Publications by authors named "Hernándes"

377 Publications

Clinical and microbiological factors predicting outcomes of nonfermenting gram-negative bacilli peritonitis in peritoneal dialysis.

Sci Rep 2021 Jun 10;11(1):12248. Epub 2021 Jun 10.

Botucatu Medical School, Sao Paulo State University Julio de Mesquita Filho (UNESP), Botucatu, Brazil.

Peritonitis due to gram-negative bacilli (GNB), particularly nonfermenting GNB (NF-GNB), is a serious complication of peritoneal dialysis with a low resolution rate. Beyond the patient's condition, microbiological properties such as antimicrobial resistance, biofilm production and other virulence factors can explain the poor outcomes. This study aimed to evaluate the influence of patient condition, microbiological characteristics, including biofilm production, and treatment on peritonitis outcome. We reviewed the records of 62 index episodes caused by NF-GNB that occurred between 1997 and 2015 in our center. The etiologies were species of Pseudomonas (51.6%), Acinetobacter (32.2%), and other NF-GNB (16.1%). There was a high (72.9%) proportion of biofilm producer lineages. The in vitro susceptibility rate of Pseudomonas spp. to amikacin, ciprofloxacin, and ceftazidime was significantly greater than that of Acinetobacter spp. and other species; however, there was a similar low resolution rate (< 45%) among the episodes attributable to them. Preexisting exit-site infection was independently associated with nonresolution. No other factor, including biofilm production, was associated with the outcome. The higher in vitro susceptibility of Pseudomonas compared to other NF-GNB that presented a similar resolution rate suggests that bacterial virulence factors such as biofilms can act in concert, thereby worsening the outcome.
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http://dx.doi.org/10.1038/s41598-021-91410-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192548PMC
June 2021

Manual versus semiautomatic segmentation of soft-tissue sarcomas on magnetic resonance imaging: evaluation of similarity and comparison of segmentation times.

Radiol Bras 2021 May-Jun;54(3):155-164

Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil.

Objective: To evaluate the degree of similarity between manual and semiautomatic segmentation of soft-tissue sarcomas on magnetic resonance imaging (MRI).

Materials And Methods: This was a retrospective study of 15 MRI examinations of patients with histopathologically confirmed soft-tissue sarcomas acquired before therapeutic intervention. Manual and semiautomatic segmentations were performed by three radiologists, working independently, using the software 3D Slicer. The Dice similarity coefficient (DSC) and the Hausdorff distance were calculated in order to evaluate the similarity between manual and semiautomatic segmentation. To compare the two modalities in terms of the tumor volumes obtained, we also calculated descriptive statistics and intraclass correlation coefficients (ICCs).

Results: In the comparison between manual and semiautomatic segmentation, the DSC values ranged from 0.871 to 0.973. The comparison of the volumes segmented by the two modalities resulted in ICCs between 0.9927 and 0.9990. The DSC values ranged from 0.849 to 0.979 for intraobserver variability and from 0.741 to 0.972 for interobserver variability. There was no significant difference between the semiautomatic and manual modalities in terms of the segmentation times ( > 0.05).

Conclusion: There appears to be a high degree of similarity between manual and semiautomatic segmentation, with no significant difference between the two modalities in terms of the time required for segmentation.
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http://dx.doi.org/10.1590/0100-3984.2020.0028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177681PMC
June 2021

Evaluation of variations of the glenoid attachment of the inferior glenohumeral ligament by magnetic resonance arthrography.

Radiol Bras 2021 May-Jun;54(3):148-154

Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil.

Objective: To evaluate the anatomical variations of the attachment of the inferior glenohumeral ligament (IGHL) to the anterior glenoid rim.

Materials And Methods: This was a retrospective review of 93 magnetic resonance arthrography examinations of the shoulder. Two radiologists, who were blinded to the patient data and were working independently, read the examinations. Interobserver and intraobserver agreement were evaluated. The pattern of IGHL glenoid attachment and its position on the anterior glenoid rim were recorded.

Results: In 50 examinations (53.8%), the glenoid attachment was classified as type I (originating from the labrum), whereas it was classified as type II (originating from the glenoid neck) in 43 (46.2%). The IGHL emerged at the 4 o'clock position in 58 cases (62.4%), at the 3 o'clock position in 14 (15.0%), and at the 5 o'clock position in 21 (22.6%). The rates of interobserver and intraobserver agreement were excellent.

Conclusion: Although type I IGHL glenoid attachment is more common, we found a high prevalence of the type II variation. The IGHL emerged between the 3 o'clock and 5 o'clock positions, most commonly at the 4 o'clock position.
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http://dx.doi.org/10.1590/0100-3984.2020.0043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177672PMC
June 2021

Genome profiling of fluoroquinolone-resistant uropathogenic Escherichia coli isolates from Brazil.

Braz J Microbiol 2021 Jun 8. Epub 2021 Jun 8.

Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil.

Urinary tract infections (UTIs) are a major public health concern in both community and hospital settings worldwide. Uropathogenic Escherichia coli (UPEC) is the main causative agent of UTI and increasingly associated with antibiotic resistance. Herein, we report the draft genome sequence of 9 fluoroquinolone-resistant UPEC isolates from Brazil and examine selected major phenotypic features, such as antimicrobial resistance profile, phylogroup, serotype, sequence type (ST), virulence genes, and resistance marks. Besides the quinolone resistance, beta-lactams, ESBL production, aminoglycosides, and tetracycline resistance were observed. High prevalence of 20 virulence genes was detected in all isolates, such as those encoding type 1 fimbriae, acid tolerance system, and hemolysin E, particularly within E. coli B2 phylogroup, as ST131 and ST1193 strains, among other genomic analyses as genomic islands, resistance plasmids, and integron identification.
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http://dx.doi.org/10.1007/s42770-021-00513-3DOI Listing
June 2021

Therapeutic versus prophylactic anticoagulation for patients admitted to hospital with COVID-19 and elevated D-dimer concentration (ACTION): an open-label, multicentre, randomised, controlled trial.

Lancet 2021 06 4;397(10291):2253-2263. Epub 2021 Jun 4.

Brazilian Research in Intensive Care Network, São Paulo, Brazil; BP-A Beneficência Portuguesa de São Paulo, São Paulo, Brazil.

Background: COVID-19 is associated with a prothrombotic state leading to adverse clinical outcomes. Whether therapeutic anticoagulation improves outcomes in patients hospitalised with COVID-19 is unknown. We aimed to compare the efficacy and safety of therapeutic versus prophylactic anticoagulation in this population.

Methods: We did a pragmatic, open-label (with blinded adjudication), multicentre, randomised, controlled trial, at 31 sites in Brazil. Patients (aged ≥18 years) hospitalised with COVID-19 and elevated D-dimer concentration, and who had COVID-19 symptoms for up to 14 days before randomisation, were randomly assigned (1:1) to receive either therapeutic or prophylactic anticoagulation. Therapeutic anticoagulation was in-hospital oral rivaroxaban (20 mg or 15 mg daily) for stable patients, or initial subcutaneous enoxaparin (1 mg/kg twice per day) or intravenous unfractionated heparin (to achieve a 0·3-0·7 IU/mL anti-Xa concentration) for clinically unstable patients, followed by rivaroxaban to day 30. Prophylactic anticoagulation was standard in-hospital enoxaparin or unfractionated heparin. The primary efficacy outcome was a hierarchical analysis of time to death, duration of hospitalisation, or duration of supplemental oxygen to day 30, analysed with the win ratio method (a ratio >1 reflects a better outcome in the therapeutic anticoagulation group) in the intention-to-treat population. The primary safety outcome was major or clinically relevant non-major bleeding through 30 days. This study is registered with ClinicalTrials.gov (NCT04394377) and is completed.

Findings: From June 24, 2020, to Feb 26, 2021, 3331 patients were screened and 615 were randomly allocated (311 [50%] to the therapeutic anticoagulation group and 304 [50%] to the prophylactic anticoagulation group). 576 (94%) were clinically stable and 39 (6%) clinically unstable. One patient, in the therapeutic group, was lost to follow-up because of withdrawal of consent and was not included in the primary analysis. The primary efficacy outcome was not different between patients assigned therapeutic or prophylactic anticoagulation, with 28 899 (34·8%) wins in the therapeutic group and 34 288 (41·3%) in the prophylactic group (win ratio 0·86 [95% CI 0·59-1·22], p=0·40). Consistent results were seen in clinically stable and clinically unstable patients. The primary safety outcome of major or clinically relevant non-major bleeding occurred in 26 (8%) patients assigned therapeutic anticoagulation and seven (2%) assigned prophylactic anticoagulation (relative risk 3·64 [95% CI 1·61-8·27], p=0·0010). Allergic reaction to the study medication occurred in two (1%) patients in the therapeutic anticoagulation group and three (1%) in the prophylactic anticoagulation group.

Interpretation: In patients hospitalised with COVID-19 and elevated D-dimer concentration, in-hospital therapeutic anticoagulation with rivaroxaban or enoxaparin followed by rivaroxaban to day 30 did not improve clinical outcomes and increased bleeding compared with prophylactic anticoagulation. Therefore, use of therapeutic-dose rivaroxaban, and other direct oral anticoagulants, should be avoided in these patients in the absence of an evidence-based indication for oral anticoagulation.

Funding: Coalition COVID-19 Brazil, Bayer SA.
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http://dx.doi.org/10.1016/S0140-6736(21)01203-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177770PMC
June 2021

Stressors in Indoor and Field Brazilian Soccer: Are They Perceived as a Distress or Eustress?

Front Psychol 2021 20;12:623719. Epub 2021 May 20.

Master's and Doctoral Programme in Physical Education, São Judas Tadeu University, São Paulo, Brazil.

Soccer players inescapably live under stress during the sportive career, and many real-life aspects of soccer situations operate in the ongoing performance. This study's main objective was to elaborate the List of Stressors in Professional Indoor and Field Soccer, a self-report instrument designed to measure the impact of 77 soccer situations upon the sport performance. Participants were 138 indoor and field soccer players from the Brazilian Premier League. Each situation was evaluated on a 7-point scale, ranging from the most negative (-3) to the most positive (+3). Data were analyzed according to the players' perception of the items: distress or eustress and its intensity, and after that, situations perceived as plus -1 and +1 were compared by time in which they were experienced and distributed among five categories established by the literature: Expectations about the Performance, Personal Factors, Competition Aspects, Training Demands, and Relationship with Significant People. Narratives of athletes' experiences were also used to discuss the results. An Exploratory Structural Equation Modeling using Bi-factorial (BI-ESEM) was employed to assess the factor structure. For the total participants, 49 situations were perceived as distress and 28 as eustress. Using the criteria established , the distribution was among the five categories in the remaining 32 situations. Differences in perception between less and more experienced players were found in 11 situations. The results revealed that Brazilian professional soccer players experience various stressful situations. These events are important representations of environmental demands and could predict the performance as they are perceived as eustress or distress. Some of these stressful situations are inherent in sport and others adjacent to the sports system or environment. Coach pressure to win and conflicts with teammates are examples of stressors in-sport, family problems and disputes with press or fans are examples of stressors external to the team, also called peripheral opponents, and showed the relative social influence of significant others in soccer performance. We can conclude that the knowledge of the direction of a given stress situation has important practical implications in preparing athletes and helping them face the performance stressors that are part of soccer daily life.
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http://dx.doi.org/10.3389/fpsyg.2021.623719DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173184PMC
May 2021

Handgrip Strength as a Reflection of General Muscle Strength in Chronic Obstructive Pulmonary Disease.

COPD 2021 May 7:1-12. Epub 2021 May 7.

Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil.

Muscle dysfunction is one of the main features in individuals with chronic obstructive pulmonary disease (COPD). Handgrip strength (HS) has been used as a representation of general muscle strength in various populations, and a few studies found correlation between HS and other measures of upper and lower limbs' muscle strength in the general population, although this was not yet studied in depth in COPD. The aims of this study were to verify if HS is cross-sectionally well correlated with upper and lower limbs' muscle strength in individuals with COPD, and to identify a new cutoff for handgrip weakness in this population. HS was assessed by a dynamometer, whereas other muscle strength assessments comprised maximal voluntary contraction (MVC) of the quadriceps femoris and 1-repetition maximum (1RM) of biceps and triceps brachii, pectoralis major, latissimus dorsi and quadriceps femoris. Additional assessments included pulmonary function and volumes, body composition and exercise capacity. Fifty individuals with COPD were studied (65 ± 7 years; FEV 51 ± 14%pred). HS showed moderate-to-strong correlations with all 1-RM assessments (0.62< < 0.75) and especially with MVC of the quadriceps femoris ( = 0.83) ( < 0.05 for all). Correlations were stronger for male than female individuals, and the assessment performed on right, left or dominant hand did not present significant differences. A cutoff of 0.3892 for HS/weight yielded an AUC = 0.90 to identify weakness. In conclusion, HS is a good reflection of upper and lower limbs' muscle strength in individuals with COPD. Its usefulness as a surrogate for more complex assessments must be based on the settings and conditions.
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http://dx.doi.org/10.1080/15412555.2021.1919608DOI Listing
May 2021

Correction to: Transdermal Permeation of Caffeine Aided by Ionic Liquids: Potential for Enhanced Treatment of Cellulites.

AAPS PharmSciTech 2021 Apr 28;22(4):144. Epub 2021 Apr 28.

PhageLab - Laboratory of Biofilms and Bacteriophages, University of Sorocaba, Sorocaba, SP, 18023-000, Brazil.

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http://dx.doi.org/10.1208/s12249-021-02015-9DOI Listing
April 2021

Overview of miRNAs for the non-invasive diagnosis of endometriosis: evidence, challenges and strategies. A systematic review.

Einstein (Sao Paulo) 2021 26;19:eRW5704. Epub 2021 Apr 26.

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

Objective: The aim of the study was to assess the evidence on miRNAs as biomarkers for the diagnosis of endometriosis, as well as to provide insights into the challenges and strategies associated with the use of these molecules as accessible tools in clinical practice.

Methods: Systematic review conducted on PubMed®, Latin American and Caribbean Health Sciences Literature (LILACS), MEDLINE® and Web of Science databases using the search terms endometriosis (all fields) AND miRNA (all fields), evaluating all publication up to May 2019.

Results: Most miRNAs found to be dysregulated in this study were harvested from tissue samples, which precludes their use as a non-invasive diagnostic test. However, differential expression of 62 miRNAs was reported in samples that may be used for non-invasive diagnosis of endometriosis, such as blood, serum and plasma.

Conclusion: Despite the identification of several candidates, studies are investigatory in nature and have been conducted with small number of samples. Also, no particular miRNA has been validated for diagnostic purposes so far. Studies based primarily on biological samples and applicable to translational research are warranted. Large databases comprising information on sample type and the use of saliva and vaginal fluid for miRNAs identification may prove essential to overcome current barriers to diagnosis of endometriosis.
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http://dx.doi.org/10.31744/einstein_journal/2021RW5704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054530PMC
April 2021

Instruments to assess function or functionality in adults after a burn injury: A systematic review.

Burns 2021 Apr 14. Epub 2021 Apr 14.

Stricto Sensu Graduate Program in Rehabilitation Sciences, State University of Londrina (UEL) and University Pitágoras Unopar (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil. Electronic address:

Introduction: Assessment of functionality or function, through valid and reliable instruments, is essential during rehabilitation of adults after a burn injury. Currently, there is no consensus in the literature regarding the most appropriate tool that should be used to assess function or functionality; there is also no synthesis of the current studies published in this area.

Objectives: To investigate and report the instruments used to assess function or functionality in adults after a burn injury; to identify the characteristics and evidence on their measurement properties; and to evaluate their clinical utility.

Methods: We systematically searched the literature via six electronic databases and via screening reference lists of relevant studies. The review was registered in PROSPERO (CRD42016048065) and reported according to the PRISMA statement. Studies in which function or functionality of upper and/or lower limbs of adults after a burn injury was assessed were included. Exclusion criteria comprised studies in pediatric populations and conference abstracts.

Results: Thirty-four studies were included. Twelve questionnaires and seven objective tests for function or functionality were identified. Three specific tools were found; four generic instruments have been validated in burns. Nine studies evaluated the instruments' measurement properties, presenting at least one property classified as 'fair' quality. Finally, 18 instruments demonstrated clinical utility.

Conclusion: This systematic review demonstrated that most instruments used to assess function or functionality in adults with a burn injury have not been specifically developed for this population and had their measurement properties poorly studied. Conversely, almost all instruments had clinical utility.
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http://dx.doi.org/10.1016/j.burns.2021.04.003DOI Listing
April 2021

Role of 5-HT receptors in the ventral hippocampus in the regulation of anxiety- and panic-related defensive behaviors in rats.

Behav Brain Res 2021 Jun 20;408:113296. Epub 2021 Apr 20.

Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil. Electronic address:

Changes in 5-HT receptor (5-HTR)-mediated neurotransmission in the hippocampus have been associated with anxiety, depression and in the mode of action of antidepressant drugs. It has been commonly accepted that whereas the dorsal pole of the hippocampus (DH) is involved in cognitive processing, the ventral pole (VH) is associated with emotional regulation. However, to date, only a few studies have directly addressed the role played by VH 5-HTRs in anxiety and panic processing, and their results are conflicting. Here we report that intra-VH administration of the 5-HT receptor agonist 8-OH-DPAT, the endogenous agonist serotonin (5-HT), or the standard anxiolytic benzodiazepine midazolam impaired the acquisition of inhibitory avoidance in the elevated T-maze (ETM) of male Wistar rats, indicating an anxiolytic effect. Conversely, local injection of the 5-HTR antagonist WAY-100635 caused the opposite effect. These results were equally found in the Vogel conflict test. None of these drugs interfered with locomotor activity in the open-field test, nor did they alter the expression of the escape response in the ETM, a defensive behavior associated with panic. Pre-injection of a sub-effective dose of WAY-100635 in the VH blocked the anxiolytic effect of 5-HT or 8-OH-DPAT in the Vogel test, confirming the involvement of 5-HTR for this behavioral effect. The effect in this test was anxiety-selective as none of the drugs affected water consumption or nociception. In conclusion, our results suggest that 5-HTRs in the VH play a tonic inhibitory role in anxiety processing. These receptors, however, are not involved in the regulation of panic-related escape behavior.
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http://dx.doi.org/10.1016/j.bbr.2021.113296DOI Listing
June 2021

Surface Wettability of a Natural Rubber Composite under Stretching: A Model to Predict Cell Survival.

Langmuir 2021 04 7;37(15):4639-4646. Epub 2021 Apr 7.

Departamento de Física, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina 88040-900, Brazil.

We report the stress-strain effect of a stretchable natural rubber (NR)-calcium phosphate composite on the surface wettability (SW) using an innovative approach coupling a uniaxial tensile micromachine, goniometer, and microscope. In situ contact angle measurements in real time were performed during mechanical tension. Our results show that SW is guided by the stress-strain relationship with two different characteristics, depending on the static or dynamic experiments. The results evidenced the limits of the classical theory of wetting. Furthermore, based on the mechanically tunable SW of the system associated with the cytocompatibility of the NR composite, we have modeled such a system for application as a cell support. From the experimental surface energy value, our proposed 3D modeling numerical simulation predicted a window of opportunities for cell-NR survival under mechanical stimuli. The presented data and the thermodynamics-based theoretical approach enable not only accurate correlation of SW with mechanical properties of the NR composite but also provide huge potential for future cell supportability in view of tissue engineering.
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http://dx.doi.org/10.1021/acs.langmuir.1c00430DOI Listing
April 2021

Metabolic Signature of Arrhythmogenic Cardiomyopathy.

Metabolites 2021 Mar 25;11(4). Epub 2021 Mar 25.

Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Via Galvani 31, 39100 Bolzano, Italy.

Arrhythmogenic cardiomyopathy (ACM) is a genetic-based cardiac disease accompanied by severe ventricular arrhythmias and a progressive substitution of the myocardium with fibro-fatty tissue. ACM is often associated with sudden cardiac death. Due to the reduced penetrance and variable expressivity, the presence of a genetic defect is not conclusive, thus complicating the diagnosis of ACM. Recent studies on human induced pluripotent stem cells-derived cardiomyocytes (hiPSC-CMs) obtained from ACM individuals showed a dysregulated metabolic status, leading to the hypothesis that ACM pathology is characterized by an impairment in the energy metabolism. However, despite efforts having been made for the identification of ACM specific biomarkers, there is still a substantial lack of information regarding the whole metabolomic profile of ACM patients. The aim of the present study was to investigate the metabolic profiles of ACM patients compared to healthy controls (CTRLs). The targeted Biocrates AbsoluteIDQ p180 assay was used on plasma samples. Our analysis showed that ACM patients have a different metabolome compared to CTRLs, and that the pathways mainly affected include tryptophan metabolism, arginine and proline metabolism and beta oxidation of fatty acids. Altogether, our data indicated that the plasma metabolomes of arrhythmogenic cardiomyopathy patients show signs of endothelium damage and impaired nitric oxide (NO), fat, and energy metabolism.
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http://dx.doi.org/10.3390/metabo11040195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064316PMC
March 2021

Transdermal Permeation of Caffeine Aided by Ionic Liquids: Potential for Enhanced Treatment of Cellulitis.

AAPS PharmSciTech 2021 Apr 1;22(3):121. Epub 2021 Apr 1.

PhageLab - Laboratory of Biofilms and Bacteriophages, University of Sorocaba, Sorocaba, SP, 18023-000, Brazil.

Ginoid hydrolipodystrophy (HDLG) or "cellulite" involves alteration of the cutaneous relief and occurs in 80-90% of the female population. Several topical treatments are available with the use of substances capable of stimulating lipolysis, such as caffeine. However, the effectiveness of topical therapy is related to the processes of release and permeation of the active in skin cells. In this sense, ionic liquids, such as choline geranate, are considered to facilitate topical permeation agents. In this way, the aim of this research was to develop and evaluation of the effectiveness of a cosmetic product for topical treatment of cellulite with caffeine in association with choline geranate. The choline geranate was synthesized by the reaction between geranic acid and choline hydroxide [1: 2]. The gel was prepared using 2% Carpobol 940®, 5% caffeine, and 1% choline geranate. Preliminary and accelerated stability tests were performed by checking pH, spreadability, and organoleptic characteristics. The transdermal permeation capacity of caffeine in vitro was evaluated by the Franz cell permeation assay, and the gel cytotoxicity by the MTS method. To prove the efficacy in the treatment of cellulite, a pilot type 1 clinical trial was carried out. The formulation was considered stable and the product maintained your characteristics during 180 days of storage. The product showed moderate cytotoxicity and high skin permeation capacity. In the clinical trial, it showed results superior to the caffeine gel without ionic liquid. The developed gel favored the cutaneous permeation of caffeine, showing a promising product in the treatment of cellulite.
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http://dx.doi.org/10.1208/s12249-021-01956-5DOI Listing
April 2021

Nighttime features derived from topic models for classification of patients with COPD.

Comput Biol Med 2021 May 10;132:104322. Epub 2021 Mar 10.

Philips Research, Data Science Department, Eindhoven, the Netherlands.

Nighttime symptoms are important indicators of impairment for many diseases and particularly for respiratory diseases such as chronic obstructive pulmonary disease (COPD). The use of wearable sensors to assess sleep in COPD has mainly been limited to the monitoring of limb motions or the duration and continuity of sleep. In this paper we present an approach to concisely describe sleep patterns in subjects with and without COPD. The methodology converts multimodal sleep data into a text representation and uses topic modeling to identify patterns across the dataset composed of more than 6000 assessed nights. This approach enables the discovery of higher level features resembling unique sleep characteristics that are then used to discriminate between healthy subjects and those with COPD and to evaluate patients' disease severity and dyspnea level. Compared to standard features, the discovered latent structures in nighttime data seem to capture important aspects of subjects sleeping behavior related to the effects of COPD and dyspnea.
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http://dx.doi.org/10.1016/j.compbiomed.2021.104322DOI Listing
May 2021

Frequency and functional translation of low muscle mass in overweight and obese patients with COPD.

Respir Res 2021 Mar 25;22(1):93. Epub 2021 Mar 25.

Department of Research and Development, CIRO+, Centre of Expertise for Chronic Organ Failure, 6080 AB Haelen, Hornerheide 1, Postbus 4009, 6085 NM, Horn, The Netherlands.

Background: Cut offs for fat-free mass index (FFMI) and appendicular skeletal muscle mass index (ASMI) are available for diagnosing low muscle mass in patients with COPD. This study aimed to investigate: (1) the frequency of low muscle mass (FFMI and ASMI) applying different cut-offs and (2) the functional translation (clinical impact) of low muscle mass, in patients with COPD stratified into BMI categories.

Methods: Patients with COPD were assessed regarding body composition, exercise capacity, quadriceps muscle strength, symptoms of anxiety and depression, dyspnea and quality of life upon referral to pulmonary rehabilitation. The proportion of patients with low muscle mass was compared among BMI categories. Clinical outcomes between patients with normal and low muscle mass within each BMI category were compared.

Results: 469 patients with COPD were included for analyses. The frequency of patients classified as low FFMI varied significantly according to the choice of cut-off (32 to 54%; P < 0.05), whereas the frequency of patients with low ASMI was 62%. When applying age-gender-BMI-specific cut-offs, 254 patients (54%) were classified as low FFMI. The choice of the cut-off affected the frequency of patients with low muscle mass in all BMI categories. Overweight and obese patients with low muscle mass were more frequently males and presented worse pulmonary function, exercise capacity and muscle strength compared with overweight and obese patients with normal muscle mass.

Conclusions: Approximately half of the overweight and obese patients with COPD have low muscle mass when applying age-gender-BMI-specific cut-offs. Low muscle mass is associated with worse functional outcomes in overweight and obese COPD patients.
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http://dx.doi.org/10.1186/s12931-021-01689-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993483PMC
March 2021

Unveiling the Molecular Structure of Antimalarial Drugs Chloroquine and Hydroxychloroquine in Solution through Analysis of H NMR Chemical Shifts.

J Phys Chem B 2021 04 24;125(13):3321-3342. Epub 2021 Mar 24.

Laboratório de Química Computacional e Modelagem Molecular (LQC-MM), Departamento de Química Inorgânica, Instituto de Química, Universidade Federal Fluminense (UFF), Outeiro de São João Batista s/n, Campus do Valonguinho, Centro, Niterói 24020-141, Rio de Janeiro, Brazil.

Chloroquine (CQ) and hydroxychloroquine (HCQ) have been standard antimalarial drugs since the early 1950s, and very recently, the possibility of their use for the treatment of COVID-19 patients has been considered. To understand the drug mode of action at the submicroscopic level (atoms and molecules), molecular modeling studies with the aid of computational chemistry methods have been of great help. A fundamental step in such theoretical investigations is the knowledge of the predominant drug molecular structure in solution, which is the real environment for the interaction with biological targets. Our strategy to access this valuable information is to perform density functional theory (DFT) calculations of H NMR chemical shifts for several plausible molecular conformers and then find the best match with experimental NMR profile in solution (since it is extremely sensitive to conformational changes). Through this procedure, after optimizing 30 trial distinct molecular structures (ωB97x-D/6-31G(d,p)-PCM level of calculation), which may be considered representative conformations, we concluded that the global minimum (named ), stabilized by an intramolecular N-H hydrogen bond, is not likely to be observed in water, chloroform, and dimethyl sulfoxide (DMSO) solution. Among fully optimized conformations (named to , and and ), we found (having no intramolecular H-bond) as the most probable structure of CQ and HCQ in water solution, which is a good approximate starting geometry in drug-receptor interaction simulations. On the other hand, the preferred CQ and HCQ structure in chloroform (and CQ in DMSO-) solution was assigned as , showing the solvent effects on conformational preferences. We believe that the analysis of H NMR data in solution can establish the connection between the macro level (experimental) and the sub-micro level (theoretical), which is not so apparent to us and appears to be more appropriate than the thermodynamic stability criterion in conformational analysis studies.
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http://dx.doi.org/10.1021/acs.jpcb.1c00609DOI Listing
April 2021

Poldip2 controls leukocyte infiltration into the ischemic brain by regulating focal adhesion kinase-mediated VCAM-1 induction.

Sci Rep 2021 Mar 10;11(1):5533. Epub 2021 Mar 10.

Division of Cardiology, Department of Medicine, Emory University, 101 Woodruff Circle, 308-C WMB, Atlanta, GA, 30322, USA.

Stroke is a multiphasic process involving a direct ischemic brain injury which is then exacerbated by the influx of immune cells into the brain tissue. Activation of brain endothelial cells leads to the expression of adhesion molecules such vascular cell adhesion molecule 1 (VCAM-1) on endothelial cells, further increasing leukocyte recruitment. Polymerase δ-interacting protein 2 (Poldip2) promotes brain vascular inflammation and leukocyte recruitment via unknown mechanisms. This study aimed to define the role of Poldip2 in mediating vascular inflammation and leukocyte recruitment following cerebral ischemia. Cerebral ischemia was induced in Poldip2 and Poldip2 mice and brains were isolated and processed for flow cytometry or RT-PCR. Cultured rat brain microvascular endothelial cells were used to investigate the effect of Poldip2 depletion on focal adhesion kinase (FAK)-mediated VCAM-1 induction. Poldip2 depletion in vivo attenuated the infiltration of myeloid cells, inflammatory monocytes/macrophages and decreased the induction of adhesion molecules. Focusing on VCAM-1, we demonstrated mechanistically that FAK activation was a critical intermediary in Poldip2-mediated VCAM-1 induction. In conclusion, Poldip2 is an important mediator of endothelial dysfunction and leukocyte recruitment. Thus, Poldip2 could be a therapeutic target to improve morbidity following ischemic stroke.
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http://dx.doi.org/10.1038/s41598-021-84987-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970934PMC
March 2021

Role of partial dehydration in a naturally ventilated room on the mycobiota, ochratoxins, volatile profile and phenolic composition of Merlot grapes intended for wine production.

Food Res Int 2021 03 18;141:110145. Epub 2021 Jan 18.

Instituto de Ciência e Tecnologia de Alimentos (ICTA), Universidade Federal do Rio Grande do Sul (UFRGS), Av. Bento Gonçalves, 9500, Prédio 43212, CEP 91501-970 Porto Alegre, Brazil. Electronic address:

Dehydration of grapes has been used in various regions of the world to produce special wines, aiming to add value to oenological products. Post-harvest dehydration in rooms may be carried out regardless of weather conditions, without the additional cost of a specific infrastructure, in addition to the benefits of protecting the grapes from damages and environmental pollution. The objective of this study was to verify, for the first time, the impact of the dehydration in a naturally ventilated room on the quality of Merlot grapes. Physicochemical characteristics, mycobiota, occurrence of mycotoxins, volatile profile and phenolic composition of grapes were monitored on 7th, 14th and 21st days of dehydration (weight loss of 10, 20 and 27%, respectively). A decrease in aw (6%), pH (4%), and berry hardness (58%), along with an increase in total soluble solid content (15%) were observed during dehydration. The presence of Pestalotiopsis clavispora, Neopestalotiopsis clavispora, Colletotrichum siamense and Alternaria porri was favored during the dehydration process, while a decrease in the occurrence of Aspergillus niger and Phanerochaete sp. was verified. A. niger isolates showed no potential to produce forms of ochratoxins. These toxins were also not found in the grape samples. Regarding the volatile profile, 1-hexanal, 2-hexenal, and 1-octanal gave rise to the corresponding alcohols during dehydration, such as 1-hexanol, 2-hexen-1-ol, and 1-octanol. Acids (hexanoic, decanoic, and 3-hexenoic) resulted in the respective ethyl esters (hexanoate, decanoate, and ethyl 3-hexenoate) during dehydration. Terpenes as limonene, myrcene, and geraniol decreased throughout dehydration, while their biotransformation products (α-terpineol, 6-methyl-5-hepten-2-one, and linalool, respectively) had an increase in concentration. The phenolic content oscillated during dehydration, with an emphasis on increased levels of four hydroxybenzoic acids (ethyl gallate, p-hydroxybenzoic acid, gallic acid-hexose, and gallic acid), two hydroxycinnamic acids (caffeic acid and caftaric acid), two flavonols (kaempeferol galactoside and quercetin) and two anthocyanins (peonidin 3-O-hexoside and delphinidin 3-O-hexoside). Grapes of satisfactory quality were produced by dehydration in a naturally ventilated room. Even small wine producers can be encouraged to implement this procedure for the diversification of oenological products, as it has no costs related to the implementation of chambers/tunnels.
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http://dx.doi.org/10.1016/j.foodres.2021.110145DOI Listing
March 2021

Swab pooling: A new method for large-scale RT-qPCR screening of SARS-CoV-2 avoiding sample dilution.

PLoS One 2021 4;16(2):e0246544. Epub 2021 Feb 4.

BiomeHub Biotechnologies, Florianópolis-SC, Brazil.

To minimize sample dilution effect on SARS-CoV-2 pool testing, we assessed analytical and diagnostic performance of a new methodology, namely swab pooling. In this method, swabs are pooled at the time of collection, as opposed to pooling of equal volumes from individually collected samples. Paired analysis of pooled and individual samples from 613 patients revealed 94 positive individuals. Having individual testing as reference, no false-positives or false-negatives were observed for swab pooling. In additional 18,922 patients screened with swab pooling (1,344 pools), mean Cq differences between individual and pool samples ranged from 0.1 (Cr.I. -0.98 to 1.17) to 2.09 (Cr.I. 1.24 to 2.94). Overall, 19,535 asymptomatic patients were screened using 4,400 RT-qPCR assays. This corresponds to an increase of 4.4 times in laboratory capacity and a reduction of 77% in required tests. Therefore, swab pooling represents a major alternative for reliable and large-scale screening of SARS-CoV-2 in low prevalence populations.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246544PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861376PMC
February 2021

Differential impact of on-site or telepharmacy in the intensive care unit: a controlled before-after study.

Int J Qual Health Care 2021 Feb;33(1)

D'Or Institute of Research and Education (IDOR), Salvador, Bahia, Brazil, Brazil.

Background: Clinical pharmacists have an important role in the intensive care unit (ICU) team but are scarce resources. Our aim was to evaluate the impact of on-site pharmacists on medical prescriptions in the ICU.

Methods: This is a retrospective, quasi-experimental, controlled before-after study in two ICUs. Interventions by pharmacists were evaluated in phase 1 (February to November 2016) and phase 2 (February to May 2017) in ICU A (intervention) and ICU B (control). In phase 1, both ICUs had a telepharmacy service in which medical prescriptions were evaluated and interventions were made remotely. In phase 2, an on-site pharmacist was implemented in ICU A, but not in ICU B. We compared the number of interventions that were accepted in phase 1 versus phase 2.

Results: During the study period, 8797/9603 (91.6%) prescriptions were evaluated, and 935 (10.6%) needed intervention. In phase 2, there was an increase in the proportion of interventions that were accepted by the physician in comparison to phase 1 (93.9% versus 76.8%, P < 0.001) in ICU A, but there was no change in ICU B (75.2% versus 73.9%, P = 0.845).

Conclusion: An on-site pharmacist in the ICU was associated with an increase in the proportion of interventions that were accepted by physicians.
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http://dx.doi.org/10.1093/intqhc/mzab011DOI Listing
February 2021

Neutrophils from patients with the cardiac clinical form of Chagas disease release less NETs than neutrophils from healthy individuals.

Parasite Immunol 2021 Apr 22;43(4):e12821. Epub 2021 Jan 22.

Department of Biomedical Sciences, School of Health Sciences, University of Rio Grande do Norte State, Mossoró, Brazil.

Introduction: Chagas disease (CD) is a global health concern with approximately 12 000 deaths per year worldwide. In the chronic phase, about 30% of patients develop the cardiac clinical form, which presents symptoms associated with the presence of inflammatory cells in the cardiac tissue. Neutrophils are inflammatory cells able to modulate the chronic immune response against pathogens. These cells are capable of interacting with Trypanosoma cruzi, the aetiological agent of CD, and perform several effector functions, such as NET release. However, few studies have been carried out to investigate the role of these cells in the disease.

Aims: To investigate the release of NETs by neutrophils from CD patients by measuring the amount of DNA and elastase released.

Methods And Results: Measurement of DNA release by neutrophils from chronic CD patients presenting the indeterminate (IND group; n = 18) and cardiac (CARD group; n = 15) clinical forms and nonchagasic subjects (n = 18) stimulated with soluble antigen of T. cruzi was quantified using the Quant-iT™ PicoGreen dsDNA assay kit. Patients from CARD group release less DNA (117.3 ± 21.85 ng/mL; *P = .0131) than neutrophils from control (177.7 ± 58.41 ng/mL). Elastase enzyme degranulation was measured using the substrate N-methoxysuccinyl-Ala-Ala-Pro-Val p-nitroanilide (SAAVNA). Absorbance values of elastase degranulation activity showed that only cells from healthy individuals presented a high release profile of elastase. Also, we found a negative correlation between DNA released concentration and risk of death (r = -.6574; *P = .0173); the lower the neutrophil DNA release from chagasic patients with cardiac event, the higher the risk of death.

Conclusion: These preliminary data show that patients with the cardiac form of CD release less NETs than nonchagasic individuals, raising the possibility that lower release of NETs enhances risk of death in CD patients with cardiac events.
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http://dx.doi.org/10.1111/pim.12821DOI Listing
April 2021

Tossing and turning: association of sleep quantity-quality with physical activity in COPD.

ERJ Open Res 2020 Oct 21;6(4). Epub 2020 Dec 21.

Laboratory of Research in Respiratory Physiotherapy, Dept of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil.

The association between characteristics of sleep and physical activity in daily life (PADL) has not yet been investigated in depth in subjects with COPD. This study evaluated whether time spent per day in physical activity (PA) and sedentary behaviour are associated with sleep quantity and quality in this population. Sleep and PADL were objectively assessed by an activity monitor for 7 days and analysed on a minute-by-minute basis. Subjects also underwent spirometry and 6-min walking test (6MWT). Fifty-five subjects with moderate-to-severe COPD (28 male, 67±8 years) were studied. Subjects with total time in bed (TIB) per night ≥9 h had higher wake-after-sleep onset than TIB 7-9 h and TIB ≤7 h (195 (147-218) 117 (75-167) and 106 (84-156) min) and more fragmented sleep than TIB ≤7 h (8.2 (6.7-14.3) 6.3 (5.6-6.9) sleeping bouts; p<0.05 for all). Subjects with TIB ≥9 h also spent more time per day in sedentary behaviour and less time per day in PA of light and moderate-to-vigorous intensity than those with TIB 7-9 h and ≤7 h. In multiple linear regression, TIB ≥9 h was the only significant predictor of physical inactivity (β=-3.3 (-5.1, -1.6), p≤0.0001), accounting for 20% of its variation. Sleep fragmentation was frequent and more pronounced in physically inactive than active patients (7.5 (6.3-9.6) 6.4 (5.5-7.3) sleeping bouts; p=0.027). In summary, subjects with COPD with TIB ≥9 h·night have more fragmented sleep, are more sedentary and less physically active than those with <9 h·night, independently of the awake time. Sleep quality is frequently poor and even worse in patients classified as physically inactive.
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http://dx.doi.org/10.1183/23120541.00370-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792763PMC
October 2020

Genomic Properties and Temporal Analysis of the Interaction of an Invasive With Epithelial Cells.

Front Cell Infect Microbiol 2020 16;10:571088. Epub 2020 Dec 16.

Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, Brazil.

Diarrhea is one of the main causes of infant mortality worldwide, mainly in the developing world. Among the various etiologic agents, is emerging as an important human enteropathogen. promote attaching and effacing (AE) lesions due to the presence of the locus of enterocyte effacement (LEE) that encodes a type three secretion system (T3SS), the afimbrial adhesin intimin and its translocated receptor, Tir, and several effector proteins. We previously showed that strain 1551-2 invades several epithelial cell lineages by a process that is dependent on the intimin-Tir interaction. To understand the contribution of T3SS-dependent effectors present in 1551-2 during the invasion process, we performed a genetic analysis of the LEE and non-LEE genes and evaluated the expression of the LEE operons in various stages of bacterial interaction with differentiated intestinal Caco-2 cells. The kinetics of the ability of the 1551-2 strain to colonize and form AE lesions was also investigated in epithelial HeLa cells. We showed that the LEE expression was constant during the early stages of infection but increased at least 4-fold during bacterial persistence in the intracellular compartment. An analysis indicated the presence of a new subtype, named . We found that the encoded protein colocalizes with Tir and polymerized F-actin during the infection process . Moreover, assays performed with Nck null cells demonstrated that the 1551-2 strain can trigger F-actin polymerization in an Nck-independent pathway, despite the fact that TccP3 is not required for this phenotype. Our study highlights the importance of the T3SS during the invasion process and for the maintenance of 1551-2 inside the cells. In addition, this work may help to elucidate the versatility of the T3SS for AE pathogens, which are usually considered extracellular and rarely reach the intracellular environment.
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http://dx.doi.org/10.3389/fcimb.2020.571088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772469PMC
June 2021

Streptomyces hygroscopicus UFPEDA 3370: A valuable source of the potent cytotoxic agent nigericin and its evaluation against human colorectal cancer cells.

Chem Biol Interact 2021 Jan 4;333:109316. Epub 2020 Dec 4.

Departamento de Antibióticos, Rua Prof. Moraes Rego, 1235, Universidade Federal de Pernambuco, Recife, Pernambuco, 50670-901, Brazil. Electronic address:

Streptomyces hygroscopicus UFPEDA 3370 was fermented in submerged cultivation and the biomass extract was partitioned, obtaining a fraction purified named EB1. After purification of EB1 fraction, nigericin free acid was obtained and identified. Nigericin presented cytotoxic activity against several cancer cell lines, being most active against HL-60 (human leukemia) and HCT-116 (human colon carcinoma) cell lines, presenting IC and (IS) values: 0.0014 μM, (30.0) and 0.0138 μM (3.0), respectively. On HCT-116, nigericin caused apoptosis and autophagy. In this study, nigericin was also screened both in vitro and in silico against a panel of cancer-related kinases. Nigericin was able to inhibit both JAK3 and GSK-3β kinases in vitro and its binding affinities were mapped through the intermolecular interactions with each target in silico.
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http://dx.doi.org/10.1016/j.cbi.2020.109316DOI Listing
January 2021

Role of gas chromatography and olfactometry to understand the wine aroma: Achievements denoted by multidimensional analysis.

J Sep Sci 2021 Jan 14;44(1):135-168. Epub 2020 Dec 14.

Instituto de Química, Universidade Federal do Rio Grande do Sul, Avenida Bento Gonçalves, Porto Alegre, Rio Grande do Sul, Brazil.

The human nose has been used as a detector in gas chromatography analysis to evaluate odoriferous compounds related to aroma and quality of wine. Several olfactometric techniques are available to access the description, intensity, and/or duration of the odor of each compound. Olfactometry can be associated with one-dimensional gas chromatography or multidimensional gas chromatography, including heart-cut gas chromatography and comprehensive two-dimensional gas chromatography. Multidimensional gas chromatography may help to resolve coeluted compounds and detect important trace components for the aroma. The identification of odor-active compounds may help to differentiate wines according to terroir, grapes cultivars used in winemaking or types of aging, understand the role of fungal infection of grapes for wine quality, find the best management practices in vineyard and vinification to obtain the greatest quality. In addition, when the instrumental techniques are combined with sensory analysis, even more accurate information may be obtained regarding the overall wine aroma. This review discloses the state of the art of olfactometric methods and the analytical techniques used to investigate odor-active compounds such as one-dimensional gas chromatography, multidimensional gas chromatography, and comprehensive two-dimensional gas chromatography. The advances in knowledge of wine aroma achieved with the use of these techniques in the target and profiling approaches were also discussed.
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http://dx.doi.org/10.1002/jssc.202000813DOI Listing
January 2021

The Gini Coefficient: A New Approach to Assess Physical Activity Inequality in COPD.

COPD 2020 12 25;17(6):623-626. Epub 2020 Nov 25.

Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, Londrina State University (UEL), Londrina, Brazil.

Increasing physical activity (PA) is a complex and challenging task in patients with chronic obstructive pulmonary disease (COPD). However, some questions are raised regarding the evaluation of PA in these patients: Have all aspects of PA evaluation in patients with COPD already been explored in the scientific literature and clinical practice? What is the clinical importance of assessing PA inequality? PA inequality is defined as the Gini coefficient (Gini) of the PA distribution of a population and is already shown to have implications for public health in the general population. It is a simple tool that might allow a better understanding of PA disparities among different COPD populations, although to our knowledge there is no previous investigation of PA inequality in patients with COPD using the Gini. In this perspective study we have provided examples of the Gini use in different scenarios. Future studies might try to apply it in order to identify subpopulations with higher PA inequality, and perhaps are therefore more prone to benefit most from interventions specifically tailored to promote PA. In summary, we propose the quantification of PA inequality with the Gini as a tool that might allow us to see PA even more comprehensively than we already do, expanding our perspective on PA in patients with COPD.
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http://dx.doi.org/10.1080/15412555.2020.1813270DOI Listing
December 2020

An association between mitochondria and microglia effector function. What do we think we know?

Neuroimmunol Neuroinflamm 2020 16;7:150-165. Epub 2020 Jun 16.

National Toxicology Program Laboratory, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709 USA.

While resident innate immune cells of the central nervous system, the microglia, represent a cell population unique in origin, microenvironment, and longevity, they assume many properties displayed by peripheral macrophages. One prominent shared property is the ability to undergo a metabolic switch towards glycolysis and away from oxidative phosphorylation (OXPHOS) upon activation by the pro-inflammatory stimuli lipopolysaccharide. This shift serves to meet specific cellular demands and allows for cell survival, similar to the Warburg effect demonstrated in cancer cells. In contrast, normal survelliance phenotype or stimulation to a non-proinflammatory phenotype relies primarily on OXPHOS and fatty acid oxidation. Thus, mitochondria appear to function as a pivotal signaling platform linking energy metabolism and macrophage polarization upon activation. These unique shifts in cell bioenergetics in response to different stimuli are essential for proper effector responses at sites of infection, inflammation, or injury. Here we present a summary of recent developments as to how these dynamics characterized in peripheral macrophages are displayed in microglia. The new insights provided by an increased understanding of metabolic reprogramming in macrophages may allow for translation to the CNS and a better understanding of microglia heterogeneity, regulation, and function.
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http://dx.doi.org/10.20517/2347-8659.2020.07DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489447PMC
June 2020

Maximum Voluntary Ventilation and Its Relationship With Clinical Outcomes in Subjects With COPD.

Respir Care 2021 Jan 18;66(1):79-86. Epub 2020 Aug 18.

Laboratory of Research in Respiratory Physiotherapy, Physiotherapy Department, State University of Londrina, Londrina, Brazil.

Background: Previous studies have reported that maximum voluntary ventilation (MVV) may be better associated with commonly used outcomes in COPD than FEV and may provide information on respiratory mechanics. In this study, we aimed to investigate the relationship between MVV and clinical outcomes in COPD and to verify whether MVV predicts these outcomes better than FEV.

Methods: We conducted a cross-sectional study involving individuals with COPD. Lung function was assessed with spirometry; maximum inspiratory and expiratory pressures (P and P, respectively) were assessed with manuvacuometry; and functional exercise capacity was assessed with the 6-min-walk test (6MWT). Dyspnea was assessed with the modified Medical Research Council (mMRC) scale; functional status was assessed with the modified Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ-m); and health status was assessed with the COPD Assessment Test (CAT). Correlations were verified with the Spearman coefficient, and stepwise multiple linear regression models investigated the predictors of clinical outcomes.

Results: Our study included 157 subjects: 82 males; median (interquartile range) age 66 (61-73) y; FEV 46 (33-57) % predicted; 6MWT 86 (76-96) % predicted; PFSDQ-m total score 34 (14-57); and CAT total score 13 (7-19). Moderate correlations were found between MVV and P (r = 0.40), 6MWT (r = 0.50), mMRC (r = -0.56), and total scores on the PFSDQ-m (r = -0.40) and the CAT (r = -0.54). In the regression models, MVV was a predictor of almost all clinical outcomes, unlike FEV.

Conclusions: MVV correlates moderately with clinical outcomes commonly used in the evaluation of individuals with COPD, and MVV is a better predictor of respiratory muscle strength, functional exercise capacity, and patient-reported outcomes than FEV.
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http://dx.doi.org/10.4187/respcare.07855DOI Listing
January 2021

Six-minute walk test in burned subjects: Applicability, reproducibility and performance at hospital discharge.

Burns 2020 Aug 14. Epub 2020 Aug 14.

Stricto Sensu Graduate Program in Rehabilitation Sciences, State University of Londrina (UEL) and University Pitágoras Unopar (UNOPAR), Londrina, Brazil; Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil. Electronic address:

Introduction: Despite its clinical relevance in several populations, there is no evidence on applicability of the 6-min walk test (6MWT) in burned subjects.

Objectives: To verify the applicability and reproducibility of the 6MWT in burned individuals and to analyze patients' performance in this test at hospital discharge.

Methods: In a cross-sectional study, burned individuals performed two 6MWT at hospital discharge, according to international standardization. In addition to walked distance, physiological and symptomatic variables were collected. Clinical history and demographic data were also recorded.

Results: One hundred individuals were evaluated (70 men, 10 [6-18]% total body surface area burned). There was excellent agreement between the two 6MWT (ICC = 0.97). However, 73% of subjects increased the walked distance in the second test (23 [-9-47]m or 5 [-2-10]%; P = 0.001). Considering the best 6MWT, the walked distance was 488 [396-718]m (80 [65-92]%pred), and 51% of the individuals had limited functional exercise capacity. Additionally, participants without lower limb involvement presented better 6MWT than others (P < 0.0001).

Conclusion: The 6MWT was applicable, well tolerated and reproducible at hospital discharge in burned individuals. However, there was considerable learning effect between the first and second test. Finally, the reduced exercise capacity observed reinforces need for early rehabilitation in this population.
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http://dx.doi.org/10.1016/j.burns.2020.03.004DOI Listing
August 2020