Molecular, cellular and physiological investigation of myostatin propeptide-mediated muscle growth in adult mice

Inhibition of myostatin signalling or its biological activity has recently emerged as a potential remedial approach against muscle wasting and degenerative diseases such as muscular dystrophies. In the present study we systemically administered a recombinant AAV8 vector expressing a mutated myostatin propeptide (AAV8ProMyo) to healthy mice in order to assess its impact on the histological, cellular and physiological properties of the skeletal muscle, exploiting the fact that myostatin is naturally inhibited by its own propeptide. We report that a single intravenous administration of AAV8ProMyo leads to increases in muscle mass of tibialis anterior, extensor digitorum longus and gastrocnemius muscles 8 weeks post-injection and tibialis anterior, gastrocnemius and rectus femoris muscles 17 weeks post-injection. Moreover, treatment resulted in muscle fibre hypertrophy but not hyperplasia, with IIB myofibres responding to the greatest extent following propeptide-induced myostatin inhibition. Additionally, myofibre nuclear: cytoplasmic ratio was decreased in the AAV8ProMyo treated animals. Importantly, the hypertrophic EDL muscle 8 weeks after AAV8ProMyo treatment did not show the dramatic decrease in specific force displayed by the germline myostatin null mice. (C) 2009 Elsevier B.V. All rights reserved.

Cognitive tests used in chronic adult human randomised controlled trial micronutrient and phytochemical intervention studies

In recent years there has been a rapid growth of interest in exploring the relationship between nutritional therapies and the maintenance of cognitive function in adulthood. Emerging evidence reveals an increasingly complex picture with respect to the benefits of various food constituents on learning, memory and psychomotor function in adults. However, to date, there has been little consensus in human studies on the range of cognitive domains to be tested or the particular tests to be employed. To illustrate the potential difficulties that this poses, we conducted a systematic review of existing human adult randomised controlled trial (RCT) studies that have investigated the effects of 24 d to 36 months of supplementation with flavonoids and micronutrients on cognitive performance. There were thirty-nine studies employing a total of 121 different cognitive tasks that met the criteria for inclusion. Results showed that less than half of these studies reported positive effects of treatment, with some important cognitive domains either under-represented or not explored at all. Although there was some evidence of sensitivity to nutritional supplementation in a number of domains (for example, executive function, spatial working memory), interpretation is currently difficult given the prevailing 'scattergun approach' for selecting cognitive tests. Specifically, the practice means that it is often difficult to distinguish between a boundary condition for a particular nutrient and a lack of task sensitivity. We argue that for significant future progress to be made, researchers need to pay much closer attention to existing human RCT and animal data, as well as to more basic issues surrounding task sensitivity, statistical power and type I error.

The programming language standards scene, ten years on paper 19: Pop

This paper, one of a simultaneously published set, describes the establishment in 1990 of the UK standards project for the Pop programming language, and the progress of the project to the end of 1993.

What is outside? The early years foundation stage in England: outdoor facilities, organisation and staff attitudes

The purpose of this paper is to report on the facilities available, organisation of, and staff attitudes to early years outdoor education from schools within the south east of England, focusing on provision for children aged three to five. One component of the successful education of the child involves providing an ���environment for learning���, including the facilities, layout and routines. This paper presents findings concerning the type and variety of facilities available outside; the various styles of organisation of the space; staff attitudes about: their roles, their aims for the environment, children���s behaviour and learning, and perceived drawbacks to practice. This paper draws on empirical data collected from schools within the University of Reading partnership. The findings suggest that although all early years settings must adhere to the statutory framework there are a range of facilities available, and there are a number of ways this environment is organised. Further there appears to be uncertainty about the adult role outside and the aims for activities. The conclusions drawn indicate that staff do not appear to be linking their aims for outdoor education to the facilities provided or to their actions outside. This means there is not a clear link between what staff provide outside and the declared ambitions for learning. This study is important as all educators need to be certain about their aims for education to ensure best outcomes for children. The implications of these findings for early years teachers are that they need to be able to articulate their aims for outdoor education and to provide the correct facilities to achieve these aims. Finally this study was undertaken to raise debate, posit questions and to ascertain the parameters for further research about the early years outdoor environment.

Childhood trauma: methods for the identification of physeal fractures in non-adult skeletal remains

Objectives Today, fractures at the growth plate (or physis) are common injuries in children, but provide challenges of identification in skeletonized remains. Clinical studies provide detailed information on the mechanisms, locations, age of occurrence, and complications associated with physeal fractures, enabling the development of new criteria for identifying this injury in non-adults. To test these criteria, skeletal remains from five rural and urban medieval cemeteries were examined. Methods The sample consisted of 961 skeletons (0-17 years) with open epiphyses. Macroscopic observation looked for any irregularities of the metaphysis or epiphysis which was consistent with the clinical appearance of physeal fractures or resulting complications. Radiographic examination was applied to identify fracture lines or early growth arrest. Results This study revealed 12 cases of physeal trauma (1.2%). Physeal fractures occurred predominantly at the distal end (75%), and while they were identified in all age categories, they were most frequent in those aged 12-17 years (0.2% TPR). The humerus was the most commonly affected location (3/12 or 25%). Conclusions This study highlights the potential for recognizing physeal fractures in children of all ages, enhancing our understanding of non-adult trauma, and enabling us to assign a more precise age of the injury to build up a picture of their activities in the past.

Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19��2 million participants

Background Underweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries. Methods We analysed, with use of a consistent protocol, population-based studies that had measured height and weight in adults aged 18 years and older. We applied a Bayesian hierarchical model to these data to estimate trends from 1975 to 2014 in mean BMI and in the prevalences of BMI categories (<18��5 kg/m2 [underweight], 18��5 kg/m2 to <20 kg/m2, 20 kg/m2 to <25 kg/m2, 25 kg/m2 to <30 kg/m2, 30 kg/m2 to <35 kg/m2, 35 kg/m2 to <40 kg/m2, ���40 kg/m2 [morbid obesity]), by sex in 200 countries and territories, organised in 21 regions. We calculated the posterior probability of meeting the target of halting by 2025 the rise in obesity at its 2010 levels, if post-2000 trends continue. Findings We used 1698 population-based data sources, with more than 19��2 million adult participants (9��9 million men and 9��3 million women) in 186 of 200 countries for which estimates were made. Global age-standardised mean BMI increased from 21��7 kg/m2 (95% credible interval 21��3���22��1) in 1975 to 24��2 kg/m2 (24��0���24��4) in 2014 in men, and from 22��1 kg/m2 (21��7���22��5) in 1975 to 24��4 kg/m2 (24��2���24��6) in 2014 in women. Regional mean BMIs in 2014 for men ranged from 21��4 kg/m2 in central Africa and south Asia to 29��2 kg/m2 (28��6���29��8) in Polynesia and Micronesia; for women the range was from 21��8 kg/m2 (21��4���22��3) in south Asia to 32��2 kg/m2 (31��5���32��8) in Polynesia and Micronesia. Over these four decades, age-standardised global prevalence of underweight decreased from 13��8% (10��5���17��4) to 8��8% (7��4���10��3) in men and from 14��6% (11��6���17��9) to 9��7% (8��3���11��1) in women. South Asia had the highest prevalence of underweight in 2014, 23��4% (17��8���29��2) in men and 24��0% (18��9���29��3) in women. Age-standardised prevalence of obesity increased from 3��2% (2��4���4��1) in 1975 to 10��8% (9��7���12��0) in 2014 in men, and from 6��4% (5��1���7��8) to 14��9% (13��6���16��1) in women. 2��3% (2��0���2��7) of the world's men and 5��0% (4��4���5��6) of women were severely obese (ie, have BMI ���35 kg/m2). Globally, prevalence of morbid obesity was 0��64% (0��46���0��86) in men and 1��6% (1��3���1��9) in women. Interpretation If post-2000 trends continue, the probability of meeting the global obesity target is virtually zero. Rather, if these trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women; severe obesity will surpass 6% in men and 9% in women. Nonetheless, underweight remains prevalent in the world's poorest regions, especially in south Asia.

Mesenchymal stem cells and inorganic bovine bone mineral in sinus augmentation: comparison with augmentation by autologous bone in adult sheep

Our aim was to compare the osteogenic potential of mononuclear cells harvested from the iliac crest combined with bovine bone mineral (BBM) (experimental group) with that of autogenous cancellous bone alone (control group). We studied bilateral augmentations of the sinus floor in 6 adult sheep. BBM and mononuclear cells (MNC) were mixed and placed into one side and autogenous bone in the other side. Animals were killed after 8 and 16 weeks. Sites of augmentation were analysed radiographically and histologically. The mean (SD) augmentation volume was 3.0 (1.0) cm(3) and 2.7 (0.3) cm(3) after 8 and 16 weeks in the test group, and 2.8 (0.3) cm(3) (8 weeks) and 2.8 (1.2) cm(3) (16 weeks) in the control group, respectively. After 8 weeks, histomorphometric analysis showed 24 (3)% BBM, and 19 (11)% of newly formed bone in the test group. The control group had 20 (13%) of newly formed bone. Specimens after 16 weeks showed 29 (12%) of newly formed bone and 19 (3%) BBM in the test group. The amount of newly formed bone in the control group was 16 (6%). The results show that mononuclear cells, including mesenchymal stem cells, in combination with BBM as the biomaterial, have the potential to form bone. (C) 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

30 million years of Permian volcanism recorded in the Choiyoi igneous province (W Argentina) and their source for younger ash fall deposits in the Parana Basin: SHRIMP U-Pb zircon geochronology evidence

We present four SHRIMP U-Pb zircon ages for the Choiyoi igneous province from the San Rafael Block, central-western Argentina. Dated samples come from the Yacimiento Los Reyunos Formation (281.4 +/- 2.5 Ma) of the Cochico Group (Lower Choiyoi section: andesitic breccias, dacitic to rhyolitic ignimbrites and continental conglomerates). Agua de los Burros Formation (264.8 +/- 2.3 Ma and 264.5 +/- 3.0 Ma) and Cerro Carrizalito Formation (251.9 +/- 2.7 Ma Upper Choiyoi section: rhyolitic ignimbrites and pyroclastic flows) spanning the entire Permian succession of the Choiyoi igneous province. A single ziron from the El Imperial Formation, that is overlain unconformably by the Choiyoi succession, yielded an early Permian age (297.2 +/- 5.3 Ma). while the main detrital zircon population indicated an Ordovician age (453.7 +/- 8.1 Ma). The new data establishes a more precise Permian age (Artinskian-Lopingian) for the section studied spanning 30 Ma of volcanic activity. Volcanological observations for the Choiyoi succession support the occurrence of explosive eruptions of plinian to ultraplinian magnitudes, capable of injecting enormous volumes of tephra in the troposphere-stratosphere. The new SHRIMP ages indicate contemporaneity between the Choyoi succession and the upper part of the Parana Basin late Paleozoic section, from the Irad up to the Rio do Rasto formations, encompassing about 24 Ma. Geochemical data show a general congruence in compositional and tectonic settings between the volcanics and Parana Basin Permian ash fall derived layers of bentonites. Thickness and granulometry of ash fall layers broadly fit into the depletion curve versus distance from the remote source vent of ultraplinian eruptions. Thus, we consider that the Choiyoi igneous province was the source of ash fall deposits in the upper Permian section of the Parana Basin. Data presented here allow a more consistent correlation between tectono-volcanic Permian events along the paleo-Pacific margin of southwestern Gondwana and the geological evolution of neighboring Paleozoic foreland basins in South America and Africa. (C) 2010 International Association for Gondwana Research. Published by Elsevier B.V. All rights reserved.

Lifestyle and health status in a sample of Swedish women four years after pregnancy : a comparison of women with a history of normal pregnancy and women with a history of gestational diabetes mellitus

Background: Despite the recommendations to continue the regime of healthy food and physical activity (PA) postpartum for women with previous gestational diabetes mellitus (GDM), the scientific evidence reveals that these recommendations may not be complied to. This study compared lifestyle and health status in women whose pregnancy was complicated by GDM with women who had a normal pregnancy and delivery. Methods: The inclusion criteria were women with GDM (ICD-10: O24.4 A and O24.4B) and women with uncomplicated pregnancy and delivery in 2005 (ICD-10: O80.0). A random sample of women fulfilling the criteria (n = 882) were identified from the Swedish Medical Birth Register. A questionnaire was sent by mail to eligible women approximately four years after the pregnancy. A total of 444 women (50.8%) agreed to participate, 111 diagnosed with GDM in their pregnancy and 333 with normal pregnancy/ delivery. Results: Women with previous GDM were significantly older, reported higher body weight and less PA before the index pregnancy. No major differences between the groups were noticed regarding lifestyle at the follow-up. Overall, few participants fulfilled the national recommendations of PA and diet. At the follow-up, 19 participants had developed diabetes, all with previous GDM. Women with previous GDM reported significantly poorer self-rated health (SRH), higher level of sick-leave and more often using medication on regular basis. However, a history of GDM or having overt diabetes mellitus showed no association with poorer SRH in the multivariate analysis. Irregular eating habits, no regular PA, overweight/obesity, and regular use of medication were associated with poorer SRH in all participants. Conclusions: Suboptimal levels of PA, and fruit and vegetable consumption were found in a sample of women with a history of GDM as well as for women with normal pregnancy approximately four years after index pregnancy. Women with previous GDM seem to increase their PA after childbirth, but still they perform their PA at lower intensity than women with a history of normal pregnancy. Having GDM at index pregnancy or being diagnosed with overt diabetes mellitus at follow-up did not demonstrate associations with poorer SRH four years after delivery.

Emergency department triage scales and their components : a systematic review of the scientific evidence

Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED? 2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (���15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity).��Methodological quality and clinical relevance��of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted. We found ED triage scales to be supported, at best, by��limited��and often��insufficient��evidence. The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity).

Biomarkers of extracellular matrix metabolism (MMP-9 and TIMP-1) and risk of stroke, myocardial infarction and cause-specific mortality : cohort study

Objective: Turnover of the extracellular matrix in all solid organs is governed mainly by a balance between the degrading matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). An altered extracellular matrix metabolism has been implicated in a variety of diseases. We investigated relations of serum levels of MMP-9 and TIMP-1 to mortality risk from an etiological perspective. Design: The prospective Uppsala Longitudinal Study of Adult Men (ULSAM) cohort, followed from 1991���1995 for up to 18.1 years. A random population-based sample of 1,082 71-year-old men, no loss to follow-up. Endpoints were all-cause (n = 628), cardiovascular (n = 230), non-cardiovascular (n = 398) and cancer mortality (n = 178), and fatal or non-fatal myocardial infarction (n = 138) or stroke (n = 163). Results: Serum MMP-9 and TIMP-1 levels were associated with risk of all-cause mortality (Cox proportional hazard ratio [HR] per standard deviation 1.10, 95% confidence interval [CI] 1.03���1.19; and 1.11, 1.02���1.20; respectively). TIMP-1 levels were mainly related to risks of cardiovascular mortality and stroke (HR per standard deviation 1.22, 95% CI 1.09���1.37; and 1.18, 1.04���1.35; respectively). All relations except those of TIMP-1 to stroke risk were attenuated by adjustment for cardiovascular disease risk factors. Relations in a subsample without cardiovascular disease or cancer were similar to those in the total sample. Conclusion: In this community-based cohort of elderly men, serum MMP-9 and TIMP-1 levels were related to mortality risk. An altered extracellular matrix metabolism may be involved in several detrimental pathways, and circulating MMP-9 or TIMP-1 levels may be relevant markers thereof.

Inflammation, oxidative stress, glomerular filtration rate, and albuminuria in elderly men : a cross-sectional study

BACKGROUND: The role of inflammation and oxidative stress in mild renal impairment in the elderly is not well studied. Accordingly, we aimed at investigating the associations between estimated glomerular filtration rate (eGFR), albumin/creatinine ratio (ACR), and markers of different inflammatory pathways and oxidative stress in a community based cohort of elderly men. FINDINGS: Cystatin C-based GFR, ACR, and biomarkers of cytokine-mediated inflammation (interleukin-6, high-sensitivity C-reactive protein[CRP], serum amyloid A[SAA]), cyclooxygenase-mediated inflammation (urinary prostaglandin F2alpha [PGF2alpha]), and oxidative stress (urinary F2 isoprostanes) were assessed in the Uppsala Longitudinal Study of Adult Men(n = 647, mean age 77 years). RESULTS: In linear regression models adjusting for age, BMI, smoking, blood pressure, LDL-cholesterol, HDL-cholesterol, triglycerides, and treatment with statins, ACE-inhibitors, ASA, and anti-inflammatory agents, eGFR was inversely associated with CRP, interleukin-6, and SAA (beta-coefficient -0.13 to -0.19, p &lt; 0.001 for all), and positively associated with urinary F2-isoprostanes (beta-coefficient 0.09, p = 0.02). In line with this, ACR was positively associated with CRP, interleukin-6, and SAA (beta- coefficient 0.09-0.12, p &lt; 0.02 for all), and negatively associated with urinary F2-isoprostanes (beta-coefficient -0.12, p = 0.002). The associations were similar but with lower regression coefficients in a sub-sample with normal eGFR (&gt;60 ml/min/1.73 m2, n = 514), with the exception that F2-isoprostane and SAA were no longer associated with eGFR. CONCLUSION: Our data indicate that cytokine-mediated inflammation is involved in the early stages of impaired kidney function in the elderly, but that cyclooxygenase-mediated inflammation does not play a role at this stage. The unexpected association between higher eGFR/lower albuminuria and increased F2-isoprostanes in urine merits further studies.

Incid��ncia de infec����o por Legionella pneumophila em pacientes que internaram no HCPA com pneumonia adquirida na comunidade

Introdu����o: O diagn��stico microbiol��gico da infec����o por Legionella �� complexo, pois a bact��ria n��o �� visualizada �� colora����o de Gram no escarro, e sua cultura n��o �� realizada na maioria dos laborat��rios cl��nicos. A imunofluoresc��ncia direta nas secre����es respirat��rias tem baixa sensibilidade, em torno de 40% e a t��cnica da ���PCR��� n��o �� ainda recomendada para o diagn��stico cl��nico (CDC, 1997). A detec����o de anticorpos no soro �� a t��cnica mais utilizada, e o crit��rio definitivo �� a soroconvers��o para no m��nimo 1:128, cuja sensibilidade �� de 70 a 80% (Edelstein, 1993). Como crit��rios diagn��sticos de poss��vel pneumonia por Legionella, eram utilizados: t��tulo ��nico de anticorpos a L pneumophila positivo na dilui����o 1:256, em paciente com quadro cl��nico compat��vel (CDC, 1990) e o achado de ant��geno a Legionella na urina (WHO, 1990). Nos ��ltimos anos, por��m, com o uso crescente do teste de antigen��ria, foram detectados casos de pneumonia por Legionella, que n��o eram diagnosticados por cultura ou sorologia, tornando-o m��todo diagn��stico de certeza para o diagn��stico de pneumonia por Legionella (CDC, 1997). Por sua f��cil execu����o, resultado imediato, e alta sensibilidade - de 86% a 98% (Kashuba & Ballow, 1986; Harrison & Doshi, 2001), tem sido recomendado para o diagn��stico das PAC que necessitam interna����o hospitalar (Mulazimoglu & Yu, 2001; Gupta et al., 2001; Marrie, 2001), especialmente em UTI (ATS, 2001). V��rios estudos documentaram baixo valor preditivo positivo do t��tulo ��nico positivo de 1:256, tornando-o sem valor para o diagn��stico da pneumonia por Legionella, exceto, talvez, em surtos (Plouffe et al., 1995). Outros detectaram alta preval��ncia de anticorpos positivos na dilui����o 1:256 na popula����o, em pessoas normais (Wilkinson et al., 1983; Nichol et al., 1991). A partir de 1996, o CDC de Atlanta recomendou que n��o seja mais utilizado o crit��rio de caso prov��vel de infec����o por Legionella pneumophila por t��tulo ��nico de fase convalescente ���1:256, por falta de especificidade(CDC, 1997). A pneumonia por Legionella �� raramente diagnosticada, e sua incid��ncia �� subestimada. Em estudos de PAC, a incid��ncia da pneumonia por Legionella nos EUA, Europa, Israel e Austr��lia, foi estimada entre 1% a 16% (Muder & Yu, 2000). Nos EUA, foi estimado que cerca de 8 000 a 23 000 casos de PAC por Legionella ocorrem anualmente, em pacientes que requerem hospitaliza����o (Marston et al., 1994 e 1977). No Brasil, a incid��ncia de PAC causadas por Legionella em pacientes hospitalizados �� tema de investiga����o pertinente, ainda n��o relatado na literatura. Objetivo: detectar a incid��ncia de pneumonias causadas por Legionella pneumophila sorogrupos 1 a 6, em pacientes que internaram no Hospital de Cl��nicas de Porto Alegre por PAC, por um ano. Material e M��todos: o delineamento escolhido foi um estudo de coorte (de incid��ncia), constitu��da por casos consecutivos de pneumonia adquirida na comunidade que internaram no HCPA de 19 de julho de 2000 a 18 de julho de 2001. Para a identifica����o dos casos, foram examinados diariamente o registro computadorizado das interna����es hospitalares, exceto as interna����es da pediatria e da obstetr��cia, sendo selecionados todos os pacientes internados com o diagn��stico de pneumonia e de insufici��ncia respirat��ria aguda. Foram exclu��dos aqueles com menos de 18 anos ou mais de 80 anos; os procedentes de institui����es, HIV-positivos, gestantes, pacientes restritos ao leito; e portadores de doen��a estrutural pulmonar ou traqueostomias. Foram exclu��dos os pacientes que tivessem tido alta hospitalar nos ��ltimos 15 dias, e aqueles j�� inclu��dos no decorrer do estudo. Os pacientes selecionados foram examinados por um pesquisador, e inclu��dos para estudo se apresentassem infiltrado ao RX de t��rax compat��vel com pneumonia, associado a pelo menos um dos sintomas respirat��rios maiores (temperatura axilar > 37,8��C, tosse ou escarro; ou dois sintomas menores (pleurisia, dispn��ia, altera����o do estado mental, sinais de consolida����o �� ausculta pulmonar, mais de 12 000 leuc��citos/mm3). O estudo foi previamente aprovado pela Comiss��o de ��tica em Pesquisa do HCPA. Os pacientes eram entrevistados por um pesquisador, dando seu consentimento por escrito, e ent��o seus dados cl��nicos e laboratoriais eram registrados em protocolo individual. N��o houve interfer��ncia do pesquisador, durante a interna����o, exceto pela coleta de urina e de sangue para exame laboratoriais espec��ficos da pesquisa. Os pacientes eram agendados, no ambulat��rio de pesquisa, num prazo de 4 a 12 semanas ap��s sua inclus��o no estudo, quando realizavam nova coleta de sangue, RX de t��rax de controle, e outros exames que se fizessem necess��rios para esclarecimento diagn��stico.Todos os pacientes foram acompanhados por 1 ano, ap��s sua inclus��o no estudo.Foram utilizadas a t��cnica de imunofluoresc��ncia indireta para detec����o de anticorpos das classes IgG, IgM e IgA a Legionella pneumophila sorogrupos 1 a 6 no soro, em duas amostras, colhidas, respectivamente, na 1�� semana de interna����o e depois de 4 a 12 semanas; e a t��cnica imunol��gica por teste ELISA para a detec����o do ant��geno de Legionella pneumophila sorogrupo 1 na urina, colhida na primeira semana de interna����o. As urinas eram armazenadas, imediatamente ap��s sua coleta, em freezer a ���70��C, e depois descongeladas e processadas em grupos de cerca de 20 amostras. A imunofluoresc��ncia foi feita no laborat��rio de doen��as Infecciosas da Universidade de Louisville (KY, EUA), em amostras de soro da fase aguda e convalescente, a partir da dilui����o 1:8; e a detec����o do ant��geno de Legionella pneumophila sorogrupo 1, nas amostras de urina, foi realizada no laborat��rio de pesquisa do HCPA, pelos investigadores, utilizando um kit comercial de teste ELISA fabricado por Binax (Binax Legionella Urinary Enzyme Assay, Raritan, EUA). As urinas positivas eram recongeladas novamente, para serem enviadas para confirma����o no mesmo laborat��rio americano, ao fim do estudo. Foram adotados como crit��rios definitivos de infec����o por Legionella pneumophila sorogrupos 1 a 6, a soroconvers��o (eleva����o de 4 vezes no t��tulo de anticorpos s��ricos entre o soro da fase aguda e da fase convalescente para no m��nimo 1:128); ou o achado de ant��geno de L pneumophila sorogrupo 1 na urina n��o concentrada, numa raz��o superior a 3, conforme instru����es do fabricante e da literatura.Os pacientes foram classificados, de acordo com suas caracter��sticas cl��nicas, em 1��) portadores de doen��as cr��nicas (doen��as pulmonares, card��acas, diabete mellitus, hepatopatias e insufici��ncia renal); 2��) portadores de doen��as subjacentes com imunossupress��o; 3��) pacientes h��gidos ou com outras doen��as que n��o determinassem insufici��ncia org��nica. Imunossupress��o foi definida como esplenectomia, ser portador de neoplasia hematol��gica, portador de doen��a auto-imune, ou de transplante; ou uso de medica����o imunossupressora nas 4 semanas anteriores ao diagn��stico (Yu et al., 2002b); ou uso de prednisolona 10 mg/dia ou equivalente nos ��ltimos 3 meses (Lim et al., 2001). As caracter��sticas cl��nicas e laboratoriais dos pacientes que evolu��ram ao ��bito por pneumonia foram comparados ��quelas dos pacientes que obtiveram cura. Para a an��lise das vari��veis categ��ricas, utilizou-se o teste qui-quadrado de Pearson ou teste exato de Fisher. Para as vari��veis num��ricas cont��nuas, utilizou-se o teste ���t��� de Student. Um valor de p< 0,05 foi considerado como resultado estatisticamente significativo (programas SPSS, vers��o 10). Foi calculada a freq����ncia de mortes por pneumonia na popula����o estudada, adotando-se a alta hospitalar como crit��rio de cura. Foi calculada a incid��ncia cumulativa para pneumonia por Legionella pneumophila sorogrupos 1 a 6, em um hospital geral, no per��odo de 1 ano. Resultados: durante um ano de estudo foram examinados 645 registros de interna����o, nos quais constavam, como motivo de baixa hospitalar, o diagn��stico de pneumonia ou de insufici��ncia respirat��ria aguda; a maioria desses diagn��sticos iniciais n��o foram confirmados. Desses 645 pacientes, foram inclu��dos no estudo 82 pacientes, nos quais os crit��rios cl��nicos ou radiol��gicos de pneumonia foram confirmados pelos pesquisadores. Durante o acompanhamento desses pacientes, por��m, foram exclu��dos 23 pacientes por apresentarem outras patologias que mimetizavam pneumonia: DPOC agudizado (5), insufici��ncia card��aca (3), tuberculose pulmonar (2), colagenose (1), fibrose pulmonar idiop��tica (1), edema pulmonar em paciente com cirrose (1), somente infec����o respirat��ria em paciente com sequelas pulmonares (4); ou por apresentarem crit��rios de exclus��o: bronquiectasias (4), HIV positivo (1), pneumatocele pr��via (1). Ao final, foram estudados 59 pacientes com pneumonia adquirida na comunidade, sendo 20 do sexo feminino e 39 do sexo masculino, com idade entre 24 e 80 anos (m��dia de 57,6 anos e desvio padr��o de ��10,6). Tivemos 36 pacientes com doen��as subjacentes classificadas como ���doen��as cr��nicas���, dos quais 18 pacientes apresentavam mais de uma co-morbidade, por ordem de preval��ncia: doen��as pulmonares, card��acas, diabete mellitus, hepatopatias e insufici��ncia renal; neoplasias ocorreram em 9 pacientes, sendo s��lidas em 7 pacientes e hematol��gicas em 2. Dos 59 pacientes, 61% eram tabagistas e 16,9%, alcoolistas. Do total, 10 pacientes apresentavam imunossupress��o. Dos demais 13 pacientes, somente um era previamente h��gido, enquanto os outros apresentavam tabagismo, sinusite, anemia, HAS, gota, ou arterite de Takayasu. A apresenta����o radiol��gica inicial foi broncopneumonia em 59,3% dos casos; pneumonia alveolar ocorreu em 23,7% dos casos, enquanto ambos padr��es ocorreram em 15,2% dos pacientes. Pneumonia intersticial ocorreu em somente um caso, enquanto broncopneumonia obstrutiva ocorreu em 5 pacientes (8,5%). Derrame pleural ocorreu em 22% dos casos, e em 21 pacientes (35%) houve comprometimento de mais de um lobo ao RX de t��rax. Foram usados beta-lact��micos para o tratamento da maioria dos pacientes (72,9%9). A segunda classe de antibi��ticos mais usados foi a das fluoroquinolonas respirat��rias, que foram receitadas para 23 pacientes (39,0%), e em 3�� lugar, os macrol��deos, usados por 11 pacientes (18,6%). Apenas 16 pacientes n��o usaram beta-lact��micos, em sua maioria recebendo quinolonas ou macrol��deos. Dos 43 pacientes que usaram beta-lact��micos, 25 n��o usaram nem macrol��deos, nem quinolonas. Em 13 pacientes as fluoroquinolonas respirat��rias foram as ��nicas drogas usadas para o tratamento da pneumonia. Do total, 8 pacientes foram a ��bito por pneumonia; em outros 3 pacientes, o ��bito foi atribu��do a neoplasia em est��gio avan��ado. Dos 48 pacientes que obtiveram cura, 33 (68,7%) estavam vivos ap��s 12 meses. Os resultados da compara����o realizada evidenciaram tend��ncia a maior mortalidade no sexo masculino e em pacientes com imunossupress��o, por��m essa associa����o n��o alcan��ou signific��ncia estat��stica. Os pacientes que usaram somente beta-lact��micos n��o apresentaram maior mortalidade do que os pacientes que usaram beta-lact��micos associados a outras classes de antibi��ticos ou somente outras classes de antibi��ticos. Examinando-se os pacientes que utiizaram macrol��deos ou quinolonas em seu regime de tratamento, isoladamente ou combinados a outros antibi��ticos, observou-se que tamb��m n��o houve diferen��a dos outros pacientes, quanto �� mortalidade. Os pacientes com padr��o radiol��gico de pneumonia alveolar tiveram maior mortalidade, e essa diferen��a apresentou uma signific��ncia lim��trofe (p= 0,05). Nossa mortalidade (11,9%) foi similar �� de Fang et al. (1990), em estudo cl��ssico de 1991 (13,7%); foi tamb��m similar �� m��dia de mortalidade das PAC internadas n��o em UTI (12%), relatada pela ATS, no seu ��ltimo consenso para o tratamento emp��rico das PAC (ATS, 2001). Foram detectados 3 pacientes com pneumonia por Legionella pneumophila sorogrupo 1 na popula����o estudada: 2 foram diagnosticados por soroconvers��o e por antigen��ria positiva, e o 3�� foi diagnosticado somente pelo crit��rio de antigen��ria positiva, tendo sorologia negativa, como alguns autores (McWhinney et al., 2000). Dois pacientes com PAC por Legionella n��o responderam ao tratamento inicial com beta-lact��micos, obtendo cura com levofloxacina; o 3�� paciente foi tratado somente com betalact��micos, obtendo cura. Conclus��es: A incid��ncia anual de PAC por Legionella pneumophila sorogrupos 1 a 6, no HCPA, foi de 5,1%, que representa a incid��ncia anual de PAC por Legionella pneumophila sorogrupos 1 a 6 em um hospital geral universit��rio. Coment��rios e Perspectivas: H�� necessidade de se empregar m��todos diagn��sticos espec��ficos para o diagn��stico das pneumonias por Legionella em nosso meio, como a cultura, a sorologia com detec����o de todas as classes de anticorpos, e a detec����o do ant��geno urin��rio, pois somente com o uso simult��neo de t��cnicas complementares pode-se detectar a incid��ncia real de pneumonias causadas tanto por Legionella pneumophila, como por outras esp��cies. A detec����o do ant��geno de Legionella na urina �� o teste diagn��stico de maior rendimento, sendo recomendado seu uso em todas as PAC que necessitarem interna����o hospitalar (Mulazimoglu & Yu, 2001; Gupta et al., 2001); em todos os pacientes com PAC que apresentarem fatores de risco potenciais para legionelose (Marrie, 2001); e para o diagn��stico etiol��gico das pneumonias graves (ATS, 2001). Seu uso �� indicado, com unanimidade na literatura, para a pesquisa de legionelose nosocomial e de surtos de legionelose na comunidade.

Determina����o do m��dulo de elasticidade da madeira juvenil e adulta de Pinus taeda por ultra-som

A madeira de Pinus sp. tem utiliza����o crescente na ind��stria madeireira brasileira. O decr��scimo constante do suprimento de ��rvores adultas com grandes di��metros, provenientes de florestas naturais, tornou comum a produ����o de madeira em ciclos curtos, com grande propor����o de madeira juvenil. Resultados de diversas pesquisas t��m reportado que o m��dulo de elasticidade e a resist��ncia a diferentes solicita����es mec��nicas s��o seriamente afetados pela presen��a de madeira juvenil. Este trabalho teve por objetivo determinar o m��dulo de elasticidade da madeira juvenil e adulta de Pinus taeda L. a partir da constante din��mica C LL, obtida em ensaios n��o-destrutivos de ultra-som. A madeira de P. taeda era origin��ria de plantios da Esta����o Experimental de Itapeva - SP, sendo amostrados seis indiv��duos arb��reos com 34 anos de idade. Os corpos-de-prova (4 cm x 4 cm x 45 cm) foram obtidos separadamente das regi��es de madeira juvenil e adulta da prancha central, previamente submetida �� secagem industrial (umidade final de 12%), para a determina����o da constante din��mica por meio de ensaios de ultra-som. Para avaliar a sensibilidade do m��todo do ultra-som, os corpos-de-prova foram ensaiados destrutivamente �� compress��o paralela. Os resultados mostraram boa sensibilidade do m��todo do ultra-som (R�� �� 0,90) na avalia����o desse par��metro mec��nico da madeira juvenil e adulta.

Increasing trends of sleep complaints in the city of S��o Paulo, Brazil

Funda����o de Amparo �� Pesquisa do Estado de S��o Paulo (FAPESP)