Pediatric severe asthma is characterized by eosinophilia and remodeling without T(H)2 cytokines

BACKGROUND: The pathology of pediatric severe therapy-resistant asthma (STRA) is little understood. OBJECTIVES: We hypothesized that STRA in children is characterized by airway eosinophilia and mast cell inflammation and is driven by the T(H)2 cytokines IL-4, IL-5, and IL-13. METHODS: Sixty-nine children (mean age, 11.8 years; interquartile range, 5.6-17.3 years; patients with STRA, n = 53; control subjects, n = 16) underwent fiberoptic bronchoscopy, bronchoalveolar lavage (BAL), and endobronchial biopsy. Airway inflammation, remodeling, and BAL fluid and biopsy specimen T(H)2 cytokines were quantified. Children with STRA also underwent symptom assessment (Asthma Control Test), spirometry, exhaled nitric oxide and induced sputum evaluation. RESULTS: Children with STRA had significantly increased BAL fluid and biopsy specimen eosinophil counts compared with those found in control subjects (BAL fluid, P < .001; biopsy specimen, P < .01); within the STRA group, there was marked between-patient variability in eosinophilia. Submucosal mast cell, neutrophil, and lymphocyte counts were similar in both groups. Reticular basement membrane thickness and airway smooth muscle were increased in patients with STRA compared with those found in control subjects (P < .0001 and P < .001, respectively). There was no increase in BAL fluid IL-4, IL-5, or IL-13 levels in patients with STRA compared with control subjects, and these cytokines were rarely detected in induced sputum. Biopsy IL-5(+) and IL-13(+) cell counts were also not higher in patients with STRA compared with those seen in control subjects. The subgroup (n = 15) of children with STRA with detectable BAL fluid T(H)2 cytokines had significantly lower lung function than those with undetectable BAL fluid T(H)2 cytokines. CONCLUSIONS: STRA in children was characterized by remodeling and variable airway eosinophil counts. However, unlike in adults, there was no neutrophilia, and despite the wide range in eosinophil counts, the T(H)2 mediators that are thought to drive allergic asthma were mostly absent.

The influence of muscle strength on the gait profile score (GPS) across different patients

BACKGROUND Muscle strength greatly influences gait kinematics. The question was whether this association is similar in different diseases. METHODS Data from instrumented gait analysis of 716 patients were retrospectively assessed. The effect of muscle strength on gait deviations, namely the gait profile score (GPS) was evaluated by means of generalised least square models. This was executed for seven different patient groups. The groups were formed according to the type of disease: orthopaedic/neurologic, uni-/bilateral affection, and flaccid/spastic muscles. RESULTS Muscle strength had a negative effect on GPS values, which did not significantly differ amongst the different patient groups. However, an offset of the GPS regression line was found, which was mostly dependent on the basic disease. Surprisingly, spastic patients, who have reduced strength and additionally spasticity in clinical examination, and flaccid neurologic patients showed the same offset. Patients with additional lack of trunk control (Tetraplegia) showed the largest offset. CONCLUSION Gait kinematics grossly depend on muscle strength. This was seen in patients with very different pathologies. Nevertheless, optimal correction of biomechanics and muscle strength may still not lead to a normal gait, especially in that of neurologic patients. The basic disease itself has an additional effect on gait deviations expressed as a GPS-offset of the linear regression line.

Influence of the application of Jasmonic Acid and Benzoic Acid on Watermelon fruit quality.

In watermelon crops in Southeastern Spain, important thermal differences appear during the first stages of plant development that can affect them. This work shows the effect of applying jasmonic acid and benzoic acid (JA+BA), inductors of systemic acquired resistance (SAR) and induced systemic resistance (ISR), respectively, on fruit quality parameters from a crop in a greenhouse in Southeastern Spain, where crops face a remarkable abiotic stress. We assessed two treatments of JA+BA, T1 (500+500 ppm), T2 (2000+2000 ppm) and a control test using an experimental design of randomized blocks with four replications. The results obtained for the parameters assessed (ºBrix, flesh firmness, rind thickness, polar and equatorial diameter) did not show statistically significant differences. The results showed that there was no metabolic cost in the plants when applying the assessed treatments of JA+BA.

Effect of the application of jasmonic acid and benzoic acid on grafted watermelons yield under greenhouse conditions in the southeast of Spain for mitigation of stress

One of the main problems of watermelon crops in Sou theast Spain is the thermal difference because of c limatic conditions that appear during the first stages of the crop. The objective of this work was to evaluate the effect of inducing the systemic acq uired resistance (SAR) and the induced systemic resistance (ISR) through the application of jasmonic ac id (JA) and benzoic acid (BA), respectively, to counter the abiotic stress. We assessed two treatments of JA and BA, T1 (500 mg·kg-1 + 500 mg·kg -1 ) and T 2 (2000 mg·kg -1 + 2000 mg·kg -1), as well as a control test using an experimental design of randomized blocks with four replications. The results obtained for kg·m -2, fruits/m², kg/plant and fruits/plant did not show statistically significant differences. However, we obtained statistically sig nificant differences in the average fruit weight co mpared with the control test in the two experiments carried out in 2009 and 2010. The results showed that there was no metabolic cost in the plants when applying the assessed treatments of JA and BA.

Intra-abdominal pressure increases stiffness of the lumbar spine

Intra-abdominal pressure (IAP) increases during many tasks and has been argued to increase stability and stiffness of the spine. Although several studies have shown a relationship between the IAP increase and spinal stability, it has been impossible to determine whether this augmentation of mechanical support for the spine is due to the increase in IAP or the abdominal muscle activity which contributes to it. The present study determined whether spinal stiffness increased when IAP increased without concurrent activity of the abdominal and back extensor muscles. A sustained increase in IAP was evoked by tetanic stimulation of the phrenic nerves either. unilaterally or bilaterally at 20 Hz (for 5 s) via percutaneous electrodes in three subjects. Spinal stiffness was measured as the force required to displace an indentor over the L4 or L2 spinous process with the subjects lying prone. Stiffness was measured as the slope of the regression line fitted to the linear region of the force-displacement curve. Tetanic stimulation of the diaphragm increased IAP by 27-61% of a maximal voluntary pressure increase and increased the stiffness of the spine by 8-31% of resting levels. The increase in spinal stiffness was positively correlated with the size of the IAP increase. IAP increased stiffness at L2 and L4 level. The results of this:study provide evidence that the stiffness of the lumbar spine is increased when IAP is elevated. (C) 2004 Elsevier Ltd. All rights reserved.

Asma, abitudini e stile di vita "Analisi retrospettiva di un campione di pazienti asmatici seguito in ambulatorio di terzo livello"

Growing evidence suggest the importance of different environments in promoting the pathogenesis and/or exacerbation of asthma. Indoor air pollution is a major contributor to human exposure, since people spend up to 90% of their day indoors. Apart from active smoking, indoor pollution is considered one of the major preventable risk factors of chronic respiratory diseases. The professional activity can also be dangerous because it exposes the subject to environments that can promote the onset of asthma or worsening of the latter in those already affected. Even bad habits such as incorrect diet, lead to more difficulty in controlling their disease. However asthma is a multifactorial disease in nature so it is not easy to distinguish the role of occupational exposure, pollution and normal habits such as smoking, nutrition, sports, etc. This retrospective study was conducted on a sample of asthma patients residing in the metropolitan area of Parma. 116 patients were selected among those who are followed up at least two years at the Asthma outpatient Clinic of Parma University Hospital. The sample in question is therefore closely controlled and monitored; it comes to patients who are well educated on the control of their disease, are able to take appropriate measures to minimize the symptomatology. With this tight approach is proposed to minimize the effect of confounding and then traced with greater certainty the possible cause of the failure to control the disease. For this purpose, each patient was subjected to regular checkups; we took as a reference the period of time between April and October 2015. During each visit, in addition to general data for each patient, we were collected personal information about their habits and way of life through a validated questionnaire delivered and completed by the patient during the visit in the presence of the permanent staff. The questionnaire covers mainly the qualification of the patient, its possible occupational exposure, his home, with information about nearby traffic, time spent outside, physical activity (place and time), exposure to chemicals, exposure to various fumes (fireplace or stove) and cigarette smoke, comorbidities and any drugs taken during the visits considered. Regarding the respiratory conditions of patients during every examination we were considered: Asthma Control Test (a test performed by patients to assess the state of the disease during the month preceding the test), the measurement of exhaled nitric oxide (FeNO) as an index of airways inflammation, measuring the resistance level of small airways (R5-R20) and some spirometric values observed in experiment; in particular the forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1), FEV1/FVC ratio, forced expiratory flow rate over the middle 50% of the FVC (FEF25–75) and FEF25-75/FVC were recorded. The sample has been studied considering both the changes of the respiratory parameters for every patient in their examinations, and the respiratory parameters of all the examinations took as a whole in relation with the variables considered. From the results obtained, the patients are clinically stable; their adopted lifestyle and the exposure to possible sources of outdoor pollution, seems not affect the overall control of their disease. Some findings of our study are of interest. First, the subjects who carry a steroid therapy show a clinical worst, as revealed by the decrease of most spirometric indices, particularly FEF25, FEF75, FEF25-75 and R5-R20; also, the presence of comorbidities and the subsequent intake of other drugs, in addition to normal therapy for asthma, seem to be conditions associated with poorer performance in the functional respiratory parameters in particular FEV1/FVC, FEF75 and FEF25-75. Spirometric indexes that are down are mainly those related to obstruction imposed on small airways; this suggests a neglect to the latter on the contrary should be further explored and treated accordingly. It is also observed that both patients are overweight than those living on the lower floors and/or who have the most windows exposed to traffic, showed a decrease of pulmonary function, especially those relate to an obstruction at the small airways level. In conclusion, our results provided the evidence that a most appropriate therapy, specific to reach the small airways, associated with a healthy lifestyle, can help improve the management of asthma.

Avaliação dos parâmetros de insensibilização e os impactos na qualidade da carne de perus (Meleagris gallopavo)

Brazil is the third largest producer and exporter of turkey meat, especially in Paraná state, with the largest production volume. In worldwide the animal welfare is a prerequisite for food quality of animal origin, especially in Europe. The Regulation of European Community No 1099/2009 provides requirements for poultry stunning that associate with animal welfare as a means to minimize the pain and suffering from the slaughter. Improper application of callousness should produce low-quality meat, and significant industry losses. This Research aimed to evaluate the impacts on the quality of meat from turkeys, applying electrical stunning parameters established in the Regulation No 1099/2009 of the Council of 24 September 2009. Was applied an outline with 8 tests set equidistantly to frequency, and set parameters for current and voltage, and a control test. Were conducted qualitative assessments of hematoms and bruises / fractures in carcasses, hematoms, blood splashed and bleeding in turkey breast, and quantitative pH, color (L *), water holding capacity and shear force in turkey breast. The individual assessments showed no significant difference (p>0,05). In multivariate cluster analysis was the formation of two distinct groups: group 1 - 50 Hz to 200 Hz (low frequency) and group 2 - 633 Hz to 1500 Hz (high frequency), which showed significant difference (p= 0,016). In principal component analysis multivariate, the group 1 tend to have a higher incidence of bruising, blood splashed, bleeding and water holding capacity in breast turkeys, and bruises / fractures and hematoms on carcasses. The Group 2 tends to have a lower incidence of these parameters, and higher pH values, shear force and color (L *). Positive correlation was obtained for the parameters pH and shear force (r= 0.7506, p=0.0198); bleeding and splashed blood (r= 0.8811, p= 0.0017), and negative correlation to color (L*) and splashed blood on breast (r= -0.7889; p= 0.0115); breast hematoms and shear force (r= -0.7844; p= 0.0123). It has been observed that at lower frequencies stunning tends to have higher incidence of defects in the carcasses and turkey breast. The use of high frequencies in stunning, create smaller quantity of trimming, and an increase in turkey breast volume produced, with a financial gain of approximately R$250,000.00 / year. Moreover, there is no need increase the workers to do the trimming tasks and, therefore, higher financial results for companies. Therefore, we recommend the use of high frequencies in the stunning of turkeys.

Efetividade da vacina antigripal sazonal na época 2015/2016: resultados do projeto EuroEVA

O projeto EuroEVA pretende obter estimativas da efetividade da vacina antigripal (EV), para a população geral e para o grupo-alvo para o qual é recomendada. Os resultados apresentados correspondem à sua implementação na época 2015/2016. Utilizou-se um delineamento caso-controlo teste negativo, onde os casos, indivíduos com síndrome gripal (SG) e com diagnóstico laboratorial positivo para o vírus da gripe, foram comparados com os controlos, indivíduos com SG e diagnóstico laboratorial negativo para o vírus da gripe. Os participantes foram selecionados entre os doentes com SG observados em consulta de cuidados de saúde primários. Foi recolhida informação clinica e epidemiológica e um exsudado da nasofaringe para diagnóstico laboratorial. A EV foi estimada através de 1- odd ratio de estar vacinado nos casos vs. controlos, ajustado para a idade, presença de doença crónica, número de consultas com médico de família (MF) nos últimos 12 meses, número de coabitantes, nível de escolaridade, sexo e mês de início de sintomas. Entre as semanas 48/2015 e 17/2016, foram recrutados 310 indivíduos com SG sendo que, após exclusão de 26 indivíduos por não cumprirem os critérios de inclusão, foram incluídos 124 casos e 186 controlos. De entre os casos, 89,5% eram positivos para o vírus da gripe do subtipo A(H1) pdm09 e 8,9% para o tipo B/Victoria. Relativamente à vacina antigripal, a cobertura era de 10,5% nos casos e 23,7% nos controlos. Após ajustamento, a EV em 2015/2016 foi de 56,1% (IC95%: 3,5%; 80,0%) e 65,8% (IC95%:12,5%; 86,7%), respetivamente na população geral e no grupo-alvo para a vacinação antigripal. Estes resultados sugerem que a vacina antigripal nesta época conferiu uma proteção moderada. As estimativas da EV estão em linha com resultados publicados por outros países europeus.

Monitorização das condições de operação de uma caldeira a biomassa

A reduzida informação e o pouco trabalho científico desenvolvido na área de sistemas de combustão de biomassa de média potência, faz dos objectivos propostos neste trabalho elementos importantes. O trabalho científico a seguir apresentado, vai permitir obter as bases para o desenvolvimento de condições apropriadas de operação de sistemas de combustão a biomassa, aumentando a eficiência e a rentabilidade económica deste tipo de sistema energético. O principal objetivo do presente trabalho consistiu na aplicação de metodologias de monitorização que permitam caracterizar e melhorar a eficiência do sistema de combustão, na implementação dos métodos escolhidos e na monitorização das condições de operação de uma caldeira industrial de combustão de biomassa, destacando-se: (i) monitorização dos caudais de alimentação de biomassa à caldeira realizada por sistemas de alimentação sem-fim; (ii) análise e monitorização de temperaturas e pressão; (iii) monitorização do caudal de ar de combustão; (iv) monitorização do caudal de gases de exaustão; (v) monitorização da potência térmica; (vi) monitorização da composição do efluente gasoso. A caracterização físicas de amostras de biomassa, o teste a diferentes tipos de biomassa com diferentes condições de operação e a recolha de amostras de cinzas de combustão para a caracterização físico-química são outros métodos de monitorização e caracterização aplicados. Também foi desenvolvido e aplicado um ensaio de controlo do sistema de alimentação em modo de operação manual e comparado com o sistema de controlo do sistema de alimentação em modo de operação automático. O estudo realizado permite concluir que deve ser desenvolvido e implementado um algoritmo de controlo e operação da fornalha que permita um doseamento mais adequado dos caudais de combustível e ar de combustão com vista a melhorar o desempenho do sistema combustão.

Influência da adição de cálcio nas propriedades de pastas geopoliméricas destinadas a cimentação de poços de petróleo

Nowadays, the search for new technologies that are able to follow the upcoming challenges in oil industry is a constant. Always trying properties improvements of the used materials, looking for the best performance and greater life time. Besides the search for technologies that show an improvement of performance, the search for materials environmentally correct along the whole production process. In Oil well cementing, this search for new technologies passes through the development of slurry systems that support these requests and that are also environmentally friendly. In this context, the use of geopolymer slurries is a great alternative route to cementing oil wells. Besides having good properties, comparable to Portland cement slurries, this alternative material releases much less CO2 gas in the production of their root materials when compared the production of Portland cement, which releases tons of CO2. In order to improve the properties of geopolymer slurries has been added Calcium Oxide, as observed in other studies that slurries where the Calcium is present the values of compressive strength is greater. The addition has been realized based in the CaO/SiO2 molar ratio of 0.05, 0.10 and 0.15. Have been performed compressive strength tests, thickening time, rheology and fliud loss control test of the slurries, following NBR 9831, as well as the physical chemical characterization of XRD, SEM and TG. Has been observed in most of the tests the slurries follow a tendency until the ratio of 0.10, which inverses in the ratio 0.15. This behavior can be explained by two phenomena that occur simultaneously, the first one is the break of the polymer chains and a consequent increase in molucules mobility, which prevails until the ratio of 0.1, and the second is possible approach of the chains due to the capacity of the calcium ions stabilize the charges of two different aluminum. There is only one linearity in the mechanical behavior that can be attributed to the appereance of the C-S-H phase. Based on this, it is concluded that the phenomenon of breaking the polymer chains predominates until the ratio of 0.1, causing an increase of the filtrate volume, lower rheological parameters and increasing thickening time. From the ratio of 0.15 the approach of the chains predominates, and the behavior is reversed

Efetividade de técnicas de fisioterapia no equilíbrio em pacientes com Acidente Vascular Cerebral

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia

Estudo piloto para avaliar a influência do biofeedbackvisual no equilíbrio sentado em pacientes após AVE

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia

Experimental evaluation of the z-resolution in different clinical Digital Breast Tomosynthesis systems using commercial phantoms

Digital Breast Tomosynthesis (DBT) is an advanced mammography technique based on the reconstruction of a pseudo-volumetric image. To date, image quality represents the most deficient section of DBT quality control protocols. In fact, related tests are not yet characterized by either action levels or typical values. This thesis work focuses on the evaluation of one aspect of image quality: the z-resolution. The latter is studied in terms of Artifact Spread Function (ASF), a function that describes the signal spread of a detail along the reconstructed focal planes. To quantify the ASF numerically, its Full Width at Half Maximum (FWHM) is calculated and used as a representative index of z-resolution. Experimental measurements were acquired in 24 DBT systems, of 7 different models, currently in use in 20 hospital facilities in Italy. The analysis, performed on the clinical reconstructed images, of 5 different commercial phantoms, lead to the identification of characteristic FWHM values for each type of DBT system. The ASF clearly showed a dependence on the size of the detail, providing higher FWHM values for larger objects. The z-resolution was found to be positively influenced by the acquisition angle: Fujifilm sistematically showed wider ASF profiles in ST mode (15°) than in HR mode (40°). However, no clear relationship was found between angular range and ASF, among different DBT systems, due to the influence of the peculiarities of each reconstruction algorithm. The experimental approach shown in this thesis work can be proposed as a z-resolution quality control test procedure. Contextually, the values found could be used as a starting point for identifying typical values to be included in the test, in a DBT protocol. Clearly, a statistically significant number of images is needed to do this. The equipment involved in this work is located in hospitals and is not available for research purposes, so only a limited amount of data was acquired and processed.

Postural control of the trunk in response to lateral support surface translations during trunk movement and loading

The postural response to translation of the support surface may be influenced by the performance of an ongoing voluntary task. This study was designed to test this proposal by applying lateral perturbations while subjects handled a load in the frontal plane. Measurements were made of medio-lateral displacement of the centre of pressure, angular displacement of the trunk and thigh in the frontal plane and intra-abdominal pressure. Subjects were translated randomly to the left and right in a variety of conditions that involved standing either quietly or with a 5 kg load in their left hand, which they were required either to hold statically or to lift or lower. The results indicate that when the perturbation occurred towards the loaded left side the subjects were able to return their centre of pressure, trunk and thigh rapidly and accurately to the initial position. However, when the perturbation occurred towards the right (away from the load) this correction was delayed and associated with multiple changes in direction of movement, suggesting decreased efficiency of the postural response. This reduced efficiency can be explained by a conflict between the motor commands for the ongoing voluntary task and the postural response, and/or by the mechanical effect of the asymmetrical addition of load to the trunk.

Quality control of Toxoplasma gondii in meat packages: Standardization of an ELISA test and its use for detection in rabbit meat cuts

Toxoplasma gondii causes severe disease both to man and livestock and its detection in meat after slaughtering requires PCR or biological tests. Meat packages contain retained exudate that could be used for serology due to its blood content. Similar studies reported false negative assays in those tests. We standardized an anti-T. gondii IgG ELISA in muscle juices from experimentally infected rabbits, with blood content determination by cyanhemoglobin spectrophotometry. IgG titers and immunoblotting profiles were similar in blood, serum or meat juice, after blood content correction. These assays were adequate regardless of the storage time up to 120 days or freeze-thaw cycles, without false negative results. We also found 1.35% (1/74) positive sample in commercial Brazilian rabbit meat cuts, by this assay. The blood content determination shows ELISA of meat juice may be useful for quality control for toxoplasmosis monitoring. (C) 2011 Elsevier Ltd. All rights reserved.