689 resultados para A.J. Singh
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PURPOSE: Salvage chemotherapy followed by high-dose therapy and autologous stem-cell transplantation (ASCT) is the standard treatment for relapsed diffuse large B-cell lymphoma (DLBCL). Salvage regimens have never been compared; their efficacy in the rituximab era is unknown. PATIENTS AND METHODS: Patients with CD20(+) DLBCL in first relapse or who were refractory after first-line therapy were randomly assigned to either rituximab, ifosfamide, etoposide, and carboplatin (R-ICE) or rituximab, dexamethasone, high-dose cytarabine, and cisplatin (R-DHAP). Responding patients received high-dose chemotherapy and ASCT. RESULTS: The median age of the 396 patients enrolled (R-ICE, n = 202; R-DHAP, n = 194) was 55 years. Similar response rates were observed after three cycles of R-ICE (63.5%; 95% CI, 56% to 70%) and R-DHAP (62.8%; 95 CI, 55% to 69%). Factors affecting response rates (P < .001) were refractory disease/relapse less than versus more than 12 months after diagnosis (46% v 88%, respectively), International Prognostic Index (IPI) of more than 1 versus 0 to 1 (52% v 71%, respectively), and prior rituximab treatment versus no prior rituximab (51% v 83%, respectively). There was no significant difference between R-ICE and R-DHAP for 3-year event-free survival (EFS) or overall survival. Three-year EFS was affected by prior rituximab treatment versus no rituximab (21% v 47%, respectively), relapse less than versus more than 12 months after diagnosis (20% v 45%, respectively), and IPI of 2 to 3 versus 0 to 1 (18% v 40%, respectively). In the Cox model, these parameters were significant (P < .001). CONCLUSION: In patients who experience relapse more than 12 months after diagnosis, prior rituximab treatment does not affect EFS. Patients with early relapses after rituximab-containing first-line therapy have a poor prognosis, with no difference between the effects of R-ICE and R-DHAP.
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CONTEXT: Previous studies may have underestimated the contribution of health behaviors to social inequalities in mortality because health behaviors were assessed only at the baseline of the study. OBJECTIVE: To examine the role of health behaviors in the association between socioeconomic position and mortality and compare whether their contribution differs when assessed at only 1 point in time with that assessed longitudinally through the follow-up period. DESIGN, SETTING, AND PARTICIPANTS: Established in 1985, the British Whitehall II longitudinal cohort study includes 10 308 civil servants, aged 35 to 55 years, living in London, England. Analyses are based on 9590 men and women followed up for mortality until April 30, 2009. Socioeconomic position was derived from civil service employment grade (high, intermediate, and low) at baseline. Smoking, alcohol consumption, diet, and physical activity were assessed 4 times during the follow-up period. MAIN OUTCOME MEASURES: All-cause and cause-specific mortality. RESULTS: A total of 654 participants died during the follow-up period. In the analyses adjusted for sex and year of birth, those with the lowest socioeconomic position had 1.60 times higher risk of death from all causes than those with the highest socioeconomic position (a rate difference of 1.94/1000 person-years). This association was attenuated by 42% (95% confidence interval [CI], 21%-94%) when health behaviors assessed at baseline were entered into the model and by 72% (95% CI, 42%-154%) when they were entered as time-dependent covariates. The corresponding attenuations were 29% (95% CI, 11%-54%) and 45% (95% CI, 24%-79%) for cardiovascular mortality and 61% (95% CI, 16%-425%) and 94% (95% CI, 35%-595%) for noncancer and noncardiovascular mortality. The difference between the baseline only and repeated assessments of health behaviors was mostly due to an increased explanatory power of diet (from 7% to 17% for all-cause mortality, respectively), physical activity (from 5% to 21% for all-cause mortality), and alcohol consumption (from 3% to 12% for all-cause mortality). The role of smoking, the strongest mediator in these analyses, did not change when using baseline or repeat assessments (from 32% to 35% for all-cause mortality). CONCLUSION: In a civil service population in London, England, there was an association between socioeconomic position and mortality that was substantially accounted for by adjustment for health behaviors, particularly when the behaviors were assessed repeatedly.
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Many currently used and candidate vaccine adjuvants are particulate in nature, but their mechanism of action is not well understood. Here, we show that particulate adjuvants, including biodegradable poly(lactide-co-glycolide) (PLG) and polystyrene microparticles, dramatically enhance secretion of interleukin-1beta (IL-1beta) by dendritic cells (DCs). The ability of particulates to promote IL-1beta secretion and caspase 1 activation required particle uptake by DCs and NALP3. Uptake of microparticles induced lysosomal damage, whereas particle-mediated enhancement of IL-1beta secretion required phagosomal acidification and the lysosomal cysteine protease cathepsin B, suggesting a role for lysosomal damage in inflammasome activation. Although the presence of a Toll-like receptor (TLR) agonist was required to induce IL-1beta production in vitro, injection of the adjuvants in the absence of TLR agonists induced IL-1beta production at the injection site, indicating that endogenous factors can synergize with particulates to promote inflammasome activation. The enhancement of antigen-specific antibody production by PLG microparticles was independent of NALP3. However, the ability of PLG microparticles to promote antigen-specific IL-6 production by T cells and the recruitment and activation of a population of CD11b(+)Gr1(-) cells required NALP3. Our data demonstrate that uptake of microparticulate adjuvants by DCs activates the NALP3 inflammasome, and this contributes to their enhancing effects on innate and antigen-specific cellular immunity.
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A class of secreted poxvirus tumor necrosis factor (TNF)-binding proteins has been isolated from Tanapox-infected cell supernatants. The inhibitor bound to a TNF-affinity column and was identified as the product of the 2L gene. Sequence analysis of 2L family members from other yatapoxviruses and swinepox virus yielded no sequence homology to any known cellular gene. The expressed Tanapox virus 2L protein bound to human TNF with high affinity (K(d) = 43 pM) and exhibits an unusually slow off-rate. However, 2L is unable to bind to a wide range of human TNF family members. The 2L protein can inhibit human TNF from binding to TNF receptors I and II as well as block TNF-induced cytolysis. Thus, Tanapox virus 2L represents an inhibitor of human TNF and offers a unique strategy with which to modulate TNF activity.
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Para avaliar as características dos óxidos de ferro e de alumínio, foram coletadas amostras de solos desenvolvidos de diferentes materiais de origem e estádios de desenvolvimento nos estados de MG, ES, RS e RR. A fração argila das amostras foi estudada por difratometria de raios-X (DRX), análise termodiferencial (ATD), análise termogravimétrica diferencial (ATGD) e microscopia eletrônica. Nos extratos resultantes da extração com oxalato de amônio (OA) e ditionito-citrato-bicarbonato (DCB), determinaram-se os teores de Al, Si e microelementos, inclusive Fe. Em geral, a goethita (Gt) foi o principal óxido de ferro da fração argila. Apenas para os solos desenvolvidos de basalto e de arenito, verificou-se o predomínio de hematita (Hm). Os solos do Grupo Barreiras (ES) apresentaram os menores teores de óxidos de ferro em decorrência do intenso processo de desferrificação sofrido pelos sedimentos. Por ser a Gt um óxido hidratado, quanto maior a relação Gt/(Gt + Hm), maior o teor de água extraída pelo DCB (r = 0,70***). Os solos menos desenvolvidos, principalmente no horizonte C, apresentaram os maiores teores de material menos cristalino extraído pelo OA (chegando a 28% para a amostra 17) e os maiores valores para a relação FeOA/FeDCB. Este material menos cristalino é constituído principalmente por Al, com menor participação de Fe. Parte das amostras apresentou valores próximos para o diâmetro médio do cristal (DMC) da Gt nas direções (110) e (111), indicando formato isodimensional do mineral. Os maiores valores de DMC para a Hm resultaram na menor superfície específica em relação à Gt. A substituição isomórfica de Fe por Al (SI) na Gt foi consideravelmente superior à da Hm (média de 218 e 85 mmol mol-1, respectivamente). Com a entrada de Al na estrutura da Gt, verificou-se redução no tamanho, principalmente na direção do eixo Z (r entre SI e DMC(111) = -0,80***), e no grau de cristalinidade do mineral. As correlações entre teor de ferro e outros elementos extraídos pelo DCB foram altas e significativas. Os microelementos, como verificado para o Al, substituem isomorficamente o Fe na estrutura dos óxidos. O DMC da gibbsita (Gb) foi consistentemente superior ao dos óxidos de ferro. Por meio de observações em microscópio eletrônico, a Gb, na fração argila, apresentou o formato de pequenas placas retangulares e, na fração silte, verificou-se tendência de formato esférico.
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Dada a extensa área ocupada pelos sedimentos do Grupo Barreiras, é importante conhecer detalhadamente a mineralogia de suas frações. Com este propósito, coletaram-se 11amostras, até 14m de profundidade, em um pacote de sedimentos do Grupo Barreiras no município de Aracruz, estado do Espírito Santo, exposto pela construção de um canal adutor de água. As frações areia, silte e argila foram estudadas por difração de raios-X, análise termodiferencial, análise termogravimétrica diferencial e microscopia eletrônica. Os teores totais de Fe das frações argila e silte e Ti e Zr da fração silte foram determinados por espectrometria por emissão por plasma, após digestão da amostra com ácido fluorídrico concentrado. Para caracterizar e quantificar os minerais, amostras das frações argila e silte foram submetidas a extrações seqüenciais e seletivas dos minerais. A fração areia apresentou mineralogia uniforme, composta quase que exclusivamente por quartzo, com pequena presença de mica, anatásio e agregados de caulinita e ferro. Nas profundidades de 2,1; 4,2 e 7,7m, verificou-se a ocorrência de concreções ferruginosas de coloração vermelho-escura. Na fração silte, também com predomínio de quartzo, verificou-se a presença de caulinita, na forma de agregados estáveis e hematita. A caulinita é o principal mineral da fração argila, atingindo 953gkg-1 a 14m de profundidade. Os baixos teores de Fe dos sedimentos e as condições úmidas dos Tabuleiros Costeiros favoreceram a concentração de caulinita e a remoção de minerais, principalmente óxidos de Fe. Os teores de goethita, principal óxido de ferro dos sedimentos, diminuíram consistentemente em profundidade. Em decorrência do elevado grau de alteração dos sedimentos, a quantidade de material de baixa cristalinidade na fração argila foi pequena, variando de 3,2 a 24,0gkg-1, para extração com oxalato de amônio, e de 0,6 a 3,5gkg-1, para extração com NaOH 0,5molL-1 fervente. Pelo mesmo motivo, os teores de mica nas frações argila e silte foram inferiores a 5,0gkg-1. Como observado para a caulinita, os teores de mica na fração argila aumentaram em profundidade.
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Os sedimentos do Grupo Barreiras são muito pobres em minerais primários fontes de nutrientes. Para estudar a distribuição de K, Mg e outros metais em minerais das frações argila, silte e areia, coletaram-se 11amostras nas profundidades de 0,7; 1,4; 2,1; 2,8; 3,5; 4,2; 4,9; 5,6; 7,7; 10,5 e 14,0m, em um pacote de sedimentos do Grupo Barreiras, no município de Aracruz (ES) (19º49'13"S 40º16'24"O). Os teores totais de K, Mg, Ca, Al, Fe, Ti, Mn, Cu, Zn, Ni, Pb, Cr, Sr e Ga na terra fina seca em estufa e nas frações argila, silte e areia foram determinados por espectrômetria de emissão por plasma, após digestão completa da amostra com ácido fluorídrico concentrado. Para avaliar a contribuição de cada espécie mineral nos teores totais de K e de Mg, amostras da fração argila foram submetidas a extrações seqüenciais e seletivas de minerais. Em virtude da presença de camadas enriquecidas com concreções ferruginosas (principalmente do tamanho silte), ao longo do pacote de sedimentos, obtiveram-se os maiores teores totais de Fe2O3, nas profundidades de 2,1; 4,2 e 7,7m. Os sedimentos do Grupo Barreiras apresentaram limitada reserva de nutrientes, com baixos teores totais de K, Mg e Ca. Verificou-se aumento nos teores de K na fração argila com a profundidade, atingindo 618,2mgkg-1 a 14m. Na fração areia, os teores de K e de Mg foram maiores nas amostras com maior impureza de quartzo. A reserva em K e Mg na fração argila foi associada com a presença de mica e caulinita. A contribuição dos óxidos de Fe e de Al, dos aluminossilicatos de baixa cristalinidade e dos óxidos de Fe mais cristalinos, nos teores totais de K e de Mg, foi inexpressiva. As frações argila e silte foram as principais fontes de metais pesados nas amostras estudadas.
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As propriedades químicas e cristalográficas detalhadas da caulinita (Ct) e dos óxidos de ferro do solo e dos sedimentos do Grupo Barreiras são pouco conhecidas. Para estudar as características desses minerais em profundidade, coletaram-se 11 amostras (0,7; 1,4; 2,1; 2,8; 3,5; 4,2; 4,9; 5,6; 7,7; 10,5 e 14m) nos horizontes Bt, BC e C de um Argissolo Amarelo no município de Aracruz (ES). As frações argila e silte foram estudadas por difração de raios-X (DRX), análise termo-diferencial (ATD) e microscopia eletrônica. Os teores totais de Fe e outros microelementos (Cr, Mn, Ni, Pb, Ti e Zn) da fração argila foram determinados por espectrometria por emissão por plasma, após digestão da amostra com HF concentrado. Nos extratos resultantes das extrações com oxalato de amônio (OA) e ditionito-citrato-bicarbonato (DCB), determinaram-se os teores de Fe, Al, Si, Cr, Mn, Ni, Pb, Ti e Zn. A composição química da Ct das frações argila (amostra desferrificada) e silte (amostra natural) foi determinada pelo tratamento com NaOH 5molL-1 e pela combinação de aquecimento e extração com NaOH 0,5molL-1 fervente, respectivamente. O teor médio de Fe2O3 da Ct da fração argila (20,7gkg-1) foi superior ao obtido para a fração silte (5,2gkg-1), verificando-se, na menor fração, aumento nos teores de Fe2O3 com a profundidade. Graças ao maior raio iônico, a presença do Fe3+ na estrutura promoveu aumento no espaço interplanar do mineral, sobretudo na direção b. O tamanho das partículas de Ct foi semelhante entre os horizontes amostrados. A Ct apresentou grau semelhante de cristalinidade com a profundidade do solo, com exceção dos horizontes mais superficiais, os quais apresentaram menores valores de índice de cristalinidade, provavelmente por interferências com compostos orgânicos. A redução dos teores de Fe2O3 extraídos pelo DCB e da participação dos teores de FeOA mais FeDCB no Fe total da fração argila com a profundidade foi atribuída à dissolução dos óxidos de ferro, provocada pela umidade nas camadas inferiores dos sedimentos. A substituição isomórfica (SI) de Fe por Al na goethita (Gt) foi cerca de três vezes superior à da hematita (Hm), com maiores valores nos horizontes mais superficiais. A Hm apresentou menor valor de superfície específica (SE) que a Gt, refletindo os maiores valores de diâmetro médio do cristal para a Hm. Baixos valores de cristalinidade e menor tamanho de partículas estão associados à maior atividade e à influência da Ct e dos óxidos de ferro sobre as propriedades físico-químicas do solo. Os óxidos de ferro apresentaram baixa associação com microelementos, sobretudo com Ni, Pb e Ti.
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The QDR (quinidine drug resistance) family of genes encodes transporters belonging to the MFS (major facilitator superfamily) of proteins. We show that QDR transporters, which are localized to the plasma membrane, do not play a role in drug transport. Hence, null mutants of QDR1, QDR2 and QDR3 display no alterations in susceptibility to azoles, polyenes, echinocandins, polyamines or quinolines, or to cell wall inhibitors and many other stresses. However, the deletion of QDR genes, individually or collectively, led to defects in biofilm architecture and thickness. Interestingly, QDR-lacking strains also displayed attenuated virulence, but the strongest effect was observed with qdr2∆, qdr3∆ and in qdr1/2/3∆ strains. Notably, the attenuated virulence and biofilm defects could be reversed upon reintegration of QDR genes. Transcripts profiling confirmed differential expression of many biofilm and virulence-related genes in the deletion strains as compared with wild-type Candida albicans cells. Furthermore, lipidomic analysis of QDR-deletion mutants suggests massive remodelling of lipids, which may affect cell signalling, leading to the defect in biofilm development and attenuation of virulence. In summary, the results of the present study show that QDR paralogues encoding MFS antiporters do not display conserved functional linkage as drug transporters and perform functions that significantly affect the virulence of C. albicans.
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Systemic fungal infections remain a significant cause of mortality in neutropenic and immunocompromised patients, despite advances in their diagnosis and treatment. The incidence of such infections is rising due to the use of intensive chemotherapy regimens in patients with solid tumours or haematological cancers, the increasing numbers of allogeneic haematopoietic stem cell and solid organ transplants, and the use of potent immunosuppressive therapy in patients with autoimmune disorders. In addition, the epidemiology of systemic fungal infections is changing, with atypical species such as Aspergillus terreus and zygomycetes becoming more common. Treatment has traditionally focused on empirical therapy, but targeted pre-emptive therapy in high-risk patients and prophylactic antifungal treatment are increasingly being adopted. New treatments, including lipid formulations of amphotericin B, second-generation broad-spectrum azoles, and echinocandins, offer effective antifungal activity with improved tolerability compared with older agents; the potential impact of these treatments is reflected in their inclusion in current treatment and prophylaxis guidelines. New treatment strategies, such as aerosolized lipid formulations of amphotericin B, may also reduce the burden of mortality associated with systemic fungal infections. The challenge is to identify ways of coupling potentially effective treatments with early and reliable identification of patients at highest risk of infection.
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BACKGROUND: Father's occupational position, education and height have all been used to examine the effects of adverse early life socioeconomic circumstances on health, but it remains unknown whether they predict mortality equally well. METHODS: We used pooled data on 18,393 men and 7060 women from the Whitehall II and GAZEL cohorts to examine associations between early life socioeconomic circumstances and all-cause and cause-specific mortality. RESULTS: During the 20-y follow-up period, 1487 participants died. Education had a monotonic association with all mortality outcomes; the age, sex and cohort-adjusted HR for the lowest versus the highest educational group was 1.45 (95% CI 1.24 to 1.69) for all-cause mortality. There was evidence of a U-shaped association between height and all-cause, cancer and cardiovascular mortality robust to adjustment for the other indicators (HR 1.41, 95% CI 1.03 to 1.93 for those shorter than average and HR 1.36, 95% CI 0.98 to 1.88 for those taller than average for cardiovascular mortality). Greater all-cause and cancer mortality was observed in participants whose father's occupational position was manual rather than non-manual (HR 1.11, 95% CI 1.00 to 1.23 for all-cause mortality), but the risks were attenuated after adjusting for education and height. CONCLUSIONS: The association between early life socioeconomic circumstances and mortality depends on the socioeconomic indicator used and the cause of death examined. Height is not a straightforward measure of early life socioeconomic circumstances as taller people do not have a health advantage for all mortality outcomes.
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Average physical stature has increased dramatically during the 20th century in many populations across the world with few exceptions. It remains unclear if social inequalities in height persist despite improvements in living standards in the welfare economies of Western Europe. We examined trends in the association between height and socioeconomic indicators in adults over three decades in France. The data were drawn from the French Decennial Health Surveys: a multistage, stratified, random survey of households, representative of the population, conducted in 1970, 1980, 1991, and 2003. We categorised age into 10-year bands, 25-34, 35-44, 45-54 and 55-64 years. Education and income were the two socioeconomic measures used. The slope index of inequality (SII) was used as a summary index of absolute social inequalities in height. The results show that average height increased over this period; men and women aged 25-34 years were 171.9 and 161.2 cm tall in 1970 and 177.0 and 164.0 cm in 2003, respectively. However, education-related inequalities in height remained unchanged over this period and in men were 4.48 cm (1970), 4.71 cm (1980), 5.58 cm (1991) and 4.69 cm (2003), the corresponding figures in women were 2.41, 2.37, 3.14 and 2.96 cm. Income-related inequalities in height were smaller and much attenuated after adjustment for education. These results suggest that in France, social inequalities in adult height in absolute terms have remained unchanged across the three decades under examination.
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BACKGROUND: There is promising but conflicting evidence to recommend the addition of probiotics to foods for prevention and treatment of allergy. Based on previous studies with fermented milk containing Lactobacillus paracasei NCC2461, we aimed to compare the effect of a powder form of the latter probiotic with the effect of a blend of Lactobacillus acidophilus ATCC SD5221 and Bifidobacterium lactis ATCC SD5219 in patients with allergic rhinitis. METHODS: A double-blind, randomized, cross-over study, involving 31 adults with allergic rhinitis to grass pollen, was performed outside the grass pollen season (registration number: NCT01233154). Subjects received each product for 4-weeks in two phases separated by a wash-out period of 6 to 8 weeks. A nasal provocation test was performed before and after each 4-week product intake period, and outcome parameters (objective and subjective clinical symptoms; immune parameters) were measured during and/or 24 hours after the test. RESULTS: Out of the 31 subject enrolled, 28 completed the study. While no effect was observed on nasal congestion (primary outcome), treatment with NCC2461 significantly decreased nasal pruritus (determined by VAS), and leukocytes in nasal fluid samples, enhanced IL-5, IL-13 and IL-10 production by peripheral blood mononuclear cells in an allergen specific manner and tended to decrease IL-5 secretion in nasal fluid, in contrast to treatment with the blend of L. acidophilus and B. lactis. CONCLUSIONS: Despite short-term consumption, NCC2461 was able to reduce subjective nasal pruritus while not affecting nasal congestion in adults suffering from grass pollen allergic rhinitis. The associated decrease in nasal fluid leukocytes and IL-5 secretion, and the enhanced IL-10 secretion in an allergen specific manner may partly explain the decrease in nasal pruritus. However, somewhat unexpected systemic immune changes were also noted. These data support the study of NCC2461 consumption in a seasonal clinical trial to further demonstrate its potentially beneficial effect.
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Tannery wastes generation is increasing every year and a suitable method for tannery sludge management is necessary in order to decrease this environmental problem. The composting is recognized as a suitable method for sludge recycling.. The effect of tannery sludge compost (TSC) rates on growth, nodulation and N fixation of cowpea was investigated. Sandy and clayey soils were amended with TSC at rates of 0, 7.5, 15, 30, and 60 t ha-1. The shoot dry weight of cowpea plants 45 days after emergence (DAE) was greater in the TSC-amended than in the unamended soil. In the sandy soil, nodule dry weight increased with TSC application 45 DAE. In the clayey soil, 45 DAE, nodule dry weight decreased with TSC amendment levels greater than 7.5 t ha-1 compared to the unamended control. The application of TSC increased N accumulation in the cowpea plants. The results suggest that cowpea responds differently to TSC depending on the amendment rate and initial soil type.
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How the apical-basal axis of polarity is established in embryogenesis is still a mystery in plant development. This axis appeared specifically compromised by mutations in the Arabidopsis GNOM gene. Surprisingly, GNOM encodes an ARF guanine-nucleotide exchange factor (ARF-GEF) that regulates the formation of vesicles in membrane trafficking. In-depth functional analysis of GNOM and its closest relative, GNOM-LIKE 1 (GNL1), has provided a mechanistic explanation for the development-specific role of a seemingly mundane trafficking regulator. The current model proposes that GNOM is specifically involved in the endosomal recycling of the auxin-efflux carrier PIN1 to the basal plasma membrane in provascular cells, which in turn is required for the accumulation of the plant hormone auxin at the future root pole through polar auxin transport. Thus, the analysis of GNOM highlights the importance of cell-biological processes for a mechanistic understanding of development.