ± 12,24. Em todos os estudos selecionados com fusão espinhal posterior para correção da EIA verificou-se redução significativa das curvaturas patológicas (> 49%), sendo que a reincidência de curvatura em nenhum dos estudos superou um ganho patológico superior a 5%. Quanto à função pulmonar, os estudos apontaram ganhos significativos de volume expiratório forçado em 1 segundo (VEF1) e capacidade vital forçada (CVF) em pacientes com EIA grave. Além disso, não foram relatados prejuízos de função pulmonar após intervenção cirúrgica para correção da EIA.
Assuntos
Humanos , Adolescente , Escoliose/cirurgia , Fusão Vertebral , Anormalidades CongênitasRESUMO
BACKGROUND: Enteroinvasive Escherichia coli (EIEC) may be the causative agent of part of those million cases of diarrhea illness reported worldwide every year and attributable to Shigella. That is because both enteropathogens have many common characteristics that difficult their identification either by traditional microbiological methods or by molecular tools used in the clinical laboratory settings. While Shigella has been extensively studied, EIEC remains barely characterized at the molecular level. Recent EIEC important outbreaks, apparently generating more life-threatening cases, have prompted us to screen EIEC for virulence traits usually related to extraintestinal pathogenic E. coli (ExPEC). That could explain the appearance of EIEC strains presenting higher virulence potential. RESULTS: EIEC strains were distributed mainly in three phylogroups in a serogroup-dependent manner. Serogroups O124, O136, O144, and O152 were exclusively classified in phylogroup A; O143 in group E; and O28ac and O29 in group B1. Only two serogroups showed diverse phylogenetic origin as follows: O164 was assigned to groups A, B1, C, and B2 (one strain each), and O167 in groups E (five strains), and A (one strain) (Table 1). Eleven of 20 virulence genes (VGs) searched were detected, and the majority of the 19 different VGs combinations found were serogroup-specific. Uropathogenic E. coli (UPEC) PAI genetic markers were detected in all EIEC strains. PAIs IJ96 and IICFT073 were the most frequent (92.1 and 80.4%, respectively). PAI IV536 was restricted to some serogroups from phylogroups A, B1 and E. PAI ICFT073 was uniquely detected in phylogroups B2 and E. A total of 45 (88%) strains presented multiple PAI markers (two to four). PAIs IJ96 and IICFT073 were found together in 80% of strains. CONCLUSIONS: EIEC is a DEC pathovar that presents VGs and pathogenicity island genetic markers typically associated with ExPEC, especially UPEC. These features are distributed in a phylogenetic and serogroup-dependent manner suggesting the existence of stable EIEC subclones. The presence of phylogroups B2 and E strains allied to the presence of UPEC virulence-associated genes may underscore the ongoing evolution of EIEC towards a hypervirulent pathotype.
Assuntos
Escherichia coli/genética , Escherichia coli Extraintestinal Patogênica/genética , Ilhas Genômicas/genética , Escherichia coli Uropatogênica/genética , Virulência/genética , DNA Bacteriano , Escherichia coli/classificação , Escherichia coli/metabolismo , Infecções por Escherichia coli/microbiologia , Evolução Molecular , Escherichia coli Extraintestinal Patogênica/classificação , Escherichia coli Extraintestinal Patogênica/patogenicidade , Marcadores Genéticos/genética , Genoma Bacteriano , Células HeLa , Humanos , Filogenia , Sorogrupo , Shigella/genética , Shigella/patogenicidade , Escherichia coli Uropatogênica/patogenicidadeRESUMO
A range of in vitro, ex vivo, and in vivo approaches are currently used for drug development. Highly predictive human intestinal absorption models remain lagging behind the times because of numerous variables concerning permeability through gastrointestinal tract in humans. However, there is a clear need for a drug permeability model early in the drug development process that can balance the requirements for high throughput and effective predictive potential. The present study developed a medium throughput screening Snapwell (MTS-Snapwell) ex vivo model to provide an alternative method to classify drug permeability. Rat small intestine tissue segments were mounted in commercial Snapwell™ inserts. Unidirectional drug transport (A-B) was measured by collecting samples at different time points. Viability of intestinal tissue segments was measured by examining transepithelial electric resistance (TEER) and phenol red and caffeine transport. As a result, the apparent permeability (Papp; ×10(-6) cm/s) was determined for atenolol (10.7 ± 1.2), caffeine (17.6 ± 3.1), cimetidine (6.9 ± 0.1), metoprolol (12.6 ± 0.7), theophylline (15.3 ± 1.6) and, ranitidine (3.8 ± 0.4). All drugs were classified in high/low permeability according to Biopharmaceutics Classification System showing high correlation with human data (r = 0.89). These findings showed a high correlation with human data (r = 0.89), suggesting that this model has potential predictive capacity for paracellular and transcellular passively absorbed molecules.