Perceptions de néphrologues transplanteurs et référents face à la quantification du risque immunologique global en transplantation rénale

Problématique : La pénurie d’organes qui sévit actuellement en transplantation rénale incite les chercheurs et les équipes de transplantation à trouver de nouveaux moyens afin d’en améliorer l’efficacité. Le Groupe de recherche transdisciplinaire sur les prédicteurs du risque immunologique du FRSQ travaille actuellement à mettre en place de nouveaux outils facilitant la quantification du risque immunologique global (RIG) de rejet de chaque receveur en attente d’une transplantation rénale. Le calcul du RIG s’effectuerait en fonction de facteurs scientifiques et quantifiables, soit le biologique, l’immunologique, le clinique et le psychosocial. La détermination précise du RIG pourrait faciliter la personnalisation du traitement immunosuppresseur, mais risquerait aussi d’entraîner des changements à l’actuelle méthode de sélection des patients en vue d’une transplantation. Cette sélection se baserait alors sur des critères quantifiables et scientifiques. L’utilisation de cette méthode de sélection possède plusieurs avantages, dont celui d’améliorer l’efficacité de la transplantation et de personnaliser la thérapie immunosuppressive. Malgré tout, cette approche soulève plusieurs questionnements éthiques à explorer chez les différents intervenants œuvrant en transplantation rénale quant à sa bonne utilisation. Buts de l’étude : Cette recherche vise à étudier les perceptions de néphrologues transplanteurs et référents de la province de Québec face à l’utilisation d’une méthode de sélection des patients basée sur des critères scientifiques et quantifiables issus de la médecine personnalisée. Les résultats pourront contribuer à déterminer la bonne utilisation de cette méthode et à étudier le lien de plus en plus fort entre science et médecine. Méthodes : Des entretiens semi-dirigés combinant l’emploi de courtes vignettes cliniques ont été effectués auprès de 22 néphrologues québécois (transplanteurs et référents) entre juin 2007 à juillet 2008. Le contenu des entretiens fut analysé qualitativement selon la méthode d’analyse de Miles et Huberman. Résultats : Les résultats démontrent une acceptation généralisée de cette approche. La connaissance du RIG pour chaque patient peut améliorer le traitement et la prise en charge post-greffe. Son efficacité serait supérieure à la méthode actuelle. Par contre, la possible exclusion de patients pose un important problème éthique. Cette nouvelle approche doit toutefois être validée scientifiquement et accorder une place au jugement clinique. Conclusions : La médecine personnalisée en transplantation devrait viser le meilleur intérêt du patient. Malgré l’utilisation de données scientifiques et quantifiables dans le calcul du RIG, le jugement clinique doit demeurer en place afin d’aider le médecin à prendre une décision fondée sur les données médicales, son expertise et sa connaissance du patient. Une réflexion éthique approfondie s’avère nécessaire quant à l’exclusion possible de patients et à la résolution de la tension entre l’équité et l’efficacité en transplantation rénale.

La consommation d’alcool et de drogue chez les étudiants suite à la fusillade de Dawson en 2006 : une analyse différenciée selon le sexe

Objectifs : Étudier l’incidence de la dépendance à l’alcool ou aux drogues chez les étudiants exposés à la fusillade du Collège Dawson dans les 18 mois suivant celle-ci. Identifier les précurseurs au développement d’une dépendance à une substance psychoactive en tenant compte de la sévérité d’exposition à l’événement. Examiner si la consommation d’alcool 18 mois après les événements est en lien avec les différents groupes de symptômes d’état de stress post-traumatique. Méthode : La population à l’étude est composée de l’ensemble des étudiants du Collège Dawson au moment de l’événement. Les analyses ont été faites auprès de 854 étudiants inscrits au Collège au moment de la fusillade. Résultats : Cinq pourcent des femmes et 7 % des hommes présentent pour la première fois de leur vie un problème de dépendance à une substance suite à la fusillade. Pour les hommes, leur jeune âge, la présence de pensées suicidaires au cours de leur vie, ainsi que le fait d’avoir vu le tireur au moment de la fusillade sont les principaux précurseurs de cas incidents de dépendance. Aucun des précurseurs étudiés n’est significatif pour les femmes. Les hommes et les femmes se distinguent également quant aux symptômes d’état de stress post-traumatique qui prédisent la consommation d’alcool 18 mois après la fusillade. Conclusion : La principale retombée de l’étude est de souligner l’importance de considérer le sexe des individus pour étudier leur consommation de substances psychoactives suite à un traumatisme.

Demonstrating the importance of criteria and sub-criteria in building assessment methods

Building assessment methods have become a popular research field since the early 1990s. An international tool which allows the assessment of buildings in all regions, taking into account differences in climates, topographies and cultures does not yet exist. This paper aims to demonstrate the importance of criteria and sub-criteria in developing a new potential building assessment method for Saudi Arabia. Recently, the awareness of sustainability has been increasing in developing countries due to high energy consumption, pollution and high carbon foot print. There is no debate that assessment criteria have an important role to identify the tool’s orientation. However, various aspects influence the criteria and sub-criteria of assessment tools such as environment, economic, social and cultural to mention but a few. The author provides an investigation on the most popular and globally used schemes: BREEAM, LEED, Green Star, CASBEE and Estidama in order to identify the effectiveness of the different aspects of the assessment criteria and the impacts of these criteria on the assessment results; that will provide a solid foundation to develop an effective sustainable assessment method for buildings in Saudi Arabia. Initial results of the investigation suggest that each country needs to develop its own assessment method in order to achieve desired results, while focusing upon the indigenous environmental, economic, social and cultural conditions. Keywords: Assessment methods, BREEAM, LEED, Green Star, CASBEE, Estidama, sustainability, sustainable buildings, Environment, Saudi Arabia.

Resistance to the anticoagulant rodenticides – the deployment of the new molecular methodology to identify mutations of the VKORC1 ‘resistance gene’, and understanding their potential impact on treatment outcome

Anticoagulants rodenticides have already known for over half a century, as effective and safe method of rodent control. However, discovered in 1958 anticoagulant resistance has given us a very important problem for their future long-term use. Laboratory tests provide the main method for identification the different types of anticoagulant resistances, quantify the magnitude of their effect and help us to choose the best pest control strategy. The main important tests are lethal feeding period (LFP) and blood clotting response (BCR) tests. These tests can now be used to quantify the likely effect of the resistance on treatment outcome by providing an estimate of the ‘resistance factor’. In 2004 the gene responsible for anticoagulant resistance (VKORC1) was identified and sequenced. As a result, a new molecular resistance testing methodology has been developed, and a number of resistance mutations, particularly in Norway rats and house mice. Three mutations of the VKORC1 gene in Norway rats have been identified to date that confer a degree of resistance to bromadiolone and difenacoum, sufficient to affect treatment outcome in the field.

Data-driven treatment selection for seamless phase II/III trials incorporating early-outcome data

Seamless phase II/III clinical trials are conducted in two stages with treatment selection at the first stage. In the first stage, patients are randomized to a control or one of k > 1 experimental treatments. At the end of this stage, interim data are analysed, and a decision is made concerning which experimental treatment should continue to the second stage. If the primary endpoint is observable only after some period of follow-up, at the interim analysis data may be available on some early outcome on a larger number of patients than those for whom the primary endpoint is available. These early endpoint data can thus be used for treatment selection. For two previously proposed approaches, the power has been shown to be greater for one or other method depending on the true treatment effects and correlations. We propose a new approach that builds on the previously proposed approaches and uses data available at the interim analysis to estimate these parameters and then, on the basis of these estimates, chooses the treatment selection method with the highest probability of correctly selecting the most effective treatment. This method is shown to perform well compared with the two previously described methods for a wide range of true parameter values. In most cases, the performance of the new method is either similar to or, in some cases, better than either of the two previously proposed methods.

Dependence of Response Functions and Orbital Functionals on Occupation Numbers

Explicitly orbital-dependent approximations to the exchange-correlation energy functional of density functional theory typically not only depend on the single-particle Kohn-Sham orbitals but also on their occupation numbers in the ground-state Slater determinant. The variational calculation of the corresponding exchange-correlation potentials with the optimized effective potential (OEP) method therefore also requires a variation of the occupation numbers with respect to a variation in the effective single-particle potential, which is usually not taken into account. Here it is shown under which circumstances this procedure is justified.

ARBETSRELATERADE STRESSFAKTORER FÖR SJUKSKÖTERSKOR INOM AKUTSJUKVÅRDEN Litteraturöversikt

Bakgrund: Arbetsrelaterad stress hos sjuksköterskor bidrar till hög andel sjukskrivningar. Inom akutsjukvården så är arbetstempot ofta högre än inom andra delar av sjukvården och omsättningen av patienter är stor. Sjuksköterskor som arbetar inom akutsjukvården är mer utsatta för stress. För att hantera stress så kan copingstrategier användas. Syfte: Syftet är att ta reda på vilka stressfaktorer som påverkar sjuksköterskans hälsa inom akutsjukvården, samt vilka copingstrategier som kan användas för att hantera dessa. Metod: Litteraturöversikt med tolv kvalitativa samt kvantitativa vetenskapliga artiklar som berör sjuksköterskan inom akutsjukvården, arbetsrelaterade stressfaktorer samt copingstrategier. Resultat: Det finns ett antal arbetsrelaterade stressfaktorer som bidrar till ohälsa och lidande för sjuksköterskan inom akutsjukvården. Copingstrategier som stöttning av kollegor, avlastande samtal, genomgång av verksamheten och mindfulness, bidrar till att den arbetsrelaterade stressen blir hanterbar och att hälsa uppnås Slutsats: Stressfaktorer som brist på sjuksköterskor, dödsfall eller sexuella övergrepp på barn, våld och hot från patienter och anhöriga, samt brister i arbetsmiljön bidrar till arbetsrelaterad stress. Copingstrategier kan hjälpa att motverka den stress som uppstår. Men för att copingstrategier ska fungera så är det viktigt att använda sig av de strategier som finns och att tid samt möjlighet finns på arbetsplatsen att utföra dessa.

Laparoscopy hepatic biopsy through cauterization

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Concepção e estudo de um biofiltro para tratamento de compostos orgânicos voláteis COVs

In the last decade, biological purification of gaseous waste has become an important alternative to many conventional methods of exhaust air treatment. More recently, biofiltration has proved to be an effective and inexpensive method for the treatment of air contaminated with volatile organic compounds (VOCs). A biofilter consists in a reactor packed with a porous solid bed material, where the microorganisms are fixed. During the biofiltration process, polluted air is transported through the biofilter medium where the contaminant is degraded. Within the biofilm, the pollutants in the waste gases are energy and carbon sources for microbial metabolism and are transformed into CO2, water and biomass. The bed material should be characterized by satisfactory mechanical and physical properties as structure, void fraction, specific area and flow resistance. The aim of this research was the biofilter construction and study of the biological degradation of ethanol and toluene, as well as the modeling of the process. Luffa cylindrica is a brazilian fiber that was used as the filtering material of the present work. The parameters and conditions studied were: composition of nutrients solution; effect of microflorae strains, namely Pseudomanas putida and Rhodococcus rhodochrous; waste gas composition; air flow rate; and inlet load of VOCs. The biofilter operated in diffusion regime and the best results for remotion capacity were obtained when a microorganisms consortion of Pseudomanas putida and Rhodococcus rhodochrous,were used, with a gas flow rate of 1 m3.h-1 and molar ratio nitrogene/phosphore N/P=2 in the nutrients solution. The maximum remotion capacity for ethanol was around 90 g.m-3.h-1 and 50 g.m-3.h-1 to toluene. It was proved that toluene has inhibitory effect on the ethanol remotion When the two VOCs were present in the same waste gas, there was a decrease of 40% in ethanol remotion capacity. Luffa cylindrica does not present considerable pressure drop. Ottengraf and van Lith models were used to represent the results obtained for ethanol and toluene, respectively. The application of the transient model indicated a satisfactory approximation between the experimental results obtained for ethanol and toluene vapors biofiltration and the ones predicted it

Melanose da margem palpebral com suspeita de malignidade: relato de caso

Apresenta-se relato de caso de paciente parda, com 47 anos de idade, havendo lesão pigmentada na margem palpebral inferior do olho direito, de aspecto irregular e heterogêneo, suspeitando-se clinicamente de lesão maligna. A paciente foi tratada com base no resultado da citologia de impressão e diagnosticada pelo exame histológico. Demonstra-se a importância da citologia para o planejamento da ressecção de lesões suspeitas como um método seguro e efetivo para assim se evitar cirurgias em áreas extensas da superfície ocular e de anexos.

Reduction of humeroulnar congenital elbow luxation in 8 dogs by using the transarticular pin

The purpose of this study was to evaluate the clinical and radiographic outcome in 8 dogs of surgical reduction of congenital humeroulnar luxation by using the transarticular pin. Five cases were bilateral and 3 were unilateral, for a total of 13 elbows. The treatment was performed in animals between 45 and 150 days of age. Articular stabilization was achieved by using a transarticular pin driven from the caudal aspect of the olecranon into the body of the humerus or into the distal condyle and distal metaphysis of the humerus. The follow-up period was between 1 and 19 months. There were 5 postsurgical reluxations, 3 related to the insertion of the pin into the humeral condyle and 3 related to the insertion into the humeral body. These animals needed further surgery. Six animals showed near normal return to limb function and 2 had lameness. We conclude that the use of the transarticular pin is an effective and simple method for the treatment of humeroulnar congenital elbow luxation.

Evaluation of the Diramic system for urine cultures

O sistema Diramic foi avaliado para o diagnóstico das infecções do trato urinário (ITU). O sistema Diramic foi desenvolvido em Cuba e possibilita resultados de diagnóstico das infecções do trato urinário (ITU) em quatro horas e baseia-se na variação da turvação do crescimento microbiano no meio de cultura após incubação a 37ºC/4 horas. 396 amostras de urinas provenientes de ambulatórios e enfermarias do HC da FMB-UNESP-Botucatu/SP foram analisadas pelo sistema Diramic. O método da alça calibrada (AC) foi adotado como método de referência. A taxa de coincidência entre os dois métodos foi de 96,46% (382 amostras de urina), não havendo diferença significativa entre os resultados obtidos nos dois métodos. Os resultados para sensibilidade e especificidade foram 84,37 e 98,80% respectivamente e 10 resultados no Diramic foram falsos negativos (2,5%) e 4 falso positivos (1,01%). Os microrganismos identificados nas urinas positivas foram Escherichia coli (68,75%), Klebsiella pneumoniae (10,94%), leveduras (6,25%), Pseudomonas aeruginosa (4,69%), Enterobacter cloacae (3,12%) e Proteus mirabilis, Staphyloccocus coagulase negativo, Morganella morganii e Citrobacter freundii também foram identificadas (1,56% para cada espécie). O método Diramic foi eficiente na triagem das urinoculturas, porém verificou-se algumas restrições quanto ao diagnóstico das infecções do trato urinário quando causadas por leveduras e em pacientes submetidos a antibioticoterapia.

Allosteric water and phosphate effects in Hoplosternum littorale hemoglobins

This paper reports the results obtained using the osmotic stress method applied to the purified cathodic and anodic hemoglobins (Hbs) from the catfish Hoplosternum littorale, a species that displays facultative accessorial air oxygenation. We demonstrate that water potential affects the oxygen affinity of H. littorale Hbs in the presence of an inert solute (sucrose). Oxygen affinity increases when water activity increases, indicating that water molecules stabilize the high-affinity state of the Hb. This effect is the same as that observed in tetrameric vertebrate Hbs. We show that both anodic and cathodic Hbs show conformational substrates similar to other vertebrate Hbs. For both Hbs, addition of anionic effectors, especially chloride, strongly increases the number of water molecules bound, although anodic Hb did not exhibit sensitivity to saturating levels of ATP. Accordingly, for both Hbs, we propose that the deoxy conformations coexist in at least two anion-dependent allosteric states, T-o and T-x, as occurs for human Hb. We found a single phosphate binding site for the cathodic Hb.

Dano de frio em limas-ácidas Tahiti, colhidas em diferentes épocas e submetidas a tratamentos térmicos e bioquímicos

O estudo objetivou o estabelecimento de um método efetivo e satisfatório do controle do dano de frio em limas-ácidas. Os frutos colhidos no município de Boa Vista-RR, 140 e 150 dias após a floração, apresentaram valores médios de 7,9 e 8,2 ºBrix; 6,3 e 6,0 mL de ácido cítrico.100mL de polpa-1 e pH de 2,8 e 3,0, respectivamente, nas duas colheitas. Após cada colheita, os frutos foram levados ao laboratório de Fitotecnia/UFRR, onde foram selecionados, limpos e submetidos aos tratamentos: T1 - controle; T2, T3 e T4 - condicionamento a 35ºC, por 6, 12 e 24 horas, respectivamente; T5 - aquecimento intermitente a 20ºC, por 8 horas, após 5 e 10 dias a 1ºC; T6 - aquecimento intermitente a 20ºC, por 8 horas, após 10 e 20 dias a 1ºC; T7 - ethephon a 1.500 mg.L-1; T8 - ethephon a 3.000 mg.L-1. Os tratamentos T9 ao T16, diferenciaram-se dos tratamentos T1 a T8, apenas, na data da colheita (10 dias após a primeira). O experimento foi avaliado a cada 15 dias, durante 75 dias, a 1 ± 0,5 ºC e 92 ± 5 % de UR, quanto ao dano de frio, aspecto visual, perda de massa fresca, sólidos solúveis (SS), acidez titulável (AT), SS/AT (ratio - RT), clorofila total e ácido ascórbico. O atraso na colheita não proporcionou efeito significativo algum. Todos os tratamentos, à exceção do controle e do aquecimento intermitente aos 10 e 20 dias, foram eficientes no controle do dano de frio. No entanto, o tratamento químico e o condicionamento térmico aceleraram precocemente o metabolismo dos frutos, principalmente no que concerne à perda de massa fresca e ao aspecto visual. O maior teor de clorofila total e de ácido ascórbico, bem como o melhor aspecto visual, a não-incidência de podridões e a menor perda de massa fresca foram detectadas nos frutos submetidos ao aquecimento intermitente aos 5 e 10 dias. Os SS, AT e RT estavam dentro dos padrões de qualidade e não variaram estatisticamente entre os tratamentos.

Whydration effects on DNA double helix stability modulates ligand binding to natural DNA in response to changes in water activity

In this work we present evidence that water molecules are actively involved on the control of binding affinity and binding site discrimination of a drug to natural DNA. In a previous study, the effect of water activity (a(w)) on the energetic parameters of actinomycin-D intercalation to natural DNA was determined using the osmotic stress method (39). This earlier study has shown evidence that water molecules act as an allosteric regulator of ligand binding to DNA via the effect of water activity on the long-range stability of the DNA secondary structure. In this work we have carried out DNA circularization experiments using the plasmid pUC18 in the absence of drugs and in the presence of different neutral solutes to evaluate the contribution of water activity to the energetics of DNA helix unwinding. The contribution of water to these independent reactions were made explicit by the description of how the changes in the free energy of ligand binding to DNA and in the free energy associated with DNA helix torsional deformation are linked to a(w) via changes in structural hydration. Taken together, the results of these studies reveal an extensive linkage between ligand binding affinity and site binding discrimination, and long range helix conformational changes and DNA hydration, This is strong evidence that water molecules work as a classical allosteric regulator of ligand binding to the DNA via its contribution to the stability of the double helix secondary structure, suggesting a possible mechanism by which the biochemical machinery of DNA processing takes advantage of the low activity of water into the cellular milieu.