Relation between weight gain during pregnancy and postpartum reclassification in gestational diabetes

PURPOSE

Gestational diabetes mellitus (GDM) is the most common metabolic disease in pregnancy. It is known that GDM is a precursor to type 2 diabetes (T2D). There is evidence that excessive gestational weight variation (GWV) increases the risk of GDM. So, in this study, we aimed to evaluate the association between GWV and the persistence of diabetes in postpartum reclassification.

METHODS

A retrospective observational study including pregnant women based on data from the Portuguese National Registry of Gestational Diabetes. Six-to-eight weeks after delivery, all women included underwent a reclassification test. We performed unadjusted and adjusted logistic regression models to evaluate the associations between GWV and diabetes diagnosis at the reclassification test. A subgroup analysis according to the pre-gestational BMI was also performed.

RESULTS

We included 10,389 pregnant women, of which 19.6% had GDM in a previous pregnancy. The median of GWV was 10.0 [6.4, 14.0] kg and was found to be higher for those with a normal BMI. At the DM reclassification test, 1% of the women were diagnosed with T2D. We found a negative association between GWV and postpartum diabetes mellitus (DM). We also present a subgroup analysis, and these associations were only significant for the group with a normal pre-gestational BMI.

CONCLUSION

Our results showed that women with normal pre-gestational BMI and lower GWV were more likely to have a diagnosis of DM in the postpartum reclassification test. This study helps to fill the gap in the effect of GWG on the persistence of diabetes in postpartum reclassification.

Facing the challenges of air quality and health in a future climate: The Aveiro Region case study

Air pollution and climate change are the most important environmental issues for European citizens. Despite the air quality improvements achieved in recent years, with most pollutants' concentrations below the European Union legislated values, it is necessary to understand whether this will continue in the future due to expected climate changes impacts. In this context, this work tries to answer two main questions: (i) What is the relative contribution of emission source regions/activities to air quality, now and in the future, considering a climate change scenario?; and (ii) What additional policies are needed to support win-win strategies for air quality and climate mitigation and/or adaptation, at urban scale? For that, a climate and air quality modelling system, with source apportionment tools, was applied to the Aveiro Region, in Portugal. Main results show that in the future, due to the implementation of carbon neutrality measures, air quality in the Aveiro Region may improve, with reduction up to 4 μg.m^-3 for particulate matter (PM) concentrations and 22 μg.m^-3 for nitrogen dioxide (NO₂), and consequently, the premature deaths due to air pollution exposure will also decrease. The expected air quality improvement will ensure that, in the future, the limit values of the European Union (EU) Air Quality Directive will not be exceeded, but the same will not happen if the proposed revision of the EU Air Quality Directive is approved. Results also shown that, in the future, industrial sector will be the one with higher relative contribution for PM concentrations and the second one for NO₂. For that sector, additional emission abatement measures were tested, showing that, in the future, it is possible to comply with all the new limit values proposed by the EU.

Source apportionment of air pollution in European urban areas: Lessons from the ClairCity project

Air pollution has become a major threat to human health in the last decades, with an increase of acute air pollution episodes in many cities worldwide. Source apportionment modelling provides valuable information on the contribution from different emission source sectors and source regions to distinct air pollutants concentrations. In this study, the CAMx model, with its PSAT tool, was applied to quantify the contribution of multiple source areas, categories and pollutant types to ambient air pollution, namely to PM and NO₂ concentrations, over six European urban areas: Bristol (United Kingdom), Amsterdam (The Netherlands), Ljubljana (Slovenia), Liguria Region (Italy), Sosnowiec (Poland) and Aveiro Region (Portugal). Results indicate overall higher annual NO₂ and PM concentrations located in the urban centres of the case studies. A comparison between the different areas showed that Liguria is the region with highest NO₂ annual mean concentrations, while Ljubljana, Liguria Region and Sosnowiec are the case studies with the highest PM annual mean concentrations. The annual average contributions denote a major influence from road transport to NO₂ concentrations, with up to 50%, except in Aveiro region, where road transport presents a lower contribution to NO₂ concentrations, and the greatest contributor is the industrial combustion and processes sector with 45%. These results indicate a negligible contribution of the transboundary transport to NO₂ concentrations, highlighting the relevance of local sources, while for PM concentrations the transboundary transport is the major contributor. The results highlight the relevance of long-range transport of PM across Europe. The transboundary transport reduces its importance during winter, when residential and commercial combustion increases its contribution. In the case of the Aveiro region, the industrial combustion and processes sector also plays an important contribution to PM concentrations.

Comparison of blood and lymph node cells after intramuscular injection with HIV envelope immunogens

Background

Harnessing CD4+ T cell help in the lymph nodes through rational antigen design could enhance formation of broadly neutralizing antibodies (bNAbs) during experimental HIV immunization. This process has remained hidden due to difficulty with direct study, with clinical studies instead focusing on responses in the blood as a proxy for the secondary lymphoid tissue.

Methods

To address this, lymph node cells (LNC) were collected using ultrasound guided fine needle aspiration of axillary lymph nodes from 11 HIV negative participants in an experimental HIV immunogen study (European AIDS Vaccine Initiative EAVI2020_01 study, NCT04046978). Cells from lymph node and blood (PBMC), were collected after intramuscular injection with HIV Env Mosaic immunogens based on HIV Envelope glycoprotein and combined with a liposomal toll-like receptor-4 adjuvant; monophosphoryl lipid A. Simultaneously sampled cells from both blood and lymph node in the same donors were compared for phenotype, function, and antigen-specificity.

Results

Unsupervised cluster analysis revealed tissue-specific differences in abundance, distribution, and functional response of LNC compared with PBMC. Monocytes were virtually absent from LNC, which were significantly enriched for CD4+ T cells compared with CD8+ T cells. T follicular helper cells with germinal center features were enriched in LNC, which contained specific CD4+ and CD8+ T cell subsets including CD4+ T cells that responded after a single injection with HIV Env Mosaic immunogens combined with adjuvant. Tissue-specific differences in response to an MHC-II dependent superantigen, staphylococcal enterotoxin B, indicated divergence in antigen presentation function between blood and lymph node.

Conclusions

LNC are phenotypically and functionally distinct from PBMC, suggesting that whole blood is only a limited proxy of the T cell lymphatic response to immunization. HIV-specific CD4+ T cells in the lymph node are rapidly inducible upon experimental injection with HIV immunogens. Monitoring evolution of CD4+ T cell memory in LNC with repeated experimental HIV immunization could indicate the strategies most likely to be successful in inducing HIV-specific bNAbs.

Assessing air pollution in European cities to support a citizen centered approach to air quality management

European cities have made significant progress over the last decades towards clean air. Despite this progress, several cities are still facing acute air pollution episodes, with various urban areas frequently exceeding air quality levels allowed by the European legal standards and WHO guidelines. In this paper, six European cities/ regions (Bristol, UK; Amsterdam, NL; Sosnowiec, PL; Ljubljana, SI; Aveiro, PT; Liguria, IT) are studied in terms of air quality, namely particulate matter, nitrogen dioxide and ozone. The concentrations trends from 2008 to 2017 in the different typology of monitoring stations are addressed, together with the knowledge of daily, weekly and seasonal pollution patterns to better understand the city specific profiles and to characterize pollutant dynamics and variations in multiple locations. Additionally, an analysis of the duration and severity of air pollution episodes is also discussed, followed by an analysis of the fulfillment of the legislated limit values. Each of our 6 case study locations face different air pollution problems, but all these case studies have made some progress in reducing ambient concentrations. In Bristol, there have been strong downward trends in many air pollutants, but the levels of NO₂ remain persistently high and of concern. In recent years, decreasing concentration levels point to some success of Amsterdam air quality policies. PM₁₀ exceedances are a seasonal pollution problem in Ljubljana, Sosnowiec and Aveiro region (even if with different levels of severity). While, exceedances of NO₂ and O₃ concentrations are still problematic in Liguria region. The main findings of this paper are particular relevant to define and compare future citizen-led strategies and policy initiatives that may be implemented to improve and fulfill the EU legislation and the WHO guidelines.

How to compute long-term averages for air quality assessment at urban areas?

This paper proposes two innovative time-effective approaches to retrieve annual averaged concentrations for air quality assessment in the framework of the AQD. In addition, a traditional method (M1) was applied through numerical simulations for an entire year on an hourly basis to compare the performance of the proposed approaches. The first time-effective approach (M2) is based on the calculation of pollutant concentrations for the full year on an hourly basis through the combination of a set of numerical simulations for 4 typical days weighted by hourly factors obtained from air quality monitoring data. While the second time-effective approach (M3) considers the numerical simulation of pollutant concentrations for a set of typical meteorological conditions. For all the methods, air quality simulations were performed with the second-generation Gaussian model URBAIR. The three methods are applied over two distinct European urban areas, the Aveiro region in Portugal and Bristol in the United Kingdom, for the simulation of NO₂ and PM10 annual concentrations. The main results highlight an underestimation of the NO₂ annual concentrations by M2 and an overestimation of those concentrations by M3 for the Aveiro region, when compared to M1 as the reference method. While, for Bristol the main differences between methods were found for NO₂ concentrations when using M3. M2 underestimates PM10 annual concentrations in the Aveiro Region, while M3 points out underestimation or overestimation of those concentrations for distinct areas of the domain. This study aims to foster the knowledge on air quality assessment under the European policy context, supporting air quality management and urban planning. The innovative nature of this study relies on the proposed time-effective tools, suitable for the fast simulation of complex urban areas applying high spatial resolution. Additionally, these modelling tools may provide key information on air quality to population, particularly where it is not readily available.

How changing climate may influence air pollution control strategies for 2030?

Air pollution is a global threat leading to large impacts on human health and ecosystems. In Europe, air quality remains poor in many areas, despite reductions in emissions and ambient concentrations. Air pollution and climate change are the biggest environmental concerns for Europeans, implying concerted and integrated actions to tackle them. The revised 2016 European National Emission Ceilings Directive (NECD) enforces Member States to implement strategies, based on emission reduction measures, aimed to comply with targets by 2030 and achieve European Union (EU) and World Health Organization air quality objectives for environment and health protection. Despite those strategies are designed for 2030, the influence of climate change on air quality is not accounted for. In this sense, the purpose of this paper is the evaluation of the climate change impact on future air quality, taking into consideration emission reduction measures. The WRF-CAMx air quality modelling system was applied over Europe for one year selected as representative of a short-term changing climate (around 2030), and compared to a base case year, to estimate to what extent the climate variables by themselves could positively or negatively influence air quality. Results indicate that meteorological conditions may be decisive for the air quality state in the future. Differences between future and present simulations pointed to a global decrease of ozone levels in the future; increases and decreases in particulate matter and nitrogen dioxide concentrations over different seasons and European regions. This work is intended to contribute to a better understanding of the influence of climate variables on air quality improvement strategies as an additional support to European environmental authorities in developing the National Air Pollution Control Programmes in the scope of NECD.

Long term prognosis of acute pulmonary embolism

BACKGROUND

Acute pulmonary embolism (PE) can be fatal if left untreated. Long-term prognosis of acute PE in the 21st century has not been fully reported. We aimed to determine the long-term prognosis of patients hospitalized with acute PE and compare survivalof patients with idiopathic and secondary PE.

MATERIALS AND METHODS

We retrospectively analysed a cohort of hospitalized patients with acute PE between 2006 and 2013.

EXCLUSION CRITERIA

<18 years, venous embolism of non-pulmonary veins, chronic thromboembolic pulmonary hypertension, and presumptive diagnosis without image confirmation. Only patients with a first PE episode were included. End-point: all-cause mortality. Patients were compared according to PE aetiology: idiopathic, secondary to neoplastic conditions and secondary to non-neoplastic conditions. A Cox-regression analysis was used to study the prognostic impact of PE aetiology.

RESULTS

We studied 872 hospitalized acute PE patients. Median age 70 years, 56.9% were women. PE was idiopathic in 376 (43.1%), secondary to a neoplastic condition in 284 (32.6%) and secondary to a condition other than neoplasia in 212 (24.3%). Patients were followed for a median 25 months period and 508 (58.3%) died. Patients with PE attributed to a neoplastic condition had the worst survival. Patients with idiopathic PE had a multivariate-adjusted HR of mortality of 1.46 (1.08-1.99) during the over 2-year follow-up period when compared to those with acute PE attributed to a non-neoplastic condition.

CONCLUSIONS

Patients with idiopathic acute PE have an almost 50% higher death risk in a median 2-year follow-up period than those with acute PE secondary to a condition other than neoplasia.

Abstract P1-15-19: Carboplatin-addition in neoadjuvant treatment of women with triple negative breast cancer (TNBC): Prognostic value in real-world patients

Background

The addition of carboplatin to an anthracycline/taxane-based chemotherapy(CT) in neoadjuvant setting has been suggested to improve pathological complete response(pCR) in TNBC. However, the impact of pCR in prognosis is unknown. We aim to study the value and feasibility of the addition of carboplatin in neoadjuvant setting.

Methods

Demographic and clinical data of TNBC patients treated with neoadjuvant CT in a comprehensive cancer center between 2010-2018 were retrospectively collected. Two cohorts were defined: one treated with Carboplatin/Paclitaxel followed by dose-dense Doxorrubicin/Cyclophosphamide(CP-AC) and other with AC followed by Docetaxel(AC-D). Median follow-up time was 3.1 and 6.9 years, respectively. pCR was defined as absence of residual invasive tumor in breast/axilla. Survival analysis using Kaplan-Meier method and Cox proportional-hazards model were applied. Statistical significance was set at p&lt;0.05.

Results

One-hundred and sixty patients were enrolled: 78 CP-AC and 38 AC-D. Groups were balanced regarding patients and tumor characteristics with exception of pre-menopausal status, more frequent in CP-AC(68% vs 47%;p=.04). Age at diagnosis was 47(28-76)years, the majority had ECOG 0(92%) ductal carcinomas(82%), clinicalT2/3 stages(76%), grade 3(81%) with lymph node involvement(N+)(57%). 14% had Inflammatory breast cancer(IBC)(CP-AC 14%;AC-D 13%; p=.9).

Neutropenia was the most prevalent adverse event(G3/4: CP-AC 61%;AC-D 16%;p=.02), 12% and 16% of febrile neutropenia(p=.8). G3/4 thrombocytopenia occurred only in CP-AC(6%). Hypersensitivity reactions were more prevalent in CP-AC(19% vs 2.7%;p=.02), majority to paclitaxel, all G1/2. Hospital admission occurred in 12%(CP-AC 13%;AC-D 9%; p=.8). There were no treatment-related deaths. Treatment schedule was complete in 89%(CP-AC 87%;AC-D 92%;p=.5), with 20% dose reductions(CP-AC 25%;AC-D 11%;p=0.9).

pCR was achieved in 42%(CP-AC 50%;AC-D 28%;p=.03). 1- and 3-year disease-free survival(DFS) was 94%/85% for CP-AC and 72%/58% for AC-D(p=.3). Risk of recurrence was higher in IBC(HR 25.1;CI95% 7.7-81.3;p&lt;.0001), N+ disease(HR 3.6;CI95% 1.2-10.5;p=.02) and non-pCR(HR 10.9;CI95% 2.3-52.3,p=.003). N+ disease was associated with higher recurrence only in AC-D(HR 11.7;CI95% 1.3-104;p=.03).

Cancer-related deaths were 20%(CP-AC 10%;AC-D 40%;p=.001). 1- and 2-year overall survival (OS) was 99%/95% for CP-AC and 70%/61% for AC-D(p=.06). N+ disease was associated with higher risk of death in AC-D(HR 6.3;CI95% 1.1-24.6;p=.04). Risk of death was independently associated with IBC(HR 4.1;CI95% 2.1-18.7; p=.001) but not with N+ disease(HR 2.7;CI95% 0.8-9.5;p=.13) or pCR(HR 4.1;CI95% 0.9-19.7;p=.08) although pCR was statistically significant in univariate analysis (1- and 2-year OS 97% vs 92% and 94% vs 86% for pCR and non-PCR;p=.003).

Conclusions

Carboplatin addition clearly increased pCR with a trend to DFS and OS benefit. This regimen was associated with more, nevertheless manageable, adverse events with most of the patients able to tolerate and complete the full-dose regimen. Though we did not find a subgroup of patients that benefit with carboplatin regimen, we should consider avoiding AC-D at least in N+ disease.

Citation Format: Coelho S, Abreu MH, Sales C, Lopes AR, Sousa MF, Couto R, Pousa I, Ferreira A, Ferreira M, Vieira C, Leal C, Castro F, Sousa S, Pereira D. Carboplatin-addition in neoadjuvant treatment of women with triple negative breast cancer (TNBC): Prognostic value in real-world patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-15-19.

Patients' and clinicians' experiences of wound care in Canada: a descriptive qualitative study

OBJECTIVE

This study sought to explore patients' and clinicians' perceptions and experiences with the provision of standard care by a home care nurse alone or by a multidisciplinary wound care team.

METHOD

The interviews were conducted using an in-depth semi structured format; following a funnel idea of starting out broad and narrowing down, ensuring that all the necessary topics were covered by the end of the interview.

RESULTS

A purposive sample of 16 patients with different wound types were interviewed to ensure that the data would reflect the range and diversity of treatment and care experience. To reflect the diversity of experiences 12 clinicians from various clinical backgrounds were interviewed. Based on the analysis of the interviews, there are four overarching themes: wound care expertise is required across health-care sectors, psychosocial needs of patients with chronic wounds are key barriers to treatment concordance, structured training, and a well-coordinated multidisciplinary team approach.

CONCLUSION

Results of this qualitative study identified different barriers and facilitators that affect the experiences of community-based wound care.

Quantification and mapping of urban fluxes under climate change: Application of WRF-SUEWS model to Greater Porto area (Portugal)

Climate change and the growth of urban populations are two of the main challenges facing Europe today. These issues are linked as climate change results in serious challenges for cities. Recent attention has focused on how urban surface-atmosphere exchanges of heat and water will be affected by climate change and the implications for urban planning and sustainability. In this study energy fluxes for Greater Porto area, Portugal, were estimated and the influence of the projected climate change evaluated. To accomplish this, the Weather Research and Forecasting Model (WRF) and the Surface Urban Energy and Water Balance Scheme (SUEWS) were applied for two climatological scenarios: a present (or reference, 1986-2005) scenario and a future scenario (2046-2065), in this case the Representative Concentration Pathway RCP8.5, which reflects the worst set of expectations (with the most onerous impacts). The results show that for the future climate conditions, the incoming shortwave radiation will increase by around 10%, the sensible heat flux around 40% and the net storage heat flux around 35%. In contrast, the latent heat flux will decrease about 20%. The changes in the magnitude of the different fluxes result in an increase of the net all-wave radiation by 15%. The implications of the changes of the energy balance on the meteorological variables are discussed, particularly in terms of temperature and precipitation.

Lianas, tree ferns and understory species: indicators of conservation status in the Brazilian Atlantic Rainforest remnants, southeastern Brazil

Indicators are applied faster and at lower costs than conventional surveys, providing quick and efficient responses that can facilitate protected areas management. Our aim was to select indicators from vegetation to monitor protected areas. For this purpose, we analyzed understory and quantified lianas and tree ferns in protected and non-protected areas, in order to find indicator species. Our study areas are located in Vale do Ribeira, southeastern São Paulo state, Brazil. One of the areas is under two protection categories (IUCN's categories II and V), and the other is a privately owned farm. Lianas with large diameters (> 13 cm) and tree ferns with great heights (> 19 m) were considered indicators of undisturbed areas (protected areas) because their growth is directly related to forest successional stage. Indicator species within the protected area were shade tolerant species, such as Bathysa australis (A.St.-Hil.) K.Schum., whereas outside the protected area were pioneer species, such as Pera glabrata (Schott) Poepp. ex Baill. e Nectandra oppositifolia Ness. All of the suggested indicators can be used in management actions, especially in protected areas, to guarantee forest maintenance and ensure fulfillment of the conservation objectives of these areas.

About an exhibitionism clinical case: Entity's review and state of the art exposure

Introduction

Exhibitionistic disorder may be present when there is sexual arousal from the exposure of one's genitals to an unsuspecting and nonconsenting person. This disorder prevalence is unknown but we know it is highly unusual in females. It generally starts at adolescence and its course is likely to vary with age. There are temperamental and environmental risk factors.

Most of what we know about exhibitionistic disorder is largely based on research with individuals convicted for criminal acts involving genital exposure, and this may represent an important bias. From a clinical case of exhibitionism, the authors intend to review this type of paraphilia from an historical, conceptual and etiologic point of view.

Objective

To review the concept behind this diagnosis and its evolution, the comprehensive theories that attempt to justify and frame it, as well as the type of intervention currently considered to be the state of the art.

Methods

Patient's observation and assessment, along with an extensive review of the relevant literature.

Conclusions

Starting from a real clinical case, the authors present a general theoretical review on the subject.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Sterile leukocyturia is associated with interstitial fibrosis and tubular atrophy in kidney allograft protocol biopsies

Kidney allograft interstitial fibrosis and tubular atrophy (IF/TA) is associated with a poorer renal function and outcome. In the current clinical practice, an early diagnosis can only be provided by invasive tests. We aimed to investigate the association of sterile leukocyturia with Banff criteria histological findings in kidney allograft protocol biopsies. We studied 348 allograft biopsies from two different European countries performed at 8.5 + 3.5 months after transplantation. In these cases, the presence of sterile leukocyturia (Leuc+, n = 70) or no leukocyturia (Leuc-, n = 278) was analyzed and related to Banff elementary lesions. Only IF/TA was significantly different between Leuc+ and Leuc- groups. IF/TA was present in 85.7% of Leuc+ and 27.7% of Leuc- patients (p < 0.001). IF/TA patients had higher serum creatinine and presence of proteinuria (p < 0.05). Independent predictors of IF/TA were donor age, donor male sex, serum creatinine and Leuc+ (hazard ratio 18.2; 95% confidence interval, 8.1-40.7). The positive predictive value of leukocyturia for predicting IF/TA was 85.7% whereas the negative predictive value was 72.3%. These studies suggest that leukocyturia is a noninvasive and low-cost test to identify IF/TA. An early diagnosis may allow timely interventional measures directed to minimize its impact and improve graft outcome.

Advanced fluorescence lifetime imaging algorithms for CMOS single-photon sensor based multi-focal multi-photon microscopy

We have developed a fast hardware friendly bi-exponential fluorescence lifetime algorithm suitable for 2D CMOS single-photon avalanche diode (SPAD) arrays. The performance of the proposed algorithm against other techniques is demonstrated on the data from a plant specimen (Convallaria) by using 0.13µm CMOS SPAD arrays mounted on a multi-beam multi-photon microscopy system.

A própolis e sua utilização em animais de produção

A própolis é um produto natural utilizado durante séculos pela humanidade e administrada sob diversas formas. Sua utilização ocorreu como apiterápico há séculos na medicina popular como agente antiinflamatório. Já foram identificados mais de 200 compostos químicos, de modo geral, a própolis contém 50-60% de resinas e bálsamos, 30-40% de ceras, 5-10% de óleos essenciais, 5% grãos de pólen, além de microelementos como alumínio, cálcio, estrôncio, ferro, cobre, manganês e pequenas quantidades de vitaminas B1, B2, B6, C e E. A própolis é conhecida principalmente, por suas propriedades antimicrobiana, antioxidante, antiinflamatória, imunomodulatória, hipotensiva, cicatrizante, anestésica, anticancerígena, anti-HIV, e anticariogênica. As investigações sobre as propriedades antibióticas da própolis têm sido conduzidas sobre tudo na área médica e veterinária, onde o produto tem demonstrado uma eficiente atividade bacteriostática e bactericida em relação a diversos gêneros de bactérias, porém poucos trabalhos, de ordem zootécnica, têm sido realizados, considerando-se as respostas dos animais, relacionadas a algumas dessas atividades biológicas.

Inhibition of human immunodeficiency virus type 1 replication with artificial transcription factors targeting the highly conserved primer-binding site

The human immunodeficiency virus type 1 (HIV-1) primer-binding site (PBS) is a highly conserved region in the HIV genome and represents an attractive target for the development of new anti-HIV therapies. In this study, we designed four artificial zinc finger transcription factors to bind at or adjacent to the PBS and repress transcription from the HIV-1 long terminal repeat (LTR). These proteins bound to the LTR in vivo, as demonstrated by the chromatin immunoprecipitation assay. In transient reporter assays, three of the four proteins repressed transcription of a reporter driven by the HIV-1 LTR. Only one of these proteins, however, designated KRAB-PBS2, was able to prevent virus production when transduced into primary lymphocytes. We observed >90% inhibition of viral replication over the course of several weeks compared to untransduced cells, and no significant cytotoxicity was observed. Long-term exposure of HIV-1 to KRAB-PBS2 induced mutations in the HIV-1 PBS that reduced the effectiveness of the repressor, but these mutations also resulted in decreased rates of viral replication. These results show that KRAB-PBS2 has the potential to be used in antiviral therapy for AIDS patients and might complement other gene-based strategies.

Orbital lymphoma misdiagnosed as Graves' ophthalmopathy

OBJECTIVE

To describe a case of bilateral orbital lymphoma mistakenly diagnosed as Graves' ophthalmopathy.

METHODS

We present a case report, with laboratory data and photographic documentation, and discuss the differential diagnosis in patients with orbital masses.

RESULTS

A 65-year-old man with bilateral exophthalmos and substantial weight loss was referred to the Endocrine Clinic for evaluation of possible Graves' disease. A 6-cm mass was detected in the left axilla. Biopsy of this mass revealed the histopathologic diagnosis of anaplastic B-cell lymphoma. Treatment with intrathecally administered methotrexate and orally administered dexamethasone promptly resulted in decreased proptosis.

CONCLUSION

The most frequent cause of bilateral proptosis is Graves' ophthalmopathy, and when it is associated with weight loss in an elderly patient, the initial diagnostic consideration is thyrotoxic Graves' disease. This case should remind physicians that bilateral orbital lymphoma, although uncommon, may mimic Graves' ophthalmopathy.

[Socioeconomic and educational characterization of nursing students in the schools of Minas Gerais]

This study compare the profile of nursing students from public and private schools located in the State of Minas Gerais, Brazil. It shows the similarities and differences between the two groups. The results show that the most significant differences are related to school life, requisites for learning and the economic situation of the students. The private schools student is in disadvantage, he enters at university later, disposes less time to study, the majority works, his parents have less regular instruction. This results can be used by other professionals to continue this kind of research with a broader scope.