RESUMO
INTRODUCTION: Glenohumeral osteoarthritis leads to a functional loss and a decrease in the quality of life of many patients that suffers it. Currently there is no agreement on the use of hemiarthroplasty or total arthroplasty as definitive treatment. The objective is to show the results of the treatment of primary glenohumeral osteoarthritis through hemiarthroplasty in our service. MATERIAL AND METHODS: We reviewed 14 patients (19 hemiarthroplasties) performed between 2004 and 2013 in patients diagnosed with primary glenohumeral osteoarthritis without glenoid morphological anomaly. We managed to collect data from eight patients (11 hemiarthroplasties), assessing functional status, pain, and performing activities of daily living using the Constant, ASES and DASH scores preoperatively and at five years of minimum follow-up (range 5-11 years), as well as related complications. The preoperative status was compared to the end of the follow-up. RESULTS: A significant improvement was found in all the parameters analyzed in the study (p. CONCLUSION: < 0.05). The average pain in EVA score decreased from 8.89 to 2.67. The ASES improved from 13.51 to 63. 51 half point. The Constant increase of 20.11 points to 65.11 points. The mean preoperative score in the DASH score was 73.68 and 28.30 postoperatively. The average survival of the implant was 81.82% in the seven years of average follow-up. Shoulder hemiarthroplasty obtains good functional results in the treatment of primary glenohumeral osteoarthritis with few complications. The cause of the failure were glenoid erosion in all the cases.
INTRODUCCIÓN: La artrosis glenohumeral conlleva a una pérdida funcional y a una disminución de la calidad de vida de muchos pacientes. Actualmente, no existe consenso en cuanto al uso de la hemiartroplastía o la artroplastía total como tratamiento definitivo para este padecimiento. El objetivo es mostrar los resultados del tratamiento de la artrosis glenohumeral primaria mediante hemiartroplastía en nuestro servicio. MATERIAL Y MÉTODOS: Revisamos 19 hemiartroplastías (14 pacientes) realizadas entre 2004 y 2013 en pacientes con artrosis glenohumeral primaria sin alteración morfológica glenoidea. Se recabaron los datos de ocho pacientes (11 hemiartroplastías), valorándose el estado funcional, el dolor y la realización de actividades de la vida diaria mediante las escalas Constant, ASES y DASH preoperatorias, a los cinco años de seguimiento mínimo (rango 5-11 años), así como las complicaciones presentadas. Se comparó el estado preoperatorio y al final del seguimiento. RESULTADOS: Se encontró una mejoría estadísticamente significativa (p. CONCLUSIÓN: < 0.05) en todos los parámetros analizados en el estudio. La media del dolor en la escala EVA disminuyó de 8.89 a 2.67. La escala ASES mejoró de 13.51 a 63.51 puntos de media. El Constant aumentó de 20.11 a 65.11 puntos. La puntuación media preoperatoria en la escala DASH fue de 73.68 y la postoperatoria de 28.30 puntos. La supervivencia media del implante fue de 81.82% a los siete años de seguimiento medio. Obtuvimos buenos resultados funcionales con la artrosis glenohumeral primaria, presentándose pocas complicaciones. La causa del fracaso fue la erosión glenoidea.
Assuntos
Hemiartroplastia , Osteoartrite , Articulação do Ombro , Atividades Cotidianas , Seguimentos , Humanos , Osteoartrite/cirurgia , Qualidade de Vida , Amplitude de Movimento Articular , Estudos Retrospectivos , Articulação do Ombro/cirurgia , Resultado do TratamentoRESUMO
La paratiroidectomía (PTx) es el tratamiento de elección en pacientes con HPT 2º severo, refractario al tratamiento médico. Se cuenta con muy poca información en Argentina de este procedimiento, por lo cual se realizó este estudio. Material y Métodos: Se incluyeron 255 pacientes con PTx entre el año 2003 al 2007 de un registro voluntario. Se evaluaron los estudios de localización prequirúrgicos, de laboratorio de metabolismo fosfocálcico previo y posterior a la cirugía y el tipo de técnica quirúrgica utilizada. Se analizó la persistencia y recidiva del HPT postcirugía. Resultados: La tasa de PTx fue de 2,7/1000 pacientes año. 83% de los pacientes tuvieron ecografía de cuello y 59% Sesta Mibi con Tc 99. Hubo una correlación positiva (p<0.001) entre el número de glándulas detectadas por ecografía y Sesta Mibi. La paratiroidectomía realizada fue: subtotal en 77%, total con autoimplante en 14% y total sin autoimplante en 9%. Hubo descensos significativos de Ca y P, fosfatasa alcalina y PTH (1744 ± 788 pg/ml a 247 ±450 pg/ml; p<0.0001) postcirugía. A los 2,4 ±2,5 meses de la PTx, el 72% de los pacientes tenía PTH <250 pg/ml, 19,8% tenía persistencia y 8,3% había recidivado. De acuerdo al tipo de cirugía la persistencia y recidiva fueron para PTx subtotal 22% y 8,3%, PTx total con implante 11% y 11% y PTx total sin autoimplante 13% y 4% respectivamente. La realización de Sesta Mibi no influyó en los resultados de la PTx. No se observaron diferencias entre los centros en relación con persistencia y recidiva. Conclusiones: La tasa de PTx fue muy baja, la ecografía fue el método de localización prequirúrgico preferido y la PTX subtotal la técnica quirúrgica más utilizada. La PTx fue exitosa en la mayoría de los pacientes y la persistencia y recidiva no estuvieron relacionadas con la técnica.
Parathyroidectomy (PTx) is the selecte treatment for patients with severe secondary hyperparathyroidism, refractory to medical treatment. There is not enough information about this procedure in Argentina, that is the reason why we performed this study. Material and Methods: 255 patients with PTx were included from the year 2003 to 2007 on a voluntary register. Studies of pre-surgical localization, phosphocalcic metabolism laboratories before and after surgery were evaluated, and the type of surgical technique used. The persistence and recurrence of post-surgical hyperparathyroidism was analyzed. Results: The PTx rate was 2,7/1000 patients year. 83% of the patients had neck echography and 59% Sestamibi scans with Tc 99. There was a positive correlation (p<0,001) between the number of detected glands by echography and Sestamibi. The parathyroidectomy performed was: subtotal in 77%, total with self-implant in 14% and total without self-implant in 9%. There were significant falls of Ca and P, Alkaline Phosphatase and PTH (1744±788 pg/ml to 247±450 pg/ml; p<0.0001) post-surgical. 2.4 ±2,5 months after the PTx, 72% of patients had PTH <250 pg/ml, 19,8% had persistence and 8,3% had recurrence. According to the type of surgery, the persistence and recurrence were for subtotal PTx 22% and 8,3%, total PTx with implant 11% and 11%, and total PTx without selfimplant 13% and 4% respectively. The performance of the Sestamibi scan did not affect the PTx results. No noticeable differences were observed among the centers for persistence and recurrence. Conclusions: The PTx rate was very low, echography was the preferred method of pre-surgical localization, and subtotal PTx was the most used surgical technique. PTx was successful in most of the patients, and persistence and recurrence were not related to the technique.
Assuntos
Humanos , Masculino , Feminino , Falência Renal Crônica , Paratireoidectomia/tendências , Cirurgia Geral , Procedimentos Cirúrgicos Operatórios , RecidivaRESUMO
BACKGROUND AND PURPOSE: Anastomotic recurrence after radical sphincter-preserving surgery preceded by neoadjuvant therapy in locally advanced rectal cancer is an uncommon event that merits further assessment. The aim of this study is to analyze the effect of preoperative chemoradiation on the risk of anastomotic recurrence. Based on the initial extension of the tumor, we analyzed whether the distal surgical section was calculated through the virtual initial extension of the rectal tumor. PATIENTS AND METHODS: Eligible patients with locally advanced rectal cancer were offered preoperative chemoradiation, sphincter sparing surgery and intraoperative radiation therapy boost. RESULTS: 180 patients were treated with anterior resection (40 %), low anterior resection (45.6 %) and ultra-low anterior resection (14.4 %). With a median follow-up of 41.1 months (0.36-143 months), anastomotic recurrence was diagnosed in 9 patients (5 %). There was no statistical correlation with downstaging (T or N), downsizing effects, or with distance from the lower limit of the residual lesion to the distal margin. Virtual intratumoral surgical section was speculated in 44 patients (3 developed anastomotic recurrence; 6.8 vs 4.8 %, p = 0.482). CONCLUSION: Anastomotic recurrence in patients with rectal cancer treated with neoadjuvant chemoradiation is an infrequent event. Virtual intratumoral surgical sections followed by anastomosis do not contribute to an excessive risk of recurrence. Our findings encourage the development of policies for preservation of the ano-rectal complex in rectal cancer patients.
Assuntos
Adenocarcinoma/terapia , Anastomose Cirúrgica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia , Recidiva Local de Neoplasia/diagnóstico , Neoplasias Retais/terapia , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Recidiva Local de Neoplasia/etiologia , Estadiamento de Neoplasias , Tratamentos com Preservação do Órgão , Cuidados Pré-Operatórios , Prognóstico , Neoplasias Retais/patologia , Fatores de RiscoRESUMO
Introducción: La deficiencia de 25 (OH) vitamina D es una alteración prevalente en los pacientes con enfermedad renal crónica (ERC) , sin embargo en nuestro medio no es medida de manera rutinaria y por ende no suele hacerse reposición vitamínica. Nuestro objetivo fue determinar la prevalencia y los factores relacionados a deficiencia de 25 (OH) D en pacientes con ERC en hemodiálisis (HD), particularmente la relación con la función y masa muscular. Métodos: Efectuamos un estudio prospectivo, multicéntrico, en pacientes adultos en HD crónica que no estuvieran recibiendo ningún derivado de la vitamina D. Se midieron en sangre los niveles de 25(OH) D, Hemoglobina, PCR, Albúmina, Ca, P, FAL, PTHi. Se realizó la medición de la fuerza del puño con dinamómetro, y la prueba de sentado-parado. Se aplicó el índice de Karnofsky para clasificar el estado funcional., Se realizó una bioimpedanciometría (BCM; Frese nius Medical Care) en aquellos pacientes sin, contraindicación. Resultados: Se incluyeron 138 pacientes. La 25(OH) vitamina fue de 20.43 ± 10.5 ng/ml, la prevalencia de insuficiencia /defi ciencia 87% (37% con menos de 15 ng/ml). Las concentraciones de vitamina D/deficiencia mostraron correlación/relación significativa con la edad, la presencia de diabetes, los niveles de hemoglobina y albúmina, la fuerza y la masa muscular y la clase funcional (p<0.05) . Conclusión: Alta prevalencia de hipovitaminosis D en pacientes hemodializados particularmente gerontes y diabéticos. Esto estaría relacionado con la desnutrición, anemia, clase funcional y la fuerza/masa muscular de los pacientes, estos últimos dos factores no reportados hasta ahora. Todos estos factores deben ser considerados al momento de la sustitución vitamínica y en la evaluación de la efectividad de la misma.
Background: 25 (OH) vitamin D deficiency is a prevailing alteration in patients with chronic kidney disease (CKD); however, in our environment, it is not routinely measured and, therefore, vitamin replacement is unusual. Our purpose was assessing the prevalence of and the factors related to 25 (OH) vitamin D deficiency in patientswith CKD in hemodialysis (HD), especially the relation to function and muscle mass. Methods: We conducted a prospective, multicenter study in adult patients on chronic HD who were not receiving any vitamin D derivative. Blood levels of 25 (OH) D, Hemoglobin, CRP, Albumin, Ca,P, ALP and PTHi were measured. The handgrip strength was measured with a dynamometer and the sitting-rising test was carried out. A bioimpedance analysis (BCM; Fresenius Medical Care) was conducted in the patients who had no contraindications. Results: 138 patients were included. The levels of 25 (OH) vitamin D were 20.43±10.5 ng/ml; the insufficiency/deficiency had 87% prevalence (and 37% prevalence with less than 15 ng/ml). Vitamin D concentrations/ deficiency showed a significant correlation with/ relation to age, diabetes, hemoglobin and albumin levels, muscle strength and mass, and functional class (p<0.05). Conclusion: High prevalence of hypovitaminosis D in patients on hemodialysis, particularly in the elderly and in patients with diabetes. This should be related to undernutrition, anemia, the functional class and the muscle strength/mass of patients, the latter two being unreported factors until now. All these factors should be considered when vitamin replacement is conducted and when its effectiveness is assessed.
Assuntos
Humanos , Debilidade Muscular , Deficiência de Vitamina D , Diálise Renal/efeitos adversos , Deficiência de VitaminasRESUMO
Introducción: La deficiencia de 25 (OH) vitamina D es una alteración prevalente en los pacientes con enfermedad renal crónica (ERC) , sin embargo en nuestro medio no es medida de manera rutinaria y por ende no suele hacerse reposición vitamínica. Nuestro objetivo fue determinar la prevalencia y los factores relacionados a deficiencia de 25 (OH) D en pacientes con ERC en hemodiálisis (HD), particularmente la relación con la función y masa muscular. Métodos: Efectuamos un estudio prospectivo, multicéntrico, en pacientes adultos en HD crónica que no estuvieran recibiendo ningún derivado de la vitamina D. Se midieron en sangre los niveles de 25(OH) D, Hemoglobina, PCR, Albúmina, Ca, P, FAL, PTHi. Se realizó la medición de la fuerza del puño con dinamómetro, y la prueba de sentado-parado. Se aplicó el índice de Karnofsky para clasificar el estado funcional., Se realizó una bioimpedanciometría (BCM; Frese nius Medical Care) en aquellos pacientes sin, contraindicación. Resultados: Se incluyeron 138 pacientes. La 25(OH) vitamina fue de 20.43 ± 10.5 ng/ml, la prevalencia de insuficiencia /defi ciencia 87% (37% con menos de 15 ng/ml). Las concentraciones de vitamina D/deficiencia mostraron correlación/relación significativa con la edad, la presencia de diabetes, los niveles de hemoglobina y albúmina, la fuerza y la masa muscular y la clase funcional (p<0.05) . Conclusión: Alta prevalencia de hipovitaminosis D en pacientes hemodializados particularmente gerontes y diabéticos. Esto estaría relacionado con la desnutrición, anemia, clase funcional y la fuerza/masa muscular de los pacientes, estos últimos dos factores no reportados hasta ahora. Todos estos factores deben ser considerados al momento de la sustitución vitamínica y en la evaluación de la efectividad de la misma.(AU)
Background: 25 (OH) vitamin D deficiency is a prevailing alteration in patients with chronic kidney disease (CKD); however, in our environment, it is not routinely measured and, therefore, vitamin replacement is unusual. Our purpose was assessing the prevalence of and the factors related to 25 (OH) vitamin D deficiency in patientswith CKD in hemodialysis (HD), especially the relation to function and muscle mass. Methods: We conducted a prospective, multicenter study in adult patients on chronic HD who were not receiving any vitamin D derivative. Blood levels of 25 (OH) D, Hemoglobin, CRP, Albumin, Ca,P, ALP and PTHi were measured. The handgrip strength was measured with a dynamometer and the sitting-rising test was carried out. A bioimpedance analysis (BCM; Fresenius Medical Care) was conducted in the patients who had no contraindications. Results: 138 patients were included. The levels of 25 (OH) vitamin D were 20.43±10.5 ng/ml; the insufficiency/deficiency had 87% prevalence (and 37% prevalence with less than 15 ng/ml). Vitamin D concentrations/ deficiency showed a significant correlation with/ relation to age, diabetes, hemoglobin and albumin levels, muscle strength and mass, and functional class (p<0.05). Conclusion: High prevalence of hypovitaminosis D in patients on hemodialysis, particularly in the elderly and in patients with diabetes. This should be related to undernutrition, anemia, the functional class and the muscle strength/mass of patients, the latter two being unreported factors until now. All these factors should be considered when vitamin replacement is conducted and when its effectiveness is assessed.(AU)
Assuntos
Humanos , Diálise Renal/efeitos adversos , Debilidade Muscular , Deficiência de Vitamina D , Deficiência de VitaminasRESUMO
UNLABELLED: Hemodialyzed patients have decreased bone strength not completely characterized. We evaluated bone microarchitecture in hemodialysis patients and compared it to that of subjects without renal disease by high-resolution peripheral quantitative computed tomography (HR-pQCT). Hemodialysis patients have a marked decreased in cortical density, thickness, and area with significant reduction in trabecular parameters that correlated with the severity of secondary hyperparathyroidism only in women. INTRODUCTION: Although fracture risk is greatly increased in dialysis patients, the corresponding decreased in bone strength has not been completely characterized. METHODS: We evaluated volumetric bone mineral density (vBMD) and bone microstructure by HR-pQCT at the distal radius and tibia in 50 hemodialyzed (HD) patients (30 females, mean age 53.2 ± 6 years and 20 males, mean age 59.1 ± 11 years) and 50 sex- and age-matched controls. RESULTS: At the distal radius HD, women showed a 29% reduction in total and trabecular density and trabecular bone volume fraction (p < 0.0001) compared to controls. Trabecular number was reduced by 25% (p < 0.0001), while trabecular separation was increased by 51%. Cortical thickness (-40%, p < 0.0001) and cortical area (-42%, p < 0.0001) were the parameters most reduced, while compact density was the parameter least reduced (-15%, p < 0.0001). Similar findings were found at the tibia. In HD men, HR-pQCT at the distal radius and tibia showed a reduction in volumetric density and microstructure parameters to a lesser extent than in women. In the hemodialyzed group, cortical thickness at the radius was negatively correlated with age both in women and men. At the distal radius and tibia, we found significant negative correlations between Log iPTH and total alkaline phosphatase with cortical vBMD(r = -0.48, p < 0.01; r = -0.69, p < 0.001), thickness (-0.37, p < 0.05; r = -0.60, p < 0.001), and area ((r = -0.43, p = 0.02; r = -0.65, p < 0.001) but only in women. CONCLUSION: We conclude that hemodialysis patients have a marked decreased in cortical density, thickness, and area with significant reduction in trabecular parameters that correlated with the severity of secondary hyperparathyroidism only in women.
Assuntos
Falência Renal Crônica/complicações , Osteoporose/etiologia , Rádio (Anatomia)/diagnóstico por imagem , Diálise Renal , Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Fatores Etários , Idoso , Antropometria/métodos , Densidade Óssea/fisiologia , Estudos de Casos e Controles , Feminino , Humanos , Hiperparatireoidismo Secundário/complicações , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico por imagem , Osteoporose/fisiopatologia , Rádio (Anatomia)/fisiopatologia , Fatores Sexuais , Tíbia/fisiopatologiaRESUMO
Murine monoclonal antibodies (MAbs) against Vibrio cholerae toxin co-regulated pilus (TCP) were generated using conventional hybridoma procedures. Four hybridomas were obtained and two characterized. Hybridomas 10E10E1 and 4D6F9 secreted antibodies of the IgG2a and IgG1 isotypes, respectively, that reacted with a 24-kDa antigen corresponding to the product of the El Tor tcpA gene fused to a six Histidine tail. Additionally, MAbs produced by 4D6F9 selectively recognized the major pilin subunit (TcpA) of El Tor and O139 vibrios in western immunoblot, while MAbs from 10E10E1 also cross-reacted with classical TcpA. Furthermore, vibrios expressing TCP on their surface selectively inhibited binding of the antibodies secreted by both hybridomas to TcpA-coated microtiter plates. Thus, the MAbs reported in this work detected the structural subunit of the pilus either denatured or assembled on the bacterial surface.
Assuntos
Anticorpos Monoclonais/biossíntese , Proteínas de Fímbrias/imunologia , Vibrio cholerae/imunologia , Animais , Anticorpos Monoclonais/química , Meios de Cultura , Proteínas de Fímbrias/genética , Fímbrias Bacterianas/imunologia , Hibridomas , Camundongos , Camundongos Endogâmicos BALB CRESUMO
Progeny tests employing molecular markers allow the identification of individuals originated by sexual means among the offspring of a facultative apomict. The objective of this work was to evaluate the effect of the pollination timing on the proportion of sexually formed individuals in progenies of a facultative apomictic Paspalum notatum genotype. Progeny families of approx. 30 plants each were generated at five different pollination times: 1-3 d pre-anthesis; at anthesis; and 2, 4 and 6 d post-anthesis. Cytoembryological analyses indicated that approx. 17% of the ovules carried a meiotic cytologically reduced embryo sac in florets formed simultaneously with those used for crosses. The parental plants and the five F1 families were analysed using RAPD molecular markers. Ninety-five oligonucleotides were assayed on the progenitors in order to search for male-specific bands. Eight primers presenting clear polymorphic bands were selected for use in the progeny tests. The proportion of sexually produced progeny reached 3.4% before anthesis and 20 % at anthesis, while pollination after anthesis generated only maternal plants. A second progeny of 97 plants obtained from pollination at anthesis produced 16 off-type plants (16.5%), of which only one was a B(III) hybrid (2n + n). Our results indicate that pollination at anthesis allows the greatest potential for sexuality to be expressed in this facultative apomictic genotype. When pollination is delayed as soon as 2 d after anthesis, only the aposporous sacs develop endosperm through pseudogamy to set seed.
Assuntos
Poaceae/genética , Pólen/fisiologia , Técnica de Amplificação ao Acaso de DNA Polimórfico/métodos , Cruzamentos Genéticos , Impressões Digitais de DNA/métodos , Marcadores Genéticos , Genótipo , Meiose/genética , Meiose/fisiologia , Mitose/genética , Mitose/fisiologia , Caules de Planta/genética , Caules de Planta/fisiologia , Poaceae/fisiologia , Poliploidia , Reprodução/fisiologia , Sementes/citologia , Sementes/embriologia , Fatores de TempoRESUMO
Paspalum notatum is a subtropical forage grass, which reproduces by either sexuality or aposporous gametophytic apomixis. The objective of this work was to identify and isolate mRNA transcripts differentially expressed during the development of the megagametophyte from spikelets of apomictic and sexual P. notatum. Crossing of a sexual mother plant with an apomictic pollen donor generated a progeny family segregating for reproductive mode. Individuals from this F1 family were cytoembryologically classified as sexual or apomictic. Spikelet mRNA compositions from both groups of plants were compared by differential display using an RNA-bulked procedure. Fifty primer combinations were assayed to generate nearly 2,500 total bands in the fingerprints. Three transcripts expressed at higher levels in apomictic plants (apo417, apo398, and apo396) were identified, isolated and cloned. Sequencing showed a high level of homology among the isolated clones. Analysis by RT-PCR Southern blots followed by densitometric studies confirmed that expression reached a level around 30 times higher in apomictic than in sexual individuals and was probably induced at early stages of the megagametophyte development. Genomic DNA from the parental and the F1 progeny plants showed 4-5 bands when hybridised with apo417 in Southern blots. Comparisons to the sequence data banks revealed no identities to genes of known function. However, a putative deduced 3' protein fragment showed homology to the well-characterised KSP multi-phosphorylation domain previously detected in several cdc2-regulated cytoskeletal proteins.
Assuntos
DNA Complementar/isolamento & purificação , Regulação da Expressão Gênica de Plantas , Poaceae/genética , RNA Mensageiro/genética , RNA de Plantas/genética , Sequência de Aminoácidos , Sequência de Bases , Northern Blotting , Southern Blotting , Cruzamentos Genéticos , DNA Complementar/genética , Perfilação da Expressão Gênica , Dados de Sequência Molecular , Proteínas de Plantas/genética , Ploidias , Poaceae/embriologia , Poaceae/fisiologia , RNA Mensageiro/biossíntese , RNA de Plantas/biossíntese , Reprodução , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sementes , Alinhamento de Sequência , Homologia de Sequência , Transcrição GênicaRESUMO
Graft-versus-host disease (GVHD) is currently one of the major obstacles for successful allogeneic bone marrow transplantation (BMT). GVHD results from a complex set of interactions between donor T cells and a variety of target tissues from the host. To gain a better understanding of the biology of the human hematopoietic system in GVHD patients, in the present study we have determined the progenitor cell content in bone marrow (BM) samples from BMT recipients, with and without GVHD, and followed their growth kinetics in Dexter-type long-term marrow cultures (LTMC). We have also assessed some aspects regarding the composition of the hematopoietic microenvironment developed in vitro. As compared to normal subjects, BMT recipients showed decreased numbers of myeloid, erythroid, and multipotent progenitor cells. Interestingly, progenitor levels were significantly lower in GVHD patients (7% of the levels in normal marrow) than in those without GVHD (44% of the levels in normal marrow). When marrow cells from BMT recipients were cultured in LTMC, hematopoiesis was sustained at lower levels and for shorter periods of time, as compared to cultures from normal subjects. The hematopoietic deficiencies observed in this in vitro system were also more pronounced in GVHD patients. In terms of the microenvironment elements, reduced numbers of fibroblastic progenitors and adherent stromal cells were observed in BMT recipients, as compared to normal subjects, who showed 7 colony-forming unit fibroblast (CFU-F)/10(5) marrow cells and 320,000 adherent cells in LTMC. Again, GVHD patients showed more severe deficiencies (0.16 CFU-F/10(5) marrow cells and 34,000 adherent cells in LTMC) than patients without GVHD (2 CFU-F/10(5) marrow cells and 122,000 adherent cells in LTMC). Our results demonstrate that the hematopoietic system of BMT recipients is impaired, both in terms of its in vitro composition and function, and that these deficiencies are clearly more pronounced in patients with GVHD than in those without GVHD. Finally, although the evidence is still preliminary, our results also indicate that the severity of the hematopoietic alterations may be greater in acute GVHD than in chronic GVHD.
Assuntos
Transplante de Medula Óssea/efeitos adversos , Medula Óssea/patologia , Doença Enxerto-Hospedeiro/patologia , Hematopoese , Células-Tronco Hematopoéticas/patologia , Doença Aguda , Adolescente , Adulto , Contagem de Células , Linhagem da Célula , Células Cultivadas/patologia , Doença Crônica , Ensaio de Unidades Formadoras de Colônias , Feminino , Fibroblastos/patologia , Seguimentos , Humanos , Leucemia/terapia , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/terapia , Células Estromais/patologia , Transplante Homólogo/efeitos adversosRESUMO
OBJECTIVE: Studies on salivary flow rates in human beings have mainly been carried out with adults. The purpose of this study was to determine the unstimulated salivary flow rates of children 4 to 7 years old. In addition, the relative contributions of the variables age, gender, race, height, body weight, dentition status, use of prescription medication, and health status (information obtained from parents) to the unstimulated salivary flow rates of children were also studied. STUDY DESIGN: Data were obtained from children (n = 447) at 2 sites in the United States (site 1, southeast Michigan; site 2, northern Michigan) and at 5 sites in Brazil (site 3, Porto Alegre; site 4, São Paulo; site 5, Belém; and sites 6 and 7, sites in Rio de Janeiro). In northern Michigan (site 2) the participants were cognitively or developmentally disabled, or both. In Rio de Janeiro (site 7), a group of 8- to 12-year-olds served as a control group. Saliva samples were collected for 3 minutes between 9 AM and noon in the spring or summer, and the saliva rate was determined gravimetrically. Data were analyzed by analysis of variance, bivariate analysis, and regression analysis. RESULTS: The secretion rates at the 7 sites were (in milliliters per minute) 0.19 +/- 0.15, 0.23 +/- 0.28, 0.34 +/- 0.23, 0.48 +/- 0.37, 0.25 +/- 0.27, 0.37 +/- 0.28, and 0.61 +/- 0.34, respectively. There were significant differences among sites (P <.0001). The older group (site 7) had flow rates that were significantly higher than the flow rates of any other group. In addition, children from Michigan (sites 1 and 2) had significantly lower rates than most groups of children in Brazil. Girls had lower unstimulated salivary flow rates than boys did at all the sites, but the differences were not statistically significant. Race was shown not to affect the flow rates. The use of any prescription medication by children in the previous 3 months was associated with lower salivary flow rates than were found in children not using prescription medication. Children who were in good health and who had no previous medical conditions had higher flow rates--but not significantly so. Higher flow rates occurred in children with mixed dentition than in children with primary dentition, although again the differences were not statistically significant. Regression analysis revealed weight to be of significance in explaining the variability of the unstimulated salivary flow rates at 2 sites, height at 1 site, the use of prescription medication at 2 sites, and age at 1 site. CONCLUSIONS: The unstimulated salivary flow rates in children in the northern United States are comparable with those reported for Japanese children, whereas the flow rates of children in Brazil are comparable with those reported for North American and European adults. In addition, none of the demographic variables/parameters tested contributed consistently to the variability of the unstimulated salivary flow rates in children at the 7 sites assessed in this study.
Assuntos
Saliva/metabolismo , Fatores Etários , Análise de Variância , Povo Asiático , População Negra , Estatura , Peso Corporal , Brasil , Criança , Pré-Escolar , Dentição Mista , Tratamento Farmacológico , Etnicidade , Feminino , Nível de Saúde , Humanos , Masculino , Michigan , Análise de Regressão , Taxa Secretória , Fatores Sexuais , Dente Decíduo , População BrancaAssuntos
Transplante de Medula Óssea , Leucemia Mieloide de Fase Acelerada/terapia , Adulto , Evolução Fatal , Hemorragia/patologia , Humanos , Leucemia Mieloide de Fase Acelerada/complicações , Leucemia Mieloide de Fase Acelerada/patologia , Pneumopatias/patologia , Masculino , Condicionamento Pré-Transplante/efeitos adversos , Condicionamento Pré-Transplante/métodosRESUMO
The objective of the present study is to investigate the perspective of mothers regarding the care given by academics of nursing to their newborn in a neonatal intensive therapy unit. This is a qualitative research based on a phenomenological approach which has as its philosophical framework the thought of Martin Heidegger expressed in his book Being and Time. The data used in the investigation were interviews given by ten mothers who had their newborns in a neonatal intensive therapy unit of a university hospital in the city of Rio de Janeiro. The interpretation of the data collected revealed that mothers viewed the nursing academics as solicitous beings regarding the care given to their newborns. They also acknowledged that these students were engaged in the assistance given and concerned with what was being done and to whom it was being done.
Assuntos
Terapia Intensiva Neonatal/normas , Mães , Cuidados de Enfermagem/normas , Filosofia em Enfermagem , Estudantes de Enfermagem , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva NeonatalRESUMO
We have previously shown that the levels of hematopoietic progenitors in long-term marrow cultures (LTMC) from patients with aplastic anemia (AA) are drastically reduced, as compared to normal LTMC. We have also reported that when LTMC from AA patients are supplemented with recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) there is an increase in colony-forming cell (CFC) levels. However, such a stimulation is only transient and it is followed by an inhibition in CFC growth. Based on these observations, in the present study we have tested the hypothesis that the levels of tumor necrosis factor-alpha (TNF-alpha), an inhibitor of hematopoiesis, are increased in AA LTMC and that such levels are further increased after rhGM-CSF has been added to the cultures for several weeks. Accordingly, we have determined the levels of TNF-alpha in the supernatant of LTMC established from normal (n = 8) and AA (n = 6) bone marrow and in AA LTMC supplemented with rhGM-CSF (n = 6). At the time of culture initiation, TNF-alpha levels were below detection in all the samples analyzed. After 5 weeks of culture, TNF-alpha levels in normal LTMC were very low, with a median of 7.3 pg/mL. In contrast, AA LTMC contained higher levels of TNF-alpha (median of 49.6 pg/mL). In keeping with our hypothesis, addition of rhGM-CSF to AA LTMC resulted in a significant further increase of TNF-alpha levels (median of 135.4 pg/mL). Our results demonstrate an inverse correlation between reduced hematopoiesis in AA LTMC and increased levels of TNF-alpha in this culture system. Based on the results presented here, together with previous reports indicating that TNF-alpha is a potent inducer of apoptosis in hematopoietic progenitor cells, it seems reasonable to suggest that TNF-alpha is implicated in the pathophysiology of AA.
Assuntos
Anemia Aplástica/metabolismo , Células da Medula Óssea/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Adulto , Anemia Aplástica/patologia , Células da Medula Óssea/patologia , Estudos de Casos e Controles , Técnicas de Cultura de Células , Divisão Celular/efeitos dos fármacos , Interações Medicamentosas , Fator Estimulador de Colônias de Granulócitos e Macrófagos/farmacologia , Humanos , Pessoa de Meia-Idade , Células-Tronco/citologia , Células-Tronco/efeitos dos fármacos , Fator de Necrose Tumoral alfa/efeitos dos fármacosRESUMO
In this study, we analyzed whether attachment of Vibrio cholerae vaccine strains to human intestinal epithelial cells can induce an interleukin-8 (IL-8) response. The IL-8 transcripts were detected by PCR amplification of reverse-transcribed mRNA, and the gene product secretion was measured by an enzyme-linked immunosorbent assay. Infection of monolayers of the undifferentiated HT29-18N2 cell line with reactogenic (JBK70 and 81) and nonreactogenic (CVD103HgR and 638) vaccine strains of V. cholerae resulted in markedly higher IL-8 expression by epithelial cells exposed to reactogenic strains than by cells exposed to the nonreactogenic strains. Additionally, epithelial cells produced IL-8 transcripts following stimulation with cholera vaccine strains in a concentration-dependent manner. These results represent a new insight into the inflammatory component of reactogenicity and could be used as a predictive marker of vaccine reactogenicity prior to human testing.
Assuntos
Vacinas contra Cólera , Interleucina-8/genética , Mucosa Intestinal/metabolismo , Vibrio cholerae/fisiologia , Aderência Bacteriana , Células HT29 , Humanos , RNA Mensageiro/análise , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
In recent clinical assays, our cholera vaccine candidate strain, Vibrio cholerae 638 El Tor Ogawa, was well tolerated and immunogenic in Cuban volunteers. In this work we describe the construction of 638T, a thymidine auxotrophic version of improved environmental biosafety. In so doing, the thyA gene from V. cholerae was cloned, sequenced, mutated in vitro, and used to replace the wild-type allele. Except for its dependence on thymidine for growth in minimal medium, 638T is essentially indistinguishable from 638 in the rate of growth and morphology in complete medium. The two strains showed equivalent phenotypes with regard to motility, expression of the celA marker, colonization capacity in the infant mouse cholera model, and immunogenicity in the adult rabbit cholera model. However, the ability of this new strain to survive environmental starvation was limited with respect to that of 638. Taken together, these results suggest that this live, attenuated, but nonproliferative strain is a new, promising cholera vaccine candidate.
Assuntos
Vacinas contra Cólera/imunologia , Timidilato Sintase/genética , Vibrio cholerae/imunologia , Sequência de Aminoácidos , Animais , Sequência de Bases , Clonagem Molecular , Camundongos , Camundongos Endogâmicos BALB C , Dados de Sequência Molecular , Coelhos , Vacinas Atenuadas/imunologia , Vibrio cholerae/crescimento & desenvolvimentoRESUMO
A beta-1,3-glucanase gene from Hordeum vulgare was isolated by a PCR strategy, cloned and subsequently sequenced. The amplified sequence contained the entire coding region of the isoenzyme II, which is interrupted by a 165 bp intron at 73 bp downstream the starting codon. This intron contains all the elements required for the processing mechanism in monocots: a high A + U content, the appropriate splice sites in the 5' and 3' ends and four typical YUNAN consensus sequences. Transient transformation of wheat protoplasts with the complete beta-1,3-glucanase gene under the control of maize polyubiquitin promoter revealed that the intron sequence was spliced out. The gene was also expressed at high levels, probably due to an enhancer-like sequence found near the 3' end of the intron.
Assuntos
Genes de Plantas/genética , Hordeum/genética , beta-Glucosidase/genética , Sequência de Bases , Northern Blotting , DNA de Plantas/química , DNA de Plantas/genética , DNA de Plantas/isolamento & purificação , Éxons , Regulação Enzimológica da Expressão Gênica , Regulação da Expressão Gênica de Plantas , Glucana 1,3-beta-Glucosidase , Hordeum/enzimologia , Íntrons , Isoenzimas/genética , Dados de Sequência Molecular , Regiões Promotoras Genéticas/genética , Protoplastos/enzimologia , RNA de Plantas/genética , RNA de Plantas/metabolismo , Proteínas Recombinantes de Fusão/genética , Proteínas Recombinantes de Fusão/metabolismo , Análise de Sequência de DNA , Triticum , Ubiquitinas/genética , Zea maysRESUMO
Between July 1995 and July 1997 we diagnosed bronchiectasis confirmed by CT scan chest in 25 (18 men and 7 women) out of 295 hospitalised patients with HIV infection who suffered from lower respiratory infection. Median age at time of diagnosis of bronchiectasis was 32 years old. The patients were mostly intravenous drug addicts. In all cases a previous pulmonary infection was revealed (Pneumocystis carinii pneumonia, tuberculosis, recurrent pneumonia) with impairment of immune status (CD4 media = 64.8 mm3). Presence of persistent or intermittent cough with purulent sputum, repeated low respiratory infection and abnormal chest radiograph were correlated to bronchiectasis by chest CT scan. We conclude, that there is a significant occurrence of bronchiectasis in patients with HIV infections and pulmonary disease, thus increasing morbidity and mortality in these patients and being the cause of repeated hospitalisations due to bacterial respiratory infections.
Assuntos
Bronquiectasia/complicações , Soropositividade para HIV/complicações , Adulto , Bronquiectasia/diagnóstico , Feminino , Humanos , Masculino , Abuso de Substâncias por Via Intravenosa/complicações , Transtornos Relacionados ao Uso de Substâncias/complicaçõesRESUMO
El propósito de este estudio fue evaluar la prevalencia de litiasis renal en la población de la Ciudad de Buenos Aires. Se obtuvo una muestra probabilística de viviendas, y en cada vivienda se encuestó a todos los habitantes de ambos sexos y todas las edades, por medio de un Formulario Epidemiológico estructurado anónimo autoadministrado, averiguando sexo, edad, y si tenían o habían tenido antes una evidencia de padecer litiasis renal; para afirmar la existencia de litiasis se incluyeron otros datos confirmatorios. De 1086 encuestados 43 contestaron tener o haber tenido cálculos, todos ellos por haber recibido diagnóstico médico y además algunos por ver el cálculo al ser eliminado. Hubo diferencia en la tasa de prevalencia según sexo, con valores mayores en los varones, pero la diferencia no fue estadísticamente significativa. No se encontraron personas con litiasis en edades inferiores a los 20 años.
Assuntos
Humanos , Feminino , Masculino , Cálculos Urinários/epidemiologia , Diretório , População Urbana/estatística & dados numéricos , PrevalênciaRESUMO
El propósito de este estudio fue evaluar la prevalencia de litiasis renal en la población de la Ciudad de Buenos Aires. Se obtuvo una muestra probabilística de viviendas, y en cada vivienda se encuestó a todos los habitantes de ambos sexos y todas las edades, por medio de un Formulario Epidemiológico estructurado anónimo autoadministrado, averiguando sexo, edad, y si tenían o habían tenido antes una evidencia de padecer litiasis renal; para afirmar la existencia de litiasis se incluyeron otros datos confirmatorios. De 1086 encuestados 43 contestaron tener o haber tenido cálculos, todos ellos por haber recibido diagnóstico médico y además algunos por ver el cálculo al ser eliminado. Hubo diferencia en la tasa de prevalencia según sexo, con valores mayores en los varones, pero la diferencia no fue estadísticamente significativa. No se encontraron personas con litiasis en edades inferiores a los 20 años. (AU)