Inflammatory cytokines and chemokines in obese adolescents with antibody against to adenovirus 36.

Obesity in adolescents has reached epidemic proportions and is associated with the inflammatory response and viral infections. The aim of this study was to understand the profile of inflammatory cytokines and chemokines associated with the inflammatory response and metabolic syndrome (MetS) in obese adolescents with positive serology for adenovirus 36 (ADV36). Thirty-six overweight, 36 obese, and 25 severe obesity adolescents aged 10 to 16 years were included in the study. The following variables were analyzed: sex, age, body mass index (BMI), blood pressure, total cholesterol and fractions, triglycerides, glucose, serum cytokine concentrations, and ADV36 antibodies. Cytokines and chemokines were quantified by cytometry and ADV36 serology was determined by enzyme-linked immunosorbent assay (ELISA). The results showed higher levels of the cytokines interleukin-1beta (IL-1ß), IL-6, IL-10 and of the chemokine interferon-gamma-inducible protein 10 (IP-10) in severe obesity adolescents compared to the obese and overweight groups, as well as in the group with MetS compared to the group without this syndrome. The frequency of ADV36-positive individuals did not differ between groups. The findings revealed differences in BMI between the obese and severe obesity groups versus the overweight group in the presence of positivity for ADV36, suggesting an association with weight gain and possibly MetS installation.

Delayed Graft Function Duration in Deceased Donor Kidney Transplants.

BACKGROUND: Delayed graft function (DGF) is an important prognostic indicator after kidney transplantation. Depending on the severity of the ischemia-reperfusion injury, DGF can have several clinical presentations, with different renal function recovery times. Both the presence and duration of DGF can have an impact on kidney transplantation outcomes. However, the definition of the cutoff point, above which the outcomes are worse, varies widely in the literature. METHODS: To investigate the impact of DGF and its duration on patient and graft survivals, a single-center retrospective study including all deceased donor kidney transplants was performed between November 2008 and December 2015 (n = 188). Through the analysis on the receiver operating characteristic curve, the cutoff point that determined the worst outcome was reached. DGF patients were then divided according to the duration of DGF (<8 days or ≥8 days). RESULTS: The overall incidence of DGF was 62.2%. Higher HLA mismatches was an independent risk factor for prolonged DGF. DGF ≥8 days was associated with acute rejection and this one was associated with patient death in 3 years. CONCLUSION: DGF with a duration of more than 8 days associated with higher HLA mismatches increases the risk of acute rejection, but graft loss and patient survival are not affected by DGF, regardless of its duration.

Analysis of wideband tympanometry in Ménière's disease / Análise da timpanometria de banda larga na doença de Ménière

Abstract Introduction: Endolymphatic hydrops is the pathophysiological substrate of Ménière's disease. The changes in the inner ear, transmitted to the middle ear through changes in the ossicular chain mobility, can be quantified by wideband tympanometry, through the measurement of the acoustic absorbance at multiple frequencies, represented by the sound energy absorbed by the middle ear, even at its early stages. Studying the behavior of the middle ear through the absorbance in patients with endolymphatic hydrops under ambient pressure and under peak pressure can be useful for detecting Ménière's disease. Objective: To characterize acoustic absorbance behavior in subjects with symptomatic and asymptomatic Ménière's disease compared to controls, in order to verify the ability of wideband tympanometry to detect Ménière's disease. Methods: We carried out a cross-sectional study with a diagnostic approach comparing the findings of wideband tympanometry at ambient pressure and peak pressure between the ears of the control group (n = 30), the asymptomatic group (n = 21) and the symptomatic group (n = 9). Results: Different peak pressure values were found between the ears of the control group (0daPa), the asymptomatic group (−11 daPa) and the symptomatic group (−192 daPa), with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction. Different absorbance values were found between the ears of the symptomatic group and the asymptomatic group compared to the control group for low frequencies at ambient pressure and peak pressure, with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction. Conclusions: The Wideband Tympanometry test was capable of identifying the presence of Ménières disease, and to differentiate between asymptomatic and symptomatic patients, when comparing them with healthy individuals.

Resumo Introdução: A hidropsia endolinfática é o substrato fisiopatológico da doença de Ménière. As alterações desencadeadas na orelha interna, transmitidas à orelha média pelas modificações na mobilidade da cadeia ossicular, podem ser quantificadas pela timpanometria de banda larga, através da medida da absorvância acústica sob múltiplas frequências, representadas pela energia sonora absorvida pela orelha média, mesmo em estágios iniciais de sua instalação. Estudar o comportamento da orelha média através da absorvância em pacientes com hidropisia endolinfática sob pressão ambiente e sob o pico de pressão pode ser útil na detecção da doença de Ménière. Objetivo: Caracterizar o comportamento da absorvância em indivíduos com diagnóstico da doença de Ménière sintomáticos e assintomáticos, comparados com controles, a fim de verificar a capacidade da timpanometria de banda larga em detectar variações clínicas relacionadas a possível hidropisia endolinfática. Método: Foi realizado um estudo transversal, com enfoque diagnóstico, que comparou os achados da timpanometria de banda larga na pressão ambiente e no pico de pressão entre orelhas do grupo controle (n = 30), grupo assintomático (n = 21) e grupo sintomático (n = 9). Resultados: Foram encontrados valores do pico de pressão diferentes entre orelhas do grupo controle (0 daPa), do grupo assintomático (-11 daPa) e do grupo sintomático (-192 daPa), com p <0,05 pelos testes de Kruskal-Wallis, Mann Whitney e correção de Bonferroni. Foram encontrados valores de absorvância diferentes entre orelhas do grupo sintomático e do grupo assintomático em relação ao grupo controle para as frequências baixas na pressão ambiente e na pressão de pico, com p < 0,05 pelos testes de Kruskal-Wallis, Mann Whitney e correção de Bonferroni. Conclusão: A timpanometria de banda larga foi um teste capaz de identificar a presença da doença de Ménière e de diferenciar os pacientes assintomáticos e sintomáticos, comparando-os com indivíduos hígidos.

Analysis of wideband tympanometry in Ménière's disease.

INTRODUCTION: Endolymphatic hydrops is the pathophysiological substrate of Ménière's disease. The changes in the inner ear, transmitted to the middle ear through changes in the ossicular chain mobility, can be quantified by wideband tympanometry, through the measurement of the acoustic absorbance at multiple frequencies, represented by the sound energy absorbed by the middle ear, even at its early stages. Studying the behavior of the middle ear through the absorbance in patients with endolymphatic hydrops under ambient pressure and under peak pressure can be useful for detecting Ménière's disease. OBJECTIVE: To characterize acoustic absorbance behavior in subjects with symptomatic and asymptomatic Ménière's disease compared to controls, in order to verify the ability of wideband tympanometry to detect Ménière's disease. METHODS: We carried out a cross-sectional study with a diagnostic approach comparing the findings of wideband tympanometry at ambient pressure and peak pressure between the ears of the control group (n = 30), the asymptomatic group (n = 21) and the symptomatic group (n = 9). RESULTS: Different peak pressure values were found between the ears of the control group (0 daPa), the asymptomatic group (-11 daPa) and the symptomatic group (-192 daPa), with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction. Different absorbance values were found between the ears of the symptomatic group and the asymptomatic group compared to the control group for low frequencies at ambient pressure and peak pressure, with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction. CONCLUSIONS: The Wideband Tympanometry test was capable of identifying the presence of Ménière´s disease, and to differentiate between asymptomatic and symptomatic patients, when comparing them with healthy individuals.

Inositol 1,4,5-trisphosphate receptor type 3 (ITPR3) is overexpressed in cholangiocarcinoma and its expression correlates with S100 calcium-binding protein A4 (S100A4).

Cholangiocarcinoma (CCA) is the second most malignant neoplasm in the liver that arises from the biliary tree. CCA is associated with a poor prognosis, and the key players involved in its pathogenesis are still not well understood. Receptor tyrosine kinases (RTKs), such as epidermal growth factor receptor (EGFR), can mediate intracellular calcium (Ca2+) signaling pathways via inositol 1,4,5-trisphosphate (InsP3), activating inositol 1,4,5-trisphosphate receptors (ITPRs) and regulating tumor growth. ITPR isoform 3 (ITPR3) is the main intracellular Ca2+ release channel in cholangiocytes. The effects of intracellular Ca2+ are mediated by calcium-binding proteins such as Calmodulin and S100 calcium-binding protein A4 (S100A4). However, the clinicopathological and biological significance of EGFR, ITPR3 and S100A4 in CCA remains unclear. Thus, the present work investigates the immunoexpression of these three proteins in 59 CCAs from patients who underwent curative surgical treatment and correlates the data with clinicopathological features and survival. High ITPR3 expression was correlated with CA 19-9 levels, TNM stage and lymph node metastasis (N). Furthermore, ITPR3 expression was increased in distal CCA compared to control bile ducts and intrahepatic and perihilar CCAs. These observations were confirmed by proteomic analysis. ITPR3 and S100A4 clinical scores were significantly correlated. Furthermore, it was demonstrated that EGF induces calcium signaling in a cholangiocarcinoma cell line and ITPR3 colocalizes with nonmuscle myosin IIA (NMIIA). In summary, ITPR3 overexpression could contribute to CCA progression and it may represent a potential therapeutic target.

PRIMARY TUMOR LYMPHOVASCULAR INVASION NEGATIVELY AFFECTS SURVIVAL AFTER COLORECTAL LIVER METASTASIS RESECTION?

BACKGROUND: About 50% of the patients with colorectal adenocarcinoma will present with liver metastasis and 20% are synchronic. Liver resection is associated with improvement in survival in comparison to chemotherapy alone. AIM: To analyze the overall survival in patients submitted to liver resection of colorectal cancer metastasis and prognostic factors related to the primary and secondary tumors. METHODS: A retrospective analysis of a prospectively maintained database regarding demographic, primary tumor and liver metastasis characteristics. RESULTS: There were 84 liver resections due to colorectal cancer metastasis in the period. The 5-year disease-free and overall survivals were 27.5% and 48.8% respectively. The statistically significant factors for survival were tumor grade (p=0.050), lymphovascular invasion (p=0.021), synchronous metastasis (p=0.020), as well as number (p=0.004), bilobar distribution (p=0.019) and diameter of the liver metastasis over 50 mm (p=0.027). Remained as independent negative predictive factors: lymphovascular invasion (HR=2.7; CI 95% 1.106-6.768; p=0.029), synchronous metastasis (HR=2.8; CI 95% 1.069-7.365; p=0.036) and four or more liver metastasis (HR=1.7; CI 95% 1.046-2.967; p=0.033). CONCLUSION: The resection of liver metastasis of colorectal adenocarcinoma leads to good survival rates. Lymphovascular invasion was the single prognostic factor related to the primary tumor. Synchronous disease and four or more metastasis were the most significant factors related to the secondary tumor.

Donor-Derived Tuberculosis: A Case Report and the Role of Communication Gaps in Transplantation Safety.

Donor-derived tuberculosis (DD-TB) accounts for less than 5% of TB cases and is considered a rare event. In the transplant setting, the frequency of active TB is estimated to be 20 to 74 times higher than that in the general population, and it is associated with high mortality. In this context, the main strategy to minimize the risk of DD transmission is to identify high-risk donors. Despite screening recommendations, failures may result in a breakdown of safety that ends in the transmission of potentially fatal diseases. This report describes a case of DD-TB and emphasizes communication gaps that may occur between organ procurement organizations and transplant centers. Failure in reporting results, lack of exchanging information regarding recipients from the same donor, and inefficient communication between organ procurement organizations and transplant centers are lacks that may be prevented by a more efficient approach towards screening protocols and communication.

Pulmonary fate and consequences of transferrin-functionalized gold nanoparticles.

Surface functionalization of nanoparticles (NPs) may alter their biological interactions such as uptake by alveolar macrophages (AMs). Pulmonary delivery of gold NPs (Au NPs) has theranostic potential due to their optoelectronic properties, minimal alveoli to blood translocation, and possibility of specific cell targeting. Here, we examined whether coating Au NPs with transferrin alters their protein corona, uptake by macrophages, and pulmonary translocation. Methods: Rats were intratracheally instilled with transferrin-coated Au NPs (Tf-Au NPs) or polyethylene glycol-coated Au NPs (PEG-Au NPs). AMs were collected and processed for quantitation of Au cell uptake using ICP-MS and electron microscopy. Au retention in the lungs and other organs was also determined. The uptake of fluorescently labeled Tf-Au NPs and PEG-Au NPs by monocyte-derived human macrophages was also evaluated in vitro. Results: We showed that Tf-Au NPs were endocytosed by AMs and were retained in the lungs to a greater extent than PEG-Au NPs. Both Au NPs acquired similar protein coronas after incubation in rat broncho-alveolar lavage fluid (BALf). The translocation of Au from both NPs to other organs was less than 0.5% of the instilled dose. Transferrin coating enhanced the uptake of Au NPs by primary monocyte-derived human macrophages. Conclusions: We report that coating of NP surface with transferrin can target them to rat AMs and human monocyte-derived macrophages. NP functionalization with transferrin may enhance NP-based therapeutic strategies for lung diseases.

Primary tumor lymphovascular invasion negatively affects survival after colorectal liver metastasis resection? / Invasão angiolinfática no tumor primário compromete a sobrevida após ressecção de metástases hepáticas colorretais?

ABSTRACT Background: About 50% of the patients with colorectal adenocarcinoma will present with liver metastasis and 20% are synchronic. Liver resection is associated with improvement in survival in comparison to chemotherapy alone. Aim: To analyze the overall survival in patients submitted to liver resection of colorectal cancer metastasis and prognostic factors related to the primary and secondary tumors. Methods: A retrospective analysis of a prospectively maintained database regarding demographic, primary tumor and liver metastasis characteristics. Results: There were 84 liver resections due to colorectal cancer metastasis in the period. The 5-year disease-free and overall survivals were 27.5% and 48.8% respectively. The statistically significant factors for survival were tumor grade (p=0.050), lymphovascular invasion (p=0.021), synchronous metastasis (p=0.020), as well as number (p=0.004), bilobar distribution (p=0.019) and diameter of the liver metastasis over 50 mm (p=0.027). Remained as independent negative predictive factors: lymphovascular invasion (HR=2.7; CI 95% 1.106-6.768; p=0.029), synchronous metastasis (HR=2.8; CI 95% 1.069-7.365; p=0.036) and four or more liver metastasis (HR=1.7; CI 95% 1.046-2.967; p=0.033). Conclusion: The resection of liver metastasis of colorectal adenocarcinoma leads to good survival rates. Lymphovascular invasion was the single prognostic factor related to the primary tumor. Synchronous disease and four or more metastasis were the most significant factors related to the secondary tumor.

RESUMO Racional: Cerca de metade dos pacientes com adenocarcinoma colorretal apresentará metástases hepáticas. Apesar da superioridade do tratamento cirúrgico, os pacientes com elas compõem um grupo muito heterogêneo. Objetivo: Descrever o impacto de fatores relacionados ao tumor primário e ao secundário na sobrevida após ressecção de metástases hepáticas colorretais. Métodos: Análise retrospectiva de base de dados mantida prospectivamente de pacientes operados. Resultados: Foram realizadas 84 hepatectomias para ressecção de metástases hepáticas de adenocarcinoma colorretal em 73 pacientes no período. A sobrevida global e livre de doença em cinco anos foram de 48,8 e 27,5%, respectivamente. Os principais preditores de sobrevida foram grau de diferenciação (p=0,050) e invasão angiolinfática (p=0,021) do tumor primário, metástases sincrônicas (p=0,020), número (p=0,004), distribuição bilobar (p=0,019) e diâmetro máximo maior que 50 mm (p=0,027) dos nódulos hepáticos. Foram significativos a presença de invasão angiolinfática (HR=2,7; IC 95% 1,106-6,768; p=0,029), metástases sincrônicas (HR=2,8; IC 95% 1,069-7,365; p=0,036) e número de nódulos hepáticos igual ou superior a quatro (HR=1,7; IC 95% 1,046-2,967; p=0,033). Conclusão: A ressecção de metástases hepáticas de adenocarcinoma colorretal proporciona melhora da sobrevida e os principais fatores prognósticos foram a invasão angiolinfática no tumor primário, metástases sincrônicas e quatro ou mais nódulos hepáticos.

Preoperative prognostic factors in patients with ductal adenocarcinoma of the head of the pancreas. / Fatores prognósticos pré-operatórios em pacientes com adenocarcinoma ductal da cabeça do pâncreas.

OBJECTIVE: To identify the preoperative prognostic factors influencing pancreatic cancer survival following curative resection in a single Brazilian institution. METHODS: From 2005 to 2018, preoperative clinic, demographic and laboratory data were prospectively collected. Survival analysis was performed by the Kaplan-Meier method and the comparison between curves by the log-rank test. For multivariate analysis, the Cox regression model was used. RESULTS: advanced age (p = 0.012) and previous history of cancer (p = 0.026) were the preoperative factors, according to the univariate analysis, that significantly impacted survival. Patients with preoperative serum levels of CA 19.9 from 38 to 554 U/mL had a 3.15 times higher chances of death (HR 3.15; 95% CI 1.01-9.82; p = 0.047), whereas patients with the marker above 554 U/mL were 3.96 times more likely than those with the normal level (HR 3.96; 95% CI 1.19-13.10; p = 0.024), by using the multivariate analysis. Patients with previous comorbidities had a 2.90 times higher chance of death than those without associated conditions (HR 2.90; 95% CI 1.10-7.67; p = 0.032). CONCLUSION: Preoperative factors related to the worst prognosis after pancreatic ductal adenocarcinoma resection were advanced age, presence of comorbidities, previous history of cancer and elevated preoperative serum CA 19.9.

OBJETIVOS: Identificar fatores prognósticos pré-operatórios relacionados à sobrevida de pacientes com adenocarcinoma ductal da cabeça de pâncreas (ADCP) submetidos a tratamento cirúrgico com intenção curativa em uma única instituição brasileira. MÉTODO: No período de 2005 a 2018, dados clinicodemográficos e laboratoriais pré-operatórios foram prospectivamente coletados. A análise de sobrevida foi feita pelo método de Kaplan-Meier e a comparação entre as curvas pelo teste de log-rank. Para a análise multivariada utilizou-se o modelo de regressão de Cox. RESULTADOS: Os fatores pré-operatórios com impacto significativo na sobrevida à análise univariada foram a idade maior ou igual a 70 anos (p=0,012) e história pessoal prévia positiva para câncer (p=0,026). A análise multivariada, pacientes com níveis séricos pré-operatórios de CA 19.9 de 38 a 554 U/ml apresentaram 3,15 vezes maior chance de óbito (HR 3,15; IC 95% 1,01 - 9,82; p=0,047), enquanto que os pacientes com o marcador acima de 554 U/ml evoluíram com chance 3,96 vezes maior de óbito que aqueles com a dosagem normal (HR 3,96; IC 95% 1,19 - 13,10; p=0,024). Pacientes com comorbidades prévias evoluíram com chance 2,90 vezes superior de óbito que doentes sem condições associadas (HR 2,90; IC 95% 1,10 - 7,67; p=0,032). CONCLUSÃO: O ADCP mostrou ser doença agressiva para a qual os fatores pré-operatórios de pior prognóstico foram idade avançada, presença de comorbidades, história prévia de câncer e nível sérico de CA 19.9 elevado no pré-operatório.

Preoperative risk score for prediction of long-term outcomes after hepatectomy for intrahepatic cholangiocarcinoma: Report of a collaborative, international-based, external validation study.

PURPOSE: A preoperative risk score (PRS) to predict outcome of patients with intrahepatic cholangiocarcinoma treated by liver surgery could be clinically relevant.To assess accuracy for broadly adoption, external validation of predictive models on independent datasets is crucial. The objective of this study was to externally validate the score for prediction of long-term outcomes after liver surgery for intrahepatic cholangiocarcinoma proposed by Sasaki et al. and based on preoperative albumin, neutrophil-to-lymphocytes-ratio, CA19-9 and tumor size. METHODS: Patients treated by liver surgery for intrahepatic cholangiocarcinoma at 11 international HPB centers from 2001 to 2018 were included in the external validation cohort. Harrell's c-index and Hosmer-Lemeshow analyses were used to test PRS discrimination and calibration. Kaplan-Meier curve for risk groups as described in the original study were displayed. RESULTS: A total of 355 patients with 174 deaths during the follow-up period (median = 41.7 months, IQR 32.8-50.6) were included. The median PRS value was 14.7 (IQR 10.7-20.6), with normal distribution across the cohort. A Cox regression on PRS covariates found coefficients similar to those of the derivation cohort, except for tumor size. Measures of discrimination estimated by Harrell's c-index was 0.61(95%CI:0.56-0.67) and Hosmer-Lemeshow p = 0.175. The Kaplan-Meyer estimation showed reasonable discrimination across risk groups, with 5years survival rate ranging from 20.1% to 0%. CONCLUSION: In this external validation cohort, the PRS had mild discrimination and poor calibration performance, similarly to the original publication. Nevertheless, its ability to identify different classes of risk is clinically useful, for a better tailoring of a therapeutic strategy.

Avaliação das características físico-químicas de óleo de café torrado (Coffea arabica) durante armazenamento em diferentes temperaturas / Evaluation of physico-chemical characteristics of roasted coffee oil (Coffea arabica) stored at different temperatures

O óleo extraído de café torrado é um produto de altíssimo valor agregado, uma vez que seu valor de mercado é muito superior que a matéria-prima principal, o café. Desse modo, o objetivo deste trabalho foi avaliar as características físico-químicas do óleo de café torrado (Coffea arabica) armazenados sob refrigeração e temperatura ambiente por um período de 12 meses. A acidez não apresentou grande variação devido à degradação da lipase durante o processo de torra dos grãos de café, o índice de peróxidos apresentou um resultado crescente durante o armazenamento, porém, mantendo-se dentro do limite estabelecido pela legislação atual (máximo 15 mEq kg-1). Durante o período de um ano, o óleo de café apresentou qualidade de utilização de acordo com a legislação vigente, independente das condições de armazenamento (6 °C ± 2 °C e 25 °C ± 2 °C).

17ß-Estradiol protects against lung injuries after brain death in male rats.

BACKGROUND: Brain death elicits microvascular dysfunction and inflammation, and thereby compromises lung viability for transplantation. As 17ß-estradiol was shown to be anti-inflammatory and vascular protective, we investigated its effects on lung injury after brain death in male rats. METHODS: Wistar rats were assigned to: sham-operation by trepanation only (SH, n = 7); brain death (BD, n = 7); administration of 17ß-estradiol (280 µg/kg, iv) at 60 minutes after brain death (BD-E2, n = 7). Experiments were performed 180 minutes thereafter. Histopathological changes in the lung were evaluated by histomorphometry. Gene expression of inducible nitric oxide synthase (iNOS), endothelial nitric oxide synthase (eNOS), and endothelin-1 was measured by real-time polymerase chain reaction. Protein expression of NO synthases, endothelin-1, platelet endothelial cell adhesion molecule-1 (PECAM-1), vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), BCL-2, and caspase 3 was assessed by immunohistochemistry. Cytokines were quantified by enzyme-linked immunosorbent assay. RESULTS: Treatment with 17ß-estradiol after brain death decreased lung edema and hemorrhage (p < 0.0001), and serum levels of cytokine-induced neutrophil chemoattractant-1 (CINC-1; p = 0.0020). iNOS (p < 0.0001) and VCAM-1 (p < 0.0001) also diminished at protein levels, while eNOS accumulated (p = 0.0002). However, gene expression of iNOS, eNOS, and endothelin-1 was comparable among groups, as was protein expression of endothelin-1, ICAM-1, BCL-2, and caspase 3. CONCLUSIONS: 17ß-Estradiol effectively reduces lung injury in brain-dead rats mainly due to its ability to regulate NO synthases. Thus, the drug may improve lung viability for transplantation.

Differential Behavior of Non-albicans Candida Species in the Central Nervous System of Immunocompetent and Immunosuppressed Mice.

The genus Candida includes commensal fungi that can cause local and systemic infections, frequently involving vital organs as the central nervous system (CNS). Candida spp. occupy the fourth place among infections that affect the CNS. Although the incidence of Candida albicans is decreasing among patients under immunosuppressive therapies, the incidence of non-albicans Candida is increasing. In this context, the objective of this work was to evaluate the ability of non-albicans Candida species to spread to the CNS of immunocompetent and immunosuppressed mice. Adult female C57BL/6 mice were treated with prednisolone, intravenously infected with Candida glabrata, Candida krusei and Candida parapsilosis yeasts and then evaluated at the 3rd and 14th days after infection. All Candida species disseminated to the brain from immunocompetent animals and induced local inflammation at the third day post-infection. The immunosuppression resulted in body weight loss, leukopenia and reduced IL-2 production by spleen cell cultures. Higher fungal loads were recovered from the CNS of immunosuppressed mice. Inflammatory infiltration associated to a Th1 subset profile was higher in brain samples from C. krusei immunosuppressed mice compared with immunocompetent ones. Additionally, C. krusei was able to transform into pseudohypha inside microglia in vitro infected cells and also to induce elevated nitric oxide production. Altogether, these results indicate that C. glabrata, C. krusei and C. parapsilosis are able to disseminate to the CNS and promote local inflammation in both immunocompetent and immunosuppressed mice. C. krusei displayed a distinct behavior at the CNS triggering a local Th1 profile. The possible contribution of these non-albicans Candida species to other CNS pathologies as multiple sclerosis, Parkinson's and Alzheimer's diseases deserves further attention.

Evaluation of scoliosis using baropodometer and artificial neural network

Abstract Introduction: One of the most recurrent pathologies in the spine is scoliosis. It occurs in the frontal plane and is formed by one or more curves in the spinal column. The scoliosis causes global postural misalignment in an individual. One of the modifications produced by postural misalignment is the way in which an individual distributes weight to the feet. We aimed to implement an electronic system for separating patients with Degree I scoliosis (i.e., 1° to 19° scoliosis according to the Ricard classification) into two groups: C1 (1°-9°) and C2 (10°-9°). The highest percentage of patients with scoliosis is in this range: those who do not need to wear vests or undergo surgery and whose treatment is performed via special physical exercise and frequent evaluations by healthcare professionals. Methods The electronic system consists of a baropodometer and artificial neural networks (ANNs). The classification of patients in the scoliosis groups was performed with MATLAB software and a Single Layer Perceptron network using the backpropagation training algorithm. Evaluations were performed on 63 volunteers. Results The mean classification sensitivity was 93.7% in the C1 group and 94.5% in the C2 group. The classification accuracy was 83.3% in the C1 group and 96.0% in the C2 group. Conclusion The implemented system can contribute to the treatment of patients with scoliosis grades ranging from 1° to 19°, which represents the highest incidence of this pathology, for which the monitoring of the clinical condition using noninvasive techniques is of fundamental importance.

APTIDÃO FÍSICA E LESÕES: 54 SEMANAS DE TREINAMENTO FÍSICO COM POLICIAIS MILITARES / PHYSICAL FITNESS AND INJURIES: 54 WEEKS OF PHYSICAL TRAINING AMONG MILITARY POLICE OFFICERS / APTITUD FÍSICA Y LESIONES: 54 SEMANAS DE ENTRENAMIENTO FÍSICO CON LA POLICÍA MILITAR

RESUMO Introdução: A aptidão física é imprescindível para policiais militares. Entretanto, apesar de a finalidade do treinamento militar ser o aperfeiçoamento de diferentes componentes da aptidão física, sua execução de forma não adequada pode associar-se ao desenvolvimento de lesões musculoesqueléticas. Objetivo: Verificar o efeito do treinamento físico militar sobre indicadores de aptidão física e incidência de lesões musculoesqueléticas em participantes do Curso de Formação de Soldados da Polícia Militar do Estado de São Paulo. Método: A amostra foi composta por 86 homens que foram submetidos ao Teste de Aptidão Física no início e depois de 54 semanas de treinamento. As informações sobre lesões foram obtidas com questionário específico. Resultados: Houve melhora significativa do volume máximo de oxigênio (VO2máx), resistência muscular localizada, força e velocidade ao final do treinamento. Entretanto, 45,3% dos policiais sofreram uma ou mais lesões, sendo 65,6% delas concentradas nos membros inferiores, 18% nos membros superiores e 16,4% no tronco e na cabeça. O nível osteoarticular concentrou 50,8% das lesões, o nível músculo-ligamentar, 26,3% e o tegumentar, 22,9%. Conclusão: Apesar do resultado satisfatório em relação à aptidão física, a incidência de lesões entre os policiais foi elevada.

ABSTRACT Introduction: Physical fitness is imperative for military police officers. However, although the purpose of military training is to improve different components of physical fitness, its inadequate performance may be associated with the development of musculoskeletal injuries. Objective: To verify the effect of military physical training on indicators of physical fitness and incidence of musculoskeletal injuries in participants of the Training Course of Military Police Officers in the State of São Paulo. Methods: The sample consisted of 86 men who were submitted to the Physical Fitness Test at the beginning and after 54 weeks of training. Information on injuries was obtained with a specific questionnaire. Results: There was significant improvement in maximum oxygen uptake (VO2max), localized muscle endurance, strength and velocity at the end of training. However, 45.3% of the officers suffered one or more injuries, 65.6% of which were concentrated in the lower limbs, 18% in the upper limbs, and 16.4% in the torso and head. The osteoarticular level concentrated 50.8% of the injuries, the musculoligamentous level, 26.3%, and the tegumentary level, 22.9%. Conclusion: Despite the satisfactory results regarding physical fitness, the incidence of injuries among military police officers was high.

RESUMEN Introducción: La buena aptitud física es indispensable para la policía militar. Si embargo, aunque el propósito del entrenamiento militar sea la mejora de los diferentes componentes de condición física, su ejecución inadecuada puede estar asociada con el desarrollo de lesiones musculoesqueléticas. Objetivo: Verificar el efecto del entrenamiento físico militar sobre los indicadores de aptitud física y la incidencia de lesiones musculoesqueléticas en los participantes del Curso de Entrenamiento de Soldados de la Policía Militar del Estado de São Paulo. Método: La muestra consistió en 86 hombres que fueron sometidos a la Prueba de Aptitud Física al inicio y después de 54 semanas de entrenamiento. La información sobre lesiones se obtuvo con cuestionario específico. Resultados: Hubo una mejora significativa del consumo máximo de oxígeno (VO2máx), la resistencia muscular localizada, fuerza y velocidad al final del entrenamiento. Sin embargo, el 45,3% de los policías sufrieron una o más lesiones, siendo el 65,6% concentrado en las extremidades inferiores, el 18% en las extremidades superiores y el 16,4% en el torso y la cabeza. El nivel osteoarticular concentra el 50,8% de las lesiones, el nivel musculoligamentoso, 26,3% y el tegumentario, 22,9%. Conclusión: A pesar de los resultados satisfactorios en términos de aptitud física, la incidencia de las lesiones entre los policías fue alto.

Associated Clinical and Laboratory Markers of Donor on Allograft Function After Heart Transplant.

INTRODUCTION: Primary graft dysfunction is a major cause of mortality after heart transplantation. OBJECTIVE: To evaluate correlations between donor-related clinical/biochemical markers and the occurrence of primary graft dysfunction/clinical outcomes of recipients within 30 days of transplant. METHODS: The prospective study involved 43 donor/recipient pairs. Data collected from donors included demographic and echocardiographic information, noradrenaline administration rates and concentrations of soluble tumor necrosis factor receptors (sTNFR1 and sTNFR2), interleukins (IL-6 and IL-10), monocyte chemoattractant protein-1, C-reactive protein and cardiac troponin I. Data collected from recipients included operating, cardiopulmonary bypass, intensive care unit and hospitalization times, inotrope administration and left/right ventricular function through echocardiography. RESULTS: Recipients who developed moderate/severe left ventricular dysfunction had received organs from significantly older donors (P =0.020). Recipients from donors who required moderate/high doses of noradrenaline (>0.23 µg/kg/min) around harvesting time exhibited lower post-transplant ventricular ejection fractions (P =0.002) and required longer CPB times (P =0.039). Significantly higher concentrations of sTNFR1 (P =0.014) and sTNFR2 (P =0.030) in donors were associated with reduced intensive care unit times (≤5 days) in recipients, while higher donor IL-6 (P =0.029) and IL-10 (P =0.037) levels were correlated with reduced hospitalization times (≤25 days) in recipients. Recipients who required moderate/high levels of noradrenaline for weaning off cardiopulmonary bypass were associated with lower donor concentrations of sTNFR2 (P =0.028) and IL-6 (P =0.001). CONCLUSION: High levels of sTNFR1, sTNFR2, IL-6 and IL-10 in donors were associated with enhanced evolution in recipients. Allografts from older donors, or from those treated with noradrenaline doses >0.23 µg/kg/min, were more frequently affected by primary graft dysfunction within 30 days of surgery.

Associated clinical and laboratory markers of donor on allograft function after heart transplant

Abstract Introduction: Primary graft dysfunction is a major cause of mortality after heart transplantation. Objective: To evaluate correlations between donor-related clinical/biochemical markers and the occurrence of primary graft dysfunction/clinical outcomes of recipients within 30 days of transplant. Methods: The prospective study involved 43 donor/recipient pairs. Data collected from donors included demographic and echocardiographic information, noradrenaline administration rates and concentrations of soluble tumor necrosis factor receptors (sTNFR1 and sTNFR2), interleukins (IL-6 and IL-10), monocyte chemoattractant protein-1, C-reactive protein and cardiac troponin I. Data collected from recipients included operating, cardiopulmonary bypass, intensive care unit and hospitalization times, inotrope administration and left/right ventricular function through echocardiography. Results: Recipients who developed moderate/severe left ventricular dysfunction had received organs from significantly older donors (P =0.020). Recipients from donors who required moderate/high doses of noradrenaline (>0.23 µg/kg/min) around harvesting time exhibited lower post-transplant ventricular ejection fractions (P =0.002) and required longer CPB times (P =0.039). Significantly higher concentrations of sTNFR1 (P =0.014) and sTNFR2 (P =0.030) in donors were associated with reduced intensive care unit times (≤5 days) in recipients, while higher donor IL-6 (P =0.029) and IL-10 (P =0.037) levels were correlated with reduced hospitalization times (≤25 days) in recipients. Recipients who required moderate/high levels of noradrenaline for weaning off cardiopulmonary bypass were associated with lower donor concentrations of sTNFR2 (P =0.028) and IL-6 (P =0.001). Conclusion: High levels of sTNFR1, sTNFR2, IL-6 and IL-10 in donors were associated with enhanced evolution in recipients. Allografts from older donors, or from those treated with noradrenaline doses >0.23 µg/kg/min, were more frequently affected by primary graft dysfunction within 30 days of surgery.

Soluble tumor necrosis factor receptors as predictors of 1-year mortality and renal dysfunction after liver transplantation.

BACKGROUND: Several risk factors influence survival after liver transplantation (LT). Some research has demonstrated a relationship between soluble tumor necrosis factor receptors (sTNFRs) and worse clinical liver disease outcomes, but there are no data showing an association between sTNFRs and outcomes after LT. The primary aim of this study was to determine whether an association exists between perioperative sTNFRs and renal dysfunction or mortality after LT. METHODS: Data were collected prospectively from 122 patients submitted to deceased-donor orthotopic LT. Blood samples were collected at seven different perioperative times and analyzed by ELISA. The statistical analysis included univariate analysis followed by logistic regression. The predictive value of significant variables was assessed using ROC curves. RESULTS: One-month and 1-year LT survivals were 91% and 81%, respectively. Increased levels of soluble tumor necrosis factor receptor 1 (sTNF-R1) after 24h of graft perfusion were associated with postoperative Renal Replacement Therapy (RRT) (OR 1.25) and 1-year mortality (OR 1.1). RRT was associated with 30-day and 1-year LT mortality, with OR 19.78 and 45.45, respectively. CONCLUSION: A higher sTNF-R1 level measured 24h after graft perfusion is an independent predictor of RRT and 1-year mortality after LT.

The impact of a chest tube management protocol on the outcome of trauma patients with tube thoracostomy.

OBJECTIVE: to investigate the effect of standardized interventions in the management of tube thoracostomy patients and to assess the independent effect of each intervention. METHODS: A chest tube management protocol was assessed in a retrospective cohort study. The tube thoracostomy protocol (TTP) was implemented in August 2012, and consisted of: antimicrobial prophylaxis, chest tube insertion in the operating room (OR), admission post chest tube thoracostomy (CTT) in a hospital floor separate from the emergency department (ED), and daily respiratory therapy (RT) sessions post-CTT. The inclusion criteria were, hemodynamic stability, patients between the ages of 15 and 59 years, and injury severity score (ISS) < 17. All patients had isolated injuries to the chest wall, lung, and pleura. During the study period 92 patients were managed according to the standardized protocol. The outcomes of those patients were compared to 99 patients treated before the TTP. Multivariate logistic regression analysis was performed to assess the independent effect of each variable of the protocol on selected outcomes. RESULTS: Demographics, injury severity, and trauma mechanisms were similar among the groups. As expected, protocol compliance increased after the implementation of the TTP. There was a significant reduction (p<0.05) in the incidence of retained hemothoraces, empyemas, pneumonias, surgical site infections, post-procedural complications, hospital length of stay, and number of chest tube days. Respiratory therapy was independently linked to significant reduction (p<0.05) in the incidence of seven out of eight undesired outcomes after CTT. Antimicrobial prophylaxis was linked to a significant decrease (p<0.05) in retained hemothoraces, despite no significant (p<0.10) reductions in empyema and surgical site infections. Conversely, OR chest tube insertion was associated with significant (p<0.05) reduction of both complications, and also significantly decreased the incidence of pneumonias. CONCLUSION: Implementation of a TTP effectively reduced complications after CTT in trauma patients.