International Consensus Guidelines for Nutrition Therapy in Pancreatitis

Guidelines for nutrition support in pancreatitis have been inconsistently adapted to clinical practice. The International Consensus Guideline Committee (ICGC) established a pancreatitis task force to review published guidelines for pancreatitis in nutrition support. A PubMed search using the terms pancreatitis, acute pancreatitis, chronic pancreatitis, nutrition support, parenteral nutrition, enteral nutrition, and guidelines was conducted for the period from January 1999 to May 2011. Eleven guidelines were identified for review. The ICGC used the following process to develop unified guideline statements: summarize the strength of evidence (grading) of the guidelines; establish level of evidence for ICGC statements as high, intermediate, and low; assign published guideline levels of evidence; and define an ICGC grading system. International Pancreatitis Guideline Grades were established as follows: platinum-high level of evidence and consistent agreement among the guidelines; gold-acceptable level of evidence and no conflicting statements in guidelines; and silver-single existing guideline statement with no conflict in other guidelines. Eighteen ICGC statements were derived from the 11 published pancreatitis guidelines. Uniform agreement from widely disparate groups (United States, Europe, Japan, and China) resulted in 4 platinum-level guideline statements for nutrition in pancreatitis: nutrition support therapy (NST) is generally not needed for mild to moderate disease, NST is needed for severe disease, enteral nutrition (EN) is preferred over parenteral nutrition (PN), and use PN when EN is contraindicated or not feasible. This methodology provides a template for future ICGC nutrition guideline development. (JPEN J Parenter Enteral Nutr. 2012;36:284-291)

THE DEVELOPMENT AND EVALUATION OF SOFTWARE TO VERIFY DIAGNOSTIC ACCURACY

This article describes the development and evaluation of software that verifies the accuracy of diagnoses made by nursing students. The software was based on a model that uses fuzzy logic concepts, including PERL, the MySQL database for Internet accessibility, and the NANDA-I 2007-2008 classification system. The software was evaluated in terms of its technical quality and usability through specific instruments. The activity proposed in the software involves four stages in which students establish the relationship values between nursing diagnoses, defining characteristics/risk factors and clinical cases. The relationship values determined by students are compared to those of specialists, generating performance scores for the students. In the evaluation, the software demonstrated satisfactory outcomes regarding the technical quality and, according to the students, helped in their learning and may become an educational tool to teach the process of nursing diagnosis.

Loss of Interleukin-10 Signaling and Infantile Inflammatory Bowel Disease: Implications for Diagnosis and Therapy

BACKGROUND & AIMS: Homozygous loss of function mutations in interleukin-10 (IL10) and interleukin-10 receptors (IL10R) cause severe infantile (very early onset) inflammatory bowel disease (IBD). Allogeneic hematopoietic stem cell transplantation (HSCT) was reported to induce sustained remission in 1 patient with IL-10R deficiency. We investigated heterogeneity among patients with very early onset IBD, its mechanisms, and the use of allogeneic HSCT to treat this disorder. METHODS: We analyzed 66 patients with early onset IBD (younger than 5 years of age) for mutations in the genes encoding IL-10, IL-10R1, and IL-10R2. IL-10R deficiency was confirmed by functional assays on patients' peripheral blood mononuclear cells (immunoblot and enzyme-linked immunosorbent assay analyses). We assessed the therapeutic effects of standardized allogeneic HSCT. RESULTS: Using a candidate gene sequencing approach, we identified 16 patients with IL-10 or IL-10R deficiency: 3 patients had mutations in IL-10, 5 had mutations in IL-10R1, and 8 had mutations in IL-10R2. Refractory colitis became manifest in all patients within the first 3 months of life and was associated with perianal disease (16 of 16 patients). Extraintestinal symptoms included folliculitis (11 of 16) and arthritis (4 of 16). Allogeneic HSCT was performed in 5 patients and induced sustained clinical remission with a median follow-up time of 2 years. In vitro experiments confirmed reconstitution of IL-10R-mediated signaling in all patients who received the transplant. CONCLUSIONS: We identified loss of function mutations in IL-10 and IL-10R in patients with very early onset IBD. These findings indicate that infantile IBD patients with perianal disease should be screened for IL-10 and IL-10R deficiency and that allogeneic HSCT can induce remission in those with IL-10R deficiency.

EDGE-PRESERVING SPECKLE TEXTURE REMOVAL BY INTERFERENCE-BASED SPECKLE FILTERING FOLLOWED BY ANISOTROPIC DIFFUSION

Ultrasonography has an inherent noise pattern, called speckle, which is known to hamper object recognition for both humans and computers. Speckle noise is produced by the mutual interference of a set of scattered wavefronts. Depending on the phase of the wavefronts, the interference may be constructive or destructive, which results in brighter or darker pixels, respectively. We propose a filter that minimizes noise fluctuation while simultaneously preserving local gray level information. It is based on steps to attenuate the destructive and constructive interference present in ultrasound images. This filter, called interference-based speckle filter followed by anisotropic diffusion (ISFAD), was developed to remove speckle texture from B-mode ultrasound images, while preserving the edges and the gray level of the region. The ISFAD performance was compared with 10 other filters. The evaluation was based on their application to images simulated by Field II (developed by Jensen et al.) and the proposed filter presented the greatest structural similarity, 0.95. Functional improvement of the segmentation task was also measured, comparing rates of true positive, false positive and accuracy. Using three different segmentation techniques, ISFAD also presented the best accuracy rate (greater than 90% for structures with well-defined borders). (E-mail: fernando.okara@gmail.com) (C) 2012 World Federation for Ultrasound in Medicine & Biology.

Software Application That Evaluates the Diagnostic Accuracy of Nursing Students

PURPOSE: Apply the educational software Fuzzy Kitten with undergraduate Brazilian nursing students. METHODS: This software, based on fuzzy logic, generates performance scores that evaluate the ability to identify defining characteristics/risk factors present in clinical cases, relate them with nursing diagnoses, and determine the diagnoses freely or using a decision support model. FINDINGS: There were differences in student performance compared to the year of the course. The time to perform the activity did not present a significant relation to the performance. The students' scores in the diagnoses indicated by the model was superior (p = .01). CONCLUSIONS: The software was able to evaluate the diagnostic accuracy of students. IMPLICATIONS: The software enables an objective evaluation of diagnostic accuracy.

The Role of Nanometer-Scaled Ligand Patterns in Polyvalent Binding by Large Mannan-Binding Lectin Oligomers

Mannan-binding lectin (MBL) is an important protein of the innate immune system and protects the body against infection through opsonization and activation of the complement system on surfaces with an appropriate presentation of carbohydrate ligands. The quaternary structure of human MBL is built from oligomerization of structural units into polydisperse complexes typically with three to eight structural units, each containing three lectin domains. Insight into the connection between the structure and ligand-binding properties of these oligomers has been lacking. In this article, we present an analysis of the binding to neoglycoprotein-coated surfaces by size-fractionated human MBL oligomers studied with small-angle x-ray scattering and surface plasmon resonance spectroscopy. The MBL oligomers bound to these surfaces mainly in two modes, with dissociation constants in the micro to nanomolar order. The binding kinetics were markedly influenced by both the density of ligands and the number of ligand-binding domains in the oligomers. These findings demonstrated that the MBL-binding kinetics are critically dependent on structural characteristics on the nanometer scale, both with regard to the dimensions of the oligomer, as well as the ligand presentation on surfaces. Therefore, our work suggested that the surface binding of MBL involves recognition of patterns with dimensions on the order of 10-20 nm. The recent understanding that the surfaces of many microbes are organized with structural features on the nanometer scale suggests that these properties of MBL ligand recognition potentially constitute an important part of the pattern-recognition ability of these polyvalent oligomers. The Journal of Immunology, 2012, 188: 1292-1306.

Structure of the haptoglobin-haemoglobin complex

Red cell haemoglobin is the fundamental oxygen-transporting molecule in blood, but also a potentially tissue-damaging compound owing to its highly reactive haem groups. During intravascular haemolysis, such as in malaria and haemoglobinopathies(1), haemoglobin is released into the plasma, where it is captured by the protective acute-phase protein haptoglobin. This leads to formation of the haptoglobin-haemoglobin complex, which represents a virtually irreversible non-covalent protein-protein interaction(2). Here we present the crystal structure of the dimeric porcine haptoglobin-haemoglobin complex determined at 2.9 angstrom resolution. This structure reveals that haptoglobin molecules dimerize through an unexpected beta-strand swap between two complement control protein (CCP) domains, defining a new fusion CCP domain structure. The haptoglobin serine protease domain forms extensive interactions with both the alpha- and beta-subunits of haemoglobin, explaining the tight binding between haptoglobin and haemoglobin. The haemoglobin-interacting region in the alpha beta dimer is highly overlapping with the interface between the two alpha beta dimers that constitute the native haemoglobin tetramer. Several haemoglobin residues prone to oxidative modification after exposure to haem-induced reactive oxygen species are buried in the haptoglobin-haemoglobin interface, thus showing a direct protective role of haptoglobin. The haptoglobin loop previously shown to be essential for binding of haptoglobin-haemoglobin to the macrophage scavenger receptor CD163 (ref. 3) protrudes from the surface of the distal end of the complex, adjacent to the associated haemoglobin alpha-subunit. Small-angle X-ray scattering measurements of human haptoglobin-haemoglobin bound to the ligand-binding fragment of CD163 confirm receptor binding in this area, and show that the rigid dimeric complex can bind two receptors. Such receptor cross-linkage may facilitate scavenging and explain the increased functional affinity of multimeric haptoglobin-haemoglobin for CD163 (ref. 4).

Search for Lorentz invariance and CPT violation with muon antineutrinos in the MINOS Near Detector

We have searched for sidereal variations in the rate of antineutrino interactions in the MINOS Near Detector. Using antineutrinos produced by the NuMI beam, we find no statistically significant sidereal modulation in the rate. When this result is placed in the context of the Standard Model Extension theory we are able to place upper limits on the coefficients defining the theory. These limits are used in combination with the results from an earlier analysis of MINOS neutrino data to further constrain the coefficients.

Measurements of atmospheric neutrinos and antineutrinos in the MINOS far detector

This paper reports measurements of atmospheric neutrino and antineutrino interactions in the MINOS Far Detector, based on 2553 live-days (37.9 kton-years) of data. A total of 2072 candidate events are observed. These are separated into 905 contained-vertex muons and 466 neutrino-induced rock-muons, both produced by charged-current nu(mu) and (nu) over bar (mu) interactions, and 701 contained-vertex showers, composed mainly of charged-current nu(e) and (nu) over bar (e) interactions and neutral-current interactions. The curvature of muon tracks in the magnetic field of the MINOS Far Detector is used to select separate samples of nu(mu) and (nu) over bar (mu) events. The observed ratio of (nu) over bar (mu) to v(mu) events is compared with the Monte Carlo ( MC) simulation, giving a double ratio of R((nu) over bar/nu)data/R(nu) over bar/nu MC = 1.03 +/- 0.08(stat) +/- 0.08(syst). The v(mu) and (nu) over bar (mu) data are separated into bins of L/E resolution, based on the reconstructed energy and direction of each event, and a maximum likelihood fit to the observed L/E distributions is used to determine the atmospheric neutrino oscillation parameters. This fit returns 90% confidence limits of |Delta m(2)| = (1.9 +/- 0.4) x 10(-3) eV(2) and sin(2)2 theta > 0.86. The fit is extended to incorporate separate nu(mu) and (nu) over bar mu oscillation parameters, returning 90% confidence limits of |Delta m(2)| - |Delta(m) over bar (2)| = 0.6(-0.8)(+2.4) x 10(-3) eV(2) on the difference between the squared-mass splittings for neutrinos and antineutrinos.

Ahamulina n. gen. (Cestoda: Diphyllidea) from the polkadot catshark, Scyliorhinus besnardi (Carcharhiniformes: Scyliorhinidae), off Brazil

A new genus and species of diphyllidean, Ahamulina catarina n. gen. n. sp., is described from the polkadot catshark, Scyliorhinus besnardi, from Santa Catarina, Brazil. The new genus exhibits apical organ armature that is unique among diphyllideans in the arrangement and shape of the apical hooks as well as in the lack of lateral hooklets. The taxon also exhibits a bipartite cirrus sac. This is the seventh diphyllidean reported from a shark, and the third reported from a catshark suggesting that the dearth of cestode data for these particular sharks belies the true extent of diphyllidean diversity they host.

PCR colorimetric dot-blot assay and clinical pretest probability for diagnosis of Pulmonary Tuberculosis in Smear-Negative patients

Abstract Background Smear-negative pulmonary tuberculosis (SNPTB) accounts for 30% of Pulmonary Tuberculosis (PTB) cases reported annually in developing nations. Polymerase chain reaction (PCR) may provide an alternative for the rapid detection of Mycobacterium tuberculosis (MTB); however little data are available regarding the clinical utility of PCR in SNPTB, in a setting with a high burden of TB/HIV co-infection. Methods To evaluate the performance of the PCR dot-blot in parallel with pretest probability (Clinical Suspicion) in patients suspected of having SNPTB, a prospective study of 213 individuals with clinical and radiological suspicion of SNPTB was carried out from May 2003 to May 2004, in a TB/HIV reference hospital. Respiratory specialists estimated the pretest probability of active disease into high, intermediate, low categories. Expectorated sputum was examined by direct microscopy (Ziehl-Neelsen staining), culture (Lowenstein Jensen) and PCR dot-blot. Gold standard was based on culture positivity combined with the clinical definition of PTB. Results In smear-negative and HIV subjects, active PTB was diagnosed in 28.4% (43/151) and 42.2% (19/45), respectively. In the high, intermediate and low pretest probability categories active PTB was diagnosed in 67.4% (31/46), 24% (6/25), 7.5% (6/80), respectively. PCR had sensitivity of 65% (CI 95%: 50%–78%) and specificity of 83% (CI 95%: 75%–89%). There was no difference in the sensitivity of PCR in relation to HIV status. PCR sensitivity and specificity among non-previously TB treated and those treated in the past were, respectively: 69%, 43%, 85% and 80%. The high pretest probability, when used as a diagnostic test, had sensitivity of 72% (CI 95%:57%–84%) and specificity of 86% (CI 95%:78%–92%). Using the PCR dot-blot in parallel with high pretest probability as a diagnostic test, sensitivity, specificity, positive and negative predictive values were: 90%, 71%, 75%, and 88%, respectively. Among non-previously TB treated and HIV subjects, this approach had sensitivity, specificity, positive and negative predictive values of 91%, 79%, 81%, 90%, and 90%, 65%, 72%, 88%, respectively. Conclusion PCR dot-blot associated with a high clinical suspicion may provide an important contribution to the diagnosis of SNPTB mainly in patients that have not been previously treated attended at a TB/HIV reference hospital.

Desenvolvimento e avaliação de um software que verifica a acurácia diagnóstica

Este artigo descreve o desenvolvimento e avaliação de um software que verifica a acurácia diagnóstica de alunos de enfermagem. O software foi baseado num modelo que utiliza conceitos da lógica fuzzy, em PERL, banco de dados MySQL para acesso pela internet e a classificação NANDA-I 2007-2008. Avaliou-se a qualidade técnica e a usabilidade do software utilizando instrumentos específicos. A atividade proposta no software possui quatro etapas nas quais o aluno estabelece valores de relação entre diagnósticos de enfermagem, características definidoras/fatores de risco e casos clínicos. Os valores de relação determinados pelo aluno são comparados aos de especialistas, gerando escores de desempenho para o aluno. Na avaliação, o software atendeu satisfatoriamente as necessidades de qualidade técnica e, segundo os alunos, trouxe benefícios ao aprendizado, podendo transformar-se em uma ferramenta educacional no ensino do diagnóstico de enfermagem.

Garota de Mitilene

A proposta é uma abordagem de "Garota de Ipanema" de Jobim e Vinicius e de um poema de Safo, "Ode a Anactória" (século VII a.C.), que abriga um verso que diz, literalmente: "Esse modo de andar que desperta o desejo". E aí, aproveitando a deixa, desenvolvo um cotejo entre outros fragmentos de Safo e essa canção paradigmática da MPB, datada de 1962. Trata-se de um contraponto com 27 séculos de permeio e que - por maior que seja o cuidado em respeitar a historicidade do afeto (e não cometer anacronismos) - revela surpreendentes invariantes. Mas entre Safo e Jobim/Vinicius há Freud, ou melhor, Jensen, com a sua Gradiva - que tematiza, exatamente, o andar da mulher desejada. Por sua vez, o musicólogo Almir Chediak vê um paralelo entre o desenho melódico da partitura de "Garota de Ipanema" e as ondas do mar, no seu movimento de fluir e refluir; e no gráfico apresentado, de fato, delineia-se esse ritmo iconizado. Efetivamente, a onda, o passo ondulante, o ritmo, o tema, "o doce balanço, caminho do mar": tudo converge nessa brasileiríssima canção, que patenteia, no entanto, tão instigantes recorrências com a lírica grega arcaica.

New insights in osteogenic differentiation revealed by mass spectrometric assessment of phosphorylated substrates in murine skin mesenchymal cells

Abstract Background Bone fractures and loss represent significant costs for the public health system and often affect the patients quality of life, therefore, understanding the molecular basis for bone regeneration is essential. Cytokines, such as IL-6, IL-10 and TNFα, secreted by inflammatory cells at the lesion site, at the very beginning of the repair process, act as chemotactic factors for mesenchymal stem cells, which proliferate and differentiate into osteoblasts through the autocrine and paracrine action of bone morphogenetic proteins (BMPs), mainly BMP-2. Although it is known that BMP-2 binds to ActRI/BMPR and activates the SMAD 1/5/8 downstream effectors, little is known about the intracellular mechanisms participating in osteoblastic differentiation. We assessed differences in the phosphorylation status of different cellular proteins upon BMP-2 osteogenic induction of isolated murine skin mesenchymal stem cells using Triplex Stable Isotope Dimethyl Labeling coupled with LC/MS. Results From 150 μg of starting material, 2,264 proteins were identified and quantified at five different time points, 235 of which are differentially phosphorylated. Kinase motif analysis showed that several substrates display phosphorylation sites for Casein Kinase, p38, CDK and JNK. Gene ontology analysis showed an increase in biological processes related with signaling and differentiation at early time points after BMP2 induction. Moreover, proteins involved in cytoskeleton rearrangement, Wnt and Ras pathways were found to be differentially phosphorylated during all timepoints studied. Conclusions Taken together, these data, allow new insights on the intracellular substrates which are phosphorylated early on during differentiation to BMP2-driven osteoblastic differentiation of skin-derived mesenchymal stem cells.

Samarbete ger stöd och skydd : Studie av fyra svenska myndigheter gällande stöd och skydd till brottsoffer för sexuell människohandel

Handel med kvinnor är idag ett globalt problem och svenska Rikskriminalpolisen uppskattar att 400 – 600 kvinnor faller offer för människohandel i Sverige varje år. Frågan om statens ansvar och skyldighet att skydda brottsoffrens rättigheter är i liten grad omdiskuterad. I Sverige är totalt åtta myndigheter inblandade i arbetet mot människohandel med sexuella ändamål, men vilken typ av stöd och skydd får brottsoffren? I detta arbete har de fyra, av totalt åtta, myndigheter som har direkt kontakt med brottsoffren undersökts. Dessa är Migrationsverket, Åklagarmyndigheten, Polismyndigheten samt Socialtjänsten. En person från vardera myndighet intervjuades med följande frågeställningar i fokus: Hur ser det stöd och skydd ut som dessa myndigheter ger till brottsoffren under rättsprocessen i Sverige? Hur ser stöd och skydd ut till brottsoffren under återvändandeprocessen? Finns några brister och vilka åtgärder behövs i så fall för att förbättra stödet och skyddet? Ett könsmaktsperspektiv och ett globaliseringsperspektiv användes för att analysera inhämtat material. Analysen visar att det stöd och skydd som brottsoffren får från myndigheterna är acceptabelt i relation till befintliga resurser men att det inte är tillräckligt. Samarbetet mellan myndigheterna kunde vara ännu bättre. Samtliga representanter från de fyra myndigheterna efterfrågar ett utökat och mer stabilt samarbete samt fler kontakter med myndigheter och frivilligorganisationer i brottsoffrens hemländer.