Custo-efetividade e impacto orçamentário da saxagliptina como terapia adicional à metformina para o tratamento do diabetes mellitus tipo 2 no sistema de saúde suplementar do Brasil

OBJETIVOS: Comparar custos e benefícios clínicos de três terapias adicionais à metformina (MF) para pacientes com diabetes mellitus tipo 2 (DMT2). MÉTODOS: Um modelo de simulação de eventos discretos foi construído para estimar a relação custo-utilidade (custo por QALY) da saxagliptina como uma terapia adicional à MF comparada à rosiglitazona ou pioglitazona. Um modelo de impacto orçamentário (BIM - Budget Impact Model) foi construído para simular o impacto econômico da adoção de saxagliptina no contexto do Sistema Suplementar de Saúde brasileiro. RESULTADOS: O custo de aquisição da medicação para o grupo de pacientes hipotéticos analisados, para o horizonte temporal de três anos, foi de R$ 10.850.185,00, R$ 14.836.265,00 e R$ 14.679.099,00 para saxagliptina, pioglitazona e rosiglitazona, respectivamente. Saxagliptina exibiu menores custos e maior efetividade em ambas as comparações, com economias projetadas para os três primeiros anos de -R$ 3.874,00 e -R$ 3.996,00, respectivamente. O BIM estimou uma economia cumulativa de R$ 417.958,00 com o reembolso da saxagliptina em três anos a partir da perspectiva de uma operadora de plano de saúde com 1 milhão de vidas cobertas. CONCLUSÃO: Da perspectiva da fonte pagadora privada, a projeção é de que o acréscimo de saxagliptina à MF poupe custos quando comparado ao acréscimo de rosiglitazona ou pioglitazona em pacientes com DMT2 que não atingiram a meta de hemoglobina glicada (HbA1c) com metformina em monoterapia. O BIM, para a inclusão de saxagliptina nas listas de reembolso das operadoras de planos de saúde, indicou uma economia significativa para o horizonte de 3 anos.

Synthesis of 15N-enriched urea (CO(15NH2)2) from 15NH3, CO, and S in a discontinuous process

CO(15NH2)2 enriched with the stable isotope 15N was synthesized based on a reaction involving CO, 15NH3, and S in the presence of CH3OH. The method differs from the industrial method; a stainless steel reactor internally lined with polytetrafluoroethylene (PTFE) was used in a discontinuous process under low pressure and temperature. The yield of the synthesis was evaluated as a function of the parameters: the amount of reagents, reaction time, addition of H2S, liquid solution and reaction temperature. The results showed that under optimum conditions (1.36, 4.01, and 4.48 g of 15NH3, CO, and S, respectively, 40 ml CH3OH, 40 mg H2S, 100 ºC and 120 min of reaction) 1.82 g (yield 76.5%) of the compound was obtained per batch. The synthesized CO(15NH2)2 contained 46.2% N, 0.55% biuret, melting point of 132.55 ºC and did not exhibit isotopic fractionation. The production cost of CO(15NH2)2 with 90.0 at. % 15N was US$ 238.60 per gram.

Detection of Genetic characterization of Porcine circovirus 2 (PCV2) in Brazilian wildlife boars

A semi-intensive wildlife boars farm presented a clinical history of high mortality in 70 - 90 days-old pigs (> 50 %). Two 90 days-old animals with weight loss and wasting were necropsied and the samples tested for PCV2 by polymerase chain reaction (PCR). The genetic material of PCV2 was sequenced and classified into the PCV2a genotype together with PCV2 sequences obtained from samples of Poland, Brazil, Slovenia and Greece wild boars.

Underexpression of MMP-2 and its regulators, TIMP2, MT1-MMP and IL-8, is associated with prostate cancer

OBJECTIVE: Extracellular matrix homeostasis is strictly maintained by a coordinated balance between the expression of metalloproteinases (MMPs) and their regulators. The purpose of this study was to investigate whether MMP-2 and its specific regulators, TIMP-2, MT1-MMP and IL-8, are expressed in a reproducible, specific pattern and if the profiles are related to prognosis and clinical outcome of prostate cancer (PCa). MATERIALS AND METHODS: MMP-2, TIMP-2, MT1-MMP and IL-8 expression levels were analyzed by quantitative real-time polymerase chain reaction (qRT-PCR) in freshly frozen malignant and benign tissue specimens collected from 79 patients with clinically localized PCa who underwent radical prostatectomies. The control group consisted of 11 patients with benign prostate hyperplasia (BPH). The expression profile of the MMP-2 and its regulators were compared using Gleason scores, pathological stage, pre-operative PSA levels and the final outcome of the PCa. RESULTS: The analysis of 79 specimens of PCa revealed that MMP-2, TIMP-2, MT1-MMP and IL-8 were underexpressed at 60.0%, 72.2%, 62.0% and 65.8%, respectively, in malignant prostatic tissue in relation to BPH samples. Considering the prognostic parameters, we demonstrated that high Gleason score tumors (> 7) overexpressed MMP-2 (p = 0.048) and TIMP-2 (p = 0.021), compared to low Gleason score tumors (< 7). CONCLUSION: We have demonstrated that MMP-2 and its regulators are underexpressed in PCa. Alternatively, overexpression of MMP-2 and TIMP-2 was related to higher Gleason score tumors. We postulate that alterations in metalloproteinase expression may be important in the control of tissue homeostasis related to prostate carcinogenesis and tumor behavior.

Growth hormone response to growth hormone-releasing peptide-2 in growth hormone-deficient Little mice

OBJECTIVE: To investigate a possible direct, growth hormone-releasing, hormone-independent action of a growth hormone secretagogue, GHRP-2, in pituitary somatotroph cells in the presence of inactive growth hormonereleasing hormone receptors. MATERIALS AND METHODS: The responses of serum growth hormone to acutely injected growth hormone-releasing P-2 in lit/litmice, which represent a model of GH deficiency arising frommutated growth hormone-releasing hormonereceptors, were compared to those observed in the heterozygous (lit/+) littermates and wild-type (+/+) C57BL/6J mice. RESULTS: After the administration of 10 mcg of growth hormone-releasing P-2 to lit/lit mice, a growth hormone release of 9.3±1.5 ng/ml was observed compared with 1.04±1.15 ng/ml in controls (p<0.001). In comparison, an intermediate growth hormone release of 34.5±9.7 ng/ml and a higher growth hormone release of 163±46 ng/ml were induced in the lit/+ mice and wild-type mice, respectively. Thus, GHRP-2 stimulated growth hormone in the lit/lit mice, and the release of growth hormone in vivo may be only partially dependent on growth hormone-releasing hormone. Additionally, the plasma leptin and ghrelin levels were evaluated in the lit/lit mice under basal and stimulated conditions. CONCLUSIONS: Here, we have demonstrated that lit/lit mice, which harbor a germline mutation in the Growth hormone-releasing hormone gene, maintain a limited but statistically significant growth hormone elevation after exogenous stimulation with GHRP-2. The present data probably reflect a direct, growth hormone-independent effect on Growth hormone S (ghrelin) stimulation in the remaining pituitary somatotrophs of little mice that is mediated by growth hormone S-R 1a.

A clinical comparison between DisCoVisc and 2% hydroxypropylmethylcellulose in phacoemulsification: a fellow eye study

OBJECTIVE: This study sought to compare the effects and outcomes of two ophthalmic viscosurgical devices, 1.6% hyaluronic acid/4.0% chondroitin sulfate and 2.0% hydroxypropylmethylcellulose, during phacoemulsification. METHODS: This prospective, randomized clinical trial comprised 78 eyes (39 patients) that received phacoemulsification performed by the same surgeon using a standardized technique. Patients were randomly assigned to receive either 1.6% hyaluronic acid/4.0% chondroitin sulfate or 2.0% hydroxypropylmethylcellulose on the first eye. The other eye was treated later and received the other viscoelastic agent. Preoperative and postoperative examinations (5, 24 and 48 hours; 7 and 14 days; 3 and 6 months) included measurements of the total volume of the ophthalmic viscosurgical device, ultrasound and washout times to completely remove the ophthalmic viscosurgical device, intraocular pressure, central corneal thickness and best-corrected visual acuity. The corneal endothelial cell count was measured at baseline and at six months postoperatively. ClinicalTrials.gov: NCT01387620. RESULTS: There were no statistically significant differences between groups in terms of cataract density or ultrasound time. However, it took longer to remove 2.0% hydroxypropylmethylcellulose than 1.6% hyaluronic acid/ 4.0% chondroitin sulfate, and the amount of viscoelastic material used was greater in the 2.0% hydroxypropylmethylcellulose group. In addition, the best-corrected visual acuity was significantly better in the hyaluronic acid/ chondroitin sulfate group, but this preferable outcome was only observed at 24 hours after the operation. There were no statistically significant differences between the two ophthalmic viscosurgical devices regarding the central corneal thickness or intraocular pressure measurements at any point in time. The corneal endothelial cell count was significantly higher in the hyaluronic acid/chondroitin sulfate group. CONCLUSION: The ophthalmic viscosurgical device consisting of 1.6% hyaluronic acid/4.0% chondroitin sulfate was more efficient during phacoemulsification and was easier to remove after IOL implantation than 2.0% hydroxypropylmethylcellulose. In addition, the corneal endothelial cell count was significantly higher following the use of hyaluronic acid/chondroitin sulfate than with hydroxypropylmethylcellulose, which promoted an improved level of corneal endothelium protection.

Surgical approach to medullary thyroid carcinoma associated with multiple endocrine neoplasia type 2

We briefly review the surgical approaches to medullary thyroid carcinoma associated with multiple endocrine neoplasia type 2 (medullary thyroid carcinoma/multiple endocrine neoplasia type 2). The recommended surgical approaches are usually based on the age of the affected carrier/patient, tumor staging and the specific rearranged during transfection codon mutation. We have focused mainly on young children with no apparent disease who are carrying a germline rearranged during transfection mutation. Successful management of medullary thyroid carcinoma in these cases depends on early diagnosis and treatment. Total thyroidectomy should be performed before 6 months of age in infants carrying the rearranged during transfection 918 codon mutation, by the age of 3 years in rearranged during transfection 634 mutation carriers, at 5 years of age in carriers with level 3 risk rearranged during transfection mutations, and by the age of 10 years in level 4 risk rearranged during transfection mutations. Patients with thyroid tumor >5 mm detected by ultrasound, and basal calcitonin levels >40 pg/ml, frequently have cervical and upper mediastinal lymph node metastasis. In the latter patients, total thyroidectomy should be complemented by extensive lymph node dissection. Also, we briefly review our data from a large familial medullary thyroid carcinoma genealogy harboring a germline rearranged during transfection Cys620Arg mutation. All 14 screened carriers of the rearranged during transfection Cys620Arg mutation who underwent total thyroidectomy before the age of 12 years presented persistently undetectable serum levels of calcitonin (<2 pg/ml) during the follow-up period of 2-6 years. Although it is recommended that preventive total thyroidectomy in rearranged during transfection codon 620 mutation carriers is performed before the age of 5 years, in this particular family the surgical intervention performed before the age of 12 years led to an apparent biochemical cure.

Steel fibre reinforced concrete pipes. Part 2: numerical model to simulate the crushing test

This paper is part of an extensive work about the technological development, experimental analysis and numerical modeling of steel fibre reinforced concrete pipes. The first part ("Steel fibre reinforced concrete pipes. Part 1: technological analysis of the mechanical behavior") dealt with the technological development of the experimental campaign, the test procedure and the discussion of the structural behavior obtained for each of the dosages of fibre used. This second part deals with the aspects of numerical modeling. In this respect, a numerical model called MAP, which simulates the behavior of fibre reinforced concrete pipes with medium-low range diameters, is introduced. The bases of the numerical model are also mentioned. Subsequently, the experimental results are contrasted with those produced by the numerical model, obtaining excellent correlations. It was possible to conclude that the numerical model is a useful tool for the design of this type of pipes, which represents an important step forward to establish the structural fibres as reinforcement for concrete pipes. Finally, the design for the optimal amount of fibres for a pipe with a diameter of 400 mm is presented as an illustrating example with strategic interest.

Proposta di un modello organizzativo aziendale per una efficace risposta agli incidenti informatici alla luce degli standard ISO/IEC 27035:2011 e 27037:2012

L'obiettivo di questo lavoro è quello di fornire una metodologia operativa, esposta sotto forma di modello organizzativo strutturato per casi, che le aziende possono utilizzare per definire le azioni immediate di risposta da intraprendere al verificarsi di un evento informatico di sicurezza, che potrebbe trasformarsi, come vedremo, in incidente informatico di sicurezza. La strutturazione di questo modello si basa principalmente su due standard prodotti dall'ISO/IEC ed appartenenti alla famiglia 27000, che delinea il sistema di gestione della sicurezza delle informazioni in azienda e che ha come scopo principale la protezione di riservatezza, integrità e disponibilità dei dati in azienda. Il contenuto di tali standard non può però prescindere dagli ordinamenti giuridici di ogni paese in cui vengono applicati, motivo per cui all'interno del lavoro sono stati integrati i riferimenti alle normative di rilevante interesse, soprattutto quelle collegate alla privacy e ai casi presi in esame all'interno del modello sviluppato. In prima battuta vengono quindi introdotti gli standard di riferimento, illustrati all'interno del Capitolo 1, proseguendo poi con la descrizione di concetti fondamentali per la strutturazione del modello organizzativo, come sicurezza informatica, incident response e informatica forense, che vengono esposti nel Capitolo 2. Nel Capitolo 3 vengono invece descritti gli aspetti normativi in merito alla privacy dei dati aziendali, dettagliando anche le motivazioni che portano alla creazione del modello organizzativo obiettivo di questo lavoro. Nel Capitolo 4 viene illustrato il modello organizzativo proposto, che presenta una struttra per casi e contiene una analisi dei casi più rilevanti dal punto di vista del business aziendale. Infine, nel Capitolo 5 vengono descritte le caratteristiche e le funzionalità di un software sviluppato sotto forma di Windows Service, nato in seguito a delle considerazioni basate sulle analisi di rischio svolte nel Capitolo 4.

Kinetische Studien zur OH-Bildung über die Reaktionen von HO 2 mit organischen Peroxyradikalen

Es wurde untersucht, wie sich das Substitutionsmuster organischer Peroxyradikale (RO2) auf die Ratenkonstante k1 und die Verzweigungsverhältnisse α, β und γ der Reaktionen von RO2 mit HO2 auswirkt. Die Effekte der Deuterierung von HO2 wurden ebenfalls studiert. Für zwei RO2 wurde zusätzlich das UV-Absorptionsspektrum bestimmt.rnrn αrnRO2 + HO2 → RO + OH + O2 R1arnrn βrn → RO2H + O2 R1brnrn γrn → ROH + O3 R1crnrnIn dieser Arbeit wurde ein neues Experiment aufgebaut. Für die direkte und zeitaufgelöste Messung der OH-Konzentration wurde das Verfahren der Laser-induzierten Fluoreszenz angewendet. Die Radikalerzeugung erfolgte mittels gepulster Laserphotolyse, wodurch unerwünschte Nebenreaktionen weitgehend unterdrückt werden konnten. Mittels transienter Absorptionsspektroskopie konnten die Menge der photolytisch erzeugten Radikale bestimmt und die Ozonbildung über R1c quantifiziert werden. Für die Auswertung wurden kinetische Modelle numerisch an die Messdaten angepasst. Um die experimentellen Unsicherheiten abzuschätzen, wurde ein Monte-Carlo-Ansatz gewählt.rnrnk1 und α reagieren sehr empfindlich auf Veränderungen des RO2-Substitutionsmusters. Während sich eine OH-Bildung für das unsubstituierte C2H5O2 (EtP) mit α EtP ≤ 5 % nicht nachweisen lässt, stellt R1a bei den α-Oxo-substituierten H3CC(O)O2 (AcP) und HOCH2C(O)O2 (HAP) mit α AcP = (63 ± 11) % bzw. α HAP = (69 ± 12) % den Hauptkanal dar. Wie die mit α HEP = (10 ± 4) % geringfügige OH-Bildung bei HOC2H4O2 (HEP) zeigt, nimmt die OH-Gruppe in β-Stellung weniger Einfluss auf den Wert von α als die Oxogruppe in α-Stellung. Bei der Erzeugung α-Oxo-substituierter RO2 kann ebenfalls OH entstehen (R+O2→RO2/OH). Die Druckabhängigkeit dieser OH-Quelle wurde mit einem innovativen Ansatz bestimmt. Mit γ AcP = (15+5-6) % bzw. γ HAP = (10+2-3) % lässt sich für die Reaktionen der α-Oxo-substituierten RO2 eine erhebliche Ozonbildung nachweisen. Durch die Einführung der α-Oxogruppe steigt k1 jeweils um 1,3 • 10-11 cm3s-1 an, der Effekt der β-Hydroxygruppe ist halb so groß (k1 AcP = (2,0 ± 0,4) • 10-11 cm3s-1, k1 HAP = (2,6 ± 0,4) • 10-11 cm3s-1). Das Verzweigungsverhältnis α steigt weiter, wenn das HO2 deuteriert wird (α AcP,iso = (80 ± 14) %, k1 AcP,iso = (2,1 ± 0,4) • 10-11 cm3s-1). Vergleiche mit älteren Studien zeigen, dass die OH-Bildung über R1a bislang deutlich unterschätzt worden ist. Die möglichen Ursachen für die Unterschiede zwischen den Studien werden ebenso diskutiert wie die Hintergründe der beobachteten Substituenteneffekte.

Relevance of In-vitro Tests of Adhesive and Composite Dental Materials. A Review in 3 Parts. Part 2: Non-standardized tests of composite materials

Summary The first part of this review examined ISO approval requirements and in vitro testing. In the second part, non-standardized test methods for composite materials are presented and discussed. Physical tests are primarily described. Analyses of surface gloss and alterations, as well as aging simulations of dental materials are presented. Again, the importance of laboratory tests in determining clinical outcomes is evaluated. Differences in the measurement protocols of the various testing institutes and how these differences can in?uence the results are also discussed. Because there is no standardization of test protocols, the values determined by different institutes cannot be directly compared. However, the ranking of the tested materials should be the same if a valid protocol is applied by different institutes. The modulus of elasticity, the expansion after water sorption, and the polishability of the material are all clinically relevant, whereas factors measured by other test protocols may have no clinical correlation. The handling properties of the materials are highly dependent on operators' preferences. Therefore, no standard values can be given.

Structure/affinity studies in the bicyclo-DNA series: Synthesis and properties of oligonucleotides containing bcen-T and iso-tricyclo-T nucleosides

We present the synthesis of the two novel nucleosides iso-tc-T and bcen-T, belonging to the bicyclo-/tricyclo-DNA molecular platform. In both modifications the torsion around C6’–C7’ within the carbocyclic ring is planarized by either the presence of a C6’–C7’ double bond or a cyclopropane ring. Structural analysis of these two nucleosides by X-ray analysis reveals a clear preference of torsion angle γ for the gauche orientation with the furanose ring in a near perfect 2’-endo conformation. Both modifications were incorporated into oligodeoxynucleotides and their thermal melting behavior with DNA and RNA as complements was assessed. We found that the iso-tc-T modification was significantly more destabilizing in duplex formation compared to the bcen-T modification. In addition, duplexes with complementary RNA were less stable as compared to duplexes with DNA as complement. A structure/affinity analysis, including the already known bc-T and tc-T modifications, does not lead to a clear correlation of the orientation of torsion angle γ with DNA or RNA affinity. There is, however, some correlation between furanose conformation (N- or S-type) and affinity in the sense that a preference for a 3’-endo like conformation is associated with a preference for RNA as complement. As a general rule it appears that Tm data of single modifications with nucleosides of the bicyclo-/tricyclo-DNA platform within deoxyoligonucleotides are not predictive for the stability of fully modified oligonucleotides.

Síndrome de Iso Kikuchi. Reporte de dos casos

We report 2 cases of Iso Kikuchi syndrome: A new born female patient with a 21 days history and a 62 year-old male. We present two cases of this unusual congenital abnormality of the nails at the extremes of life.