Immune response and tolerability of varicella vaccine in children and adolescents with systemic lupus erythematosus previously exposed to varicella-zoster virus

Objectives The aim of the present paper is to evaluate the immune response and tolerability of varicella vaccine in children and adolescents with systemic lupus erythematosus previously exposed to varicella-zoster virus. Methods We performed a prospective and controlled study on a group of 54 SLE patients that were chosen at random to be or not to be vaccinated (28 were vaccinated and 26 were not). Twenty-eight healthy controls, of matching age and sex were also vaccinated. All were submitted to a questionnaire, physical evaluation and laboratory assays: lymphocyte immuno-phenotyping by flow cytometry, plasma varicella zoster virus (VZV) serology by ELISA and in vitro interferon gamma (IFN gamma) production by T-cells after stimulus with VZV antigen. They were evaluated before vaccination and at 30, 45, 180 and 360 days afterwards. Results We did not observe any differences in the frequency of adverse events in both vaccinated groups. At study entry, all individuals were seropositive for VZV antibodies. The serum VZV antibody titres similarly increased after vaccination. The frequency of flares and the SLEDAI score were also similar among the patients. Thirty days after vaccination the production of IFN gamma specific to VZV was lower in the SLE group compared to healthy, controls. In the follow-up we observed 4 cases of herpes zoster in the SLE unvaccinated group, but no zoster in the vaccinated group. Conclusion The varicella vaccine was well tolerated in SLE group, who had pre-existing immunity to varicella. The varicella vaccine immunogenicity measurement by serum antibody titres was appropriate. The incidence of HZ was lower in the vaccinated lupus group.

Auriculo-Condylar Syndrome. Confronting a Diagnostic Challenge

Auriculo-condylar syndrome (ACS) is characterized by typical ears malformation (so-called "question mark" ears), prominent cheeks, microstomia, and abnormality of the temporomandibular joint and condyle of the mandible. In this report we describe a new simplex case and a previously unreported family with affected individuals in three generations documenting clinical variability. Linkage study for markers located in candidate region for ACS1 (1p21.1-q23.3) was excluded in our familial case, reinforcing the hypothesis of genetic heterogeneity for this condition. A review of the literature focusing diagnostic criteria and features of ACS was performed. (C) 2011 Wiley Periodicals, Inc.

A Cost-Effectiveness-Assessing Model of Vaccination for Varicella and Zoster

A decision analytical model is presented and analysed to assess the effectiveness and cost-effectiveness of routine vaccination against varicella and herpes-zoster, or shingles. These diseases have as common aetiological agent the varicella-zoster virus (VZV). Zoster can more likely occur in aged people with declining cell-mediated immunity. The general concern is that universal varicella vaccination might lead to more cases of zoster: with more vaccinated children exposure of the general population to varicella infectives become smaller and thus a larger proportion of older people will have weaker immunity to VZV, leading to more cases of reactivation of zoster. Our compartment model shows that only two possible equilibria exist, one without varicella and the other one where varicella arid zoster both thrive. Threshold quantities to distinguish these cases are derived. Cost estimates on a possible herd vaccination program are discussed indicating a possible tradeoff choice.

Drug reaction with Eosinophilia and Systemic Symptoms (DRESS) / Drug-induced Hypersensitivity Syndrome (DIHS): a review of current concepts

The Drug Reaction with Eosinophilia and Systemic Symptoms syndrome, also known as Drug Induced Hypersensitivity Syndrome presents clinically as an extensive mucocutaneous rash, accompanied by fever, lymphadenopathy, hepatitis, hematologic abnormalities with eosinophilia and atypical lymphocytes, and may involve other organs with eosinophilic infiltration, causing damage to several systems, especially to the kidneys, heart, lungs, and pancreas. Recognition of this syndrome is of paramount importance, since the mortality rate is about 10% to 20%, and a specific therapy may be necessary. The pathogenesis is related to specific drugs, especially the aromatic anticonvulsants, altered immune response, sequential reactivation of herpes virus and association with HLA alleles. Early recognition of the syndrome and withdrawal of the offending drug are the most important and essential steps in the treatment of affected patients. Corticosteroids are the basis of the treatment of the syndrome, which may be associated with intravenous immunoglobulin and, in selected cases, Ganciclovir. The article reviews the current concepts involving this important manifestation of adverse drug reaction.

Brazilian blood donation eligibility criteria for dermatologic patients

A focused and commented review on the impact of dermatologic diseases and interventions in the solidary act of donating blood is presented to dermatologists to better advise their patients. This is a review of current Brazilian technical regulations on hemotherapeutic procedures as determined by Ministerial Directive #1353/2011 by the Ministry of Health and current internal regulations of the Hemotherapy Center of Ribeirão Preto, a regional reference center in hemotherapeutic procedures. Criteria for permanent inaptitude: autoimmune diseases (>1 organ involved), personal history of cancer other than basal cell carcinoma, severe atopic dermatitis or psoriasis, pemphigus foliaceus, porphyrias, filariasis, leprosy, extra pulmonary tuberculosis or paracoccidioidomycosis, and previous use of etretinate. Drugs that impose temporary ineligibility: other systemic retinoids, systemic corticosteroids, 5-alpha-reductase inhibitors, vaccines, methotrexate, beta-blockers, minoxidil, anti-epileptic, and anti-psychotic drugs. Other conditions that impose temporary ineligibility: occupational accident with biologic material, piercing, tattoo, sexually transmitted diseases, herpes, and bacterial infections, among others. Discussion: Thalidomide is currently missing in the teratogenic drugs list. Although finasteride was previously considered a drug that imposed permanent inaptitude, according to its short halflife current restriction of 1 month is still too long. Dermatologists should be able to advise their patients about proper timing to donate blood, and discuss the impact of drug withdrawal on treatment outcomes and to respect the designated washout periods.

Dermatomiosite em adulto: experiência de um centro terciário brasileiro

OBJETIVOS: Relatamos os resultados de um estudo de coorte retrospectivo envolvendo 139 pacientes com dermatomiosite, conduzido de 1991 a 2011. MÉTODOS: Todos os pacientes preenchiam pelo menos quatro dos cinco critérios de Bohan and Peter (1975). RESULTADOS: A média de idade dos pacientes no início da doença foi de 41,7 ± 14,1 anos, e a duração da doença foi de 7,2 ± 5,2 anos. A amostragem constitui-se de 90,2% de indivíduos brancos, 79,9% do gênero feminino. Sintomas constitucionais foram detectados em menos da metade dos casos. Envolvimentos cutâneo e articular ocorreram em 95,7% e 41,7% dos pacientes, respectivamente. Em 48,2% dos pacientes foram apresentadas pneumopatia incipiente, opacidades em "vidro fosco" e/ou fibrose pulmonar. Todos os pacientes receberam prednisona (1 mg/kg/dia) e 51,1% receberam também metilprednisolona intravenosa (1 g/dia por três dias). Vários imunossupressores foram usados como poupadores de corticosteroide de acordo com tolerância, efeitos colaterais e/ou refratariedade. Houve recidiva de doença (clínica e/ou laboratorial) em 53,2% dos casos; 76,3% permaneceram em remissão no momento do estudo. A taxa de infecção grave foi de 35,3%, com o predomínio de herpes zoster. Houve 15 (10,8%) casos de câncer, dos quais 12 foram confirmados em um período de um ano após o diagnóstico da doença. Houve ainda 16 óbitos (11,5%) cujas causas principais foram sepse/choque séptico (27,5%), pneumopatia atribuída à doença (31,3%), neoplasias (31,3%) e eventos cardiovasculares (12,5%). CONCLUSÕES: No presente trabalho, os dados clínico-laboratoriais foram semelhantes aos de outros grupos populacionais descritos na literatura, com diferenças mínimas quanto à frequência e às características das manifestações extramusculares.

Tratamento alternativo para neuralgia pós-herpética após transplante pulmonar. Relato de caso

JUSTIFICATIVA E OBJETIVOS: A neuralgia pós-herpética (NPH) é a dor que permanece após o desaparecimento do episódio agudo de herpes zoster. O objetivo deste estudo foi relatar o tratamento da dor da NPH em paciente transplantado pulmonar. RELATO DO CASO: Paciente do sexo masculino, 73 anos, transplantado pulmonar há três anos, em uso de imunossupressores. Desenvolveu quadro de herpes zoster há um ano, com vesículas no oitavo espaço intercostal do hemitórax direito (HTD). O tratamento foi efetivo com ganciclovir; entretanto, o paciente evoluiu com dor em queimação, intensa, constante, com piora no último mês, com intensidade pela escala visual numérica (EVN) de 9, mesmo com uso de 600 mg/dia de gabapentina. Ao exame físico apresentava uma lesão avermelhada no HTD, hiperestésica. Foi instituído tratamento com gabapentina (900 mg), amitriptilina (25 mg), dipirona (8 g) e oxicodona (20 mg) ao dia. Feita a aplicação de laser de baixa intensidade (LBI) diariamente por uma semana, seguido de tratamento com amitriptilina tópica a 4%. A intensidade da dor diminuiu para 5. A frequência de aplicação do LBI diminuiu para uma vez a cada dois dias com melhora significativa com EVN entre 1 e 2. Teve alta hospitalar, com 25 mg/dia de amitriptilina oral e amitriptilina tópica a 4%. CONCLUSÃO: O uso do LBI e da amitriptilina tópica foi eficaz para remissão do quadro doloroso.

Pair approximation for a model of vertical and horizontal transmission of parasites.

We apply Stochastic Dynamics method for a differential equations model, proposed by Marc Lipsitch and collaborators (Proc. R. Soc. Lond. B 260, 321, 1995), for which the transmission dynamics of parasites occurs from a parent to its offspring (vertical transmission), and by contact with infected host (horizontal transmission). Herpes, Hepatitis and AIDS are examples of diseases for which both horizontal and vertical transmission occur simultaneously during the virus spreading. Understanding the role of each type of transmission in the infection prevalence on a susceptible host population may provide some information about the factors that contribute for the eradication and/or control of those diseases. We present a pair mean-field approximation obtained from the master equation of the model. The pair approximation is formed by the differential equations of the susceptible and infected population densities and the differential equations of pairs that contribute to the former ones. In terms of the model parameters, we obtain the conditions that lead to the disease eradication, and set up the phase diagram based on the local stability analysis of fixed points. We also perform Monte Carlo simulations of the model on complete graphs and Erdös-Rényi graphs in order to investigate the influence of population size and neighborhood on the previous mean-field results; by this way, we also expect to evaluate the contribution of vertical and horizontal transmission on the elimination of parasite. Pair Approximation for a Model of Vertical and Horizontal Transmission of Parasites.

Bioindicadores funcionales en macroalgas del litoral canario : evaluación de la vulnerabilidad y aclimatación al estrés ambiental

Programa de doctorado de Acuicultura: producción controlada de animales acuáticos.

Acto celebrado en la sala de grado de la Facultad de Ciencias del Mar de la Universidad de Las Palmas de Gran Canaria, el 28 de junio de 2013, actuando como Presidenta María Candelaria Gil Rodríguez (Universidad de La Laguna), Secretaria Ascensión Viera Rodríguez (Universidad de Las Palmas de Gran Canaria), vocales, José María Gorostiaga Garay (Universidad del País Vasco), Juan Luis Gómez Pinchetti (Universidad de Las Palmas de Gran Canaria) y Nathalie Korbee Peinado (Universidad de Málaga)

Enhanced Mixed Integer Programming Techniques and Routing Problems

Mixed integer programming is up today one of the most widely used techniques for dealing with hard optimization problems. On the one side, many practical optimization problems arising from real-world applications (such as, e.g., scheduling, project planning, transportation, telecommunications, economics and finance, timetabling, etc) can be easily and effectively formulated as Mixed Integer linear Programs (MIPs). On the other hand, 50 and more years of intensive research has dramatically improved on the capability of the current generation of MIP solvers to tackle hard problems in practice. However, many questions are still open and not fully understood, and the mixed integer programming community is still more than active in trying to answer some of these questions. As a consequence, a huge number of papers are continuously developed and new intriguing questions arise every year. When dealing with MIPs, we have to distinguish between two different scenarios. The first one happens when we are asked to handle a general MIP and we cannot assume any special structure for the given problem. In this case, a Linear Programming (LP) relaxation and some integrality requirements are all we have for tackling the problem, and we are ``forced" to use some general purpose techniques. The second one happens when mixed integer programming is used to address a somehow structured problem. In this context, polyhedral analysis and other theoretical and practical considerations are typically exploited to devise some special purpose techniques. This thesis tries to give some insights in both the above mentioned situations. The first part of the work is focused on general purpose cutting planes, which are probably the key ingredient behind the success of the current generation of MIP solvers. Chapter 1 presents a quick overview of the main ingredients of a branch-and-cut algorithm, while Chapter 2 recalls some results from the literature in the context of disjunctive cuts and their connections with Gomory mixed integer cuts. Chapter 3 presents a theoretical and computational investigation of disjunctive cuts. In particular, we analyze the connections between different normalization conditions (i.e., conditions to truncate the cone associated with disjunctive cutting planes) and other crucial aspects as cut rank, cut density and cut strength. We give a theoretical characterization of weak rays of the disjunctive cone that lead to dominated cuts, and propose a practical method to possibly strengthen those cuts arising from such weak extremal solution. Further, we point out how redundant constraints can affect the quality of the generated disjunctive cuts, and discuss possible ways to cope with them. Finally, Chapter 4 presents some preliminary ideas in the context of multiple-row cuts. Very recently, a series of papers have brought the attention to the possibility of generating cuts using more than one row of the simplex tableau at a time. Several interesting theoretical results have been presented in this direction, often revisiting and recalling other important results discovered more than 40 years ago. However, is not clear at all how these results can be exploited in practice. As stated, the chapter is a still work-in-progress and simply presents a possible way for generating two-row cuts from the simplex tableau arising from lattice-free triangles and some preliminary computational results. The second part of the thesis is instead focused on the heuristic and exact exploitation of integer programming techniques for hard combinatorial optimization problems in the context of routing applications. Chapters 5 and 6 present an integer linear programming local search algorithm for Vehicle Routing Problems (VRPs). The overall procedure follows a general destroy-and-repair paradigm (i.e., the current solution is first randomly destroyed and then repaired in the attempt of finding a new improved solution) where a class of exponential neighborhoods are iteratively explored by heuristically solving an integer programming formulation through a general purpose MIP solver. Chapters 7 and 8 deal with exact branch-and-cut methods. Chapter 7 presents an extended formulation for the Traveling Salesman Problem with Time Windows (TSPTW), a generalization of the well known TSP where each node must be visited within a given time window. The polyhedral approaches proposed for this problem in the literature typically follow the one which has been proven to be extremely effective in the classical TSP context. Here we present an overall (quite) general idea which is based on a relaxed discretization of time windows. Such an idea leads to a stronger formulation and to stronger valid inequalities which are then separated within the classical branch-and-cut framework. Finally, Chapter 8 addresses the branch-and-cut in the context of Generalized Minimum Spanning Tree Problems (GMSTPs) (i.e., a class of NP-hard generalizations of the classical minimum spanning tree problem). In this chapter, we show how some basic ideas (and, in particular, the usage of general purpose cutting planes) can be useful to improve on branch-and-cut methods proposed in the literature.

Studien zur physiologischen Funktion löslicher Zytokinrezeptoren und zur Wirkungsweise viral kodierter Zytokine

Interleukin-6 (IL-6) aktiviert Zielzellen durch Bindung an den Interleukin-6-Rezeptor (IL-6R) und anschließende Homodimerisierung von gp130. IL-6 alleine kann nur Zellen aktivieren, die IL-6R exprimieren, der Komplex aus IL-6 und löslichem IL-6R (sIL-6R) kann gp130 auf Zellen aktivieren, die keinen IL-6R exprimieren. Von gp130 gibt es eine lösliche Form (sgp130), die in Komplexen mit sIL-6R und IL-6 vorliegen kann.Es wurden rekombinante Versionen von sgp130 konstruiert, exprimiert und aufgereinigt. Die sgp130 Proteine inhibieren die sIL-6R-abhängige Stimulation von Zellen, nicht jedoch über membrangebundenen IL-6R vermittelte IL-6-Aktivitäten. sgp130 inhibiert also selektiv sIL-6R-abhängige Antworten und hat keinen Einfluß auf IL-6-Antworten über membrangebundenen IL-6R.Das Genom von Humanem Herpesvirus-8 kodiert für ein virales IL-6 (vIL-6). Um zu klären, ob vIL-6 direkt an IL-6R oder gp130 bindet, wurden Immunpräzipitationen mit radioaktiv markiertem vIL-6 durchgeführt. Dabei zeigte vIL-6 eine direkte Interaktion mit gp130, nicht jedoch mit IL-6R.Die biologische Aktivität von vIL-6 ist IL-6R-unabhängig. Es gibt keinen Unterschied in der Effektivität von vIL-6 bei der Stimulation von Zellen die nur gp130 oder gp130 und IL-6R exprimieren. Die Ergebnisse demonstrieren, daß vIL-6 das erste bekannte Zytokin ist, welches direkt gp130 binden und aktivieren kann.

Neue Methoden zur Computersimulation von Polymersystemen auf verschiedenen Längenskalen und ihre Anwendungen

In dieser Dissertation stellen wir einen neuen Ansatz zurModellierungvon Polymersystemen vor. Es werden (von methodischer Seiteher) zweiautomatisierte Iterationschemata dazu eingeführt,Kraftfeldparametermesoskopischer Polymersysteme systematisch zu optimieren:DasSimplex-Verfahren und das Struktur-Differenzen-Verfahren. Sowerdendiejenigen Freiheitsgrade aus Polymersystemen eliminiert,die einehohe Auflösung erfordern, was die Modellierung größerersystemeermöglicht. Nach Tests an einfachen Flüssigkeiten werdenvergröberteModelle von drei prototypischen Polymeren (Polyacrylsäure,Polyvinylalkohol und Polyisopren) in unterschiedlichenUmgebungen(gutes Lösungsmittel und Schmelze) entwickelt und ihrVerhalten aufder Mesoskala ausgiebig geprüft. Die zugehörige Abbildung(vonphysikalischer Seite her) so zu gestalten, daß sie dieunverwechselbaren Charakteristiken jedes systems auf diemesoskopischeLängenskala überträgt, stellt eine entscheidende Anforderungan dieautomatisierten Verfahren dar. Unsere Studien belegen, daß mesoskopische Kraftfeldertemperatur- unddichtespezifisch sind und daher bei geändernden Bedingungennachoptimiert werden müssen. Gleichzeitig läßt sichabschätzen, beiwelchen Umgebungsbedingungen dies noch nicht notwendig wird.In allenFällen reichen effektive Paarpotentiale aus, einrealistischesmesoskopisches Modell zu konstruieren. VergröberteSimulationenwerden im Falle der Polyacrylsäure erfolgreich gegenexperimentelleLichtstreudaten getestet. Wir erzielen für Molmassen bis zu300000g/mol eine hervorragende Übereinstimmung für denhydrodynamischenRadius. Unsere Ergebnisse erklären auch Korrekturen zudessenVerhalten als Funktion der Kettenlänge ('Skalenverhalten'). Im Fallevon Polyisopren untersuchen wir sowohl statische als auchdynamischeGrößen und stellen klare Unterschiede unserer Ergebnisse zudeneneines einfachen semi-flexiblen Mesoskalenmodells fest. InderProteinforschung werden aus Datenbanken gewonnene effektivePaarwechselwirkungen dazu verwendet, die freie Energie einesneuensystems vorherzusagen. Wir belegen in einem Exkurs mittelsGittersimulationen, daß es selbst in einfachsten Fällennicht gelingt,dies auch nur qualitativ korrekt zu bewerkstelligen.

Genetic and environmental factors associated with the risk of cognitive decline and dementia

AD is the most common age related neurodegenerative disease in the industrialized world. Clinically AD is defined as a progressing decline of cognitive functions. Neuropathologically, AD is characterized by the aggregation of b-amyloid (Ab) peptide in the form of extracellular senile plaques, and hyperphosphorlylated tau protein in the form of intracellular neurofibrillary tangles. These neuropathological hallmarks are often accompanied by abundant microvascular damage and pronounced inflammation of the affected brain regions. In this thesis we investigated several aspects of AD focusing on the genetic aspect. We confirmed that Alpha 1 antichymotrypsin (ACT), an acute phase protein, was associated to AD subjects, being plasma levels higher in AD cases than controls. In addition, in a GWA study we demonstrated that two different gene, Clusterin and CR1 were strongly associated to AD. A single gene association not explain such a complex disease like AD. The goal should be to created a network of genetic, phenotypic and clinical data associated to AD. We used a new algorithm, the ANNs, aimed to map variables and search for connectivity among variables. We found specific variables associated to AD like cholesterol levels, the presence of variation in HMGCR enzyme and the age. Other factors such as the BMI, the amount of HDL and blood folate levels were also associated with AD. Pathogen infections, above all viral infections, have been previously associated to AD. The hypothesis suggests that virus and in particular herpes virus could enter the brain when an individual becomes older, perhaps because of a decline in the immune system. Our new hypothesis is that the presence of SNPs in our GWA gene study results in a genetic signature that might affect individual brain susceptibility to infection by herpes virus family during aging.

Kostimulatorische Rezeptoren in der Aktivierung humaner neutrophiler Granulozyten

Neutrophile Granulozyten spielen eine wichtige Rolle in der ersten Phase der Inflammation. Sie infiltrieren den Infektionsort um den eingedrungenen Erreger zu bekämpfen und Ihre Effektor Funktion auszuführen. Neben den Mustererkennenden Rezeptoren des angeborenen Immunsystems (pattern recognition receptors) werden weitere Rezeptoren auf der Oberfläche von neutrophilen Granulozyten exprimiert, welche zur Aktivierung der Zelle beitragen können. In dieser arbeit wurden der Herpes Virus Entry Mediator (HVEM) und Triggering Receptor expressed on Myeloid Cells-1 (TREM-1) auf neutrophilen untersucht. Für HVEM konnte eine synergistische Aktivierung von neutrophilen Granulozyten im Zusammenspiel mit Toll like Rezeptor (TLR) Liganden nachgewiesen werden. Für TREM-1 konnte ein Vorhandensein eines Liganden auch Thrombozyten beschrieben. Es wurden weiterhin Mechanismen untersucht und beschrieben, welche für die synergistische Aktivierung von neutrophilen Granulozyten verantwortlich sind, welche nach TREM-1 und TLR Stimulation erkennbar ist.

Genetic and environmental factors associated with cardiovascular diseases and acute myocardial infarction

Acute myocardial infarction (AMI) is a multifactorial disease with a complex pathogenesis where lifestyle, individual genetic background and environmental risk factors are involved. Altered inflammatory responses seems to be implicated in the pathogenesis of atherosclerosis. To understand which genes may predispose to increased risk of cardiovascular disease gene polymorphism of immune regulatory genes, and clinical events from the Offs of parents with an early AMI were investigated. Genetics data from Offs were compared with those obtained from healthy subjects and an independent cohort of patients with clinical sporadic AMI. Rates of clinical events during a 24 years follow up from Offs and from an independent Italian population survey were also evaluated. This study showed that a genetic signature consisting of the concomitant presence of the CC genotype of VEGF, the A allele of IL-10 and the A allele of IFN-γ was indeed present in the Offs population. During the 24-year follow-up, Offs with a positive familiarity in spite of a relatively young age showed an increased prevalence of diabetes, ischemic heart disease and stroke. In these patients with the genetic signature the EBV and HHV-6 herpes virus were also investigated and founded. These findings reinforce the notion that subjects with a familial history of AMI are at risk of an accelerated aging of cardiovascular system resulting in cardiovascular events. These data suggest that selected genes with immune regulatory functions and envoronmental factors are part of the complex genetic background contributing to familiarity for cardiovascular diseases.N