Combined remote ischemic perconditioning and local postconditioning on liver ischemia–reperfusion injury

Background

Remote ischemic perconditioning (rPER) is the newest technique described to mitigate ischemia and reperfusion (IR) injury. Local postconditioning (POS) is also an effective technique for this purpose. It is uncertain if adding local POS to rPER provides superior liver protection, so we tested this hypothesis.

Materials and methods

Twenty five Wistar rats were assigned into five groups: sham, IR, POS, rPER, and rPER + POS. Animals were subjected to liver ischemia for 60 min. POS consisted of four cycles of 5-min liver perfusion followed by 5-min liver ischemia (40 min total) after the major ischemic period. rPER consisted of four cycles of 5-min hindlimb ischemia followed by 5 min hindlimb perfusion contemporaneously to major liver ischemic period, during its last 40 min. After 2 h, median and left lobes were harvested for malondialdehyde and Trolox equivalent antioxidant capacity (TEAC) measurement, and blood for the measurement of serum transaminases.

Results

All tissue conditioning techniques were able to reduce transaminases serum levels, having no differences among them. All tissue conditioning techniques were able to reduce hepatic tissue MDA level; however, only rPER + POS had higher values than SHAM. All tissue conditioning techniques also enhanced TEAC; however, only POS had lower TEAC than SHAM.

Conclusions

rPER appears as the most promising technique to avoid IR injury. This technique reduced oxidative stress of cell membranes and lowered transaminases serum level. There was no additive protection when POS and rPER were held together.     

A gene expression profile related to immune dampening in the tumor microenvironment is associated with poor prognosis in gastric adenocarcinoma

Background

The TNM Classification of Malignant Tumours (TNM) staging system is the primary means of determining a prognosis for gastric adenocarcinoma (GC). However, tumor behavior in the individual patient is unpredictable and in spite of treatment advances, a classification of 'advanced stage' still portends a poor prognosis. Thus, further insights from molecular analyses are needed for better prognostic stratification and determination of new therapeutic targets.

Methods

A total of fifty-one fresh frozen tumor samples from patients with histopathologically confirmed diagnoses of GC, submitted to surgery with curative intent, were included in the study. Total RNA was extracted from an initial group of fifteen samples matched for known prognostic factors, categorized into two subgroups, according to patient overall survival: poor (<24 months) or favorable (at or above 24 months), and hybridized to Affymetrix Genechip human genome U133 plus 2.0 for genes associated with prognosis selection. Thirteen genes were selected for qPCR validation using those initial fifteen samples plus additional thirty-six samples.

Results

A total of 108 genes were associated with poor prognosis, independent of tumor staging. Using systems biology, we suggest that this panel reflects the dampening of immune/inflammatory response in the tumor microenvironment level and a shift to Th2/M2 activity. A gene trio (OLR1, CXCL11 and ADAMDEC1) was identified as an independent marker of prognosis, being the last two markers validated in an independent patient cohort.

Conclusions

We determined a panel of three genes with prognostic value in gastric cancer, which should be further investigated. A gene expression profile suggestive of a dysfunctional inflammatory response was associated with unfavorable prognosis.     

Factors associated to persistence with hormonal therapy in women with breast cancer

OBJECTIVE

To analyze factors associated with persistence to breast cancer hormone therapy in order to contribute to the quality of care improvement.

METHODS

Retrospective longitudinal study, based on secondary data. A cohort of 5,861 women with breast cancer registered in different datasets of the Brazilian National Cancer Institute and the Brazilian Unified Health System were analyzed. All women were treated at this hospital, which provides free medication, and the follow-up period was from January 2004 to October 2010. Sociodemographic, behavioral, and clinical variables, as well as aspects of lifestyle and health care, were considered in the explanation of variations in the persistence to hormone therapy, applying the Kaplan-Meier method and the Cox proportional hazard model.

RESULTS

Overall persistence to hormone therapy was 79.0% at the end of the first year, and 31.0% in five years of treatment. The risk of discontinuing hormone therapy was higher among women under 35 years old, with more advanced disease (stages III and IV), alcohol drinkers, those undergoing chemotherapy, and for each additional hospitalization, exam performed, and month between diagnosis and beginning of treatment. In the opposite direction, the risk of discontinuity was lower among women who had at least finished high school, those with partner, with a family history of cancer, those who had undergone breast surgery, and who had outpatient visits to a Mastologist, and a Clinical Oncologist.

CONCLUSIONS

The majority of the women with breast cancer (69.0%) do not persist with hormone treatment for the five years recommended, increasing the risk of inadequate clinical results. The results show aspects of care that can provide better results.     

Validity and reliability of a pediatric patient classification instrument

OBJECTIVES:

to assess the construct validity and reliability of the Pediatric Patient Classification Instrument.

METHODS:

correlation study developed at a teaching hospital. The classification involved 227 patients, using the pediatric patient classification instrument. The construct validity was assessed through the factor analysis approach and reliability through internal consistency.

RESULTS:

the Exploratory Factor Analysis identified three constructs with 67.5% of variance explanation and, in the reliability assessment, the following Cronbach''s alpha coefficients were found: 0.92 for the instrument as a whole; 0.88 for the Patient domain; 0.81 for the Family domain; 0.44 for the Therapeutic procedures domain.

CONCLUSIONS:

the instrument evidenced its construct validity and reliability, and these analyses indicate the feasibility of the instrument. The validation of the Pediatric Patient Classification Instrument still represents a challenge, due to its relevance for a closer look at pediatric nursing care and management. Further research should be considered to explore its dimensionality and content validity.     

Tuberculosis care: an evaluability study

OBJECTIVE:

to verify whether the tuberculosis control program (TCP) is evaluable and to examine the feasibility of building an evaluation model in apriority municipality for the control of tuberculosis.

METHOD:

this evaluability study was conducted in a municipality in northeastern Brazil. For data collection, documental analysis and interviews with key informants were performed. For indicator validation, the nominal group technique was adopted.

RESULTS:

the details of TCP were described, and both the logical model and the classification framework for indicators were developed and agreed up on, with the goal of characterizing the structural elements of the program, defining the structure and process indicators, and formulating the evaluation questions.

CONCLUSION:

TCP is evaluable. Based on logical operational analysis, it was possible to evaluate the adequacy of the program goals for the control of tuberculosis. Therefore, the performance of a summative evaluation is recommended, with a focus on the analysis of the effects of tuberculosis control interventions on decreasing morbidity and mortality.     

Accuracy of traditional and novel serology tests for predicting cross-protection in foot-and-mouth disease vaccinated cattle

Foot-and-mouth disease virus (FMDV) antigenic-match between vaccine and field viruses has traditionally been estimated in vitro by computing the r1 value using virus neutralization test (VNT) or ELISA titers. In this study we compared the accuracy in predicting cross-protection between the r1 value estimated by VNT and two recently developed tests that measure IgG subtypes and avidity. Data analyzed consisted of 64 serum samples from FMDV A24/Cruzeiro vaccinated bovines challenged with the heterologous A/Argentina/2001 strain and evaluated for podal generalization. We computed the tests sensitivity (Se), specificity (Sp), and receiving operating characteristics (ROC) curve. The heterologous IgG1/IgG2 ratio was the most accurate test (Se = 0.71, Sp = 0.98), followed by heterologous IgG1 (Se = 0.53, Sp = 0.96), VNT (Se = 0.47, Sp = 1.00), whereas r1 accuracy was substantially low (Se = 0.41, Sp = 0.81). Because sensitivity of individual tests was limited, we argue that two or more of the tests should be used in combination to produce accurate estimates of protection.     

Telegenetics: application of a tele-education program in genetic syndromes for Brazilian students

With the high occurrence of genetic anomalies in Brazil and the manifestations of communication disorders associated with these conditions, the development of educative actions that comprise these illnesses can bring unique benefits in the identification and appropriate treatment of these clinical pictures.

Objective

The aim of this study was to develop and analyze an educational program in genetic syndromes for elementary students applied in two Brazilian states, using an Interactive Tele-education model.

Material and Methods

The study was carried out in 4 schools: two in the state of São Paulo, Southeast Region, Brazil, and two in the state of Amazonas, North Region, Brazil. Forty-five students, both genders, aged between 13 and 14 years, of the 9^th grade of the basic education of both public and private system, were divided into two groups: 21 of São Paulo Group (SPG) and 24 of Amazonas Group (AMG). The educational program lasted about 3 months and was divided into two stages including both classroom and distance activities on genetic syndromes. The classroom activity was carried out separately in each school, with expository lessons, graphs and audiovisual contents. In the activity at a distance the educational content was presented to students by means of the Interactive Tele-education model. In this stage, the students had access a Cybertutor, using the Young Doctor Project methodology. In order to measure the effectiveness of the educational program, the Problem Situation Questionnaire (PSQ) and the Web Site Motivational Analysis Checklist adapted (FPM) were used.

Results

The program developed was effective for knowledge acquisition in 80% of the groups. FPM showed a high satisfaction index from the participants in relation to the Interactive Tele-education, evaluating the program as "awesome course". No statistically significant differences between the groups regarding type of school or state were observed.

Conclusion

Thus, the Tele-Education Program can be used as a tool for educational purposes in genetic syndromes of other populations, in several regions of Brazil.