The suppressive effect on CD4 T cell alloresponse against endothelial HLA-DR via PD-L1 induced by anti-A/B ligation.

While donor-specific human leukocyte antigen (HLA) antibodies are a frequent cause for chronic antibody-mediated rejection in organ transplantation, this is not the case for antibodies targeting blood group antigens, as ABO-incompatible (ABO-I) organ transplantation has been associated with a favorable graft outcome. Here, we explored the role of CD4 T cell-mediated alloresponses against endothelial HLA-D-related (DR) in the presence of anti-HLA class I or anti-A/B antibodies. CD4 T cells, notably CD45RA-memory CD4 T cells, undergo extensive proliferation in response to endothelial HLA-DR. The CD4 T cell proliferative response was enhanced in the presence of anti-HLA class I, but attenuated in the presence of anti-A/B antibodies. Microarray analysis and molecular profiling demonstrated that the expression of CD274 programmed cell death ligand 1 (PD-L1) increased in response to anti-A/B ligation-mediated extracellular signal-regulated kinase (ERK) inactivation in endothelial cells that were detected even in the presence of interferon-γ stimulation. Anti-PD-1 antibody enhanced CD4 T cell proliferation, and blocked the suppressive effect of the anti-A/B antibodies. Educated CD25+ CD127- regulatory T cells (edu.Tregs ) were more effective at preventing CD4 T cell alloresponses to endothelial cells compared with naive Treg ; anti-A/B antibodies were not involved in the Treg -mediated events. Finally, amplified expression of transcript encoding PD-L1 was observed in biopsy samples from ABO-I renal transplants when compared with those from ABO-identical/compatible transplants. Taken together, our findings identified a possible factor that might prevent graft rejection and thus contribute to a favorable outcome in ABO-I renal transplantation.

Accuracy of mandible-independent maxillary repositioning using pre-bent locking plates: a pilot study.

The double splint method is considered the gold standard for maxillary repositioning, but the procedure is lengthy and prone to error. Recent splintless methods have shown high repositioning accuracy; however, high costs and technical demands make them inaccessible to many patients. Therefore, a new cost-effective method of mandible-independent maxillary repositioning using pre-bent locking plates is proposed. Plates are bent on maxillary models in the planned position prior to surgery. The locations of the plate holes are replicated during surgery using osteotomy guides made from thermoplastic resin sheets. Pre-bent plates are subsequently fitted onto the maxilla, and plate holes are properly set to reposition the maxilla. The purpose of this study was to evaluate the accuracy of this method for maxillary repositioning and the reproducibility of the plate holes. Fifteen orthognathic surgery patients were evaluated retrospectively by superimposing preoperative simulations over their postoperative computed tomography models. The median deviations in maxillary repositioning and plate hole positioning between the preoperative plan and postoperative results were 0.43mm (range 0-1.55mm) and 0.33mm (range 0-1.86mm), respectively. There was no significant correlation between these deviations, suggesting that the method presented here allows highly accurate and reliable mandible-independent maxillary repositioning.

Reservoir longitudinal gradient promotes ordered losses on diversity and density of Ephemeroptera community / O gradiente longitudinal de um reservatório promove perdas ordenadas na diversidade e densidade da comunidade de Ephemeroptera

Abstract Reservoir operations alter, eliminate or restrain the natural hydrologic cycles. Biotic community has become subject to these non-cyclic events, responding by reducing the species diversity. Ephemeroptera species present distinct responses to environmental deterioration such that poses this assemblage between the most useful groups in biomonitoring programs. We hypothesized an alteration in beta diversity at the longitudinal species gradient, which will be influenced mainly by species losses between zones. Changes in temporal beta diversity is also expected, but the main drivers of such alterations will be the species turnover between the sampling period. Ephemeroptera community was monitored in nine sampling points from Itaipu Reservoir, where were installed three sets of substrates composed by a float and 2 wooden substrates. We took biological samples in triplicates monthly, from June-01 to August-02. Our initial hypothesis was partially supported and with significant variations only for spatial approach, between the Reservoir zones. The generated ordering from Non-Metric Dimensional Scale - NMDS - corroborated with spatial analyzes, with the formation of two groups along the gradient zonation of the reservoir. The temporal ordination showed no clear pattern. As expected, the contribution to beta diversity was different for our two approaches, such that the loss of species was more important along the spatial gradient and despite of no significant result, the species replacement was more important among months. The spatial results lead us to infer that differences in limnological characteristics between zones are important for determining differences in Ephemeroptera composition and can reflect the dependency degree of the species in relation to the lentic and sometimes-lotic conditions, mainly in the riverine zone of reservoirs. On the other hand, the absence of a temporal pattern can be result of chaotic variations in the physical and chemical attributes imposed by the reservoir operation, disrupting continuity of the biota and natural succession processes.

Resumo As operações de reservatórios alteram, eliminam ou restringem os ciclos hidrológicos naturais. A comunidade biótica torna-se sujeita a estes eventos não-cíclicos, respondendo com a redução da diversidade de espécies. As espécies de Ephemeroptera apresentam respostas distintas à deterioração ambiental, sendo o grupo muitousado em programas de biomonitoramento. Nós hipotetizamos uma alteração na diversidade beta das espécies no gradiente longitudinal, influenciada principalmente pelo componente aninhamento com a consequente perda de espécies entre as zonas do reservatório. Também são esperadas mudanças na diversidade beta entre os meses de amostragem, mas o principal fator dessas alterações será a substituição das espécies entre os períodos, em função dos rápidos ciclos de vida que o grupo apresenta. A comunidade Ephemeroptera foi monitorada em nove pontos amostrais do reservatório de Itaipu, onde foram instalados três conjuntos de substratos compostos por um flutuador e 2 substratos de madeira. Tomamos amostras biológicas em triplicatas mensalmente, de junho de 2001 a agosto de 2002. Nossa hipótese inicial foi parcialmente suportada, com variações significativas apenas na escala espacial. A ordenação gerada pelo Escalonamento Dimensional Não-Métrico - NMDS - corroborou com as análises espaciais, com a formação de dois grupos ao longo do gradiente de zonação do reservatório. A ordenação temporal não mostrou um padrão claro. Como esperado, a contribuição para a diversidade beta foi diferente para nossas duas abordagens, de modo que a perda de espécies foi mais importante ao longo do gradiente espacial e apesar de não haver resultado significativo, a substituição das espécies foi mais importante entre os meses de amostragem. Os resultados espaciais levam-nos a inferir que as diferenças nas características limnológicas entre as zonas são importantes para determinar as diferenças na composição de Ephemeroptera e podem refletir o grau de dependência das espécies em relação às condições lênticas e às vezes lóticas, principalmente na zona fluvial dos reservatórios. Por outro lado, a ausência de um padrão temporal pode ser resultado de variações caóticas nos atributos físicos e químicos impostos pela operação do reservatório, que interrompem a continuidade da biota e os processos de sucessão naturais.

Effects of food availability and habitat features on the Ephemeroptera species composition at seasonal and spatial scales from neotropical floodplain rivers / Efeitos da disponibilidade de alimento e características do habitat sobre a composição de espécies de Ephemeroptera nas escalas sazonal e espacial de rios de planície neotropicais

Abstract Brazilian floodplains have suffered great changes in their natural characteristics in recent decades, mainly in the flood pulse. The Upper Paraná River floodplain is one of the few places where are found remained areas in which such peculiar characteristics keep reflecting on its high biodiversity. Ephemeroptera nymphs are one of the higher density groups among benthic community, occurring in many water bodies like large rivers and secondary channels. We sought to understand which factors are needed for the species establishment and how much important is the species colonization, especially in environments with anthropogenic changes. The marginal areas, which are more structured with presence of macrophytes, showed the highest density and richness even in the Paraná River that has great human impact. We verified dominance of Americabaetis alphus, Tricorythopsis araponga, Tricorythopsis artigas on the Parana River, correlated with transparency, depth and electric conductivity, while the dominance of Traverella sp. was correlated with water temperature, especially in marginal areas. Consequently, the increasing transparency and electric conductivity due to the Porto Primavera dam in Parana River can be favoring those Ephemeroptera species. We demonstrated the importance of preserving the wetlands of Ivinhema River State Park mainly for Guajirolus sp., which was only registered in this region. Therefore, our study provides support for understanding gaps from previously studies using artificial substrates in three large rivers which are of great importance to the upper Paraná River floodplain.

Resumo Muitas planícies de inundação brasileiras vêm sofrendo enormes alterações em suas características naturais nas últimas décadas, principalmente no pulso de inundação. A planície de inundação do alto rio Paraná é um dos poucos lugares onde ainda há áreas nas quais essas características peculiares se mantêm, o que reflete em sua alta biodiversidade. Dentre a comunidade zoobentônica, Ephemeroptera é um dos grupos com maior densidade, ocorrendo em diversos corpos aquáticos como rios de grande porte e canais secundários. Nós buscamos compreender quais fatores são necessários para o estabelecimento das espécies e o quão importante é a colonização dessas espécies, principalmente em ambientes com modificações antrópicas. As áreas marginais mais estruturadas com presença de macrófitas apresentaram altas densidade e riqueza mesmo no rio Paraná que apresenta grande impacto antrópico. Verificamos que as dominâncias de Americabaetis alphus, Tricorythopsis araponga e Tricorythopsis artigas no rio Paraná foram correlacionadas com maiores valores de transparência, profundidade e condutividade, enquanto que a dominância de Traverella sp. foi correlacionada com temperatura, principalmente em áreas marginais. Consequentemente, o aumento da transparência e da condutividade devido à barragem de Porto Primavera no rio Paraná pode estar favorecendo essas espécies de Ephemeroptera. Nossos resultados demonstram a importância da preservação do Parque nacional das várzeas do rio Ivinhema, principalmente para o gênero Guajirolus sp., o qual apenas foi registrado nessa região. Portanto, nosso estudo vem trazer subsídios para compreensão de lacunas verificadas em estudos anteriores utilizando substratos artificiais em três rios de enorme influência na planície de inundação do alto rio Paraná.

Efficacy of Eculizumab Therapy for Atypical Hemolytic Uremic Syndrome Recurrence and Antibody-Mediated Rejection Progress After Renal Transplantation With Preformed Donor-Specific Antibodies: Case Report.

Atypical hemolytic uremic syndrome (aHUS) develops as the result of unregulated complement progression and precipitates de novo thrombotic microangiopathy. Plasma therapy is used to control the progression of the complement cascade, but that therapy is not effective in all patients and is accompanied by risk of infection and/or allergy. Eculizumab has been reported as an efficient therapy for aHUS. We report the case of a 35-year old woman who underwent effective eculizumab therapy for aHUS recurrence and antibody-mediated rejection (AMR) progress after renal transplantation with preformed donor-specific antibodies (DSA). She developed end-stage renal disease due to suspicious IgA nephropathy at age 33 years. Kidney transplantation was performed at age 35 years, and aHUS recurred 2 weeks later, leading to the progressive hemolytic anemia and renal dysfunction. Therefore, she underwent plasma therapy several times. Because it was difficult to continue to plasma therapy for severe allergy, eculizumab was proposed as an alternate therapy. Treatment with eculizumab was initiated 36 days after renal transplantation. After 3 years of eculizumab treatment, and without plasma therapy, schistocytes decreased, haptoglobin increased to within normal limits, creatinine levels stabilized, and no further episodes of diarrhea were reported. At protocol biopsy 1 year after transplantation, she was diagnosed with C4d-negative subclinical AMR. However, her pathologic findings at follow-up biopsy 3 years after transplantation were recovered. We conclude that eculizumab alone, without plasma therapy, is sufficient to treat recurrence of aHUS and AMR due to DSA after renal transplantation and to maintain long-term graft function.

Effects of food availability and habitat features on the Ephemeroptera species composition at seasonal and spatial scales from neotropical floodplain rivers

Abstract Brazilian floodplains have suffered great changes in their natural characteristics in recent decades, mainly in the flood pulse. The Upper Paraná River floodplain is one of the few places where are found remained areas in which such peculiar characteristics keep reflecting on its high biodiversity. Ephemeroptera nymphs are one of the higher density groups among benthic community, occurring in many water bodies like large rivers and secondary channels. We sought to understand which factors are needed for the species establishment and how much important is the species colonization, especially in environments with anthropogenic changes. The marginal areas, which are more structured with presence of macrophytes, showed the highest density and richness even in the Paraná River that has great human impact. We verified dominance of Americabaetis alphus, Tricorythopsis araponga, Tricorythopsis artigas on the Parana River, correlated with transparency, depth and electric conductivity, while the dominance of Traverella sp. was correlated with water temperature, especially in marginal areas. Consequently, the increasing transparency and electric conductivity due to the Porto Primavera dam in Parana River can be favoring those Ephemeroptera species. We demonstrated the importance of preserving the wetlands of Ivinhema River State Park mainly for Guajirolus sp., which was only registered in this region. Therefore, our study provides support for understanding gaps from previously studies using artificial substrates in three large rivers which are of great importance to the upper Paraná River floodplain.

Resumo Muitas planícies de inundação brasileiras vêm sofrendo enormes alterações em suas características naturais nas últimas décadas, principalmente no pulso de inundação. A planície de inundação do alto rio Paraná é um dos poucos lugares onde ainda há áreas nas quais essas características peculiares se mantêm, o que reflete em sua alta biodiversidade. Dentre a comunidade zoobentônica, Ephemeroptera é um dos grupos com maior densidade, ocorrendo em diversos corpos aquáticos como rios de grande porte e canais secundários. Nós buscamos compreender quais fatores são necessários para o estabelecimento das espécies e o quão importante é a colonização dessas espécies, principalmente em ambientes com modificações antrópicas. As áreas marginais mais estruturadas com presença de macrófitas apresentaram altas densidade e riqueza mesmo no rio Paraná que apresenta grande impacto antrópico. Verificamos que as dominâncias de Americabaetis alphus, Tricorythopsis araponga e Tricorythopsis artigas no rio Paraná foram correlacionadas com maiores valores de transparência, profundidade e condutividade, enquanto que a dominância de Traverella sp. foi correlacionada com temperatura, principalmente em áreas marginais. Consequentemente, o aumento da transparência e da condutividade devido à barragem de Porto Primavera no rio Paraná pode estar favorecendo essas espécies de Ephemeroptera. Nossos resultados demonstram a importância da preservação do Parque nacional das várzeas do rio Ivinhema, principalmente para o gênero Guajirolus sp., o qual apenas foi registrado nessa região. Portanto, nosso estudo vem trazer subsídios para compreensão de lacunas verificadas em estudos anteriores utilizando substratos artificiais em três rios de enorme influência na planície de inundação do alto rio Paraná.

Reservoir longitudinal gradient promotes ordered losses on diversity and density of Ephemeroptera community

Abstract Reservoir operations alter, eliminate or restrain the natural hydrologic cycles. Biotic community has become subject to these non-cyclic events, responding by reducing the species diversity. Ephemeroptera species present distinct responses to environmental deterioration such that poses this assemblage between the most useful groups in biomonitoring programs. We hypothesized an alteration in beta diversity at the longitudinal species gradient, which will be influenced mainly by species losses between zones. Changes in temporal beta diversity is also expected, but the main drivers of such alterations will be the species turnover between the sampling period. Ephemeroptera community was monitored in nine sampling points from Itaipu Reservoir, where were installed three sets of substrates composed by a float and 2 wooden substrates. We took biological samples in triplicates monthly, from June-01 to August-02. Our initial hypothesis was partially supported and with significant variations only for spatial approach, between the Reservoir zones. The generated ordering from Non-Metric Dimensional Scale NMDS - corroborated with spatial analyzes, with the formation of two groups along the gradient zonation of the reservoir. The temporal ordination showed no clear pattern. As expected, the contribution to beta diversity was different for our two approaches, such that the loss of species was more important along the spatial gradient and despite of no significant result, the species replacement was more important among months. The spatial results lead us to infer that differences in limnological characteristics between zones are important for determining differences in Ephemeroptera composition and can reflect the dependency degree of the species in relation to the lentic and sometimes-lotic conditions, mainly in the riverine zone of reservoirs. On the other hand, the absence of a temporal pattern can be result of chaotic variations in the physical and chemical attributes imposed by the reservoir operation, disrupting continuity of the biota and natural succession processes.

Resumo As operações de reservatórios alteram, eliminam ou restringem os ciclos hidrológicos naturais. A comunidade biótica torna-se sujeita a estes eventos não-cíclicos, respondendo com a redução da diversidade de espécies. As espécies de Ephemeroptera apresentam respostas distintas à deterioração ambiental, sendo o grupo muitousado em programas de biomonitoramento. Nós hipotetizamos uma alteração na diversidade beta das espécies no gradiente longitudinal, influenciada principalmente pelo componente aninhamento com a consequente perda de espécies entre as zonas do reservatório. Também são esperadas mudanças na diversidade beta entre os meses de amostragem, mas o principal fator dessas alterações será a substituição das espécies entre os períodos, em função dos rápidos ciclos de vida que o grupo apresenta. A comunidade Ephemeroptera foi monitorada em nove pontos amostrais do reservatório de Itaipu, onde foram instalados três conjuntos de substratos compostos por um flutuador e 2 substratos de madeira. Tomamos amostras biológicas em triplicatas mensalmente, de junho de 2001 a agosto de 2002. Nossa hipótese inicial foi parcialmente suportada, com variações significativas apenas na escala espacial. A ordenação gerada pelo Escalonamento Dimensional Não-Métrico NMDS - corroborou com as análises espaciais, com a formação de dois grupos ao longo do gradiente de zonação do reservatório. A ordenação temporal não mostrou um padrão claro. Como esperado, a contribuição para a diversidade beta foi diferente para nossas duas abordagens, de modo que a perda de espécies foi mais importante ao longo do gradiente espacial e apesar de não haver resultado significativo, a substituição das espécies foi mais importante entre os meses de amostragem. Os resultados espaciais levam-nos a inferir que as diferenças nas características limnológicas entre as zonas são importantes para determinar as diferenças na composição de Ephemeroptera e podem refletir o grau de dependência das espécies em relação às condições lênticas e às vezes lóticas, principalmente na zona fluvial dos reservatórios. Por outro lado, a ausência de um padrão temporal pode ser resultado de variações caóticas nos atributos físicos e químicos impostos pela operação do reservatório, que interrompem a continuidade da biota e os processos de sucessão naturais.

Pulmonary thromboembolism as a result of ovarian vein thrombosis after laparoscopic-assisted vaginal hysterectomy for uterine myoma.

Pulmonary thromboembolism is a potentially life-threatening disorder, which can occur secondary to deep vein thrombosis. Ovarian vein thrombosis has classically been considered to be a postpartum complication and is less frequently associated with other disease processes, such as recent pelvic surgery. Herein, we report a case of pulmonary thromboembolism as a result of ovarian vein thrombosis in a 39-year-old woman after an uneventful laparoscopic-assisted vaginal hysterectomy for uterine myoma. On postoperative day 3, the patient experienced fever of unknown origin, followed by lower abdominal pain, chest discomfort and shortness of breath. A hematological examination revealed an elevated D-dimer level. Computerized tomography revealed pulmonary thromboembolism caused by left ovarian vein thrombosis. The administration of anticoagulants resolved the symptoms. In order to avoid significant morbidities and potential mortality, attention should be paid to the possibility of pulmonary thromboembolism resulting from ovarian vein thrombosis, even after minimally invasive gynecologic surgery for benign conditions.

Chironomidae feeding habits in different habitats from a Neotropical floodplain: exploring patterns in aquatic food webs / Hábitos alimentares de Chironomidae em diferentes habitats de uma planície de inundação Neotropical: explorando padrões em redes alimentares aquáticas

Abstract Ecological studies on food webs have considerably increased in recent decades, especially in aquatic communities. Because Chironomidae family are highly specious, occurring in almost all aquatic habitats is considered organisms-key to initiate studies on ecological relationships and trophic webs. We tested the hypothesis that the diversity of the morphospecies diet reflects differences on both the food items available among habitats and the preferences of larval feeding. We analyzed the gut content of the seven most abundant Chironomidae morphospecies of the different habitats from the Upper Paraná River. We categorized the food items found into algae, fungal spores, fragments of plants, algae and animal fragments and sponge spicules. We observed the algae predominance in the gut content of morphospecies from lakes. Considering the different regions from each lake, we registered the highest food abundance in the littoral regions in relation to the central regions. From the variety of feeding habits (number of item kinds), we classified Chironomus strenzkei, Tanytarsus sp.1, Procladius sp.1 as generalist morphospecies. We found a nested pattern between food items and Chironomidae morphospecies, where some items were common to all taxa (e.g., Bacillariophyceae algae, especially), while others were found in specific morphospecies (e.g., animals fragments found in Procladius sp.1). The algae represented the most percentage of gut contents of Chironomidae larvae. This was especially true for the individuals from littoral regions, which is probably due to the major densities of algae associated to macrophytes, which are abundant in these regions. Therefore, the feeding behavior of these morphospecies was generalist and not selective, depending only of the available resources.

Resumo Estudos sobre redes alimentares têm aumentado consideravelmente nas últimas décadas em pesquisas de ecologia, principalmente em comunidades aquáticas. Em função Família Chironomidae ser altamente especiosa, ocorrendo em quase todos os hábitats aquáticos, é considerada como organismos-chave para estudos preliminares sobre as relações ecológicas como redes tróficas. Nós testamos a hipótese de que a diversidade de dietas das morfoespécies reflete diferenças tanto na disponibilidade dos itens alimentares entre os hábitats analisados, quanto preferencias alimentares das larvas. Nós analisamos o conteúdo digestivo das sete morfoespécies mais abundantes de diferentes habitats da planície de inundação do alto rio Paraná. Nós categorizamos os itens alimentares encontrados como algas, esporos de fungos, fragmentos vegetais, fragmentos de algas ou de animais e espículas de esponjas. Nós observamos a predominância de algas no conteúdo digestivo das morfoespécies lacustres. Considerando as diferentes regiões de cada lagoa, nós registramos as maiores abundâncias de alimentos nas regiões litorâneas, quando comparadas com as regiões centrais. A partir da variedade de hábitos alimentares (número de tipos de itens), classificamos Chironomus strenzkei, Tanytarsus sp.1 e Procladius sp.1 como morfoespécies generalistas. Nós encontramos um padrão aninhado entre os itens alimentares e as morfoespécies de Chironomidae, onde alguns itens foram comuns a todos os táxons (por exemplo, algas da Classe Bacillariophyceae), enquanto outros foram encontrados em morfoespécies mais especificas (por exemplo, fragmentos de animais encontrados em Procladius sp.1). As algas representaram a maior porcentagem do conteúdo digestivo das larvas de Chironomidae. Este fato foi especialmente verdadeiro para os indivíduos das regiões litorâneas, o qual é devido, provavelmente, pelas maiores densidades de algas associadas à macrófitas, que são abundantes nessas regiões. Portanto, o comportamento alimentar dessas morfoespécies foi generalista e não seletivo, dependendo apenas dos recursos disponíveis.

Limnoperna fortunei Dunker, 1857 larvae in different environments of a Neotropical floodplain: relationships of abiotic variables and phytoplankton with different stages of development / Larvas de Limnoperna fortunei Dunker, 1857 em diferentes ambientes de uma planície de inundação Neotropical: relação com variáveis abióticas e algas fitoplanctônicas em diferentes estágios de desenvolvimento

Abstract Limnoperna fortunei Dunker, 1857 is an Asian invasive freshwater bivalve. Although there need to contain their spread, studies about the biology of the larvae are scarce. We correlated the larval stages of L. fortunei with biotic factors such as phytoplankton and main abiotic variables in lotic environments of the Upper Paraná River floodplain. The four samples were taken quarterly during the year 2012. The Principal component analysis (PCA) showed only spatial differences, as did a Canonical Correspondence Analysis (CCA). High densities of larvae were recorded in all samples the Paraná River and Baía River only in December, especially those in their initial stage. In the biovolume of Class of algae, Bacillarophyceae showed the highest value, but Chlorophycea who was strongly correlated with the density of D-stage larvae. The large variety of phytoplankton, especially microplankton Chlorophyceae, high values of PO4, NH4 and temperature were positively correlated with high densities of D-stage larvae. We conclude that high temperature, and food availability, indicated by phytoplankton community, favored the reproduction of L. fortunei and enhance the ability of specie dispersion due to the increase in the emission of propagules. Therefore, studies that address the biology of golden mussel larvae should be performed in order to prevent its spread.

Resumo Limnoperna fortunei Dunker, 1857 é um bivalve asiático dulcícola invasor. Embora haja necessidade de conter sua dispersão, estudos que abordam a biologia de suas larvas ainda são escassos. Analisou-se as fases larvais de L. fortunei relacionando-as a fatores bióticos como a comunidade fitoplânctônica e às principais variáveis abióticas, em ambientes lóticos da planície de inundação do alto do rio Paraná. As quatro coletas foram trimestrais durante o ano de 2012. A análise de componentes principais (PCA) demonstrou apenas diferenças espaciais, assim como a Análise de Correspondência Canônica (CCA). Altas densidades de larvas foram registradas em todas as coletas no rio Paraná e no rio Baía apenas no mês de dezembro, principalmente para as larvas em estádio inicial. No biovolume das classes de algas, Bacillarophyceae obteve o maior valor, porém Chlorophycea foi a que fortemente correlacionou-se com a densidade de larvas D. A grande variedade de fitoplâncton, em especial de Chlorophyceae microplanctônica, altos valores de PO4, NH4 e temperatura estiveram positivamente correlacionadas com altas densidades de larvas D. Conclui-se que, altas temperaturas, e disponibilidade de alimento, como a comunidade fitoplanctônica, favorecem a reprodução de L. fortunei e aumentam a capacidade de dispersão da espécie devido ao incremento na emissão de propágulos. Portanto, estudos que abordem a biologia das larvas de mexilhão-dourado devem ser realizados a fim de evitar sua propagação.

Influence of antifouling paint on freshwater invertebrates (Mytilidae, Chironomidae and Naididae): density, richness and composition / Influência de revestimentos antiincrustantes em invertebrados aquáticos (Mytilidae, Chironomidae and Naididae): densidade, riqueza e composição

Abstract We conducted a study about invertebrates on artificial substrates with different antifouling paints in order to answer the following questions 1) is there lower accumulation of organic matter on substrates with antifouling paints, 2) is invertebrate colonization influenced by the release of biocides from antifouling paints, 3) is the colonization of aquatic invertebrates positively influenced by the material accumulated upon the substrate surface and 4) is the assemblage composition of invertebrates similar among the different antifouling paints? To answer these questions, four structures were installed in the Baía River in February 1st, 2007. Each structure was composed of 7 wood boards: 5 boards painted with each type of antifouling paints (T1, T2, T3, T4 and T5), one painted only with the primer (Pr) and the other without any paint (Cn). After 365 days, we observed a greater accumulation of organic matter in the substrates with T2 and T3 paint coatings. Limnoperna fortunei was recorded in all tested paints, with higher densities in the control, primer, T2 and T3. The colonization of Chironomidae and Naididae on the substrate was positively influenced by L. fortunei density. The non-metric multidimensional scaling (NMDS) of the invertebrate community provided evidence of the clear distinction of invertebrate assemblages among the paints. Paints T2 and T3 were the most similar to the control and primer. Our results suggest that antifouling paints applied on substrates hinder invertebrate colonization by decreasing the density and richness of invertebrates.

Resumo O estudo dos invertebrados em substrato artificial com diferentes revestimentos antiincrustantes foi realizado com o intuito de responder as seguintes questões 1) Há menor acumulação de material orgânico nos substratos com revestimentos antiincrustantes? 2) A colonização de invertebrados é afetada pela liberação de biocidas dos revestimentos antiincrustantes? 3) A colonização dos invertebrados aquáticos é facilitada por material acumulado sobre a superfície do substrato? 4) A composição da assembléia é similar entre os diferentes revestimentos? Para realização deste estudo, quatro estruturas foram instaladas em 01 de fevereiro de 2007 no rio Baía. Em cada estrutura foram colocadas sete placas de madeira: cinco placas com aplicação de um tipo de revestimentos antiincrustantes (T1, T2, T3, T4 e T5), uma placa apenas com a aplicação do primer (Pr) e a outra placa permaneceu sem aplicação de nenhum revestimento (Cn). Ao final dos 365 dias em que os substratos ficaram submersos observou-se maior acumulação de material orgânico nos substratos dos revestimentos T2 e T3. Limnoperna fortunei foi registrada em todos os revestimentos testados, com maiores densidades encontradas no controle, primer, T2 e T3. A colonização de Chironomidae e Naididae sobre os substratos foi influenciada pela densidade de L. fortunei. A ordenação (NMDS) evidenciou a separação da assembléia de invertebrados entre os revestimentos. Os revestimentos T2 e T3 foram os mais similares ao controle e ao primer. Os resultados obtidos sugerem que revestimentos antiicrustantes aplicados sobre substratos dificultam a colonização de invertebrados, reduzindo a densidade e riqueza de invertebrados.

Influence of antifouling paint on freshwater invertebrates (Mytilidae, Chironomidae and Naididae): density, richness and composition

Abstract We conducted a study about invertebrates on artificial substrates with different antifouling paints in order to answer the following questions 1) is there lower accumulation of organic matter on substrates with antifouling paints, 2) is invertebrate colonization influenced by the release of biocides from antifouling paints, 3) is the colonization of aquatic invertebrates positively influenced by the material accumulated upon the substrate surface and 4) is the assemblage composition of invertebrates similar among the different antifouling paints? To answer these questions, four structures were installed in the Baía River in February 1st, 2007. Each structure was composed of 7 wood boards: 5 boards painted with each type of antifouling paints (T1, T2, T3, T4 and T5), one painted only with the primer (Pr) and the other without any paint (Cn). After 365 days, we observed a greater accumulation of organic matter in the substrates with T2 and T3 paint coatings. Limnoperna fortunei was recorded in all tested paints, with higher densities in the control, primer, T2 and T3. The colonization of Chironomidae and Naididae on the substrate was positively influenced by L. fortunei density. The non-metric multidimensional scaling (NMDS) of the invertebrate community provided evidence of the clear distinction of invertebrate assemblages among the paints. Paints T2 and T3 were the most similar to the control and primer. Our results suggest that antifouling paints applied on substrates hinder invertebrate colonization by decreasing the density and richness of invertebrates.

Resumo O estudo dos invertebrados em substrato artificial com diferentes revestimentos antiincrustantes foi realizado com o intuito de responder as seguintes questões 1) Há menor acumulação de material orgânico nos substratos com revestimentos antiincrustantes? 2) A colonização de invertebrados é afetada pela liberação de biocidas dos revestimentos antiincrustantes? 3) A colonização dos invertebrados aquáticos é facilitada por material acumulado sobre a superfície do substrato? 4) A composição da assembléia é similar entre os diferentes revestimentos? Para realização deste estudo, quatro estruturas foram instaladas em 01 de fevereiro de 2007 no rio Baía. Em cada estrutura foram colocadas sete placas de madeira: cinco placas com aplicação de um tipo de revestimentos antiincrustantes (T1, T2, T3, T4 e T5), uma placa apenas com a aplicação do primer (Pr) e a outra placa permaneceu sem aplicação de nenhum revestimento (Cn). Ao final dos 365 dias em que os substratos ficaram submersos observou-se maior acumulação de material orgânico nos substratos dos revestimentos T2 e T3. Limnoperna fortunei foi registrada em todos os revestimentos testados, com maiores densidades encontradas no controle, primer, T2 e T3. A colonização de Chironomidae e Naididae sobre os substratos foi influenciada pela densidade de L. fortunei. A ordenação (NMDS) evidenciou a separação da assembléia de invertebrados entre os revestimentos. Os revestimentos T2 e T3 foram os mais similares ao controle e ao primer. Os resultados obtidos sugerem que revestimentos antiicrustantes aplicados sobre substratos dificultam a colonização de invertebrados, reduzindo a densidade e riqueza de invertebrados.

Habitats and trophic relationships of Chironomidae insect larvae from the Sepotuba River basin, Pantanal of Mato Grosso, Brazil.

Benthic habitats are linked by physical processes and are essential elements in assessing of the distribution dynamics of Chironomidae dipteran insects and their role in aquatic ecosystems. This work presents results of distribution patterns of chironomids larvae in 38 sites that are abundant in the study site, inhabiting the substrate of the main river channel, rapids, tributary brook, floodplain lakes and reservoir along the Sepotuba River from its mouth at the Paraguay River to the headwater region. A total of 1,247 larvae was registered. The most abundant taxa were Polypedilum (Tripodura) sp. (25.2%), Cricotopus sp.3 (23.0%) and Tanytarsus sp. (15.0%). Fissimentum desiccatum were found only in the reservoir; Fissimentum sp.2 and Tanytarsus cf. T. obiriciae sp.2 in floodplain lakes, and Goeldichironomus sp. in the main channel. The low diversity of the sites S06 and S35 is caused by the near-exclusive presence of the species Cricotopus sp.3, alone or together with one or another taxon (Tanytarsus sp., Djalmabatista sp.3). Collectors-filterers represent 16%, collectors-gatherers 15%, predators 11% and scrapers only 1%. The predators dominated in the secondary channel (±88 ind/m2), corresponding to 40% of the total of this group. Cryptochironomus sp.2 (34%) and Ablasbemyia gr. annulata (26%) were the most abundant among the predators. The differences along the river course are decisive for the formation of distinct or discontinuous communities and the limits become obvious though the interrelations between the populations in the community, as for instance, competition for food and habitats.

Acute antibody-mediated rejection possibly due to anti-human leukocyte antigen DQB1 antibodies after renal transplantation - case report.

A 61-year-old Japanese woman, who had undergone hemodialysis because of chronic glomerulonephritis, received a living renal transplant from her ABO blood type-compatible spouse. HLA typing of A, B and DRB showed 3/6 mismatches. Complement-dependent cytotoxicity crossmatches, HLA antibody screening with the use of flow panel reactive antibody (PRA), and flow cytometry crossmatches (FCXM) were all negative. Tacrolimus, mycophenolate mofetil, methylprednisolone (MP), and basiliximab induction were used as the standard immunosuppressive therapy. After renal transplantation, her serum creatinine level favorably decreased, but urine output was not sufficiently obtained, contrary to our expectations. Doppler sonography revealed disappearance of diastolic arterial flow on postoperative day 2. The episode biopsy showed acute antibody-mediated rejection (AMR) based on the current Banff classification, although FCXM and flow PRA were still negative. To determine the cause of acute AMR, we expanded the HLA typing at high resolution levels to Cw, DQB1, and DPB1. Retrospective analysis of perioperative sera demonstrated the presence of low levels of donor-specific HLA IgG and moderate levels of IgM antibody against DQB1 before transplantation. There was an elevation of IgM antibody at the time of rejection, whereas IgG antibody showed no remarkable change. AMR was successfully treated with plasma exchange, low-dose intravenous immunoglobulin, high-dose intravenous MP pulse, and rituximab.

The influence of fish cage culture on delta13C and delta15N of filter-feeding Bivalvia (Mollusca) / A influência dos tanques rede sobre o delta13C e delta15N de uma espécie filtradora Bivalvia (Mollusca)

The objective of this study was to evaluate the effect of Oreochromis niloticus cage culture promoted variations in the 13C and 15N in Corbicula fluminea (Mollusca; Bivalvia) and in the sediment of an aquatic food web. Samples were taken before and after net cage installation in the Rosana Reservoir (Paranapanema River, PR-SP). Samples of specimens of the bivalve filterer C. fluminea and samples of sediment were collected using a modified Petersen grab. All samples were dried in an oven (60 °C) for 72 hours, macerated to obtain homogenous fine powders and sent for carbon (delta13C) and nitrogen (delta15N) isotopic value analysis in a mass spectrometer. There were significant differences in the delta13C and delta15N values of the invertebrate C. fluminea between the beginning and the end of the experiment. There were no differences between the delta13C and delta15N values of sediment. These results indicate that the installation of fish cage culture promoted impacts in the isotopic composition of the aquatic food web organisms, which could exert influence over the native species and the ecosystem.

O objetivo deste estudo foi avaliar o efeito do cultivo de Oreochromis niloticus em tanques rede sobre os valores de 13C e 15N em tecidos Corbicula fluminea (Mollusca; Bivalvia) e no sedimento da cadeia alimentar aquática. As amostragens foram realizadas em períodos prévios e posteriores a instalação de tanques redes no reservatório de Rosana (Rio Paranapanema, PR-SP). As amostras de espécimes de bivalves filtradores exóticos e as de sedimento foram coletadas utilizando uma versão modificada do pegador tipo Petersen. Todas as amostras foram secas em estufa (60 °C) durante 72 horas, maceradas até obtenção de pó fino e homogêneo e enviadas para determinação do carbono (delta13C) e do nitrogênio (delta15N) em espectrofotômetro de massa. Houve diferenças significativas nos valores delta13C e delta15N do invertebrado C. fluminea entre o início e o fim do experimento. Entretanto, não foram evidenciadas diferenças nos valores delta13C e delta15N presente no sedimento. Estes resultados demonstram que a instalação dos tanques rede promoveram impactos na composição isotópica do invertebrado, que podem influenciar as espécies nativas e o ecossistema.

The influence of fish cage culture on 13C and 15N of filter-feeding Bivalvia (Mollusca)

The objective of this study was to evaluate the effect of Oreochromis niloticus cage culture promoted variations in the 13C and 15N in Corbicula fluminea (Mollusca; Bivalvia) and in the sediment of an aquatic food web. Samples were taken before and after net cage installation in the Rosana Reservoir (Paranapanema River, PR-SP). Samples of specimens of the bivalve filterer C. fluminea and samples of sediment were collected using a modified Petersen grab. All samples were dried in an oven (60 °C) for 72 hours, macerated to obtain homogenous fine powders and sent for carbon (13C) and nitrogen (15N) isotopic value analysis in a mass spectrometer. There were significant differences in the 13C and 15N values of the invertebrate C. fluminea between the beginning and the end of the experiment. There were no differences between the 13C and 15N values of sediment. These results indicate that the installation of fish cage culture promoted impacts in the isotopic composition of the aquatic food web organisms, which could exert influence over the native species and the ecosystem.

O objetivo deste estudo foi avaliar o efeito do cultivo de Oreochromis niloticus em tanques rede sobre os valores de 13C e 15N em tecidos Corbicula fluminea (Mollusca; Bivalvia) e no sedimento da cadeia alimentar aquática. As amostragens foram realizadas em períodos prévios e posteriores a instalação de tanques redes no reservatório de Rosana (Rio Paranapanema, PR-SP). As amostras de espécimes de bivalves filtradores exóticos e as de sedimento foram coletadas utilizando uma versão modificada do pegador tipo Petersen. Todas as amostras foram secas em estufa (60 °C) durante 72 horas, maceradas até obtenção de pó fino e homogêneo e enviadas para determinação do carbono (13C) e do nitrogênio (15N) em espectrofotômetro de massa. Houve diferenças significativas nos valores 13C e 15N do invertebrado C. fluminea entre o início e o fim do experimento. Entretanto, não foram evidenciadas diferenças nos valores 13C e 15N presente no sedimento. Estes resultados demonstram que a instalação dos tanques rede promoveram impactos na composição isotópica do invertebrado, que podem influenciar as espécies nativas e o ecossistema.

Comparing diagnostic tests: trials in people with discordant test results.

Diagnostic tests are traditionally compared for accuracy against a gold standard but can also be compared prospectively in a trial. A conventional trial comparing two tests would randomize each participant to a testing strategy, but a more efficient alternative is to give both tests to all participants and follow up those with discordant results. Participants could be randomized before or after testing. The statistical analysis of such a trial has not previously been described. We investigated two estimates of the risk difference for a binary outcome: one based on analysing outcomes as if from a conventional trial and one combining estimates of different parameters in the manner of a decision analysis. We show that the trial estimate and decision analysis estimate are both unbiased and derive approximate formulae for their standard errors. By using the decision analysis estimate (but not the trial estimate), the same precision can be achieved by randomizing before testing as by randomizing after. To avoid destroying equipoise, and to allow consenting and randomizing to be carried out at the same visit, we recommend randomizing before testing. Giving both tests to all participants means fewer need to be recruited: in one example from the literature, the proposed design was nearly four times more efficient in this sense than a conventional trial design.

Comparison of clinical, tumour-related and dosimetric factors in grade 0-1, grade 2 and grade 3 radiation pneumonitis after stereotactic body radiotherapy for lung tumours.

OBJECTIVE: The aim of this study was to investigate significant clinical, tumour-related and dosimetric factors among patients with grade 0-1, grade 2 and grade 3 radiation pneumonitis (RP) after stereotactic body radiotherapy (SBRT) for lung tumours. METHODS: Patients (n=128) with a total of 133 lung tumours treated with SBRT of 50 Gy in 5 fractions were analysed. RP was graded according to the Common Terminology Criteria for Adverse Events v.3.0. Significant factors were identified by univariate and multivariate analyses. Threshold dose-volume histograms (DVHs) were constructed to identify the incidence of RP. RESULTS: The median follow-up period was 12 months (range, 6-45 months). In univariate analyses, gender, operability, forced expiratory volume in 1 s (FEV1), internal target volume, lung volumes treated with doses >5-30 Gy (V5-30) and mean lung dose were significant factors differentiating between grade 0-1 and grade 2 RP, and V15-30 were significant factors differentiating between grade 2 and grade 3. However, no factors were significant between grade 0-1 and grade 3 RP. Multivariate analysis showed that female gender, high FEV1 and high V15 were significant factors differentiating between grade 0-1 and grade 2 RP. Threshold DVH curves were created based on ≤5% and ≤15% risk of grade 2 RP among patients with grade 0-2 RP. CONCLUSIONS: Grade 0-2 RP was dose-volume dependent, and female gender and high FEV1 were significant predictive clinical factors for grade 2 RP among patients with grade 0-2 RP. However, incidences of V15-30 in grade 3 RP were significantly lower than those in grade 2 RP, and no significant clinical or tumour-related factors were found. Further studies are needed to identify the mechanism underlying the development of grade 3 RP after SBRT for lung tumours.

CT evaluations of focal liver reactions following stereotactic body radiotherapy for small hepatocellular carcinoma with cirrhosis: relationship between imaging appearance and baseline liver function.

This study aimed to assess the imaging appearances of focal liver reactions following stereotactic body radiotherapy (SBRT) for small hepatocellular carcinoma (HCC) and to examine relationships between imaging appearance and baseline liver function. We retrospectively studied 50 lesions in 47 patients treated with SBRT (30-40 Gy in 5 fractions) for HCC, who were followed up for more than 6 months. After SBRT, all patients underwent regular follow-ups with blood tests and dynamic CT scans. At a median follow-up of 18.1 months (range 6.2-43.7 months), all lesions but one were controlled. 3 density patterns describing focal normal liver reactions around HCC tumours were identified in pre-contrast, arterial and portal-venous phase scans: iso/iso/iso in 4 patients (Type A), low/iso/iso in 8 patients (Type B) and low/iso (or high)/high in 38 patients (Type C). Imaging changes in the normal liver surrounding the treated HCC began at a median of 3 months after SBRT, peaked at a median of 6 months and disappeared 9 months later. Liver function, as assessed by the Child-Pugh classification, was the only factor that differed significantly between reactions to treatment showing "non-enhanced" (Type A and B) and "enhanced" (Type C) appearances in CT. Hence, liver tissue with preserved function is more likely to be well enhanced in the delayed phase of a dynamic contrast-enhanced CT scan. The CT appearances of normal liver seen in reaction to the treatment of an HCC by SBRT were therefore related to background liver function and should not be misread as recurrence of HCC.

Sustained 24-h efficacy of NVA237, a once-daily long-acting muscarinic antagonist, in COPD patients.

NVA237 is a once-daily inhaled long-acting muscarinic antagonist in development for the treatment of COPD. This randomized, double-blind, placebo-controlled, four-period, incomplete block crossover study, with open-label active comparator (tiotropium), assessed the efficacy and safety of NVA237. Patients (>or=40 years; smoking history >or=10 pack-years) with stable moderate-to-severe COPD (post-bronchodilator FEV(1) >or= 30% and <80% predicted, FEV(1)/FVC < 0.7) received NVA237 12.5, 25, 50 or 100 microg, placebo, or tiotropium 18 microg once-daily for 7 days. The primary endpoint was mean trough (23-24 h post-dose) FEV(1) on Day 7. Secondary endpoints included mean trough FEV(1) on Day 1, and FEV(1) and FVC at individual time points post-dose on Days 1 and 7. 83 patients (mean age 64.4 years; male 83.1%; mean COPD duration 6.7 years; mean post-bronchodilator FEV(1) 1.5 L/52.7% predicted) were randomized; 78 completed. Mean trough FEV(1) on Day 7 and Day 1 was significantly higher with all active treatments versus placebo (p < 0.05). NVA237 50 microg, 100 microg and tiotropium showed clinically relevant improvements versus placebo on Day 7 (differences of 131, 142 and 127 mL, respectively; p < 0.0001) and 1 (differences of 121, 135 and 112 mL, respectively; p < 0.0001). On Day 1, but not Day 7, FEV(1) was significantly higher (p < 0.05) with NVA237 50 and 100 microg versus tiotropium from 5 min up to 2 and 4 h post-dose, respectively. All doses of NVA237 and tiotropium were well tolerated. NVA237 once-daily was effective and well tolerated versus placebo, and demonstrated rapid and sustained 24-h bronchodilation. (ClinicalTrials.gov Identifier: NCT00501852).