Urinary biomarkers for lupus nephritis: the role of the vascular cell adhesion molecule-1.

Renal involvement is one of the main complications of systemic lupus erythematosus, causing a significant impact on patients' morbidity and mortality. Renal biopsy is still the gold standard of diagnosis, but it has many limitations. In this sense, several recent studies aim to identify biomarkers that not only predict disease activity and renal histology, but also lead to earlier treatment. In previous studies, the soluble vascular cell adhesion molecule-1 measured in urine showed a strong association with the presence of lupus nephritis, with clinical and histological activity indexes of the disease and with more severe renal lesions. This paper reviews the main urinary biomarkers of lupus nephritis that have been studied, with special emphasis on vascular cell adhesion molecule-1 results.

Orofacial features and medical profile of eight individuals with Kabuki syndrome.

BACKGROUND: To evaluate oral, craniofacial and systemic characteristics of eight patients with Kabuki syndrome (KS), aged between 3 and 16 years old. MATERIAL AND METHODS: in this retrospective study, medical records of all patients were reviewed for information on family history, growth and development, medications in use, general systemic complications and oral and craniofacial characteristics. RESULTS: the medical alterations found included recurrent infections such as pneumonia and otitis media (n = 6), cardiovascular malformations (n = 4), kidney abnormalities (n = 2), epilepsy (n = 2) and visual deficiency (n = 2). The individuals exhibited dental caries (n = 5), agenesis (n = 5), delayed tooth eruption (n = 4), cleft lip/palate (n = 2) enamel hypoplasia (n = 2), fusion (n = 1) and microdontia (n = 1). CONCLUSIONS: There was a great diversity of oral, craniofacial and systemic characteristic among the KS patients, suggesting that an inter-disciplinary approach should be taken for their dental treatment.

Peripheral cytokine and chemokine alterations in depression: a meta-analysis of 82 studies.

OBJECTIVE: To conduct a systematic review and meta-analysis of studies that measured cytokine and chemokine levels in individuals with major depressive disorder (MDD) compared to healthy controls (HCs). METHOD: The PubMed/MEDLINE, EMBASE, and PsycINFO databases were searched up until May 30, 2016. Effect sizes were estimated with random-effects models. RESULT: Eighty-two studies comprising 3212 participants with MDD and 2798 HCs met inclusion criteria. Peripheral levels of interleukin-6 (IL-6), tumor necrosis factor (TNF)-alpha, IL-10, the soluble IL-2 receptor, C-C chemokine ligand 2, IL-13, IL-18, IL-12, the IL-1 receptor antagonist, and the soluble TNF receptor 2 were elevated in patients with MDD compared to HCs, whereas interferon-gamma levels were lower in MDD (Hedge's g = -0.477, P = 0.043). Levels of IL-1ß, IL-2, IL-4, IL-8, the soluble IL-6 receptor (sIL-6R), IL-5, CCL-3, IL-17, and transforming growth factor-beta 1 were not significantly altered in individuals with MDD compared to HCs. Heterogeneity was large (I2 : 51.6-97.7%), and sources of heterogeneity were explored (e.g., age, smoking status, and body mass index). CONCLUSION: Our results further characterize a cytokine/chemokine profile associated with MDD. Future studies are warranted to further elucidate sources of heterogeneity, as well as biosignature cytokines secreted by other immune cells.

Blasted copper slag as fine aggregate in Portland cement concrete.

The present work focuses on assessing the viability of applying blasted copper slag, produced during abrasive blasting, as fine aggregate for Portland cement concrete manufacturing, resulting in an alternative and safe disposal method. Leaching assays showed no toxicity for this material. Concrete mixtures were produced, with high aggregate replacement ratios, varying from 0% to 100%. Axial compressive strength, diametrical compressive strength, elastic modulus, physical indexes and durability were evaluated. Assays showed a significant improvement in workability, with the increase in substitution of fine aggregate. With 80% of replacement, the concrete presented lower levels of water absorption capacity. Axial compressive strength and diametrical compressive strength decreased, with the increase of residue replacement content. The greatest reductions of compressive strength were found when the replacement was over 40%. For tensile strength by diametrical compression, the greatest reduction occurred for the concrete with 80% of replacement. After the accelerated aging, results of mechanic properties showed a small reduction of the concrete with blasted copper slag performance, when compared with the reference mixture. Results indicated that the blasted copper slag is a technically viable material for application as fine aggregate for concrete mixtures.

Desmoplastic fibroma of the mandible in a 5-year-old child as an early oral manifestation of familial adenomatous polyposis.

Desmoplastic fibroma (DF) is a benign yet locally aggressive intraosseous tumour rarely encountered in the mandible. It often mimics other oral lesions. Familial adenomatous polyposis (FAP) is a condition in which individuals tend to develop multiple colorectal polyps, which may convert to colorectal cancer unless treated. FAP has various colonic and extra-colonic manifestations, including oral manifestations. A case of DF of the mandible in a 5-year-old child is presented here. The patient remained free of recurrence 4 years after segmental resection and immediate reconstruction with a fibula free flap. Subsequent genetic testing revealed FAP, implicating DF as an early oral manifestation. A review of the existing literature emphasizes the challenges in diagnosing DF and its association with FAP, stressing the importance of comprehensive assessment and genetic screening in suspected cases.

[Hibernoma and cervical rib: two rare diseases, the same manifestation]. / Hibernoma y costilla cervical: dos enfermedades raras, la misma manifestación.

The hibernoma is a rare benign tumor of soft tissue, derived from remnants of fetal brown adipose tissue. A cervical rib is a supernumerary or accessory rib derived from the 7th cervical vertebra. CLINCAL CASE: 2-year-old girl, previously healthy, referenced to Pediatrics consultation, for left supraclavicular mass. No history of infectious diseases or systemic symptoms. At exam presented mass in supraclavicular left region, 1.5 to 2 cm in diameter, hard, mobile, non-adherent to the deep planes. Laboratory tests exclude an infectious or lymphoproliferative disease. In cervical radiograph we observed bilateral cervical ribs. Cervical ultrasound revealed calcified nodule 0.8 cm, compatible with calcified adenopathy. Biopsy was performed and histology revealed a hibernoma, which was completely removed surgically. This case illustrates the association of two diagnoses, uncommon in children. These were made during the investigation of lymphadenopathies, a frequent reason for pediatrics consultation.

The hydrophobicity and roughness of a nasoenteral tube surface influences the adhesion of a multi-drug resistant strain of Staphylococcus Aureus.

IN THIS STUDY, WE EXAMINED THE PHYSIOCHEMICAL PROPERTIES OF NASOENTERAL FEEDING TUBES MADE FROM TWO DIFFERENT TYPES OF POLYMER: silicone materials and polyurethane. The internal surfaces of the nasoenteral feeding tubes were analyzed for their hydrophobicity, roughness, microtopography, rupture-tension and ability to stretch. We also studied the adhesion of an isolated, multi-drug resistant strain of S. aureus to these polymers. The polyurethane nasoenteral tube, which was classified as hydrophilic, was more resistant to rupture-tension and stretching tests than the silicone tube, which was classified as hydrophobic. Additionally, the polyurethane tube had a rougher surface than the silicone tube. Approximately 1.0 log CFU.cm(-2) of S. aureus cells adhered to the tubes and this number was not statistically different between the two types of surfaces (p > 0.05). In future studies, new polymers for nasoenteral feeding tubes should be tested for their ability to support bacterial growth. Bacterial adhesion to these polymers can easily be reduced through modification of the polymer's physicochemical surface characteristics.

AmAMP1 from Acropora millepora and damicornin define a family of coral-specific antimicrobial peptides related to the Shk toxins of sea anemones.

A candidate antimicrobial peptide (AmAMP1) was identified by searching the whole genome sequence of Acropora millepora for short (<125AA) cysteine-rich predicted proteins with an N-terminal signal peptide but lacking clear homologs in the SwissProt database. It resembled but was not closely related to damicornin, the only other known AMP from a coral, and was shown to be active against both Gram-negative and Gram-positive bacteria. These proteins define a family of AMPs present in corals and their close relatives, the Corallimorpharia, and are synthesised as preproproteins in which the C-terminal mature peptide contains a conserved arrangement of six cysteine residues. Consistent with the idea of a common origin for AMPs and toxins, this Cys motif is shared between the coral AMPs and the Shk neurotoxins of sea anemones. AmAMP1 is expressed at late stages of coral development, in ectodermal cells that resemble the "ganglion neurons" of Hydra, in which it has recently been demonstrated that a distinct AMP known as NDA-1 is expressed.

The effects of systemic proteolytic enzyme therapy on pain and swelling in third molar surgery equal to diclofenac therapy: a prospective randomized double blinded clinical trial.

OBJECTIVE: The aim of this study was to determine if the timing of administration of systemic enzyme therapy [SET] has any effect on its efficacy in controlling postoperative sequelae of third molar surgery. STUDY DESIGN: A double blinded prospective randomized control trial was planned. The sample included patients requiring impacted mandibular third molar surgical extraction. Patients were randomly allocated to four groups (50 patients per group). Group A included administration of SET 48 h prior to surgery; Group B, started on the day of surgery; Group C started immediately after surgery and control group D included NSAIDS started 3 h after surgery. The predictor variable was timing of administration of SET. The primary outcome variables were pain and swelling measured on 1st day, 5th day, and 7th day after surgery. FINDINGS: Groups A and D reported lower mean and median VAS scores and lesser swelling than groups C and D on postop day 1. On days 5 and 7, all four groups were comparable. On overall analysis, no statistically significant difference (p > 0.05) was evident. INTERPRETATION: The results of the study showed that the differences in swelling and pain with starting the SET 2 days before, on the day of surgery, or immediately after when compared with diclofenac was not statistically significant. TRIAL REGISTRATION: CTRI Registration Number CTRI/2018/03/012502.

Is dermis fat arthroplasty better than plain gap arthroplasty? A prospective randomised controlled trial.

The aim of the study was to compare interpositional arthroplasty using a dermis fat graft with gap arthroplasty in the management of ankylosis of the temporomandibular joint (TMJ). We organised a prospective randomised study of 22 patients who presented with ankylosis of the TMJ. They were randomised to be treated with either plain gap arthroplasty or dermis fat arthroplasty, and the predictor variable was the method of treatment. The primary outcome variables were mouth opening and pain on jaw exercises. Pain and interincisal opening were measured on day 5, day 14, at the end of one month, and at six months, one year, two years, and three years. There was a significant difference between the two groups on two occasions: postoperative day 5 (p=0.013) and at one year (p=0.018). The mean (SD) scores for mouth-opening were higher in the dermis fat group at all times (41.20 (4.69) mm compared with 39.50 (2.46) mm in gap arthroplasty at two years, and 41.40 (3.60) mm compared with 38.9 (2.02) mm at three years). The visual analogue pain scores were also lower in the dermis fat graft group. The groups showed similar results at the end of three years follow up, with no significant difference in mouth opening. We conclude therefore that the two techniques have similar outcomes in the management of ankylosis of the TMJ.

Clinical outcomes after femtosecond laser-assisted implantation of an intrastromal corneal ring segment with a 340-degree arc length in postkeratoplasty patients: 12-month follow-up.

PURPOSE: To assess the clinical outcomes after implantation of a new 340-degree arc length intrastromal corneal ring segment (ICRS) aided by the femtosecond laser in postkeratoplasty patients after a 12-month follow-up. SETTING: Private practice, Brasilia, Brazil. DESIGN: Prospective case series. METHODS: Eyes with previous keratoplasty had ICRS implantation assisted by femtosecond laser. The primary outcome measure was the change in the uncorrected distance visual acuity (UDVA) 12 months postoperatively. The secondary outcome measures were the corrected distance visual acuity (CDVA), refraction, and corneal tomography 1, 3, 6, and 12 months postoperatively. The astigmatism results were analyzed using vector analysis through the double-angle polar plot. RESULTS: Of the 18 patients, 7 (38.9%) were men, and 11 (61.1%) were women. The mean UDVA was 20/250 (1.15 logarithm of the minimum angle of resolution [logMAR]) before implantation and 20/70 (0.54 logMAR) at the last follow-up (P < .001). The mean CDVA improved from 20/35 (0.26 logMAR) to 20/25 (0.10 logMAR) (P < .001). The mean spherical equivalent and astigmatism components were significantly reduced after ICRS implantation. The mean corneal astigmatism decreased from 5.55 ± 2.29 D preoperatively to 3.92 ± 1.82 D postoperatively (P < .001). The CDVA remained the same or improved in 19 of 20 eyes and decreased by 1 line in 1 patient. There were no surgical complications. CONCLUSION: A new ICRS with a 340-degree arc length was effective in treating postkeratoplasty eyes, improving visual acuity and reducing corneal astigmatism.

Lack of clastogenic/genotoxic effects of Baccharis dracunculifolia extract on Swiss mouse peripheral blood cells.

Baccharis dracunculifolia De Candole (DC) (Asteraceae) is indigenous throughout southeastern Latin America and is used by local people in traditional medicine. This plant is known to be the source of resin for the highly valued Brazilian green propolis. As no information is available on the safety of high doses of B. dracunculifolia extract, we evaluated the mutagenic potential of high doses of this plant extract in vivo on peripheral blood cells of Swiss mice using the comet assay and the micronucleus test. The extract was administered by gavage at doses of 1000, 1500 and 2000 mg/kg body weight. Peripheral blood cell samples were collected 4 and 24 h after treatment for the comet assay (genotoxicity assay), and at 48 and 72 h for the micronucleus test (clastogenicity assay). The B. dracunculifolia extract was devoid of clastogenic/genotoxic activity at all doses.

[Loco-regional anesthesia in vascular surgery]. / Anestesia loco-regional em cirurgia vascular.

Per-operative management of patients with cardiovascular pathology, has been regarded, since ever, as a challenge for anesthesiologists and vascular surgeons. Vascular disease, often diffuse and asymptomatic, has a high prevalence in the community and is associated to an annual mortality rate of 12%. This requires that anesthetic technique should be concentrated in the preservation of myocardial, renal, pulmonary and cerebral functions, during the hemodynamic alterations related to surgery, in order to lower the per-operative complications and to promote faster and safer post-operative recovery. In this paper we describe the experience of the Anesthesiology Department of S. Joatilde;o Hospital, Porto, particulary with the superficial and deep cervical plexus block, in carotid endarterectomy surgery.

Intra-muscular haemangioma of the masseter: A clinical update and differential diagnosis of a rare entity.

The intramuscular haemangioma (IMH) is a rare variant of unknown aetiology and comprises 0.8% of soft tissue haemangiomas. Less than 20% of IMHs occur in the craniofacial region of which the masseter is the most common site. It presents as a non-specific, painful soft tissue enlargement in young adults. Symptoms common to vascular lesions usually are absent. Due to the paucity of clinical symptoms, advanced imaging techniques like MRIs are needed to clinch a definitive pre-operative diagnosis. The therapeutic modalities mentioned in the literature range from total surgical excision to non-surgical methods like cryotherapy, sclerotherapy, embolization and feeder vessel ligation. We present a case of an intra-massetric IMH in a 16-year-old male which was treated by total surgical excision with a follow up of 3 years. We also stress on the differential diagnosis of intra-massetric lesions and the key findings of the various imaging modalities available for IMH.

Does the Intensity of IGG4 Immunostaining Have a Correlation with the Clinical Presentation of Riedel's Thyroiditis?

Riedel's thyroiditis (RT) represents one type of IgG4-related thyroid disease (IgG4RTD) and the diagnosis involves quantitative immunohistochemistry showing dense lymphoplasmacellular inflammatory infiltrate consisting of IgG4-positive plasma cells with storiform fibrosis and obliterative phlebitis. We report a case of RT with progressive enlargement of the anterior neck, severe dysphagia, odynophagia, and dyspnea. The patient underwent surgical decompression of the airway, protection tracheotomy, and gastrostomy for nutritional intake 6 months after first symptoms. Complete resolution occurred after surgical treatment combined with prednisolone. Immunostaining revealed IgG4-positive plasma cells 12/HPF (high-power field) and the IgG4/IgG ratio 25%, values that were disproportionate to the intensity of the patient's symptoms. As to this case and the few cases described and analyzed in the literature, our impression is that there is no relation between the intensity of symptoms in RT with the total number of IgG4-positive plasma cells and the IgG4/IgG ratio, but more studies are needed.

Bleeding during and after dental extractions in patients with liver cirrhosis.

Little is known about the prevention and management of acquired coagulopathies, such as those affecting cirrhotic patients. The objective of this analytic retrospective observational study was to evaluate patients on the liver transplant waiting list according to the following outcomes: (1) presence of unusual intraoperative bleeding (>10min after routine haemostatic procedures); and (2) presence of postoperative haemorrhagic complications. The outcomes were analysed according to clinical and laboratory variables. A total of 190 visits were performed for extraction of 333 teeth (ranging from 1 to 9 teeth per visit), with platelet count ranging from 16,000 to 216,000 and international normalized ratio (INR) below 3. Twelve cases (6.31%) had unusual intraoperative bleeding and 12 had postoperative haemorrhagic complications. All the events were controlled by local measures. Intraoperative bleeding was associated with low count of platelets (P=0.026). However, this counting could explain only 16% (adjusted R2=0.16) of the cases of bleeding (P=0.44), meaning that platelet function changes might be involved. Our results show that cirrhotic patients presenting platelet count above 16,000 and INR below 3 need no previous blood transfusion, with local measures being enough to manage haemorrhagic events.

Risk factors for early onset prosthetic valve endocarditis: a case-control study.

BACKGROUND: Early onset prosthetic valve endocarditis (EO-PVE) is an infrequent complication of cardiac valve surgery. It is considered a healthcare-associated infection due to contamination of the prosthesis during the implant or in the early postoperative period. AIM: To evaluate which factors may be related to the acquisition of EO-PVE. METHODS: A nested case-control study was conducted from 2006 to 2016. Cases were patients who had definite prosthetic endocarditis by the modified Duke criteria up to 12 months of heart valve replacement. Cases and controls were matched by age, gender, date and type of surgery. FINDINGS: There were 26 cases and 78 controls, in 2496 valve surgeries. The median incidence of EO-PVE was 1.1%. Risk factors identified during surgery were: use of ≥2 cryoprecipitate units (odds ratio (OR): 5.95; 95% confidence interval (CI): 1.31-27.0) and ≥2 plasma units (OR: 2.73; 95% CI: 1.0-7.5). In the postoperative period, associated factors were bloodstream infection (OR: 14.00; CI: 1.49-131.77), pneumonia (4.38; 1.21-15.84), any infection (4.46; 1.63-12.21), central line for ≥2 weeks (5.33; 2.06-13.78), presence of dialysis catheter (3.22; 1.15-9.03), and new open chest surgery (3.89; 1.28-11.78). Mortality at 12 months was 34.6% in cases and 6.4% in controls (OR: 7.73; CI: 2.3-26.06). CONCLUSION: Cases had more infections, invasive procedures and surgical re-interventions in the early postoperative period, which favoured contamination of the newly implanted prosthesis. A preventive approach, with reinforcement of infection control practices, may curb the incidence of this condition.

Fish products developed from ground rainbow trout and tilapia fillet mixtures: physico-chemical, microbiological and toxicological analyses / Produtos de pescado elaborados a partir de misturas de carne moída de truta-arco-íris (Oncorhynchus mykiss) e tilápia (Oreochromis sp. ): análises físico-químicas, microbiológicas e toxicológicas

Constant fishing industry innovations in response to consumer demands for novel, balanced healthy products exhibiting high nutritional value, as well as easy to prepare and ready to consume, have led to the emergence of new technologies. Among them, the development of products based on ground beef and fish mixtures are noteworthy. In this context, the purpose of this study was to develop products from different ground rainbow trout and tilapia fillet ratios, in the form of meatballs and nuggets, determining their proximate composition and physico-chemical, microbiological and toxicological characteristics. The average dry matter percentage of the developed products was 29.20±2.30%, while mineral content was 1.45±0.55%, lipid pulp content, 3.70±0.30% and crude pulp protein, 16.60±2.04%. Total psychotropic counts remained below 102 CFU/g, for standard counting on aerobic microorganism plates. Histamine and sulfur-based compounds were not detected in any of the prepared samples. The purpose of the work proposal was to develop foods and technologies that can serve as standards, allowing for simple handling products that apply ground meat mixtures from different fish species to maintain adequate nutritional indices after processing.(AU)

A constante inovação da indústria pesqueira, em resposta às demandas dos consumidores por novos produtos saudáveis, com alto valor nutritivo, balanceados, de fácil preparo e prontos para consumo, levou ao surgimento de novas tecnologias, entre elas o desenvolvimento de produtos à base de mistura de carne moída de pescado. Nesse contexto, a proposta deste trabalho é desenvolver produtos a partir de carne moída de pescado de truta-arco-íris e tilápia, confeccionando almôndegas e nuggets em diferentes proporções, com determinação da composição centesimal e de suas características físico-químicas, microbiológicas e toxicológicas. A matéria seca percentual média foi de 29,20±2,30%. Teores de matéria mineral nos produtos estão em 1,45±0,55%. Os teores de lipídeos aferidos na polpa foram de 3,70±0,30%, e os níveis de proteína bruta apresentados na polpa de 16,60±2,04%. A contagem de psicrotróficos totais manteve-se abaixo de 102 CFU/g, para contagem padrão em placas de micro-organismos aeróbicos. Nas amostras, não foram detectados níveis de histamina e de compostos à base de enxofre. A proposta de trabalho objetivou, por fim, desenvolver alimentos e tecnologias que possam servir como padrões, permitindo que produtos de manipulação simples e que utilizem misturas de carne moída de diferentes espécies de pescado mantenham índices nutricionais adequados após o processamento.(AU)

Innervation of human epicardial coronary veins: immunohistochemistry and vasomotility.

OBJECTIVE: The aim was to investigate the innervation and vasomotor responses to classical and putative transmitters of the coronary venous bed. METHODS: The innervation of human epicardial coronary veins was investigated using acetylcholinesterase histochemistry and immunofluorescence staining, together with antisera against the general neuronal marker protein gene product 9.5 (PGP 9.5), the catecholamine synthesising enzyme tyrosine hydroxylase, and neuropeptides [neuropeptide Y, vasoactive intestinal peptide (VIP), substance P, and calcitonin gene related peptide (CGRP)]. The vasomotor responses to noradrenaline, acetylcholine, neuropeptide Y, substance P, human alpha calcitonin gene related peptide (alpha CGRP), and VIP were tested on isolated circular human epicardial coronary vein segments. RESULTS: A network of nerve fibres was shown in the major epicardial coronary veins by means of an antiserum to PGP 9.5. The majority of the perivascular nerve fibres possessed neuropeptide Y and tyrosine hydroxylase immunoreactivity. Only a few nerve fibres displayed substance P, CGRP, and VIP immunoreactivity and acetylcholinesterase activity. Noradrenaline and acetylcholine induced powerful contractions of all the tested segments, whereas no contraction was induced by neuropeptide Y, alpha CGRP, substance P, or VIP. All segments precontracted with U46619 responded with potent relaxation to alpha CGRP, substance P, and VIP, whereas noradrenaline and acetylcholine only in low concentrations induced weak relaxation of a few of the segments. No relaxation was induced by neuropeptide Y. CONCLUSIONS: This is the first study to demonstrate comprehensively the perivascular innervation of human coronary veins and corresponding vasomotor effects, suggesting a role in regulation of the coronary venous circulation.