International Consensus Document on Obstructive Sleep Apnea

The main aim of this international consensus document on obstructive sleep apnea is to provide guidelines based on a critical analysis of the latest literature to help health professionals make the best decisions in the care of adult patients with this disease. The expert working group was formed primarily of 17 scientific societies and 56 specialists from a wide geographical area (including the participation of 4 international societies), an expert in methodology, and a documentalist from the Iberoamerican Cochrane Center. The document consists of a main section containing the most significant innovations and a series of online manuscripts that report the systematic literature searches performed for each section of the international consensus document. This document does not discuss pediatric patients or the management of patients receiving chronic non-invasive mechanical ventilation (these topics will be addressed in separate consensus documents).

CDK2 is a target for retinoic acid-mediated growth inhibition in MCF-7 human breast cancer cells

Retinoic acid (RA) inhibition of breast cancer cell growth is associated with an accumulation of cells in G1 phase of the cell cycle. We have investigated the effects of RA on the expression and activity of cell cycle-regulatory proteins in MCF-7 human breast cancer cells. Flow cytometry analysis of MCF-7 cells treated with RA revealed a decrease in the percentage of cells in S phase by 48 h, which was maximal by 72 h. Phosphorylation of the retinoblastoma protein (pRb) was partially reduced in RA-treated cells accompanied by a decrease in the level of retinoblastoma protein. Expression of the cyclin D1 transcript was reduced by 48 h and cyclin-dependent kinase 2 (cdk2) mRNA levels declined within 8 h posttreatment followed by a decrease in cyclin D1 and cdk2 protein levels. Message and protein levels of cdk4 and cdc2 were not affected by RA. While cdk4 activity was similar in control and RA-treated cells, cdk2 activity began to decrease within 48 h of exposure to RA and was profoundly reduced after 72 h. This reduced activity was associated with decreased phosphorylation of cdk2. The decrease in cdk2 activity occurred in the absence of RA-mediated increases in the levels of the cdk inhibitors p21 and p27. However, assays of cdk2 from pooled lysates from RA-treated and control cells showed that RA-treated cells contain a cdk2-inhibitory activity. Our results show that RA inhibits cell cycle progression of MCF-7 cells by inhibiting cdk2 mRNA and protein production and by decreasing cdk2 activity.

Immigrant Entrepreneurship, Institutional Discrimination, and Implications for Public Policy: A Case Study in Toronto

Immigration since World War 2 has been a primary engine of economic, social, and cultural change in Canada. Two of its important characteristics have been its ‘urban’ character and the non-European origins of immigrants since the 1960s. The Toronto Census Metropolitan Area (CMA) has been a major destination for those immigrants who have entered the self-employed sector of the economy in ever-larger numbers. The authors focus on the barriers and challenges experienced by the Polish, Portuguese, Caribbean, Korean, and Somali immigrants in the establishment and operation of their businesses in the Toronto CMA. With information collected through key-informant interviews, a questionnaire survey, and focus groups, it is found that, despite the Canadian commitment to multiculturalism at all levels of government, visible-minority entrepreneurs still confront more barriers in their business practice than do non-visible-minority entrepreneurs, with access to financing being a persistent problem. Given the increasingly multicultural nature of major Canadian cities and the acknowledged role of immigrants as an engine of economic growth, the authors identify barriers to entrepreneurship among immigrants as an area of clear concern both for policymakers and for scholars, and suggest solutions to address this concern.

Lactiplantibacillus plantarum 299v (LP299V®): three decades of research

This review aims to provide a comprehensive overview of the in vitro, animal, and clinical studies with the bacterial strain Lactiplantibacillus plantarum 299v (L. plantarum 299v; formerly named Lactobacillus plantarum 299v) published up until June 30, 2020. L. plantarum 299v is the most documented L. plantarum strain in the world, described in over 170 scientific publications out of which more than 60 are human clinical studies. The genome sequence of L. plantarum 299v has been determined and is available in the public domain (GenBank Accession number: NZ_LEAV01000004). The probiotic strain L. plantarum 299v was isolated from healthy human intestinal mucosa three decades ago by scientists at Lund University, Sweden. Thirty years later, a wealth of data coming from in vitro, animal, and clinical studies exist, showing benefits primarily for gastrointestinal health, such as reduced flatulence and abdominal pain in patients with irritable bowel syndrome (IBS). Moreover, several clinical studies have shown positive effects of L. plantarum 299v on iron absorption and more recently also on iron status. L. plantarum 299v is safe for human consumption and does not confer antibiotic resistance. It survives the harsh conditions of the human gastrointestinal tract, adheres to mannose residues on the intestinal epithelial cells and has in some cases been re-isolated more than ten days after administration ceased. Besides studying health benefits, research groups around the globe have investigated L. plantarum 299v in a range of applications and processes. L. plantarum 299v is used in many different food applications as well as in various dietary supplements. In a freeze-dried format, L. plantarum 299v is robust and stable at room temperature, enabling long shelf-lives of consumer healthcare products such as capsules, tablets, or powder sachets. The strain is patent protected for a wide range of indications and applications worldwide as well as trademarked as LP299V^®.

The most extensive oil spill registered in tropical oceans (Brazil): the balance sheet of a disaster

This article presents a synthesis of information about the massive oil spill in Brazil (2019/2020). The event affected 11 states; however, the majority of the oil residue was collected (~ 5380 tons) near nine states (99.8%) in northeastern Brazil. This spill was not the largest in volume (between 5000 m³ and 12,000 m³) recorded in tropical oceans, but it was the most extensive (2890 km). This spill develops an overwashed tar that remains mostly in the undersurface drift (non-floating oil plume) below 17 m of depth while on the continental shelf. Ten ecosystems were impacted, with potentially more severe effects in mangroves and seagrasses. Certain negative effects are still understudied, such as effects on tropical reefs and rhodolith beds. A total of 57 protected areas in seven management categories were affected, most of which (60%) were characterized as multiple-use regions. The spill affected at least 34 threatened species, with impacts detected on plankton and benthic communities. Acute impacts were reported on echinoderms, coral symbionts, polychaetes, and sponges with evidence of oil ingestion. Socioeconomic impacts were detected in food security, public health, lodging, gender equality, tourism, and fishing, with reduced sales, prices, tourist attractiveness, gross domestic product, and employment. Moreover, chemical contamination was detected in some states by toxic metals (Hg, As, Cd, Pb, and Zn) and polycyclic aromatic hydrocarbons (acenaphthalene, fluoranthene, fluorene, naphthalene, and phenanthrene). This summary aims to aid in the design of science-based strategies to understand the impacts and develop strategies for the most extensive spill observed in tropical oceans.

Development of Plasmodium falciparum protease inhibitors in the past decade (2002-2012)

New drug targets for the development of antimalarial drugs have emerged after the unveiling of the Plasmodium falciparum genome in 2002. Potential antimalarial drug targets can be broadly classified into three categories according to their function in the parasite's life cycle: (i) biosynthesis, (ii) membrane transport and signaling, and (iii) hemoglobin catabolism. The latter plays a key role, as inhibition of hemoglobin degradation impairs maturation of bloodstage malaria parasites, ultimately leading to remission or even cure of the most severe stage of the infection. Intraerythrocytic Plasmodia parasites have limited capacity to biosynthesize amino acids which are vital for their growth. Therefore, the parasites obtain those essential amino acids via degradation of host cell hemoglobin, making this a crucial process for parasite survival. Several plasmodial proteases are involved in hemoglobin catabolism, among which plasmepsins and falcipains are well-known examples. Hence, development of P. falciparum protease inhibitors is a promising approach to antimalarial chemotherapy, as highlighted by the present review which is focused on the Medicinal Chemistry research effort recorded in the past decade in this particular field.

Guidelines for maintenance of adult patients with brain death and potential for multiple organ donations: the Task Force of the Brazilian Association of Intensive Medicine the Brazilian Association of Organs Transplantation, and the Transplantation Center of Santa Catarina

INTRODUCTION

The organ shortage for transplantation, the principal factor that increases waiting lists, has become a serious public health problem. In this scenario, the intensivist occupies a prominent position as one of the professionals that first has a chance to identify brain death and to be responsible for the maintenance of the potential deceased donor.

OBJECTIVE

This report attempts to establish guidelines for care and maintenance of adult deceased donor organs guiding and standardizing care provided to patients with brain death.

METHOD

These guidelines were composed by intensivists, transplant coordinators, professionals from various transplant teams, and used transplant center. The formulated questions were forwarded to all members and recommendations were constructed after an extensive literature review selecting articles with the highest degree of evidence.

RESULTS

Guidelines were developed in the form of questions reflecting frequent experiences in clinical intensive care practices. The main questions were: Is there an optimal interval for keeping organs of deceased donors viable? What actions are considered essential for maintaining deceased donors in this period? What are the limits of body temperature? How should the patient be warmed? Which laboratory tests should be performed? What is the collection interval? What are the limits in the laboratory and the capture scenario? What are the limits of blood pressure? When and how should one use catecholamines?

CONCLUSIONS

This pioneer project involved a multidisciplinary team working in organ transplantation seeking to provide treatment guidance to increase the number of viable organs from deceased adult donors.

The AF-2 region of the retinoic acid receptor alpha mediates retinoic acid inhibition of estrogen receptor function in breast cancer cells

The growth of estrogen receptor (ER)-positive breast cancer cells is inhibited by all-trans-retinoic acid (RA). In the present study, estrogen (E2) induction of pS2 mRNA levels was significantly reduced within 6 h following cotreatment with RA. In transient transfection experiments, RA repressed transactivation from a vitellogenin E2-responsive element by approximately 50% and wild-type RA receptor alpha (RARalpha) or RARbeta enhanced this inhibition. Transfection of truncated RARalpha mutants terminating before or at amino acid 412 markedly decreased RA inhibition of E2-induced reporter gene activity. Expression of RARs with deletions of amino acids 413 and 414 in the transactivation-2 (AF-2) domain also reduced RA inhibition, while deletions and point mutations beyond amino acid 414 behaved like the wild-type RARalpha. RA-treated MCF-7 cells transfected with an RARalpha AF-2 region mutant were twice as sensitive to growth inhibition as untransfected and vector-transfected control cells. Thus, the AF-2 domain in the C terminus of the RARalpha mediates RA inhibition of ER-induced transcription in breast cancer cells. In addition, transcriptional interference between RARs and ERs may contribute to RA inhibition of ER-positive breast cancer cell growth.

Detection of wheezes using their signature in the spectrogram space and musical features

In this work thirty features were tested in order to identify the best feature set for the robust detection of wheezes. The features include the detection of the wheezes signature in the spectrogram space (WS-SS) and twenty-nine musical features usually used in the context of Music Information Retrieval. The method proposed to detect the signature of wheezes imposes a temporal Gaussian regularization and a reduction of the false positives based on the (geodesic) morphological opening by reconstruction operator. Our dataset contains wheezes, crackles and normal breath sounds. Four selection algorithms were used to rank the features. The performance of the features was asserted having into account the Matthews correlation coefficient (MCC). All the selection algorithms ranked the WS-SS feature as the most important. A significant boost in performance was obtained by using around ten features. This improvement was independent of the selection algorithm. The use of more than ten features only allows for a small increase of the MCC value.

Cu(ii) and V(iv)O complexes with tri- or tetradentate ligands based on (2-hydroxybenzyl)-l-alanines reveal promising anticancer therapeutic potential

New Cu^II- and V^IVO amino acid complexes show antiproliferative activity mediated by apoptosis and genomic damage.

Contribution of B(2) receptors for bradykinin in arthus reaction-induced plasma extravasation in wild-type or B(2) transgenic knockout mice

The aim of the present study was to investigate the contribution of bradykinin (BK) B(1) and B(2) receptors in a model of type III hypersensitivity, the reverse passive Arthus reaction (RPA), in wild-type mice and transgenic B(2) knockout littermates. BK (10 microg mouse(-1)) or bovine serum albumin (0.5 mg mouse(-1)) induced a sustained Evans blue extravasation for more than 80 min in naive or rabbit anti-bovine serum albumin-treated mice (RPA model), respectively. The response to the two stimuli was prevented by the B(2) receptor antagonist, HOE-140, but not by [Leu(8)]desArg(9)-BK (B(1) receptor antagonist). In contrast to the wild-type littermates, RPA and bradykinin were unable to trigger an increase in plasma extravasation in B(2) knockout mice. Furthermore, endothelin-1 (5 microg mouse(-1)) and a selective NK-1 receptor agonist [Sar(9),Met (O(2))(11)]-SP (20 microg mouse(-1)), triggered a significant increase in peritoneal plasma extravasation in both wild-type and B(2) knockout animals. A pretreatment with indomethacin (200 microg mouse(-1)) significantly reduced the RPA-induced but not the BK-induced increase in Evans blue extravasation. Furthermore, RPA, but not BK, triggered a significant indomethacin-sensitive increase in peritoneal prostaglandin E(2) content. Our results suggest a pivotal role for B(2) receptors in the mechanism of plasma extravasation which occurs during the reverse passive Arthus reaction in the mouse. Moreover, our results suggest an important contribution of prostanoids in the plasma leakage mechanisms triggered by RPA but not by bradykinin.

Retirement risks: Invasive coral on old oil platform on the Brazilian equatorial continental shelf

The objective of this study was to report, for the first time, the presence of an invasive coral (Tubastraea tagusensis) in an oil platform on the Brazilian equatorial continental shelf. This structure is located more than 1200 km north from other oil and gas structures colonized by this coral. We also discussed the retirement and decommissioning of old biofouling-encrusted oil and gas platforms (~62 platforms) from decreased production and the current oil crisis, exacerbated by the COVID-19 pandemic. This presents an ecological concern due invasive coral range expansion and potential impacts to poorly studied ecosystems such as marginal shallow-water coral reefs and mesophotic ecosystems. It is imperative that mindful risk analysis and rigorous environmental studies must precede the installation of new oil and gas platforms. In addition, decommissioning of retired structures should take into consideration marine restoration and non-indigenous species dispersal, and more specifically, Tubastraea bioinvasion.

VPA/PLGA microfibers produced by coaxial electrospinning for the treatment of central nervous system injury

The central nervous system shows limited regenerative capacity after injury. Spinal cord injury (SCI) is a devastating traumatic injury resulting in loss of sensory, motor, and autonomic function distal from the level of injury. An appropriate combination of biomaterials and bioactive substances is currently thought to be a promising approach to treat this condition. Systemic administration of valproic acid (VPA) has been previously shown to promote functional recovery in animal models of SCI. In this study, VPA was encapsulated in poly(lactic-co-glycolic acid) (PLGA) microfibers by the coaxial electrospinning technique. Fibers showed continuous and cylindrical morphology, randomly oriented fibers, and compatible morphological and mechanical characteristics for application in SCI. Drug-release analysis indicated a rapid release of VPA during the first day of the in vitro test. The coaxial fibers containing VPA supported adhesion, viability, and proliferation of PC12 cells. In addition, the VPA/PLGA microfibers induced the reduction of PC12 cell viability, as has already been described in the literature. The biomaterials were implanted in rats after SCI. The groups that received the implants did not show increased functional recovery or tissue regeneration compared to the control. These results indicated the cytocompatibility of the VPA/PLGA core-shell microfibers and that it may be a promising approach to treat SCI when combined with other strategies.

Alpha-2-HS-glycoprotein gene frequencies in Galicia: further evidence for a cline in European populations

alpha 2-HS-glycoprotein (AHSG) phenotypes were determined in 506 unrelated autochthonous individuals from the Galician population (NW Spain) by means of isoelectric focusing followed by silver stain immunofixation. The phenotype frequency distribution fitted with the Hardy-Weinberg law. No evidence of intrapopulation heterogeneity was observed. The allele frequencies obtained were: AHSG*1 = 0.7559 +/- 0.013 and AHSG*2 = 0.2441 +/- 0.013. Our findings lend support to the hypothesis of an AHSG gene frequency cline in European populations. Other population genetics' considerations have also been discussed.

Prophylactic use of liposomal amphotericin B in preventing fungal infections early after liver transplantation: a retrospective, single-center study

In this study the authors evaluated the efficacy of prophylaxis with liposomal amphotericin B (L-AmB) in the incidence of fungal infections (FI) during the first 3 months after liver transplant (LT). The study was retrospective and accessed a 4-year period from 2008 to 2011. All patients who died in the first 48 hours after LT were excluded. Patients were divided by the risk groups for FI: Group 1, high-risk (at least 1 of the following conditions: urgent LT; serum creatinine >2 mg/dL; early acute kidney injury [AKI] after LT; retransplantation; surgical exploration early post-LT; transfused cellular blood components [>40 U]); and Group 2, low-risk patients. Group 1 patients were further separated into those who received antifungal prophylaxis with L-AmB and those who did not. Prophylaxis with L-AmB consisted of intravenous administration of L-AmB, 100 mg daily for 14 days. Four hundred ninety-two patients underwent LT; 31 died in the first 48 hours after LT. From the remaining 461 patients, 104 presented with high-risk factors for FI (Group 1); of these, 66 patients received antifungal prophylaxis and 38 did not. In this group 8 FI were observed, 5 in patients without antifungal prophylaxis (P = .011). Three more FI were identified in Group 2. By logistic regression analysis, the categorical variable high-risk group was independently related to the occurrence of invasive FI (P = .006). We conclude that prophylaxis with L-AmB after LT was effective in reducing the incidence of FI. No influence on mortality was detected.

Uveomeningoencephalitis in a human immunodeficiency virus type 2-seropositive patient

A 35-year-old woman developed longstanding uveitis and later a uveomeningoencephalitis of unknown origin and died of toxoplasmal brain abscesses. The presence of immunological impairment, human immunodeficiency virus type 2 (HIV-2) seropositivity, and multinucleated cells in the brain led us to suspect neurotropic properties for HIV-2 similar to those of HIV-1.

The impact of gentrification on ethnic neighbourhoods in Toronto: a case study of little Portugal

Despite extensive literature on the nature and impact of gentrification, there has been little consideration of the effects of gentrification on ethnic neighbourhoods. This study evaluates the negative and positive effects of gentrification on the Portuguese in west central Toronto. Details concerning the settlement patterns of the Portuguese, the characteristics of Portuguese residents and patterns of gentrification in inner-city Toronto were obtained from census data. Evaluations of neighbourhood change and attitudes of the residents towards gentrification were obtained from key informant and focus group interviews. The results suggest considerable ambivalence among the respondents, but most agreed that the long-term viability of Little Portugal as an immigrant reception area with a good supply of low-cost housing is in doubt.

Are there real advantages of induction therapy with basiliximab in renal transplantation?

BACKGROUND

Randomized clinical trials have supported the use of interleukin-2 receptor (IL-2R) antagonists as induction therapy in renal transplantation. This strategy has reduced the incidence of acute rejection episodes (ARE) but not improved graft survival. Our objective was to investigate the impact of induction therapy using the IL-2R antagonist basiliximab, as compared with no induction therapy, on relevant clinical outcomes-initial length of stay, incidence of ARE, long-term graft function, and graft survival.

METHODS

We retrospectively reviewed the medical records of patients transplanted in a tertiary care center between 1996 and 2011. We selected patients who received cyclosporine, mycophenolate mofetil, and prednisolone (n = 334) to classify as: no induction therapy (n = 131; group 1); induction therapy with basiliximab (n = 203; group 2). Estimated glomerular filtration rate (eGFR) was assessed with the 4-variable Modification of Diet in Renal Disease (MDRD) equation.

RESULTS

Mean follow-up was 72.7 ± 35.4 months. Patients who received basiliximab had a shorter mean hospital stay (19.2 versus 22.5 days; P = .02), lower incidence of ARE (10.8% versus 23.7%; P = .02) and better graft function post transplantation at 12 months (mean eGFR 59.4 ± 18.4 versus 54.8 ± 18.7 mL/min/1.73 m(2); P = .015) and 5 years (mean eGFR 64.1 ± 21.5 versus 55.4 ± 19.6 mL/min/1.73 m(2); P = .009). On multivariate analysis, induction therapy with basiliximab was independently associated with a lower incidence of ARE and better graft function at 1 and 5 years after transplantation. There was no difference in 5-year graft survival between the two groups (log-rank: P = .54).

CONCLUSIONS

Induction therapy with basiliximab was associated with a reduced incidence of ARE and better long-term graft function but no difference in 5-year graft survival.