Frequentist and Bayesian Hypothesis Testing: An Intuitive Guide for Urologists and Clinicians / Pruebas de hipótesis frecuentista y bayesiana: Una Guía intuitiva para urólogos y clínicos

Given the limitations of frequentist method for null hypothesis significance testing, different authors recommend alternatives such as Bayesian inference. A poor understanding of both statistical frameworks is common among clinicians. The present is a gentle narrative review of the frequentist and Bayesian methods intended for physicians not familiar with mathematics. The frequentist p-value is the probability of finding a value equal to or higher than that observed in a study, assuming that the null hypothesis (H0) is true. The H0 is rejected or not based on a p threshold of 0.05, and this dichotomous approach does not express the probability that the alternative hypothesis (H1) is true. The Bayesian method calculates the probability of H1 and H0 considering prior odds and the Bayes factor (Bf). Prior odds are the researcher's belief about the probability of H1, and the Bf quantifies how consistent the data is concerning H1 and H0. The Bayesian prediction is not dichotomous but is expressed in continuous scales of the Bf and of the posterior odds. The JASP software enables the performance of both frequentist and Bayesian analyses in a friendly and intuitive way, and its application is displayed at the end of the paper. In conclusion, the frequentist method expresses how consistent the data is with H0 in terms of p-values, with no consideration of the probability of H1. The Bayesian model is a more comprehensive prediction because it quantifies in continuous scales the evidence for H1 versus H0 in terms of the Bf and the

Dadas las limitaciones del método de significancia frecuentista basado en la hipótesis nula, diferentes autores recomiendan alternativas como la inferencia bayesiana. Es común entre los médicos una comprensión deficiente de ambos marcos estadísticos. Esta es una revisión narrativa amigable de los métodos frecuentista y bayesiano dirigida quienes no están familiarizados con las matemáticas. El valor de p frecuentista es la probabilidad de encontrar un valor igual o superior al observado en un estudio, asumiendo que la hipótesis nula (H0) es cierta. La H0 se rechaza o no con base en un umbral p de 0.05, y este enfoque dicotómico no expresa la probabilidad de que la hipótesis alternativa (H1) sea verdadera. El método bayesiano calcula la probabilidad de H1 y H0 considerando las probabilidades a priori y el factor de Bayes (fB). Las probabilidades a priori son la creencia del investigador sobre la probabilidad de H1, y el fB cuantifica cuán consistentes son los datos con respecto a H1 y H0. La predicción bayesiana no es dicotómica, sino que se expresa en escalas continuas del fB y de las probabilidades a posteriori. El programa JASP permite realizar análisis frecuentista y bayesiano de una forma simple e intuitiva, y su aplicación se muestra al final del documento. En conclusión, el método frecuentista expresa cuán consistentes son los datos con H0 en términos de valores p, sin considerar la probabilidad de H1. El modelo bayesiano es una predicción más completa porque cuantifica en escalas continuas la evidencia de H1 versus H0 en términos del fB y de las probabilidades a posteriori.

Evaluation of the melting temperature of TaqMan probes as a genotyping method for IDH1, IDH2, and H3F3A in pediatric astrocytomas / Evaluación del método de temperatura de disociación de sondas TaqMan para la genotipificación de IDH1, IDH2 y H3F3A en astrocitomas pediátricos

Abstract Background: Astrocytomas are cancer tumors of the central nervous system and represent the most common type of solid tumors during human childhood. In 2016, the World Health Organization established a molecular classification system to regroup tumor entities to achieve a more accurate diagnosis and a better clinical decision-making and selection of treatment in patients with these types of tumors. Methods: We evaluated a genotyping assay for rapid and cost-effective mutation detection in astrocytomas using TaqMan probes in an asymmetric polymerase chain reaction (PCR) assay. Results: Four diffuse astrocytomas (Grade II), three anaplastic astrocytomas (Grade III), and four glioblastomas (Grade IV) were sequenced, and all of them displayed the wild-type (WT) sequence. We tried to set up this melting analysis for the genotyping of pediatric astrocytomas by identifying the specific melting temperatures of the TaqMan probes due to the presence of the WT sequences in the isocitrate dehydrogenase 1 and 2 (IDH1 and IDH2) and H3.3 histone A genes (H3F3A). We used an IDH1-TaqMan probe to identify the WT status of IDH1 in two different WT deoxyribonucleic acid (DNA) templates (pilocytic and diffuse astrocytoma) and obtained four melting temperature values ranged from 65.6 to 92.2°C. Furthermore, only four out of 29 reactions displayed amplification of the DNA template. Sanger sequencing was faster and more reliable to detect the gene status in all the sequenced samples. Conclusions: We conclude that conventional Sanger sequencing remains the gold standard for the genotyping of pediatric astrocytomas.

Resumen Introducción: Los astrocitomas son un tipo de cáncer que afecta al sistema nervioso central y representan el tumor sólido más común durante la infancia. En el año 2016, la Organización Mundial de la Salud estableció un sistema de clasificación molecular para reagrupar tumores con identidades genéticas similares y lograr un diagnóstico más preciso, lo que lleva a tomar las decisiones clínicas idóneas al elegir el tratamiento de pacientes con este tipo de tumores. Métodos: Se evaluó un protocolo que involucra el uso de sondas TaqMan en un ensayo de reacción en cadena de la polimerasa asimétrica para la detección de mutaciones en astrocitomas. Se secuenciaron cuatro astrocitomas difusos (Grado II), tres astrocitomas anaplásicos (Grado III) y cuatro glioblastomas (Grado IV). Se intentó establecer las condiciones del análisis para la genotipificación de los astrocitomas pediátricos mediante la identificación de las temperaturas de disociación específicas de las sondas TaqMan producidas por la prescencia de las secuancias WT en los genes isocitrato deshidrogenasa 1 y 2 (IDH1, IDH2) y H3.3 histona A (H3F3A). Resultados: Los astrocitomas mostraron la secuencia wild type (WT) (silvestre) de los genes. Se utilizó una sonda TaqMan IDH1 para identificar el estado de este gen en dos templados WT de DNA (astrocitoma pilocítico y difuso) y se obtuvieron cuatro valores de temperatura de disociación (65.6-92.2 °C). Solo cuatro de las 29 reacciones mostraron amplificación de DNA. La secuenciación de Sanger fue más rápida y confiable para detectar el estado de los genes en todas las muestras. Conclusiones: La secuenciación de Sanger sigue siendo la técnica más práctica para la genotipificación de astrocitomas pediátricos.

Enriched environment improves sevoflurane-induced cognitive impairment during late-pregnancy via hippocampal histone acetylation

Fetal exposure to sevoflurane induces long-term cognitive impairment. Histone acetylation regulates the transcription of genes involved in memory formation. We investigated whether sevoflurane exposure during late-pregnancy induces neurocognitive impairment in offspring, and if this is related to histone acetylation dysfunction. We determined whether the effects could be reversed by an enriched environment (EE). Pregnant rats were exposed to 2.5% sevoflurane or control for 1, 3, or 6 h on gestational day 18 (G18). Sevoflurane reduced brain-derived neurotrophic factor (BDNF), acetyl histone H3 (Ac-H3), and Ac-H4 levels and increased histone deacetylases-2 (HDAC2) and HDAC3 levels in the hippocampus of the offspring on postnatal day 1 (P1) and P35. Long-term potentiation was inhibited, and spatial learning and memory were impaired in the 6-h sevoflurane group at P35. EE alleviated sevoflurane-induced cognitive dysfunction and increased hippocampal BDNF, Ac-H3, and Ac-H4. Exposure to 2.5% sevoflurane for 3 h during late-pregnancy decreased hippocampal BDNF, Ac-H3, and Ac-H4 in the offspring but had no effect on cognitive function. However, when the exposure time was 6 h, impaired spatial learning and memory were linked to reduced BDNF, Ac-H3, and Ac-H4, which could be reversed by EE.

Obesidad parental y modificaciones epigenéticas en la descendencia / Parental obesity and epigenetic modifications in offspring

RESUMEN La obesidad es una enfermedad multifactorial definida como acumulación patológica de grasa. Su prevalencia ha aumentado enormemente en el mundo. Chile presenta una de las mayores prevalencias de obesidad de la OCDE. Su casuística simplificada comprende una diferencia sostenida entre gasto e ingesta de energía, manteniendo un delta positivo traducido en mayor acumulación de grasa. No obstante, la etiología completa de esta enfermedad comprende también factores psicológicos, genéticos, ambientales, etc. El ambiente juega un papel clave en la predisposición al consumo de alimentos, a la realización de ejercicio físico, incluso afectando la susceptibilidad genómica, exacerbando o disminuyendo la carga genética. Esta modificación de susceptibilidad genética por el ambiente se conoce como epigenética, que se refiere a una serie de modificaciones por "sobre" la genética que son altamente modificables por factores ambientales. Se ha descrito que algunas de estas modificaciones pueden heredarse de una generación a otra, lo que otorga otro nivel de complejidad al estudio de nuevas terapias complementarias para frenar la tendencia al sobrepeso. En la presente revisión se describe cuales son las modificaciones epigenéticas más frecuentes encontradas, su relación con obesidad y dieta, y finalmente como se relaciona con la transmisión transgeneracional de esta patología.

ABSTRACT Obesity is a multifactorial disease defined by a pathological accumulation of body fat. Its prevalence has increased greatly across the world. Chile has one of the highest prevalence of obesity among OCDE countries. It is caused by a sustained difference between energy expenditure and intake, keeping a positive delta, which drives fat accumulation. However, its etiology is comprised several factors: psychological, genetics, environmental, etc. The environment plays a key role in the predisposition towards food consumption, the adoption of exercise, and genetic susceptibility, increasing or decreasing the genetic load towards obesity. This modification of susceptibility is known as epigenetics, which refers to modifications "over" genetics, which are highly modifiable by environmental factors. Some of these modifications can be inherited from one generation to another, granting a higher complexity level regarding designing novel complementary therapies against obesity. Thus, the present review described which epigenetic modifications are related to obesity and different dietary patterns, and finally how epigenetic modifications can be related to transgenerational transmission of obesity.

Glioma difuso de línea media H3K27M positivo en adulto. Caso clínico / H3K27 positive diffuse midline glioma. Report of one case

The 2016 WHO Classification of Tumours of the Central Nervous System incorporates a new diagnostic entity: the mutant diffuse midline glioma H3K27, a tumor with a characteristic location and special molecular biology. We report the case of a 51-year-old male patient with progressive diplopia. The imaging study showed a mesencephalic tumor; the stereotacic biopsy disclosed an Anaplastic Astrocytoma Isocitrate dehydrogenase (IDH) wild type. The molecular study concludes H3K27 mutation. The patient was treated with radiotherapy with concurrent and adjuvant chemotherapy (temozolomide) with partial recovery of the diplopia.

Epigenetics in non-small cell lung carcinomas / Epigenetica en carcinomas pulmonares de células no pequeñas

Abstract: Objective: To perform a systematic review of the main epigenetic aberrations involved in non-small cell lung carcinomas' (NSCLC) diagnosis, progression, and therapeutics. Materials and methods: We performed a systematic review of the scientific literature on lung cancer epigenetics, focusing on NSCLC. Results: Several advances in the molecular study of classical epigenetic mechanisms and massive studies of lung cancer epigenome have contributed relevant new evidence revealing that various molecular complexes are functionally influencing genetic-epigenetic and transcriptional mechanisms that promote lung tumorigenesis (initiation, promotion, and progression), and are also involved in NSCLC therapy-resistance mechanisms. Conclusion: Several epigenetic complexes and mechanisms must be analyzed and considered for the design of new and efficient therapies, which could be fundamental to develop an integrated knowledge to achieve a comprehensive lung cancer personalized medicine.

Resumen: Objetivo: Realizar una revisión sistemática y estructurada de las principales aberraciones epigenéticas involucradas en el diagnóstico, progresión y terapia del cáncer pulmonar de células no pequeñas (CPCNP). Material y métodos: Revisión sistemática de literatura científica sobre epigenética del cáncer pulmonar del grupo CPCNP. Resultados: El estudio de los diversos mecanismos epigenéticos y su impronta epigenética en el epigenoma del cáncer pulmonar han arrojado nuevas evidencias a nivel biológico, biomédico y médico-clínico del impacto que los mecanismos epigenético-transcripcionales promueven de manera activa y reversible sobre los procesos de tumorigénesis, progresión histopatológica y mecanismos de resistencia a la terapia oncológica pulmonar. Conclusión: Deben analizarse diferentes complejos y mecanismos epigenéticos para el estudio y diseño de esquemas nuevos y eficaces de terapia epigenética, los cuales podrían ser fundamentales para desarrollar un conocimiento integral en el desarrollo de la medicina personalizada en el cáncer pulmonar del grupo CPCNP.

Perspectivas moleculares en cardiopatía hipertrófica: abordaje epigenético desde la modificación de la cromatina / Molecular perspectives in hypertrophic cardiomyopathy: epigenetic approach from chromatin remodeling

Resumen Los cambios epigenéticos inducidos por factores ambientales tienen cada día más relevancia en las enfermedades cardiovasculares. Uno de los componentes moleculares más observados en la hipertrofia cardiaca es la reactivación de los genes fetales causados por diversas patologías que incluyen obesidad, hipertensión arterial, estenosis valvular aórtica, causas congénitas, entre otras. A pesar de las múltiples investigaciones cuyo objetivo es obtener información acerca de los componentes moleculares de esta patología, su influencia en las estrategias terapéuticas es relativamente escasa. En la actualidad se busca información acerca de las proteínas que modifican la expresión de los genes fetales que se reactivan en esta condición. La relación entre las histonas y el ADN tiene un control reconocido en la expresión de genes que son condicionados por el ambiente e inducen modificaciones epigenéticas. Las deacetilasas de histonas son un grupo de proteínas que han demostrado tener un papel importante en la diferenciación de la célula cardiaca y además pueden ser claros componentes en el desarrollo de la hipertrofia cardiaca. En este trabajo se revisan los conocimientos actuales sobre la influencia de estas proteínas y los posibles planes terapéuticos en la hipertrofia cardiaca.

Abstract Epigenetic alterations induced by environmental factors are more relevant each day for cardiovascular diseases. One of the most observed molecular components in hypertrophic cardiomyopathy is the reactivation of fetal genes caused by multiple conditions, including obesity, high blood pressure, aortic valve stenosis and congenital causes. Despite several investigations with the objective of obtaining information regarding molecular components of this condition, its influence in therapeutic strategies is relatively scarce. Nowadays information is being searched about proteins that modify the expression of the fetal genes that reactivate with this condition. The relationship between histones and DNA has a recognised control in the expression of genes that are subject to the environment and induce epigenetic alterations. Histone deacetylases are a group of proteins that have revealed to play an important role in differentiation the cardiac cell and could be clear components in the development of hypertrophic cardiomyopathy. In this study current knowledge about the influence of these proteins and possible therapeutic plans for hypertrophic cardiomyopathy are revised.

Induced pluripotent stem cells reprogramming: Epigenetics and applications in the regenerative medicine / Células-tronco de pluripotência induzida: papel da epigenética na reprogramação e sua aplicabilidade clínica

Summary Induced pluripotent stem cells (iPSCs) are somatic cells reprogrammed into an embryonic-like pluripotent state by the expression of specific transcription factors. iPSC technology is expected to revolutionize regenerative medicine in the near future. Despite the fact that these cells have the capacity to self-renew, they present low efficiency of reprogramming. Recent studies have demonstrated that the previous somatic epigenetic signature is a limiting factor in iPSC performance. Indeed, the process of effective reprogramming involves a complete remodeling of the existing somatic epigenetic memory, followed by the establishment of a "new epigenetic signature" that complies with the new type of cell to be differentiated. Therefore, further investigations of epigenetic modifications associated with iPSC reprogramming are required in an attempt to improve their self-renew capacity and potency, as well as their application in regenerative medicine, with a new strategy to reduce the damage in degenerative diseases. Our review aimed to summarize the most recent findings on epigenetics and iPSC, focusing on DNA methylation, histone modifications and microRNAs, highlighting their potential in translating cell therapy into clinics.

Resumo As células-tronco de pluripotência induzida (CTPI) ou do inglês induced pluripotent stem cells (iPSCs) são células somáticas reprogramadas para o estado embrionário por meio da expressão de fatores ectópicos de transcrição específicos, tornando-as um alvo promissor para a medicina regenerativa. Apesar das CTPI compartilharem características embrionárias, como pluripotência e capacidade de autorrenovação, elas possuem uma baixa eficiência de reprogramação, sendo a memória epigenética uma das principais barreiras nesse processo. A epigenética é caracterizada por alterações reversíveis e herdáveis no genoma funcional que não alteram a sequência de nucleotídeos do DNA. Dentre as diferentes modificações epigenéticas, destacam-se metilação de DNA, alterações em histonas e microRNA. Atualmente, sabe-se que o processo de reprogramação efetivo das CTPI envolve um completo remodelamento da memória epigenética somática existente, seguido pelo estabelecimento de uma "assinatura epigenética" que esteja de acordo com o novo tipo de célula a ser diferenciada. Modificações epigenéticas personalizadas são capazes de melhorar o rendimento e a efetividade das CTPI geradas, abrindo uma nova perspectiva para a terapia celular. Nesta revisão reunimos as principais informações sobre os fatores epigenéticos que afetam a reprogramação das CTPI, bem como seus benefícios na aplicação da terapia celular.

miR-22 suppresses tumorigenesis and improves radiosensitivity of breast cancer cells by targeting Sirt1

BACKGROUND: miR-22 has been shown to be frequently downregulated and act as a tumor suppressor in multiple cancers including breast cancers. However, the role of miR-22 in regulating the radioresistance of breast cancer cells, as well as its underlying mechanism is still not well understood. METHODS: The expressions of miR-22 and sirt1 at mRNA and protein levels were examined by qRT-PCR and Western Blot. The effects of miR-22 overexpression and sirt1 knockdown on cell viability, apoptosis, radiosensitivity, γ-H2AX foci formation were evaluated by CCK-8 assay, flow cytometry, colony formation assay, and γ-H2AX foci formation assay, respectively. Luciferase reporter assay and qRT-PCR analysis were performed to confirm the interaction between miR-22 and sirt1. RESULTS: miR-22 was downregulated and sirt1 was upregulated at both mRNA and protein levels in breast cancer cells. miR-22 overexpression or sirt1 knockdown significantly suppressed viability, induced apoptosis, reduced survival fraction, and increased the number of γ-H2AX foci in breast cancer cells. Sirt1 was identified as a target of miR-22 and miR-22 negatively regulated sirt1 expression. Ectopic expression of sirt1 dramatically reversed the inhibitory effect of miR-22 on cell viability and promotive effect on apoptotic rates and radiosensitivity in breast cancer cells. CONCLUSIONS: miR-22 suppresses tumorigenesis and improves radiosensitivity of breast cancer cells by targeting sirt1, providing a promising therapeutic target for breast cancer.

Regulação epigenética da expressão gênica de Schistosoma mansoni induzida por inibidor de histona deacetilase / Epigenetic regulation of gene expression in Schistosoma mansoni induced by histone deacetilase inhibitor

A esquistossomose é um grave problema de saúde pública, com alta mortalidade e morbidade em países endêmicos, causada pelo verme trematódeo do gênero Schistosoma. O praziquantel é a única droga disponível para tratamento da doença, é usada em larga escala para tratamento de populações de áreas endêmicas, porém não previne a reinfecção e tem efeito somente em vermes adultos. Drogas estudadas em câncer como inibidores de histona deacetilases (iHDACs) modificam o padrão epigenético da célula desencadeando a morte celular, e em Schistosoma mansoni já foi mostrado que a inibição de HDACs além de aumentar a acetilação de histonas alterou o fenótipo de miracídios e provocou morte em esquistossômulos e vermes adultos. O presente estudo investigou o efeito do iHDAC Trichostatin A (TSA) na regulação da transcrição gênica em esquistossômulos, detectando por meio de ensaios de microarray centenas de genes diferencialmente expressos, relacionados a replicação de DNA, metabolismo e complexos modificadores de histonas. A inibição de HDAC em vermes adultos levou a um aumento da acetilação nas marcas de histonas H3K9ac, H3K14ac e H4K5ac relacionadas à indução de transcrição. Com imunoprecipitação de cromatina seguida de PCR (ChIP-qPCR) detectou-se o aumento de deposição de H3K9ac e H3K14ac na região promotora de genes com expressão aumentada ou diminuída, porém a marca de repressão H3K27me3 não sofreu alteração na região promotora de nenhum gene analisado. Análises adicionais indicaram um conjunto de genes diferencialmente expressos que codificam proteínas histone readers, que fazem parte de complexos modificadores de histonas, como EED capaz de identificar a marca de repressão H3K27me3 e regular a atividade de EZH2, apontando um novo alvo terapêutico. O efeito sinérgico entre iHDAC e um iEZH2 foi testado e detectou-se o aumento da mortalidade de esquistossômulos. A estrutura de SmEZH2 foi modelada por homologia e usada para análises computacionais que sugeriram uma alta afinidade de ligação de SmEZH2 com o iEZH2, abrindo uma perspectiva de desenvolvimento de novas drogas específicas para tratamento da esquistossomose

Schistosomiasis is a serious public health problem, with high mortality and morbidity in endemic countries, caused by trematode worms of the genus Schistosoma. Praziquantel is the only available drug for treatment of the disease; it is used extensively to treat populations in endemic areas, but does not prevent reinfection and is effective only in adult worms. Drugs studied in cancer as histone deacetylase inhibitors (iHDACs) modify the epigenetic status of the cell, triggering cell death, and it has been shown in Schistosoma mansoni that inhibition of HDACs increase histone acetylation, alter the phenotype of miracidia and cause death in schistosomules and adult worms. The present study investigated the effect of iHDAC Trichostatin A (TSA) on the regulation of gene transcription in schistosomules, detecting by means of microarray assays hundreds of differentially expressed genes related to DNA replication, metabolism and histone remodeling complexes. Inhibition of HDAC in adult worms led to an increase in histone acetylation marks H3K9ac, and H3K14ac H4K5ac related to transcriptional induction. With chromatin immunoprecipitation followed PCR (ChIP-qPCR) we detected an increased deposition of H3K9ac and H3K14ac at the promoter region of genes with increased or decreased expression, but the repressive mark H3K27me3 was not changed at all analyzed gene promoter regions. Additional analysis indicated a set of differentially expressed genes that encode histone reader proteins that are part of histone modifier complexes such as EED, which is able to identify the repression mark H3K27me3 and to regulate EZH2 activity, pointing to a new therapeutic target. The synergistic effect between iHDAC and one iEZH2 has been tested and found to cause an increase in schistosomules mortality. The SmEZH2 structure was modeled by homology and used for computational analyses, which suggested a high affinity binding of SmEZH2 with iEZH2, opening the opportunity for development of new specific drugs for treatment of schistosomiasis

Supplementation of fetal bovine serum alters histone modification H3R26me2 during preimplantation development of in vitro produced bovine embryos / Suplementação com soro fetal bovino altera a modificação de histona H3R26me2 durante o período pré-implantacional em embriões bovinos produzidos in vitro

In vitro production (IVP) of bovine embryos is not only of great economic importance to the cattle industry, but is also an important model for studying embryo development. The aim of this study was to evaluate the histone modification, H3R26me2 during pre-implantation development of IVP bovine embryos cultured with or without serum supplementation and how these in vitro treatments compared to in vivo embryos at the morula stage. After in vitro maturation and fertilization, bovine embryos were cultured with either 0 or 2.5% fetal bovine serum (FBS). Development was evaluated and embryos were collected and fixed at different stages during development (2-, 4-, 8-, 16-cell, morula and blastocyst). Fixed embryos were then used for immunofluorescence utilizing an antibody for H3R26me2. Images of stained embryos were analyzed as a percentage of total DNA. Embryos cultured with 2.5% FBS developed to blastocysts at a greater rate than 0%FBS groups (34.85±5.43% vs. 23.38±2.93%; P<0.05). Levels of H3R26me2 changed for both groups over development. In the 0%FBS group, the greatest amount of H3R26me2 staining was at the 4-cell (P<0.05), 16-cell (P<0.05) and morula (P<0.05) stages. In the 2.5%FBS group, only 4-cell stage embryos were significantly higher than all other stages (P<0.01). Morula stage in vivo embryos had similar levels as the 0%FBS group, and both were significantly higher than the 2.5%FBS group. These results suggest that the histone modification H3R26me2 is regulated during development of pre-implantation bovine embryos, and that culture conditions greatly alter this regulation...

A produção in vitro (PIV) de embriões de bovinos não é apenas de grande importância econômica para a pecuária, mas é também um importante modelo para estudar o desenvolvimento embrionário. O objetivo deste estudo foi avaliar a modificação de histona, H3R26me2 durante o desenvolvimento pré-implantacional em embriões bovinos produzidos in vitro, cultivados com ou sem suplementação de soro fetal bovino (SFB), bem como comparar essa modificação específica entre mórulas produzidas in vitro e in vivo. Após a maturação in vitro e fertilização, embriões foram cultivados com suplementação de 0 ou 2,5% SFB. O desenvolvimento embrionário foi avaliado e embriões foram coletados e fixados em diferentes fases durante o desenvolvimento (2, 4, 8 e 16 células, mórula e blastocisto). Os embriões fixados foram avaliados por imunofluorescência utilizando um anticorpo para H3R26me2. Imagens de embriões corados foram analisadas baseadas na porcentagem do DNA total. Embriões cultivados com 2,5% SFB tiveram uma taxa de desenvolvimento ao estágio de blastocisto maior que o grupo que não recebeu suplementação com SFB (34.85±5,43% vs 23.38±,93%; P<0,05). Níveis de H3R26me2 variaram para ambos os grupos ao longo do desenvolvimento. No grupo 0% SFB, a marcação para H3R26me2 foi mais intensa nos estágios de 4 células (P<0,05), 16 células (P<0,05) e mórula (P<0.05). No grupo 2.5% SFB, apenas os embriões de 4 células tiveram marcação significativamente maior que todas as outras fases (P<0,01). Mórulas produzidas in vivo apresentaram níveis de H3R26me2 semelhantes ao grupo 0% SFB, e ambos foram significativamente maiores que o grupo 2.5% SFB. Estes resultados sugerem que a modificação de histona H3R26me2 é regulada durante o desenvolvimento pré-implantacional de embriões bovinos, e que as condições de cultura alteram de maneira importante esta regulação...

Assessment of adherence to the guidelines for the management of nausea and vomiting induced by chemotherapy / Avaliação da aderência à diretriz de cuidados para náuseas e vômitos induzidos por quimioterapia

ABSTRACT Objective: To assess adherence of the prescribing physicians in a private cancer care center to the American Society of Clinical Oncology guideline for antiemetic prophylaxis, in the first cycle of antineoplastic chemotherapy. Methods: A total of 139 chemotherapy regimens, of 105 patients, were evaluated retrospectively from 2011 to 2013. Results: We observed 78% of non-adherence to the guideline rate. The main disagreements with the directive were the prescription of higher doses of dexamethasone and excessive use of 5-HT3 antagonist for low risk emetogenic chemotherapy regimens. On univariate analysis, hematological malignancies (p=0.005), the use of two or more chemotherapy (p=0.05) and high emetogenic risk regimes (p=0.012) were factors statistically associated with greater adherence to guidelines. Treatment based on paclitaxel was the only significant risk factor for non-adherence (p=0.02). By multivariate analysis, the chemotherapy of high emetogenic risk most correlated with adherence to guideline (p=0.05). Conclusion: We concluded that the adherence to guidelines is greater if the chemotherapy regime has high emetogenic risk. Educational efforts should focus more intensely on the management of chemotherapy regimens with low and moderate emetogenic potential. Perhaps the development of a computer generated reminder may improve the adherence to guidelines. .

RESUMO Objetivo: Avaliar a adesão dos médicos prescritores, de um centro privado especializado em oncologia, à diretriz de antiêmese profilática da American Society of Clinical Oncology, no primeiro ciclo de quimioterapia antineoplásica. Métodos: Foram avaliados retrospectivamente 139 esquemas de quimioterapia, de 105 pacientes, tratados no período de 2011 a 2013. Resultados: Foram observados 78% de taxa de não adesão à diretriz. As principais discordâncias com a diretriz foram prescrição de doses mais elevadas de dexametasona e uso excessivo de antagonista 5-HT3 para regimes de quimioterapia de risco emetogênico baixo. Pela análise univariada, malignidades hematológicas (p=0,005), uso de dois ou mais quimioterápicos (p=0,05) e regimes de alto risco emetogênico (p=0,012) foram fatores estatisticamente associados a maior adesão à diretriz. O tratamento baseado em paclitaxel foi o único fator estatisticamente significativo para a não adesão (p=0,02). Pela análise multivariada, a quimioterapia de alto risco emetogênico apresentou maior correlação com a adesão à diretriz (p=0,05). Conclusão: Houve maior aderência para a quimioterapia de alto risco emetogênico. Esforços educacionais devem se concentrar mais intensamente na gestão de regimes de quimioterapia com potencial emetogênico baixo e moderado. Talvez o desenvolvimento de lembretes gerados por sistemas informatizados possa melhorar a aderência à diretriz. .

Are 30 minutes of rest between two incremental shuttle walking tests enough for cardiovascular variables and perceived exertion to return to baseline values?

Objective: To verify whether 30 minutes of rest between two incremental shuttle walking tests (ISWT) are enough for cardiovascular variables and perceived exertion to return to baseline values in healthy subjects in a broad age range. Method: The maximal exercise capacity of 334 apparently healthy subjects (age ≥18) was evaluated using the ISWT. The test was performed twice with 30 minutes of rest in between. Heart rate (HR), arterial blood pressure (ABP), dyspnea, and leg fatigue were evaluated before and after each test. Subjects were allocated to 6 groups according to their age: G1: 18-29 years; G2: 30-39 years; G3: 40-49 years; G4: 50-59 years; G5: 60-69 years and G6: ≥70 years. Results: All groups had a good performance in the ISWT (median >90% of the predicted distance). The initial HR (HRi) of the second ISWT was higher than the first ISWT in the total sample (p<0.0001), as well as in all groups (p<0.0001). No difference was observed in the behavior of ABP (systolic and diastolic) and dyspnea between the two tests, but this difference occurred for leg fatigue (greater before the second ISWT) in G1 (p<0.05). Most subjects (58%) performed better in the second test. Conclusion: 30 minutes of rest between two ISWTs are not enough for all cardiovascular variables and perceived exertion to return to baseline values. However, this period appears to be sufficient for blood pressure and performance to recover in most subjects. .

Letramento em saúde de diabéticos tipo 2: fatores associados e controle glicêmico / Health literacy in type 2 diabetics: associated factors and glycemic control

Pacientes com diabetes mellitus requerem um autocuidado extenso, com tratamentos complexos e comportamentos de saúde adequados, sendo, essas habilidades, fator chave. Frente a tal complexidade surge a importância do letramento funcional em saúde. O objetivo do estudo foi analisar fatores associados ao letramento em saúde e sua relação com controle glicêmico em pacientes diabéticos. Este estudo foi realizado com 82 pacientes diabéticos tipo 2, atendidos em um ambulatório de endocrinologia de um hospital público, de ambos os sexos e com idade entre 19 e 59 anos, que responderam à versão abreviada e traduzida do Test of Functional Health Literacy in Adults (b-TOFHLA). Valores de glicemia de jejum e hemoglobina glicada foram coletados dos prontuários dos participantes. Foram realizadas correlações, comparações de médias e modelos de regressão linear. O letramento inadequado foi encontrado em 65,9% dos pacientes. Foram fatores associados à pontuação do b-TOFHLA, a idade e os anos de estudos. O letramento global não explicou o controle glicêmico, mas o numeramento apresentou associação com tal controle. Nossos resultados apontam para a necessidade de melhorar o numeramento em saúde dos pacientes para obter seu melhor controle glicêmico, principalmente naqueles com maior idade e menos anos de estudo.

Diabetes mellitus patients must concentrate on self-care, with complex treatments and adequate health behavior in which such habits are a key factor. Due to the complexity of this issue, the importance of literacy in health arises. The goal of the study was to analyze factors associated with literacy in health and its relation with glycemic control in diabetic patients. It involved a study with 82 type 2 diabetic patients of both sexes and aged between 19 and 59 attended in the outpatient endocrinology ward of a public hospital, who filled out an abbreviated and translated version of the Test of Functional Health Literacy in Adults (b-TOFHLA). Fasting glycaemia values and glycated hemoglobin were collected from the clinical history of the participants. Correlations, mean comparisons and linear regression models were tested. Inadequate literacy in health was encountered in 65.9% of the patients. The issues involved factors associated with the b-TOFHLA point scores were age and years of schooling. Global literacy did not explain the glycemic control, but the level of numeracy presented an association with this control. The results point to the need to improve the numeracy in health of the patients to obtain enhanced glycemic control, mainly in those with more advanced age and less years of schooling.

Envolvimento do receptor TLR-9 na resposta imune do hospedeiro durante o curso da infecção pelo Mycobacterium leprae / Involvement of the TLR9 receptor in host immune responses during infection by Mycobacterium leprae

Mycobacterium leprae, agente etiológico da hanseníase, expressa em abundância uma proteína catiônica semelhante às histonas, denominada Hlp, presente tanto no envelope como no nucleóide bacteriano. O reconhecimento do DNA bacteriano, rico em motivos CpG não metilados, pelo receptor TLR-9 representa uma importante via para a ativação da resposta imune inata, a qual pode levar à eliminação do agente infeccioso ou mediar manifestações patológicas. Foi mostrado ainda que complexos DNA-histona são mais potentes agonistas de TLR-9 que DNA sozinho. Assim, o presente trabalho teve como objetivo investigar o envolvimento do receptor TLR-9 na ativação da resposta imune do hospedeiro durante o curso da infecção pelo M. leprae.Inicialmente foi analisada a participação do TLR-9 na ativação da resposta imune inata em células epiteliais alveolares da linhagem A549 após estímulo com M. leprae. M. leprae foi capaz de induzir aumento das quimiocinas IL-8 eMCP-1 e a transcrição gênica do peptídeo antimicrobiano HbetaD-2 nas células epiteliais. O aumento da expressão de CD80 na superfície celular também foi observada após estímulo com o bacilo. O complexo CpG-Hlp micobacteriano solúvel também induziu aumento na produção de IL-8 nas células A549. Foi observado que o aumento de IL-8 induzido pelo M. leprae ocorre de forma dependente da translocação nuclear do NF-capaB e que o antagonista sintético deTLR-9 afetou a secreção de IL-8 induzida pelo M. leprae. A adição de CpG aoM. smegmatis selvagem, mas não mutante para o gene hlp, aumentou a produção de IL-8 pelas células epiteliais. Em conjunto, esses dados sugerem que as células epiteliais respiratórias podem reconhecer M. leprae via TLR-9 e,assim, participar da resposta imune inata no sítio inicial da infecção. Uma vez que o aparecimento do eritema nodoso hansênico (ENH) está associado a liberação massiva de antígenos micobacterianos, foi investigado o envolvimento do TLR-9 na patogênese do ENH...

Mycobacterium leprae, etiological agent of leprosy, expresses in abundance acationic protein similar to histones, called histone-like protein (Hlp), present inthe envelope as well as in bacterial nucleoid.The recognition of bacterial DNArich in unmethylated CpG motifs by TLR-9 is an important pathway for activationof the innate immune response, which can lead to the elimination of theinfectious agent or mediate pathological manifestations. Moreover, studiesshowed that DNA-histone complexes are more potent agonists of TLR-9 thanDNA alone. This study aimed to investigate the involvement of TLR-9 in theactivation of the host immune response during the course of M. leprae infection.Initially, we analyzed the participation of TLR-9 activation on the innate immuneresponse in A549 alveolar epithelial cells after stimulation with M. leprae. It wasshown that M. leprae was able to induce the chemokines IL-8 and MCP-1, andgene transcription of antimicrobial peptide HbetaD-2 in epithelial cells. Theincrease of CD80 expression on the cell surface was also observed afterstimulation with bacillus. Soluble mycobacterial CpG-Hlp complex also inducedan increase in IL-8 in A549 cells. It was observed that the increase of IL-8,induced by M. leprae, occurs dependently nuclear translocation of NF-capaB andsynthetic TLR-9 antagonist affected IL-8 secretion induced by M. leprae. Theaddition of CpG to wild type M. smegmatis, but not to the mutant gene hlp,increased IL-8 production by epithelial cells. As a whole, these results suggestthat respiratory epithelial cells can recognize M. leprae via TLR-9 and thusparticipate in the innate immune response in the initial infection site. Since theappearance of erythema nodosum leprosum (ENL) is associated with themassive release of mycobacterial antigens, it was investigated the involvementof TLR-9 in the pathogenesis of ENL...

Evaluation of Cellular Proliferative Activity in Patients with Oral Lichen Planus and Hepatitis C through AgNOR Method

The objective of this study was to evaluate the cellular proliferative potential of oral lichen planus (OLP) lesions from patients without hepatitis C virus (HCV) by means of AgNOR method, as well as the cellular proliferative potential of the normal oral mucosa from patients with HCV, treated or untreated by interferon and ribavirin. A cross-sectional study was developed to investigate four groups: 10 HCV+ patients without clinical signs of OLP who had never been treated for HCV infection - Group 1; 10 HCV+ patients that were under interferon and ribavirin treatment - Group 2; 15 patients with reticular OLP lesions histopathologically confirmed, without HCV - Group 3; and 15 blood donors without HCV infection and no clinical signs of OLP GROUP 4 Control Group. The cytological material of all groups was collected by the liquid-based cytology technique. Then, the sedimented material from each patient was filled with the Nucleolar Organizer Regions impregnation by silver method (AgNOR). The count of NORs was performed on 100 epithelial cell nuclei per patient using the Image Tool(tm) software. The Tukey HSD test was used to compare the median value of NORs among the groups and showed that the oral mucosa of HCV+ patients previously treated with anti-HCV drugs (GROUP 2), presented a higher average number of NORs in relation to others (p<0.05). The anti-HCV treatment may be related to increased cell proliferation of oral mucosa, indicating a possible relationship between OLP and HCV+ patients treated with interferon and ribavirin.

O propósito deste estudo foi avaliar o potencial proliferativo celular das lesões de líquen plano bucal (LPB) de pacientes sem vírus da hepatite C (VHC) por meio do método AgNOR, comparando-o ao potencial proliferativo celular da mucosa bucal normal de portadores de VHC, tratados ou não com interferon e ribavirina. Um estudo transversal foi realizado para investigar 4 grupos: 10 pacientes VHC+ sem sinais clínicos de LPB que nunca haviam sido tratados para a infecção por VHC - Grupo 1; 10 pacientes VHC+ que estavam sob tratamento com interferon e ribavirina - Grupo 2; 15 pacientes com LPB reticular histopatologicamente confirmado, sem VHC - Grupo 3; e 15 doadores de sangue sem infecção por VHC e sem sinais clínicos de LPB (Grupo 4 - Grupo de Controle). O material celular de todos os grupos foi coletado pela técnica da citologia em base líquida. Então, o material sedimentado de cada paciente foi submetido ao método da impregnação das regiões organizadoras nucleolares pela prata (AgNOR). A contagem das NORs foi realizada em 100 núcleos celulares epiteliais por paciente por meio do programa Image Tool(r). O teste Tukey HSD foi utilizado para comparar o valor médio de NORs entre os grupos e mostrou que a mucosa bucal dos pacientes VHC+ previamente tratados com fármacos anti-VHC (Grupo 2) apresentou maior número médio de NORs por núcleo em relação aos outros (p<0,05). O tratamento anti-VHC pode estar relacionado ao aumento da atividade proliferativa celular da mucosa bucal, aventando uma possível relação entre LPB e pacientes VHC+ tratados com interferon e ribavirina.

ChIP-seq analysis of histone H3K9 trimethylation in peripheral blood mononuclear cells of membranous nephropathy patients

Membranous nephropathy (MN), characterized by the presence of diffuse thickening of the glomerular basement membrane and subepithelial in situ immune complex disposition, is the most common cause of idiopathic nephrotic syndrome in adults, with an incidence of 5-10 per million per year. A number of studies have confirmed the relevance of several experimental insights to the pathogenesis of human MN, but the specific biomarkers of MN have not been fully elucidated. As a result, our knowledge of the alterations in histone methylation in MN is unclear. We used chromatin immunoprecipitation followed by high-throughput sequencing (ChIP-seq) to analyze the variations in a methylated histone (H3K9me3) in peripheral blood mononuclear cells from 10 MN patients and 10 healthy subjects. There were 108 genes with significantly different expression in the MN patients compared with the normal controls. In MN patients, significantly increased activity was seen in 75 H3K9me3 genes, and decreased activity was seen in 33, compared with healthy subjects. Five positive genes, DiGeorge syndrome critical region gene 6 (DGCR6), sorting nexin 16 (SNX16), contactin 4 (CNTN4), baculoviral IAP repeat containing 3 (BIRC3), and baculoviral IAP repeat containing 2 (BIRC2), were selected and quantified. There were alterations of H3K9me3 in MN patients. These may be candidates to help explain pathogenesis in MN patients. Such novel findings show that H3K9me3 may be a potential biomarker or promising target for epigenetic-based MN therapies.

Epigenética en obesidad y diabetes tipo 2: papel de la nutrición, limitaciones y futuras aplicaciones / Epigenetics in obesity and type 2 diabetes: role of nutrition, limitations and future applications

In the last years, epigenetics is helping to explain the mechanisms non dependent on the genetic sequence by which the nutrients and other environmental factors contribute to modulate gene expression and disease development. Obesity and type 2 diabetes are two diseases that have been linked to changes in epigenetic marks (particularly DNA methylation, covalent modifications of histones and miRNAs). These epigenetic changes appear to be influenced, mainly in the perinatal period but also in adulthood, by environmental factors such as hyperglycemia or the diet. Among the food compounds that have been linked to epigenetic modifications, there are methyl donor groups, excessive or deficient caloric intake, short chain fatty acids, some minerals and antioxidant vitamins, and various compounds of plant origin, as catechins, isoflavones or isothiocyanates. EWAS studies, that analyze the methylation of thousands of CpG sites in thousands of individuals, will contribute in the next years to identify some of the epigenetic marks that can be used as early predictors of metabolic risk, as well as some intimate mechanisms that explain the development of obesity, type 2 diabetes and its complications. Moreover, epigenetic marks, among them the CpG-SNPs, can be heritable but some of them could be potentially reversible. One of the medium-term objectives is to develop drug or diet-related treatments that could delay or even reverse these epigenetic changes.

Avaliação das histonas de L. infantum como candidatos à vacinas na infecção por l.infantum em hamsters / Evaluation of histones from L. infantum as candidate vaccines in infection in hamsters l.infantum

A leishmaniose visceral é uma doença infecciosa grave, causada por protozoários intracelulares obrigatórios do gênero Leishmania. Vários antígenos de Leishmania têm sido avaliados como candidatos vacinais, destacando-se as proteínas de histonas (HIS), antígenos altamente conservados. A exposição de HIS pela Leishmania induz uma resposta imune potente no hospedeiro vertebrado. Desse modo, neste estudo, avaliamos, em hamsters, a capacidade imunoprotetora dos antígenos de histonas contra a infecção por Leishmania infantum. Os animais foram vacinados com estratégia homóloga, utilizando-se plasmídeos de DNA que codificam para HIS (pcDNA3LiH2A-H3, pcDNA3LiH2B-H4) ou heteróloga (DNA/proteínas HIS) mais 1nM de CpG. Quinze dias após a última imunização, os animais foram desafiados pela via intradérmica com 105 Leishmania infantum metacíclicas mais 0,5 par de glândula salivar de Lutzomya longipalpis. Após a última imunização e durante a infecção, realizaram-se dosagens de citocinas por PCR em tempo real (linfonodo e baço), sorologia por ELISA (soro), carga parasitária por diluição limitante e análise histopatológica de tecidos (linfonodo, baço e fígado). Detectou-se produção de anticorpos IgG anti HIS nos grupos imunizados com a estratégia homóloga e heteróloga, quando comparados aos hamsters não imunizados. As imunizações homóloga e heteróloga diferiram na razão IFN-γ/IL-10 no linfonodo em relação ao grupo controle. Não houve diferença significativa na expressão dessas citocinas no baço após a imunização, entretanto, cinco meses após o desafio o grupo homólogo apresentou um aumento na produção de IL-10 nesse órgão. Na análise histopatológica do baço, verificou-se formação de mais folículos com centro germinativo, evidentes nos animais imunizados independentemente do grupo analisado. Observou-se, também, leucocitose intrasinusoidal e periportal no fígado, e folículos reativos no linfonodo. Nenhuma das estratégias de imunizações com antígenos de histonas acarretou em diminuição da carga parasitária no linfonodo, baço e fígado. As estratégias de imunização homóloga e heteróloga, com antígenos de histonas nucleossomais, não foram capazes de proteger contra infecção por L. infantum no modelo do hamster.