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Oostdijk C, Ferreira JA, Ruijs WLM, Mollema L, Van Zoonen K. Adolescent and parental decision-making for the MenACWY vaccination: influential predictors and parental-adolescent differences among households in the Netherlands. BMC Public Health 2023; 23:947. [PMID: 37231425 DOI: 10.1186/s12889-023-15872-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Between 2015 and 2018 The Netherlands experienced increases of invasive meningococcal disease (IMD) serogroup W (MenW). Therefore in 2018 the MenACWY vaccination was introduced in the National Immunisation Programme (NIP) and a catch-up campaign was initiated targeting adolescents. This study aimed to gain insight into what factors played a role in the decision-making process regarding the MenACWY vaccination. The focus was on the differences in the decision-making of parents and adolescents in order to assess what factors influence the decisions made. METHODS An online questionnaire was offered to adolescents and one of their parents. We used random forest analyses to determine which factors best predict the outcome of the MenACWY vaccination decision. We carried out ROC (receiver-operator characteristics) analyses to confirm the predictive value of the variables. RESULTS Among parents several factors stand out, centring on the process of the decision, their attitude about the MenACWY vaccination, trust in the vaccination, and ideas of important people around them. Among adolescents the three stand-out predictors are the ideas of important people around them, the process of the decision and trust in the vaccination. Parents have prominent influence in the decision-making, while the adolescent's influence in the household decision-making is more limited. Adolescents tend to be less engaged and spend less time thinking about the decision compared to parents. Opinions of parents and adolescents from the same households concerning the factors that are influential do not differ a lot in the final decision-making. CONCLUSIONS Information about MenACWY vaccination might be mainly addressed to the parents of the adolescents and whereby the dialogue about MenACWY vaccination between parents and adolescents will be stimulated. With regard to the predictor trust in vaccination, raising the frequency of use of certain sources, especially those deemed very reliable among households such as conversations with a GP or the provider of the vaccination (GGD/JGZ), might prove a useful strategy to solidify vaccination uptake numbers.
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Affiliation(s)
- C Oostdijk
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands
| | - J A Ferreira
- Department of Statistics, Informatics and Mathematical Modeling, National Institute for Public Health and the Environment (RIVM), PO box 1, Bilthoven, 3720 BA, the Netherlands
| | - W L M Ruijs
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands
| | - L Mollema
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - K Van Zoonen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands
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Borges-Rosa J, Campos GM, Martinho S, Almeida JL, Goncalves V, Ferreira C, Freitas AA, Milner J, Ferreira JA, Marinho V, Alves PM, Oliveira-Santos M, Goncalves L. Do not underestimate the blood urea nitrogen-to-creatinine ratio in heart failure. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The blood urea nitrogen-to-creatinine ratio (BUN/SCr) has been proposed as a prognostic marker in heart failure (HF). We aimed to evaluate whether BUN/SCr predicts mortality outcomes in a real-world Southern European population with decompensated chronic HF.
Methods
We retrospectively studied 1057 patients with chronic HF admitted to our emergency department between November 2016 and December 2017 with acute decompensation. We excluded patients with a GFR <15mL/min/m2 or on dialysis. The incidence of cardiovascular (CV) and all-cause death was evaluated through multivariable logistic regression models and by Kaplan-Meyer survival curves.
Results
1025 patients were included, median age 80 years (IQR 73-85), 52.4% male, mean LVEF 42.8 ± 12.7%, and mean GFR 57.2 ± 23.9 mL/min/m2. Mean BUN/SCr was 24.9 ± 8.2 and mean SBP was 139 ± 29mmHg (r=-0.17, p < 0.001). After a median follow-up of 5 months (IQR 3-11 months), CV and all-cause death occurred in 8.0% and 21.6%, respectively. Mean BUN/SCr was higher in patients with fatal outcomes both for CV (31.3 vs. 24.3, p < 0.001) and all-cause death (28.6 vs. 23.8, p < 0.001). BUN/Scr was grouped by terciles: T1 (<20.78), T2 (20.78-27.15), T3 (>27.15). In the T3 group, the multivariable-adjusted OR for CV and all-cause death was 5.43 (95% CI 2.20-13.37) and 2.72 (95% CI 1.66-4.46), respectively, compared to the T1 group. No significant differences between T1 and T2 groups.
Conclusions
BUN/SCr at admission predicts CV and all-cause death in patients with chronic HF after an episode of decompensation. BUN/SCr, as an easy-to-use tool, helps to identify those patients who benefit from tight monitoring both during hospitalization and after discharge.
Abstract Figure_1
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Affiliation(s)
| | - GM Campos
- University Hospitals of Coimbra, Coimbra, Portugal
| | - S Martinho
- University Hospitals of Coimbra, Coimbra, Portugal
| | - JL Almeida
- University Hospitals of Coimbra, Coimbra, Portugal
| | - V Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
| | - C Ferreira
- University Hospitals of Coimbra, Coimbra, Portugal
| | - AA Freitas
- University Hospitals of Coimbra, Coimbra, Portugal
| | - J Milner
- University Hospitals of Coimbra, Coimbra, Portugal
| | - JA Ferreira
- University Hospitals of Coimbra, Coimbra, Portugal
| | - V Marinho
- University Hospitals of Coimbra, Coimbra, Portugal
| | - PM Alves
- University Hospitals of Coimbra, Coimbra, Portugal
| | | | - L Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
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Borges-Rosa J, Campos GM, Martinho S, Almeida JPL, Goncalves V, Ferreira C, Freitas AA, Ferreira JA, Milner J, Oliveira-Santos M, Baptista R, Goncalves L. Does lipoprotein(a) predict cardiovascular events in a long-term follow-up? Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Elevated plasma lipoprotein(a) [Lp(a)] concentrations are associated with an increased risk of atherosclerotic cardiovascular disease and its role in risk categorizing was recognized in the new ESC guidelines for the management of dyslipidaemias. We investigated 1) the association between baseline Lp(a) levels and incident long-term cardiovascular (CV) events and 2) its relationship with type 2 diabetes mellitus (T2DM) in a Southern European population.
Methods
We retrospectively assessed baseline Lp(a) concentrations in a total of 499 patients of a primary prevention cohort followed at the Lipidology Clinic of our hospital, with a median follow-up time of 15 (IQR 12-17) years. Lp(a) was analysed as a continuous variable, as a categorical variable with a 180mg/dL cut-off and by quartiles. We collected data on major CV events (CV death, myocardial infarction, stroke) as a composite outcome. Cox proportional hazard regression analyses were used to estimate hazard ratios (HR) and 95% confidence interval (CI).
Results
Mean age was 48.30 ± 14.41 years and 61.70% were male (n = 499). Median Lp(a) was 36.60 (IQR 0-396) mg/dL and 12.4% of patients had very high Lp(a) (≥180mg/dL); T2DM prevalence was 13.60%. The composite outcome incidence was 10%. At the baseline, individuals with T2DM had lower Lp(a) levels (11.85 IQR 3-330 mg/dL vs. 46.40 IQR 0-396, p < 0.01 mg/dL). There was a moderate inverse correlation between Lp(a) and HbA1c (r = -0.67, p < 0.01) but no significant correlations with lipid profile (total, LDL or HDL), risk scores (SCORE or the ACC pooled cohort equation), age nor gender. We found no relationship between baseline Lp(a) quartiles and composite outcome’s incidence (age-, sex-, and diabetes-adjusted HR: 1.15, 95%CI: 0.71-1.87, p = 0.57) (Figure 1), neither with the individual CV endpoints. Exploratory analysis showed that patients on aspirin had lower Lp(a) levels (29.55 IQR 0-264 mg/dL vs. 63.60 IQR 1-396 mg/dL, p < 0.01).
Conclusion
In a single centre cohort of a primary prevention southern European population, we did not find an association between Lp(a) levels and incident CV events in a 15-year median follow-up time.
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Affiliation(s)
| | - GM Campos
- University Hospitals of Coimbra, Coimbra, Portugal
| | - S Martinho
- University Hospitals of Coimbra, Coimbra, Portugal
| | - JPL Almeida
- University Hospitals of Coimbra, Coimbra, Portugal
| | - V Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
| | - C Ferreira
- University Hospitals of Coimbra, Coimbra, Portugal
| | - AA Freitas
- University Hospitals of Coimbra, Coimbra, Portugal
| | - JA Ferreira
- University Hospitals of Coimbra, Coimbra, Portugal
| | - J Milner
- University Hospitals of Coimbra, Coimbra, Portugal
| | | | - R Baptista
- University Hospitals of Coimbra, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
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Borges-Rosa J, Campos GM, Martinho S, Almeida JL, Goncalves V, Ferreira C, Freitas AA, Milner J, Ferreira JA, Monteiro S, Goncalves F, Monteiro P, Baptista R, Oliveira-Santos M, Goncalves L. Myocardial infarction in young adults: are the risk profile and mortality outcomes different from older patients? Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The incidence of acute myocardial infarction (AMI) among young patients is increasing. The YOUNG-MI Registry reported that those under 40 years had similar risk profiles and outcomes compared to those aged 41 to 50. We aimed to evaluate cardiovascular risk factors and mortality outcomes in two age cohorts from southern European.
Methods
We retrospectively evaluated 4758 patients admitted to our coronary intensive care unit between 2004 and 2017 with AMI. We only included patients <60 years in two subgroups: cohort A < 50 years and cohort B 50-60 years.
Results
From the 1233 patients included (mean age 50.5 ± 6.5 years, 82.2% male), 53% had STEMI. Cohort B had higher rates of hypertension (59.8 vs. 42.9%, p < 0.001), diabetes (41.8 vs. 28.9%, p < 0.001), and dyslipidemia (59.4 vs. 46.4%, p < 0.001), while cohort A had higher rates of familial premature coronary artery disease (20.9 vs. 13.2%, p < 0.001) and smoking habits (54.4 vs. 40.0%, p < 0.001). Regarding coronary angiography, cohort B had higher rates of obstructive disease in each epicardial artery, except for left main involvement and non-obstructive disease (Fig. 1). Cohort A had lower all-cause mortality rates at the index hospitalization (1.3 vs. 3.2%, p = 0.045), 6-months (2.9 vs.5.4, p = 0.038), 1-year (3.1 vs. 6.3%, p = 0.014), and 3-years (3.6 vs 8.4, p = 0.001). After multivariable adjustment, we found no relationship between age cohorts and all-cause mortality for any follow-up timing: HR 1.57 (95% CI 0.56-4.37), 1.37 (95% CI 0.50-3.74), and 0.92 (95% CI 0.35-2.39) at 6-months, 1-year, and 3-years, respectively.
Conclusion
Among patients who suffer AMI, those under 50 years old have a different risk profile, compared to the 50-60 years cohort. However, there is no significant difference in all-cause mortality.
Abstract Figure.
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Affiliation(s)
| | - GM Campos
- University Hospitals of Coimbra, Coimbra, Portugal
| | - S Martinho
- University Hospitals of Coimbra, Coimbra, Portugal
| | - JL Almeida
- University Hospitals of Coimbra, Coimbra, Portugal
| | - V Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
| | - C Ferreira
- University Hospitals of Coimbra, Coimbra, Portugal
| | - AA Freitas
- University Hospitals of Coimbra, Coimbra, Portugal
| | - J Milner
- University Hospitals of Coimbra, Coimbra, Portugal
| | - JA Ferreira
- University Hospitals of Coimbra, Coimbra, Portugal
| | - S Monteiro
- University Hospitals of Coimbra, Coimbra, Portugal
| | - F Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
| | - P Monteiro
- University Hospitals of Coimbra, Coimbra, Portugal
| | - R Baptista
- University Hospitals of Coimbra, Coimbra, Portugal
| | | | - L Goncalves
- University Hospitals of Coimbra, Coimbra, Portugal
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5
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Queirós Gomes J, Brosseron L, Ferreira JA, Rosmaninho I, Lopes I. Flour sensitization in a wooden door factory: what is the relationship? Eur Ann Allergy Clin Immunol 2021; 53:191-192. [PMID: 33949171 DOI: 10.23822/eurannaci.1764-1489.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- J Queirós Gomes
- Department of Allergy and Clinical Immunology, Centro Hospitalar Vila Nova de Gaia (Espinho EPE), Vila Nova de Gaia, Portugal
| | - L Brosseron
- Department of Allergy and Clinical Immunology, Centro Hospitalar Vila Nova de Gaia (Espinho EPE), Vila Nova de Gaia, Portugal
| | - J A Ferreira
- Department of Allergy and Clinical Immunology, Centro Hospitalar Vila Nova de Gaia (Espinho EPE), Vila Nova de Gaia, Portugal
| | - I Rosmaninho
- Department of Allergy and Clinical Immunology, Centro Hospitalar Vila Nova de Gaia (Espinho EPE), Vila Nova de Gaia, Portugal
| | - I Lopes
- Department of Allergy and Clinical Immunology, Centro Hospitalar Vila Nova de Gaia (Espinho EPE), Vila Nova de Gaia, Portugal
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6
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Jácome C, Pereira R, Almeida R, Amaral R, Correia MA, Mendes S, Vieira-Marques P, Ferreira JA, Lopes I, Gomes J, Vidal C, López Freire S, Méndez Brea P, Arrobas A, Valério M, Chaves Loureiro C, Santos LM, Couto M, Araujo L, Todo Bom A, Azevedo JP, Cardoso J, Emiliano M, Gerardo R, Lozoya C, Pinto PL, Castro Neves A, Pinto N, Palhinha A, Teixeira F, Ferreira-Magalhães M, Alves C, Coelho D, Santos N, Menezes F, Gomes R, Cidrais Rodrigues JC, Oliveira G, Carvalho J, Rodrigues Alves R, Moreira AS, Costa A, Abreu C, Silva R, Morête A, Falcão H, Marques ML, Câmara R, Cálix MJ, Bordalo D, Silva D, Vasconcelos MJ, Fernandes RM, Ferreira R, Freitas P, Lopes F, Almeida Fonseca J. Validation of App and Phone Versions of the Control of Allergic Rhinitis and Asthma Test (CARAT). J Investig Allergol Clin Immunol 2020; 31:270-273. [PMID: 32856596 DOI: 10.18176/jiaci.0640] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - R Pereira
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - R Almeida
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - R Amaral
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Dept. of Cardiovascular and Respiratory Sciences, Porto Health School, Polytechnic Institute of Porto, Porto, Portugal
| | - M A Correia
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - S Mendes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - P Vieira-Marques
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - J A Ferreira
- Serviço de Imunoalergologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - I Lopes
- Serviço de Imunoalergologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - J Gomes
- Serviço de Imunoalergologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - C Vidal
- Servicio de Alergia, Complejo Hospitalario Universitario de Santiago, Santiago De Compostela, Spain
| | - S López Freire
- Servicio de Alergia, Complejo Hospitalario Universitario de Santiago, Santiago De Compostela, Spain
| | - P Méndez Brea
- Servicio de Alergia, Complejo Hospitalario Universitario de Santiago, Santiago De Compostela, Spain
| | - A Arrobas
- Serviço de Pneumologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M Valério
- Serviço de Pneumologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Chaves Loureiro
- Serviço de Pneumologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - L M Santos
- Serviço de Pneumologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M Couto
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - L Araujo
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - A Todo Bom
- Serviço de Imunoalergologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J P Azevedo
- Imunoalergologia, Centro Hospitalar de Leiria, Leiria, Portugal
| | - J Cardoso
- Serviço de Pneumologia, Hospital Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - M Emiliano
- Serviço de Pneumologia, Hospital Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - R Gerardo
- Serviço de Pneumologia, Hospital Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - C Lozoya
- Serviço de Imunoalergologia, Hospital Amato Lusitano, Unidade Local de Saúde de Castelo Branco, Castelo Branco, Portugal
| | - P L Pinto
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - A Castro Neves
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - N Pinto
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - A Palhinha
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - F Teixeira
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - M Ferreira-Magalhães
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - C Alves
- Serviço de Pneumologia, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - D Coelho
- Serviço de Pneumologia, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - N Santos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - F Menezes
- Serviço de Pneumologia, Hospital Garcia de Orta, Almada, Portugal
| | - R Gomes
- Serviço de Pneumologia, Hospital Garcia de Orta, Almada, Portugal
| | - J C Cidrais Rodrigues
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - G Oliveira
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - J Carvalho
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - R Rodrigues Alves
- Serviço de Imunoalergologia, Hospital do Divino Espirito Santo, Ponta Delgada, Portugal
| | - A S Moreira
- Serviço de Imunoalergologia, Hospital do Divino Espirito Santo, Ponta Delgada, Portugal
| | - A Costa
- Serviço de Pediatria, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - C Abreu
- Serviço de Imunoalergologia, Hospital São Pedro de Vila Real, Centro Hospitalar De Trás-Os-Montes E Alto Douro, Vila Real, Portugal
| | - R Silva
- Serviço de Imunoalergologia, Hospital São Pedro de Vila Real, Centro Hospitalar De Trás-Os-Montes E Alto Douro, Vila Real, Portugal
| | - A Morête
- Serviço de Imunoalergologia, Hospital Infante D. Pedro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - H Falcão
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - M L Marques
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - R Câmara
- Serviço de Imunoalergologia, Serviço de Saúde da Região Autónoma da Madeira, Funchal, Portugal
| | - M J Cálix
- Serviço de Pediatria, Hospital de São Teotónio, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - D Bordalo
- Serviço de Pediatria, Unidade Hospitalar de Famalicão, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, Portugal
| | - D Silva
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - M J Vasconcelos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - R M Fernandes
- Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - R Ferreira
- Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,Clínica Universitária de Pediatria, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - P Freitas
- Bloco operatório, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - F Lopes
- MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
| | - J Almeida Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Allergy Unit, Instituto and Hospital CUF, Porto, Portugal.,MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
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7
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Alves P, Marinho AV, Ferreira JA, Milner J, Freitas A, Ferreira C, Almeida JP, Martinho S, Baptista R, Martins R, Goncalves L. P320 Left atrial mechanics in moderate mitral valve disease: earlier markers of damage. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Left atrial (LA) mechanics is impaired in mitral valve disease, but it is not clear whether reservoir, conduit or contractile functions are differentially impaired in stenosis (MS) or regurgitation (MR). We aimed to study LA mechanics in patients with moderate MR or moderate MS and identify discriminators of disease.
METHODS
We conducted a prospective, observational study of 100 patients with isolated moderate MR and 100 patients with moderate MS. LA mechanics with speckle tracking echocardiography (STE) assessed LA reservoir (LA ɛsys and SRs), conduit(LAɛe, SRe), and contractile (LAɛa, SRa) functions. Left ventricle (LV) functional parameters were assessed as well, including LV ejection fraction (LVEF), LV end-diastolic diameter (LVDD) and LV global longitudinal strain (LV-GLS).
RESULTS
The mean age was 67 ± 14 years and 75% were female. Mean left ventricular ejection fraction (LVEF), LV end-diastolic diameter (LVDD), LV global longitudinal strain (LV-GLS) and systolic pulmonary artery pressure (sPAP) did not differ between MR and MS (table 1).LA indexed volume (LAVi) and LA strain did not vary between MR and MS, but strain rate did. SRs and SRe had better values in MR, whereas SRa had worse values in MR (table 1). SRe (<-0.7%) had the superior discriminative power for MR, with an area under the curve of 0.85, sensitivity of 76% and specificity of 85%.
CONCLUSIONS
LA strain rate phases were the only parameters that varied between MR and MS. Contractile phase strain rate was more impaired in MR and conduit phase strain rate in MS. This highly specific data reflect the earlier hemodynamic changes occurring in LA in the setting of mitral valve disease.
mMR mMS P value LVEF (±SD,%) 57.4 ± 6.4 59.6 ± 4.6 0.145 LV-GLS (±SD, %) -17.7 ± 4.5 -17.1 ± 3.5 0.587 sPAP (±SD, mmHg) 30.3 ± 10.5 32.4 ± 8.3 0.387 LAVi (± SD, ml/m2) 46.3 ± 6.4 48.2 ± 7.4 0.281 LAɛs (± SD, %) 15.8 ± 7.3 13.3 ± 9 0.062 LAɛe (± SD, %) 8.4 ± 4.7 7.1 ± 5.4 0.074 LAɛa (± SD, %) 6.3 ± 4.8 7.4 ± 4.5 0.081 LA SRs (± SD, %) 0.8 ± 0.4 0.6 ± 0.3 0.004 LA SRe (± SD, %) -0.9 ± 0.5 -0.5 ± 0.3 <0.001 LA SRa (± SD, %) -0.5 ± 0.4 -0.8 ± 0.5 0.007
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Affiliation(s)
- P Alves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - A V Marinho
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J A Ferreira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Milner
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - A Freitas
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - C Ferreira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J P Almeida
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - S Martinho
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Baptista
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Martins
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - L Goncalves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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8
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Meijs AP, Prantner I, Kärki T, Ferreira JA, Kinross P, Presterl E, Märtin P, Lyytikäinen O, Hansen S, Szőnyi A, Ricchizzi E, Valinteliėnė R, Zerafa S, de Greeff SC, Berg TC, Fernandes PA, Štefkovičová M, Asensio A, Lamagni T, Sartaj M, Reilly J, Harrison W, Suetens C, Koek MBG. Prevalence and incidence of surgical site infections in the European Union/European Economic Area: how do these measures relate? J Hosp Infect 2019; 103:404-411. [PMID: 31265856 DOI: 10.1016/j.jhin.2019.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In 2011-2012, the European Centre for Disease Prevention and Control (ECDC) initiated the first European point prevalence survey (PPS) of healthcare-associated infections (HCAIs) in addition to targeted surveillance of the incidence of specific types of HCAI such as surgical site infections (SSIs). AIM To investigate whether national and multi-country SSI incidence can be estimated from ECDC PPS data. METHODS In all, 159 hospitals were included from 15 countries that participated in both ECDC surveillance modules, aligning surgical procedures in the incidence surveillance to corresponding specialties from the PPS. National daily prevalence of SSIs was simulated from the incidence surveillance data, the Rhame and Sudderth (R&S) formula was used to estimate national and multi-country SSI incidence from the PPS data, and national incidence per specialty was predicted using a linear model including data from the PPS. FINDINGS The simulation of daily SSI prevalence from incidence surveillance of SSIs showed that prevalence fluctuated randomly depending on the day of measurement. The correlation between the national aggregated incidence estimated with R&S formula and observed SSI incidence was low (correlation coefficient = 0.24), but specialty-specific incidence results were more reliable, especially when the number of included patients was large (correlation coefficients ranging from 0.40 to 1.00). The linear prediction model including PPS data had low proportion of explained variance (0.40). CONCLUSION Due to a lack of accuracy, use of PPS data to estimate SSI incidence is recommended only in situations where incidence surveillance of SSIs is not performed, and where sufficiently large samples of PPS data are available.
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Affiliation(s)
- A P Meijs
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
| | - I Prantner
- National Center for Epidemiology, Department of Hospital Epidemiology and Hygiene, Budapest, Hungary; National Public Health Center, Budapest, Hungary
| | - T Kärki
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - J A Ferreira
- Department of Statistics, Informatics and Modelling, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - P Kinross
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - E Presterl
- Medical University Vienna, Vienna, Austria
| | - P Märtin
- West Tallinn Central Hospital, Health Board, Tallinn, Estonia
| | - O Lyytikäinen
- National Institute for Health and Welfare, Helsinki, Finland
| | - S Hansen
- Institute of Hygiene and Environmental Health Charité, University Medicine Berlin, Berlin, Germany
| | - A Szőnyi
- National Center for Epidemiology, Department of Hospital Epidemiology and Hygiene, Budapest, Hungary; National Public Health Center, Budapest, Hungary
| | - E Ricchizzi
- Agenzia sanitaria e sociale regionale - Regione Emilia Romagna, Bologna, Italy
| | | | - S Zerafa
- Mater Dei Hospital, Msida, Malta
| | - S C de Greeff
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - T C Berg
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - M Štefkovičová
- Alexander Dubcek University in Trenčín and Regional Public Health Authority in Trenčín, Slovakia
| | - A Asensio
- Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - T Lamagni
- Public Health England, London, England, UK
| | - M Sartaj
- HSC Public Health Agency, Belfast, Northern Ireland, UK
| | - J Reilly
- Health Protection Scotland National Services Scotland and Glasgow Caledonian University, Glasgow, Scotland, UK
| | | | - C Suetens
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - M B G Koek
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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9
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Alves P, Marinho AV, Ferreira JA, Milner J, Oliveira-Santos M, Baptista R, Martins R, Pego M. P5458Left atrial mechanics in aortic stenosis: a marker of severity and prognosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Alves
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - A V Marinho
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J A Ferreira
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - J Milner
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | | | - R Baptista
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - R Martins
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
| | - M Pego
- University Hospitals of Coimbra, Cardiology, Coimbra, Portugal
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10
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Carrascal MA, Silva M, Ferreira JA, Azevedo R, Ferreira D, Silva AMN, Ligeiro D, Santos LL, Sackstein R, Videira PA. A functional glycoproteomics approach identifies CD13 as a novel E-selectin ligand in breast cancer. Biochim Biophys Acta Gen Subj 2018; 1862:2069-2080. [PMID: 29777742 DOI: 10.1016/j.bbagen.2018.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/12/2018] [Accepted: 05/15/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND The glycan moieties sialyl-Lewis-X and/or -A (sLeX/A) are the primary ligands for E-selectin, regulating subsequent tumor cell extravasation into distant organs. However, the nature of the glycoprotein scaffolds displaying these glycans in breast cancer remains unclear and constitutes the focus of the present investigation. METHODS We isolated glycoproteins that bind E-selectin from the CF1_T breast cancer cell line, derived from a patient with ductal carcinoma. Proteins were identified using bottom-up proteomics approach by nanoLC-orbitrap LTQ-MS/MS. Data were curated using bioinformatics tools to highlight clinically relevant glycoproteins, which were validated by flow cytometry, Western blot, immunohistochemistry and in-situ proximity ligation assays in clinical samples. RESULTS We observed that the CF1_T cell line expressed sLeX, but not sLeA and the E-selectin reactivity was mainly on N-glycans. MS and bioinformatics analysis of the targeted glycoproteins, when narrowed down to the most clinically relevant species in breast cancer, identified CD44 glycoprotein (HCELL) and CD13 as key E-selectin ligands. Additionally, the co-expression of sLeX-CD44 and sLeX-CD13 was confirmed in clinical breast cancer tissue samples. CONCLUSIONS Both CD44 and CD13 glycoforms display sLeX in breast cancer and bind E-selectin, suggesting a key role in metastasis development. Such observations provide a novel molecular rationale for developing targeted therapeutics. GENERAL SIGNIFICANCE While HCELL expression in breast cancer has been previously reported, this is the first study indicating that CD13 functions as an E-selectin ligand in breast cancer. This observation supports previous associations of CD13 with metastasis and draws attention to this glycoprotein as an anti-cancer target.
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Affiliation(s)
- M A Carrascal
- UCIBIO, Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Portugal; CEDOC, Chronic Diseases Research Center, NOVA Medical School/Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - M Silva
- CEDOC, Chronic Diseases Research Center, NOVA Medical School/Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal; Departments of Dermatology and Medicine, Brigham & Women's Hospital, and Program of Excellence in Glycosciences, Harvard Medical School, USA
| | - J A Ferreira
- Experimental Pathology and Therapeutics Group, Portuguese Institute of Oncology, Porto, Portugal; Glycobiology in Cancer, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal; Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; International Iberian Nanotechnology Laboratory, Braga, Portugal; Department of Pathology and Immunology, ICBAS-UP, Porto, Portugal
| | - R Azevedo
- Experimental Pathology and Therapeutics Group, Portuguese Institute of Oncology, Porto, Portugal
| | - D Ferreira
- Experimental Pathology and Therapeutics Group, Portuguese Institute of Oncology, Porto, Portugal
| | - A M N Silva
- REQUIMTE-LAQV/Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto, Portugal
| | - D Ligeiro
- Centro de Sangue e Transplantação de Lisboa, Instituto Português de Sangue e Transplantação, IP, Lisboa, Portugal
| | - L L Santos
- Experimental Pathology and Therapeutics Group, Portuguese Institute of Oncology, Porto, Portugal
| | - R Sackstein
- Departments of Dermatology and Medicine, Brigham & Women's Hospital, and Program of Excellence in Glycosciences, Harvard Medical School, USA
| | - P A Videira
- UCIBIO, Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Portugal; CEDOC, Chronic Diseases Research Center, NOVA Medical School/Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal; Professionals and Patient Associations International Network (CDG & Allies-PPAIN), Departamento Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, 2820-287 Lisboa, Portugal.
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11
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Searcy RJ, Jankowski CA, Johnson DW, Ferreira JA. Evaluation of sedation-related medication errors in patients on contact isolation in the intensive care unit. J Hosp Infect 2017; 98:175-180. [PMID: 28666781 DOI: 10.1016/j.jhin.2017.06.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/21/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients in intensive care units (ICUs) may be placed on contact isolation for meticillin-resistant Staphylococcus aureus (MRSA) colonization to prevent transmission. Prior studies suggest that isolated patients may receive substandard care compared with non-isolated patients. An optimal level of sedation is required to facilitate mechanical ventilation (MV) and to minimize adverse outcomes. AIM To determine if patients on MV and isolated for MRSA colonization are at increased risk of oversedation compared with non-isolated patients. METHODS Retrospective chart review of adult patients on MV who received an MRSA nasal polymerase chain reaction assay and sedation within 24 and 48 h of ICU admission, respectively. Endpoints included rate of inappropriate sedation, length of ICU stay, length of time on MV, and incidence of ventilator-associated complications. FINDINGS In total, 226 patients were included (114 MRSA positive, 112 MRSA negative). Baseline demographics were similar between the groups, with the exception of ICU admission diagnosis. Fifty-six (55%) isolated patients experienced inappropriate sedation compared with 49 (50%) non-isolated patients (P=0.482). Isolated patients spent longer in the ICU (10.4 vs 6.8 days, P=0.0006), longer on MV (8.98 vs 4.81 days, P<0.001), and required tracheostomies more frequently [37 (32%) vs 14 (13%), P=0.0003] than non-isolated patients. CONCLUSIONS Isolated patients were not at increased risk of oversedation compared with non-isolated patients. There was an association between the use of contact isolation for MRSA nares colonization and prolonged ICU stay and prolonged MV.
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Affiliation(s)
- R J Searcy
- University of Florida Health Jacksonville, Jacksonville, Florida, USA.
| | - C A Jankowski
- University of Florida Health Jacksonville, Jacksonville, Florida, USA
| | - D W Johnson
- University of Florida Health Jacksonville, Jacksonville, Florida, USA
| | - J A Ferreira
- University of Florida Health Jacksonville, Jacksonville, Florida, USA
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12
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Jeong Y, Carleton SM, Gentry BA, Yao X, Ferreira JA, Salamango DJ, Weis M, Oestreich AK, Williams AM, McCray MG, Eyre DR, Brown M, Wang Y, Phillips CL. Hindlimb Skeletal Muscle Function and Skeletal Quality and Strength in +/G610C Mice With and Without Weight-Bearing Exercise. J Bone Miner Res 2015; 30:1874-86. [PMID: 25829218 PMCID: PMC8157311 DOI: 10.1002/jbmr.2518] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 03/16/2015] [Accepted: 03/20/2015] [Indexed: 11/08/2022]
Abstract
Osteogenesis imperfecta (OI) is a heterogeneous heritable connective tissue disorder associated with reduced bone mineral density and skeletal fragility. Bone is inherently mechanosensitive, with bone strength being proportional to muscle mass and strength. Physically active healthy children accrue more bone than inactive children. Children with type I OI exhibit decreased exercise capacity and muscle strength compared with healthy peers. It is unknown whether this muscle weakness reflects decreased physical activity or a muscle pathology. In this study, we used heterozygous G610C OI model mice (+/G610C), which model both the genotype and phenotype of a large Amish OI kindred, to evaluate hindlimb muscle function and physical activity levels before evaluating the ability of +/G610C mice to undergo a treadmill exercise regimen. We found +/G610C mice hindlimb muscles do not exhibit compromised muscle function, and their activity levels were not reduced relative to wild-type mice. The +/G610C mice were also able to complete an 8-week treadmill regimen. Biomechanical integrity of control and exercised wild-type and +/G610C femora were analyzed by torsional loading to failure. The greatest skeletal gains in response to exercise were observed in stiffness and the shear modulus of elasticity with alterations in collagen content. Analysis of tibial cortical bone by Raman spectroscopy demonstrated similar crystallinity and mineral/matrix ratios regardless of sex, exercise, and genotype. Together, these findings demonstrate +/G610C OI mice have equivalent muscle function, activity levels, and ability to complete a weight-bearing exercise regimen as wild-type mice. The +/G610C mice exhibited increased femoral stiffness and decreased hydroxyproline with exercise, whereas other biomechanical parameters remain unaffected, suggesting a more rigorous exercise regimen or another exercise modality may be required to improve bone quality of OI mice.
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Affiliation(s)
- Youngjae Jeong
- Department of Biochemistry, University of Missouri, Columbia, MO, USA
| | | | - Bettina A Gentry
- Department of Veterinary Pathobiology, University of Missouri, Columbia, MO, USA
| | - Xiaomei Yao
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
| | - J Andries Ferreira
- Department of Biomedical Sciences and Physical Therapy Program, University of Missouri, Columbia, MO, USA
| | | | - MaryAnn Weis
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Arin K Oestreich
- Department of Biological Sciences, University of Missouri, Columbia, MO, USA
| | - Ashlee M Williams
- Department of Biochemistry, University of Missouri, Columbia, MO, USA
| | - Marcus G McCray
- Department of Biochemistry, University of Missouri, Columbia, MO, USA
| | - David R Eyre
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Marybeth Brown
- Department of Biomedical Sciences and Physical Therapy Program, University of Missouri, Columbia, MO, USA
| | - Yong Wang
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Charlotte L Phillips
- Department of Biochemistry, University of Missouri, Columbia, MO, USA.,Department of Child Health, University of Missouri, Columbia, MO, USA
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Lima L, Severino PF, Silva M, Miranda A, Tavares A, Pereira S, Fernandes E, Cruz R, Amaro T, Reis CA, Dall'Olio F, Amado F, Videira PA, Santos L, Ferreira JA. Response of high-risk of recurrence/progression bladder tumours expressing sialyl-Tn and sialyl-6-T to BCG immunotherapy. Br J Cancer 2013; 109:2106-14. [PMID: 24064971 PMCID: PMC3798967 DOI: 10.1038/bjc.2013.571] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 08/15/2013] [Accepted: 08/26/2013] [Indexed: 12/29/2022] Open
Abstract
Background: High risk of recurrence/progression bladder tumours is treated with Bacillus Calmette-Guérin (BCG) immunotherapy after complete resection of the tumour. Approximately 75% of these tumours express the uncommon carbohydrate antigen sialyl-Tn (Tn), a surrogate biomarker of tumour aggressiveness. Such changes in the glycosylation of cell-surface proteins influence tumour microenvironment and immune responses that may modulate treatment outcome and the course of disease. The aim of this work is to determine the efficiency of BCG immunotherapy against tumours expressing sTn and sTn-related antigen sialyl-6-T (s6T). Methods: In a retrospective design, 94 tumours from patients treated with BCG were screened for sTn and s6T expression. In vitro studies were conducted to determine the interaction of BCG with high-grade bladder cancer cell line overexpressing sTn. Results: From the 94 cases evaluated, 36 had recurrence after BCG treatment (38.3%). Treatment outcome was influenced by age over 65 years (HR=2.668; (1.344–5.254); P=0.005), maintenance schedule (HR=0.480; (0.246–0.936); P=0.031) and multifocallity (HR=2.065; (1.033–4.126); P=0.040). sTn or s6T expression was associated with BCG response (P=0.024; P<0.0001) and with increased recurrence-free survival (P=0.001). Multivariate analyses showed that sTn and/or s6T were independent predictive markers of recurrence after BCG immunotherapy (HR=0.296; (0.148–0.594); P=0.001). In vitro studies demonstrated higher adhesion and internalisation of the bacillus to cells expressing sTn, promoting cell death. Conclusion: s6T is described for the first time in bladder tumours. Our data strongly suggest that BCG immunotherapy is efficient against sTn- and s6T-positive tumours. Furthermore, sTn and s6T expression are independent predictive markers of BCG treatment response and may be useful in the identification of patients who could benefit more from this immunotherapy.
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Affiliation(s)
- L Lima
- 1] Experimental Pathology and Therapeutics Group, Portuguese Institute of Oncology, Porto, Portugal [2] Institute of Biomedical Sciences of Abel Salazar, University of Porto, Porto, Portugal [3] Nucleo de Investigação em Farmácia-Centro de Investigação em Saúde e Ambiente (CISA), Health School of the Polytechnic Institute of Porto, Porto, Portugal [4] LPCC, Research Department-Portuguese League Against Cancer (NRNorte), Porto, Portugal
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Jamaladin H, Ferreira JA, Kuijper LD, Vos MC, Koek M. O055: Can incidence of surgical site infections (SSI) in hospitals be predicted from point prevalence surveillance data of SSI? Antimicrob Resist Infect Control 2013. [PMCID: PMC3687997 DOI: 10.1186/2047-2994-2-s1-o55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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15
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Roberts MD, Brown JD, Company JM, Oberle LP, Heese AJ, Toedebusch RG, Wells KD, Cruthirds CL, Knouse JA, Ferreira JA, Childs TE, Brown M, Booth FW. Phenotypic and molecular differences between rats selectively bred to voluntarily run high vs. low nightly distances. Am J Physiol Regul Integr Comp Physiol 2013; 304:R1024-35. [PMID: 23552494 DOI: 10.1152/ajpregu.00581.2012] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of the present study was to partially phenotype male and female rats from generations 8-10 (G8-G10) that had been selectively bred to possess low (LVR) vs. high voluntary running (HVR) behavior. Over the first 6 days with wheels, 34-day-old G8 male and female LVRs ran shorter distances (P < 0.001), spent less time running (P < 0.001), and ran slower (P < 0.001) than their G8 male and female HVR counterparts, respectively. HVR and LVR lines consumed similar amounts of standard chow with or without wheels. No inherent difference existed in PGC-1α mRNA in the plantaris and soleus muscles of LVR and HVR nonrunners, although G8 LVR rats inherently possessed less NADH-positive superficial plantaris fibers compared with G8 HVR rats. While day 28 body mass tended to be greater in both sexes of G9-G10 LVR nonrunners vs. G9-G10 HVR nonrunners (P = 0.06), body fat percentage was similar between lines. G9-G10 HVRs had fat mass loss after 6 days of running compared with their prerunning values, while LVR did not lose or gain fat mass during the 6-day voluntary running period. RNA deep sequencing efforts in the nucleus accumbens showed only eight transcripts to be >1.5-fold differentially expressed between lines in HVR and LVR nonrunners. Interestingly, HVRs presented less Oprd1 mRNA, which ties in to potential differences in dopaminergic signaling between lines. This unique animal model provides further evidence as to how exercise may be mechanistically regulated.
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Affiliation(s)
- Michael D Roberts
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
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Spence M, Childs TE, Ferreira JA, Brown M. Sonic hedgehog gene expression is increased in adult skeletal muscle in ovarian hormone deficient mice that wheel exercise. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.lb782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Marybeth Brown
- Biomedical SciencesUniversity of MissouriColumbiaMO
- Physical TherapyUniversity of MissouriColumbiaMO
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Crissey JM, Ferreira JA, Lubahn DB, Brown M. Membrane Estrogen Receptors Regulate Voluntary Wheel Running and Contractile Function in Skeletal Muscle in Mice. Med Sci Sports Exerc 2011. [DOI: 10.1249/01.mss.0000402172.78561.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Brown M, Ferreira JA, Foley AM, Hemmann KM. A rehabilitation exercise program to remediate skeletal muscle atrophy in an estrogen-deficient organism may be ineffective. Eur J Appl Physiol 2011; 112:91-104. [PMID: 21499884 DOI: 10.1007/s00421-011-1925-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 03/15/2011] [Indexed: 01/25/2023]
Abstract
To determine rehabilitation exercise program effects under hormone deficient (ovariectomy or OVX) and hormone supplemented [OVX + 17-beta estradiol (E2)] conditions. Mature female rats (n = 123) were assigned to OVX or OVX + E2-supplemented groups. OVX and OVX + E2 groups were allocated to one of four conditions: (1) control, (2) hindlimb unweighted (HLU) for 4 weeks to induce muscle atrophy, (3) cage Recovery for 2 weeks after HLU, and (4) Recovery with 2 weeks of rehabilitation exercise program after 4 weeks of HLU. Atrophy following HLU was comparable for OVX and OVX + E2-supplemented rats and was significant in all muscles examined (soleus, tibialis anterior, plantaris, gastrocnemius, quadriceps). Also significant with HLU was the decline in muscle force (P < 0.05) in soleus, plantaris, gastrocnemius and tibialis anterior (quadriceps not tested). There were trends toward return of muscle mass in Recovery OVX and Recovery OVX + E2 groups but only the E2 supplemented OVX rats had return of muscle mass (4/5 muscles studied) with exercise. Peak tetanic tension (Po) returned to control values in the E2 supplemented Exercise rats but not in the unsupplemented Exercise group. For example, gastrocnemius Po for OVX HLU, OVX Recovery and OVX-Exercise groups was 82%*, 82%* and 76%* of control. Gastrocnemius Po for E2 supplemented HLU, Recovery and Exercise groups was 72%*, 95% and 106% of control (*P < 0.05 compared to control). H&E cross-sections from OVX-Exercise rats showed central nuclei. In conclusion, a rehabilitation exercise program to remediate acute atrophy in females appears more effective if E2 is present.
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Affiliation(s)
- Marybeth Brown
- Biomedical Sciences, University of Missouri, Columbia, MO 65211, USA.
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Abstract
The Morey-Holton hindlimb unloading (HU) method is a widely accepted National Aeronautics and Space Administration (NASA) ground-based model for studying disuse-atrophy in rodents. Our study evaluated an alternant method to the gold-standard Morey-Holton HU tail-traction technique in mice. Fifty-four female mice (4-8 mo.) were HU for 14 days (n=34) or 28 days (n=20). Recovery from HU was assessed after 3 days of normal cage ambulation following HU (n=22). Aged matched mice (n=76) served as weight-bearing controls. Prior to HU a tail ring was formed with a 2-0 sterile surgical steel wire that was passed through the 5(th), 6(th), or 7(th) inter-vertebral disc space and shaped into a ring from which the mice were suspended. Vertebral location for the tail-ring was selected to appropriately balance animal body weight without interfering with defecation. We determined the success of this novel HU technique by assessing body weight before and after HU, degree of soleus atrophy, and adrenal mass following HU. Body weight of the mice prior to HU (24.3 ± 2.9g) did not significantly decline immediately after 14d of HU (22.7 ± 1.9g), 28d of HU (21.3 + 2.1g) or after 3 days recovery (24.0 ± 1.8g). Soleus muscle mass significantly declined (-39.1%, and -46.6%) following HU for 14 days and 28 days respectively (p<0.001). Following 3 days of recovery soleus mass significantly increased to 74% of control values. Adrenal weights of HU mice were not different compared to control mice. The success of our novel HU method is evidenced by the maintenance of animal body weight, comparable adrenal gland weights, and soleus atrophy following HU, corresponding to expected literature values. The primary advantages of this HU method include: 1) ease of tail examination during suspension; 2) decreased likelihood of cyanotic, inflamed, and/or necrotic tails frequently observed with tail-taping and HU; 3) no possibility of mice chewing the traction tape and coming out of the suspension apparatus; and 4) rapid recovery and normal cage activity immediately after HU.
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Abstract
Absence of functional myostatin (MSTN) during fetal development results in adult skeletal muscle hypertrophy and hyperplasia. To more fully characterize MSTN loss in hindlimb muscles, the morphology and contractile function of the soleus, plantaris, gastrocnemius, tibialis anterior, and quadriceps muscles in male and female null (Mstn(-/-)), heterozygous (Mstn(+/-)), and wild-type (Mstn(+/+)) mice were investigated. Muscle weights of Mstn(-/-) mice were greater than those of Mstn(+/+) and Mstn(+/-) mice. Fiber cross-sectional area (CSA) was increased in female Mstn(-/-) soleus and gastrocnemius muscles and in the quadriceps of male Mstn(-/-) mice; peak tetanic force in Mstn(-/-) mice did not parallel the increased muscle weight or CSA. Male Mstn(-/-) muscle exhibited moderate degeneration. Visible pathology in male mice and decreased contractile strength relative to increased muscle weight suggest MSTN loss results in muscle impairment, which is dose-, sex-, and muscle-dependent.
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Affiliation(s)
- Bettina A Gentry
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, USA
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Tabarés FL, Ferreira JA, Ramos A, van Rooij G, Westerhout J, Al R, Rapp J, Drenik A, Mozetic M. Suppression of tritium retention in remote areas of ITER by nonperturbative reactive gas injection. Phys Rev Lett 2010; 105:175006. [PMID: 21231056 DOI: 10.1103/physrevlett.105.175006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Indexed: 05/30/2023]
Abstract
A technique based on reactive gas injection in the afterglow region of the divertor plasma is proposed for the suppression of tritium-carbon codeposits in remote areas of ITER when operated with carbon-based divertor targets. Experiments in a divertor simulator plasma device indicate that a 4 nm/min deposition can be suppressed by addition of 1 Pa·m³ s⁻¹ ammonia flow at 10 cm from the plasma. These results bolster the concept of nonperturbative scavenger injection for tritium inventory control in carbon-based fusion plasma devices, thus paving the way for ITER operation in the active phase under a carbon-dominated, plasma facing component background.
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Tabarés FL, Tafalla D, Ferreira JA, Guzmán F. Toward a full exploitation of the helium beam edge diagnostic. Rev Sci Instrum 2010; 81:10D708. [PMID: 21033901 DOI: 10.1063/1.3464462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In this article, extension of the He beam diagnostic, which is routinely applied in fusion devices for the characterization of the edge electronic parameters-ne and Te-and their profile, to the measurement of ion temperature and plasma rotation is proposed. The theoretical background for these new applications is reviewed and examples of their use in TJ-II are provided. Also, the shortcomings and their possible solutions are addressed. Finally, the field of application of the technique to other beam-based diagnostics is discussed.
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Affiliation(s)
- F L Tabarés
- National Laboratory for Fusion, CIEMAT, Av Complutense 22, 28040 Madrid, Spain.
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Gentry BA, Ferreira JA, McCambridge AJ, Brown M, Phillips CL. Skeletal muscle weakness in osteogenesis imperfecta mice. Matrix Biol 2010; 29:638-44. [PMID: 20619344 DOI: 10.1016/j.matbio.2010.06.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 06/23/2010] [Accepted: 06/25/2010] [Indexed: 12/11/2022]
Abstract
Exercise intolerance, muscle fatigue and weakness are often-reported, little-investigated concerns of patients with osteogenesis imperfecta (OI). OI is a heritable connective tissue disorder hallmarked by bone fragility resulting primarily from dominant mutations in the proα1(I) or proα2(I) collagen genes and the recently discovered recessive mutations in post-translational modifying proteins of type I collagen. In this study we examined the soleus (S), plantaris (P), gastrocnemius (G), tibialis anterior (TA) and quadriceps (Q) muscles of mice expressing mild (+/oim) and moderately severe (oim/oim) OI for evidence of inherent muscle pathology. In particular, muscle weight, fiber cross-sectional area (CSA), fiber type, fiber histomorphology, fibrillar collagen content, absolute, relative and specific peak tetanic force (P(o), P(o)/mg and P(o)/CSA respectively) of individual muscles were evaluated. Oim/oim mouse muscles were generally smaller, contained less fibrillar collagen, had decreased P(o) and an inability to sustain P(o) for the 300-ms testing duration for specific muscles; +/oim mice had a similar but milder skeletal muscle phenotype. +/oim mice had mild weakness of specific muscles but were less affected than their oim/oim counterparts which demonstrated readily apparent skeletal muscle pathology. Therefore muscle weakness in oim mice reflects inherent skeletal muscle pathology.
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Affiliation(s)
- Bettina A Gentry
- Department of Veterinary Pathobiology, University of Missouri, 117 Schweitzer Hall, Columbia, MO 65211, USA.
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Ferreira JA, Crissey JM, Brown M. An alternative method to the traditional NASA hindlimb suspension model in mice. FASEB J 2010. [DOI: 10.1096/fasebj.24.1_supplement.616.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Marybeth Brown
- Physical Therapy
- Biomedical SciencesUniversity of MissouriColumbiaMO
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Crissey JM, Ferreira JA, Brown M. Effects of hindlimb unweighting on estrogen replete and deficient mice. FASEB J 2010. [DOI: 10.1096/fasebj.24.1_supplement.821.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Marybeth Brown
- Biomedical SciencesUniversity of MissouriColumbiaMO
- Physical TherapyUniveristy of MissouriColumbiaMO
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Brown M, Ferreira JA. Estrogen And Exercise Effects On The Recovery Of Atrophic Skeletal Muscle. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000355586.41072.ac] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Brown M, Ning J, Ferreira JA, Bogener JL, Lubahn DB. Estrogen receptor-alpha and -beta and aromatase knockout effects on lower limb muscle mass and contractile function in female mice. Am J Physiol Endocrinol Metab 2009; 296:E854-61. [PMID: 19176355 PMCID: PMC2670624 DOI: 10.1152/ajpendo.90696.2008] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Estrogen (E2) is reported to regulate skeletal muscle mass and contractile function; whether E2 exerts its effects through estrogen receptor-alpha (ERalpha) or -beta (ERbeta) is unclear. We determined the effect of ERalpha or ERbeta elimination on muscle mass and contractile function in multiple muscles of the lower limb, muscles with different locomotor tasks and proportions of fiber types I and II: soleus (Sol), plantaris (Plan), tibialis anterior (TA), and gastrocnemius (Gast) in mature female mice. To determine E2 elimination effects on muscle, we also used aromatase (Ar) knockout (KO) and wild-type (WT) mice. ERalpha and ArKO body weights were approximately 10 and 20% higher than WT. Although muscle mass tended to show a commensurate increase in both groups, only the TA was significantly larger in ERalpha (P<0.05). Ratios of muscle mass to body mass revealed significantly lower values for Gast and TA in ArKO mice (P<0.05). Tetanic tension (Po) per calculated anatomical cross-sectional area (aCSA) in ERalpha KO was lower in TA and Gast than in WT. Lower Po/aCSA in ERalpha KO Gast and TA was also supported histologically by significantly less Po/fiber areas (P<0.05). ArKO mice also had lower Po/aCSA in Gast and TA compared with WT. ERbeta KO and WT mice were comparable in all measures. Our results support the hypothesis that E2 effects on skeletal muscle are mediated in part via the ERalpha but that E2 effects may be mediated via more than one mechanism or receptor.
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Affiliation(s)
- Marybeth Brown
- Department of Biomedical Sciences, SHP/Physical Therapy Program, University of Missouri-Columbia, 106 Lewis Hall, Columbia, MO 65211, USA.
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Ferreira JA, Hemmann KM, Brown M. Exercise effectiveness for atrophic muscle in estrogen (E2) replete and ovariectomized (OVX) female rats. FASEB J 2009. [DOI: 10.1096/fasebj.23.1_supplement.955.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Weber BA, Ferreira JA, Carleton S, McCambridge A, Phillips C, Brown M. Effect of impact exercise on skeletal muscle and bone in OI model mice. FASEB J 2009. [DOI: 10.1096/fasebj.23.1_supplement.lb170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Weber BA, Phillips CL, Carleton SM, McCambridge A, Timm D, Ning J, Ferreira JA, Brown M. Characterization of Skeletal Muscle in Osteogenesis Imperfecta Model Mice. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.1123.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | - Jie Ning
- Biomedical SciencesUniversity of Missouri‐ColumbiaColumbiaMO
| | | | - Marybeth Brown
- Biomedical SciencesUniversity of Missouri‐ColumbiaColumbiaMO
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Ning J, Ferreira JA, Lubahn DB, Brown M. Skeletal muscle function in ERα −/− and ERβ −/− female mice. FASEB J 2007. [DOI: 10.1096/fasebj.21.6.a1310-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - J Andries Ferreira
- SHP/Physical TherapyUniversity of Missouri1600 E Rollins drColumbiaMO65211
| | - Dennis B Lubahn
- BiochemistryUniversity of Missouri110a Animal Sci Res CenterColumbiaMO65211
| | - Marybeth Brown
- SHP/Physical TherapyUniversity of Missouri106 Lewis HallColumbiaMO65211
- Center for Gender Physiology106 Lewis HallColumbiaMO65211
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Ferreira JA, Jump SS, Foley AM, Foley CM, Brown M. Animal age affects soleus myosin heavy chain (MHC) mRNA expression and myostatin protein following hindlimb unweighting (HU). FASEB J 2006. [DOI: 10.1096/fasebj.20.5.lb32-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Seth S. Jump
- Biomedical SciencesUniversity of Missouri1600 RollinsColumbiaMO65211
| | - Andrea M. Foley
- Physical TherapyUniversity of MissouriSHP, 106 Lewis HallColumbiaMO65211
| | - C. Michael Foley
- Dalton CV CenterUniversity of Missouri134 Research ParkColumbiaMO65211
| | - Marybeth Brown
- Biomedical SciencesUniversity of Missouri1600 RollinsColumbiaMO65211
- Center for Gender PhysiologyUniversity of MissouriMA415 Medical Science BldgColumbiaMO65211
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Tatum WO, Ferreira JA, Benbadis SR, Heriaud LS, Gieron M, Rodgers-Neame NT, Vale FL. Vagus nerve stimulation for pharmacoresistant epilepsy: clinical symptoms with end of service. Epilepsy Behav 2004; 5:128-32. [PMID: 14751218 DOI: 10.1016/j.yebeh.2003.10.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Limited capability exists to predict when vagus nerve stimulation (VNS) battery deterioration becomes significant. Initial models last 2-5 years. We evaluated the first 18 patients with pharmacoresistent epilepsy after reimplantation to examine the clinical course observed during VNS end of service (EOS). METHODS Of 72 patients with VNS, 18 patients had generator replacement. EOS was estimated based on duration of use and stimulus parameters in accordance with manufacturer guidelines. Eight males and ten females had pharmacoresistent epilepsy for a mean of 17.9 years. Thirteen with localization-related epilepsy (LRE) and 5 nonverbal patients with symptomatic generalized epilepsy (SGE) failed a mean of 11.1 antiepileptic drugs (AEDs) over 21.5 years. Seven had intracranial evaluations and five failed epilepsy surgery. Reimplantation was performed after a mean of 34.4 months. Symptoms at end of service (EOS) were addressed by postoperative survey submitted at initial reprogramming within 2 weeks of reimplantation. Stimulus parameters were compared before and after surgery. RESULTS Nine of thirteen (69.2%) verbal patients and 11 of 18 (61.1%) total patients had signs or symptoms prior to replacement, suggesting clinical EOS, and 4 of 18 (22.2%) failed interrogation denoting battery failure without symptoms; however, this did not reach significance (chi2=0.359,p=0.54). Increased seizures were the most frequent sign in 8 of 18 (44.4%), with intensification in 7 of 18 (38.9%). Irregular stimulation was detected in 5 of 18 (27.7%), with less intense stimulation in 4 of 18 (22.2%). Painful stimulation and behavioral worsening each occurred in 2 of 18 (11.1%). A subjective improvement in function after reimplantation was noted in 12 of 13 (92.3%) verbal patients, with greater intensity and consistency. Maximally tolerated reimplant current averaged -0.56 mA less. All but one (94.4%) felt surgery should be performed before clinical EOS occurred. CONCLUSIONS We conclude that clinical signs and symptoms may arise during VNS EOS and following replacement. Seizure increase or a change in seizure pattern was most frequently observed. The tolerated reimplant current was less than the preoperative output current in most cases. Battery replacement before EOS appears desirable from a patient perspective.
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Affiliation(s)
- W O Tatum
- Tampa General Hospital Epilepsy Center, Tampa, FL, USA.
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Abstract
Predicting the neurologic outcome of children after a hypoxic-ischemic event continues to be a challenge for intensivists and pediatric neurologists. Nevertheless, with accurate history taking, serial neurologic examination, and some ancillary studies, the clinician can predict accurately whether a child will die or have profound neurologic damage. Aggressive resuscitation should be offered to all children when found in CPA. A simple ingestion might have led to this clinical scenario, and complete neurologic recovery may be possible if effective resuscitation is implemented. In cases of drowning, several factors, if present, are consistent with profound neurologic sequelae or death. These include prolonged submersions with asystole, delayed onset of CPR, no spontaneous respirations on arrival to the emergency department, and low initial pH value. The options of withdrawal of life support or a DNR status should be offered to families of children who have survived a devastating hypoxic-ischemic event but who are in a PVS. If brain-death criteria have been fulfilled, the patient must then be disconnected from life support after organ donation has been discussed with the family.
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Affiliation(s)
- S J Jacinto
- Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida, USA
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Abstract
Based on a literature review, the paper calls attention to public and occupational health problems related to poor municipal solid waste management resulting from a development model that views environmental protection, public health, and workers' health as secondary issues. The authors emphasize the need for research to support a new waste management model highlighting the importance of environmental preservation and protection of human health, in addition to suggesting measures to achieve such goals. The discussion aims to incorporate solid waste management into the public health agenda.
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Affiliation(s)
- J A Ferreira
- Departamento de Engenharia Sanitária e do Meio Ambiente, Faculdade de Engenharia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, 20550-013, Brasil.
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Abstract
The authors prospectively assessed drug reduction and patient satisfaction in 21 patients using vagus nerve stimulation (VNS) for refractory epilepsy and compared results to a case-matched control group with a mean follow-up of 13.2 months. Significant antiepileptic drug (AED) reduction occurred in 9/21 (42.9%) of VNS patients averaging 0.43 AED/patient, with dose reduction in four patients (19.0%). For 12/21 (57.1%) patients not reducing AED, dose reduction occurred in 6/21 (28.6%). Drug and dose reduction of AED is possible in patients using VNS for refractory epilepsy without loss of seizure control and with improved patient satisfaction.
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Affiliation(s)
- W O Tatum
- Tampa General Hospital Comprehensive Epilepsy Center, FL, USA.
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Ferreira JA, Nascimento OR, Martin-Neto L. Hydrophobic interactions between spin-label 5-SASL and humic acid as revealed by ESR spectroscopy. Environ Sci Technol 2001; 35:761-765. [PMID: 11349289 DOI: 10.1021/es0010251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The spin-label probe 5-SASL (stearic acid spin-label with nitroxide free radical in position 5 of hydrocarbon chain), detectable by electron spin resonance (ESR), was tested to evaluate pH and reaction time dependencies of hydrophobic interactions with humic acid (HA). Strong changes were observed in 5-SASL ESR spectra in the presence of HA suspensions below pH 5, with disappearance of the three isotropic narrow hyperfine lines of the nitroxide group (typical of free spin-label) and formation of "immobilized" 5-SASL spectra. These changes were interpreted as due to 5-SASL bonding with hydrophobic groups of HA, by van der Waals forces and/or hydrogen bonds, in very hydrophobic sites (probably water-protected) existent in HA below pH 5. However, such sites are absent above pH 5, as demonstrated by a specific experiment to check 5-SASL spectra reversibility. On the other hand, the HA suspension was more efficient in dissolving 5-SASL than water above pH 5. This fact also suggests the existence of "surface" hydrophobic sites, where the spin-label binds to HA while maintaining the nitroxide group in contact with water, as evidenced by the typical free spin-label spectrum and hyperfine interaction splitting (a0 = 1.574 mT). Also experiments checking 5-SASL reversibility bonding with HA were consistent with the supramolecular association model to HA.
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Affiliation(s)
- J A Ferreira
- Embrapa Instrumentação Agropecuária, R. XV de Novembro 1452, C.P. 741, 13560-970, São Carlos, SP, Brazil, IQSC-USP
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Ferreira JA, Ilharco LM, Costa SM. Water in toluene revisited: vibrational patterns in the stretching region. Spectrochim Acta A Mol Biomol Spectrosc 2001; 57:137-147. [PMID: 11209855 DOI: 10.1016/s1386-1425(00)00352-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The symmetric (v1) and antisymmetric (v3) stretching bands of water monomers in toluene are revisited using two approaches: (i) calculation of dipole autocorrelation functions (ii) the solvatochromic behaviour of both vibration frequency shifts. The time constants extracted from the autocorrelations account for meaningful differences between the couplings established by the antisymmetric and symmetric vibrations with the solvent. The dipole autocorrelation function for the symmetric stretching band fits well a Lorentzian spectral density and shows a higher contribution to hindered rotation relatively to the one obtained from the antisymmetric stretching. The spectral shifts of stretching frequencies in toluene and in other relevant solvents were interpreted as arising from the electronic and orientational polarisations. Characteristic donor/acceptor interactions also contribute to the red shift and were tested by using empirical solvent basicity scales such as Kamlet-Taft beta and the recently proposed SB. The deviations detected in toluene as regards the continuum dielectric predictions are quantitatively treated and account for the specific interaction between the water and the molecular pi electron system referred to in the literature.
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Affiliation(s)
- J A Ferreira
- Centro de Química Estrutural, Complexo I, Instituto Superior Técnico, Lisboa, Portugal
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Anjos LA, Ferreira JA. [The evaluation of the physiological workload in the Brazilian legislation should be revised! The case of garbage collectors in Rio de Janeiro]. CAD SAUDE PUBLICA 2000; 16:785-90. [PMID: 11035517 DOI: 10.1590/s0102-311x2000000300026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The physiological workload (PW) involved in garbage collection was assessed in a probabilistic sample of 70 Rio de Janeiro city garbage collectors to determine the adequacy of Brazilian labor legislation regarding classification of work. PW was measured as energy expenditure (EE) and heart rate (HR) during total work time (TT) and actual time (AT) in garbage collection on 4 consecutive days. Median EE values were 288.4 and 319.1 kcal.h-1 during TT and AT, respectively, indicating moderately intense work according to Brazilian legislation. However, PW was considered heavy when work classifications based on individual response to work were used: 1) ratio of EE and resting metabolic rate was above 5.0, indicating heavy workload according to the WHO; 2) mean percentage of maximal EE was higher (36.2 and 41.1% for TT and AT, respectively) than the limit for garbage collection (30%) suggested as maximal for Dutch workers; and 3) percentage of maximal HR reserve was also higher than 30% (32.2 and 37.5% for TT and AT, respectively). These results indicate the need for a revision of the workload classification in the Brazilian legislation to take individual workers' characteristics into account.
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Affiliation(s)
- L A Anjos
- Centro de Estudos da Saúde do Trabalhador e Ecologia Humana, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, 21041-210, Brasil
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Correia MJ, Mascarenhas M, Madureira R, Neves LS, Ferreira JA, Gonçalves MD. Extra-adrenal pheochromocytoma (paraganglioma). Rev Port Cardiol 2000; 19:117-9. [PMID: 10731797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
The authors describe the case of a 19-year-old female patient with an abdominal paraaortic extra-adrenal pheochromocytoma (paraganglioma), presenting arterial hypertension. The predominant catecholamine produced by the tumor was norepinephrine (4110 pg/ml; normal < 450 pg/ml). 131I metaiodobenzylguanidine (131I-MIBG), computed tomography and magnetic resonance imaging allowed location and characterization of the tumor. Histologically the tumor (weight = 34.2 g; 5.8 x 4 x 3 cm) was a typical pheochromocytoma.
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Affiliation(s)
- M J Correia
- UTIC-Arsénio Cordeiro, Hospital de Santa Maria, Lisboa
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Ferreira JA, Tambellini AT, da Silva CL, Guimarães MA. Hepatitis B morbidity in municipal and hospital waste collection workers in the city of Rio de Janeiro. Infect Control Hosp Epidemiol 1999; 20:591-2. [PMID: 10501252 DOI: 10.1086/503147] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Tatum WO, Moore DB, Stecker MM, Baltuch GH, French JA, Ferreira JA, Carney PM, Labar DR, Vale FL. Ventricular asystole during vagus nerve stimulation for epilepsy in humans. Neurology 1999; 52:1267-9. [PMID: 10214755 DOI: 10.1212/wnl.52.6.1267] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Electrical stimulation of the vagus nerve, a recently available option for patients with refractory epilepsy, has demonstrated safety and efficacy. We report four patients with refractory epilepsy who experienced ventricular asystole intraoperatively during initial testing for implantation of the vagus nerve stimulator. Acute intraoperative vagus nerve stimulation may create ventricular asystole in humans. Extracorporeal cervical vagus nerve stimulation testing with continuous EKG monitoring intraoperatively before generator implantation is warranted.
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Affiliation(s)
- W O Tatum
- Department of Neurology, Tampa General Hospital, University of South Florida, USA.
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Wehba S, Fernandes CE, Ferreira JA, Azevedo LH, Machado RB, Lunardelli JL, Lima SR, Iwamoto V. Transvaginal ultrasonography assessment of ovarian volumes in postmenopausal women. SAO PAULO MED J 1996; 114:1152-5. [PMID: 9181745 DOI: 10.1590/s1516-31801996000300002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The authors evaluated ovarian volumes by transvaginal ultrasonography at different periods after menopause. Ninety-eight postmenopausal women with an average age of 51.9 years and a one- to eight-year postmenopausal period were studied. The control group consisted of 40 women during menacme with an average age of 31.8 years, who were also submitted to transvaginal ultrasonography to evaluate ovarian volume. There was no significant difference between right and left ovarian volumes in the study groups. There was a significant decrease in measure and standard deviations of the volumes after the first year of menopause (mean volume--2.2 +/- 0.9 cm3) when compared to the control group (mean volume--6.3 +/- 2.0 cm3), followed by a slow and gradual shrinking after this phase. Decrease in ovarian volume became significant after the fourth postmenopausal year. Transvaginal ultrasonography demonstrated great importance as an investigative method of ovarian diseases in postmenopausal women.
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Affiliation(s)
- S Wehba
- Clinic of Endocrine Gynecology and Climacterium, College of Medical Sciences, Santa Casa of São Paulo, Brazil
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Bohmann K, Ferreira JA, Lamond AI. Mutational analysis of p80 coilin indicates a functional interaction between coiled bodies and the nucleolus. J Biophys Biochem Cytol 1995; 131:817-31. [PMID: 7490287 PMCID: PMC2200013 DOI: 10.1083/jcb.131.4.817] [Citation(s) in RCA: 119] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Coiled bodies are conserved subnuclear domains found in both plant and animal cells. They contain a subset of splicing snRNPs and several nucleolar antigens, including Nopp140 and fibrillarin. In addition, autoimmune patient sera have identified a coiled body specific protein, called p80 coilin. In this study we show that p80 coilin is ubiquitously expressed in human tissues. The full-length human p80 coilin protein correctly localizes in coiled bodies when exogenously expressed in HeLa cells using a transient transfection assay. Mutational analysis identifies separate domains in the p80 coilin protein that differentially affect its subnuclear localization. The data show that p80 coilin has a nuclear localization signal, but this is not sufficient to target the protein to coiled bodies. The results indicate that localization in coiled bodies is not determined by a simple motif analogous to the NLS motifs involved in nuclear import. A specific carboxy-terminal deletion in p80 coilin results in the formation of pseudo-coiled bodies that are unable to recruit splicing snRNPs. This causes a loss of endogenous coiled bodies. A separate class of mutant coilin proteins are shown to localize in fibrillar structures that surround nucleoli. These mutants also lead to loss of endogenous coiled bodies, produce a dramatic disruption of nucleolar architecture and cause a specific segregation of nucleolar antigens. The structural change in nucleoli is accompanied by the loss of RNA polymerase I activity. These data indicate that p80 coilin plays an important role in subnuclear organization and suggest that there may be a functional interaction between coiled bodies and nucleoli.
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Affiliation(s)
- K Bohmann
- European Molecular Biology Laboratory, Heidelberg, Germany
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Abstract
O presente artigo trata da questão dos resíduos sólidos, discutindo os problemas decorrentes de um modo de ser e de agir, resultante das relações entre Primeiro Mundo e Terceiro Mundo e as perspectivas para o meio ambiente se não ocorrer uma ética renovada de solidariedade entre seres humanos e de respeito à vida. A partir dessa visão mais geral, o artigo trata, então, das questões específicas dos resíduos hospitalares, as interferências e imposições da "cultura" de Primeiro Mundo nos sistemas de manuseio, tratamento e disposição dos resíduos, no Brasil, procurando problematizar a questão da periculosidade (ou não) de tais resíduos.
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Affiliation(s)
- J A Ferreira
- Companhia Municipal de Limpeza Urbana, Rio de Janeiro, Brasil
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Werneck-Barroso E, Kritski AL, Vieira MA, Carvalho CE, Carvalho AC, Ferraz CM, Ferreira JA. Tuberculosis as a cause of false-positive results in HIV screening EIA tests. Tuber Lung Dis 1994; 75:394-5. [PMID: 7841435 DOI: 10.1016/0962-8479(94)90089-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Ferreira JA, Carmo-Fonseca M, Lamond AI. Differential interaction of splicing snRNPs with coiled bodies and interchromatin granules during mitosis and assembly of daughter cell nuclei. J Biophys Biochem Cytol 1994; 126:11-23. [PMID: 8027171 PMCID: PMC2120090 DOI: 10.1083/jcb.126.1.11] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
In the interphase nucleus of mammalian cells the U1, U2, U4/U6, and U5 small nuclear ribonucleoproteins (snRNPs), which are subunits of spliceosomes, associate with specific subnuclear domains including interchromatin granules and coiled bodies. Here, we analyze the association of splicing snRNPs with these structures during mitosis and reassembly of daughter nuclei. At the onset of mitosis snRNPs are predominantly diffuse in the cytoplasm, although a subset remain associated with remnants of coiled bodies and clusters of mitotic interchromatin granules, respectively. The number and size of mitotic coiled bodies remain approximately unchanged from metaphase to early telophase while snRNP-containing clusters of mitotic interchromatin granules increase in size and number as cells progress from anaphase to telophase. During telophase snRNPs are transported into daughter nuclei while the clusters of mitotic interchromatin granules remain in the cytoplasm. The timing of nuclear import of splicing snRNPs closely correlates with the onset of transcriptional activity in daughter nuclei. When transcription restarts in telophase cells snRNPs have a diffuse nucleoplasmic distribution. As cells progress to G1 snRNP-containing clusters of interchromatin granules reappear in the nucleus. Coiled bodies appear later in G1, although the coiled body antigen, p80 coilin, enters early into telophase nuclei. After inhibition of transcription we still observe nuclear import of snRNPs and the subsequent appearance of snRNP-containing clusters of interchromatin granules, but not coiled body formation. These data demonstrate that snRNP associations with coiled bodies and interchromatin granules are differentially regulated during the cell division cycle and suggest that these structures play distinct roles connected with snRNP structure, transport, and/or function.
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Affiliation(s)
- J A Ferreira
- Institute of Histology and Embryology, Faculty of Medicine, University of Lisbon, Portugal
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Fellmeth BD, Buckner NK, Ferreira JA, Rooker KT, Parsons PM, Brown PR. Postcatheterization femoral artery injuries: repair with color flow US guidance and C-clamp assistance. Radiology 1992; 182:570-2. [PMID: 1732983 DOI: 10.1148/radiology.182.2.1732983] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Color flow ultrasound-guided compression repair of postcatheterization femoral artery injuries was attempted with the assistance of a C-clamp device in 10 patients. The C-clamp device was designed to hold the transducer in the optimal compression position and eliminate operator fatigue. In nine patients, the lesion was eliminated in a mean compression time of 59 minutes. The C-clamp maintained the transducer in an effective compression position in six procedures; in the other four, intervention to prevent slippage was required.
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Affiliation(s)
- B D Fellmeth
- Department of Radiology, Mercy General Hospital, Sacramento, CA 95819
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Pieniazek D, Peralta JM, Ferreira JA, Krebs JW, Owen SM, Sion FS, Filho CF, Sereno AB, de Sa CA, Weniger BG. Identification of mixed HIV-1/HIV-2 infections in Brazil by polymerase chain reaction. AIDS 1991; 5:1293-9. [PMID: 1768377 DOI: 10.1097/00002030-199111000-00002] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Analysis of sera from hospitalized Brazilian patients by whole-virus lysate-based enzyme immunoassay and Western blot indicated that 0.4% were reactive to HIV-2 alone while 4% were reactive to both HIV-1 and HIV-2. When these sera were tested for HIV antibody by type-specific peptide enzyme immunoassays, dual seropositivity was confirmed in only 0.4% of patients. To define genetically the HIV strains within the population, we analyzed peripheral blood mononuclear cells from selected seropositive patients for the presence of HIV-1 and HIV-2 proviral DNA using the polymerase chain reaction (PCR). Independent primers/probes sets were used for the amplification and detection of viral sequences from the long terminal repeat (LTR), gag, and protease (prt) gene regions. Our findings confirmed the serologic evidence of HIV-2 in Brazil and determined the extent of mixed HIV-1 and HIV-2 infections. Detailed evaluation of the amplified viral protease sequences by endonuclease restriction analysis and DNA sequencing independently confirmed mixed HIV-1 and HIV-2 infections in the two patients seropositive for HIV-1 and HIV-2. The data further indicated that these isolates are distinct from the HIV laboratory standards. We interpret the combination of culture and PCR findings to demonstrate the presence of both HIV-1 and HIV-2 in Brazil.
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Affiliation(s)
- D Pieniazek
- Division of HIV/AIDS, Centers for Disease Control, Atlanta, GA 30333
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50
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Fernandes CE, Morita MH, Ferreira JA, da Silva EP, Wehba S. [Approach to urinary tract disorders in postmenopausal women]. Rev Paul Med 1990; 108:230-5. [PMID: 2103063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Urinary disorders in the postmenopausal women are important due to their high incidence and to the negative influence on the quality of life of these women. The authors make a brief review of the pathophysiology of these disorders, emphasizing the significant effects of an estrogen fall on the urinary tract during this period of life. They present a modern approach to the current diagnostic and therapeutic aspects of urinary incontinence, urinary tract infections, and urethral syndrome. They also point out the importance of systemic and/or local estrogen therapy in these different aspects, observing the benefits and risks involved in these therapeutic procedures. They comment on the treatment with antibiotics, with adrenergic and/or anticholinergic drugs, surgical treatment, and the techniques of vesical reeducation in the case of detrusor instability. They recommend that physicians should inform and offer their patients the resources above which lead to the cure and/or improvement of the urinary symptoms of those women, given them an expectation of a longer and better life.
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Affiliation(s)
- C E Fernandes
- Departamento de Obstrícia e Ginecologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo
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