Publications by authors named "Paula Martins"

123 Publications

Sheep Erythrocyte Preparation for Hemolytic Tests Exploring Complement Functional Activities.

Methods Mol Biol 2021 ;2227:61-67

Unité INSERM UMRS 1138, "Inflammation, Complement and Cancer" Team, Centre de Recherche des Cordeliers, Paris, France.

Sheep erythrocytes (SE) are commonly used in complement functional tests. Non sensitized SE are useful to study the FH activity of cell protection. Indeed, as the cell surface of sheep erythrocytes is rich in sialic acids, Factor H (FH) is able to bind on it and therefore they represent a model of nonactivating surface. Because of their high capacity of complement regulation SE need to be modified to explore other functionality of the complement pathways, like the Complement hemolytic 50 (CH50) or the AP C3 convertase decay assays. For these tests, SE are sensitized with an anti-sheep red blood cell stroma antibody. In presence of serum or plasma complement components, sensitized SE may initiate complement cascade activation via the classic pathway explored in the CH50 assay. Sensitized SE may also be used to prepare C3b-coated SE that, with the use of buffers favoring AP, are suitable for the C3 Nef hemolytic assay and for the hemolytic assay studying the AP decay activity of FH. In this chapter we describe how to prepare SE for these different hemolytic tests.
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http://dx.doi.org/10.1007/978-1-0716-1016-9_6DOI Listing
January 2021

The influence of distinct techniques of local dental anesthesia in 9- to 12-year-old children: randomized clinical trial on pain and anxiety.

Clin Oral Investig 2021 Mar 14. Epub 2021 Mar 14.

Dental PostGraduate Program, State University of Ponta Grossa, Rua Carlos Cavalcanti, 4748, Bloco M - Uvaranas, Paraná, Ponta Grossa, Brazil.

Objectives: To evaluate pain, disruptive behavior, and anxiety in children undergoing different local dental anesthetic techniques.

Methods: This randomized/parallel clinical trial analyzed three groups of patients (9-12 years old) (n = 35) who received infiltrative anesthesia using conventional (CA), vibrational (VBA), and computer-controlled techniques (CCLAD). The outcomes were pain self-perception (Wong-Baker Faces Pain Rating Scale (WBF); Numerical Ranting Scale (NRS)), disruptive behavior (Face, Legg, Activity, Crying, Consolability Scale (FLACC)), anxiety (Corah's Dental Anxiety Scale; modified Venham Picture test (VPTm)), and physiological parameters (systolic (SBP)/diastolic pressure (DBP); heart rate (HR); oxygen saturation (SpO2); respiratory rate (RR)). Statistical analysis was accomplished using Kruskall-Wallis test and ANOVA for repeated measures (α = 0.05).

Results: Dental anxiety levels at the baseline were similar for all patients. CA promoted less pain than VBA in WBF (p = 0.018) and NRS (p = 0.006) and CCLAD in WBF (p = 0.029). There were no differences in disruptive behavior (FLACC p = 0.573), anxiety (VPTm p = 0.474), blood pressure (SBP p = 0.954; DBP p = 0.899), heart rate (p = 0.726), oxygen saturation (p = 0.477), and respiratory rate (p = 0.930) between anesthetic techniques.

Conclusion: Conventional technique resulted in less pain perception for dental local anesthesia.

Clinical Relevance: Conventional technique reduces the self-reported pain in children 9-12 years old, and therefore, the use of additional devices or different anesthetic techniques is not justified.
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http://dx.doi.org/10.1007/s00784-020-03713-7DOI Listing
March 2021

Persister Cells Form in the Plant Pathogen subsp. under Different Stress Conditions.

Microorganisms 2021 Feb 14;9(2). Epub 2021 Feb 14.

Biotechnology Laboratory, Centro de Citricultura Sylvio Moreira, Instituto Agronômico de Campinas, Rodovia Anhanguera Km 158, Cordeirópolis-SP 13490-000, Brazil.

Citrus canker disease, caused by the bacterium subsp. is a constant threat to citrus-producing areas. Since it has no cure, agricultural practices to restrain its dissemination are essential to reduce the economic damage. Hence, increased knowledge of the basic aspects of biology could lead to more efficient management practices that can eliminate dormant bacteria in the field. The dormant cells, also referred to as persisters, are phenotypic variants with lowered metabolism, which in turn leads to tolerance to antimicrobials and undermines existing control approaches. We show here that forms persisters, identifying triggers for this phenotype, including antibiotics, high temperature, and metals (copper and zinc), which increase persistence rates by 10-100 times. The antioxidant N-acetylcysteine reduced copper and zinc-induced persisters, but not those induced by tetracycline, indicating that oxidative stress may be an important inducer of persistence. In addition, we found that metabolism-independent drugs like cisplatin and mitomycin C are able to eliminate persistent cells, as well as copper, at high concentrations. Specific amino acids like proline and isoleucine interfered with the physiological balance of the dormancy in , stimulating or preventing persister resuscitation. Taken together, we discover chemicals that can induce, wake, and kill persister cells; these results provide insights that should be considered for more efficient integrated control management in the field.
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http://dx.doi.org/10.3390/microorganisms9020384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918609PMC
February 2021

Riboswitch theo/ as a Transcription Regulation Tool for subsp. .

Microorganisms 2021 Feb 6;9(2). Epub 2021 Feb 6.

Department of General and Applied Biology, Biosciences Institute, São Paulo State University (UNESP), Rio Claro SP 13506-900, Brazil.

subsp. () is the causal agent of Asiatic Citrus Canker (ACC), a disease that affects citrus. ACC has no cure, and growers must rely on special agricultural practices to prevent bacterial spreading. Understanding basic biology is essential to foresee potential genetic targets to control ACC. Traditionally, microbial genetics use gene deletion/disruption to investigate gene function. However, essential genes are difficult to study this way. Techniques based on small-RNAs and antisense-RNAs are powerful for gene characterization, but not yet fully explored in prokaryotes. One alternative is riboswitches, which derive from bacteria, and can control transcription/translation. Riboswitches are non-coding RNAs able to modulate gene expression in the presence of specific ligands. Here we demonstrate that the riboswitch theo/ decreases expression in in a platform responsive to theophylline. By monitoring cell respiration, we showed that higher concentrations of the ligand interfered with bacterial viability. Therefore, we determined the safe dose of theophylline to be used with . Finally, in downstream investigations of transcription modulation, we show evidence for the fact that ParB is stable, remains functional throughout the cell cycle, and is inherited by the daughter cells upon cell division.
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http://dx.doi.org/10.3390/microorganisms9020329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914508PMC
February 2021

Atherosclerotic Process in Seroreverter Children and Adolescents Exposed to Fetal Antiretroviral Therapy.

Curr HIV Res 2020 Nov 18. Epub 2020 Nov 18.

Coimbra Institute for Clinical and Biomedical Researh (iCBR) - Faculty of Medicine - University of Coimbra, Coimbra. Portugal.

Background: Human immunodeficiency virus infection is a recognized risk factor for premature atherosclerosis in children and adolescents. However, the atherosclerotic process in uninfected children exposed in utero to the virus and antiretroviral therapy is less clear.

Objective: To determine the potential cardiovascular risk associated to this in utero milieu exposition.

Material And Methods: A total of 115 individuals were studied (77 in the sample group and 38 controls). Eighteen analytical mediators involved in the atherogenic pathways (metabolic dysregulation, inflammation and prothrombotic state) were analyzed. The carotid intima-media thickness, which is a subclinical marker of atherosclerosis, was also measured.

Results: No significant statistical differences were identified between the sample and control groups, either in the biochemical or the echographic markers.

Conclusion: In utero exposure to the HIV virus and antiretroviral therapy in uninfected children and adolescents is not correlated to accelerated atherosclerosis.
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http://dx.doi.org/10.2174/1570162X18999201118155026DOI Listing
November 2020

Multifunctional potential of endophytic bacteria from Anacardium othonianum Rizzini in promoting in vitro and ex vitro plant growth.

Microbiol Res 2021 Jan 28;242:126600. Epub 2020 Sep 28.

Federal Institute of Education, Science and Technology Goiano, (Instituto Federal de Instituto Federal de Educação, Ciência e Tecnologia Goiano - IF Goiano), Rio Verde, Goiás, Brazil.

Anacardium othonianum Rizzini, a cashew tree native to the Brazilian Cerrado, is economically important due to its applications in the food, chemical and pharmaceutical industries. However, A. othonianum yields a crop with low productivity due to a number of factors, such as nutritionally poor soils, drought and losses due to pests and diseases. Brazil is one of the nine largest cashew nut producers worldwide, and sustainable technologies are needed to increase the productivity of this crop. In this context, the use of endophytic microorganisms could promote plant growth and provide protection against phytopathogens. In this study, the isolation of the root endophytic community of A. othonianum led to the characterization of 22 distinct bacterial strains with multifunctional traits for plant growth promotion. The results of in vitro assays to assess auxin synthesis, phosphate solubilization, phosphatase and siderophore production and biocontrol against Fusarium oxysporum led to the selection of Acinetobacter lwoffii Bac109 and Pantoea agglomerans Bac131 as the most promising strains. The reinoculation of the Bac109 and Bac131 strains onto A. othonianum seeds showed that the treatment containing a mixture of these strains was the most effective in promoting increases in the biometric parameters of early plant growth. Thus, this study highlights the biotechnological potential of a consortium of A. lwoffii Bac109 and P. agglomerans Bac131 for future applications in sustainable cashew cultivation.
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http://dx.doi.org/10.1016/j.micres.2020.126600DOI Listing
January 2021

Bioaccessibility and cellular uptake by Caco-2 cells of carotenoids and chlorophylls from orange peels: A comparison between conventional and ionic liquid mediated extractions.

Food Chem 2021 Mar 12;339:127818. Epub 2020 Aug 12.

Department of Biosciences, Universidade Federal de São Paulo (UNIFESP), Rua Silva Jardim 136, Vila Mathias, 11015-020 Santos, SP, Brazil. Electronic address:

Native extracts from orange peels were obtained by a conventional method using acetone and, an alternative method using ionic liquid (1-butyl-3-methylimidazolium chloride ([Cmim]Cl)). The bioaccessibilities and cellular uptakes of carotenoids, esters and chlorophylls were evaluated, since the influence of esterification on bioaccessibility and bioavailability is not well established. For this, the extracts were emulsified, submitted to in vitro simulated digestion model according to the INFOGEST protocol, followed by uptake by Caco-2 cells. Compounds were separated, identified and quantified by HPLC-PDA-MS/MS. After digestion, 22.0% and 26.2% of the total carotenoids and 45.9% and 68.7% of the chlorophylls were bioaccessible from the acetone and [Cmim]Cl extracts, respectively. The bioaccessibilities of xanthophylls and carotenes were significantly higher than those of the mono- and diesters. The uptake by Caco-2 cells varied from 130.2 to 131.9 ng/mg cell protein for total carotenoids and from 243.8 to 234.2 ng/mg cell protein for chlorophylls in the acetone and [Cmim]Cl extracts, respectively. In general, xanthophylls and esters were better absorbed than carotenes.
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http://dx.doi.org/10.1016/j.foodchem.2020.127818DOI Listing
March 2021

The effect of voluntary wheel running on the antioxidant status is dependent on sociability conditions.

Pharmacol Biochem Behav 2020 11 20;198:173018. Epub 2020 Aug 20.

Department of Biochemistry, Federal University of Santa Catarina, 88040-900 Florianópolis, SC, Brazil.

Voluntary wheel running is widely used as a physical activity (PA) model in rodents, but most studies investigate the beneficial effects of this intervention in socially isolated mice. Social isolation stress (SIS) is associated with vulnerability to oxidative stress and reduced mitochondrial activity. Thus, the aim of this study was to investigate the effects of free access to a running wheel for 21 days on the various markers of the cellular redox/antioxidant status as well as mitochondrial function of mice subjected to SIS or maintained in groups of 3 in the homecage. SIS increased thiobarbituric acid reactive substance (TBARS) levels in the cerebral cortex, and PA intervention was not able to reverse such alteration. PA reduced TBARS levels in the liver of grouped mice and gastrocnemius of socially isolated mice. PA increased nonprotein thiol (NPSH) levels in the cerebral cortex of grouped mice. Furthermore, socially isolated mice presented lower glutathione peroxidase (GPx) activity in the cerebellum and gastrocnemius, and glutathione reductase (GR) activity in the cerebral cortex and liver. By contrast, SIS induced higher GPx activity in the cerebral cortex and heart. PA reduced GPx (cerebral cortex) and GR (cerebral cortex and liver) activities of socially isolated mice. SIS caused higher activity of mitochondrial complexes I and II in the cerebral cortex, and the PA paradigm was not able to alter this effect. Interestingly, the PA produced antidepressant-like effect at both SIS and control groups. In conclusion, the results showed the influence of SIS for the effects of PA on the antioxidant status, but not on the mitochondrial function and emotionality.
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http://dx.doi.org/10.1016/j.pbb.2020.173018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7438373PMC
November 2020

Serological biomarkers for monitoring response to treatment of pulmonary and extrapulmonary tuberculosis in children and adolescents.

Tuberculosis (Edinb) 2020 07 26;123:101960. Epub 2020 Jun 26.

Laboratório Multiusuário de Apoio à Pesquisa Em Nefrologia e Ciências Médicas, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil; Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil. Electronic address:

Key measures to halt the spread of tuberculosis (TB) include early diagnosis, effective treatment, and monitoring disease management. We sought to evaluate the use of serum immunoglobulin levels against antigens present in cell envelope of Mycobacterium tuberculosis to monitor TB treatment response in children and adolescents with pulmonary (PTB) or extrapulmonary TB (EPTB). Blood samples were collected prior to and one, two, and six months following treatment initiation. Serum immunoglobulin levels against cardiolipin, sulfatide, mycolic acid and Mce1A protein were measured by ELISA. Serum from 53 TB patients and 12 healthy participants were analyzed. After six months of successful treatment, there was a significant decrease (p < 0.0001) in IgM levels against cardiolipin, sulfatide, mycolic acid and Mce1A protein and IgG levels against Mce1A protein when compared to baseline immunoglobulin levels. There was no significant variation in antibody levels during follow-up between participants with PTB and EPTB, confirmed and unconfirmed TB diagnosis, and HIV infection status. Antibody levels in control participants without TB did not decrease during follow-up. These results suggest that immunoglobulin responses to mycobacterial cell wall products may be a useful tool to monitor treatment response in children and adolescents with PTB or EPTB.
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http://dx.doi.org/10.1016/j.tube.2020.101960DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436889PMC
July 2020

Experience on statin therapy in paediatric age: retrospective study in a Portuguese referral centre.

Cardiol Young 2020 Jun 15;30(6):840-851. Epub 2020 May 15.

Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

Background: The use of statins in children, although not frequent, is recommended in specific clinical contexts, namely, familial hypercholesterolaemia, conditions carrying a moderate-high cardiovascular risk and sub-optimal cholesterol levels after implementation of lifestyle modifications. The aim of this study is to characterise children with dyslipidaemia managed with statins, followed at a tertiary referral centre in central Portugal.

Methods And Results: The authors carried out a retrospective and descriptive study made up of 66 patients (50% males, mean age of therapy onset 11.9 years) followed up at the Cardiovascular Clinic of a tertiary referral centre between January, 2012, and May, 2018. Clinical, analytical, and echocardiographic parameters were analysed. About 60.6% had clinical and/or molecular diagnosis of familial hypercholesterolaemia. On average, each patient had three cardiovascular risk factors, obesity (31%) being most prevalent, followed by arterial hypertension (14%). Statin therapy showed a statistically significant reduction in the lipid profile, particularly in the total cholesterol (23%) and low-density lipoprotein cholesterol (30%) levels, as well as in the carotid intima-media thickness (p = 0.015). Hepatic and muscle integrity markers were within normal range.

Conclusions: Statins are safe and efficient in the management of children with hypercholesterolaemia. Our study showed that apart from its lipid-lowering properties, it also reduced significantly the carotid intima-media thickness and, implicitly, the cardiovascular risk of these patients.
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http://dx.doi.org/10.1017/S1047951120001158DOI Listing
June 2020

Evaluation of pain, disruptive behaviour and anxiety in children aging 5-8 years old undergoing different modalities of local anaesthetic injection for dental treatment: a randomised clinical trial.

Acta Odontol Scand 2020 Aug 29;78(6):445-453. Epub 2020 Apr 29.

Departament of Dentistry, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil.

To evaluate the influence of different local anaesthetic techniques in pain, disruptive behaviour and anxiety in children´s dental treatment. This was a randomised and parallel clinical trial. The sample consisted of 105 children (5-8 years old) that were divided into three groups ( = 35) according to the anaesthetic technique: conventional anaesthesia (CA); vibrational anaesthesia (VBA); computer-controlled local anaesthesia delivery (CCLAD). The outcomes were self-perception of pain (Wong-Baker Faces Pain Rating Scale - WBF; Numerical Rating Scale - NRS); disruptive behaviour (Face, Legg, Activity, Cry, Consolability Scale - FLACC); anxiety (Corah's Dental Anxiety Scale; modified Venham Picture test - VPTm) and physiological parameters (blood pressure - systolic - SBP and diastolic - DBP; heart rate - HR; oxygen saturation - SpO2; respiratory rate - RR). Data were statistically analysed with Kruskall-Wallis test and ANOVA for repeated measures with Tukey post hoc test ( = 0.05). All the patients exhibited the same level of dental anxiety at baseline (Corah's Dental Anxiety Scale). There was no difference in self-perception pain, irrespective the evaluation tool used (WBF -  = .864; VAS -  = .761). No differences were detected in disruptive behaviour (FLACC -  = .318); anxiety (VPTm -  = .274); blood pressure (SBP -  = .239; DBP -  = .512); heart rate ( = .728); oxygen saturation ( = .348) and respiratory rate ( = .238) between anaesthetic techniques. Different anaesthetic dental local techniques do not affect the levels of pain, disruptive behaviour, anxiety and physiological parameters in children aged 5-8 years old.
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http://dx.doi.org/10.1080/00016357.2020.1757752DOI Listing
August 2020

Fetal atrial septal aneurysm: a differential diagnosis of aortic arch retrograde flow.

BMJ Case Rep 2020 Jan 21;13(1). Epub 2020 Jan 21.

Paediatric Cardiology Department, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

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http://dx.doi.org/10.1136/bcr-2019-232773DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021174PMC
January 2020

A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections.

Respir Med 2020 02 1;162:105861. Epub 2020 Jan 1.

School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal. Electronic address:

Introduction: Physiotherapy may play a role in the recovery of signs, symptoms and function of patients with lower respiratory tract infections (LRTI) but its effectiveness is still controversial.

Objectives: To assess the effects of respiratory physiotherapy compared with standard pharmacological care on symptoms and function in outpatients with LRTI.

Design: Single-blind, randomised controlled trial.

Setting: Outpatients were recruited from the casualties of a central hospital.

Participants: Outpatients with LRTI were recruited and randomly allocated to the control (pharmacological) or experimental (pharmacological and respiratory physiotherapy) group.

Intervention: The intervention consisted of conventional pharmacological treatment and conventional pharmacological treatment plus respiratory physiotherapy. Respiratory physiotherapy included breathing and airway clearance techniques, exercise training and education during 3-weeks, 3 times per week.

Main Outcome Measure: Primary outcome measures - occupation rate of wheezes Wh%; Secondary outcome measures - number of crackles, peripheral oxygen saturation (SpO2) modified Borg scale (mBorg), modified Medical Research Council scale (mMRC), 6-min walk test (6MWT), forced expiratory volume in 1 s and forced vital capacity, and volume and density of the lung and bronchial tree volume.

Results: Ninety-seven patients (53 controls and 44 experimental) completed the intervention. After the intervention, both groups improved significantly in all variables (0.0001 < p < 0.04; 0.001<ƞ<0.092), with the exception of the mBorg. The magnitude of improvement of the experimental group exceeded the control group in the number of crackles, SpO2 levels, mMRC and 6MWT (0.002 < p < 0.032; 0.002<ƞ<0.092).

Conclusion: Adding respiratory physiotherapy to the pharmacological treatment of outpatients with LRTI results in greater recovery of symptoms and function parameters.

Trial Registration: NCT02053870.
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http://dx.doi.org/10.1016/j.rmed.2019.105861DOI Listing
February 2020

Green Extraction Approaches for Carotenoids and Esters: Characterization of Native Composition from Orange Peel.

Antioxidants (Basel) 2019 Dec 3;8(12). Epub 2019 Dec 3.

Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Via Consolare Valeria, 98125 Messina, Italy.

Orange peel is a by-product produced in large amounts that acts as a source of natural pigments such as carotenoids. Xanthophylls, the main carotenoid class found in citrus fruit, can be present in its free form or esterified with fatty acids, forming esters. This esterification modifies the compound's chemical properties, affecting their bioavailability in the human body, and making it important to characterize the native carotenoid composition of food matrices. We aimed to evaluate the non-saponified carotenoid extracts of orange peel (cv. Pera) obtained using alternative green approaches: extraction with ionic liquid (IL), analyzed by high performance liquid chromatography coupled to a diode array detector with atmospheric pressure chemical ionization and mass spectrometry HPLC-DAD-APCI-MS, and supercritical fluid extraction (SFE), followed by supercritical fluid chromatography with atmospheric pressure chemical ionization and triple quadrupole mass spectrometry detection (SFC-APCI/QqQ/MS) in an online system. Both alternative green methods were successfully applied, allowing the total identification of five free carotenoids, one apocarotenoid, seven monoesters, and 11 diesters in the extract obtained with IL and analyzed by HPLC-DAD-APCI-MS, and nine free carotenoids, six carotenoids esters, 19 apocarotenoids, and eight apo-esters with the SFE-SFC-APCI/QqQ/MS approach, including several free apocarotenoids and apocarotenoid esters identified for the first time in oranges, and particularly in the Pera variety, which could be used as a fruit authenticity parameter.
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http://dx.doi.org/10.3390/antiox8120613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6943544PMC
December 2019

Myocardial peak systolic velocity-a tool for cardiac screening of HIV-exposed uninfected children.

Eur J Pediatr 2020 Mar 25;179(3):395-404. Epub 2019 Nov 25.

Coimbra Institute for Clinical and Biomedical Researh (iCBR) - Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

HIV-uninfected children exposed prenatally to the virus and to prophylactic antiretroviral therapy are at an uncertain risk of long-term myocardial dysfunction. This study aimed to analyse the structure and function of their ventricles and to identify potential screening tools for this at-risk population. One hundred and fifteen children (77 exposed vs 38 controls) aged between 2.7 and 16.2 years were included. An echocardiographic study was performed where both ventricles' dimensions and systolic functions were evaluated. In the left ventricle, parameters related to diastolic function were also analysed. Tissue Doppler values were determined in the basal state and after passive leg raising. Serologic analysis of amino-terminal pro-B-type natriuretic peptide (NT-proBNP) was carried out. The two groups had identical ventricular sizes and left ventricular diastolic functions. However, contractility assessed by myocardial peak systolic velocity was significantly inferior in the exposed group. These systolic echocardiographic differences were present despite similar values of NT-proBNP in both groups.Conclusion: HIV-exposed uninfected children may be vulnerable to ventricular systolic dysfunction at long term. Cardiovascular surveillance and periodic monitoring of biventricular function are therefore recommended. Myocardial peak systolic velocity may be a useful screening tool for this purpose.What is Known:• Previous studies on HIV-exposed uninfected children subjected prenatally to antiretroviral therapy have alerted to potential long-term cardiovascular toxicity effects on the left ventricle.What is New:• The study gives new insights on ventricular function and morphology in HIV-exposed uninfected children.• Myocardial peak systolic velocities are significantly inferior in this paediatric sub-group, therefore long-term cardiac surveillance is recommended.
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http://dx.doi.org/10.1007/s00431-019-03477-7DOI Listing
March 2020

Ionic liquid associated with ultrasonic-assisted extraction: A new approach to obtain carotenoids from orange peel.

Food Res Int 2019 12 3;126:108653. Epub 2019 Sep 3.

Department of Bioscience, Universidade Federal de São Paulo (UNIFESP), Rua Silva Jardim 136, Santos, São Paulo CEP 11015-020, Brazil. Electronic address:

The aim of this study was to develop a new method for carotenoid extraction from orange peel, using ionic liquid (IL) to replace conventional organic solvents, assisted by ultrasound. Four different IL were tested: 1-butyl-3-methylimidazolium chloride ([BMIM][Cl]), 1-n-butyl-3-methylimidazolium hexafluorophosphate ([BMIM][PF]), 1-n-butyl-3-methylimidazolium tetrafluoroborate ([BMIM][BF]), and 1-hexyl-3-methylimidazolium chloride ([HMIM][Cl]). Response surface methodology was applied in order to optimize the carotenoid extraction conditions, and Amberlite XAD-7HP resin was used to separate the carotenoids from the IL, allowing their recovery. Determination of carotenoids was carried out by high-performance liquid chromatography coupled to photodiode array and mass spectrometry detectors (HPLC-DAD-MS). Thermal stability at different temperatures (60 °C and 90 °C) and peroxyl radical scavenging activity of the carotenoid extracts obtained with acetone and IL were evaluated. [BMIM][Cl] was the most effective IL, leading to a total carotenoid content of 32.08 ± 2.05 μg/g, while 7.88 ± 0.59 μg/g of dry matter was obtained by acetone extraction. IL and carotenoid recoveries using XAD-7HP resin were in the range of 59.5-63.8% and 52.2-58.7%, respectively. A carotenoid extract was successfully obtained with IL, finally isolated just by using ethanol, besides being more stable and presenting higher antioxidant activity than that obtained with acetone.
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http://dx.doi.org/10.1016/j.foodres.2019.108653DOI Listing
December 2019

Presence of N-acetylgalactosamine/galactose residues on bronchioloalveolar cells during rat postnatal development.

Eur J Histochem 2019 Sep 11;63(3). Epub 2019 Sep 11.

Instituto de Histologia e Embriologia, Faculdade de Medicina, Universidade de Coimbra; Hospitais da Universidade de Coimbra .

In mammals, the alveolarization process develops predominantly after birth. Airway cells display a complex assemblage of glycans on their surface. These glycans, particularly terminal glycan extensions, are important effective carriers of information that change during the differentiation process. Nevertheless, few systematic data are reported about the cell surface sugar residue content during post-natal lung development. In the present work, we aimed to identify and semi-quantify N-acetylgalactosamine (GalNAc)/galactose (Gal) residues on the bronchioloalveolar cell surface in rat lung sections from 1-, 4-, 8- day old and adult animals and link these data with the lung glycocalyx composition. Horseradish peroxidase-conjugated lectin from Glycine max (soybean agglutinin, SBA) was used, and light microscopy methodologies were performed. SBA labelling intensity was studied before and after sialidase pre-treatment, at one-, four- and eight-day-old animals and adult animals. For semi-quantitative evaluation of SBA binding intensity, two investigators performed the analysis independently, blinded to the type of experiment. Reactivity of the lectin was assessed in bronchiolar and respiratory portion/alveolar epithelial cell surfaces. We evidenced a stronger positive reaction when lung sections were pre-treated with neuraminidase before incubation with the lectin in one- and four-day-old animals and adult animals. These results were not so manifest in eight-day-old animals. This binding pattern, generally points towards the presence of terminal but mainly sub-terminal GalNAc/Gal residues probably capped by sialic acids on the rat bronchiolar/respiratory tract epithelial cells. As this glycan extension is common in O- and N-glycans, our results suggest that these glycan classes can be present in bronchioloalveolar cells immediately after birth and exist during the postnatal period. The results observed in eight-day-old rat lung sections may be due to the dramatic lung morphologic changes and the possible underlying biological mechanisms that occur during this age-moment.
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http://dx.doi.org/10.4081/ejh.2019.3040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6755261PMC
September 2019

The Antitoxin Is Important Not Only for Human Pathogens: Evidence of Its Role in the Plant Pathogen subsp. .

J Bacteriol 2019 10 20;201(20). Epub 2019 Sep 20.

Centro de Citricultura Sylvio Moreira/Instituto Agronômico, Cordeirópolis, São Paulo, Brazil

subsp. causes citrus canker disease worldwide in most commercial varieties of citrus. Its transmission occurs mainly by wind-driven rain. Once reaches a leaf, it can epiphytically survive by forming a biofilm, which enhances the persistence of the bacteria under different environmental stresses and plays an important role in the early stages of host infection. Therefore, the study of genes involved in biofilm formation has been an important step toward understanding the bacterial strategy for survival in and infection of host plants. In this work, we show that the toxin-antitoxin (TA) system, which was previously identified only in human bacterial pathogens, is conserved in many spp. We further show that in , is involved in important processes, such as biofilm formation, exopolysaccharide (EPS) production, and motility. In addition, we show that plays a role in survival and virulence in host plants. Thus, this mechanism represents an important bacterial strategy for survival under stress conditions. Very little is known about TA systems in phytopathogenic bacteria. , in particular, has only been studied in bacterial human pathogens. Here, we showed that it is present in a wide range of sp. phytopathogens; moreover, this is the first work to investigate the functional role of this TA system in biology, suggesting an important new role in adaptation and survival with implications for bacterial pathogenicity.
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http://dx.doi.org/10.1128/JB.00796-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6755731PMC
October 2019

Presence of sialic acids in bronchioloalveolar cells and identification and quantification of N-acetylneuraminic and N-glycolylneuraminic acids in the lung.

Acta Histochem 2019 Aug 24;121(6):712-717. Epub 2019 Jun 24.

Instituto de Histologia e Embriologia, Faculdade de Medicina, Universidade de Coimbra, Polo I Rua Larga, 3004-504, Coimbra, Portugal; Hospitais da Universidade de Coimbra, Av. Bissaya Barreto Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal.

The lung, in air-breathing vertebrates, is a tree-like structure composed of branching tubes ending in alveoli and lined by diverse and highly specialized epithelial cells. A dense array of complex and diverse glycoconjugates is present on essentially all animal cell surfaces. Sialic acids are widely allocated at the outermost ends of glycan chains, attached to membrane proteins and lipids below. Due to their abundance and their terminal position in glycans, sialic acids are implicated in many physiological and pathological functions. Although the composition of lung epithelial cell-surface glycans has been studied over the years, it is not yet completely understood. In the present work, we aimed to histochemically localize N-acetylneuraminic acid (Neu5Ac)>N-glycolylneuraminic acid (Neu5Gc) residues on rat bronchioloalveolar epithelial cell surfaces using light microscopy (LM) methods. In lung membranes isolated from adult rat lung homogenates, we also separated, identified and quantified Neu5Ac and Neu5Gc by means of high-performance liquid chromatography (HPLC), and systematically described the optimized HPLC methods used. Sialic acid residues were localized on the surface coat of bronchioloalveolar cells, and the mean quantification of Neu5Ac and Neu5Gc in the adult rat lung homogenates was 12,26 and 2,73 μg/mg prot., respectively, revealing a manifest preponderance of Neu5Ac. A coefficient of variation (CV) of 4,98% and 4,40%, respectively was obtained and an optimal dispersion variability expressed by the SD and the CV was also reported, confirming the efficiency of the methodology. To the best of our knowledge, our group was the first to identify, separate and quantify sialic acids in purified lung membranes. The presence of these residues contributes to a strong anionic shield and may provide an hydrating and protective barrier as well as a repulsive structure that is crucial to lung physiology.
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http://dx.doi.org/10.1016/j.acthis.2019.06.004DOI Listing
August 2019

Improving access to community-based pulmonary rehabilitation: 3R protocol for real-world settings with cost-benefit analysis.

BMC Public Health 2019 May 31;19(1):676. Epub 2019 May 31.

Pulmonology Department, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.

Background: Pulmonary rehabilitation (PR) has demonstrated patients' physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit.

Methods: A 12-week community-based PR will be implemented in primary healthcare centres where programmes are not available. Healthcare professionals will be trained. 73 patients with CRD and their caregivers (dyads patient-caregivers) will compose the experimental group. The control group will include dyads age- and disease-matched willing to collaborate in data collection but not in PR. Patients/family-centred outcomes will be dyspnoea (modified Medical Research Council Questionnaire), fatigue (Checklist of individual strength and Functional assessment of chronic illness therapy - fatigue), cough and sputum (Leicester cough questionnaire and Cough and sputum assessment questionnaire), impact of the disease (COPD Assessment Test), emotional state (The Hospital Anxiety and Depression Scale), number of exacerbations, healthcare utilisation, health-related quality of life and family adaptability/cohesion (Family Adaptation and Cohesion Scale). Other clinical outcomes will be peripheral (biceps and quadriceps-hand held dynamometer, 1 or 10 repetition-maximum) and respiratory (maximal inspiratory and expiratory pressures) muscle strength, muscle thickness and cross sectional area (biceps brachialis, rectus femoris and diaphragm-ultrasound imaging), exercise capacity (six-minute walk test and one-minute sit to stand test), balance (brief-balance evaluation systems test) and physical activity (accelerometer). Data will be collected at baseline, at 12 weeks, at 3- and 6-months post-PR. Changes in the outcome measures will be compared between groups, after multivariate adjustment for possible confounders, and effect sizes will be calculated. A cost-benefit analysis will be conducted.

Discussion: This study will enhance patients access to PR, by training healthcare professionals in the local primary healthcare centres to conduct such programmes and actively involving caregivers. The cost-benefit analysis of this intervention will provide an evidence-based insight into the economic benefit of community-based PR in chronic respiratory diseases.

Trial Registration: The trial was registered in the ClinicalTrials.gov U.S. National Library of Medicine, on 10th January, 2019 (registration number: NCT03799666 ).
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http://dx.doi.org/10.1186/s12889-019-7045-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6544941PMC
May 2019

Effect of the Bolsa Familia Programme on tuberculosis treatment outcomes.

Lancet Glob Health 2019 05;7(5):e565

Postgraduate Programme in Health Sciences, University of Southern Santa Catarina, Tubarão 88704-900, Brazil. Electronic address:

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http://dx.doi.org/10.1016/S2214-109X(19)30152-4DOI Listing
May 2019

Effects of Ghrelin on the Oxidative Stress and Healing of the Colonic Anastomosis in Rats.

J Surg Res 2019 02 11;234:167-177. Epub 2018 Oct 11.

Department of Surgery, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil.

Background: Anastomotic leakage is the deadliest complication of colonic procedures. Ghrelin is an orexigenic hormone with potent actions on growth hormone release and functions in the processes of growth, tissue inflammation, repair, and oxidative stress. We evaluated the hypothesis that the exogenous administration of ghrelin causes beneficial effects on the healing of colonic anastomosis.

Materials And Methods: Sixty-four male Wistar rats were randomly assigned to eight subgroups receiving postoperative intraperitoneal administration of ghrelin (23 μg/kg/d) or saline after a colonic anastomosis. The anastomotic tissue was evaluated on the third, seventh, and 14th postoperative days. Anastomotic bursting pressure, histological parameters, hydroxyproline content, and tissue oxidative stress markers were compared.

Results: There was a significant increase in the mean anastomotic bursting pressure in the ghrelin subgroup on the seventh postoperative day (P = 0.035). Histological evaluation demonstrated a significant difference in the neutrophilic infiltrate (P = 0.035) on the third and 14th d and in apoptosis (P = 0.004), granulation tissue (P = 0.011) and peritoneal inflammation (P = 0.014) on the 14th postoperative day. There was a statistically significant increase in the hydroxyproline content in the ghrelin subgroup on the 14th postoperative day (P = 0.043). There were significant differences in the nitrite tissue levels (P = 0.021) on day 3 and in reactive oxygen species (P = 0.012) on day 14.

Conclusions: The administration of ghrelin had beneficial anti-inflammatory and antioxidant effects, increasing the resistance of the anastomosis and the hydroxyproline tissue content in the postoperative period.
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http://dx.doi.org/10.1016/j.jss.2018.09.045DOI Listing
February 2019

Presence of N-acetylglucosamine residues on the surface coating of bronchioloalveolar cells during rat postnatal development: What is their purpose?

Acta Histochem 2019 Feb 15;121(2):119-124. Epub 2018 Nov 15.

Instituto de Histologia e Embriologia, Faculdade de Medicina, Universidade de Coimbra, Polo I Rua Larga, 3004-504, Coimbra, Portugal; Hospitais da Universidade de Coimbra, Av. Bissaya Barreto Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal.

Mammalian lung development is a complex process that is partially accomplished during the postnatal period. Surface carbohydrates are crucial in many biological and pathological phenomena and are key partners during development. The outer surface of lung epithelial cells, which is rich in carbohydrate components, plays a pivotal role throughout the developmental process. However, systematic studies on the sugar residue content of the cell surface coating during postnatal rat lung development are scarce. The aim of the present study was to identify and determine the localization of N-acetylglucosamine residues on the bronchioloalveolar cell surface during rat lung development using light and pre-embedding transmission electron microscopy methodologies, and to associate these data with the components underlying postnatal lung growth. Strong binding sites for the lectin Triticum vulgare (common name Wheat Germ, WGA) are present on the luminal surface of adult rat bronchioloalveolar cells throughout the entire postnatal period and have been identified as N-acetylglucosamine residues. The consistent positive reaction observed on the surface coating of bronchioloalveolar lining cells before and after neuraminidase treatment suggests that aside from possible terminal sialic acids, the lectin specificity for N-acetylglucosamine residues is still evident. Our results also suggest a stronger positive reaction on the bronchioloalveolar cell surface when compared with endothelial cell surface. N-acetylglucosamine residues for lectin binding can be present in glycoproteins in the membrane and also within heparin sulfate chains of glycosaminoglycans, which are crucial for lung development. The work described here has sought to highlight the presence and possible importance of N-acetylglucosamine residues on the glycocalyx of bronchioloalveolar cells, during postnatal lung development.
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http://dx.doi.org/10.1016/j.acthis.2018.10.012DOI Listing
February 2019

Chronic Metabolic Derangement-Induced Cognitive Deficits and Neurotoxicity Are Associated with REST Inactivation.

Mol Neurobiol 2019 Mar 14;56(3):1539-1557. Epub 2018 Jun 14.

Laboratório de Bioenergética e Estresse Oxidativo (LABOX), Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina (UFSC), Campus Universitário - Córrego Grande, Bloco C 201/214, Florianópolis, SC, 88040-900, Brazil.

Chronic metabolic alterations may represent a risk factor for the development of cognitive impairment, dementia, or neurodegenerative diseases. Hyperglycemia and obesity are known to imprint epigenetic markers that compromise the proper expression of cell survival genes. Here, we showed that chronic hyperglycemia (60 days) induced by a single intraperitoneal injection of streptozotocin compromised cognition by reducing hippocampal ERK signaling and by inducing neurotoxicity in rats. The mechanisms appear to be linked to reduced active DNA demethylation and diminished expression of the neuroprotective transcription factor REST. The impact of the relationship between adiposity and DNA hypermethylation on REST expression was also demonstrated in peripheral blood mononuclear cells in obese children with reduced levels of blood ascorbate. The reversible nature of epigenetic modifications and the cognitive impairment reported in obese children, adolescents, and adults suggest that the correction of the anthropometry and the peripheral metabolic alterations would protect brain homeostasis and reduce the risk of developing neurodegenerative diseases.
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http://dx.doi.org/10.1007/s12035-018-1175-9DOI Listing
March 2019

Tetrahydrobiopterin improves hippocampal nitric oxide-linked long-term memory.

Mol Genet Metab 2018 09 11;125(1-2):104-111. Epub 2018 Jun 11.

Laboratório de Bioenergética e Estresse Oxidativo - LABOX, Departamento de Bioquímica, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Centre de Psychiatrie et Neurosciences, INSERM UMR 894, Paris, France.

Tetrahydrobiopterin (BH4) is synthesized by the combined action of three metabolic pathways, namely de novo synthesis, recycling, and salvage pathways. The best-known function of BH4 is its mandatory action as a natural cofactor of the aromatic amino acid hydroxylases and nitric oxide synthases. Thus, BH4 is essential for the synthesis of nitric oxide, a retrograde neurotransmitter involved in learning and memory. We investigated the effect of BH4 (4-4000 pmol) intracerebroventricular administration on aversive memory, and on BH4 metabolism in the hippocampus of rodents. Memory-related behaviors were assessed in Swiss and C57BL/6 J mice, and in Wistar rats. It was consistently observed across all rodent species that BH4 facilitates aversive memory acquisition and consolidation by increasing the latency to step-down in the inhibitory avoidance task. This effect was associated with a reduced threshold to generate hippocampal long-term potentiation process. In addition, two inhibitors of memory formation (N(ω)-nitro-L-arginine methyl ester - L-Name - and dizocilpine - MK-801 -) blocked the enhanced effect of BH4 on memory, while the amnesic effect was not rescue by the co-administration of BH4 or a cGMP analog (8-Br-cGMP). The data strongly suggest that BH4 enhances aversive memory by activating the glutamatergic neurotransmission and the retrograde activity of NO. It was also demonstrated that BH2 can be converted into BH4 by activating the BH4 salvage pathway under physiological conditions in the hippocampus. This is the first evidence showing that BH4 enhances aversive memory and that the BH4 salvage pathway is active in the hippocampus.
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http://dx.doi.org/10.1016/j.ymgme.2018.06.003DOI Listing
September 2018

Persistence in Phytopathogenic Bacteria: Do We Know Enough?

Front Microbiol 2018 25;9:1099. Epub 2018 May 25.

Laboratório de Biotecnologia, Centro de Citricultura, Instituto Agronômico de Campinas, Cordeiropolis, Brazil.

Phytopathogenic bacteria affect a wide range of crops worldwide and have a negative impact in agriculture due to their associated economic losses and environmental impacts. Together with other biotic and abiotic stress factors, they pose a threat to global food production. Therefore, understanding bacterial survival strategies is an essential step toward the development of new strategies to control plant diseases. One mechanism used by bacteria to survive under stress conditions is the formation of persister cells. Persisters are a small fraction of phenotypic variants within an isogenic population that exhibits multidrug tolerance without undergoing genetic changes. They are dormant cells that survive treatment with antimicrobials by inactivating the metabolic functions that are disrupted by these compounds. They are thus responsible for the recalcitrance of many human diseases, and in the same way, they are thought to contribute to the survival of bacterial phytopathogens under a range of stresses they face in the environment. It is believed that persister cells of bacterial phytopathogens may lead to the reoccurrence of disease by recovering growth and recolonizing the host plant after the end of stress. However, compared to human pathogens, little is known about persister cells in phytopathogens, especially about their genetic regulation. In this review, we describe the overall knowledge on persister cells and their regulation in bacterial phytopathogens, focusing on their ability to survive stress conditions, to recover from dormancy and to maintain virulence.
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http://dx.doi.org/10.3389/fmicb.2018.01099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5981161PMC
May 2018

Importance of ambulatory blood pressure monitoring in the diagnosis and prognosis of pediatric hypertension.

Rev Port Cardiol 2018 09 2;37(9):783-789. Epub 2018 Jun 2.

Serviço de Cardiologia Pediátrica, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

The prevalence of high blood pressure (BP) at pediatric age has increased progressively, one of the causes of which is obesity. However, the dominant etiology in this age group is renal and/or cardiovascular pathology. Ambulatory blood pressure monitoring (ABPM) is the method of choice for the diagnosis of hypertension, especially in children at high cardiovascular risk. Its use is limited to children from five years of age. Choosing appropriate cuff size is key to obtaining correct blood pressure. The main indication for ABPM is to confirm the diagnosis of hypertension. It also allows the diagnosis of white coat hypertension (which may represent an intermediate stage between the normotensive phase and hypertension), or masked hypertension, associated with progression to sustained hypertension and left ventricular hypertrophy (LVH). Children with isolated nocturnal hypertension should be considered as having masked hypertension. BP load is defined as the percentage of valid measurements above the 95th percentile for age, gender, and height. Values above 25-30% are pathological and those above 50% are predictive of LVH. ABPM correlates with target organ damage, particularly LVH and renal damage. It is useful in the differentiation of secondary hypertension, since these children show higher BP load and less nocturnal dipping, and confirmation of response to therapy. Thus ABPM allows the diagnosis and classification of hypertension, provides cardiovascular prognostic information and identifies patients with intermediate phenotypes of hypertension.
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http://dx.doi.org/10.1016/j.repc.2017.09.026DOI Listing
September 2018

Outer Membrane Vesicles from Neisseria Meningitidis (Proteossome) Used for Nanostructured Zika Virus Vaccine Production.

Sci Rep 2018 05 29;8(1):8290. Epub 2018 May 29.

Faculty of Pharmaceutical Sciences - FCF, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil.

The increase of Zika virus (ZIKV) infections in Brazil in the last two years leaves a prophylactic measures on alert for this new and emerging pathogen. Concerning of our positive experience, we developed a new prototype using Neisseria meningitidis outer membrane vesicles (OMV) on ZIKV cell growth in a fusion of OMV in the envelope of virus particles. The fusion of nanoparticles resulting from outer membrane vesicles of N. meningitidis with infected C6/36 cells line were analyzed by Nano tracking analysis (NTA), zeta potential, differential light scattering (DLS), scan and scanning transmission eletronic microscopy (SEM and STEM) and high resolution mass spectometry (HRMS) for nanostructure characterization. Also, the vaccination effects were viewed by immune response in mice protocols immunization (ELISA and inflammatory chemokines) confirmed by Zika virus soroneutralization test. The results of immunizations in mice showed that antibody production had a titer greater than 1:160 as compared to unvaccinated mice. The immune response of the adjuvant and non-adjuvant formulation activated the cellular immune response TH1 and TH2. In addition, the serum neutralization was able to prevent infection of virus particles in the glial tumor cell model (M059J). This research shows efficient strategies without recombinant technology or DNA vaccines.
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http://dx.doi.org/10.1038/s41598-018-26508-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5974080PMC
May 2018

Unusual cause of left ventricular dysfunction in a child.

Rev Port Cardiol 2019 02 21;38(2):159.e1-159.e5. Epub 2018 May 21.

Centro de Cirurgia Cardiotorácica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery is a rare congenital heart disease and a cause of myocardial ischemia during childhood. Most undiagnosed cases die in the first year of life as an extensive collateral network is essential for survival. The diagnosis requires a high index of clinical suspicion. The authors present the case of an 8-year-old black asymptomatic child referred from Cape Verde Island in order to clarify left ventricular dilatation and dysfunction with systo-diastolic turbulent flows observed at the interventricular septum. At the age of 3 months, she was diagnosed with heart failure, in the context of showing dilated cardiomyopathy. She was managed and clinically improved with anticongestive therapy, which she was still taking at the time of admission to our Center. The echocardiogram findings suggested Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery and the diagnosis was confirmed by computerized angiotomography and cardiac catheterization. The patient was successfully submitted to direct implantation of the left coronary artery into the aorta, allowing the creation of a double coronary perfusion system. This case illustrates an unusual presentation of a rare pathology that survived without a diagnosis after the first year of life. It also reinforces the importance of multimodality image screening in these cases.
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http://dx.doi.org/10.1016/j.repc.2017.07.017DOI Listing
February 2019