Tracheal metallic hybrid stent removal via tracheostomy: an unconventional approach.

Increasing use of tracheal expandable metallic hybrid stents will lead to common encounters with these devices in emergency airway management. The presence of these stents qualifies any patient as a challenge when an emergency tracheostomy is needed. We report an unorthodox technique of tracheostomy with concomitant removal of tracheal stent, without any major complications. Although the combined approach with bronchoscopy and tracheostomy has been reported in similar cases, we present a safe procedure when rigid bronchoscopy is not available.

Nutritive Value and Bioactivities of a Halophyte Edible Plant: Crithmum maritimum L. (Sea Fennel).

Crithmum maritimum L. (sea fennel), an edible xerophyte of coastal habitats, is considered an emerging cash crop for biosaline agriculture due to its salt-tolerance ability and potential applications in the agri-food sector. Here, the nutritional value and bioactive properties of sea fennel are described. Sea fennel leaves, flowers, and schizocarps are composed of carbohydrates (>65%) followed by ash, proteins, and lipids. Sea fennel's salty, succulent leaves are a source of omega-6 and omega-3 polyunsaturated fatty acids, especially linoleic acid. Extracts obtained from flowers and fruits/schizocarps are rich in antioxidants and polyphenols and show antimicrobial activity against Staphylococcus aureus, Staphylococcus epidermis, Candida albicans, and Candida parapsilosis. Plant material is particularly rich in sodium (Na) but also in other nutritionally relevant minerals, such as calcium (Ca), chlorine (Cl), potassium (K), phosphorus (P), and sulfur (S), beyond presenting a potential prebiotic effect on Lactobacillus bulgaricus and being nontoxic to human intestinal epithelial Caco-2 model cells, up to 1.0% (w/v). Hence, the rational use of sea fennel can bring nutrients, aroma, and flavor to culinary dishes while balancing microbiomes and contributing to expanding the shelf life of food products.

Acute kidney injury in autologous hematopoietic stem cell transplant for patients with lymphoma - KDIGO classification with creatinine and urinary output criteria: a cohort analysis.

Eligibility and indication for autologous hematopoietic stem cell transplantation (HSCT) in patients with lymphoma are increasing. Acute kidney injury (AKI) is a known complication of HSCT with studies including a miscellaneous of hematological diagnoses and using different definitions of AKI. We aimed to evaluate incidence, risk factors and prognostic impact of AKI post-HSCT in patients with lymphoma submitted to autologous HSCT using the KDIGO classification with both serum creatinine and urinary output criteria. We performed a single-center retrospective cohort study including patients with lymphoma admitted for autologous HSCT. We used survival analysis with competing risks to evaluate cumulative incidence of AKI, AKI risk factors and AKI impact on disease-free survival. We used Cox regression for impact of AKI on overall survival. We used backward stepwise regression to create multivariable models. A total of 115 patients were included. Cumulative incidence of AKI: 63.7% 100 d post-HSCT. First diagnosis criteria: creatinine in 54.8%, urinary output in 41.1% and both in 4.1%. AKI highest stage: 1 in 57.5%, 2 in 17.8% and 3 in 24.7%. Variables independently associated with higher incidence of AKI were: use of nephrotoxic drugs (HR: 2.87, 95% CI: 1.07-7.65; p = 0.035), mucositis (HR: 1.95, 95% CI: 1.16-3.29; p = 0.012) and shock (HR: 2.63, 95% CI: 1.19-5.85; p = 0.017). Moderate to severe AKI was independently associated with lower overall survival (HR: 2.04, 95% CI: 1.06-3.94; p = 0.033). No association with relapse nor progression to chronic kidney disease (CKD) was found. AKI affects almost two thirds of patients with lymphomas submitted to autologous HSCT. Nephrotoxic drugs, mucositis and shock are important independent AKI risk factors. More than one third of AKI episodes are moderate to severe and these are associated with lower overall survival.

Discrimination between protein glycoforms using lectin-functionalised gold nanoparticles as signal enhancers.

Glycoforms (and other post-translational modifications) of otherwise identical proteins can indicate pathogenesis/disease state and hence new tools to detect and sense a protein's glycosylation status are essential. Antibody-based assays against specific protein sequences do not typically discriminate between glycoforms. Here we demonstrate a 'sandwich' bio-assay approach, whereby antibodies immobilised onto biolayer interferometry sensors first select proteins, and then the specific glycoform is identified using gold nanoparticles functionalised with lectins which provide signal enhancement. The nanoparticles significantly enhance the signal relative to lectins alone, allowing glycoform specific detection as low as 0.04 µg mL-1 (1.4 nM) in buffer, and crucially there is no need for an enrichment step and all steps can be automated. Proof of concept is demonstrated using prostate specific antigen: a biomarker for prostate cancer, where glycoform analysis could distinguish between cancerous and non-cancerous status, rather than only detecting overall protein concentration.

Edible flowers of Helichrysum italicum: Composition, nutritive value, and bioactivities.

Helichrysum italicum (H. italicum) is a halophyte shrub with bright yellow flowers with a strong curry-like aroma. The essential oils of H. italicum have been used in the production of cosmetics and pharmaceuticals, due to their antiallergic and anti-inflammatory properties. In the agri-food sector, H. italicum flowers can be used for seasoning and flavoring food, and as natural food preservatives. Here, we report on the composition, bioactive compounds, and nutritive value of H. italicum flowers. Flowers were mainly composed of carbohydrates (>80 % dry weight), followed by minerals (6.31 ± 0.95 % dw), protein (5.44 ± 0.35 % dw), and lipids (3.59 % ± 0.53 % dw). High percentages of Fe, Zn, Ca, and K were found in the flower material, along with a high content in antioxidants, polyphenols, and carotenoids, as corroborated by the nuclear magnetic resonance (NMR) data. Flowers were mainly composed of saturated fatty acids (SFAs) (54.50 ± 0.95 % of total FA), followed by polyunsaturated fatty acids (PUFAs) (37.73 ± 1.25 % of total FA) and monounsaturated fatty acids (MUFAs) (7.77 ± 0.34 %), as detected by gas chromatography mass spectrometry (GC-MS). The omega-6 PUFA linoleic acid (22.55 ± 0.76 % of total FA) was the most abundant fatty acid found. Flower extracts showed antimicrobial activity against Saccharomyces cerevisiae and Komagataella phaffii, as well as against Gram-negative (Klebsiella pneumoniae) and Gram-positive (Staphylococcus aureus) bacteria. H. italicum flower material was nontoxic to human intestinal Caco-2 model cells at concentrations up to 1.0 % w/v.

Enrichment of Sunflower Oil with Ultrasound-Assisted Extracted Bioactive Compounds from Crithmum maritimum L.

Crithmum maritimum L., or sea fennel, is an edible halophyte plant, rich in phenolic compounds with antioxidant and antimicrobial activities, that naturally grows in Mediterranean coasts. This study aims to incorporate bioactive compounds extracted from lyophilized Crithmum maritimum to sunflower oil assisted by ultrasounds (UAE), to improve its biological value and oxidative stability. UAE conditions were optimized as a function of time (5-20 min) and lyophilized plant concentration (5-20% m/v). The experiments were dictated by a central composite rotatable matrix. Oxidation products were not influenced by UAE conditions. Acidity, chlorophyll, and carotenoid contents were affected by both factors, while total phenols, flavonoids, and antioxidant activity (FRAP method) only increased with plant concentration. Response surfaces were fitted to these experimental results. Flavonoids were highly related with oil antioxidant activity. No sensory defects were detected in supplemented oil (12.5% m/v plant/5 min UAE). The oxidative stability of this oil was evaluated at 60 °C/12 days. Chlorophylls, phenols, radical scavenging (DPPH), and antioxidant activities decreased over time but were always higher than the values in non-supplemented oil (8.6 and 7-fold with FRAP and DPPH, respectively). C. maritimum presented high amounts of bioactive compounds with antioxidant activity, adequate for sunflower oil supplementation by UAE.

Optimization of Ultrasound-Assisted Extraction of Bioactive Compounds from Pelvetia canaliculata to Sunflower Oil.

In this study, Pelvetia canaliculata L. macroalga, collected from the Atlantic Portuguese coast, was used as a source of bioactive compounds, mostly antioxidants, to incorporate them in sunflower oil with the aim of increasing its biological value and oxidative stability. The lyophilized alga was added to the oil, and ultrasound-assisted extraction (UAE) was performed. Algae concentration and UAE time varied following a central composite rotatable design (CCRD) to optimize extraction conditions. The following parameters were analyzed in the oils: oxidation products, acidity, color, chlorophyll pigments, carotenoids, flavonoids, total phenolic content, antioxidant activity by DPPH (2,2-diphenyl-1-picrylhydrazyl) and FRAP (ferric reducing antioxidant power) assays, and sensory analysis. Extraction conditions did not affect the acidity and the amount of oxidation products in the oil. Chlorophylls and carotenoid contents increased with algae concentration, while flavonoid extraction did not depend on algae content or UAE time. Total phenolics in the oil were highly related only to FRAP antioxidant activity. Storage experiments of supplemented oil (12.5% algae; 20 min UAE) were carried out under accelerated oxidation conditions at 60 °C/12 days. Antioxidant activity (FRAP) of supplemented oil was 6-fold higher than the value of non-supplemented oil. Final samples retained 40% of their initial antioxidant activity. The presence of algae extracts contributed to the increased oxidative stability of sunflower oil.

Enhancing oxidative stability of sunflower oil by supplementation with prickled broom (Pterospartum tridentatum) ethanolic extract.

This study aimed to evaluate the effect of ethanolic extract of Pterospartum tridentatum flowers in the stability of sunflower oil. The extract was characterized regarding to its antioxidant activity by the 2,2,1-diphenyl-1-picrylhydrazyl (DPPH) scavenging method (EC50 = 76.3 ± 2.6 µg/mL) and total phenolic content (200 ± 8 mg GAE/g). Extracts were added at 500 mg/L (E1) and 1,000 mg/L (E2), and after 30 days of storage at room temperature, E2 oil showed improved quality parameters, with a reduction of 22.4%, 17.2%, and 45.6% in the values of acidity, peroxide, and p-anisidine, respectively. The extract also increased oil stability at 180 °C. After 27 hr, the acidity (0.216 ± 0.016 mg KOH/g) and the total oxidation value (TOTOX) (69.30 ± 0.26) values of E2 oil were significantly lower than the control. These results showed that P. tridentatum effectively improved the shelf-life and thermal stability of sunflower oil, being a promising source of antioxidants for edible oils processing. PRACTICAL APPLICATION: Pterospartum tridentatum ethanolic extracts increased stability of sunflower oil during storage at room temperature and at 180 °C. Oil stability increased with extract concentration, being highest for 1,000 mg/L. Therefore, P. tridentatum may be a promising source of antioxidants for edible oils processing.

Multidrug-resistant Acinetobacter baumannii: differential adherence to HEp-2 and A-549 cells.

Acinetobacter baumannii has been associated with antimicrobial resistance and ability to form biofilms. Furthermore, its adherence to host cells is an important factor to the colonization process. Therefore, this study intended to identify some virulence factors that can explain the success of A. baumannii in causing nosocomial infections. We studied 92 A. baumannii isolates collected from hospitals in Rio de Janeiro, Brazil. Isolates were identified and the susceptibility to antimicrobials was determined. Oxacilinase type ß-lactamase encoding genes were amplified by polymerase chain reaction, and genetic diversity was investigated by pulsed-field gel electrophoresis (PFGE). In addition, biofilm formation on polystyrene plates using crystal violet staining was quantified, and adherence to human cell lines was evaluated. Eighty-six isolates were multidrug-resistant, of which 93% were carbapenem-resistant. All isolates had the blaOXA-51 gene and 94% had the blaOXA-23 gene, other searched blaOXA genes were not detected. PFGE typing showed two predominant clones, and biofilm production was observed in 79% of isolates. A. baumannii isolates adhered better to HEp-2 cell compared with A-549 cell. Clones A, B, E, and F showed a significantly increased adherence to HEp-2 compared with adherence to A-549 cell. Our findings revealed that A. baumannii isolates had high frequencies of resistance to antimicrobial agents, ability to form biofilm, and capacity to adhere to HEp-2 cells.

Quantum dots as nanolabels for breast cancer biomarker HER2-ECD analysis in human serum.

Early detection of cancer increases the possibility for an adequate and successful treatment of the disease. Therefore, in this work, a disposable electrochemical immunosensor for the front-line detection of the ExtraCellular Domain of the Human Epidermal growth factor Receptor 2 (HER2-ECD), a breast cancer biomarker, in a simple and efficient manner is presented. Bare screen-printed carbon electrodes were selected as the transducer onto which a sandwich immunoassay was developed. The affinity process was detected through the use of an electroactive label, core/shell CdSe@ZnS Quantum Dots, by differential pulse anodic stripping voltammetry in a total time assay of 2 h, with an actual hands-on time of less than 30 min. The proposed immunosensor responded linearly to HER2-ECD concentration within a wide range (10-150 ng/mL), showing acceptable precision and a limit of detection (2.1 ng/mL, corresponding to a detected amount (sample volume = 40 µL) of 1.18 fmol) which is about 7 times lower than the established cut-off value (15 ng/mL). The usefulness of the developed methodology was tested through the analysis of spiked human serum samples. The reliability of the presented biosensor for the selective screening of HER2-ECD was confirmed by analysing another breast cancer biomarker (CA15-3) and several human serum proteins.

Congenital bilateral dacryocystocele.

INTRODUCTION: Newborns are obligatory nasal breathers. Therefore, nasal obstruction can lead to cyanosis and desaturation. In spite of being very rare, congenital bilateral dacryocystocele is a possible etiology for neonatal respiratory distress. CASE SUMMARY: Case report of a male newborn with respiratory distress caused by a bilateral polypoid and bluish lesion occupying almost the entire inferior nasal meatus. Imaging confirmed bilateral dacryocystocele. Treatment was conservative. There was spontaneous drainage, with relief of respiratory distress. Discussion The diagnosis of congenital dacryocystocele is clinical, although imaging exams may be requested to confirm it. Treatment is controversial, because the natural history is variable. An initial conservative management may be recommended, but, if there is a permanent respiratory obstruction without improvement, surgical management is mandatory.

Predictive factors of recurrent endovascular intervention for cephalic arch stenosis after percutaneous transluminal angioplasty.

OBJECTIVE: Cephalic arch stenosis (CAS) is an important and recurring problem arising in hemodialysis patients because of the requirement for repeated interventions to maintain patency. The aim of this study was to determine predictive factors for recurrence of CAS after successful angioplasty. METHODS: A retrospective, case-control study was conducted at two ambulatory vascular access (VA) centers. All patients with a dysfunctional VA referred for an angiographic procedure and with a documented CAS as evidenced during the endovascular intervention (EI) between January 1, 2013, and December 31, 2015, were enrolled; 15 patients in whom an efficacious intervention was not possible were excluded. The study thus concerned 375 EIs using percutaneous transluminal angioplasty without stent placement on 241 VAs for CAS (9% of all procedures performed) during a 3-year period. Patients were compared regarding the absence (group 1; n = 181) or presence (group 2; n = 60) of recurrent CAS. We defined recurrence as that which occurred within 180 days of the previous successful EI for CAS. Any CAS diagnosed and treated >180 days after a previous one was considered a novel CAS and not a recurrence. Multivariate analysis was performed to determine variables independently associated with recurrence of CAS. Kaplan-Meier analysis was performed for determination of primary and assisted primary patency in this population. RESULTS: The recurrence rate of CAS was high (25%). Patients in both groups had similar demographic characteristics, time on hemodialysis, and mean dialysis dose and access flow rate at referral (P > .05). Multivariate analysis provided a significant discriminatory influence pertaining to diabetes (hazard ratio [HR], 2.054; 95% confidence interval [CI], 1.22-3.46; P = .007), residual stenosis even though it was <30% (HR, 1.86; 95% CI, 1.005-3.439; P = .048), and the finding of an isolated CAS lesion (HR, 0.445; 95% CI, 0.219-0.905; P = .025) in comparing group 1 and group 2. All other variables lost statistical significance on multivariate analysis. Primary patency at 6 months was 72%, increasing to an assisted primary patency of 89% at 6 months. The median durations of primary patency and assisted primary patency were 9.5 months and 15.6 months, respectively. CONCLUSIONS: Multivariate analysis showed that diabetes and residual stenosis (albeit <30%) were predictive of recurrence, whereas the finding of an isolated CAS lesion as opposed to stenoses in multiple locations was shown to be negatively associated with recurrent CAS, appearing to be "protective".

Acute kidney injury in major abdominal surgery: incidence, risk factors, pathogenesis and outcomes.

Acute kidney injury (AKI) is a common complication in patients undergoing major abdominal surgery. Various recent studies using modern standardized classifications for AKI reported a variable incidence of AKI after major abdominal surgery ranging from 3 to 35%. Several patient-related, procedure-related factors and postoperative complications were identified as risk factors for AKI in this setting. AKI following major abdominal surgery has been shown to be associated with poor short- and long-term outcomes. Herein, we provide a contemporary and critical review of AKI after major abdominal surgery focusing on its incidence, risk factors, pathogeny and outcomes.

Diabetes, deafness and renal disease.

Deafness, kidney disease and diabetes are not a usual association, neither is a family history of these diseases. We present the case of a 47-year-old woman with non-nephrotic proteinuria, no haematuria, normal renal function, sensorineural hearing loss, recently diagnosed diabetes and maculopathy. There was a maternal family history of deafness, diabetes and renal disease. Renal biopsy revealed focal and segmental glomerulosclerosis (FSGS), leading to the pursuit of an m.3243A > G mitochondrial mutation and diagnosis of maternally inherited diabetes and deafness. The association of FSGS with mitochondrial diseases is not well known among nephrologists. Its timely diagnosis is important to avoid exposure to ineffective and unnecessary immunosuppression.

Severe acute kidney injury and multiple myeloma: evaluation of kidney and patient prognostic factors.

BACKGROUND: Patients with multiple myeloma (MM) manifesting acute kidney injury (AKI) and who later recover renal function and independence from renal replacement therapy (RRT) are considered to have a better outcome. The aim of this work was to study the factors associated with renal function recovery (independence of hemodialysis) and longer survival in these patients. METHODS: A retrospective single center study including patients with a diagnosis of MM and severe AKI, defined as stage 3 of the Kidney Disease: Improving Global Outcomes (KDIGO) criteria: 3.0 times baseline increase in serum creatinine (sCr) or increase in sCr to ≥4.0mg/dL or initiation of RRT, was conducted. Data was registry-based and collected between January 2000 and December 2011. We examined demographic and laboratorial data, presenting clinical features, precipitating factors, need for RRT and chemotherapy. Death was considered the primary endpoint. RESULTS: Lower serum ß2-microglobulin was the only independent factor associated with recovery of renal function and independence of RRT (OR 0.95, 95% CI: 0.91-0.99, P=0.02). The median survival after AKI was 10.7±12.1months. The factors associated with longer survival were independence of RRT (HR 2.21; 95% CI: 1.08-4.49; P=0.02), lower CRP (HR 1.07; 95% CI: 1.03-1.12; P=0.001) and younger age (HR 1.03; 95% CI: 1.01-1.06; P=0.005). CONCLUSIONS: Our study suggests that MM patients with lower serum ß2-microglobulin have a higher likelihood of recovering renal function after severe AKI. Independence of RRT, lower CRP and younger age are associated with longer survival.

Evaluation of 2',4'-dihydroxy-3,4,5-trimethoxychalcone as antimitotic agent that induces mitotic catastrophe in MCF-7 breast cancer cells.

We previously reported the synthesis and the anti-proliferative action of 2',4'-dihydroxy-3,4,5-trimethoxychalcone. Here we reported its mechanism of action on MCF-7 cells. The compound induced aberrant spindles, and arrested cells at metaphase/anaphase boundary with accumulation of checkpoint proteins Mad2, Bub1 and BubR1. Live cell imaging revealed that the compound sustained a prolonged mitotic arrest, followed by massive cell death. The results indicate that 2',4'-dihydroxy-3,4,5-trimethoxychalcone exerts its anti-proliferative activity by affecting microtubules and causing mitotic catastrophe, and thus has the potential for antitumor activity.

Potential small-molecule activators of caspase-7 identified using yeast-based caspase-3 and -7 screening assays.

Caspases-3 and -7 are at the core of the execution phase of apoptosis. The search for activators of these proteases has therefore deserved particular attention in the field of anticancer drug discovery. Here, a simplified yeast-based screening approach was developed and used to search for activators of caspases-3 and -7, followed by evaluation of the activity of the selected compounds in the human tumor cell lines HL-60 (acute promyelocytic leukemia) and MCF-7 (breast adenocarcinoma). By using the yeast approach, two potential activators of caspase-7, 5,6-dihydroxy-7-prenyloxyflavone (1a) and 3-hydroxy-7-geranyloxyflavone (2a), were identified. Unlike the known caspases-3 and -7 activator, the procaspase activating compound-1 (PAC-1), these flavonoids did not interfere with the caspase-3 activity in yeast. Moreover, flavonoids 1a and 2a processed procaspase-7 to the active caspase-7 both in yeast and in vitro processing assays, and inhibited the growth of HL-60 and MCF-7 human tumor cells with higher potencies than PAC-1, particularly in the absence of caspase-3 (MCF-7 cells). In MCF-7 cells, the flavonoids processed procaspase-7, increased its activity and sensitized these cells to the effects of the cytotoxic drug, etoposide. In conclusion, the developed yeast target-based screening assays led to the identification of potential caspase-7 activators. A proof of concept is therefore provided for the effectiveness of the yeast assays in the discovery of caspase activators. Additionally, the identified compounds may pave the way for a new class of caspase activators with improved anticancer properties.

Clinical challenges of an oligosecretory plasma cell dyscrasia.

Light chain deposition disease (LCDD) and immunoglobulin light chain (AL) amyloidosis are uncommon, and heterogeneous clonal plasma cell (PC) proliferative disorders defined by the different biochemical characteristics of the underlying anomalous immunoglobulin. The deposits are usually multisystemic and the two diseases can coexist. The diagnosis is sometimes made difficult by the absence of a detectable paraprotein by routine immunofixation techniques, and the use of serum-free light chain (FLC) immunoassay brought new value in terms of their diagnosis, prognosis and assessment of treatment response. Association of LCDD and AL amyloidosis with multiple myeloma (MM) at the time of diagnosis is common, but further progression to this condition is considered rare. We present a case of a patient diagnosed with systemic LCDD and AL amyloidosis of atypical biochemical characteristics, with no paraprotein detected in immunoelectrophoresis and immunofixation techniques, who progressed to MM in the later course of her disease.

Avaliação da contaminação microbiana em produtos desinfetantes de uso geral / Microbial contamination in household disinfectant products

Em vista de um estudo desenvolvido no Setor de Saneantes do Instituto Nacional de Controle deQualidade em Saúde da Fundação Oswaldo Cruz, referente à avaliação da atividade antimicrobiana dedesinfetantes, no presente trabalho foram analisados produtos desinfetantes de uso geral disponíveis nomercado brasileiro. Os desinfetantes foram coletados aleatoriamente, dos quais três (produtos A, B e C),apresentaram contaminação microbiana. Para efetuar o isolamento e a identificação dos microrganismoscontaminantes foram utilizados o aparelho Vitek® 2, a amplificação e o sequenciamento do gene rRNA16S. A análise realizada por meio de Vitek® 2 revelou a presença das bactérias Serratia marcescens eAchromobacter xylosoxidans, respectivamente, nos produtos A e B. No produto C foram detectadasAeromonas salmonicida pelo Vitek® 2 e Burkholderia lata pela técnica de amplificação da reação em cadeiada polimerase.

Synthesis of a natural chalcone and its prenyl analogs--evaluation of tumor cell growth-inhibitory activities, and effects on cell cycle and apoptosis.

Six prenyl (=3-methylbut-2-en-1-yl) chalcones (=1,3-diphenylprop-2-en-1-ones), 2-7, and one natural non-prenylated chalcone, 1, have been synthesized and evaluated for their in vitro growth-inhibitory activity against three human tumor cell lines. A pronounced dose-dependent growth-inhibitory effect was observed for all prenylated derivatives, except for 7. The chalcone possessing one prenyloxy group at C(2'), i.e., 2, was the most active derivative against the three human tumor cell lines (5.9