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1.
Z Rheumatol ; 80(5): 408-417, 2021 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-33258019

RESUMO

BACKGROUND: In March 2020 the SARS-CoV­2 pandemic disseminated initially especially in Bavaria. At that time data on patients with rheumatic diseases and immunomodulatory treatment was lacking. OBJECTIVE: The aim was to analyze the influence of the SARS-CoV­2 pandemic on the clinical treatment strategy. MATERIAL AND METHODS: Between 16 March and 31 July 2020 all patients who consecutively presented at the rheumatology outpatient clinic of the Klinikum rechts der Isar of the Technical University of Munich were included in the study. Individual treatment adjustments were based on clinical judgment and the recommendations for action of the German Society for Rheumatology (DGRh). RESULTS: A total of 322 patients were included. The most frequent diagnosis was rheumatoid arthritis with 17%, ANCA-associated vasculitis (AAV) with 14% and SLE with 12%. Of the patients 262 were on DMARD treatment and 77 received oral glucocorticoids. There were 5 cases of suspected SARS-CoV­2 infection; however, no patient verifiably became ill due to COVID-19. In 40 patients, treatment adjustments were done due to the pandemic, whereby 3 patients developed a flare of the underlying disease. In retrospect, treatment de-escalation occurred most frequently in AAV, IgG4-related disease, immunosuppressive treatment with rituximab and the simultaneous presence of malignant diseases. CONCLUSION: The total lack of confirmed SARS-CoV­2 infections in an otherwise strongly affected region could indicate that the infection risk for SARS-CoV­2 is not substantially increased for patients with inflammatory rheumatic diseases. A continuation of most immunosuppressive medications therefore seems reasonable during the ongoing pandemic.


Assuntos
COVID-19 , Doenças Reumáticas , Reumatologia , Instituições de Assistência Ambulatorial , Humanos , Pandemias , Estudos Prospectivos , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/tratamento farmacológico , Doenças Reumáticas/epidemiologia , SARS-CoV-2 , Universidades
2.
Lupus ; 29(3): 324-333, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32013725

RESUMO

OBJECTIVE: In the context of systemic autoimmunity, that is systemic lupus erythematosus (SLE) or adult-onset Still's disease (AOSD), secondary haemophagocytic lymphohistiocytosis (HLH; also referred to as macrophage activation syndrome (MAS) or more recently MAS-HLH) is a rare and potentially life-threatening complication. Pathophysiological hallmarks are aberrant macrophage and T cell hyperactivation and a systemic cytokine flare, which generate a sepsis-like, tissue-damaging, cytopenic phenotype. Unfortunately, for adult MAS-HLH we lack standardized treatment protocols that go beyond high-dose corticosteroids. Consequently, outcome data are scarce on steroid refractory cases. Aside from protocols based on treatment with calcineurin inhibitors, etoposide, cyclophosphamide and anti-IL-1, favourable outcomes have been reported with the use of intravenous immunoglobulin (IvIG) and plasma exchange (PE). METHODS: Here we report a retrospective series of steroid refractory MAS-HLH, the associated therapeutic regimes and outcomes. RESULTS: In this single-centre experience, 6/8 steroid refractory patients survived (median follow-up: 54.4 (interquartile range: 23.3-113.3) weeks). All were initially treated with PE, which induced partial response in 5/8 patients. Yet, all patients required escalation of immunosuppressive therapies. One case of MAS-HLH in new-onset AOSD had to be escalated to etoposide, whereas most SLE-associated MAS-HLH patients responded well to cyclophosphamide. Relapses occurred in 2/8 cases. CONCLUSION: Together, early use of PE is at most a supportive measure, not a promising monotherapy of adult MAS-HLH. In refractory cases, conventional cytoreductive therapies (i.e. cyclophosphamide and etoposide) constitute potent and reliable rescue approaches, whereas IvIG, anti-thymoglobulin, and biologic agents appear to be less effective.


Assuntos
Imunoglobulinas Intravenosas/uso terapêutico , Linfo-Histiocitose Hemofagocítica/etiologia , Linfo-Histiocitose Hemofagocítica/terapia , Síndrome de Ativação Macrofágica/etiologia , Síndrome de Ativação Macrofágica/terapia , Troca Plasmática/métodos , Corticosteroides/uso terapêutico , Adulto , Idoso , Ciclosporina/uso terapêutico , Citocinas/metabolismo , Feminino , Humanos , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sepse/etiologia , Sepse/terapia , Doença de Still de Início Tardio/complicações , Doença de Still de Início Tardio/terapia , Adulto Jovem
3.
Anal Chem ; 90(20): 11933-11940, 2018 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-30179456

RESUMO

The response to thermal stress is an important parameter relevant for characterizing the biological activity and long-term stability of recombinant proteins, which may show irreversible, pH dependent structural changes under these conditions. We selected the recombinant pollen allergen of mugwort ( Artemisia vulgaris) rArt v 3.0201 as a relevant model to study structural changes due to thermal and pH stress by means of capillary zone electrophoresis (CZE)-UV and capillary zone electrophoresis (CZE)-electrospray ionization (ESI)-TOF-MS. Therefore, this recombinant protein was exposed to 95 °C under acidic (pH 3.4) and slightly alkaline (pH 7.3) conditions for up to 120 min. CZE-UV data showed a continuous degradation of the allergen accompanied by the gradual formation of several reaction products. Characterization of novel allergen variants occurring at longer migration times was done via CZE-ESI-TOF-MS using in-capillary transient capillary isotachophoresis (tCITP) preconcentration to facilitate the identification of minor variants. MS data revealed various modifications of rArt v 3.0201 in response to heating. Variants with deamidations and sulfur-related modifications including both yield and loss of sulfur were identified at increased migration times. Desulfurization produced allergen variants with up to four lanthionines that replaced initial disulfide bonds. In addition, mass spectra revealed shifts in the charge state distribution which indicate concomitant conformational alterations. Moreover, several low-abundant oxidized variants were identified. With extended thermal stress, the portfolio of variants increased and progressively shifted toward rArt v 3.0201 with high lanthionine content. The kinetics of conversion and the complexity of variant composition were pH dependent and increased under alkaline conditions.

4.
Anal Chem ; 90(8): 5055-5065, 2018 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-29582994

RESUMO

Protein function critically depends on structure. However, current analytical tools to monitor consistent higher-order structure with high sensitivity, as for instance required in the development of biopharmaceuticals, are limited. To complement existing assays, we present the analytical cascade of enzymes (ACE), a method based on enzymatic modifications of target proteins, which serve to exponentially amplify structural differences between them. The method enables conformational and chemical fingerprinting of closely related proteins, allowing for the sensitive detection of heterogeneities in protein preparations with high precision. Using this method, we detect protein variants differing in conformation only, as well as structural changes induced by diverse covalent modifications. Additionally, we employ this method to identify the nature of structural variants. Moreover, the ACE method should help to address the limited reproducibility in fundamental research, which partly relates to sample heterogeneities.


Assuntos
Ensaios Enzimáticos/métodos , Proteínas/química , Cromatografia em Gel , Cisteína Endopeptidases/metabolismo , Temperatura Alta , Humanos , Peróxido de Hidrogênio/química , Concentração de Íons de Hidrogênio , Mutagênese , Oxirredução , Proteínas/genética , Proteínas/metabolismo , Rituximab/química , Rituximab/genética , Rituximab/metabolismo , Transglutaminases/metabolismo , Raios Ultravioleta
6.
Anesth Analg ; 121(5): 1157-64, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26426861

RESUMO

BACKGROUND: Evidence suggests that cannabinoids can prevent chemotherapy-induced nausea and vomiting. The use of tetrahydrocannabinol (THC) has also been suggested for the prevention of postoperative nausea and vomiting (PONV), but evidence is very limited and inconclusive. To evaluate the effectiveness of IV THC in the prevention of PONV, we performed this double-blind, randomized, placebo-controlled trial with patient stratification according to the risk of PONV. Our hypothesis was that THC would reduce the relative risk of PONV by 25% compared with placebo. METHODS: With IRB approval and written informed consent, 40 patients at high risk for PONV received either 0.125 mg/kg IV THC or placebo at the end of surgery before emergence from anesthesia. The primary outcome parameter was PONV during the first 24 hours after emergence. Secondary outcome parameters included early and late nausea, emetic episodes and PONV, and side effects such as sedation or psychotropic alterations. RESULTS: The relative risk reduction of overall PONV in the THC group was 12% (95% confidence interval, -37% to 43%), potentially less than the clinically significant 25% relative risk reduction demonstrated by other drugs used for PONV prophylaxis. Calculation of the effect of treatment group on overall PONV by logistic regression adjusted for anesthesia time gave an odds ratio of 0.97 (95% confidence interval, 0.21 to 4.43, P = 0.97). Psychotropic THC side effects were clinically relevant and mainly consisted of sedation and confusion that were not tampered by the effects of anesthesia. The study was discontinued after 40 patients because of the inefficacy of THC against PONV and the finding of clinically unacceptable side effects that would impede the use of THC in the studied setting. CONCLUSIONS: Because of an unacceptable side effect profile and uncertain antiemetic effects, IV THC administered at the end of surgery before emergence from anesthesia cannot be recommended for the prevention of PONV in high-risk patients.


Assuntos
Antieméticos/administração & dosagem , Antieméticos/efeitos adversos , Dronabinol/administração & dosagem , Dronabinol/efeitos adversos , Náusea e Vômito Pós-Operatórios/prevenção & controle , Administração Intravenosa , Adulto , Confusão/induzido quimicamente , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Náusea e Vômito Pós-Operatórios/diagnóstico , Estudos Prospectivos
7.
J Econ Entomol ; 106(3): 1430-9, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23865211

RESUMO

Cotton aphid, Aphis gossypii Glover, has a history of developing resistance to novel insecticides. A program is needed to monitor cotton aphid susceptibility to new insecticides. Concentration-mortality bioassays were conducted from 2008 to 2011 to monitor the susceptibility of cotton aphids from fields across the midsouthern United States to thiamethoxam and sulfoxaflor. Flonicamid was included in 2010 and 2011. Bioassays followed the procedures described by the Insecticide Resistance Action Committee for testing neonicotinoids against cotton aphid. Mortality was rated at 48 and 72 h. These bioassays suggest that high levels of resistance to thiamethoxam occur in cotton aphid throughout the midsouthern United States. Resistance ratios ranged from 0.9 to 562.6 at 48 h, and from 0.9 to 29.1 at 72 h. Aphid colonies tested were considered susceptible to flonicamid and sulfoxaflor. The LC50 values ranged from 1.43 to 6.60 ppm for flonicamid. The LC50 values for sulfoxaflor ranged from 1.01 to 5.85 ppm and 0.92-4.13 ppm at 48 and 72 h, respectively. These values represent the baseline variability of the susceptibility of cotton aphid to flonicamid and sulfoxaflor. The moderate level of variability observed combined with the high level of efficacy at low rates and the high reproductive rate of cotton aphid suggests that an effective resistance management plan needs to be devised for these insecticides. Flonicamid and sulfoxaflor should provide effective control of cotton aphid in areas where thiamethoxam resistance occurs. However, these insecticides need to be incorporated into a rotation strategy to preserve their efficacy against cotton aphid.


Assuntos
Afídeos/efeitos dos fármacos , Resistência a Inseticidas/efeitos dos fármacos , Inseticidas/farmacologia , Niacinamida/análogos & derivados , Nitrocompostos/farmacologia , Oxazinas/farmacologia , Piridinas/farmacologia , Compostos de Enxofre/farmacologia , Tiazóis/farmacologia , Animais , Afídeos/genética , Afídeos/crescimento & desenvolvimento , Bioensaio , Relação Dose-Resposta a Droga , Dose Letal Mediana , Neonicotinoides , Niacinamida/farmacologia , Ninfa/efeitos dos fármacos , Ninfa/genética , Ninfa/crescimento & desenvolvimento , Seleção Genética , Sudeste dos Estados Unidos , Texas , Tiametoxam
8.
PLoS One ; 18(3): e0282644, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36893109

RESUMO

OBJECTIVE: The study aimed to demonstrate the feasibility of an unassisted and community-based HIV self-testing (HIVST) distribution model and to evaluate its acceptability among men-having-sex-with-men (MSM) and transgender women (TGW). METHODS: Our demonstration study focused on implementing the HIVST distribution model in Metro Manila, Philippines. Convenience sampling was done with the following inclusion criteria: MSM or TGW, at least 18 years old, and had no previous HIV diagnosis. Individuals taking HIV pre-exposure prophylaxis, on antiretroviral therapy, or female sex at birth were excluded. The implementation of the study was done online using a virtual assistant and a delivery system via courier due to COVID-19-related lockdowns. Feasibility was measured by the number of HIVST kits successfully delivered and utilized and the HIV point prevalence. Moreover, acceptability was evaluated by a 10-item system usability scale (SUS). HIV prevalence was estimated with linkage to care prioritized for reactive participants. RESULTS: Out of 1,690 kits distributed, only 953 (56.4%) participants reported their results. Overall, HIV point prevalence was 9.8%, with 56 (60.2%) reactive participants linked to further testing. Furthermore, 261 (27.4%) of respondents self-reported, and 35 (13.4%) of the reactive participants were first-time testers. The HIVST service had an overall median and interquartile range (IQR) SUS score of 82.5 (IQR: 75.0, 90.0), rendering the HIVST kits very acceptable. CONCLUSIONS: Our study suggests the acceptability and feasibility of HIVST among the MSM and TGW in Metro Manila, Philippines, regardless of their age or HIV testing experience. In addition, other platforms of information dissemination and service delivery of HIVST should be explored, including access to online instructional videos and printed materials, which may facilitate easier use and interpretation of results. Furthermore, due to our study's limited number of TGW respondents, a more targeted implementation strategy to reach the TGW population is warranted to increase their access and uptake of HIVST.


Assuntos
COVID-19 , Infecções por HIV , Minorias Sexuais e de Gênero , Pessoas Transgênero , Masculino , Recém-Nascido , Humanos , Feminino , Adolescente , Homossexualidade Masculina , HIV , Autoteste , Filipinas/epidemiologia , Pandemias , COVID-19/diagnóstico , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Teste de HIV
9.
Chemistry ; 18(3): 836-47, 2012 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-22170731

RESUMO

The synthesis of various periphery-substituted shape-persistent cage compounds by twelve-fold condensation reactions of four triptycene triamines and six salicyldialdehydes is described, where the substituents systematically vary in bulkiness. The resulting cage compounds were studied as permanent porous material by nitrogen sorption measurements. When the material is amorphous, the steric demand of the cages exterior does not strongly influence the gas uptake, resulting in BET surface areas of approximately 700 m(2) g(-1) for all cage compounds 3 c-e, independently of the substituents bulkiness. In the crystalline state, materials of the same compounds show a strong interconnection between steric demand of the peripheral substituent and the resulting BET surface area. With increasing bulkiness, the overall BET surface area decreases, for example 1291 m(2) g(-1) (for cage compound 3 c with methyl substituents), 309 m(2) g(-1) (for cage compound 3 d with 2-(2-ethyl-pentyl) substituents) and 22 m(2) g(-1) (for cage compound 3 e with trityl substituents). Furthermore, we found that two different crystalline polymorphs of the cage compound 3 a (with tert-butyl substituents) differ also in nitrogen sorption, resulting in a BET surface area of 1377 m(2) g(-1), when synthesized from THF and 2071 m(2) g(-1), when recrystallized from DMSO.

10.
BMJ Open ; 12(3): e056697, 2022 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-35314474

RESUMO

OBJECTIVES: Our study identified barriers and facilitators in implementing HIV self-testing (HIVST), including the perceptions of men-having-sex-with-men (MSM) and transgender women (TGW) on HIVST. Furthermore, we explored the current knowledge, practices and potential of HIVST among the MSM and TGW populations. DESIGN: Qualitative in-depth key informant interviews were administered using semistructured interviews administered in both English and Filipino. Thematic analysis of the findings was done after transcribing all audio recordings. SETTING: The study was done in the National Capital Region (NCR), Philippines using online video conferencing platforms due to mobility restrictions and lockdowns caused by the COVID-19 pandemic. PARTICIPANTS: All study participants were either MSM or TGW, 18-49 years old and residing/working in NCR. Exclusion criteria include biologically born female and/or currently on pre-exposure prophylaxis, antiretroviral therapy medications or an HIV-positive diagnosis. RESULTS: Twenty informants were interviewed, of which 75% were MSM, and most of them preferred the use of HIVST. Facilitators and barriers to the use of HIVST were grouped into three main themes: Acceptability, distribution and monitoring and tracking. Convenience and confidentiality, overcoming fears and normalisation of HIV testing services (HTS) in the country were the participants' perceived facilitators of HIVST. In contrast, lack of privacy and maintenance of confidentiality during kit delivery were perceived as barriers in HIVST implementation. Moreover, social media was recognised as a powerful tool in promoting HIVST. The use of a welcoming tone and positive language should be taken into consideration due to the prevalent HIV stigma. CONCLUSIONS: The identified facilitators and barriers from the study may be considered by the Philippine HTS programme implementers. The HIVST strategy may complement the current HTS. It will be very promising to involve the MSM and TGW communities and other key populations to know their HIV status by bringing testing closer to them.


Assuntos
COVID-19 , Infecções por HIV , Minorias Sexuais e de Gênero , Pessoas Transgênero , Adolescente , Adulto , COVID-19/diagnóstico , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Teste de HIV , Homossexualidade Masculina , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Pandemias , Filipinas , Autoteste , Adulto Jovem
11.
Anesthesiology ; 115(1): 102-10, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21572318

RESUMO

BACKGROUND: This prospective, randomized, controlled trial compares the performance of the pediatric i-gel (Intersurgical Ltd., Wokingham, United Kingdom) with the Ambu AuraOnce laryngeal mask (Ambu A/S, Ballerup, Denmark) in anesthetized and ventilated children. METHODS: With ethics committee approval and written informed consent, the authors included 208 children, aged 0-17 yr, scheduled for elective day-surgery under general anesthesia. The primary outcome variable was oropharyngeal leak pressure. Other outcome variables were first-attempt and overall success, time to sufficient ventilation, and adverse events. RESULTS: Demographic data did not differ between groups. The leak pressure of the i-gel was significantly higher than the leak pressure of the Ambu (mean ± SD: 22 ± 5 cm H2O vs. 19 ± 3, P < 0.01). First-attempt success was 91% for the i-gel and 93% for the Ambu (P = 0.50). Overall success was 93% for the i-gel versus 98% for the Ambu (P = 0.10). Successfully inserted i-gels needed to be secured by taping in place to ensure the seal in 44% (0% with the Ambu, P < 0.01). Insertion was faster with the Ambu (24 ± 8 s vs. 27 ± 11, P = 0.02). There were no major side effects with either device. CONCLUSIONS: The leak pressure of the i-gel was statistically but not clinically significantly higher than the leak pressure of the Ambu. Time to insertion was longer with the i-gel. Both airway devices are suitable for positive pressure ventilation with high success rates in infants and children. Because the i-gel is prone to sliding out, it must be taped in place to avoid loss of the airway.


Assuntos
Manuseio das Vias Aéreas/instrumentação , Anestesia Geral , Máscaras Laríngeas , Respiração Artificial , Adolescente , Manuseio das Vias Aéreas/efeitos adversos , Anestesia Geral/efeitos adversos , Criança , Pré-Escolar , Equipamentos Descartáveis , Desenho de Equipamento , Feminino , Humanos , Lactente , Recém-Nascido , Máscaras Laríngeas/efeitos adversos , Masculino , Complicações Pós-Operatórias/epidemiologia , Respiração Artificial/efeitos adversos , Resultado do Tratamento
12.
J Econ Entomol ; 114(2): 739-746, 2021 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-33576417

RESUMO

Tarnished plant bug, Lygus lineolaris Palisot de Beauvois (Hemiptera: Miridae), has become a primary pest of cotton in the Midsouthern United States. Insect growth regulators such as novaluron are an important part of L. lineolaris management. While novaluron is lethal to nymphs, it does not kill adults, so it has been used when nymphs are the primary stage present. However, cotton yield protection was observed from an application of novaluron when adults were the predominant stage present. To explain this, a series of studies were conducted to examine sublethal impacts of novaluron to L. lineolaris adults. Novaluron ingestion by adults reduced hatch rate and sometimes reduced oviposition rate. Ingestion by either males or females reduced hatch rates, but the reduction was greater from female exposure. Contact exposure of adults with novaluron residues within 1 d of application reduced hatch rate by about 50%, but the impact on oviposition was inconsistent. A field study showed reduced hatch rate from contact exposure to mixed-age natural populations, but the overall net reproductive rate was not reduced. Surface exposure of eggs to novaluron did not reduce hatch rate. Overall, exposure of tarnished plant bug adults to novaluron, regardless of adult age or exposure route, reduced egg viability. However, the impact on oviposition rate and net reproductive rate varied with adult age and exposure route. This understanding of sublethal impacts of novaluron, in addition to lethal impacts on nymphs, should be considered when choosing application times to maximize effects on L. lineolaris populations.


Assuntos
Hemípteros , Heterópteros , Animais , Feminino , Masculino , Ninfa , Oviposição , Compostos de Fenilureia/farmacologia
13.
Phys Chem Chem Phys ; 12(23): 6247-52, 2010 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-20431831

RESUMO

In this study we present a systematic investigation of the phase behaviour of microemulsions containing near- or supercritical solvents. The starting point of this study are microemulsions of the type water/NaCl-propane-polyethyleneglycol mono-n-alkyl ether at a pressure of p = 220 bar. Replacing propane stepwise by supercritical carbon dioxide the typical phase behavior of microemulsions systems can still be observed using scCO(2) as the only nonpolar solvent. Thus, increasing the temperature a phase inversion from a CO(2)-in-water to a water-in-CO(2) microemulsion via a balanced CO(2) microemulsion is found for the first time. Such mixtures of water and scCO(2) are expected to be versatile solvents in green chemistry. In addition, the formulation of supercritical microemulsions is the initial step in the Principle Of Supercritical Microemulsion Expansion (POSME) (DE Pat., 102 60 815 B4, 2008), which is a promising new approach for the production of low-cost nanocellular foams. In contrast to conventional foaming procedures, this approach suggests the formation of nanofoams by expanding micelles swollen with a supercritical blowing agent, thereby ensuring the unhindered formation and growth of bubbles without mass transport.

14.
Alcohol Alcohol ; 45(1): 70-8, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-19889887

RESUMO

AIMS: This project investigated different dissemination strategies of an online quality improvement programme for alcohol-related disorders into routine care in South Baden and South Württemberg in Germany. METHODS: In a cluster-randomized controlled trial, 112 general practices were randomized into three groups. The first group (n = 43) received access to the online system and a training programme for the general practitioners (GPs). The second group (n = 42) additionally received education for the whole practice team. The third group (n = 27) acted as control and received only access to the online system. RESULTS: Two thousand six hundred and forty-seven practitioners were asked to take part in the study, and it was possible to randomize 112 (4%) practices. There were no significant differences concerning the use of the system between the groups: 41.9% of the GPs in the first group, 42.9% in the second group and 44.4% in the control group used the system. In terms of only the system users, 55.6% of the GPs in the first group, 33.3% in the second group and 8.3% in the control group used the system six times or more (P = 0.019). Diagnostic assessments made by the GPs in the groups differed substantially: 72.2% of diagnoses in the first group were correct, while this figure lay at 69.7% in the second group and 36.4% in the control group (P = 0.034). CONCLUSIONS: No effect of the additional training on the primary outcome (acceptance) was identified, but on two of the secondary outcomes. Further cost-effectiveness studies should investigate whether the effort involved in providing training additionally to the system is justifiable. The study is registered at ClinicalTrials.gov: NCT00314067. This article conforms to the guidelines in the Consolidated Standards of Reporting Trials (CONSORT) statement (Moher et al., 2001; Campbell et al., 2004).


Assuntos
Transtornos Relacionados ao Uso de Álcool/diagnóstico , Educação Médica Continuada/métodos , Medicina de Família e Comunidade/educação , Disseminação de Informação/métodos , Sistemas On-Line , Qualidade da Assistência à Saúde , Educação em Enfermagem/métodos , Prática Clínica Baseada em Evidências/métodos , Medicina de Família e Comunidade/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Avaliação de Programas e Projetos de Saúde
15.
J Econ Entomol ; 113(1): 249-254, 2020 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-31560749

RESUMO

The stages of rice, Oryza sativa L. (Poales: Poaceae), grain maturity that are most susceptible to rice stink bug, Oebalus pugnax (F.), damage have been identified; however, the stage at which they are no longer capable of causing appreciable damage during grain maturity is unclear. The objective of this study was to determine the susceptibility of rice to rice stink bug feeding at different levels of grain maturity and determine an insecticide termination timing. Rice stink bug damage was examined using five levels of grain maturity described as percent of kernels reaching mature straw coloration referred to as hard dough (20, 40, 60, 80, and 100%) across a range of infestation levels using single panicle sleeve cages and large cages. Hybrid and conventional cultivar rice panicles at 20, 40, and 60% hard dough were found to be susceptible to indirect yield loss, as two rice stink bugs per panicle resulted in over 7% peck. In large cage trials, 25 rice stink bugs caused 0.7-1% peck to hybrid and conventional rice plots at 20% hard dough. Much less damage was observed once rice reached 60% hard dough, where peck averages only reached 0.4%. Decreased damage at 60% hard dough was validated using uncaged trials where 0.4% additional peck was observed in unsprayed plots. These data indicate that rice in the early stages of hard dough is susceptible to large levels of indirect yield loss, but unless significant densities of rice stink bug are present at 60% hard dough, no more sampling or applications are necessary.


Assuntos
Heterópteros , Inseticidas , Oryza , Animais , Grão Comestível , Poaceae
16.
Anesthesiology ; 111(1): 55-62, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19512881

RESUMO

BACKGROUND: The single-use supraglottic airway devices LMA-Supreme (LMA-S; Laryngeal Mask Company, Henley-on-Thames, United Kingdom) and i-gel (Intersurgical Ltd, Wokingham, Berkshire, United Kingdom) have a second tube for gastric tube insertion. Only the LMA-S has an inflatable cuff. They have the same clinical indications and might be useful for difficult airway management. This prospective, crossover, randomized controlled trial was performed in a simulated difficult airway scenario using an extrication collar limiting mouth opening and neck movement. METHODS: Sixty patients were included. Both devices were placed in random order in each patient. Primary outcome was overall success rate. Other measurements were time to successful ventilation, airway leak pressure, fiberoptic glottic view, and adverse events. RESULTS: Success rate for the LMA-S was 95% versus 93% for the i-gel (P = 1.000). LMA-S needed shorter insertion time (34 +/- 12 s vs. 42 +/- 23 s, P = 0.024). Tidal volumes and airway leak pressure were similar (LMA-S 26 +/- 8 cm H20; i-gel 27 +/- 9 cm H20; P = 0.441). Fiberoptic view through the i-gel showed less epiglottic downfolding. Overall agreement in insertion outcome was 54 (successes) and 1 (failure) or 55 (92%) of 60 patients. The difference in success rate was 1.7% (95% CI -11.3% to 7.6%). CONCLUSIONS: Both airway devices had similar insertion success and clinical performance in the simulated difficult airway situation. The authors found less epiglottic downfolding and better fiberoptic view but longer insertion time with the i-gel. Our study shows that both devices are feasible for emergency airway management in patients with reduced neck movement and limited mouth opening.


Assuntos
Anestesia/métodos , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Adolescente , Adulto , Idoso , Obstrução das Vias Respiratórias/fisiopatologia , Anestesia/efeitos adversos , Estudos Cross-Over , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Máscaras Laríngeas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Respiração Artificial/efeitos adversos , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Volume de Ventilação Pulmonar/fisiologia , Adulto Jovem
17.
Mol Immunol ; 116: 140-150, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31654938

RESUMO

BACKGROUND: Non-specific lipid transfer proteins (LTPs) are important allergens in fruits, pollen, vegetables, nuts and latex. Due to their compact structure, LTPs are highly resistant to heat treatment. Here, Art v 3 from mugwort pollen and Pru p 3 from peach were used as model allergens to in-depth investigate structural and immunological properties upon thermal treatment at different buffer conditions. METHODS: Recombinant Art v 3 and Pru p 3 were purified from E. coli and incubated at 95 °C up to 120 min using sodium phosphate buffer pH 3.4 or 7.3. Physicochemical properties of allergens were analyzed in circular dichroism spectroscopy, Fourier transform infrared spectroscopy, dynamic light scattering, size exclusion chromatography, and mass spectrometry. The crystal structure of Art v 3.0201 was determined to 1.9 Šresolution. IgG and IgE binding was investigated in ELISA using murine and LTP allergic patients' sera. RESULTS: Highly pure and homogenous recombinant allergens were obtained from bacterial production. The crystal structure of Art v 3.0201 revealed an antiparallel four helix bundle with a C-terminal extension mediating an asymmetric, transient dimer interface and differently sized cavities. Both allergens showed high thermal stability at acidic conditions. In contrast, extensive heat treatment in neutral buffer induced irreversible structural changes due to lanthionine-based cysteine rearrangement. This fostered loss of the typical α-helical structure, increased molecular size and abrogation of IgG and IgE binding epitopes. Pru p 3 lost its structural integrity at shorter heat stress duration than Art v 3, which did however only partially affect the molecule's IgE binding epitopes. CONCLUSION: During thermal treatment, susceptibility to structural changes of the LTP-fold is highly dependent on the surrounding environment but also on intrinsic features of individual LTPs. This is a crucial fact to consider when processing LTP-containing food or food products as this will directly influence their allergenic potential.


Assuntos
Alanina/análogos & derivados , Antígenos de Plantas/metabolismo , Proteínas de Transporte/metabolismo , Cisteína/metabolismo , Proteínas de Plantas/metabolismo , Sulfetos/metabolismo , Alanina/metabolismo , Sequência de Aminoácidos , Animais , Artemisia/metabolismo , Reações Cruzadas/fisiologia , Epitopos/metabolismo , Escherichia coli/metabolismo , Hipersensibilidade Alimentar/metabolismo , Humanos , Imunoglobulina E/metabolismo , Imunoglobulina G/metabolismo , Camundongos , Pólen/metabolismo , Prunus/metabolismo
18.
J Econ Entomol ; 111(1): 187-192, 2018 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-29177425

RESUMO

Neonicotinoid seed treatments are one of several effective control options used in corn, Zea mays L., production in the Mid-South for early season insect pests. An analysis was performed on 91 insecticide seed treatment trials from Arkansas, Louisiana, Mississippi, and Tennessee to determine the value of neonicotinoids in corn production systems. The analysis compared neonicotinoid insecticide treated seed plus a fungicide to seed only with the same fungicide. When analyzed by state, corn yields were significantly higher when neonicotinoid seed treatments were used compared to fungicide only treated seed in Louisiana and Mississippi. Corn seed treated with neonicotinoid seed treatments yielded 111, 1,093, 416, and 140 kg/ha, higher than fungicide only treatments for Arkansas, Louisiana, Mississippi, and Tennessee, respectively. Across all states, neonicotinoid seed treatments resulted in a 700 kg/ha advantage compared to fungicide only treated corn seed. Net returns for corn treated with neonicotinoid seed treatment were $1,446/ha compared with $1,390/ha for fungicide only treated corn seed across the Mid-South. Economic returns for neonicotinoid seed treated corn were significantly greater than fungicide-only-treated corn seed in 8 out of 14 yr. When analyzed by state, economic returns for neonicotinoid seed treatments were significantly greater than fungicide-only-treated seed in Louisiana. In some areas, dependent on year, neonicotinoid seed treatments provide significant yield and economic benefits in Mid-South corn.


Assuntos
Proteção de Cultivos/métodos , Fungicidas Industriais/administração & dosagem , Controle de Insetos/economia , Inseticidas/administração & dosagem , Neonicotinoides/administração & dosagem , Zea mays , Proteção de Cultivos/economia , Sudeste dos Estados Unidos , Tennessee , Zea mays/crescimento & desenvolvimento
19.
J Econ Entomol ; 111(1): 10-15, 2018 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-29281077

RESUMO

Neonicotinoid insecticides are currently one of two classes of chemicals available as a seed treatment for growers to manage early season insect pests of cotton, Gossypium hirsutum L. (Malvales: Malvaceae), and they are used on nearly 100% of cotton hectares in the midsouthern states. An analysis was performed on 100 seed-treatment trials from Arkansas, Louisiana, Mississippi, and Tennessee to determine the value of neonicotinoid seed treatments in cotton production systems. The analysis compared seed treated with neonicotinoid insecticides seed treatments plus a fungicide with seed only treated with fungicide. When analyzed by state, cotton yields were significantly greater when neonicotinoid seed treatments were used compared with fungicide-only treatments. Cotton treated with neonicotinoid seed treatments yielded 123, 142, 95, and 104 kg ha-1, higher than fungicide only treatments for Arkansas, Louisiana, Mississippi, and Tennessee, respectively. Across all states, neonicotinoid seed treatments provided an additional 115 kg lint ha-1 comparedwith fungicide only treated seed. Average net returns from cotton with a neonicotinoid seed treatment were $1,801 per ha-1 compared with $1,660 per ha-1 for cottonseed treated with fungicide only. Economic returns for cotton with neonicotinoid seed treatments were significantly greater than cottonseed treated with fungicide only in 8 out of 15 yr representing every state. These data show that neonicotinoid seed treatments provide significant yield and economic benefits in Mid-South cotton compared with fungicide only treated seed.


Assuntos
Fungicidas Industriais , Controle de Insetos/métodos , Inseticidas , Neonicotinoides , Arkansas , Proteção de Cultivos/economia , Proteção de Cultivos/métodos , Gossypium/crescimento & desenvolvimento , Controle de Insetos/economia , Louisiana , Mississippi , Sementes/fisiologia , Tennessee
20.
J Econ Entomol ; 100(6): 1916-23, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18232411

RESUMO

A complex of hemipterans, especially the tarnished plant bug, Lygus lineolaris (Palisot de Beauvois) (Hemiptera: Miridae), has become a major target of insecticides in flowering cotton, Gossypium hirsutum L., in the mid-southern United States. Sampling protocols for this complex during this period of cotton development are poorly established, resulting in uncertainty about when infestations warrant treatment. Nine direct and indirect sampling methods were evaluated for bias, precision, and efficiency in cotton throughout the Mid-South during 2005 and 2006. The tarnished plant bug represented 94% of the bug complex in both years. Sweep-net and black drop-cloth methods were more efficient than other direct sampling methods, but they were biased toward adults and nymphs, respectively. Sampling dirty blooms was the most efficient indirect sampling method. The sweep-net, whole-plant, and dirty-bloom methods were more accurate than the other sampling methods evaluated based on correlations with other sampling methods. Variability attributed to the person collecting the sample was significant for all sampling methods, but least significant for the dirty-square method. Further research is needed to establish thresholds based on sweep-net, drop-cloth, dirty-square, and dirty-bloom sampling methods as these methods provide the best combinations of accuracy and efficiency for sampling tarnished plant bugs in cotton.


Assuntos
Gossypium/parasitologia , Hemípteros/fisiologia , Projetos de Pesquisa , Animais
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