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Prior to transplantation into individuals with type 1 diabetes, in vitro assays are used to evaluate the quality, function and survival of isolated human islets. In addition to the assessments of these parameters in islet, they can be evaluated by multiparametric morphological scoring (0–10 points) and grading (A, B, C, D, and F) based on islet characteristics (shape, border, integrity, single cells, and diameter). However, correlation between the multiparametric assessment and transplantation outcome has not been fully elucidated. In this study, 55 human islet isolations were scored using this multiparametric assessment. The results were correlated with outcomes after transplantation into immunodeficient diabetic mice. In addition, the multiparametric assessment was compared with oxygen consumption rate of isolated islets as a potential prediction factor for successful transplantations. All islet batches were assessed and found to score: 9 points ( n = 18, Grade A), 8 points ( n = 19, Grade B), and 7 points ( n = 18, Grade B). Islets that scored 9 (Grade A), scored 8 (Grade B) and scored 7 (Grade B) were transplanted into NOD/SCID mice and reversed diabetes in 81.2%, 59.4%, and 33.3% of animals, respectively ( P < 0.0001). Islet scoring and grading correlated well with glycemic control post-transplantation ( P < 0.0001) and reversal rate of diabetes ( P < 0.05). Notably, islet scoring and grading showed stronger correlation with transplantation outcome compared to oxygen consumption rate. Taken together, a multiparametric assessment of isolated human islets was highly predictive of transplantation outcome in diabetic mice.

Background: Islet transplantation is a promising treatment for type-1 diabetes; however, donor shortage is a concern. Even when a pancreas is available, low islet yield limits the success of transplantation. Islet culture enables pooling of multiple low-yield isolations into an effective islet mass, but isolated islets rapidly deteriorate under conventional culture conditions. Oxygen depletion in the islet core, which leads to central necrosis and volume loss, is one of the major reasons for this deterioration. Methods: To promote long-term culture of human islets in PIM-R medium (used for islet research), we adjusted temperature (12, 22, and 37°C) and oxygen concentration (21% and 50%). We simulated the oxygen distribution in islets based on islet oxygen consumption rate and dissolved oxygen in the medium. We determined the optimal conditions for oxygen distribution and volume maintenance in a 2-week culture and assessed viability and insulin secretion compared to noncultured islets. In vivo islet engraftment was assessed by transplantation into diabetic NOD-SCID mouse kidneys. We validated our results using CMRL 1066 medium (used for clinical islet transplantation). Results: Simulation revealed that 12°C–50% oxygen PIM-R culture supplied oxygen effectively into the islet core. This condition maintained islet volume at >90% for 2 weeks. There were no significant differences in viability and function in vitro or diabetic reversal rate in vivo between 2-week cultured and noncultured islets. Similar results were obtained using CMRL 1066. Conclusion: By optimizing temperature and oxygen concentration, we cultured human islets for 2 weeks with minimal loss of volume and function.

OBJECTIVES The aim of this study was to determine whether the size of islets isolated from human donors-measured pretransplant-impacts transplantation outcomes in diabetic mice. METHODS Human islets (1200 islet equivalents) were transplanted into the kidney capsules of streptozotocin-induced diabetic immunodeficient mice. Data from a total of 174 mice that received islets from 45 isolations were analyzed to evaluate the correlation between pretransplant islet size and posttransplant diabetes reversal. Fluorescent images of islet clusters were used to categorize individual islets by size (small, 50-150 μm; medium, 150-250 μm; large, >250 μm), and the fractions of islets in each category were calculated. RESULTS The fraction of large islets negatively correlated with diabetes reversal rates. Mice that received islet grafts containing 0% to 5%, 5% to 10%, and more than 10% large islets had diabetes reversal rates of 75%, 61%, and 45%, respectively (P = 0.0112). Furthermore, mice that exhibited diabetes reversal received smaller fractions of large islets than mice that did not (5.5% vs 8.0%, P = 0.0003). Intriguingly, the fractions of medium and small islets did not correlate with diabetes reversal outcomes. CONCLUSIONS The fraction of large islets is a sensitive predictor of human islet transplantation outcomes in diabetic mice.

In clinical and experimental human pancreatic islet transplantations, establishing pretransplant assessments that accurately predict transplantation outcomes is crucial. Conventional in vitro viability assessment that relies on manual counting of viable islets is a routine pretransplant assessment. However, this method does not correlate with transplantation outcomes; to improve the method, we recently introduced a semi-automated method using imaging software to objectively determine area-based viability. The goal of the present study was to correlate semi-automated viability assessment with posttransplantation outcomes of human islet transplantations in diabetic immunodeficient mice, the gold standard for in vivo functional assessment of isolated human islets. We collected data from 61 human islet isolations and 188 subsequent in vivo mouse transplantations. We assessed islet viability by fluorescein diacetate and propidium iodide staining using both the conventional and semi-automated method. Transplantations of 1,200 islet equivalents under the kidney capsule were performed in streptozotocin-induced diabetic immunodeficient mice. Among the pretransplant variables, including donor factors and post-isolation assessments, viability measured using the semi-automated method demonstrated a strong influence on in vivo islet transplantation outcomes in multivariate analysis. We calculated an optimized cutoff value (96.1%) for viability measured using the semi-automated method and showed a significant difference in diabetes reversal rate for islets with viability above this cutoff (77% reversal) vs. below this cutoff (49% reversal). We performed a detailed analysis to show that both the objective measurement and the improved area-based scoring system, which distinguished between small and large islets, were key features of the semi-automated method that allowed for precise evaluation of viability. Taken together, our results suggest that semi-automated viability assessment offers a promising alternative pretransplant assessment over conventional manual assessment to predict human islet transplantation outcomes.

This paper reports on the first MEMS silicon cutters designed to rapidly section donor pancreatic islets below oxygen diffusion-limited dimensions to improve viability of grafts during the critical period of re-implantation and revascularization by the host. The monolithic silicon chips feature an array of spaced nano-sharp (r < 100 nm) blades that cleanly section islet tissue. This work represents the first time that sectioning of pancreatic islets has been proposed and validated as a means to overcome the well-known problems of hypoxia and core-necrosis that is encountered in current islet transplantation procedures.

Objetivo: Analisar a qualidade de vida no trabalho do enfermeiro atuante em um bloco cirúrgico. Método: Pesquisa quantitativa e descritiva, mediante uma entrevista estruturada com questionário de avaliação da Qualidade de Vida no Trabalho (QWLQ-78) validado e simplificado, para coletar dados dos enfermeiros, atuantes há mais de 6 meses no Bloco Cirúrgico. Resultados: Participaram da pesquisa 15 profissionais enfermeiros, 13 (87%) pertencendo ao sexo feminino, 8 (53%) trabalhadores de enfermagem com faixa etária entre 31 à 40 anos, nenhum filho, relacionado aos vínculos 11 (73%) destes revelaram possuir 2 vínculos empregatícios e renda entre até 3 salários e acima de 5 salários mínimos. E a qualidade de vidas destes profissionais foi avaliada como mais ou menos de acordo com a escala de likert, por 9 (60%) integrantes da pesquisa. Conclusão: Considerando que Qualidade de Vida no Trabalho (QVT) é um conjunto de elementos relacionados entre si e com isto obtivemos valores moderado como insatisfações para com a instituição e vida pessoal. Os resultados mostram que as percepções destes enfermeiros em sua maioria relataram de acordo com alguns pontos da Escala de Likert.

Objetivo: Analisar as condições de acessibilidade aos serviços de saúde, vivenciadas por pessoas com deficiência, predominantemente nas unidades básicas de saúde no estado de Pernambuco. Métodos: Trata-se de uma pesquisa de natureza exploratória e de abordagem qualitativa. A população estudada foi formada por pessoas com algum tipo de deficiência sensorial (visual/auditiva) ou física, residentes de área coberta, usuárias ou não dos serviços de saúde. As entrevistas foram realizadas sob a anuência do entrevistado e, posteriormente, transcritos para análise. Foram entrevistados doze usuários com deficiência: o primeiro participante foi escolhido por um profissional de uma das unidades de saúde, e os demais foram definidos a partir da técnica de amostragem snowball. Resultados: A análise dos dados foi feita através da análise de discurso, cujas ideias centrais originaram duas grandes categorias: Acessibilidade aos serviços de saúde e a Rede de Cuidados a Pessoa com Deficiência. Conclusão: As limitações de acessibilidade aos serviços de saúde foram relatadas pelos entrevistados, englobando barreiras tanto físicas quanto atitudinais. Foi identificada a relevância da escuta das pessoas com deficiência para a discussão e elaboração de ações para a prática do cuidado integral à saúde de tal parcela da população.

Access to functional high-quality pancreatic human islets is critical to advance diabetes research. The Integrated Islet Distribution Program (IIDP), a major source for human islet distribution for over 15 years, conducted a study to evaluate the most advantageous times to ship islets postisolation to maximize islet recovery. For the evaluation, three experienced IIDP Islet Isolation Centers each provided samples from five human islet isolations, shipping 10,000 islet equivalents (IEQ) at four different time periods postislet isolation (no 37°C culture and shipped within 0 to 18 hours; or held in 37°C culture for 18 to 42, 48 to 96, or 144 to 192 hours). A central evaluation center compared samples for islet quantity, quality, and viability for each experimental condition preshipment and postshipment, as well as post 37°C culture 18 to 24 hours after shipment receipt. Additional evaluations included measures of functional potency by static glucose-stimulated insulin release (GSIR), represented as a stimulation index. Comparing the results of the four preshipment holding periods, the greatest IEQ loss postshipment occurred with the shortest preshipment times. Similar patterns emerged when comparing preshipment to postculture losses. In vitro islet function (GSIR) was not adversely impacted by increased tissue culture time. These data indicate that allowing time for islet recovery postisolation, prior to shipping, yields less islet loss during shipment without decreasing islet function.

Pancreatic islets consist of several endocrine cell types that maintain glucose homeostasis. Type 1 diabetes (T1D) results from autoimmune-mediated destruction of insulin producing beta cells in pancreatic islets. Islet transplantation is a treatment for certain individuals with T1D. Islet transplantation in rodents, as an experimental model of the clinical scenario, requires consistency of islet quantity and quality to obtain reproducible results. In this study, we investigated the yield and function of the isolated islets from rats of different ages. Pancreata were harvested from young (10–20 week-old), intermediate (21–40 week-old) and old (>41 week-old) male rats and islets were isolated using a standard protocol. Islet number, morphometry, viability, function, and metabolism were characterized. Islet yield, normalized to body weight, decreased as a function of increasing donor age. Islets from pancreata from young animals were larger and less fragmented compared to islets from organs from intermediate and older animals. Islet viability following overnight culture was the same for islets derived from young and intermediate aged donors but less for islets from old donors. Glucose-stimulated insulin secretion was decreased in islets from older donors. Islet metabolism following glucose challenge, as measured by oxygen consumption, revealed that islets from old donors were metabolically slower and lagged in response to glucose-stimuli. These data demonstrate that increasing donor age has a negative impact on isolated islet yield and quality.

Objetivo: Identificar, a partir da compreensão de gestores e profissionais de saúde, as dificuldades e desafios, potencialidades e facilidades encontradas na Atenção à Saúde Integral de Lésbicas, Gays, Bissexuais, Travestis e Transexuais, no município do Recife. Métodos: É uma pesquisa de natureza exploratória, com metodologia qualitativa, realizada com entrevistas semiestruturadas, colhidas de gestores e profissionais de quatro estabelecimentos de saúde que direcionam ações voltadas para população LGBT, tanto a nível de gestão, quanto assistencial. As entrevistas foram realizadas de maneira individual, gravadas, e posteriormente transcritas. A análise dos dados coletados foi feita através da Análise de Discurso, da qual emergiu duas categorias temáticas: conhecimento sobre a Política de Saúde Integral a População LGBT e o entendimento sobre a Atenção à Saúde Integral a população LGBT. Resultados: A análise dos dados coletados foi feita através da Análise de Discurso, da qual emergiu duas categorias temáticas: conhecimento sobre a Política de Saúde Integral a População LGBT e o entendimento sobre a Atenção à Saúde Integral a população LGBT. Conclusão: Foi possível conhecer a percepção dos entrevistados, tornando visível as necessidades de direcionar ações mais amplas a população LGBT, preenchendo algumas lacunas na construção da Atenção Integral à Saúde, desde acolhimento, acesso aos serviços de saúde, a qualidade do atendimento oferecida, tornando o estudo com profissionais de saúde e gestores praticamente pioneiro na produção cientifica brasileira.

Cell transplantation is a promising treatment for complementing lost function by replacing new cells with a desired function, e.g., pancreatic islet transplantation for diabetics. To prevent cell obliteration, oxygen supply is critical after transplantation, especially until the graft is sufficiently re-vascularized. To supply oxygen during this period, we developed a chemical-/electrical-free implantable oxygen transporter that delivers oxygen to the hypoxic graft site from ambient air by diffusion potential. This device is simply structured using a biocompatible silicone-based body that holds islets, connected to a tube that opens outside the body. In computational simulations, the oxygen transporter increased the oxygen level to >120 mmHg within grafts; in contrast, a control device that did not transport oxygen showed < 6.5 mmHg. In vitro experiments demonstrated similar results. To test the effectiveness of the oxygen transporter in vivo, we transplanted pancreatic islets, which are susceptible to hypoxia, subcutaneously into diabetic rats. Islets transplanted using the oxygen transporter showed improved graft viability and cellular function over the control device. These results indicate that our oxygen transporter, which is safe and easily fabricated, effectively supplies oxygen locally. Such a device would be suitable for multiple clinical applications, including cell transplantations that require changing a hypoxic microenvironment into an oxygen-rich site.

Existe uma escassez de dados em relação ao conhecimento e acesso à saúde bucal de adolescentes gestantes. Portanto, procurou-se avaliar o grau de conhecimento de gestantes adolescentes sobre saúde bucal, bem como alguns indicadores de acesso à atenção odontológica. Os dados coletados foram obtidos através de questionário desenvolvido para esta pesquisa, adaptado de Hullah et al. (2008) em 33 gestantes adolescentes, realizados no período de 12 meses. A média de idade da amostra foi de 15,5 anos, sendo que a maioria (n= 19) encontrava-se no terceiro trimestre de gestação. Visitaram o dentista durante o período gestacional 60,6% (n=20) e receberam orientações sobre cuidados bucais 51,5% (n= 17). Entretanto apenas 2 gestantes receberam algum tipo de material instrucional. Em relação à saúde bucal durante a gravidez, 81% (n=27) relataram não ter mudado seus hábitos de higiene e 75% (n=25) das adolescentes não notaram alterações significativas na mucosa. Apenas 26,7% (n=8) responderam saber cuidar da boca e dos dentes do bebê. Apesar da maioria das adolescentes ter visitado o dentista durante a gestação, observa-se um desconhecimento em relação aos cuidados bucais da mãe e do bebê. Há necessidade de aumentar o nível de informação e acesso à atenção odontológica no grupo pesquisado.