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BACKGROUND: HIV-positive patients represent an immunosuppressed population at risk for severe influenza. In the event of a pandemic, such as 2009 H1N1, rapid implementation of vaccine clinical trials in target populations will be critical. In the present paper, knowledge and attitudes of HIV-positive adults regarding seasonal/pandemic influenza vaccination were evaluated, and facilitators and barriers to participation in vaccine clinical trials were explored.

Various photocatalytic nanomaterials for environmental remediation have been promoted due to the pollution caused by different organic pollutants. In this study, Nb 2 O 5 nanofibers were obtained by electrospinning technique, presenting controlled crystallinity and high specific surface area to improve the photoactivity response. The structural characterization indicated Nb 2 O 5 nanofibers with orthorhombic phase formation. The photoluminescence measurements showed different energy levels contributing to the electronic transition events. The nanofibers with a bandgap up to 3.6 eV were applied to photocatalysis of dyes (rhodamine B (RhB) or methylene blue (MB)) and fluoxetine (FLX), listed as an emergent pollutant. In the optimized condition (pH = 9), the RhB and MB photocatalysis was 59% and 93% more efficient than photolysis due to ζ = - 50 mV ± 5 for EtOH_550 sample increased interaction with MB (cationic) compared to RhB unprotonated (pKa = 3.7). Therefore, FLX (pKa = 10.7) was selected due to protonated form at pH = 9 and showed 68% ± 1 adsorption in 30 min for EtOH_550. The FLX photocatalytic degradation under UV light irradiation was up to 17% higher than the photolytic degradation. The formation of hydroxyl radicals in the photocatalytic system (EtOH_550) was proven by the Coumarine probe assay, corroborating with the greater amount of α-[2-(methylamino)ethyl]benzylalcohol (MAEB), a by-product obtained after FLX oxidation. Additionally, the material achieved specific catalytic activity for the different organic compounds (RhB, MB, or FLX). Therefore, Nb 2 O 5 nanofibers were efficient for degrading three different pollutants under UV light, proving a viable alternative for environmental remediation., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Histopathologic grading has been routinely used as a complement for clinical staging in the prognostication of patients with oral tongue squamous cell carcinoma (OTSCC). However, this subject remains contentious because there is no universally accepted grading system., Objectives: This study compared the prognostic significance of four histopathologic grading systems in 80 cases of oral tongue squamous cell carcinoma (OTSCC)., Methods: Clinical and follow-up information of the patients were obtained from medical records. Histopathologic malignancy grading of the tumor invasive front, Histologic risk assessment (HRA), World Health Organization (WHO) grading system, and Budding and Depth of invasion (BD) model were evaluated in the surgical specimens., Results: The HRA, histopathologic malignancy grading and WHO systems did not predict survival. Patients with larger tumor size [Hazard ratio (HR): 2.38; 95% confidence interval (CI): 1.07-5.27; P = 0.026] and patients with BD model high-grade tumors (HR: 2.99; 95% CI: 1.03-8.68; P = 0.034) were significantly associated with a poor 5-year overall survival rate. In the multivariate analysis, tumor size was identified as the only significant independent prognostic factor (HR: 2.23; 95% CI: 1.00-4.99; P = 0.050). None of the grading systems studied was associated with 5-year disease-free survival rates., Conclusions: BD model was the only histopathologic grading system associated with the outcome of patients with OTSCC, indicating its potential value as an effective tool for the prognostication of OTSCC., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The pathophysiology of subscapularis (SS) lesions is still relatively unknown despite recent interest in predictive factors for SS tears. Our goal was to determine the influence of the coracoid morphology and humeral version on SS tears., Methods: This was a retrospective, controlled, single-blinded study. We analyzed 232 shoulders with SS lesions confirmed by magnetic resonance imaging. The coracoid proximal length, coracoid distal length (CLD), and coracoid total length were measured. The coracoid length ratio, coracoid angle (CA), and humeral version were also evaluated., Results: We found that greater humeral retroversion was progressively related to more serious SS injuries, with values of -28.6° ± 19.5° and -51.0° ± 11.1° in the normal SS group and tear group, respectively (P < .001). The same tendency was shown for the CA, with values of 123.8° ± 11.1° in the control group vs. 97.4° ± 10.1° in the tear group (P < .001). Greater CLD, coracoid total length, and coracoid length ratio were also associated with an increased risk of SS tears (P < .001). The CA and CLD represented the best predictors of SS tears, presenting areas under the receiver operating characteristic curve of 90.0% and 89.0%, respectively., Conclusions: This article is the first to study the influence of different parameters of the coracoid process morphology and humeral version on SS tears. We proved that humeral version and coracoid morphology were important risk factors for SS pathology and could accurately predict these lesions. Finally, our study was the first to create a classification system to divide coracoids according to their morphology and relative risk of associated SS tears., (Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose: The query for biomarkers that indicate tumor aggressiveness and the host's response to treatment is still one of the leading aims of cancer research. To investigate a possible role for DNA nucleotide repair proteins in oral cancer behavior, this study evaluated the immunoexpression of the proteins TFIIH and XPF and its association with clinical, histological, and survival parameters in oral tongue squamous-cell carcinoma (OTSCC)., Methods: TFIIH and XPF immunoexpressions were evaluated in 82 cases of oral tongue squamous-cell carcinoma. Tumor budding and depth of invasion were assessed for histopathological grading (BD model)., Results: Tumor cells exhibited high expression of TFIIH and XPF, which was associated to nodal status; both proteins were not associated with other clinical parameters, histopathological grading or survival. Tumor size, nodal status, tumor staging, and depth of invasion > 4 mm were significantly associated to disease-specific survival., Conclusions: We have demonstrated that the overexpression of TFIIH correlates positively with node metastasis, while XPF correlates negatively with node metastasis; therefore, the expression of XPF and TFIIH had a potential value for predicting the progression of OTSCC patients.

This article brings the results of a research of which main goal was to investigate the use of practical intelligence by an oncology nurse team in an oncological ward, in a hospital in the city of Rio de Janeiro, Brazil. We assume that, in spite of the suffering inherent to health care work, it can have a creative and potent dimension in the exercise of care, even in the presence of the challenges faced by the precarious working conditions, the growing demand of patients and the demands of productivity. Participant observation, in-depth interviews and group interviews were carried out with a selected nursing staff. We observed two main forms of practical intelligence manifestations. The first is the exercise of speaking and listening. The second, as an exercise in the production of comfort. Such forms of practical intelligence interpenetrate and cannot be captured by numbers, indicators, and methods of performance evaluation. They are invisible to instruments that do not go through the word of the workers. We conclude that it is necessary to create collective spaces in health organizations where managers and workers can express and dialogue on such issues, socially validating this know-how and those workers'experiences.

Although regular exercise-training improves immune/inflammatory status, the influence of air pollutants exposure during outdoor endurance training compared to a sedentary lifestyle has not yet been clarified. This study aimed to compare the immune/inflammatory responses in the airways of street runners and sedentary people after acute and chronic particulate matter (PM) exposure. Forty volunteers (street runners (RUN, n = 20); sedentary people (SED, n = 20)) were evaluated 1 (acute) and 10 (chronic) weeks after PM exposure. Cytokines [interferon (IFN)-γ, tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, IL-13, and IL-17A] in nasal lavage fluid, salivary antibacterial peptides (lactoferrin (LTF), cathelicidin (LL-37), defensin-α 1-3), and secretory immunoglobulin A (SIgA), plasma club cell protein (CC16), and fractional exhaled nitric oxide (FeNO) were analyzed. After acute exposure, the RUN group showed lower levels of IL-13, IL-10, and FeNO, but higher defensin-α than the SED group. After chronic exposure, the RUN group showed elevation of IFN-γ, IL-10, IL-17A, and a decrease of FeNO levels, whereas the SED group showed elevation of TNF-α, IL-6, IL-10, and a decrease of IL-13 levels. Comparing these groups, the RUN group showed higher levels of SIgA and LTF, and lower FeNO levels than the SED group. In relation to the Th immune response analysis after acute and chronic PM exposure, the RUN group showed a pattern associated with Th1, while in the SED group, a Th2 pattern was found. Both groups showed also a Th17 immune response pattern. Our results allow us to suggest that the immune/inflammatory status of the respiratory tract after acute and chronic PM exposure was improved by the long-standing regular practice of outdoor endurance exercise compared to a sedentary lifestyle.

Background: Subscapularis (SS) lesions are often underdiagnosed because of an incomplete understanding of contributing factors but also because of a greater difficulty in SS tear diagnosis with magnetic resonance imaging or physical examination. In this setting, predicting factors can be useful tools in these injuries' management. The goal of this study was to determine the influence of the coracohumeral distance (CHD) and coracoid overlap (CO) in anterior rotator cuff lesions, as well as to determine the CHD and CO values that can accurately predict SS and long head of the biceps (LHB) injuries., Methods: We performed a retrospective, controlled, single-blinded study. We analyzed 301 patients with rotator cuff pathology and magnetic resonance imaging studies; patients with SS lesions represented the study group. The CHD and CO were measured., Results: We found that lower CHD and higher CO values were progressively related to more serious injuries of the SS and LHB. The CHD was a very strong predictor of SS injury and tear and a good predictor of LHB injuries. A CHD of 7.6 mm had a sensitivity of 84.4% and specificity of 88.6% for SS tears. The CO was also a very strong predictor of SS tears and a good predictor of LHB injury, with a CO of 16.6 mm reaching a sensitivity of 77.8% and specificity of 68.3% for SS tears., Conclusions: The CHD is an excellent predictor of SS tears and a good predictor of LHB lesions, with the CO also being a very strong predictor of SS tears and a good model for LHB injuries., (Copyright © 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Based on interviews with physiotherapists, we explored the arguments produced by them about their actions and the relationships of a change that has been taking place in the profile of illness in children, where an increased prevalence of complex chronic conditions has been observed. Structured in a qualitative approach, data were generated based on two provocative affirmations that generated arguments by the professionals. Data analysis revealed statements that can be referred to as results of power struggles over the performance in this new field of knowledge. Physiotherapists seek to affirm themselves through their knowledge and by approaching other professional categories, especially Medicine, in order to feel recognized and valued. However, we see that these professionals use a simpler discourse with family and caregivers, creating a bond of trust and identification with them, which facilitates their care and access to children. We point out the need for the hospital environment to be recognized as a place for the action of other categories, besides Medicine and Nursing, and the valuation in pediatric physiotherapy.

Rheumatoid arthritis (RA) is a chronic inflammatory and systemic disease characterized by endothelial activation. The main objective of this study was to verify the profile of cell adhesion molecules (CAM) in RA patients, and the influence of metabolic syndrome (MetS) and drugs used in the treatment of RA in this profile. A second objective was to propose models of prediction of activity in RA using these biomarkers. A total of 115 healthy individuals and 144 RA patients were enrolled. Disease activity was determined by DAS28 (disease activity score 28) based on erythrocyte sedimentation rate (DAS28-ESR) or C-reactive protein (DAS28-CRP). Serum CAM and plasminogen activator inhibitor type-1 (PAI-1), anthropometric and immunological parameters were measured. Vascular cell adhesion molecule-1 (VCAM-1) was significantly decreased, and PAI-1 was significantly higher in RA patients as compared to controls. Binary logistic regression analysis showed that VCAM-1, CRP, and tumor necrosis factor-α (TNF-α) predicted RA with a sensitivity of 95.9% and a specificity of 89.5%. 42.9% of the variance in DAS28-ESR and 49.2% of the variance in DAS28-CRP are explained by increased PAI-1, TNF-α, body mass index (BMI) and decreased platelet endothelial cell adhesion molecule 1 (PECAM-1). Our data show that lower levels of VCAM-1 are associated with RA independently of MetS, while increased PAI-1 levels were associated with both RA and MetS and increased selectins (E-selectin and P-selectin) were exclusively associated with MetS and not with RA. A model to predict disease activity based on PECAM-1, PAI-1, TNF-α, age and BMI is proposed.

Oxidative stress plays a role in the pathophysiology of rheumatoid arthritis (RA). The aim of the present study was to verify the influence of metabolic syndrome (MetS) and disease-modifying antirheumatic drugs on nitrosative and oxidative biomarkers in patients with RA. A total of 177 patients with RA and 150 healthy volunteers participated in this study, which measured lipid hydroperoxides, advanced oxidation protein products (AOPP), nitric oxide metabolites (NOx), carbonyl protein, total radical-trapping antioxidant parameter (TRAP), uric acid (UA), and C-reactive protein (CRP). NOx and the NOx/TRAP ratio were significantly increased in RA, while no significant differences in lipid hydroperoxides, AOPP, UA, and TRAP levels were found between both groups. Treatment with leflunomide was associated with increased levels of carbonyl protein, and lowered levels in TRAP and UA, while the NOx/TRAP ratio further increased. NOx and the NOx/TRAP ratio were significantly higher in women than in men, while TRAP and UA were significantly lower in women. MetS was accompanied by increased AOPP and UA levels. RA was best predicted by increased NOx/TRAP ratio, CRP, and BMI. In conclusion, our data demonstrated that NOx and NOx/TRAP are strongly associated with RA physiopathology. Our findings suggest that inhibition of iNOS may become an interesting therapeutic approach for the treatment of RA. In addition, the presence of MetS and a decrease in levels of UA by leflunomide favor redox imbalance in RA patients. More studies are needed to evaluate the impact of antioxidant capacity reduction on RA progression.

The article presents partial results of a study at Hospital Edgar Santos, Universidade Federal da Bahia (HUPES), Brazil, analyzing the service's experience with improvement in quality of care within a context of hospital accreditation. The article focuses on the hematology service and specifically its quality of care and intersubjective processes. The study adopted a qualitative approach, using interviews and observation. From the theoretical point of view, the work of Campos, Cecílio, and Merhy acknowledge healthcare's complex nature and micropolitical and intersubjective dimension and the capacity of health professionals to produce meanings and practice creativity. To understand the health professionals' processes of psychosocial linkage and subjective mobilization, we drew on concepts from the French school of psychosociology (Enriquez) and Dejours' psychodynamics of work. The analysis was organized along three lines: psychosocial linkage and the imaginary of self-management; bonding and affect: singularity of the subject's care and clinical case; real work and the healthcare team. One of the main conclusions is the building of a self-management imaginary, expressed in shared projects, expectations, and some forms of interpreting and operating reality, based on affectively invested representations of autonomy and unity. Alongside technical elements such as protocols, the article highlights professional judgment, proper to the intersubjective dimension, fostering the singularity of care. In our view, the real work in the patient care scene is traversed by adjustments that demonstrate team cooperation.

This study investigated nitro-oxidative stress in patients with systemic lupus erythematosus (SLE) in association with disease activity, immune-inflammatory biomarkers, and adhesion molecules. Two-hundred-four patients with SLE and 256 healthy volunteers were enrolled in this case-control study, which measured nitro-oxidative stress biomarkers, including lipid peroxides (LOOH), advanced oxidation protein products (AOPPs), nitric oxide metabolites (NO x ), sulfhydryl (-SH) groups, products of deoxyribonucleic acid (DNA)/ribonucleic acid (RNA) oxidative degradation, and total radical-trapping anti-oxidant parameter (TRAP). Also measured were anti-nuclear antibodies (ANAs), antibodies against double-stranded DNA (dsDNA), plasma levels of diverse cytokines, C-reactive protein, and adhesion molecules. LOOH (p < 0.001) and AOPP (p < 0.001) were significantly higher, while TRAP was significantly lower (p < 0.001) in SLE patients than in controls. AOPP and LOOH were significantly and positively associated with SLE disease activity index (SLEDAI) scores, anti-nuclear antibodies, and antibodies against double-stranded DNA (anti-dsDNA) levels, while TRAP was significantly and inversely correlated with SLEDAI, ANA, and dsDNA antibody levels. There were significant positive associations between AOPP and LOOH and immune-inflammatory markers, indicating T helper (Th)-17 and Th1 bias and Th1 + Th17/Th2 ratio (p = 0.002 and p = 0.001, respectively). AOPP and LOOH (positively) and TRAP (inversely) were associated with adhesion molecule expression. A model predicting SLE was computed showing that, using LOOH, AOPP, NO x , adhesion molecules, and body mass index, 94.2% of the patients were correctly classified with a specificity of 91.5%. Increased nitro-oxidative stress takes part in the (auto)immune pathophysiology of SLE and modulates severity of illness and adhesion molecule expression.

This article focuses on the inter-subjective aspects involved in the care of psychosocial crises of adolescents, their representations and developments. A qualitative research was developed from a psycho-sociological perspective by constructing life story narratives of adolescents treated at a Psychosocial Care Center for Children and Adolescents (CAPSi). It was based on the theoretical contributions of René Kaës on group and cultural aspects of the crisis, as well as its relation to adolescence. Life narratives, constructed through in-depth interviews with adolescents, close relatives, and CAPSi caretakers depict crisis as a "surprise", as violence and estrangement, an episode that must be forgotten, denied, silenced, and medicalized. We concluded that the crisis involves strong mental suffering for adolescents, for the people close to them, and for caretakers, which calls into question the possibilities and limits of care. We, therefore, highlight the importance of protected spaces in both the institution and the health network that would allow the collective construction of new meanings, representations and destinies of crisis, both by users and caretakers.

Background: DNA repair systems play a critical role in protecting the human genome from damage caused by carcinogens. Modifications in DNA repair genes may be responsible for tumor development and resistance of malignant cells to chemotherapeutic agents. The major pathway for oxidative DNA damage repair is the base excision repair pathway. This study aimed to assess the immunoexpression of DNA repair proteins APE-1 and XRCC-1 and its association with clinical, histologic, and survival parameters in oral tongue squamous cell carcinoma, to investigate a possible role for those proteins in tumor behavior., Methods: The expression of APE-1 and XRCC-1 was evaluated by immunohistochemistry in 82 cases of oral tongue squamous cell carcinoma. Histopathological grading was performed for each case. Pearson's chi-square and Fisher's exact tests were used to determine the association between protein expressions and clinicopathological features of tumors, whereas Kaplan-Meier curves and Cox regression were used to analyze disease-specific and disease-free survival. Statistical significance was set at P ≤ 0.05., Results: APE-1 was highly expressed in the nucleus and cytoplasm in 64.6% of cases, and XRCC-1 showed overexpression only in the nucleus in 61% of cases. High expression of XRCC-1 was significantly associated with tumors at early clinical stages (I and II, P < 0.01) and nodal status (P = 0.03). Both proteins were not associated with other clinical parameters, histopathological grading, or survival., Conclusions: DNA base excision repair proteins APE-1 and XRCC-1 are upregulated in oral tongue squamous cell carcinoma, and XRCC-1 expression is associated with better clinical staging and nodal status., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This study aimed to analyze organizational processes of change in the hospital care management by using qualitative evaluation developed in the case study. The study was developed at the Hospital Fornecedores de Cana de Piracicaba, in São Paulo State, Brazil, in September and October of 2012. There were 25 interviews with members of the senior board of directors of the hospital, managers and health professionals linked to healthcare of adults, in addition to the analysis of managerial documents and observations of some activities. In this article it is analyzed part of the results, dividing the organizational change in three axes: the planning process developed in the healthcare sectors; The protocol/creation of assisted routines in order to obtain better efficiency and safety for the patient; and the work of hospitalist physicians. The study highlights the complexity of the processes of change in the care management sphere in hospitals and the dynamism between a given management concept and its rational tools and the subjects and groups that seek, in the micropolitic and intersubjective processes, meanings to their practices.

Aim: To analyse the immunoreactivity of IL-1α, TNF-α and IL-10 in odontogenic cysts and tumours and to investigate possible associations with established biological behaviours of these different lesions., Methodology: Immunohistochemical expression of anti-IL-1α, anti-TNF-α and anti-IL-10 antibodies was assessed on epithelium and mesenchyme of 20 radicular cysts (RCs), 20 residual cysts (RECs), 20 dentigerous cysts (DCs), 18 solid ameloblastomas (SAs), 20 keratocystic odontogenic tumours (KCOTs) and 15 dental follicles (DFs). Comparative analysis of data was performed using the nonparametric Wilcoxon signed-rank test and Kruskal-Wallis's test., Results: Significantly greater expression of IL-1α in the epithelium was noted in RC, KCOT and SA (P = 0.01), whilst IL-10 and TNF-α was in the epithelium of RC, DC and KCOT (P < 0.01). In the mesenchyme, significantly greater immunopositivity was observed for IL-1α, IL-10 and TNF-α in KCOT, DC and RC (P < 0.01). In epithelial and mesenchymal tissues, there were a significant number of cases of RC and DC with IL-1α < IL-10 ratio (P < 0.01), whilst SA and KCOT showed IL-1α > IL-10 (P < 0.01). There was a significantly greater percentage of DF, DC and KCOT with TNF-α > IL10 ratio (P < 0.01)., Conclusion: These results suggest involvement of the proteins in the pathogenesis of odontogenic cysts and tumours, with emphasis on the highest immunoreactivity of osteolysis stimulating factors in tumours with aggressive biological behaviour, such as SA and KCOT., (© 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

A healthy 6-year-old boy presented with an erythematous macular exanthema, meningeal signs and fever, initially diagnosed with probable bacterial meningitis and treated with antibiotic and anti-inflammatory drugs. Enteroviral meningitis was confirmed, but the skin lesions continued to evolve and the patient was ultimately diagnosed with erythema dyschromicum perstans. The boy was followed during three years until the spontaneous resolution of the dermatosis.

A double blind randomized clinical trial of sufentanil as an adjunct in spinal anesthesia for cesarean section and, thereby, be able to reduce the dose of bupivacaine, a local anesthetic, with the same result of an anesthetic block with higher doses but with fewer perioperative side effects, such as hypotension., (Copyright © 2016 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

Early guidance emphasizes the provision of information to families about growth and normal development in childhood such as specific information about security at home. This research aimed to analyze mothers' knowledge about the prevention of accidents in childhood before and after an educational intervention. It was conducted as a quasi-experimental study with 155 mothers in a Basic Health Unit in northeastern of Brazil in April and May of 2015. The data were collected in two stages through a self-report questionnaire performed before and after the educational intervention by the subjects. The results revealed a significant increase in knowledge about prevention of accidents in childhood in all the self-applied questions (p<0.05). After the educational intervention, there seemed to be a significant difference with the questions regarding the knowledge on preventing fall (p=0.000), drowning (p=0.000), and intoxication (p=0.007). The authors concluded that the educational intervention performed in this study increased the subjects' knowledge on prevention of accidents in childhood.

Background: Healthy shoulder morphology is still unclear. Since bone morphology influences prosthetic features, this is relevant for glenohumeral joint reconstruction. The objective of this study was to assess the normal values of glenoid version, maximum width, base width and vault depth on computed tomography scans., Methods: Axial cut CT scans of 1072 healthy glenoids were retrospectively reviewed. Values of glenoid version, maximum glenoid width, glenoid base width and glenoid vault depth were measured by two different observers. Differences were determined between genders, and reproducibility and interrater reliability assessed., Results: Glenoid version was 37.71° ± 10.75°, range -6.20° to 71.30°; maximum glenoid width was 26.06 ± 3.27 mm, range 15.40-36.90 mm; glenoid base width was 16.59 ± 2.61 mm, range 8.90-25.40 mm; glenoid vault depth was 9.72 ± 1.62 mm, range 4.70-15.90 mm. All measurements except for glenoid version were significantly higher in males than in females. Reproducibility was good for every measurement, except glenoid vault depth., Conclusion: We found differences in maximum glenoid width, base width and vault depth by gender in a large sample. Glenoid components' maximum width was defined, as was reaming extension and orientation, the space available for implantation of the glenoid component, placement of pegs or keels in anatomic prostheses and the target for glenoid screws in inverted prostheses., Level of Evidence: II.

Background: The methicillin resistance of bacteria from the genus Staphylococcus and its ability to form biofilms are important factors in pathogenesis of these microorganisms. Thus, the search for new antimicrobials agents, especially from plants, has been intensified. In this context, Terminalia species have been the subject of research for many pharmacological activities. In this study we evaluated the antibacterial, antibiofilm and cytotoxic activities of the ethanol extract (EtE) from Terminalia fagifolia stem bark as well as that of three fractions of the extract (AqF, HaF and WSF)., Methods: We determined the minimum inhibitory concentration (MIC) by microdilution in 96-well plates, where the strains were exposed to serial dilutions of the ethanol extract and fractions, ranging from 12.5 to 400 μg/mL. We then determined the minimum bactericidal concentration (MBC), seeding the inoculum (10 μL) with concentrations equal to or greater than the MIC in Mueller-Hinton agar. To test the antibiofilm activity biofilm formation was induced in the presence of concentrations equivalent to 1/2, 1/4 and 1/8 of the MIC extract or fraction tested. In addition, the effect of the EtE and the fractions on cell viability was tested by the MTT assay on human MCF-7 breast cancer and mouse fibroblast NIH/3T3. To obtain high-resolution images of the effect of the aqueous fraction on the bacterial morphology, atomic force microscopy (AFM) imaging of treated S. aureus cells was performed., Results: We observed antibacterial activity of EtE and fractions with MICs ranging from 25-200 μg/mL and MBCs ranging from 200-400 μg/mL. Regarding antibiofilm activity, both the EtE as the AqF, HaF and WSF fractions showed significant inhibition of the biofilm formation, with inhibition of biofilms formation of over 80% for some strains. The EtE and fractions showed a moderate cytotoxicity in cell line NIH/3T3 viability and potential antitumoral activity on human breast cancer cell line MCF-7. The microscopic images obtained revealed morphological changes to the S. aureus ATCC 29213 surface caused by AqF, as well as significant size alterations., Conclusions: The results show potential antibacterial, antibiofilm and antitumoral activities of the ethanol extract and fractions of T. fagifolia.

Objective: Sports practice alters the homeostasis of athletes. To achieve homeostatic equilibrium, the integrated action of the neuroendocrine and immune systems is necessary. Here we studied the relation between cytokines, hormones and mood states in marathon runners., Methods: A total of 20 male recreational marathon runners (mean age = 35.7 ± 9 years) and 20 male sedentary individuals (mean age = 35.5 ± 7 years) were recruited. We compared the serum levels of growth hormone (GH), cortisol and interleukins 8 and 10 and the amounts of these two cytokines spontaneously produced by peripheral blood mononuclear cells. Blood samples of the sedentary group were collected at rest. Blood from the marathon runners was collected at rest (baseline: 24 h before the race), immediately after a marathon and 72 h after a marathon. Mood state analysis in both groups was performed using the 24-item Brunel Mood Scale (BRUMS)., Results: Our results showed that, at rest, levels of interleukins 8 and 10 in the supernatant of culture cells, the serum concentration of GH, and tension and vigour (evaluated using the BRUMS), were significantly higher in athletes compared to sedentary people. Immediately after the race all serum parameters analysed were statistically higher than baseline values. At 72 h after the marathon, serum levels of hormones and interleukins returned to values at rest, but the concentrations of interleukins in the supernatant of culture cells showed a significant reduction compared to values at rest., Conclusion: The higher serum levels of GH in athletes at rest and the higher production of cytokines in culture without previous stimulus suggest that marathon runners present mechanisms that may be associated with preparing the body to perform prolonged strenuous exercise, such as a marathon., (© 2014 S. Karger AG, Basel.)

Background: Early warning score (EWS) is a system that assists in the timely recognition of hospitalized patients outside critical care areas with potential or established critical illness at risk of deteriorating and who may be receiving suboptimal care. No such systems have been implemented in Portuguese National Health Service's wards. We performed a preliminary study to assess the potential outcome of applying the EWS in our hospital setting., Methods: An observational retrospective study was conducted based on 100 patients assessed by the outreach team due to an acute event. The EWS was calculated a posteriori on three preceding periods from the acute deterioration (-12, -24, and -72 h)., Results: In 35 patients, there was insufficient recording of vital signs. The final sample of 65 patients includes 62.0% men, and the mean age (±SD) was 67 ± 16 years old. Respiratory problems were the main cause of deterioration (44.6%). The EWS score increased from -72 to -12 h. More than half of cases (63.0%) were admitted into high care units, and their mean (±SD) score was higher in comparison to those remaining in general wards (Intermediate Care Units 3.75 ± 1.9, Intensive Care Units 4.2 ± 1.5, wards 3.5 ± 1.4). Score at -24 and -12 h seemed to predict length of stay (LoS; p < 0.05) and mortality, respectively. The EWS would have incremented early medical attention by 40.0% if a threshold of ≥3 was used., Conclusions: EWS systems are not widely used in Portuguese health service. Our data suggests that the EWS would allow early recognition for a higher number of patients in comparison to current ward care. Clinical worsening, lengths of stay, admission into high care units, and mortality may be predicted by the EWS. Prospective studies with multivariable analysis are needed to clarify the global outcome of the EWS implementation in national wards.

The prevalence of carbon monoxide intoxication in the World shows that this is a common situation. In Portugal, there are no concrete data available in literature and its incidence remains unknown. Currently, the use of hyperbaric oxygen is a valid therapeutic for carbon monoxide poisoning management. However, its effectiveness and its proper handling are still controversial. The first aim of this study was to estimate the incidence of carbon monoxide intoxication in Portugal and to analyze its demographic characteristics. The second objective of this work was to evaluate the possible change in the type of treatment applied in areas near de hyperbaric chamber of Unidade Local de Saúde de Matosinhos, since its opening in June 2006. To achieve these objectives, we conducted a survey on admissions data for carbon monoxide intoxication occured between January first, 2000 and December 31, 2007. These data was collected in seven hospitals and in the Administração Central do Sistema de Saúde, I.P. Nationally, 621 hospitalizations were recorded, which represents an incidence of 5,86/100000 in 8 years. In the seven hospitals, there were 93 hospitalizations due to carbon monoxide intoxication during the same period of time. There was a peak of incidence during winter, between November and March and there was a similar distribution in men (47,3%) and women (52,7%). Since June 2006, date of opening of the hyperbaric chamber, the Unidade Local de Saúde de Matosinhos, E.P.E. recorded a sharp increase in the number of hospitalization for carbon monoxide intoxication. The number of admissions in the 19 months after the chamber opening was double the number of all cases occurred in that institution in the 65 months prior. We concluded that, in Portugal, carbon monoxide intoxication is an uncommon situation but it´s still an important cause of hospitalization. The referral of cases to the Unidade Local de Saúde de Matosinhos, E.P.E. since the opening of hyperbaric chamber objectively increased. Thus, we can assume that peripheral hospitals are aware of the existence of hyperbaric chamber and its potential in treatment of carbon monoxide poisoning.

Pulmonary function is impaired in untreated mucopolysaccharidosis type VI (MPS VI). Pulmonary function was studied in patients during long-term enzyme replacement therapy (ERT) with recombinant human arylsulfatase B (rhASB; rhN-acetylgalactosamine 4-sulfatase). Pulmonary function tests prior to and for up to 240 weeks of weekly infusions of rhASB at 1 mg/kg were completed in 56 patients during Phase 1/2, Phase 2, Phase 3 and Phase 3 Extension trials of rhASB and the Survey Study. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and, in a subset of patients, maximum voluntary ventilation (MVV), were analyzed as absolute volume in liters. FEV1 and FVC showed little change from baseline during the first 24 weeks of ERT, but after 96 weeks, these parameters increased over baseline by 11% and 17%, respectively. This positive trend compared with baseline continued beyond 96 weeks of treatment. Improvements from baseline in pulmonary function occurred along with gains in height in the younger group (5.5% change) and in the older patient group (2.4% change) at 96 weeks. Changes in MVV occurred earlier within 24 weeks of treatment to approximately 15% over baseline. Model results based on data from all trials showed significant improvements in the rate of change in pulmonary function during 96 weeks on ERT, whereas little or no improvement was observed for the same time period prior to ERT. Thus, analysis of mean percent change data and longitudinal modeling both indicate that long-term ERT resulted in improvement in pulmonary function in MPS VI patients.

BACKGROUND AND METHODS: Growth failure is characteristic of untreated mucopolysaccharidosis type VI (MPS VI: Maroteaux-Lamy syndrome). Growth was studied in fifty-six MPS VI patients (5 to 29 years old) prior to and for up to 240 weeks of weekly infusions of recombinant human arylsulfatase B (rhASB) at 1 mg/kg during Phase 1/2, Phase 2, Phase 3 or Phase 3 Extension clinical trials. Height, weight, and Tanner stage data were collected. Pooled data were analyzed to determine mean height increase by treatment week, growth impacts of pubertal status, baseline urinary GAG, and age at treatment initiation. Growth rate for approximately 2 years prior to and following treatment initiation was analyzed using longitudinal modeling. RESULTS: Mean height increased by 2.9 cm after 48 weeks and 4.3 cm after 96 weeks on enzyme replacement therapy (ERT). Growth on ERT was not correlated with baseline urinary GAG. Patients under 16 years of age showed greatest increases in height on treatment. Model results based on pooled data showed significant improvement in growth rate during 96 weeks of ERT when compared to the equivalent pretreatment time period. Delayed pubertal onset or progression was noted in 10 patients entering the clinical trials; all of whom showed progression of at least one Tanner stage during 2 years on ERT, and 6 of whom (60%) completed puberty. CONCLUSION: Analysis of mean height by treatment week and longitudinal modeling demonstrate significant increase in height and growth rate in MPS VI patients receiving long-term ERT. This impact was greatest in patients aged below 16 years. Height increase may result from bone growth and/or reduction in joint contractures. Bone growth and resolution of delayed puberty may be related to improvements in general health, bone cell health, nutrition, endocrine gland function and reduced inflammation.

The main clinical features of two siblings from a consanguineous marriage were progressive myoclonic epilepsy without intellectual impairment and a nephrotic syndrome with a strong accumulation of C1q in capillary loops and mesangium of kidney. The biochemical analysis of one of the patients revealed a normal beta-glucocerebrosidase activity in leukocytes, but a severe enzymatic deficiency in cultured skin fibroblasts. This deficiency suggested a defect in the intracellular sorting pathway of this enzyme. The sequence analysis of the gene encoding LIMP-2 (SCARB2), the sorting receptor for beta-glucocerebrosidase, confirmed this hypothesis. A homozygous nonsense mutation in codon 178 of SCARB2 was found in the patient, whereas her healthy parents were heterozygous for the mutation. Besides lacking immunodetectable LIMP-2, patient fibroblasts also had decreased amounts of beta-glucocerebrosidase, which was mainly located in the endoplasmic reticulum, as assessed by its sensitivity to Endo H. This is the first report of a mutation in the SCARB2 gene associated with a human disease, which, contrary to earlier proposals, shares no features with Charcot-Marie-Tooth disease both at the clinical and neurophysiological levels.

Tarlov's cyst or perineurial cyst is disease on portion of the posterior nerve root in lumbo-sacral region. The lack of knowledge of physicians around the world about Tarlov's cyst as to their nature, significance and treatment also with differential diagnostics to radiculopathy in legs. With review of literature discuss about definition, etiopathogenesis, diagnostic investigation and treatment clinic and/or surgery. The pathogenesis Tarlov's cyst remains unclear; several cases have history of the trauma, old hemorrhage, congenital and iatrogenic. Cysts provoke low back pain, sacral radiculopathy, dyspareunia, urinary incontence. The magnetic resonance imaging is now the gold standard to diagnose cysts. The treatment is clinic or surgery depending neurologics finding and neuroimage.

Objective: The objective of this Phase 3 study was to confirm the efficacy and safety of recombinant human arylsulfatase B (rhASB) treatment of mucopolysaccharidosis type VI (MPS VI; Maroteaux-Lamy syndrome), a rare, fatal lysosomal storage disease with no effective treatment., Study Design: Thirty-nine patients with MPS VI were evaluated in a randomized, double-blind, placebo-controlled, multicenter, multinational study for 24 weeks. The primary efficacy variable was the distance walked in a 12-minute walk test (12MWT), whereas the secondary efficacy variables were the number of stairs climbed in a 3-minute stair climb (3MSC) and the level of urinary glycosaminoglycan (GAG) excretion. All patients received drug in an open-label extension period for an additional 24 weeks., Results: After 24 weeks, patients receiving rhASB walked on average 92 meters (m) more in the 12MWT (p=.025) and 5.7 stairs per minute more 3MSC (p=.053) than patients receiving placebo. Continued improvement was observed during the extension study. Urinary GAG declined by -227+/-18 microg/mg more with rhASB than placebo (p<.001). Infusions were generally safe and well tolerated. Patients exposed to drug experienced positive clinical benefit despite the presence of antibody to the protein., Conclusion: rhASB significantly improves endurance, reduces GAG, and has an acceptable safety profile.

Objective: Mucopolysaccharidosis VI (MPS VI; Maroteaux-Lamy syndrome) is a lysosomal storage disease caused by a deficiency of the enzyme N-acetylgalactosamine 4-sulfatase (ASB). This enzyme deficiency leads to a progressive disorder with multiple tissue and organ involvement. The disease is rare and is heterogeneous in its clinical presentation and progression. A potential treatment for this disease exists in the form of enzyme-replacement therapy (ERT) with recombinant human ASB (rhASB), and a phase 1/2 randomized, double-blind, 2-dose (0.2 and 1 mg/kg) study in 6 patients showed the treatment at 48 weeks to be well tolerated. Greater biochemical efficacy based on a urine glycosaminoglycan occurred in the high-dose (1 mg/kg) group, and functional improvement seemed greater in patients in the high-dose group with rapidly advancing disease. On the basis of the phase 1/2 results, a phase 2, open-label study in patients with rapidly advancing disease was initiated primarily to evaluate efficacy variables that measure endurance, mobility, and joint function in a larger group of patients., Methods: This was an open-label, multinational study of 10 MPS VI patients who received 48 weekly intravenous treatments with 1.0 mg/kg rhASB and had assessments of biochemical and clinical responses at regular intervals., Results: After 24 weeks of treatment, each patient on average experienced a 155-m (98%) improvement in the 12-minute walk, a 64-m (62%) improvement at the 6-minute time point of the 12-minute walk, and a 48-stair (110%) gain in the 3-minute stair climb versus the baseline mean values. Additional improvements after 48 weeks of treatment were observed, including mean values of 211 m (138%) in the 12-minute walk, 75 m (80%) at the 6-minute time point of the 12-minute walk, and 61-stair (147%) gain in the 3-minute stair climb versus the baseline mean values. Joint Pain and Stiffness Questionnaire scores improved by at least 50% by week 24 and were maintained at week 48, whereas there were only small improvements in active shoulder range of motion (<10 degrees ) and in the time taken to stand, walk, and turn starting from a seated position (Expanded Timed Get-Up and Go test). Improvement in pulmonary function based on forced vital capacity and forced expiratory volume at 1 minute in the absence of growth was observed in 3 of 6 patients, and the observed gains occurred in the 24- to 48-week treatment interval. A mean decrease of 76% in urinary excretion of glycosaminoglycans indicated that a satisfactory biochemical response was achieved and the ERT was well tolerated., Conclusions: The results suggest that a 12-minute walk extends the dynamic range of the conventional 6-minute walk and, along with the 3-minute stair climb, provide a robust approach to documenting the improvement in endurance in MPS VI patients who undergo ERT with rhASB.

Four perineurial cysts cases (Tarlov's cysts) are reported. The purpose of this study is to describe and to compare them with data from a literature review. The evaluation was performed among 88 adult patients with symptoms of radiculopathy, sacral pain, low back pain. Four patients revealed Tarlov's cysts (4.5%). The diagnosis was made by magnetic resonance imaging. Four cases underwent sacral laminectomy. Following surgery, the claudication pain resolved with no motor or sensory deficits. Tarlov's cysts should be considered as a differential diagnosis of sacral radiculopathy, sacral or lumbar pain syndromes and mainly to the lumbar disc prolapse. The goal of the surgical treatment is to relieve the neural compression and stop bone erosion.

Changes in apoplastic peroxidases during auxin-induced in vitro rooting of cultured grapevine (Vitis vinifera L. cv. Touriga) stems have been studied. The largest increase in peroxidase activity (EC 1.11.1.7) was associated with the early stages of root initiation and could be attributed to an increase in activity of an apoplastic 36 kDa cationic peroxidase (PxB2). Relative to other peroxidases, PxB2 demonstrated high indole-3-acetic acid (IAA) oxidase activity and apparently contributed the majority of potential IAA oxidase activity in rooting tissues. The distribution of this peroxidase in developing roots additionally associates it with early phases of growth restriction. PxB2 was purified from cell wall extracts prepared from the basal 1 cm of rooting stems. Microsequencing and subsequent cloning of its corresponding 3' truncated cDNA (encoding 255 amino acids of the mature protein) revealed it to have a typical class III peroxidase structure. The results suggest that this class III peroxidase with IAA oxidase activity is important for the control of IAA levels during root initiation and development., (Copyright 2004 Elsevier SAS)

Antiserum raised against purified Trypanosoma cruzi proteasomes was used to isolate two cDNA clones, tcpr29 and tcpr29B, and the corresponding genomic sequence, termed tcpr29A. Both cDNAs and the gene contain a 798-bp ORF, coding for a 266-amino acid protein, with a predicted molecular mass of 29 kDa. Sequence comparisons show that the protein encoded by tcpr29 belongs to the alpha6 subfamily of proteasome subunits. Southern analysis indicated that tcpr29 subunit is encoded by a single-copy gene which maps to chromosome 20 of the CL Brener clone. Allelic variants were found in other T. cruzi isolates, suggesting heterozygosity for the gene in some and homozygosity in other strains. A spliced-leader addition site was identified 123 bp upstream from the start codon, generating a stable 1.5-kb transcript. Western analysis revealed that tcpr29A is constitutively expressed during the life cycle of the parasite.

The mild base-promoted reaction of methyl 2-phenyl-1-azirine-3-acetate (1) with aldehydes and acetone provides a new and simple route to the 3-oxazolines 5, which are formed in good yields by the electrophilic trapping of an imino anion produced by C-N bond cleavage in the 1-azirine enolate intermediate 6. Chloranil oxidation of 5 containing an aromatic substituent at C-2 affords oxazoles 7, while reaction of 5 containing an aliphatic group at C-2 produces 5-methylene-3-oxazolines 8 and 5-spiro-2-oxazolines 9 in addition to 7.

Two pigeons, with previous exposure to concurrent schedules, were submitted to 29 sessions of 8 hours each with concurrent variable-interval variable-interval schedules in which reinforcement parameters changed from session to session. In the first nine sessions reinforcement durations were equal in both schedules while reinforcement frequencies varied; in Sessions 10 through 18, both frequency and duration of reinforcement were varied; in Sessions 19 through 29, only reinforcement duration was varied. Results with this different procedure confirm previous findings that behavior is more sensitive to changes in reinforcement frequency than to reinforcement magnitude.