Long term trends in prevalence of neural tube defects in Europe: population based study.

STUDY QUESTION: What are the long term trends in the total (live births, fetal deaths, and terminations of pregnancy for fetal anomaly) and live birth prevalence of neural tube defects (NTD) in Europe, where many countries have issued recommendations for folic acid supplementation but a policy for mandatory folic acid fortification of food does not exist? METHODS: This was a population based, observational study using data on 11 353 cases of NTD not associated with chromosomal anomalies, including 4162 cases of anencephaly and 5776 cases of spina bifida from 28 EUROCAT (European Surveillance of Congenital Anomalies) registries covering approximately 12.5 million births in 19 countries between 1991 and 2011. The main outcome measures were total and live birth prevalence of NTD, as well as anencephaly and spina bifida, with time trends analysed using random effects Poisson regression models to account for heterogeneities across registries and splines to model non-linear time trends. SUMMARY ANSWER AND LIMITATIONS: Overall, the pooled total prevalence of NTD during the study period was 9.1 per 10 000 births. Prevalence of NTD fluctuated slightly but without an obvious downward trend, with the final estimate of the pooled total prevalence of NTD in 2011 similar to that in 1991. Estimates from Poisson models that took registry heterogeneities into account showed an annual increase of 4% (prevalence ratio 1.04, 95% confidence interval 1.01 to 1.07) in 1995-99 and a decrease of 3% per year in 1999-2003 (0.97, 0.95 to 0.99), with stable rates thereafter. The trend patterns for anencephaly and spina bifida were similar, but neither anomaly decreased substantially over time. The live birth prevalence of NTD generally decreased, especially for anencephaly. Registration problems or other data artefacts cannot be excluded as a partial explanation of the observed trends (or lack thereof) in the prevalence of NTD. WHAT THIS STUDY ADDS: In the absence of mandatory fortification, the prevalence of NTD has not decreased in Europe despite longstanding recommendations aimed at promoting peri-conceptional folic acid supplementation and existence of voluntary folic acid fortification. FUNDING, COMPETING INTERESTS, DATA SHARING: The study was funded by the European Public Health Commission, EUROCAT Joint Action 2011-2013. HD and ML received support from the European Commission DG Sanco during the conduct of this study. No additional data available.

Controle de qualidade de monitores de diagnóstico por imagem e iluminância nos espaços de pós-processamento em serviços de imagiologia

OBJETIVO: Avaliar a qualidade dos monitores de diagnóstico e tratamento de imagem digital em radiologia convencional (raios X) com base nos níveis de luminância. Fez-se a medição da iluminância dos postos de trabalho onde estavam os monitores. MATERIAIS E MÉTODOS: A medição da luminância foi realizada usando-se um detector Unfors Xi Light em cinco instituições, com 23 monitores primários e 22 secundários, sendo 6 usados em urgência, seguindo o método descrito no relatório TG18 da American Association of Physicists in Medicine (AAPM). O instrumento de medida utilizado foi o Delta Ohm HD 9221 luximeter. RESULTADOS: Para as recomendações da AAPM, tanto monitores primários como secundários cumpriram, no geral, os níveis de tolerância. No caso dos níveis de iluminância, nos locais de trabalho dos monitores primários encontravam-se ligeiramente acima do intervalo recomendado. Quanto às recomendações do The Royal College of Radiologists (RCR), os monitores que respeitaram os níveis recomendados estavam em minoria, embora as diferenças não fossem significativas. CONCLUSÃO: Em geral, os resultados foram satisfatórios, embora os monitores não fossem adequados para atingir as recomendações exigentes do RCR. Os níveis de referência entre os monitores primários e secundários deveriam aproximar-se, de modo a garantir a qualidade de imagem. Os monitores para visualização e diagnóstico de imagens médicas devem ser regularmente avaliados para manter um sistema com a qualidade exigida, dada a função que desempenham.

Fosfomycin plus β-Lactams as Synergistic Bactericidal Combinations for Experimental Endocarditis Due to Methicillin-Resistant and Glycopeptide-Intermediate Staphylococcus aureus.

The urgent need of effective therapies for methicillin-resistant Staphylococcus aureus (MRSA) infective endocarditis (IE) is a cause of concern. We aimed to ascertain the in vitro and in vivo activity of the older antibiotic fosfomycin combined with different beta-lactams against MRSA and glycopeptide-intermediate-resistant S. aureus (GISA) strains. Time-kill tests with 10 isolates showed that fosfomycin plus imipenem (FOF+IPM) was the most active evaluated combination. In an aortic valve IE model with two strains (MRSA-277H and GISA-ATCC 700788), the following intravenous regimens were compared: fosfomycin (2 g every 8 h [q8h]) plus imipenem (1 g q6h) or ceftriaxone (2 g q12h) (FOF+CRO) and vancomycin at a standard dose (VAN-SD) (1 g q12h) and a high dose (VAN-HD) (1 g q6h). Whereas a significant reduction of MRSA-227H load in the vegetations (veg) was observed with FOF+IPM compared with VAN-SD (0 [interquartile range [IQR], 0 to 1] versus 2 [IQR, 0 to 5.1] log CFU/g veg; P = 0.01), no statistical differences were found with VAN-HD. In addition, FOF+IPM sterilized more vegetations than VAN-SD (11/15 [73%] versus 5/16 [31%]; P = 0.02). The GISA-ATCC 700788 load in the vegetations was significantly lower after FOF+IPM or FOF+CRO treatment than with VAN-SD (2 [IQR, 0 to 2] and 0 [IQR, 0 to 2] versus 6.5 [IQR, 2 to 6.9] log CFU/g veg; P < 0.01). The number of sterilized vegetations after treatment with FOF+CRO was higher than after treatment with VAN-SD or VAN-HD (8/15 [53%] versus 4/20 [20%] or 4/20 [20%]; P = 0.03). To assess the effect of FOF+IPM on penicillin binding protein (PBP) synthesis, molecular studies were performed, with results showing that FOF+IPM treatment significantly decreased PBP1, PBP2 (but not PBP2a), and PBP3 synthesis. These results allow clinicians to consider the use of FOF+IPM or FOF+CRO to treat MRSA or GISA IE.

Receiver operating characteristic (ROC) curve for classification of18F-NaF uptake on PET/CT

Abstract Objective: To assess the cutoff values established by ROC curves to classify18F-NaF uptake as normal or malignant. Materials and Methods: PET/CT images were acquired 1 hour after administration of 185 MBq of18F-NaF. Volumes of interest (VOIs) were drawn on three regions of the skeleton as follows: proximal right humerus diaphysis (HD), proximal right femoral diaphysis (FD) and first vertebral body (VB1), in a total of 254 patients, totalling 762 VOIs. The uptake in the VOIs was classified as normal or malignant on the basis of the radiopharmaceutical distribution pattern and of the CT images. A total of 675 volumes were classified as normal and 52 were classified as malignant. Thirty-five VOIs classified as indeterminate or nonmalignant lesions were excluded from analysis. The standardized uptake value (SUV) measured on the VOIs were plotted on an ROC curve for each one of the three regions. The area under the ROC (AUC) as well as the best cutoff SUVs to classify the VOIs were calculated. The best cutoff values were established as the ones with higher result of the sum of sensitivity and specificity. Results: The AUCs were 0.933, 0.889 and 0.975 for UD, FD and VB1, respectively. The best SUV cutoffs were 9.0 (sensitivity: 73%; specificity: 99%), 8.4 (sensitivity: 79%; specificity: 94%) and 21.0 (sensitivity: 93%; specificity: 95%) for UD, FD and VB1, respectively. Conclusion: The best cutoff value varies according to bone region of analysis and it is not possible to establish one value for the whole body.

Dominant-Negative Effects of Adult-Onset Huntingtin Mutations Alter the Division of Human Embryonic Stem Cells-Derived Neural Cells.

Mutations of the huntingtin protein (HTT) gene underlie both adult-onset and juvenile forms of Huntington's disease (HD). HTT modulates mitotic spindle orientation and cell fate in mouse cortical progenitors from the ventricular zone. Using human embryonic stem cells (hESC) characterized as carrying mutations associated with adult-onset disease during pre-implantation genetic diagnosis, we investigated the influence of human HTT and of an adult-onset HD mutation on mitotic spindle orientation in human neural stem cells (NSCs) derived from hESCs. The RNAi-mediated silencing of both HTT alleles in neural stem cells derived from hESCs disrupted spindle orientation and led to the mislocalization of dynein, the p150Glued subunit of dynactin and the large nuclear mitotic apparatus (NuMA) protein. We also investigated the effect of the adult-onset HD mutation on the role of HTT during spindle orientation in NSCs derived from HD-hESCs. By combining SNP-targeting allele-specific silencing and gain-of-function approaches, we showed that a 46-glutamine expansion in human HTT was sufficient for a dominant-negative effect on spindle orientation and changes in the distribution within the spindle pole and the cell cortex of dynein, p150Glued and NuMA in neural cells. Thus, neural derivatives of disease-specific human pluripotent stem cells constitute a relevant biological resource for exploring the impact of adult-onset HD mutations of the HTT gene on the division of neural progenitors, with potential applications in HD drug discovery targeting HTT-dynein-p150Glued complex interactions.

Treatment-related renal side-effects in pediatric cancer patients

Background: The long-term side-effects of cancer treatments are of growing importance, since the number of pediatric cancer survivors has considerably increased. Renal side-effects should be noted early to prevent further deterioration. Renal dysfunction may also develop long after cancer treatment. Easy and reliable methods for assessing renal function are needed. Aims: The aims were to find the mechanisms behind methotrexate-induced renal damage by studying renal tubular cells (LLC-PK1cells), and to evaluate the usefulness of laboratory tests in assessing glomerular function in pediatric cancer patients by comparing an isotope clearance method with alternative methods. The aim was also to study the long-term effects of bone marrow transplantation (BMT) and high-dose methotrexate (HD-MTX) treatment in renal function. Results: Methotrexate induced time-dependent renal tubular cell swelling and cell death. In patients treated with HD-MTX a significant decrease in GFR was noted after a follow-up time of one to ten years. One year after BMTthe GFR was reduced, especially in patients treated with total body irradiation (TBI). GFR recovered slightly but remained stable thereafter. In glomerular function assessment the serum cystatin C (cysC) concentration showed a significant association with GFR measured by the isotope method. Conclusions: Methotrexate induced acute damage in renal tubular cells. In assessing GFR the isotope method still remains the method of choice, but the assay of cystatin C was the most reliable of other alternatives. Long-term follow-up of renal function is needed in BMT patients and patients treated with HD-MTX.

Determinação da 2,5-hexanodiona em amostras de urina submetidas à hidrólise ácida: importância da coluna cromatográfica e do pH do meio

Acidic hydrolysis of samples is frequent in urinary 2,5-hexanodione determination. This hydrolysis should be performed under proper conditions, in order to avoid interference, such as the presence of 2,5-dimethylfurane and 2-acetylfurane. The results of the present work, as well as data from the literature, show that the use of non-polar or slightly polar chromatographic columns of 30 m length is an essential condition for 2,5-HD determination in an acid hydrolysed urine sample. In the same way the pH should be kept between 0.3 and 0.5. The mean concentrations of 2,5-HD in samples submitted to hydrolysis (0.50 ± 0.28 mg/g of creatinine) was about 3 times higher than those found in the samples without acid hydrolysis (0.19 ± 0.3 mg/g of creatinine).

Urinary 2,5-hexanedione in workers exposed to n-hexane: influence of the sample treatment

The aim of the present study was to determine 2,5-hexanedione (2,5-HD), a metabolite of n-hexane, by gas chromatography/flame ionization detection in 31 workers exposed to n-hexane after two types of sample pretreatment, i.e., with (total 2,5-HD) and without (free 2,5-HD) acid hydrolysis. The mean urinary 2,5-HD was 0.52 mg/L (free) and 2.88 mg/L (total), this difference being significant (Student t-test, p < 0.05). The differences in the results according to the sample treatment support the need to modify the current Brazilian legislation, which proposes the analysis of 2,5-HD without indicating whether it is the free or total metabolite.

Is contextual-potentiated eating dependent on caloric density of food?

One experiment tested whether a specific context could elicit eating in rats as a result of Pavlovian conditioning and whether this effect depended on the caloric density of food. Thirty two deprived rats experienced two contexts. They had access to food in context A, but no food was available in context B. During conditioning, half of the animals received high density caloric food (HD groups) whereas the other half, low density caloric food (LD groups). Then, half of the rats in each type of food group was tested in context A and the other half in context B. The results demonstrated an effect of context conditioning only in HD groups. These findings suggest the relevance of both contextual conditioning and caloric density of food in eating behaviour. Implications for the aetiology of binge eating will be discussed.

Importância das variáveis altura dominante e altura total em equaçõea hipsométricas e volumétricas

Este estudo foi conduzido, visando avaliar as seguintes hipóteses: a) equações hipsométricas devem ser obtidas por parcela, apenas em função do dap; e b) equações volumétricas devem ser locais, em função apenas do dap. Foram utilizados dados de quatro parcelas distribuídas ao acaso em um povoamento de eucalipto de 67,81 ha e de 50 parcelas distribuídas ao acaso em um povoamento de 121,3 ha, da mesma espécie. Em uma análise inicial, a fim de obter valores reais de altura total e de volume sólido, realizou-se uma cubagem rigorosa de todas as árvores das quatro parcelas. Foram utilizados, ainda, dados de 277 árvores cubadas rigorosamente nos povoamentos. Para avaliar a exatidão das estimativas e as hipóteses formuladas, empregou-se o procedimento estatístico proposto por Leite & Oliveira (2002). Com base nos resultados, as hipóteses a e b foram rejeitadas a 1% de probabilidade. Concluiu-se, portanto, que em um inventário florestal a variável Hd deve ser considerada e que as equações volumétricas devem ser regionais.

Utilização de lisímetros de pesagem para a determinação dos coeficientes de cultura do meloeiro (Cucumis melo L.) para cultivo em estufa agrícola na região de Araras - SP

Esta pesquisa foi conduzida em uma estufa agrícola instalada na área experimental do Centro de Ciências Agrárias da Universidade Federal de São Carlos, localizado em Araras - SP. O solo da área experimental é um Latossolo Vermelho-Escuro, distrófico, de horizonte A moderado e textura argilosa. Os meloeiros estudados foram os híbridos Louis e HD 90. O experimento foi irrigado por gotejamento, e o controle da irrigação, realizado por meio de dois lisímetros de pesagem instalados dentro da estufa. A umidade do solo foi monitorada com uma sonda de TDR e mantida próxima de sua capacidade de campo. As informações climatológicas relevantes ao projeto foram coletadas em estações meteorológicas automáticas, instaladas dentro e fora da estufa. A evapotranspiração de referência (ETo) foi estimada pelos modelos agroclimáticos de Penman-Monteith, Penman, Makkink e do Tanque Classe A. Os consumos totais de água medidos nos lisímetros foram de 254,5 mm e 188,6 mm, respectivamente, para os meloeiros Louis e HD 90, os quais correspondem ao consumo médio diário de 3,18 mm e 2,35 mm. Todos os modelos agroclimáticos avaliados subestimaram a evapotranspiração de referência estimada pelo modelo padrão de Penman-Monteith, variando de um mínimo de 26,9%, no caso do modelo de Penman, até um máximo de 74,3%, no caso do modelo de Makkink. Os coeficientes de cultura determinados pelo modelo padrão de Penman-Monteith, considerando-se aqui o valor médio dos dois tipos de meloeiros estudados, foram os seguintes: estádio inicial: 0,20; estádio intermediário: 1,10, e estádio final: 0,50.

Associação entre o escore do International Consultation on Incontinence Questionaire: Urinary Incontinence/Short Form e a Avaliação Urodinâmica em mulheres com incontinência urinária

OBJETIVO: Avaliar a correlação entre o International Consultation on Incontinence Questionnaire - Urinary Incontinence/Short Form (ICIQ-UI/SF) e a Avaliação Urodinâmica (AU) em mulheres com incontinência urinária (IU). MÉTODOS: Foram analisados retrospectivamente dados clínicos, AU e escore do ICIQ-UI/SF de 358 mulheres com IU atendidas em clínica privada. O teste de correlação entre ICIQ-UI/SF e os parâmetros urodinâmicos foi o teste de Spearman. Foi utilizada a curva ROC, com os valores de sensibilidade e especificidade dos escores do ICIQ-UI/SF apresentados pelas pacientes, para identificar o valor do questionário que determinasse a presença da alteração urodinâmica estudada. Para o cálculo do valor p foi utilizado o teste do c² ou exato de Fisher. O nível de significância foi de 5% e o software utilizado para análise foi o SAS versão 9.2. RESULTADOS: As pacientes com IU aos Esforços segundo a AU - IUE urodinâmica - representaram 67,3% do total; aquelas com IUE na AU e Hiperatividade Detrusora (HD) - IUM urodinâmica - 16,2%, e as pacientes com HD isolada - HD - 7,3% do total. As pacientes com AU normal representaram 9,2% do total da amostra. Houve associação significativa entre escore ³14 no ICIQ-UI/SF e as pacientes com IUE urodinâmica e IUM urodinâmica. Pacientes com Pressão de Perda ao Esforço (PPE) £90 cmH2O apresentaram escore ao ICIQ-UI/SF³15. O teste de Spearman mostrou correlação inversa fraca entre o escore e a PPE, porém não mostrou correlação entre esse escore e a Capacidade Cistométrica Máxima (CCM) ou com o volume vesical no primeiro desejo miccional. CONCLUSÃO: Houve associação entre o escore do ICIQ-UI/SF e IUE urodinâmica (isolada ou associada à HD); porém não houve associação com a HD isolada. Quanto menor o valor da PPE, maior o escore total do ICIQ-UI/SF. O ICIQ-UI/SF não foi capaz de discriminar o tipo de IU na população estudada.

Desenvolvimento de um modelo experimental de hemodiálise em cães

Com o objetivo de desenvolver um modelo de hemodiálise (HD) em cães, foram estudados 18 animais, sem raça definida, machos, clinicamente sadios, com peso corporal variando entre sete e 14 kg. O acesso vascular foi obtido através de implantação do cateter de duplo lúmen em veia jugular externa. As sessões de HD, em número de cinco por animal, com até três horas de duração, foram realizadas em hemodialisadora de sistema proporcional com ultrafiltração (UF) controlada, com solução dialisante padrão e tampão bicarbonato. A UF foi ajustada para HD isovolêmica, utilizou-se perfil de sódio, e para anticoagulação heparina sódica. Os animais foram mantidos anestesiados com cloridrato de levomepromazina e propofol. Foram avaliados dados hematológicos, bioquímicos, hemogasometria, pressão arterial sistêmica e tempo de coagulação ativado. Foi observada diminuição do número global de hemácias, volume globular, hemoglobina e leucócitos. Em relação aos exames bioquímicos, houve manutenção nos níveis de sódio sérico, e quanto à hemogasometria, a manutenção da SO2. A pressão arterial sistêmica manteve-se constante. Os resultados obtidos no presente trabalho permitiram concluir que foi possível o desenvolvimento do modelo proposto e mostrou que a HD em cães é um método viável e seguro, que poderá contribuir para o tratamento clínico da insuficiência renal nesta espécie.

Macroalgae across environmental gradients : tools for managing rocky coastal areas of the northern Baltic Sea

Macroalgae are the main primary producers of the temperate rocky shores providing a three-dimensional habitat, food and nursery grounds for many other species. During the past decades, the state of the coastal waters has deteriorated due to increasing human pressures, resulting in dramatic changes in coastal ecosystems, including macroalgal communities. To reverse the deterioration of the European seas, the EU has adopted the Water Framework Directive (WFD) and the Marine Strategy Framework Directive (MSFD), aiming at improved status of the coastal waters and the marine environment. Further, the Habitats Directive (HD) calls for the protection of important habitats and species (many of which are marine) and the Maritime Spatial Planning Directive for sustainability in the use of resources and human activities at sea and by the coasts. To efficiently protect important marine habitats and communities, we need knowledge on their spatial distribution. Ecological knowledge is also needed to assess the status of the marine areas by involving biological indicators, as required by the WFD and the MSFD; knowledge on how biota changes with human-induced pressures is essential, but to reliably assess change, we need also to know how biotic communities vary over natural environmental gradients. This is especially important in sea areas such as the Baltic Sea, where the natural environmental gradients create substantial differences in biota between areas. In this thesis, I studied the variation occurring in macroalgal communities across the environmental gradients of the northern Baltic Sea, including eutrophication induced changes. The aim was to produce knowledge to support the reliable use of macroalgae as indicators of ecological status of the marine areas and to test practical metrics that could potentially be used in status assessments. Further, the aim was to develop a methodology for mapping the HD Annex I habitat reefs, using the best available data on geology and bathymetry. The results showed that the large-scale variation in the macroalgal community composition of the northern Baltic Sea is largely driven by salinity and exposure. Exposure is important also on smaller spatial scales, affecting species occurrence, community structure and depth penetration of algae. Consequently, the natural variability complicates the use of macroalgae as indicators of human-induced changes. Of the studied indicators, the number of perennial algal species, the perennial cover, the fraction of annual algae, and the lower limit of occurrence of red and brown perennial algae showed potential as usable indicators of ecological status. However, the cumulated cover of algae, commonly used as an indicator in the fully marine environments, showed low responses to eutrophication in the area. Although the mere occurrence of perennial algae did not show clear indicator potential, a distinct discrepancy in the occurrence of bladderwrack, Fucus vesiculosus, was found between two areas with differing eutrophication history, the Bothnian Sea and the Archipelago Sea. The absence of Fucus from many potential sites in the outer Archipelago Sea is likely due to its inability to recover from its disappearance from the area 30-40 years ago, highlighting the importance of past events in macroalgal occurrence. The methodology presented for mapping the potential distribution and the ecological value of reefs showed, that relatively high accuracy in mapping can be achieved by combining existing available data, and the maps produced serve as valuable background information for more detailed surveys. Taken together, the results of the theses contribute significantly to the knowledge on macroalgal communities of the northern Baltic Sea that can be directly applied in various management contexts.

Oral tolerance induction with altered forms of ovalbumin

As a T cell-dependent phenomenon, oral tolerance is not expected to depend necessarily on native configuration of antigens. We investigated the induction of oral tolerance with modified ovalbumin (Ova). Oral administration of heat-denatured (HD-Ova) and cyanogen bromide-degraded ovalbumin was less effective than native Ova in inducing oral tolerance in B6D2F1 mice. HD-Ova was effective in suppressing delayed-type hypersensitivity (DTH) reactions but did not suppress specific antibody formation. Injection of Ova directly into the stomach, but not into the ileum or cecum, suppressed subsequent immunization to DTH reactions. Gavage with protease inhibitors (aprotinin or ovomucoid) before gavage with Ova was ineffective in blocking tolerance induction. Treatment with hydroxyurea to destroy cycling cells 24 h before gavage with Ova blocked oral tolerance induction and also the possibility to passively transfer tolerance to naive recipients with the serum of mice gavaged with Ova 1 h before. The implications of these findings about oral tolerance induction are discussed