A lesão de isquémia/reperfusão em transplante hepático: análise genética, morfológica e correlação clínica

RESUMO: O transplante hepático ortotópico é uma terapêutica aceite para casos selecionados de falência hepática terminal. O procedimento tem-­‐se aperfeiçoado, evidenciado pelo aumento da taxa de sobrevida de 30 para 75% aos 5 anos, mas cerca de 13 a 27% dos enxertos desenvolve falência primária (PNF) ou disfunção primária (DF) após o transplante. As consequências são devastadoras para a sobrevida do doente e do enxerto. A sua etiologia é multifactorial, incluindo factores relacionados com o dador e o receptor, tempos de isquémia, agressões cirúrgicas, bem como características anatomopatológicas do enxerto. A lesão de isquémia/reperfusão mantem-­‐se como um factor de risco intra operatório, com implicações directas sobre toda a evolução do transplante : existe uma relação íntima entre a PNF e a DF, a preservação do enxerto, a lesão de isquémia/reperfusão, e a falência do transplante. Além disso, está comprovada evidência que sugere que a lesão de I/R torna um aloenxerto mais vulnerável por aumento da imunogenicidade, aumentando a probabilidade de episódios de rejeição precoce e tardia. Com base na prática clínica quotidiana do CHBPT HCC, estudaram-­‐se 54 casos de transplante hepático, agrupados segundo grupos por alocação do enxerto respectivo: Grupo 1(n=27): dador cadáver para receptor cirrótico, Grupo 2 (n=15): dador cadáver para receptor PAF, Grupo 3 (n=12): dador PAF para receptor cirrótico. Observaram-­‐se as alterações histológicas e moleculares sobre o enxerto até ao final da operação do receptor, e as suas consequências clínicas,avaliando: -­‐ As diferentes capacidades de resistência e cada enxerto à lesão de isquémia/reperfusão. -­‐ As situações em que os factores do receptor se sobrepõem às do enxerto na definição do prognóstico, e vice versa. -­‐ A relevância das lesões histológicas e moleculares precoces no tecido hepático na evolução do enxerto e do receptor. Foram colhidas biópsias por agulha dos 54 enxertos hepáticos,42 provenientes de cadáver com coração batente(morte cerebral) e 12 provenientes de dador vivo com PAF, em três tempos diferentes do processo de colheita e transplante hepático: ­‐ A primeira(T0)antes da clampagem da aorta do dador -­‐ A segunda (T1) no final da isquémia fria -­‐ A terceira (T2) após a reperfusão do enxerto, durante o encerramento da parede abdominal. A estas amostras foi extraído RNA total, convertido em cDNA por transcrição reversa e feita a análise da expressão dos genes da CTLA4, IL-­‐1β, IL-­‐4, IL-­‐6, IL-­‐13, TNF-­‐α, Perforina, Selectina, (SELE), Fas-­‐ligando, Granzima-­‐B, Heme-­‐Oxigenase 1(HO1)e Óxido Nítrico Sintetase(iNOS2A)por PCR quantitativo segundo o método do Ct comparativo, utilizando como referência a expressão dos genes da amostra não-­‐isquémica –T0. Os fragmentos de todas as biópsias foram seccionados, para envio de amostra comparativa para processamento histológico habitual, sem qualquer alteração ao protocolo seguido habitualmente na Unidade de Transplantação do Hospital Curry Cabral. A presença de alguns parâmetros histológicos definidos, como esteatose, necrose, vacuolização, congestão sinusoidal e infiltração neutrofílica, foi registada e contabilizada numa classificação numérica. O seguimento clínico e laboratorial, bem como o acompanhamento de eventuais complicações, foi registado e correlacionado com os dados das colheitas de órgãos e com os dados das biópsias. Foram consideradas as seguintes variáveis, como as mais relevantes e objectivas para a interpretação da evolução clínica, tendo sido comparadas estatisticamente com os dados recolhidos, laboratoriais e clínicos: disfunção do enxerto, 207 pós operatórias, número de internamentos igual ou superior a 2 e rejeição crónica e/ou morte do receptor. Foram identificadas características clínicas menos favoráveis, a considerar, nalgumas circunstâncias: género feminino do receptor (sobretudo associado a enxerto masculino, p=0,077), isquémia fria superior a 500 minutos (p=0,074), isquémia quente superior a 90 minutos (p=0,099). Na análise laboratorial, distinguiram-­‐se duas características histológicas desfavoráveis e irreversíveis, como índice de mau prognóstico: a necrose e a balonização (p=0,029); no painel genético escolhido neste estudo,a expressão basal de IL-­‐1β(p=0,028), de SELE p=0,013)e de FAS-­‐L (p=0,079)relacionaram-­‐se com pior prognóstico. Algumas características protectoras intrínsecas dos enxertos só se revelaram indirectamente, como menor infiltração neutrofílica e maior expressão de HO1 e de iNOS nos enxertos PAF, não tendo sido possível provar uma interferência directa nos resultados clínicos. Não se obteve expressão mensurável de genes anti-­‐ inflamatórios nas biopsias hepáticas processadas neste estudo, como a IL13 e a I 4: assim, com a metodologia utilizada, não foi possível obter um perfil de expressão genética associado a boa evolução clínica. O perfil inverso foi sugerido apenas pela expressão basal dos 3 genes mencionados (FAS-­‐L,IL-­‐1β e SELE)no mesmo painel, com o protocolo seguido neste conjunto de 54 doentes. As características do receptor sobrepuseram-­‐se às do enxerto no caso de: -­‐ diagnóstico de PAF no receptor, que determinou uma maior predisposição para a disfunção do enxerto, o que, por sua vez, determina uma menor sobrevida. No entanto, o diagnóstico de PAF no receptor exibe uma curva de sobrevida mais favorável. -­‐ receptores com um baixo balanço de risco (BAR)definiram características favoráveis para enxertos com níveis baixos e moderados de esteatose, fazendo que esta característica, definida como um risco acrescido, não só não se manifestasse clinicamente,como parecesse um factor favorável. As características do enxerto sobrepuseram-­‐se às do receptor no caso de: -­‐ tempo de isquémia fria superior a 500 minutos -­‐ balonização, necrose, FAS-­‐L,IL-­‐1β e SELE em T0 A integração dos resultados moleculares e morfológicos com a evolução clínica, realça o papel da mobilização precoce de neutrófilos nos desempenhos menos favoráveis do enxerto hepático. -------------ABSTRACT: Orthotopic liver transplantation is na accepted therapeutic procedure for selected cases of terminal liver failure. The procedure has been improved, evidenced by the rise of survival rates from 30 to 70% at 5 years, but 13 to 27% of the liver grafts develops primary non function (PNF) or primary dysfunction (PDF) after transplantation. The consequences are devastating for the survival of the patient and of the graft. Its etiology is multifactorial, including factos related with the donor and with the recipient, ischemic times, surgical aggressions, as well as the histological characteristics of the graft. The ischemia/reperfusion lesion is still an intraoperative risk factor, with direct implications in the whole transplant outcome: there is a close interrelation between PNF and DF, graft preservation, ischemia / reperfusion lesion and graft failure. Beyond his, there is proved evidence that suggests that I/R lesion turns the allograft more vulnerable by increasing its immunogenity, increasing the probability of precocious and late rejection episodes. Based on the daily clinical practice at CHBPT /HCC, 54 cases of hepatic transplantation have been studied, grouped by allocation of each graft: Group (n=27):deceased do nortocirrhotic recipient, Group 2 (n=15): deceased donor to FAP recipient, Group 3 (n=12): FAP living donor to cirrhotic recipient. The histologic and molecular changes in the liver graft were observed until the end of the recipiente operation,together with its clinical consequences, evaluating:-­‐The different capacity of resistance of each graft to the ischemia / reperfusion lesion -­‐ The situations where the recipiente factos overlap the ones of the graft, in the definition of prognosis, and vice versa.-­‐ The relevance of the precocious histologic and molecular lesions of the hepatic tissue in the clinical outcome of the graft and the recipient. Needle biopsies were obtained from 54 liver grafts, 42 deceased brain dead donors and 12 from FAP living donors, at three diferente times of the harvesting and the hepatic transplantation: The first one (T0) before clamping the donor aorta -­‐ The second one (T2) in the end of cold ischemia time -­‐ The third one (T) after the reperfusion of the graft, during the closure of the abdominal wall. Total RNAwas extracted to these samples, converted to cDNA by reverse transcription and the analysis of gene expression was made for CTLA4,IL-­‐1β,IL-­‐4,IL-­‐6,IL-­‐13,TNF-­‐α,Perforin,E Selectin (SELE),Fas-­‐ligand,Granzyme-­‐B,Heme-­‐oxigenase 1 (HO1) and Nitric Oxide Sintetase (iNOS2A) by quantitative PCR, according with the Ct comparative method, using the expression of the non ischemic sample – T0. The fragments of all the biopsies were divided, to send a comparative sample to the usual histologic processement, keeping the same usual protocol at the Transplantation Unit of Curry Cabral Hospital. The presence of some defined histologic parameters, such as steatosis, necrosis, vacuolization, sinusoidal congestion and neutrophilic infiltration, was registered and catalogued in a numeric classification. The clinical and laboratory follow-­‐up, as well as the following of eventual complications, was registered and correlated with the data from organ procurement operations and with the data from the biopsies. The following variables were considered as the most relevant and objective ones, to the interpretation of the clinical evolution, being statistically compared with the clinical and laboratorial collected data: graft dysfunction, post-­‐operative complications, number of readmissions of 2 or more and chronic rejection and /or recipiente death. There were identified some unfavorable clinical characteristics, to be considered under certain circumstances: recipiente female gender (specially associated with malegraft, p=0,077), cold ischemia time of more than 500 minutes (p=0,074), warm ischemia time of more than 90 minutes (p=0,099). In the laboratory analysis, two histologic characteristics were identified as unfavorable and irreversible, associated with bad prognosis: necrosis and balonization (p=0,029); in the gene panel selected in this study, the basal expression of IL-­‐1β (p=0,028), SELE (p=0,013) and FAS-­‐L (p=0,079)were related with worse prognosis.Some intrinsic protective characteristics of the grafts were only indirectly revealed, such as less neutrophilic infiltration and bigger expression of HO1 and iNOS in FAP grafts, being impossible to prove any direct inte ference in the clinical results. A relevant and measurable expression of the anti inflammatory genes IL13 and IL4 was not obtained: with the used methodology, it was impossible to obtain a gene expression profile associated with a favorable clinical outcome.The inverse profile was suggested only by the basal expression of the three mentioned genes (FAS-­‐L, IL-­‐ 1β e SELE) in the same gene panel, according with the followed protocol in this group of 54 patients. The characteristics of the recipient overlapped those from the graft, in the case of :-­‐ FAP diagnosis in the recipient, which determined a bigger predisposition to graft dysfunction, which by itself determines a shorter survival. However, FAP diagnosis in the recipiente depicts a more favorable survival curve. -­‐ Recipients with a low balance risk índex (BAR) defined favorable characteristics to grafts with low and moderate grades of steatosis, making that this characteristic, associated with bad prognosis, looked like a favorable factor, and with no clinical interference. The graft characteristics overlapped those from the receptor in the case of: -­‐ Cold ischemic time more than 500 minutes -­‐ Balonization, necrosis, FAS-­‐L, IL-­‐1β and SELE at T0. The integration of molecular and morphologic results with the clinical evolution, stresses the role of a precocious neutrophils mobilization in the worse outcomes of liver grafts.

La production et la diffusion des céramiques utilitaires de style à bandes à Argilos et dans le nord de l'Égée aux périodes archaïque et classique.

Thèse doctorale effectuée en cotutelle au département d'histoire de l'Université de Montréal et à l'École doctorale d'archéologie de l'Université Paris 1 Panthéon-Sorbonne - UMR 7041, Archéologies et Sciences de l'Antiquité - Archéologie du monde grec.

Transport magnetischer Partikel durch maßgeschneiderte magnetische Feldlandschaften zur Anwendung in mikrofluidischen Mischprozessen

Die Miniaturisierung von konventioneller Labor- und Analysetechnik nimmt eine zentrale Rolle im Bereich der allgemeinen Lebenswissenschaften und medizinischen Diagnostik ein. Neuartige und preiswerte Technologieplattformen wie Lab-on-a-Chip (LOC) oder Mikrototalanalysesysteme (µTAS) versprechen insbesondere im Bereich der Individualmedizin einen hohen gesellschaftlichen Nutzen zur frühzeitigen und nichtinvasiven Diagnose krankheitsspezifischer Indikatoren. Durch den patientennahen Einsatz preiswerter und verlässlicher Mikrochips auf Basis hoher Qualitätsstandards entfallen kostspielige und zeitintensive Zentrallaboranalysen, was gleichzeitig Chancen für den globalen Einsatz - speziell in Schwellen- und Entwicklungsländern - bietet. Die technischen Herausforderungen bei der Realisierung moderner LOC-Systeme sind in der kontrollierten und verlässlichen Handhabung kleinster Flüssigkeitsmengen sowie deren diagnostischem Nachweis begründet. In diesem Kontext wird der erfolgreichen Integration eines fernsteuerbaren Transports von biokompatiblen, magnetischen Mikro- und Nanopartikeln eine Schlüsselrolle zugesprochen. Die Ursache hierfür liegt in der vielfältigen Einsetzbarkeit, die durch die einzigartigen Materialeigenschaften begründet sind. Diese reichen von der beschleunigten, aktiven Durchmischung mikrofluidischer Substanzvolumina über die Steigerung der molekularen Interaktionsrate in Biosensoren bis hin zur Isolation und Aufreinigung von krankheitsspezifischen Indikatoren. In der Literatur beschriebene Ansätze basieren auf der dynamischen Transformation eines makroskopischen, zeitabhängigen externen Magnetfelds in eine mikroskopisch veränderliche potentielle Energielandschaft oberhalb magnetisch strukturierter Substrate, woraus eine gerichtete und fernsteuerbare Partikelbewegung resultiert. Zentrale Kriterien, wie die theoretische Modellierung und experimentelle Charakterisierung der magnetischen Feldlandschaft in räumlicher Nähe zur Oberfläche der strukturierten Substrate sowie die theoretische Beschreibung der Durchmischungseffekte, wurden jedoch bislang nicht näher beleuchtet, obwohl diese essentiell für ein detailliertes Verständnis der zu Grunde liegenden Mechanismen und folglich für einen Markteintritt zukünftiger Geräte sind. Im Rahmen der vorgestellten Arbeit wurde daher ein neuartiger Ansatz zur erfolgreichen Integration eines Konzepts zum fernsteuerbaren Transport magnetischer Partikel zur Anwendung in modernen LOC-Systemen unter Verwendung von magnetisch strukturierten Exchange-Bias (EB) Dünnschichtsystemen verfolgt. Die Ergebnisse zeigen, dass sich das Verfahren der ionenbe-schussinduzierten magnetischen Strukturierung (IBMP) von EB-Systemen zur Herstellung von maßgeschneiderten magnetischen Feldlandschaften (MFL) oberhalb der Substratoberfläche, deren Stärke und räumlicher Verlauf auf Nano- und Mikrometerlängenskalen gezielt über die Veränderung der Materialparameter des EB-Systems via IBMP eingestellt werden kann, eignet. Im Zuge dessen wurden erstmals moderne, experimentelle Verfahrenstechniken (Raster-Hall-Sonden-Mikroskopie und rastermagnetoresistive Mikroskopie) in Kombination mit einem eigens entwickelten theoretischen Modell eingesetzt, um eine Abbildung der MFL in unterschiedlichen Abstandsbereichen zur Substratoberfläche zu realisieren. Basierend auf der quantitativen Kenntnis der MFL wurde ein neuartiges Konzept zum fernsteuerbaren Transport magnetischer Partikel entwickelt, bei dem Partikelgeschwindigkeiten im Bereich von 100 µm/s unter Verwendung von externen Magnetfeldstärken im Bereich weniger Millitesla erzielt werden können, ohne den magnetischen Zustand des Substrats zu modifizieren. Wie aus den Untersuchungen hervorgeht, können zudem die Stärke des externen Magnetfelds, die Stärke und der Gradient der MFL, das magnetfeldinduzierte magnetische Moment der Partikel sowie die Größe und der künstlich veränderliche Abstand der Partikel zur Substratoberfläche als zentrale Einflussgrößen zur quantitativen Modifikation der Partikelgeschwindigkeit genutzt werden. Abschließend wurde erfolgreich ein numerisches Simulationsmodell entwickelt, das die quantitative Studie der aktiven Durchmischung auf Basis des vorgestellten Partikeltransportkonzepts von theoretischer Seite ermöglicht, um so gezielt die geometrischen Gegebenheiten der mikrofluidischen Kanalstrukturen auf einem LOC-System für spezifische Anwendungen anzupassen.

Geochemical mapping of carbonate sediments in the Makgadikgadi basin, Botswana using moderate resolution remote sensing data

This paper maps the carbonate geochemistry of the Makgadikgadi Pans region of northern Botswana from moderate resolution (500 m pixels) remotely sensed data, to assess the impact of various geomorphological processes on surficial carbonate distribution. Previous palaeo-environmental studies have demonstrated that the pans have experienced several highstands during the Quaternary, forming calcretes around shoreline embayments. The pans are also a significant regional source of dust, and some workers have suggested that surficial carbonate distributions may be controlled, in part, by wind regime. Field studies of carbonate deposits in the region have also highlighted the importance of fluvial and groundwater processes in calcrete formation. However, due to the large area involved and problems of accessibility, the carbonate distribution across the entire Makgadikgadi basin remains poorly understood. The MODIS instrument permits mapping of carbonate distribution over large areas; comparison with estimates from Landsat Thematic Mapper data show reasonable agreement, and there is good agreement with estimates from laboratory analysis of field samples. The results suggest that palaeo-lake highstands, reconstructed here using the SRTM 3 arc-second digital elevation model, have left behind surficial carbonate deposits, which can be mapped by the MODIS instrument. Copyright (c) 2006 John Wiley & Sons, Ltd.

Geochemical mapping of carbonate sediments in the Makgadikgadi basin, Botswana using moderate resolution remote sensing data

This paper maps the carbonate geochemistry of the Makgadikgadi Pans region of northern Botswana from moderate resolution (500 m pixels) remotely sensed data, to assess the impact of various geomorphological processes on surficial carbonate distribution. Previous palaeo-environmental studies have demonstrated that the pans have experienced several highstands during the Quaternary, forming calcretes around shoreline embayments. The pans are also a significant regional source of dust, and some workers have suggested that surficial carbonate distributions may be controlled, in part, by wind regime. Field studies of carbonate deposits in the region have also highlighted the importance of fluvial and groundwater processes in calcrete formation. However, due to the large area involved and problems of accessibility, the carbonate distribution across the entire Makgadikgadi basin remains poorly understood. The MODIS instrument permits mapping of carbonate distribution over large areas; comparison with estimates from Landsat Thematic Mapper data show reasonable agreement, and there is good agreement with estimates from laboratory analysis of field samples. The results suggest that palaeo-lake highstands, reconstructed here using the SRTM 3 arc-second digital elevation model, have left behind surficial carbonate deposits, which can be mapped by the MODIS instrument. Copyright (c) 2006 John Wiley & Sons, Ltd.

Whole crop cereals 1. Effect of method of harvest and preservation on chemical composition, apparent digestibility and energy value

A total of 133 samples (53 fermented unprocessed, 19 fermented processed. 62 urea-treated processed) of whole crop wheat (WCW) and 16 samples (five fermented unprocessed, six fermented processed, five urea-treated processed) of whole crop barley (WCB) were collected from commercial farms over two consecutive years (2003/2004 and 2004/2005). Disruption of the maize grains to increase starch availability was achieved at the point of harvest by processors fitted to the forage harvesters. All samples were subjected to laboratory analysis whilst 50 of the samples (24 front Year 1, 26 front Year 2 all WCW except four WCB in Year 2) were subjected to in vivo digestibility and energy value measurements using mature wether sheep. Urea-treated WCW had higher (P<0.05) pH, and dry matter (DM) and crude protein contents and lower concentrations of fermentation products than fermented WCW. Starch was generally lower in fermented, unprocessed WCW and no effect of crop maturity at harvest (as indicated by DM content) on starch concentrations was seen. Urea-treated WCW had higher (P<0.05) in vivo digestible organic matter contents in the DM (DOMD) in Year 1 although this was not recorded in Year 2. There was a close relationship between the digestibility values of organic matter and gross energy thus aiding the use of DOMD to predict metabolisable energy (ME) content. A wide range of ME values was observed (WCW. 8.7-11.8 MJ/kg DM; WCB 7.9-11.2 MJ/kg DM) with the overall ME/DOMD ratio (ME = 0.0156 DOMD) in line With Studies in other forages. There was no evidence that a separate ME/DOMD relationship was needed for WCB which is helpful for practical application. This ratio and other parameters were affected by year of harvest (P<0.05) highlighting the influence of environmental and Other undefined factors. The variability in the composition and nutritive value of WCW and WCB highlights the need for reliable and accurate evaluation methods to be available to assess the Value of these forages before they are included in diets for dairy cows. (C) 2008 Elsevier B.V. All rights reserved.

The water quality of the River Enborne, UK: observations from high-frequency Monitoring in a rural, lowland river system

This paper reports the results of a 2-year study of water quality in the River Enborne, a rural river in lowland England. Concentrations of nitrogen and phosphorus species and other chemical determinands were monitored both at high-frequency (hourly), using automated in situ instrumentation, and by manual weekly sampling and laboratory analysis. The catchment land use is largely agricultural, with a population density of 123 persons km−2. The river water is largely derived from calcareous groundwater, and there are high nitrogen and phosphorus concentrations. Agricultural fertiliser is the dominant source of annual loads of both nitrogen and phosphorus. However, the data show that sewage effluent discharges have a disproportionate effect on the river nitrogen and phosphorus dynamics. At least 38% of the catchment population use septic tank systems, but the effects are hard to quantify as only 6% are officially registered, and the characteristics of the others are unknown. Only 4% of the phosphorus input and 9% of the nitrogen input is exported from the catchment by the river, highlighting the importance of catchment process understanding in predicting nutrient concentrations. High-frequency monitoring will be a key to developing this vital process understanding.

High-frequency water quality monitoring in an urban catchment: hydrochemical dynamics, primary production and implications for the Water Framework Directive

This paper describes the hydrochemistry of a lowland, urbanised river-system, The Cut in England, using in situ sub-daily sampling. The Cut receives effluent discharges from four major sewage treatment works serving around 190,000 people. These discharges consist largely of treated water, originally abstracted from the River Thames and returned via the water supply network, substantially increasing the natural flow. The hourly water quality data were supplemented by weekly manual sampling with laboratory analysis to check the hourly data and measure further determinands. Mean phosphorus and nitrate concentrations were very high, breaching standards set by EU legislation. Though 56% of the catchment area is agricultural, the hydrochemical dynamics were significantly impacted by effluent discharges which accounted for approximately 50% of the annual P catchment input loads and, on average, 59% of river flow at the monitoring point. Diurnal dissolved oxygen data demonstrated high in-stream productivity. From a comparison of high frequency and conventional monitoring data, it is inferred that much of the primary production was dominated by benthic algae, largely diatoms. Despite the high productivity and nutrient concentrations, the river water did not become anoxic and major phytoplankton blooms were not observed. The strong diurnal and annual variation observed showed that assessments of water quality made under the Water Framework Directive (WFD) are sensitive to the time and season of sampling. It is recommended that specific sampling time windows be specified for each determinand, and that WFD targets should be applied in combination to help identify periods of greatest ecological risk. This article is protected by copyright. All rights reserved.

Listeria monocytogenes in ready-to-eat, sliced, cooked ham and salami products, marketed in the city of Sao Paulo, Brazil Occurrence, quantification, and serotyping

The preference for ready-to-eat sliced foods may pose an increased risk for food-borne diseases and a major concern is the presence of Listeria monocytogenes L monocytogenes was assessed in two types of products cooked ham and salami One hundred and thirty samples of each product were acquired in retail shops in the city of Sao Paulo and submitted to laboratory analysis The rate of positives was significantly higher in salami samples than in ham samples (62% and 0 8% respectively) L. monocytogenes counts in salami samples varied between <10 and 1900 colony-forming units per gram (CFU/g) The serotypes found in both products were as follows according to incidence 4b (37 5%) 1/2b (25%) 3b (25%) and 1/2c (12 5%) Based on the results of the present study the authors suggest that the risk of listeriosis resulting from the consumption of salami is higher than that associated with the consumption of cooked ham (C) 2010 Elsevier Ltd All rights reserved

Correlation Between Etest (R), Disk Diffusion, and Microdilution Methods for Antifungal Susceptibility Testing of Candida Species From Infection and Colonization

The correlation between the microdilution (MD), Etest (R) (ET), and disk diffusion (DD) methods was determined for amphotericin B, itraconazole and fluconazole. The minimal inhibitory concentration (MIC) of those antifungal agents was established for a total of 70 Candida spp. isolates from colonization and infection. The species distribution was: Candida albicans (n = 27), C. tropicalis (n = 17), C. glabrata (n = 16), C. parapsilosis (n = 8), and C. lusitaniae (n = 2). Non-Candida albicans Candida species showed higher MICs for the three antifungal agents when compared with C. albicans isolates. The overall concordance (based on the MIC value obtained within two dilutions) between the ET and the MD method was 83% for amphotericin B, 63% for itraconazole, and 64% for fluconazole. Considering the breakpoint, the agreement between the DD and MD methods was 71% for itraconazole and 67% for fluconazole. The DD zone diameters are highly reproducible and correlate well with the MD method, making agar-based methods a viable alternative to MD for susceptibility testing. However, data on agar-based tests for itraconazole and amphotericin B are yet scarce. Thus, further research must still be carded out to ensure the standardization to other antifungal agents. J. Clin. Lab. Anal. 23:324-330, 2009. (C) 2009 Wiley-Liss, Inc.

Detection of citrus canker in citrus plants using laser induced fluorescence spectroscopy

Citrus canker is a serious disease caused by Xanthomonas citri subsp. citri bacteria, which infects citrus plants (Citrus spp.) leading to a large economic loss in citrus production worldwide. In Brazil citrus canker control is done by an official eradication campaign, therefore early detection of such disease is important to prevent greater economic losses. However, detection is difficult and so far it has been done by visual inspection of each tree. Suspicious leaves from citrus plants in the field are sent to the laboratory to confirm the infection by laboratory analysis, which is a time consuming. Our goal was to develop a new optical technique to detect and diagnose citrus canker in citrus plants with a portable field spectrometer unit. In this paper, we review two experiments on laser induced fluorescence spectroscopy (LIF) applied to detect citrus canker. We also present new data to show that the length of time a leaf has been detached is an important variable in our studies. Our results show that LIF has the potential to be applied to citrus plants.

A systematic review of triage-related interventions to improve patient flow in emergency departments

Background Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department), and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency department or having nurses to request certain x-rays results in shorter waiting time and length of stay.

Prevalência da infecção pelo Papilomavírus humano, Chlamydia Trachomatis e Herpes Simples do tipo 2 em adolescentes atendidas em unidades de saúde pública de Natal

This study assessed the level of knowledge, attitude and practice of Pap smear and human papillomavirus (HPV), in addition to analyzing the prevalence of genital HPV infection, Herpes Simplex Type 2 (HSV-2) and Chlamydia trachomatis in teenagers. The study consisted of two approaches, one based only on interviews conducted with adolescents enrolled in public schools or in public health facilities in the city of Natal. The other approach involved only a group of 132 adolescents enrolled among those admitted to two health units in Natal-RN. This second group of participants two specimens were collected for laboratory analysis: one was directed to prepare the blade for the Pap test, and other processed for DNA extraction for molecular analysis, focusing on the detection of HPV, HSV-2 and C . trachomatis. The presence of DNA of the three pathogens was investigated by the technique of polymerase chain reaction (PCR). The presence of each of the three pathogens was analyzed in terms of socio-demographic characteristics, as well as sexual and reproductive activity to identify risk factors for infection and development of lesions of the uterine cervix. The results show that the adolescents in this study had levels of knowledge and attitude very low, both in relation to cytology to HPV as though they have made a reasonable percentage of adequate practice exam and prevention of HPV infection. The overall prevalence of HPV infection was 54.5% and 48.2% in adolescents with normal cytology and 86.4% in those with abnormal cytology. We observed a higher proportion of cases of infection in the age group of 18 to 21. The prevalence of HPV infection was slightly higher among pregnant teenagers. The overall prevalence of HSV-2 infection was 13.6% and 11.8% in women with normal cytology and 22.7% in those with abnormal cytology. A higher proportion of cases of infection was found in the age group from 14 to 17, with a slightly higher prevalence among pregnant women. The C. trachomatis was found with an overall prevalence of 19.7% and 21.8% in adolescents with normal cytology and 9.1% in those with abnormal cytology. The prevailing rate was highest in the age group 18 to 21 years and in nonpregnant

Alterações nas concentrações das SRAT, conteúdo de GSH e atividade da CAT em pacientes com esquistossomose aguda

Schistosomiasis is an ancient disease caused by helminth Schistosoma mansoni and is a public health problem in Brazil. The granulomatous lesion, typical of the disease, associates itself with increase in the oxidative damage through the generation of free radicals. The aim of this work was to evaluate the occurrence of changes in parameters oxidant / antioxidant that are part of the human defense system, and observe whether they would cause oxidative stress in subjects with schistosomiasis. Moreover, correlating with some biochemical and hematological parameters. Two groups were selected for study, consisting of individuals of both sexes, aged between 16 and 30 years. A control group, formed by individuals without schistosomiasis (n = 30) and a test group, formed by individuals with schistosomiasis (n = 30). The evaluation of lipid peroxidation in plasma was performed by determination of malondialdehyde and antioxidant defense by the quantification of reduced glutathione and catalase activity. For the parameters that assess oxidative stress, the results showed a decrease in the content of reduced glutathione and no change in the activity of catalase, with an increase in the value of malondialdehyde. Therefore, the data found suggest the occurrence of oxidative stress in subjects with schistosomiasis. Of the parameters that assess hepatic function, only levels of aspartate aminotransferase have been high, while there was a decrease of bilirubine. There was a significant change in the lipid profile (p <0.5), however with regard to the renal function of patients, there was a decrease in creatinine. The assessment hematological, made through hemogram and the quantification of hemoglobin, shows increase of eosinophils individuals in the group test, which can be related to the presence of the parasite. The amendments suggest the involvement of oxidative stress in the pathophysiology of this disease

Ocorrência de poliúria-polidpsia em eqüinos estabulados - descrição de dois casos de polidipsia psicogênica

Dois eqüinos da raça Brasileira de Hipismo, machos, quatro anos de idade, apresentando sinais de poliúria-polidipsia, foram submetidos a completa avaliação clínica e a exames de sangue e urina. Não foram observadas alterações clínicas, hematológicas ou bioquímicas, a não ser um decréscimo na gravidade específica da urina de ambos os animais (1,009 e 1,008). Realizou-se um teste de privação de água de 24 horas e durante esse período a gravidade especifica da urina subiu gradualmente até atingir a normalidade (1,028 e 1,026, respectivamente). O comportamento anormal ocorreu por confinamento excessivo. Os resultados clínicos e de laboratório e o teste de privação de água indicam o diagnóstico de polidipsia psicogênica.