La inflamación en la hipertensión arterial, mecanismos de producción e implicancias terapéuticas / Role of inflammation in hypertension

Even though the mechanisms that mediate essential hypertension (HT) are not fully understood, an immunological-inflammatory mechanism could be the common pathway for diverse pathophysiological mechanisms. We analyze in a simplified way the participation of the immune system in HT. T lymphocytes (TL) and antigen presenting cells (APCs) are components of the immune system capable of generating proinflammatory cytokines. They cause endothelial damage, vasoconstriction, and decreased urinary sodium excretion. CD4+ and CD8+ TL are effector cells, causally implicated in the development of HT, whereas type γδ TL play their pathogenic role in HT enhancing endothelial dysfunction. Additionally, a immunomodulation decrease by regulatory TL, worsens endothelial dysfunction and reduces vasodilation in experimental HT. Results of recent studies indicate that lymphocyte activation would be mediated by antigens captured by antigen APCs for subsequent presentation to "naive" TL. On the other hand, proinflammatory states such as obesity, the change of the intestinal microbiota and the increase in salt intake favors TL and APC activation, contributing to HT development.

Avaliação in vitro e in vivo do potencial imunomodulador de frações polissacarídicas extraídas do chuchu / In vitro and in vivo evaluation of the immunomodulatory potential of polysaccharide fractions extracted from chayote

Os polissacarídeos não amido constituem importante parcela das fibras dietéticas, e podem ser considerados modificadores de resposta biológica (MRBs), uma vez que são capazes de interagir com o sistema imune, e suas características estruturais estão atreladas aos efeitos biológicos gerados. O potencial imunomodulador dos polissacarídeos do chuchu já foi demonstrado, entretanto, informações sobre suas características estruturais e sua relação com o perfil imunológico são limitadas a ensaios in vitro, não havendo, até o momento, estudos in vivo. Assim, o objetivo do estudo foi avaliar, in vitro e in vivo, o perfil imunomodulador de frações isoladas do polissacarídeo do chuchu. Por meio da filtração tangencial foram obtidas as frações de estudo, SeRI<50 e SeSE<50, respectivamente as frações isoladas do polissacarídeo do chuchu extraídas do resíduo insolúvel e do sobrenadante pós-tratamento enzimático para retirada do amido com peso molecular menor que 50 kDa. A caracterização por meio da determinação da composição monossacarídica e da análise de ligação apontou que ambas as frações são formadas por galacturonanos, arabinanos, arabinogalactanos e glicomananos. A SeRI<50 é menos ramificada e, provavelmente, composta por galactanos, enquanto SeSE<50 é mais ramificada e, provavelmente, composta por galactuglucomananos. Essas frações foram capazes de estimular os macrófagos murinos RAW 264.7 e as células mononucleares do baço, do sangue e do intestino delgado de camundongos Balb/c, sugerindo um perfil de ação mais pró-inflamatório, com base nos efeitos produzidos pelas espécies reativas de oxigênio, citocinas e pelos marcadores de ativação de linfócitos. Ambas as amostras, SeRI<50 e SeSE<50, mostraram ser eficientes em ativar a cascata imunológica, não sendo citotóxicas mesmo com a maior concentração testada no ensaio in vitro

Non-starch polysaccharides are important components of dietary fibers, and they may be considered biological response modifiers (MRBs), as they may interact with the immune system, depending on their structural characteristics. The immunomodulatory potential of chayote polysaccharides has already been demonstrated, however, information on their structural characteristics and their relationship with the immunological profile are limited to in vitro assays, with no reports on in vivo studies. Thus, the objective of the study was to evaluate, in vitro and in vivo, the immunomodulatory profile of polysaccharide from chayote. Through tangential filtration two fractions, SeRI <50 and SeSE <50, were obtained, respectively the fraction isolated from the chayote polysaccharide extracted from the insoluble residue and the fraction from the enzymatic post-treatment supernatant to remove starch, both under molecular weight 50 kDa. The monosaccharide composition and linkage analysis showed that both fractions are formed by galacturonans, arabinans, arabinogalactans and glycomanans. SeRI <50 is less branched and probably composed of galactans, while SeSE <50 is more branched and probably composed of galactuglucomannans. These fractions were able to stimulate murine macrophages RAW 264.7 and mononuclear cells of the spleen, blood and small intestine of Balb / c mice, suggesting a more proinflammatory action profile, based on the reactive oxygen species production, cytokines and lymphocyte activation markers. Both samples, SeRI <50 and SeSE <50, were able to efficiently activate the immunological cascade, not being cytotoxic even at the highest concentration tested in the in vitro assay

Identificação de proteínas imunodominantes provenientes dos subgêneros Viannia e Leishmania como potenciais candidatos vacinais pan específicos no controle das leishmanioses / Identification of immunodominant proteins from the Viannia and Leishmania subgenus as potential pan-specific vaccine candidates in the control of leishmaniasis

As leishmanioses são causadas por cerca de 20 espécies de Leishmania e se apresentam em diversas formas clínicas, que podem variar de branda a muito grave. Elas afetam milhões de pessoas e até então não existem medidas de controle eficazes. Assim, a imunização da população seria uma alternativa eficiente de controle. Evidências sugerem que a resposta imune que se estabelece após a cura clínica de leishmanioses deva constituir um padrão de resposta imunológica associado à proteção, e que uma preparação vacinal deveria estimulá-la preferencialmente. Nosso grupo demonstrou que antígenos de L. (Viannia) naiffi (espécie considerada benigna) conseguem induzir respostas bem moduladas, e que soros de voluntários curados de leishmaniose tegumentar cutânea reconheceram frações desse antígeno consideradas imunodominantes. Experimentos anteriores demonstraram em hamster que a imunização intranasal com antígenos totais dessa espécie são capazes de induzir uma imunidade protetora contra L. (V.) braziliensis. O mesmo grupo já havia obtido a mesma resposta protetora utilizando o antígeno total de L. (L.) amazonensis. No entanto, sabe-se que nem todos os componentes presentes nesses antígenos estão associados à proteção e que a identificação de proteínas que sejam imunogênicas é uma etapa indispensável na formulação de uma vacina.

O objetivo deste trabalho foi identificar as proteínas imunodominantes presentes nas frações solúveis de L. (L.) amazonensis (LaAg(s)) e L.(V.) naiffi (LnAg(s)), que sejam conservadas dentro do gênero Leishmania, para formular uma vacina pan específica para o controle das leishmanioses. Primeiramente, os antígenos LnAg(s) e LaAg(s) foram subfracionados em gel de poliacrilamida e as bandas com peso molecular entre 35 e 100KDa foram extraídas e submetidas à análise por espectrometria de massa para análise proteômica. Desta análise, foram obtidas as sequências de aminoácidos, o tamanho das sequências, e a abundância das proteínas. As proteínas mais abundantes foram submetidas à análise de similaridade com proteínas de hospedeiros. As proteínas de LnAg(s) e LaAg(s) com baixa similaridade (<30%) às proteínas humanas foram analisadas por preditores de epítopos reconhecidos por linfócitos B.

Em paralelo, a predição de epítopos presentes em LnAg(s) e LaAg(s), capazes de se ligar com alta afinidade a moléculas HLA classes I e II, assim como a promiscuidade de ligação a alelos de HLA para cada proteína, foram avaliados dentre aquelas que apresentaram maior abundância e baixa similaridade. Por fim, após a análise de homologia das proteínas entre as espécies de Leishmania, foram identificadas 11 proteínas com mais homólogos. Elas apresentaram potencial de reconhecimento por linfócitos B, assim como também por componentes da resposta imune celular (como predito para a apresentação por HLA classes I e II). O potencial de ativação de linfócitos T pelos epítopos presentes nas 11 proteínas foi incrementado pela ampla capacidade de apresentação antigênica na população humana, devido à alta promiscuidade quanto à capacidade de ligação destes epítopos a alelos de HLA. Esses resultados contribuem para a identificação de antígenos com potencial de compor um protótipo vacinal capaz de induzir uma resposta imune protetora pan específica em humanos, com características imunodominantes e indutoras de resposta humoral e celular, para serem empregados no controle das leishmanioses. (AU)

Drug-induced Liver Injury Caused by Ipragliflozin Administration with Causality Established by a Positive Lymphocyte Transformation Test (LTT) and the Roussel Uclaf Causality Assessment Method (RUCAM): A Case Report

ABSTRACT A 75-year old male patient had been regularly visiting our hospital for the management of his type 2 diabetes mellitus since he was diagnosed at age 64 years. When he developed hypoglycemic episodes with sulfonylurea, ipragliflozin (50 mg/day) was started to replace the sulfonylurea therapy. However, 49 days after starting ipragliflozin, his AST increased from 13 to 622 U/L, ALT increased from 9 to 266 U/L, ALP increased from 239 to 752 U/L, and γ-GTP increased from 19 to 176 U/L. ZTT was 3.5 U, TTT was 0.4 U, and total bilirubin was 0.7 mg/dL. IgM hepatitis A antibody, hepatitis B antigen, hepatitis C virus antibody, IgM CMV antibody, and IgM EB VCA antibody were negative, whereas a lymphocyte transformation test for ipragliflozin was positive. Abdominal CT scan showed mild fatty liver but no sign of nodular lesions. Following admission to our hospital, he received liver supportive therapy with the discontinuation of ipragliflozin therapy. He was discharged from the hospital 18 days later with AST and ALT levels reduced to 20 U/L and 13 U/L, respectively. Based on the clinical presentation of this patient, it is highly important to monitor liver function along with other possible clinical complications (e.g., dehydration, ketosis, and urinary tract infection) associated with SGLT2 inhibitor therapy.

Circulating myeloid-derived suppressor cells predict disease activity and treatment response in patients with immune thrombocytopenia

Immune thrombocytopenia (ITP) is a disease characterized by isolated thrombocytopenia. Abnormal effector T cell activation is an important mechanism in the pathogenesis of ITP. Regulatory T cells (Treg) have a strong immunosuppressive function for T cell activation and their importance in the pathophysiology and clinical treatment of ITP has been confirmed. Myeloid-derived suppressor cells (MDSCs) are other immunosuppressive cells, which can also suppress T cell activation by secreting arginase, iNOS and ROS, and are essential for Treg cells’ differentiation and maturation. Therefore, we speculate that MDSCs might also be involved in the immune-dysregulation mechanism of ITP. In this study, we tested MDSCs and Treg cells in peripheral blood samples of twenty-five ITP patients and ten healthy donors. We found that MDSCs and Treg cells decreased simultaneously in active ITP patients. Relapsed ITP patients showed lower MDSCs levels compared with new patients. All patients received immunosuppressive treatment including dexamethasone alone or in combination with intravenous immune globulin. We found that MDSCs’ level after treatment correlated with platelet recovery. Our study is the first that focused on MDSCs’ role in ITP. Based on our results, we concluded that circulating MDSCs could predict disease activity and treatment response in ITP patients. This preliminary conclusion indicates a substantial significance of MDSCs in the pathophysiology and clinical treatment of ITP, which deserves further investigation.

Linfócitos Th17 e linfócitos T CD4+ multifuncionais em pacientes com lúpus eritematoso sistêmico / Th17 cells and CD4+ multifunctional T cells in patients with systemic lupus erythematosus

Resumo Introdução/Objetivo: Evidências recentes sugerem que anormalidades que envolvem os linfócitos Th17 estão associadas à fisiopatologia do lúpus eritematoso sistêmico (LES). Além disso, os linfócitos T multifuncionais (LTM), ou seja, aqueles que produzem múltiplas citocinas simultaneamente, estão presentes no meio inflamatório e podem estar implicados no processo autoimune observado no LES. No presente estudo, objetiva-se caracterizar o estado funcional dos linfócitos T CD4+ no LES e determinar simultaneamente a concentração de IL-2, IFN-γ e IL-17 em culturas de linfócitos sob estímulos exógenos e autoantigênicos. Pacientes e métodos: Dezoito pacientes com doença ativa, 18 com doença inativa e 14 controles saudáveis foram submetidos à análise do estado funcional dos linfócitos T CD4+. Resultados: Encontrou-se que os pacientes com LES apresentaram uma diminuição na quantidade total de células CD4+, um aumento na quantidade de linfócitos T ativados e um aumento na frequência de linfócitos Th17 em comparação com controles saudáveis (HC). As células LTM tinha frequência aumentada em pacientes com LES e houve um aumento na frequência de LTM trifuncionais em pacientes com LES ativo em comparação com aqueles com LES inativo. Curiosamente, as células MTF produziram quantidades maiores de IFN-γ do que os linfócitos T monofuncionais em pacientes e controles. Conclusão: Analisados em conjunto, esses dados indicam a participação dos linfócitos Th17 recentemente ativados e células MTF na fisiopatologia do LES.

Abstract Introduction/Objective: Recent evidence suggests that abnormalities involving Th17 lymphocytes are associated with the pathophysiology of systemic lupus erythematosus (SLE). In addition, multifunctional T cells (MFT), i. e., those producing multiple cytokines simultaneously, are present in the inflammatory milieu and may be implicated in the autoimmune process observed in SLE. In the present study, we aimed to characterize the functional status of CD4+ T cells in SLE by simultaneously determining the concentration of IL-2, IFN-γ and IL-17 in lymphocyte cultures under exogenous and self-antigenic stimuli. Patients and methods: Eighteen patients with active disease, 18 with inactive disease, and 14 healthy controls had functional status of CD4+ T cells analyzed. Results: We found that SLE patients presented a decreased number of total CD4+ cells, an increased number of activated T cells, and an increased frequency of Th17 cells compared to healthy controls (HC). MFT cells had increased frequency in SLE patients and there was an increased frequency of tri-functional MFT in patients with active SLE compared with those with inactive SLE. Interestingly, MTF cells produced larger amounts of IFNγ than mono-functional T cells in patients and controls. Conclusion: Taken together these data indicate the participation of recently activated Th17 cells and MTF cells in the SLE pathophysiology.

CD19+ B cell subsets in the peripheral blood and skin lesions of psoriasis patients and their correlations with disease severity

T lymphocytes are important in the pathogenesis of psoriasis, and increasing evidence indicates that B cells also play an important role. The mechanisms of action, however, remain unclear. We evaluated the ratios of CD19+ B cells in peripheral blood mononuclear cells (PBMCs) from 157 patients with psoriasis (65 patients with psoriasis vulgaris, 32 patients with erythrodermic psoriasis, 30 patients with arthropathic psoriasis, and 30 patients with pustular psoriasis) and 35 healthy controls (HCs). Ratios of CD19+ B cells in skin lesions were compared with non-lesions in 7 erythrodermic psoriasis patients. The Psoriasis Area Severity Index (PASI) was used to measure disease severity. CD19+ B cell ratios in PBMCs from psoriasis vulgaris (at both the active and stationary stage) and arthropathic psoriasis patients were higher compared with HCs (P<0.01), but ratios were lower in erythrodermic and pustular psoriasis patients (P<0.01). CD19+ B cell ratios in erythrodermic psoriasis skin lesions were higher than in non-lesion areas (P<0.001). Different subsets of CD19+CD40+, CD19+CD44+, CD19+CD80+, CD19+CD86+, CD19+CD11b+, and CD19+HLA-DR+ B cells in PBMCs were observed in different psoriasis clinical subtypes. PASI scores were positively correlated with CD19+ B cell ratios in psoriasis vulgaris and arthropathic psoriasis cases (r=0.871 and r=0.692, respectively, P<0.01), but were negatively correlated in pustular psoriasis (r=-0.569, P<0.01). The results indicated that similar to T cells, B cells activation may also play important roles in different pathological stages of psoriasis.

Follicular helper T cell in immunity and autoimmunity

The traditional concept that effector T helper (Th) responses are mediated by Th1/Th2 cell subtypes has been broadened by the recent demonstration of two new effector T helper cells, the IL-17 producing cells (Th17) and the follicular helper T cells (Tfh). These new subsets have many features in common, such as the ability to produce IL-21 and to express the IL-23 receptor (IL23R), the inducible co-stimulatory molecule ICOS, and the transcription factor c-Maf, all of them essential for expansion and establishment of the final pool of both subsets. Tfh cells differ from Th17 by their ability to home to B cell areas in secondary lymphoid tissue through interactions mediated by the chemokine receptor CXCR5 and its ligand CXCL13. These CXCR5+ CD4+ T cells are considered an effector T cell type specialized in B cell help, with a transcriptional profile distinct from Th1 and Th2 cells. The role of Tfh cells and its primary product, IL-21, on B-cell activation and differentiation is essential for humoral immunity against infectious agents. However, when deregulated, Tfh cells could represent an important mechanism contributing to exacerbated humoral response and autoantibody production in autoimmune diseases. This review highlights the importance of Tfh cells by focusing on their biology and differentiation processes in the context of normal immune response to infectious microorganisms and their role in the pathogenesis of autoimmune diseases.

Aerobic training modulates T cell activation in elderly women with knee osteoarthritis

Osteoarthritis of the knee (kOA) is a disease that mainly affects the elderly and can lead to major physical and functional limitations. However, the specific effects of walking, particularly on the immune system, are unknown. Therefore, this study aimed to analyze the effect of 12 weeks of walking (3×/week) on the leukocyte profile and quality of life (QL) of elderly women with kOA. Sixteen women (age: 67±4 years, body mass index: 28.07±4.16 kg/m2) participated in a walking program. The variables were assessed before and after 12 weeks of training with a progressively longer duration (30–55 min) and higher intensity (72–82% of HRmax determined using a graded incremental treadmill test). The QL was assessed using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and blood samples were collected for analysis with a cell counter and the San Fac flow cytometer. Walking training resulted in a 47% enhancement of the self-reported QL (P<0.05) and a 21% increase in the VO2max (P<0.0001) in elderly women with kOA. Furthermore, there was a reduction in CD4+ cells (pre=46.59±7%, post=44.58±9%, P=0.0189) and a higher fluorescence intensity for CD18+CD4+ (pre=45.30±10, post=64.27±33, P=0.0256) and CD18+CD8+ (pre=64.2±27, post=85.02±35, P=0.0130). In conclusion, the walking program stimulated leukocyte production, which may be related to the immunomodulatory effect of exercise. Walking also led to improvements in the QL and physical performance in elderly women with kOA.

Poblaciones linfocitarias, células dendríticas y perfil de citoquinas en ratones con melanoma tratados con Uncaria tomentosa / Lymphocyte subsets, dendritic cells and cytokine profiles in mice with melanoma treated with Uncaria tomentosa

Evaluar el efecto inmunomodulador sobre poblaciones linfocitarias, células dendríticas (DC), citoquinas Th1/Th2/Th17 (T-helper) e inflamatorias en el ámbito sistémico y/o en el microambiente tumoral de ratones con o sin melanoma. Materiales y métodos. Se obtuvieron muestras de sangre periférica y/o de tumores primarios de ratones con melanoma B16 tratados o no con un extracto hidroalcohólico de Uncaria tomentosa (UT) con 5,03% de alcaloides oxindólicos pentacíclicos (UT-POA) obtenido de la corteza de la planta. Todos los ensayos de medición de células y citoquinas fueron realizados por citometría de flujo. Resultados. UT-POA a nivel sistémico incrementa la relación CD4/CD8a (Cluster of Differenciation), mientras que la activación celular es inversamente proporcional; incrementa la proporción de DCm (DC mieloides); induce un perfil Th1 proinflamatorio y reduce la respuesta Th17. TNF-a (tumor necrosis factor alpha) y IL-17A (interleuquina) correlacionan positiva y negativamente con la relación CD4/CD8a. Conclusiones. El incremento de Th1 (TNF-a) puede tener como consecuencia el incremento de linfocitos CD4 o la activación de macrófagos M1. Aunque UT-POA muestra un incremento de DCm, este no es dosis-dependiente. La disminución de Th17 (IL-17A) puede favorecer el funcionamiento de los linfocitos CD8a. UT-POA muestra mejores efectos inmunomoduladores en el ámbito sistémico que intratumoral...

To evaluate the immunomodulatory effect on lymphocyte subsets, dendritic cells (DC), Th1 / Th2 / Th17 and inflammatory cytokines on systemic level and/or in the tumor microenvironment of mice with or without melanoma. Materials and methods: Peripheral blood and/or primary tumors samples were obtained of mice with B16 melanoma treated or not with a hydroalcoholic extract of Uncaria tomentosa (UT) with 5.03% of pentacyclic oxindole alkaloids (UT-POA) obtained from the bark of the plant. All cell assays and cytokine measurements were performed by flow cytometry. Results. UT-POA systemically increased CD4/CD8a relation while cell activation was inversely proportional; increased the proportion of DCm; induced a pro-inflammatory Th1 profile and reduced Th17 response. TNF-a and IL-17A positively and negatively correlated with CD4/CD8a relation. Conclusions. The increase of Th1 (TNF-a) may result in the increase of CD4 or M1 macrophage activation. Although UT-POA shows increased DCm, is not dose-dependent. Th17(IL-17A) decreased can support the function of CD8a lymphocytes. UT-POA shows better systemic immunomodulatory effects than intratumoral...

Co-administration of plasmid-encoded granulocyte-macrophage colony-stimulating factor increases human immunodeficiency virus-1 DNA vaccine-induced polyfunctional CD4+ T-cell responses

T-cell based vaccines against human immunodeficiency virus (HIV) generate specific responses that may limit both transmission and disease progression by controlling viral load. Broad, polyfunctional, and cytotoxic CD4+T-cell responses have been associated with control of simian immunodeficiency virus/HIV-1 replication, supporting the inclusion of CD4+ T-cell epitopes in vaccine formulations. Plasmid-encoded granulocyte-macrophage colony-stimulating factor (pGM-CSF) co-administration has been shown to induce potent CD4+ T-cell responses and to promote accelerated priming and increased migration of antigen-specific CD4+ T-cells. However, no study has shown whether co-immunisation with pGM-CSF enhances the number of vaccine-induced polyfunctional CD4+ T-cells. Our group has previously developed a DNA vaccine encoding conserved, multiple human leukocyte antigen (HLA)-DR binding HIV-1 subtype B peptides, which elicited broad, polyfunctional and long-lived CD4+ T-cell responses. Here, we show that pGM-CSF co-immunisation improved both magnitude and quality of vaccine-induced T-cell responses, particularly by increasing proliferating CD4+ T-cells that produce simultaneously interferon-γ, tumour necrosis factor-α and interleukin-2. Thus, we believe that the use of pGM-CSF may be helpful for vaccine strategies focused on the activation of anti-HIV CD4+ T-cell immunity.

Differential expression of CC chemokines (CCLs) and receptors (CCRs) by human T lymphocytes in response to different Aggregatibacter actinomycetemcomitans serotypes

In Aggregatibacter actinomycetemcomitans, different serotypes have been described based on LPS antigenicity. Recently, our research group has reported a differential immunogenicity when T lymphocytes were stimulated with these different serotypes. In particular, it was demonstrated that the serotype b of A. actinomycetemcomitans has a stronger capacity to trigger Th1- and Th17-type cytokine production.Objective This study aimed to quantify the expression of different CC chemokines (CCLs) and receptors (CCRs) in T lymphocytes stimulated with the differentA. actinomycetemcomitans serotypes. In addition, the expression of the transcription factors T-bet, GATA-3, RORC2, and Foxp3, master-switch genes implied in the Th1, Th2, Th17, and T-regulatory differentiation, respectively, was analysed in order to determine T-cell phenotype-specific patterns of CCL and CCR expression upon A. actinomycetemcomitans stimulation.Material and Methods Human naïve CD4+ T lymphocytes were obtained from healthy subjects and stimulated with autologous dendritic cells primed with the differentA. actinomycetemcomitans serotypes. The expression levels for the chemokines CCL1, CCL2, CCL3, CCL5, CCL11, CCL17, CCL20, CCL21, CCL25, and CCL28, as well as the chemokine receptors CCR1, CCR2, CCR3, CCR4, CCR5, CCR6, CCR7, CCR8, CCR9, and CCR10 were quantified by qPCR. Similarly, the expression levels for the transcription factors T-bet, GATA-3, RORC2, and Foxp3 were quantified and correlated with the CCL and CCR expression levels.Results Higher expression levels of CCL2, CCL3, CCL5, CCL20, CCL21, CCL28, CCR1, CCR2, CCR5, CCR6, CCR7, and CCR9 were detected in T lymphocytes stimulated with the serotype b of A. actinomycetemcomitans compared with the other serotypes. In addition, these higher expression levels of CCLs and CCRs positively correlated with the increased levels of T-bet and RORC2 when T lymphocytes were stimulated with the serotype b.Conclusion A T-lymphocyte response biased towards a Th1- and Th17-pattern of CCL and CCR expression was detected under stimulation with the serotype b ofA. actinomycetemcomitans.

T-cell receptor Vβ repertoire of CD8+ T-lymphocyte subpopulations in cutaneous leishmaniasis patients from the state of Rio de Janeiro, Brazil

In human cutaneous leishmaniasis (CL), the immune response is mainly mediated by T-cells. The role of CD8⁺ T-lymphocytes, which are related to healing or deleterious functions, in affecting clinical outcome is controversial. The aim of this study was to evaluate T-cell receptor diversity in late-differentiated effector (LDE) and memory CD8⁺ T-cell subsets in order to create a profile of specific clones engaged in deleterious or protective CL immune responses. Healthy subjects, patients with active disease (PAD) and clinically cured patients were enrolled in the study. Total CD8⁺ T-lymphocytes showed a disturbance in the expression of the Vβ2, Vβ9, Vβ13.2, Vβ18 and Vβ23 families. The analyses of CD8⁺T-lymphocyte subsets showed high frequencies of LDE CD8⁺T-lymphocytes expressing Vβ12 and Vβ22 in PAD, as well as effector-memory CD8⁺ T-cells expressing Vβ22. We also observed low frequencies of effector and central-memory CD8⁺ T-cells expressing Vβ2 in PAD, which correlated with a greater lesion size. Particular Vβ expansions point to CD8⁺ T-cell clones that are selected during CL immune responses, suggesting that CD8⁺ T-lymphocytes expressing Vβ12 or Vβ22 are involved in a LDE response and that Vβ2 contractions in memory CD8⁺T-cells are associated with larger lesions.

Accuracy of dose planning for prostate radiotherapy in the presence of metallic implants evaluated by electron spin resonance dosimetry

Radiotherapy is one of the main approaches to cure prostate cancer, and its success depends on the accuracy of dose planning. A complicating factor is the presence of a metallic prosthesis in the femur and pelvis, which is becoming more common in elderly populations. The goal of this work was to perform dose measurements to check the accuracy of radiotherapy treatment planning under these complicated conditions. To accomplish this, a scale phantom of an adult pelvic region was used with alanine dosimeters inserted in the prostate region. This phantom was irradiated according to the planned treatment under the following three conditions: with two metallic prostheses in the region of the femur head, with only one prosthesis, and without any prostheses. The combined relative standard uncertainty of dose measurement by electron spin resonance (ESR)/alanine was 5.05%, whereas the combined relative standard uncertainty of the applied dose was 3.35%, resulting in a combined relative standard uncertainty of the whole process of 6.06%. The ESR dosimetry indicated that there was no difference (P>0.05, ANOVA) in dosage between the planned dose and treatments. The results are in the range of the planned dose, within the combined relative uncertainty, demonstrating that the treatment-planning system compensates for the effects caused by the presence of femur and hip metal prostheses.

Acarbose versus trans-chalcone: comparing the effect of two glycosidase inhibitors on obese mice

Objective Acarbose and trans-chalcone are glucosidase inhibitors whose beneficial effects have been demonstrated in diabetes. The present study aimed at investigating their potential effects in obesity.Materials and methods NMRI male mice (n = 48) were subjected to a high fat diet for four weeks, which induced an initial state of obesity. One control group was given normal rodent diet. Obese animals were then switched to normal rodent diet, and divided to four groups (n = 12 in each): untreated, sham (receiving grape seed oil), and experimental groups receiving acarbose and trans-chalcone (12 mg/kg) during eight weeks. Body weight, blood glucose and other biochemical parameters including triglycerides (TG), cholesterol, HDL, AST, and ALT were measured, as well as leptin, adiponectin, TNF-α, and total antioxidant capacity (TAC). Histological studies were performed on adipose cells and liver tissue samples.Results All factors were affected in a positive manner by acarbose, save for body weight, blood sugar and leptin levels, on which acarbose effects, although observable, were not statistically significant. Grape seed oil, used as a solvent for trans-chalcone was found to possess significant effect on TG and TAC, and had beneficial effects on other factors including liver enzymes and cholesterol. Trans-chalcone effects were significant on HDL, leptin and ALT. All compounds seemed to be able to affect fat deposition in liver tissue, and decrease the size of adipose tissue cells to some extent.Conclusion In conclusion, the tested compounds were able to affect lipid accumulation in tissues and influence adipokines, which may result in an enhanced state with regard to inflammation and oxidative stress. Arch Endocrinol Metab. 2015;59(3):202-9.

Seasonal variation of haemoglobin A1c in a Portuguese adult population

Objective Haemoglobin A1c (Hb A1c) is routinely used for monitoring glycemic control in patients with diabetes. Hb A1c seasonal fluctuations can be directly related to different biological, geographical and cultural influences. Our purpose was to evaluate seasonal variation of Hb A1c in a hospital-based adult population over a period of 5 years.Materials and methods We analyzed retrospectively monthly Hb A1c mean values (DCCT, %) based on all the assays performed to adult patients at a tertiary care university Portuguese hospital between 2008-2012.Results We obtained 62,384 Hb A1c valid measurements, with a peak level found in January-February (7.1%), a trough in August-October (6.8%) and an average peak-to-trough amplitude value of 0.3%. This trend was observed in both genders and age subgroups evaluated.Conclusions There is a Hb A1c circannual seasonal pattern with peak levels occurring in winter months in this Portuguese population. This finding should be recognized in daily clinical practice to warrant better clinical and epidemiological interpretation of Hb A1c values. Arch Endocrinol Metab. 2015;59(3):231-5.

A systematic review of nursing research priorities on health system and services in the Americas / Revisión sistemática de las prioridades de investigación de enfermería en sistemas y servicios de salud en la Región de las Américas

OBJECTIVE: To systematically review literature on priorities in nursing research on health systems and services in the Region of the Americas as a step toward developing a nursing research agenda that will advance the Regional Strategy for Universal Access to Health and Universal Health Coverage. METHOD: This was a systematic review of the literature available from the following databases: Web of Science, PubMed, LILACS, and Google. Documents considered were published in 2008-2014; in English, Spanish, or Portuguese; and addressed the topic in the Region of the Americas. The documents selected had their priority-setting process evaluated according to the "nine common themes for good practice in health research priorities." A content analysis collected all study questions and topics, and sorted them by category and subcategory. RESULTS: Of 185 full-text articles/documents that were assessed for eligibility, 23 were selected: 12 were from peer-reviewed journals; 6 from nursing publications; 4 from Ministries of Health; and 1 from an international organization. Journal publications had stronger methodological rigor; the majority did not present a clear implementation or evaluation plan. After compiling the 444 documents' study questions and topics, the content analysis resulted in a document with 5 categories and 16 subcategories regarding nursing research priorities on health systems and services. CONCLUSIONS: Research priority-setting is a highly important process for health services improvement and resources optimization, but implementation and evaluation plans are rarely included. The resulting document will serve as basis for the development of a new nursing research agenda focused on health systems and services, and shaped to advance universal health coverage and universal access to health.

OBJETIVO: Revisar sistemáticamente la bibliografía sobre las prioridades de investigación de enfermería en materia de sistemas y servicios de salud en la Región de las Américas, como un paso más en la elaboración de un programa de investigación de enfermería que impulse la Estrategia Regional para el Acceso Universal a la Salud y la Cobertura Universal de Salud. MÉTODOS: Se llevó a cabo una revisión sistemática de la bibliografía disponible en las siguientes bases de datos: Web of Science, PubMed, LILACS y Google. Se tuvieron en cuenta los documentos publicados del 2008 al 2014 en inglés, español o portugués, y que trataran del tema en el ámbito de la Región de las Américas. En los documentos seleccionados se evaluaron los procesos de establecimiento de prioridades según los "nueve temas comunes para buenas prácticas en establecimiento de prioridades de investigación de salud". Mediante un análisis de los contenidos se recopilaron todas las preguntas y temas de estudio, y se clasificaron los documentos por categorías y subcategorías. RESULTADOS: De los 185 artículos o documentos de texto completo evaluados, se seleccionaron 23: 12 procedían de revistas con revisión por pares, 6 de publicaciones de enfermería, 4 de ministerios de salud y 1 de una organización internacional. Las publicaciones de las revistas mostraron un mayor rigor metodológico; la mayoría no presentaba un plan definido de ejecución o evaluación. Después de compilar las 444 preguntas y temas de estudio de los documentos, el análisis de los contenidos dio lugar a un documento con 5 categorías y 16 subcategorías con respecto a las prioridades de investigación de enfermería en materia de sistemas y servicios de salud. CONCLUSIONES: El establecimiento de prioridades de investigación es un proceso muy importante para la mejora de los servicios de salud y la optimización de los recursos, pero raramente se incluyen planes de ejecución y evaluación. El documento resultante servirá de base para la elaboración de una nueva agenda de investigación de enfermería centrada en los sistemas y servicios de salud, y configurada para impulsar la cobertura universal de salud y el acceso universal a la salud.

Local anesthesia with epinephrine is safe and effective for oral surgery in patients with type 2 diabetes mellitus and coronary disease: a prospective randomized study

OBJECTIVE: To investigate the variations in blood glucose levels, hemodynamic effects and patient anxiety scores during tooth extraction in patients with type 2 diabetes mellitus T2DM and coronary disease under local anesthesia with 2% lidocaine with or without epinephrine. STUDY DESIGN: This is a prospective randomized study of 70 patients with T2DM with coronary disease who underwent oral surgery. The study was double blind with respect to the glycemia measurements. Blood glucose levels were continuously monitored for 24 hours using the MiniMed Continuous Glucose Monitoring System. Patients were randomized into two groups: 35 patients received 5.4 mL of 2% lidocaine, and 35 patients received 5.4 mL of 2% lidocaine with 1:100,000 epinephrine. Hemodynamic parameters (blood pressure and heart rate) and anxiety levels were also evaluated. RESULTS: There was no difference in blood glucose levels between the groups at each time point evaluated. Surprisingly, both groups demonstrated a significant decrease in blood glucose levels over time. The groups showed no significant differences in hemodynamic and anxiety status parameters. CONCLUSION: The administration of 5.4 mL of 2% lidocaine with epinephrine neither caused hyperglycemia nor had any significant impact on hemodynamic or anxiety parameters. However, lower blood glucose levels were observed. This is the first report using continuous blood glucose monitoring to show the benefits and lack of side effects of local anesthesia with epinephrine in patients with type 2 diabetes mellitus and coronary disease. .

Cyberbullying and adolescent mental health: systematic review / Cyberbullying e saúde mental dos adolescentes: revisão sistemática / Acoso cibernético y la salud mental de los adolescentes: revisión sistemática

Cyberbullying is a new form of violence that is expressed through electronic media and has given rise to concern for parents, educators and researchers. In this paper, an association between cyberbullying and adolescent mental health will be assessed through a systematic review of two databases: PubMed and Virtual Health Library (BVS). The prevalence of cyberbullying ranged from 6.5% to 35.4%. Previous or current experiences of traditional bullying were associated with victims and perpetrators of cyberbullying. Daily use of three or more hours of Internet, web camera, text messages, posting personal information and harassing others online were associated with cyberbullying. Cybervictims and cyberbullies had more emotional and psychosomatic problems, social difficulties and did not feel safe and cared for in school. Cyberbullying was associated with moderate to severe depressive symptoms, substance use, ideation and suicide attempts. Health professionals should be aware of the violent nature of interactions occurring in the virtual environment and its harm to the mental health of adolescents.

Cyberbullying, uma nova forma de violência expressa por meio da mídia eletrônica, tem preocupado pais, educadores e pesquisadores. A associação entre cyberbullying e a saúde mental dos adolescentes será revisada. Revisão sistemática em duas bases de dados: PubMed e a Biblioteca Virtual em Saúde (BVS). A prevalência do cyberbullying variou entre 6,5% a 35,4%. Bullying tradicional prévio ou atual estava associado às vítimas e agressores do cyberbullying. Uso diário de três ou mais horas de Internet, web câmera, mensagens de texto, postar informações pessoais e assediar outros online estavam associados ao cyberbullying. "Cybervítimas" e cyberbullies tinham mais problemas emocionais, psicossomáticos, dificuldades sociais, e não se sentiam seguros e cuidados na escola. O cyberbullying estava associado à sintomatologia depressiva moderada e grave, uso de substâncias, ideação e tentativas de suicídio. Profissionais de saúde devem conhecer as interações de natureza violenta que ocorrem no ambiente virtual e de seus agravos para a saúde mental dos adolescentes.

Se revisa la asociación entre el acoso cibernético y la salud mental de los adolescentes. Se realiza una revisión sistemática de dos bases de datos: PubMed y la Biblioteca Virtual en Salud (BVS). La prevalencia de ciberacoso varió de un 6,5% a un 35,4%. Los acosos cibernéticos tradicionales -pasados o actuales- se asociaron con las víctimas y los acosadores cibernéticos. El uso diario de tres o más horas de Internet, cámara web, mensajes de texto, la publicación de información personal y acosar a los demás se asociaron con el acoso cibernético. Cibervíctimas y acosadores cibernéticos tenían más problemas emocionales, psicosomáticos, dificultades sociales y no se sentían seguros y cuidados en la escuela. El ciberacoso se asoció con síntomas de moderados a graves de depresión, abuso de sustancias, ideación suicida e intentos de suicidio. Los profesionales de salud deben conocer la naturaleza violenta de las interacciones que se producen en el entorno virtual y sus peligros para la salud mental de los adolescentes.