Evolution of mammographic image quality in the state of Rio de Janeiro / A evolução da qualidade da imagem em mamografia no Estado do Rio de Janeiro

Objective: To evaluate the evolution of mammographic image quality in the state of Rio de Janeiro on the basis of parameters measured and analyzed during health surveillance inspections in the period from 2006 to 2011. Materials and Methods: Descriptive study analyzing parameters connected with imaging quality of 52 mammography apparatuses inspected at least twice with a one-year interval. Results: Amongst the 16 analyzed parameters, 7 presented more than 70% of conformity, namely: compression paddle pressure intensity (85.1%), films development (72.7%), film response (72.7%), low contrast fine detail (92.2%), tumor mass visualization (76.5%), absence of image artifacts (94.1%), mammography-specific developers availability (88.2%). On the other hand, relevant parameters were below 50% conformity, namely: monthly image quality control testing (28.8%) and high contrast details with respect to microcalcifications visualization (47.1%). Conclusion: The analysis revealed critical situations in terms of compliance with the health surveillance standards. Priority should be given to those mammography apparatuses that remained non-compliant at the second inspection performed within the one-year interval. .

Objetivo: Avaliar a evolução da qualidade da imagem de mamógrafos localizados no Estado do Rio de Janeiro, de 2006 a 2011, com base em parâmetros medidos e observados durante inspeções sanitárias. Materiais e Métodos: Estudo descritivo sobre a evolução de parâmetros que condicionam a qualidade da imagem focalizou 52 mamógrafos, inspecionados no mínimo duas vezes, com intervalo de um ano. Resultados: Dos 16 parâmetros avaliados, 7 apresentaram mais de 70% de conformidade: força do dispositivo de compressão (85,1%), processamento dos filmes (72,7%), resposta do filme do serviço (72,7%), detalhes lineares de baixo contraste (92,2%), visualização de massas tumorais (76,5%), ausência de artefatos de imagem (94,1%), existência de processadoras específicas para mamografia (88,2%). Importantes parâmetros apresentaram-se abaixo de 50% de conformidade: realização de testes mensais da qualidade de imagem pelo estabelecimento (28,8%) e detalhes de alto contraste, que dizem respeito à visualização de microcalcificações (47,1%). Conclusão: A análise revelou situações críticas da atuação da vigilância sanitária, cuja prioridade deveria ser dirigida aos estacionários, ou seja, os mamógrafos que permaneceram na situação de não conformidade nas inspeções realizadas com intervalo de um ano. .

Tuberculosis in renal transplant patients: The experience of a single center in Medellín-Colombia, 2005-2013 / Tuberculose em pacientes transplantados renais: experiência de um único centro em Medellín-Colômbia, 2005-2013

Introduction: Tuberculosis is a common opportunistic infection in renal transplant patients. Objective: To obtain a clinical and laboratory description of transplant patients diagnosed with tuberculosis and their response to treatment during a period ranging from 2005 to 2013 at the Pablo Tobón Uribe Hospital. Methods: Retrospective and descriptive study. Results: In 641 renal transplants, tuberculosis was confirmed in 12 cases. Of these, 25% had a history of acute rejection, and 50% had creatinine levels greater than 1.5 mg/dl prior to infection. The disease typically presented as pulmonary (50%) and disseminated (33.3%). The first phase of treatment consisted of 3 months of HZRE (isoniazid, pyrazinamide, rifampicin and ethambutol) in 75% of the cases and HZME (isoniazid, pyrazinamide, moxifloxacin and ethambutol) in 25% of the cases. During the second phase of the treatment, 75% of the cases received isoniazid and rifampicin, and 25% of the cases received isoniazid and ethambutol. The length of treatment varied between 6 and 18 months. In 41.7% of patients, hepatotoxicity was associated with the beginning of anti-tuberculosis therapy. During a year-long follow-up, renal function remained stable, and the mortality rate was 16.7%. Conclusion: Tuberculosis in the renal transplant population studied caused diverse nonspecific symptoms. Pulmonary and disseminated tuberculosis were the most frequent forms and required prolonged treatment. Antituberculosis medications had a high toxicity and mortality. This infection must be considered when patients present with a febrile syndrome of unknown origin, especially during the first year after renal transplant. .

Introdução: A tuberculose é uma infecção oportunista comum em pacientes transplantados renais. Objetivo: Oferecer uma descrição clínica e laboratorial de pacientes transplantados com diagnóstico de tuberculose e sua resposta ao tratamento durante o período entre 2005 e 2013 no Hospital Pablo Tobón Uribe. Métodos: Estudo retrospectivo descritivo. Resultados: Em 641 transplantes renais, a tuberculose foi confirmada em 12 pacientes. Destes, 25% tinham histórico de rejeição aguda e 50% apresentaram níveis de creatinina superiores a 1,5 mg/dl antes da infecção. A patologia geralmente se apresentava como pulmonar (50%) e disseminada (33,3%). A primeira fase do tratamento consistiu de três meses de HZRE (isoniazida, pirazinamida, rifampicina e etambutol) em 75% dos casos e HZME (isoniazida, pirazinamida, moxifloxacina e etambutol) em 25% dos pacientes. Durante a segunda fase do tratamento, 75% dos pacientes receberam isoniazida e rifampicina e 25% isoniazida e etambutol. A duração do tratamento variou entre seis e 18 meses. Em 41,7% dos pacientes, hepatotoxicidade foi associada ao início do tratamento da tuberculose. Durante o seguimento de um ano a função renal manteve-se estável e a taxa de mortalidade foi de 16,7%. Conclusão: A tuberculose foi responsável por diversos sintomas inespecíficos na população de transplantados renais estudada. Tuberculose pulmonar e disseminada foram as formas mais frequentes de acometimento e necessitaram de tratamento prolongado. Medicamentos contra a tuberculose apresentaram alta toxicidade e mortalidade. Esta infecção deve ser considerada quando o paciente apresenta síndrome febril de origem desconhecida, especialmente durante o primeiro ano após o transplante renal. .

Numerical exploration of the influence of neural noise on the psychometric function at low stimulation intensity levels.

The relationship between stimulus intensity and the probability of detecting the presence of the stimulus is described by the psychometrical function.The probabilistic nature of this relationship is based on the stochastic behaviour of sensory neural channels and sensory networks involved in perceptual processing (Kiang 1968). This study tries to establish a continuum of variability across different levels of integration in the central nervous system. Once the opening and closing times of ionic channels was simulated, a threshold to the collective behaviour of voltage-gated ionic channels was imposed in order to generate the spike train of a single neuron. Afterwards,the trains of spikes of different neurons were added up,simulating the activity of a sensory nerve. By adding the activity due to the stimulus to the spontaneous neural behaviour,the psychometric function was simulated using a thresholding approach.The results can replicate the stochastic resonance phenomenon, but also open up the possibility that attentional phenomena can be mediated not only by increasing neural activity (bursting or oscillatory),but also by increasing noise at the neural level.

Large conductance Ca2+-activated K+ (BK) channel: Activation by Ca2+ and voltage

Large conductance Ca2+-activated K+ (BK) channels belong to the S4 superfamily of K+ channels that include voltage-dependent K+ (Kv) channels characterized by having six (S1-S6) transmembrane domains and a positively charged S4 domain. As Kv channels, BK channels contain a S4 domain, but they have an extra (S0) transmembrane domain that leads to an external NH2-terminus. The BK channel is activated by internal Ca2+, and using chimeric channels and mutagenesis, three distinct Ca2+-dependent regulatory mechanisms with different divalent cation selectivity have been identified in its large COOH-terminus. Two of these putative Ca2+-binding domains activate the BK channel when cytoplasmic Ca2+ reaches micromolar concentrations, and a low Ca2+ affinity mechanism may be involved in the physiological regulation by Mg2+. The presence in the BK channel of multiple Ca2+-binding sites explains the huge Ca2+ concentration range (0.1 ìM-100 ìM) in which the divalent cation influences channel gating. BK channels are also voltage-dependent, and all the experimental evidence points toward the S4 domain as the domain in charge of sensing the voltage. Calcium can open BK channels when all the voltage sensors are in their resting configuration, and voltage is able to activate channels in the complete absence of Ca2+. Therefore, Ca2+ and voltage act independently to enhance channel opening, and this behavior can be explained using a two-tiered allosteric gating mechanism.

Molecular biology of neuronal voltage-gated calcium channels

No abstract available.

Coupling between charge movement and pore opening in voltage dependent potassium channels

Ionic and gating currents from Shaker K+ channels were characterized with the cut-open oocyte voltage clamp (COVG) technique. Experiments were performed in normally conducting channels and in channels with the W434F mutation which completely abolished ion conduction without affecting the voltage dependence of gating charge. Subtracted and unsubtracted gating currents with the COVG technique, and gating currents recorded in cell attached macro-patches had the same properties and time course. However, OFF gating currents and ionic deactivation tails became slower after patch excision. Gating currents had the following salient properties: 1) the turn-on of the gating current shows a rising phase, 2) the more negative position of the charge-voltage curve (Q-V) vs. the conductance-voltage (G-V) curve and the charge displacement by hyperpolarizing prepulses indicate that a large fraction of the voltage-dependence occurs in the transitions between closed states, 3) the Q-V relationship showed two component with different half activation potential and effective valence; the one appearing at more negative potential had a shallower voltage dependence, while the one at more depolarized potentials had a larger effective valence and correlated with channel opening, 4) ionic and gating currents were similarly time shifted by preceding hyperpolarizing and depolarizing pulses which substantiates the relationship between charge movement and channel opening, 5) in the wild type Shaker K+ clone with fast inactivation, the OFF gating charge is partially immobilized for large depolarizing pulses, while in the mutant channel lacking inactivation the charge is recovered quickly at the end of the pulse, indicating that the channel blockade by the inactivating particle slows down charge recovery, 6) the OFF gating current rapidly returns for small depolarizations, while for larger pulses which open the channel the OFF gating current return is delayed suggesting that the closed to open transitions carry little charge and 7) in the W434F mutant with the conserved amino terminus large depolarizations that would have opened the channel induced OFF charge immobilization, indicating that although the conduction pathway was not functional, the channel can still undergo the closed-open conformation in response to voltage changes. In conclusion, the kinetic properties of gating currents discard equal and independent gating subunits with two positions.

Potassium channel opening drugs and the airways

1. Potassium channel opening drugs (KCOs) include benzopyrans such as cromakalim, cyanoguanidines such as pinacidil and tetrahydrothiopyrans such as RP 49356. 2. While clinical trials have indicated that cromakalim may be of benefit in the treatment of nocturnal asthma, it remains to be determined whether KCOs will find a place in our armamentarium of clinically useful anti-asthma agents. 3. KCOs inhibit the spontaneous tone of airways smooth muscle in vitro, an action associated with membrane hyperpolarization towards the potassium equilibrium potential and with the promotion of 86Rb+ or 42K+ efflux from the muscle cells. KCOs suppress spasm of airways smooth muscle evoked by low (< 40 mM) but not high (> 40 mM) concentrations of KCl. Their relaxant effects in airways smooth muscle can be attenuated by a variety of agents (including sulphonylureas) known to inhibit the opening of plasmalemmal K(+)-channels. 4. The KCOs open an ATP-sensitive K(+)-channel (KATP) in the plasmalemma. KATP is not open under normal circumstances and does not play an important role in determining the strong outward rectifying behavior of the cell membrane. The biochemical mechanisms by which the KCOs promote the opening of KATP remain to be elucidated but probably do not involve channel phosphorylation consequent to the intracellular accumulation of cAMP. 5. By causing hyperpolarization of the plasmalemma, the KCOs inhibit the cellular influx of Ca2+ through voltage-dependent channels. Relaxation follows both as a direct consequence of the fall in cytosolic free Ca2+ and also as a consequence of reduced production of phosphoinositide second messengers. The KCOs may also inhibit Ca2+ uptake by, and hence Ca2+ release from, the sarcoplasmic reticulum. 6. KCOs can inhibit cholinergic and non-adrenergic, non-cholinergic (NANC) excitatory neuroeffector transmission in the airways by glibenclamide-sensitive mechanisms which may involve inhibition of neurotransmitter release. The KCOs do not attenuate NANC inhibitory neuroeffector transmission, suggesting that KATP may not be expressed in neurones of this type. 7. The active enantiomer of cromakalim has been found to be effective in alleviating nocturnal asthma at plasma concentrations just threshold for relaxing human airways smooth muscle in vitro. The clinical efficacy of cromakalim may therefore depend on an action other than the direct relaxation of airways smooth muscle. Animal studies indicate that KCOs can reduce airway hyper-reactivity at sub-bronchodilator doses. The mechanism of this effect remains to be elucidated and may not crucially depend upon inhibition of neurotransmitter release within the lung

Channels for water flow in epithelia: characteristics and regulation

Pos y Pd, los coeficientes de permeabilidad osmótica y difusiva al agua, de túbulos proximales (TP) de conejo (por cm**2 de membrana celular real, micronm/s) son Pos, 396; Pd, 22; Pos/Pd, 18 (controles). Con paracloromercuribencenosulfonato son Pos, 32; Pd, 10; Pos/Pd, 3. El reactivo de grupos sulfhidrilos ditiotreitol (DTT) revierte la acción del pCMBS. Las energías de activación (Kcal/mol) son Pos, 3.2 (controles); 9.2 (pCMBS); Pd, 5.2 (controles, 9.1 (pCMBS). Por lo tanto, canales acuosos atraviesan la membrana celular control y son cerrados por pCMBS. Las altas permeabilidades de TP (controles) son similares a las de la vejiga urinaria de anfibio (un análogo del túbulo colector, TC), estimulada con hormona antidiurética (ADH) y los valores bajos con pCMBS en TP recuerdan los de TC en reposo (sin ADH). La permeabilidad transcelular puede ser regulada por el estado de grupos sulfhidrilo en TP y por la adición de canales acuosos por la HAD (o su supresión, reposo). En T.P.(a) no-electrólitos extracelulares son arrastrados por el flujo de agua indicando interacción extracelular aguasoluto; (b) la Pos transepitelial es mucho mayor que la transcelualr. Por consiguiente, en adición al flujo transcelular hay flujo paracelular de agua. La permeabilidad en TP se incrementa si la urea luminal es mayor que la sanguínea (en 15-50 mM) y se reduce en la situación inversa. En TD (control) la permeabilidad paracelular es cero. Se incrementa con urea en condición control en TP y muy pequeña en TC...