Acerola (Malpighia glabra L.) and guava (Psidium guayaba L.) industrial processing by-products stimulate probiotic Lactobacillus and Bifidobacterium growth and induce beneficial changes in colonic microbiota.

AIMS: This study evaluated whether by-products from industrial processing of acerola (Malpighia glabra L.; AB) and guava (Psidium guajava L.; GB) fruit may stimulate the growth and metabolism of probiotic Lactobacillus and Bifidobacterium and induce changes in human colonic microbiota. METHODS AND RESULTS: The ability of non-digested and digested AB or GB to stimulate the growth ad metabolism of Lactobacillus acidophilus LA-05, Lactobacillus casei L-26 and Bifidobacterium animalis subsp. lactis BB-12 was evaluated. Changes in populations of distinct bacterial groups of human colonic microbiota induced by digested AB and GB were evaluated using an in vitro colonic fermentation system. Non-digested and digested AB and GB favoured probiotic growth. No difference among counts of probiotics in media with glucose, fructooligosaccharides and non-digested and digested AB and GB was found during a 48-h cultivation. Cultivation of probiotics in media with non-digested and digested AB and GB resulted in decreased pH, increased organic acid production and sugar consumption over time. Digested AB and GB caused overall beneficial changes in abundance of Bifidobacterium spp., Lactobacillus-Enterococcus, Eubacterium rectall-Clostridium coccoides and Bacteroides-Provotella populations, besides to decrease the pH and increase the short-chain fatty acid production during a 24-h in vitro colonic fermentation. CONCLUSION: AB and GB could be novel prebiotic ingredients because they can stimulate the growth and metabolism of probiotics and induce overall beneficial changes in human colonic microbiota. SIGNIFICANCE AND IMPACT OF THE STUDY: AB and GB stimulated the growth and metabolism of probiotics, in addition to induce beneficial alterations in human colonic microbiota composition and increase short-chain fatty acid production. These results characterize AB and GB as potential prebiotic ingredients and fruit processing by-products as sources of added-value compounds.

Impact of a surgical safety checklist on surgical site infections, antimicrobial resistance, antimicrobial consumption, costs and mortality.

BACKGROUND: In 2010, following the recommendations of the World Health Organization (WHO), our hospital implemented a surgical safety programme centred around a surgical safety checklist. AIM: The aim of this study was to compare indicators of surgical site infection, antimicrobial consumption, antimicrobial resistance, costs and in-hospital mortality before (January 2006 to July 2010) and after (August 2010 to December 2014) implementation of the programme. METHODS: A case-control study was carried out matching patients with surgical site infection (SSI) to surgical patients without infection to examine the impact of the intervention. FINDINGS: Use of the surgical checklist was associated with a significant reduction in SSI. When comparing the two time periods, we also identified a reduction in infections due to micro-organisms in the ESKAPE group (from 90.7% to 73.9%, P<0.001), a reduction of SSI in patients with contaminated, infected and potentially contaminated wounds, and for those in whom perioperative antimicrobial prophylaxis was discontinued in less than 48 hours. Overall, there was a reduction in antimicrobial resistance, though there was increased resistance to carbapenems for, to glycopeptides for Enterococcus faecium, and to clindamycin for Staphylococcus aureus. We also detected increased antimicrobial consumption of second- and third-generation cephalosporins and clindamycin. We observed a reduction in hospital deaths from 6.4% to 3.2% (P=0.001), but we did not observe any reduction in costs. CONCLUSIONS: Implementation of a surgical checklist was an independent predictor of SSI reduction, and was also associated with a decrease in antimicrobial resistance and reduced in-hospital mortality.

What is the impact of surgical site infection on graft function in kidney transplant recipients?

The impact of surgical site infections (SSIs) on graft function in kidney transplant recipients is controversial. We conducted a matched case-control study (1:1 ratio) between April 2001 and December 2004 in a Brazilian cohort of kidney transplant recipients. The epidemiological and clinical characteristics of SSIs were described based on chart review. The impact on graft function was assessed by comparing serum creatinine measurements and creatinine clearance up to 18 months after transplantation with analysis of variance model. Among 1939 kidney transplants, 120 patients with 145 SSIs were enrolled. Most wound infections were superficial (73.1%). The mortality rate was 0.8%. No impact on graft function was detected. In conclusion, accurate identification of SSIs may have resulted in shorter hospitalization periods, but they had no impact on graft function up to 18 months post transplantation.

P2X7R and PANX-1 channel relevance in a zebrafish larvae copper-induced inflammation model.

Copper is a metal that participates in several essential reactions in living organisms, and it has been used as an inflammatory inducing agent in zebrafish larvae. In this study, we evaluated the effect P2X7 receptor and/or pannexin channel 1 (PANX-1) blockage in this inflammation model. To perform the experiments, 7 dpf larvae were exposed to 10 µM of copper and treated with 100 µM probenecid, PANX-1 inhibitor, and/or 300 nM A740003, a P2X7R selective antagonist. Larvae survival was assessed up to 24 h after treatments. The evaluation of larvae behavior was evaluated after acute (4 h) and chronic (24 h) exposure. The parameters of locomotor activity measured were: mobile time, average speed, distance and turn angle. We analyzed the gene expression of the P2X7 receptor, PANX1a and PANX1b channels and interleukins IL-10 and IL-1b after 24 h of treatment. Treatments did not decrease larval survival in the time interval studied. Changes in larvae locomotion were observed after the longest time of exposure to copper and the treatment with probenecid was able to reverse part of the effects caused by copper. No significant difference was observed in the oxidative stress assays and probenecid and copper treatment decrease partially PANX1a gene expression groups. The data presented herein shows the relevance of the blockage of P2X7-PANX-1 in copper-induced inflammation.

Clinical and molecular markers in COPD.

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease, and there is a clinical need for validated markers and biomarkers that can contribute to the assessment of patients, risk prediction, treatment guidance, and assessment of response. Although according to the 2018 GOLD guidelines clinically useful biomarkers for COPD patients in stable condition have yet to be identified, several clinical markers and biomarkers have been proposed for COPD. These include isolated clinical markers, such as symptoms and Health Status assessment, exercise tests, function tests and imaging, and also composite scores and molecular markers. However, and despite strong efforts to identify useful markers in an attempt to improve prognostic and therapeutic approaches, results have not been consistent and expectations of relying on these markers in near future are faint. Current approaches to COPD have shifted from treating the disease to treating the individual patient. There is a clear need to identify treatable traits, focusing more on the patient and not on the disease, in order to implement an increasingly personalized treatment of COPD in the clinic, leading to true precision medicine. There is a need to identify combinations of clinical markers and biomarkers, genetic markers, and phenotypes that can guide the personalized therapy of COPD patients. This critical review will therefore focus not only on currently established markers and biomarkers in COPD but also on possible future approaches toward precision medicine.

Spitz Tumors of the Skin.

Spitz tumors are melanocytic neoplasms hallmarked by large cell size, lack of high-grade atypia, and a regular architecture. Most are nonpigmented or poorly pigmented. Malignant potential ranges from absent (Spitz nevus), to fully present (spitzoid melanoma), with a further, ill-defined group of Spitz tumors with limited metastatic potential. Microscopic evaluation may prove inconclusive in some instances, resulting in a verdict of Spitz tumor of uncertain malignant potential (STUMP). STUMP is, therefore, not an entity, and should not be equated with Spitz tumors with limited metastatic potential. Novel diagnostic techniques are yielding promising results, and further evaluation is ongoing.

The impact of shrimp farming effluent on bacterial communities in mangrove waters, Ceará, Brazil.

The effects of shrimp farm effluents on bacterial communities in mangroves have been infrequently reported. Classic and molecular biology methods were used to survey bacterial communities from four mangroves systems. Water temperature, salinity, pH, total heterotrophic bacteria and maximum probable numbers of Vibrio spp. were investigated. Genetic profiles of bacterial communities were also characterized by polymerase chain reaction (PCR) amplification of eubacterial and Vibrio 16S rDNA using denaturing gradient gel electrophoresis (DGGE). Highest heterotrophic counts were registered in the mangrove not directly polluted by shrimp farming. The Enterobacteriaceae and Chryseomonas luteola dominated the heterotrophic isolates. Vibrio spp. pathogenic to humans and shrimps were identified. Eubacterial genetic profiles suggest a shared community structure independent of mangrove system. Vibrio genetic profiles were mangrove specific. Neither microbial counts nor genetic profiling revealed a significant decrease in species richness associated with shrimp farm effluent. The complex nature of mangrove ecosystems and their microbial communities is discussed.

Active surveillance and safety organizational goals to reduce central line-associated bloodstream infections outside the intensive care unit: 9 years of experience.

We performed a quasi-experimental, cohort study in the medical-surgical inpatient wards comparing central line-associated bloodstream infection (CLABSI) rates and microbiologic characteristics in 3 phases. The CLABSI rates decreased 60% from phase 1 to 2 and 61.5% from phase 2 to 3. Gram-positive organisms were most frequently isolated in phases 1 and 3, and gram-negative bacilli were most frequently isolated in phase 2. The CLABSI surveillance and prevention program focusing on patient safety had a significant impact on CLABSI rates.

Wound healing of laparoscopic esophageal myotomy with or without an added gastric patch.

BACKGROUND: The purpose of this research is to compare the wound healing of the laparoscopic esophagomyotomy with and without a gastric patch. METHODS: Twelve male pigs were distributed into two groups of six animals. Esophagomyotomy was performed in group A. A gastric patch was associated to the myotomy in group B. On the 21st postoperative day, lumen molding was accomplished to determine the index of stenosis (IS) at the area of myotomy (AM). Macroscopic and microscopic aspects of wound healing were also studied at AM. Three microscopic morphologic patterns were defined for morphometric evaluation: leukocytes (constituted by polymorphonuclear and mononuclear cells), new endothelial cells, and collagen fibers. RESULTS: There was a longer operative duration in group B (93.6 min) than in group A (45 min). At AM, IS was negative (lumen increased) and equivalent in both groups: -11.1% in group A and -12.7% in group B. Mesotelial epithelium covering RM was observed in group A. Inflammatory reaction was greater in group B in comparison with group A (leuCocytes: 22 cells versus 8.6; fibrosis: 25.5 fibers versus 15.6; granulation tissue: 18.7 vessels versus 9.7). CONCLUSION: Esophagomyotomy followed by gastric patch does not heal adequately and is worsened by the presence of foreign body granulomas around stitches. Myotomy without gastric patch is faster and causes lower inflammation. Myotomy alone or with gastric patch does not lead to esophageal stenosis at RM and does not lead to restoration of the esophageal musculature continuity.

CYP2D6*4 polymorphism: A new marker of response to hormonotherapy in male breast cancer?

BACKGROUND: Tamoxifen remains the standard hormonotherapy for Male breast cancer patients (MBC). Previous studies, in women, tried to evaluate the impact of CYP2D6 polymorphisms in tamoxifen efficacy with conflicting results. Herein we analyze the relation between CYP2D6*4 polymorphism and survival in MBC patients. PATIENTS AND METHODS: Fifty-three patients, proposed to tamoxifen in adjuvant setting, were enrolled. Clinical information was collected from records and histological revision with additional immunochemistry analysis was done to better characterize the tumors. Comprehensive CYP2D6*4 genotyping from blood or tumor tissue was performed and translated into two predicted metabolic activity groups. RESULTS: Patients included in the two CYP2D6*4 groups did not differ concerning to age, histological characteristics, and primary treatments performed. Median age at diagnosis was 63 years-old and patients were submitted at least to mastectomy and adjuvant hormonotherapy. Recurrence was observed in 7 patients (13.2%) and 13 patients (25.5%) died with a 5-year disease-free survival of 86.2%. The poorer metabolizer group had a high risk for recurrence (p = 0.034) and this outcome effect remains in different subgroups: in tumors larger than 2 cm (p < 0.001), nodal status, N0 vs N+ (p = 0.04) and in advanced stage, stage III (p < 0.001). Poorer metabolizer patients had also a worse overall survival when tumors were larger than 2 cm (p = 0.03). CONCLUSIONS: In our series, there was an association between CYP2D6*4 polymorphism and a probability of recurrence, with a consistent effect in risk groups defined by classic prognostic factors. Multicentric studies with larger samples are needed to validate these results.

Genetic associations between visual scores, body weight and age at first calving in nellore breed cattle / Associações genéticas entre escores visuais, peso corporal e idade ao primeiro parto de bovinos da raça Nelore

Body weight records of 231,416 Nellore females obtained from the Brazilian Association of Zebu Breeders were used to determine a linear combination between visual appraisal scores (body structure, precocity and muscling) using principal components analysis (PC), and to verify their genetic association with body weight at 12 months (BW) and age at first calving (AFC). The mixed linear model included the fixed effect of the contemporary group and the linear and quadratic effects of age at calving, random effects of genetic additive, maternal environment and temporary environment. Heritability estimates for BW, PC and AFC were 0.51, 0.30 and 0.17, respectively. Genetic additive correlations between BW and PC; BW and AFC, and PC and AFC were 0.48; -0.31 and -0.55; respectively. Spearman's correlations for the best-ranked bulls based on PC prediction were positive between BW and PC and negative among the other combinations. Heritability estimates and correlations indicate potential genetic gains for BW and CP with reduced AFC in cows. The use of PC allows positive responses on precocity and body weight development.(AU)

Utilizaram-se registros de pesos corporais de 231.416 fêmeas bovinas da raça Nelore, oriundos dos registros da Associação Brasileira de Criadores de Zebu-ABCZ, com o objetivo de estabelecer, por componentes principais, uma combinação linear (CP) das características de escores visuais de estrutura (E), precocidade (P) e musculosidade (M), bem como verificar sua associação genética com o peso corporal aos 12 meses (PC) e à idade ao primeiro parto (IPP). O modelo linear misto utilizado incluiu os efeitos fixos de grupo de contemporâneos e os efeitos linear e quadrático da idade da vaca ao parto, os efeitos aleatórios genético aditivo, ambiente materno e ambiente temporário. Estimativas de herdabilidade para PC, CP e IPP foram iguais a 0,51; 0,30 e 0,17, respectivamente. Correlações genéticas aditivas entre PC e CP; PC e IPP; e, ainda, CP e IPP foram iguais a 0,48; -0,31 e -0,55, respectivamente. As correlações de Spearman para os melhores reprodutores classificados em relação à predição de CP foram positivas entre PC e CP e negativas entre as demais combinações. Estimativas de herdabilidade e de correlações indicam possibilidade de ganhos genéticos expressivos para PC e CP com redução para IPP nas fêmeas. A utilização de CP possibilita respostas favoráveis para precocidade sexual e desenvolvimento ponderal.(AU)

Descrição anatômica da artéria carótida externa e seus ramos na preguiça-comum / Anatomical description of external carotid artery and its branches in sloth

Bradypus variegatus, espécie pertencente à família Bradypodidae e à superordem Xenarthra, pode ser considerada modelo biológico de caráter multidisciplinar. Assim, realizou-se um trabalho de descrição anatômica da artéria carótida externa (ACE) e dos seus ramos no bicho-preguiça B. variegatus. Utilizaram-se 10 animais adultos, sendo todos fêmeas, que foram submetidos à dissecação, constatando-se que a artéria (a.) carótida comum se bifurca, em externa e interna, no nível do primeiro anel traqueal. A ACE, então, segue estendendo-se até a maxila, onde emite ramos para a região temporal e para o polo posterior do olho. Em todos os animais estudados, foram observados sete ramos principais da ACE, que, segundo a sua origem e localização, foram denominados como a. auricular, a. lingual, a. facial, a. alveolar, a. inferior, a. temporal, a. maxilar e a. oftálmica. Os ramos maxilar e oftálmico correspondem aos terminais e os demais são ramos colaterais. Em 50% dos animais analisados, foi verificada a presença de anastomoses arteriais e 40% deles apresentaram o acréscimo de um ramo aos principais. Desses, 30% demonstraram a presença de um ramo traqueal e 10% de um ramo sublingual, sendo esses ramos colaterais.(AU)

Bradypus variegatus is a species belonging to the family Bradypodidae and superorder Xenarthra, which should be considered as a multidisciplinary biological model. Thus, an anatomical description of the external carotid artery (ACE) and its branches in sloth B. variegatus was studied. Ten adult animals, all of them female, were submitted to dissection, and it was observed that the common carotid artery (a.) bifurcates in external and internal at the level of the first tracheal ring. Then, ACE extends through the maxilla where it launches branches to the temporal region and posterior eye side. For all sampled animals, seven principal branches of ACE were observed, and according to their origin and location were denominated as auricular, lingual, facial, bottom alveolar, temporal, maxillary and ophthalmic arteries. The maxillary and ophthalmic branches correspond to the terminals and the other branches are collateral. Presence of arterial anastomoses was observed in 50% of the sampled animals and 40% of them had increase of a branch on the principal. In these, 30% had presence of one tracheal branch and 10% of a sublingual branch, considering these branches as collateral.(AU)

Arterial tissue and plasma concentration of enzymatic-driven oxysterols are associated with severe peripheral atherosclerotic disease and systemic inflammatory activity.

INTRODUCTION: Cholesterol undergoes oxidation via both enzymatic stress- and free radical-mediated mechanisms, generating a wide range of oxysterols. In contrast to oxidative stress-driven metabolites, enzymatic stress-derived oxysterols are scarcely studied in their association with atherosclerotic disease in humans. METHODS: 24S-hydroxycholesterol (24S-HC), 25-hydroxycholesterol (25-HC), and 27-hydroxycholesterol (27-HC) were assessed in plasma and arteries with atherosclerotic plaques from 10 patients (54-84 years) with severe peripheral artery disease (PAD) as well as arteries free of atherosclerotic plaques from 13 individuals (45-78 years, controls). RESULTS: Plasma 25-HC was higher in PAD individuals than in controls (6.3[2] vs. 3.9[1.9] ng/mgCol; p = 0.004). 24S-HC and 27-HC levels were, respectively, five- and 20-fold higher in the arterial tissue of PAD individuals than in those of the controls (p = 0.016 and p = 0.001). Plasma C-reactive protein correlated with plasma 24-HC (r = 0.51; p = 0.010), 25-HC (r = 0.75; p < 0.001), 27-HC (r = 0.48; p = 0.015), and with tissue 24S-HC (r = 0.4; p = 0.041) and 27-HC (r = 0.46; p = 0.023). CONCLUSION: Arterial intima accumulation of 27-HC and 24S-HC is associated with advanced atherosclerotic disease and systemic inflammatory activity in individuals with severe PAD.

Asthma app use and interest among patients with asthma: a multicenter study

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Inhibition of insulin release by Jatrophone.

In many countries, including Brazil, extracts of Jatrophona elliptica species are currently used for the treatment of several diseases. Recently it was shown that a purified compound from these plants inhibits contraction of smooth and cardiac muscle in the microM range, probably involving alterations in membrane Ca2+ permeability and/or internal Ca2+ distribution. In collagenase-isolated rat islets and in the absence of glucose, basal insulin secretion measured by radioimmunoassay averaged 122 +/- 13 microU/islet per 90 min (N = 25). At 16.7 mM glucose, the insulin output reached 445 +/- 32 microU/islet per 90 min (N = 27). Jatrophone (1-100 microM/l) caused a dose-related inhibition of glucose-induced insulin release, over basal secretion, with an ID50 close to 8 microM/l. Complete inhibition of insulin release was obtained with 100 microM/l Jatrophone. However, at 100 microM/l (but not at 10 microM/l) concentration, Jatrophone also provoked a reduction in glucose metabolism by the islets which could explain, at least in part, the reduction in insulin secretion. After 120-min incubation, the glucose metabolism, measured by the 14CO2 production, was reduced from 26.58 +/- 3.63 (N = 42) to 7.48 +/- 1.36 (N = 16) pmol/l per islet. In conclusion, at lower concentrations (10 microM/l) Jatrophone could be a valuable tool for the study of the mechanism of insulin release induced either by glucose or other secretagogues.

A time-course study of physiological indicators of handling stress in the tropical fish Piaractus mesopotamicus (pacu).

The response of juvenile cultivated Piaractus mesopotamicus to handling stress, without anesthesia, was determined over 3-5 min (T1), 1 h (T2) and 6 h (T3) after capture. Plasma cortisol, glucose and total cholesterol were measured. Hyperglycemia present at T2 continued to rise until T3 while plasma cortisol levels increased but were similar at T2 and T3. Total plasma cholesterol was altered only at T3. Hyperglycemic changes were greater in fish without than with stomach contents during the T2-T3 period. These differences in hyperglycemic changes may reflect the role of hormones other than cortisol in the regulation of glucose release in these fish.

Microbicidal effect of medicinal plant extracts (Psidium guajava Linn. and Carica papaya Linn.) upon bacteria isolated from fish muscle and known to induce diarrhea in children.

Out of the twenty-four samples of shrimp and fish muscle used for this study, twelve were collected near a large marine sewer for waste disposal, 3 km off the coast of Fortaleza (Brazil) and used for the isolation of E. coli. Other twelve were collected at the Mucuripe fresh fish market (Fortaleza, Brazil) and used for the isolation of Staphylococcus aureus. Ethanol, water and acetone-diluted extracts of guava and papaya leaf sprouts were tested on the bacteria in order to verify their microbicidal potential. The E. coli strains used in the trials were rated LT positive. The papaya leaf extracts (Carica papaya Linn) showed no microbicidal activity while the guava sprout extracts (Psidium guajava Linn) displayed halos exceeding 13 mm for both species, an effect considered to be inhibitory by the method employed. Guava sprout extracts by 50% diluted ethanol most effectively inhibited E. coli (EPEC), while those in 50% acetone were less effective. It may be concluded that guava sprout extracts constitute a feasible treatment option for diarrhea caused by E. coli or by S. aureus-produced toxins, due to their quick curative action, easy availability in tropical countries and low cost to the consumer.