Implementation of the Needs Assessment Tool for patients with interstitial lung disease (NAT:ILD): facilitators and barriers.

A Needs Assessment Tool (NAT) was developed previously to help clinicians identify the supportive/palliative needs of people with interstitial lung disease (ILD) (NAT:ILD). This letter presents barriers and facilitators to clinical implementation. Data from (1) a focus group of respiratory clinicians and (2) an expert consensus group (respiratory and palliative clinicians, academics, patients, carers) were analysed using Framework Analysis. Barriers related to resources and service reconfiguration, and facilitators to clinical need, structure, objectiveness, flexibility and benefits of an 'aide-memoire'. Identified training needs included communication skills and local service knowledge. The NAT:ILD was seen as useful, necessary and practical in everyday practice.

Relative Fitness of Helicoverpa armigera (Lepidoptera: Noctuidae) on Seven Host Plants: A Perspective for IPM in Brazil.

The cotton bollworm Helicoverpa armigera (Hübner) (Lepidoptera: Noctuidae) is a widespread pest of many cultivated and wild plants in Europe, Africa, Asia, and Australia. In 2013, this species was reported in Brazil, attacking various host crops in the midwestern and northeastern regions of the country and is now found countrywide. Aiming to understand the effects of different host plants on the life cycle of H. armigera, we selected seven species of host plants that mature in different seasons and are commonly grown in these regions: cotton (Gossypium hirsutum, "FM993"), corn (Zea mays, "2B587"), soybean (Glycine max, "99R01"), rattlepods (Crotalaria spectabilis), millet (Pennisetum glaucum, "ADR300"), sorghum (Sorghum bicolor, "AGROMEN70G35"), and cowpea (Vigna unguiculata, "SEMPRE VERDE"). The development time of immatures, body weight, survivorship, and fecundity of H. armigera were evaluated on each host plant under laboratory conditions. The bollworms did not survive on corn, millet, or sorghum and showed very low survival rates on rattlepods. Survival rates were highest on soybean, followed by cotton and cowpea. The values for relative fitness found on soybean, cotton, cowpea, and rattlepods were 1, 0.5, 0.43, and 0.03, respectively. Survivorship, faster development time, and fecundity on soybean, cotton, and cowpea were positively correlated. Larger pupae and greater fecundity were found on soybean and cotton. The results indicated that soybean, cotton, and cowpea are the most suitable plants to support the reproduction of H. armigera in the field.

The Enemy is Outside: Releasing the Parasitoid Tamarixia radiata (Hymenoptera: Eulophidae) in External Sources of HLB Inocula to Control the Asian Citrus Psyllid Diaphorina citri (Hemiptera: Liviidae).

Huanglongbing (HLB), the most destructive citrus disease worldwide, was first recorded in Brazil in 2004, and since then, more than 50 million trees identified with this disease have been eliminated. The disease is managed mainly by controlling the psyllid vector Diaphorina citri Kuwayama, 1908 (Hemiptera: Liviidae). Although the presence of the insect in commercial citrus groves is low, HLB infection rates increase in areas bordering the groves. The disease is transmitted by psyllids from host citrus plants in areas outside the managed groves, such as abandoned or organic groves and residential trees, and from orange jasmine plants in urban settings. In order to provide information to support HLB control, this study evaluated the biotic and abiotic variables that affect the dynamics of D. citri populations after releases of the parasitoid wasp Tamarixia radiata (Waterston, 1922) (Hymenoptera: Eulophidae) in external sources of HLB inocula. The study was divided into two parts. After releasing the parasitoids in non-commercial areas, we determined the following: (a) the variables that significantly affected the number of nymphs collected on shoots in the same non-commercial area; (b) the variables that significantly affected the number of adult psyllids collected in a neighboring commercial citrus area. Our results indicated that the number of nymphs in external areas was affected only by the host plant and rainfall. However, periodic parasitoid releases significantly reduced the number of adult psyllids collected in the commercial area. The results indicate that the release of parasitoids in external sources of inocula has the potential to maximize actions for D. citri control, contributing to the reduction of psyllid populations in commercial areas. Consequently, this strategy may help to manage the disease infection without an increase in insecticide use.

Potential of Two Trichogrammatidae species for Helicoverpa armigera control.

Helicoverpa armigera (Hübner) has attacked several economically important crops since it was first reported in Brazil in 2013. Because insecticides have been used intensively to control H. armigera, resistant populations have been detected more frequently. One alternative to insecticides is the use of biological control with egg parasitoids from the family Trichogrammatidae (Hymenoptera). The present study evaluated the use of different species and strains of these parasitoids to control H. armigera in soybean. Five strains of Trichogramma pretiosum (Riley): RV (Rio Verde, Goiás, Brazil), SO (Sorriso, Mato Grosso, Brazil), 47A (Irvine, CA, USA), PR (Colombo, Paraná, Brazil), and AN (Anhumas, São Paulo, Brazil), and Trichogrammatoidea annulata (De Santis) denominated TR, from Anhumas, were used. The following parasitoid biological parameters were evaluated: parasitism rates (%), offspring viability (%) number of parasitoids emerged per egg, egg-adult duration (days), female longevity, and offspring sex ratio. Strain RV of T. pretiosum from central Brazil performed best.

Hepatic Artery Thrombosis After Liver Transplantation: Five-Year Experience at the State University of Campinas.

BACKGROUND: Hepatic artery thrombosis (HAT) is reported in 4%-15% of orthotopic liver transplants. Risk factors include technical error in the anastomosis, vascular anatomic variation, and high microvascular resistance. The aim of this study was to verify the incidence of HAT, early or late, and possible risk factors. METHODS: This was a retrospective study from January 2007 to December 2012 at the State University of Campinas. Variables analyzed were age, sex, cold and warm ischemia times, underlying disease, presence of hepatocellular carcinoma, Model for End-Stage Liver Disease (MELD) score, arterial anatomic variation in the graft, cytomegalovirus (CMV) infection, rejection, biliary complications, retransplantation rate, and survival. RESULTS: The incidence of HAT was 21/263, or 7.9%. Pure average MELD score was 22 ± 7.4. There was vascular anatomic variation in the graft in 14.2% of cases, in the majority (66.6%) a right hepatic artery from the superior mesenteric artery, and 4.76% of patients had CMV infection and acute cellular rejection (1 case each). There were biliary complications in 38% of patients, 13.3% of cases in patients with early HAT, and 100% of patients with late HAT (P = .002). Body mass index in late HAT was higher (P = .01). CONCLUSIONS: Late HAT was related to a significant increase in biliary complications (stenosis), and the survival rate was similar at 5 years.

Association Safety of Liver Preservation Solutions at the State University of Campinas From 2010 to 2014.

The probable reason for mixing solutions during the harvesting procedure is due to the presence of multiple transplant teams that have their own solution usage tradition. Despite numerous studies comparing the efficacy of different preservation solutions, there is no study addressing the associating solution and if there is any impact on liver graft and patient survival. The aim was to evaluate the effect of the association of preservation solutions during the harvesting procedure on liver transplantation outcomes, especially in relation to the degree of preservation injury in the postreperfusion period and patient survival. We analyzed 206 transplants that were distributed as follows: when there was association (89/206 = 43.2%) and when there was no association (117/206 = 56.8%). There was a statistically significant difference in relation to the degree of preservation injury correlated to cold ischemia time (P = .009, odds ratio 1.992; 95% confidence interval 1.185-3.347). Severe harvesting (grades III and IV) was 71.8% when the solution was not associated (P = .008). There was no difference regarding patient survival either. We found that the association of liver preservation solutions has no impact on patient survival, so it can be done safely. The best survival rate was associated with minimal harvesting.

Sirolimus as rescue therapy after liver transplantation.

UNLABELLED: Sirolimus has immunosuppressive properties and antitumor effects. It was prescribed in liver transplantation initially in association with calcineurin inhibitors because of its lower nephrotoxic and neurotoxic effects and its potential antitumor effects. The aim of this study was to analyze the use of sirolimus as rescue therapy for liver transplant patients. METHODS: We retrospectively analyzed all 15 patients treated with sirolimus from 2009 to 2011 among 150 liver transplantations. We analyzed pre- and postconversion data. With statistical analysis using the Student's t-test. RESULTS: Sirolimus was the immunosuppressant therapy in 15 of 150 (10%) patients. Their average age was 56.2 years (range, 42-69) including 9 men (60%). The mean time between liver transplantation and the introduction of sirolimus was 24.6 months (range, 1-120). Sirolimus remained as the sole medication for 4 patients (26.6%). The overall time of sirolimus thereby averaged 14.3 months (range, 1-18). The reasons for the introduction of sirolimus were acute rejection (n = 8; 53.3%), chronic rejection (n = 2; 13.3%), development of malignancy (n = 3; 20%) or prior hepatocellular carcinoma (n = 2; 13.3%). Among 9 patients who initiated sirolimus because of rejection, 7 (77.7%) showed improvement in serum liver enzymes. Among the 3 (33.3%) patients who displayed renal insufficiency before the introduction of sirolimus (creatinine level > 1.5 mg/dL) 1 showed improvement with a decrease of ≥50%. The average follow-up was 18 months (range, 1-36). The average sirolimus level during the first 3 months was 10.3 ng/mL (range, 6.1-19.3). All patients developed side effects such as anemia, hypertriglyceridemia, hypercholesterolemia, and infection. In conclusion, sirolimus was useful as rescue therapy.

Portal vein thrombosis and liver transplantation: long term.

Obstruction of the portal vein may be related to constriction by malignant tumors or thrombosis associated with liver disease. We herein have reported our experience with patients undergoing liver transplantation with portal vein thrombosis (PVT) whose diagnosis was made intraoperatively. From September 1991 to May 2009, we studied 27/419 (6.4%) patients with PVT who were evaluated according to the presence of esophagogastric varices, underlying disease, malignancy, and if there was previous surgery, review of medical records on data collected prospectively. We observed 24 (88.9%) patients with PVT grade 1, 2 (7.4%) with grade 2, and 1 (3.7%) with grade 3. The average age of the PVT patients was 47.5 years; the average model for End-Stage Liver Discase score was 18.3, and the predominant diagnosis, hepatitis C cirrhosis. Eighteen underwent a sclerotherapy/ligature. The sensitivity of ultrasound for grade 1 thrombosis was 39.1%; for grade 2, 50%; and for grade 3, 100%. Portal vein thrombectomy was performed in 24 patients. In other patients (grade 2), we performed an anastomosis of the donor portal vein to the recipient gastric vein or to a greater splanchnic collateral vein. In only 1 patient was the graft performed using the donor portal vein-donor iliac vein-recipient superior mesenteric vein. None of the patients displayed PVT in the immediate postoperative period. Actuarial survivals at the years 1, 3, and 5 were 85%, 74%, and 63%, respectively. We concluded that PVT cannot be considered to be a contraindication for liver transplantation.

Larval density, temperature and biological aspects of Chrysomya megacephala (Diptera: Calliphoridae) / Densidade larval, temperatura e aspectos biológicos de Chrysomya megacephala (Diptera: Calliphoridae)

The effect of larval density on the survival, fecundity and body size at two temperatures in experimental populations of C. megacephala was studied. No effect from simultaneous influence of density and temperature on life history characteristics of C. megacephala was found. Significant effects of density and temperature on survival, fecundity and body size were observed. The importance of these results for the population dynamics of C. megacephala is discussed.

Analisou-se o efeito de duas densidades larvais e duas temperaturas sobre a sobrevivência, fecundidade e tamanho corpóreo de C. megacephala em condições experimentais. Nenhum efeito simultâneo da densidade e temperatura foi encontrado sobre as variáveis investigadas em C. megacephala. Entretanto, foram observados efeitos isolados significativos da densidade e da temperatura sobre a fecundidade e tamanho corpóreo. A importância desses resultados para a dinâmica populacional de C. megacephala foi discutida.