Pregnancy outcomes following in vitro fertilization frozen embryo transfer (IVF-FET) with or without preimplantation genetic testing for aneuploidy (PGT-A) in women with recurrent pregnancy loss (RPL): a SART-CORS study.

STUDY QUESTION: Can preimplantation genetic testing for aneuploidy (PGT-A) improve the live birth rate in patients with recurrent pregnancy loss (RPL)? SUMMARY ANSWER: PGT-A use was associated with improved live birth rates in couples with recurrent pregnancy loss undergoing frozen embryo transfer (IVF-FET). WHAT IS KNOWN ALREADY: Euploid embryo transfer is thought to optimize outcomes in some couples with infertility. There is insufficient evidence, however, supporting this approach to management of recurrent pregnancy loss. STUDY DESIGN, SIZE, DURATION: This study included data collected by the Society of Assisted Reproductive Technologies Clinical Outcomes Reporting System (SART-CORS) for IVF-FET cycles between years 2010 through 2016. A total of 12 631 FET cycles in 10 060 couples were included in this analysis designed to assess the utility of PGT-A in couples with RPL undergoing FET, including 4287 cycles in couples with tubal disease who formed a control group. PARTICIPANTS/MATERIALS, SETTING, METHODS: The experimental group included couples with RPL (strictly defined as a history of 3 or more pregnancy losses) undergoing FET with or without PGT-A. The primary outcome was live birth rate. Secondary outcomes included rates of clinical pregnancy, spontaneous abortion, and biochemical pregnancy loss. Differences were analyzed using generalized estimating equations logistic regression models to account for multiple cycles per patient. Covariates included in the model were age, gravidity, geographic region, race/ethnicity, smoking history, and indication for assisted reproductive technologies. Analyses were stratified for age groups as defined by SART: <35 years, 35-37 years, 38-40 years, 41-42 years, and >42 years. MAIN RESULTS AND THE ROLE OF CHANCE: In women with a diagnosis of RPL, the adjusted odds ratio (OR) comparing IVF-FET with PGT-A versus without PGT-A for live birth outcome was 1.31 (95% CI: 1.12, 1.52) for age <35 years, 1.45 (95% CI: 1.21, 1.75) for ages 35-37 years, 1.89 (95% CI: 1.56, 2.29) for ages 38-40, 2.62 (95% CI: 1.94-3.53) for ages 41-42, and 3.80 (95% CI: 2.52, 5.72) for ages >42 years. For clinical pregnancy, the OR was 1.26 (95% CI: 1.08, 1.48) for age <35 years, 1.37 (95% CI: 1.14, 1.64) for ages 35-37 years, 1.68 (95% CI: 1.40, 2.03) for ages 38-40 years, 2.19 (95% CI: 1.65, 2.90) for ages 41-42, and 2.31 (95% CI: 1.60, 3.32) for ages >42 years. Finally, for spontaneous abortion, the OR was 0.95 (95% CI: 0.74, 1.21) for age <35 years, 0.85 (95% CI: 0.65, 1.11) for ages 35-37 years, 0.81 (95% CI: 0.60, 1.08) for ages 38-40, 0.86 (95% CI: 0.58, 1.27) for ages 41-42, and 0.58 (95% CI: 0.32, 1.07) for ages >42 years. LIMITATIONS, REASONS FOR CAUTION: The retrospective collection of data including only women with recurrent pregnancy loss undergoing FET presents a limitation of this study, and results may not be generalizable to all couples with recurrent pregnancy loss. Also, data regarding evaluation and treatment for RPL for the included women is unavailable. WIDER IMPLICATIONS OF THE FINDINGS: This is the largest study to date assessing the utility of PGT-A in women with RPL. PGT-A was associated with improvement in live birth and clinical pregnancy in women with RPL, with the largest difference noted in the group of women with age greater than 42 years. Couples with RPL warrant counseling on all management options to reduce subsequent miscarriage, which may include IVF with PGT-A for euploid embryo selection. STUDY FUNDING/COMPETING INTEREST(S): There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: N/A.

First report of fatal autochthonous angiostrongylosis in a dog in Greece.

Canine angiostrongylosis caused by Angiostrongylus vasorum is a life-threatening disease which is emerging in regions of Europe. Thus, there is the merit for a continuous epidemiological surveillance in dog populations. This is the first description of a clinical autochthonous case of canine angiostrongylosis in Greece. A 7-month-old, male, mixed-breed dog was presented with progressively worsening anorexia, respiratory distress, coughing, bleeding diathesis and succumbed four days post admission. Gross post mortem examination revealed numerous nodular fistulated lesions in the lungs, and pulmonary cytology and histopathology showed a verminous pyogranulomatous pneumonia. The definitive diagnosis was based on the morphological identification of first stage larvae (L1) retrieved in the feces by the Baermann method, the detection of the circulating antigen by an in-clinic test and the molecular identification of L1. This report underlines the epidemiological and clinical implications, as well as the infection risks when the index of clinical suspicion is low and the disease is unexpected in a country.

Real-world efficacy and safety of lenvatinib: data from a compassionate use in the treatment of radioactive iodine-refractory differentiated thyroid cancer patients in Italy.

BACKGROUND: Lenvatinib is a multi-kinase inhibitor approved for patients with radioactive iodine (RAI)-resistant differentiated thyroid cancer (DTC). Before the drug approval from the Italian National Regulatory Agency, a compassionate use programme has been run in Italy. This retrospective study aimed to analyse data from the first series of patients treated with lenvatinib in Italy. METHODS: The primary aim was to assess the response rate (RR) and progression-free survival (PFS). Secondary end-points include overall survival (OS) and toxicity data. RESULTS: From November 2014 to September 2016, 94 patients were treated in 16 Italian sites. Seventeen percent of patients had one or more comorbidities, hypertension being the most common (60%). Ninety-eight percent of patients were treated by surgery, followed by RAI in 98% of cases. Sixty-four percent of patients received a previous systemic treatment. Lenvatinib was started at 24 mg in 64 subjects. Partial response and stable disease were observed in 36% and in 41% of subjects, respectively; progression was recorded in 14% of patients. Drug-related side-effects were common; the most common were fatigue (13.6%) and hypertension (11.6%). Overall, median PFS and OS were 10.8 months (95% confidence interval [CI], 7.7-12.6) and 23.8 months (95% CI, 19.7-25.0) respectively. CONCLUSION: Lenvatinib is active and safe in unselected, RAI-refractory, progressive DTC patients in real-life setting. RR and PFS seem to be less favourable than those observed in the SELECT trial, likely due to a negative selection that included heavily pretreated patients or with poor performance status.

Long-term efficacy and safety of fourth-line multikinase inhibitor treatment with lenvatinib in a young papillary thyroid carcinoma patient.

Lenvatinib, a multikinase inhibitor, is approved for the treatment of patients with radioiodine-refractory metastatic thyroid cancer on the basis of a Phase III, prospective, double-blind, randomized, placebo-controlled trial that showed longer progression-free survival in the drug-treated arm. Here, we report the case of a young papillary thyroid cancer patient, pretreated with three other kinase inhibitors, who achieved a long-term clinical benefit from lenvatinib in the fourth-line setting.

Osteoblastic protein tyrosine phosphatases inhibition and connexin 43 phosphorylation by alendronate.

Bisphosphonates (BPs), potent inhibitors of bone resorption which inhibit osteoclasts, have also been shown to act on osteocytes and osteoblasts preventing apoptosis via connexin (Cx) 43 hemichannels and activating the extracellular signal regulated kinases ERKs. We previously demonstrated the presence of a saturable, specific and high affinity binding site for alendronate (ALN) in osteoblastic cells which express Cx43. However, cells lacking Cx43 also bound BPs. Herein we show that bound [(3)H]-alendronate is displaced by phosphatase substrates. Moreover, similar to Na3VO4, ALN inhibited the activity of transmembrane and cytoplasmic PTPs, pointing out the catalytic domain of phosphatases as a putative BP target. In addition, anti-phospho-tyrosine immunoblot analysis revealed that ALN stimulates tyrosine phosphorylation of several proteins of whole cell lysates, among which the major targets of the BP could be immunochemically identified as Cx43. Additionally, the transmembrane receptor-like PTPs, RPTPµ and RPTPα, as well as the cytoplasmic PTP1B, are highly expressed in ROS 17/2.8 cells. Furthermore, we evidenced that Cx43 interacts with RPTPµ in ROS 17/2.8 and ALN decreases their association. These results support the hypothesis that BPs bind and inhibit PTPs associated to Cx43 or not, which would lead to the activation of signaling pathways in osteoblasts.

Preparation of spiked grass for use as an environmental radioactivity reference material.

Measurement of radionuclides from environmental samples includes a wide variety of matrix compositions and densities. To improve the traceability of environmental monitoring, LNE-LNHB intends to produce mixed γ-ray reference materials with a known mass activity and a composition as representative as possible of real environmental samples. This paper describes the preparation and characterization of a low density treated grass matrix spiked with mixed γ-emitters. This material was used in a proficiency test exercise whose results are presented.

Cobalt chloride induces metaphase when topically applied to larvae and pupae of the stingless bee Melipona scutellaris (Hymenoptera, Apidae, Meliponini).

In order to optimize preparations of bee metaphases, we tested cobalt chloride, which has been used as a metaphase inducer in other organisms, such as hamsters and fish. Four microliters of 65 mM cobalt chloride aqueous solution was topically applied to larval and pupal stages of the stingless bee Melipona scutellaris. The cerebral ganglion was removed after treatment and prepared for cytogenetic analysis. Identically manipulated untreated individuals were used as controls. The number of metaphases was increased 3-fold in treated individuals compared to controls. The micronucleus test showed no mutagenic effects of cobalt chloride on M. scutellaris cells. We concluded that cobalt chloride is a metaphase-inducing agent in M. scutellaris, thus being useful for cytogenetic analyses.

Human exposure to lead, cadmium and mercury through fish and seafood product consumption in Italy: a pilot evaluation.

The presence of selected toxic heavy metals, such as cadmium (Cd), lead (Pb) and mercury (Hg), was investigated in fish and seafood products, namely, blue mussel, carpet shell clam, European squid, veined squid, deep-water rose shrimp, red mullet, European seabass, gilthead seabream, Atlantic cod, European hake, Atlantic bluefin tuna and swordfish so as to assess their human exposure through diet. Metals were detected by quadrupole inductively coupled plasma mass spectrometry (Q-ICP-MS) and hydride generation atomic absorption spectrometry (Hg-AAS). Measurements of Cd, Pb and Hg were performed by means of analytical methods validated in compliance with UNI CEI EN ISO/IEC 17025 [2005. General requirements for the competence of testing and calibration laboratories. Milano (Italy): UNI Ente Nazionale Italiano di Unificazione]. The exposure assessment was undertaken matching the levels of Cd, Pb and total Hg with consumption data related to fish and seafood products selected for this purpose. In order to establish human health implications, the estimated weekly intakes (EWIs) for Cd, Pb and Hg were compared with the standard tolerable weekly intakes (TWI) for Cd and provisional tolerable weekly intakes (PTWIs) for Pb and Hg stipulated by the European Food Safety Authority (EFSA) and the Food and Agriculture Organization/World Health Organization (FAO/WHO) Joint Expert Committee on Food Additives (JECFA). The found metal concentrations were largely below the maximum levels (MLs) established at the European Union level with the exception of Cd. This metal exceeded the MLs in squid, red mullet, European hake and Atlantic cod. Squid and blue mussel showed the highest Pb concentrations which accounted for 60% and 10% of the MLs, respectively. Highest Hg levels were found in predatory fish. The concentrations of Hg in swordfish, Atlantic bluefin tuna and red mullet accounted for 50%, 30% and 30% of the MLs, respectively. The EWIs for Cd, Pb and Hg related to the consumption of fish and seafood products by the median of the Italian total population accounted for 20%, 1.5% and 10% of the standard TWI for Cd as well as PTWIs for Pb and Hg, respectively. Furthermore, the EWIs estimated using consumption data concerning Italian consumers did not exceed the standard TWI and PTWIs, except for Cd at 95th percentile.

Role of connexin 43 in the mechanism of action of alendronate: dissociation of anti-apoptotic and proliferative signaling pathways.

Bisphosphonates (BPs) inhibit osteocyte and osteoblast apoptosis via opening of connexin (Cx) 43 hemichannels and activating the extracellular signal regulated kinases ERKs. Previously, we hypothesized that intracellular survival signaling is initiated by interaction of BPs with Cx43. However, using whole cell binding assays with [(3)H]-alendronate, herein we demonstrated the presence of saturable, specific and high affinity binding sites in the Cx43-expressing ROS 17/2.8 osteoblastic cells, authentic osteoblasts and MLO-Y4 cells expressing Cx43 or not, as well as in HeLa cells lacking Cx43 expression and ROS 17/2.8 cells pretreated with agents that disassemble Cx channels. In addition, both BPs and the PTP inhibitor Na(3)VO(4) increased proliferation of cells expressing Cx43 or not. Furthermore, although BPs are internalized and inhibit intracellular enzymes in osteoclasts, whether the drugs penetrate non-resorptive bone cells is not known. To clarify this, we evaluated the osteoblastic uptake of AF-ALN, a fluorescently labeled analog of alendronate. AF-ALN was rapidly internalized in cells expressing Cx43 or not indicating that this process is not mediated via Cx43 hemichannels. Altogether, these findings suggest that although required for triggering intracellular survival signaling by BPs, Cx43 is dispensable for cellular BP binding, its uptake, as well as the proliferative effects of these agents.

Validação do procedimento operacional padrão (POP) de colheita de alimentos importados / Validation of the operational procedure standard (SOP) of imported food

O objetivo desse trabalho foi avaliar o Procedimento Operacional Padrão (POP) de colheita de alimentos importados para verificar a sua legitimidade como instrumento nas ações de vigilância sanitária. O POP visa o controle e a certificação da qualidade dos alimentos importados e foi elaborado por técnicos da Coordenação de Vigilância Sanitária de Portos, Aeroportos e Fronteiras do Estado de São Paulo (CVSPAF/SP) , sendo revisado, juntamente, com a equipe técnica da Divisão de Bromatologia e Química, do Instituto Adolfo Lutz, de São Paulo (IAL/SP). A validação do POP foi realizada na avaliação das condições higiênico-sanitárias de 17 ingredientes e 10 aditivos, produtos alimentícios importados, armazenados numa Estação Aduaneira Interior – EADI, do Estado de São Paulo, que sofreu intempérie decorrente de forte tempestade, com possibilidade de comprometimento da integridade desses produtos.(...) A elaboração desse POP estabeleceu uma adoção de medidas rigorosas, com base legal que garantem a correta ação da vigilância sanitária para a certificação da qualidade dos produtos alimentícios importados.

On the variation of the 210Po half-life at low temperature.

Experiments were performed to verify the possible influence of the temperature and source matrix on the half-life of (210)Po. Since the precise measurement of the activity of an alpha-emitting source at cryogenic temperature is far from trivial, a simpler approach was used: the activity of a (210)Po source was measured at ambient temperature, but in between the measurements, the source was cooled down during a few weeks in a liquid helium Dewar. A (210)Po solid source was prepared by electro-deposition on a silver plate. The activity of this source was first measured at room temperature, using the defined solid angle alpha measurement method. The source was then placed in a specific gastight container inside a liquid helium bath at 4 K during 28 days. Then the source was heated up and measured again using the same instrument in the same geometric conditions. The same experiment was repeated with the source coated with a thin layer of silver, in order to be sure that the radioactive material was fully embedded inside the metallic matrix. Our experiments showed no evidence of (210)Po half-life change at low temperature. A reduction of the half-life of (210)Po by 6.3% at low temperature, as claimed by Raiola et al. (2007), would have lead to a decay-corrected activity reduction of about 1% after 29 days, which would have been easily detectable. The paper describes the steps of this experiment and gives a detailed uncertainty budget for the measurements. The half-life of (210)Po obtained in each measurement is compared with the evaluated value of (138.3763+/-0.0017) d.

Immunogenicity of advanced glycation end products in diabetic patients and in nephropathic non-diabetic patients on hemodialysis or after renal transplantation.

Advanced glycation end products (AGE) increase as a consequence of diabetic hyperglycemia and, in nephropathic patients, following renal function loss. Protein-bound AGE behave as immunogens, inducing formation of specific antibodies (Ab-AGE). In this work AGE immunogenicity was studied in 42 diabetic patients, 26 nephropathic patients on hemodialysis and 26 patients with end-stage renal disease who underwent kidney transplantation and in 20 normal subjects. Non-oxidation-derived AGE (nox-AGE), oxidation-derived AGE (ox-AGE) and Ab-AGE were measured by competitive or direct enzyme-linked immunosorbent assay (ELISA) and circulating immune complexes (CIC) by C1q ELISA. Nox- AGE increased significantly in all patient groups (p < or = 0.05 to < or = 0.0001) except in patients on hemodialysis for less than 6 yr. Ox-AGE were only significantly increased in patients transplanted more than 3 yr previously (p < 0.05). Ab-AGE were significantly lower than controls in both diabetic groups and in patients on hemodialysis for more than 6 yr (p < 0.005 to < 0.0001) and not unlike controls in the other groups. These results demonstrate that hemodialysis or renal transplantation can, initially, reduce either nox- or ox-AGE levels, which however go back to being high in time. Renal transplantation fails to normalize nox-AGE. More importantly, plasma Ab-AGE levels are reduced or unchanged in all patient groups in comparison with controls, despite higher circulating AGE levels. This suggests the importance of tissue-bound AGE as Ab-AGE targets. Additional interventions are needed to control AGE levels in treated nephropathic patients. The search and quantification of specific Ab-AGE would give more meaningful results if performed over specific tissue specimens.

Comparative study of two drying techniques used in radioactive source preparation: freeze-drying and evaporation using hot dry nitrogen jets.

Quantitative solid sources are used widely in the field of radionuclide metrology. With the aim to improve the detection efficiency for electrons and x-rays, a comparative study between two source drying techniques has been undertaken at LNE-Laboratoire National Henri Becquerel (LNE-LNHB, France). In this paper, freeze-drying using commercial equipment is compared with a system of drying using hot jets of nitrogen developed at Institute for Reference Materials and Measurements (IRMM, Belgium). In order to characterize the influence of self-absorption, the detection efficiencies for (51)Cr sources have been measured by coincidence counting and photon spectrometry.

Evolutionary cytogenetics of the Hoplias lacerdae, Miranda Ribeiro, 1908 group: a particular pathway concerning the other Erythrinidae fish

The taxonomy/systematics of the Erythrinidae fish is still imprecise, with several doubts on their relationships. Karyotypes and chromosomal characteristics of some species of the Hoplias lacerdae group (Erythrinidae), from different Brazilian hydrographic basins and pisciculture stations, were analyzed in the present study, using conventional Giemsa staining, C-banding, silver staining, Mithramycin and Distamycin/DAPI fluorochromes, and fluorescent in situ hybridization (FISH). A diploid chromosome number of 2n = 50 and karyotypes composed of meta- and submetacentric chromosomes without sex-related differences were found. Only one active NOR (Nucleolar Organizer Region) site was found, which was identified by silver staining (Ag-NOR) and FISH, located on the chromosome pair 11, although additional 45S rDNA sites were also mapped on other chromosome pairs only by FISH. The Ag-NOR of the chromosome pair 11 was found to be GC-rich, appearing positive after Mithramycin staining. Mithramycin-positive/DAPI-negative sites were also observed in the centromeric/pericentomeric regions of the chromosome pairs 4, 6, 15, and 19, which have also affinity to silver nitrate. However, these four sites were not detected by FISH with the rDNA probe, indicating to be only argentophilic GC-rich heterochromatic regions. Chromosome data show that the karyotype evolution in Hoplias lacerdae group is relatively conserved and follows a particular pathway concerning the other Erythrinidae fishes, such as Hoplias malabaricus, Hoplerythrinus unitaeniatus, and Erythrinus erythrinus, in which polytypic karyotypes are found. Thus, the H. lacerdae group shows chromosome features that are not closely related to those of the congeneric H. malabaricus group. These finds, together with genetic and morphologic data, are important tools to be considered in a major revision of the Erythrinidae family, as well as for conservation programs.

A taxonomia dos Erythrinidae encontra-se ainda por ser totalmente esclarecida, existindo várias dúvidas sobre suas relações filogenéticas. No presente estudo, foram analisados os cariótipos e características cromossômicas de algumas espécies do grupo Hoplias lacerdae (Erythrinidae), de diferentes bacias hidrográficas do Brasil e estações de piscicultura, empregando-se a coloração Giemsa convencional, bandamento C, coloração com nitrato de prata, fluorocromos Mitramicina e Distamicina/DAPI, e hibridação fluorescente in situ (FISH). O número diplóide de 2n = 50 cromossomos foi constante, sendo os cariótipos formados por cromossomos de dois braços, meta- e submetacêntricos, sem diferenciação relacionada ao sexo. Foi identificado apenas um sítio ativo de região organizadora de nucléolo (NOR), presente no par cromossômico no. 11, identificado tanto pela coloração com nitrato de prata (Ag-NOR) como por FISH com sonda de DNAr 45S, embora alguns sítios adicionais de DNAr tenham sido identificados em outros pares de cromossomos, apenas por FISH. O sítio de Ag-NOR no cromossomo 11 mostrou-se rico em pares de bases GC, sendo Mitramicina-positivo. Sítios Mitramicina-positivos/DAPI-negativos foram igualmente observados nas regiões centroméricas/pericentroméricas dos pares cromossômicos 4, 6, 15 e 19, os quais mostraram também afinidade pelo nitrato de prata. Contudo, estes quatro sítios não foram evidenciados por FISH com sonda de DNAr 45S, indicando serem somente regiões de heterocromatina GC-rica, com afinidade pela prata. Os dados cromossômicos mostram que a evolução cariotípica no grupo Hoplias lacerdae é relativamente conservada e segue um comportamento particular em relação aos outros eritrinídeos, como Hoplias malabaricus, Hoplerythrinus unitaeniatus e Erythrinus erythrinus, nos quais foram encontrados cariótipos politípicos. Assim sendo, o grupo H. lacerdae mostra características cromossômicas discordantes daquelas evidenciadas pelo grupo...

Experience at Italian National Institute of Health in the quality control in telemedicine: tools for gathering data information and quality assessing.

The authors proposed a set of tools and procedures to perform a Telemedicine Quality Control process (TM-QC) to be submitted to the telemedicine (TM) manufacturers. The proposed tools were: the Informative Questionnaire (InQu), the Classification Form (ClFo), the Technical File (TF), the Quality Assessment Checklist (QACL). The InQu served to acquire the information about the examined TM product/service; the ClFo allowed to classify a TM product/service as belonging to one application area of TM. The TF was intended as a technical dossier of product and forced the TM supplier to furnish the only requested documentation of its product, so to avoid redundant information. The QACL was a checklist of requirements, regarding all the essential aspects of the telemedical applications, that each TM products/services must be met. The final assessment of the TM product/service was carried out via the QACL, by computing the number of agreed requirements: on the basis of this computation, a Quality Level (QL) was assigned to the telemedical application. Seven levels were considered, ranging from the Basic Quality Level (QL1-B) to the Excellent Quality Level (QL7-E). The TM-QC process resulted a powerful tool to perform the quality control of the telemedical applications and should be a guidance to all the TM practitioners, from the manufacturers to the expert evaluators. The quality control process procedures proposed thus could be adopted in future as routine procedures and could be useful in the assessing the TM delivering into the National Health Service versus the traditional face to face healthcare services.

Experience at Italian National Institute of Health in the assessment of the quality in telemedicine: submission to a quality control process.

For applying a quality control of the telemedicine (TM) applications, in order to prevent device and/or service failure and to standardize some features of TM applications, a telemedicine quality control (TM-QC) process was proposed by authors. This TM-QC process was submitted to some TM manufacturers in order to assess their products/services and applied in two following phases, during which a set of procedures and tools were delivered to the TM suppliers. In the 1 degrees phase an Informative Questionnaire (InQu) and the Classification Form (ClFo) were delivered: the InQu gathered all the relevant information about the TM application in exam, the ClFo classified the TM product as belonging to one category (or application area) of TM. In the 2nd phase a Technical File (TF) and a Quality Assessment CheckList (QACL) were delivered: the TF was intended as a technical dossier of product; the QACL was a checklist of requirements that TM products must be agreed. The number of met requirements was computed and a Quality Level (QL), ranging from Basic Quality Level (QL1-B) to the Excellent Quality Level (QL7-E), was assigned to the examined TM products. The tested TM products presented in this paper, reached at least the minimum quality level (QL1-B). The TM-QC process allowed the definition of standardized quality levels for the TM products/services and the proposed procedures should be useful for promoting the using of standardized TM applications, so to speed up the integration process into the National Health Service.

Management of fluid balance in continuous renal replacement therapy: technical evaluation in the pediatric setting.

Fluid overload control and fluid balance management represent very important factors in critically ill children requiring renal replacement therapy. A relatively high fluid volume administration in children and neonates is often necessary to deliver adequate amounts of blood derivatives, vasopressors, antibiotics, and parenteral nutrition. Fluid balance errors during pediatric continuous renal replacement therapy (CRRT) might significantly impact therapy delivery and have been described as potentially lethal. The aim of this study was to evaluate the accuracy of delivered vs. prescribed net ultrafiltration (UF) during CRRT applied to 2 neonates and 2 small children, either as dialytic treatment alone or during extracorporeal membrane oxygenation (ECMO). In accordance with an Acute Dialysis Quality Initiative workgroup statement, net UF was defined as the ""overall amount of fluid extracted from the patient in a given time"". Mean prescribed net UF was 18.5 ml/h (SD=6.7) during neonatal treatments and 70.3 ml/h (SD=22.5) during CRRT in small children. Daily net UF ranged from 200 mL to about 600 mL in the 2 neonates and from 1,200 to 1800 mL in the 2 children. The percentage error of delivered net UF ranged from -1.6% to 5.8% of the prescribed level. The mean error of the ECMO/CRRT patients was 3.024 ml/h vs. 0.45 m/h for the CRRT patients (p<0.001). The same difference was not evident when the 2 neonates were compared with the 2 small children (without considering the presence of ECMO). CRRT and net UF delivery appeared to be accurate, safe, and effective in this small cohort of high-risk pediatric patients.

Evolutionary cytogenetics of the Hoplias lacerdae, Miranda Ribeiro, 1908 group: a particular pathway concerning the other Erythrinidae fish

The taxonomy/systematics of the Erythrinidae fish is still imprecise, with several doubts on their relationships. Karyotypes and chromosomal characteristics of some species of the Hoplias lacerdae group (Erythrinidae), from different Brazilian hydrographic basins and pisciculture stations, were analyzed in the present study, using conventional Giemsa staining, C-banding, silver staining, Mithramycin and Distamycin/DAPI fluorochromes, and fluorescent in situ hybridization (FISH). A diploid chromosome number of 2n = 50 and karyotypes composed of meta- and submetacentric chromosomes without sex-related differences were found. Only one active NOR (Nucleolar Organizer Region) site was found, which was identified by silver staining (Ag-NOR) and FISH, located on the chromosome pair 11, although additional 45S rDNA sites were also mapped on other chromosome pairs only by FISH. The Ag-NOR of the chromosome pair 11 was found to be GC-rich, appearing positive after Mithramycin staining. Mithramycin-positive/DAPI-negative sites were also observed in the centromeric/pericentomeric regions of the chromosome pairs 4, 6, 15, and 19, which have also affinity to silver nitrate. However, these four sites were not detected by FISH with the rDNA probe, indicating to be only argentophilic GC-rich heterochromatic regions. Chromosome data show that the karyotype evolution in Hoplias lacerdae group is relatively conserved and follows a particular pathway concerning the other Erythrinidae fishes, such as Hoplias malabaricus, Hoplerythrinus unitaeniatus, and Erythrinus erythrinus, in which polytypic karyotypes are found. Thus, the H. lacerdae group shows chromosome features that are not closely related to those of the congeneric H. malabaricus group. These finds, together with genetic and morphologic data, are important tools to be considered in a major revision of the Erythrinidae family, as well as for conservation programs.

A taxonomia dos Erythrinidae encontra-se ainda por ser totalmente esclarecida, existindo várias dúvidas sobre suas relações filogenéticas. No presente estudo, foram analisados os cariótipos e características cromossômicas de algumas espécies do grupo Hoplias lacerdae (Erythrinidae), de diferentes bacias hidrográficas do Brasil e estações de piscicultura, empregando-se a coloração Giemsa convencional, bandamento C, coloração com nitrato de prata, fluorocromos Mitramicina e Distamicina/DAPI, e hibridação fluorescente in situ (FISH). O número diplóide de 2n = 50 cromossomos foi constante, sendo os cariótipos formados por cromossomos de dois braços, meta- e submetacêntricos, sem diferenciação relacionada ao sexo. Foi identificado apenas um sítio ativo de região organizadora de nucléolo (NOR), presente no par cromossômico no. 11, identificado tanto pela coloração com nitrato de prata (Ag-NOR) como por FISH com sonda de DNAr 45S, embora alguns sítios adicionais de DNAr tenham sido identificados em outros pares de cromossomos, apenas por FISH. O sítio de Ag-NOR no cromossomo 11 mostrou-se rico em pares de bases GC, sendo Mitramicina-positivo. Sítios Mitramicina-positivos/DAPI-negativos foram igualmente observados nas regiões centroméricas/pericentroméricas dos pares cromossômicos 4, 6, 15 e 19, os quais mostraram também afinidade pelo nitrato de prata. Contudo, estes quatro sítios não foram evidenciados por FISH com sonda de DNAr 45S, indicando serem somente regiões de heterocromatina GC-rica, com afinidade pela prata. Os dados cromossômicos mostram que a evolução cariotípica no grupo Hoplias lacerdae é relativamente conservada e segue um comportamento particular em relação aos outros eritrinídeos, como Hoplias malabaricus, Hoplerythrinus unitaeniatus e Erythrinus erythrinus, nos quais foram encontrados cariótipos politípicos. Assim sendo, o grupo H. lacerdae mostra características cromossômicas discordantes daquelas evidenciadas pelo grupo congenérico H. malabaricus. Estes dados, juntamente com os outros dados genéticos e morfológicos, constituem ferramentas importantes a serem consideradas em uma revisão ampla da família Erythrinidae, assim como para programas de conservação.

Evolutionary cytogenetics of the Hoplias lacerdae, Miranda Ribeiro, 1908 group. A particular pathway concerning the other Erythrinidae fish.

The taxonomy/systematics of the Erythrinidae fish is still imprecise, with several doubts on their relationships. Karyotypes and chromosomal characteristics of some species of the Hoplias lacerdae group (Erythrinidae), from different Brazilian hydrographic basins and pisciculture stations, were analyzed in the present study, using conventional Giemsa staining, C-banding, silver staining, Mithramycin and Distamycin/DAPI fluorochromes, and fluorescent in situ hybridization (FISH). A diploid chromosome number of 2n = 50 and karyotypes composed of meta- and submetacentric chromosomes without sex-related differences were found. Only one active NOR (Nucleolar Organizer Region) site was found, which was identified by silver staining (Ag-NOR) and FISH, located on the chromosome pair 11, although additional 45S rDNA sites were also mapped on other chromosome pairs only by FISH. The Ag-NOR of the chromosome pair 11 was found to be GC-rich, appearing positive after Mithramycin staining. Mithramycin-positive/DAPI-negative sites were also observed in the centromeric/pericentomeric regions of the chromosome pairs 4, 6, 15, and 19, which have also affinity to silver nitrate. However, these four sites were not detected by FISH with the rDNA probe, indicating to be only argentophilic GC-rich heterochromatic regions. Chromosome data show that the karyotype evolution in Hoplias lacerdae group is relatively conserved and follows a particular pathway concerning the other Erythrinidae fishes, such as Hoplias malabaricus, Hoplerythrinus unitaeniatus, and Erythrinus erythrinus, in which polytypic karyotypes are found. Thus, the H. lacerdae group shows chromosome features that are not closely related to those of the congeneric H. malabaricus group. These finds, together with genetic and morphologic data, are important tools to be considered in a major revision of the Erythrinidae family, as well as for conservation programs.