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1.
Seizure ; 70: 90-96, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31323566

RESUMO

PURPOSE: To evaluate whether the onset of pediatric refractory status epilepticus (rSE) is related to time of day. METHOD: We analyzed the time of day for the onset of rSE in this prospective observational study performed from June 2011 to May 2019 in pediatric patients (1 month to 21 years of age). We evaluated the temporal distribution of pediatric rSE utilizing a cosinor analysis. We calculated the midline estimating statistic of rhythm (MESOR) and amplitude. MESOR is the estimated mean number of rSE episodes per hour if they were evenly distributed. Amplitude is the difference between MESOR and maximum rSE episodes/hour, or between MESOR and minimum rSE episodes/hour. We also evaluated the temporal distribution of time to treatment. RESULTS: We analyzed 368 patients (58% males) with a median (p25 - p75) age of 4.2 (1.3-9.7) years. The MESOR was 15.3 (95% CI: 13.9-16.8) and the amplitude was 3.2 (95% CI: 1.1-5.3), p = 0.0024, demonstrating that the distribution is not uniform, but better described as varying throughout the day with a peak in the morning (11am-12 pm) and trough at night (11 pm-12 am). The duration from rSE onset to application of the first non-benzodiazepine antiseizure medication peaked during the early morning (2am-3 am) with a minimum during the afternoon (2 pm-3 pm) (p = 0.0179). CONCLUSIONS: The distribution of rSE onset is not uniform during the day. rSE onset shows a 24-h distribution with a peak in the mid-morning (11am-12 pm) and a trough at night (11 pm-12am).

2.
Seizure ; 68: 62-71, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29941225

RESUMO

PURPOSE: To summarize the available evidence related to pediatric refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE), with emphasis on epidemiology, etiologies, therapeutic approaches, and clinical outcomes. METHODS: Narrative review of the medical literature using MEDLINE database. RESULTS: RSE is defined as status epilepticus (SE) that fails to respond to adequately used first- and second-line antiepileptic drugs. SRSE occurs when SE persist for 24 h or more after administration of anesthesia, or recurs after its withdrawal. RSE and SRSE represent complex neurological emergencies associated with long-term neurological dysfunction and high mortality. Challenges in management arise as the underlying etiology is not always promptly recognized and therapeutic options become limited with prolonged seizures. Treatment decisions mainly rely on case series or experts' opinions. The comparative effectiveness of different treatment strategies has not been evaluated in large prospective series or randomized clinical trials. Continuous infusion of anesthetic agents is the most common treatment for RSE and SRSE, although many questions on optimal dosing and rate of administration remain unanswered. The use of non-pharmacological therapies is documented in case series or reports with low level of evidence. In addition to neurological complications resulting from prolonged seizures, children with RSE/SRSE often develop systemic complications associated with polypharmacy and prolonged hospital stay. CONCLUSION: RSE and SRSE are neurological emergencies with limited therapeutic options. Multi-national collaborative efforts are desirable to evaluate the safety and efficacy of current RSE/SRSE therapies, and potentially impact patients' outcomes.

3.
Pediatr Neurol ; 86: 33-41, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30075875

RESUMO

OBJECTIVE: We aimed to evaluate and compare the status epilepticus treatment pathways used by pediatric status epilepticus research group (pSERG) hospitals in the United States and the American Epilepsy Society (AES) status epilepticus guideline. METHODS: We undertook a descriptive analysis of recommended timing, dosing, and medication choices in 10 pSERG hospitals' status epilepticus treatment pathways. RESULTS: One pathway matched the timeline in the AES guideline; nine pathways described more rapid timings. All pathways matched the guideline's stabilization phase in timing and five suggested that first-line benzodiazepine (BZD) be administered within this period. For second-line therapy timing (initiation of a non-BZD antiepileptic drug within 20 to 40 minutes), one pathway matched the guideline; nine initiated the antiepileptic drug earlier (median 10 [range five to 15] minutes). Third-line therapy timings matched the AES guideline (40 minutes) in two pathways; eight suggested earlier timing (median 20 [range 15 to 30] minutes). The first-line BZD recommended in all hospitals was intravenous lorazepam; alternatives included intramuscular midazolam or rectal diazepam. In second-line therapy, nine pathways recommended fosphenytoin. For third-line therapy, eight pathways recommended additional boluses of second-line medications; most commonly phenobarbital. Two pathways suggested escalation to third-line medication; most commonly midazolam. We found variance in dosing for the following medications: midazolam as first-line therapy, fosphenytoin, and levetiracetam as second-line therapy, and phenobarbital as third-line therapy medications. CONCLUSIONS: The pSERG hospitals status epilepticus pathways are consistent with the AES status epilepticus guideline in regard to the choice of medications, but generally recommend more rapid escalation in therapy than the guideline.


Assuntos
Anticonvulsivantes/administração & dosagem , Tratamento de Emergência , Hospitalização , Estado Epiléptico/terapia , Adolescente , Criança , Pré-Escolar , Esquema de Medicação , Hospitais Pediátricos , Humanos , Lactente , Guias de Prática Clínica como Assunto , Sociedades Médicas , Estados Unidos
4.
Public Health Nutr ; 21(13): 2402-2408, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29784065

RESUMO

OBJECTIVE: To verify the association between changes in socio-economic level (SEL) and nutritional status of Chilean adults over a 10-year period. DESIGN: Concurrent cohort study.Setting/SubjectsIndividuals born from 1974 to 1978 in the Valparaíso Region of Chile were evaluated between 2000 and 2002 (n 1232) and again between 2010 and 2012 (n 796). SEL was characterized according to the occupation and educational level of the head of household. Nutritional status was based on measurement of BMI and waist circumference (WC). RESULTS: Between the first and second evaluation there was a 13 % reduction in the number of individuals classified as poor and a 12 % increase in those classified in the medium high SEL. Increases in BMI were found among women who remained in the low SEL (ß=2·2, 95 % CI 0·16, 2·87) compared with women who maintained the same SEL (and whose SEL was above low over the 10-year period). Women who remained in the low SEL increased their WC (ß=4·10, 95 % CI 0·27, 7·93). There were no associations between nutritional status and SEL among males. CONCLUSIONS: In the period studied, the SEL of the study population improved between the third and fourth decade of life, but BMI and WC also increased among women, with the lowest socio-economic group experiencing the greatest changes. Meanwhile, among males we found no association between anthropometric measurements and changes in SEL.


Assuntos
Estado Nutricional , Dinâmica Populacional/tendências , Fatores Socioeconômicos , Adulto , Índice de Massa Corporal , Chile , Estudos de Coortes , Características da Família , Feminino , Seguimentos , Humanos , Masculino , Ocupações , Circunferência da Cintura , Adulto Jovem
5.
Can Vet J ; 59(3): 307-310, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29599561

RESUMO

A 5-year-old male barn cat was presented with lethargy and excessive bleeding following castration. The patient developed hemolytic anemia and diagnostic tests revealed infection with feline immunodeficiency virus and Mycoplasma haemofelis. This case serves as a reminder of the importance of testing for infectious diseases and educating owners on feline infectious disease prevention and management.


Assuntos
Doenças do Gato/diagnóstico , Síndrome de Imunodeficiência Adquirida Felina/diagnóstico , Vírus da Imunodeficiência Felina/isolamento & purificação , Infecções por Mycoplasma/veterinária , Animais , Castração/veterinária , Gatos , Diagnóstico Diferencial , Síndrome de Imunodeficiência Adquirida Felina/complicações , Masculino , Mycoplasma/isolamento & purificação , Infecções por Mycoplasma/complicações , Infecções por Mycoplasma/diagnóstico , Hemorragia Pós-Operatória/complicações , Hemorragia Pós-Operatória/veterinária
6.
Neuroreport ; 28(8): 421-425, 2017 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-28394781

RESUMO

Transcranial pulsed current stimulation (tPCS) is a neuromodulatory technique that has been studied in the last decade. Several parameters have been assessed independently to optimize the effects. Our aim was to explore the effects of tPCS using different montages on cortical brain oscillations indexed by power spectrum and interhemispheric coherence in different electroencephalography frequency bands. Twenty healthy individuals were randomized to receive either active tPCS or sham intervention using the following bilateral montages: ear clip (conventional), ear hook, or mastoid placement. Electroencephalography was recorded before and after the electroencephalography intervention to assess tPCS-induced after effects. Our results showed that active tPCS with bimastoid montage increased significantly alpha absolute power (P=0.0166) and low alpha (P=0.0014) in the frontal region, as well as in the low alpha power spectrum in the central (P=0.0001) and parieto-occipital regions (P=0.0068) compared with the other montages. For interhemispheric coherence analysis, the Kruskal-Wallis test showed a significant main effect of group for theta (P=0.0012) in the frontal region, mainly for ear-clip montage. Our findings evidenced that tPCS delivered through different electrode montages exert different effects on cortical brain oscillations and thus have a different neural signature. We discuss the implications of these findings as well as potential clinical explorations of this technique.


Assuntos
Ritmo alfa , Córtex Cerebral/fisiologia , Ritmo Teta , Estimulação Transcraniana por Corrente Contínua/métodos , Adulto , Eletrodos , Feminino , Humanos , Masculino , Adulto Jovem
7.
PLoS One ; 12(3): e0174614, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28346815

RESUMO

Honeybees face many parasites and pathogens and consequently rely on a diverse set of individual and group-level defenses to prevent disease. The crop microbiota of Apis mellifera, composed of 13 Lactic Acid Bacterial (LAB) species within the genera Lactobacillus and Bifidobacterium, form a beneficial symbiotic relationship with each other and the honeybee to protect their niche and their host. Possibly playing a vital role in honeybee health, it is important that these honeybee specific Lactic Acid Bacterial (hbs-LAB) symbionts can be correctly identified, isolated and cultured, to further investigate their health promoting properties. We have previously reported successful identification to the strain level by culture-dependent methods and we recently sequenced and annotated the genomes of the 13 hbs-LAB. However, the hitherto applied techniques are unfortunately very time consuming, expensive and not ideal when analyzing a vast quantity of samples. In addition, other researchers have constantly failed to identify the 13 hbs-LAB from honeybee samples by using inadequate media and/or molecular techniques based on 16S rRNA gene sequencing with insufficient discriminatory power. The aim of this study was to develop better and more suitable methods for the identification and cultivation of hbs-LAB. We compared currently used bacterial cultivation media and could for the first time demonstrate a significant variation in the hbs-LAB basic requirements for optimal growth. We also present a new bacterial identification approach based on amplicon sequencing of a region of the 16S rRNA gene using the Illumina platform and an error correction software that can be used to successfully differentiate and rapidly identify the 13 hbs-LAB to the strain level.


Assuntos
Abelhas/microbiologia , Bifidobacterium/isolamento & purificação , Lactobacillaceae/isolamento & purificação , Animais , Bifidobacterium/genética , DNA Bacteriano/genética , Lactobacillaceae/genética , Microbiota , RNA Ribossômico 16S/genética , Análise de Sequência de DNA
8.
Laryngoscope Investig Otolaryngol ; 2(6): 410-416, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29299516

RESUMO

Objective: A locally disturbed commensal microbiome might be an etiological factor in chronic rhinosinusitis (CRS) in general and in CRS without nasal polyps (CRSsNP) in particular. Lactic acid bacteria (LAB) have been suggested to restore commensal microbiomes. A honeybee LAB microbiome consisting of various lactobacilli and bifidobacteria have been found potent against CRS pathogens in vitro. Recently, we examined effects of single nasal administrations of this microbiome in healthy subjects and found it inert. In this study, we examined effects of repeated such administrations in patients with CRSsNP. Study Design: The study was of a randomized, double-blinded, crossover, and sham-controlled design. Methods: Twenty patients received 2 weeks' treatment administered using a nasal spray-device. The subjects were monitored with regard to symptoms (SNOT-22 questionnaire, i.e., the primary efficacy variable), changes to their microbiome, and inflammatory products (IL-6, IL-8, TNF-, IL-8,a, and MPO) in nasal lavage fluids. Results: Neither symptom scores, microbiological explorations, nor levels of inflammatory products in nasal lavage fluids were affected by LAB (c.f. sham). Conclusion: Two weeks' nasal administration of a honeybee LAB microbiome to patients with CRSsNP is well tolerated but affects neither symptom severity nor the microbiological flora/local inflammatory activity. Level of Evidence: 1b.

9.
Neuromodulation ; 19(7): 679-688, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27400423

RESUMO

OBJECTIVE: To explore the duration of tPCS after effects given different durations of stimulation on power and interhemispheric coherence of the EEG frequency bands. Our hypothesis was that longer tPCS duration would induce a differential effect on the EEG analysis and a longer duration of after effects on the EEG frequency bands. MATERIALS AND METHODS: We conducted a double blind, sham controlled study in which forty healthy subjects were randomized to receive a single session of either 10, 20, 30 min of active (2 mA, random frequency between 6 and 10 Hz, ear clip montage) or sham tPCS. EEG was recorded before and after the intervention to assess tPCS induced after effects. RESULTS: We found that 10 and 20 min of active tPCS induced a significant increase in alpha (p = 0.004) and theta (p = 0.006) coherence in the frontal region as compared with the sham stimulation. No significant changes were found with 30 min of stimulation (p < 0.05). The Kaplan Meier analysis showed that 10 and 20 min of tPCS induced after effects that lasted 50 min. CONCLUSIONS: These results evidence the nonlinear relationship between the stimulation duration and the tPCS after effects, suggesting the presence of homeostatic mechanisms.


Assuntos
Mapeamento Encefálico , Ondas Encefálicas/fisiologia , Encéfalo/fisiologia , Eletroencefalografia , Estimulação Transcraniana por Corrente Contínua/métodos , Adulto , Método Duplo-Cego , Feminino , Lateralidade Funcional/fisiologia , Voluntários Saudáveis , Humanos , Estimativa de Kaplan-Meier , Masculino , Fatores de Tempo , Adulto Jovem
10.
Curr Microbiol ; 73(4): 463-73, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27324340

RESUMO

In the global perspective of antibiotic resistance, it is urgent to find potent topical antibiotics for the use in human and animal infection. Healing of equine wounds, particularly in the limbs, is difficult due to hydrostatic factors and exposure to environmental contaminants, which can lead to heavy bio-burden/biofilm formation and sometimes to infection. Therefore, antibiotics are often prescribed. Recent studies have shown that honeybee-specific lactic acid bacteria (LAB), involved in honey production, and inhibit human wound pathogens. The aim of this pilot study was to investigate the effects on the healing of hard-to-heal equine wounds after treatment with these LAB symbionts viable in a heather honey formulation. For this, we included ten horses with wound duration of >1 year, investigated the wound microbiota, and treated wounds with the novel honeybee LAB formulation. We identified the microbiota using MALDI-TOF mass spectrometry and DNA sequencing. In addition, the antimicrobial properties of the honeybee LAB formulation were tested against all wound isolates in vitro. Our results indicate a diverse wound microbiota including fifty-three bacterial species that showed 90 % colonization by at least one species of Staphylococcus. Treatment with the formulation promoted wound healing in all cases already after the first application and the wounds were either completely healed (n = 3) in less than 20 days or healing was in progress. Furthermore, the honeybee LAB formulation inhibited all pathogens when tested in vitro. Consequently, this new treatment option presents as a powerful candidate for the topical treatment of hard-to-heal wounds in horses.


Assuntos
Abelhas/microbiologia , Terapia Biológica , Mel/microbiologia , Doenças dos Cavalos/terapia , Infecções Estafilocócicas/veterinária , Staphylococcus/efeitos dos fármacos , Ferimentos e Lesões/veterinária , Animais , Bifidobacterium/metabolismo , Mel/análise , Mel/estatística & dados numéricos , Doenças dos Cavalos/microbiologia , Doenças dos Cavalos/fisiopatologia , Cavalos , Ácido Láctico/metabolismo , Lactobacillus/metabolismo , Projetos Piloto , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/fisiopatologia , Infecções Estafilocócicas/terapia , Staphylococcus/genética , Staphylococcus/crescimento & desenvolvimento , Staphylococcus/isolamento & purificação , Cicatrização , Ferimentos e Lesões/microbiologia , Ferimentos e Lesões/fisiopatologia , Ferimentos e Lesões/terapia
11.
Int Forum Allergy Rhinol ; 6(9): 956-63, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27080343

RESUMO

BACKGROUND: Lactic acid bacteria (LAB) can restore commensal microbiomes and prevent infections. Arguably, nasal administrations of LAB may therefore be beneficial in chronic rhinosinusitis (CRS). Previous studies have examined effects of topical/nasal LAB in children with secretory otitis media, but little is as yet known about their effects on the human nasal airway. The aim of this pilot study was to examine effects on nasal symptoms and commensal bacteria in healthy subjects of nasal administration of a honeybee LAB microbiome; ie, a mixture of 9 Lactobacillus spp. and 4 Bifidobacterium spp. obtained from the honeybee Apis mellifera. Furthermore, we aimed to assess whether or not the honeybee LAB produced a local inflammatory response. METHODS: Twenty-two healthy subjects received a single administration of honeybee LAB in a sham-controlled, double-blinded, and crossover design. Using questionnaires, microbiological methods, and nasal lavages, they were assessed regarding symptoms, changes to commensal bacteria, and inflammatory products in nasal lavage fluids. RESULTS: The honeybee LAB did not produce any symptoms or other untoward effects. No changes were observed of commensal bacteria by the honeybee LAB, and no inflammatory response was detected (compared to sham); ie, unaffected nasal lavage fluid levels of monocyte chemoattractant protein-1 (MCP-1), interleukin-8 (IL-8), monokine induced by interferon-γ (MIG), interleukin-15 (IL-15), epidermal growth factor (EGF), eotaxin, interferon gamma-induced protein-10 (IP-10), and interleukin-1 receptor antagonist (IL-1RA). CONCLUSION: A single human nasal administration of a honeybee LAB microbiome is well tolerated. Specifically, it does not affect commensal bacteria and does not produce an inflammatory response.


Assuntos
Bactérias , Abelhas/microbiologia , Microbiota , Administração Intranasal , Adulto , Animais , Bactérias/isolamento & purificação , Biomarcadores , Estudos Cross-Over , Citocinas/imunologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Líquido da Lavagem Nasal/imunologia , Líquido da Lavagem Nasal/microbiologia , Adulto Jovem
12.
Int Wound J ; 13(5): 668-79, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25195876

RESUMO

Could honeybees' most valuable contribution to mankind besides pollination services be alternative tools against infections? Today, due to the emerging antibiotic-resistant pathogens, we are facing a new era of searching for alternative tools against infections. Natural products such as honey have been applied against human's infections for millennia without sufficient scientific evidence. A unique lactic acid bacterial (LAB) microbiota was discovered by us, which is in symbiosis with honeybees and present in large amounts in fresh honey across the world. This work investigates if the LAB symbionts are the source to the unknown factors contributing to honey's properties. Hence, we tested the LAB against severe wound pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and vancomycin-resistant Enterococcus (VRE) among others. We demonstrate a strong antimicrobial activity from each symbiont and a synergistic effect, which counteracted all the tested pathogens. The mechanisms of action are partly shown by elucidating the production of active compounds such as proteins, fatty acids, anaesthetics, organic acids, volatiles and hydrogen peroxide. We show that the symbionts produce a myriad of active compounds that remain in variable amounts in mature honey. Further studies are now required to investigate if these symbionts have a potential in clinical applications as alternative tools against topical human and animal infections.


Assuntos
Mel , Animais , Antibacterianos , Anti-Infecciosos , Abelhas , Ácido Láctico , Lactobacillales , Staphylococcus aureus Resistente à Meticilina
13.
Int Wound J ; 13(5): 729-37, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25196349

RESUMO

Treatment and management of chronic wounds is a large burden on the health sector and causes substantial suffering for the patients. We believe that 13 lactic acid bacteria (LAB) symbionts isolated from the honey crop of the honeybee are important players in the antimicrobial action of honey, by producing antimicrobial substances and can be used in combination with heather honey as an effective treatment in wound management. A total of 22 patients with chronic ulcers were included; culture-dependent and molecular-based (MALDI-MS and 16S rRNA gene sequencing) techniques were used to identify bacteria from chronic wounds. These clinical isolates were used for in vitro antimicrobial testing with standardised viable LAB and sterilised heather honey mixture. Twenty of the patients' wounds were polymicrobial and 42 different species were isolated. Patient isolates that were tested in vitro were inhibited by the LAB and honey combination with inhibitory zones comparable with different antibiotics. LAB and heather honey in combination presents a new topical option in chronic wound management because of the healing properties of honey, antimicrobial metabolite production from the LAB and their bactericidal effect on common chronic wound pathogens. This new treatment may be a stepping stone towards an alternative solution to antibiotics.


Assuntos
Antibiose , Bactérias , Abelhas/microbiologia , Terapia Biológica , Mel/microbiologia , Úlcera Varicosa/terapia , Ferimentos e Lesões/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Anti-Infecciosos/uso terapêutico , Doença Crônica/terapia , Feminino , Humanos , Ácido Láctico/metabolismo , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Simbiose , Cicatrização/fisiologia , Ferimentos e Lesões/microbiologia
14.
Rev. méd. Chile ; 143(12): 1552-1559, dic. 2015. graf, tab
Artigo em Espanhol | LILACS | ID: lil-774441

RESUMO

Background: Hip fractures (HFx) are an important geriatric syndrome, with a high incidence in developing countries. Aim: To describe characteristics of a group of Chilean patients with HFx. Patients and Methods: In a cross-sectional study we included patients aged 60 years or more with a HF admitted to an orthopedic service along three years. Age, incidence, location, seasonality, hospital stay, time between HFx and surgery, mortality, prior treatment for osteoporosis, anatomical location, etiology and type of surgery were evaluated. Results: We reviewed 647 patients with a median age of 81 years (76% women). The calculated incidence of hip fracture for people aged ≥ 65 years was 177/100,000. Sixty six percent of fractures were extracapsular. Mean hospital stay was 17 days and the mean lapse between the fracture and surgery was 19 days. Eighty four percent of patients had osteoporosis and only 5% were receiving treatment. Eighty three percent of patients were operated. Osteosynthesis was mainly used for extracapsular fractures and arthroplasty for intracapsular lesions. Intracapsular HFx tended to occur more commonly during warm seasons (Odds ratio = 1.534). Mortality at one year was 24%. It was higher among non-operated patients in whom the proportion of males and number of comorbidities were significantly higher. Conclusions: A high proportion of patients with HFx have osteoporosis albeit a reduced number is receiving treatment. Non-operated patients had a higher risk profile and higher mortality.


Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas do Quadril/cirurgia , Estudos Transversais , Chile/epidemiologia , Fraturas do Quadril/mortalidade , Tempo de Internação/estatística & dados numéricos , Fatores de Risco , Estações do Ano
15.
Expert Rev Med Devices ; 12(6): 679-88, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26415093

RESUMO

Transcranial direct current stimulation (tDCS) is a neuromodulatory technique that has been extensively studied. While there have been initial positive results in some clinical trials, there is still variability in tDCS results. The aim of this article is to review and discuss patents assessing novel methods to optimize the use of tDCS. A systematic review was performed using Google patents database with tDCS as the main technique, with patents filling date between 2010 and 2015. Twenty-two patents met our inclusion criteria. These patents attempt to address current tDCS limitations. Only a few of them have been investigated in clinical trials (i.e., high-definition tDCS), and indeed most of them have not been tested before in human trials. Further clinical testing is required to assess which patents are more likely to optimize the effects of tDCS. We discuss the potential optimization of tDCS based on these patents and the current experience with standard tDCS.


Assuntos
Estimulação Transcraniana por Corrente Contínua , Humanos , Resultado do Tratamento
16.
Genome Biol Evol ; 7(6): 1455-73, 2015 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-25953738

RESUMO

Lactobacillus kunkeei is the most abundant bacterial species in the honey crop and food products of honeybees. The 16 S rRNA genes of strains isolated from different bee species are nearly identical in sequence and therefore inadequate as markers for studies of coevolutionary patterns. Here, we have compared the 1.5 Mb genomes of ten L. kunkeei strains isolated from all recognized Apis species and another two strains from Meliponini species. A gene flux analysis, including previously sequenced Lactobacillus species as outgroups, indicated the influence of reductive evolution. The genome architecture is unique in that vertically inherited core genes are located near the terminus of replication, whereas genes for secreted proteins and putative host-adaptive traits are located near the origin of replication. We suggest that these features have resulted from a genome-wide loss of genes, with integrations of novel genes mostly occurring in regions flanking the origin of replication. The phylogenetic analyses showed that the bacterial topology was incongruent with the host topology, and that strains of the same microcluster have recombined frequently across the host species barriers, arguing against codiversification. Multiple genotypes were recovered in the individual hosts and transfers of mobile elements could be demonstrated for strains isolated from the same host species. Unlike other bacteria with small genomes, short generation times and multiple rRNA operons suggest that L. kunkeei evolves under selection for rapid growth in its natural growth habitat. The results provide an extended framework for reductive genome evolution and functional genome organization in bacteria.


Assuntos
Abelhas/microbiologia , Genoma Bacteriano , Lactobacillus/genética , Animais , Proteínas de Bactérias/genética , Transferência Genética Horizontal , Tamanho do Genoma , Lactobacillus/classificação , Filogenia , Recombinação Genética
17.
BMC Genomics ; 16: 284, 2015 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-25880915

RESUMO

BACKGROUND: In the honeybee Apis mellifera, the bacterial gut community is consistently colonized by eight distinct phylotypes of bacteria. Managed bee colonies are of considerable economic interest and it is therefore important to elucidate the diversity and role of this microbiota in the honeybee. In this study, we have sequenced the genomes of eleven strains of lactobacilli and bifidobacteria isolated from the honey crop of the honeybee A. mellifera. RESULTS: Single gene phylogenies confirmed that the isolated strains represent the diversity of lactobacilli and bifidobacteria in the gut, as previously identified by 16S rRNA gene sequencing. Core genome phylogenies of the lactobacilli and bifidobacteria further indicated extensive divergence between strains classified as the same phylotype. Phylotype-specific protein families included unique surface proteins. Within phylotypes, we found a remarkably high level of gene content diversity. Carbohydrate metabolism and transport functions contributed up to 45% of the accessory genes, with some genomes having a higher content of genes encoding phosphotransferase systems for the uptake of carbohydrates than any previously sequenced genome. These genes were often located in highly variable genomic segments that also contained genes for enzymes involved in the degradation and modification of sugar residues. Strain-specific gene clusters for the biosynthesis of exopolysaccharides were identified in two phylotypes. The dynamics of these segments contrasted with low recombination frequencies and conserved gene order structures for the core genes. Hits for CRISPR spacers were almost exclusively found within phylotypes, suggesting that the phylotypes are associated with distinct phage populations. CONCLUSIONS: The honeybee gut microbiota has been described as consisting of a modest number of phylotypes; however, the genomes sequenced in the current study demonstrated a very high level of gene content diversity within all three described phylotypes of lactobacilli and bifidobacteria, particularly in terms of metabolic functions and surface structures, where many features were strain-specific. Together, these results indicate niche differentiation within phylotypes, suggesting that the honeybee gut microbiota is more complex than previously thought.


Assuntos
Abelhas/microbiologia , Bifidobacterium/genética , Intestinos/microbiologia , Lactobacillus/genética , Animais , Bifidobacterium/classificação , Bifidobacterium/isolamento & purificação , Metabolismo dos Carboidratos/genética , Repetições Palindrômicas Curtas Agrupadas e Regularmente Espaçadas/genética , Hibridização Genômica Comparativa , DNA Bacteriano/análise , DNA Bacteriano/isolamento & purificação , DNA Bacteriano/metabolismo , Variação Genética , Genoma Bacteriano , Lactobacillus/classificação , Lactobacillus/isolamento & purificação , Microbiota , Filogenia , RNA Ribossômico 16S/análise , RNA Ribossômico 16S/genética , Análise de Sequência de DNA
18.
Rev Med Chil ; 143(12): 1552-9, 2015 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-26928617

RESUMO

BACKGROUND: Hip fractures (HFx) are an important geriatric syndrome, with a high incidence in developing countries. AIM: To describe characteristics of a group of Chilean patients with HFx. PATIENTS AND METHODS: In a cross-sectional study we included patients aged 60 years or more with a HF admitted to an orthopedic service along three years. Age, incidence, location, seasonality, hospital stay, time between HFx and surgery, mortality, prior treatment for osteoporosis, anatomical location, etiology and type of surgery were evaluated. RESULTS: We reviewed 647 patients with a median age of 81 years (76% women). The calculated incidence of hip fracture for people aged ≥ 65 years was 177/100,000. Sixty six percent of fractures were extracapsular. Mean hospital stay was 17 days and the mean lapse between the fracture and surgery was 19 days. Eighty four percent of patients had osteoporosis and only 5% were receiving treatment. Eighty three percent of patients were operated. Osteosynthesis was mainly used for extracapsular fractures and arthroplasty for intracapsular lesions. Intracapsular HFx tended to occur more commonly during warm seasons (Odds ratio = 1.534). Mortality at one year was 24%. It was higher among non-operated patients in whom the proportion of males and number of comorbidities were significantly higher. CONCLUSIONS: A high proportion of patients with HFx have osteoporosis albeit a reduced number is receiving treatment. Non-operated patients had a higher risk profile and higher mortality.


Assuntos
Fraturas do Quadril/cirurgia , Idoso , Idoso de 80 Anos ou mais , Chile/epidemiologia , Estudos Transversais , Feminino , Fraturas do Quadril/mortalidade , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estações do Ano
19.
J Phys Chem A ; 119(9): 1494-501, 2015 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-25072358

RESUMO

Elucidation of the chemical reactivity of metal clusters is often cumbersome due to the nonintuitive structures of the corresponding transition states. In this work, a hierarchical transition-state algorithm as implemented in the deMon2k code has been applied to locate transition states of small sodium clusters with 6-10 atoms. This algorithm combines the so-called double-ended interpolation method with the uphill trust region method. The minimum structures needed as input were obtained from Born-Oppenheimer molecular dynamics simulations. To connect the found transition states with the corresponding minimum structures, the intrinsic reaction coordinates were calculated. This work demonstrates how nonintuitive rearrangement mechanisms can be studied in metal clusters.

20.
Biol Open ; 4(1): 95-103, 2014 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-25527646

RESUMO

The flight membranes of bats serve a number of physiological functions important for survival. Although flight membrane injuries are commonly observed in wild-caught bats, in most cases the damage heals completely. Previous studies examining wound healing in the flight membranes of bats have not taken into consideration energy constraints that could influence healing times. Wound healing results in increased energy demands, therefore we hypothesized that wound healing times would be slower during periods of energy conservation and/or energy output. In this study we used an 8 mm diameter circular punch tool to biopsy the wing membranes of healthy adult female big brown bats (Eptesicus fuscus) from a captive research colony to test the hypothesis that healing times will vary with seasonal temperature changes between the summer and winter seasons, and with reproductive condition between lactating and non-reproductive females. As expected, membrane biopsies took significantly longer to heal during the winter when bats were hibernating compared to the summer when bats were active. Surprisingly, no difference in healing time was observed between lactating and non-reproductive females. The wings of most bats fully healed, although some individuals showed wound expansion demonstrating that impaired healing is occasionally observed in otherwise healthy subjects.

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