Evaluación holística semipresencial de la disfagia orofaríngea en el marco de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud: optimizar la valoración para mejorar el tratamiento rehabilitador / Holistic semi-presential evaluation of oropharygeal dysphagia with the framework of International Classification of Functioning, Disability and Health: Optimizing evaluation to improve rehabilitation treatment

Inrtroducción: La disfagia orofaríngea puede comportar complicaciones médicas, y una disminución de la calidad de vida. Aunque existe una amplia diversidad de procedimientos instrumentales y clínicos para valorarla, el consenso para su valoración holística es todavía insuficiente o poco detallado. El presente artículo tiene como objetivo presentar el diseño de un modelo de exploración holística de la disfagia orofaríngea que tenga en cuenta los componentes de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF) y que se pueda realizar tanto en modalidad presencial como semipresencial utilizando herramientas de las Tecnologías de la Información y Comunicación (TIC). Material y métodos: Se realiza una revisión no sistemática de la literatura con el fin de seleccionar las herramientas de valoración de la disfagia orofaríngea validadas y con mayor grado de recomendación. Estas herramientas se analizan por un grupo de expertos en disfagia del Hospital de la Santa Creu i Sant Pau de Barcelona para diseñar un modelo de exploración holística. Resultados: Este modelo de evaluación incluye una valoración al inicio y otra al final del tratamiento, así como un seguimiento continuo durante el proceso de rehabilitación. Se implementa de forma semipresencial y multidisciplinar con la finalidad de comprender la disfagia orofaríngea holísticamente para diseñar y monitorizar un plan terapéutico individualizado. Conclusiones: La evaluación de la disfagia orofaríngea debe ubicarse en el marco biopsicosocial propuesto por la CIF. La aplicación de las TIC en las intervenciones semipresenciales lo facilitan.(AU)

Introduction: Oropharyngeal dysphagia can lead to medical complications and decreased quality of life. Although there is a wide diversity of instrumental and clinical procedures to assess it, consensus for its holistic evaluation is scarce and poorly defined. The objective of this article is to present the design of a model for the holistic examination of oropharyngeal dysphagia that takes into account the components of the International Classification of Functioning, Disability and Health (ICF) and that can be carried out both face to face and semi-presentially using Information and Communication Technology (ICT) tools. Material and methods: A non-systematic review of the literature is carried out in order to select validated oropharyngeal dysphagia assessment tools with the highest degree of recommendation. These tools are analyzed by a group of experts in oropharyngeal dysphagia from the Hospital de la Santa Creu i Sant Pau in Barcelona to design a holistic exploration model. Results: This evaluation model includes an assessment at the beginning and at the end of the treatment, as well as continuous monitoring during the rehabilitation process. It is implemented in a semi-presential and multidisciplinary way, and its purpose is to understand oropharyngeal dysphagia holistically to design and monitor an individualized therapeutic plan. Conclusions: The evaluation of oropharyngeal dysphagia should be within the biopsychosocial framework proposed by the ICF. The application of ICT in blended interventions facilitates this.(AU)

[Holistic semi-presential evaluation of oropharygeal dysphagia with the framework of International Classification of Functioning, Disability and Health: Optimizing evaluation to improve rehabilitation treatment]. / Evaluación holística semipresencial de la disfagia orofaríngea en el marco de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud: optimizar la valoración para mejorar el tratamiento rehabilitador.

INTRODUCTION: Oropharyngeal dysphagia can lead to medical complications and decreased quality of life. Although there is a wide diversity of instrumental and clinical procedures to assess it, consensus for its holistic evaluation is scarce and poorly defined. The objective of this article is to present the design of a model for the holistic examination of oropharyngeal dysphagia that takes into account the components of the International Classification of Functioning, Disability and Health (ICF) and that can be carried out both face to face and semi-presentially using Information and Communication Technology (ICT) tools. MATERIAL AND METHODS: A non-systematic review of the literature is carried out in order to select validated oropharyngeal dysphagia assessment tools with the highest degree of recommendation. These tools are analyzed by a group of experts in oropharyngeal dysphagia from the Hospital de la Santa Creu i Sant Pau in Barcelona to design a holistic exploration model. RESULTS: This evaluation model includes an assessment at the beginning and at the end of the treatment, as well as continuous monitoring during the rehabilitation process. It is implemented in a semi-presential and multidisciplinary way, and its purpose is to understand oropharyngeal dysphagia holistically to design and monitor an individualized therapeutic plan. CONCLUSIONS: The evaluation of oropharyngeal dysphagia should be within the biopsychosocial framework proposed by the ICF. The application of ICT in blended interventions facilitates this.

Role of Endothelial Kinin B1 Receptor on the Membrane Potential of Transgenic Rat Aorta.

The kinin receptors are classically involved in inflammation, pain and sepsis. The effects of the kinin B1 receptor agonist des-Arg9-bradykinin (DBK) and lipopolysaccharide (LPS) were investigated by comparing the membrane potential responses of aortic rings from transgenic rats overexpressing the kinin B1 receptor (B1R) in the endothelium (TGR(Tie2B1)) and Sprague Dawley (SD) rats. No difference in the resting membrane potential in the aorta's smooth muscle from the transgenic and SD rats was observed. The aorta rings from SD rats hyperpolarized only to LPS but not to DBK, whereas the aorta rings from TGR(Tie2B1) responded by the administration of both drugs. DBK and LPS responses were inhibited by the B1 receptor antagonist R715 and by iberiotoxin in both cases. Thapsigargin induced a hyperpolarization in the smooth muscle of SD rats that was not reversed by R715, but was reversed by iberiotoxin and this hyperpolarization was further augmented by DBK administration. These results show that the model of overexpression of vascular B1 receptors in the TGR(Tie2B1) rats represent a good model to study the role of functional B1 receptors in the absence of any pathological stimulus. The data also show that KCa channels are the final mediators of the hyperpolarizing responses to DBK and LPS. In addition, we suggest an interaction between the B1R and TLR4, since the hyperpolarization induced by LPS could be abolished in the presence of R715.

Clinically inapparent right heart dysfunction is associated with reduced myofilament force development in coronary artery disease.

BACKGROUND: Right ventricular dysfunction after CABG is associated with poor peri- and postoperative outcomes. We aimed to identify clinical and experimental predictors for preoperative inapparent right ventricular dysfunction and therefore hypothesized that reduced myofilament force development as well as altered levels of biomarkers might predict inapparent right ventricular dysfunction. METHODS: From 08/2016 to 02/2018, 218 patients scheduled for CABG were divided into two groups (TAPSE ≥ 20 mm, n = 178; TAPSE < 20 mm, n = 40). Baseline serum samples for biomarkers (Galectin, TGFß1, N Acyl-SDMA, Arginine, ADMA and Pentraxin-3), clinical laboratory and transthoracic echocardiographic parameters were evaluated. To examine the myocardial apparatus of the right ventricle intraoperative right auricular tissue was harvested for stepwise skinned fiber force measurements. RESULTS: Patients with TAPSE < 20 mm had a higher incidence of DM (55 vs. 34%, p = 0.018), preoperative AFib (43 vs. 16%, p < 0.001), reduced GFR (67 ± 18 vs. 77 ± 24 ml/min/1.73 m2, p = 0.013), larger LA area (22 ± 6 vs. 20 ± 5 cm2, p = 0.005) and reduced LVEF (50 vs. 55%, p = 0.008). Furthermore, higher serum ADMA (0.70 ± 0.13 vs. 0.65 ± 0.15 µmol/l, p = 0.046) and higher serum Pentraxin-3 levels (3371 ± 1068 vs. 2681 ± 1353 pg/dl, p = 0.004) were observed in these patients. Skinned fiber force measurements showed significant lower values at almost every step of calcium concentration (pCa 4.52 to pCa 5.5, p < 0.01 and pCa 5.75-6.0, p < 0.05). Multivariable analysis revealed DM (OR 2.53, CI 1.12-5.73, Euro Score II (OR 1.34, CI 1.02-1.78), preoperative AF (OR 4.86, CI 2.06-11.47), GFR (OR 7.72, CI 1.87-31.96), albumin (OR 1.56, CI 0.52-2.60), Pentraxin-3 (OR 19.68, CI 14.13-25.24), depressed LVEF (OR 8.61, CI 6.37-10.86), lower force values: (pCa 5.4; OR 2.34, CI 0.40-4.29 and pCa 5.2; OR 2.00, CI 0.39-3.60) as predictors for clinical inapparent right heart dysfunction. CONCLUSIONS: These preliminary data showed that inapparent right heart dysfunction in CAD is already associated with reduced force development of the contractile apparatus.

Treadmill training in Parkinson's patients after deep brain stimulation: Effects on gait kinematic.

OBJECTIVE: The purpose of this study was to evaluate the effect of treadmill training with body weight support on gait kinematics parameters in patients with PD using DBS. DESIGN: Twelve patients completed the protocols (age: 60.9±10.6 years; disease duration: 20±7 years; and time since DBS surgery: 20±4 months). The same set of patients underwent two trainings protocols and four gait analyses (before and after each training). They received eight weeks of treadmill training without body weight support (16 sessions) in conjunction with physiotherapy program followed by six weeks of wash out period, followed by eight weeks of body-weight-supported treadmill training in conjunction with a same physiotherapy program. The Gait Kinematic Analysis involved eight infrared cameras that detected 19 reflective spherical markers attached in limb lower of patients. Statistical analysis used the Wilcoxon test (p≤0.05). RESULTS: Both the training no showed significant differences in linear variables. As the angular variables, only training with support showed significant increase of ranges of motion: pelvis tilt, obliquity and rotation amplitude; hip adduction-abduction and rotation amplitude; percentage of peak flexion in swing phase; foot progression amplitude. CONCLUSION: The body weight supported treadmill training may promote increase of mobility of lower limbs during gait and it could be a targeted intervention for PD patients treated with DBS.

Doctors' awareness concerning primary immunodeficiencies in Brazil.

BACKGROUND: PIDs are a heterogeneous group of genetic illnesses, and delay in their diagnosis is thought to be caused by a lack of awareness among physicians concerning PIDs. The latter is what we aimed to evaluate in Brazil. METHODS: Physicians working at general hospitals all over the country were asked to complete a 14-item questionnaire. One of the questions described 25 clinical situations that could be associated with PIDs and a score was created based on percentages of appropriate answers. RESULTS: A total of 4026 physicians participated in the study: 1628 paediatricians (40.4%), 1436 clinicians (35.7%), and 962 surgeons (23.9%). About 67% of the physicians had learned about PIDs in medical school or residency training, 84.6% evaluated patients who frequently took antibiotics, but only 40.3% of them participated in the immunological evaluation of these patients. Seventy-seven percent of the participating physicians were not familiar with the warning signs for PIDs. The mean score of correct answers for the 25 clinical situations was 48.08% (±16.06). Only 18.3% of the paediatricians, 7.4% of the clinicians, and 5.8% of the surgeons answered at least 2/3 of these situations appropriately. CONCLUSIONS: There is a lack of medical awareness concerning PIDs, even among paediatricians, who have been targeted with PID educational programmes in recent years in Brazil. An increase in awareness with regard to these disorders within the medical community is an important step towards improving recognition and treatment of PIDs.

VEGF and TSP1 levels correlate with prognosis in advanced non-small cell lung cancer

PURPOSE: There is a need for biomarkers that may help in selecting the most effective anticancer treatments for each patient. We have investigated the prognostic value of a set of angiogenesis, inflammation and coagulation markers in patients treated for advanced non-small cell lung cancer. PATIENTS AND METHODS: Peripheral blood samples were obtained from 60 patients before first line platinum-based chemotherapy ± bevacizumab, and after the third cycle of treatment. Blood samples from 60 healthy volunteers were also obtained as controls. Angiogenesis, inflammation and coagulation markers vascular endothelial growth factor (VEGF), their soluble receptors 1 (VEGFR1) and 2 (VEGFR2), thrombospondin-1 (TSP-1), interleukin-6 (IL6), sialic acid (SA) and tissue factor (TF) were quantified by ELISA. RESULTS: Except for TSP-1, pre- and post-treatment levels of all markers were higher in patients than in controls (p < 0.05). There was a positive and significant correlation between VEGF and VEGFR2 before treatment. VEGF also correlated with inflammatory markers IL-6 and SA. Moreover, there was a positive and significant correlation between levels of VEGFR1 and TF. Decreased levels of TSP-1 and increased levels of VEGF were associated with shorter survival. Bevacizumab significantly modified angiogenesis parameters and caused a decrease of VEGF and an increase of TSP-1. CONCLUSION: Angiogenesis, inflammation and coagulation markers were increased in NSCLC patients. Increased levels of VEGF and low levels of TSP-1 correlated with a poor prognosis (AU)

VEGF and TSP1 levels correlate with prognosis in advanced non-small cell lung cancer.

PURPOSE: There is a need for biomarkers that may help in selecting the most effective anticancer treatments for each patient. We have investigated the prognostic value of a set of angiogenesis, inflammation and coagulation markers in patients treated for advanced non-small cell lung cancer. PATIENTS AND METHODS: Peripheral blood samples were obtained from 60 patients before first line platinum-based chemotherapy ± bevacizumab, and after the third cycle of treatment. Blood samples from 60 healthy volunteers were also obtained as controls. Angiogenesis, inflammation and coagulation markers vascular endothelial growth factor (VEGF), their soluble receptors 1 (VEGFR1) and 2 (VEGFR2), thrombospondin-1 (TSP-1), interleukin-6 (IL6), sialic acid (SA) and tissue factor (TF) were quantified by ELISA. RESULTS: Except for TSP-1, pre- and post-treatment levels of all markers were higher in patients than in controls (p < 0.05). There was a positive and significant correlation between VEGF and VEGFR2 before treatment. VEGF also correlated with inflammatory markers IL-6 and SA. Moreover, there was a positive and significant correlation between levels of VEGFR1 and TF. Decreased levels of TSP-1 and increased levels of VEGF were associated with shorter survival. Bevacizumab significantly modified angiogenesis parameters and caused a decrease of VEGF and an increase of TSP-1. CONCLUSION: Angiogenesis, inflammation and coagulation markers were increased in NSCLC patients. Increased levels of VEGF and low levels of TSP-1 correlated with a poor prognosis.

Circulating endothelial and endothelial progenitor cells in non-small-cell lung cancer

New treatments have recently been introduced for treating non-small-cell lung cancer. Chemotherapeutic agents, such as pemetrexed, and targeted therapies, such as bevacizumab, erlotinib or gefitinib, have extended treatment options for selected histological subgroups. Antiangiogenic treatments, either associated with conventional chemotherapeutic drugs or given alone as maintenance therapy, constitute an active clinical research field. However, not all lung cancer patients benefit from antiangiogenic compounds. Moreover, tumour response assessment is often difficult when using these drugs, since targeted therapies generally do not cause rapid and measurable tumour shrinkage but, rather, long stabilisations and slight density changes on imaging tests. The finding of clinical or biological factors that might identify patients who will better benefit from these treatments, as well as identifying surrogate markers of tumour response and prognosis, is an issue of great interest. In that sense, different research lines have investigated the epidermal growth factor receptor (EGFR) and the vascular endothelial growth factor receptor (VEGFR) pathways. Circulating endothelial (CECs) and endothelial progenitor cells (CEPCs) are of prognostic value in different types of cancers, and relevant data are published about their potential usefulness as predictors of response to chemotherapy and antiangiogenic treatments. In this review, we discuss the data available on the role of CECs and CEPCs as prognostic factors and as surrogate markers of treatment response in non-small-cell lung cancer (AU)

Production of interleukin-10 in asthmatic children after Beta-1-3-glucan.

BACKGROUND: Beta-1-3 Glucan is a polysaccharide extracted from Saccharomyces cerevisiae with a possible immunomodulating action that may have a favourable action on asthma symptoms and other allergic diseases. An experimental study carried out using a murine respiratory model detected a decrease in pulmonary tissue eosinophilia, as well as an increase in Interleukin-10 (IL-10) after glucan use. METHODS: This open, exploratory study with blind outcome evaluation included asthmatic children between 6 and 12 years of age with mild to moderate persistent asthma and inadequate disease control (rescue medication needed more than twice a week) in spite of inhaled budesonide 400 microg/day. After a four week run-in period, subcutaneous Beta-1-3-glucan injections were given weekly for the first four weeks and then every two weeks for the last four weeks. IL-10 levels, measured by the immunoenzymatic method (ELISA), were compared before and after glucan administration. RESULTS: Twenty patients (14 male and 6 female) were included. Mean IL-10 levels were 6.4 pg/ml and 11.3 pg/ml before and after glucan, respectively (p = 0.02). There was also a reduction of asthmatic symptoms score at the end of study. CONCLUSIONS: This is the first study which shows that subcutaneous particulate Beta-1-3-glucan increases serum IL-10 levels in asthmatics. The possibility of glucan being able to modulate allergic sensitisation and having a beneficial action in restoring Th2 function should be assessed by means of properly planned controlled clinical trials, as it may represent a new therapeutic strategy.

What is the best biomarker for diagnosis of rejection in heart transplantation?

INTRODUCTION: Acute cellular rejection is a major cause of graft loss in heart transplantation (HT). Endomyocardial biopsy remains the gold standard for its diagnosis, but it is an invasive procedure not without risk. A proinflammatory state exists in rejection that could be assessed by determining plasma levels of inflammatory biomarkers. OBJECTIVE: To analyze the utility of various inflammatory markers, which is most important and what values best classify patients to diagnose rejection. MATERIALS AND METHODS: A prospective study in 123 consecutive cardiac transplant recipients was conducted from January 2002 to December 2006. Fibrinogen protein (Fgp) and function (Fgf), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and sialic acid (SA) determinations were performed at one, two, four, six, nine, and 12 months post-HT at the same time as biopsies. Coronary arteriography and intravascular ultrasound were performed on the first and last follow-up visits. Heart-lung transplants, retransplants, pediatric transplants, patients who died in the first month, and patients who refused consent were excluded. Also excluded were determinations that coincided with renal dysfunction, active infection, hemodynamic instability, or a non-evaluable biopsy. The final analysis included 79 patients and 294 determinations. The correlation between the levels of these biomarkers and the presence of rejection in the biopsy (> or = ISHLT grade 3) was studied. RESULTS: We did not find significant differences in the values of any of the markers analyzed on the six follow-up visits. Only CRP showed significant and sustained differences between the two groups (with and without rejection) from the second follow-up visit (month 2). The area under the curve showed significant differences in Fgp (0.614, p = 0.013), Fgf (0.585, p = 0.05), TNF-alpha (0.605, p = 0.02), SA (0.637, p = 0.002) and mainly CRP (0.765, p = 0.0001). CRP levels below 0.87 mg/dL ruled out rejection with a specificity of 90%. CONCLUSIONS: Among the inflammatory markers analyzed, CRP was the most useful parameter for non-invasive screening of acute cellular rejection in the first year post-HT.

Production of interleukin-10 in asthmatic children after Beta-1-3-glucan

Background Beta-1-3 Glucan is a polysaccharide extracted from Saccharomyces cerevisiae with a possible immunomodulating action that may have a favourable action on asthma symptoms and other allergic diseases. An experimental study carried out using a murine respiratory model detected a decrease in pulmonary tissue eosinophilia, as well as an increase in Interleukin-10 (IL-10) after glucan use. Methods This open, exploratory study with blind outcome evaluation included asthmatic children between 6 and 12 years of age with mild to moderate persistent asthma and inadequate disease control (rescue medication needed more than twice a week) in spite of inhaled budesonide 400 µg/day. After a four week run-in period, subcutaneous Beta-1-3-glucan injections were given weekly for the first four weeks and then every two weeks for the last four weeks. IL-10 levels, measured by the immunoenzymatic method (ELISA), were compared before and after glucan administration. Results: Twenty patients (14 male and 6 female) were included. Mean IL-10 levels were 6.4 pg/ml and 11.3 pg/ml before and after glucan, respectively (p=0.02). There was also a reduction of asthmatic symptoms score at the end of study. Conclusions: This is the first study which shows that subcutaneous particulate Beta-1-3-glucan increases serum IL-10 levels in asthmatics. The possibility of glucan being able to modulate allergic sensitisation and having a beneficial action in restoring Th2 function should be assessed by means of properly planned controlled clinical trials, as it may represent a new therapeutic strategy (AU)

Erythrocyte membrane composition in patients with primary hypercholesterolemia.

There are conflicting results regarding the erythrocyte membrane cholesterol and phospholipid content in patients with primary hypercholesterolemia (PHC), due to methodological problems in obtaining haemoglobin-free ghosts. At the same time, the different units used and the fact that the cholesterol and phospholipids are not expressed in relation with integral protein membrane content, produces contradictory results. We have analysed in 33 patients with PHC (12 male, 31 female) aged 43+/-12 years and in 33 healthy normolipaemic volunteers (9 male, 24 female) aged 43+/-13 years plasma lipids, along with, erythrocyte membrane cholesterol, phospholipids and integral proteins. PHC patients showed increased erythrocyte membrane cholesterol: 0.36+/-0.15 mg/mg when compared with controls: 0.29+/-0.75 mg/mg; p=0.018. Phospholipid membrane content, although higher in the cases, did not reach statistical significance (PHC patients: 0.38+/-0.15 mg/mg vs. 0.33+/-0.72 mg/mg; p=0.098). The cholesterol/phospholipids ratio (Chol/Ph) was 0.99+/-0.22 in PHC patients versus 0.92+/-0.28 in controls; p=0.127. Our results suggest that there is a slight increase in erythrocyte membrane cholesterol in patients with PHC. Given the increasing importance of erythrocyte membrane cholesterol in the stability of the atheroma plaque due its possible contribution to the clinical signs of ischaemic heart disease, it seems relevant to determine this parameter in risk populations. Therefore, a simple and reproducible method needs to be standardised which would enable comparisons between laboratories and facilitate further studies aimed to it as a marker of acute coronary syndromes.

Níveis séricos de proteína catiônica eosinofílica e contagem de eosinófilos em crianças enteroparasitadas,residentes em área de baixo nível sócio-econômico na cidade de Natal, RN, Brasil / Serum eosinophil cationic protein levels end eosinophil counting in children enteroparasited

A Proteína Catiônica Eosinofílica (ECP) foi purificada de células humanas, pela primeira vez, em 1971 e, após cinco anos, foi identificada como sendo uma proteína granular eosinofílica que possui uma potente toxicidade para uma variedade de helmintos, bactérias e outros microrganismos. O objetivo deste trabalho foi diagnosticar as infecções por enteroparasitas correlacionando com níveis séricos de proteína catiônica eosinofílica e eosinofilia. Foram estudadas 150 crianças de ambos os sexos, com idade variando entre 3 e 6 anos, residentes no mesmo bairro e frequentadoras de creche. A Infecção Parasitária foi investigada por Exames de fezes pelosMétodos de Hoffmann, Pons & Janer e o de Baermann-Morais. Os níveis séricos de proteína catiônica eosinofílica foram determinadospor Fluoroenzimaimunoensaio, utilizando o Kit Unicap (Pharmacia & Upjonh) e a contagem de eosinófilos realizada em esfregaço sanguíneo corado pelo Leishman. Das crianças estudadas 140 (93,3%) apresentaram infecção por enteroparasitas e 10 (6,7%) apresentaram ausência de ovos e larvasde helmintos e cistos de protozoários. Cento e quarenta e oito amostras de soro foram analisadas para determinar os níveis de proteína catiônica eosinofílica e os resultados obtidos mostraram que foi 45,45μg/L a mediana das concentrações observadas e que com relação aos níveis de ECP em crianças parasitadas e não parasitadas por helmintos observou-se que as crianças parasitadas apresentaramconcentrações (MD=52,20μg/L) significantemente mais elevadas do que as não parasitadas (MD=29,70μg/L) e que houve uma correlação positiva entre níveis séricos de ECP e eosinófilos ( p< 0,0001 e r= 0,57).

The eosinophil cationic protein was purified from human cells, for the fist time in 1971, after five years, it was identified as being a eosinophil granular protein that is potencially toxic for helminthics, bacteria and other microorganisms. The purpose of this study was to diagnose the enteroparasitics infections co-related to the serum levels of eosinophil cationic protein and eosinophilia. One hundred and fifty children form both sexes, ages varying from 3 to 6 years old who live in the same neighbourhood and go to the same nursery were observed. The parasitic infection was investigated by faecal examinations using the Hoffmann, Pons & Janer and Baermann-morais methods. The serum cationic protein levels were determined by fluorimmunassay using the unicap kit (Pharmacia & Upjohn) and the counting of eosinophis was made by Leishman- stained smears. From the studied children 140 (93,3%) were infected by enteroparasitics and 10 (6,7%) showed no signs of eggs, helminthics, larva,and protozoarios cysts. One hundred and light samples of serum were analysed to determine the levels of eosinophil cationis protein and the obtaind results have showed that 45,45 ìg/L was the overage of the studied concentrations and that the relationship between the levels of eosinophil cationic protein (ECP) in parasited and non-parasited children was that the parasited children showed significantly hight concentrations (MD=52,20ìg/L) than the non-parasited children (MD=29,70 ìg/L). The results also have showed that there was a positive correlation between the serum levels of ECP and eosinophis ( p<0,0001 and r = 0,57).

Erythrocyte deformability in obesity measured by ektacytometric techniques.

Erythrocyte deformability (ED) has been scarcely evaluated in obese patients without other concomitant cardiovascular risk factors and contradictory results have been published regarding the influence of plasma lipids on the erythrocyte membrane lipid composition and insulin resistance on this rheological parameter. In 67 severe or morbid obese patients without other cardiovascular risk factors (51 women and 11 men, aged 34+/-11 years) and in 67 controls (45 women and 22 men, aged 32+/-10 years), ED has been determined by ektacytometric techniques in a Rheodyn SSD, the elongation index (EI) being measured at 12, 30 and 60 Pa, along with plasma lipids, red blood cell membrane lipids (cholesterol and phospholipids) and insulin resistance indexes in basal conditions and after a three month diet period. No significant differences were obtained in the EI between obese patients and the control group at any of the shear stresses tested (P>0.05). The cholesterol and phospholipid content of the red blood cell membrane did not significantly differ between cases and controls (P>0.05). Obese patients with metabolic syndrome showed lower EI at 30 and 60 Pa than those without metabolic syndrome (P=0.014 and P=0.031 respectively). Weight loss was not accompanied by any changes in these rheological parameters. Obesity itself does not seem to modify ED. However, metabolic syndrome seems to decrease ED, possibly through insulin resistance.

Usefulness of von Willebrand factor in cardiac allograft vasculopathy: preliminary experience.

BACKGROUND: Cardiac allograft vasculopathy (CAV) is a disease that significantly limits the survival of transplant patients intravascular ultrasound (IVUS) is considered the method of choice for its diagnosis. von Willebrand factor (vWf) has been used as a marker of endothelial malfunction. We sought to evaluate the usefulness of vWf as a CAV marker. MATERIALS AND METHODS: We prospectively analyzed 22 cardiac transplant subjects, on whom we performed a first study using coronary angiography and IVUS at 36 +/- 3 days and a second study at 598 +/- 49 days. During the follow-up period, five vWf serum controls were performed per patient. We analyzed the results with the repeated-measures ANOVA test and a ROC curve. RESULTS: CAV was detected in 10 (45.5%) of the 22 patients. Although vWf levels tended to diminish progressively during evolution, this trend was not statistically significant (P = .3). However, differences were appreciated based on the presence versus absence of CAV (298 +/- 139 mg/dL versus 212 +/- 105 mg/dL, P = .02). The ROC curve showed a sensitivity of 40%, a specificity of 83%, and a negative predictive value of 82% with a cutoff point of 300 mg/dL. CONCLUSIONS: Subjects with CAV showed significantly higher vWf serum concentrations, particularly during the preliminary phases of cardiac transplantation decreasing during its evolution. This marker could be useful for early screening of CAV.

Diagnostic usefulness of inflammatory markers in acute cellular rejection after heart transplantation.

BACKGROUND: Acute cellular rejection (ACR) affects early morbidity and mortality after heart transplantation. The diagnostic technique of choice is endomyocardial biopsy. Our aim was to evaluate the diagnostic usefulness of inflammatory markers as a noninvasive method to monitor cellular rejection. MATERIAL AND METHODS: We prospectively analyzed 73 cardiac transplant patients by determining the serum levels of protein fibrinogen (fgpro), functional fibrinogen (fgfun), C-reactive protein (CRP), and sialic acid (SA) coinciding with an endomyocardial biopsy (5.1 revisions/patient). The statistical methods were chi(2), Student's t-test, and ROC curves. RESULTS: Of the 373 controls, significant rejection was detected in 19%. Analysis of the relationship between ACR and the markers showed significantly elevated levels of fgpro (345 +/- 90 versus 307 +/- 74 mg/dL; P = .03), fgfun (361 +/- 101 versus 318 +/- 89 mg/dL; P = .04), and SA (74 +/- 22 versus 66 +/- 15 mg/dL; P = .02), but not CRP (19 +/- 29 versus 10 +/- 21 mg/dL; P = .07). SA displayed a better diagnostic utility (area under the curve 0.7; P < .01), 35% sensitivity, 85% specificity, and 82% negative predictive value for a cutoff point of 80 mg/dL. CONCLUSIONS: Among the inflammatory markers increased in ACR, SA was the most useful noninvasive tool for screening.

La atorvastaina modula a la trombospondina en células endoteliales umbilicales humanas / Atorvastatin modulates thrombospondin in human endothelial cells

El objetivo del presente trabajo es determinar el efecto de la atorvastatina sobre la síntesis y liberación de trombospondina en células endoteliales umbilicales humanas y su regulación por los metabolitos de la vía del mevalonato. Los resultados muestran que la atorvastatina disminuye el contenido celular de trombospondina y su liberación, de forma dependiente de la dosis, en células endoteliales. El mevalonato revierte totalmente el efecto inhibitorio producido por la atorvastatina sobre el contenido y la liberación de la trombospondina celular. El farnesil pirofosfato y el geranilgeranil pirofosfato revierten el efecto inhibitorio producido por la atorvastatina en el contenido celular de trombospondina; sin embargo, ni el farnesil pirofosfato ni el geranilgeranil pirofosfato revierten el efecto inhibitorio producido por la atrovastatina en la liberación de trombospondina. En conclusión, la atorvastatina regula negativamente a la trombospondina, en células endoteliales umbilicales humanas, a través de la inhibición del mevalonato (AU)

The aim of this study was to evaluate the effect of atorvastatin on thrombospondin synthesis and secretion in human umbilical endothelial cells and its regulation by mevalonate or its derivatives. Our results show that atorvastatin decreased endothelial cell thrombospondin content and secretion in a dose-dependent manner. Mevalonate totally reversed the inhibitory effect produced by atorvastatin on the content and secretion of cellular thrombospondin. Farnesyl pyrophosphate and geranylgeranyl pyrophosphate reversed the inhibitory effect produced by atorvastatin on the cellular content of thrombospondin but did not prevent the inhibitory effect of atorvastatin on thrombospondin secretion. In conclusion, atorvastatin down-regulates thrombospondin in human endothelial cells through mevalonate inhibition (AU)

IgA secretora total e específica no colostro e leite de mães da cidade do Natal-Rio Grande do Norte, Brasil / Total and specific IgA in colostrum and milk of mothers of Natal-Rio Grande do Norte, Brasil

PURPOSE: To determine the concentration of total secretory IgA and evaluate the repertoire of IgA antibodies to enteropathogenic Escherichia coli and Shigella flexneri antigens in colostrums and milk from mothers in Natal, RN. METHODS: The sample was constituted by 22 healthy clinically women whose babies were born at public hospital in Natal, RN. To determine total secretory IgA a radial immunedifusion tecnique (Mancini et al, 1965), was employed and to detect specific antibodies, immuneenzimatic assays, ELISA was used. RESULTS: The median values of total secretory IgA concentration presented individual variations with high levels in colostrums samples, decreasing during lactation, it was observed a p < 0.001 among the samples from the first day of lactation, to the thirtieth for total IgA concentration. All the donators present in colostrum and milk specific antibodies to Escherichia coli enteropathogenic (EPEC) and Shigella flexneri with titles higer in colostrum. There was parallel and directional pattern between total IgA and IgA anti-EPEC and Shegella flexneri, during period. CONCLUSION: The concentrations of total SIgA and specific antibodies to enteropathogenic Escherichia coli and Shigella flexneri in colostrums and milk in our study do not differ from others accomplished among populations with the same social and econimic features, stressing the importance of human milk as a protector agent against pathogens.

Avaliação nutricional em crianças com infecçoes por enteroparasitas / Nutritional evaluation of children with enteroparasitosis

PURPOSE: To evaluate the nutritious state in children of low social-economic class in order to look over a possible corelationship among this status and the infections caused by enteroparasites. METHODS: 103 children were submitted to a nutritions evolution and to accomplish a exam of serial samples. The method employed searched protozoan cystos, helmints eggs and larvae and it counted helmint eggs when presented through 4 different methods of diagnosis. RESULTS: The results obtained show that the poor environmental and social-economic conditions helped create a high infectious frequency caused by enteroparasites, mainly by Trichuris trichiura and Ascaris lumbricoides, among the helminthes, and Endolimax nana and Giardia lamblia, among the protozoans. light malnutrition without protein deficit was found in 93.55% and moderate malnutrition in 6.45% of the children malnutrition (30.7%). CONCLUSION: Then, it is possible to suggest that children besides bearing many parasitosis were not weth their nutritional state deeply compromised.