Dotações seguras de enfermagem em cuidados continuados / Safe nursing appropriations in long-term care

Introdução: Assistimos nos dias de hoje a um aumentado a esperança média de vida, a prevalência de doenças crónicas incapacitantes, a necessidade de cuidados de saúde, a necessidade de continuidade de cuidados, o que traz uma exigência em cuidados de enfermagem ainda pouco estudada particularmente de dotações segurança. Objetivos: Analisar as necessidades em cuidados de enfermagem em doentes internados em cuidados continuados de longa duração; Descrever as caracteristicas dos doentes internados em unidades de longa duração; Analisar as necessidades dos doentes face às suas características. Com este estudo pretendemos Contribuir para a criação de um instrumento de classificação de utentes por grau de dependência em cuidados de enfermagem em utentes internados em unidades de longa duração. Metodologia: O estudo é de natureza quantitativo , de carater descritivo e exploratório. A amostra será de natureza não probabilística intencional, constituída por pessoas internadas numa unidade de cuidados continuados de longa duração e manutenção. Foram analisados 81 casos que estavam internados no período de 26/03/2021 a 01/04/2021 durante 7 dias de internamente. Resultados e Conclusões: Maioritariamente nas unidades de cuidados continuados de longa duração existem homens com idades compreendidas entre os 61-70 anos. Com o estudo foi possivel perceber que a patologia com maior representação foi a Doença Vascular (29.6%), seguida da Doença Neurologica (23.5%), as duas doenças juntas totalizam mais de metade da amostra. As necessidades mais frequentes de cuidados são eles, a necessidade de ajuda total na higiene (48.6%); a necessidade de ajuda total >7xdia no movimento (20.9%); a necessidade de ajuda total na eliminação (68.1%); necessiade de administração de terapêutica via oral, rectal, vaginal, aplicação tópica 3-4x dia (94.7%) e a necessidade de cuidados às feridas/execução de pensos (10.2%). O tempo médio de cuidados de enfermagem necessários para cuidar de utentes internados em unidades de longa duração é de 4,282 , sendo que as recomendações da ordem apontam para 5,23 nas unidades de convalescença, 4 para as unidades de longa duração e manutenção (Ordem dos Enfermeiros, 2014), esta proximidade de valores leva-nos a questionar se a qualidade dispensada está ajustada ás expectativas dos clientes (doentes e familiares). A adequação das dotações de enfermagem ao número de utentes e ao grau de depndêcia dos mesmos, garante uma maior proximidade dos doentes, logo uma prestação de cuidados com segurança e qualidade.

Introduction: The population ageing characterizing the last 40 years has been resulting in severe changes in societies. In fact, taking into account the increasing average life expectancy, the prevalence of disabling chronic diseases, the need for health care, the need for continuity of care, as well as an intermediate response between the community and the hospital environment, long-term care is a current reality. And since nursing is a discipline present in long-term care units, there is a direct impact of nursing care on patient safety. Objectives: Analyze the nursing care needs of patients institutionalized in long-term care units; Describe the characteristics of patients institutionalized in long-term units; Analyze the patients' needs according to their characteristics. With this study, we aim at building an instrument for the classification of users of long-term units in terms of their degree of dependence in nursing care. Methodology: This is a quantitative, descriptive and exploratory study. The sample used is a non-probabilistic intentional sample, consisting of patients institutionalized in a long-term and maintenance care unit. Cases under study are the ones institutionalized between 26/03/2021 and 01/04/2021. The analysis was limited to 7 days of hospitalization, since it is considered that changes are slow. Results and Conclusions: Mostly in long-term care units there are men aged between 61-70 years. With the study, it was possible to perceive that the pathology with the highest representation was Vascular Disease (29.6%), followed by Neurological Disease (23.5%), the two diseases together total more than half of the sample. The most frequent care needs are, the need for total help with hygiene (48.6%); the need for total assistance >7xday in movement (20.9%); the need for total elimination assistance (68.1%); need for oral, rectal, vaginal, topical application 3-4x daily (94.7%) and need for wound care/dressing (10.2%). The average time of nursing care needed to care for patients hospitalized in long-term units is 4.282 , with the recommendations of the order pointing to 5.23 in convalescent units, 4 for long-term and maintenance units (Order of nurse, 2014), this proximity of values leads us to question whether the quality provided is adjusted to the expectations of clients (patients and family members). The adequacy of nursing staff to the number of users and their degree of dependence ensures greater proximity to patients, thus providing care with safety and quality.

Short communication: Feasibility of dengue vaccine to infect different human cell lines: An alternative potency test using HEK293T cells.

Dengue is caused by an arbovirus that belongs to the Flaviviridae family and there are four distinct, but close related, circulating serotypes. Dengue disease is of great importance for global public health, with vaccination being its main prophylactic measure. However, there is a paucity of biological models for evaluating tetravalent dengue vaccines. The aim of this study was to evaluate the susceptibility of human cell lines HEK293T and THP-1 to a commercial dengue vaccine and test the feasibility of this approach in the development of a potency assay with human cell lines, as a methodological alternative to the golden standard potency assay with VERO cells. In this context, we used a batch of the commercial vaccine Dengvaxia® (CYD-TDV) for the infection tests. We evaluated the presence of the vaccine virus in THP-1 cells, differentiated into macrophages (dTHP-1), and in HEK293T by confocal microscopy, using 4G2 pan-flavivirus antibody. Vaccine infectivity and potency were determined by immunocolorimetric assay using monoclonal antibodies specific for each serotype. The results indicated that the human strain HEK293T was responsive to the tetravalent vaccine, as shown by the presence of virus particles in the cell cytoplasm in a pattern similar to the one observed with VERO cells. Moreover, it was possible to determine the infectivity and potency values of each vaccine virus serotype in the HEK293T, with serotype 4 prevailing over the others. Thus, the human cell line HEK293T provides a potential candidate to be used in assays to determine potency and identity of tetravalent dengue vaccines.

A protocol for rapid monocyte isolation and generation of singular human monocyte-derived dendritic cells.

The monocyte-derived dendritic cells (moDCs) are a subset of dendritic cells widely used in immunological studies as a convenient and easy approach after isolation of mononuclear cells directly from peripheral blood mononuclear cells (PBMC). Both the purification and cell culture of monocytes impact on the differentiation of monocytes into moDCs. The methodology to isolate and differentiate monocytes into moDCs is still controversial. We aimed to compare three different protocols for monocyte isolation from PBMC: 1) Cold-aggregation; 2) Percoll gradient; and 3) Magnetic beads cell-enrichment. Additionally we also compared four different monocyte differentiation and culture techniques: 1) Cell culture media; 2) Serum sources; 3) required GM-CSF and IL-4 concentrations; 4) Cell culture systems. We used flow cytometry analysis of light scattering and/or expression of pan surface markers, such as CD3, CD14 and CD209 to determine isolation/differentiation degree. Purified PBMC followed by two steps of cold aggregation, yielded cell viability around 95% with poor monocyte enrichment (monocytes increase vs. lymphocytes reduction was not statistically significant, p>0.05). Conversely, monocyte isolation from PBMC with discontinuous Percoll gradient generated around 50% cell viability. Albeit, we observed a significant reduction (p≤0.05) of lymphocytes contaminants. The magnetic beads cell-enrichment yield cell viability higher than 95%, as high as a significant lymphocyte depletion (p≤0.005) when compared to all other techniques employed. The moDCs showed better differentiation based on increased CD209 expression, but lower CD14 levels, when cells were cultured in RPMI medium plus 500IU/mL of both GM-CSF and IL-4 in a semi-adherent fashion. Serum sources showed no influence on the culture performance. In conclusion, the magnetic beads cell-enrichment showed superior cell viability, indicating that this approach is a better choice to isolate monocytes, and moDCs cultured afterwards in appropriate medium, serum, cytokines and culture system might influence the monocytes differentiation into moDC.

Profiling of behavioral effects evoked by ketamine and the role of 5HT2 and D2 receptors in ketamine-induced locomotor sensitization in mice.

Ketamine has addictive potential, a troublesome fact due to its promising use as a therapeutic drug. An important phenomenon associated with drug addiction is behavioral sensitization, usually characterized as augmented locomotion. However, other behaviors may also be susceptible to sensitization, and/or interfere with locomotor activity. Thus, this study drew a comprehensive behavioral 'profiling' in an animal model of repeated administration of ketamine. Adult Swiss mice received single daily ketamine injections (30 or 50 mg/Kg, i.p.), which were followed by open field testing for 7 days (acquisition period, ACQ). A ketamine challenge (sensitization test, ST) was carried out after a 5-day withdrawal. Locomotion, rearing, grooming, rotation and falling were assessed during ACQ and ST. All behaviors were affected from the first ACQ day onwards, with no indication of competition between locomotion and the other behaviors. Only locomotion in response to 30 mg/Kg of ketamine both escalated during ACQ and expressed increased levels at ST, evidencing development and expression of locomotor sensitization. Considering the involvement of serotonin 5HT(2) and dopamine D(2) receptors on addiction mechanisms, we further tested the involvement of these receptors in ketamine-induced sensitization. Ketanserin (5HT2 antagonist, 3 mg/Kg, s.c.) prevented ketamine-evoked development of locomotor sensitization. However, ketanserin pretreatment during ACQ failed to inhibit its expression during ST. Raclopride (D2 antagonist, 0.5 mg/Kg, s.c.) evoked less robust reductions in locomotion but prevented the development of ketamine-evoked sensitization. Pretreatment during ACQ further inhibited the expression of sensitization during ST. These results indicate that a partial overlap in serotonergic and dopaminergic mechanisms underlies ketamine-induced locomotor sensitization.

Ensaio do linfonodo local murino (LLNA) na diferenciação entre a dermatite de contato alérgica e de contato irritante: um estudo da expressão de marcadores de superfície de linfócitos T / Local Lymph node assay in the differentiation between an allergic contact dermatitis and irritation: study of the expression of T lymphocyte surface markers

Introdução: O ensaio do linfonodo local murino (LLNA) foi desenvolvido como uma alternativa aos testes de Buhler e Maximização. O teste é utilizado com o objetivo de identificar substâncias capazes de induzir dermatite de contato e tem como desfecho a quantificação celular nos linfonodos auriculares. Embora recomendado por agências internacionais envolvidas no desenvolvimento de metodologias alternativas, o LLNA ainda necessita de aprimoramento. Objetivo: O objetivo do trabalho foi estudar possíveis diferenças nos padrões de subpopulações linfocitárias entre camundongos tratados com substâncias irritantes e dermosensibilizantes. Método: Os animais foram tratados com os sensibilizantes dinitroclorobenzeno (DNCB) e parafenilenidiamina (PPD), os irritantes lauril sulfato de sódio (LSS) e tritonX-100 (TX-100), por três dias consecutivos no dorso de ambas as orelhas. As subpopulações foram analisadas por citometria de fluxo e possíveis alterações histopatológicas nas orelhas dos animais foram também analisadas. Resultados: Foram observadas diferenças nas células CD4+CD25+ e CD4+CD69+, assim como na proliferação dessas subpopulações. Nenhuma diferença foi vista nos estudos histopatológicos das orelhas dos animais quando tratados com dermosensibilizantes ou irritantes. Conclusões: A fenotipagem de linfócitos T pode ser considerada útil no desenvolvimento de possíveis protocolos de ensaios que visem a diferenciação entre substâncias dermosensibilizantes e irritantes. Além disso, os resultados obtidos podem vir a contribuir com o aumento do conhecimento nesta área e auxiliar na busca por um ensaio in vitro correlato.

Introduction: The Local Lymph Node Assay (LLNA) was developed as an alternative to Buhler and Maximization assays. It is applied to discriminate substances that are able to induce contact dermatitis and the endpoint is cell quantification in mice auricular lymph nodes. Although recommended by international agencies involved in the development of alternative methodologies, LLNA still needs to be improved. Objective: In this context, the goal of this study was to investigate possible differences in lymphocyte subpopulation patterns among mice treated with irritants and dermosensitizers. Method: Animals were treated with sensitizers dinitrochlorobenzene (DNCB) and paraphenylenediamine (PPD) and irritants sodium lauryl sulfate (SLS) and tritonX-100 (TX-100) for 3 days, using dorsum area of both ears. The percentage of different lymphocyte subpopulations were analyzed by flow cytometry. Ears of animals were also evaluated for possible pathological alterations. Results: Differences were observed in CD4+ CD25+ and CD4+ CD69+ cells, as well as in the proliferation of these subpopulations. The histopathological analysis of the ears showed no difference between the treatment with either dermosensitizers or irritants. Conclusions: T lymphocyte phenotyping might still be a useful tool in the development of an assay to differentiate between dermosensitizers and irritants. Moreover, these results may contribute to improving knowledge on this field and helping in the search of a correlate in vitro assay.

Flow Cytometry as a Tool for Quality Control of Fluorescent Conjugates Used in Immunoassays.

The use of antibodies in immunodiagnostic kits generally implies the conjugation of these proteins with other molecules such as chromophores or fluorochromes. The development of more sensitive quality control procedures than spectrophotometry is essential to assure the use of better fluorescent conjugates since the fluorescent conjugates are critical reagents for a variety of immunodiagnostic kits. In this article, we demonstrate a new flow cytometric protocol to evaluate conjugates by molecules of equivalent soluble fluorochromes (MESF) and by traditional flow cytometric analysis. We have coupled microspheres with anti-IgG-PE and anti-HBSAg-PE conjugates from distinct manufactures and/or different lots and evaluated by flow cytometry. Their fluorescence intensities were followed for a period of 18 months. Our results showed that there was a great difference in the fluorescence intensities between the conjugates studied. The differences were observed between manufactures and lots from both anti-IgG-PE and anti-HBSAg-PE conjugates. Coefficients of variation (CVs) showed that this parameter can be used to determine better coupling conditions, such as homogenous coupling. The MESF analysis, as well as geometric mean evaluation by traditional flow cytometry, showed a decrease in the values for all conjugates during the study and were indispensable tools to validate the results of stability tests. Our data demonstrated the feasibility of the flow cytometric method as a standard quality control of immunoassay kits.

Aspects of T Cell-Mediated Immunity Induced in Mice by a DNA Vaccine Based on the Dengue-NS1 Antigen after Challenge by the Intracerebral Route.

Dengue disease has emerged as a major public health issue across tropical and subtropical countries. Infections caused by dengue virus (DENV) can evolve to life-threatening forms, resulting in about 20,000 deaths every year worldwide. Several animal models have been described concerning pre-clinical stages in vaccine development against dengue, each of them presenting limitations and advantages. Among these models, a traditional approach is the inoculation of a mouse-brain adapted DENV variant in immunocompetent animals by the intracerebral (i.c.) route. Despite the historical usage and relevance of this model for vaccine testing, little is known about the mechanisms by which the protection is developed upon vaccination. To cover this topic, a DNA vaccine based on the DENV non-structural protein 1 (pcTPANS1) was considered and investigations were focused on the induced T cell-mediated immunity against i.c.-DENV infection. Immunophenotyping assays by flow cytometry revealed that immunization with pcTPANS1 promotes a sustained T cell activation in spleen of i.c.-infected mice. Moreover, we found that the downregulation of CD45RB on T cells, as an indicator of cell activation, correlated with absence of morbidity upon virus challenge. Adoptive transfer procedures supported by CFSE-labeled cell tracking showed that NS1-specific T cells induced by vaccination, proliferate and migrate to peripheral organs of infected mice, such as the liver. Additionally, in late stages of infection (from the 7th day onwards), vaccinated mice also presented reduced levels of circulating IFN-γ and IL-12p70 in comparison to non-vaccinated animals. In conclusion, this work presented new aspects about the T cell-mediated immunity concerning DNA vaccination with pcTPANS1 and the i.c. infection model. These insights can be explored in further studies of anti-dengue vaccine efficacy.

Cooperation between CD4+ T Cells and Humoral Immunity Is Critical for Protection against Dengue Using a DNA Vaccine Based on the NS1 Antigen.

Dengue virus (DENV) is spread through most tropical and subtropical areas of the world and represents a serious public health problem. At present, the control of dengue disease is mainly hampered by the absence of antivirals or a vaccine, which results in an estimated half worldwide population at risk of infection. The immune response against DENV is not yet fully understood and a better knowledge of it is now recognized as one of the main challenge for vaccine development. In previous studies, we reported that a DNA vaccine containing the signal peptide sequence from the human tissue plasminogen activator (t-PA) fused to the DENV2 NS1 gene (pcTPANS1) induced protection against dengue in mice. In the present work, we aimed to elucidate the contribution of cellular and humoral responses elicited by this vaccine candidate for protective immunity. We observed that pcTPANS1 exerts a robust protection against dengue, inducing considerable levels of anti-NS1 antibodies and T cell responses. Passive immunization with anti-NS1 antibodies conferred partial protection in mice infected with low virus load (4 LD50), which was abrogated with the increase of viral dose (40 LD50). The pcTPANS1 also induced activation of CD4+ and CD8+ T cells. We detected production of IFN-γ and a cytotoxic activity by CD8+ T lymphocytes induced by this vaccine, although its contribution in the protection was not so evident when compared to CD4+ cells. Depletion of CD4+ cells in immunized mice completely abolished protection. Furthermore, transfer experiments revealed that animals receiving CD4+ T cells combined with anti-NS1 antiserum, both obtained from vaccinated mice, survived virus infection with survival rates not significantly different from pcTPANS1-immunized animals. Taken together, results showed that the protective immune response induced by the expression of NS1 antigen mediated by the pcTPANS1 requires a cooperation between CD4+ T cells and the humoral immunity.

Reduction of cell viability induced by IFN-alpha generates impaired data on antiviral assay using Hep-2C cells.

Type I interferons (IFNs) exert an array of important biological functions on the innate immune response and has become a useful tool in the treatment of various diseases. An increasing demand in the usage of recombinant IFNs, mainly due to the treatment of chronic hepatitis C infection, augmented the need of quality control for this biopharmaceutical. A traditional bioassay for IFN potency assessment is the cytopathic effect reduction antiviral assay where a given cell line is preserved by IFN from a lytic virus activity using the cell viability as a frequent measure of end point. However, type I IFNs induce other biological effects such as cell-cycle arrest and apoptosis that can influence directly on viability of many cell lines. Here, we standardized a cytopathic effect reduction antiviral assay using Hep-2C cell/mengovirus combination and studied a possible impact of cell viability variations caused by IFN-alpha 2b on responses generated on the antiviral assay. Using the four-parameter logistic model, we observed less correlation and less linearity on antiviral assay when responses from IFN-alpha 2b 1000 IU/ml were considered in the analysis. Cell viability tests with MTT revealed a clear cell growth inhibition of Hep-2C cells under stimulation with IFN-alpha 2b. Flow cytometric cell-cycle analysis and apoptosis assessment showed an increase of S+G2 phase and higher levels of apoptotic cells after treatment with IFN-alpha 2b 1000 IU/ml under our standardized antiviral assay procedure. Considering our studied dose range, we also observed strong STAT1 activation on Hep-2C cells after stimulation with the higher doses of IFN-alpha 2b. Our findings showed that the reduction of cell viability driven by IFN-alpha can cause a negative impact on antiviral assays. We assume that the cell death induction and the cell growth inhibition effect of IFNs should also be considered while employing antiviral assay protocols in a quality control routine and emphasizes the importance of new approaches for IFN potency determination.

Phenotypic profiles and detection of target genes by PCR in isolates from different sources and reference strains, identified as Cronobacter spp. (Enterobacter sakazakii)

Cronobacter, formerly known as Enterobacter sakazakii, is a novel genus of the Enterobacteriaceae family recognized as a cause of high number of fatal cases in neonates, after consuming infant formula. The conventional methods for detecting these organisms are time-consuming and lack sensitivity. The ISO/TS 22964:2006 is the most recently standardized methodology for detecting Cronobacter in powderedinfant formula. This study aimed at confirming the Brazilian isolates previously identified as E. sakazakiias Cronobacter spp. by biochemical assays, and also to compare characteristics of 37 Cronobacter andnon-Cronobacter isolates; and the miniaturized kits and the ISO/TS methodology were evaluated. A conventional PCR protocol targeting dna G was also developed and a previously described gluA targeting protocol was used. The majority of the Brazilian isolates were not confirmed as Cronobacter spp., and the selective enrichment step of ISO/TS methodology was inhibitory to some Cronobacter strains. The ID 32 Ewas the most reliable kit. The PCR protocol targeting gluA showed consistent results with ID 32E and the developed dnaG PCR protocol was 100% sensitive and specific. Thus, the PCR protocols targeting gluA and dnaG might be used to complement the Cronobacter spp. detection or identification after performing the conventional isolation and identification methods.

Potency determination of recombinant IFN-alpha based on phosphorylated STAT1 using flow cytometry.

The interferon (IFN) family of cytokines is recognized as a key component of the innate immune response and the first line of defense against viral infection. The usage of the IFN-alpha as a biopharmaceutical has been mainly applied in the treatment of chronic hepatitis C. In the literature it is possible to find a great variety of methods to determine the potency of these cytokines, and many efforts have been made in order to develop practical bioassays to study the biological activity of IFNs. In this technical note, we present a different approach to determine the potency of a recombinant IFN-alpha preparation based on the activation of the signal transducers and activators of transcription 1 (STAT1) using flow cytometry technique. Under the conditions of this study, this new approach proved to be useful and promising to assess the potency of these biopharmaceuticals and may also be used as an important tool in the quality control of such biological products.

Aplicação do conceito do erro total na validação do ensaio de potência da vacina oral contra a poliomielite / Use of the total error approach for validating the potency assay for oral poliomyelitis vaccine

Esta pesquisa foi realizada utilizando-se uma abordagem alternativa na validação do ensaio de potênciada vacina oral contra a poliomielite para traçar o perfil deste ensaio, levando-se em conta a grande variabilidade de ensaios biológicos. Foram adotadas duas abordagens para a validação do ensaio: a abordagem Clássica da “International Conference on Harmonization” aplicada aos ensaios biológicos e a abordagem do Conceito do Erro Total. As principais características avaliadas no estudo de validação, por se tratar de um ensaio quantitativo, foram a veracidade, a precisão e a exatidão. Foram ainda avaliadas: a adequação do ensaio aos critérios de aceitação preconizados pelo Food and Drug Administration (EUA) para validação, adotando-se a variação máxima aceita de 20 por cento, a reprodutibilidade do ensaio em uma abordagem prática, com o uso das variâncias entre os resultados de potência de 39 lotes da vacina (do mesmo produtor) obtidos no INCQS e no laboratório produtor, por amostra, para calcular o Coeficiente de Variação geométrico geral. Foi também determinada a Incerteza de Medição do Teste. O ensaio apresentou veracidade e precisão satisfatórias, o que demonstrou sua Exatidão satisfatória para a intenção de uso nas duas abordagens de validação.

RNA interference-mediated knockdown of CD49e (α5 integrin chain) in human thymic epithelial cells modulates the expression of multiple genes and decreases thymocyte adhesion.

BACKGROUND: The thymus is a central lymphoid organ, in which bone marrow-derived T cell precursors undergo a complex process of maturation. Developing thymocytes interact with thymic microenvironment in a defined spatial order. A component of thymic microenvironment, the thymic epithelial cells, is crucial for the maturation of T-lymphocytes through cell-cell contact, cell matrix interactions and secretory of cytokines/chemokines. There is evidence that extracellular matrix molecules play a fundamental role in guiding differentiating thymocytes in both cortical and medullary regions of the thymic lobules. The interaction between the integrin α5ß1 (CD49e/CD29; VLA-5) and fibronectin is relevant for thymocyte adhesion and migration within the thymic tissue. Our previous results have shown that adhesion of thymocytes to cultured TEC line is enhanced in the presence of fibronectin, and can be blocked with anti-VLA-5 antibody. RESULTS: Herein, we studied the role of CD49e expressed by the human thymic epithelium. For this purpose we knocked down the CD49e by means of RNA interference. This procedure resulted in the modulation of more than 100 genes, some of them coding for other proteins also involved in adhesion of thymocytes; others related to signaling pathways triggered after integrin activation, or even involved in the control of F-actin stress fiber formation. Functionally, we demonstrated that disruption of VLA-5 in human TEC by CD49e-siRNA-induced gene knockdown decreased the ability of TEC to promote thymocyte adhesion. Such a decrease comprised all CD4/CD8-defined thymocyte subsets. CONCLUSION: Conceptually, our findings unravel the complexity of gene regulation, as regards key genes involved in the heterocellular cell adhesion between developing thymocytes and the major component of the thymic microenvironment, an interaction that is a mandatory event for proper intrathymic T cell differentiation.

Hepatic damage associated with dengue-2 virus replication in liver cells of BALB/c mice.

One difficulty in studying dengue virus (DENV) is the lack of an experimental model that reproduces the human disease. In a previous work, we have shown that BALB/c mice intraperitoneally inoculated with a DENV-2 isolate presented viremia and mild focal areas of liver injuries. In this study, mice were inoculated by the intravenous route and presented extensive damage areas in the liver tissue, which were evaluated by histopathological and ultrastructural analysis. Hepatic injury was noted mainly around the central vein and portal tracts. Damages consist of hepatocyte injury, including steatosis, swelling and necrosis. Further, erythrophagocytosis, intercellular edema and vascular damages were evident, including hemorrhage, which is characteristic of the dengue-induced hepatitis in human liver. Hepatic lesions were already noted 2 days post infection (p.i.), although effects were more extensive after the seventh day p.i. An increase in alanine aminotransferase and aspartate aminotransferase serum levels was detected 7 and 14 days p.i., respectively, and had correlation to hepatic lesions. Alterations caused by the DENV infection were self-limiting, with a remarkable reduction of all liver damages 49 days p.i. Virus antigens were detected in hepatocytes, Kupffer cells and vascular endothelium, suggesting virus replication in these cells. In situ hybridization, using a probe that anneals in the virus negative RNA strand, showed positive reaction in hepatocytes and vascular endothelium cells of infected mice, thus confirming virus replication in such cells. In general, results revealed that this mouse model reproduces some histopathological effects observed in humans and supports previous findings indicating virus replication in the hepatic tissue.

Control of human thymocyte migration by Neuropilin-1/Semaphorin-3A-mediated interactions.

It is largely established that molecules first discovered in the nervous system are also found in the immune system. Neuropilin-1 (NP-1) was initially identified to mediate semaphorin-induced chemorepulsion during brain development and is also involved in peripheral T cell/dendritic cell interactions. Herein, we studied NP-1 during T cell development in the human thymus. NP-1 is expressed in both cortex and medulla of thymic lobules, being found in distinct CD4/CD8-defined thymocyte subsets. NP-1 is also found in thymic epithelial cells (TEC) in situ and in vitro, and is recruited at the site of TEC-thymocyte contact. Moreover, NP-1 was rapidly up-regulated during thymocyte stimulation by T cell receptor (TCR) and IL-7 or after adhesion to TEC. Semaphorin-3A (Sema-3A), a natural ligand of NP-1, is also present in human thymus, both in TEC and thymocytes, being up-regulated in thymocytes after TCR engagement. Functionally, Sema-3A decreases the adhesion capacity of NP-1(+) thymocytes and induces their migration by a repulsive effect. In conclusion, we show here that NP-1/Sema-3A-mediated interactions participate in the control of human thymocyte development.

Functional effects of acute coronary occlusion and catecholinergic stimuli on the isolated normothermic hemoperfused porcine heart.

The aim of this study was to characterize functional parameters in the isolated and normothermic hemoperfused porcine beating heart model after pathophysiological stimuli for extended perfusion periods. Hearts were prepared and connected to a specially developed perfusion equipment, which simultaneously allowed perfusion with warm autologous blood as well as blood dialysis. Two groups were established: group A (12 hearts: no intervention) and group B (6 hearts: occlusion of the ramus circumflexus of the left coronary artery for 2 hours). Blood gas analyses and oxymetry were performed at baseline and every 30 min during a 6 hours perfusion period. Coronary perfusion pressure (CPP) and blood flow (CBF), right and left ventricular pressure, blood and dialyzate pH-values, and temperature were monitored online by a microcontroller. A steady state regarding the CPP and the CBF was achieved after 1 hour of perfusion for both groups. In group B, CPP increased during occlusion. Comparison of both groups showed no significant differences in the bicarbonate and sodium levels in blood and dialyzate. The potassium concentration in blood and dialyzate increased in both groups constantly during the experiments. No clear alteration of the oxygen consumption was observed. Lactate levels in blood and dialyzate increased during occlusion as did the aspartataminotransferase (AST) venous levels (both determined only for group B). Four concentrations of norepinephrine were injected into the stem of the coronary arteries (10, 20, 40, 80 microg). A clear inotropic effect of this hormone on right and left ventricular pressure was observed. It was concluded that longer perfusion periods and simulation of myocardial infarction for a clinically relevant period can be performed using this model. In addition, right and left ventricular function appear to be well preserved in this model, since the isolated porcine heart responded to norepinephrine stimuli.

[Information for health equity in Chile]. / Informacion para la equidad en salud en Chile .

OBJECTIVES: To estimate the magnitude of geographical health inequalities in Chile through key indicators based on data and information that are routinely collected and easily obtained, and to characterize the current situation with respect to the availability, quality, and access to information on health equity that official sources routinely collect. METHODS: A conceptual framework proposed by the World Health Organization was used to study health equity in terms of four dimensions: 1) state of health, 2) health determinants, 3) resources for and the supply of health system services, and 4) utilization of health system services. For each of these four dimensions, indicators were selected for which there was available information. The information was aggregated according to geographical and administrative units in the country: communes (342 in Chile), sanitary districts called "Health Services" (28), and regions (13). The aggregated information was analyzed using univariate analysis (distribution characteristics), bivariate analysis (correlations and frequency tables), and tabulation of values for selected indicators for the communes. RESULTS: With respect to the first dimension, state of health, we found an inverse relationship between mortality and average family income in the communes (r = -0.24; P < 0.001; n = 191 communes). With health determinants, there were important differences among the communes with regard to average household income, years of schooling, literacy, quality of housing, drinking water supply, and the wastewater disposal system. In terms of resources for and the supply of health system services, the municipal governments of the communes with higher average household incomes tended to contribute more funds per beneficiary (r = 0.19; P = 0.013). The financial contributions from the national government were targeted well, but they only partially compensated for the more limited resources available in poorer communes. With respect to the utilization of health care services per beneficiary in the different sanitary districts, we found some large differences. In terms of the ratio between the highest rate of utilization in any of the districts and the lowest rate in any other district, the ratio for primary-care visits per beneficiary was 2.8, the ratio for emergency-care visits was 3.9, and the ratio for hospitalizations was 2.0. CONCLUSIONS: There are important geographical differences in Chile with respect to mortality and other health outcomes, income and environmental conditions, and the financing and utilization of health care services. The information that is collected regularly and is available to characterize the health-related variables frequently has limitations in terms of quality, sustainability, and access. In Chile it would be pointless to focus the greatest efforts on reorganizing the information systems. The existing indicators showing marked inequalities are adequate to support the planning of interventions aimed at making urgently needed improvements in the situation of the worst-off Chileans.