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BACKGROUND: Pasireotide is a newer generation somatostatin analogue that led to a significant reduction in pancreatic fistula after pancreatectomy in a single-center randomized controlled trial. We sought to determine if pasireotide reduces the incidence of pancreatic fistula and other complications after pancreaticoduodenectomy at our high volume center. STUDY DESIGN: All patients undergoing pancreaticoduodenectomy between April 2011 and January 2017 were prospectively followed, and their complications were graded using the Modified Accordion Grading System (MAGS) in our institutional complications database. For 18 months, 5 pancreatic surgeons used pasireotide routinely in patients undergoing pancreaticoduodenectomy. Patients receiving pasireotide were then propensity score-matched to patients who did not receive pasireotide, and their outcomes were compared. RESULTS: There were 459 patients who underwent pancreaticoduodenectomy, and 127 patients (28%) received pasireotide. Patients who received pasireotide were significantly more likely to have dilated pancreatic ducts and have a drain left at the time of surgery. Patients who received pasireotide had no difference in pancreatic fistula, overall complications, 90-day readmission, or 90-day mortality. However, patients who received pasireotide had a significantly reduced rate of postoperative bleeding/anemia (8.7% vs 16.9%, p = 0.03). Among 112 propensity score-matched pairs, patients who received pasireotide did not have significantly different rates of pancreatic fistula, and the rates of severe (MAGS grades 3 to 6) pancreatic fistula were identical between the 2 groups (7.1% vs 7.1%, p = 1.00). Matched patients who received pasireotide had significantly decreased postoperative bleeding/anemia (9.8% vs 19.6%, p = 0.04). CONCLUSIONS: Pasireotide did not reduce the incidence or severity of pancreatic fistulas after pancreaticoduodenectomy, but was associated with a decrease in postoperative bleeding/anemia. A multicenter randomized trial is needed to accurately define the role of pasireotide in the postoperative management of pancreaticoduodenectomy patients.
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Hormonas/administración & dosificación , Enfermedades Pancreáticas/tratamiento farmacológico , Enfermedades Pancreáticas/cirugía , Pancreaticoduodenectomía/efectos adversos , Hemorragia Posoperatoria/prevención & control , Somatostatina/análogos & derivados , Anciano , Anemia/etiología , Anemia/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fístula Pancreática/etiología , Fístula Pancreática/prevención & control , Hemorragia Posoperatoria/etiología , Puntaje de Propensión , Estudios Prospectivos , Somatostatina/administración & dosificaciónRESUMEN
BACKGROUND: We estimated the occurrence rate of the booster phenomenon by using an intradermal test with 43 kDa glycoprotein in an endemic area of paracoccidioidomycosis in the central-west region of Brazil. METHODS: Individuals who had a negative result on a survey performed by using an intradermal test with 43 kDa glycoprotein in an endemic area of paracoccidioidomycosis underwent a second intradermal test after 10-15 days to determine the presence or absence of the booster phenomenon. Statistical analyses were performed using the Chi-square test, Chi-square for linear trend test, Student's t test, and binomial test; p < 0.05 was considered significant. RESULTS: For the first time, we reported the occurrence of the booster phenomenon to an intradermal reaction caused by 43 kDa glycoprotein at a rate of 5.8-8.4%, depending on the test's cutoff point. This suggests that a cutoff point should be considered for the booster phenomenon in intradermal tests with 43 kDa glycoprotein: a difference of 6-7 mm between readings according to the first and second tests, depending on the purpose of the evaluation. CONCLUSION: The results indicate that the prevalence of paracoccidioidal infection in endemic areas is underestimated, as the booster phenomenon has not been considered in epidemiological surveys for this infection.
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Antígenos Fúngicos/inmunología , Proteínas Fúngicas/inmunología , Glicoproteínas/inmunología , Inmunización Secundaria/métodos , Inmunización Secundaria/normas , Paracoccidioidomicosis/diagnóstico , Pruebas Cutáneas/métodos , Pruebas Cutáneas/normas , Adulto , Anciano , Brasil , Enfermedades Endémicas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paracoccidioidomicosis/epidemiología , PrevalenciaRESUMEN
Considerando a abordagem analítico-comportamental, atitudes podem ser consideradas respostasavaliativas emitidas de acordo com uma história prévia de aprendizagem. O paradigma deequivalência de estímulos, utilizando procedimentos que simulam o comportamento simbólico nolaboratório, tem possibilitado entender a formação de atitudes como uma rede de relações arbitráriasentre classes de estímulos e atributos avaliativos. Esta visão tem auxiliado na compreensão de comofenômenos sociais, tais como estereótipos e preconceitos, podem ser estabelecidos e modificados. Oobjetivo deste trabalho é apresentar algumas contribuições, a partir de evidências empíricasdemonstradas por pesquisas que utilizaram este paradigma nas últimas décadas, particularmente apartir da década de 90, que fortalecem a equivalência de estímulos como um modelocomportamental importante para o estudo das atitudes(AU)
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Programa de Estímulos e Incentivos , PrejuicioRESUMEN
Epidemiological studies of paracoccidioidomycosis have been based on surveys achieved with intradermal tests, and paracoccidioidin is the most common antigen used in most cases. The glycoprotein of 43-kDa (gp43) has been used in intradermal tests. It is the most antigenic component of Paracoccidioides brasiliensis, and it provides greater specificity to evaluate infection for this fungus. In this study, the prevalence of P. brasiliensis infection was estimated with intradermal tests involving gp43 for 695 people in rural Central-West Brazil. The infection rate was 45.8 % (95 % CI = 42.1-49.5), and the average age of those infected was 45.8 ± 18.2 years. The prevalence did not show gender-based differences but increased with age. The results demonstrate the importance of P. brasiliensis infection in rural settlements and the early exposure of children in the region to the fungus. Despite the high antigenicity and specificity of gp43, its usage must be standardized, so that epidemiological surveys will be comparable and more accurately reflect P. brasiliensis infection in endemic areas.
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Antígenos Fúngicos , Proteínas Fúngicas , Glicoproteínas , Pruebas Intradérmicas/métodos , Paracoccidioides/inmunología , Paracoccidioidomicosis/diagnóstico , Paracoccidioidomicosis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Prevalencia , Población Rural , Sensibilidad y Especificidad , Adulto JovenRESUMEN
Four derivatives of an α,ß-amyrin mixture were synthesized by acylation with appropriate anhydrides. The structures of the compounds were confirmed by means of IR and (1)H and (13)C NMR. The compounds were screened for cytotoxic activity using four human tumor cell lines (HL-60, MDAMB-435, SF-295 and HCT-8) and normal peripheral blood mononuclear cells (PBMC). 3-O-Carboxymaleinate of α,ß-amyrin (3a/3b) were found to be the only active compounds of the series (high cytotoxicity), showing IC(50) values ranging from 1.8 to 3µM. In PBMC, 3a/3b were not toxic, suggesting selectivity for tumor cells. To better understand the mechanism of action involved in the cytotoxicity of 3a/3b, HL-60 cells treated with 3a/3b were examined for morphological changes, DNA fragmentation, cell cycle perturbation, externalization of phosphatidylserine and activation of caspases 3/7, with doxorubicin serving as the positive control. The results indicate that the cytotoxicity of 3a/3b involves the induction of cell death by apoptosis.
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Antineoplásicos/síntesis química , Antineoplásicos/farmacología , Apoptosis/efectos de los fármacos , Burseraceae , Muerte Celular/efectos de los fármacos , Leucocitos Mononucleares/efectos de los fármacos , Ácido Oleanólico/análogos & derivados , Preparaciones de Plantas/síntesis química , Antineoplásicos/química , Caspasa 3/metabolismo , Ciclo Celular/efectos de los fármacos , Línea Celular Tumoral , Células HL-60 , Humanos , Estructura Molecular , Ácido Oleanólico/síntesis química , Ácido Oleanólico/química , Ácido Oleanólico/farmacología , Preparaciones de Plantas/análogos & derivados , Preparaciones de Plantas/farmacologíaRESUMEN
The apicomplexan parasite Neospora caninum can cause abortions and is recognized as an important causative agent responsible for economic and reproductive losses in the cattle industry. Humoral immune response was investigated in BALB/c mice by using recombinant NcSRS2 expressed in Escherichia coli as polyhistidine-tagged fusion proteins. NcSRS2 is the major immunodominant tachyzoite surface antigen of N. caninum. Separate groups of female BALB/c mice were infected subcutaneously with (P) PBS, (N) recNcSRS2, (NIL) recNcSRS2 plus interleukin-12 or (NF) recNcSRS2, in Freunds adjuvant. Serological analysis showed that the antibodies produced by immunization recognized native protein from N. caninum tachyzoites and that, 14 days after the initial immunization, NcSRS2-specific antibodies were present in all sera tested from the groups N, NIL and NF. NcSRS2 with Freuds adjuvant led to a stronger immune response, as measured by IgG1 and IgG2a levels, than did other formulations (NF > NIL > N > P; p < 0.001), with a Th2 bias. The results corroborate the potential use of recombinant protein NcSRS2 as a vaccine aimed at reducing congenital transmission. Further studies are required to identify new adjuvants capable of improving the induction of Th1 immune response.
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Antígenos de Protozoos/inmunología , Coccidiosis/veterinaria , Inmunización , Interleucina-12/inmunología , Neospora/inmunología , Vacunas Antiprotozoos/inmunología , Animales , Coccidiosis/prevención & control , Femenino , Ratones , Ratones Endogámicos BALB CRESUMEN
Introdução: o ramo externo do nervo laríngeo superior (RELS) é um ramo motor que tem origem no nível do osso hióide e desce medialmente à artéria carótida interna para inervar o músculo cricotireóideo da laringe. Nesse trajeto, aproxima-se do pólo superior da glândula tireóide. Muitos estudos têm sido feitos com o objetivo de avaliar a necessidade e viabilidade técnica de sua identificação durante operações sobre a glândula, mas alguns com resultados adversos. Objetivo: estudar a relação anatômica entre o RELS, a tireóide e a artéria tireoidiana superior e a viabilidade técnica e o tempo despendido em sua identificação durante procedimentos cirúrgicos sobre a glândula tireóide. Pacientes e método: foram estudados 40 RELS em pacientes que se submeteram a tireoidectomia por bócios nodulares, bócio difuso tóxico e câncer de tireóide. Foi analisado o tipo de disposição do nervo em relação à glândula tireóide e artéria tireoideana superior; a viabilidade de sua identificação durante a operação; e o tempo despendido para isso. Resultados: em mais da metade dos pacientes o RELS está a menos de 1,0cm da glândula e, em 62,5% dos casos, o nervo foi devidamente identificado em menos de quatro minutos. Conclusão: o RELS está muito próximo do pólo superior do lobo tireoideano; sua identificação cuidadosa é viável; e não acrescenta tempo significativo à cirurgia, devendo ser realizada sempre, para diminuir a morbidade da operação.
Introduction: the external branch of the superior laryngeal nerve (EBSL) is a motor branch that begins near the hyoid bone, than it goes down between the internal carotid artery and the larynx, and finds the cricothyroid muscle. In the way to the muscle, the nerve crosses the superior pole of the thyroid lobe. Many studies have been performed in order to observe the technical viability of finding the nerve during the thyroid surgery, and if we have to do it. There is some disagreement about this point. Objective: to study the anatomical relationship among the EBSL, the thyroid gland and the superior thyroid artery and the technical availability and the time spent in that identification during the surgical approach on the gland. Materials and methods: 40 EBLS were studied in patients who had the thyroid operated. These people had nodular goiter, toxic diffuse goiter, follicular adenoma or thyroid cancer. The anatomical relationship among the nerve, thyroid gland and superior thyroid artery were studied; as well as the viability of the nerve identification and the time spent to do it. Results: the nerve was near the superior pole of the lobe of the thyroid gland in 52.5% of cases; it was spent less than 4 minutes to find the EBSL in 62.5% of patients. Conclusion: the nerve is frequently very close to the gland, and its identification, which is possible in a few minuts, is recommended during thyroid surgery to avoid nerve damage.
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In this study, the knowledge, attitudes, and practices associated with pesticide use and exposure were evaluated in the agricultural community of Culturama, in the state of Mato Grosso do Sul, Brazil. A standardized questionnaire was completed by 250 farm workers aged > or =18 years old. The average age of the studied population was 43.6 years and 17.6% had never been to school. Their farms were small (approximately 30ha) and family operated and did not utilize advanced farming technology. About 92% of the interviewees had worked directly with pesticides and 59.6% reported typical intoxication symptoms. Only 44.3%, however, believe that they had been intoxicated. A significant correlation was found between hand washing after pesticide application and reporting symptoms (P=0.014). Over 90% of the farmers reported using the organophosphorus insecticide methamidophos. A great majority (>90%) considered pesticides to be harmful to human health, but less than 20% used masks, impermeable clothes, or gloves during pesticide application. These results indicate that special educational programs, legislation promoting the use of safer pesticides, and implementation of personal protective measures are necessary to decrease the pesticide exposure of farmers in Culturama.
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Agricultura , Conocimientos, Actitudes y Práctica en Salud , Herbicidas/toxicidad , Insecticidas/toxicidad , Exposición Profesional/efectos adversos , Adolescente , Adulto , Brasil , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
We generated a recombinant vesicular stomatitis virus (VSV-E2) encoding the bovine viral diarrhea virus (BVDV) E2 glycoprotein with the VSV-G protein signal peptide. Infection of BHK21 cells with VSV-E2 induced the synthesis of a recombinant E2 (rE2) that comigrated with authentic BVDV-E2 in PAGE-SDS gels. Non-reducing immunoblots showed that rE2 is a disulfide bond-linked homodimer with at least 10-fold higher avidity for conformation-dependent anti-BVDV-E2 antibodies than its reduced monomeric counterpart. Immunofluorescence microscopy also showed that rE2 was transported to the plasma membrane of infected cells and analysis of purified particles demonstrated that dimeric rE2 was incorporated into VSV-E2 virions in approximately 1:10 ratio with respect to the G glycoprotein. BALB/c mice inoculated intranasally with VSV-E2 doses of up to 10(7) plaque forming units (pfu) showed no symptoms of viral-induced disease and developed a specific BVDV neutralizing response that lasted for at least 180 days post inoculation.
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Anticuerpos Antivirales/biosíntesis , Virus de la Diarrea Viral Bovina/genética , Virus de la Diarrea Viral Bovina/inmunología , Glicoproteínas de Membrana , Virus de la Estomatitis Vesicular Indiana/genética , Proteínas del Envoltorio Viral/genética , Proteínas del Envoltorio Viral/inmunología , Secuencia de Aminoácidos , Animales , Anticuerpos Antivirales/sangre , Secuencia de Bases , Bovinos , Línea Celular , Quimera/genética , Quimera/inmunología , Cricetinae , ADN Recombinante/genética , Femenino , Ratones , Ratones Endogámicos BALB C , Pruebas de Neutralización , Proteínas Recombinantes/genética , Proteínas Recombinantes/inmunología , Vacunas Sintéticas/genética , Vacunas Virales/genéticaRESUMEN
A polarity thresholding algorithm that has recently been developed for split-spectrum processing for ultrasonic coherent noise reduction is theoretically analyzed to evaluate its performance. The probability density function (PDF) of the output of the algorithm is derived and used to calculate the theoretical signal-to-noise ratio (SNR) enhancement and the receiver operating characteristics. The performance limits of the algorithm are also established. Some experimental results of SNR enhancement obtained with the polarity thresholding algorithm are presented.
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Three experiments examined a discrimination training sequence that led to emergent simple discrimination in human subjects. The experiments differed primarily in their subject populations. Normally capable adults served in the first experiment, preschool children in the second, and mentally retarded adults in the third. In all experiments, subjects learned a simple simultaneous discrimination: When visual stimuli A1 and A2 were displayed together, reinforcers followed selections of A1, the S+, but not A2, the S-. The subjects also learned a conditional discrimination taught with an arbitrary visual-visual matching-to-sample procedure. Comparisons were two additional visual stimuli, B1 and B2, and samples were A1 and A2. Reinforcers followed selections of B1 in the presence of A1 and of B2 in the presence of A2. After the simple-discrimination and conditional-discrimination baselines had been acquired, B1 and B2 were displayed alone (without a sample) on probe trials. Subjects had never been taught explicitly how to respond to such displays. Nonetheless, they almost always selected B1, which was involved in a conditional relation with A1, the stimulus that served as S+ on the simple-discrimination trials. This outcome suggested the formation of stimulus classes during conditional-discrimination training. Through class formation, B1 and B2 had apparently acquired stimulus functions similar to those shown by A1 and A2 on simple-discrimination trials, thereby leading to emergent selections of B1 on the probes.
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Atención , Aprendizaje Discriminativo , Percepción de Forma , Discapacidad Intelectual/psicología , Reconocimiento Visual de Modelos , Adolescente , Adulto , Aprendizaje por Asociación , Preescolar , Condicionamiento Operante , Educación de las Personas con Discapacidad Intelectual , Femenino , Humanos , Masculino , Persona de Mediana Edad , Esquema de RefuerzoRESUMEN
Three mentally retarded humans first acquired a simple discrimination: Simultaneously displayed visual stimuli A1 and A2 functioned as S+ and S-, respectively. The subjects also acquired a conditional discrimination, learning to select visual stimuli B1 and B2 conditionally upon A1 and A2, respectively. Then, B1 and B2 were displayed without A1 or A2. Subjects selected B1, an emergent discrimination that showed that B1 and B2 had become functionally equivalent to A1 and A2, respectively. Two subjects next learned to select C1 and C2 conditionally upon B1 and B2, respectively. They also learned to select B1 and B2 conditionally upon D1 and D2, respectively. Subsequent simple discrimination probe trials displayed (a) C1 and C2 and (b) D1 and D2. On the former, the subjects nearly always selected C1. On the latter, they initially selected D1 and D2 about equally often. Thus, the emergence of simple discrimination appears to depend on a specific experimental history.
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Prednisolona/metabolismo , Adulto , Niño , Relación Dosis-Respuesta a Droga , Humanos , Cinética , MasculinoAsunto(s)
Vértebras Cervicales , Luxaciones Articulares , Mucopolisacaridosis I/complicaciones , Espasticidad Muscular/etiología , Cuadriplejía/etiología , Compresión de la Médula Espinal/etiología , Vértebras Cervicales/anomalías , Vértebras Cervicales/diagnóstico por imagen , Niño , Preescolar , Femenino , Humanos , Luxaciones Articulares/complicaciones , Masculino , Mucopolisacaridosis I/diagnóstico por imagen , Cuadriplejía/diagnóstico por imagen , Radiografía , Compresión de la Médula Espinal/complicacionesAsunto(s)
Anemia Hipocrómica/epidemiología , Complicaciones Hematológicas del Embarazo/epidemiología , Anemia Hipocrómica/etiología , Células Sanguíneas/análisis , Análisis Químico de la Sangre , Dieta , Femenino , Hemoglobinas/análisis , Humanos , Embarazo , Complicaciones Hematológicas del Embarazo/etiología , Trinidad y Tobago , Vitamina B 12/sangreAsunto(s)
Humanos , Embarazo , Femenino , Anemia Hipocrómica/epidemiología , Complicaciones Hematológicas del Embarazo/epidemiología , Anemia Hipocrómica/etiología , Células Sanguíneas/análisis , Análisis Químico de la Sangre , Dieta , Hemoglobinas/análisis , Complicaciones Hematológicas del Embarazo/etiología , Trinidad y Tobago , Vitamina B 12/sangreRESUMEN
At the Trinidad Nutrition Centre hemoglobin levels were determined in 555 pregnant women and a third of these were found to be less than 10 gm percent. Serum iron levels were diminished and total iron binding capacity increased wile the present saturation of TIBC was decreased in this anemic group. Serum folic acid levels were low but serum Vit. B12 levels normal. Average total protein intake was 56 gm (49 percent of animal and 51 percent of vegetable sources), representing a deficit of 26.8 percent in total protein intake. Average iron intake was 10.3 mg (20 percent of animal and 80 percent of vegetable sources), representing a 31.3 percent deficiency. In 84 percent of the patients anemia was of the hypochromic microcytic type. The authors intend to investigate further whether the high proportion of iron intake from vegetable sources plays any part in the production of anemia (AU)