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1.
Palliat Med ; : 269216319883981, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31659938

RESUMO

BACKGROUND: Multidrug resistant pathogens are a large-scale healthcare issue. In particular, children with life-limiting conditions have a significantly increased risk of multidrug resistant pathogen colonization. Official hygiene requirements recommend children, who are colonized with multidrug resistant pathogens, to be isolated. In the context of pediatric palliative care, such isolation adversely affects the aim of social participation. To overcome this challenge of conflicting interests on a pediatric palliative care inpatient unit, a hygiene concept for patients colonized with multidrug resistant pathogens, called PALLINI, was implemented. AIM: The aim of this study was to identify the nurses' attitudes and opinions toward PALLINI. METHODS: Nurses (N = 14) from the pediatric palliative care unit were queried in guideline-oriented interviews. Interviews were analyzed qualitatively by means of content analysis. RESULTS: The following four categories were identified: (1) safety, (2) effort, (3) quality of care, and (4) participation. All categories demonstrated ambivalence by nursing staff regarding PALLINI. Ambivalence arose from guaranteeing infection control versus noncompliance by the families, additional workload for patients with multidrug resistant pathogens versus lack of resources, impaired relationship with the parents versus enabling better care for the child, as well as enabling some limited contact versus the larger goal of genuine social participation. Despite this, nurses reported the importance of arranging everyday-life for the patients so that they experience as much social participation as possible. CONCLUSION: The implementation of a new hygiene concept is challenging. Despite positive reception of PALLINI from the nurses, ambivalence remained. Addressing these ambivalences may be critical to best implement the new hygiene concept.

2.
Eur Neuropsychopharmacol ; 29(2): 235-246, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30552041

RESUMO

The nicotinic acetylcholine receptor (nAChR) agonist nicotine and the noradrenaline transporter inhibitor atomoxetine are widely studied substances due to their propensity to alleviate cognitive deficits in psychiatric and neurological patients and their beneficial effects on some aspects of cognitive functions in healthy individuals. However, despite growing evidence of acetylcholine-noradrenaline interactions, there are only very few direct comparisons of the two substances. Here, we investigated the effects of nicotine and atomoxetine on response inhibition in the stop-signal task and we characterised the neural correlates of these effects using blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) at 3T. Nicotine (7 mg dermal patch) and atomoxetine (60 mg per os) were applied to N = 26 young, healthy adults in a double-blind, placebo-controlled, cross-over, within-subjects design. BOLD images were collected during a stop-signal task that controlled for infrequency of stop trials. There were no drug effects on behavioural performance or subjective state measures. However, there was a pronounced upregulation of activation in bilateral prefrontal and left parietal cortex following nicotine during successful compared to unsuccessful stop trials. The effect of nicotine on BOLD during failed stop trials was correlated across individuals with a measure of trait impulsivity. Atomoxetine, however, had no discernible effects on BOLD. We conclude that nicotine effects on brain function during inhibitory control are most pronounced in individuals with higher levels of impulsivity. This finding is compatible with previous evidence of nicotine effects on stop-signal task performance in highly impulsive individuals and implicates the nAChR in the neural basis of impulsivity.


Assuntos
Inibidores da Captação Adrenérgica/uso terapêutico , Cloridrato de Atomoxetina/farmacologia , Encéfalo/efeitos dos fármacos , Inibição (Psicologia) , Nicotina/farmacologia , Agonistas Nicotínicos/farmacologia , Administração Cutânea , Adolescente , Adulto , Estudos Cross-Over , Método Duplo-Cego , Feminino , Voluntários Saudáveis , Humanos , Processamento de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Masculino , Oxigênio/sangue , Tempo de Reação/efeitos dos fármacos , Escala Visual Analógica , Adulto Jovem
4.
Support Care Cancer ; 27(1): 33-42, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30056529

RESUMO

CONTEXT: Opioids administered by various routes are a mainstay of tumour-related pain management. Subcutaneous or intravenous patient-controlled analgesia (PCA) with opioids is an appropriate and safe form of treatment for postoperative pain but studies on this form of administration are sparse in the setting of cancer pain despite widespread use. OBJECTIVE: To evaluate the published studies on opioids administered by subcutaneous and intravenous patient-controlled analgesia for patients with cancer pain. METHODS: Articles were identified from the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 7, 2016), PubMed (Medline; 1975 to 2016) and EMBASE (1974 to 2016). Additional reports were identified from the reference lists of retrieved papers. Studies based on original data with a focus on intravenous or subcutaneous PCA administration of opioids in patients suffering from cancer-related pain were selected. The language was restricted to Dutch, English or German. Predefined information was extracted depending on the topic. RESULTS: Fifty studies published since 1980 met the inclusion criteria. A wide range of study designs, study quality and research objectives were observed. The studies indicated use of standard or by proxy PCA in the inpatient and outpatient setting were safe and useful while significant adverse effects were rarely observed. CONCLUSION: This systematic review of the current evidence suggests PCA can be appropriately used in a wide range of clinical situations.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/administração & dosagem , Dor do Câncer/tratamento farmacológico , Administração Intravenosa , Analgesia Controlada pelo Paciente/efeitos adversos , Analgésicos Opioides/efeitos adversos , Humanos , Injeções Subcutâneas , Neoplasias/tratamento farmacológico , Neoplasias/cirurgia , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico
5.
Clin Interv Aging ; 13: 1971-1979, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30349216

RESUMO

Purpose: Falls are a common cause of morbidity and mortality in older people, and identification of risk indicators and risk factors to prevent falling is essential. Dry mouth (xerostomia and hyposalivation) can exacerbate conditions known to be fall risk indicators, such as nutritional status and sarcopenia. But there is little evidence regarding whether it is an independent risk factor for falling. We explored xerostomia prevalence and intensity and objective salivation rates in hospitalized geriatric patients to determine whether they were associated with an increased risk of falling. Patients and methods: Hospitalized geriatric patients with and without a fall history were compared. We investigated several oral health issues including xerostomia, stimulated and unstimulated salivation rates, total number of teeth and prosthetics, periodontal status, and oral health-related quality of life. Results: Forty patients were included, 28 in the fall history group and 12 in the control group. All patients had oral health issues that impacted on their oral health-related quality of life. However, there were no significant differences between the groups, including xerostomia and hyposalivation, apart from increased dysphagia and less flavor in food in patients with a fall history. Conclusion: Dry mouth does not appear to be an independent risk factor for falling in this population, but oral health was impaired. Thus, it is important that dentists and geriatricians are aware of and investigate these conditions in their patients and that appropriate action is taken to reduce the consequences of impaired oral health, including a potential reduction in falls.

6.
Am J Hosp Palliat Care ; 35(7): 951-958, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29316802

RESUMO

BACKGROUND: Multidisciplinary teamwork is considered central to pediatric palliative care. Although different studies state that volunteers play an essential role in palliative care, little is known about the collaboration between volunteers and staff. AIM: This study aims to explore and compare the perspectives of volunteers and staff regarding collaboration in a pediatric palliative care unit. DESIGN: A mixed-methods approach was chosen to appropriately reflect the complex aspects of collaboration. SETTING/PARTICIPANTS: Both face-to-face interviews with staff who work together with volunteers and a group discussion with all volunteers were conducted. These were supplemented by 2 questionnaires designed for this study that examined participants' characteristics and their estimation of what information volunteers need before they meet a patient. RESULTS: Nine staff members and 7 volunteers participated in this study. Their ideas of collaboration could be grouped into 3 categories: (i) factual level of collaboration, (ii) relationship level of collaboration, and (iii) overall appraisal of collaboration (suggestions for improvement). CONCLUSION: Communication can be considered a key factor in successful collaboration between volunteers and staff. Because many patients in pediatric palliative care units are not able to communicate verbally, good information flow between volunteers and staff is crucial for ensuring quality patient care. Moreover, communication is the key to establishing a team philosophy by clarifying roles and building relationships between volunteers and staff.


Assuntos
Comportamento Cooperativo , Cuidados Paliativos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Voluntários/psicologia , Adulto , Criança , Comunicação , Feminino , Hospitais Pediátricos/normas , Humanos , Masculino , Papel Profissional
7.
Pain Med ; 19(1): 16-28, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-28486647

RESUMO

Objective: Disabling pediatric chronic pain is accompanied by a significant burden to those affected and by high societal costs. Furthermore, it bears the risk of aggravation into adulthood. Studies have shown intensive interdisciplinary pain treatment to result in short-term positive effects on pain-related and psychological outcomes. In this study, we aimed to prove the stability of the long-term effects of intensive interdisciplinary pain treatment four years after treatment. Methods: This longitudinal observational study followed adolescents who had received intensive interdisciplinary pain treatment over four years. We defined a combined end point, overall improvement (pain intensity, pain-related disability, and school/work absence), and investigated three additional psychological outcome domains (anxiety, depression, pain catastrophizing). We also examined changes to economic parameters (health care utilization, subjective financial burden) and their relationship to patient improvement. Results: Similar patterns were observed for pain-related and psychological outcome domains, with data showing statistically and clinically significant reductions from admission to four-year follow-up. These positive effects were stable from one- to four-year follow-up. Approximately 60% of the adolescents showed an overall long-term improvement. Older age was found to be a risk factor for treatment failure. Economic parameters decreased statistically significantly, particularly for those with an overall improvement of the chronic pain disorder. Conclusions: The results of this study support the long-term effectiveness of intensive interdisciplinary pain treatment and indicate that it can interrupt pain chronification. Future research is warranted to investigate why some of the adolescents did not show improvement and to allow for a more individualized treatment.

8.
Epilepsia ; 58(3): 343-355, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28067423

RESUMO

We explored the current practice with respect to the neuropsychological assessment of surgical epilepsy patients in European epilepsy centers, with the aim of harmonizing and establishing common standards. Twenty-six epilepsy centers and members of "E-PILEPSY" (a European pilot network of reference centers in refractory epilepsy and epilepsy surgery), were asked to report the status of neuropsychological assessment in adults and children via two different surveys. There was a consensus among these centers regarding the role of neuropsychology in the presurgical workup. Strong agreement was found on indications (localization, epileptic dysfunctions, adverse drugs effects, and postoperative monitoring) and the domains to be evaluated (memory, attention, executive functions, language, visuospatial skills, intelligence, depression, anxiety, and quality of life). Although 186 different tests are in use throughout these European centers, a core group of tests reflecting a moderate level of agreement could be discerned. Variability exists with regard to indications, protocols, and paradigms for the assessment of hemispheric language dominance. For the tests in use, little published evidence of clinical validity in epilepsy was provided. Participants in the survey reported a need for improvement concerning the validity of the tests, tools for the assessment of everyday functioning and accelerated forgetting, national norms, and test co-normalization. Based on the present survey, we documented a consensus regarding the indications and principles of neuropsychological testing. Despite the variety of tests in use, the survey indicated that there may be a core set of tests chosen based on experience, as well as on published evidence. By combining these findings with the results of an ongoing systematic literature review, we aim for a battery that can be recommended for the use across epilepsy surgical centers in Europe.


Assuntos
Transtornos Cognitivos , Epilepsia/cirurgia , Testes Neuropsicológicos/normas , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Epilepsia/complicações , Epilepsia/epidemiologia , Europa (Continente)/epidemiologia , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Cooperação Internacional , Neuroimagem
9.
Eur J Haematol ; 98(4): 348-354, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27893163

RESUMO

OBJECTIVE: Patients with acute myeloid leukemia (AML) carrying FLT3-ITD mutations (FLT3-ITD+) who relapse after allogeneic transplantation (allo-SCT) have a very dismal prognosis with the currently available treatment options. METHODS: We treated eight patients with FLT3-ITD+ AML who had relapsed in median 91 d (range, 28-249) following allo-SCT with a combination of the multikinase inhibitor sorafenib and the DNA methyltransferase inhibitor azacitidine (Aza). RESULTS: Patients received a median of five cycles of Aza (range, 2-9) and sorafenib with a median daily dosage of 750 mg (range 400-800) for 129 d (range, 61-221). Six of eight patients received donor lymphocyte infusions (DLI) with a median number of two DLI per patient (range, 1-4). Following this treatment, four patients (50%) achieved a complete remission and three of them a complete molecular remission. Median duration of CR was 182 d (range, 158-406), and two patients remain in ongoing remission for 406 and 168 d. Median overall survival was 322 d (range, 108-574 d) with three patients being currently alive. CONCLUSION: Taken together, the combination of sorafenib, Aza, and DLI shows promising efficacy and deserves further evaluation in larger patient groups.


Assuntos
Azacitidina/administração & dosagem , Leucemia Mieloide Aguda/mortalidade , Leucemia Mieloide Aguda/terapia , Niacinamida/análogos & derivados , Compostos de Fenilureia/administração & dosagem , Terapia de Salvação/métodos , Tirosina Quinase 3 Semelhante a fms/genética , Adulto , Aloenxertos , Intervalo Livre de Doença , Feminino , Transplante de Células-Tronco Hematopoéticas , Humanos , Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/metabolismo , Masculino , Pessoa de Meia-Idade , Niacinamida/administração & dosagem , Recidiva , Sorafenibe , Taxa de Sobrevida
10.
Support Care Cancer ; 24(7): 2869-75, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26838025

RESUMO

PURPOSE: Although the popularity of complementary and alternative medicine (CAM) has risen in the last decade, information about its use by pediatric patients in palliative care is still scarce. The purpose of the study was to assess the frequency and types of CAM administered by parents with children suffering from cancer during the palliative phase. METHODS: All parents who lost their child due to cancer in the federal state North Rhine Westfalia/Germany were eligible for the study. The first group of eligible parents was contacted in 1999-2000 and a second group of parents in 2005-2006. Upon agreement, parents were asked to complete a semi-structured questionnaire about the frequency of CAM use and the specific treatments that had been used. The types of CAM were categorized according to the National Center for Complementary and Alternative Medicine (NCCAM). RESULTS: A total of 96 parents participated in the study (48 in each cohort). Forty-three percent of all parents in both groups reported CAM use. The results show an increase of CAM use from 38 % in the first group to 49 % in the second cohort of pediatric patients during palliative care. The most common types of CAM used in both groups were homeopathy and treatment with mistletoe preparations. CONCLUSIONS: The study provides information about usage of CAM in children suffering from cancer during the palliative phase of the disease. Further research is required to investigate benefits, potential adverse effects, and the potential efficacy of CAM in this population.


Assuntos
Terapias Complementares/métodos , Neoplasias/terapia , Cuidados Paliativos/métodos , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino
11.
Blood Cells Mol Dis ; 54(1): 123-31, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25128083

RESUMO

DEK is important in regulating cellular processes including proliferation, differentiation and maintenance of stem cell phenotype. The translocation t(6;9) in Acute Myeloid Leukemia (AML), which fuses DEK with NUP214, confers a poor prognosis and a higher risk of relapse. The over-expression of DEK in AML has been reported, but different studies have shown diminished levels in pediatric and promyelocytic leukemias. This study has characterized DEK expression, in silico, using a large multi-center cohort of leukemic and normal control cases. Overall, DEK was under-expressed in AML compared to normal bone marrow (NBM). Studying specific subtypes of AML confirmed either no significant change or a significant reduction in DEK expression compared to NBM. Importantly, the similarity of DEK expression between AML and NBM was confirmed using immunohistochemistry analysis of tissue mircorarrays. In addition, stratification of AML patients based on median DEK expression levels indicated that DEK showed no effect on the overall survival of patients. DEK expression during normal hematopoiesis did reveal a relationship with specific cell types implicating a distinct function during myeloid differentiation. Whilst DEK may play a potential role in hematopoiesis, it remains to be established whether it is important for leukemagenesis, except when involved in the t(6;9) translocation.


Assuntos
Proteínas Cromossômicas não Histona/biossíntese , Proteínas de Ligação a DNA/biossíntese , Bases de Dados Genéticas , Regulação Leucêmica da Expressão Gênica , Hematopoese , Leucemia Mieloide Aguda/metabolismo , Proteínas Oncogênicas/biossíntese , Animais , Proteínas Cromossômicas não Histona/genética , Cromossomos Humanos Par 6/genética , Cromossomos Humanos Par 9/genética , Estudos de Coortes , Proteínas de Ligação a DNA/genética , Intervalo Livre de Doença , Humanos , Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/patologia , Estudos Multicêntricos como Assunto , Proteínas Oncogênicas/genética , Proteínas de Ligação a Poli-ADP-Ribose , Taxa de Sobrevida , Translocação Genética
12.
Pain ; 155(1): 118-28, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24060708

RESUMO

Pediatric chronic pain, which can result in deleterious effects for the child, bears the risk of aggravation into adulthood. Intensive interdisciplinary pain treatment (IIPT) might be an effective treatment, given the advantage of consulting with multiple professionals on a daily basis. Evidence for the effectiveness of IIPT is scarce. We investigated the efficacy of an IIPT within a randomized controlled trial by comparing an intervention group (IG) (n=52) to a waiting-list control group (WCG) (n=52). We made assessments before treatment (PRE), immediately after treatment (POST), as well as at short-term (POST6MONTHS) and long-term (POST12MONTHS) follow-up. We determined a combined endpoint, improvement (pain intensity, disability, school absence), and investigated 3 additional outcome domains (anxiety, depression, catastrophizing). We also investigated changes in economic parameters (health care use, parental work absenteeism, subjective financial burden) and their relationship to the child's improvement. Results at POST showed that significantly more children in the IG than in the WCG were assigned to improvement (55% compared to 14%; Fisher P<.001; 95% confidence interval for incidence difference: 0.21% to 0.60%). Although immediate effects were achieved for disability, school absence, depression, and catastrophizing, pain intensity and anxiety did not change until short-term follow-up. More than 60% of the children in both groups were improved long-term. The parents reported significant reductions in all economic parameters. The results from the present study support the efficacy of the IIPT. Future research is warranted to investigate differences in treatment response and to understand the changes in economic parameters in nonimproved children.


Assuntos
Dor Crônica , Manejo da Dor/economia , Manejo da Dor/métodos , Adolescente , Ansiedade/psicologia , Catastrofização/psicologia , Criança , Dor Crônica/economia , Dor Crônica/psicologia , Dor Crônica/terapia , Depressão/psicologia , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Pacientes Internados , Masculino , Medição da Dor , Resultado do Tratamento
13.
J Pain ; 15(1): 32-9, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24268356

RESUMO

UNLABELLED: Assessing if an individual patient has achieved clinically meaningful changes in pain intensity is a core aspect in the evaluation of pain treatments. The aim of the present study was to define minimally clinically significant differences (MCSDs) for the numerical rating scale (0-10 NRS) in adolescents with chronic pain. Data from 153 adolescents who completed an inpatient treatment were analyzed. MCSDs were defined as those cut points that yielded an optimal balance between sensitivity and specificity with regard to patients' global impression of change. The variability of the empirically defined cut points was quantified using bootstrapping. Our results show that raw changes of 1 NRS point and percent changes of 12.5% can be considered MCSDs both within the full sample and within various subsamples of patients. Applying the MCSDs developed for adults to pediatric patients yielded extremely low sensitivities; for example, only 22% of the children who described global improvement met the 50% decrease in pain criterion. Studies evaluating chronic pain treatments for adolescents should use MCSDs that are specifically developed for this group of patients. Raw changes of 1 point and 12.5% on the 0 to 10 NRS should be considered clinically meaningful. On a methodological level, we call for more systematic studies aimed at defining MCSDs that also address the variability of cut point estimates so as to foster the integration of findings. PERSPECTIVE: Many studies are aimed at empirically defining cut points for clinically relevant pain using receiver operating characteristic-based methods. For the first time, we apply these methods to children and show that even when taking into account the variability of the method, cut points specific for children are needed.


Assuntos
Dor Crônica/diagnóstico , Medição da Dor/métodos , Adolescente , Avaliação da Deficiência , Feminino , Humanos , Masculino , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença
14.
Learn Mem ; 21(1): 5-8, 2013 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-24344178

RESUMO

Memory can be distorted by misleading post-event information. These memory distortions may have serious consequences, for example in eyewitness testimony. Many situations in which memory reports are solicited, and suggestive or misleading information is presented, are highly stressful for the respondent, yet little is known about how stress affects people's susceptibility to misinformation. Here, we exposed participants to a stressor or a control manipulation before they were presented misinformation about a previous event. We report that stressed participants endorsed misinformation in a subsequent memory test less often than control participants, suggesting that stress reduces distortions of memory by misleading information.


Assuntos
Comunicação , Transtornos da Memória/etiologia , Estresse Psicológico/complicações , Adulto , Análise de Variância , Pressão Sanguínea/fisiologia , Feminino , Humanos , Hidrocortisona/metabolismo , Masculino , Saliva/metabolismo , Adulto Jovem
15.
J Palliat Med ; 16(9): 1034-9, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23901834

RESUMO

BACKGROUND: Awareness for pediatric palliative care in children with cancer increased in the last ten years in Germany. In this study we sought to determine whether this change in awareness led to improved palliative care outcomes in children dying due to cancer. METHODS: In 2005 we interviewed a cohort of 48 bereaved parents who had a lost a child to cancer approximately five years earlier (2000 cohort), and in 2010 we interviewed another cohort of 48 parents who had lost a child due to cancer approximately five years before (2005 cohort). Children of the 2000 cohort were cared for by six specialized oncology departments in North-Rhine-Westphalia (NRW), Germany, and children of the 2005 cohort by 16 specialized pediatric oncology departments in NRW, Germany. Parents of both cohorts were interviewed using the Survey of Caring for Children with Cancer (SCCC). RESULTS: The children of both parental cohorts were similar in terms of disease characteristics and sociodemographic variables. Children suffered in a very similar manner from core symptoms such as pain and dyspnea. However, symptom treatment increased for all symptoms. In case of treatment of anxiety the increase was statistically significant (p=0.035). Location of care changed with almost three-quarters of the 2005 cohort receiving palliative home care, significantly more than in the 2000 cohort (p=0.007). Additionally, fewer children of the 2005 cohort died in the intensive care unit. CONCLUSION: While the location of care during the end-of-life period shifted (from hospital to home), there remains substantial work to ease the suffering in children with cancer at end of life.


Assuntos
Acesso aos Serviços de Saúde , Neoplasias/terapia , Cuidados Paliativos , Pais/psicologia , Assistência Terminal , Adulto , Luto , Criança , Feminino , Alemanha , Humanos , Entrevistas como Assunto , Masculino , Neoplasias/fisiopatologia , Neoplasias/psicologia , Qualidade de Vida , Estresse Psicológico
16.
PLoS One ; 7(12): e52218, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23284942

RESUMO

Genomic plasticity is a mechanism for adaptation to environmental cues such as host responses and antifungal drug pressure in many fungi including the human pathogenic yeast Candida glabrata. In this study we evaluated the phenotypic and genotypic stability of the world-wide used C. glabrata reference strain CBS138/ATCC2001 under laboratory conditions. A set of ten lineages of this wild type strain and genetically modified progenies were obtained from different scientific laboratories, and analyzed for genotypic and phenotypic alterations. Even though the derivates were indistinguishable by multi locus sequence typing, different phenotypic groups that correlated with specific karyotypic changes were observed. In addition, modifications in the adherence capacity to plastic surface emerged that were shown to correlate with quantitative changes in adhesin gene expression rather than subtelomeric gene loss or differences in the number of macrosatellite repeats within adhesin genes. These results confirm the genomic plasticity of C. glabrata and show that chromosomal aberrations and functional adaptations may occur not only during infection and under antimicrobial therapy, but also under laboratory conditions without extreme selective pressures. These alterations can significantly affect phenotypic properties such as cell surface attributes including adhesion and the cell wall carbohydrate composition and therefore, if unnoticed, may adulterate the outcome of genetic studies.


Assuntos
Candida glabrata/genética , Proteínas Fúngicas/genética , Genoma Fúngico/genética , Cariotipagem
17.
Proteomics ; 8(3): 534-44, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18186024

RESUMO

Micro-organisms must adapt to environmental change to survive, and this is particularly true for fungal pathogens such as Candida glabrata. C. glabrata is found both in the environment and in diverse niches in its human host. The ambient pH of these niches varies considerably, and therefore we have examined the response of C. glabrata to changes in ambient pH using a proteomic approach. Proteins expressed in C. glabrata cells growing at pH 4.0, 7.4 or 8.0 were compared by 2-DE, and 174 spots displaying reproducible and statistically significant changes in expression level were identified by peptide mass fingerprinting, thereby extending our 2-DE map of the C. glabrata proteome to a total of 272 identified spots. Proteins involved in glucose metabolism, the TCA cycle, respiration and protein synthesis were expressed at lower levels during growth at pH 7.4 and/or 8.0, whereas proteins involved in stress responses and protein catabolism were expressed at higher levels under these alkaline conditions. Our data suggest that C. glabrata perceives low pH as less stressful than higher pH. This contrasts with another opportunistic fungal pathogen of humans, Candida albicans.


Assuntos
Candida glabrata/metabolismo , Proteínas Fúngicas/metabolismo , Proteoma/metabolismo , Eletroforese em Gel Bidimensional/métodos , Concentração de Íons de Hidrogênio
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