Access to Liver Transplantation in Different ABO-Blood Groups and "Exceptions Points" in a Model for End-Stage Liver Disease Allocation System: A Brazilian Single-Center Study.

BACKGROUND: In the Model for End-Stage Liver Disease (MELD) system, patients with "MELD exceptions" points may have unfair privilege in the competition for liver grafts. Furthermore, organ distribution following identical ABO blood types may also result in unjust organ allocation. The aim of this study was to investigate access to liver transplantation in a tertiary Brazilian center, regarding "MELD exceptions" situations and among ABO-blood groups. METHODS: A total of 465 adult patients on the liver waitlist from August 2015 to August 2016 were followed up until August 2017. Patients were divided into groups according to ABO-blood type and presence of "exceptions points." RESULTS: No differences in outcomes were observed among ABO-blood groups. However, patients from B and AB blood types spent less time on the list than patients from A and O groups (median, 46, 176, 415, and 401 days, respectively; P = .03). "Exceptions points" were granted for 141 patients (30.1%), hepatocellular carcinoma being the most common reason (52.4%). Patients with "exceptions points" showed higher transplantation rate, lower mortality on the list, and lower delta-MELD than non-exceptions patients (56.7% vs 19.1% [P < .01]; 18.4% vs 38.5% [P < .01], and 2.0 ± 2.6 vs 6.9 ± 7.0 [P < .01], respectively). Patients with refractory ascites had a higher mortality rate than those with other "exceptions" or without (48%). CONCLUSIONS: The MELD system provides equal access to liver transplantation among ABO-blood types, despite shorter time on the waitlist for AB and B groups. The current MELD exception system provides advantages for candidates with "exception points," resulting in superior outcomes compared with those without exceptions.

Stratifying Mortality in a Model for End-Stage Liver Disease Waiting List: A Brazilian Single-Center Study.

BACKGROUND: The Model for End-Stage Liver Disease (MELD) system reliably predicts mortality in cirrhotic patients. However, the etiology of liver disease and presence of portal vein thrombosis are not directly taken into account in MELD score. Its impact on the outcomes of patients on the waiting list is still unclear. The aim of this study was to investigate mortality and access to transplantation regarding etiology of liver disease and portal vein thrombosis (PVT). METHODS: A total of 465 adult patients on the liver waiting list from August 2015 to August 2016 were followed up until August 2017. Patients were divided into groups according to the etiology of liver disease and presence of PVT. RESULTS: The most frequent etiologies were hepatitis C (26.88%), alcoholic cirrhosis (26.02%) and cryptogenic cirrhosis (10.75%). Death while on the waiting list occurred in 168 patients (36.1%) and was more frequent in nonalcoholic steatohepatitis (NASH, 65.4%) and alcoholic cirrhosis (41.3%). A total of 142 (30.5%) patients underwent transplantation and viral, autoimmune, and biliary diseases showed higher proportion of transplantation (36.3%, 53.8%, and 34%, respectively; P < .01). Mean delta-MELD at the study endpoint was higher in patients with autoimmune hepatitis, biliary diseases, and NASH (8.3 ± 7.2, 8.3 ± 9.1, and 7.5 ± 9.1, respectively; P < .01). A total 77 patients (16.7%) presented PVT. There was no significant difference in outcomes between patients with and without PVT. CONCLUSIONS: Patients with NASH and alcoholic liver disease had higher mortality while on the waiting list, whereas patients with viral and autoimmune hepatitis had higher transplantation rate. Outcomes were not influenced by PVT.

In situ evaluation of low-fluoride toothpastes associated to calcium glycerophosphate on enamel remineralization.

OBJECTIVES: This study aimed to evaluate the effect of low-fluoride toothpastes with calcium glycerophosphate (CaGP) on enamel remineralization in situ. METHODS: Volunteers (n=10) wore palatal devices holding four bovine enamel blocks. The treatments involved 5 experimental phases of 3 days each according to the following toothpastes: placebo, 500 ppm F (500 NaF), 500 ppm F with 0.25% CaGP (500 NaF CaGP), 500 ppm F with 0.25% CaGP (500 MFP CaGP) and 1100 ppm F (1100; positive control). After this experimental period, the fluoride, calcium, and phosphorus ion concentrations from enamel were determined. Surface and cross-sectional hardness were also performed. Data were analysed by 1-way ANOVA, Student-Newman-Keuls' test and by Pearson's correlation. RESULTS: The addition of 0.25% CaGP improved the remineralization potential of low-fluoride toothpastes and the NaF as source of fluoride yielded the best results (p<0.001) as evidenced by the hardness analysis. The 1100 ppm F toothpaste provided higher presence of fluoride in the enamel after remineralization (p<0.001). The addition of CaGP to the NaF and MFP toothpastes led to similar calcium concentration in the enamel as the observed with the positive control (p=0.054). CONCLUSIONS: Toothpastes with 500 ppm F (NaF or MFP) and CaGP showed similar remineralization potential than 1100 ppm F toothpaste. CLINICAL SIGNIFICANCE: Toothpastes containing 500 ppm F associated to CaGP, with both fluoride source (NaF or MFP), showed a potential of remineralization similar to commercial toothpaste. Although there is a need for confirmation in the clinical setting, these results point to an alternative for improving the risk-benefit relationship between fluorosis and dental caries in small children.

Analysis of EGFR and HER-2 expressions in ductal carcinomas in situ in canine mammary glands / Análise da expressão de EGFR e HER-2 em carcinomas ductais in situ da glândula mamária canina

Biomolecular evidence has shown that ductal carcinoma in situ (DCIS) may develop into invasive carcinoma of the canine mammary gland, and mutations in proto-oncogenes HER2 and EGFR; two members of the family of epidermal growth factor receptors, may be involved in this process. The purpose of this study was the characterization of the immunohistochemical expression of the EGFR and HER2 proteins in the process of neoplastic transformation, supposedly present in ductal carcinomas in situ in canine mammary glands. Fifteen cases of DCIS were evaluated, with a higher expression of HER2 and EGFR being observed in low-grade carcinomas when compared with high-grade neoplasms, and with a high positive statistical correlation in the latter. Results suggest that aggressive tumors tend to lose the expression of EGFR and HER2 simultaneously. The loss of the expression of these markers may be related to the process of neoplastic progression in canine mammary tumors...

Evidências biomoleculares sugerem que o carcinoma ductal in situ (CDIS) pode progredir para carcinoma invasor na mama canina e que mutações nos proto-oncogenes HER-2 e EGFR, dois membros da família de receptores para fatores de crescimento epidérmicos, podem estar envolvidas neste processo. A partir disso, este trabalho teve por objetivo caracterizar a expressão imuno-histoquímica das proteínas EGFR e HER-2 no processo de transformação neoplásica supostamente presente em carcinomas ductais in situ da glândula mamária canina. Foram avaliados 15 casos de CDIS, sendo observada maior expressão de HER-2 e EGFR em carcinomas de baixo grau em comparação às neoplasias de alto grau, com correlação estatística positiva alta nestes últimos. Os resultados sugerem que tumores mais agressivos tendem a perder, simultaneamente, a expressão de EGFR e HER-2. A perda na expressão desses marcadores pode estar envolvida no processo de progressão neoplásica em tumores mamários caninos...

Analysis of EGFR and HER-2 expressions in ductal carcinomas in situ in canine mammary glands / Análise da expressão de EGFR e HER-2 em carcinomas ductais in situ da glândula mamária canina

Biomolecular evidence has shown that ductal carcinoma in situ (DCIS) may develop into invasive carcinoma of the canine mammary gland, and mutations in proto-oncogenes HER2 and EGFR; two members of the family of epidermal growth factor receptors, may be involved in this process. The purpose of this study was the characterization of the immunohistochemical expression of the EGFR and HER2 proteins in the process of neoplastic transformation, supposedly present in ductal carcinomas in situ in canine mammary glands. Fifteen cases of DCIS were evaluated, with a higher expression of HER2 and EGFR being observed in low-grade carcinomas when compared with high-grade neoplasms, and with a high positive statistical correlation in the latter. Results suggest that aggressive tumors tend to lose the expression of EGFR and HER2 simultaneously. The loss of the expression of these markers may be related to the process of neoplastic progression in canine mammary tumors.(AU)

Evidências biomoleculares sugerem que o carcinoma ductal in situ (CDIS) pode progredir para carcinoma invasor na mama canina e que mutações nos proto-oncogenes HER-2 e EGFR, dois membros da família de receptores para fatores de crescimento epidérmicos, podem estar envolvidas neste processo. A partir disso, este trabalho teve por objetivo caracterizar a expressão imuno-histoquímica das proteínas EGFR e HER-2 no processo de transformação neoplásica supostamente presente em carcinomas ductais in situ da glândula mamária canina. Foram avaliados 15 casos de CDIS, sendo observada maior expressão de HER-2 e EGFR em carcinomas de baixo grau em comparação às neoplasias de alto grau, com correlação estatística positiva alta nestes últimos. Os resultados sugerem que tumores mais agressivos tendem a perder, simultaneamente, a expressão de EGFR e HER-2. A perda na expressão desses marcadores pode estar envolvida no processo de progressão neoplásica em tumores mamários caninos.(AU)

Simulium lobatoi, new species of blackfly (Diptera: Simuliidae) from the states of Mato Grosso and Goiás, Central Brazil.

During studies on the taxonomy of the Simuliidae of Brazil, a new species of Simulium was found. Full descriptions of the adults and pupae of this species are described here, its affinities with other species are discussed and its distribution, biology, and medical importance in Brazil are recorded.

Effect of eggplant (Solanum melongena) extract on the in vitro labeling of blood elements with technetium-99m and on the biodistribution of sodium pertechnetate in rats.

The use of eggplant has been suggested to treat different diseases. We studied the effect of eggplant extract on the labeling of red blood cells (RBC) and plasma proteins with technetium-99m (Tc-99m) and on biodistribution of sodium pertechnetate (Tc-99m) in rats. Blood was incubated with an eggplant extract (final concentrations 3.12 to 250.00 mg/ml) for 60 min. Then, stannous chloride (SnCl2) (0.06 or 1.2 microg/ml) and Tc-99m, as sodium pertechnetate, were added. Samples of RBC and plasma (P) were separated and also precipitated and soluble (SF) and insoluble (IF) fractions were isolated. The percent of radioactivity (%ATI) in the fractions was calculated. In the biodistribution study, Wistar rats were treated with eggplant extract (300 mg/ml) for 4 weeks, in drinking water. Tc-99m was administered in the rats, after 90 min they were sacrificed and organs and blood were isolated. When 0.06 microg/ml SnCl2 was used, eggplant extract: i/ inhibited the label of RBC (97.14 +/- 2.01 to 52.21 +/- 3.97%ATI), ii/ decreased the labeling in IF-P from 38.79 +/- 11.73 to 5.49 +/- 2.65%ATI, and iii/ diminished the labeling in IF-RBC from 90.04 +/- 2.65 to 46.17 +/- 9.49%ATI. This inhibitory effect was not observed with SnCl2 1.2 microg/ml. In the biodistribution study, the %ATI: i/ increased in the liver from 2.15 +/- 0.54 to 3.11 +/- 1.29 and ii/ in the other organs the Tc-99m uptake was not modified. The uptake of Tc-99m in red blood cells protein (IF-RBC) decreased from 66.62 +/- 19.67 to 31.66 +/- 8.84%. It is possible to suggest that some components of the eggplant extract present an oxidation power able to alter the fixation of the Tc-99m on the blood elements. Moreover, as eggplant is metabolized in the liver, this fact could justify the alteration of the uptake in this organ.

Simulium cuasiexiguum, a new blackfly species (Diptera: Simuliidae) from the Minaçu area in the State of Goiás, Central Brazil.

During studies of Simuliidae at a suspected new focus of human onchocerciasis in central Brazil a new species of Simulium was found. Full descriptions of the adults and pupae of this species, S. cuasiexiguum, are described here, its affinities to closely related species in the subgenus Notolepria are discussed and its distribution in Brazil recorded.

Simulium cuasiexiguum, a new blackfly species (Diptera: Simuliidae) from the Minaçu area in the State of Goiás, Central Brazil

During studies of Simuliidae at a suspected new focus of human onchocerciasis in central Brazil a new species of Simulium was found. Full descriptions of the adults and pupae of this species, S. cuasiexiguum, are described here, its affinities to closely related species in the subgenus Notolepria are discussed and its distribution in Brazil recorded

Biting behaviour and potential vector status of anthropophilic blackflies in a new focus of human onchocerciasis at Minaçu, central Brazil.

Monthly collections were made of man-biting female blackflies: Simulium auripellitum Enderlein, S. guianense Wise, S. minusculum Lutz and S. nigrimanum Macquart (Diptera: Simuliidae) from four catching stations in the newly discovered focus of human onchocerciasis at Minaçu (13 degrees 35 minutes S 48 degrees 18 minutes W), 300 km north of Brasília in Goiás State. These provided baseline data on biting habits, population density and seasonal prevalence during the year before completion of the Serra da Mesa hydroelectric dam on the Rio Tocantins near Minaçu, in a project investigating the effect of dam construction on onchocerciasis transmission in the area. All four simuliid species were most abundant during the dry season, and only bit in low numbers (S. auripellitum S. minusculum, S. nigrimanum) or were absent (S. guianense) in the wet season. Simulium minusculum was the predominant species at all catching stations, being particularly abundant by the large River Tocantins. The other three species were mainly associated with smaller rivers. In the dry season, biting rhythms of S. minusculum varied with catching site, while S. nigrimanum showed peaks of activity in early morning and during the afternoon. Experimental infection with Onchocerca volvulus (Leuckart) (Nematoda: Onchocercidae), from a human volunteer, showed that this parasite could develop fully in the four simuliid species, which are all considered to be potential vectors in the area.

Discovery of a new focus of human onchocerciasis in central Brazil.

An autochthonous case of human onchocerciasis was reported 13 years ago in the town of Minaçu, northern Goiás (Brazil), but a subsequent survey of the population using the traditional technique of examining skin biopsies with the light microscope failed to detect other cases. Recent surveys using more sensitive diagnostic techniques (serodiagnosis, DNA probes, Mazzotti test) that are detailed in this paper revealed the presence of other cases of the disease in Minaçu, the nearby town of Formoso and at the Buracão gold mine near Paranã. The data show that transmission of the disease has occurred to local people living in town and on farms and that gold miners (garimpeiros) are a likely source of infection.

Activity and stability of a Rhizomucor miehei lipase in hydrophobic media.

The effects of detergents and organic solvents on a commercial lipase (Lipozyme) from Rhizomucor miehei were investigated. It was shown that the detergent sodium cholate is possibly an activator of the enzyme, increasing lipase activity 2.5 times (250% of the control) when the enzyme was preincubated with 7 mM cholate. Lipozyme activity was over twice as high (230% of the control) in the presence of 80 mM Tween 80 or 90 mM Tween 20 (polyoxyethylenesorbitan monolaurate), apparently through an additional emulsifying action on the substrate. Preincubation with Tween 80 (polyoxyethylenesorbitan mono-oleate) did not affect enzyme activity. In contrast, lipase activity was completely inhibited in the presence of an 8.9 mM concentration of another non-ionic detergent, Brij 58, whereas with a 16.4 mM concentration of the cationic detergent cetyltrimethylammonium bromide (CTAB), enzyme activity was reduced by 80%. Preincubation of Lipozyme with the same concentrations of Brij 58 [poly(oxyethylene)20 cetyl ether] and CTAB promoted total inactivation of the enzyme. Organic solvents had different effects on lipase activity and stability. Of the tested solvents, hexane was least deleterious to lipase activity and did not alter enzyme stability on preincubation. These results suggest that Lipozyme can be used in esterification reactions with hexane as solvent or in hydrolysis reactions with Tween 20 or Tween 80 as emulsifying agents, after pretreatment with sodium cholate.

Four new cytotypes of the onchocerciasis vector blackfly Simulium guianense in Brazil.

Simulium (Trichodagmia) guianense is an important Amazonian vector of onchocerciasis. Examination of the polytene chromosome banding patterns of larvae from five sites in Brazil revealed the occurrence of four cytotypes, designated A, B, C and D. The chromosomal standard, Simulium guianense A, occurred at two localities in Goias State (on the Rio Tocantins and Rio Mucambão) where it was the only cytotype. The other three sites examined yielded one different cytotype from each: B from Rio Oyapoque in Amapa State, C from Rio Tocantins in Maranhão State, and D from Rio Xingu in Para State. All cytotypes differed by at least two fixed inversions, but a sex determining system was not evident in any cytotype. As the cytotypes have been found allopatrically it is not certain that they represent sibling species; sampling of sympatric populations would resolve this. During certain times of the year, voracious anthropophagy by S.guianense sensu lato occurs at the localities sampled for cytotypes A, C and D (biting data are not available for the cytotype B locality). In some other areas, however, S.guianense s.l. is entirely zoophilic. Further studies are needed, therefore, to elucidate the biting habits, vectorial capacity, geographic distribution and taxonomic status of these four, and perhaps additional, cytotypes comprising the S.guianense complex.

Identification of vector species (Diptera:Simuliidae) of human onchocerciasis in the amazonia focus of Brazil and Venezuela.

The taxonomic status of three Amazonian simuliid species, Simulium guianese Wise, S. oyapockense Floch & Abonnenc and S. yarzabali Ramirez Perez is reviewed. Simulium cuasisanguineum Ramirez Perez, Yarzabal & Peterson is synonymized with S. oyapockense, and S. yarzabali is revalidated from its synonymy with S. incrustatum Lutz. The role of these three species in the transmission of human onchocerciasis and mansonelliasis in Amazonia is reviewed.

The status of Simulium oyapockense and S. limbatum as vectors of human onchocerciasis in Brazilian Amazonia.

In an attempt to explain the current distribution of onchocerciasis in the forests of northern Brazil (Moraes et al., 1979, 1986), and its potential for dispersal to other areas, this study compares the vector status of Simulium oyapockense Floch and Abonnenc, 1946 in both a hypoendemic and an onchocerciasis free area with that of S. limbatum Knab, 1915 in the latter area. Both species allowed the full development of Onchocerca volvulus (Leuckart) to the infective L3 stage after experimental infection with microfilariae. Their vector competence was significantly lower than for other efficient vector species in South America and Africa because of the lethal effect of the cibarial armature on ingested microfilariae. The low vector capacity of S. oyapockense, together with the low prevalence and intensity of infection of O. volvulus, probably explains why onchocerciasis has not significantly increased in intensity over the last 10 years in the hypoendemic part of the Amazonian focus. Omnipresence of both vector species in the adjacent savanna region, however, could facilitate the spread of onchocerciasis if human population movements continue from the hyperendemic part of the onchocerciasis focus.

[The Brazilian focus of onchocerciasis: new observations in the areas of the Mucajaí and Catrimâni rivers, Territory of Roraima]. / O foco brasileiro de oncocercose: novas observações feitas nas áreas dos rios Mucajaí e Catrimãni, Território de Roraima.

A recent survey for onchocerciasis conducted among the Yanomami Indians living on the middle reaches of the Mucajaí and Catrimâni Rivers (Territory of Roraima) has failed to show any alteration in the local pattern of the disease. In fact, after a decade from the first surveys in these areas located at the periphery of the Yanomami focus, the prevalence and the intensity of infection have not experienced a significant change. Considering only the residents in the villages inside the surveyed areas, the prevalence varied from zero in the neighbourhood of the Catrimâni mission to 3.1 per cent near the Mucajaí mission. Had there been a competent vector of Onchocerca volvulus in the region higher rates might be expected due to the Yanomami custom of periodic visits among the groups of the tribe. In some of these visits, numbers of highly infected Indians from the central and mountainous part of the Yanomami territory--where more than 90 per cent of the adults have onchocerciasis--come to the villages in the lowland area, attracted by the facilities offered by the mission posts. As the visitors stay in the host villages for several days or weeks, the residents could become exposed to the disease. Simulium oyapockense s.1., a man-biting species of black fly, widely distributed in Northern Brazil, is the only possible vector of O. volvulus in the investigated areas, on the grounds of its local abundance.(ABSTRACT TRUNCATED AT 250 WORDS)

[Mansonella ozzardi in the Federal Territory of Roraima, Brazil. Distribution and finding of a new vector in the area of Surumu River]. / Mansonella ozzardi no Território Federal de Roraima, Brasil. Distribuição e achado de um novo vetor na area do Rio Surumu.

A survey conducted among the Makuxi Indians from 15 settlements in the northeastern part of the Territory of Roraima, Brazil, revealed the occurrence of Mansonella ozzardi in 3,2% (21/652) of the persons examined. The absence of demonstrable infection--with one exception--in persons under 15 years of age, and the low microfilaria density in adults suggest that mansonelliasis has been acquired by the Makuxi Indians outside their villages. As many Indians from the region pan gold on the Upper Maú (Ireng) river--where black flies occur in great quantity--the mining camps are probably the sites of transmission. Experimental infection with M. ozzardi of Simulium oyapockense s.l. (or Simulium roraimense) showed that this species, at the least in the Surumu river area, is capable of supporting the full development of the microfilariae. Although S. oyapockense has a wide distribution in the extreme north of Brazil, it does not appear to be an efficient vector, since only 20,6% (19/92) of the specimens collected after a blood meal on a naturally infected Indian contained larval stages of M. ozzardi (with an average of 1-2 larvae per fly). The high prevalence rate of infection found, in a previous survey, among the Sanumá and Mayongong, two Indian groups living at the Auaris river area, on the other side of the Territory of Roraima, indicates that a more competent intermediate host should exist in that region.

Simulium species of the amazonicum group as vectors of Mansonella ozzardi in the Brazilian Amazon.

Experimental infection with Mansonella ozzardi of common haematophagous Diptera collected at a Ticuna Indian village on the upper reaches of the Solimões river in the Brazilian Amazon, showed that Simulium amazonicum and Simulium n.sp. are capable of supporting full development of the parasite. Natural infections with this filaria were found in both species including infective larvae in Simulium n.sp. No development of M. ozzardi occurred in Mansonia amazonensis, Culicoides insinuatus or Lepiselaga crassipes (Tabanidae). The dimensions of developing larvae of M. ozzardi in both species of black-fly were recorded. Infective larvae of this species may easily be distinguished from those of Onchocerca volvulus, also transmitted in the Amazon by a species closely resembling S. amazonicum, by the presence of a bifid tail and higher anal ratio in M. ozzardi.