Toward better outcomes with tacrolimus therapy: Population pharmacokinetics and individualized dosage prediction in adult liver transplantation

Patient outcomes in transplantation would improve if dosing of immunosuppressive agents was individualized. The aim of this study is to develop a population pharmacokinetic model of tacrolimus in adult liver transplant recipients and test this model in individualizing therapy. Population analysis was performed on data from 68 patients. Estimates were sought for apparent clearance (CL/F) and apparent volume of distribution (V/F) using the nonlinear mixed effects model program (NONMEM). Factors screened for influence on these parameters were weight, age, sex, transplant type, biliary reconstructive procedure, postoperative day, days of therapy, liver function test results, creatinine clearance, hematocrit, corticosteroid dose, and interacting drugs. The predictive performance of the developed model was evaluated through Bayesian forecasting in an independent cohort of 36 patients. No linear correlation existed between tacrolimus dosage and trough concentration (r(2) = 0.005). Mean individual Bayesian estimates for CL/F and V/F were 26.5 8.2 (SD) L/hr and 399 +/- 185 L, respectively. CL/F was greater in patients with normal liver function. V/F increased with patient weight. CL/F decreased with increasing hematocrit. Based on the derived model, a 70-kg patient with an aspartate aminotransferase (AST) level less than 70 U/L would require a tacrolimus dose of 4.7 mg twice daily to achieve a steady-state trough concentration of 10 ng/mL. A 50-kg patient with an AST level greater than 70 U/L would require a dose of 2.6 mg. Marked interindividual variability (43% to 93%) and residual random error (3.3 ng/mL) were observed. Predictions made using the final model were reasonably nonbiased (0.56 ng/mL), but imprecise (4.8 ng/mL). Pharmacokinetic information obtained will assist in tacrolimus dosing; however, further investigation into reasons for the pharmacokinetic variability of tacrolimus is required.

Epistemic marking and multiple perspective : an introduction

This paper discusses forms of epistemic marking that instantiate multiple perspective constructions (see Evans 2005). Such forms express the speaker’s and the addressee’s simultaneous epistemic perspectives from the point of view of the speaker, crucially relying on the assumptions of the speaker with regard to the addressee’s knowledge. The analysis of forms considers established semanto-pragmatic concepts, such as semantic scope, mitigation strategies and communicative intention (as marked by sentence-type) in the exploration of forms. In addition, the notion of knowledge asymmetry is discussed alongside the concepts of epistemic status and stance as tools for a semantic analysis of investigated forms

Measurement of scleral thickness in humans using anterior segment optical coherent tomography

Anterior segment optical coherent tomography (AS-OCT, Visante; Zeiss) is used to examine meridional variation in anterior scleral thickness (AST) and its association with refractive error, ethnicity and gender. Scleral cross-sections of 74 individuals (28 males; 46 females; aged between 18-40 years (27.7±5.3)) were sampled twice in random order in 8 meridians: [superior (S), inferior (I), nasal (N), temporal (T), superior-temporal (ST), superior-nasal (SN), inferior-temporal (IT) and inferior-nasal (IN)]. AST was measured in 1mm anterior-toposterior increments (designated the A-P distance) from the scleral spur (SS) over a 6mm distance. Axial length and refractive error were measured with a Zeiss IOLMaster biometer and an open-view binocular Shin-Nippon autorefractor. Intra- And inter-observer variability of AST was assessed for each of the 8 meridians. Mixed repeated measures ANOVAs tested meridional and A-P distance differences in AST with refractive error, gender and ethnicity. Only right eye data were analysed. AST (mean±SD) across all meridians and A-P distances was 725±46μm. Meridian SN was the thinnest (662±57μm) and I the thickest (806 ±60μm). Significant differences were found between all meridians (p<0.001), except S:ST, IT:IN, IT:N and IN:N. Significant differences between A-P distances were found except between SS and 6 mm and between 2 and 4mm. AST measurements at 1mm (682±48 μm) were the thinnest and at 6mm (818±49 μm) the thickest (p<0.001); a significant interaction occurred between meridians and A-P distances (p<0.001). AST was significantly greater (p<0.001) in male subjects but no significant differences were found between refractive error or ethnicity. Significant variations in AST occur with regard to meridian and distance from the SS and may have utility in selecting optimum sites for pharmaceutical or surgical intervention.

Parâmetros bioquímicos e níveis de IgE total e específicas para aeroalérgenos em mulheres obesas com síndrome dos ovários policísticos

Introduction: Polycystic ovary syndrome (PCOS) whose classic features (menstrual irregularity of oligo/ amenorrhea type, chronic anovulation, infertility and hyperandrogenism clinical and/ or biochemical), is associated with aspects of metabolic syndrome (MS), as obesity and insulin resistance. The level of obesity determines different levels of inflammation, increasing cytokines participants of metabolic and endocrine functions, beyond modulate the immune response. Metabolic changes, added to the imbalance of sex hormones underlying irregular menstruation observed in (PCOS) can trigger allergic processes and elevation of total and specific IgE antibodies indicate that a sensitization process was started. Objective: To evaluate the influence of PCOS on biochemical parameters and levels of total and specific IgE to aeroallergens in obese women. Methods: After approval by the Committee of Ethics in Research, were recruited 80 volunteers with BMI ≥ 30 kg/m2 and age between 18 and 45 years. Among these, 40 with PCOS according to the Rotterdam criteria and 40 women without PCOS (control group). All participants were analysed with regard to anthropometric, clinical, gynecological parameters, interviewed using a questionnaire, and underwent blood sampling for realization of laboratory tests of clinical biochemistry: Total cholesterol, LDL-cholesterol, HDL- cholesterol, Triglycerides, Fasting glucose, Urea, Creatinine, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) and immunological: total and specific IgE to Dermatophagoides pteronyssinus, Blomia tropicalis, Dermatophagoides farinae and Dermatophagoides microceras.Statistical analysis was performed using SPSS 15.0 software through the chi-square tests, Fisher, Student t test and binary logistic regression, with significance level (p <0.05). Results: It was observed in the group of obese women with PCOS that 29 (72.5%) had menstrual cycle variable and 27 (67.5%) had difficulty getting pregnant. According to waist-hip ratio, higher average was also observed in obese PCOS (0.87). Blood level of HDL (36.9 mg/dL) and ALT (29.3 U/L) were above normal levels in obese women with PCOS, with statistically significant relationship. In the analysis of total and specific IgE to D. pteronyssinus high results were also prevalent in obese PCOS, with blood level (365,22 IU/mL) and (6.83 kU/L), respectively, also statistically significant. Conclusions: Observed predominance of cases with high levels of total IgE in the group of obese women with PCOS, 28 (70%) of the participants, whose mean blood concentration of the group was 365.22 IU/mL. In the analysis of Specific IgE between the groups, the allergen Dermatophagoides pteronyssinus showed greater dispersion and average the results of sensitization in the group of obese PCOS, whose mean blood concentration was 6.83 kU/l. Keywords: Obesity, Allergens and Polycystic Ovary Syndrome

Avaliação dos efeitos tóxicos in vitro e in vivo do extrato hidroetanólico dos frutos de Genipa americana L. (Rubiaceae) em camundongos Swiss

The therapeutic use of medicinal plants has contributed since antiquity in a beneficial way for health. However, many species lacks of scientific evidence which provide basis for their use in therapeutic practice. In this context is the Genipa americana L. species (Rubiaceae), popularly known as jenipapo and used to treat syfilis, ulcer and hemorrhagic disturbs. It's also used against bruising, as tonic and as aphrodisiac. Due this species lacks toxicological studies, the aim of this study was to evaluate the toxicity in vivo (acute and sub-chronic toxicity) and in vitro (cytotoxicity) of the hydroethanolic extract from G. americana fruits. The hydroethanolic extract of G. americana fruits was prepared by maceration. A preliminary phytochemical analysis was performed to assess the presence of secondary metabolites in the extract. The cytotoxicity study of the extract (0.1, 1.0, 10, 100 and 1000 mg / 100 ul) were performed against normal cells (3T3) and tumor (786-0, HepG2 and B16), analyzed by the MTT assay. To evaluate the acute (single dose of 2000 mg / Kg) and subchronic (100, 500 and 1000 mg / kg for 30 days) toxicity Swiss mice of both sexes were used. At the end of the experiment, blood samples and organs were collected for analysis. Data between groups were compared by t test or ANOVA with Dunnett's post-test with 5% significance level. The phytochemical study of the extracts mainly indicated the presence of iridoids. Results for cytotoxicity tests showed up to 70% inhibition of B16 cell line at a dose of 1000 mg / 100 ul, and up to 29% inhibition of 786-0 at a dose of 10 ug / 100 ul. The extract did not cause death in 3T3 and HepG2 cells. During the in vivo assays, there were no animal deaths. Analysis of blood samples revealed that the animals submitted to the evaluation of acute toxicity had changes in AST and ALT, and that the animals evaluated for subchronic toxicity showed changes in the relative wet weight of the kidney and plasma urea concentration. No differences were observed between groups on histopathological evaluation of the collected organs. Despite the changes found in the in vivo toxicity tests, using the criteria described by the OECD Guidelines, it is suggested that the hydroethanolic extract of the fruits of the G. americana is classified as low toxicity. The cytotoxicity of the extract suggests that they have potential against melanoma cell lines (B16).

Avaliação dos efeitos tóxicos in vitro e in vivo do extrato hidroetanólico dos frutos de Genipa americana L. (Rubiaceae) em camundongos Swiss

The therapeutic use of medicinal plants has contributed since antiquity in a beneficial way for health. However, many species lacks of scientific evidence which provide basis for their use in therapeutic practice. In this context is the Genipa americana L. species (Rubiaceae), popularly known as jenipapo and used to treat syfilis, ulcer and hemorrhagic disturbs. It's also used against bruising, as tonic and as aphrodisiac. Due this species lacks toxicological studies, the aim of this study was to evaluate the toxicity in vivo (acute and sub-chronic toxicity) and in vitro (cytotoxicity) of the hydroethanolic extract from G. americana fruits. The hydroethanolic extract of G. americana fruits was prepared by maceration. A preliminary phytochemical analysis was performed to assess the presence of secondary metabolites in the extract. The cytotoxicity study of the extract (0.1, 1.0, 10, 100 and 1000 mg / 100 ul) were performed against normal cells (3T3) and tumor (786-0, HepG2 and B16), analyzed by the MTT assay. To evaluate the acute (single dose of 2000 mg / Kg) and subchronic (100, 500 and 1000 mg / kg for 30 days) toxicity Swiss mice of both sexes were used. At the end of the experiment, blood samples and organs were collected for analysis. Data between groups were compared by t test or ANOVA with Dunnett's post-test with 5% significance level. The phytochemical study of the extracts mainly indicated the presence of iridoids. Results for cytotoxicity tests showed up to 70% inhibition of B16 cell line at a dose of 1000 mg / 100 ul, and up to 29% inhibition of 786-0 at a dose of 10 ug / 100 ul. The extract did not cause death in 3T3 and HepG2 cells. During the in vivo assays, there were no animal deaths. Analysis of blood samples revealed that the animals submitted to the evaluation of acute toxicity had changes in AST and ALT, and that the animals evaluated for subchronic toxicity showed changes in the relative wet weight of the kidney and plasma urea concentration. No differences were observed between groups on histopathological evaluation of the collected organs. Despite the changes found in the in vivo toxicity tests, using the criteria described by the OECD Guidelines, it is suggested that the hydroethanolic extract of the fruits of the G. americana is classified as low toxicity. The cytotoxicity of the extract suggests that they have potential against melanoma cell lines (B16).

Hepatite C crônica em serviço de referência no nordeste do Brasil: um estudo retrospectivo de dezoito anos de acompanhamento

Chronic Hepatitis C is the leading cause of chronic liver disease in advanced final stage of hepatocellular carcinoma (HCC) and of death related to liver disease. Evolves progressively in time 20-30 years. Evolutionary rates vary depending on factors virus, host and behavior. This study evaluated the impact of hepatitis C on the lives of patients treated at a referral service in Hepatology of the University Hospital Onofre Lopes - Liver Study Group - from May 1995 to December 2013. A retrospective evaluation was performed on 10,304 records, in order to build a cohort of patients with hepatitis C, in which all individuals had their diagnosis confirmed by gold standard molecular biological test. Data were obtained directly from patient charts and recorded in an Excel spreadsheet, previously built, following an elaborate encoding with the study variables, which constitute individual data and prognostic factors defined in the literature in the progression of chronic hepatitis C. The Research Ethics Committee approved the project. The results were statistically analyzed with the Chi-square test and Fisher's exact used to verify the association between variable for the multivariate analysis, we used the Binomial Logistic regression method. For both tests, it was assumed significance p < 0.05 and 95%. The results showed that the prevalence of chronic hepatitis C in NEF was 4.96 %. The prevalence of cirrhosis due to hepatitis C was 13.7%. The prevalence of diabetes in patients with Hepatitis C was 8.78 % and diabetes in cirrhotic patients with hepatitis C 38.0 %. The prevalence of HCC was 5.45%. The clinical follow-up discontinuation rates were 67.5 %. The mortality in confirmed cases without cirrhosis was 4.10% and 32.1% in cirrhotic patients. The factors associated with the development of cirrhosis were genotype 1 (p = 0.0015) and bilirubin > 1.3 mg % (p = 0.0017). Factors associated with mortality were age over 35 years, abandon treatment, diabetes, insulin use, AST> 60 IU, ALT> 60 IU, high total bilirubin, extended TAP, INR high, low albumin, treatment withdrawal, cirrhosis and hepatocarcinoma. The occurrence of diabetes mellitus increased mortality of patients with hepatitis C in 6 times. Variables associated with the diagnosis of cirrhosis by us were blood donor (odds ratio 0.24, p = 0.044) and professional athlete (odds ratio 0.18, p = 0.35). It is reasonable to consider a revaluation in screening models for CHC currently proposed. The condition of cirrhosis and diabetes modifies the clinical course of patients with chronical hepatitis C, making it a disease more mortality. However, being a blood donor or professional athlete is a protective factor that reduces the risk of cirrhosis, independent of alcohol consumption. Public policies to better efficient access, hosting and resolution are needed for this population.

MID-IR luminosities and UV/optical star formation rates at z < 1.4

Ultraviolet (UV) nonionizing continuum and mid-infrared (IR) emission constitute the basis of two widely used star formation (SF) indicators at intermediate and high redshifts. We study 2430 galaxies with z < 1.4 in the Extended Groth Strip with deep MIPS 24 μm observations from FIDEL, spectroscopy from DEEP2, and UV, optical, and near-IR photometry from the AEGIS. The data are coupled with dust-reddened stellar population models and Bayesian spectral energy distribution (SED) fitting to estimate dust-corrected star formation rates (SFRs). In order to probe the dust heating from stellar populations of various ages, the derived SFRs were averaged over various timescales—from 100 Myr for "current" SFR (corresponding to young stars) to 1-3 Gyr for long-timescale SFRs (corresponding to the light-weighted age of the dominant stellar populations). These SED-based UV/optical SFRs are compared to total IR luminosities extrapolated from 24 μm observations, corresponding to 10-18 μm rest frame. The total IR luminosities are in the range of normal star-forming galaxies and luminous IR galaxies (10^10-10^12 L_☉). We show that the IR luminosity can be estimated from the UV and optical photometry to within a factor of 2, implying that most z < 1.4 galaxies are not optically thick. We find that for the blue, actively star-forming galaxies the correlation between the IR luminosity and the UV/optical SFR shows a decrease in scatter when going from shorter to longer SFR-averaging timescales. We interpret this as the greater role of intermediate age stellar populations in heating the dust than what is typically assumed. Equivalently, we observe that the IR luminosity is better correlated with dust-corrected optical luminosity than with dust-corrected UV light. We find that this holds over the entire redshift range. Many so-called green valley galaxies are simply dust-obscured actively star-forming galaxies. However, there exist 24 μm detected galaxies, some with L_IR>10^11 L_☉, yet with little current SF. For them a reasonable amount of dust absorption of stellar light (but presumably higher than in nearby early-type galaxies) is sufficient to produce the observed levels of IR, which includes a large contribution from intermediate and old stellar populations. In our sample, which contains very few ultraluminous IR galaxies, optical and X-ray active galactic nuclei do not contribute on average more than ~50% to the mid-IR luminosity, and we see no evidence for a large population of "IR excess" galaxies.

Determining star formation rates for infrared galaxies

We show that measures of star formation rates (SFRs) for infrared galaxies using either single-band 24 μm or extinction-corrected Paα luminosities are consistent in the total infrared luminosity = L(TIR) ~ 10^10 L_☉ range. MIPS 24 μm photometry can yield SFRs accurately from this luminosity upward: SFR(M_☉ yr^–1) = 7.8 × 10^–10 L(24 μm, L_☉) from L(TIR) = 5× 10^9 L_☉ to 10^11 L_☉ and SFR = 7.8 × 10^–10 L(24 μm, L_☉)(7.76 × 10^–11 L(24))^0.048 for higher L(TIR). For galaxies with L(TIR) ≥ 10^10 L_☉, these new expressions should provide SFRs to within 0.2 dex. For L(TIR) ≥ 10^11 L_☉, we find that the SFR of infrared galaxies is significantly underestimated using extinction-corrected Paα (and presumably using any other optical or near-infrared recombination lines). As a part of this work, we constructed spectral energy distribution templates for eleven luminous and ultraluminous purely star forming infrared galaxies and over the spectral range 0.4 μm to 30 cm. We use these templates and the SINGS data to construct average templates from 5 μm to 30 cm for infrared galaxies with L(TIR) = 5× 10^9 to 10^13 L_☉. All of these templates are made available online.

Search for associations containing young stars (SACY). VII. New stellar and substellar candidate members in the young associations

Context. The young associations offer us one of the best opportunities to study the properties of young stellar and substellar objects and to directly image planets thanks to their proximity (<200 pc) and age (≈5−150 Myr). However, many previous works have been limited to identifying the brighter, more active members (≈1 M_⊙) owing to photometric survey sensitivities limiting the detections of lower mass objects. Aims. We search the field of view of 542 previously identified members of the young associations to identify wide or extremely wide (1000−100 000 au in physical separation) companions. Methods. We combined 2MASS near-infrared photometry (J, H, K) with proper motion values (from UCAC4, PPMXL, NOMAD) to identify companions in the field of view of known members. We collated further photometry and spectroscopy from the literature and conducted our own high-resolution spectroscopic observations for a subsample of candidate members. This complementary information allowed us to assess the efficiency of our method. Results. We identified 84 targets (45: 0.2−1.3 M_⊙, 17: 0.08−0.2 M_⊙, 22: <0.08 M_⊙) in our analysis, ten of which have been identified from spectroscopic analysis in previous young association works. For 33 of these 84, we were able to further assess their membership using a variety of properties (X-ray emission, UV excess, Hα, lithium and K I equivalent widths, radial velocities, and CaH indices). We derive a success rate of 76–88% for this technique based on the consistency of these properties. Conclusions. Once confirmed, the targets identified in this work would significantly improve our knowledge of the lower mass end of the young associations. Additionally, these targets would make an ideal new sample for the identification and study of planets around nearby young stars. Given the predicted substellar mass of the majority of these new candidate members and their proximity, high-contrast imaging techniques would facilitate the search for new low-mass planets.

A Test of the Biogenicity Criteria Established for Microfossils and Stromatolites on Quaternary Tufa and Speleothem Materials Formed in the “Twilight Zone” at Caerwys, UK

Natural Resources Wales and Steven Griffiths are thanked for access to Caerwys quarry and permission to work on the site. Sebastiaan Edelman and Thomas Logeman assisted with fieldwork and provided some of the field photographs. Bouke Lacet (Sedimentology laboratory, VU University Amsterdam) prepared the thin-sections. Three anonymous reviewers helped to sharpen the manuscript, and Sherry Cady provided valuable editorial advice and assistance. A.T.B. was inspired by Martin Brasier. He dedicates this manuscript to his father’s memory.

A Test of the Biogenicity Criteria Established for Microfossils and Stromatolites on Quaternary Tufa and Speleothem Materials Formed in the “Twilight Zone” at Caerwys, UK

Natural Resources Wales and Steven Griffiths are thanked for access to Caerwys quarry and permission to work on the site. Sebastiaan Edelman and Thomas Logeman assisted with fieldwork and provided some of the field photographs. Bouke Lacet (Sedimentology laboratory, VU University Amsterdam) prepared the thin-sections. Three anonymous reviewers helped to sharpen the manuscript, and Sherry Cady provided valuable editorial advice and assistance. A.T.B. was inspired by Martin Brasier. He dedicates this manuscript to his father’s memory.

Influência das alturas iniciais de pasto diferido na recria de cordeiros sobre o desempenho na terminação em confinamento

The objective of this study was to evaluate the productive performance, metabolic and feeding behavior of sheep after ninety days deferred pasture at different heights. The experiment was conducted at Capim Branco experimental farm of the Universidade Federal de Uberlândia. During the period of 90 days, from June to September 2013, forty-eight crossbred lambs Santa Inês x Dorper, divided into groups of four animals, occupied twelve pickets deferred pasture with four initial heights (15 cm, 25 cm, 35 cm and 45 cm). During this period we evaluated the structural characteristics of pasture. For confinement, from September to December 2013, 32 of these animals were used (16 males and 16 females), divided into four bays, separated as pasture were using. The consumption was assessed daily, while biometric measurements were made every 21 days. In relation to gender, there were differences in average daily gain weight. Reviews of feeding behavior occurred at the beginning, middle and end of the experiment for 24 hours. The rumination and leisure activities do not present statistical differences, both initial height of pasture and by period. The time spent on intake was higher during the daytime both treatments starting height as the experimental periods, however, rumination activity was more intense at night. Blood glucose was achieved in five periods of the day, while other metabolites have been obtained with a collection made fortnightly. The different initial heights not promoted effects on blood glucose. The harvesting times were not affected. However, there was a reduction of basal blood glucose of animals throughout the experimental period. There was a significant interaction between the initial pasture heights and periods of evaluation of basal glucose. Cholesterol and triglyceride levels were below recommended levels, however the final phase of confinement cholesterol level increased significantly. The values of VLDL and GGT were above the reference range. FA and AST showed average values within the recommended values. Total protein was influenced by different initial heights of pasture. The creatinine and albumin had values below the recommended range. Moreover, the albumin decreased during the confinement time. Uric acid showed close to the recommended maximum. There was stabilization of compensatory growth, with modification of consumption and weight gain at 45 days of experiment.

A Test of the Biogenicity Criteria Established for Microfossils and Stromatolites on Quaternary Tufa and Speleothem Materials Formed in the “Twilight Zone” at Caerwys, UK

Natural Resources Wales and Steven Griffiths are thanked for access to Caerwys quarry and permission to work on the site. Sebastiaan Edelman and Thomas Logeman assisted with fieldwork and provided some of the field photographs. Bouke Lacet (Sedimentology laboratory, VU University Amsterdam) prepared the thin-sections. Three anonymous reviewers helped to sharpen the manuscript, and Sherry Cady provided valuable editorial advice and assistance. A.T.B. was inspired by Martin Brasier. He dedicates this manuscript to his father’s memory.

Safety criteria for the private spaceflight industry

The Federal Aviation Administration (FAA) Office of Commercial Space Transportation (AST) has set specific rules and generic guidelines to cover experimental and operational flights by industry forerunners such as Virgin Galactic and XCOR. One such guideline Advisory Circular (AC) 437.55-1[1] contains exemplar hazard analyses for spacecraft designers and operators to follow under an experimental permit. The FAA's rules and guidelines have also been ratified in a report to the United States Congress, Analysis of Human Space Flight Safety[2] which cites that the industry is too immature and has 'insufficient data' to be proscriptive and that 'defining a minimum set of criteria for human spaceflight service providers is potentially problematic' in order not to 'stifle the emerging industry'. The authors of this paper acknowledge the immaturity of the industry and discuss the problematic issues that Design Organisations and Operators now face.