Efficacy of oral metformin in a patient with metastatic adrenocortical carcinoma: Examination of mechanisms and therapeutic implications.

Although rare, adrenocortical carcinoma is among the most common tumors found in children with Li-Fraumeni syndrome and Li-Fraumeni-like syndrome, associated with germ-line mutations in the TP53 gene. In southern Brazil, one form of Li-Fraumeni syndrome, associated with childhood adrenocortical carcinoma, is caused by a mutation in the R337H TP53 tetramerisation domain and is attributed to a familial founder effect. Adrenocortical carcinoma is considered an aggressive neoplasm, usually of poor prognosis and is generally unresponsive to systemic chemotherapy. Optimal treatment regimens remain to be established. We report the case of a young woman with metastatic adrenocortical carcinoma, who achieved stable disease with mitotane, cisplatin, doxorubicin, and etoposide as first-line therapy, but then had an objective response to oral metformin that lasted 9 months. The presence of the R337H TP53 mutation suggests a mechanism for the observed response to metformin.

Main causes of nonfulfillment of corneal donation in five hospitals of a Brazilian state.

The waiting list for corneal transplantation in Brazil had 6684 patients in June 2012, with great variations in the number of patients among different states. The mean waiting time for a corneal transplant also differs substantially across the states: it is 2 years in State of Espirito Santo (ES) at the time of this study. The aim of the study was to determine the main reasons for nonfulfillment of corneal donation in five ES hospitals. The data collection was performed from March to August 2010. The data were collected using forms completed daily by the Intrahospital Commissions of Organ and Tissues Donation for Transplantation. The total number of deaths was 1347. The main causes of nonfulfillment of donations were medical contraindications (67.86%), logistical/structural problems (27.84%), and family refusal (2.15%). The main medical contraindications were age outside the required range (24.49%), the presence of infectious disease (11.36%), or age outside the range plus infection (15.66%). In 2010, there were 459 people on the waiting list for corneas in ES. Considering the average of failures in these five hospitals multiplied by the number of hospitals in the ES, it seems clear that the solutions to these problems might eliminate the waiting list of the State. In fact, the number of individuals on the waiting list in ES did reach zero in August 2011, after the inauguration of a new Eye Bank that trains employees to interview and perform procurements, in addition to keeping them available in the most important hospitals. Additionally, the maximal age for donation in ES was increased.

Reasons for noneffectiveness of organ donation programs in five hospitals in the state of Espírito Santo, Brazil.

Although, in absolute numbers, more organ transplantations are performed in Brazil than in many other countries, the donation rate (the number of donors per million individuals) remains quite low. The aim of this study was to determine the reasons for nonfulfillment of organ donations in five hospitals in the State of Espirito Santo, Brazil. This knowledge could help to identify strategies and implement changes to improve the organ donation process and to increase the rate in Brazil and other countries that face similar challenges. This prospective study collected data including the numbers of patients with suspected brain death (both confirmed and nonconfirmed), effective, and of nonfulfilled donations. Data were collected using forms completed daily by the Intra-Hospital Commission for Organ and Tissue Donation of the hospitals during the period from March to August 2010. There were 1386 deaths. The protocol for brain death diagnosis was initiated in 2.8% of them, but only 28.21% of confirmed brain death patients became effective donors. The causes of nondonation differed among the hospitals surveyed, suggesting that different strategies should be implemented to combat the specific weaknesses of each service, which must be continuously evaluated to increase the efficiency of the organ donation process.

Changes in protein profile detected in seedlings of Caesalpinia peltophoroides (Fabaceae) after exposure to high concentration of cadmium.

Sibipiruna (Caesalpinia peltophoroides Benth) is a tree of the Brazilian Atlantic Forest. It is a flowering ornamental tree widely planted throughout Brazil and indicated for restoration of degraded areas. We examined protein profile changes in leaves of seedlings of C. peltophoroides grown in nutrient solution under greenhouse conditions, after exposure to cadmium (Cd; 32 mg/L). A two-dimensional gel was used to analyze proteins expressed in response to stress 24 and 72 h after initiation of treatment with Cd. Various protein bands were identified that were related to stress response and/or metabolic adjustments, including proteins involved with resistance to stress, including detoxification, degradation, antioxidant, transport, signal transduction, photosynthesis, electron transport, biosynthesis reactions, and transcription regulation. After 24 h of Cd exposure, the genes of most of these proteins were upregulated. These putative proteins were associated with resistance to stress, including heat shock proteins, heat stress transcriptional factor and other transcriptional factors, aquaporins, glutathione transferase and choline monooxygenase. Most of the putative proteins observed after 72 h of exposure to Cd were downregulated. They were mainly photosynthetic process proteins, such as NAD(P)H-quinone oxidoreductase, photosystem I assembly, and photosystem II CP47 chlorophyll apoprotein. There were also proteins involved with degradation, biosynthesis and antioxidant activity, such as ATP-dependent Clp protease, methylthioribose-1-phosphate and glutathione peroxidase 2. Based on preliminary proteomic analysis, we conclude that proteins related to photosynthetic activity are inhibited, decreasing plant performance under stress conditions and that several proteins related to defense mechanisms are activated, inducing the plant defense response.

Photo-assisted electrochemical degradation of real textile wastewater.

In the present study, photo-assisted electrochemical degradation of real textile wastewater was performed. Degradation assays were performed at constant current (40 mA cm(-2)) in a combined electro/photochemical flow-cell using a Ti/Ru(0.3)Ti(0.7)O(2) DSA type electrode. The results show that the method is capable of removing color and chemical oxygen demand (COD) from the effluent. Additionally, the effect of initial pH and type of supporting electrolyte (Na(2)SO(4) or NaCl) was investigated. The principal figures of merit used in this study were COD removal and color removal (605 nm). The results show that up to 72% color and up to 59% COD removal in 120 min is possible under the operating conditions employed. Studies of the phytotoxicity of the wastewater before and after the photo-assisted degradation assays are also presented and the results demonstrate that the toxicity of the effluent is dependent on the length of electrolysis time and the treatment procedure employed.

[Neurosarcoidosis: case report]. / Neurossarcoidose: relato de caso.

We report a case of sarcoidosis in a 21 years old male with history of headache since he was three years old, with absence of abnormalities in a brain computerized tomography (CT). Brain magnetic resonance (MRI) disclosed a meningeal involvement with intense and homogeneous enhancement of the right fronto-temporal convexity and anterior third of the interhemispheric fissure. The brain MRI is more sensitive than brain CT and is the most appropriate method for the evaluation of meningeal and parenchymatous lesions, as well as monitoring the response to therapy and patients follow up.

Effects of occupational exposure to low frequency noise on cognition.

INTRODUCTION: Previous studies performed on groups of workers employed in the aeronautical industry revealed morphological vascular changes of the central nervous system (CNS) and some difficulty in attention and memory retention. The goal of this study is, therefore, to determine whether prolonged occupational exposure to large pressure amplitude (> or = 90 dB SPL) and low frequency (< or = 500 Hz) (LPALF) noise leads to cognitive deterioration. METHODS: We observed 40 male workers employed as aircraft technicians, with average age of 43.3 yr (range 35-56, SD = 4.82) occupationally exposed to LPALF noise for a long period of time, average 22 yr (range 13-30, SD = 4.90), and 30 educationally- and age-matched male controls. None of the subjects had a history of alcoholism, and all were drug-free. The P300 event-related brain potential elicited with an auditory discrimination task was recorded and psychological tests (the Wechsler memory scale and the Toulouse-Piéron test) were performed. RESULTS: The P300 latency was significantly longer (328.5 vs. 307.5 ms, F = 11.7, deg. signif.=0.001) and the amplitude significantly smaller (10.9 vs. 12.6, F = 4.3, deg. signif.=0.04) in the exposed group than in the controls. No significant differences were found in the results of the Toulouse-Piéron test. The different subscales of the Wechsler memory scale did not show any significant difference except in the immediate verbal memory, where the exposed workers were found to have poorer results than the controls (10.0 vs. 11.3, F = 5.6, deg. signif.=0.02). However, the memory quotient obtained from the Wechsler memory scale indicated a significant difference between both groups (101.8 vs. 108.3, F = 10.1, deg. signif.=0.002); exposed subjects presented lower results. CONCLUSION: These findings suggest that prolonged exposure to LPALF noise might contribute to cognitive impairment and that the P300 event-related brain potential recording may be a valuable diagnostic tool.