Teaching Cardiopulmonary Auscultation to Medical Students using a Virtual Patient Simulation Technology.

The teaching process of auscultation is complex in itself, and difficult to operate since it requires a wide spectrum of patients with the most diverse cardiopulmonary pathologies, readily available during teaching and assessment hours, for an ever-growing number of medical students. In this paper we will focus on how virtual patient technologies can promote the evolution of the current teaching methodologies, promoting better learning. The chosen methodology was: a) a review of available medical simulation technologies for auscultation teaching; b) a case study illustrating how a virtual patient simulation technology has been successfully used to teach and certify auscultation skills. Results show the positive impact and high acceptability of virtual patient simulation technologies in the teaching of auscultation to medical students.

Transmission line method for the simulation of fiber Bragg gratings.

A new method for the analysis and design of fiber Bragg gratings (FBGs) based on the theory of transmission lines has been developed and verified both theoretically and experimentally. The method is an extension of the coupled-mode theory and utilizes the equivalent transmission lines in order to simulate any type of grating, with an easy and direct implementation. The method provides the ability to analyze the optical devices without using full wave approaches, while also facilitating the incorporation of core materials with a complex or non-linear refractive index, non-uniform distributions of the grating's refractive index, and tilted and phase-shifted gratings. The approach also allows the design of the grating for a given reflection spectra. Numerical results of the method's application on a randomly varied inscription of the refractive index of a FBG have also been simulated and discussed. Using this method, the characteristics of an erbium-doped (ED)-FBG have been simulated and the predictions verified experimentally.

Optical fiber sensors for monitoring in critical care.

Monitoring of key physiological and pharmacological parameters is an important part of a closed loop control system in critical care. Optical fiber sensors provide a versatile platform technology that can be easily incorporated into existing in-dwelling catheters or face masks. With appropriate functional coatings they can be used to monitor a range of relevant parameters and two different examples are presented: (i) respiration monitoring; (ii) drug level monitoring. Respiration monitoring involves monitoring of temperature and humidity in inhaled and exhaled breath. The optical fiber sensor consists of a fiber Bragg grating to measure temperature and a tip coating whose refractive index changes with humidity. The sensor is demonstrated to be able to track breath to breath changes when incorporated into a mask. Drug level monitoring is demonstrated in vitro using a long period grating coated with molecularly imprinted polymer nanoparticles that are sensitive to fentanyl. The sensor has a limit of detection of 50ng/ml.

Curcumin and fisetin internalization into Saccharomyces cerevisiae cells via osmoporation: impact of multiple osmotic treatments on the process efficiency.

Cell osmoporation is a simple and straightforward procedure of creating food-grade biocapsules. This study proposes a new protocol of sequential cell osmoporation stages and evaluates its impact on the efficiency of curcumin and fisetin internalization into Saccharomyces cerevisiae cells. To the best of our knowledge, this is the first report in the literature regarding the subject. To assess how multiple osmoporation stages influence the encapsulation efficiency (% EE), encapsulated amount of curcumin (IC) and fisetin (IF) into S. cerevisiae cells and cell viability, the residual supernatant was used for the subsequent encapsulation stages and viability was assessed by the CFU method. Quantification was carried through direct extraction, using an ultrasonic bath and UV-Vis spectrophotometry. Experimental data demonstrated that the addition of a second osmoporation stage increases both the EE (% EE) and the amount of encapsulated curcumin and fisetin (IC and IF). As a result, the EE was considerably improved and the obtained microcapsules contained a higher amount of the targeted bioactive compounds in its internal structure. However, adding a third osmoporation stage proved to less beneficial to the process efficiency due to its lower yield and the significant negative impact to cell viability. SIGNIFICANCE AND IMPACT OF THE STUDY: For the first time in the literature, a protocol of serial osmoporation stages to enhance the encapsulation efficiency of hydrophobic low molecular weight molecules (curcumin and fisetin) into Saccharomyces cerevisiae cells was determined. By increasing overall efficiency, this protocol empowers the encapsulation process and creates a rational way to reduce waste for future industrial osmoporation applications.

Normal variation of bone marrow B-cell precursors according to age - reference ranges for studies in myelodysplastic syndromes in Brazil.

BACKGROUND: Normal B lymphoid maturation occurs in bone marrow (BM) throughout life, but immature B-cell progenitors (BCPs) are more numerous in children than in adults. To assess the normal values according to age became important as BCPs are decreased in myelodysplastic syndromes and have been considered an important diagnostic and prognostic feature in these clonal disorders. METHODS: in a multicenter retrospective study from the Brazilian Group of Flow Cytometry we analyzed the variation of BCPs in normal BM according to age and technical peculiarities of each laboratory. We analysed of 45 BM donors and 89 cases examined for elucidation of transitory reactive cytopenias presenting a normal BM immunophenotyping. BCPs were enumerated as CD19+ /CD34+ /CD45dim /CD10+ cells (panel 1) or CD19+ /CD34+ /CD45dim cells (panel 2) among the total nucleated non-erythroid cells and as percentage of CD34+ cells. RESULTS: we included 134 cases. Panel 1 was applied in 88 cases and panel 2 was used in 46. Age range: 10 months to 89 years. In a multiple regression, % BCPs/total nucleated cells was an exponential function of age. Age explained alone 49.4% of the variance, while 'panel used' explained 1.8% and 'laboratory' explained 0.7%. Age explained only 24.9% of the variance of BCPs/CD34+ cells. CONCLUSIONS: in normal individuals, BM B-cell precursors varied mainly according to age, but were also dependent on technical peculiarities of operators and equipments. Analysis by phenotype and as percentage of total nucleated cells was more accurate and less susceptible to variation than evaluating % BCPs/total CD34+ cells. © 2017 International Clinical Cytometry Society.

A ten-color tube with dried antibody reagents for the screening of hematological malignancies.

INTRODUCTION: The workflow in clinical flow cytometry laboratories must constantly be reviewed to develop technical procedures that improve quality and productivity and reduce costs. Using the Beckman Coulter dry coating technology, we customized a ten-color tube with dried antibody reagents, designated the Duraclone screening tube (DST), for screening hematological malignancies. Here, we compared the applicability, clinical and numerical equivalence, and cost and time required for the technical procedures between the liquid reagents and the DST. METHODS: The DST contains CD4 + Kappa-FITC, CD8 + Lambda-PE, CD3 + CD14-ECD, CD33-PE-Cy5.5, CD20 + CD56-PE-Cy7, CD34-APC, CD19-APC-AlexaFluor700, CD10-APC-AlexaFluor750, CD5-Pacific Blue, and CD45-Krome Orange. We evaluated 20 bone marrow samples, 13 peripheral blood samples, 6 lymph node biopsy samples, 5 fine-needle aspirate samples, 5 cerebrospinal fluid samples, and 1 pleural fluid sample. RESULTS: The DST was useful for more than 60% of our samples. It was able to enumerate the majority of the populations in all types of samples with a statistically acceptable correlation with the liquid reagents. The use of the DST translated into significant time and cost savings of 15.8% and 12.3%, respectively, compared with the use of the liquid reagent. The cost was reduced by $14.36 per sample. CONCLUSIONS: The DST is an efficient solution for screening hematological malignancies with improved quality, productivity, standardization, and sustainability. These improvements could benefit patients by providing faster diagnoses using a higher quality and lower cost reagent.

Teaching cardiopulmonary auscultation in workshops using a virtual patient simulation technology - A pilot study.

Auscultation is currently both a powerful screening tool, providing a cheap and quick initial assessment of a patient's clinical condition, and a hard skill to master. The teaching of auscultation in Universities is today reduced to an unsuitable number of hours. Virtual patient simulators can potentially mitigate this problem, by providing an interesting high-quality alternative to teaching with real patients or patient simulators. In this paper we evaluate the pedagogical impact of using a virtual patient simulation technology in a short workshop format for medical students, training them to detect cardiac pathologies. Results showed a significant improvement (+16%) in the differentiation between normal and pathological cases, although longer duration formats seem to be needed to accurately identify specific pathologies.

Resistance of beef cattle of two genetic groups to ectoparasites and gastrointestinal nematodes in the state of São Paulo, Brazil.

The resistance to infestations by ectoparasites and infections by gastrointestinal nematodes was studied in 45 animals (males and females) of two genetic groups: purebred Nelore (NI, n=28) and Three-Cross (1/2 Angus+1/4 Canchim+1/4 Nelore - TC, n=17). The animals were monitored for 24 months, during which they were left to graze in tropical pastures without receiving treatment for parasites. Each month the animals were examined for infestations by external parasites, to count the numbers of cattle ticks Rhipicephalus microplus with diameter greater than 4.5mm present on the left side, horn flies (Haematobia irritans) present in the lumbar region and botfly larvae (Dermatobia hominis) present on the entire body. The H. irritans counts were performed with the aid of digital photographs. At the time of examination, fecal samples were collected to count the eggs per gram (EPG) and to perform coprocultures, and peripheral blood samples were drawn to determine the packed cell volume (PCV) and to count the eosinophils. For statistical analysis, the count data were transformed into log10 (n+1), where n is the number of parasites. For PCV, significant effects (P<0.05) were found for collection month (CO), genetic group (GG) and gender (SX), with means and respective standard errors of 41.5 ± 0.65% for the NI animals, 39.3 ± 0.83% for the TC, 41.5 ± 0.72% for the females and 39.3 ± 0.77% for the males. Regarding the eosinophil counts, only the effect of sex was significant (P<0.01), with means and respective standard errors of 926.0 ± 46.2/µL, for males and 1088.0 ± 43.8/µL of blood, for females. The NI animals presented lower mean counts for all the external parasites compared to the TC animals (P<0.01). For ticks, the transformed means followed by standard errors for the NI and TC animals were 0.06 ± 0.01 and 0.34 ± 0.02, while for horn flies these were 0.92 ± 0.05 and 1.36 ± 0.06 and for botfly larvae they were 0.05 ± 0.03 and 0.45 ± 0.05, respectively. The average EPG values were only influenced by CO (P<0.01). The coprocultures revealed the presence of the following endoparasites: Haemonchus spp., Cooperia spp., Oesophagostomum spp. and Trichostrongylus spp., the last in smaller proportion. There were no significant differences between the genetic groups for the endoparasite loads, except for Cooperia spp., which were present in greater number (P<0.05) in the NI group. The results obtained in this experiment confirm previous findings of greater susceptibility of the Nelore breed to Cooperia spp. and high resistance to ectoparasites.

Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED).

Atrophic gastritis, intestinal metaplasia, and epithelial dysplasia of the stomach are common and are associated with an increased risk for gastric cancer. In the absence of guidelines, there is wide disparity in the management of patients with these premalignant conditions. The European Society of Gastrointestinal Endoscopy, the European Helicobacter Study Group, the European Society of Pathology, and the Sociedade Portuguesa de Endoscopia Digestiva have therefore combined efforts to develop evidence-based guidelines on the management of patients with precancerous conditions and lesions of the stomach. A multidisciplinary group of 63 experts from 24 countries developed these recommendations by means of repeat online voting and a meeting in June 2011 in Porto, Portugal. The recommendations emphasize the increased cancer risk in patients with gastric atrophy and metaplasia and the need for adequate staging in the case of high-grade dysplasia, and they focus on treatment and surveillance indications and methods.

Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED).

Atrophic gastritis, intestinal metaplasia, and epithelial dysplasia of the stomach are common and are associated with an increased risk for gastric cancer. In the absence of guidelines, there is wide disparity in the management of patients with these premalignant conditions. The European Society of Gastrointestinal Endoscopy (ESGE), the European Helicobacter Study Group (EHSG), the European Society of Pathology (ESP) and the Sociedade Portuguesa de Endoscopia Digestiva (SPED) have therefore combined efforts to develop evidence-based guidelines on the management of patients with precancerous conditions and lesions of the stomach (termed MAPS). A multidisciplinary group of 63 experts from 24 countries developed these recommendations by means of repeat online voting and a meeting in June 2011 in Porto, Portugal. The recommendations emphasize the increased cancer risk in patients with gastric atrophy and metaplasia, and the need for adequate staging in the case of high grade dysplasia, and they focus on treatment and surveillance indications and methods.

Resonant Raman scattering in ZnO:Mn and ZnO:Mn:Al thin films grown by RF sputtering.

Raman spectroscopy results obtained under visible (non-resonant) and UV (resonant) excitation for nanocrystalline ZnO, ZnO:Mn and ZnO:Mn:Al thin films grown by radio frequency magnetron sputtering are presented and compared. The origin of the multiple longitudinal optical (LO) phonon Raman peaks, strongly enhanced under resonance conditions, and the effects of the dopants on them are discussed in the framework of the 'cascade' model. It is suggested that the observed suppression of the higher-order LO phonon lines for ZnO:Mn:Al is caused by the dissociation of excitons in the heavily n-type doped material. On the basis of the cascade model interpretation of the higher-order Raman peaks in the resonant spectra, the LO phonon frequencies for wavevectors away from the Γ point are evaluated and compared to previously published phonon dispersion curves.

Silicate and borate glasses as composite fillers: a bioactivity and biocompatibility study.

Composites filled with a silicate glass (CSi) and a new borate glass (CB) were developed and compared in terms of their in vitro behaviour both in acellular and cellular media. Acellular tests were carried out in SBF and the composites were characterized by SEM-EDS, XRD and ICP. Biocompatibility studies were investigated by in vitro cell culture with MG-63 osteoblast-like and human bone marrow cells. The growth of spherical calcium phosphate aggregates was observed in acellular medium on all composite surfaces indicating that these materials became potentially bioactive. The biological assessment resulted in a dissimilar behavior of the composites. The CSi demonstrated an inductive effect on the proliferation of cells. The cells showed a normal morphology and high growth rate when compared to standard culture plates. Contrarily, inhibition of cell proliferation occurred in the CB probably due to its high degradation rate, leading to high B and Mg ionic concentration in the cell culture medium.

Mitochondrial DNA depletion and its correlation with TFAM, TFB1M, TFB2M and POLG in human diffusely infiltrating astrocytomas.

Mitochondrial DNA (mtDNA) alterations and their clinical and pathological implications have been analyzed in several human malignancies. A marked decrease in mtDNA copy number along with the increase in malignancy was observed in diffusely infiltrating astrocytomas (24 WHO grade II, 18 grade III, and 78 grade IV or GBM) compared to non-neoplastic brain tissues, being mostly depleted in GBM. Although high relative gene expression levels of mtDNA replication regulators (mitochondrial polymerase catalytic subunit (POLG), transcription factors A (TFAM), B1 (TFB1M) and B2 (TFB2M)) were detected, it cannot successfully revert the mtDNA depletion observed in our samples. On the other hand, a strong correlation among the expression levels of mitochondrial transcription factors corroborates with the TFAM role in the direct control of TFB1M and TFB2M during initiation of mtDNA replication. POLG expression was related to decreased mtDNA copy number, and its overexpression associated with TFAM expression levels also have an impact on long-term survival among GBM patients, interpreted as a potential predictive factor for better prognosis.

DigiScope--unobtrusive collection and annotating of auscultations in real hospital environments.

Digital stethoscopes are medical devices that can collect, store and sometimes transmit acoustic auscultation signals in a digital format. These can then be replayed, sent to a colleague for a second opinion, studied in detail after an auscultation, used for training or, as we envision it, can be used as a cheap powerful tool for screening cardiac pathologies. In this work, we present the design, development and deployment of a prototype for collecting and annotating auscultation signals within real hospital environments. Our main objective is not only pave the way for future unobtrusive systems for cardiac pathology screening, but more immediately we aim to create a repository of annotated auscultation signals for biomedical signal processing and machine learning research. The presented prototype revolves around a digital stethoscope that can stream the collected audio signal to a nearby tablet PC. Interaction with this system is based on two models: a data collection model adequate for the uncontrolled hospital environments of both emergency room and primary care, and a data annotation model for offline metadata input. A specific data model was created for the repository. The prototype has been deployed and is currently being tested in two Hospitals, one in Portugal and one in Brazil.

Design and fabrication of piezoelectric microactuators based on ß-poly (vinylidene fluoride) films for microfluidic applications.

This paper reports a fabrication method for producing piezoelectric poly (vinylidene fluoride) films in their electroactive ß-phase that features controlled thickness, smooth and flat surface, and high transparency. These piezoelectric films are suitable for being used as integrated microactuators, such as piezoelectric pumps and/or mixers, in microfluidic applications. Their actuation circuit design is also reported. ATR-FTIR, UV-VIS transmittance spectroscopy and SEM techniques were used for calculating the ß-phase content, for determining the transparency and for evaluating the morphology of the produced ß-PVDF films, respectively. ß-PVDF films with a thickness of about 25 µm were deposited by spin-coating. It was concluded that the processing parameter that mostly affect the films quality was their drying temperature. Indeed, the drying temperature of 30 °C proved to be the most suitable for obtaining non-porous and transparent films, with a ß-phase content of approximately 75%.

Emamectin benzoate (Affirm). a modern insecticide for the control of lepidoptera larvae on fruits, grapes and vegetables crops.

Emamectin benzoate (Affirm) is a novel insecticide with potent efficacy against many specie of lepidoptera which are damaging fruits and leaves of agricultural crops. The active ingredient belongs to the naturally derived chemical group of avermectine, causing paralysis of lepidoptera larvae due to the activation of chloride channel at nerves level. Affirm is acting mainly through ingestion, due to its mode of action and fast activity, it is effective at very low rates and on all instars stages. It has been developed for the use on pomefruits, stonefruits, grapes and a broda range of vegetables crops at a rate range of 1.5 to 3 g ai/100L. The product shows translaminar activity and rapid degradation on leaf surface; therefore the active ingredient breaks down in a very short time to sublethal doses for most beneficials organisms living on the vegetation. The short rentry time, generally 24 hours for beneficials and impollinators, makes Affirm compatible for IPM programme in orchards and greenhouses. Also the residue profile is very favourable, leading to a very low maximum residue level and short preharvest interval in all edible crops.

Qualidade microbiologica da carne de frango irradiada em embalagem convencional e a vácuo / Microbiological evaluation of chicken breast meat irradiated in conventional and vacuum package

Foram avaliados os efeitos da radiação gama nas doses de 1,5 e 3,0kGy, em peitos de frango embalados em embalagem convencional e a vácuo. As amostras embaladas foram submetidas à irradiação e estocadas sob refrigeração (4ºC) por 30 dias. A radiação mostrou-se eficiente na redução de mesófilos aeróbios estritos e facultativos viáveis, coliformes totais e termotolerantes, com destaque para Salmonella spp. Os bolores e leveduras mostraram-se bastante resistentes à radiação. Os resultados sugerem que a dose de 3,0kGy pode ser utilizada no controle da microbiota do peito de frango armazenado sob refrigeração, sendo uma alternativa para o aumento da vida de prateleira por até 10 dias, ao garantir a segurança do consumidor pela eliminação de possíveis patógenos.

The effects of gamma radiation doses of 1.5 and 3.0kGy on chicken breasts packed under conventional or vacuum atmosphere were evaluated. The packed samples were subjected to irradiation and stored under refrigeration (4ºC) for 30 days. The radiation was efficient in reducing strict and facultative aerobic mesophiles, total and fecal coliforms, and mainly Salmonella spp. The molds and yeasts were very resistant to radiation. The results suggest that gamma radiation at 3.0kGy can be used to control the microbiota in chicken breast stored under refrigeration, as an alternative to extend the shelf-life for more than ten days and ensure the food safety by eliminating potential pathogens.

Liver transplantation at a university hospital, faculty of the medicine of Ribeirão Preto, University of São Paulo: results for the first 60 recipients.

The purpose of the present article was to present the series operated by a Liver Transplant Group of the interior of the State of Sao Paulo, Brazil. Sixty patients were transplanted from May 2001 to May 2007. Thirty percent of the patients had alcoholic cirrhosis. 18.3% had C virus-induced cirrhosis, 10% had C virus- and alcohol-induced cirrhosis, 6% had B virus-induced cirrhosis, 13.3% had cryptogenic cirrhosis, 8.3% autoimmune cirrhosis, 13.3% had familial amyloidotic polyneuropathy (FAP), and 13.3% had hepatocellular carcinomas. The series was divided by a chronological criterion into two periods: A (n = 42) and B (n = 18) with the latter group operated based upon the Model for End-stage Liver Disease (MELD) criterion. Sixty-nine percent were men. Age ranged from 14 to 66 years. Period A included 12% Child A: 59.2%, Child B; 24%, Child C; and 4.8%, FAP. Period B comprises 22.2% Child A: 11.1%, Child B: 33.3%, Child C: and 33.3%, FAP. MELD scores ranged from 8 to 35 for period A and from 14 to 31 for period B. Intraoperative mortality was 2/42 patients for period A and 0/18 for period B, overall postoperative mortality was 40% including for period A, 35% among Child B and C patients, and 5% among FAP and Child A patients (P < .05) and 16.6% for period B among 11.1% Child B patients and 5.5% FAP patients; 3.3% of patients required retransplantation due to hepatic artery thrombosis. Real postoperative survival was 60% during period A and 83.3% during period B, with an overall survival rate of 67% for the two periods. The present results show levels of postoperative mortality, (especially during period B), and survival rates similar to those reported by several other centers in Brazil.