Post-COVID-19 tomographic abnormalities

BACKGROUND: The prevalence of persistent respiratory symptoms tends to be low in patients with a longer recovery time after COVID-19. However, some patients may present persistent pulmonary abnormalities.OBJECTIVE: To evaluate the prevalence of tomographic abnormalities 90 days after symptom onset in patients with COVID-19 and compare two chest high-resolution computed tomography (HRCT) analysis techniques.METHODS: A multicentre study of patients hospitalised with COVID-19 having oxygen saturation <93% on room air at hospital admission were evaluated using pulmonary function and HRCT scans 90 days after symptom onset. The images were evaluated by two thoracic radiologists, and were assessed using software that automatically quantified the extent of pulmonary abnormalities.RESULTS: Of the 91 patients included, 81% had at least one pulmonary lobe with abnormalities 90 days after discharge (84% were identified using the automated algorithm). Ground-glass opacities (76%) and parenchymal bands (65%) were the predominant abnormalities. Both chest HRCT technical assessments presented high sensitivity (95.9%) and positive predictive value (92%), with a statistically significant correlation at baseline (R = 0.80) and after 90 days (R = 0.36).CONCLUSION: The prevalence of pulmonary abnormalities on chest HRCT 90 days after symptom onset due to COVID-19 was high; both technical assessments can be used to analyse the images.

An anti-infective synthetic peptide with dual antimicrobial and immunomodulatory activities

Antibiotic-resistant infections are predicted to kill 10 million people per year by 2050, costing the global economy $100 trillion. Therefore, there is an urgent need to develop alternative technologies. We have engineered a synthetic peptide called clavanin-MO, derived from a marine tunicate antimicrobial peptide, which exhibits potent antimicrobial and immunomodulatory properties both in vitro and in vivo. The peptide effectively killed a panel of representative bacterial strains, including multidrug-resistant hospital isolates. Antimicrobial activity of the peptide was demonstrated in animal models, reducing bacterial counts by six orders of magnitude, and contributing to infection clearance. In addition, clavanin-MO was capable of modulating innate immunity by stimulating leukocyte recruitment to the site of infection, and production of immune mediators GM-CSF, IFN-γ and MCP-1, while suppressing an excessive and potentially harmful inflammatory response by increasing synthesis of anti-inflammatory cytokines such as IL-10 and repressing the levels of pro-inflammatory cytokines IL-12 and TNF-α. Finally, treatment with the peptide protected mice against otherwise lethal infections caused by both Gram-negative and -positive drug-resistant strains. The peptide presented here directly kills bacteria and further helps resolve infections through its immune modulatory properties. Peptide anti-infective therapeutics with combined antimicrobial and immunomodulatory properties represent a new approach to treat antibiotic-resistant infections.

Association between subjective evaluation and physical parameters for radiographic images optimization

PURPOSE

The purpose of this study was to develop a methodology to optimize computed radiographic techniques to image the skull, chest, and pelvis of a standard patient.

METHODS

Optimization was performed by varying exposure levels with different tube voltages to generate images of an anthropomorphic phantom. Image quality was evaluated using visual grading analysis and measuring objective parameters such as the effective detective quantum efficiency and the contrast-to-noise ratio. Objective and subjective evaluations were compared to obtain an optimized technique for each anatomic region.

RESULTS

Gold standard techniques provided a significant reduction in X-ray doses compared to the techniques used in our radiology service, without compromising diagnostic accuracy. They were chosen as follows 102 kVp/1.6 mAs for skull; 81 kVp/4.5 mAs for pelvis and 90 kVp/3.2 mAs for chest.

CONCLUSION

There is a range of acceptable techniques that produce adequate images for diagnosis in computed radiography systems. This aspect allows the optimization process to be focused on the patient dose without compromising diagnostic capabilities. This process should be performed through association of quantitative and qualitative parameters, such as effective detective quantum efficiency, contrast-to-noise ratio, and visual grading analysis.

Is superior hypogastric plexus block effective for treatment of chronic pelvic pain?

BACKGROUND AND OBJECTIVES

Hypograstric plexus block has been considered a safe and effective alternative for treat patients with chronic pelvic pain. Published studies available at MedLine on the subject were included and evaluated in this review.

CONTENTS

Some studies have documented superior hypogastric plexus block effectiveness in relieving pain and decreasing opioid consumption, mainly in cancer patients. However, studies had failures in method or design.

CONCLUSIONS

New prospective and better-designed studies are still needed to confirm the effectiveness of hypogastric plexus block in relieving pelvic pain. These studies shall have stricter inclusion criteria, longer follow-up, and evaluation of other symptoms and quality of life before and after the procedure. Superior hypogastric plexus block should be recommended as alternative and not as primary therapy.

[A comparative study of ultrasonography, computed tomography and magnetic resonance imaging in the staging and invasiveness of adjacent structures by renal tumors]

BACKGROUND

Ultrasonography (US), Computed Tomography (CT), and Magnetic Resonance imaging (MR) were compared for the staging of renal tumors. The differences between these imaging techniques were also studied for their ability to detect adenopathies, vascular invasion, distant intra-abdominal metastases, and particularly adjacent organ invasion.

METHODS

Thirty-one patients with solid or complex renal masses were prospectively studied using US, CT, and MR. Differences between the results obtained were studied using the COCHRAN G test and the McNEMAR test. The sensitivity and specificity of each diagnostic technique were compared against a "gold standard" of the surgical and histopathological findings.

RESULTS

The following sensitivities were obtained: For the detection of adenopathy, US 63.6%, CT and MR 90.9%. For vascular invasion, US 42.8%, CT and MR 85.7%. For the adjacent organ invasion, US 28.5%, CT 85.7%, and MR 71.4%. Some of the criteria that suggest invasion of adjacent structures include: the envelopment of the adjacent structures by the tumor, tumor extension into the adjacent structures with an irregular appearance, and alterations in shape, size, and density of adjacent structures. Loss of fat planes between the tumor and adjacent structures is not a sign of tumor invasion.

CONCLUSIONS

Significant differences were found in the detection capacity of US in relation to CT and MR, which were similar. All three techniques were highly sensitive and specific only in the detection of distant abdominal metastases. In addition to the accuracy of these diagnostic modalities for the detection and staging of tumors, invasiveness, risks and cost should be considered in relation to relative costs and benefits.

The activation sequence of thrombospondin-1 interacts with the latency-associated peptide to regulate activation of latent transforming growth factor-beta

One of the primary points of regulation of transforming growth factor-beta (TGF-beta) activity is control of its conversion from the latent precursor to the biologically active form. We have identified thrombospondin-1 as a major physiological regulator of latent TGF-beta activation. Activation is dependent on the interaction of a specific sequence in thrombospondin-1 (K412RFK415) with the latent TGF-beta complex. Platelet thrombospon-din-1 has TGF-beta activity and immunoreactive mature TGF-beta associated with it. We now report that the latency-associated peptide (LAP) of the latent TGF-beta complex also interacts with thrombospondin-1 as part of a biologically active complex. Thrombospondin.LAP complex formation involves the activation sequence of thrombospondin-1 (KRFK) and a sequence (LSKL) near the amino terminus of LAP that is conserved in TGF-beta1-5. The interactions of LAP with thrombospondin-1 through the LSKL and KRFK sequences are important for thrombospondin-mediated activation of latent TGF-beta since LSKL peptides can competitively inhibit latent TGF-beta activation by thrombospondin or KRFK-containing peptides. In addition, the association of LAP with thrombospondin-1 may function to prevent the re-formation of an inactive LAP.TGF-beta complex since thrombospondin-bound LAP no longer confers latency on active TGF-beta. The mechanism of TGF-beta activation by thrombospondin-1 appears to be conserved among TGF-beta isoforms as latent TGF-beta2 can also be activated by thrombospondin-1 or KRFK peptides in a manner that is sensitive to inhibition by LSKL peptides.

Thrombospondin-1 is a major activator of TGF-beta1 in vivo

The activity of TGF-beta1 is regulated primarily extracellularly where the secreted latent form must be modified to expose the active molecule. Here we show that thrombospondin-1 is responsible for a significant proportion of the activation of TGF-beta1 in vivo. Histological abnormalities in young TGF-beta1 null and thrombospondin-1 null mice were strikingly similar in nine organ systems. Lung and pancreas pathologies similar to those observed in TGF-beta1 null animals could be induced in wild-type pups by systemic treatment with a peptide that blocked the activation of TGF-beta1 by thrombospondin-1. Although these organs produced little active TGF-beta1 in thrombospondin null mice, when pups were treated with a peptide derived from thrombospondin-1 that could activate TGF-beta1, active cytokine was detected in situ, and the lung and pancreatic abnormalities reverted toward wild type.

Mechanism of citrinin-induced dysfunction of mitochondria. VI. Effect on iron-induced lipid peroxidation of rat liver mitochondria and microsomes

The inhibition by citrinin (CTN) of lipid peroxidation of mitochondria, sub-mitochondrial particles (SMP) and microsomes was studied. This effect was reversed by the presence of high concentrations of Fe3+ (0.4 and 0.5 mM), suggesting chelation of the mycotoxin with iron or interference in the reduction of Fe3+.

[The students' page. Are we making good use of this space?]

The current study aimed to make a survey of the articles written by nursing students that were published through the Students' Pages in the Brazilian Nursing Journal, Nursing Journal from Bahia and Nursing Journal from São Paulo from 1982 to 1995, in order to verify if this space is being used and the themes that have been approached. This investigation evidenced that, from the three studied periodicals, 109 issues were available in the library, 15 presented articles published in the Students' Pages and 21 texts were found. Among these, the most approached themes are related to nursing practice.

Mechanism of citrinin-induced dysfunction of mitochondria. V. Effect on the homeostasis of the reactive oxygen species

The effects of citrinin in the maintenance of the homeostasis of the reactive oxygen species in rat liver cells were evaluated. Citrinin (CTN) modifies the antioxidant enzymatic defences of cells through the inhibition of GSSG-reductase and transhydrogenase. No effect was observed on GSH-peroxidase, catalase, glucose 6-phosphate and 6 phosphogluconate dehydrogenases, and superoxide dismutase. The mycotoxin increased the generation of reactive oxygen species, stimulating the production of the superoxide anion in the respiratory chain. The results suggest that oxidative stress is an important mechanism, side by side with other effects previously shown, in the establishment of the cytotoxicity and cellular death provoked by CTN in several tissues.

Effect of amiodarone (AMD) on the antioxidant enzymes, lipid peroxidation and mitochondrial metabolism

The effects of amiodarone (AMD) on lipid peroxidation of rat liver mitochondria, the formation of superoxide anions at the respiratory chain level, and the cytosolic and mitochondrial enzymatic protective mechanisms of oxidative stress were studied. An attempt of classify AMD according to its toxic ability to interfere with the integrated function of electron transport enzymes was also investigated. The results confirm the effects of AMD on complex I and permit the placing of this drug in class A of the classification of Knobeloch, together with rotenone, amytal and chaotropic agents. AMD has no effect on the activity of the enzymes superoxide dismutase, catalase, glutathione reductase and glutathione peroxidase, nor on glucose 6-phosphate dehydrogenase. AMD did not promote an increase in the formation of anion superoxide at the respiratory chain level. Pre-incubation with AMD (16.6 microM) inhibited about 70 per cent of lipid peroxidation. The results suggest a protective effect of AMD against lipid peroxidation in mitochondrial membranes by iron-dependent systems.

[Current concepts of digestion and absorption of carbohydrates]

The aim of this paper is to review recent aspects of digestion and absorption of carbohydrates that are the main source of energy in human diets. Recent researches have found that starch is not largely hydrolysed and absorbed in the small bowel but one part of it is resistant to digestion. Several food factors may be responsible for digestion and absorption velocity and totality of carbohydrates. Therefore, carbohydrate classification must be based not only on molecular size to express the real carbohydrates utilization as an energy source by humans. In agreement with molecular size of carbohydrate, its classification can be: a) monosaccharides; b) disaccharides; c) oligosaccharides; d) polysaccharides. In agreement with carbohydrate digestibility or availability, its classification can be: a) digestible carbohydrates; b) undigestable carbohydrates (NSP). Carbohydrate digestibility can be altered by several factors like: Intrinsic factors: a) physical structure; b) molecular physical distribution; c) physical state of food; d) food antinutrients. Extrinsics factors: a) chewing; b) transit time of food; c) amount of starch present; d) diet antinutrients. Under influence of this factors, process of digestion happen by enzymatic activity a long the gastrointestinal tract. Salivary and pancreatic amylase; glycosidases of the duodenal enterocyte brush border (lactase, sacarase and maltase), whose activity happen by close interaction of digestive breakdown with transport. The summarized pathways of the absorptive process: 1. movement from the bulk phase of the lumenal or mucosal fluid to enterocyte surface; 2. movement across the brush border membrane through specific transporters: a) SGLT1; b) GLUT 5; c) passive diffusion. 3. movement across the basolateral membrane by the GLUT 2.

Heparin-binding vitronectin up-regulates latent TGF-beta production by bovine aortic endothelial cells

Vitronectin, a serum and extracellular matrix protein, is present in vivo in two different conformations: a native form, which does not bind heparin, and a heparin-binding conformer, which results from interactions of native vitronectin with either the thrombin-antithrombin III complex or the terminal complement complex, C5b-9. We found that vitronectin stimulates the activity of the growth regulatory peptide, TGF-beta, in the conditioned media of bovine aortic endothelial cells as a result of increased production of latent TGF-beta. This effect is specific for the denatured, heparin-binding, form of vitronectin, since native vitronectin has no effect on the production of latent TGF-beta by those cells. Stimulation is time and concentration-dependent, but is independent of protease activity. Stimulation is dependent on the presence of cells, since there was no increase in TGF-beta activity observed when vitronectin was added to the conditioned media after removal from cells. Furthermore, incubation of recombinant latent TGF-beta with vitronectin in a cell-free system does not result in increased TGF-beta activity. Assays of total TGF-beta levels in heat-treated conditioned media showed that vitronectin treatment elevates the levels of total TGF-beta in the conditioned media. These results were further confirmed by western blot analysis of the conditioned media with antibodies specific for latent TGF-beta. These data suggest that vitronectin regulates expression and/or secretion of TGF-beta by bovine aortic endothelial cells. This cellular response to the heparin-binding form of vitronectin seems to be mediated by alpha v beta 3 integrins.(ABSTRACT TRUNCATED AT 250 WORDS)

Ca2+ and Mg2+ requirements for growth are not concomitantly reduced during cell transformation

The effects of Mg2+ and Ca2+ deprivation on survival and growth of normal and transformed cultured cells were studied. Normal fibroblast from several origins (mouse, hamster and human) did not grow in 2 microM Mg2+ medium, whereas transformed fibroblasts (mouse and rat) and tumor cells of other types (mouse adrenocortical and rat glial cells) grew optimal. All transformed or tumorogenic cells that showed low growth requirement for Mg2+ were able to develop colonies in agarose suspension cultures, i.e., were anchorage-independent fo growth. Mg2+ deprivation of normal cells did not lead to cell cycle arresting at G0/G1 and cell death accounts for the limited growth of these cells in medium containing low Mg2+ concentration. Contrary to Mg2+, starvation for serum or for Ca2+ caused normal cells to undergo cell cycle arrest at the G0/G1 phase. During the progressive spontaneous transformation of Swiss mouse 3T3 fibroblasts, the decrease in growth requirements for Mg2+ and Ca2+ do not occur at the same time. The requirement for external Ca2+ lowers before the onset of anchorage-independent growth while the Mg2+ requirement only decreases after cells become anchorage-independent. Therefore the reductions in growth requirement for Mg2+ and Ca2+ that take place in cell transformation are not linked events.

Glucocorticoid hormone renders rat glioma cells dependent on high concentrations of external Ca2+ for growth

C6 rat glioma cells, like other tumor cells, grow optimally in Ca2+-or Mg2+-depleted 5% serum medium. However, the glucocorticoid hormone hydrocortisone renders these cells dependent on high concentrations of external Ca2+ for growth. Upon Ca2+ deprivation (30-80 microM Ca2+ medium) hydrocortisone-treated C6 cells undergo reversible cell-cycle arrest at G0/G1 phase. This effect is specific for glucocorticoid hormones and occurs at physiological concentrations. Growth restimulation of Ca2+-deprived, hydrocortisone-treated C6 cells by bovine pituitary growth factors or serum growth factors only takes place if the external Ca2+ concentration is increased. On the other hand, C6 cell growth requirement for external Mg2+ was not increased by the glucocorticoid hormone treatment. A minimum of 80 microM of external Mg2+ is required to keep cells adhered and spread in Ca2+-depleted (30 microM) 5% serum medium; in high Ca2+ concentration (1.8 mM), Mg2+ is not required for adhesion or spreading. Thus, the hormone hydrocortisone renders the cell cycle of C6 glioma cells controllable by the levels of external Ca2+, a minimal external Mg2+ being necessary to warrant normal adhesion.