Efficiency in hospital care in Brazilian capitals for the period 2014-2017

Objective: Analyze the level of efficiency of the hospital care in the Brazilian capitals and the Federal District between the years 2014 to 2017. Methods: The investigation method used was the Data Envelopment Analysis to estimate resource the resource efficiency levels. Results: The results indicate that there are differences in the level of efficiency of the state capitals and the Federal District, making it possible to develop the potential of inefficient units, in order to increase technical efficiency in hospital care. Conclusion: Analyzing the use of public resources helps to identify whether resources are being applied efficiently and when not, they signal the need for decision making that is more consistent with the reality of each capital.

Eficiência nos atendimentos hospitalares nas capitais brasileiras no período de 2014-2017 / Efficiency in hospital care in Brazilian capitals for the period 2014-2017

Objetivo: Analisar o nível de eficiência dos atendimentos hospitalares nas capitais estaduais e Distrito Federal entre os anos de 2014 a 2017. Métodos: O método de investigação utilizado foi a Análise Envoltória de Dados para estimar os níveis de eficiência dos recursos. Resultados: Os resultados indicam que ocorrem diferenças no nível de eficiência das capitais estaduais e Distrito Federal, sendo possível desenvolver o potencial das unidades ineficientes, de forma que aumentem a eficiência técnica nos atendimentos hospitalares. Conclusão: Analisar o uso dos recursos públicos contribui para identificar se os recursos estão sendo aplicados de forma eficiente e, quando não, sinaliza para a necessidade de tomada de decisões mais coerentes com a realidade de cada capital.

Objective: Analyze the level of efficiency of the hospital care in the Brazilian capitals and the Federal District between the years 2014 to 2017. Methods: The investigation method used was the Data Envelopment Analysis to estimate resource the resource efficiency levels. Results: The results indicate that there are differences in the level of efficiency of the state capitals and the Federal District, making it possible to develop the potential of inefficient units, in order to increase technical efficiency in hospital care. Conclusion: Analyzing the use of public resources helps to identify whether resources are being applied efficiently and when not, they signal the need for decision making that is more consistent with the reality of each capital.

Efficiency of carboxymethylcellulose in red wine tartaric stability: Effect on wine phenolic composition, chromatic characteristics and colouring matter stability.

In this work, the effect of carboxymethylcellulose structural features on the efficiency to prevent potassium hydrogen tartrate precipitation in red wines and on the phenolic composition, chromatic characteristics and colouring matter stability was studied. The degree of substitution of carboxymethylcellulose was important for its efficiency in highly unstable wines. Application of carboxymethylcellulose doesn't result in a significant change in the phenolic, monomeric anthocyanin composition, colour intensity, and chromatic characteristics of red wines. Sensory analysis also showed that carboxymethylcellulose doesn't have a significant impact on wine sensory attributes. Carboxymethylcellulose doesn't decrease the colouring matter stability. The use of turbidity for evaluating the colouring matter stability of wines has severe drawbacks as the turbidity value measured might not be related to the amount of suspended material. Therefore, the application of carboxymethylcellulose in red wines is efficient in increasing tartaric stability without impacting on the phenolic composition, sensory characteristics, and colouring matter stability.

Genetic code ambiguity modulates the activity of a C. albicans MAP kinase linked to cell wall remodeling.

The human fungal pathogen Candida albicans ambiguously decodes the universal leucine CUG codon predominantly as serine but also as leucine. C. albicans has a high capacity to survive and proliferate in adverse environments but the rate of leucine incorporation fluctuates in response to different stress conditions. C. albicans is adapted to tolerate this ambiguous translation through a mechanism that combines drastic decrease in CUG usage and reduction of CUG-encoded residues in conserved positions in the protein sequences. However, in a few proteins, the residues encoded by CUG codons are found in strictly conserved positions, suggesting that this genetic code alteration might have a functional impact. One such example is Cek1, a central signaling protein kinase that contains a single CUG-encoded residue at a conserved position, whose identity might regulate the correct flow of information across the MAPK cascade. Here we show that insertion of a leucine at the CUG-encoded position decreases the stability of Cek1, apparently without major structural alterations. In contrast, incorporation of a serine residue at the CUG position induces the autophosphorylation of the conserved tyrosine residue of the Cek1 231TEY233 motif, and increases its intrinsic kinase activity in vitro. These findings show that CUG ambiguity modulates the activity of Cek1, a key kinase directly linked to morphogenesis and virulence in C. albicans.

Probing the Occurrence of Soluble Oligomers through Amyloid Aggregation Scaling Laws.

Drug discovery frequently relies on the kinetic analysis of physicochemical reactions that are at the origin of the disease state. Amyloid fibril formation has been extensively investigated in relation to prevalent and rare neurodegenerative diseases, but thus far no therapeutic solution has directly arisen from this knowledge. Other aggregation pathways producing smaller, hard-to-detect soluble oligomers are increasingly appointed as the main reason for cell toxicity and cell-to-cell transmissibility. Here we show that amyloid fibrillation kinetics can be used to unveil the protein oligomerization state. This is illustrated for human insulin and ataxin-3, two model proteins for which the amyloidogenic and oligomeric pathways are well characterized. Aggregation curves measured by the standard thioflavin-T (ThT) fluorescence assay are shown to reflect the relative composition of protein monomers and soluble oligomers measured by nuclear magnetic resonance (NMR) for human insulin, and by dynamic light scattering (DLS) for ataxin-3. Unconventional scaling laws of kinetic measurables were explained using a single set of model parameters consisting of two rate constants, and in the case of ataxin-3, an additional order-of-reaction. The same fitted parameters were used in a discretized population balance that adequately describes time-course measurements of fibril size distributions. Our results provide the opportunity to study oligomeric targets using simple, high-throughput compatible, biophysical assays.

Distribution of Amyloid-Like and Oligomeric Species from Protein Aggregation Kinetics.

Amyloid fibrils and soluble oligomers are two types of protein aggregates associated with neurodegeneration. Classic therapeutic strategies try to prevent the nucleation and spread of amyloid fibrils, whilst diffusible oligomers have emerged as promising drug targets affecting downstream pathogenic processes. We developed a generic protein aggregation model and validate it against measured compositions of fibrillar and non-fibrillar assemblies of ataxin-3, a protein implicated in Machado-Joseph disease. The derived analytic rate-law equations can be used to 1) identify the presence of parallel aggregation pathways and 2) estimate the critical sizes of amyloid fibrils. The discretized population balance supporting our model is the first to quantitatively fit time-resolved measurements of size and composition of both amyloid-like and oligomeric species. The new theoretical framework can be used to screen a new class of drugs specifically targeting toxic oligomers.

Octanoylation of early intermediates of mycobacterial methylglucose lipopolysaccharides.

Mycobacteria synthesize unique intracellular methylglucose lipopolysaccharides (MGLP) proposed to modulate fatty acid metabolism. In addition to the partial esterification of glucose or methylglucose units with short-chain fatty acids, octanoate was invariably detected on the MGLP reducing end. We have identified a novel sugar octanoyltransferase (OctT) that efficiently transfers octanoate to glucosylglycerate (GG) and diglucosylglycerate (DGG), the earliest intermediates in MGLP biosynthesis. Enzymatic studies, synthetic chemistry, NMR spectroscopy and mass spectrometry approaches suggest that, in contrast to the prevailing consensus, octanoate is not esterified to the primary hydroxyl group of glycerate but instead to the C6 OH of the second glucose in DGG. These observations raise important new questions about the MGLP reducing end architecture and about subsequent biosynthetic steps. Functional characterization of this unique octanoyltransferase, whose gene has been proposed to be essential for M. tuberculosis growth, adds new insights into a vital mycobacterial pathway, which may inspire new drug discovery strategies.

SUMOylation of the brain-predominant Ataxin-3 isoform modulates its interaction with p97.

BACKGROUND: Machado-Joseph Disease (MJD), a form of dominantly inherited ataxia belonging to the group of polyQ expansion neurodegenerative disorders, occurs when a threshold value for the number of glutamines in Ataxin-3 (Atx3) polyglutamine region is exceeded. As a result of its modular multidomain architecture, Atx3 is known to engage in multiple macromolecular interactions, which might be unbalanced when the polyQ tract is expanded, culminating in the aggregation and formation of intracellular inclusions, a unifying fingerprint of this group of neurodegenerative disorders. Since aggregation is specific to certain brain regions, localization-dependent posttranslational modifications that differentially affect Atx3 might also contribute for MJD. METHODS: We combined in vitro and cellular approaches to address SUMOylation in the brain-predominant Atx3 isoform and assessed the impact of this posttranslational modification on Atx3 self-assembly and interaction with its native partner, p97. RESULTS: We demonstrate that Atx3 is SUMOylated at K356 both in vitro and in cells, which contributes for decreased formation of amyloid fibrils and for increased affinity towards p97. CONCLUSIONS AND GENERAL SIGNIFICANCE: These findings highlight the role of SUMOylation as a regulator of Atx3 function, with implications on Atx3 protein interaction network and self-assembly, with potential impact for further understanding the molecular mechanisms underlying MJD pathogenesis.

Examination of Ataxin-3 (atx-3) Aggregation by Structural Mass Spectrometry Techniques: A Rationale for Expedited Aggregation upon Polyglutamine (polyQ) Expansion.

Expansion of polyglutamine stretches leads to the formation of polyglutamine-containing neuronal aggregates and neuronal death in nine diseases for which there currently are no treatments or cures. This is largely due to a lack in understanding of the mechanisms by which expanded polyglutamine regions contribute to aggregation and disease. To complicate matters further, several of the polyglutamine-disease related proteins, including ataxin-3, have a multistage aggregation mechanism in which flanking domain self-assembly precedes polyglutamine aggregation yet is influenced by polyglutamine expansion. How polyglutamine expansion influences flanking domain aggregation is poorly understood. Here, we use a combination of mass spectrometry and biophysical approaches to investigate this issue for ataxin-3. We show that the conformational dynamics of the flanking Josephin domain in ataxin-3 with an expanded polyglutamine tract are altered in comparison to those exhibited by its nonexpanded counterpart, specifically within the aggregation-prone region of the Josephin domain (amino acid residues 73-96). Expansion thus exposes this region more frequently in ataxin-3 containing an expanded polyglutamine tract, providing a molecular explanation of why aggregation is accelerated upon polyglutamine expansion. Here, harnessing the power of ion mobility spectrometry-mass spectrometry, oligomeric species formed during aggregation are characterized and a model for oligomer growth proposed. The results suggest that a conformational change occurs at the dimer level that initiates self-assembly. New insights into ataxin-3 fibril architecture are also described, revealing the region of the Josephin domain involved in protofibril formation and demonstrating that polyglutamine aggregation proceeds as a distinct second step after protofibril formation without requiring structural rearrangement of the protofibril core. Overall, the results enable the effect of polyglutamine expansion on every stage of ataxin-3 self-assembly, from monomer through to fibril, to be described and a rationale for expedited aggregation upon polyglutamine expansion to be provided.

Structure of mycobacterial maltokinase, the missing link in the essential GlgE-pathway.

A novel four-step pathway identified recently in mycobacteria channels trehalose to glycogen synthesis and is also likely involved in the biosynthesis of two other crucial polymers: intracellular methylglucose lipopolysaccharides and exposed capsular glucan. The structures of three of the intervening enzymes - GlgB, GlgE, and TreS - were recently reported, providing the first templates for rational drug design. Here we describe the structural characterization of the fourth enzyme of the pathway, mycobacterial maltokinase (Mak), uncovering a eukaryotic-like kinase (ELK) fold, similar to methylthioribose kinases and aminoglycoside phosphotransferases. The 1.15 Šstructure of Mak in complex with a non-hydrolysable ATP analog reveals subtle structural rearrangements upon nucleotide binding in the cleft between the N- and the C-terminal lobes. Remarkably, this new family of ELKs has a novel N-terminal domain topologically resembling the cystatin family of protease inhibitors. By interfacing with and restraining the mobility of the phosphate-binding region of the N-terminal lobe, Mak's unusual N-terminal domain might regulate its phosphotransfer activity and represents the most likely anchoring point for TreS, the upstream enzyme in the pathway. By completing the gallery of atomic-detail models of an essential pathway, this structure opens new avenues for the rational design of alternative anti-tubercular compounds.

Structural basis for host membrane remodeling induced by protein 2B of hepatitis A virus.

UNLABELLED: The complexity of viral RNA synthesis and the numerous participating factors require a mechanism to topologically coordinate and concentrate these multiple viral and cellular components, ensuring a concerted function. Similarly to all other positive-strand RNA viruses, picornaviruses induce rearrangements of host intracellular membranes to create structures that act as functional scaffolds for genome replication. The membrane-targeting proteins 2B and 2C, their precursor 2BC, and protein 3A appear to be primarily involved in membrane remodeling. Little is known about the structure of these proteins and the mechanisms by which they induce massive membrane remodeling. Here we report the crystal structure of the soluble region of hepatitis A virus (HAV) protein 2B, consisting of two domains: a C-terminal helical bundle preceded by an N-terminally curved five-stranded antiparallel ß-sheet that displays striking structural similarity to the ß-barrel domain of enteroviral 2A proteins. Moreover, the helicoidal arrangement of the protein molecules in the crystal provides a model for 2B-induced host membrane remodeling during HAV infection. IMPORTANCE: No structural information is currently available for the 2B protein of any picornavirus despite it being involved in a critical process in viral factory formation: the rearrangement of host intracellular membranes. Here we present the structure of the soluble domain of the 2B protein of hepatitis A virus (HAV). Its arrangement, both in crystals and in solution under physiological conditions, can help to understand its function and sheds some light on the membrane rearrangement process, a putative target of future antiviral drugs. Moreover, this first structure of a picornaviral 2B protein also unveils a closer evolutionary relationship between the hepatovirus and enterovirus genera within the Picornaviridae family.

Development and characterization of a PHB-HV-based 3D scaffold for a tissue engineering and cell-therapy combinatorial approach for spinal cord injury regeneration.

Spinal cord injury (SCI) leads to devastating neurological deficits. Several tissue engineering (TE)-based approaches have been investigated for repairing this condition. Poly (3-hydroxybutyrate-co-3-hydroxyvalerate) (PHB-HV) is found to be particularly attractive for TE applications due to its properties, such as biodegradability, biocompatibility, thermoplasticity and piezoelectricity. Hence, this report addresses the development and characterization of PHB-HV-based 3D scaffolds, produced by freeze-drying, aimed to SCI treatment. The obtained scaffolds reveal an anisotropic morphology with a fully interconnected network of pores. In vitro studies demonstrate a lack of cytotoxic effect of PHB-HV scaffolds. Direct contact assays also reveal their ability to support the culture of CNS-derived cells and mesenchymal-like stem cells from different sources. Finally, histocompatibility studies show that PHB-HV scaffolds are well tolerated by the host tissue, and do not negatively impact the left hindlimb locomotor function recovery. Therefore results herein presented suggest that PHB-HV scaffolds may be suitable for SCI treatment.

Biochemical and biophysical characterization of recombinant yeast proteasome maturation factor ump1.

Protein degradation is essential for maintaining cellular homeostasis. The proteasome is the central enzyme responsible for non-lysosomal protein degradation in eukaryotic cells. Although proteasome assembly is not yet completely understood, a number of cofactors required for proper assembly and maturation have been identified. Ump is a short-lived maturation factor required for the efficient biogenesis of the 20S proteasome. Upon the association of the two precursor complexes, Ump is encased and is rapidly degraded after the proteolytic sites in the interior of the nascent proteasome are activated. In order to further understand the mechanisms behind proteasomal maturation, we expressed and purified yeast Ump in E. coli for biophysical and structural analysis. We show that recombinant Ump is purified as a mixture of different oligomeric species and that oligomerization is mediated by intermolecular disulfide bond formation involving the only cysteine residue present in the protein. Furthermore, a combination of bioinformatic, biochemical and structural analysis revealed that Ump shows characteristics of an intrinsically disordered protein, which might become structured only upon interaction with the proteasome subunits.

Benefits of spine stabilization with biodegradable scaffolds in spinal cord injured rats.

Spine stabilization upon spinal cord injury (SCI) is a standard procedure in clinical practice, but rarely employed in experimental models. Moreover, the application of biodegradable biomaterials for this would come as an advantage as it would eliminate the presence of a nondegradable prosthesis within the vertebral bone. Therefore, in the present work, we propose the use of a new biodegradable device specifically developed for spine stabilization in a rat model of SCI. A 3D scaffold based on a blend of starch with polycaprolactone was implanted, replacing delaminated vertebra, in male Wistar rats with a T8-T9 spinal hemisection. The impact of spinal stabilization on the locomotor behavior was then evaluated for a period of 12 weeks. Locomotor evaluation--assessed by Basso, Beatie, and Bresnahan test; rotarod; and open field analysis--revealed that injured rats subjected to spine stabilization significantly improved their motor performance, including higher coordination and rearing activity when compared with SCI rats without stabilization. Histological analysis further revealed that the presence of the scaffolds not only stabilized the area, but also simultaneously prevented the infiltration of the injury site by connective tissue. Overall, these results reveal that SCI stabilization using a biodegradable scaffold at the vertebral bone level leads to an improvement of the motor deficits and is a relevant element for the successful treatment of SCI.

The secretome of stem cells isolated from the adipose tissue and Wharton jelly acts differently on central nervous system derived cell populations.

INTRODUCTION: It is hypothesized that administration of stromal/stem cells isolated from the adipose tissue (ASCs) and umbilical cord (HUCPVCs) can ameliorate the injured central nervous system (CNS). It is still not clear, however, whether they have similar or opposite effects on primary cultures of neuronal populations. The objective of the present work was to determine if ASCs and HUCPVCs preferentially act, or not, on specific cell populations within the CNS. METHODS: Primary cultures of hippocampal neurons were exposed to ASCs and HUCPVCs conditioned media (CM) (obtained 24, 48, 72 and 96 hours after three days of culture) for one week. RESULTS: Cell viability experiments (MTS (3-(4, 5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2(4-sulfophenyl)-2H tetrazolium) test) revealed that CM obtained from both cell populations at all time points did not cause any deleterious effects on neuronal cells. In fact, it was determined that whenever the ASCs CM were supplemented with basic fibroblast growth factor (bFGF) and B27, there was a significant increase in the metabolic viability and neuronal cell density of the cultures. On the other hand, in the absence of CM supplementation, it was the HUCPVCs secretome that had the highest impact on the metabolic viability and cell density. In an attempt to unveil which factors could be involved in the observed effects, a screening for the presence of bFGF, nerve growth factor (NGF), stem cell factor (SCF), hepatocyte growth factors (HGF) and vascular endothelial growth factor (VEGF) in the CM was performed. Results revealed the presence of all these factors in ASCs CM, except bFGF; in contrast, in HUCPVCs CM it was only possible to detect robust NGF expression. CONCLUSIONS: Overall, the results confirm important differences on the secretome of ASCs and HUCPVCs, which lead to distinct effects on the metabolic viability and neuronal cell densities in primary cultures of hippocampal neurons; however, the factor(s) that promote the stronger effect of the HUCPVCs CM in neuronal survival is(are) still to be identified.

Carboxymethylchitosan/poly(amidoamine) dendrimer nanoparticles in central nervous systems-regenerative medicine: effects on neuron/glial cell viability and internalization efficiency.

The applicability of CMCht/PAMAM dendrimer nanoparticles for CNS applications was investigated. AFM and TEM observations revealed that the nanoparticles possessed a nanosphere-like shape with a size from 22.0 to 30.7 nm. The nanoparticles could be bound to fluorescent-probe FITC for tracing purposes. Post-natal hippocampal neurons and cortical glial cells were both able to internalize the FITC-labeled CMCht/PAMAM dendrimer nanoparticles with high efficiency. The percentage of positive cells internalizing the nanoparticles varied, reaching a peak after 48 h of incubation. Further experiments for periods up to 7 d revealed that the periodical addition of FITC-labelled CMCht/PAMAM dendrimer nanoparticles was needed to maintain the overall percentage of cells internalizing them. Finally, it was also observed that cell viability was not significantly affected by the incubation of dendrimer nanoparticles.

Role of human umbilical cord mesenchymal progenitors conditioned media in neuronal/glial cell densities, viability, and proliferation.

It has been recently reported that mesenchymal progenitor/stem cells isolated from the Wharton's Jelly (WJ) of umbilical cords (UC) ameliorate the condition of animals suffering from central nervous system (CNS)-related conditions. However, little is known on the mechanisms that regulate these actions. Therefore, the objective of the present work was to determine how the conditioned media (CM) of a population of mesenchymal progenitors present in the UC WJ, known as human umbilical cord perivascular cells (HUCPVCs), regulate processes such as cell viability, survival, and proliferation of postnatal hippocampal neurons and glial cells. For this purpose primary hippocampal and cortical cultures of neurons and glial cells, respectively, were incubated with CM from HUCPVCs. Results revealed that HUCPVCs CM increase glial cell viability and proliferation. Furthermore, it was observed that glial cell cultures exhibited higher numbers of GFAP-positive cells (astrocytes) and O4-positive cells (oligodendrocytes) when incubated with the CM. Additionally, it was also observed that the growth factors presents in the CM did not induce an increase on the microglial cells number. For hippocampal neurons similar results were obtained, as cultures exposed to HUCPVCs CM disclosed higher numbers of MAP-2-positive cells. Moreover it was also observed that the cell viability and proliferation in this primary hippocampal cell culture system was also higher, when compared to control cultures. From these results it was possible to conclude that HUCPVCs release neuroregulatory factors that have a direct impact on the densities, viability, and proliferation of glial cells and hippocampal primary cultures.

Eficácia de um programa de dança para prevenir quedas entre idosos / Efficacy of a dance program in preventing falls among the elderly

s quedas e as fraturas influenciam na capacidade funcional dos idosos. O objetivo deste trabalho foi verificar a eficácia de um programa de dança para diminuir a incidência de quedas entre idosos e melhorar suas próprias avaliações subjetivas de saúde. O desenho metodológico foi um ensaio clínico controlado. A amostra incluiu 30 mulheres maiores de 60 anos, de nível socioeconômico baixo, moradoras de uma área central da cidade de Salvador, Bahia, Brasil. Não foram verificadas diferenças significativas entre os grupos em relação à incidência de quedas nem às avaliações subjetivas de saúde. Conclusivamente, encontrou-se que, para desenvolver ações destinadas a reduzir o risco de quedas, deve-se contemplar uma abordagem multidimensional do problema e não apenas observar os determinantes ligados à saúde física do indivíduo.