Ulcerative Colitis Narrative findings: Australian survey data comparing patient and physician disease management views.

BACKGROUND AND AIM: The Global Ulcerative Colitis (UC) Narrative Survey aimed to evaluate the impact of UC, perceptions of UC burden, and management approaches. Here, we present data from patients and physicians in Australia. METHODS: Surveys, fielded by The Harris Poll, were completed by 215 patients with UC and 90 physicians, between August 2017 and February 2018. Surveys included questions on disease characteristics, impact on life, communication with physicians, and patient knowledge of UC. Results are presented descriptively from all respondents (with no imputation for missing data). RESULTS: Based on medication history, 84% of patients had moderate to severe UC. Diagnostic delay was on average 1.9 (SD 5.0) years and 48% of patients had waited ≥1 year for diagnosis. Nearly two-thirds (65%) of patients considered themselves to be in remission, with 97% also reporting a flare in the past year. The majority (92%) of patients were satisfied with their UC medication and, if their treatment made them feel "good enough," many (75%) would not consider an alternative. Most (90%) patients were satisfied with communication with their physician; however, only 48% felt comfortable raising emotional concerns. Both patients and physicians desired more time during routine appointments. Patients had gaps in their knowledge of UC, which physicians mostly recognized. CONCLUSIONS: The Australian survey results highlighted the diagnostic delay and burden of UC patients' experience, gaps in patients' knowledge of UC, and challenges in patient-physician communication. Compared with the overall Global UC Narrative Survey, patients in Australia reported a high burden of disease.

Human disturbance drives loss of soil organic matter and changes its stability and sources in mangroves.

Mangrove soils with high organic carbon (Corg) content are likely to contain Corg that is vulnerable to remineralization during land use changes. Mangrove conversion to different land uses might deplete soil Corg stocks causing variable carbon dioxide emissions, but the extent of these emissions and the fraction of soil Corg (i.e., labile or stable/recalcitrant) that is mostly lost is poorly understood. Here, we study mangrove soil Corg degradability and its susceptibility to mineralization after mangrove disturbance. We measured changes in soil properties, organic matter (OM) stability and Corg pools and sources across a mangrove disturbance gradient (i.e., pristine forests, degraded mangroves receiving domestic sewage and shrimp farm effluents, and shrimp ponds). Results showed that the conversion of mangroves to shrimp ponds caused the most severe changes in soil properties, OM and Corg characteristics. Shrimp pond soils contained the lowest OM-Corg pools, consisted mostly of stable OM (i.e., recalcitrant and refractory; 36.0 ± 5.7% of the total OM) and enriched δ13Corg (-22.6 ± 2.7‰). Conversely, control mangrove soils had the largest OM-Corg pools consisting of a large unstable OM fraction (i.e., labile; 46.4 ± 4.2%) and lighter δ13Corg (-26.8 ± 0.4‰) being characteristic of Corg from a mangrove origin. Conversion of mangroves to shrimp ponds and its degradation by shrimp farm and domestic sewage effluents caused a loss of 97%, 61%, and 35% of soil Corg stocks in the upper meter, representing potential emissions of ~1200, 800, and 400 Mg CO2 ha-1, respectively. These losses were explained by enhanced OM mineralization of unstable fractions driven by the loss of the physico-chemical protection provided by fine-grained soils and vegetation cover. The differences in Corg stability among sites can be used to predict potential carbon dioxide produced during mineralization, hence aid at prioritizing areas for conservation, restoration or management.

Roadmap on emerging concepts in the physical biology of bacterial biofilms: from surface sensing to community formation.

Bacterial biofilms are communities of bacteria that exist as aggregates that can adhere to surfaces or be free-standing. This complex, social mode of cellular organization is fundamental to the physiology of microbes and often exhibits surprising behavior. Bacterial biofilms are more than the sum of their parts: single-cell behavior has a complex relation to collective community behavior, in a manner perhaps cognate to the complex relation between atomic physics and condensed matter physics. Biofilm microbiology is a relatively young field by biology standards, but it has already attracted intense attention from physicists. Sometimes, this attention takes the form of seeing biofilms as inspiration for new physics. In this roadmap, we highlight the work of those who have taken the opposite strategy: we highlight the work of physicists and physical scientists who use physics to engage fundamental concepts in bacterial biofilm microbiology, including adhesion, sensing, motility, signaling, memory, energy flow, community formation and cooperativity. These contributions are juxtaposed with microbiologists who have made recent important discoveries on bacterial biofilms using state-of-the-art physical methods. The contributions to this roadmap exemplify how well physics and biology can be combined to achieve a new synthesis, rather than just a division of labor.

Influencia de la espiritualidad en las dimensiones del cuidado en mujeres adultas mayores

RESUMEN Objetivo: Describir la influencia de la espiritualidad en las dimensiones del cuidado en mujeres adultas mayores de un centro día de la ciudad de Bogotá. Material y Método: Estudio cualitativo etnográfico con entrevistas a profundidad, diarios de campo y observación participante durante actividades de arteterapia y cartas al cuerpo. Participaron 12 mujeres mayores de 60 años que asistían a un programa de atención en modalidad día en la ciudad de Bogotá (Colombia). Los datos fueron analizados siguiendo las cuatro fases propuestas por Leininger. Se tuvieron en cuenta los criterios éticos de la Resolución 8430 del Ministerio de Salud y la Declaración de Helsinki. Resultados: En la dimensión física se evidenciaron prácticas que integran capacitación constante, alimentación y ejercicio. En la dimensión psicológica se reflejaron necesidad de contar con relaciones sociales, contacto con la música y la naturaleza, así como emociones positivas. En la dimensión espiritual se encontró que está influenciada por la creencia de un ser superior, ayudar a otros y el constante agradecimiento. Conclusiones: La espiritualidad, en las mujeres participantes de la investigación, impregna la dimensión física como la psicológica, por ello se requiere implementar procesos de atención en salud integrales que reivindiquen estas prácticas para fortalecer el cuidado y el envejecimiento saludables

ABSTRACT Objective: To describe the influence of spirituality on the dimensions of caregiving among elderly women in a day care center in the city of Bogotá (Colombia). Material and Method: Qualitative ethnographic study carried out using in-depth interviews, field diaries and participant observation during art therapy activities and letters to the body. Twelve women over 60 years who attended a day care program in the city of Bogotá participated. The data were analyzed following the four phases proposed by Leininger. The ethical criteria of Resolution 8430 of the Ministry of Health and the Helsinki Declaration were also considered. Results: The study showed practices, in the physical dimension, that integrate constant training, food and exercise. In the psychological dimension, there was evidence for the need for social relationships, contact with music and nature, as well as positive emotions. The spiritual dimension was found to be influenced by the belief in a higher being, helping others, and constant gratitude. Conclusions: Spirituality, in the women participating in the research, influences the physical as well as the psychological dimension. It is, therefore, necessary to implement comprehensive health care processes that promote these practices to strengthen care and healthy aging

RESUMO Objetivo: Descrever a influência da espiritualidade nas dimensões do cuidado em mulheres idosas em uma creche na cidade de Bogotá (Colômbia). Material e Método: Estudo etnográfico qualitativo com entrevistas em profundidade, diários de campo e observação dos participantes durante atividades de arte-terapia e cartas ao corpo. Participaram doze mulheres com mais de 60 anos de idade que frequentavam um programa de creche na cidade de Bogotá. Os dados foram analisados seguindo as quatro fases propostas por Leininger. Foram considerados os critérios éticos da Resolução 8430 do Ministério da Saúde e da Declaração de Helsinque. Resultados: Na dimensão física, evidenciaram-se práticas que integram treinamento constante, alimentação e exercício físico. Na dimensão psicológica, houve evidência da necessidade de relacionamento social, contato com a música e a natureza, assim como as emoções positivas. Na dimensão espiritual, descobriu-se que é influenciada pela crença em um ser superior, a ajuda aos outros e gratidão constante. Conclusões: A espiritualidade, nas mulheres participantes da pesquisa, influencia tanto a dimensão física quanto a psicológica. Portanto, é necessária a implementação de processos de atenção integral à saúde que justifiquem essas práticas para fortalecer o cuidado e o envelhecimento saudáveis

Antibacterial Activity of Nitrogen-Doped Carbon Dots Enhanced by Atomic Dispersion of Copper.

Antibiotic resistance is an imminent threat to human health, requiring the development of effective alternate antibacterial agents. One such alternative includes nanoparticle (photo)catalysts that are good at producing reactive oxygen species (ROS). Herein, we report the design and preparation of nitrogen-doped carbon dots functionalized with atomically dispersed copper centers by Cu-N coordination (Cu/NCD) that exhibit apparent antibacterial activity toward Gram-negative Escherichia coli (E. coli) under photoirradiation. The growth of E. coli cells is found to be markedly inhibited by Cu/NCD under 365 nm photoirradiation, whereas no apparent inhibition is observed in the dark or with the copper-free carbon dots alone. This is ascribed to the prolonged photoluminescence lifetime of Cu/NCD that facilitates the separation of photogenerated electron-hole pairs and ROS formation. The addition of tert-butyl alcohol is found to completely diminish the antimicrobial activity, suggesting that hydroxyl radicals are responsible for microbial death. Consistent results are obtained from fluorescence microscopic studies using CellROX green as the probe. Similar bactericidal behaviors are observed with Gram-positive Staphylococcus epidermidis (S. epidermidis). The copper content within the carbon material is optimized at a low loading of 1.09 wt %, reducing the possibility of toxic copper-ion leaching. Results from this study highlight the significance of carbon-based nanocomposites with isolated metal species as potent antimicrobial reagents.

Antimicrobial activity of graphene oxide quantum dots: impacts of chemical reduction.

Design and engineering of graphene-based functional nanomaterials for effective antimicrobial applications has been attracting extensive interest. In the present study, graphene oxide quantum dots (GOQDs) were prepared by chemical exfoliation of carbon fibers and exhibited apparent antimicrobial activity. Transmission electron microscopic measurements showed that the lateral length ranged from a few tens to a few hundred nanometers. Upon reduction by sodium borohydride, whereas the UV-vis absorption profile remained largely unchanged, steady-state photoluminescence measurements exhibited a marked blue-shift and increase in intensity of the emission, due to (partial) removal of phenanthroline-like structural defects within the carbon skeletons. Consistent results were obtained in Raman and time-resolved photoluminescence measurements. Interestingly, the samples exhibited apparent, but clearly different, antimicrobial activity against Staphylococcus epidermidis cells. In the dark and under photoirradiation (400 nm), the as-produced GOQDs exhibited markedly higher cytotoxicity than the chemically reduced counterparts, likely because of (i) effective removal by NaBH4 reduction of redox-active phenanthroline-like moieties that interacted with the electron-transport chain of the bacterial cells, and (ii) diminished production of hydroxyl radicals that were potent bactericidal agents after chemical reduction as a result of increased conjugation within the carbon skeletons.

Partnership for productive development of biosimilar products: perspectives of access to biological products in the Brazilian market.

The manufacturing process for biological products is complex, expensive and critical to the final product, with an impact on their efficacy and safety. They have been increasingly used to treat several diseases, and account for approximately 50% of the yearly budget for the Brazilian public health system. As the patents of biological products expire, several biosimilars are developed. However, there are concerns regarding their efficacy and safety; therefore, the regulatory agencies establish rules to approve and monitor these products. In Brazil, partnership programs between national government-owned companies and private technology holders have been implemented, aiming at knowledge sharing, capacity-building and technological transfer. Such partnerships locally promote manufacturing of these strategic drugs at reduced costs to the public health system. These agreements offer mutual advantages to both the government and patent holders: for the former, a biotechnological development flow is established and enables potential cost reduction and self-sufficient production; whereas for the latter, exclusive sales of the product are ensured during technological transfer, for a fixed period.

Maintenance of low disease activity and remission with etanercept-disease-modifying antirheumatic drug (DMARD) combination therapy compared with treatment with DMARDs alone in Latin American patients with active rheumatoid arthritis: Subset analysis of a randomized trial.

BACKGROUND: Current guidelines on the treatment of rheumatoid arthritis (RA) recommend early therapy targeting the achievement of low disease activity (LDA) or clinical remission. Little published information is available on the success of this treatment strategy in Latin America. In a subset analysis of patients from Latin America, we compared efficacy maintenance with etanercept 50 mg once weekly (ETN50) versus placebo (PBO), on a background of methotrexate (MTX) ±â€Šother non-biologic, disease-modifying antirheumatic drugs, in patients with moderate-to-severe RA who had achieved LDA with ETN50. METHODS: In the Treat-to-Target trial, adult patients with active RA nonresponsive to MTX were treated with ETN50 for 24 weeks (Period 1). Patients achieving LDA were randomized to receive ETN50 or PBO for 28 additional weeks (Period 2). The proportion of patients maintaining LDA at week 52 and other efficacy and quality-of-life measures were assessed. Descriptive statistics are presented using last observation carried forward imputation of data. RESULTS: Of the 64 patients from Latin America treated in Period 1, 61 (95.3%) achieved LDA. Among patients receiving ETN50, 13/34 remained in LDA and 6/14 maintained remission at week 52 versus 6/27 and 4/10 patients receiving PBO. The median time to flare was 113 days and 33 days for the ETN50 and PBO groups, respectively. In the overall population, adverse events were reported in 37% and 43%, serious adverse events in 1% and 4%, and serious infections in 0% and 2% of patients in the ETN50 and PBO groups, respectively. CONCLUSIONS: In patients with RA from Latin America, continuing treatment with ETN50 after achieving LDA appears to result in a higher proportion of patients maintaining LDA and remission compared with switching to PBO. CLINICALTRIALS. GOV REGISTRATION: NCT01578850.

Highly Tunable Hollow Gold Nanospheres: Gaining Size Control and Uniform Galvanic Exchange of Sacrificial Cobalt Boride Scaffolds.

In principle, the diameter and surface plasmon resonance (SPR) frequency of hollow metal nanostructures can be independently adjusted, allowing the formation of targeted photoactivated structures of specific size and optical functionality. Although tunable SPRs have been reported for various systems, the shift in SPR is usually concomitant with a change in particle size. As such, more advanced tunability, including constant diameter with varying SPR or constant SPR with varying diameter, has not been properly achieved experimentally. Herein, we demonstrate this advanced tunability with hollow gold nanospheres (HGNs). HGNs were synthesized through galvanic exchange using cobalt-based nanoparticles (NPs) as sacrificial scaffolds. Co2B NP scaffolds were prepared by sodium borohydride nucleation of aqueous cobalt chloride and characterized using UV-vis, dynamic light scattering, X-ray absorption spectroscopy, and X-ray photoelectron spectroscopy. Careful control over the size of the Co2B scaffold and its galvanic conversion is essential to realize fine control of the resultant HGN diameter and shell thickness. In pursuit of size control, we introduce B(OH)4- (the final product of NaBH4 hydrolysis) as a growth agent to obtain hydrodynamic diameters ranging from ∼17-85 nm with relative standard deviation <3%. The highly monodisperse Co2B NPs were then used as scaffolds for the formation of HGNs. In controlling HGN shell thickness and uniformity, environmental oxygen was shown to affect both the structural and optical properties of the resultant gold shells. With careful control of these key factors, we demonstrate an HGN synthesis that enables independent variation of diameter and shell thickness, and thereby SPR, with unprecedented uniformity. The new synthesis method creates a truly tunable plasmonic nanostructure platform highly desirable for a wide range of applications, including sensing, catalysis, and photothermal therapy.

Partnership for productive development of biosimilar products: perspectives of access to biological products in the Brazilian market / Parceria para o desenvolvimento produtivo com produtos biossimilares: perspectivas de acesso a produtos biológicos no mercado brasileiro

ABSTRACT The manufacturing process for biological products is complex, expensive and critical to the final product, with an impact on their efficacy and safety. They have been increasingly used to treat several diseases, and account for approximately 50% of the yearly budget for the Brazilian public health system. As the patents of biological products expire, several biosimilars are developed. However, there are concerns regarding their efficacy and safety; therefore, the regulatory agencies establish rules to approve and monitor these products. In Brazil, partnership programs between national government-owned companies and private technology holders have been implemented, aiming at knowledge sharing, capacity-building and technological transfer. Such partnerships locally promote manufacturing of these strategic drugs at reduced costs to the public health system. These agreements offer mutual advantages to both the government and patent holders: for the former, a biotechnological development flow is established and enables potential cost reduction and self-sufficient production; whereas for the latter, exclusive sales of the product are ensured during technological transfer, for a fixed period.

RESUMO O processo de manufatura de produtos biológicos é complexo, oneroso e crítico para o produto final, com impacto em sua eficácia e segurança. Seu uso está sendo cada vez mais ampliado no tratamento de diversas doenças, e cerca de 50% do orçamento anual do sistema de saúde público brasileiro é consumido por tais produtos. Com o término da proteção de patentes de produtos biológicos diversos, estão sendo desenvolvidos os biossimilares. Porém, há preocupações relacionadas com sua eficácia e segurança, fazendo com que os órgãos reguladores criem regulamentações para sua aprovação e monitoramento. No Brasil, estão sendo implantados programas de parceria entre laboratórios públicos nacionais e laboratórios detentores de tecnologia, objetivando a obtenção de conhecimento, capacitação profissional e transferência desta tecnologia. Tais parcerias visam à produção local destes medicamentos estratégicos a um custo reduzido para o Sistema Único de Saúde. Os acordos oferecem vantagens mútuas para o governo e o laboratório detentor da patente do produto biológico: ao primeiro, estabelece-se um fluxo de desenvolvimento biotecnológico, que possibilita potencial redução de custos e autossuficiência na produção, enquanto ao segundo garante-se a exclusividade da venda do produto durante a transferência da tecnologia por um prazo estabelecido.

Photo-enhanced antibacterial activity of ZnO/graphene quantum dot nanocomposites.

Synthesis of new, highly active antibacterial agents has become increasingly important in light of emerging antibiotic resistance. In the present study, ZnO/graphene quantum dot (GQD) nanocomposites were produced by a facile hydrothermal method and characterized by an array of microscopic and spectroscopic measurements, including transmission electron microscopy, X-ray photoelectron spectroscopy, UV-vis and photoluminescence spectroscopy. Antibacterial activity of the ZnO/GQD nanocomposites was evaluated with Escherichia coli within the context of minimum inhibitory concentration and the reduction of the number of bacterial colonies in a standard plate count method, in comparison to those with ZnO and GQD separately. It was found that the activity was markedly enhanced under UV photoirradiation as compared to that in ambient light. This was ascribed to the enhanced generation of reactive oxygen species under UV photoirradiation, with minor contributions from membrane damage, as manifested in electron paramagnetic resonance and fluorescence microscopic measurements. The results highlight the significance of functional nanocomposites based on semiconductor nanoparticles and graphene derivatives in the development of effective bactericidal agents.

Antibacterial mechanisms of graphene-based composite nanomaterials.

Pathogenic bacteria are gaining resistance to conventional antibiotics at an alarming rate due to overuse and rapid transfer of resistance genes between bacterial populations. As bacterial resistance to antibiotics causes millions of fatalities worldwide, it is of urgent importance to develop a new class of antibiotic materials with both broad-spectrum bactericidal activity and suitable biocompatibility. Graphene derivatives are rapidly emerging as an extremely promising class of antimicrobial materials due to their diverse bactericidal mechanisms and relatively low cytotoxicity towards mammalian cells. By combining graphene derivatives with currently utilized antibacterial metal and metal-oxide nanostructures, composite materials with exceptional bactericidal activity can be achieved. In this review, the antibacterial activities of graphene derivatives as well as their metal and metal-oxide composite nanostructures will be presented. The synthetic methodology for these various materials will be briefly mentioned, and emphasis will be placed on the evaluation of their mechanisms of action. This information will provide a valuable insight into the current understanding of the interactions governing the microbial toxicity of graphene-based composite nanostructures.

Silver complexes of ligands derived from adamantylamines: Water-soluble silver-donating compounds with antibacterial properties.

Two new silver(I) complexes, namely [Ag(qyAm)2](CF3SO3) (1) and [Ag(qyTAm)2](CF3SO3) (2), (qyAm=2-(quinonyl)iminoadamantane, qyTAm=2-(quinonyl)iminotriazaadamantane) have been synthesized and characterized by elemental analyses, 1H NMR, IR, electronic absorption spectroscopy, and X-ray diffraction. The coordination geometry of the silver center in both complexes is distorted tetrahedral where their respective qyAm and qyTAm ligand bind in a bidentate fashion using the imine and quinoline nitrogen atoms. Complex 2 is soluble in water and exhibits strong antimicrobial actions on both Gram-negative (E. coli, and P. aeruginosa) and Gram-positive (S. aureus) bacteria. The minimal inhibitory concentration (MIC) values for complex 2 (4, 4, and 8 µg for E. coli, P. aeruginosa, and S. aureus, respectively) are comparable to MIC values of silver nitrate and silver sulfadiazine.

Tracking silver delivery to bacteria using turn-on fluorescence.

Herein we present a novel silver complex [Ag(qBODIPY)(CF3SO3)] (1) that exhibits dramatic increase in fluorescence upon silver release. Complex 1 has a minimum inhibitory concentration comparable to that of silver nitrate. Confocal microscopy was used to track the delivery of silver to bacterial targets.

Uniformity microsprinkler irrigation system using statistical quality control / Uniformidade da irrigação por microaspersão utilizando o controle estatístico de qualidade

ABSTRACT: The objective of this study was to evaluate the use of statistical quality control tools in the analysis of the uniformity of a microsprinkler irrigation system. For the analysis of irrigation Christiansen uniformity coefficient (CUC) and the distribution uniformity coefficient (DU) were statistically analyzed by means of the Shewhart control charts and process capability index (Cp). For the experiment 25 tests were carried out with a single micro sprinkler and subsequently seven different spacing between micro sprinklers were simulated. Control charts contributed to the diagnosis of the treatments to be under control and with satisfactory uniformity outcomes. Increase in process capability index was directly proportional to the average of CUC and DU.

RESUMO: O estudo objetivou avaliar o uso das ferramentas do controle estatístico de qualidade na análise da uniformidade de um sistema de irrigação por microaspersão. Para a análise da irrigação foram utilizados os coeficientes de uniformidade de Christiansen (CUC) e o coeficiente de uniformidade de distribuição (CUD), e estes foram analisados estatisticamente através dos gráficos de controle de Shewhart e do índice de capacidade do processo (Cp). Para o experimento foram realizados 25 ensaios com um único microaspersor, sendo posteriormente simulados sete diferentes espaçamentos entre microaspersores. Os gráficos de controle contribuíram para o diagnóstico dos tratamentos sob controle e com resultados satisfatórios de uniformidade. O aumento do índice de capacidade do processo mostrou-se diretamente proporcional as médias dos valores de CUC e CUD.

Thermoswitchable Janus Gold Nanoparticles with Stimuli-Responsive Hydrophilic Polymer Brushes.

Well-defined thermoswitchable Janus gold nanoparticles with stimuli-responsive hydrophilic polymer brushes were fabricated by combining ligand exchange reactions and the Langmuir technique. Stimuli-responsive polydi(ethylene glycol) methyl ether methacrylate was prepared by addition-fragmentation chain-transfer polymerization. The polymer brushes were then anchored onto the nanoparticle surface by interfacial ligand exchange reactions with hexanethiolate-protected gold nanoparticles, leading to the formation of a hydrophilic (polymer) hemisphere and a hydrophobic (hexanethiolate) one. The resulting Janus nanoparticles showed temperature-switchable wettability, hydrophobicity at high temperatures, and hydrophilicity at low temperatures, due to thermally induced conformational transition of the polymer ligands. The results further highlight the importance of interfacial engineering in the deliberate functionalization of nanoparticle materials.

Platinum nanoparticles functionalized with ethynylphenylboronic acid derivatives: selective manipulation of nanoparticle photoluminescence by fluoride ions.

Platinum nanoparticles functionalized with 4-ethynylphenylboronic acid pinacol ester (Pt-EPBAPE) were successfully synthesized by a simple chemical reduction procedure. Because of the formation of conjugated metal-ligand interfacial linkages, the resulting nanoparticles exhibited apparent photoluminescence arising from the nanoparticle-bound acetylene moieties that behaved analogously to diacetylene derivatives. Interestingly, the nanoparticle photoluminescence was markedly quenched upon the addition of fluoride ions (F⁻). In contrast, significantly less or virtually no change was observed with a variety of other anions such as Cl⁻, Br⁻, I⁻, NO3⁻, HSO4⁻, H2PO4⁻, ClO4⁻, BF4⁻, and PF6⁻. The high selectivity toward fluoride ion is most probably because of the strong specific affinity of the boronic acid moiety to fluoride. The formation of B-F bonds led to the conversion of Bsp² to Bsp³, as manifested in ¹¹B NMR measurements, which impacted the intraparticle charge delocalization between the particle-bound acetylene moieties and hence the nanoparticle photoluminescence.

Uric acid biorhythm, a feature of long-term variation in a clinical laboratory database.

BACKGROUND: The biorhythm of serum uric acid was evaluated in a large sample of a clinical laboratory database by spectral analysis and the influence of the gender and age on uric acid variability. METHODS: Serum uric acid values were extracted from a large database of a clinical laboratory from May 2000 to August 2006. Outlier values were excluded from the analysis and the remaining data (n=73,925) were grouped by gender and age ranges. Rhythm components were obtained by the Lomb Scargle method and Cosinor analysis. RESULTS: Serum uric acid was higher in men than in women older than 13 years (p<0.05). Compared with 0-12 year group, uric acid increased in men but not in women older than 13 years (p<0.05). Circannual (12 months) and transyear (17 months) rhythm components were detected, but they were significant only in adult individuals (>26 years, p<0.05). Cosinor analysis showed that midline estimating statistic of rhythm (MESOR) values were higher in men (range: 353-368 µmol/L) than in women (range: 240-278 µmol/L; p<0.05), independent of the age and rhythm component. The extent of predictable change within a cycle, approximated by the double amplitude, represented up to 20% of the corresponding MESOR. CONCLUSIONS: Serum uric acid biorhythm is dependent on gender and age and it may have relevant influence on preanalytical variability of clinical laboratory results.

Clinical utility of image-guided chest wall mass biopsy: results in 28 patients.

The purpose of our study was to determine the clinical usefulness of percutaneous image-guided biopsy of chest wall masses. A retrospective study of 28 patients who underwent image-guided biopsy of chest wall masses from 2005 to 2007 was performed. In 19 (68%) patients, the mass was detected as part of a staging evaluation in patients with known malignancy; 9 (32%) patients had no known malignancy. Biopsy results were classified as diagnostic (malignant or benign) or non-diagnostic (atypical and insufficient). Sensitivity, specificity and negative predictive value were calculated for all patients, and the Fisher-Freeman-Halton exact test was used to determine if test characteristics varied in patients with and without a history of cancer, masses smaller and greater than 5 cm, or according to needle size. The overall diagnostic rate was 71%. Of these, there were 20 true-positives, 3 true-negatives, 5 false-negatives and no false-positive results (sensitivity 80% (20/25), specificity 100% (3/3) and negative predictive value 37.5% (3/8)). There were no differences between patients with and without cancer. Among 19 patients with known cancer, 10 had metastatic disease from their known primary. Biopsy test characteristics did not differ with respect to mass or needle size. Minor complications were seen in 7% of patients. Image-guided chest wall mass biopsy is a sensitive and specific procedure, which is clinically important in the care of patients both with and without a known primary cancer.

Clinicopathological aspects and their relation to prognosis in adult-type granulosa cell tumor of the ovary / Aspectos clinicopatológicos e sua relação com o prognóstico em tumor de células da granulosa do tipo adulto do ovário

INTRODUCTION AND OBJECTIVE: The adult granulosa cell tumors (AGCT) correspond to less than 5 percent of ovarian neoplasias. They are considered low malignant potential tumors and may recur after many years. The differential diagnosis must be made with other primary or metastatic ovarian neoplasias. The aim was to analyze clinical and pathological aspects of AGCT and relate them to its evolution. METHOD: in a 10- year (1995-2004) review of the files from University of Campinas Clinical Hospital, Brazil, 20 AGCT cases were found. The clinical records and slides were reviewed and age, symptoms, macro and microscopic aspects, diagnostic staging and recurrence were considered. When there was intraoperative biopsy, its accuracy was evaluated. RESULTS: Age ranged from 27 to 79 years (mean: 53) and the follow-up from 12 to 96 months (mean: 42). The main symptoms were post-menopause bleeding (45 percent), abdominal pain (35 percent) and palpable mass (25 percent). Most tumors were yellowish (60 percent) and the solid aspect (40 percent) was more common than the cystic or solid-cystic. The histological patterns were 40 percent solid, 15 percent macrofollicular and 45 percent combined forms. All of them with low mitotic index. Only three out of nine intraoperative frozen sections were accurately diagnosed. The clinical staging was 13 cases in Ia (65 percent), one case Ic and 6 IIIc. In three out of 14 hysterectomies there was simple endometrial hyperplasia with no atypia. Only the disease staging was significantly associated with recurrence (p < 0.0001). CONCLUSION: ACGT generally occurs after menopause and intraoperative biopsies are commonly inconclusive. Only advanced staging was related to the worst prognosis.

INTRODUÇÃO E OBJETIVO: O tumor de células da granulosa tipo adulto (TCGA) corresponde a menos de 5 por cento das neoplasias ovarianas. São de baixo potencial de malignidade, podem recorrer depois de muitos anos, e o diferencial deve ser feito com outras neoplasias primárias ou metastáticas. Analisamos os aspectos clínicos e patológicos do tumor, relacionando-os à evolução. MÉTODOS: Na revisão de 10 anos dos arquivos do laboratório de Anatomia Patológica do Hospital das Clínicas da Universidade de Campinas (UNICAMP), 20 casos de TCGA foram encontrados. Os prontuários e as lâminas foram revisados e considerados: idade, sintomas, aspectos macro e microscópicos, estádio ao diagnóstico e à recidiva. Quando houve biópsia intraoperatória, sua acurácia foi avaliada. RESULTADOS: A idade variou de 27 a 79 anos (média: 53); o seguimento de 12 a 96 meses (média: 42). Os sintomas principais: sangramento pós-menopausa (45 por cento), dor abdominal (35 por cento) e massa palpável (25 por cento). A maioria era amarelada (60 por cento), o aspecto sólido mais comum (40 por cento) que o cístico ou sólido-cístico. Os padrões histológicos foram: 40 por cento sólido, 15 por cento macrofolicular e 45 por cento de formas combinadas, todos com baixo índice mitótico. Apenas três de nove casos submetidos à biópsia intraoperatória foram diagnosticados corretamente. O estádio clínico foi: 13 casos Ia (65 por cento), um caso Ic e seis, IIIc. Em três de 14 histerectomias analisadas, havia hiperplasia endometrial simples sem atipia. Apenas o estádio da doença foi significativamente associado à recidiva (p < 0,0001). CONCLUSÃO: TCGA geralmente ocorre após a menopausa, as biópsias intraoperatórias são mais comumente inconclusivas e apenas o estádio avançado esteve relacionado com o pior prognóstico.