Estratégia de captação de doadores de sangue como fator inovador na pandemia da COVID-19

Objetivo: Descrever e analisar novas estratégias institucionais de enfrentamento ao baixo estoque de bolsas de sangue frente à pandemia. Métodos: Trata-se de um estudo descritivo, de metodologia qualitativa com revisão documental e bibliográfica, nos moldes de relato de caso. Relata-se o aumento dos esforços da Instituição no contato com seus doadores, incentivando-os a retornar e realizar novas doações, além da busca pela intensificação das coletas em dependências das forças armadas. Resultados: Em abril de 2020 foi lançada a campanha “HEMORIO em casa”, que logrou aumentar os estoques de bolsa de sangue durante o primeiro ano da pandemia, momento que de fato ocorreram as medidas sanitárias emitidas pelo governo do Estado do RJ, diminuindo a distância e estreitando os laços entre a instituição e os doadores. Conclusão: Constata-se que momentos de crise estimulam o processo de ideação e criação de soluções nas organizações de modo geral, especialmente instituições de saúde que precisam implementar a cultura da inovação para que melhorias sejam geradas para o SUS e para a sociedade.

Trends in osteoporosis care patterns during the COVID-19 pandemic in Alberta, Canada

PURPOSE/INTRODUCTION

The objective of this study was to describe osteoporosis-related care patterns during the coronavirus disease 2019 (COVID-19) pandemic in Alberta, Canada, relative to the 3-year preceding.

METHODS

A repeated cross-sectional study design encompassing 3-month periods of continuous administrative health data between March 15, 2017, and September 14, 2020, described osteoporosis-related healthcare resource utilization (HCRU) and treatment patterns. Outcomes included patients with osteoporosis-related healthcare encounters, physician visits, diagnostic and laboratory test volumes, and treatment initiations and disruptions. The percent change between outcomes was calculated, averaged across the control periods (2017-2019), relative to the COVID-19 periods (2020).

RESULTS

Relative to the average control March to June period, all HCRU declined during the corresponding COVID-19 period. There was a reduction of 14% in patients with osteoporosis healthcare encounters, 13% in general practitioner visits, 9% in specialist practitioner visits, 47% in bone mineral density tests, and 13% in vitamin D tests. Treatment initiations declined 43%, 26%, and 35% for oral bisphosphonates, intravenous bisphosphonates, and denosumab, respectively. Slight increases were observed in the proportion of patients with treatment disruptions. In the subsequent June to September period, HCRU either returned to or surpassed pre-pandemic levels, when including telehealth visits accounting for 33-45% of healthcare encounters during the COVID periods. Oral bisphosphonate treatment initiations remained lower than pre-pandemic levels.

CONCLUSIONS

This study demonstrates the COVID-19 pandemic and corresponding public health lockdowns further heightened the "crisis" around the known gap in osteoporosis care and altered the provision of care (e.g., use of telehealth and initiation of treatment). Osteoporosis has a known substantial care and management disparity, which has been classified as a crisis. The COVID-19 pandemic created additional burden on osteoporosis patient care with healthcare encounters, physician visits, diagnostic and laboratory tests, and treatment initiations all declining during the initial pandemic period, relative to previous years.

Trends in osteoporotic fracture and related in-hospital complications during the COVID-19 pandemic in Alberta, Canada

Fragility fractures (i.e., low-energy fractures) account for most fractures among older Canadians and are associated with significant increases in morbidity and mortality. Study results suggest that low-energy fracture rates (associated with surgical intervention and outcomes) declined slightly, but largely remained stable in the first few months of the COVID-19 pandemic.

PURPOSE/INTRODUCTION

This study describes rates of low-energy fractures, time-to-surgery, complications, and deaths post-surgery in patients with fractures during the coronavirus disease (COVID-19) pandemic in Alberta, Canada, compared to the three years prior.

METHODS

A repeated cross-sectional study was conducted using provincial-level administrative health data. Outcomes were assessed in 3-month periods in the 3 years preceding the COVID-19 pandemic and in the first two 3-month periods after restrictions were implemented. Patterns of fracture- and hospital-related outcomes over the control years (2017-2019) and COVID-19 restrictions periods (2020) were calculated.

RESULTS

Relative to the average from the control periods, there was a slight decrease in the absolute number of low-energy fractures (n = 4733 versus n = 4308) during the first COVID-19 period, followed by a slight rise in the second COVID-19 period (n = 4520 versus n = 4831). While the absolute number of patients with low-energy fractures receiving surgery within the same episode of care decreased slightly during the COVID-19 periods, the proportion receiving surgery and the proportion receiving surgery within 24 h of admission remained stable. Across all periods, hip fractures accounted for the majority of patients with low-energy fractures receiving surgery (range: 58.9-64.2%). Patients with complications following surgery and in-hospital deaths following fracture repair decreased slightly during the COVID-19 periods.

CONCLUSIONS

These results suggest that low-energy fracture rates, associated surgeries, and surgical outcomes declined slightly, but largely remained stable in the first few months of the pandemic. Further investigation is warranted to explore patterns during subsequent COVID-19 waves when the healthcare system experienced severe strain.

Active surveillance protocol in prostate cancer in Portugal

OBJECTIVE

To examine clinical practice patterns in locally managing patients under an active surveillance protocol among Portuguese urologists.

INTRODUCTION

Prostate cancer (PCa) is a heterogeneous disease with many prostate adenocarcinomas being indolent and a low probability of ever causing symptoms or death. Active surveillance (AS) is a form of conservative management aimed to reduce over-treatment for low-risk PCa patients. Over the years, experience with AS has grown considerably and is now standard in some countries, however a universal protocol still does not exist.

METHODS

Nationwide anonymous e-survey concerning habits and practices on AS among Portuguese urologists, that consisted of twelve questions and was sent electronically to all 368 current members of the Portuguese Urological Association.

RESULTS

56 urologists were surveyed (15.21% answer rate), evenly distributed geographically and allocated according to years of experience as well as number of PCa patients managed monthly. The vast majority of respondents recommends AS to their patients, particularly ISUP grade 1 patients, whose PSA serum level is bellow 20 ng/mL. Observance of AS programs by patients was not in question but concerns exist over psychological morbidity while harboring disease. Majority believed that international guidelines surveillance protocols were adequate and sufficient, but there are some constraints concerning availability of periodic MRIs and re-biopsy needs.

CONCLUSIONS

AS seems to be sustained in urologist clinical practice, although patients still lag to adhere and choose for active treatment. AS may not be an easy choice for patients and clinicians due to uncertainty of disease progression, risk of loss to follow-up and repeated biopsies but is also a cause for anxiety, depression, uncertainty and a perception of danger.

Cost analysis of acute care resource utilization among individuals with sickle cell disease in a middle-income country

BACKGROUND

The costs associated with the treatment of sickle cell disease (SCD) are understudied in low and middle-income countries (LMIC). We evaluated the cost of treating SCD-related acute complications and the potential cost-savings of hydroxyurea in a specialized hematology center in Brazil.

METHODS

The costs (US dollars) of emergency department (ED) and hospitalizations from SCD-related complications between 01.01.2018 and 06.30.2018 were ascertained using absorption and micro-costing approaches. The reasons for acute hospital visits were grouped as: 1) vaso-occlusive (VOC) pain, 2) infection, 3) anemia exacerbation, and 4) chronic organ damage complications. Hydroxyurea adherence was estimated by medication possession ratio (MPR) during the study period.

RESULTS

In total, 1144 patients, median age 17 years (range 0-70), 903 (78.9%) with HbSS/HbSβ0-thalassemia, 441 (38.5%) prescribed hydroxyurea, visited the ED, of whom 381 (33%) were admitted. VOC accounted for 64% of all ED visits and 60% of all admissions. Anemia exacerbation was the most expensive reason for ED visit ($321.87/visit), while chronic organ damage carried the highest admission cost ($2176.40/visit). Compared with other genotypes, individuals with HbSS/HbSβ0-thalassemia were admitted more often (79% versus 21%, p < 0.0001), and their admission costs were higher ($1677.18 versus $1224.47/visit, p = 0.0001). Antibiotics and analgesics accounted for 43% and 42% of the total ED costs, respectively, while housing accounted for 46% of the total admission costs. Costs of ED visits not resulting in admissions were lower among HbSS/HbSβ0-thalassemia individuals with hydroxyurea MPR ≥65% compared with visits by patients with MPR <65% ($98.16/visit versus $182.46/visit, p = 0.0007). No difference in admission costs were observed relative to hydroxyurea use.

DISCUSSION

In a LMIC hematology-specialized center, VOCs accounted for most acute visits from patients with SCD, but costs were highest due to anemia exacerbation. Analgesics, antibiotics, and housing drove most expenses. Hydroxyurea may reduce ED costs among individuals with HbSS/HbSβ0-thalassemia but is dependent on adherence level.

HDAC inhibition induces EMT and alterations in cellular iron homeostasis to augment ferroptosis sensitivity in SW13 cells

Epithelial-to-mesenchymal transition (EMT) is an essential mechanism for development and wound healing, but in cancer it also mediates the progression and spread of aggressive tumors while increasing therapeutic resistance. Adoption of a mesenchymal state is also associated with increased iron uptake, but the relationship between EMT and the key regulators of cellular iron metabolism remains undefined. In this regard, the human adrenal cortical carcinoma SW13 cell line represents an invaluable research model as HDAC inhibitor treatment can convert them from an epithelial-like (SW13-) cell type to a mesenchymal-like (SW13+) subtype. In this study we establish SW13 cells as a model for exploring the link between iron and EMT. Increased iron accumulation following HDAC inhibitor mediated EMT is associated with decreased expression of the iron export protein ferroportin, enhanced ROS production, and reduced expression of antioxidant response genes. As availability of redox active iron and loss of lipid peroxide repair capacity are hallmarks of ferroptosis, a form of iron-mediated cell death, we next examined whether HDAC inhibitor treatment could augment ferroptosis sensitivity. Indeed, HDAC inhibitor treatment synergistically increased cell death following induction of ferroptosis. The exact mechanisms by which HDAC inhibition facilitates cell death following ferroptosis induction requires further study. As several HDAC inhibitors are already in use clinically for the treatment of certain cancer types, the findings from these studies have immediate implications for improving iron-targeted chemotherapeutic strategies.

Abstract 2006: The contributions of iron regulatory proteins 1 and 2 to ferroptosis activation and ferroptotic cell death

The essentiality of iron for cell growth and proliferation, coupled with its capacity to promote damaging free radical production, has made it a desirable target for cancer treatment and prevention. One such approach may be through the activation of ferroptosis, a form of iron-mediated programmed cell death. However, we must first understand how cancer cells manipulate the homeostatic regulators of iron metabolism to promote malignancy before we can fully harness iron's therapeutic potential. The iron regulatory proteins 1 and 2 (IRP1 and IRP2) are the master regulators of intracellular iron homeostasis because they coordinate the expression of proteins involved in iron storage, uptake, and utilization. Yet, the roles and regulation of IRPs during cellular ferroptosis remain unknown. The primary objective of this work was to examine the reciprocal relationship between ferroptosis activation and IRP mRNA binding activity. Utilizing tetracycline-inducible plasmids, we found that overexpression of IRP1 or IRP2 significantly increases sensitivity to ferroptotic cell death in HEK293T cells. Intriguingly however, ferroptosis induction by erastin treatment differentially influences IRP1 and IRP2 mRNA binding activity in a cell-type dependent manner, with those cell types expressing higher levels IRP2 exhibiting increased sensitivity to ferroptosis activation. Yet, IRP2 knockout cells are still subject to ferroptotic cell death, as are cells that lack IRP1 expression. Collectively, our findings suggest that while increased expression of IRP1 and IRP2 can promote ferroptotic cell death, expression of IRP1 or IRP2 is sufficient to convey sensitivity to ferroptosis activation. To identify mechanism driving increased IRP mRNA binding activity during cellular ferroptosis, we are currently assessing both iron-dependent and -independent regulators of IRP1 and IRP2 function and stability. As iron is an essential, yet potentially toxic nutrient, such findings will be important because they are expected to provide novel insights for exploiting the toxic nature of iron without compromising the essential homeostatic control mechanisms.

Citation Format: Evan Hermann, Thais Oliveira, McKale Montgomery. The contributions of iron regulatory proteins 1 and 2 to ferroptosis activation and ferroptotic cell death [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2006.

Mangrove carbon and nutrient accumulation shifts driven by rapid development in a tropical estuarine system, northeast Brazil

Mangrove environments are important for maintaining biodiversity and carbon cycling. However, these systems are being degraded at alarming rates around the world, particularly in rapidly developing regions. Here, we examine a sediment profile from a mangrove forest near a large port complex at Suape, northeast Brazil, in order to assess the impact of rapid urbanization and industrialization. We find that total organic carbon (TOC) and total nitrogen (TN) accumulation rates have increased in the estuary since the 1980's, directly related to rapid urban development. The TN and heavy δ¹⁵N values in the sediment column suggest increasing anthropogenic influences. In contrast, heavy metal fluxes did not increase during these transitions. The increase in TOC and TN accumulation rates during the past four decades highlight the significant role mangrove areas play as sinks for anthropogenically enhanced nutrients in poorly-understood tropical areas.

Impacts of social distancing during the covid19 pandemic on the development of children with autism in Brazil

Introduction

COVID-19 is a respiratory disease and its main symptoms are fever, dry cough and difficulty breathing. It spread to several countries, which led the World Health Organization to decree, on March 11, 2020, a pandemic state that deeply affected Brazil. Due to the impossibility of leaving the house, the routine of children with autism was changed. Children in Autism Spectrum Disorder (ASD) have a qualitative deficit in social interaction. Clinical and daily observations reinforce several scientific studies that defend the importance of maintaining a routine as stable as possible for people with ASD, without this stability they may become emotionally disorganized, feel discomfort or even irritability.

Objectives

Investigate the impact caused by social distancing on the development of children and adolescents with autism.

Methods

An online questionnaire based on the DIR/Floortime basic map of emotional functional capacity development was distributed in Brazil from April to May, 2020. The results were analyzed using SPSS software.

Results

Results obtained from 122 questionnaires showed that after 30 days of quarantine 20% of children no longer had the characteristic of being able to remain calm and organized for at least 2 minutes; 11% no longer initiates interactions with their parents; 27% demonstrated more protests and anger than before the social distancing; 18% demonstrated more emotions such as anger, fear and intimacy, 28% began to understand their limits and 12% of the children are using greater facial expression during the social distancing.

Conclusions

This study brings results that can help to understand the processes in a child with autism.

The Functioning of Outreach Programs Of/On the Street and the Work Processes of the Nurse

Problem

Homeless people (PSR) are a heterogeneous and fragile group. They are among the most excluded ones from health service access because they cannot present a regular home. They are also a population who have great difficulty of accessing the entrance and mostly search only for emergency and urgency services when their lives are at stake. This intervention is important because it aims at decreasing the inequalities to health access and, moreover, it decreases the difficulties to health access.

Description of the problem

A field visit to an outreach program on the street (CR) in Belo Horizonte was made on April, 22nd and on May, 6th in 2019. This program is linked to a Health Center. The objectives were knowing the functioning of outreach programs on the street and understanding the assignments and participation of the team nurse on working with PSR.

Results

By acting with and approaching PSR, the nurse can create contact and humanized listening. This is an attempt to establish user / professional bonds. During this contact, the professional struggles to encourage the user to search the health attention net. This professional also approaches the rupture with home, with the family, with the work, and with others. He/She tries to support users to face the challenges and to stimulate social reinsertion as well. Tests on the street to detect HIV/AIDS and syphilis are made, guaranteeing the individual privacy right. By approaching PSR, it is crucial that the nurse, who is part of the multi-professional team, be free of any prejudice and stigmas which can make the attendance success difficult. The application of health expanded concept was also present because it considers the complexity of health, mainly to those who inhabit the streets.

Lessons

The nurse can succeed in facing inequity. This decreases not only the barriers established by social inequalities but also the organizational barriers PSR are exposed all the time.

Key messages

Attendance prioritizes local care. It not only tries to attend social and health problems but also shared actions with Health Centers. At last, it should be an example to other countries. It is important for health professionals to reinvent their practices, searching partnerships and the acquisition of new knowledge to succeed in decreasing individuals’ demands.

Profile of incarcerated women in the interior of Brazil and the challenge of education in prison

According to the Ministry of Justice and Public Security, Brazil is fourth in the world position in relation to the absolute size of female prison population, with 42.000 women deprived of freedom (2016), behind the United States, China and Russia. Around 50% are young (&lt; 29 years old), 62% are black and 66% have not yet attended high school. This study aimed to characterize the profile of women incarcerated in a penitentiary in the interior of Brazil, through the survey of sociodemographic data, education, health, legal and life expectations. This is a descriptive and exploratory study conducted with 68 women (20 to 67 years old) in 2019 and 2020. Most women declared themselves black or brown (56%), incomplete elementary school (42%), have work experience (73%). Around 69% reported needing health treatment and 76% have already used psychoactive substances including alcohol, cigarettes, marijuana, cocaine or crack. The main reasons that led to the arrest were drug trafficking (54%) and theft (26%) and the majority (53%) are repeat offenders in prison system. Regarding the biggest dream of life, the main answers were related to family life (44%), having a job (26%) and access to education (20%). With these results, an extension project was proposed to offer a professional qualification in vegetable gardens, aromatic and medicinal plants for women prisoners. In addition to professional qualification, the project is dedicated to promoting debates on map of life, ethics, human relations, citizenship, gender, women's rights and health, quality of life, body and verbal expression, digital inclusion, food and nutrition security, entrepreneurship, cooperativism, solidary economy, rights and duties of the worker, aiming at better employment conditions. This research contributed to articulate actions between university and society, empower women through access to education and allowed the work team to develop competencies related to collaborative work and interdisciplinarity.

Key messages

This study aimed to characterize the profile of women incarcerated in a penitentiary in Brazil, through the survey of sociodemographic data, education, health, legal and life expectations. This research contributed to articulate actions between university-society, empower incarcerated women through access to education and allowed the work team collaborative and interdisciplinarity work.

TP53 Mutation Status Influences Iron Regulatory Protein RNA Binding Activity and Sensitivity to Ferroptotic Cell Death

Objectives

The tumor suppressor gene TP53 is the most commonly mutated gene in human cancer, but mutations in TP53 do not just result in loss of tumor suppressor function, they can also promote cancer progression by altering cellular iron acquisition and metabolism. A newly identified role for TP53 in the mediation of iron homeostasis and cancer cell survival lies in the ability for TP53 to protect against ferroptosis, a form of iron mediated cell death. The purpose of this study was to determine the extent to which TP53 mutation status effects iron-mediated cell death in response to ferroptosis induction. We also measured TP53 dependent differences in iron regulatory protein (IRP) RNA binding activity to begin to clarify the mechanisms by which TP53 mutation status may influence sensitivity to ferroptosis.

Methods

Using H1299 cells, which are null for TP53, we generated cell lines expressing either a tetracycline inducible wild-type TP53 gene, or a representative mutated TP53 gene from exemplary “hotspot” mutations in the DNA binding domain (R248, R273, R282, G245, R249 and R175). These six mutation types were selected because they represent 25% of all TP53 mutations in human cancer. To determine the influence of TP53 mutation status on sensitivity to ferroptotic cell death, we treated cells with erastin, a potent inducer of ferroptosis and measured differences in cell viability between these cell lines using PrestoBlue cell viability reagent. To assess mutant TP53-depenent differences in IRP RNA binding activity during ferroptosis we measured differences in IRP RNA binding activity via Electrophoretic Mobility-Shift Assay.

Results

We found that TP53 mutants (R273, R248, R175, G245, and R249) were significantly less viable (P &lt; 0.05) after initiation of ferroptosis compared to cells expressing WT TP53. Following ferroptosis induction, we observed a significant (P &lt; 0.05) increase in IRP RNA binding in G245, R248, and R175 mutants.

Conclusions

Our preliminary analyses indicate that TP53 mutants may be more sensitive to ferroptosis, but IRPs do not seem to be solely responsible for the increase in iron during ferroptotic cell death. Furthermore, ferroptosis may be a potential therapeutic target for cancers with these TP53 mutations but further investigation is warranted.

Funding Sources

Internal funding at Oklahoma State University.

Impaired decision-making and time perception in individuals with stroke: Behavioral and neural correlates

Several studies have demonstrated that stroke subjects present impairment of functions related to decision-making and timing, involving the information processing in the neural circuits of the cerebellum in association with the prefrontal cortex. This review is aimed to identify the gaps, and demonstrate a better understanding of decision-making and timing functions in the patients with stroke. Electronic literature database was searched and the findings of relevant studies were used to explore the mechanisms of decision-making and timing in patients with stroke, as well as the circuit connections in timing mediated by prefrontal cortex and cerebellum. A literature review was conducted with 65 studies that synthesized findings on decision-making and time perception in individuals with stroke. Types of neurobiological modalities in this study included: Relationships among decision-making, time perception, related cognitive aspects (such as discrimination tasks, verbal estimation, bisection tasks, time production and motor reproduction), and motor control. We demonstrate that the timing processes are important for the performance in cognitive tasks and that the cerebellum and prefrontal cortex are involved in decision-making and time perception. In the context, the decision-making is impaired in stroke patients has a great impact on executive functions, and this seems to be important in determining neurobiological aspects relevant to the time interval interpretation.

Reduction of Breast Cancer Treatment Delay as a Result of Efforts Carried Out by Two Brazilian NGOs

Background: Brazilian breast cancer patients present disease often at advanced stages (III, IV). Previous studies indicated that system delay is a causal factor of bad prognosis and increased mortality rate. In the state of Paraíba, northeast of Brazil, two non-governmental organizations (NGOs) Américas Amigas and Mulheres de Peito de Campina Grande (MLDP), promote faster access to treatment by donating diagnostic mammography and biopsies as well as anatomo-histopathological and immunohistochemical analysis. Aim: The current study aimed at evaluating the effectiveness of the assistance provided by both NGOs and comparing patient flow between HNL and FAP, two reference cancer centers in João Pessoa and Campina Grande, respectively. Methods: Time-to-treatment was analyzed for different time intervals between first medical consultation and initiation of treatment. Comparison was performed between three groups of patients: 40 patients from Hospital Napoleão Laureano (HNL) in João Pessoa; 80 patients from Fundação Assistencial da Paraíba (FAP) in Campina Grande and 15 patients from FAP, who received support from the NGOs. Kaplan-Meier analysis was performed to compare time-intervals among the groups. To estimate the impact of socioeconomic variables Cox regression analysis was performed. Results: Mean time-interval between first medical consultation and hospital admission was 135 (SD=21.0), 370 (SD=73.7) and 515 (SD=36.6) days, for patients of HNL, MLDP and FAP, respectively ( P = 0.0021). Time intervals analyzed for patients within the FAP hospital, between first medical consultation and hospital admission, tended to be shorter for patients who were assisted by the NGOs, compared with those who did not receive any assistance from the NGOs. Patients who had consulted specialized oncological health services beforehand had an increased chance (HZ=2.32; 95% CI: 1.17-4.60; P = 0.016) of being admitted at the reference hospital within 90 days after the first medical consultation, compared with those who had not consulted such specialized services. There were no significant differences between HNL and FAP, regarding the time interval between hospital admission and treatment initiation ( P = 0.21). Conclusion: The assistance to patients provided by the two NGOs, aimed at speeding up the diagnosis process, accelerated patient flow between first medical consultation and admission at the hospitals. Regarding HNL, patients from the inland had been sent by primary health units in their municipalities, directly to the cancer reference hospital in João Pessoa, without being referred to an in-between health service. Such procedure explains the variation of time intervals when admissions at FAP and HNL are compared. The results of the current study indicate that by providing faster breast cancer diagnosis, the NGOs’ mediation can significantly improve patient flow.

Effect of carbohydrate mouth rinse on exercise performance in horses

The mechanism related to the practice of oral carbohydrate (CHO) supplementation prior to intense exercise of a short duration (<30 min) for athletic horses remains unclear. Several studies in human athletes showed that the central nervous system played an important role in the enhancement of athletic performance due to CHO contact with undefined receptors in the oropharyngeal mucosa. This study aims to investigate the influence of CHO mouth rinse on the exercise performance of horses. In this double blind, randomised, placebo-controlled study, seven Mangalarga Marchador horses underwent a standardised exercise test (SET) in a field. The following protocols involving a single mouthwash (1 litre) had been used: a mouth rinse of 6.4% maltodextrin-water solution (CHO test), and a mouth rinse of only water solution (placebo test). The mean plasma lactate concentration immediately after SET (lactate peak) was higher in the CHO test (24.33±3.72 mmol/l) than in the placebo test (18.19±4.01 mmol/l), (P<0.001). No difference was observed in the mean time-to-exhaustion, mean and maximum heart rate, plasma glucose concentration and serum creatinine-kinase activity. Several studies described that there were improvements in the time-trial performance of cyclists and runners after a mouth rinse of CHO solution, whereas some did not. Carbohydrate mouth rinse had no influence on exercise performance in this study. Further investigations are required, as the significance of an increased plasma lactate concentration due to a CHO mouth rinse has yet to be elucidated.

Pulp tissue response to Portland cement associated with different radio pacifying agents on pulpotomy of human primary molars

The objective of this research was to evaluate the response of Portland cement associated with different radio pacifying agents on pulp treatment of human primary teeth by clinical and radiographic exams and microscopic analysis. Thirty mandibular primary molars were randomly divided into the following groups: Group I - Portland cement; Group II - Portland cement with iodoform (Portland cement + CHI3 ); Group III - Portland cement with zirconium oxide (Portland cement + ZrO2 ); and treated by pulpotomy technique (removal of a portion of the pulp aiming to maintain the vitally of the remaining radicular pulp tissue using a therapeutic dressing). Clinical and radiographic evaluations were recorded at 6, 12 and 24 months follow-up. The teeth at the regular exfoliation period were extracted and processed for histological analysis. Data were tested using statistical analysis with a significance level of 5%. The microscopic findings were descriptively analysed. All treated teeth were clinically and radiographically successful at follow-up appointments. The microscopic analysis revealed positive response to pulp repair with hard tissue barrier formation and pulp calcification in the remaining roots of all available teeth. The findings of this study suggest that primary teeth pulp tissue exhibited satisfactory biological response to Portland cement associated with radio pacifying agents. However, further studies with long-term follow-up are needed to determine the safe clinical indication of this alternative material for pulp therapy of primary teeth.

Copper phytoremediation by a salt marsh plant (Phragmites australis) enhanced by autochthonous bioaugmentation

Here we evaluated whether the potential of Phragmites australis to phytoremediate Cu contaminated sediments could be enhanced by bioaugmentation with an autochthonous microorganism consortium (AMC) that is resistant to Cu. Saltmarsh plants with sediment attached to their roots were collected, placed in vessels and kept in greenhouses, under tidal simulation. Sediments were contaminated with Cu and the AMC was added to half of the vessels. After two months, plants accumulated significant amounts of Cu (2-10 times more) in all tissues although in higher amounts (7-10 times more) in belowground structures. AMC addition increased Cu bioavailability (5-10%) in sediments leading to a decrease in belowground structures biomass. However, bioaugmentation increased Cu translocation, with higher amounts (2 times more) of Cu in the plant stems, without significant visual toxicity signs. Therefore, autochthonous bioaugmentation can increase Cu phytoextraction potential of P. australis, which can be a valuable strategy for the recovery and management of moderately impacted estuaries.

Instrumented hip implants: electric supply systems

Instrumented hip implants were proposed as a method to monitor and predict the biomechanical and thermal environment surrounding such implants. Nowadays, they are being developed as active implants with the ability to prevent failures by loosening. The generation of electric energy to power active mechanisms of instrumented hip implants remains a question. Instrumented implants cannot be implemented without effective electric power systems. This paper surveys the power supply systems of seventeen implant architectures already implanted in-vivo, namely from instrumented hip joint replacements and instrumented fracture stabilizers. Only inductive power links and batteries were used in-vivo to power the implants. The energy harvesting systems, which were already designed to power instrumented hip implants, were also analyzed focusing their potential to overcome the disadvantages of both inductive-based and battery-based power supply systems. From comparative and critical analyses of the methods to power instrumented implants, one can conclude that: inductive powering and batteries constrain the full operation of instrumented implants; motion-driven electromagnetic energy harvesting is a promising method to power instrumented passive and active hip implants.

Effects of Game Location, Period, and Quality of Opposition in Elite Handball Performances

The aims of the present study were to identify (i) home advantage in elite handball according to the quality of opponent, (ii) the game periods where the teams score more goals, and (iii) the game statistics associated with the teams' success according to the game's location. The sample comprised 480 regular season games (2007–2009) from the Spanish Professional Handball League. The goals scored and shot effectiveness (6 m, 7 m, 9 m and fast breaks) were analyzed for each 5-min. game period in games between players of balanced and unbalanced quality. The home advantage was 64%, with higher values (71%) in balanced and lower values (55%) in unbalanced games. The 5-min. game periods in which teams scored more goals were the last 5-min. period of each half, especially in the second half. The effectiveness was only different in shots closer to the goal (6 m), which supports the territoriality theory of home advantage.

[Positive bronchoalveolar lavage and quantitative cultures results in suspected late-onset ventilator associated penumonia evaluation--retrospective study]

INTRODUCTION

Bronchoalveolar lavage (BAL) with quantitative cultures has been used in order to increase ventilator associated pneumonia (VAP) diagnosis specificity, although the accurate technique for this entity diagnosis remains controversial.

OBJECTIVES

To evaluate the influence of using positive BAL and quantitative cultures results in microbiologic diagnosis and treatment of patients with suspected late VAP and prior antibiotherapy.

MATERIAL AND METHODS

Retrospective analysis of intensive care unit (UCI) patients, during a one year period, with clinical suspicion of late VAP and prior use of antibiotics that presented a growth in BAL cultures.

RESULTS

Of 243 BAL performed, there were 71 (29.2%) positive cultures (60 patients, 76.7% male, 54 ± 19 years). BAL was done after 13 days (median) of invasive mechanical ventilation, 11 days of ICU antibiotherapy and in the day in which a new antibiotic for VAP suspicion was started. Colony forming units (CFU)/ml count was performed in 71.8% and endotracheal aspirate (ETA) simultaneously collected for qualitative analysis in 85.9%. Therapeutic approach was changed in 38.0%: correction (16.9%), de-escalation (12.7%) and directed antibiotherapy start (8.4%). Therapeutic changes were made in the presence of CFU > 10(4) in 84.2% and in agreement with ETA in 70.8%. In cases in which antibiotherapy was maintained (62.0%), quantitative cultures would have allowed de-escalation in 9.1%. Changes in prescription were more frequent when CFU was > 10(4) (48.5%), comparing with situations in which counts were lower and BAL analysis was qualitative (28.9%), p = 0.091. There were no significant differences between patients submitted to different therapeutic approaches concerning to ICU mortality or length of stay.

CONCLUSION

In late onset VAP, positive BAL and quantitative cultures allowed therapeutic changes, leading to antibiotic adequacy and consumption reduction, which can however be maximised.

Thoracic outlet lymphangioma

We report a case of a lymphangioma causing thoracic outlet syndrome (TOS) in a young collegiate athlete. This was completely resected with a combined cervical and axillary osteo-muscular sparing approach.

Crystallization and preliminary structure determination of the membrane-bound complex cytochrome c nitrite reductase from Desulfovibrio vulgaris Hildenborough

The cytochrome c nitrite reductase (cNiR) isolated from Desulfovibrio vulgaris Hildenborough is a membrane-bound complex formed of NrfA and NrfH subunits. The catalytic subunit NrfA is a soluble pentahaem cytochrome c that forms a physiological dimer of about 120 kDa. The electron-donor subunit NrfH is a membrane-anchored tetrahaem cytochrome c of about 18 kDa molecular weight and belongs to the NapC/NirT family of quinol dehydrogenases, for which no structures are known. Crystals of the native cNiR membrane complex, solubilized with dodecylmaltoside detergent (DDM), were obtained using PEG 4K as precipitant. Anomalous diffraction data were measured at the Swiss Light Source to 2.3 A resolution. Crystals belong to the orthorhombic space group P2(1)2(1)2(1), with unit-cell parameters a = 79.5, b = 256.7, c = 578.2 A. Molecular-replacement and MAD methods were combined to solve the structure. The data presented reveal that D. vulgaris cNiR contains one NrfH subunit per NrfA dimer.

[Cervical spondylodiscitis in an infant]

Spondylitis in childhood is rare, presenting a great variety of symptoms that are related to the child s age and to the site of the inflammatory process. We present the case of a nine-month-old infant, who presented to the emergency department with a torticollis of six weeks evolution. The diagnosis of spondylitis (C6-C7) was confirmed by MRI. Intravenous antibiotic therapy was administered. The patient showed complete regression of symptoms and imaging tests were normal. The rarity of this disease in patients in this age group, as well as the site and form of presentation are emphasised as is the importance of diagnosing this disease to prevent permanent neurological injuries or bone deformities.

Fetal fibronectin as a predictor of preterm delivery in twin gestations

OBJECTIVE

To evaluate fetal fibronectin as a predictor of premature delivery in twin pregnancies.

METHOD

Cervicovaginal secretions were obtained from 52 pregnant women with twin pregnancies between 24 and 34 weeks of gestation. The secretions were analyzed to detect the presence of fetal fibronectin by immediate-reading membrane test. The correlation between the presence of fetal fibronectin and preterm birth was evaluated. In addition, cervical dilatation and effacement were evaluated with each sampling.

RESULT

The sensitivity, specificity, positive predictive value and negative predictive value to predict preterm delivery were 89.3, 50.0, 67.6, and 80.0%, respectively. A positive fetal fibronectin result was associated with a relative risk (RR) for preterm birth of 3.4 (95% CI, 1.2-9.5). A positive fetal fibronectin test associated with cervical dilatation or effacement increased the RR for preterm birth to 4.3 and 7.7, respectively, when compared with those with negative test and without cervical dilatation and effacement.

CONCLUSION

Fetal fibronectin in the cervicovaginal secretions of patients with twin pregnancies is a sensitive predictor of preterm delivery. However, because of its low specificity, the fetal fibronectin test should be evaluated along with cervical changes for better identification of twins likely to develop preterm labor.