Feasibility, acceptability, and outcome responsiveness of the SYMPERHEART intervention to support symptom perception in persons with heart failure and their informal caregivers: a feasibility quasi-experimental study

BACKGROUND

Symptom perception is an important process of heart failure (HF) self-care that persons with HF need in order to master self-care management. It also leads to better patient outcomes. Symptom perception consists of body observation and analysis, which are both challenging. We aimed to test the feasibility, acceptability, and outcome responsiveness of a novel intervention (SYMPERHEART) delivered to persons with HF with their informal caregiver.

METHODS

We designed SYMPERHEART as a complex evidence-informed education and support intervention targeting body observation and analysis. We conducted a feasibility quasi-experimental study with a single group pre-post-test design. We included three subsamples: persons with HF receiving home-based care, their informal caregivers exposed to SYMPERHEART, and home-care nurses who delivered SYMPERHEART during 1 month. We assessed feasibility by recruitment time, time to deliver SYMPERHEART, eligibility rate, and intervention fidelity. We assessed acceptability by consent rate, retention rate, persons with HF engagement in body observation, and treatment acceptability. Outcome responsiveness was informed by patient-reported (PRO) and clinical outcomes: HF self-care and the informal caregivers' contribution to HF self-care, perception of HF symptom burden, health status, caregivers' burden, and HF events. We performed descriptive analyses for quantitative data and calculated Cohen's d for PROs. A power analysis estimated the sample size for a future full-scale effectiveness study.

RESULTS

We included 18 persons with HF, 7 informal caregivers, and 9 nurses. Recruitment time was 112.6 h. The median time to deliver SYMPERHEART for each participant was 177.5 min. Eligibility rate was 55% in persons with HF. Intervention fidelity revealed that 16 persons with HF were exposed to body observation and analysis. Consent and retention rates in persons with HF were 37.5% and 100%, respectively. Participants engaged actively in symptom and weight monitoring. Treatment acceptability scores were high. Symptom perception and informal caregivers' contribution to symptom perception were found to be responsive to SYMPERHEART. We estimate that a sample size of 50 persons with HF would be needed for a full-scale effectiveness study.

CONCLUSIONS

SYMPERHEART was found to be feasible and acceptable. This feasibility study provides information for a subsequent effectiveness study.

TRIAL REGISTRATION

ISRCTN. ISRCTN18151041 , retrospectively registered on 4 February 2021, ICTRP Search Portal.

A multicomponent complex intervention for supportive follow-up of persons with chronic heart failure: a randomized controlled pilot study (the UTILE project)

BACKGROUND

Heart failure (HF) is a progressive disease associated with a high burden of symptoms, high morbidity and mortality, and low quality of life (QoL). This study aimed to evaluate the feasibility and potential outcomes of a novel multicomponent complex intervention, to inform a future full-scale randomized controlled trial (RCT) in Switzerland.

METHODS

We conducted a pilot RCT at a secondary care hospital for people with HF hospitalized due to decompensated HF or with a history of HF decompensation over the past 6 months. We randomized 1:1; usual care for the control (CG) and intervention group (IG) who received the intervention as well as usual care. Feasibility measures included patient recruitment rate, study nurse time, study attrition, the number and duration of consultations, intervention acceptability and intervention fidelity. Patient-reported outcomes included HF-specific self-care and HF-related health status (KCCQ-12) at 3 months follow-up. Clinical outcomes were all-cause mortality, hospitalization and days spent in hospital.

RESULTS

We recruited 60 persons with HF (age mean = 75.7 years, ± 8.9) over a 62-week period, requiring 1011 h of study nurse time. Recruitment rate was 46.15%; study attrition rate was 31.7%. Follow-up included 2.14 (mean, ± 0.97) visits per patient lasting a total of 166.96 min (mean, ± 72.55), and 3.1 (mean, ± 1.7) additional telephone contacts. Intervention acceptability was high. Mean intervention fidelity was 0.71. We found a 20-point difference in mean self-care management change from baseline to 3 months in favour of the IG (Cohens' d = 0.59). Small effect sizes for KCCQ-12 variables; less IG participants worsened in health status compared to CG participants. Five deaths occurred (IG = 3, CG = 2). There were 13 (IG) and 18 (CG) all-cause hospital admissions; participants spent 8.90 (median, IQR = 9.70, IG) and 15.38 (median, IQR = 18.41, CG) days in hospital. A subsequent full-scale effectiveness trial would require 304 (for a mono-centric trial) and 751 participants (for a ten-centre trial) for HF-related QoL (effect size = 0.3; power = 0.80, alpha = 0.05).

CONCLUSION

We found the intervention, research methods and outcomes were feasible and acceptable. We propose increasing intervention fidelity strategies for a full-scale trial.

TRIAL REGISTRATION

ISRCTN10151805 , retrospectively registered 04/10/2019.

SYMPERHEART: an intervention to support symptom perception in persons with heart failure and their informal caregiver: a feasibility quasi-experimental study protocol

INTRODUCTION

Symptom perception in heart failure (HF) has been identified as crucial for effective self-care, and is related to patient and health system outcomes. There is uncertainty regarding the feasibility and acceptability of symptom perception support and doubts regarding how to include informal caregivers. This study aims to test the feasibility, acceptability and outcome responsiveness of an intervention supporting symptom perception in persons with HF and their informal caregiver.

METHODS AND ANALYSIS

A feasibility study with a quasi-experimental pretest and post-test single group design is conducted. The convenience sample consists of 30 persons with HF, their informal caregivers and six nurses. SYMPERHEART is an evidence-informed intervention that targets symptom perception by educational and support components. Feasibility is measured by time-to-recruit; time-to-deliver; eligibility rate; intervention delivery fidelity rate. Acceptability is measured by rate of consent, retention rate, treatment acceptability and the engagement in the intervention components. Outcome responsiveness includes: HF self-care (via the Self-care of Heart Failure Index V.7.2); perception of HF symptom burden (via the Heart Failure Somatic Perception Scale V.3); health status (via the Kansas City Cardiomyopathy Questionnaire-12); caregivers' contribution to HF self-care (via the Caregiver Contribution to Self-Care of Heart Failure Index 2); caregivers' burden (via the Zarit Burden Interview). Clinical outcomes include HF events, hospitalisation reason and length of hospital stay. Descriptive statistics will be used to report feasibility, acceptability, patient-reported outcomes (PRO) and clinical outcomes. PRO and caregiver-reported outcome responsiveness will be reported with mean absolute change and effect sizes.

ETHICS AND DISSEMINATION

The study is conducted according to the Declaration of Helsinki. The Human Research Ethics Committee of the Canton of Vaud, Switzerland, has approved the study. Written informed consent from persons with HF and informal caregivers are obtained. Results will be published via peer reviewed and professional journals, and further disseminated via congresses.

TRIAL REGISTRATION NUMBER

ISRCTN18151041.

Self-care, symptom experience, needs, and past health-care utilization in individuals with heart failure: results of a cross-sectional study

AIMS

Self-care in heart failure (HF) is generally sub-optimal and impacts morbidity and mortality. To describe self-care prevalence and explore its relationships with symptom experience, patient needs, and health-care utilization in a Swiss hospital providing regional secondary care.

METHODS AND RESULTS

Cross-sectional study, convenience sample of individuals with HF from four campuses of one regional Swiss hospital. Self-care was assessed via the Self-Care of Heart Failure Index (SCHFI) and the European Heart Failure Self-care Behaviour Scale (EHFScBS), symptom experience via the M.D. Anderson Symptom Inventory-HF (MDASI-HF) and needs via the Heart Failure Needs Assessment Questionnaire (HFNAQ). Healthcare utilization reflected the preceding year's hospitalization incidence. A cut-off level of ≥70% indicated adequate self-care. We analysed SCHFI, EHFScBS, MDASI-HF and HFNAQ scores' relationships with hospitalizations using Spearman's rho correlation; no prior hypotheses were stated. Sample of 310 individuals with HF (37.4% female; mean age 76.8; 55% NYHA III). Adequate self-care maintenance, management, and confidence were reported by 24%, 10%, and 61%. respectively. The sample's mean number of experienced symptoms was 12.8 (SD 4.0) and 14.0 (SD 5.8) for needs. Over the previous year, 269 hospitalizations had occurred (median: 0, IQR 1). Hospitalizations positively correlated with self-care; symptom experience with needs. Neither symptom experience nor needs correlated with hospitalizations.

CONCLUSION

The findings indicated low self-care levels and suggest a need for increased support to maintain physiological stability, manage symptoms and prevent hospitalizations. This study is the first of its kind in Switzerland and among few studies worldwide to report on self-care, symptom experience, needs, and health-care utilization. Interventional studies are warranted considering baseline self-care capabilities, symptoms, and needs of individuals with HF.

Influence of the Fabrication Technique on the Marginal and Internal Adaptation of Ceramic Onlays

This study aimed to evaluate the marginal and internal adaptation of partial coverage crowns (ceramic onlays) fabricated with Press, CEREC BlueCam, and CEREC OmniCam systems, using two preparation designs and evaluating the internal discrepancies at different locations. Two phantom maxillary premolars (master teeth) received different preparation designs, with (BX) and without (NB) a modified occlusal box with round internal angles. Sixty IPS e-max ceramic restorations were fabricated with three systems: Press (n=20), CEREC BlueCam (n=20), and CEREC OmniCam (n=20). Both marginal and internal discrepancy width were measured by using a stereomicroscope at ×25 magnification. The data were evaluated statistically using analysis of variance followed by Tukey's Honestly Significant Difference test (α=0.05). The ceramic restorations fabricated with the Press system presented significantly smaller marginal and internal disadaptations than the BlueCam and OmniCam CEREC systems (p<0.0001). Regarding the preparation designs, preparation BX presented the smallest marginal discrepancies for all fabrication systems and larger internal discrepancies than for restorations fabricated with the Press system. The occlusal location presented a larger internal discrepancy compared with the axial locations. Although the three systems resulted in the fabrication of restorations within a clinically acceptable adaptation with marginal discrepancies below 100 μm, the Press system presented the smallest marginal and internal discrepancies. An improved marginal adaptation was observed in the preparation design with a modified occlusal box with rounded internal angles.

Symptom perception in heart failure - Interventions and outcomes: A scoping review

BACKGROUND

Symptom perception in heart failure has recently been described as essential in the self-care process bridging self-care maintenance and self-care management. Accordingly, symptom perception appears to be critical for improving patient outcomes such as decreased hospital readmission and increased survival.

OBJECTIVES

To explore what interventions have been reported on heart failure symptom perception and to describe outcomes responsive to symptom perception.

DESIGN

We conducted a scoping review using PRISMA Extension for Scoping Reviews.

DATA SOURCES

Structured searches of Medline, PubMed, Embase, CINAHL, PsychINFO, Web of Science, Cochrane, Joanna Briggs Institute and Grey literature databases.

REVIEW METHODS

Two authors independently screened references for eligibility. Eligible articles were written in English, French, German, Swedish, Italian or Spanish and concerned symptom perception in adults with heart failure. Data were extracted and charted in tables by three reviewers. Results were narratively summarized.

RESULTS

We identified 99 eligible studies from 3055 references. Seven interventional studies targeted symptom perception as the single intervention component. Mixed results have been found: while some reported decreased symptom frequency, intensity and distress, enhanced health-related quality of life, improved heart failure self-care maintenance and management as well as a greater ability to mention heart failure symptoms, others found more contacts with healthcare providers or no impact on anxiety, heart failure self-care nor a number of diary reported symptoms. Additional interventional studies included symptom perception as one component of a multi-faceted intervention. Outcomes responsive to symptom perception were improved general and physical health, decreased mortality, heart failure decompensation, as hospital/emergency visits, shorter delays in seeking care, more consistent weight monitoring, improved symptom recognition as well as self-care management, decreased hospital length of stay and decreased costs.

CONCLUSIONS

While many studies allowed to map a comprehensive overview of interventions supporting symptom perception in heart failure as well as responsiveness to outcomes, only a few single component intervention studies targeting symptom perception have been reported and study designs preclude assessing intervention effectiveness. With regard to multiple component interventions, the specific impact of symptom perception interventions on outcomes remains uncertain to date. Well-designed studies are needed to test the effectiveness of symptom perception interventions and to elucidate relationships with outcomes.

Symptom perception in heart failure: a scoping review on definition, factors and instruments

Background:

Symptom perception in heart failure has been identified as crucial for effective self-care that is a modifiable factor related to decreased hospital readmission and improved survival.

Aims:

To review systematically the heart failure symptom perception literature and synthesise knowledge on definition, description, factors and instruments.

Methods:

We conducted a scoping review including studies reporting patient-reported symptom perception in adults with heart failure. Structured searches were conducted in Medline, PubMed, Embase, CINAHL, PsychINFO, Web of Science, Cochrane, JBI and grey literature. Two authors independently reviewed references for eligibility. Data were charted in tables and results narratively summarised.

Results:

The search yielded 3057 references, of which 106 were included. The definition of heart failure symptom perception comprised body listening, monitoring signs, recognising, interpreting and labelling symptoms, and furthermore awareness of and assigning meaning to the change. Symptom monitoring, recognition and interpretation were identified as challenging. Symptom perception facilitators include prior heart failure hospitalisation, heart failure self-care maintenance, symptom perception confidence, illness uncertainty and social support. Barriers include knowledge deficits, symptom clusters and lack of tools/materials. Factors with inconsistent impact on symptom perception include age, sex, education, experiences of living with heart failure, comorbidities, cognitive impairment, depression and symptom progression. One instrument measuring all dimensions of heart failure symptom perception was identified.

Conclusion:

Heart failure symptom perception definition and description have been elucidated. Several factors facilitating or hampering symptom perception are known. Further research is needed to determine a risk profile for poor symptom perception – which can then be taken into consideration when supporting heart failure self-care.

Metabolomic Analysis Reveals Vitamin D-induced Decrease in Polyol Pathway and Subtle Modulation of Glycolysis in HEK293T Cells

We combined ¹H NMR metabolomics with functional and molecular biochemical assays to describe the metabolic changes elicited by vitamin D in HEK293T, an embryonic proliferative cell line adapted to high-glucose concentrations. Activation of the polyol pathway, was the most important consequence of cell exposure to high glucose concentration, resembling cells exposed to hyperglycemia. Vitamin D induced alterations in HEK293T cells metabolism, including a decrease in sorbitol, glycine, glutamate, guanine. Vitamin D modulated glycolysis by increasing phosphoglycerate mutase and decreasing enolase activities, changing carbon fate without changing glucose consumption, lactate export and Krebs cycle. The decrease in sorbitol intracellular concentration seems to be related to vitamin D regulated redox homeostasis and protection against oxidative stress, and helped maintaining the high proliferative phenotype, supported by the decrease in glycine and guanine and orotate concentration and increase in choline and phosphocholine concentration. The decrease in orotate and guanine indicated an increased biosynthesis of purine and pyrimidines. Vitamin D elicited metabolic alteration without changing cellular proliferation and mitochondrial respiration, but reclaiming reductive power. Our study may contribute to the understanding of the metabolic mechanism of vitamin D upon exposure to hyperglycemia, suggesting a role of protection against oxidative stress.

Effect of bixin on DNA damage and cell death induced by doxorubicin in HL60 cell line

Bixin is a natural red pigment extracted from annatto. Although it is widely used as a coloring agent in food, there are few studies about the effect of this carotenoid on DNA. This study aimed to investigate the effects of bixin on cytotoxicity and genotoxicity induced by doxorubicin in HL60 cells. At concentrations above 0.3 μg/mL, bixin demonstrated cytotoxic effects in HL60 cells. Furthermore, this carotenoid was neither mutagenic nor genotoxic to HL60 cells and reduced the DNA damage induced by doxorubicin. Bixin and doxorubicin showed no apoptotic effect in HL60 cells, but the simultaneous combined treatments showed an increase in the percentage of apoptotic cells. In conclusion, our results showed that bixin modulates the cytotoxicity of doxorubicin via induction of apoptosis. The results of this study provide more knowledge about the toxic effects of anticancer treatments and how the natural compounds can be useful on these therapeutic approaches.

First record of the genus Lumahyphes Molineri, 2004 (Ephemeroptera: Leptohyphidae) from Brazil with description of a new species

The genus Lumahyphes Molineri, 2004 (Ephemeroptera: Leptohyphidae) currently is comprised of three species. Lumahyphes cocal sp. nov. is described based on material from the state of Roraima in northern Brazil. The new species differs from the other described species by having the following combination of characteristics: greyish wing membrane; terga base color whitish and terga I-III & VIII-X washed completely with gray; dorsal structure of penes rounded; spines of penes S-shaped in lateral view; and apex of spines directed anteriorly.

Photostimulation of Japanese quail

To adapt commercial poultry production to a new scenario of energy savings and to develop specific practices for quail production aimed at reducing costs while maintaining or improving productivity, four experiments were conducted. In the first experiment, birds were allocated to four treatments (photoperiod duration): T1: 14 L:10 D; T2: 15 L:9 D; T3: 16 L:8 D; and T4: 17 L:7 D. In the second experiment, birds were subjected to four levels of brightness: T1: 5 lux; T2: 10 lux; T3:15 lux; and T4: 22 lux (control). In the third experiment, four types of lamps were evaluated: T1: compact fluorescent lamp (color temperature: 6,500 K); T2: compact fluorescent lamp (color temperature: 2,700 K); T3: incandescent lamp; and T4: yellow LED. In the last experiment, four lighting programs were compared: T1: continuous program (control), in which there was a single photoperiod of 15 h; the other treatments consisted of intermittent lighting programs, as follows: T2: 1 h of light provided 1 h after dusk; T3: 1 h of light provided 2 h before dawn; T4: half an hour of light provided 1 h after dusk and half an hour of light provided 1.5 h before dawn. In each experiment, 1,296 Japanese quail were evaluated for four 28-d cycles, totaling 112 experimental days. A completely randomized experimental design of 4 treatments with 12 replicates of 27 birds each was applied in all trials. Performance and egg quality were evaluated in each experiment. Higher egg production and adequate egg quality, as well as energy savings, can be obtained with Japanese quail using compact fluorescent lamps or LEDs and a photoperiod of 15 h/d supplied using an intermittent lighting program, with 1 h of artificial light 2 h before dawn at a brightness of 5 lux.

Gene expression of coffee seed oxidation and germination processes during drying

Coffee (Coffea arabica L.) seeds are sensitive to desiccation and oxidative stress during drying processes. We investigated the effect of drying and moisture levels on germination-related gene expressions associated with enzymatic systems that prevent oxidative stress in coffee seeds. Coffee seeds collected at physiological maturity were subjected to slow and quick drying to 40, 30, 20, and 12% moisture levels (wet basis), and as the control, seeds without drying were used. The seeds' physiological quality was calculated as percentage of normal seedlings at 15 and 30 days, normal vigorous seedlings at 30 days, and cotyledonary leaves at 45 days. The isoenzymes esterase, catalase (CAT), peroxidase (POX), and endo-β-mannanase expressions were electrophoretically analyzed. CAT and POX expressions were analyzed using RT-qPCR with specific primers constructed from the target gene sequences from the Brazilian Coffee Genome Database. Slow drying showed better physiological quality for seeds at 40 and 12% moisture levels, while quick drying was the most effective for seeds with 20% moisture. Sensitivity to water loss was confirmed by quick drying and activation of enzymes. CAT and POX transcriptions reduced during drying. RT-qPCR revealed a complex gene-expression pattern during the oxidative process, with high gene expression in wet seeds.

Clinical Evaluation of Ceramic Inlays and Onlays Fabricated With Two Systems: Five-Year Follow-Up

This study evaluated the five-year clinical performance of ceramic inlays and onlays made with two systems: sintered Duceram (Dentsply-Degussa) and pressable IPS Empress (Ivoclar Vivadent). Eighty-six restorations were placed by a single operator in 35 patients with a median age of 33 years. The restorations were cemented with dual-cured resin cement (Variolink II, Ivoclar Vivadent) and Syntac Classic adhesive under rubber dam. The evaluations were conducted by two independent investigators at baseline, and at one, two, three, and five years using the modified United States Public Health Service (USPHS) criteria. At the five-year recall, 26 patients were evaluated (74.28%), totalling 62 (72.09%) restorations. Four IPS restorations were fractured, two restorations presented secondary caries (one from IPS and one from Duceram), and two restorations showed unacceptable defects at the restoration margin and needed replacement (one restoration from each ceramic system). A general success rate of 87% was recorded. The Fisher exact test revealed no significant difference between Duceram and IPS Empress ceramic systems for all aspects evaluated at different recall appointments (p>0.05). The McNemar chi-square test showed significant differences in relation to marginal discoloration, marginal integrity, and surface texture between the baseline and five-year recall for both systems (p<0.001), with an increased percentage of Bravo scores. However, few Charlie or Delta scores were attributed to these restorations. In conclusion, these two types of ceramic materials demonstrated acceptable clinical performance after five years.

Bioremediation of direct dyes in simulated textile effluents by a paramorphogenic form of Aspergillus oryzae

Azo dyes are extensively used for coloring textiles, paper, food, leather, drinks, pharmaceutical products, cosmetics and inks. The textile industry consumes the largest amount of azo dyes, and it is estimated that approximately 10-15% of dyes used for coloring textiles may be lost in waste streams. Almost all azo dyes are synthetic and resist biodegradation, however, they can readily be reduced by a number of chemical and biological reducing systems. Biological treatment has advantages over physical and chemical methods due to lower costs and minimal environmental effect. This research focuses on the utilization of Aspergillus oryzae to remove some types of azo dyes from aqueous solutions. The fungus, physically induced in its paramorphogenic form (called 'pellets'), was used in the dye biosorption studies with both non-autoclaved and autoclaved hyphae, at different pH values. The goals were the removal of dyes by biosorption and the decrease of their toxicity. The dyes used were Direct Red 23 and Direct Violet 51. Their spectral stability (325-700 nm) was analyzed at different pH values (2.50, 4.50 and 6.50). The best biosorptive pH value and the toxicity limit, (which is given by the lethal concentration (LC(100)), were then determined. Each dye showed the same spectrum at different pH values. The best biosorptive pH was 2.50, for both non- autoclaved and autoclaved hyphae of A. oryzae. The toxicity level of the dyes was determined using the Trimmed Spearman-Karber Method, with Daphnia similis in all bioassays. The Direct Violet 51 (LC(100) 400 mg · mL(-1)) was found to be the most toxic dye, followed by the Direct Red 23 (LC(100) 900 mg · mL(-1)). The toxicity bioassays for each dye have shown that it is possible to decrease the toxicity level to zero by adding a small quantity of biomass from A. oryzae in its paramorphogenic form. The autoclaved biomass had a higher biosorptive capacity for the dye than the non-autoclaved biomass. The results show that bioremediation occurs with A. oryzae in its paramorphogenic form, and it can be used as a biosorptive substrate for treatment of industrial waste water containing azo dyes.

Effect of Dentin-cleaning Techniques on the Shear Bond Strength of Self-adhesive Resin Luting Cement to Dentin

Objective

This in vitro study evaluated the influence of different cleansing techniques on the bond strength of self-adhesive cement to dentin.

Methods and Materials

A total of 33 noncarious human molars were sectioned mesiodistally and embedded in chemically cured resin with the buccal or lingual surfaces facing upward. Superficial dentin was exposed and resin disk provisional restorations were cemented to the dentin surfaces with noneugenol provisional cement and were stored in distilled water at 37°C. After seven days, the provisional restorations were removed and 13 specimens were randomly assigned to each of the five groups (n=13), according to the following cleansing treatments: G1—excavator (control); G2—0.12% chlorhexidine digluconate; G3—40% polyacrylic acid; G4—mixture of flour pumice and water; and G5—sandblasting with 50 μm aluminum oxide particles at a pressure of 87 psi. Resin composite disks (Filtek Supreme Plus, 3M ESPE Dental Products, St Paul, MN, USA) 4.7 (±0.1) mm in diameter and 3.0 (±0.5) mm in height were cemented with self-adhesive cement (RelyX Unicem, 3M ESPE), photocured, and stored in distilled water at 37°C for 24 hours. Shear bond strength testing was conducted using a universal test machine at a crosshead speed of 0.5 mm/min until failure.

Results

Data were analyzed using analysis of variance (ANOVA) and the Tukey-B rank order test. Sandblasting with aluminum oxide (11.32 ± 1.70 MPa) produced significantly higher shear bond strength values compared with any other treatment groups (p<0.05). No significant differences were found between G1-control (7.74 ± 1.72 MPa), G2-chlorhexidine (6.37 ± 1.47 MPa), and G4-pumice (7.33 ± 2.85 MPa) (p<0.05).

Expression analysis of transcription factors from the interaction between cacao and Moniliophthora perniciosa (Tricholomataceae)

Cacao (Theobroma cacao) is one of the most important tropical crops; however, production is threatened by numerous pathogens, including the hemibiotrophic fungus Moniliophthora perniciosa, which causes witches' broom disease. To understand the mechanisms that lead to the development of this disease in cacao, we focused our attention on cacao transcription factors (TFs), which act as master regulators of cellular processes and are important for the fine-tuning of plant defense responses. We developed a macroarray with 88 TF cDNA from previously obtained cacao-M. perniciosa interaction libraries. Seventy-two TFs were found differentially expressed between the susceptible (Catongo) and resistant (TSH1188) genotypes and/or during the disease time course--from 24 h to 30 days after infection. Most of the differentially expressed TFs belonged to the bZIP, MYB and WRKY families and presented opposite expression patterns in susceptible and resistant cacao-M. perniciosa interactions (i.e., up-regulated in Catongo and down-regulated in TSH1188). The results of the macroarray were confirmed for bZIP and WRKY TFs by real-time PCR. These differentially expressed TFs are good candidates for subsequent functional analysis as well as for plant engineering. Some of these TFs could also be localized on the cacao reference map related to witches' broom resistance, facilitating the breeding and selection of resistant cacao trees.

Inducing mutations in the mouse genome with the chemical mutagen ethylnitrosourea

When compared to other model organisms whose genome is sequenced, the number of mutations identified in the mouse appears extremely reduced and this situation seriously hampers our understanding of mammalian gene function(s). Another important consequence of this shortage is that a majority of human genetic diseases still await an animal model. To improve the situation, two strategies are currently used: the first makes use of embryonic stem cells, in which one can induce knockout mutations almost at will; the second consists of a genome-wide random chemical mutagenesis, followed by screening for mutant phenotypes and subsequent identification of the genetic alteration(s). Several projects are now in progress making use of one or the other of these strategies. Here, we report an original effort where we mutagenized BALB/c males, with the mutagen ethylnitrosourea. Offspring of these males were screened for dominant mutations and a three-generation breeding protocol was set to recover recessive mutations. Eleven mutations were identified (one dominant and ten recessives). Three of these mutations are new alleles (Otop1mlh, Foxn1sepe and probably rodador) at loci where mutations have already been reported, while 4 are new and original alleles (carc, eqlb, frqz, and Sacc). This result indicates that the mouse genome, as expected, is far from being saturated with mutations. More mutations would certainly be discovered using more sophisticated phenotyping protocols. Seven of the 11 new mutant alleles induced in our experiment have been localized on the genetic map as a first step towards positional cloning.

Brazilian medical publications: citation patterns for Brazilian-edited and non-Brazilian literature

Today, the quality of a scientific article depends on the periodical in which it is published and on the number of times the article is cited in the literature. In Brazil, the criteria for the evaluation of this scientific production are improving. However, there is still some resistance, with authors arguing that Brazilian publications must be preferentially addressed to the national readers and, therefore, they should ideally be written in Portuguese. In order to determine the kind of scientific journals cited in the reference lists of articles published in medical periodicals edited in Brazil, in the present study we determine the rate of Portuguese/English citations. Three issues of 43 periodicals (19 indexed in SciELO, 10 in PubMed, 10 in LILACS, and 4 in the ISI-Thompson base) of different medical specialties were analyzed, and the number of both Portuguese and English citations in the reference list of each article was recorded. The results showed that in Brazilian-edited journals the mean number of citations/article was 20.9 +/- 6.9 and the percentage of citations of international non-Brazilian periodicals was 86.0 +/- 11.2%. Of the latter, 94.4 +/- 7.0 are indexed by ISI-Thompson. Therefore, we conclude that Brazilian medical scientists cite the international non-Brazilian periodicals more than the national journals, and most of the cited papers are indexed by ISI-Thompson.

Antigen retrieval methods and estrogen receptor immunoexpression using 1D5 antibody: a comparative study

Long-term formalin tissue fixation results in antigen masking, probably through aldehydic linkage between proteins and fixative molecules. Immunohistochemistry results depend on the type of the detection procedure and the type of antibody used for the reaction. Considering the difficulty in working with estrogen receptor (ER) antibodies and the lack of standardization of the antigen retrieval methods, we quantified the immunoexpression of ER using the 1D5 antibody and a standard streptavidin-biotin detection procedure retrieving with microwave oven, steamer, pressure cooker, and water bath in a set of SBR grade 2 invasive breast carcinomas. Pressure-cooking provided the best results. No significant differences were observed in using the other methods. Pressure-cooking should be recommended as the method of choice for standardization of the ER immunohistochemical reaction.

Effect of light curing method on volumetric polymerization shrinkage of resin composites

Volumetric polymerization shrinkage of three resin composites (Suprafil, Z100 and Filtek P60) was determined using four light curing methods: method 1: continuous output with conventional intensity light; method 2: continuous output with higher intensity light; method 3: ramp output and method 4: pulse-delay output. Five disc-shaped specimens were prepared from each material for each curing method. Specimen weight was determined with an analytical electronic hydrostatic balance in air and in water before and after curing. Specific gravity values were then determined. Volumetric polymerization shrinkage was calculated using mathematical formulas. Mean volumetric polymerization shrinkage ranged from 1.882 (.015)% to 2.169 (.028)%. ANOVA indicated significant differences among the materials (p<.05). Light curing methods had no effect on volumetric polymerization shrinkage except for Z-100, where method 2 resulted in significantly higher shrinkage than methods 1 and 4. Suprafil shrunk significantly less than the other two materials in all curing methods.

Sporothrix schenckii lipid inhibits macrophage phagocytosis: involvement of nitric oxide and tumour necrosis factor-alpha

The role of cell-wall compounds in the immune response to sporotrichosis is unknown. The effect of cell-wall compounds and exoantigen obtained from Sporothrix schenckii in macrophage/fungus interaction was analysed with respect to nitric oxide (NO) and tumour necrosis factor-alpha (TNF-alpha). The lipid compound of the cell wall plays an important role in the pathogenesis of this mycosis and was found to inhibit the phagocytic process and to induce high liberation of NO and TNF-alpha in macrophage cultures in the present study. This is a very interesting result because it is the first report about one compound of the fungus S. schenckii that presents this activity.

Immunocytochemical study of malignant lymphoma in serous effusions

OBJECTIVE

To cytologically evaluate a large series of serous effusions associated with malignant lymphoma (ML), identify the immunoreaction patterns of the cells from selected positive cases and to investigate the correlation of cytomorphology with tissue section diagnosis.

STUDY DESIGN

From 1966 to 1990, a review of the files of the Department of Anatomic Pathology, A. C. Camargo Hospital, disclosed 4,297 cases of serous effusions, 256 of which were associated with ML. Cytopathologically positive cases were selected for immunocytochemical study. All paraffin sections stained with hematoxylin and eosin were reviewed to confirm the malignancy of the cases. Immunostaining was performed on both cytocentrifuge slides previously stained with Papanicolaou stain and new sections of the biopsy samples using the immunoperoxidase method and avidin-biotin complex with monoclonal mouse antihuman B-cell marker L-26 and monoclonal (mouse) antihuman T-cell marker UCHL-1.

RESULTS

Immunocytochemical reactions were performed in 54 cases: 22 were pan-B positive and 10 pan-T positive; 24 cases showed no reactivity for either monoclonal antibody. Immunohistochemical reactions were performed in 24 available cases: 15 were pan-B positive and pan-T positive; 3 cases showed no reactivity for either monoclonal antibody. Cytohistoimmunoreactions were similar in 11 pan-B positive cases and 2 pan-T positive cases. Three cases were negative for both markers, 4 cases were pan-T positive in tissue samples and negative in cytocentrifuge smears, 3 cases were pan-B positive in tissue and negative on cytology and 3 cases were negative for both markers in both tissue and cytologic specimens.

CONCLUSION

Cytology is an effective method of evaluating serous effusions associated with malignant lymphoma: no false positive diagnosis was observed in this series. Immunophenotyping of lymphoid cells is useful to classify and confirm the cytologic diagnosis.

Fine needle aspiration of thoracic lesions: experience in a Brazilian cancer center

STUDY OBJECTIVES

This study is a retrospective analysis of cytological specimens of fine needle aspiration (FNA) of thoracic lesions under computed tomography guidance, over a 2-year period to assess the diagnostic performance of cytology method.

DESIGN

A total of 134 aspirations were performed using a 22 and 20 gauge needle (spinal long). The cytological diagnosis was achieved in 126 cases (94%). The histopathological findings were correlationed in order observe the cytologic diagnosis performance.

PATIENTS

The cases were obtained from patients examined at A. C. Camargo Hospital ambulatory.

RESULTS

There were 89 cases of malignant lesions (66.4%), 27 benign lesions (20%) and 10 cases (7.5%) of suspected for malignancy. The correlation with histopathology was possible in cases with previous histopathological exams and with tissue diagnosis after puncture. The correlation between FNA and histology showed an overall sensitivity of 77%, specificity of 100%, false-negative rate of 20% and no false-positive results.

CONCLUSIONS

We conclude that FNA is a sensitive and highly specific technique for the diagnosis of thoracic neoplasms.

Fine-needle aspiration cytology and immunocytochemistry of soft-tissue extramedullary plasma-cell neoplasms

This study presents 19 patients with extramedullary plasma-cell tumors diagnosed by fine-needle aspiration (FNA) cytology together with immunocytochemistry. Eight patients had primary extramedullary plasmacytoma, while 11 patients had tumors secondary to myeloma. The most common localization was soft tissue (9 cases), followed by lymph nodes (5), scalp (3), and oral and nasal mucosa (2). All FNA smears were cellular, and 12 cases showed dissociated monomorphic plasma cells. Seven cases showed a dominance of immature bare nuclei, which made then difficult to diagnose conclusively using cytomorphology only. Immunocytochemistry demonstrated monoclonal expression of light immunoglobulin chains in all cases which, together with demonstration of CD 38 positivity and cytomorphology, allowed a conclusive diagnosis of plasmacytoma.

Multivariate survival analysis of 128 cases of oral cavity minor salivary gland carcinomas

BACKGROUND

Minor salivary gland carcinomas are uncommon tumors of the oral cavity. The decision regarding treatment remains controversial. The main objective of this paper is to report on the survival results of 128 patients treated in a single institution.

METHODS

Tumor sites were: hard palate (62 cases), tongue (16 cases), buccal mucosa (13 cases), soft palate (12 cases), and other sites (25 cases). The most common histology was mucoepidermoid carcinoma (76 cases). Clinically metastatic lymph nodes were palpable in 21 patients. Cox regression technique was used to construct the mathematical-statistical models, aiming to predict the risks of recurrence and of death as functions of the different variables under study.

RESULTS

The 5-year overall survival rates were, respectively, 85.9% and 87.7% in the groups of patients treated by surgery or combined therapy. There were significant differences in survival rates according to N stage, bone involvement, tumor histology, sex, and type of surgery.

CONCLUSIONS

Most of the recurrences were at the site of primary tumor; neck metastases were rare at presentation and after initial treatment. Prognosis involves several factors related to stage, histology, and treatment.

Effect of chronic ethanol consumption on the activities of residual small bowel brush-border enzymes after proximal jejunum resection in the rat

Ethanol consumption has a toxic effect on the epithelium of the small bowel, but enterocyte maturity is very difficult to measure under these circumstances. However, when ethanol intake is combined with enterectomy, enterocyte immaturity is greater, permitting an easier separation of these two effects. In a group of rats (13 male Wistar rats weighing approximately 220 g) fed a liquid diet containing 35% ethanol for 4 weeks after resection of the proximal jejunum, the residual small intestine brush border maltase, sucrase, and lactase activities were similar to those of a pair-fed control group (13 animals). However, alkaline phosphatase activity was decreased in the mucosa and in the enterocyte brush border, probably because of the lower activity of this enzyme in the jejunum-ileum remnant of the alcoholic group.

[Gastrointestinal endocrine cells: brief history and main identification methods under light microscopy]

The gastrointestinal tract shows a wide spectrum of endocrine cells diffusely distributed along the mucosa, interspersed among the exocrine cells. These cells share several features such as the capacity to produce a series of peptides. Despite the development of digestive endocrinology, especially in the last decade and with respect to the biochemical knowledge and cellular localization of gastrointestinal regulatory peptides, their functional significance and their role in digestive phisiopathology remain partially unknown. This review represents a summary of the principal information about morphological and histochemical features, embryologic origin, historical data, methods of identification and types of endocrine cells, of gastrointestinal tract.

Ileum brush border alkaline phosphatase activity in an experimental model of chronic alcoholism after small bowel proximal resection in the rat

Literature reports that chronically ingested ethanol induces changes in the morphology of the small bowel mucous membranes. It has a topical toxic effect on the epithelium of the proximal jejunum and a blood-borne effect on the epithelium of the ileum because its absorption is almost complete in the stomach, duodenum and proximal jejunum. In addition there are also reports showing stimulation of enterocyte proliferation after segmental intestine resection. In this report we compare a group of rats submitted to resection of the proximal jejunum and fed a liquid diet containing 35% of the total calories intake as ethanol for four weeks to its control pair-fed group. In both groups we studied the mucosal alkaline phosphatase (APase) activity by histochemical as well as biochemical methods. We found a decreased APase activity in the homogenate of the intestinal mucous membrane in the alcoholic group and a reduced enzymatic activity in the brush border of the ileum enterocytes, as demonstrated by histochemical qualitative and densitometric assays. The result suggests that this change in APase activity of the brush border may represent enterocyte immaturity induced by long-standing ethanol intake in the remnant ileum after proximal resection.

[Jejunal myenteric denervation induced by benzalkonium chloride]

The effects of benzalkonium chloride (BAC) on the number of myenteric neurons, muscle thickness and external perimeter after acute (until 10 days after BAC application) and chronic (30 and 60 days after BAC application) denervation of the proximal jejunum were determined in rats. There was a significant reduction in the number of myenteric neurons of all segments treated with BAC. The extent of denervation varied along the time, and it was reduced in the denervated segments of the chronic group in comparison with the acute group. This may be due to the neuroplasticity phenomenon appearing during the chronic phase. Myenteric denervation increased the thickness of the propria muscle layer, especially in the longitudinal muscle layer, suggesting a higher sensitivity of this layer to myenteric denervation.

Myenteric neuron number after acute and chronic denervation of the proximal jejunum induced by benzalkonium chloride

The effects of benzalkonium chloride (BAC) on the number of myenteric neurons after acute (until 10 days after BAC application) and chronic (30 and 60 days after BAC application) denervation of the proximal jejunum were determined in rats. There was a significant reduction in the number of myenteric neurons of all segments treated with BAC. The extent of denervation varied with time, and it was reduced in the denervated segments of the chronic group in comparison with the acute group. This may be due to the neuroplasticity phenomenon appearing during the chronic phase.

Accumulation of brown adipose tissue and nutritional status. A prospective study of 366 consecutive autopsies

Increased amounts of brown adipose tissue have been reported to occur in association with several diseases. The objective of the present study was to determine whether brown adipose tissue accumulation is related to nutritional status. Histologic sections of periadrenal tissue prospectively obtained at consecutive autopsies from 366 adults were examined. The cases were separated into three groups: malnourished (101 autopsies), normotrophic (128 autopsies), and obese (137 autopsies), according to the Quetelet index. Of these patients, 89 had brown adipose tissue accumulation, 35 were malnourished, 32 were normotrophic, and 22 were obese. The results showed a correlation between brown adipose tissue and patient nutritional status and a higher brown adipose tissue accumulation in malnourished patients. Cardiovascular disease was the most common type of illness present in the cases with brown adipose tissue accumulation.

[Colon adenocarcinoma with neuroendocrine and squamous cell differentiation. A case report]

A tubular adenocarcinoma of the colon with solid area composed by small cells that was found by immunohistochemistry study using antibody to neuron-specific enolase (NSE) to possess neuroendocrine differentiation is related. In another areas of the tumor were visualized keratinizing squamous cells. The presence of neuro-endocrine and squamous cells features provide further evidence that neoplastic colonic cells have the capacity for multi-directional differentiation. The implications of this combination in relation to theories of tumor origin and differentiation and the prognostic significance of neuro-endocrine cells in malignant neoplasms of the gastrointestinal tract are discussed.