Arterial and interstitial remodelling processes in non-specific interstitial pneumonia: systemic sclerosis versus idiopathic

Aims: To compare septal and vascular matrix remodelling, vascular occlusion, Pulmonary function tests and survival between two groups: one with idiopathic non-specific interstitial pneumonia (NSIP) and one with NSIP associated with systemic sclerosis (SSc). Methods and results: Pulmonary biopsy specimens were examined from 40 patients, 22 with NSIP and 18 with NSIP associated with SSc. The content of septal collagen and elastic fibres, as well as the elastic fibres in the vascular interstitium, were higher in the SSc group (P = 0.01, P = 0.001 and P < 0.0001, respectively). Among pulmonary function tests. the diffusing capacity for carbon monoxide/alveolar volume was affected to a greater extent in the SSc group (59%) of the predicted value in SSc and 97% in the idiopathic group). There were no differences in collagen content of the vascular interstitium, arterial occlusion, or survival between the two groups. Conclusions: Although the fibrotic process is more intense in the SSc group. it, does not affect the prognosis of these patients. Because the elastotic process is higher in the SSc group, this might suggest that autoimmune inflammatory mechanisms affecting the elastic fibre system play a greater role in the pathogenesis and pulmonary remodelling process of SSc NSIP than in idiopathic NSIP.

HLA polymorphisms as incidence factor in the progression to end-stage renal disease in Brazilian patients awaiting kidney transplant

Chronic renal failure (CRF) leads in the majority of instances to end-stage renal disease (ESRD) requiring renal replacement therapy. Age, gender, genetics, race, hypertension, and smoking among others are factors associated with ESRD. Our interest was to evaluate the possible associations of class I and II HLA antigens with ESRD renal disease independent of other factors, among patients with CRF, having various diagnoses in the Brazilian population of the Sao Paulo state. So 21 HLA-A, 31 HLA-B, and 13 HLA-DR were detected in 105 patients who were compared with 160 healthy controls of both sexes who were not related to the patients evaluated until 2005. We calculated allelic frequencies, haplotypes frequencies, etiological fractions (EF), preventive fractions, and relative risks (RR). We compared demographic data of patients and controls. The antigens positively associated with ESRD were: HLA-A78 (RR = 30.31 and EF = 0.96) and HLA-DR11 (RR = 18.87 and EF = 0.65). The antigens HLAB14 (RR = 29.90 and EF = 0.75) was present at a significantly lower frequency among patients compared with controls. In contrast, no haplotype frequency showed statically significant associations. Further molecular studies may clarify types and subtypes of alleles involved with ESRD progression.

MRI findings of prostate stromal tumour of uncertain malignant potential: a case report

Prostatic stromal tumours are rare neoplasias that include benign, malignant and borderline lesions. Stromal tumour of uncertain malignant potential (STUMP) has been recently described and only a few reports exist in the literature. As a rare and distinct neoplasia, to date, there is no description of MRI findings of prostate STUMP. In this article, we describe the clinical and MRI features with histopathological correlation of a patient with prostate STUMP.

Interieukin-17 and Kidney Allograft Outcome

Acute rejection episodes (ARE) are important complications that involve the interplay between mechanisms that maintain graft tolerance and promote rejection. The proinflammatory cytokine interieukin-17 (IL-17) has been implicated in many conditions in humans and mice. In kidney transplant patients, the evaluation IL-17 levels has been performed in only a few patients. We performed a cross-sectional study correlating quantitative IL-17 levels and clinical outcomes. Patients and methods. We studied 19 specimens from biopsies performed in patients (n = 19) who received isolated kidney grafts. ARE signs were present in 9 (47%) patients who provide specimens; whereas, 10 (53%) others showed no signs of rejection. Eighteen healthy control sample IL-17 underwent measurement, all of which were performed by an enzyme-linked immunosorbent assay method. We assessed other factors, such as the recipients demographic data, cold ischemia time, HLA mismatches, time elapsed from transplantation to the biopsy, posttransplantation status, antibody panel, donor type, and immunosuppressive treatment. Results. IL-17 levels were clearly increased among samples derived from patients with ongoing rejection (125.7 +/- 27.06 pg/mL) in contrast, to the nonrejection group, (30 +/- 13.32 pg/mL) (P < .05). Healthy controls showed no detectable IL-17 levels. Conclusions. These findings suggested that IL-17 was important in the pathophysiology of acute kidney rejection.

Interferon-gamma+874 Polymorphism in the First Intron of the Human Interferon-gamma Gene and Kidney Allograft Outcome

Background. Despite advances in immunosuppressive therapy in the past decade, allograft rejection remains an important cause of kidney graft failure. Cytokines play a major role in the inflammatory and immune responses that mediate allograft outcomes. Several studies have shown that the production of cytokines varies among individuals. These variations are determined by genetic polymorphisms, most commonly within the regulatory region of cytokine genes. The aim of the present study was to assess the effect of allelic variation on acute rejection episodes (ARE) or chronic allograft nephropathy (CAN) after kidney transplantation. Methods. To determine a possible correlation between the interferon (INF)-gamma +874 polymorphism and kidney allograft outcome, we isolated genomic DNA from 74 patients who underwent isolated kidney allografts and were classified into 2 groups-a rejection and a nonrejection group-for comparison with a control group of 163 healthy subjects. Results. We genotyped INF-gamma +874 polymorphisms in all groups. The transplant group showed a significantly increased homozygous genotype T/T (P = .0118) compared with healthy controls. Similarly, considering only patients with CAN, the homozygous genotype T/T (P = .0067) was significantly increased compared with the healthy controls. The rejection group indicated a significant increased homozygous genotype Tic compared with the control group (P = .0061). Conclusion. Homozygous genotype T/T was associated with increased levels of INF-gamma and greater numbers among the rejection and CAN cohorts.

Glucocorticoid resistance in dialysis patients may impair the kidney allograft outcome

This study examines in vitro steroid sensitivity in chronic renal failure ( CRF) patients and its influence on the allograft outcome. We determined the inhibitory effect of dexamethasone ( DEX) on concanavalin A ( Con-A)-stimulated peripheral blood mononuclear cell ( PBMC) proliferation, and glucocorticoid receptor` ( GR) number of binding sites ( B-max) and affinity ( K-d) in 28 CRF patients and 40 normal healthy controls. Based on K-d values > 95th percentile from controls, patients were divided into two groups: glucocorticoid resistant ( n = 11) and glucocorticoid sensitive ( n = 17). Patients were followed during 18 months post-transplantation observing acute rejection episodes ( ARE), chronic allograft nephropathy ( CAN), allograft failure and death. The DEX concentration that caused 50% inhibition of Con-A-stimulated PBMC proliferation ( IC50) was higher in CRF than in healthy controls ( 2.2 x 10(-5) +/- 1.0 x 10(-5) versus 8.3 x 10(-6) +/- 4.2 x 10(-6) mol/ L, P = 0.02). Values of Kd ( 12.4 +/- 1.8 versus 7.2 +/- 0.9 nM) and Bmax ( 7.7 +/- 1.1 versus 4.1 +/- 0.3 fmol/ mg protein) were higher in CRF patients ( P = 0.02 and P = 0.001, respectively). There were higher incidences of ARE ( P = 0.02) and CAN ( P = 0.002) in the glucocorticoid-resistant group. Univariate and multivariate logistic regression showed that Kd was an independent predictor of ARE ( OR 8.8, P= 0.03) aswell as of CAN ( OR 16.5, P= 0.01). In conclusion, we observed glucocorticoid resistance in a subgroup of CRF patients undergoing dialysis, which led to a higher morbidity due to ARE and CAN in an 18-month follow-up period.

Frequency of insertion/deletion polymorphism in exon 8 of HLA-G and kidney allograft outcome

Human leukocyte antigen-G (HLA-G) is a non-classical major histocompatibility complex (MHC) class Ib molecule predominantly expressed in cytotrophoblasts, where it acts as a specific immunosuppressor. Literature data have shown that grafts in some settings, such as cardiac and liver/kidney-associated transplantations, express HLA-G and this expression is associated with less severe rejection and also reduces the incidence of rejection. Fourteen-base pair deletion/insertion polymorphism has been reported in exon 8 of the 3`-untranslated region of HLA-G. This polymorphism within exon 8 of the HLA-G gene might influence transcription activity, which in turn may influence the stability of HLA-G transcripts. This influences the stability of the HLA-G protein and therefore is of potential functional relevance. In order to determine a possible correlation between the 14-bp insertion/deletion polymorphism and kidney allograft outcome, we isolated genomic DNA from 83 patients who had received isolated kidney allografts, and we classified the 83 specimens into two groups, grafts presenting Banff features of rejection group and a non-rejection group, and compared them with a control group of 97 healthy subjects. The 14-bp polymorphism at exon 8 was genotyped in all groups. There was no significant difference in allelic frequencies of 14-bp insertion/deletion polymorphism between normal controls and kidney transplant patients. In the RG, the homozygous genotype +14/+14 bp (P = 0.0238) was significantly increased in the group with acute rejection compared with the healthy control group. Analysis of other HLA-G polymorphisms and functional studies on immune regulation are essential to elucidate the role of HLA-G in kidney allografts.

Sistema de controle de remanejamento e reserva t??cnica: siscort

O Sistema de Controle de Remanejamento e Reserva T??cnica (SISCORT) ?? uma tecnologia social in??dita na gest??o p??blica. ?? um inovador instrumento de gest??o no desenvolvimento de pol??ticas p??blicas voltadas para a melhoria da qualidade da educa????o. O SISCORT, por meio de suas consultas e cadastros dispon??veis, ?? ferramenta eficaz na concretiza????o das a????es propostas. Ele facilita, registra e controla o remanejamento dos livros adquiridos e distribu??dos em todas as escolas p??blicas de ensino fundamental, no ??mbito do maior programa do g??nero no mundo, o Programa Nacional do Livro Did??tico (PNLD). Acessando o SISCORT, no s??tio eletr??nico do FNDE, ?? poss??vel saber a quantidade de livros enviados para cada escola, por t??tulo, por s??rie e por componente curricular, permitindo que as escolas, ap??s informar o seu alunado real, saibam, automaticamente, se e onde h?? excesso ou escassez de livros, proporcionando mais transpar??ncia e maior controle social dos recursos p??blicos

A hist??ria de Andrea: como manter uma postura profissional quando n??o se sabe como agir?

Andrea, apesar de bem jovem, foi promovida ?? chefia de uma equipe com profissionais experientes e qualificados, mas as dificuldades come??aram logo. Sem saber lidar com isso, ela come??ou a se esquivar de situa????es dif??ceis, deixando a solu????o para a sua experiente equipe. Apesar disso, Andrea continuava com uma boa imagem perante seus superiores. Ao final do caso, prop??e-se um exerc??cio de avalia????o sobre as habilidades de Andrea

Programa trabalhando com parteiras tradicionais

Estes trabalho, ao propiciar o contato e a aproxima????o entre o universo das parteiras tradicionais e dos profissionais de sa??de vem possibilitando uma rica troca de experi??ncias, em que as parteiras contribuem principalmente com li????es de solidariedade, de assist??ncia marcada pelo v??nculo com as mulheres atendidas e com um saber emp??rico, constru??do no contexto das dificuldades da assist??ncia ?? sa??de. E, os profissionais de sa??de contribuem, por sua vez, com conhecimentos t??cnicos fundamentais para garantir que a gesta????o, o parto e o puerp??rio transcorram de forma mais segura e saud??vel para a mulher e o beb??

Texto para discuss??o 5: reforma administrativa e direito adquirido ao regime da fun????o p??blica

O direito adquirido tem sido argumento freq??entemente invocado pelos opositores da reforma constitucional do aparelho administrativo do Estado. Nesse debate, entretanto, este argumento ?? completamente destitu??do de validade t??cnica. Dizer que a reforma constitucional n??o pode alterar o regime jur??dico dos servidores p??blicos (o estatuto jur??dico da estabilidade, disponibilidade, remunera????o etc.) ?? incorrer em completo equ??voco. As raz??es dessa incompreens??o decorrem do desconhecimento de no m??nimo dois t??picos relevantes encartados no tema, a saber: a) a natureza do regime jur??dico que vincula o servidor p??blico civil ?? administra????o; e b) a distin????o entre efic??cia imediata e efic??cia retroativa das normas constitucionais

Texto para discuss??o 20: a reforma administrativa francesa: da crise da fun????o p??blica a uma nova racionalidade da a????o coletiva, uma dif??cil transi????o

Um dos marcos da reforma francesa ?? a crise da gest??o p??blica. Sabemos que a crise da gest??o p??blica ?? um fen??meno hoje universal que se tornou vis??vel a partir da d??cada de 70, especificamente com a crise do petr??leo.Com o fim do conflito Leste/Oeste em 1989, esta crise torna-se mais evidente e v??m-se refor??adas suas conota????es ideol??gicas. No caso franc??s, ao lado desta crise mundial, os analistas identificam uma crise espec??fica, a saber, a fal??ncia do modelo de Estado. Dentre os pa??ses industrializados do Ocidente, o Estado franc??s ??, sem d??vida, um dos que mais interv??m na vida social, econ??mica e pol??tica

Projeto estrada-piloto

A Escola T??cnica Federal do Cear??, hoje Centro Federal de Educa????o Tecnol??gica, mant??m entre seus cursos de n??vel m??dio, o de Estradas, por sinal, o mais antigo da institui????o. Para uma boa forma????o dos alunos, s??o necess??rias aulas pr??ticas em campo, a fim de que os alunos possam dominar o saber fazer da constru????o de estradas, barragens, obras de terra etc. Idealizamos ent??o a disciplina de Pr??tica de Constru????o de Estradas, cujo conte??do seria a execu????o de um projeto de uma obra real, em parceria com uma Prefeitura carente do interior cearense. A Escola entraria com o servi??o t??cnico, que seria executado pelos alunos e seus professores, e a Prefeitura entraria com as despesas de hospedagem e alimenta????o dos envolvidos. No final, a Prefeitura receberia um projeto de uma estrada, barragem, pra??a p??blica etc, pronto para ser implementado, e os alunos teriam treinado de forma pr??tica os conhecimentos adquiridos durante o curso. Nasceu ent??o o Projeto Estrada-Pil??to realizado em Ibaretama-Ce no per??odo de Abril a Junho de 98, que foi um grande sucesso para os alunos e as comunidades beneficiadas. Um segundo projeto tamb??m j?? foi realizado em Itapipoca-Ce no per??odo de Janeiro a Maio de 99, e as conversa????es j?? est??o bastante adiantadas para a realiza????o de um terceiro projeto em Trairi-Ce

Relat??rio de avalia????o da pol??tica de Gratifica????o de Desempenho de Atividade T??cnico-Administrativa

O Caderno 22 surgiu da necessidade de identificar at?? que ponto as pol??ticas de avalia????o para fins de gratifica????o (GDATA) est??o formuladas de maneira a realizar uma efetiva gest??o do desempenho dos servidores avaliados. O interesse em pesquisar esse tema surgiu com base em uma preocupa????o em saber se a GDATA est?? trazendo mudan??as na maneira de avaliar do governo ou se ela mant??m os procedimentos anteriores considerados inadequados e ineficientes. O relat??rio a ser discutido avalia os crit??rios adotados (a partir das portarias publicadas pelos ??rg??os) e questiona a maneira como as avalia????es v??m sendo realizadas nas diversas institui????es pesquisadas. Os resultados alcan??ados s??o bastante produtivos e levam a uma reflex??o sobre a necessidade de aprimorar os crit??rios de avalia????o a fim de realizar uma adequada gest??o do desempenho dos servidores p??blicos federais

Negocia????o coletiva no setor p??blico: experi??ncias internacionais recentes por meio de an??lise da literatura

Neste trabalho ?? feita uma an??lise da literatura internacional sobre rela????es de trabalho no setor p??blico. Os principais objetivos s??o examinar as institui????es e processos de negocia????o coletiva caracter??sticos de algumas experi??ncias internacionais e avaliar as explica????es te??ricas para os padr??es de intera????o entre o Estado e seus empregados. Espera-se que essa vis??o comparativa possa contribuir para o aperfei??oamento das raras experi??ncias existentes no Brasil. A pesquisa ?? baseada no princ??pio de que ?? mais vantajoso para todos os envolvidos que as diverg??ncias entre as partes em negocia????o trabalhista traduzam-se em conflito institucionalizado. Conflitos desregulados tendem a ser imprevis??veis e seus custos pol??ticos bastante altos. S??o discutidos tamb??m, na medida do poss??vel, os determinantes do comportamento dos atores envolvidos nessas negocia????es, a saber: os sindicatos, os dirigentes governamentais e os pol??ticos. Este relat??rio est?? dividido em quatro se????es, al??m da introdu????o