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Efforts to characterize HIV-1 polymorphism and anti-HIV immune response are being made in areas where anti-HIV/AIDS vaccines are to be employed. Anti-HIV-1 humoral immune response is being studied in infected individuals resident in Rio de Janeiro, in distinct cohorts involving recent seroconvertors, pregnant women or intravenous drug users (IDU). Comparative analyses of specificity of antibody response towards epitopes important for anti-HIV-1 immune response indicate quantitative differences between cohorts, with an exceptionally strong response in IDUs and weakest response in pregnant women. However, a comparative analysis between pregnant women cohorts from Rio de Janeiro and Rio Grande do Sul indicated an even lower response (with exception of the anti-V3-C clade peptide recognition) for the southern cohort. Studies analysing the immune function of the humoral response indicate a quite elevated occurrence of antibodies capable of neutralizing heterologous primary HIV-1 isolates from Rio de Janeiro. Attempts to correlate seroreactivity with HIV-1 neutralization with respect to HIV-1 polymorphism were not very successfull: while the Brazilian B clade B" variant could be recognized by binding assays, no significant distinction of HIV-1 clades/variants was observed in viral neutralization assays.

This article, published in the journal Endoscopy, discusses the use of Macroscopic On-Site Evaluation (MOSE) in endoscopic ultrasound fine needle biopsy (EUS-FNB) procedures. The study aimed to assess the performance of MOSE in EUS-FNB using a specific type of needle. The researchers conducted a retrospective cohort study, including patients who underwent EUS-FNB with a 22G Franseen needle. They found that MOSE utilization during EUS-FNB was associated with a high diagnostic yield, and fragments of 4 mm or larger were more likely to provide a diagnostic cytology. The study suggests that MOSE can enhance the efficacy of EUS-FNB procedures. [Extracted from the article]

The anatomopathological examination of the surgical specimen showed a moderately differentiated ADC in intestinal-type intraductal papillary neoplasm of the bile duct (IPNB) (pT1N0R0) (Fig. An abdominal computed tomography followed by magnetic resonance cholangiopancreatography (MRCP) showed common bile duct (CBD) stenosis, without mural thickening or intraluminal mass, and intrahepatic and extrahepatic duct dilation. IPNBs are rare neoplasms arising from the bile duct considered to be an important precursor of cholangiocarcinoma. [Extracted from the article]

The relationship between mitochondrial metabolism and cell viability and differentiation in stem cells (SCs) remains poorly understood. In the present study, we compared mitochondrial physiology and metabolism between P19SCs before/after differentiation and present a unique fingerprint of the association between mitochondrial activity, cell differentiation and stemness. In comparison with their differentiated counterparts, pluripotency of P19SCs was correlated with a strong glycolytic profile and decreased mitochondrial biogenesis and complexity: round, low-polarized and inactive mitochondria with a closed permeability transition pore. This decreased mitochondrial capacity increased their resistance against dichloroacetate. Thus, stimulation of mitochondrial function by growing P19SCs in glutamine/pyruvate-containing medium reduced their glycolytic phenotype, induced loss of pluripotent potential, compromised differentiation and became P19SCs sensitive to dichloroacetate. Because of the central role of this type of SCs in teratocarcinoma development, our findings highlight the importance of mitochondrial metabolism in stemness, proliferation, differentiation and chemoresistance. In addition, the present work suggests the regulation of mitochondrial metabolism as a tool for inducing cell differentiation in stem line therapies. [ABSTRACT FROM AUTHOR]

Abstract: Background: It is uncertain whether donor-transmitted coronary artery disease (DTCAD) affects heart transplant (HT) recipients. Methods: This retrospective analysis includes records of all patients who underwent a HT at our center over an 8-year period, who survived for at least 1 month, and who were examined by coronary angiography within 2 months post-HT. We distinguished angiographically from keep ultrasonography (IVUS) detected DTCAD. Major adverse cardiovascular events (MACE) comprised death, myocardial infarction, unstable angina, coronary revascularization, and admission because of heart failure not due to an acute rejection episode. Results: Among the 171 patients of mean age 53 ± 13 years and including 83% men, 65 (38%) were evaluated by IVUS. Donors were aged 40 ± 14 years (range = 14–73). Angiographic DTCAD affected seven patients (4.1%), and IVUS-detected DTCAD, 35 (53.8% of those examined by IVUS). DTCAD donors were older than non-DTCAD donors, by an average of 13 years (P = .001) for angiographic DTCAD and 18 years (P < .0001) for IVUS-detected DTCAD. Two patients underwent percutaneous revascularization upon detection of angiographic DTCAD. The angiographic- and IVUS-detected DTCAD groups did not differ significantly from the corresponding non-DTCAD groups as regards MACE incidence during 54 ± 41 and 38 ± 20 months follow-up, respectively. Cox regression analysis with adjustment for relevant confounders confirmed that IVUS-detected DTCAD was not a predictor of MACE (hazard ratio 1.2, 95% confidence interval 0.2–8.1). Conclusions: Among HT patients surviving ≥ 1 month, angiographic- and IVUS-detected DTCAD showed prevalences of <10% and >50%, respectively. Neither detection method was associated with a greater long-term incidence of MACE. [ABSTRACT FROM AUTHOR]

In this study, we evaluated patients with pulmonary arterial hypertension (PAH) and impaired right ventricular function. We used cardiac MRI for the detection of myocardial delayed enhancement (MDE) and its possible association with other clinical variables. 20 patients (6 males and 14 females, aged 44.5±11 years; 15 New York Heart Association class III, 5 class IV) with known PAH (13 idiopathic, 7 resulting from chronic pulmonary embolism) were evaluated for the detection of MDE. Short-axis cine images of the heart were made for ventricular function assessment using a steady-state free precession sequence. For MDE evaluation, a short-axis phase-sensitive inversion recovery sequence was performed 10 min after intravenous administration of 0.2 mmol kg-1 gadodiamide. Right ventricle (RV) systolic dysfunction, RV enlargement and RV hypertrophy were present in 20 patients (RV ejection fraction, 21.5±7.2%; RV diastolic diameter, 5.97±0.79 cm; RV wall thickness, 0.73±0.10 cm). 13 of the 20 patients (65%) were positive for MDE (10 anterior, 12 inferior). All 13 positive patients with MDE demonstrated small hyperintense areas at the insertion points of the RV free wall in the interventricular septum. We found no significant correlation between MDE and ejection fraction or other haemodynamic variables. In this study, MDE correlated positively only with the duration of disease. We found that septal MDE can be present in patients with PAH and impaired ventricular function. However, further studies are necessary to investigate this possible association and its prognostic implication. [ABSTRACT FROM AUTHOR]

Historically, the administrative abilities have been more valued than the leadership abilities in the health services. Actually there is a crucial necessity for development of leadership in nursing. The article describes the steps followed for the construction and validation of a questionnaire that can assess the type of leadership developed by Nurses-chiefs: Questionnaire of Leadership in Nursing (QLN). This questionnaire appeared based on scale LPC (least prefered coworker) and on Fiedler Contingence Model -- adjusting then to health area and in special nursing. After a bibliography research of important authors in this field their psychometric proprieties were analyzed and verified. The study was realized with a sample constituted by 114 nurses -- chiefs of Hospitals 'S.A.' from center of country. The QLN is composed by 2 scales: LPC Scale and Situational Influence Control Scale and the last one is divided in 3 subscales (team relationships scale, care structure scale and formal power scale). Considering their psychometrics characteristics the questionnaire presents a strong internal consistency (LPC Scale -- Cronbach alpha of 0,762 and standard alpha of 0,947; Situational influence control scale ---- Cronbach alpha of 0,766 and standard alpha of 0,777). [ABSTRACT FROM AUTHOR]

This paper presents the results of clinical trials performed using two upper-limb orthotic devices for tremor suppression, developed under the Fifth Framework Project DRIFTS (Contract QLK6-CT-2002-00536). The orthoses were tested on six subjects presenting various aetiological forms of tremor. Two different strategies of tremor reduction were investigated: viscous friction and notch filtering. The results obtained from the trials suggest that ambulatory and controllable mechanical suppression of tremor by orthotic means is a feasible intervention. The degree of tremor reduction is dependent upon the power associated with tremor. Expected reduction of tremor can be as high as 98% in severe cases. There are hints that for many persons suffering with tremor active mechanical suppression of tremor can produce a reinforcing feedback: when participants perceived and initial reduction of tremor due to the orthosis, they exhibited a further spontaneous reduction of the tremor. There are also indications in some participants that tremor can migrate from a controlled joint to other free joints. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Cardiac allograft vasculopathy (CAV) remains a major impediment to long-term survival after heart transplantation (HT). Limited data exist regarding the impact of coronary revascularization in these patients. Objective: To evaluate the outcomes of revascularization procedures in patients with CAV compared with patients who did not undergo revascularization. Methods: Retrospective analysis of 249 patients who underwent HT at our center between June 1998 and December 2009 and who were examined by coronary angiography after HT. We included patients with moderate or severe CAV according to the International Society for Heart and Lung Transplantation (ISHLT) nomenclature to evaluated outcomes after revascularization or diagnostic angiography. Major adverse cardiovascular events (MACE) comprised death, acute coronary syndrome, coronary revascularization, admission because of heart failure not due to an acute rejection episode, and cardiac retransplantation. Results: Moderate or severe CAV was detected in 43 patients. Twelve (27.9%) underwent coronary revascularization: eight percutaneous interventions and four bypass surgeries. Indications for revascularization were symptomatic ischemia or noninvasive evidence of ischemia (n = 6, 14.0%) or high-risk asymptomatic CAV (n = 6; 14.0%), namely, lesions located in the left main or proximal anterior descending arteries or multivessel disease with left ventricular dysfunction. The remaining 31 (72.1%), who did not undergo revascularization showed an absence of ischemia during exercise echocardiography (n = 11; 25.6%) or diffuse disease not amenable to revascularization (n = 20; 46.5%). During a mean follow-up of 3.0 ± 2.4 years, MACE occurred in three revascularized patients (25.0%), in one with absence of stress-induced ischemia (9.1%) and in 13 with nonrevascularizable disease (65%; P = .012). Conclusions: Revascularization procedures were effective in HT patients with evidence of ischemia or high-risk CAV. Patients with absence of stress-induced ischemia have a good prognosis without revascularization. On the other hand, diffuse nonrevascularizable CAV is associated with a poor prognosis. [Copyright &y& Elsevier]

The article offers information on the Portuguese Society of Digestive Endoscopy (SPED), which is aimed to promote the development and monitoring of training activities in the field of Digestive Endoscopy.

Abstract Background Robot-mediated therapies offer entirely new approaches to neurorehabilitation. In this paper we present the results obtained from trialling the GENTLE/S neurorehabilitation system assessed using the upper limb section of the Fugl-Meyer (FM) outcome measure. Methods We demonstrate the design of our clinical trial and its results analysed using a novel statistical approach based on a multivariate analytical model. This paper provides the rational for using multivariate models in robot-mediated clinical trials and draws conclusions from the clinical data gathered during the GENTLE/S study. Results The FM outcome measures recorded during the baseline (8 sessions), robot-mediated therapy (9 sessions) and sling-suspension (9 sessions) was analysed using a multiple regression model. The results indicate positive but modest recovery trends favouring both interventions used in GENTLE/S clinical trial. The modest recovery shown occurred at a time late after stroke when changes are not clinically anticipated. Conclusion This study has applied a new method for analysing clinical data obtained from rehabilitation robotics studies. While the data obtained during the clinical trial is of multivariate nature, having multipoint and progressive nature, the multiple regression model used showed great potential for drawing conclusions from this study. An important conclusion to draw from this paper is that this study has shown that the intervention and control phase both caused changes over a period of 9 sessions in comparison to the baseline. This might indicate that use of new challenging and motivational therapies can influence the outcome of therapies at a point when clinical changes are not expected. Further work is required to investigate the effects arising from early intervention, longer exposure and intensity of the therapies. Finally, more function-oriented robot-mediated therapies or sling-suspension therapies are needed to clarify the effects resulting from each intervention for stroke recovery.

Urgent heart transplantation (HT) on short-term mechanical circulatory support (MCS) is increasing and survival is closely related to the patient's recovery from multiorgan failure (MOF). We present a case of urgent HT after 6 weeks of short-term MCS where inter-centre coordination and fine-tuned complication management were key to success. A 56-year-old male was admitted to a tertiary hospital with ST-elevation myocardial infarction. Emergent angiography showed 3-vessel disease with occlusion of the right coronary artery. During the procedure, the patient suffered cardiac arrest with refractory ventricular fibrillation and profound cardiogenic shock. Peripheral veno-arterial ECMO was implanted and subsequent revascularization of right and left anterior coronary artery was performed. After angiography an Impella® CP was implanted through the femoral artery to decrease left ventricle (LV) afterload. Three days after MCS support, without evidence of neurological deficit nor MOF and no cardiac recovery the patient was transferred to the HT center, 135 km far away, for HT evaluation. No absolute contraindication for transplantation was identified, so the patient was included in the HT urgent list 3 days after admission to the HT center. During ECMO+Impella® support the patient developed significant hemolysis, LV distension and pulmonary edema, therefore on day 15 on the HT waiting list, MCS was changed to a left CentriMag® by a minimally invasive approach (LV apex-left axillary artery). Nineteen days later, HT was performed by bicaval technique without major complications. Acute kidney failure after HT requiring 4-day hemodiafiltration therapy and serratia marcescens bacteremia were the 2 main complications. The patient was discharged to the cardiology ward 61 days after admission. The post-transplant clinical course was satisfactory with a progressive clinical improvement and only one treated episode of moderate acute cellular rejection (2R, ISHLT) without allograft dysfunction. The patient was successfully discharged 91 days after initial admission. Short-term MCS after cardiac arrest and profound shock allows recovery from MOF, but maintaining it without life-threatening complications during prolonged HT waiting times requires careful management and excellent coordination between "Hub and Spoke" centres. [ABSTRACT FROM AUTHOR]