The Role of the Urobiome in Kidney Transplantation: A Systematic Review

Background

The urinary microbiome, also known as the urobiome, was traditionally considered sterile. However, emerging evidence suggests its presence in the urinary tract. Urobiome dysbiosis has been associated with various urologic conditions, making it a topic of interest also in kidney transplantation. This systematic review examines the evidence of urobiome changes in kidney transplant recipients (KTRs).

Methods

Systematic literature searches in the PubMed and SCOPUS databases.

Results

Of the 770 articles identified, 8 met the inclusion criteria. The urobiome showed reduced diversity in KTRs compared with healthy controls and patients on dialysis. Proteobacteria enrichment was associated with graft stability or spontaneous tolerance in KTRs without immunological events. Kidney interstitial fibrosis and tubular atrophy were associated with changes in resident urinary microbes and increased pathogenic bacteria. Additionally, KTRs with chronic allograft dysfunction had a higher prevalence of Corynebacterium.

Conclusions

The review highlights the importance of studying the urobiome in KTRs and its potential impact on transplant outcomes. The field remains largely unexplored, and further research is needed to establish consistent study designs and objectives. Future studies could lead to biomarker discovery, personalized therapies, and improved outcomes and graft survival in KTRs.

Prevalence of non-neurogenic male lower urinary tract symptoms after kidney transplantation

OBJECTIVE

This review investigates the prevalence of male non-neurogenic lower urinary tract symptoms (LUTS) after renal transplant, as kidney transplantation is a transformative intervention for patients with end-stage renal disease significantly enhancing quality of life that might be diminished by LUTS.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A systematic search in the PubMed and Scopus databases was performed using specific terms. Inclusion criteria considered male kidney transplant recipients, analysing outcomes in English-language studies. Discrepancies were resolved by consultation.

RESULTS

Among 18 studies involving 29 086 recipients, the prevalence of non-neurogenic LUTS ranged from 5.8% to 33.0%. Studies predominantly used the International Prostate Symptom Score for evaluation. Surgical interventions, mostly for benign prostatic obstruction, ranged from 2.5% to 20.0%. Voiding and post-micturition symptoms were under-represented.

CONCLUSION

This review found varied non-neurogenic LUTS prevalence and characteristics in male kidney transplant recipients, emphasising the need for standardised assessments, prospective studies, and improved understanding of LUTS mechanisms. Enhanced knowledge can guide interventions, additionally benefiting recipient quality of life.

Zinner's syndrome, a retrospective series of three cases: different strategies to the same problem

A 106 years have passed since Zinner's syndrome was first described and current knowledge is still almost exclusively based on case reports. This article presents three patients with Zinner's syndrome with different clinical presentations and consequent different treatment options, showing the possible full spectrum of this condition. The first patient presented with storage lower urinary tract symptoms and benefited from laparoscopic removal of the seminal vesicle. The second patient has an incidental diagnosis on CT and remains asymptomatic on follow-up. The third patient presented with persistent lumbar pain and underwent open surgical removal of the seminal vesicle. The authors further present a literature review of the current knowledge on this topic, hopefully to clarify the state of art and improve the management of these patients.

MEDIDAS DE BIOSSEGURANÇA PARA ENFRENTAMENTO AO COVID: UM RELATO DE EXPERIÊNCIA DE UM HEMOCENTRO DE FORTALEZA

Introdução

A doença coronavírus 2019 (COVID-19) é uma infecção respiratória causada pelo coronavírus 2 da síndrome respiratória aguda grave (SARS-CoV-2), com uma gravidade dos sintomas que varia de uma doença leve a uma pneumonia viral grave que leva à síndrome do desconforto respiratório agudo potencialmente fatal. Os sintomas mais comuns são: febre, tosse, dispneia, mialgia e cansaço. A taxa de letalidade é baixa nas faixas etárias mais baixas e aumenta após os 60 anos de idade. Alguns estudos apontam que o vírus SARS-CoV-2 pode sobreviver em superfícies por vários dias, dependendo do tipo, temperatura ou umidade do ambiente. Os serviços de saúde, enquanto serviços essenciais, devem ter o cuidado excepcional para evitar a contaminação dos equipamentos, pacientes e profissionais. Em tempos de pandemia, tomar medidas que garantam a prevenção, a minimização ou a eliminação de riscos à saúde é fundamental. Por décadas, as normas relativas à biossegurança foram negligenciadas, mas, com o advento da COVID-19, medidas básicas estão sendo reconsideradas, principalmente no que diz respeito aos cuidados necessários para a minimização dos riscos biológicos ao profissional da saúde. A Agência Nacional de Vigilância Sanitária (ANVISA) define a Biossegurança como um conjunto de medidas técnicas que são de suma importância durante a manipulação de agentes e materiais biológicos. Inúmeras são as ações de controle que estão sendo reforçadas a partir das experiências de outros países e da experiência de saúde acumulada em tratamento de outras doenças respiratórias que apresentam meios de transmissão semelhante ao da COVID-19.

Objetivo

Descrever as medidas de biossegurança utilizadas para prevenção da Covid 19; Contribuir com a construção de conhecimento sobre a Covid 19.

Metodologia

Assim, baseados nestas experiências, faremos um relato de experiência das ações que foram tomadas para mitigar o efeito da COVID-19 em profissionais de saúde de um Hemocentro de Fortaleza. As medidas de enfretamento ao Covid 19 foram correlacionadas em cinco tópicos: Biossegurança e Trabalhador, Comunicação, Portas de Entrada, Doadores/ Pacientes e Insumos e EPIs.

Conclusão

Os estudos e autoridades sanitárias de saúde mundial, nacional, estadual e municipal ainda não indicam um período para finalização da pandemia provocada pelo novo coronavírus. A importância de elaborar um Plano de Biossegurança veio garantir a segurança dos profissionais bem como pacientes/ doadores que precisam de atendimento no serviço. O trabalho de educação em saúde deve ser permanente visto que a doença vem sendo estudada e que pouco se sabe. As novas evidências apontam para cepas variantes fazendo com que as medidas de precauções não cessem e que os cuidados sejam redobrados, contínuos e regados de conscientização acerca das medidas sociais de minimização de contaminação.

P3353Safety and performance of stress testing: results from 78220 nuclear cardiology studies performed over 15 years in Brazil

Background

Stress testing for nuclear cardiology (NC) is safe for evaluating suspected or known coronary heart disease (CHD). Rates of serious adverse events (SAE) are low, roughly 1 death/myocardial infarction: 10,000 studies. However, this may vary depending on patient characteristics using different stress modalities.

Purpose

To describe the rates of SAE using different stress modalities in patients referred to NC.

Methods

We included all patients undergoing NC at Quanta in Curitiba, Brazil from 2003 to 2018. Stress modalities were categorized as: exercise (Ex), dipyridamole (Dip), a hybrid protocol of dypiridamole and low workload exercise (DipEx), and dobutamine (Dob). SAE during/after stress were recorded: cardiac arrest or ST segment elevation myocardial acute infarction (STEMI). Development of second or third degree atrial ventricular block (AVB) during stress and recovery were also recorded.

Results

From 78220 studies in 61984 patients (47% women, mean age 63 years-old), Ex was the most frequent stress modality (67%), followed by Dip (24%), DipEx (7%) and Dob (1,7%). Patients undergoing Ex were the youngest (mean age 60 vs 70 vs 65 vs 71 years old), the least likely of having hypertension (62 vs 78 vs 76 vs 75%) and diabetes (22 vs 35 vs 32 vs 32%) and had the lowest prevalence of known CHD (26 vs 35 vs 41 vs 30%, for Ex vs Dip vs DipEx vs Dob respectively, p<0.001 for all comparisons). Six patients had cardiac arrest and one STEMI, results in SAE rate of 1:11.144 studies. There was important differences among stress modalities, being higher for pharmacological stress, particularly DipEx (Table). This group had the highest prevalence of known CHD and higher baseline risk. AVB rates were higher when dipyridamole was used. All patients who arrested in the laboratory recovered with treatment.

Serious adverse events and stress in NC Adverse event Ex Dip DipEx Dob N=52,237 N=18,848 N=5,824 N=1,311 Cardiac Arrest or MI 1 : 17,412 1 : 9,424 1 : 2,912 None 2nd or 3rd Degree AVb 1 : 4,353 1 : 1,885 1 : 1,941 None Observe how adverse event rates different importantly in patients undergoing different stress modalities in NC.

Conclusion

In this large 15-year registry, rates of SAE related to stress testing in NC were low, albeit the SAE were much higher with pharmacological stress modalities, particularly with DipEx, which had the highest rate of patients with known CHD. Our findings suggest that the well-known 1:10,000 event rate does not necessarily apply to all stress modalities in NC. Physicians should take patient's baseline risk into account, particularly those requiring pharmacologic stress.

Cardiac morphofunctional characteristics of transgenic rats with overexpression of the bradykinin B1 receptor in the endothelium

Our aim was to evaluate whether endothelial overexpressing of the bradykinin B1 receptor could be associated with altered left ventricular and myocardial performance. Echocardiography and hemodynamic were employed to assess left ventricular morphology and function in Sprague Dawley transgenic rats overexpressing the endothelial bradykinin B1 receptor (Tie2B1 rats). The myocardial inotropism was evaluated on papillary muscles contracting in vitro. In Tie2B1 animals, an enlarged left ventricular cavity and lower fractional shortening coupled with a lower rate of pressure change values indicated depressed left ventricular performance. Papillary muscle mechanics revealed that both Tie2B1 and wild-type rat groups had the same contractile capacities under basal conditions; however, in transgenic animals, there was accentuated inotropism due to post-pause potentiation. Following treatment with the Arg(9)-BK agonist, Tie2B1 papillary muscles displayed a reduction in myocardial inotropism. Endothelial B1 receptor overexpression has expanded the LV cavity and worsened its function. There was an exacerbated response of papillary muscle in vitro to a prolonged resting pause, and the use of a B1 receptor agonist impairs myocardial inotropism.

Using air, soil and vegetation to assess the environmental behaviour of siloxanes

This study aimed to contribute to the enhancement of the knowledge of levels, trends and behaviour of eight siloxanes (four linear and four cyclic) in the environment. Adding to the prioritised scrutiny of the incidence in the atmosphere through passive samplers (sorbent-impregnated polyurethane foam disks—SIPs), the sampling of pine needles and soil was also performed, thus closing the circle of atmospheric exposure in the areas of study. Two sampling campaigns (one in summer and one in winter) were done in a total of eight sampling points in the Portuguese territory, which covered a wide range of human presence and land uses (urban, industrial, remote and beach areas). By adopting a “green” approach in terms of analytical methods, namely reducing the clean-up steps for the passive air samples and using the quick, easy, cheap, effective, rugged and safe (QuEChERS) technology for soils and pine needles, the results showed total concentration of siloxanes between 5 and 70 ng g−1 (dry weight) for soils and from 2 to 118 ng g−1 (dry weight (dw)) for pine needles, with no clear seasonal trend. For SIPs, the levels varied from 0.6 to 7.8 ng m−3 and were higher in summer than in winter in all sites. Overall, the cyclic siloxanes were found in much higher concentrations, with D5 and D6 being the most predominant in a great majority of cases. Also, the urban and industrial areas had the highest incidence, suggesting a strong anthropogenic fingerprint, in line with their main uses.

Genetic diversity among coffee tree progenies Big Coffee VL based on growth traits and production

In a coffee plantation of a coffee 'Acaiá' cultivar (Coffea arabica), on the Midwest of Minas Gerais in Capitólio city, a different kind of coffee tree was found (1989), possibly due to a mutation. It presented larger leaves and grains than those of conventional coffee trees and was named as "Big Coffee VL." The aim of this study was to estimate the genetic diversity of Big Coffee VL progenies cultivated at Universidade Federal de Lavras, by evaluating growth and production traits, based on genetic distances and clusters. The experiment was established in a lattice design with 100 progenies of this coffee tree and 23 repetitions. Traits evaluated were vigor, plant height, stem diameter, node number of plagiotropic branches, pair numbers of plagiotropic branches, and productivity. Genetic divergence was evaluated by multivariate procedures: Mahalanobis generalized distance, clustering methods, and principal component analysis. Genetic distances were estimated using Mahalanobis distance and presented variations from 0.04 to 18.70. The most similar progenies were P23 and P29 and the most dissimilar progenies were G8 and P14. The progenies were divided into three groups, with P14 present as an isolated group. Thus, it was possible to observe the existence of genetic variability among the progenies of Big Coffee VL, which can be used in breeding programs to increase grain size. Progenies G8 and P14 presented the highest genetic distance, and were the most suitable for future integration of crossings in plant breeding programs.

The impact of charcoal production on forest degradation: a case study in Tete, Mozambique

Charcoal production for urban energy consumption is a main driver of forest degradation in sub Saharan Africa. Urban growth projections for the continent suggest that the relevance of this process will increase in the coming decades. Forest degradation associated to charcoal production is difficult to monitor and commonly overlooked and underrepresented in forest cover change and carbon emission estimates. We use a multitemporal dataset of very high-resolution remote sensing images to map kiln locations in a representative study area of tropical woodlands in central Mozambique. The resulting maps provided a characterization of the spatial extent and temporal dynamics of charcoal production. Using an indirect approach we combine kiln maps and field information on charcoal making to describe the magnitude and intensity of forest degradation linked to charcoal production, including aboveground biomass and carbon emissions. Our findings reveal that forest degradation associated to charcoal production in the study area is largely independent from deforestation driven by agricultural expansion and that its impact on forest cover change is in the same order of magnitude as deforestation. Our work illustrates the feasibility of using estimates of urban charcoal consumption to establish a link between urban energy demands and forest degradation. This kind of approach has potential to reduce uncertainties in forest cover change and carbon emission assessments in sub-Saharan Africa.

PCR Conditions for 16S Primers for Analysis of Microbes in the Colon of Rats

The study of the composition of the intestinal flora is important to the health of the host, playing a key role in maintaining intestinal homeostasis and the evolution of the immune system. For these studies, various universal primers of the 16S rDNA gene are used in microbial taxonomy. Here, we report an evaluation of 5 universal primers to explore the presence of microbial DNA in colon biopsies preserved in RNAlater solution. The DNA extracted was used for the amplification of PCR products containing the variable (V) regions of the microbial 16S rDNA gene. The PCR products were studied by restriction fragment length polymorphism (RFLP) analysis and DNA sequence, whose percent of homology with microbial sequences reported in GenBank was verified using bioinformatics tools. The presence of microbes in the colon of rats was quantified by the quantitative PCR (qPCR) technique. We obtained microbial DNA from rat, useful for PCR analysis with the universal primers for the bacteria 16S rDNA. The sequences of PCR products obtained from a colon biopsy of the animal showed homology with the classes bacilli (Lactobacillus spp) and proteobacteria, normally represented in the colon of rats. The proposed methodology allowed the attainment of DNA of bacteria with the quality and integrity for use in qPCR, sequencing, and PCR-RFLP analysis. The selected universal primers provided knowledge of the abundance of microorganisms and the formation of a preliminary test of bacterial diversity in rat colon biopsies.

Quality of the Solimões River water for domestic use by the riverine community situated in Manacapuru-Amazonas-Brazil

The Amazon has the largest watershed in the world, with abundant fresh water reserves. Such abundance contrasts with the quality of the water consumed in the riverine communities. This work highlights the importance of assessing the quality of water of the Solimões River in the stretch situated opposite the Community Nossa Senhora das Graças-Costa do Pesqueiro, in front of the town of Manacapuru-Amazonas-Brazil. The research aimed to evaluate environmental indicators for the quality of the river water as well as in households in this community, according to the regional seasonality. The monitored parameters such as conductivity, dissolved oxygen, turbidity, color, pH, nitrate, nitrite, and sulfate were compared with the water quality standards in force in Brazil. Values well above the maximum level allowed (MLA) for color and turbidity parameters were found in some households, indicating that the water collected from the river is not getting appropriate treatment. The analysis of the correlation matrix of the parameters in the flood period of the river evidenced high correlation among dissolved oxygen (D.O), NO3 (-), Cl(-), SO4 (2-), and color. In this study, by principal component analysis (PCA), it was observed that the characteristics of the water, obtained from the river to be consumed in the households, in the flood period showed similarities with the river water samples, indicating absence of efficient treatment for human consumption.

Using air, soil and vegetation to assess the environmental behaviour of siloxanes

This study aimed to contribute to the enhancement of the knowledge of levels, trends and behaviour of eight siloxanes (four linear and four cyclic) in the environment. Adding to the prioritised scrutiny of the incidence in the atmosphere through passive samplers (sorbent-impregnated polyurethane foam disks--SIPs), the sampling of pine needles and soil was also performed, thus closing the circle of atmospheric exposure in the areas of study. Two sampling campaigns (one in summer and one in winter) were done in a total of eight sampling points in the Portuguese territory, which covered a wide range of human presence and land uses (urban, industrial, remote and beach areas). By adopting a "green" approach in terms of analytical methods, namely reducing the clean-up steps for the passive air samples and using the quick, easy, cheap, effective, rugged and safe (QuEChERS) technology for soils and pine needles, the results showed total concentration of siloxanes between 5 and 70 ng g(-1) (dry weight) for soils and from 2 to 118 ng g(-1) (dry weight (dw)) for pine needles, with no clear seasonal trend. For SIPs, the levels varied from 0.6 to 7.8 ng m(-3) and were higher in summer than in winter in all sites. Overall, the cyclic siloxanes were found in much higher concentrations, with D5 and D6 being the most predominant in a great majority of cases. Also, the urban and industrial areas had the highest incidence, suggesting a strong anthropogenic fingerprint, in line with their main uses.

Renal changes in the early stages of diet-induced obesity in ovariectomized rats

The relationship between obesity and renal lesions, especially in low estrogen levels, has been less documented. The aim of this study was to assess the renal changes in diet-induced obesity in ovariectomized rats. Wistar rats were ovariectomized or sham-operated and divided into four groups: sham-operated rats fed a standard diet (SSD); ovariectomized rats fed a standard diet (OSD); sham-operated rats fed a high-fat diet (SHFD); ovariectomized rats fed a high-fat diet (OHFD). Body weight and blood pressure were measured weekly. The rats were killed 24 weeks after initiation of standard or high-fat diet treatment, the kidneys were removed for immunohistochemical and histological studies. Blood and urine samples were collected to quantify sodium, potassium and creatinine. OHFD rats presented increases in visceral adipose tissue, serum insulin levels, blood pressure and proteinuria, and a decrease in fractional excretion of sodium as well. Histological and morphometric studies showed focal alterations in the renal cortex. Expression of macrophages, lymphocytes, nuclear factor-kappa B (NF-kappaB), Proliferating Cell Nuclear Antigen (PCNA), angiotensin II (ANG II) and vimentin was greater in OHFD rats than in control rats. Thus, these results demonstrate that the high-fat diet in ovariectomized rats promoted renal function and structure changes, renal interstitial infiltration of mononuclear cells and increased expression of ANG II and NF-kappaB.

Molecular characterization of Anthurium genotypes by using DNA fingerprinting and SPAR markers

We characterized single primer amplification reaction (SPAR) molecular markers from 20 genotypes of Anthurium andraeanum Lind., including 3 from commercial varieties and 17 from 2 communities in the State of Espírito Santo, Brazil. Twenty-four SPAR, consisting of 7 random amplified polymorphic DNA and 17 inter-simple sequence repeat markers were used to estimate the genetic diversity of 20 Anthurium accessions. The set of SPAR markers generated 288 bands and showed an average polymorphism percentage of 93.39%, ranging from 71.43 to 100%. The polymorphism information content (PIC) of the random amplified polymorphic DNA primers averaged 0.364 and ranged from 0.258 to 0.490. Primer OPF 06 showed the lowest PIC, while OPAM 14 was the highest. The average PIC of the inter-simple sequence repeat primers was 0.299, with values ranging from 0.196 to 0.401. Primer UBC 845 had the lowest PIC (0.196), while primer UCB 810 had the highest (0.401). By using the complement of Jaccard's similarity index and unweighted pair group method with arithmetic mean clustering, 5 clusters were formed with a cophenetic correlation coefficient of 0.8093, indicating an acceptable clustering consistency. However, no genotype clustering patterns agreed with the morphological data. The Anthurium genotypes investigated in this study are a germplasm source for conservational research and may be used in improvement programs for this species.

Lovastatin decreases the synthesis of inflammatory mediators during epileptogenesis in the hippocampus of rats submitted to pilocarpine-induced epilepsy

Statins may act on inflammatory responses, decreasing oxidative stress and also reducing brain inflammation in several brain disorders. Epileptogenesis is a process in which a healthy brain becomes abnormal and predisposed to generating spontaneous seizures. We previously reported that lovastatin could prevent neuroinflammation in pilocarpine-induced status epilepticus (SE). In this context, this study investigated the long-lasting effects of lovastatin on mRNA expression of proinflammatory cytokines (interleukin-1β, tumor necrosis factor α, interleukin-6) and the antiinflammatory cytokine IL-10 in the hippocampus during epileptogenesis by immunohistochemistry and real time polymerase chain reaction (RT-PCR) during the latent and chronic phases in the epilepsy model induced by pilocarpine in rats. For these purposes, four groups of rats were employed: saline (CONTROL), lovastatin (LOVA), pilocarpine (PILO), and pilocarpine plus lovastatin (PILO+LOVA). After pilocarpine injection (350mg/kg, i.p.), the rats were treated with 20mg/kg of lovastatin via an esophagic probe 2h after SE onset. All surviving rats were continuously treated during 15days, twice/day. The pilocarpine plus lovastatin group showed a significant decrease in the levels of IL-1β, TNF-α, and IL-6 during the latent phase and a decreased expression of IL-1β and TNF-α in the chronic phase when compared with the PILO group. Moreover, lovastatin treatment also induced an increased expression of the antiinflammatory cytokine, IL-10, in the PILO+LOVA group when compared with the PILO group in the chronic phase. Thus, our data suggest that lovastin may reduce excitotoxicity during epileptogenesis induced by pilocarpine by increasing the synthesis of IL-10 and decreasing proinflammatory cytokines in the hippocampus.

RFLP linkage map and genome analysis of Saccharum spontaneum

An RFLP linkage map of the wild sugarcane species Saccharum spontaneum L. (2n = 8x = 40-128) was constructed, comprising 216 loci, detected by 116 DNA probes, and distributed over 44 linkage groups. At a density of at least one marker every 25-cM interval, the coverage of the genome was estimated as 86%. For the generation of RFLP markers, probes were surveyed from seven DNA libraries: three sugarcane cDNA, one oat cDNA, one rice cDNA, and one barley cDNA, as well as one sugarcane genomic. Sixty-two maize genomic clones that were previously mapped on maize were used to initiate a comparative map between the sugarcane, sorghum, and maize genomes. Based on the RFLP segregation data, we conclude that this species is an autopolyploid, with an estimated genome size of 2107 cM.

Panic-like defensive behavior but not fear-induced antinociception is differently organized by dorsomedial and posterior hypothalamic nuclei of Rattus norvegicus (Rodentia, Muridae)

The hypothalamus is a forebrain structure critically involved in the organization of defensive responses to aversive stimuli. Gamma-aminobutyric acid (GABA)ergic dysfunction in dorsomedial and posterior hypothalamic nuclei is implicated in the origin of panic-like defensive behavior, as well as in pain modulation. The present study was conducted to test the difference between these two hypothalamic nuclei regarding defensive and antinociceptive mechanisms. Thus, the GABA(A) antagonist bicuculline (40 ng/0.2 µL) or saline (0.9% NaCl) was microinjected into the dorsomedial or posterior hypothalamus in independent groups. Innate fear-induced responses characterized by defensive attention, defensive immobility and elaborate escape behavior were evoked by hypothalamic blockade of GABA(A) receptors. Fear-induced defensive behavior organized by the posterior hypothalamus was more intense than that organized by dorsomedial hypothalamic nuclei. Escape behavior elicited by GABA(A) receptor blockade in both the dorsomedial and posterior hypothalamus was followed by an increase in nociceptive threshold. Interestingly, there was no difference in the intensity or in the duration of fear-induced antinociception shown by each hypothalamic division presently investigated. The present study showed that GABAergic dysfunction in nuclei of both the dorsomedial and posterior hypothalamus elicit panic attack-like defensive responses followed by fear-induced antinociception, although the innate fear-induced behavior originates differently in the posterior hypothalamus in comparison to the activity of medial hypothalamic subdivisions.

Benefits of blackberry nectar (Rubus spp.) relative to hypercholesterolemia and lipid peroxidation

INTRODUCTION

In humans, the normal metabolic activity produces free radicals that constantly, along with other risk factors, including hypercholesterolemia may be responsible for the onset of degenerative diseases. Some bioactive compounds present in blackberry (Rubus spp.) have the ability to act as natural antioxidants can make the food to minimize effects on the body caused by reactive oxygen species.

OBJECTIVE

This study verified the benefits of blackberry nectar through the quantification of triglycerides, total and fraction cholesterol HDL (high density lipoprotein) and LDL-cholesterol (low density lipoprotein), blood glucose and lipid peroxidation in hypercholesterolemic hamsters.

METHODS

Two groups were treated with hypercholesterolemic diets (0.1% cholesterol), one of them receiving an additional 5 mL of nectar daily, and a third (control group) treated only with a standard diet. In the blood the quantification of lipids, blood glucose and lipid peroxidation was performed. In the brain, liver and small intestine the lipid peroxidation was determined and in other organs, histopathological evaluations were carried out.

RESULTS

The blackberry nectar reduced the triglycerides serum levels, total cholesterol and LDL-cholesterol in hypercholesterolemic hamsters, without influencing the HDL and blood glucose concentrations. A decrease in the initiation of lipid peroxidation reactions in the blood, brain and small intestine was also observed. Only the liver showed histopathological changes (steatosis), due to excess cholesterol, with no positive influence from the nectar.

Portuguese guidelines for the use of biological agents in rheumatoid arthritis - October 2011 update

The authors present the revised version of the Portuguese Society of Rheumatology (SPR) guidelines for the treatment of Rheumatoid Arthritis (RA) with biological therapies. In these guidelines the criteria for introduction and maintenance of biological agents are discussed as well as the contraindications and procedures in the case of nonresponders. Biological treatment (with a tumour necrosis factor antagonist, abatacept or tocilizumab) should be considered in RA patients with a disease activity score 28 (DAS 28) equal to or greater than 3.2 despite treatment with at least 20mg-weekly-dose of methotrexate (MTX) for at least 3 months or, if such treatment is not possible, after 3 months of other conventional disease modifying drug or combination therapy. A DAS 28 score between 2.6 and 3.2 with a significant functional or radiological deterioration under treatment with conventional regimens could also constitute an indication for biological treatment. The treatment goal should be remission or, if that is not achievable, at least a low disease activity, defined by a DAS28 lower than 3.2, without significative functional or radiological worsening. The response criteria, at the end of the first 3 months of treatment, are a decrease of at least 0.6 in the DAS28 score. After 6 months of treatment res­ponse criteria is defined as a decrease greater than 1.2 in the DAS28 score. Non-responders, in accordance to the Rheumatologist’s clinical opinion, should try a switch to another biological agent (tumour necrosis factor antagonist, abatacept, rituximab or tocilizumab).

[Practical guide for the use of biological agents in rheumatoid arthritis - December 2011 update]

The authors review the practical aspects of biological therapy use for rheumatoid arthritis patients, commenting safety issues before and after treatment initiation and the best treatment strategies to optimize efficacy.

[Portuguese recommendations on "How to diagnose, monitor, and treat undifferentiated peripheral arthritis": systematic review of the literature and the experts' opinion]

OBJECTIVE

The 3E (Evidence, Expertise, Exchange) Initiative is a multinational effort of rheumatologists aimed at developing evidence-based recommendations addressing specific questions relevant to clinical practice. The objective of the Portuguese contribution for the 3E Initiative was to develop evidence-based recommendations on how to investigate, follow-up and treat undifferentiated peripheral inflammatory arthritis (UPIA) adapted to local reality and develop additional recommendations considered relevant in the national context.

METHODS

An international scientific committee from 17 countries selected a set of questions concerning the diagnosis and monitoring of UPIA using a Delphi procedure. Evidence-based answers to each question were sought by a systematic literature search, performed in Medline, Embase, the Cochrane Library and ACR/EULAR 2007-2009 meeting abstracts. Relevant articles were reviewed for quality assessment, data extraction and synthesis. In a national meeting, a panel of 63 Portuguese rheumatologists used the evidence which was gathered to develop recommendations, and filled the gaps in the evidence with their expert opinion. Finally, national recommendations were formulated and agreement among the participants was assessed.

RESULTS

A total of 54754 references were identified, of which 267 were systematically reviewed. Thirteen national key recommendations about the investigation, follow-up and treatment of UPIA were formulated. One recommendation addressed differential diagnosis and investigations prior to the established operational diagnosis of UPIA, eight recommendations were related to the diagnostic and prognostic value of clinical and laboratory assessments in established UPIA (history and physical examination, acute phase reactants, serologies, autoantibodies, radiographs, magnetic resonance imaging and ultrasound, genetic markers and synovial biopsy), one recommendation highlighted predictors of persistence (chronicity), one addressed monitoring of clinical disease activity in UPIA, one aimed to find an useful method/score to predict a definitive diagnosis and the last one was related to treatment.

CONCLUSION

Portuguese evidence-based recommendations for the management of UPIA in everyday practice were developed. Their dissemination and implementation in daily clinical practice should help to improve practice uniformity and optimize the management of UPIA patients.

Characterization of inflammatory cell infiltrate in human dental pulpitis

INTRODUCTION

To evaluate the microscopic characteristics and densities (per mm(2) ) of tryptase(+) mast cells, CD4(+) T helper lymphocytes, CD45RO(+) memory T lymphocytes, foxp3(+) T regulatory lymphocytes, CD20(+) B lymphocytes, CD68(+) macrophages, and CD31(+) blood vessels in human dental pulpitis (n=38) and healthy pulpal tissue (n=6).

METHODOLOGY

The pulps of 38 human teeth with a clinical diagnosis of irreversible pulpitis were removed by pulpectomy. The pulp tissue was immersed in 10% buffered formalin for evaluation using light microscopy. Tryptase, CD4, CD45RO, foxp3, CD20, CD68, and CD31 expressions were analysed using immunohistochemistry; other microscopic features, such as intensity of inflammatory infiltrate and collagen deposition, were evaluated using haematoxylin and eosin stain. Wilcoxon and Mann-Whitney tests were used for statistical analysis. The significance level was set at α=5%.

RESULTS

Two microscopic patterns of pulpitis were found: group 1 (G1) (n=15) had an intense inflammatory infiltrate and mild collagen deposition; conversely, group 2 (G2) (n=23) had a scarce inflammatory infiltrate and intense collagen deposition. The numbers of CD68(+) macrophages (P=0.004) and CD20(+) B (P=0.068) lymphocytes and the density of blood vessels (P=0.002) were higher in G1 than in G2. However, a similar number of CD4(+) and CD45RO(+) T lymphocytes was found in both groups (P>0.05). When present, tryptase(+) mast cells were equally distributed in G1 and G2, whereas foxp3(+) T regulatory lymphocytes were detected in 59% and 14% of the samples of G1 and G2. Controls exhibited lower numbers of foxp3, tryptase, CD4, CD45RO, CD68 and CD20 positive cells than G1 and G2.

CONCLUSIONS

Irreversible pulpitis had distinct microscopic features with important quantitative and qualitative differences in inflammatory cell infiltration.

Low level laser therapy (LLLT): attenuation of cholinergic hyperreactivity, beta(2)-adrenergic hyporesponsiveness and TNF-alpha mRNA expression in rat bronchi segments in E. coli lipopolysaccharide-induced airway inflammation by a NF-kappaB dependent mechanism

BACKGROUND AND OBJECTIVES

It is unknown if the decreased ability to relax airways smooth muscles in asthma and other inflammatory disorders, such as acute respiratory distress syndrome (ARDS), can be influenced by low level laser therapy (LLLT) irradiation. In this context, the present work was developed in order to investigate if LLLT could reduce dysfunction in inflamed bronchi smooth muscles (BSM) in rats.

STUDY DESIGN/MATERIALS AND METHODS

A controlled ex vivo study was developed where bronchi from Wistar rat were dissected and mounted in an organ bath apparatus with or without a TNF-alpha.

RESULTS

LLLT administered perpendicularly to a point in the middle of the dissected bronchi with a wavelength of 655 nm and a dose of 2.6 J/cm(2), partially decreased BSM hyperreactivity to cholinergic agonist, restored BSM relaxation to isoproterenol and reduced the TNF-alpha mRNA expression. An NF-kappaB antagonist (BMS205820) blocked the LLLT effect on dysfunction in inflamed BSM.

CONCLUSION

The results obtained in this work indicate that the LLLT effect on alterations in responsiveness of airway smooth muscles observed in TNF-alpha-induced experimental acute lung inflammation seems to be dependent of NF-kappaB activation.

Pulse wave velocity and coronary risk stratification

BACKGROUND

Arterial compliance or stiffness is an important determinant of cardiovascular disease and there is considerable interest in its noninvasive measurement. Pulse wave velocity (PWV) is widely used as an index of arterial stiffness.

AIM

To determine whether PWV is useful for risk stratification in both healthy individuals and coronary patients.

METHODS

Control subjects, n=510, aged 46.1 +/- 11 years, with no history of coronary disease, were selected from electoral rolls, and coronary patients, n=301, aged 53.7 +/- 10 years, were selected from hospital patients with a history of coronary artery disease (CAD) confirmed by coronary angiogram (at least 75% obstruction of one of the main coronary vessels). The asymptomatic subjects without CAD formed Group A, and were subdivided into A1 (without hypertension, dyslipidemia and/or diabetes) and A2 (with hypertension, dyslipidemia and/or diabetes). The coronary patients formed Group B, who were also subdivided into B1, without these classic risk factors, and B2 with hypertension, dyslipidemia and/or diabetes. We used the Student's t test to compare continuous variables and the chi-square test to compare categorical data. The strength of correlation between continuous variables was tested by Pearson's linear correlation. Independent variables predictive of CAD were determined by backward logistic regression analysis. The statistical analysis was performed using SPSS for Windows version 11.0 and data were expressed as means +/- SD; a p value of 0.05 was considered significant.

RESULTS

Comparing the two groups A1 and A2, mean PWV was significantly lower in group A1. Comparing B1 and B2, mean PWV was also significantly lower in group B1. In group A1, PWV was significantly and positively correlated with age, body mass index, waist-to-hip ratio, alcohol consumption, total/HDL cholesterol ratio, systolic, diastolic and mean blood pressure (BP), blood glucose, apo B, triglycerides, and high-sensitivity C-reactive protein, unlike HDL which was inversely correlated (Pearson's coefficient). In group A2, PWV was significantly and positively correlated with age, alcohol consumption, total/HDL cholesterol ratio, systolic, diastolic and mean BP, blood glucose and pulse pressure (PP), but not HDL, which was inversely correlated with PWV. In group B1, PWV was only significantly and positively correlated with age, systolic, mean, and diastolic BP and PP, and presented a significant inverse correlation with ejection fraction. However, in the high-risk coronary population (group B2), there was a positive correlation with age, waist-to-hip ratio, systolic and mean BP, PP and homocysteine. After stepwise logistic regression, PWV remained in the model and proved to be a significant and independent risk factor for CAD.

CONCLUSION

The results of our study show that PWV is higher in high-risk groups and significantly correlated with many classic and new CAD risk markers, suggesting that there is a cumulative influence of risk factors in the development of arterial stiffness. We believe that PWV is a useful index of vascular status and hence cardiovascular risk and that it may be useful for risk stratification in both asymptomatic and coronary patients.

Low level laser therapy (LLLT) decreases pulmonary microvascular leakage, neutrophil influx and IL-1beta levels in airway and lung from rat subjected to LPS-induced inflammation

BACKGROUND AND OBJECTIVE

Low level laser therapy (LLLT) is a known anti-inflammatory therapy. Herein we studied the effect of LLLT on lung permeability and the IL-1beta level in LPS-induced pulmonary inflammation. STUDY DESIGN/METHODOLOGY: Rats were divided into 12 groups (n = 7 for each group). Lung permeability was measured by quantifying extravasated albumin concentration in lung homogenate, inflammatory cells influx was determined by myeloperoxidase activity, IL-1beta in BAL was determined by ELISA and IL-1beta mRNA expression in trachea was evaluated by RT-PCR. The rats were irradiated on the skin over the upper bronchus at the site of tracheotomy after LPS.

RESULTS

LLLT attenuated lung permeability. In addition, there was reduced neutrophil influx, myeloperoxidase activity and both IL-1beta in BAL and IL-1beta mRNA expression in trachea obtained from animals subjected to LPS-induced inflammation.

CONCLUSION

LLLT reduced the lung permeability by a mechanism in which the IL-1beta seems to have an important role.

[Monitoring of neuromuscular blocking]

Neuromuscular blockade monitoring aims should be based on effectiveness criteria, that is, to administer the lowest effective dose, and on security criteria, avoiding overdosage and detecting possible residual blockade before patient extubation. A neuromuscular blockade monitoring and usage protocol should be available with predefined objectives for each patient to achieve the minimum effective doses. Maintenance of a light blockade level probably influences the decrease in complications associated with these drugs' use. Train-of-four monitoring, along with muscular movement detection allow adjustment to meet these aims. Ulnar nerve stimulation with response detection in the adductor pollicis muscle is the recommended neurostimulation in critically ill patients, while facial neurostimulation is recommended in situations where edema or skin temperature prevent correct ulnar nerve stimulation. Ensuring adequate sedation and analgesia in a paralysed patient is essential. An inadequately sedated but paralysed patient may subsequently suffer serious psychological and emotional stress. Bispectral index monitoring with sedative doses adjusted to 40-60 values assures, in most situations, correct sedation.

[Delusion in the critical patient]

Delirium, the acute confusional syndrome, is a common although infradiagnosed problem in the critically ill patient, especially the hypoactive subtype. Risk factors for delirium are previous cognitive disturbances, some comorbidities, ambiental factors and the acute organic alterations of critical illness. Delirium is associated to an increase in short and long term mortality, prolongation of mechanical ventilation, increased Intensive Care Unit (ICU) and hospital length of stay, and cognitive impairment after hospital discharge. In the last years several tools have been developed to detect delirium in critically ill patients. The Intensive Care Delirium Screening Checklist (ICDSC) and the Confusion Assessment Method for ICU patients (CAM-ICU) have been validated and are useful even in patients receiving mechanical ventilation. Some interventions on specific risk factors can decrease the incidence of delirium in hospitalized patients. Treatment of delirium is based on the identification and correction of contributing factors, the introduction of support measures, and pharmacological therapy for symptomatic control. Halloperidol is the first line therapy of delirium in the critically ill patient, while experience with atypical neuroleptics and other drugs is limited, precluding to do recommendations about its use. Neuroleptic drugs can produce severe side effects and need careful dosage and monitoring. When agitation is important, can be necessary the simultaneous use of benzodiazepines or propofol, and some times, the temporal and protocolized application of physical restraints.

COX-2 mRNA expression decreases in the subplantar muscle of rat paw subjected to carrageenan-induced inflammation after low level laser therapy

OBJECTIVE AND DESIGN

Low level laser therapy (LLLT) has been presented as a novel therapy to treat inflammation. Herein we studied the effect of LLLT on the COX-2 mRNA expression in subplantar tissue taken from rats treated with carrageenan.

MATERIAL

The groups consisted of 32 rats: A(1) (Saline), A(2) (Carrageenan), A(3) (Carrageenan + laser 660 nm) and A(4) (Carrageenan + laser 684 nm).

TREATMENT

A(3) and A(4) were irradiated in the first hour after carrageenan.

METHODS

The edema was measured by a plethysmometer and COX-2 mRNA was by RT-PCR. Statistical were evaluated by ANOVA and Tukey-Kramer Test.

RESULTS

Carrageenan increased both edema (A 1)= 0.6 +/- 0.04 vs. A(2)= 2.24 +/- 0.08) and COX-2 mRNA (A(1)= 1.1 +/- 0.26 vs. A(2)= 3.52 +/- 0.69). Irradiation reduced the edema (A(3)= 0.84 +/- 0.09; A(4)= 1.31 +/- 0.05) and the COX-2 mRNA (A(3)= 2.16 +/- 0.28; A(4)= 1.86 +/- 0.20).

CONCLUSION

LLLT reduce the expression of COX-2 mRNA.

Low level laser therapy modulates kinin receptors mRNA expression in the subplantar muscle of rat paw subjected to carrageenan-induced inflammation

Low level laser therapy (LLLT) has been used clinically in order to treat inflammatory processes. In this work, we evaluated if LLLT alters kinin receptors mRNA expression in the carrageenan-induced rat paw edema. Experimental groups were designed as followed: A1 (Control-saline), A2 (Carrageenan-only), A3 (Carrageenan+laser 660 nm) and A4 (Carrageenan+laser 684 nm). Edema was measured by a plethysmometer. Subplantar tissue was collected for kinin receptors mRNA quantification by Real time-PCR. LLLT of both 660 and 684 nm wavelengths administrated 1 h after carrageenan injection was able to promote the reduction of edema produced by carrageenan. In the A2 group, B1 receptor expression presented a significantly increase when compared to control group. Kinin B1 receptor mRNA expression significantly decreased after LLLT's 660 or 684 nm wavelength. Kinin B2 receptor mRNA expression also diminished after both laser irradiations. Our results suggest that expression of both kinin receptors is modulated by LLLT, possibly contributing to its anti-inflammatory effect.

Antimicrobial efficacy of ozonated water, gaseous ozone, sodium hypochlorite and chlorhexidine in infected human root canals

AIM

To determine the antimicrobial efficacy of ozonated water, gaseous ozone, sodium hypochlorite and chlorhexidine in human root canals infected by Enterococcus faecalis.

METHODOLOGY

Thirty human maxillary anterior teeth were prepared and inoculated with E. faecalis for 60 days. Eppendorf tubes were connected to the coronal portion of the teeth. Urethane hoses were attached to the tubes and to the entrance of a peristaltic pump. The exit of the apparatus corresponded to the apical portion of the root canals. The test irrigating solutions were ozonated water, gaseous ozone, 2.5% sodium hypochlorite (NaOCl), 2% chlorhexidine that circulated at a constant flow of 50 mL min(-1) for 20 min. Samples from the root canals were collected and immersed in 7 mL Letheen Broth (LB), followed by incubation at 37 degrees C for 48 h. Bacterial growth was analysed by turbidity of the culture medium and subculture on a specific nutrient broth. A 0.1 mL inoculum obtained from LB was transferred to 7 mL of brain heart infusion and incubated at 37 degrees C for 48 h. Bacterial growth was checked by turbidity of the culture medium carried out in triplicate.

RESULTS

No solution used as an irrigant over a 20-min contact time demonstrated an antimicrobial effect against E. faecalis.

CONCLUSION

The irrigation of infected human root canals with ozonated water, 2.5% NaOCl, 2% chlorhexidine and the application of gaseous ozone for 20 min was not sufficient to inactivate E. faecalis.

Successful bilateral lung transplantation from a methanol-poisoned donor

The shortage of suitable organ donors is an important limiting factor that is making the evaluation of marginal donors necessary and, consequently, allowing expansion of standard donor criteria for organ removal. Lung procurement after methanol poisoning is anecdotal; in fact, there is only one published case in literature and that case showed a successful outcome. In this report, we describe a case of lung donation from a previously healthy individual who died from methanol poisoning. Both lungs were successfully implanted to a 20-year-old man who suffered from cystic fibrosis. This case report is new evidence that lung transplantation from methanol-poisoned donors may be safely performed with a good outcome.

Immunocharacterization of the DNA puff BhC4-1 protein of Bradysia hygida (Diptera: Sciaridae)

The DNA puff BhC4-1 gene is amplified and highly expressed in the salivary gland of Bradysia hygida late larvae. Using affinity-purified polyclonal antibodies we have identified the product of the BhC4-1 gene as a 43 kDa polypeptide which is present in extracts of salivary glands from late fourth instar larvae and in the corresponding gland secretion, but not in glands from earlier stages. We also demonstrate that this protein is produced mainly in the S1 and S3 regions of the salivary gland, where BhC4-1 amplification levels are more pronounced and larger amounts of mRNA are produced. By immunoelectron microscopy the BhC4-1 protein was detected in secretory granules of the S1 and S3 regions, and localized in fibrous structures present in the saliva.