Cost-effectiveness comparison between pituitary down-regulation with a gonadotropin-releasing hormone agonist short regimen on alternate days and an antagonist protocol for assisted fertilization treatments

Objective: To compare cost-effectiveness between pituitary down-regulation with a GnRH agonist (GnRHa) short regimen on alternate days and GnRH antagonist (GnRHant) multidose protocol on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcome. Design: Prospective, randomized. Setting: A private center. Patient(s): Patients were randomized into GnRHa (n = 48) and GnRHant (n = 48) groups. Intervention(s): GnRHa stimulation protocol: administration of triptorelin on alternate days starting on the first day of the cycle, recombinant FSH (rFSH), and recombinant hCG (rhCG) microdose. GnRHant protocol: administration of a daily dose of rFSH, cetrorelix, and rhCG microdose. Main Outcome Measure(s): ICSI outcomes and treatment costs. Result(s): A significantly lower number of patients underwent embryo transfer in the GnRHa group. Clinical pregnancy rate was significantly lower and miscarriage rate was significantly higher in the GnRHa group. It was observed a significant lower cost per cycle in the GnRHa group compared with the GnRHant group ($5,327.80 ± 387.30 vs. $5,900.40 ± 472.50). However, mean cost per pregnancy in the GnRHa was higher than in the GnRHant group ($19,671.80 ± 1,430.00 vs. $11,328.70 ± 907.20). Conclusion(s): Although the short controlled ovarian stimulation protocol with GnRHa on alternate days, rFSH, and rhCG microdose may lower the cost of an individual IVF cycle, it requires more cycles to achieve pregnancy. Clinical Trial Registration Number: NCT01468441. © 2013 by American Society for Reproductive Medicine.

Recent advances in DNA vaccines for autoimmune diseases

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Antiretroviral resistance mutations in human immunodeficiency virus type 1 infected patients enrolled in genotype testing at the Central Public Health Laboratory, São Paulo, Brazil: preliminary results

Antiretroviral resistance mutations (ARM) are one of the major obstacles for pharmacological human immunodeficiency virus (HIV) suppression. Plasma HIV-1 RNA from 306 patients on antiretroviral therapy with virological failure was analyzed, most of them (60%) exposed to three or more regimens, and 28% of them have started therapy before 1997. The most common regimens in use at the time of genotype testing were AZT/3TC/nelfinavir, 3TC/D4T/nelfinavir and AZT/3TC/efavirenz. The majority of ARM occurred at protease (PR) gene at residue L90 (41%) and V82 (25%); at reverse transcriptase (RT) gene, mutations at residue M184 (V/I) were observed in 64%. One or more thymidine analogue mutations were detected in 73%. The number of ARM at PR gene increased from a mean of four mutations per patient who showed virological failure at the first ARV regimens to six mutations per patient exposed to six or more regimens; similar trend in RT was also observed. No differences in ARM at principal codon to the three drug classes for HIV-1 clades B or F were observed, but some polymorphisms in secondary codons showed significant differences. Strategies to improve the cost effectiveness of drug therapy and to optimize the sequencing and the rescue therapy are the major health priorities.

Níveis de proteína digestível e energia digestível em dietas para tilápias-do-nilo formuladas com base no conceito de proteína ideal

This study was carried out to determine the best digestible energy and digestible protein ratio in feeds for Nile tilapia (Oreochromis niloticus) juveniles 30.0 +/- 4.21 g) based on digestible amino acids and the ideal protein concept). Twelve rations were formulated with protein levels 22.0; 26.0; 30.0 and 34.0% of digestible protein and levels 3,000, 3,300 and 3,600 kcal/kg digestible energy. The digestible energy/digestible protein ratio was between 8.94 and 15.19 kcal/g. Three hundred and twenty four tilapias were randomly distributed in thirty six 250 L circular tanks at a density of 9 fish/tank, a total of 12 treatments with three replications. After 60 days, there was no significant difference in weight gain, daily weight gain and feed conversion ratio among the studied treatments. A linear increase was observed in fillet yield with increasing digestible protein. With respect to feed cost/kg weight gain, the treatment with 30.0% DP and 3,000 kcal/kg DE presented low cost and better cost effectiveness index. Therefore, it was concluded that digestible energy did not influence the productive performance parameters and that effective feeds can be formulated with DP levels lower than 34% when feeding juvenile tilapias. The ration should be formulated based on the concept of ideal protein.

Estudio de viabilidad tecnico-economica para la conversion de hornos electricos en hornos a gas natural

Technical and economic feasibility of using natural gas as a non-polluting energy source was studied. Conversion of electric ovens to gas-fired ovens for the preparation of aluminum plates for laminations was used as an example of this application. Four cases were evaluated for the use of heat derived from residual gases following combustion of the natural gas. Additionally, two possibilities are included for the use of systems of co-generation; one using an internal combustion engine, and second using a gas turbine. Results suggested that it was technically and economically feasible to convert the electric ovens considered to natural gas-operated ovens.

Modelo de otimização para seleção de árvores matrizes de Eucalyptus grandis

Individual data of basic density and volume of wood, pulp kappa number, soluble lignin, cost of pulping process as well as gravimetric gross yield of pulping process were used from 64 trees of Eucalyptus grandis W. Hill ex Maiden from a commercial population at Lençóis Paulista, SP. The Eucalyptus grandis's seeds were originally from a Seed Production Area (SPA) of Duratex S/A at Botucatu, SP. Obtained data were quantified considering objective of maximization no-bleaching pulp and volume and mass wood restriction, mass of residual and soluble lignin, planted area and pulping process cost. it has also been aimed a selection method for matrix trees through mathematical programming techniques. Obtained strategy maximized the economical result, selected matrix trees and followed all limits of technological and organizing productivities imposed by the company. It also aimed the production of no-bleaching pulp within the planned time.

Comparison of a multiplex-PCR assay with mycolic acids analysis and conventional methods for the identification of Mycobacteria

A fast, sensitive and cost-effective multiplex-PCR assay for Mycobacterium tuberculosis complex (MTC) and Mycobacterium avium (M. avium) identification for routine diagnosis was evaluated. A total of 158 isolates of mycobacteria from 448 clinical specimens from patients with symptoms of mycobacterial disease were analyzed. By conventional biochemical methods 151 isolates were identified as M. tuberculosis, five as M. avium and two as Mycobacterium chelonae (M. chelonae). Mycolic acid patterns confirmed these results. Multiplex-PCR detected only IS6110 in isolates identified as MTC, and IS1245 was found only in the M. avium isolates. The method applied to isolates from two patients, identified by conventional methods and mycolic acid analysis, one as M. avium and other as M. chelonae, resulted positive for IS6110, suggesting co-infection with M. tuberculosis. These patients were successfully submitted to tuberculosis treatment. The multiplex-PCR method may offer expeditious identification of MTC and M. avium, which may minimize risks for active transmission of these organisms and provide useful treatment information.

A comparison of mycolic acid analysis for nontuberculous mycobacteria identification by thin-layer chromatography and molecular methods

The development of fast, inexpensive, and reliable tests to identify nontuberculous mycobacteria (NTM) is needed. Studies have indicated that the conventional identification procedures, including biochemical assays, are imprecise. This study evaluated a proposed alternative identification method in which 83 NTM isolates, previously identified by conventional biochemical testing and in-house M. avium IS1245-PCR amplification, were submitted to the following tests: thin-layer chromatography (TLC) of mycolic acids and PCR-restriction enzyme analysis of hsp65 (PRA). High-performance liquid chromatography (HPLC) analysis of mycolic acids and Southern blot analysis for M. avium IS1245 were performed on the strains that evidenced discrepancies on either of the above tests. Sixty-eight out of 83 (82%) isolates were concordantly identified by the presence of IS1245 and PRA and by TLC mycolic acid analysis. Discrepant results were found between the phenotypic and molecular tests in 12/83 (14.4%) isolates. Most of these strains were isolated from non-sterile body sites and were most probably colonizing in the host tissue. While TLC patterns suggested the presence of polymycobacterial infection in 3/83 (3.6%) cultures, this was the case in only one HPLC-tested culture and in none of those tested by PRA. The results of this study indicated that, as a phenotypic identification procedure, TLC mycolic acid determination could be considered a relatively simple and cost-effective method for routine screening of NTM isolates in mycobacteriology laboratory practice with a potential for use in developing countries. Further positive evidence was that this method demonstrated general agreement on MAC and M. simiae identification, including in the mixed cultures that predominated in the isolates of the disseminated infections in the AIDS patients under study. In view of the fact that the same treatment regimen is recommended for infections caused by these two species, TLC mycolic acid analysis may be a useful identification tool wherever molecular methods are unaffordable.

Medicação de alto custo para portador de sofrimento psíquico: Um estudo preliminar dos custos

The present work aims to raise the costs of high-cost drugs used to treat patients of Refractory Schizophrenia in ambulatory unit. The study was carried out in the Psychosocial Support Center, which treated 33 patients with these medications, during the period of June, 2005 to May, 2006. Data analysis disclosed that the mostly used drugs to treat the carriers of Refractory Schizophrenia were: clozapina and risperidona. It was observed that the treatment with olanzapina is more expensive than that with risperidona. The study concluded that the analysis of the consumption and costs of drugs of high cost is necessary to subside better management of the expenses and new investments in the service. Moreover, the necessity of more studies in the area was also identified to contribute with the control of costs.

Towards intelligent manufacturing

This article describes the application of an Artificial Intelligence Planner in a robotized assembly cell that can be integrated to a Flexible Manufacturing System. The objective is to allow different products to be automatically assembled in a single production line with no pre-established assembly plans. The planner function is to generate action plans to the robot, in real time, from two input information: the initial state (disposition of parts of the product in line) and the final state (configuration of the assembled product). Copyright © 2007 IFAC.

Petri nets teaching in the Mechatronics Engineering course

The current solutions implanted in the majority of manufacturing systems controlled by PLCs were developed through the language of programming known as ladder. Such a language, easily learned and handled, shows to be efficient whenever the system to be implanted does not demand greater complexity of analyses. Bigger systems, presenting characteristics in which resource compartments, parallelism and synchronizing among processes are more frequent, demand the adoption of solutions differentiation. This article presents a teaching experience and practical application of Petri nets in a Mechatronics Engineering graduation course. Copyright © 2007 IFAC.

An efficient methodological approach in the didatic of automation applied to integrated manufacturing

This work presents challenges and solutions for the teaching and learning of automation applied to integrated manufacturing by means of a methodological approach based on techniques, tools and industrial equipment directly applicable in the industry. The approach was implemented in a control and automation engineering course divided into expositive and laboratory classes. Since the success of the approach is mainly from the practical activities, the article focus more on activities developed in laboratory than theorical classes. Copyright © 2007 IFAC.

Avaliação de desempenho do microaspersor amanco em bancada de testes

The need for a rational use of water and supply of food for a growing world population have led to the development of research in the area of irrigation systems. Thus, some irrigation systems which join efficiency with low cost of material have been developed. Although some technical characteristics are provided by the manufacturers, tests are required to verify functioning of the system and uniformity of water distribution. Continuous research on uniformity, characteristics of the materials and design of water distribution systems is essential for system improvement. Therefore, the objective of this work was to evaluate the CV (manufacturer's coefficient of variation) of Amanco microsprinkler (1.0 mm light green nipple) using bench testing in the laboratory of Irrigation at UNESP - FCA campus of Botucatu-SP. Twenty-five microsprinklers in a sequential design were used in the tests. Three flow systems were tested as follows: a Coil system based on serial connected pipes; a Lateral system, the most common system in which secondary lines are fed by a main line; and a Mesh system used in the urban water supply. The results showed that 4.17% CVf met the production standards and the Lateral and Mesh systems were similar regarding outflow using bench testing. The Mesh system presented the highest mean value of outflow and the lowest range of variation.

Prevention of hypertension in patients with pre-hypertension: Protocol for the PREVER-prevention trial

Background: Blood pressure (BP) within pre-hypertensive levels confers higher cardiovascular risk and is an intermediate stage for full hypertension, which develops in an annual rate of 7 out of 100 individuals with 40 to 50 years of age. Non-drug interventions to prevent hypertension have had low effectiveness. In individuals with previous cardiovascular disease or diabetes, the use of BP-lowering agents reduces the incidence of major cardiovascular events. In the absence of higher baseline risk, the use of BP agents reduces the incidence of hypertension. The PREVER-prevention trial aims to investigate the efficacy, safety and feasibility of a population-based intervention to prevent the incidence of hypertension and the development of target-organ damage.Methods: This is a randomized, double-blind, placebo-controlled clinical trial, with participants aged 30 to 70 years, with pre-hypertension. The trial arms will be chlorthalidone 12.5 mg plus amiloride 2.5 mg or identical placebo. The primary outcomes will be the incidence of hypertension, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new sub-clinical atherosclerosis, and sudden death. The study will last 18 months. The sample size was calculated on the basis of an incidence of hypertension of 14% in the control group, a size effect of 40%, power of 85% and P alpha of 5%, resulting in 625 participants per group. The project was approved by the Ethics committee of each participating institution.Discussion: The early use of blood pressure-lowering drugs, particularly diuretics, which act on the main mechanism of blood pressure rising with age, may prevent cardiovascular events and the incidence of hypertension in individuals with hypertension. If this intervention shows to be effective and safe in a population-based perspective, it could be the basis for an innovative public health program to prevent hypertension in Brazil.Trial Registration: Clinical Trials NCT00970931. © 2011 Fuchs et al; licensee BioMed Central Ltd.