Vitamin D status, oxidative stress, and inflammation in children and adolescents: A systematic review.

Vitamin D deficiency is considered a global public health problem with high prevalence in children and adolescents. The majority of the studies in the literature have identified a relationship between vitamin D insufficiency/deficiency and obesity, as well as other traditional cardiometabolic risk factors in children and adolescents. Scarce studies address vitamin D status with oxidative stress and inflammation in the young population. The aim of this systematic review was to evaluate the evidence of the association of vitamin D status with oxidative stress and inflammation in children and adolescents. This is a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guideline on reporting systematic reviews. Eight studies were selected for this review. All included studies evaluated inflammatory biomarkers and two out of eight evaluated biomarkers of oxidative stress. The majority of the studies (five out of eight) found association of vitamin D status with biomarkers of oxidative stress and inflammation such as C-reactive protein (CRP), interleukin-6 (IL-6), cathepsin S, vascular cell adhesion molecule-1 (VCAM-1), malondialdehyde (MDA), myeloperoxidase, 3-nitrotyrosine, and superoxide dismutase (SOD). Vitamin D status is associated with oxidative stress and inflammation in the majority of the studies with children and adolescents. Thus, the assessment of vitamin D status is important because it is associated with nontraditional cardiometabolic markers in the pediatric population (review registration: PROSPERO CRD42018109307).

Frailty in End-Stage Renal Disease Patients under Dialysis and Its Association with Clinical and Biochemical Markers.

Frailty is a common complication in elderly patients with end-stage renal disease (ESRD) under dialysis, which is a strong risk factor for low quality of life, morbidity, and mortality. In this work, we aimed to evaluate the prevalence of frailty in a group of Portuguese ESRD patients, and its association with socio-demographic, clinical and biochemical markers. We performed a cross-sectional study with 83 ESRD patients (44 males and 39 females, 64.3 [±14.6] years old) on regular dialysis. The classification of the ESRD patients as robust, pre-frail and frail was performed using the FRAIL questionnaire. Social support, data about sociodemographic and comorbidities, and haematological, iron status, dialysis adequacy, nutritional and inflammatory markers were also evaluated. Our results confirmed that frailty is a highly prevalent condition in ESRD patients, particularly in female patients. An association between FRAIL score and increased depressive symptoms, presence of hypertension and decrease nutritional status was also found.

Concentrations of Metals, Metalloids, and Chlorinated Pollutants in Blood and Plasma of White Stork (Ciconia ciconia) Nestlings From Spain.

The aim of this study was to determine the levels of different inorganic elements (lead [Pb], mercury [Hg], and arsenic [As]) and persistent chlorinated pollutants (including polychlorinated biphenyls [PCBs] and organochlorine pesticides [OCPs]) in blood and plasma of White stork (Ciconia ciconia) nestlings from northwest (NW) Spain. The concentrations of PCBs were lower than the limit of detection in all samples. The OCPs γ-HCH, 4,4'-DDE, HCB, and endosulfan were detected most frequently in plasma from White stork nestlings. These OCPs were detected in 98, 54, 39, and 37 % of all samples, respectively. However, the concentrations of organic pollutants were lower than the risk thresholds for birds. The mean levels of the inorganic elements Pb, Hg, and As were found to be 36.92 ± 33.48, 16.48 ± 12.87, and 9.813 ± 13.84 µg/L, respectively. These levels were also lower than the risk thresholds for birds. This study not only provides a snapshot of the levels of both inorganic and organic contaminants in wild White storks in NW Spain, it also provides a useful baseline for biomonitoring levels of the measured contaminants in this area.

NOTES transvaginal cholecystectomy: preliminary clinical application.

BACKGROUND: Natural orifice translumenal endoscopic surgery (NOTES) is an emerging concept in the recent literature that could lead to potential benefits in clinical applications. Restricted to animal experiments, however, human procedures have not yet been published. Because of the technical and ethical challenges involved in perforation and closure of a healthy organ-as is also seen in operating via the transgastric route-and because of the lack of understanding of the physiopathology and infection risk with these approaches, they have not been applied in the clinical setting. Thus the present study, based on previous animal experiments, describes preliminary clinical application in four cases of transvaginal NOTES cholecystectomy, and discusses safety, feasibility, and potential benefits of the method. METHODS: Preliminary acute and survival animal experiments developed by the NOTES Research Group at our institution solved such technical problems for transvaginal NOTES as spatial orientation, insufflation, and instrumentation, making possible the introduction of NOTES as a clinical application. The trials were approved by ethics committee of our institution, and informed consent was obtained from all patients. Since 13 March 2007, four female patients with elective surgical indication for cholecystectomy have undergone transvaginal NOTES cholecystectomy. All intraoperative and postoperative parameters were documented. Vaginal access was achieved under direct vision with conventional instruments, and a 2-channel colonoscope was inserted into the abdominal cavity. After endoscopic insufflation to achieve pneumoperitoneum with CO(2), instruments were inserted through and alongside a colonoscope, allowing successful NOTES cholecystectomy in all patients, with vaginal extraction of the gallbladder. The vaginal wound was closed by direct vision using conventional instruments. RESULTS: The procedure was successful in all patients, with operative time of 45-115 min. Patients experienced low need for postoperative analgesia. Free oral intake was permitted 2 h after the procedure. There were no postoperative complications, and patients were discharged, according to the study protocol, 48 h after the procedure. CONCLUSIONS: Preliminary results showed the feasibility and safety of the transvaginal NOTES method in this small initial study population. The technique, developed in our institution, and not transgastric NOTES, may be the preferred approach to serve as the basis for clinical studies.

Aberrant phenotypes in acute myeloid leukemia: a high frequency and its clinical significance.

BACKGROUND AND OBJECTIVES: Immunophenotyping is an essential method for diagnosis and classification of acute myeloid leukemias (AML), and its extensive use could identify blast cell subpopulations with aberrant phenotypes rarely seen in normal myelopoiesis. The aberrant phenotypes have been correlated with clinical, morphological and prognostic features but their occurrence in AML differs in the various studies. DESIGN AND METHODS: In this study, we analyzed 35 cases of AML, examining them for aberrant phenotypes by multiparametric flow cytometry. Co-expression of lymphoid-associated markers in myeloblasts and asynchronous antigen expression were correlated with clinical features. RESULTS: Aberrant phenotypes were found in 88.6% of the cases studied. In this group, cross-lineage antigen expression was present in 34.3% and asynchronous expression in 82.4% of the cases. CD7 was the most frequent lymphoid-associated antigen. Among the cases of asynchronous antigen expression, the most frequent phenotype was CD117(+) and/or CD34(+) in association with CD11c(+), followed by CD15(+) and CD65(+), corresponding to 67.6%, 61.7 and 50.0% of the cases, respectively. Twenty out of 33 patients were available for complete remission assessment. The CD117(+) CD15(+) phenotype correlated significantly with complete remission achievement and with the lack of unfavorable chromosome associations. INTERPRETATION AND CONCLUSIONS: We conclude that aberrant phenotypes, as they are described here, are present in the great majority of cases of AML, asynchronous antigen expression being the most frequent example; and that CD117(+) CD15(+) phenotype shows a relevant association with clinical prognosis.

Multicystic dysplastic kidney detected by fetal sonography: conservative management and follow-up.

The most common cystic lesion recognized antenatally is multicystic dysplastic kidney (MCDK). Recently, conservative management without nephrectomy has been advocated. The purpose of this study was to report our experience in the conservative management of unilateral MCDK. Between 1989 and 1997, 20 children with MCDK detected by prenatal ultrasonography (US) were prospectively followed. At birth, US confirmed the prenatal findings in all cases. All patients were submitted to radioisotope scans and a micturating cystogram. Follow-up US examinations were performed annually. Mean age at diagnosis during the prenatal period was 31 weeks of gestation (range 24-38). Median follow-up time was 33 months (range 7-91). Follow-up US was performed in 19 children; 13 (68%) showed partial involution, 4 (21%) complete involution, and 2 (11%) an increase in unit size. The mean age at complete or partial involution of the lesion was 18 months. No children developed hypertension or tumors, and all maintained normal growth. In conclusion, the natural history of MCDK is usually benign, and serial US examinations show that affected kidneys frequently show involution with time.

Primary megaureter detected by prenatal ultrasonography: conservative management and prolonged follow-up.

With the widespread use of obstetric echography the incidence of fetal hydronephrosis has been reported more frequently. Consequently, many uropathies have been detected in asymptomatic neonates. The authors report their experience with prenatally detected primary non-refluxing megaureter. Newborns with fetal hydronephrosis were investigated by ultrasonography and micturating cystourethrogram after the beginning of chemoprophylaxis. If primary megaureter was identified, after 1 month the children underwent 99tm-DMSA, diuretic 99tm-DTPA, and intravenous urography. Eight infants with primary megaureter (bilateral in 3 cases) were identified, for a total of 11 renal units for study. All children were submitted to non-operative management. We performed ultrasonography and diuretic 99tm-DTPA during follow-up, which lasted on average 75 months. The mean cross-sectional diameter of the dilated ureter was 13.6 mm during neonatal period, and reached 8.4 mm at the end of follow-up. The renal function and the diuretic renogram remained stable throughout follow-up. Two neonates presented transitory hypertension. Our results support the notion that conservative management is safe for primary megaureter detected in asymptomatic neonates, with most cases showing spontaneous regression during a prolonged follow-up.

[Paracoccidioidomycosis of the central nervous system: case report]. / Paracoccidioidomicose do sistema nervoso central: relato de caso.

The involvement of the central nervous system in paracoccidioidomycosis is more frequent than previously thought. The first reference to the possibility that Paracoccidioides brasiliensis could affect the central nervous system was by Pereira & Jacobs in 1919. Since then, a great number of other studies has showed this form of clinical behavior and, in some of them, the frequency has ranged 27.27%. We report a clinical case of a 34-year-old white Brazilian woman admitted because of bacterial pneumonia. In the sixth day of admission, the patient developed cerebellar symptomatology with nausea, vomiting, dysmetria and gait disturbance. Central nervous system computer tomographic scanning disclosed a hypodense lesion in the right cerebellar hemisphere. The patient was submitted to surgery with total excision of the lesion. Histopathological examination confirmed the diagnosis of neuroparacoccidioidomycosis. Coadjuvant treatment with sulfamethoxazole-trimetoprim was introduced. The patient had a good outcome and was discharge 30 days after surgery.

Microstructure of ceramic coating on titanium surface as a result of hydrothermal treatment.

Hydroxyapatite coating on commercially pure titanium has been produced by a biomimetic method in order to improve osteointegration for medical implant purposes. A specific chemical treatment by etching titanium substrate with different concentrations of NaOH aqueous solution at 130 degrees C in an autoclave, followed by heat treatment at 600 degrees C was selected to obtain an activated titanium substrate. The microporous surface obtained has allowed the nucleation and growth of a calcium phosphate layer by soaking the substrate in a simulated body fluid (SBF). Scanning electron microscopy (SEM) together with energy dispersive analyzer for X-ray (EDS), X-ray diffraction (XRD) as well as Fourier transform infrared spectroscopy (FT-IR) were employed to evaluate the hydroxyapatite coating. A homogeneous structure coating without cracks defined the chemical treatment condition of the substrate.

Nucleation and growth of hydroxyapatite on titanium pretreated in NaOH solution: experiments and thermodynamic explanation.

Titanium was submitted to chemical attack with sodium hydroxide solution under hydrothermal (SBF) conditions and then kept for 4 weeks in simulated body fluid after heat treatment. The resultant coating titanium samples were characterized regarding nucleation and growth of hydroxyapatite on their surfaces using scanning electron microscopy and energy dispersive spectroscopy, as well as low angle X-ray diffraction. In order to obtain a thermodynamic explanation of same results, Eh-pH diagrams of Na-Ti-H2O and Ca-Ti-H2O systems at 25, 100, 200, and 300 degrees C were built for selected activities of the species in aqueous solutions. Values of pairs corresponding to the predominance limit of the species in solution at equilibrium with 0.21 atm of oxygen pressure were taken from these Eh-pH diagrams for subsequent building of the pNa-pH and pCa-pH diagrams of the same systems at each referred temperature (pi = -log10ai). In addition, the titanate-apatite free energy of formation was estimated and then a pCa-pH diagram of the Ca-P-Ti-H2O system at 25 degrees C was built. Examination of the resultant diagrams could elucidate the thermodynamic viability of the process.

[Electroencephalographic modification in Down syndrome]. / Alterações eletrencefalográfricas na síndrome de Down.

The frequency of epilepsy in Down syndrome (DS) has been reported in literature varying from 6 to 17%. A typical electroencephalographic (EEG) pattern has not been established for this condition. There is a great variation on EEG abnormalities and most of them are not associated to behavior alterations or neurological signs. The aim of this study was to establish epidemiological and electroencephalographic parameters in institutionalized patients with clinical diagnosis of DS. We studied 77 individuals of both sexes, age ranging from 0-38 years old. The EEG was performed on all the patients; 20.7% had EEG abnormalities and 31.3% of these were epileptic. The non-epileptic patients presented inespecific EEG abnormalities. Therefore, our data did not allow us to propose a typical EEG pattern for DS.

Epilepsy is not a disease. Proposal for a new approach in the International Classification of Diseases (ICD).

What is epilepsy? a disease? a symptom? a syndrome? is it important to define it? Basing his study on an extensive bibliography, the author shows that epilepsy is not a disease. He emphasizes the significance of that definition and suggest a new approach in the International Classification of Diseases (ICD).

Solution effects on the surface reactions of three bioactive glass compositions.

The in vitro five-stage surface reactions of two bioactive glass compositions, 45S5 and 52S4.6, and one bioinert glass, 60S3.8, exposed to three simulated body fluids (SBF) were analyzed using Fourier Transform infrared Spectroscopy (FTIR). There was little effect of SBF composition on ion exchange, silica hydrolysis, and silica polymerization (stages 1-3) of glass with silica content up to 52 wt%. However, calcium and phosphate ions in SBF accelerated the formation of an amorphous calcium-phosphate (a-CP) layer (stage 4), and crystallization (stage 5) of the hydroxycarbonate apatite (HCAp) layer. The magnesium ions had a retardation effect on the kinetics of stages 4 and 5, but little effect on stages 1-3. In SBF solutions which contained calcium and phosphate ions an amorphous calcium-phosphate (a-CaP) layer formed on even a 60S3.8 glass which was not bioactive in vivo. However, the a-CaP layer did not crystallize to form HCAp. Thus, there is a significant contribution from the ions present in the SBF solutions to the HCAP formation and crystallization of HCAp on bioactive glasses. Also, silanol repolymerization is necessary for rapid crystallization of HCAp.

Solution effects on the surface reactions of a bioactive glass.

The in vitro surface reactions of a 45S5 bioactive glass in three simulated body fluids (SBF) are analyzed using Fourier transform infrared (FTIR) spectroscopy. Five reaction stages are observed. Calcium and phosphate ions in SBF accelerate to a small extent the repolymerization of silica (Stage 3) and formation of an amorphous calcium-phosphate (a-CP) layer (Stage 4) on the glass surface. The a-CaP layer is crystallized to form hydroxy-carbonate apatite (HCAp) (Stage 5) more rapidly in the Ca- and P-containing SBF solutions (in 90 min rather than 120 min). However, Mg ions in SBF slow down formation of the a-CaP layer and greatly retard crystallization of HCAp on the glass surface.

[Definitively: epilepsy is not a disease]. / Definitivamente: epilepsia não é doença.

The author analyses past concepts which still hold good today. Such concepts regard epilepsy as a mental disease and the epileptic is usually taken as someone suffering from a severe mental disorder, tending to criminal behaviour. The author proves, taking into account various statements from prominent personalities in the scientific world, that epilepsy is neither a mental disease nor a disease in its own sense, and that the epileptic has not an aggressive behaviour.

Cardiolipin, a major phospholipid of Gram-positive bacteria that is not readily extractable.

Extraction of phospholipids from stationary phase grown cells of the Gram+ bacteria, Bacillus megaterium, Bacillus subtilis, Bacillus cereus and Micrococcus lysodeikticus was found to be incomplete with various commonly used extraction procedures. Phosphatidylglycerol and phosphatidylethanolamine were readily extracted but up to 95% of the cardiolipin appeared to be retained within the cell residue. Extraction of the cardiolipin could be slightly enhanced by increasing the temperature or the acidity of the extraction solutions but complete extraction was obtained only after lysozyme treatment of intact cells or cell residues remaining after extraction. In addition complete extraction could be observed in the case of cells harvested in the early logarithmic phase. Freeze-fracture electron microscopy was carried out on the cell residue remaining after extraction of all phospholipids except cardiolipin. A fracture plane through the plasma membrane could not be observed anymore. Instead fracture planes through lipid vesicles were observed. These vesicles reside within the remnants of the cytoplasm and consist most likely of the non-extracted cardiolipin.

[Leber's disease. Genetic study of a family]. / Doença de Leber. Estudo genetico de uma familia

In this paper it is done the genetic study of a large family that segregates the hereditary optical atrophy gene. The modality of the hereditary transmission is the sex-linked recessive form (Leber's form). Five generations were studied, with a total of 134 individuals. Thirteen are affected (12 men: 1 woman). The study of the heredogram allows the observation of the high occurrence of women carriers and the affected men with descendents (2 married men in the heredogram) exhibit normal offspring (22 individuals, being 16 men and 6 women). One affected woman carrier is also observed. Such observations are in accordance with the literature. This study allows one to conclude by the high importance of genetic counselling, considering that the normal women carriers, which occur in great number, segregate the gene to individuals who will manifest the atrophy.