APOE genotype influences triglyceride and C-reactive protein responses to altered dietary fat intake in UK adults

Background: The response of plasma lipids to dietary fat manipulation is highly heterogeneous, with some indications that APOE genotype may be important. Objective: The objective was to use a prospective recruitment approach to determine the effect of dietary fat quantity and composition on both lipid and nonlipid cardiovascular disease biomarkers according to APOE genotype. Design: Participants had a mean (±SD) age of 51 ± 9 y and a BMI (in kg/m2) of 26.0 ± 3.8 (n = 44 E3/E3, n = 44 E3/E4) and followed a sequential dietary intervention (the SATgenϵ study) in which they were assigned to a low-fat diet, a high-fat high-SFA (HSF) diet, and the HSF diet with 3.45 g DHA/d (HSF-DHA), each for 8 wk. Fasting blood samples were collected at the end of each intervention arm. Results: An overall diet effect was evident for all cholesterol fractions (P < 0.01), with no significant genotype × diet interactions observed. A genotype × diet interaction (P = 0.033) was evident for plasma triglycerides, with 17% and 30% decreases in APOE3/E3 and APOE3/E4 individuals after the HSF-DHA diet relative to the low-fat diet. A significant genotype × diet interaction (P = 0.009) was also observed for C-reactive protein (CRP), with only significant increases in concentrations after the HSF and HSF-DHA diets relative to the low-fat diet in the APOE3/E4 group (P < 0.015). Conclusions: Relative to the wild-type APOE3/E3 group, our results indicate a greater sensitivity of fasting triglycerides and CRP to dietary fat manipulation in those with an APOE3/E4 genotype (25% population), with no effect of this allelic profile on cholesterol concentrations. The SATgenϵ study was registered at clinicaltrials.gov as NCT01384032.

Proportions of A1, A2, B and C β-casein protein variants in retail milk in the UK

The A1 variant protein of the β-casein family has been implicated in various disease states although much evidence is weak or contradictory. The primary objective was to measure, for the first time, the proportions of the key β-casein variant proteins in UK retail milk over the course of one year. In total, 55 samples of semi-skimmed milk were purchased from five supermarkets over the course of a year and the proportions of the A1, A2, B and C casein variant proteins were measured, using high resolution HPLC-MS. The results showed that β-casein in UK retail milk comprises approximately 0.58, 0.31, 0.07 and 0.03 A2, A1, B and C protein variants, respectively. The proportion of A2 is higher than some early studies would predict although the reasons for this and any implications for health are unclear

Objective determination of feature resolution in two sea surface temperature analyses

Considerable effort is presently being devoted to producing high-resolution sea surface temperature (SST) analyses with a goal of spatial grid resolutions as low as 1 km. Because grid resolution is not the same as feature resolution, a method is needed to objectively determine the resolution capability and accuracy of SST analysis products. Ocean model SST fields are used in this study as simulated “true” SST data and subsampled based on actual infrared and microwave satellite data coverage. The subsampled data are used to simulate sampling errors due to missing data. Two different SST analyses are considered and run using both the full and the subsampled model SST fields, with and without additional noise. The results are compared as a function of spatial scales of variability using wavenumber auto- and cross-spectral analysis. The spectral variance at high wavenumbers (smallest wavelengths) is shown to be attenuated relative to the true SST because of smoothing that is inherent to both analysis procedures. Comparisons of the two analyses (both having grid sizes of roughly ) show important differences. One analysis tends to reproduce small-scale features more accurately when the high-resolution data coverage is good but produces more spurious small-scale noise when the high-resolution data coverage is poor. Analysis procedures can thus generate small-scale features with and without data, but the small-scale features in an SST analysis may be just noise when high-resolution data are sparse. Users must therefore be skeptical of high-resolution SST products, especially in regions where high-resolution (~5 km) infrared satellite data are limited because of cloud cover.

Memory for medication side effects in younger and older adults: the role of subjective and objective importance

Older adults often experience memory impairments, but can sometimes use selective processing and schematic support to remember important information. The current experiments investigate to what degree younger and healthy older adults remember medication side effects that were subjectively or objectively important to remember. Participants studied a list of common side effects, and rated how negative these effects were if they were to experience them, and were then given a free recall test. In Experiment 1, the severity of the side effects ranged from mild (e.g., itching) to severe (e.g., stroke), and in Experiment 2, certain side effects were indicated as critical to remember (i.e., “contact your doctor if you experience this”). There were no age differences in terms of free recall of the side effects, and older adults remembered more severe side effects relative to mild effects. However, older adults were less likely to recognize critical side effects on a later recognition test, relative to younger adults. The findings suggest that older adults can selectively remember medication side effects, but have difficulty identifying familiar but potentially critical side effects, and this has implications for monitoring medication use in older age.

A novel combined biomarker including plasma carotenoids, vitamin C, and ferric reducing antioxidant power is more strongly associated with fruit and vegetable intake than the individual components

BACKGROUND: Monitoring of fruit and vegetable (F&V) intake is fraught with difficulties. Available dietary assessment methods are associated with considerable error, and the use of biomarkers offers an attractive alternative. Few studies to date have examined the use of plasma biomarkers to monitor or predict the F&V intake of volunteers consuming a wide range of intakes from both habitual F&V and manipulated diets. OBJECTIVE: This study tested the hypothesis that an integrated biomarker calculated from a combination of plasma vitamin C, cholesterol-adjusted carotenoid concentration and Ferric Reducing Antioxidant Power (FRAP) had more power to predict F&V intake than each individual biomarker. METHODS: Data from a randomized controlled dietary intervention study [FLAVURS (Flavonoids University of Reading Study); n = 154] in which the test groups observed sequential increases of 2.3, 3.2, and 4.2 portions of F&Vs every 6 wk across an 18-wk period were used in this study. RESULTS: An integrated plasma biomarker was devised that included plasma vitamin C, total cholesterol-adjusted carotenoids, and FRAP values, which better correlated with F&V intake (r = 0.47, P < 0.001) than the individual biomarkers (r = 0.33, P < 0.01; r = 0.37, P < 0.001; and r = 0.14, respectively; P = 0.099). Inclusion of urinary potassium concentration did not significantly improve the correlation. The integrated plasma biomarker predicted F&V intake more accurately than did plasma total cholesterol-adjusted carotenoid concentration, with the difference being significant at visit 2 (P < 0.001) and with a tendency to be significant at visit 1 (P = 0.07). CONCLUSION: Either plasma total cholesterol-adjusted carotenoid concentration or the integrated biomarker could be used to distinguish between high- and moderate-F&V consumers. This trial was registered at www.controlled-trials.com as ISRCTN47748735.

Objective determination of the extratropical transition of tropical cyclones in the Northern Hemisphere

Extratropical transition (ET) has eluded objective identification since the realisation of its existence in the 1970s. Recent advances in numerical, computational models have provided data of higher resolution than previously available. In conjunction with this, an objective characterisation of the structure of a storm has now become widely accepted in the literature. Here we present a method of combining these two advances to provide an objective method for defining ET. The approach involves applying K-means clustering to isolate different life-cycle stages of cyclones and then analysing the progression through these stages. This methodology is then tested by applying it to five recent years from the European Centre of Medium-Range Weather Forecasting operational analyses. It is found that this method is able to determine the general characteristics for ET in the Northern Hemisphere. Between 2008 and 2012, 54% (±7, 32 of 59) of Northern Hemisphere tropical storms are estimated to undergo ET. There is great variability across basins and time of year. To fully capture all the instances of ET is necessary to introduce and characterise multiple pathways through transition. Only one of the three transition types needed has been previously well-studied. A brief description of the alternate types of transitions is given, along with illustrative storms, to assist with further study

Analysis of total visual and CCD V-broadband observations of Comet C/1995 O1 (Hale-Bopp): 1995-2001

We developed a general method for determination of water production rates from groundbased visual observations and applied it to Comet Hale-Bopp. Our main objective is to extend the method to include total visual magnitude observations obtained with CCD detector and V filter in the analysis of total visual magnitudes. We compare the CCD V-broadband careful observations of Liller [Liller, W. Pre-perihelion CCD photometry of Comet 1995 01 (Hale-Bopp). Planet. Space Sci. 45, 1505-1513, 1997; Liller, W. CCD photometry of Comet C/1995 O1 (Hale-Bopp): 1995-2000. Int. Comet Quart. 23(3), 93-97, 2001] with the total visual magnitude observations from experienced international observers found in the International Comet Quarterly (ICQ) archive. A data set of similar to 400 CCD observations covering about the same 6 years time span of the similar to 12,000 ICQ selected total visual magnitude observations were used in the analysis. A least-square method applied to the water production rates, yields power laws as a function of the heliocentric distances for the pre- and post-perihelion phases. The average dimension of the nucleus as well as its effective active area is determined and compared with values published in the literature. (C) 2009 COSPAR. Published by Elsevier Ltd. All rights reserved.

Multi-objective clustering ensemble for gene expression data analysis

In this paper, we present an algorithm for cluster analysis that integrates aspects from cluster ensemble and multi-objective clustering. The algorithm is based on a Pareto-based multi-objective genetic algorithm, with a special crossover operator, which uses clustering validation measures as objective functions. The algorithm proposed can deal with data sets presenting different types of clusters, without the need of expertise in cluster analysis. its result is a concise set of partitions representing alternative trade-offs among the objective functions. We compare the results obtained with our algorithm, in the context of gene expression data sets, to those achieved with multi-objective Clustering with automatic K-determination (MOCK). the algorithm most closely related to ours. (C) 2009 Elsevier B.V. All rights reserved.

Upgrading a TCABR data analysis and acquisition system for remote participation using Java, XML, RCP and modern client/server communication/authentication

The TCABR data analysis and acquisition system has been upgraded to support a joint research programme using remote participation technologies. The architecture of the new system uses Java language as programming environment. Since application parameters and hardware in a joint experiment are complex with a large variability of components, requirements and specification solutions need to be flexible and modular, independent from operating system and computer architecture. To describe and organize the information on all the components and the connections among them, systems are developed using the extensible Markup Language (XML) technology. The communication between clients and servers uses remote procedure call (RPC) based on the XML (RPC-XML technology). The integration among Java language, XML and RPC-XML technologies allows to develop easily a standard data and communication access layer between users and laboratories using common software libraries and Web application. The libraries allow data retrieval using the same methods for all user laboratories in the joint collaboration, and the Web application allows a simple graphical user interface (GUI) access. The TCABR tokamak team in collaboration with the IPFN (Instituto de Plasmas e Fusao Nuclear, Instituto Superior Tecnico, Universidade Tecnica de Lisboa) is implementing this remote participation technologies. The first version was tested at the Joint Experiment on TCABR (TCABRJE), a Host Laboratory Experiment, organized in cooperation with the IAEA (International Atomic Energy Agency) in the framework of the IAEA Coordinated Research Project (CRP) on ""Joint Research Using Small Tokamaks"". (C) 2010 Elsevier B.V. All rights reserved.

Development and Validation of a Mice liar Electrokinetic Chromatography Method for Quantitative Determination of Butenolides in Piper malacophyllum (C. Presl) C. DC.

Introduction - A large number of natural and synthetic compounds having butenolides as a core unit have been described and many of them display a wide range of biological activities. Butenolides from P. malacophyllum have presented potential antifungal activities but no specific, fast, and precise method has been developed for their determination. Objective - To develop a methodology based on micellar electrokinetic chromatography to determine butenolides in Piper species. Methodology - The extracts were analysed in an uncoated fused-silica capillaries and for the micellar system 20 mmol/L SDS, 20% (v/v) acetonitrile (ACN) and 10 mmol/L STB aqueous buffer at pH 9.2 were used. The method was validated for precision, linearity, limit of detection (LOD) and limit of quantitation (LOQ) and the standard deviations were determined from the standard errors estimated by the regression line. Results - A micellar electrokinetic chromatography (MEKC) method for determination of butenolides in extracts gave full resolution for 1 and 2. The analytical curve in the range 10.0-50.0 mu g/mL (r(2) = 0.999) provided LOD and LOQ for 1 and 2 of 2.1/6.3 and 1.1/3.5 mu g/mL, respectively. The RSD for migration times were 0.12 and 1.0% for peak area ratios with 100.0 +/- 1.4% of recovery. Conclusions - A novel high-performance MEKC method developed for the analysis of butenolides 1 and 2 in leaf extracts of P. malacophyllum allowed their quantitative determined within an analysis time shorter than 5 min and the results indicated CE to be a feasible analytical technique for the quantitative determination of butenolides in Piper extracts. Copyright (C) 2010 John Wiley & Sons, Ltd.

Visualization of spirography-based objective measures in Parkinson's disease

Objective: To investigate whether advanced visualizations of spirography-based objective measures are useful in differentiating drug-related motor dysfunctions between Off and dyskinesia in Parkinson’s disease (PD). Background: During the course of a 3 year longitudinal clinical study, in total 65 patients (43 males and 22 females with mean age of 65) with advanced PD and 10 healthy elderly (HE) subjects (5 males and 5 females with mean age of 61) were assessed. Both patients and HE subjects performed repeated and time-stamped assessments of their objective health indicators using a test battery implemented on a telemetry touch screen handheld computer, in their home environment settings. Among other tasks, the subjects were asked to trace a pre-drawn Archimedes spiral using the dominant hand and repeat the test three times per test occasion. Methods: A web-based framework was developed to enable a visual exploration of relevant spirography-based kinematic features by clinicians so they can in turn evaluate the motor states of the patients i.e. Off and dyskinesia. The system uses different visualization techniques such as time series plots, animation, and interaction and organizes them into different views to aid clinicians in measuring spatial and time-dependent irregularities that could be associated with the motor states. Along with the animation view, the system displays two time series plots for representing drawing speed (blue line) and displacement from ideal trajectory (orange line). The views are coordinated and linked i.e. user interactions in one of the views will be reflected in other views. For instance, when the user points in one of the pixels in the spiral view, the circle size of the underlying pixel increases and a vertical line appears in the time series views to depict the corresponding position. In addition, in order to enable clinicians to observe erratic movements more clearly and thus improve the detection of irregularities, the system displays a color-map which gives an idea of the longevity of the spirography task. Figure 2 shows single randomly selected spirals drawn by a: A) patient who experienced dyskinesias, B) HE subject, and C) patient in Off state. Results: According to a domain expert (DN), the spirals drawn in the Off and dyskinesia motor states are characterized by different spatial and time features. For instance, the spiral shown in Fig. 2A was drawn by a patient who showed symptoms of dyskinesia; the drawing speed was relatively high (cf. blue-colored time series plot and the short timestamp scale in the x axis) and the spatial displacement was high (cf. orange-colored time series plot) associated with smooth deviations as a result of uncontrollable movements. The patient also exhibited low amount of hesitation which could be reflected both in the animation of the spiral as well as time series plots. In contrast, the patient who was in the Off state exhibited different kinematic features, as shown in Fig. 2C. In the case of spirals drawn by a HE subject, there was a great precision during the drawing process as well as unchanging levels of time-dependent features over the test trial, as seen in Fig. 2B. Conclusions: Visualizing spirography-based objective measures enables identification of trends and patterns of drug-related motor dysfunctions at the patient’s individual level. Dynamic access of visualized motor tests may be useful during the evaluation of drug-related complications such as under- and over-medications, providing decision support to clinicians during evaluation of treatment effects as well as improve the quality of life of patients and their caregivers. In future, we plan to evaluate the proposed approach by assessing within- and between-clinician variability in ratings in order to determine its actual usefulness and then use these ratings as target outcomes in supervised machine learning, similarly as it was previously done in the study performed by Memedi et al. (2013).

Multi-Objective Pipe Smoothing Genetic Algorithm For Water Distribution Network Design

This paper describes the formulation of a Multi-objective Pipe Smoothing Genetic Algorithm (MOPSGA) and its application to the least cost water distribution network design problem. Evolutionary Algorithms have been widely utilised for the optimisation of both theoretical and real-world non-linear optimisation problems, including water system design and maintenance problems. In this work we present a pipe smoothing based approach to the creation and mutation of chromosomes which utilises engineering expertise with the view to increasing the performance of the algorithm whilst promoting engineering feasibility within the population of solutions. MOPSGA is based upon the standard Non-dominated Sorting Genetic Algorithm-II (NSGA-II) and incorporates a modified population initialiser and mutation operator which directly targets elements of a network with the aim to increase network smoothness (in terms of progression from one diameter to the next) using network element awareness and an elementary heuristic. The pipe smoothing heuristic used in this algorithm is based upon a fundamental principle employed by water system engineers when designing water distribution pipe networks where the diameter of any pipe is never greater than the sum of the diameters of the pipes directly upstream resulting in the transition from large to small diameters from source to the extremities of the network. MOPSGA is assessed on a number of water distribution network benchmarks from the literature including some real-world based, large scale systems. The performance of MOPSGA is directly compared to that of NSGA-II with regard to solution quality, engineering feasibility (network smoothness) and computational efficiency. MOPSGA is shown to promote both engineering and hydraulic feasibility whilst attaining good infrastructure costs compared to NSGA-II.

Trombose da veia porta em crianças e adolescentes : deficiência das proteínas C, S e Antitrombina e pesquisa das mutações fator V Leiden, G20210A da Protrombina e C677T da Metileno-tetraidrofolato redutase

Objetivo: A trombose da veia porta é uma causa importante de hiper-tensão porta em crianças e adolescentes, porém, em uma proporção importante dos casos, não apresenta fator etiológico definido. O objetivo desse estudo é determinar a freqüência de deficiência das proteínas inibidoras da coagulação – proteínas C, S e antitrombina − e das mutações fator V Leiden, G20210A no gene da protrombina e C677T da metileno-tetraidrofolato redutase em crianças e adolescentes com trom-bose da veia porta, definir o padrão hereditário de uma eventual deficiência das pro-teínas inibidoras da coagulação nesses pacientes e avaliar a freqüência da deficiên-cia dessas proteínas em crianças e adolescentes com cirrose. Casuística e Métodos: Foi realizado um estudo prospectivo com 14 crianças e adolescentes com trombose da veia porta, seus pais (n = 25) e dois gru-pos controles pareados por idade, constituídos por um grupo controle sem hepato-patia (n = 28) e um com cirrose (n = 24). A trombose da veia porta foi diagnosticada por ultra-sonografia abdominal com Doppler e/ou fase venosa do angiograma celíaco seletivo. A dosagem da atividade das proteínas C, S e antitrombina foi determinada em todos os indivíduos e a pesquisa das mutações fator V Leiden, G20210A da pro-trombina e C677T da metileno-tetraidrofolato redutase, nas crianças e adolescentes com trombose da veia porta, nos pais, quando identificada a mutação na criança, e nos controles sem hepatopatia. Resultados: Foram avaliados 14 pacientes caucasóides, com uma média e desvio padrão de idade de 8 anos e 8 meses ± 4 anos e 5 meses e do diagnóstico de 3 anos e 8 meses ± 3 anos e seis meses. Metade dos pacientes pertenciam ao gênero masculino. O motivo da investigação da trombose da veia porta foi hemorra-gia digestiva alta em 9/14 (64,3%) e achado de esplenomegalia ao exame físico em 5/14 (35,7%). Anomalias congênitas extra-hepáticas foram identificadas em 3/14 (21,4%) e fatores de risco adquiridos em 5/14 (35,7%) dos pacientes. Nenhum pa-ciente tinha história familiar de consangüinidade ou trombose venosa. A deficiência das proteínas C, S e antitrombina foi constatada em 6/14 (42,9%) (p < 0,05 vs con-troles sem hepatopatia), 3/14 (21,4%) (p > 0,05) e 1/14 (7,1%) (p > 0,05) pacientes com trombose da veia porta, respectivamente. A deficiência dessas proteínas não foi identificada em nenhum dos pais ou controles sem hepatopatia. A mutação G20210A no gene da protrombina foi identificada em um paciente com trombose da veia porta e em um controle sem hepatopatia (p = 0,999), mas em nenhum desses foi identificado a mutação fator V Leiden. A mutação C677T da metileno-tetraidrofo-lato redutase foi observada na forma homozigota, em 3/14 (21,4%) dos pacientes com trombose da veia porta e em 5/28 (17,9%) controles sem hepatopatia (p = 0,356). A freqüência da deficiência das proteínas C, S e antitrombina nos pacientes com cir-rose foi de 14/24 (58,3%), 7/24 (29,2%) e 11/24 (45,8%), respectivamente (p < 0,05 vs controles sem hepatopatia), sendo mais freqüente nos pacientes do subgrupo Child-Pugh B ou C, que foi de 11/12 (91,7%), 5/12 (41,7%) e 9/12 (75%), respectivamente (p < 0,05 vs controles sem hepatopatia). Conclusões: A deficiência de proteína C foi freqüente nas crianças e adolescentes com trombose da veia porta e não parece ser de origem genética. A deficiência de proteína S, antitrombina e as presenças das mutações G20210A da protrombina e C677T da metileno-tetraidrofolato redutase foram observadas mas não apresentaram diferença estatística significativa em relação ao grupo controle sem hepatopatia. O fator V Leiden não foi identificado. Os resultados deste estudo sugerem que a deficiência da proteína C pode ocorre como conseqüência da hiper-tensão porta. Os distúrbios pró-trombóticos hereditários não parecem apresentar um papel importante em relação à trombose nas crianças e adolescentes estudadas.

O outro lado de cá: histórias e memórias de Cachoeira da Prata

O principal objetivo dessa dissertação é analisar, através de um estudo caso, como a questão do “preconceito intergrupal” pode ser percebida no desenvolvimento histórico de pequenos municípios brasileiros. Escolhendo a história da memória da cidade de Cachoeira da Prata como objeto central, buscamos discutir como ocorreu o processo de diferenciação social da pequena comunidade formada pelos descendentes do ex-escravo Nicolau Teixeira do restante da cidade. Para tanto, dividimos a dissertação em duas partes. A primeira é formada pelos três primeiros capítulos, nos quais apresentamos a vila fabril de Cachoeira de Macacos como o cenário, no qual o cel. Américo Teixeira é identificado como o líder maior de um projeto de domínio político e industrial que deixou marcas duradouras na memória da população mais antiga da cidade. Nesse contexto, buscamos discutir como o fenômeno do pós-emancipação da escravidão se manifestou na localidade, analisando parte da trajetória de vida do ex-escravo Nicolau Teixeira, um leal apoiador do projeto político do cel. Américo, que se tornou, na primeira metade do século XX, o patriarca de uma comunidade criada nas imediações da antiga vila fabril. Na segunda parte, composta exclusivamente pelo quarto capítulo, discutimos de maneira conjugada, a história da diferenciação social da comunidade e diferentes posicionamentos políticos e metodológicos que adotamos ao longo da pesquisa. Após essa análise, concluímos que só é possível entender os meandros do processo que levou os descendentes de Nicolau Teixeira à condição de exclusão social após percebê-los como atores capazes de elaborar narrativas e representações que auxiliam a população de Cachoeira da Prata a conhecer um “outro lado” da história local.

Valor prognóstico das cinéticas da procalcitonina e da proteína C reativa na pneumonia associada à ventilação mecânica

Introdução A pneumonia hospitalar é a principal causa de morte dentre as infecções hospitalares. A prevalência de pneumonia hospitalar em Unidades de Tratamento Intensivo (UTI) varia de 10 a 65%, com taxas de mortalidade que podem variar de 24 a 76%. A pneumonia associada à ventilação mecânica (PAV) é um determinante de mortalidade independente em pacientes submetidos à ventilação mecânica. A adequação do tratamento empírico precoce parece ser fundamental no prognóstico. Os critérios atualmente estabelecidos para avaliar adequação do tratamento empírico utilizam parâmetros clínicos, escores de gravidade e, principalmente, a sensibilidade do germe causador da infecção aos antibióticos administrados. Estes resultados balizam a necessidade de possíveis modificações no esquema antimicrobiano. A possibilidade de utilizar a Procalcitonina (PCT), a Proteína-C Reativa (CRP) e o escore SOFA (Avaliação de Falência de Órgãos Relacionada a Sepse), como indicadores de resposta do paciente, comparando seu status no dia do início do tratamento antimicrobiano (D0) com a evolução destes indicadores no quarto dia de tratamento (D4) abre a possibilidade de comparar o paciente com ele próprio, independente da exuberância da expressão da resposta inflamatória que ele possa desenvolver. Os resultados desta cinética entre D0 e D4 podem ser preditivos de gravidade de infecção, de eficiência antimicrobiana, e possivelmente de sobrevivência ou mortalidade hospitalar nos pacientes com suspeita de PAV. Objetivos Determinar e comparar o valor prognóstico de sobrevivência da cinética da PCT, da CRP, dos escores clínicos CPIS (Escore Clínico de Infecção Pulmonar) e SOFA, e do APACHE II (Avaliação da Fisiologia Aguda e da Saúde Crônica) na PAV entre o diagnóstico e o quarto dia de tratamento, quando a adequação do tratamento é avaliada. Pacientes e Métodos Realizamos um estudo de coorte prospectivo observacional que avaliou 75 pacientes internados no Centro de Tratamento Intensivo clínico-cirúrgico de adultos do Hospital de Clínicas de Porto Alegre que desenvolveram PAV no período de outubro de 2003 a agosto de 2005. Os pacientes com suspeita clínica de PAV que se adequaram aos critérios de inclusão e exclusão do estudo foram os candidatos a participar. Os familiares ou representantes dos pacientes receberam esclarecimentos por escrito acerca dos exames a serem realizados, bem como dos objetivos gerais da pesquisa. Os que aceitaram participar do estudo assinaram o termo de Consentimento Informado. O projeto foi aprovado pelo Comitê de Ética em Pesquisa do Hospital de Clínicas de Porto Alegre. No dia do diagnóstico de PAV foram coletados aspirado traqueal quantitativo, hemoculturas e sangue para a realização de dosagens de PCT, CRP, hemograma, plaquetas, creatinina, bilirrubinas, gasometria arterial e radiografia de tórax, com o objetivo de calcular o CPIS e o escore SOFA. No terceiro dia de tratamento foram novamente coletados aspirados traqueais quantitativos e os demais exames para o cálculo do CPIS. No quarto dia foi coletado sangue para dosagens de PCT, CRP e para os demais exames necessários para o cálculo do SOFA. Os pacientes foram acompanhados por 28 dias após o diagnóstico de PAV, quando foram considerados sobreviventes. Todos os pacientes que morreram antes do vigésimo oitavo dia foram considerados não-sobreviventes. Resultados Os níveis de PCT foram mais baixos nos sobreviventes em D0 (p=0.003) e em D4 (p=0.001). Os níveis de CRP não foram diferentes em sobreviventes e nãosobreviventes em D0 (p=0.77) e em D4 (p=0.14). O CPIS não pode diferenciar sobreviventes de não-sobrevientes em D0 (p=0.32) e em D3 (p=0.45). ΔCPIS decrescente não foi correlacionado a sobrevivência (p=0.59), o mesmo ocorrendo com CPIS <6 em D3 (p=0.79). Pacientes que morreram antes de D4 não puderam ter sua cinética calculada e foram considerados casos perdidos. Variáveis incluídas no modelo de regressão logística univariável para sobrevivência foram idade, APACHE II, ΔSOFA decrescente, ΔPCT decrescente e ΔCRP decrescente. Sobrevivência foi diretamente correlacionada a ΔPCT decrescente com RC = 5.67 (1.78;18.03) p = 0.003, ΔCRP com RC = 3.78 (1.24;11.50) p = 0.02, ΔSOFA decrescente com RC = 3.08 (1.02;9.26) p = 0.05 e escore APACHE II com RC = 0.92 (0.86;0.99) p = 0.02. O modelo de regressão logística multivariável para sobrevivência incluiu todas as variáveis participantes da análise univariável. Somente ΔPCT decrescente com RC = 4.43 (1.08;18.18) p = 0.04 e ΔCRP com RC = 7.40 (1.58;34.73) p = 0.01 permaneceram significativos. A avaliação da cinética dos marcadores inflamatórios e a associação com sobrevida no estudo mostraram que: - Em 95,1% dos sobreviventes houve queda dos níveis de PCT ou de CRP. - Em 61% dos sobreviventes ambos os níveis de PCT e de CRP caíram. Apenas 4,9% dos sobreviventes tiveram níveis de PCT e CRP crescentes. Com relação aos não-sobreviventes, 78.9% tiveram pelo menos um dos dois marcadores ou ambos com níveis crescentes. Conclusão As cinéticas da PCT e da CRP, obtidas pelas dosagens de seus níveis no dia do diagnóstico e no 4º dia de tratamento, podem predizer sobrevivência em pacientes com PAV. A queda dos níveis de pelo menos um destes marcadores ou de ambos indica maior chance de sobrevivência.