The prognostic accuracy evaluation of SAPS 3, SOFA and APACHE II scores for mortality prediction in the surgical ICU: an external validation study and decision-making analysis.

BACKGROUND: The early postoperative period is critical for surgical patients. SOFA, SAPS 3 and APACHE II are prognostic scores widely used to predict mortality in ICU patients. This study aimed to evaluate these index tests for their prognostic accuracy for intra-ICU and in-hospital mortalities as target conditions in patients admitted to ICU after urgent or elective surgeries and to test whether they aid in decision-making. The process comprised the assessment of discrimination through analysis of the areas under the receiver operating characteristic curves and calibration of the prognostic models for the target conditions. After, the clinical relevance of applying them was evaluated through the measurement of the net benefit of their use in the clinical decision. RESULTS: Index tests were found to discriminate regular for both target conditions with a poor calibration (C statistics-intra-ICU mortality AUROCs: APACHE II 0.808, SAPS 3 0.821 and SOFA 0.797/in-hospital mortality AUROCs: APACHE II 0.772, SAPS 3 0.790 and SOFA 0.742). Calibration assessment revealed a weak correlation between the observed and expected number of cases in several thresholds of risk, calculated by each model, for both tested outcomes. The net benefit analysis showed that all score's aggregate value in the clinical decision when the calculated probabilities of death ranged between 10 and 40%. CONCLUSIONS: In this study, we observed that the tested ICU prognostic scores are fair tools for intra-ICU and in-hospital mortality prediction in a cohort of postoperative surgical patients. Also, they may have some potential to be used as ancillary data to support decision-making by physicians and families regarding the level of therapeutic investment and palliative care.

Lifespan Extension Induced by Caffeine in Caenorhabditis elegans is Partially Dependent on Adenosine Signaling.

Caffeine is a widely used psychoactive substance. Studies have shown that caffeine may play a protective role in aging-associated disorders. However, the mechanisms by which caffeine modulates aging are not yet clear. In this study, we have shown that caffeine increases Caenorhabditis elegans lifespan, delays its larval development, reduces reproduction and body length. These phenotypes were partly reversed by worm's exposure to adenosine, which suggest a putative common target. Moreover, they were dependent on a functional insulin/IGF-1-like pathway. Our results may shed light on new genetic determinants of aging.

Dopamine signaling regulates fat content through ß-oxidation in Caenorhabditis elegans.

The regulation of energy balance involves an intricate interplay between neural mechanisms that respond to internal and external cues of energy demand and food availability. Compelling data have implicated the neurotransmitter dopamine as an important part of body weight regulation. However, the precise mechanisms through which dopamine regulates energy homeostasis remain poorly understood. Here, we investigate mechanisms through which dopamine modulates energy storage. We showed that dopamine signaling regulates fat reservoirs in Caenorhabditis elegans. We found that the fat reducing effects of dopamine were dependent on dopaminergic receptors and a set of fat oxidation enzymes. Our findings reveal an ancient role for dopaminergic regulation of fat and suggest that dopamine signaling elicits this outcome through cascades that ultimately mobilize peripheral fat depots.

Molecular medicine: a path towards a personalized medicine / Medicina molecular: um passo em direção à medicina personalizada

Psychiatric disorders are among the most common human illnesses; still, the molecular and cellular mechanisms underlying their complex pathophysiology remain to be fully elucidated. Over the past 10 years, our group has been investigating the molecular abnormalities in major signaling pathways involved in psychiatric disorders. Recent evidences obtained by the Instituto Nacional de Ciência e Tecnologia de Medicina Molecular (National Institute of Science and Technology - Molecular Medicine, INCT-MM) and others using behavioral analysis of animal models provided valuable insights into the underlying molecular alterations responsible for many complex neuropsychiatric disorders, suggesting that "defects" in critical intracellular signaling pathways have an important role in regulating neurodevelopment, as well as in pathophysiology and treatment efficacy. Resources from the INCT have allowed us to start doing research in the field of molecular imaging. Molecular imaging is a research discipline that visualizes, characterizes, and quantifies the biologic processes taking place at cellular and molecular levels in humans and other living systems through the results of image within the reality of the physiological environment. In order to recognize targets, molecular imaging applies specific instruments (e.g., PET) that enable visualization and quantification in space and in real-time of signals from molecular imaging agents. The objective of molecular medicine is to individualize treatment and improve patient care. Thus, molecular imaging is an additional tool to achieve our ultimate goal.

Os transtornos psiquiátricos estão entre as doenças humanas mais comuns. Os mecanismos celulares e moleculares subjacentes à sua complexa fisiopatologia ainda não estão totalmente esclarecidos. Nosso grupo está envolvido na investigação de anormalidades moleculares nas principais vias de sinalização das doenças psiquiátricas nos últimos 10 anos. Evidências recentemente obtidas pelo Instituto Nacional de Ciência e Tecnologia de Medicina Molecular (INCT-MM), utilizando análise comportamental de modelos animais, forneceram informações valiosas sobre as alterações moleculares subjacentes responsáveis por muitos distúrbios neuropsiquiátricos complexos, sugerindo que os "defeitos" nas vias de sinalização intracelular têm um papel importante na regulação do neurodesenvolvimento, bem como na fisiopatologia e eficácia do tratamento. Recursos do INCT nos permitiram iniciar pesquisas na área de imagem molecular. A imagem molecular é uma disciplina de investigação que visualiza, caracteriza e quantifica processos biológicos que ocorrem em níveis celular e molecular em seres humanos, e em outros sistemas vivos, através dos resultados de imagem dentro da realidade do ambiente fisiológico. A fim de reconhecer alvos, a imagem molecular aplica instrumentos específicos (PET, por exemplo) que permitem a visualização e quantificação em espaço e tempo real dos sinais dos agentes de imagem molecular, fornecendo medições de processos a nível molecular e celular. O objetivo da medicina molecular é individualizar o tratamento e melhorar a assistência ao paciente. Desse modo, a imagem molecular consiste em mais uma ferramenta para atingirmos nosso objetivo final.

Analyses of C. elegans fat metabolic pathways.

In Caenorhabdatis elegans as in other animals, fat regulation reflects the outcome of behavioral, physiological, and metabolic processes. The amenability of C. elegans to experimentation has led to utilization of this organism for elucidating the complex homeostatic mechanisms that underlie energy balance in intact organisms. The optical advantages of C. elegans further offer the possibility of studying cell biological mechanisms of fat uptake, transport, storage, and utilization, perhaps in real time. Here, we discuss the rationale as well as advantages and potential pitfalls of methods used thus far to study metabolism and fat regulation, specifically triglyceride metabolism, in C. elegans. We provide detailed methods for visualization of fat depots in fixed animals using histochemical stains and in live animals by vital dyes. Protocols are provided and discussed for chloroform-based extraction of total lipids from C. elegans homogenates used to assess total triglyceride or phospholipid content by methods such as thin-layer chromatography or used to obtain fatty acid profiles by methods such as gas chromatography/mass spectrometry. Additionally, protocols are provided for the determination of rates of intestinal fatty acid uptake and fatty acid breakdown by ß-oxidation. Finally, we discuss methods for determining rates of de novo fat synthesis and Raman scattering approaches that have recently been employed to investigate C. elegans lipids without reliance on invasive techniques. As the C. elegans fat field is relatively new, we anticipate that the indicated methods will likely be improved upon and expanded as additional researchers enter this field.