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Aim: This randomized controlled clinical trial aimed to evaluate the contribution of family social support to the clinical/metabolic control of people with type 2 diabetes mellitus., Background: Diabetes mellitus is a chronic disease that requires continuous care in order for individuals to reach glycemic control, the primordial goal of treatment. Family social support is essential to the development of care skills and their maintenance. However, there are few studies that investigate the contribution of family social support to diabetes control., Methods: The study was developed between June 2011 and May 2013, and included 164 people who were randomized using simple randomization. The intervention group differed from the control group in that it included a family caregiver, who was recognized by the patient as a source of social support. The educational interventions received by people with diabetes mellitus were used as the basis of the education provided through telephone calls to patients' family members and caregivers, and their purpose was to encourage dialogue between the patients and their relatives about the topics related to diabetes., Results: Regarding the clinical impact, the results showed that there was a greater reduction in blood pressure and glycated hemoglobin in the intervention group than in the control group, showing a positive effect on the control of the disease., Conclusions: Families should be incorporated into the care of people with diabetes mellitus and especially in health care programs, in particular those that can promote different forms of social support to strengthen the bond between family members., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Introduction: The HIV lipodystrophy syndrome is characterized by changes in metabolism, and body composition that increase cardiovascular risk of people living with HIV/AIDS (PLWHA) using highly active antiretroviral therapy (HAART)., Objective: To assess the prevalence of lipodystrophy and changes in lipid and glucose metabolism in PLWHA in use of HAART., Methods: For the anthropometric evaluation we measured weight, height and abdominal circumference (AC). For the lipodystrophy evaluation we conducted physical examination (subjective) and the (objective) examination of absorptiometry with X-ray dual energy (DEXA) by fat mass ratio (FMR). We also conducted lipid profile tests and fasting glucose and used the criteria suggested by The National Cholesterol Education Program III for metabolic disorders classification., Results: The final sample consisted of 262 patients with a mean age of 44.3 ± 10.2 years. Lipodystrophy, according to the physical examination, was present in 47.7% (95%CI 41.7 - 53.8) of patients, while the prevalence using FMR (DEXA) was 40.8% (95%CI 33.1 - 48.5). Most (53.0%; 95%CI 47.0 - 59.1) of the patients showed increased abdominal adiposity according to AC. The most prevalent metabolic alterations were reduced HDL (67.6%; 95%CI 61.9 - 73.2) and hypertriglyceridemia (55.7%; 95%CI 49.7 - 61.7)., Conclusion: The high prevalence of lipodystrophy and changes in lipid and glucose metabolism show the importance of early intervention in this group of patients to prevent cardiovascular complications.

Metabolic stress is a physiological process that occurs during exercise in response to low energy that leads to metabolite accumulation [lactate, phosphate inorganic (Pi) and ions of hydrogen (H + )] in muscle cells. Traditional exercise protocol ( i.e ., Resistance training) has an important impact on the increase of metabolite accumulation, which influences hormonal release, hypoxia, reactive oxygen species (ROS) production and cell swelling. Changes in acute exercise routines, such as intensity, volume and rest between sets, are determinants for the magnitude of metabolic stress, furthermore, different types of training, such as low-intensity resistance training plus blood flow restriction and high intensity interval training, could be used to maximize metabolic stress during exercise. Thus, the objective of this review is to describe practical applications that induce metabolic stress and the potential effects of metabolic stress to increase systemic hormonal release, hypoxia, ROS production, cell swelling and muscle adaptations., Competing Interests: Conflict-of-interest statement: None.

To evaluate the effects of the ambient climatic conditions in lichen vitality along some well oriented transect in different altitudes, lichen transplants of Parmotrema bangii were exposed approximately every 250 m starting from 50 to 1500 m during a 1-year period in 3 transects along Pico mountain at Azores; electric conductivity of leachates, elemental concentrations, and the ambient conditions such as temperature, precipitation, humidity, and altitude were the compared parameters. According to the obtained values of electric conductivity, it is credible to consider that vitality was not seriously affected under different altitudes. In accordance with previous studies, electric conductivity values in this study show high negative correlation with precipitation and humidity. The significantly high differences between minimum and maximum electric conductivity values found along the altitude transect makes that, when comparing elemental concentrations in time or spatial series, it is required a comparison with lichen vitality, because the different vitality stages could induce variability in metal uptake.

Introduction: Familial partial lipodystrophy (FPL) is a rare genetic disorder characterized by selective lack of subcutaneous fat, which is associated with insulin-resistant diabetes. The Dunnigan variety (FPLD2) is caused by several missense mutations in the lamin A/C (LMNA) gene, most of which are typically located in exon 8 at the codon position 482., Objective: The aim of this study was to assess and compare the dietary intake, leisure-time physical activity (LTPA), and biochemical measurements (glucose, A1C, and plasma lipids) in women with FPLD2 and without (control group, CG) and to examine the associations between dietary intake and biochemical measurements (BM)., Methods: LTPA was measured with a questionnaire and metabolic equivalent (MET) hours per week (hours/week) were calculated. Dietary intake by the 3-day recall method and clinical laboratory parameters were collected., Results: Characteristics of women with FPLD2: 35.8 ± 13.9 years, fat mass = 10 ± 2.3 kg and fat free mass = 41.4 ± 4.5 kg (p < 0.05). Women with FPLD2 showed a smaller intake of energy (kcal), lipids, and carbohydrates and a large intake of protein (p < 0.01) compared to CG. Comparing the 2 groups in terms of LTPA, 78% of women with FPLD2 performed insufficient physical activity. In addition, they had a higher levels of glucose, A1C, and triglycerides (TG) and lower levels of high-density lipoprotein (HDL). There was no correlation between dietary intake and biochemical measurements., Conclusions: Women with FPLD2 have a lower intake of energy (kcal), lipids, and carbohydrates and greater changes in biochemical measurements. Because this is a rare disease, future studies are needed with encouragement of the practice of physical activity and of healthy eating habits, preventing the onset of diseases.

Purpose: The aim of this study was to investigate the association between the results of functionality scales and dysphagia severity determined from videofluoroscopy swallowing study (VSS) in post-stroke patients., Methods: A retrospective study of 109 VSS analysis of post-stroke patients. From the exams was collected information on the diagnosis of dysphagia severity and evaluated regarding the swallowing functionality in an independent way by two evaluators., Results: A high number of discrete dysphagia was observed. In one third of dysphagic patients it was noticed the presence of tracheal aspiration. There was a significant association between the scores of Functional Oral Intake Scale and Dysphagia Outcome and Severity Scale in post-stroke patients which means when the swallowing is highly compromised, the level of intake by mouth will be smaller according to the evaluators' analysis (p < 0.001)., Conclusion: There is an association between the scales and it can be used as evaluative benchmarks and in the management of clinical Speech Pathology intervention.

The objective of this study was to evaluate markers of oxidative stress in the brains of rats exposed to lead acetate (Pb(C 2 H 3 O 2 ) 2 ), either associated or not associated with ferrous sulfate (FeSO 4 ). A total of 36 weaning rats (Rattus norvegicus) were divided into 6 groups of six animals and exposed to lead acetate for six weeks. In the control group (control), the animals received deionized water. The Pb260 and Pb260 + Fe received 260 µM lead acetate, and the Pb1050 and Pb1050 + Fe received 1050 µM lead acetate. The Pb260 + Fe and Pb1050 + Fe were supplemented with 20 mg of ferrous sulfate/Kg body weight every 2 days. Group Fe received deionized water and ferrous sulfate. The rat brains were collected to analyze the enzymatic activity of catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), and the concentration of reduced glutathione (GSH), lipid peroxidation (TBARS), and total antioxidant substance (TAS) (DPPH • technique). The activity of SOD and GPx in the experimental groups decreased compared to the control, together with the concentration of GSH (p < 0.05). For CAT analysis, SOD tended to increase in concentration in the experimental groups without a concomitant exposure to FeSO 4 , whereas GPx showed a slight tendency to increase in activity compared to the control. For TAS-DPPH • , there was a decrease in the experimental groups (p < 0.05). According to the results, SOD, GPx, and GSH were affected by lead acetate and exposure to ferrous sulfate changed this dynamic. However, further studies are needed to verify whether ferrous sulfate acts as a protectant against the toxic effects of lead. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 813-822, 2017., (© 2016 Wiley Periodicals, Inc.)

Introduction: The societal and economic impact of ischemic stroke in young adults is considerable. The etiological investigation of ischemic stroke in this population is also challenging., Objective: To describe the characteristics of young patients with ischemic stroke admitted to a neurological rehabilitation program in Brazil., Methods: This transversal retrospective study analyzed data from the electronic health records of 134 patients aged 18 to 45 years with ischemic stroke admitted from 2008 to 2012., Results: The average patient age at the time of ictus was 33 years; 56% of the subjects were female, and 29.3% had undetermined etiologies of stroke, on the basis of both TOAST and SSS TOAST criteria. Further, 48.7% of the subjects had a known vascular risk factor, which was arterial hypertension in most cases. The results of thrombophilia testing were positive in 13.7% of patients, but in only 3.7% of patients, thrombophilia was determined to be the causal mechanism of the stroke. There was a significant association between thrombophilia and patent foramen ovale, but no significant association was found between thrombophilia and arterial dissection. Among the patients with artery dissections, 46% had a history of trauma, which was statistically significant., Conclusions: Etiological diagnosis of stroke in the young is challenging for clinicians. Hence, a more effective classification scheme, better investigative mechanisms, and correct determination of causal associations in ischemic stroke are needed. Thrombophilia screening should be performed in the presence of relevant clinical signs and/or family history.

Objective: The aim of this study was to evaluate the usefulness of the comfort theory for the clinical nursing care of new mothers., Methods: This is a reflexive-theoretical study conducted in November and December 2014, based on the usefulness criterion proposed in the critical analysis of the Barnum nursing theory., Results: The comfort theory in nursing care for new mothers applied to study analysis revealed that this theory meets the criteria of usefulness because it provides applicable concepts that facilitated the clinical nursing care of women in the postpartum period and helped increase their comfort level. The verification of these concepts showed that the theory can be applied in different settings of clinical care for new mothers., Conclusion: The theory can be used to support and improve clinical nursing care for postpartum women, and help improve puerperal comfort.

This paper aims at providing insight about bromine (Br) cycle in four Portuguese estuaries: Minho, Lima (in the NW coast) and Sado, Mira (in the SW coast). The focus is on their tidal marsh environments, quite distinct with regard to key biophysicochemical attributes. Regardless of the primary bromide (Br - ) common natural source, i.e., seawater, the NW marshes present relatively higher surface soil/sediment Br concentrations than the ones from SW coast. This happens in close connection with organic matter (OM) content, and is controlled by their main climatic contexts. Yet, the anthropogenic impact on Br concentrations cannot be discarded. Regarding [Br] spatial patterns across the marshes, the results show a general increase from tidal flat toward high marsh. Maxima [Br] occur in the upper driftline zone, at transition from highest low marsh to high marsh, recognized as a privileged setting for OM accumulation. Based on the discovery of OM ubiquitous bromination in marine and transitional environments, it is assumed that this Br occurs mainly as organobromine. Analysis of two dated sediment cores indicates that, despite having the same age (AD ~1300), the Caminha salt marsh (Minho estuary) evidences higher Br enrichment than the Casa Branca salt marsh (Mira estuary). This is related to a greater Br storage ability, which is linked to OM build-up and rate dynamics under different climate scenarios. Both cores evidence a fairly similar temporal Br enrichment pattern, and may be interpreted in light of the sun-climate coupling. Thereby, most of the well-known Grand Solar Minima during the Little Ice Age appear to have left an imprint on these marshes, supported by higher [Br] in soils/sediments. Besides climate changes driven by solar activity and impacting marsh Br biogeodynamics, those Br enrichment peaks might also reflect inputs of enhanced volcanic activity covarying with Grand Solar Minima., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Beach sand can harbour pathogenic and opportunistic microorganisms, as well as faecal indicator bacteria that influence directly the bathing water quality. Pathogenic and opportunistic microorganisms often raise concern of exposure during beach related recreational activities. In this work, three different types of sandy beaches (natural basaltic, natural calcareous and artificial calcareous) of the Archipelago of Madeira (Portugal) were sampled for bacterial and fungal contaminants and grain size distribution, during four years (2010-2013). Following an extreme weather event in 2010, the faecal indicator bacteria levels spiked, returning to base levels shortly thereafter. The same phenomenon occurred with fungi, where potentially pathogenic fungi were the dominant group. Yeast-like fungi and dermatophytes were, however, mainly associated to months of higher usage by recreational users. Statistical analysis showed higher contamination of sediment in artificial beaches compared to natural beaches and granulometry and chemical composition of sand did not influence in the microbial loads. Instead, bather density and the influence of coastal protection structures needed to maintain the volume of artificial beach sand regarding the removal potential of wave induced currents are obvious influencing factors., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Mid-Late Holocene environmental changes in the Cantabrian Mountains are a consequence of both climate variability and human activity. A 182cm-long sedimentary sequence was collected from Belbín depression, Western Massif of Picos de Europa (Cantabrian Mountains, NW Spain), in order to reconstruct Holocene environmental dynamics and the factors triggering landscape changes in the area. Using multi-proxy analysis of the uppermost 60cm of the sediments (texture, organic matter content, quartz grains microstructures, charcoal deposition) together with three 14 C AMS dates, a sequence of alternating warmer and colder phases has been inferred for the last ca. 6.7kycalBP. Warm stages are defined by low to moderate chemical weathering of the quartz grain particles with relative increases of the C/N ratio, while colder phases show a moderate to intense physical weathering of the quartz grains and lower C/N ratios. Warmer temperatures were recorded in Belbín area between: 6.7-5, 3.7-3, 2.6-1.1, 0.87-0.51 and since 0.01kycalBP. A colder regime occurred between 5-3.7, 3-2.6, 1.1-0.87 and 0.51 to 0.01kycalBP. The increasing organic matter content during the Late Holocene may be associated with increasing temperatures. The charcoal particles do not show a higher or lower concentration during prevailing colder or warmer conditions, and therefore may be linked to human-induced fire management of the landscape. The most intense period with fire activity occurred between 3.5 and 3kycalBP during the Bronze Age., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Introduction: Nutritional disorders have been reported to be important causal factors that can intensify or cause a painful response in individuals with chronic musculoskeletal pain., Aim: To assess the habitual intake of and the serum and erythrocyte levels of selenium and zinc in patients with chronic myofascial pain., Materials and Methods: A case-control study of 31 patients with chronic myofascial pain (group I) and 31 subjects without pain (group II). Dietary record in five days for assessing food intake were used. The serum and erythrocyte concentrations of selenium and zinc were analyzed using an atomic absorption spectrophotometry. Pain intensity was assessed using a visual analog scale., Results: The group of patients with chronic myofascial pain, compared with the control group, showed a lower erythrocyte concentration of selenium (79.46 ± 19.79 μg/L vs. 90.80 ± 23.12 μg/L; p = 0.041) and zinc (30.56 ± 7.74 μgZn/gHb vs. 38.48 ± 14.86 μgZn/gHb, respectively; p = 0.004). In this study, a compromised food intake of zinc was observed in the majority of the subjects in both groups. The selenium intake was considered to be safe in 80% of the subjects in both groups; however, the likelihood of inadequate intake of this mineral was twice as high in group I (49.5% vs. 24.4%, respectively). In the logistic regression analysis, the erythrocyte concentration of zinc was associated with the presence of pain. In each additional 1 mg of Zn2+ per gram of hemoglobin, a reduction of 12.5% was observed in the risk of the individual having chronic myofascial pain (B = -0.133; adjusted OR = 0.875, 95% CI = 0.803 to 0.954, Wald = 9.187, standard error = 0.044, p = 0.002). Physical inactivity and obesity were noted more commonly in group I compared with the control group., Conclusion: In this study, patients with chronic myofascial pain showed lower intracellular stores of zinc and selenium and inadequate food intake of these nutrients., Competing Interests: The authors have declared that no competing interests exist.

Objective: The goal of this study was evaluate the conicity index (C index) in women and its association with hypertension (SAH) and diabetes mellitus (DM)., Subjects and Methods: This was a cross-sectional study, with 573 women between 20 and 59 years of age. After analysis of clinical and demographic characteristics, anthropometric variables were measured and used to calculate the C index. Plasma glucose and lipid profile were evaluated by standard methods. The analysis of the results was based on logistic regression and the odds ratio (OR) was calculated, which was used to assess the association of the variable outcome with the variable exposure using two logistic regression models that tested the possible influence of the C index in the chance of developing SAH or DM. A confidence interval of 95% was used., Results: In the crude and adjusted models, the OR confirmed the association of the C index with DM and SAH. Compared with women that showed C index p < 75, the risk of women with C index (p ≥ 75) developing DM and SAH was 1.72 and 1.75, respectively. Results demonstrated that the negative impact of age on these associations significantly raised the odds of women having DM and SAH. The high C index was also linked to low HDL-C., Conclusion: The C index is an important tool in estimating the risk of diabetes and hypertension in women. Besides, high C indexes are negatively associated with HDL-C, an important lipid marker related to cardiovascular risk.

Bacteroides fragilis , member from commensal gut microbiota, is an important pathogen associated to endogenous infections and metronidazole remains a valuable antibiotic for the treatment of these infections, although bacterial resistance is widely reported. Considering the need of a better understanding on the global mechanisms by which B. fragilis survive upon metronidazole exposure, we performed a RNA-seq transcriptomic approach with validation of gene expression results by qPCR. Bacteria strains were selected after in vitro subcultures with subinhibitory concentration (SIC) of the drug. From a wild type B. fragilis ATCC 43859 four derivative strains were selected: first and fourth subcultures under metronidazole exposure and first and fourth subcultures after drug removal. According to global gene expression analysis, 2,146 protein coding genes were identified, of which a total of 1,618 (77%) were assigned to a Gene Ontology term (GO), indicating that most known cellular functions were taken. Among these 2,146 protein coding genes, 377 were shared among all strains, suggesting that they are critical for B. fragilis survival. In order to identify distinct expression patterns, we also performed a K-means clustering analysis set to 15 groups. This analysis allowed us to detect the major activated or repressed genes encoding for enzymes which act in several metabolic pathways involved in metronidazole response such as drug activation, defense mechanisms against superoxide ions, high expression level of multidrug efflux pumps, and DNA repair. The strains collected after metronidazole removal were functionally more similar to those cultured under drug pressure, reinforcing that drug-exposure lead to drastic persistent changes in the B. fragilis gene expression patterns. These results may help to elucidate B. fragilis response during metronidazole exposure, mainly at SIC, contributing with information about bacterial survival strategies under stress conditions in their environment.

This study evaluated the impact of orange juice on the bond strength (BS) of dentin bonding systems (DBSs) to enamel surface after simulation with an in situ/ ex vivo erosive cycling. One hundred and ninety two bovine enamel fragments (4x4x2mm) were obtained and randomized regarding superficial microhardness and distributed to palatal devices for 8 volunteers, in three phases (one for each DBS), containing 8 blocks, which were, allocated in 4 pairs. Daily, these pairs were subjected extraorally to the following conditions: CONT- neither erosive nor abrasive challenge; ERO- erosive challenge only; ABR- abrasive challenge only and ERO + ABR- with erosive and abrasive challenges. Erosive cycles (immersion in orange juice, 3 times/day/5 min/5 days) or/and abrasive challenges (electric toothbrush, 3 times/day/1 min/5 days) were performed. After these cycles, all specimens were restored with the adhesive systems Adper Scotchbond Multi Purpose (MP), Adper Single Bond 2 (SB) or Clearfil SE Bond (SE), and the composite resin Filtek Z250. After 7 days, sticks (area ≅1 mm2) were obtained and subjected to the microtensile bond strength test (μTBS) at 0.5 mm/min. Data was statistically analyzed by ANOVA and Tukey tests (a=0.05). Failure modes were determined using a digital microscope (40´). DBS was the only statistical significant factor. SE was the unique DBS not affected in any challenge, whereas MP and SB performed according to the scenario. The adhesive and mixed failures were predominant in all groups. Overall performance suggested that BS to enamel after erosive /abrasive challenged by orange juice was not affected and it was material-dependent.

Introduction: Feeding difficulties in children with cleft lip and palate (CLP) are frequent and appear at birth due to impairment of sucking and swallowing functions. The use of appropriate feeding methods for the different types of cleft and the period of the child's life is of utmost importance for their full development., Objective: Review studies comparing feeding methods for children with CLP, pre- and postoperatively., Methods: The search covered the period between January 1990 and August 2015 in the PubMed, LILACS, SciELO, and Google Scholar databases using the terms: cleft lip or cleft palate and feeding methods or breastfeeding or swallowing disorders and their synonyms. This systematic review was recorded in PROSPERO under number CRD42014015011. Publications that compared feeding methods and published in Portuguese, English, and Spanish were included in the review. Studies with associated syndromes, orthopedic methods, or comparing surgical techniques were not included., Results: The three reviewed studies on the period prior to surgical repair showed better feeding performance with three different methods: squeezable bottle, syringe, and paladai bottle. Only one study addressed the postoperative period of cleft lip and/or palate repair, with positive results for the feeding method with suction. Likewise, the post-lip repair studies showed better results with suction methods. After palatoplasty, two studies showed better performance with alternative feeding routes, one study with suction method, and one study that compared methods with no suction showed better results with spoon., Conclusion: The studies show that prior to surgical repair, the use of alternative methods can be beneficial. In the postoperative period following lip repair, methods with suction are more beneficial. However, in the postoperative period of palatoplasty, there are divergences of opinion regarding the most appropriate feeding methods., (Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Objectives: The aim of this study was to evaluate the 12-year clinical performance of sintered (Duceram, Dentsply-Degussa, Dentsply International Inc., PA, USA)-D and pressable (IPS Empress, Ivoclar-Vivadent, Schaan, Leichtenstein)-IPS ceramic inlay and onlay restorations., Methods: Eighty-six restorations were placed in 35 patients with a median age of 33 years by a single operator. The restorations were luted with dual-cured resin luting material (Variolink II, Ivoclar-Vivadent, Schaan, Leichtenstein) and Syntac Classic adhesive under rubber dam. The evaluations were conducted by two independent investigators at the baseline, 1, 2, 3, 5, and 12 years using the modified USPHS criteria., Results: At the 12-year recall, 22 patients were evaluated (62.86 %), totalling 48 (55.81 %) restorations. Seven restorations were fractured (one from Duceram and six from IPS), eight restorations presented secondary caries (three from Duceram and five from IPS), nine restorations showed unacceptable defects at the restoration margin and needed repair or replacement (two from Duceram and seven from IPS), and four IPS restorations presented pulp sensitivity., Conclusion: Chi-square and Mann-Whitney tests revealed that IPS Empress system showed the best results for color match and surface texture (p < 0.05) but a significant worse result for fracture (p = 0.05). Wilcoxon test showed significant differences in relation to color match, surface texture, marginal discoloration, and marginal integrity between the baseline and 12-year recall for both ceramic systems., Clinical Significance: This long-term clinical study observed that the main reasons for failure of ceramic restorations were related to fracture, recurrent caries, and decreased marginal integrity over time. Carefully monitoring of the ceramic-tooth interface may extend their clinical longevity.

Besides the well recognized association of HLA-DRB1 and DQB1 alleles with type 1 diabetes mellitus (T1D), linkage studies have identified a gene region close to the non-classical class I HLA-G gene as an independent susceptibility marker. HLA-G is constitutively expressed in the endocrine compartment of the human pancreas and may play a role in controlling autoimmune responses. We evaluated the genetic diversity of the 3' untranslated region (3'UTR) of HLA-G, which have been associated with HLA-G mRNA post-transcriptional regulation, in 120 Brazilian T1D patients and in 120 healthy controls. We found the +3001 T allele was observed only in T1D patients. Notably, the +3001 T allele was in linkage disequilibrium with polymorphic sites associated with low production of HLA-G mRNA or soluble HLA-G levels. Moreover, T1D patients showed a low frequency of the HLA-G 3'UTR-17 (14bpINS/+3001T/+3003T/+3010C/+3027C/+3035T/+3142G/+3187A/+3196C). The +3010 CC genotype and the UTR-3 haplotype (14bpDEL/+3001C/+3003T/+3010C/+3027C/+3035C/+3142G/+3187A/+3196C), associated with low and moderate soluble HLA-G expression, respectively, were underrepresented in patients. The decreased expression of HLA-G at the pancreas level should be detrimental in individuals genetically prone to produce less HLA-G., (Copyright © 2016 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.)

Objective: To develop a subset of nursing diagnoses for the elderly followed in primary health care based on the bank of terms for clinical nursing practice with the elderly, in the International Classification for Nursing Practice (ICNP(r)) version 2013, and on the Model of Nursing Care., Method: Descriptive study developed in sequential steps of construction and validation of the bank of terms, elaboration of the nursing diagnoses based on the guidelines of the International Council of Nurses and the bank of terms, and categorization of diagnostics according to the Care Model., Results: The total of 127 nursing diagnoses were elaborated from 359 validated terms, distributed according to the basic human needs., Conclusion: It is expected that these diagnoses will form the basis for the planning of nursing care and use of a unified language for documentation of clinical nursing practice with the elderly in primary care., Objetivo: Desenvolver um subconjunto de diagnósticos de enfermagem para idosos acompanhados na Atenção Primária à Saúde, com base no banco de termos para a prática clínica de enfermagem com idosos, na Classificação Internacional para a Prática de Enfermagem (CIPE(r)) Versão 2013 e no Modelo de Cuidados de Enfermagem., Métodos: Pesquisa descritiva, desenvolvida em etapas sequenciadas de construção e validação do banco de termos, elaboração dos enunciados de diagnósticos de enfermagem, com base nas diretrizes do Conselho Internacional de Enfermeiros e no banco de termos, e categorização dos diagnósticos segundo o Modelo de Cuidados., Resultados: A partir de 359 termos validados foram elaborados 127 enunciados de diagnósticos de enfermagem, distribuídos segundo as necessidades humanas fundamentais., Conclusão: Acredita-se que esses enunciados servirão de base para o planejamento dos cuidados de enfermagem e utilização de uma linguagem unificada para a documentação da prática clínica de enfermagem com idosos na atenção primária.

Background: Studies on diabetic foot and its complications involving a significant and representative sample of patients in South American countries are scarce. The main objective of this study was to acquire clinical and epidemiological data on a large cohort of diabetic patients from 19 centers from Brazil and focus on factors that could be associated with the risk of ulcer and amputation., Methods: This study presents cross sectional, baseline results of the BRAZUPA Study. A total of 1455 patients were included. Parameters recorded included age, gender, ethnicity, diabetes and comorbidity-related records, previous ulcer or amputation, clinical symptomatic score, foot classification and microvascular complications., Results: Patients with ulcer had longer disease duration (17.2 ± 9.9 vs. 13.2 ± 9.4 years; p < 0.001), and poorer glycemic control (HbA1c 9.23 ± 2.03 vs. 8.35 ± 1.99; p < 0.001). Independent risk factors for ulcer were male gender (OR 1.71; 95 % CI 1.2-3.7), smoking (OR 1.78; 95 % CI 1.09-2.89), neuroischemic foot (OR 20.34; 95 % CI 9.31-44.38), region of origin (higher risk for those from developed regions, OR 2.39; 95 % CI 1.47-3.87), presence of retinopathy (OR 1.68; 95 % CI 1.08-2.62) and absence of vibratory sensation (OR 7.95; 95 % CI 4.65-13.59). Risk factors for amputation were male gender (OR 2.12; 95 % CI 1.2-3.73), type 2 diabetes (OR 3.33; 95 % CI 1.01-11.1), foot at risk classification (higher risk for ischemic foot, OR 19.63; 95 % CI 3.43-112.5), hypertension (lower risk, OR 0.3; 95 % CI 0.14-0.63), region of origin (South/Southeast, OR 2.2; 95 % CI 1.1-4.42), previous history of ulcer (OR 9.66; 95 % CI 4.67-19.98) and altered vibratory sensation (OR 3.46; 95 % CI 1.64-7.33). There was no association between either outcome and ethnicity., Conclusions: Ulcer and amputation rates were high. Age at presentation was low and patients with ulcer presented a higher prevalence of neuropathy compared to ischemic foot at risk. Ischemic disease was more associated with amputations. Ethnical differences were not of great importance in a miscegenated population.

Background: Highly active antiretroviral therapy (HAART) can cause side effects in HIV patients, as the metabolic syndrome. Early identification of risk for development of cardiovascular diseases using available reliable and practical methods is fundamental. On this basis, the aim of this study was to compare the effectiveness of anthropometric indicators to identify metabolic syndrome in HIV patients on HAART., Methods: It is a cross-sectional study. A number of 280 stable HIV patients were studied. It measured weight, height, waist circumference (WC), hip circumference (HP), thigh circumference (TC) and calculated body mass index (BMI), body adiposity index (BAI), waist to hip ratio (WHR) and waist to thigh ratio (WTR). There was also a performance of biochemical tests of lipid profile and fasting glucose. Systemic blood pressure was measured. The criteria proposed by the National Cholesterol Education Program III (NCEP-ATP III) to metabolic syndrome classification was used. Individuals were divided in groups with or without metabolic alterations and their anthropometric indicators were compared. Receiver operating characteristic (ROC) curves were designed for each anthropometric indicator using the metabolic syndrome classification to identify sensitivity and specificity., Results: WC was a good tool to identify each metabolic disorder separately: total cholesterol (only females, p<0.05), triglycerides (only males, p<0.001), HDL cholesterol (p<0.05), LDL cholesterol (p<005) and fasting glycemic (p<005). WC also showed the best performance to identify metabolic syndrome in both genders (areas under the curve (AUCs): 0.79 and 0.76 for male and female, respectively), while BAI proved to be an inadequate indicator (AUCs: 0.63 and 0.67 for males and females), respectively, in this population., Conclusions: The central adiposity measure (WC) had the best performance to identify metabolic syndrome, and it is a convenient, cheap and reliable tool that can be used in clinical practice routinely to prevent cardiovascular complications in HIV patients.

Even though several in vitro studies have focused on bacterial biology, the extent of such knowledge is not complete when considering an actual infection. As culture-independent microbiology methods such as high-throughput sequencing became available, important aspects of host-bacterium interactions will be elucidated. Based on microbiological relevance, we considered Bacteroides fragilis in a murine experimental infection as a model system to evaluate the in vivo bacterial transcriptome in host exudates. A disproportionate number of reads belonging to the host genome were retrieved in the first round of pyrosequencing, even after depletion of ribosomal RNA; the average number of reads related to the eukaryotic genome was 71.924-67.7%, whereas prokaryotic reads represented 34.338-32.3% in host exudates. Thus, different treatments were used to improve the prokaryotic RNA yield: i) centrifugation; ii) ultrasonic treatment; and iii) ultrasonic treatment followed by centrifugation. The latter treatment was found to be the most efficient in generating bacterial yields, as it resulted in a higher number of Bacteroides cells. However, the RNA extracted after this treatment was not of sufficient quality to be used in cDNA synthesis. Our results suggest that the methodology routinely used for RNA extraction in transcriptional analysis is not appropriate for in vivo studies in complex samples. Furthermore, the most efficient treatment for generating good bacterial cell yields was not suitable to retrieve high-quality RNA. Therefore, as an alternative methodological approach to enable in vivo studies on host-bacterium interactions, we advise increasing the sequencing depth despite the high costs.

Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities., Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected., Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North-Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined., Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities.

Background/aims: micronutrient deficiency may contribute to a poorer control of diabetes. Thus, the objective of the present study was to assess the urinary excretion of micronutrients in patients with type 2 diabetes mellitus., Methods: patients with diabetes and controls were assessed regarding food intake, anthropometry, urinary loss of micronutrients and compared by the nonparametric Mann-Whitney test (p < 0.05)., Results: nine diabetic volunteers (52 ± 14 years, BMI 30 ± 11 kg/m² and abdominal circumference (AC) of 99 ± 25 cm) and 9 control individuals (51 ± 16 years, BMI 26 ± 5 kg/m² and AC of 90 ± 13 cm) were studied. Higher iron excretion was observed in the diabetic group and higher magnesium excretion in the control group., Conclusions: the type 2 diabetic patients here studied did not show increased micronutrient excretion in urine when compared to controls., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Introduction: Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids (CLIPPERS Syndrome) was first described in 2010. Since then, about 50 cases have been reported around the world, but none in Portuguese-speaking countries. We report a case of patient of the Neurological Rehabilitation ward of Sarah Hospital/Brasilia, with clinical and radiologic features compatible with CLIPPERS Syndrome. The diagnosis was made only after fourteen years of symptoms onset., Case Report: 49-year-old male, presenting with progressive pancerebellar syndrome followed by spastic paraplegia with neurogenic bladder and progressive worsening over 14 years. The radiological response to steroid was suggestive of CLIPPERS Syndrome, however it was not accompanied by significant clinical improvement., Conclusion: This is the first described case in Brazil,and this pattern of progression suggests that CLIPPERS is a degenerative disease. Its relevance must be acknowledged for being an important differential diagnosis of multiple sclerosis and other demyelinating diseases. Early diagnosis may be critical to halt the progression and affect outcome of the disease., (Copyright © 2015 Elsevier B.V. All rights reserved.)

The development of type 2 diabetes mellitus (T2D) is associated with a number of genetic and environmental factors. Hyperglycemia, a T2D hallmark, is related to several metabolic complications, comorbidities and increased DNA damage. However, the molecular alterations of a proper glucose control are still unclarified. In this study, we aimed to evaluate DNA damage (comet assay), as well as to compare the transcriptional expression (mRNA and miRNA analyzed by the microarray technique) displayed by peripheral blood mononuclear cells (PBMCs) from three distinct groups: hyperglycemic T2D patients (T2D-H, n=14), non-hyperglycemic T2D patients (T2D-N, n=15), and healthy non-diabetic individuals (n=16). The comet assay revealed significantly (p<0.05) higher levels of DNA damage in T2D-H group compared to both T2D-N and control groups, while a significant difference was not observed between the control and T2D-N groups. After bioinformatics analysis, the differentially expressed mRNAs were subjected to functional enrichment analysis (DAVID) and inflammatory response was among the enriched terms found when comparing T2D-N with controls and T2D-H with T2D-N. Concerning the gene set enrichment and gene set analyses, among the differentially expressed gene sets, three were of interest: regulation of DNA repair (T2D-H versus T2D-N), superoxide response (T2D-H versus control group), and response to endoplasmic reticulum stress (T2D-H versus control group). We also identified miRNAs related with T2D and hyperglycemia not yet associated with these conditions in the literature. Some of the differentially expressed mRNAs were among the predicted targets of the differentially expressed miRNAs. Our results showed the association of hyperglycemia with increased DNA damage and aberrant expression of miRNAs and genes related to several biological processes, such as inflammation, DNA repair, ROS production and antioxidant defense, highlighting the importance of proper glycemic control. Moreover, the transcriptional expression of miRNAs provided novel information for understanding the regulatory mechanisms involved in the T2D progression., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Objective: ω-3 Polyunsaturated α-linolenic acid (ALA) supplementation has not been studied in the setting of adiponectin levels and insulin sensitivity (IS) improvements in patients with type 2 diabetes mellitus (T2DM) by hyperinsulinemic-euglycemic clamp (HEC). The aim of this study was to examine the influence of ω-3 ALA on IS and adiponectin., Methods: We conducted a randomized study in patients with T2DM and assessed IS using HEC. Twenty patients with T2DM were included and randomly assigned to receive 3 g/d of ALA or placebo for 60 d, in a double-blind design. The assessment of IS by HEC was performed at baseline and after 60 d in all patients; blood samples were taken for the measurement of serum lipids, glucose, insulin, adiponectin, and cytokines. The primary outcome variables were an increase of both glucose infusion rate (GIR) in steady state and glucose metabolization (M) by HEC. The secondary outcomes were an increase in adiponectin levels and a decrease in fasting plasma glucose, glycated hemoglobin, homeostasis model assessment-estimated insulin resistance (HOMA-IR) index, lipids and cytokines. The study was conducted at an academic medical center., Results: The ALA group improved IS corrected for fat-free mass (M/FFM; P = 0.04). Both groups showed increased adiponectin after 60 d (P = 0.01), however, the increase for the ALA group was greater (P = 0.04). In the ALA group, adiponectin was positively correlated with GIR (r = 0.76; P = 0.01) and M/FFM (r = 0.62; P = 0.06), and negatively correlated with HOMA-IR (r = -0.61; P = 0.03)., Conclusion: ω-3 ALA supplementation improved glucose homeostasis and was associated with an increase in adiponectin. Improvement in the overall metabolic profile with ω-3 ALA suggests a potential clinical utility for this agent and requires further investigation., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Ligation-mediated-PCR was performed followed by the mapping of 177 and 150 integration sites from HepG2 and Hek293 transduced with chimera vector carrying recombinant human Factor IX (rhFIX) cDNA, respectively. The sequences were analyzed for chromosome preference, CpG, transcription start site (TSS), repetitive elements, fragile sites and target genes. In HepG2, rhFIX was had an increased preference for chromosomes 6 and 17; the median distance to the nearest CpG islands was 15,240 base pairs and 37 % of the integrations occurred in RefSeq genes. In Hek293, rhFIX had an increased preference for chromosome 5; the median distance to the nearest CpG islands was 209,100 base pairs and 74 % of the integrations occurred in RefSeq genes. The integrations in both cell lines were distant from the TSS. The integration patterns associated with this vector are different in each cell line.

Ambient air pollution is recognised as one of the potential environmental risk factors causing health hazards to the exposed population, demonstrated in numerous previous studies. Several longitudinal, ecological and epidemiological studies have shown associations between outdoor levels of outdoor atmospheric pollutants and adverse health effects, especially associated with respiratory and cardiovascular hospital admissions. The aim of this work is to assess the influence of atmospheric pollutants over the hospital admissions in Lisbon, by Ordinary Least Squares Linear Regression. The pollutants (CO, NO, NO2, SO2, O3, PM10 and PM2.5) were obtained from 13 monitoring stations of the Portuguese Environmental Agency, which provide hourly observations. Hospital admission data were collected from the Central Administration of the Health System and were compiled by age: <15, 15-64, >64 years old. The study period was 2006-2008. Results showed significant positive associations between the following: (1) the pollutants CO, NO, NO2, SO2, PM10 and PM2.5 and circulatory diseases for ages between 15 and 64 years (0.5% hospital admissions (HA) increase with 10 μg m(-3) NO increase) and above 64 years (1.0% stroke admission increase with 10 μg m(-3) NO2 increase); (2) the pollutants CO, NO, NO2, SO2, PM10 and PM2.5 and respiratory diseases for ages below 15 years (up to 1.9% HA increase with 10 μg m(-3) pollutant increase); and (3) the pollutants NO, NO2 and SO2 and respiratory diseases for ages above 64 years (1.3% HA increase with 10 μg m(-3) CO increase).

A sediment core collected in Caminha tidal marsh, NW Portugal, was used to assess bromine (Br) signal over the last ca. 1,700 years. The Br temporal variability reflects its close relationship with soil/sediment organic matter (OM) and also alterations in Br biogeochemical recycling in marsh environment. The highest Br enrichment in sediments was found during the Maunder Solar Minimum, a major solar event characterized by lower irradiance (TSI) and temperature, increased cloudiness and albedo. The obtained results suggest that those climate-induced changes weakened the natural mechanisms that promote Br biochemical transformations, driven by both living plants metabolism and plant litter degradation, with the ensuing generation of volatile methyl bromide (CH3Br). It seems that the prevailing climate conditions during the Maunder favoured the retention of more Br in marsh ecosystem, ultimately decreasing the biogenic Br emissions to the atmosphere. During the 20th century, the Br pattern in sediments appears to mirror likewise anthropogenic sources. The significant correlation (p<0.05) between Br/OM ratios and Pb contents in sediments after 1934 suggests a common source. This is most probably related with the rise, massive consumption and prohibition of leaded gasoline, where ethylene dibromide was added as lead scavenger to antiknock mixtures. More regionally, the concerted use of flame retardants on forest fire management, covering the 1980s through mid-1990s in the north of Portugal and Galicia, could be responsible for the observed increase of sediment Br (relatively to Pb) pool of this tidal marsh. Although man-made brominated compounds are being phased-out since the inception of the 1992 Montreal Protocol, the Caminha tidal marsh sedimentary record showed that Br levels only started to decline after 2002., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objectives: To propose objective ratios using anthropometry and dual-energy X-ray absorptiometry (DXA) and to suggest cutoff points for them in order to classify lipodystrophy in male patients., Methods: It is a cross-sectional study. DXA was applied and anthropometric measurements were performed in 100 men on highly active antiretroviral therapy. Receiver operating characteristic curves were used to propose cutoffs. Individuals were divided in without (lipo-) or with (lipo+) lipodystrophy and their metabolic parameters were compared., Results: The following ratios were proposed: fat mass ratio by DXA (FMR), waist thigh ratio (WTR), waist calf ratio (WCR), and arm to trunk ratio (ATR). The best cutoffs observed for FMR, WTR and ATR were 1.26, 1.74 and 2.08, respectively. Using the proposed cutoff for FMR, we observed worse metabolic profile, with increased tryglicerides, fasting serum glucose and more hypercholesterolemia in the lipo+ group. WTR and ATR showed a significant correlation with FMR., Conclusions: Anthropometric ratios (WTR/ATR) and FMR can be used to aid the diagnosis of lipodystrophy in order to contribute to a more accurate and earlier diagnosis permitting intervention and even preventing metabolic disturbances.

The most important properties of a protein are determined by its primary structure, its amino acid sequence. However, protein features can be also modified by a large number of posttranslational modifications. These modifications can occur during or after the synthesis process, and glycosylation appears as the most common posttranslational modification. It is estimated that 50% of human proteins have some kind of glycosylation, which has a key role in maintaining the structure, stability, and function of the protein. Besides, glycostructures can also influence the pharmacokinetics and immunogenicity of the protein. Although the glycosylation process is a conserved mechanism that occurs in yeast, plants, and animals, several studies have demonstrated significant differences in the glycosylation pattern in recombinant proteins expressed in mammalian, yeast, and insect cells. Thus, currently, important efforts are being done to improve the systems for the expression of recombinant glycosylated proteins. Among the different mammalian cell lines used for the production of recombinant proteins, a significant difference in the glycosylation pattern that can alter the production and/or activity of the protein exists. In this context, human cell lines have emerged as a new alternative for the production of human therapeutic proteins, since they are able to produce recombinant proteins with posttranslational modifications similar to its natural counterpart and reduce potential immunogenic reactions against nonhuman epitopes. This chapter describes the steps necessary to produce a recombinant glycoprotein in a human cell line in small scale and also in bioreactors.

As antimicrobials are introduced into the environment, microorganisms may respond in different ways, sometimes displaying alterations in cellular physiology. Considering the clinical relevance of the Bacteroides fragilis, strains were selected to investigate bacterial response after exposure to subinhibitory concentrations (SIC) of ampicillin (AMP), ampicillin-sulbactam (AMS), clindamycin (CLI), chloramphenicol (CHL), and its relationship to a host model (BALB/c mice) after experimental challenge. Morphological alterations, and biochemical-physiological and genetic profiles were evaluated among drug-selected bacteria. Histopathological evaluation of the liver and spleen, and inflammatory cytokines were determined after bacterial infection in mice. AMP and AMS exposure were related to most significant cellular alterations. Decreased sensitivity to all antimicrobials was observed for all drug-selected bacteria. Down regulation in adherence properties were also observed. Spleen and liver alterations were observed in different patterns. Increased levels of TNF-α, IL-6 and IFN-γ were also observed. Our results show that SICs of AMP, AMS, CLI and CHL may be related to alterations in cell physiology in B. fragilis with implications to the host-bacteria relationship. The data emphasizes the risks of inappropriate chemotherapy, and the concerns regarding ecological consequences lead by SICs of antimicrobials in resident microbiota., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objectives: The central point of the HIV lipodystrophy syndrome is changes in body composition that mainly involve the loss of fat in the limbs and face (lipoatrophy) and/or fat gain in the abdominal region and back neck (lipohypertrophy). Currently, the determination of fat per body segment in this group can be obtained by imaging methods such as dual-energy X-ray absorptiometry (DXA) but not by methods that would be more feasible in the practical clinics. The aim of this study was to develop equations to estimate total body fat and fat in each segment using anthropometric and bioelectrical impedance analysis (BIA) variables in HIV-seropositive patients., Methods: We measured circumferences (arm, waist, hip, thigh, calf), skinfolds (biceps, triceps, subscapular, suprailiac) and conducted examinations of BIA, segmental BIA, and DXA in 100 HIV-seropositive men on highly active antiretroviral therapy. Equations were developed by linear regression from these variables to estimate total and segmental fat (arm, leg, and trunk)., Results: We developed a model for estimation of total body fat with BIA variables and a model based on anthropometric variables. To estimate segmental fat, we developed one model for each segment using anthropometric variables. The coefficients of determination for models of total fat-free mass (BIA and anthopometry), arm fat, trunk fat, and leg fat were 0.87, 0.84, 0.66, 0.76, and 0.5, respectively., Conclusions: The equations proposed in this study allow the assessment of total body fat and fat per body segment with data obtained from accessible, accurate, and reliable methods used in clinical practice., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To analyze the methodological aspects used for the preparation of terminology subsets of the International Classification for Nursing Practice (ICNP®), in dissertations and theses in the Brazilian nursing., Method: This is an integrative review of the Brazilian dissertations and theses defended in the period from 2007 to 2013, which were included seven dissertations., Results: The increasing production of studies on the theme by Brazilian nurses shows a concern for a unified language for the profession. However, the results demonstrate the lack of uniformity in the conduct of studies, especially in relation to the stages of content validation. The initiatives of some authors to systematize alternative methods for creating these subsets also stood out., Conclusion: We suggest the development of new terminology subsets, following standards of methodological rigor, as well as its application and validation by the selected clientele, to ensure greater reliability of results and desired changes for the profession.

Staphylococcus aureus is an opportunistic pathogen often multidrug-resistant that not only causes a variety of human diseases, but also is able to survive on biotic and abiotic surfaces through biofilm communities. The best way to inhibit biofilm establishment is to prevent cell adhesion. In the present study, subinhibitory concentrations of the bacteriocins bovicin HC5 and nisin were tested for their capability to interfere with the adhesion of S. aureus to polystyrene. Subinhibitory dosages of the bacteriocins reduced cell adhesion and this occurred probably due to changes in the hydrophobicity of the bacterial cell and polystyrene surfaces. After treatment with bovicin HC5 and nisin, the surfaces became more hydrophilic and the free energy of adhesion (∆G(adhesion)) between bacteria and the polystyrene surface was unfavorable. The transcriptional level of selected genes was assessed by RT-qPCR approach, revealing that the bacteriocins affected the expression of some important biofilm associated genes (icaD, fnbA, and clfB) and rnaIII, which is involved in the quorum sensing mechanism. The conditioning of food-contact surfaces with bacteriocins can be an innovative and powerful strategy to prevent biofilms in the food industry. The results are relevant for food safety as they indicate that bovicin HC5 and nisin can inhibit bacterial adhesion and consequent biofilm establishment, since cell adhesion precedes biofilm formation., (Copyright © 2014 Elsevier B.V. All rights reserved.)

This study aimed to evaluate the adaptation of elderly individuals voluntarily reside in Institution for the Aged (LTCF) in the city of Fortaleza-CE, based on the theoretical model of Roy. Descriptive study, in a IPLI involving thirteen elderly residents. Data collect was through interviews in the months of October and December 2011 and organized by thematic content analysis. The following themes has emerged: I Physical subdivided into body sensation and body image; Staff and I, subdivided into self-consistency and auto ideal be moral-ethical-spiritual. Thus, the option to live in ILPI not effectively changed the lives of elderly people. They managed to adapt to the local and coexist well with internal and external stimuli.

ortho Substituted (diphenylphosphoryl)-, (diphenylphosphorothioyl)- and (diphenylphosphoroselenoyl)-phosphinic amides o-C6H4(P(X)Ph2)(P(O)N(i)Pr2) (X = O (20a), S (20b), Se (20c)) were synthesized by ortho directed lithiation of N,N-diisopropyl-P,P-diphenylphosphinic amide (Ph2P(O)N(i)Pr2) followed by trapping with Ph2PCl and subsequent oxidation of the o-(diphenylphosphine)phosphinic amide (19) with H2O2, S8 and Se. The reaction of the new mixed-donor bidentate ligands with zinc dichloride afforded the corresponding complexes [ZnCl2(P(X)Ph2)o-C6H4(P(O)N(i)Pr2)] (21a-c). The new compounds were structurally characterized in solution by nuclear magnetic resonance spectroscopy and in the solid-state by X-ray diffraction analysis of the ligand (20b) and the three complexes (21a-c). The X-ray crystal structure of 20b suggests the existence of a P[double bond, length as m-dash]O→P(S)-C intramolecular nonbonded interaction. The natural bond orbital (NBO) analysis using DFT methods showed that the stabilization effect provided by a nO→σ*P-C orbital interaction was negligible. The molecular structure of the complexes consisted of seven-membered chelates formed by O,X-coordination of the ligands to the zinc cation. The metal is four-coordinated by binding to the two chlorine atoms showing a distorted tetrahedral geometry. Applications in catalysis revealed that hemilabile ligands 20a-c act as significant promoters of the addition of diethylzinc to aldehydes, with 20a showing the highest activity. Chelation of Et2Zn with 20a was evidenced by NMR spectroscopy.

Introduction: Albumin is considered an important extracellular antioxidant molecule. hypoalbuminemia is a strong and independent predictor of mortality in patients on hemodialysis. The present study evaluated the relation between hypoalbuminemia and oxidative stress by comparing superoxide dismutase activity, lipid peroxidation and antioxidant micronutrient consumption in chronic renal failure patients., Methods: A case-control study was carried out with 64 patients of both sexes aged 18 to 59 years. The patients with hypoalbuminemia (ALB < 3,5 g/dL) were defined as case (n = 26) and control (n = 38) those with ALB ≥ 3.5 g/dL.Determinations of activity superoxide dismutase (SOD)and nitric oxide production by the contraction of nitrite in erythrocytes, concentration of malondialdehyde (MDA)in plasma, lipid profile and micronutrient antioxidants intake were performed. For comparisons between groups,the Student t test was used. Possible associations between variables were tested using the chi-square test and Pearson correlation test., Results: Consumption of copper was significantly lower(p < 0.05) in the group with hypoalbuminemia. There was a positive correlation between the concentrations of albumin and intake copper (r = 0.280). Negative correlation was found between albumin and MDA concentrations., Conclusion: Hypoalbuminemia is associated with increased lipid peroxidation, and can contribute to oxidative stress in chronic renal failure patients. Additionally, patients with chronic renal disease undergoing hemodialysis evaluated in this study had reduced consumption of cooper., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Aims: Hyperglycemia leads to increased production of reactive oxygen species (ROS), which reduces cellular antioxidant defenses and induces several DNA lesions. We investigated the effects on DNA damage of a seven-day hospitalization period in patients with type 2 diabetes mellitus (T2DM) to achieve adequate blood glucose levels through dietary intervention and medication treatment, compared with non-diabetic individuals., Methods: DNA damage levels were evaluated by the alkaline comet assay (with modified and without conventional use of hOGG1 enzyme, which detects oxidized DNA bases) for 10 patients and 16 controls. Real time PCR array method was performed to analyze the transcriptional expression of a set of 84 genes implicated in antioxidant defense and response to oxidative stress in blood samples from T2DM patients (n=6) collected before and after the hospitalization period., Results: The seven-day period was sufficient to improve glycemic control and to significantly decrease (p<0.05) DNA damage levels in T2DM patients, although those levels were slightly higher than those in control subjects. We also found a tendency towards a decrease in the levels of oxidative DNA damage in T2DM patients after the hospitalization period. However, for all genes analyzed, a statistically significant difference in the transcriptional expression levels was not observed., Conclusions: The study demonstrated that although the transcriptional expression of the genes studied did not show significant alterations, one-week of glycemic control in hospital resulted in a significant reduction in DNA damage levels detected in T2DM patients, highlighting the importance of an adequate glycemic control., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Qualitative research, based on the Theory of Social Representations, which aimed to apprehend the social representations of teenagers in a public school and a private on ageing, and to compare them between these two groups. Participants were 60 adolescents, 30 from the private school and 30 from the public school, who responded to semi-structured interviews in the period May-June 2012. The collected data were subjected to content analysis techniques, from which emerged three categories, namely: representations of ageing, the treatment of the elderly, and the recognition of oneself as a subject in the aging process. The adolescents' social representations have showed negative and positive aspects in relation to old age, marked by the influence of socio-cultural aspects.

Background: To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D)., Methods: This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups., Results: We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). The majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001)., Conclusions: Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.

Background: Type 1 diabetes (T1D) is an autoimmune disease, while type 2 (T2D) and gestational diabetes (GDM) are considered metabolic disturbances. In a previous study evaluating the transcript profiling of peripheral mononuclear blood cells obtained from T1D, T2D and GDM patients we showed that the gene profile of T1D patients was closer to GDM than to T2D. To understand the influence of demographical, clinical, laboratory, pathogenetic and treatment features on the diabetes transcript profiling, we performed an analysis integrating these features with the gene expression profiles of the annotated genes included in databases containing information regarding GWAS and immune cell expression signatures., Methods: Samples from 56 (19 T1D, 20 T2D, and 17 GDM) patients were hybridized to whole genome one-color Agilent 4x44k microarrays. Non-informative genes were filtered by partitioning, and differentially expressed genes were obtained by rank product analysis. Functional analyses were carried out using the DAVID database, and module maps were constructed using the Genomica tool., Results: The functional analyses were able to discriminate between T1D and GDM patients based on genes involved in inflammation. Module maps of differentially expressed genes revealed that modulated genes: i) exhibited transcription profiles typical of macrophage and dendritic cells; ii) had been previously associated with diabetic complications by association and by meta-analysis studies, and iii) were influenced by disease duration, obesity, number of gestations, glucose serum levels and the use of medications, such as metformin., Conclusion: This is the first module map study to show the influence of epidemiological, clinical, laboratory, immunopathogenic and treatment features on the transcription profiles of T1D, T2D and GDM patients.

Objective: Nowadays recombinant factor VIII is produced in murine cells including in Chinese hamster ovary (CHO) and baby hamster kidney cells (BHK). Previous studies, using the murine leukemia virus-derived retroviral vector pMFG-FVIII-P140K, modified two recombinant human cell lines, HepG2 and Hek293 to produce recombinant factor VIII. In order to characterize these cells, the present study aimed to analyze the integration pattern of retroviral vector pMFG-FVIII-P140K., Methods: This study used ligation-mediated polymerase chain reaction to locate the site of viral vector integration by sequencing polymerase chain reaction products. The sequences were compared to genomic databases to characterize respective clones., Results: The retroviral vector presented different and non-random profiles of integration between cells lines. A preference of integration for chromosomes 19, 17 and 11 was observed for HepG2FVIIIdB/P140K and chromosome 9 for Hek293FVIIIdB/P140K. In genomic regions such as CpG islands and transcription factor binding sites, there was no difference in the integration profiles for both cell lines. Integration in intronic regions of encoding protein genes (RefSeq genes) was also observed in both cell lines. Twenty percent of integrations occurred at fragile sites in the genome of the HepG2 cell line and 17% in Hek293., Conclusion: The results suggest that the cell type can affect the profile of chromosomal integration of the retroviral vector used; these differences may interfere in the level of expression of recombinant proteins., (Copyright © 2014 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier Editora Ltda. All rights reserved.)

Type 1 diabetes mellitus (T1DM) results from an autoimmune attack against the insulin-producing pancreatic β-cells, leading to elimination of insulin production. The exact cause of this disorder is still unclear. Although the differential expression of microRNAs (miRNAs), small non-coding RNAs that control gene expression in a post-transcriptional manner, has been identified in many diseases, including T1DM, only scarce information exists concerning miRNA expression profile in T1DM. Thus, we employed the microarray technology to examine the miRNA expression profiles displayed by peripheral blood mononuclear cells (PBMCs) from T1DM patients compared with healthy subjects. Total RNA extracted from PBMCs from 11 T1DM patients and nine healthy subjects was hybridized onto Agilent human miRNA microarray slides (V3), 8x15K, and expression data were analyzed on R statistical environment. After applying the rank products statistical test, the receiver-operating characteristic (ROC) curves were generated and the areas under the ROC curves (AUC) were calculated. To examine the functions of the differentially expressed (p-value<0.01, percentage of false-positives <0.05) miRNAs that passed the AUC cutoff value ≥ 0.90, the database miRWalk was used to predict their potential targets, which were afterwards submitted to the functional annotation tool provided by the Database for Annotation, Visualization, and Integrated Discovery (DAVID), version 6.7, using annotations from the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. We found 57 probes, corresponding to 44 different miRNAs (35 up-regulated and 9 down-regulated), that were differentially expressed in T1DM and passed the AUC threshold of 0.90. The hierarchical clustering analysis indicated the discriminatory power of those miRNAs, since they were able to clearly distinguish T1DM patients from healthy individuals. Target prediction indicated that 47 candidate genes for T1DM are potentially regulated by the differentially expressed miRNAs. After performing functional annotation analysis of the predicted targets, we observed 22 and 12 annotated KEGG pathways for the induced and repressed miRNAs, respectively. Interestingly, many pathways were enriched for the targets of both up- and down-regulated miRNAs and the majority of those pathways have been previously associated with T1DM, including many cancer-related pathways. In conclusion, our study indicated miRNAs that may be potential biomarkers of T1DM as well as provided new insights into the molecular mechanisms involved in this disorder., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Phenotypic expression of human leukocyte antigen (HLA)-E on the surface of tumor lesions includes intact heterodimer [HLA-E heavy chain and β2-microglobulin (β2m)] and β2m-free monomer. Anti-HLA-E monoclonal antibodies (mAbs), MEM-E/02 or 3D12 bind to the peptide sequences in β2m-free HLA-E, which is common and shared with HLA-Ia monomers. A newly developed monospecific anti-HLA-E mAb (TFL-033) recognizes HLA-E-restricted peptide sequences on α1 and α2 helices away from β2-m-site. Tumor progression may involve shedding of β2-m from HLA-E or overexpression of β2m-free monomers. There is a need to identify and distinguish the different phenotypic expression of HLA-E, particularly the intact heterodimer from the β2m-free monomer on the surface of tumor lesions. Because of the unique peptide-binding affinities of the mAbs, it is hypothesized that TFL-033 and MEM-E/02 may distinguish the phenotypic expressions of cell surface HLA-E during stages of tumor progression. Only TFL-033 stained diffusely the cytoplasm of normal mucosa. The incidence and intensity of TFL-033 staining of the cell surface in early stages, poorly or undifferentiated and non-nodal lesions and in diffuse carcinoma is greater than that of MEM-E/02. Whereas MEM-E/02 stained terminal stages, adenocarcinoma and lymph node metastatic lesions intensely, either owing to increased expression of β2m-free HLA-E with tumor progression or owing to expression of HLA-Ia molecules. Our study evaluates the relative diagnostic potential of HLA-E-monospecific TFL-033 and the HLA-Ia-reactive MEM-E/02 for determining the specific distribution and immunodiagnosis of different phenotypic expression HLA-E in tumor lesions, and the structural and functional alterations undergone by HLA-E during tumor progression., (© 2013 UICC.)

Context: The phenotypic effects of ADIPOQ mutations early in life, prior to type 2 diabetes onset, have not been studied., Aim: The objective of the study was to characterize the impact of a novel ADIPOQ mutation in vitro and in vivo., Design: The design of the study was ADIPOQ screening, adiponectin oligomerization, and cardiometabolic phenotype assessment., Subjects: Fourteen hypoadiponectinemic (<3 μg/mL) and 686 normoadiponectinemic young adults (23-25 y) were prospectively followed up since birth., Main Outcome Measures: Human and recombinant murine mutant adiponectin oligomerization, the proband's ADIPOQ and ADIPOR1/R2 adipose tissue (AT) expression, and cardiometabolic profile were measured., Results: The heterozygous ADIPOQ p.M40K mutation was identified in one hypoadiponectinemic male (2.4 μg/mL) and three other family members. Carriers presented a marked reduction of serum high-molecular weight to total adiponectin ratio when compared with controls (9.4% ± 1% vs 56.6% ± 13%; P < .05) and family noncarriers (9.4% ± 1% vs 42% ± 0.5%; P = .05). Both mRNA and protein levels of adiponectin were increased in the AT of the proband (2.3- and 1.6-fold, respectively). However, the high-molecular weight to total adiponectin ratio of adiponectin was decreased (3.3-fold). Moreover, the expressions of ADIPOR1 and ADIPOR2 were significantly down-regulated in the AT of the proband (6- and 1.2-fold, respectively). The results were confirmed by in vitro studies on the recombinant murine homologous mutation (p.M43K). The proband's cardiometabolic phenotype progression was further characterized: born small for gestational age and adolescence-onset obesity; insulin resistance (homeostasis assessment model of insulin resistance of 4.7), and dyslipidemia at 25 years; decreased high-molecular weight adiponectin (0.24 μg/mL = 10%), hypertension (180/120 mm Hg), steatosis (fat liver = 40% ± 6%), increased carotid intima-media thickness at 31 years, and type 2 diabetes (glycosylated hemoglobin = 6.6%) at 34 years of age. Of note, all of the affected family members presented features of metabolic syndrome., Conclusion: The newly identified ADIPOQ p.M40K mutation associates with severe cardiometabolic dysfunction due to the impairment of high-molecular weight adiponectin complex formation.

Background: To determine the relationship between adherence to the diet reported by patients with type 1 diabetes under routine clinical care in Brazil, and demographic, socioeconomic status, glycemic control and cardiovascular risk factors., Methods: This was a cross-sectional, multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. The data was obtained from 3,180 patients, aged 22 ± 11.8 years (56.3% females, 57.4% Caucasians and 43.6% non-Caucasians). The mean time since diabetes diagnosis was 11.7 ± 8.1 years., Results: Overall, 1,722 (54.2%) of the patients reported to be adherent to the diet without difference in gender, duration of diabetes and socioeconomic status. Patients who reported adherence to the diet had lower BMI, HbA1c, triglycerides, LDL-cholesterol, non HDL-cholesterol and diastolic blood pressure and had more HbA1c at goal, performed more frequently self-monitoring of blood glucose (p < 0.001), and reported less difficulties to follow specific schedules of diet plans (p < 0.001). Less patients who reported to be adherent were obese or overweight (p = 0.005). The quantity of food and time schedule of the meals were the most frequent complaints. Logistic regression analysis showed that ethnicity, (Caucasians, (OR 1.26 [1.09-1.47]), number of medical clinical visits in the last year (OR 1.10 [1.06-1.15]), carbohydrate counting, (OR 2.22 [1.49-3.30]) and diets recommended by diabetes societies', (OR 1.57 [1.02-2.41]) were related to greater patients' adherence (p < 0.05) and age, [adolescents (OR 0.60 [0.50-0.72]), high BMI (OR 0.58 [0.94-0.98]) and smoking (OR 0.58 [0.41-0.84]) with poor patients' adherence (p < 0.01)., Conclusions: Our results suggest that it is necessary to rethink medical nutrition therapy in order to help patients to overcome barriers that impair an optimized adherence to the diet.

The aim of this study is to report the case of a patient with Fahr's Disease in order to describe the main stomatognathic and vocal changes that can be found in individuals with this disease. In order to establish the diagnosis, an assessment of the conditions of orofacial motor system and speech production, as well the efficiency of swallowing, was realized. Based on these assessments, there were difficulties in coordinating and sustaining muscle during speech and presence of oropharyngeal dysphagia. Speech disorders found in Fahr's disease manifest themselves in complex and cover various aspects of phonological knowledge and the diseases that affect the basal ganglia have similar frames of speech-language disorders of the stomatognathic system, being able to present a picture of dysarthria.