Endophytic species of Colletotrichum associated with cashew tree in northeastern Brazil.

Anthracnose caused by Colletotrichum is the most severe and widely occurring cashew disease in Brazil. Colletotrichum species are commonly found as pathogens, endophytes and occasionally as saprophytes in a wide range of hosts. The endophytic species associated with cashew trees are poorly studied. In this study, we report the Colletotrichum endophytic species associated with cashew trees in two locations in the state of Pernambuco, their prevalence in different plant organs (leaves, veins, branches and inflorescences), and compare the species in terms of pathogenicity and aggressiveness using different inoculation methods (wounded × unwounded). Six species of Colletotrichum were identified according to multilocus phylogenetic analyses, including Colletotrichum asianum, Colletotrichum chrysophilum, Colletotrichum karsti, Colletotrichum siamense, Colletotrichum theobromicola, and Colletotrichum tropicale. There were differences in the percentage of isolation in relation to the prevalence of colonized tissues and collection locations. C. tropicale was the prevalent species in both geographic areas and plant tissues collected, with no pattern of distribution of species between areas and plant tissues. All isolates were pathogenic in injured tissues of cashew plants. The best method to test the pathogenicity of Colletotrichum species was utilizing the combination of leaves + presence of wounds + conidial suspension, as it better represents the natural infection process. C. siamense was the most aggressive species.

Ubiquitination detection techniques.

Ubiquitination is an intricately regulated post-translational modification that involves the covalent attachment of ubiquitin to a substrate protein. The complex dynamic nature of the ubiquitination process regulates diverse cellular functions including targeting proteins for degradation, cell cycle, deoxyribonucleic acid (DNA) damage repair, and numerous cell signaling pathways. Ubiquitination also serves as a crucial mechanism in protein quality control. Dysregulation in ubiquitination could result in lethal disease conditions such as cancers and neurodegenerative diseases. Therefore, the ubiquitination cascade has become an attractive target for therapeutic interventions. Enormous efforts have been made to detect ubiquitination involving different detection techniques to better grasp the underlying molecular mechanisms of ubiquitination. This review discusses a wide range of techniques stretching from the simplest assays to real-time assays. This includes western blotting/immunoblotting, fluorescence assays, chemiluminescence assays, spectrophotometric assays, and nanopore sensing assays. This review compares these applications, and the inherent advantages and limitations.

Real-time bio-layer interferometry ubiquitination assays as alternatives to western blotting.

Ubiquitination is a crucial cellular pathway enabling normal cellular functions. Abnormalities in the ubiquitination process can lead to cellular dysfunction and cause a range of diseases. Efforts to screen and develop small molecule inhibitors targeting portions of the ubiquitination cascade require rapid and robust methods for detecting ubiquitination. Enormous efforts have been made in the field to detect ubiquitination using various techniques including fluorescence, spectrophotometry, chemiluminescence, NMR, and radioactive tracers. The most common method to detect ubiquitination is western blotting. However, western blotting is time-consuming and difficult to use when seeking fine-grained time course experiments. Here we present the use of bio-layer interferometry to rapidly assay ubiquitination in real-time. An E3 ligase auto-ubiquitination system and a substrate ubiquitination assay have been applied as tests for the newly developed assay. The developed BLI ubiquitination assay provides one-second time resolution and detects the formation of polyubiquitin chains directly on a biosensor-bound target. Results are returned instantaneously, and reagent concentrations are identical to those used by traditional western blot-based ubiquitination assays. The developed BLI ubiquitination assay is a viable alternative to traditional western blot assays to detect ubiquitination in a rapid real-time manner.

Diversity of Colletotrichum species associated with torch ginger anthracnose.

Anthracnose caused by Colletotrichum species is one of the most important diseases of torch ginger. The disease leads to loss of aesthetic and commercial value of torch ginger stems. This study aimed to characterize Colletotrichum species associated with torch ginger anthracnose in the production areas of Pernambuco and Ceará. A total of 48 Colletotrichum isolates were identified using molecular techniques. Pathogenicity tests were performed on torch ginger with representative isolates. Phylogenetic analyses based on seven loci-DNA lyase (APN2), intergenic spacer between DNA lyase and the mating-type locus MAT1-2-1 (APN2/MAT-IGS), calmodulin (CAL), intergenic spacer between glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and a hypothetical protein (GAP2-IGS), glutamine synthetase (GS), and ß-tubulin (TUB2)-revealed that they belong to five known Colletotrichum species, namely, C. chrysophilum, C. fructicola, C. siamense, C. theobromicola, and C. tropicale, and three newly discovered species, described here as C. atlanticum, C. floscerae, and C. zingibericola. Of these, C. atlanticum was the most dominant. Pathogenicity assays showed that all isolates were pathogenic to torch ginger bracts. All species are reported for the first time associated with torch ginger in Brazil. The present study contributes to the current understanding of the diversity of Colletotrichum species associated with anthracnose on torch ginger and demonstrates the importance of accurate species identification for effective disease management strategies.

Racial/Ethnic Differences Among Tumor-Infiltrating Lymphocytes in Breast Cancer Tumors.

PURPOSE: Tumor-infiltrating lymphocytes (TILs) have emerged as a predictor of breast cancer treatment response and patient outcomes. Current studies investigating racial/ethnic differences in TILs and immune profiles in breast cancer offer varying results. Our study provides some preliminary data in the breast cancer tumor microenvironment where there is a paucity of information, from Asian and Native Hawaiian/Pacific Islander (NHPI) racial/ethnic groups, not well represented in the literature. METHODS: We reviewed 183 cases of women diagnosed with early stage breast cancer who received neoadjuvant treatment at 2 large health systems in Hawaii between 2008 and 2020. We evaluated clinical and demographic information including: age at diagnosis, self-reported race/ethnicity, tumor stage, tumor subtype according to ER, PR, and HER2 receptor status, the amount of TILs and pathologic complete response (pCR). RESULTS: We found a significantly greater amount of TILs in Asians (37.7%, P = .01) and NHPI (37.2%, P = .02) patients compared to White patients on multivariate analysis. We found no significant differences in pCR among the different racial/ethnic groups. CONCLUSIONS: Racial/ethnic differences in the amount of TILs in breast cancer tumors may suggest differences in the breast tumor microenvironment. This may in part contribute to known outcome disparities in these populations and should be further evaluated.

Elucidating the Colletotrichum spp. diversity responsible for papaya anthracnose in Brazil.

Papaya (Carica papaya L.) is among the most important tropical fruits produced in Brazil and is grown in nearly every state. However, several diseases can affect papaya production. Anthracnose stands out among these diseases due to high postharvest yield losses. Previous studies identified Colletotrichum magna (invalid name) and Colletotrichum gloeosporioides causing anthracnose of papaya in Brazil, but species identification was inadequate due to reliance on nuclear ribosomal internal transcribed space (nrITS) and glutamine synthetase (GS) sequences. Thus, the diversity of Colletotrichum spp. causing papaya anthracnose in Brazil may be underestimated. The present study aims to identify the Colletotrichum species associated with papaya anthracnose in Brazil based on broad geographical sampling and multilocus phylogenetic analysis, as well as to assess the prevalence and aggressiveness of the species found. Here, we report C. chrysophilum, C. fructicola, C. gloeosporioides, C. karsti, C. okinawense, C. plurivorum, C. queenslandicum, C. siamense, C. theobromicola, Colletotrichum truncatum causing papaya anthracnose in Brazil. We are also synonymizing Colletotrichum corchorum-capsularis under C. truncatum. Colletotrichum okinawense was the most prevalent species in general and in most sampled locations, and with C. truncatum represents the most aggressive species.

Use of Molecular Methods to Authenticate Animal Species and Tissue in Bovine Liver Dietary Supplements.

Dietary supplements containing bovine (subfamily Bovinae) liver are susceptible to fraud due to their high value and the lack of modern detection methods available for processed animal tissues. The objective of this research was to use molecular methods to authenticate dietary supplements claiming to contain bovine liver or beef liver through the verification of animal species and tissue type. A total of 53 bovine/beef liver dietary supplements were purchased from online sources. The presence of liver was verified with reverse transcription and real-time PCR testing for microRNA-122 (miR-122), which is highly expressed in liver tissue. Multiplex real-time PCR targeting domestic cattle (Bos taurus), horse (Equus caballus), sheep (Ovis aries), and pork (Sus scrofa) was used to verify species. Samples that failed species identification with multiplex real-time PCR underwent DNA mini-barcoding. Overall, bovine species were detected in 48/53 liver supplements: 35 samples were confirmed as domestic cattle with multiplex real-time PCR and an additional 13 samples were confirmed as domestic cattle or Bos spp. with DNA mini-barcoding. One of these samples was also positive for sheep/lamb, which was declared on the label. One product contained undeclared pork in addition to beef. MiR-122 was detected in 51 out of 53 supplements, suggesting the presence of liver. While this study demonstrates the potential use of tissue-specific microRNAs in verifying tissues in dietary supplements, more research is needed to evaluate the specificity of these markers.

Application of whole-genome sequencing for norovirus outbreak tracking and surveillance efforts in Orange County, CA.

Noroviruses are the leading cause of acute gastroenteritis and foodborne illness in the United States. Traditional Sanger sequencing of short genomic regions (~300-600 bp) is the primary method for differentiation of this pathogen; however, whole-genome sequencing (WGS) offers a valuable approach to further characterize strains of this virus. The objective of this study was to investigate the ability of WGS compared to Sanger sequencing to differentiate norovirus strains and enhance outbreak investigation and surveillance efforts. WGS results for 41 norovirus-positive stool samples from 15 different outbreaks occurring from 2012 to 2019 in Orange County, CA, were analyzed for this study. All samples were genotyped with both WGS and Sanger sequencing based on the B-C region. WGS generated nearly full-length viral genome sequences (7029-7768 bp) with 4x to 35,378x coverage. Phylogenetic analysis of WGS data enabled differentiation of genotypically similar strains from separate outbreaks. Single nucleotide variation (SNV) analysis on a subset of strains revealed nucleotide variations (15-79 nt) among isolates from multiple outbreaks of GII.4 Sydney_2015[P31] and GII.17[P17]. Overall, the results demonstrated that coupling norovirus genotype identification with WGS enables enhanced genetic differentiation of strains and provides valuable information for outbreak investigation and surveillance efforts.

DNA-based techniques for seafood species authentication.

Global trade of seafood has increased in the last decade, leading to significant concerns associated with seafood fraud. Seafood fraud involves the intentional misrepresentation of fish or shellfish for the purpose of economic gain and includes acts such as species substitution, illegal transshipment, overtreatment/short weighting, and mislabeling country of origin or production method. These fraudulent acts have had economic, environmental, and public health consequences on a global level. DNA-based techniques for seafood authentication are utilized by regulatory agencies and can be employed as part of a food fraud risk mitigation plan. This chapter will focus specifically on the use of DNA-based methods for the detection of seafood species substitution. Various methods have been developed for DNA-based species identification of seafood, including polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), species-specific PCR, real-time PCR, Sanger sequencing, microarrays, and high-resolution melting (HRM). Emerging techniques for seafood authentication include droplet digital PCR, isothermal amplification, PCR-enzyme-linked immunosorbent assay (ELISA), and high-throughput or next-generation sequencing. Some of these DNA-based methods target specific species, such as real-time PCR and droplet digital PCR, while other methods allow for simultaneous differentiation of a wide range of fish species, including Sanger sequencing and high-throughput sequencing. This chapter will begin with an introduction on seafood fraud and species substitution, followed by an analysis of the main DNA-based authentication methods and emerging techniques for species identification.

Soroprevalência de Ehrlichia canis em cães de abrigos e associações de proteção, do oeste do Paraná, Brasil / Soroprevalence of Ehrlichia canis in dogs from shelters and protection associations in western Paraná, Brazil / Soroprevalencia de Ehrlichia canis en perros de refugios y asociaciones de protección, del oeste de Paraná, Brasil

A erliquiose é uma doença riquetsial infecciosa causada por uma bactéria, pertencente ao gênero Ehrlichia, muito comum em cães e considerada uma importante hemoparasitose. Devido sua relevância na população canina e fácil transmissão por meio de carrapatos, mostra-se necessário conhecer melhor os aspectos epidemiológicos desta doença. Este estudo teve como objetivo avaliar a prevalência de Ehrlichia canis e os aspectos hematológicos em cães de abrigos temporários, de associações de proteção aos animais abandonados, nos municípios de Palotina e Guaíra, no Paraná. No total, 60 cães foram submetidos à coleta de amostras sanguíneas, para realização de hemograma e imunoflourescência indireta para detecção dos anticorpos anti-E. canis. A prevalência encontrada foi de 60% (36/60), não houve correlação positiva com relação ao sexo dos animais, presença de carrapatos ou trombocitopenia. Os dados revelam uma alta prevalência desta doença parasitária em cães de abrigos e a necessidade do estabelecimento de medidas de controle dos agentes transmissores.(AU)

Ehrlichiosis is an infectious ricketsial disease caused by bacteria belonging to the Ehrlichia genus. It is very common in dogs and is considered as an important hemoparasitosis. Due to its relevance in the canine population and its easy transmission through ticks, it is necessary to further understand the epidemiological aspects of the disease. This study aimed at evaluating the prevalence of Ehrlichia canis and the hematological aspects in dogs from temporary shelters and associations for the protection of abandoned animals in the cities of Palotina and Guaíra, in the state of Paraná. Blood samples were collected from 60 dogs for blood count and indirect immunofluorescence testing, and detection of anti-E. canis antibodies. A prevalence of 60% (36/60) was found, with no positive correlation regarding the gender of the animals, presence of ticks, or thrombocytopenia. The data reveal a high prevalence of this parasitic disease in shelter dogs and the need to establish control measures related to the transmitting agents.(AU)

Ehrlichiosis es una enfermedad ricketsial infecciosa causada por una bacteria perteneciente al género Ehrlichia, muy frecuente en perros y considerada una importante hemoparasitaria. Debido a su relevancia en la población canina y fácil transmisión a través de garrapatas, es necesario conocer mejor los aspectos epidemiológicos de esta enfermedad. Este estudio tenía como objetivo evaluar la prevalencia de Ehrlichia canis, así como los aspectos hematológicos para la protección de animales abandonados en los municipios de Palotina y Guaíra, Paraná. Un total de 60 perros fueron sometidos a muestras de sangre para el recuento sanguíneo y la inmunoflourescencia indirecta detección de anticuerpos anti-E canis. La prevalencia encontrada fue del 60% (36/60), sin correlación positiva con la el sexo de los animales, la presencia de garrapatas o trombocitopenia. Los datos revelan una alta prevalencia de esta enfermedad parasitaria en perros refugio y la necesidad de establecer medidas de control para los agentes transmisores.(AU)

Optimal markers for the identification of Colletotrichum species.

Colletotrichum is among the most important genera of fungal plant pathogens. Molecular phylogenetic studies over the last decade have resulted in a much better understanding of the evolutionary relationships and species boundaries within the genus. There are now approximately 200 species accepted, most of which are distributed among 13 species complexes. Given their prominence on agricultural crops around the world, rapid identification of a large collection of Colletotrichum isolates is routinely needed by plant pathologists, regulatory officials, and fungal biologists. However, there is no agreement on the best molecular markers to discriminate species in each species complex. Here we calculate the barcode gap distance and intra/inter-specific distance overlap to evaluate each of the most commonly applied molecular markers for their utility as a barcode for species identification. Glyceraldehyde-3-phosphate dehydrogenase (GAPDH), histone-3 (HIS3), DNA lyase (APN2), intergenic spacer between DNA lyase and the mating-type locus MAT1-2-1 (APN2/MAT-IGS), and intergenic spacer between GAPDH and a hypothetical protein (GAP2-IGS) have the properties of good barcodes, whereas sequences of actin (ACT), chitin synthase (CHS-1) and nuclear rDNA internal transcribed spacers (nrITS) are not able to distinguish most species. Finally, we assessed the utility of these markers for phylogenetic studies using phylogenetic informativeness profiling, the genealogical sorting index (GSI), and Bayesian concordance analyses (BCA). Although GAPDH, HIS3 and ß-tubulin (TUB2) were frequently among the best markers, there was not a single set of markers that were best for all species complexes. Eliminating markers with low phylogenetic signal tends to decrease uncertainty in the topology, regardless of species complex, and leads to a larger proportion of markers that support each lineage in the Bayesian concordance analyses. Finally, we reconstruct the phylogeny of each species complex using a minimal set of phylogenetic markers with the strongest phylogenetic signal and find the majority of species are strongly supported as monophyletic.

A Influência da Espiritualidade e da Religiosidade na Aceitação da Doença e no Tratamento de Pacientes Oncológicos: Revisão Integrativa da Literatura / The Influence of Spirituality and Religiosity in Acceptance of the Disease and Treatment of Oncologic Patients: an Integrative Literature Review / La Influencia de la Espiritualidad y la Religiosidad en la Aceptación de Enfermedad y Tratamiento de Pacientes con Cáncer: una Revisión Integradora de Literatura

Introdução: A religiosidade e a espiritualidade são fatores ímpares na saúde do ser humano. Elas servem de auxílio para lidar com o câncer em seu processo de história natural. Objetivo: Analisar a produção científica nacional e internacional, acerca dos temas espiritualidade, religiosidade e pacientes oncológicos. Método: Revisão integrativa de literatura sobre a influência da espiritualidade e da religiosidade em pacientes oncológicos, nas bases de dados SciELO, MEDLINE e EBSCO e nos idiomas português e inglês, que buscou artigos publicados entre janeiro de 2009 a janeiro de 2019. Resultados: Oito artigos relataram a influência da religiosidade e da espiritualidade desde o momento do diagnóstico do câncer até a aceitação do tratamento. Dez artigos relataram que ambas servem como apoio, chance de encarar a vida e a morte de forma diferentes e de melhorar a qualidade de vida e bem-estar do paciente. A religiosidade e a espiritualidade ajudam os pacientes com as consequências do câncer e influenciarão a sua vida e o seu modo de viver durante o tratamento. Além disso, constituem uma estratégia que legitima e ameniza a incerteza diante das questões de caráter moral, pessoal e social, relativas à condição oncológica crônica. Conclusão: O apego à espiritualidade e à religiosidade influencia positivamente na saúde biopsicossocial do paciente com câncer. Ademais, pacientes dotados de espiritualidade e religiosidade podem apresentar melhor maior aceitação do câncer do tratamento, além de maior esperança e positividade no decorrer da doença.

Introduction: Religiosity and spirituality are unique factors in human health. They are helpful in dealing with cancer in its natural course. Objective: Analyze the national and international scientific publications involving the themes of Spirituality and Religiosity in Cancer Patients. Method: Integrative literature review that searched SciELO, MEDLINE and EBSCO databases for articles published between January 2009 and January 2019, in Portuguese and in English, about the influence of spirituality and religiosity in cancer patients from. Results: Eight articles reported the influence of religiosity and spirituality from the moment of cancer diagnosis through acceptance of the treatment. 10 articles reported that both serve as support, chance of facing life and death differently and to improve the patient's quality of life and well-being. Religiosity and spirituality help patients with the consequences of cancer and will influence their life and lifestyle during and after treatment. Moreover, they constitute a strategy that legitimizes and mitigates uncertainty about moral, personal and social issues related to the chronic oncological condition. Conclusion: Attachment to spirituality and religiosity positively influences the biopsychosocial health of cancer patients. Moreover, patients endowed with spirituality and religiosity may have better acceptance of cancer treatment, in addition of greater hope and positiveness during the course of the disease.

Introducción: La religiosidad y la espiritualidad son factores únicos en la salud humana. Son útiles para tratar el cáncer en su proceso de historia natural. Objetivo: Analizar la producción científica nacional e internacional, sobre los temas Espiritualidad, Religiosidad y Pacientes con cáncer. Método: Revisión bibliográfica integradora sobre la influencia de la espiritualidad y la religión en pacientes con cáncer en las bases de datos SciELO, MEDLINE y EBSCO, en idiomas portugués e inglés, quienes buscaron artículos publicados entre enero de 2009 y enero de 2019. Resultados: Ocho de los artículos informaron la influencia de la religiosidad y la espiritualidad desde el momento del diagnóstico del cáncer hasta la aceptación del tratamiento. Diez artigos informaron que ambos sirven como apoyo, una oportunidad para enfrentar la vida y la muerte de manera diferente y para mejorar la calidad de vida y el bienestar del paciente.La religiosidad y la espiritualidad ayudan a los pacientes con las consecuencias del cáncer e influirán en su vida y estilo de vida durante el tratamiento. Además, constituyen una estrategia que legitima y mitiga la incertidumbre frente a cuestiones morales, personales y sociales relacionadas con la condición oncológica crónica. Conclusion: Attachment to spirituality and religiosity positively influences the biopsychosocial health of cancer patients. Moreover, patients with spirituality and religiosity may have better acceptance of cancer treatment, and greater hope and positivity during the course of the disease.

Medical adjuvant treatment to increase patency of arteriovenous fistulae and grafts.

BACKGROUND: End-stage renal disease (ESRD) patients often require either the formation of an arteriovenous (AV) fistula or an AV interposition prosthetic shunt for haemodialysis. These access sites should ideally have a long life and a low rate of complications (for example thrombosis, infection, stenosis, aneurysm formation and distal limb ischaemia). Although some of the complications may be unavoidable, any adjuvant technique or medical treatment aimed at decreasing complications would be welcome. This is the second update of the review first published in 2004. OBJECTIVES: To assess the effects of adjuvant drug treatment in ESRD patients on haemodialysis via autologous AV fistulae or prosthetic interposition AV shunts. SEARCH METHODS: For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched March 2015) and CENTRAL (2015, Issue 2). SELECTION CRITERIA: Randomised controlled trials (RCTs) of active drug versus placebo in people with ESRD undergoing haemodialysis via an AV fistula or prosthetic interposition AV graft. DATA COLLECTION AND ANALYSIS: For this update, the two review authors (NCT, ADS) independently assessed trial quality and one review author (NCT) extracted data. Information on adverse events was collected from the trials. The primary outcome was the long-term fistula or graft patency rate. Secondary outcomes included duration of hospital stay, complications and number of related surgical interventions. MAIN RESULTS: For this update, an additional six studies were deemed suitable for inclusion, making a total of 15 trials with 2230 participants. Overall the quality of the evidence was low due to short follow-up periods, heterogeneity between trials and moderate methodological quality of the studies due to incomplete reporting. Medical adjuvant treatments used in the trials were aspirin, ticlopidine, dipyridamole, dipyridamole plus aspirin, warfarin, fish oil, clopidogrel, sulphinpyrazone, and human type I pancreatic elastase (PRT-201). Where possible, the included studies were pooled into similar medical adjuvant groups for meta-analyses.All included studies reported on graft patency by measuring graft thrombosis. There was insufficient evidence to determine if there was a difference in graft patency in studies comparing aspirin versus placebo (three RCTs, 175 participants) (odds ratio (OR) 0.40, 95% confidence interval (CI) 0.07 to 2.25; P = 0.30). The meta-analysis for graft patency comparing ticlopidine versus placebo (three RCTs, 339 participants) favoured ticlopidine (OR 0.45, 95% CI 0.25 to 0.82; P = 0.009). There was insufficient evidence to determine if there was a difference in graft patency in studies comparing fish oil versus placebo (two RCTs, 220 participants; OR 0.24, 95% CI 0.03 to 1.95; P = 0.18); and studies comparing clopidogrel and placebo (two RCTs, 959 participants; OR 0.40, 95% CI 0.13 to 1.19; P = 0.10). Similarly, there was insufficient evidence to determine if there was a difference in graft patency in three studies (306 participants) comparing PRT-201 versus placebo (OR 0.75, 95% CI 0.42 to 1.32; P = 0.31); in one trial comparing the effect of dipyridamole versus placebo (42 participants; OR 0.46, 95% CI 0.11 to 1.94, P = 0.29) and dipyridamole plus aspirin versus placebo (41 participants; OR 0.64, CI 0.16 to 2.56, P = 0.52); in one trial comparing low-dose warfarin with placebo (107 participants; OR 1.76, 95% CI 0.78 to 3.99, P = 0.17); and one trial (16 participants) comparing sulphinpyrazone versus placebo (OR 0.43, 95% CI 0.03 to 5.98, P = 0.53). The single trial evaluating warfarin was terminated early because of major bleeding events in the warfarin group. Only two studies published data on the secondary outcome of related interventions (surgical or radiological); there was insufficient evidence to determine if there was a difference in related interventions between placebo and treatment groups. No studies reported on the length of hospital stay and data reporting on complications was limited and varied between studies. AUTHORS' CONCLUSIONS: The meta-analyses of three studies for ticlopidine (an anti-platelet treatment), which all used the same dose of treatment but with a short follow-up of only one month, suggest ticlopidine may have a beneficial effect as an adjuvant treatment to increase the patency of AV fistulae and grafts in the short term. There was insufficient evidence to determine if there was a difference in graft patency between placebo and other treatments such as aspirin, fish oil, clopidogrel, PRT-201, dipyridamole, dipyridamole plus aspirin, warfarin, and sulphinpyrazone. However, the quality of the evidence was low due to short follow-up periods, the small number of studies for each comparison, heterogeneity between trials and moderate methodological quality of the studies due to incomplete reporting. It, therefore, appears reasonable to suggest further prospective studies be undertaken to assess the use of these anti-platelet drugs in renal patients with an arteriovenous fistula or graft.

Beta blockers for peripheral arterial disease.

BACKGROUND: Beta (ß) blockers are indicated for use in coronary artery disease (CAD). However, optimal therapy for people with CAD accompanied by intermittent claudication has been controversial because of the presumed peripheral haemodynamic consequences of beta blockers, leading to worsening symptoms of intermittent claudication. This is an update of a review first published in 2008. OBJECTIVES: To quantify the potential harmful effects of beta blockers on maximum walking distance, claudication distance, calf blood flow, calf vascular resistance and skin temperature when used in patients with peripheral arterial disease (PAD). SEARCH METHODS: For this update, the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched March 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2013, Issue 2). SELECTION CRITERIA: Randomised controlled trials (RCTs) evaluating the role of both selective (ß1) and non-selective (ß1 and ß2) beta blockers compared with placebo. We excluded trials that compared different types of beta blockers. DATA COLLECTION AND ANALYSIS: Primary outcome measures were claudication distance in metres, time to claudication in minutes and maximum walking distance in metres and minutes (as assessed by treadmill).Secondary outcome measures included calf blood flow (mL/100 mL/min), calf vascular resistance and skin temperature (ºC). MAIN RESULTS: We included six RCTs that fulfilled the above criteria, with a total of 119 participants. The beta blockers studied were atenolol, propranolol, pindolol and metoprolol. All trials were of poor quality with the drugs administered over a short time (10 days to two months). None of the primary outcomes were reported by more than one study. Similarly, secondary outcome measures, with the exception of vascular resistance (as reported by three studies), were reported, each by only one study. Pooling of such results was deemed inappropriate. None of the trials showed a statistically significant worsening effect of beta blockers on time to claudication, claudication distance and maximal walking distance as measured on a treadmill, nor on calf blood flow, calf vascular resistance and skin temperature, when compared with placebo. No reports described adverse events associated with the beta blockers studied. AUTHORS' CONCLUSIONS: Currently, no evidence suggests that beta blockers adversely affect walking distance, calf blood flow, calf vascular resistance and skin temperature in people with intermittent claudication. However, because of the lack of large published trials, beta blockers should be used with caution, if clinically indicated.

The effect of ethylene glycol on the phytovolatilization of 1,4-dioxane.

Phytoremediation at contaminated sites is often complicated by the presence of more than one chemical However, the effects of common co-contaminants such as ethylene glycol on the phytoremediation of other chemicals, e.g., 1,4-dioxane, is not well understood. Field studies with DN34 poplar trees revealed a 28% decline in growth rate in response to 10 g/L ethylene glycol in the groundwater, thus indicating a significant and deleterious effect on tree viability, and likely, the plants' utility for phytoremediation. Thorough investigations using Arabidopsis thaliana, with its small size and rapid life cycle, indicated significant growth reduction at 10 g/L and complete inhibition of germination at 40 g/L ethylene glycol Ethylene glycol was almost as severe a stressor as the well characterized osmotic inhibitor, sorbitoL Watering potted trees with 10 g/L ethylene glycol reduced their growth by more than 50%, and similar results were observed in hydroponically grown poplar and willow trees. Under hydroponic conditions, 60 g/L ethylene glycol inhibited the phytovolatilization of l,4-dioxane by more than 80%, and all trees evapo-transpired 1,4-dioxane less efficiently than water. In fact, this efficiency differed between trees and the difference became more pronounced in the presence of ethylene glycol.

Cumprimento do calendário de vacinação de crianças em uma unidade de saúde da família / Compliance with the child immunization calendar in family healthcare units

OBJETIVO: Analisar o cumprimento do calendário de vacinação de crianças pelos usuários da Unidade de Saúde da Família Água Cristal bem como possíveis razões para o seu eventual não cumprimento. MÉTODO: O estudo foi prospectivo, transversal e qualitativo, realizado a partir de visitas às residências das crianças pesquisadas, sendo a casuística constituída por 108 pessoas, número obtido através do registro presente nas fichas da família observadas. Incluíram-se crianças de ambos os sexos, analisando-se a faixa etária de 0 a 2 anos de idade, cadastradas na Unidade no ano de 2007. RESULTADOS: Verificou-se que 87,97 por cento das crianças estão com a vacinação atualizada, sendo que 13,89 por cento dessas têm histórico de atrasos. Um fator fortemente atribuído a estes bons índices foi a atuação constante dos agentes comunitários de saúde. Entre aquelas que apresentaram atraso ou não receberam as vacinas, a falta da vacina contra rotavírus foi a mais observada, em 22,46 por cento dos casos. Foram analisados fatores que poderiam contribuir para o índice de atraso, como escolaridade e ocupação dos pais. Nenhum desses foi estatisticamente significante. CONCLUSÃO: Os resultados encontrados são comparáveis a ambulatórios de centros de referência latino-americanos, o que indica a efetividade da atuação do Programa Saúde da Família naquela comunidade. Contudo, a vacinação tem forte apelo na saúde da população e merece iniciativas de fortalecimento das ações, a fim de diminuir e evitar reaparecimento de doenças...

OBJECTIVE: This study evaluated compliance with the child immunization calendar among users of the Água Cristal Family Healthcare Unit and explored the reasons for potential non-compliance. METHOD: This study was prospective and qualitative. It was based on visits to the surveyed children's residences and consisted of a sample of 108 people. The data for this sample were obtained through the current records in the health unit's family files. The sample included children of both genders between the ages of 0 and 2 years who were registered at the Unit in 2007. RESULTS: We found that 87.97 per cent of the children had up-to-date immunizations, and 13.89 per cent had a history of delayed immunizations. The study found that healthcare community agents' regular interventions were strongly linked to the up-to-date immunization results. Among the children who were immunized late or not at all, the Rotavirus was the most common illness, representing 22.46 per cent of the cases. We also analyzed the factors, such as education and parents' occupation, that could contribute to delayed immunizations. None of these were statistically significant. CONCLUSION: The results were comparable to other Latin American healthcare centers and confirmed the efficacy of the Family Healthcare Program in the community. However, immunizations have a strong influence on a population's health, and initiatives should be undertaken to decrease the prevalence of diseases and prevent their recurrence...

Medical adjuvant treatment to increase patency of arteriovenous fistulae and grafts.

BACKGROUND: End-stage renal disease (ESRD) patients often require either the formation of an arteriovenous (A-V) fistula or an A-V interposition prosthetic shunt for haemodialysis. OBJECTIVES: To determine the effects of adjuvant drug treatment on the patency of fistulae and grafts in patients with ESRD who are undergoing haemodialysis by assessing the number of thrombotic episodes. SEARCH STRATEGY: The Cochrane Peripheral Vascular Diseases Group (PVD) searched their Specialised Register (last searched May 2008) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 2). SELECTION CRITERIA: RCTs of active drug versus placebo in patients with ESRD undergoing haemodialysis via an A-V fistula or prosthetic interposition A-V graft. DATA COLLECTION AND ANALYSIS: For the update, two review authors (ADS, GO) independently assessed trial quality and ADS, XE, and GO extracted data. Information on adverse events was collected from the trials. The outcome measure analysed was the long-term fistula or graft patency rate. MAIN RESULTS: The overall results of the meta-analysis (three RCTs) comparing aspirin versus placebo favoured treatment with aspirin (odds ratio (OR) 0.42, 95% confidence interval (CI) 0.20 to 0.86; P = 0.02).The overall result of the meta-analysis ( three RCTs) comparing ticlopidine (a platelet aggregation inhibitor) versus placebo favoured active treatment (OR 0.47, 95% CI 0.26 to 0.85; P = 0.01).The overall result from one trial comparing the effect of dipyridamole versus placebo and dipyridamole plus aspirin versus placebo favoured treatment (OR 0.57, 95% CI 0.13 to 2.51; OR 0.77, CI 0.19 to 3.19, respectively).One trial compared fish oil (4 g/daily) versus placebo with 24 participants, follow-up 12 months. The overall result favoured treatment (OR 0.07, 95% CI 0.01 to 0.49).One trial compared low-dose warfarin with placebo, 107 patients were followed for 37 months but the trial was terminated prematurely due to increased bleeding events in the treatment group. The overall result favoured placebo (OR 1.76, 95% CI 0.78 to 3.99).One trial compared sulfinpyrazone versus placebo. Sixteen patients, follow-up three months, and the overall result favoured treatment (OR 0.14, 95% CI 0.01 to 1.99).Finally, one trial compared clopidogrel (75 mg/once daily) with placebo. Twenty-four patients, follow-up over a three-year period until their first episode of thrombosis. The overall result favoured treatment (OR 0.01, 95% CI 0.00 to 0.15). AUTHORS' CONCLUSIONS: The meta-analysis confirmed the beneficial effect of anti-platelet treatment as an adjuvant used to increase the patency of A-V fistulae and grafts in the short term.

Beta blockers for peripheral arterial disease.

BACKGROUND: Beta (ss) blockers are indicated for use in coronary artery disease (CAD). However, optimal therapy for people with CAD accompanied by intermittent claudication has been controversial due to the presumed peripheral haemodynamic consequences of beta blockers, leading to worsening symptoms of intermittent claudication. OBJECTIVES: To quantify the potential harm of beta blockers on maximum walking distance, claudication distance, calf blood flow, calf vascular resistance, and skin temperature when used in patients with peripheral arterial disease (PAD). SEARCH STRATEGY: The Cochrane Peripheral Vascular Diseases (PVD) Group searched for publications describing randomised controlled trials (RCTs) of beta blockers in PAD in their Trials Register (last searched 6 May 2008) and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched The Cochrane Library 2008, Issue 2). We handsearched relevant journals and conference proceedings. SELECTION CRITERIA: Randomised controlled trials evaluating the role of both selective (beta1) and non-selective (beta1 and beta2) beta blockers compared with placebo. We excluded trials comparing different types of beta blockers. DATA COLLECTION AND ANALYSIS: Primary outcome measures were claudication distance in metres, and the time to claudication in minutes, and maximum walking distance in metres and minutes (as assessed by treadmill).Secondary outcome measures were calf blood flow (ml/100 ml/min), calf vascular resistance, and skin temperature (degrees C). MAIN RESULTS: We included six RCTs fulfilling the above criteria, with a total of 119 patients. The beta blockers studied were atenolol, propranolol, pindolol, and metoprolol. None of the trials showed a statistically significant worsening effect of beta blockers on either the primary or secondary outcomes. There were no reports of any adverse events with the beta blockers studied. AUTHORS' CONCLUSIONS: There is currently no evidence that beta blockers adversely affect walking distance in people with intermittent claudication. However, due to the lack of large published trials beta blockers should be used with caution if clinically indicated.