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ABSTRACT Introduction: The sources of stress involved in chronic kidney disease (CKD) can lead to depressive states, directly affecting the hemodialysis patient's quality of life (QOL). There are few reports and studies on therapeutic interventions that aim to minimize depressive symptoms in these patients and an even greater shortage of studies using music therapy. Objective: This study evaluated the effect of music therapy on QOL and depressive symptoms in hemodialysis patients. Method: This was a music therapy intervention study in which 23 patients were evaluated regarding QOL and depression symptoms at two distinct stages - before and after the intervention. Eight sessions of music therapy were conducted, with two weekly sessions and an average duration of 75 minutes. The intervention was conducted by the music therapist herself, using specific music therapy techniques, besides voice and guitar to conduct harmonic and rhythmic support for the groups' sound-music production. Results: The patients showed a significant reduction in depression symptoms (p < 0.001) and better QOL results, with significant differences in the following dimensions: functional capacity (p = 0.011), pain (p = 0.036), general health (p = 0.01), vitality (p = 0.004), mental health (p = 0.012), symptom and problem list (p = 0.01), and overall health (p = 0.01). Conclusions: Intervention with music therapy constitutes an effective option in the treatment and prevention of depressive symptoms and improved QOL of HD patients.

RESUMO Introdução: Fontes de estresse representadas pela doença renal crônica (DRC) podem gerar estados de depressão, interferindo diretamente na qualidade de vida (QV) dos pacientes em hemodiálise (HD). Poucos são os relatos e estudos de intervenção terapêutica visando minimizar os sintomas depressivos nesses pacientes, com maior escassez de trabalhos utilizando a musicoterapia. Objetivo: O presente estudo avaliou o efeito da musicoterapia na QV e nos sintomas depressivos em pacientes em HD. Método: Estudo de intervenção musicoterapêutica, no qual 23 pacientes foram avaliados quanto à QV e sintomas de depressão em duas fases distintas: pré e pós-intervenção. Foram realizadas duas sessões em grupo por semana, com duração de 75 minutos, em um período de quatro semanas. A intervenção foi realizada por um musicoterapeuta, que utilizou técnicas específicas da musicoterapia, além da voz e do violão para conduzir apoio rítmico e harmônico na produção sonoro-musical dos grupos. Resultados: Os pacientes apresentaram redução significativa dos sintomas de depressão (p<0,001) e melhores resultados na QV, com diferenças estatísticas significantes nas dimensões: capacidade funcional (p=0,011), dor (p=0,036), estado geral de saúde (p=0,01), vitalidade (p=0,004), saúde mental (p=0,012), lista de sintomas e problemas (p=0,01) e saúde global (p=0,01). Conclusões: A intervenção com musicoterapia constitui-se opção efetiva no tratamento e prevenção de sintomas depressivos e na melhora da QV de pacientes em HD.

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INTRODUCTION: The sources of stress involved in chronic kidney disease (CKD) can lead to depressive states, directly affecting the hemodialysis patient's quality of life (QOL). There are few reports and studies on therapeutic interventions that aim to minimize depressive symptoms in these patients and an even greater shortage of studies using music therapy. OBJECTIVE: This study evaluated the effect of music therapy on QOL and depressive symptoms in hemodialysis patients. METHOD: This was a music therapy intervention study in which 23 patients were evaluated regarding QOL and depression symptoms at two distinct stages - before and after the intervention. Eight sessions of music therapy were conducted, with two weekly sessions and an average duration of 75 minutes. The intervention was conducted by the music therapist herself, using specific music therapy techniques, besides voice and guitar to conduct harmonic and rhythmic support for the groups' sound-music production. RESULTS: The patients showed a significant reduction in depression symptoms (p < 0.001) and better QOL results, with significant differences in the following dimensions: functional capacity (p = 0.011), pain (p = 0.036), general health (p = 0.01), vitality (p = 0.004), mental health (p = 0.012), symptom and problem list (p = 0.01), and overall health (p = 0.01). CONCLUSIONS: Intervention with music therapy constitutes an effective option in the treatment and prevention of depressive symptoms and improved QOL of HD patients.

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Renin-angiotensin system activation promotes oxidative stress and endothelial dysfunction. However, no previous study has examined the effects of the renin inhibitor aliskiren, either alone or combined with angiotensin II type 1 antagonists on alterations induced by two-kidney, one-clip (2K1C) hypertension. We compared the vascular effects of aliskiren (50mg/kg/day), losartan (10mg/kg/day), or both by gavage for 4 weeks in 2K1C and control rats. Treatment with losartan, aliskiren, or both exerted similar antihypertensive effects. Aliskiren lowered plasma Ang I concentrations in sham rats and in hypertensive rats treated with aliskiren or with both drugs. Aliskiren alone or combined with losartan decreased plasma angiotensin II concentrations measured by high performance liquid chromatography, whereas losartan alone had no effects. In contrast, losartan alone or combined with aliskiren abolished hypertension-induced increases in aortic angiotensin II concentrations, whereas aliskiren alone exerted no such effects. While hypertension enhanced aortic oxidative stress assessed by dihydroethidium fluorescence and by lucigenin chemiluminescence, losartan alone or combined with aliskiren, but not aliskiren alone, abolished this alteration. Hypertension impaired aortic relaxation induced by acetylcholine, and losartan alone or combined with aliskiren, but not aliskiren alone, reversed this alteration. Losartan alone or combined with aliskiren, but not aliskiren alone, increased plasma nitrite concentrations in 2K1C rats. These findings show that antihypertensive effects of aliskiren do not prevent hypertension-induced vascular oxidative stress and endothelial dysfunction. These findings contrast those found with losartan and suggest that renin inhibition is not enough to prevent hypertension-induced impaired redox biology and vascular dysfunction.

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OBJECTIVE: To assess the prevalence, intensity, and extent of the impacts on daily performances related to wearing different types of orthodontic appliances. MATERIALS AND METHODS: A total of 1657 students, 15 to 16 years old, were randomly selected from those attending all secondary schools in Bauru, São Paulo, Brazil. Only those wearing orthodontic appliances at the time of the survey were included. Face-to-face structured interviews were done to collect information about impacts on quality of life related to wearing orthodontic appliances, using the Oral Impact on Daily Performances (OIDP). Adolescents were also clinically examined to assess the type of orthodontic appliance they were wearing. Comparisons, by type of orthodontic appliance and covariables, were performed using nonparametric statistical tests. RESULTS: Three hundred fifty-seven adolescents (36.1% boys and 63.9% girls) undergoing orthodontic treatment participated in the study. The prevalence of condition-specific impacts related to wearing orthodontic appliances was 22.7%. Among adolescents with impacts related to wearing orthodontic appliances, 35.8% reported impacts of severe or very severe intensity and 90.1% reported impacts on only one daily performance, commonly eating or speaking. The prevalence, but not the intensity or the extent, of condition-specific impacts differed by type of orthodontic appliance (P = .001). CONCLUSIONS: One in four Brazilian adolescents undergoing orthodontic treatment reported side effects, specific impacts on daily living, related to wearing orthodontic appliances. Such impacts were higher among adolescents wearing fixed rather than removable or a combination of fixed and removable orthodontic appliances. This information could help to inform patients about the frequency and intensity of sociodental impacts during the course of their treatment.

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En un reciente estudio publicado en esta revista, empleamos una técnica de cuantificación de la actividad PET que nos permite la detección de áreas del cerebro con una actividad patológica frente a una base normativa. En nuestro esfuerzo por comprobar la eficacia del método estamos desarrollando diversos estudios para verificar su validez. En el presente trabajo mostramos que es posible observar la actividad cerebral de un sujeto control en diferentes niveles de alerta. En particular, la actividad de regiones frontales y parietales del hemisferio derecho se encuentran incrementadas como consecuencia de un estado de alerta mayor respecto del estado de relajación.

In a recent study published in this journal, we use a quantification technique for the PET exploration that allows us the detection of areas of the brain with a pathological activity compared to a normative database. In our effort to check the effectiveness of the method diverse studies have been developed to verify the validity of the method. In the present experiment, we show an interesting result that confirms that is possible to observe the brain activity of a healthy control in different levels of arousal. In particular, the activity of frontal and parietal regions of the right hemisphere is enhanced as a consequence of an increased level of arousal compared to the relaxation state.

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OBJECTIVE: To study the acute aftereffects of exercise and relaxation, performed alone and in combination, on blood pressure (BP) measured at baseline and during stressful conditions. DESIGN: Clinical trial with comparison of groups and repeated measures in each group. SETTING: Exercise Hemodynamic Laboratory, University of São Paulo, Brazil. PARTICIPANTS: Fourteen normotensive (NT) and 16 essential hypertensive (HT) subjects. INTERVENTIONS: Four random experimental sessions: relaxation (RX-20 min); exercise [EX-cycle ergometer, 53 min, 50% peak oxygen uptake (VO2peak)]; exercise plus relaxation (EX+RX); and control (C-73 min rest). Measures were taken before and after interventions at baseline and during Stroop color test. MAIN OUTCOME MEASURES: Auscultatory and plesthysmographic BPs. RESULTS: Systolic and diastolic BPs decreased significantly after all the interventions. The decreases in both BPs were significantly greater after the EX+RX session, and were also greater in the HT (EX+RX session, -10+/-1/-7+/-1 and -15+/-2/-8+/-1 mm Hg for the NT and HT, respectively). During mental stress, systolic BP increased significantly and similarly after all the experimental sessions. Diastolic BP also increased significantly during stress; however, the increase was significantly greater after the RX session. At the end of the mental stress, diastolic BP was significantly lower after the EX (74+/-3 mm Hg) and EX+RX (72+/-3 mm Hg) sessions than after the C (79+/-3 mm Hg) and RX (78+/-3 mm Hg) sessions. CONCLUSIONS: In NT and HT subjects, a single bout of exercise or relaxation has hypotensive effects, further enhanced by their combination, and greater in the HT. Moreover, exercise performed alone or in combination with relaxation decreases systolic and diastolic BPs during mental stress.

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O objetivo deste artigo é discutir os conceitos e diferentes estudos relacionados ao estado de relaxamento e as diferentes abordagens usadas na hidroterapia. Diferentes técnicas têm sido aplicadas com a finalidade de alcançar o estado de relaxamento, contudo, este estudo se deterá na descrição das abordagens mais utilizadas na hidroterapia e psicologia, e relação entre os efeitos fisiológicos da imersão e privação sensorial...

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Encontramos que después de inducir la anestesia con propofol intravenoso, ocurrió un aumento en la temperatura del antebrazo y la mano. Presentamos datos registrados durante los primeros 60 minutos siguientes a la inducción de la anestesia (n=16). En pacientes cuya temperatura corporal no se reguló, la temperatura central fue 36,3 (36,0 -36,6)ºC (n=10) y cambió 0,9 (-1,0 - 0,7)ºC (p<0,01). La temperatura inicial del antebrazo fue 32,0 (30,7 - 32,79ºC e incrementó 2,4 (1,6 - 3,4)ºC (p<0,01). El tiempo para alcanzar a la mitad del cambio máximo de temperatura en el antebrazo fue 23,0 (19,0 - 26,0) minutos. La temperatura inicial de la eminencia hipotenar fue 29,3 (27,7 - 31,0)ºC y aumentó 5,8 (4,2 - 7,1)ºC. El cambio de la temperatura inicial de la eminencia hipotenar fue una función lineal de la temperatura inicial de la mano. La temperatura de la mano también cambió hacia la temperatura central, y después de una hora de anestesia se registró una diferencia con esa última de 0,5 (0,2 -0,8)ºC. El tiempo a la mitad del cambio máximo en la mano fue 7.0 (5,8 -10,0) minutos. Los cambios en la temperatura de la mano que ocurieron durante la inducción de la anestesia fueron suficientemente grandes para modificar significativamente el electromiograma compuesto integrado. Las variaciones de amplitud de éste, producidas mediante estímulo con el tren de cuatro resultarían en falta de control de la relajación muscular. La calibración incorrecta del instrumento hecha con una mano fría, produce la falsa impresión de relajación por una reducción de los valores del electromiograma debida a temperatura, que sería atribuida a las drogas utilizadas

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