Higher vegetable protein consumption,assessed by an isoenergetic macronutrient exchange model,is associated with a lower presence of overweight and obesity in the web-based Food4me European study

The objective was to evaluate differences in macronutrient intake and to investigate the possible association between consumption of vegetable protein and the risk of overweight/obesity, within the Food4Me randomised, online intervention. Differences in macronutrient consumption among the participating countries grouped by EU Regions (Western Europe, British Isles, Eastern Europe and Southern Europe) were assessed. Relation of protein intake, within isoenergetic exchange patterns, from vegetable or animal sources with risk of overweight/obesity was assessed through the multivariate nutrient density model and a multivariate-adjusted logistic regression. A total of 2413 subjects who completed the Food4Me screening were included, with self-reported data on age, weight, height, physical activity and dietary intake. As success rates on reducing overweight/obesity are very low, form a public health perspective, the elaboration of policies for increasing intakes of vegetable protein and reducing animal protein and sugars, may be a method of combating overweight/obesity at a population level.     

Fibrin,the preferred scaffold for cell transplantation after myocardial infarction? An old molecule with a new life

Fibrin is a topical haemostat, sealant and tissue glue, which consists of concentrated fibrinogen and thrombin. It has broad medical and research uses. Recently, several studies have shown that engineered patches comprising mixtures of biological or synthetic materials and progenitor cells showed therapeutic promise for regenerating damaged tissues. In that context, fibrin maintains cell adherence at the site of injury, where cells are required for tissue repair, and offers a nurturing environment that protects implanted cells without interfering with their expected benefit. Here we review the past, present and future uses of fibrin, with a focus on its use as a scaffold material for cardiac repair. Fibrin patches filled with regenerative cells can be placed over the scarring myocardium; this methodology avoids many of the drawbacks of conventional cell‐infusion systems. Advantages of using fibrin also include extraction from the patient's blood, an easy readjustment and implantation procedure, increase in viability and early proliferation of delivered cells, and benefits even with the patch alone. In line with this, we discuss the numerous preclinical studies that have used fibrin–cell patches, the practical issues inherent in their generation, and the necessary process of scaling‐up from animal models to patients. In the light of the data presented, fibrin stands out as a valuable biomaterial for delivering cells to damaged tissue and for promoting beneficial effects. However, before the fibrin scaffold can be translated from bench to bedside, many issues must be explored further, including suboptimal survival and limited migration of the implanted cells to underlying ischaemic myocardium. Copyright © 2016 John Wiley & Sons, Ltd.     

Induction of IgA and sustained deficiency of cell proliferative response in chronic hepatitis C

AIM： In the present study, antibody and peripheral blood mononuclear cells （PBMC） proliferative responses against hepatitis C virus （HCV） antigens were evaluated in HCV chronically infected patients. METHODS： Paired serum and PBMC samples were taken six months apart from 34 individuals, either treated or not, and tested by enzyme-linked immunosorbent assay （ELISA） and carboxyfluorescein succinimidyl ester staining. RSULTS： Over 70% of the patients showed specific IgG and IgM against capsid, E1 and NS3, while HVR-1 was recognized by half of the patients. An increase in the levels of the anti-capsid IgM （P = 0.027） and IgG （P = 0.0006） was observed in six-month samples, compared to baseline. Similarly, a significantly higher percent of patients had detectable IgA reactivity to capsid （P = 0.017） and NS3 （P = 0.005） after six months, compared to baseline. Particularly, IgA against structural antigens positively correlated with hepatic damage （P = 0.036）. IgG subclasses evaluation against capsid and NS3 revealed a positive recognition mediated by IgG1 in more than 80% of the individuals. On the contrary, less than 30% of the patients showed a positive proliferative response either of CD4＋ or CD8＋ T cells, being the capsid poorly recognized. CONCLUSION： These results confirm that while the cellular immune response is narrow and weak, a broad and vigorous humoral response occurs in HCV chronic infection. The observed correlation between IgA and hepatic damage may have diagnostic significance, although it warrants further confirmation.     

Depression as a determinant of quality of life in patients with chronic disease: data from Brazil

Background  

Depressive symptoms are associated with impaired quality of life (QOL). However, there are scarce data comparing the magnitude of depression on QOL among persons with different chronic diseases in developing countries. This study aimed to evaluate the impact of depression on QOL in patients with ischemic heart disease (IHD) and end-stage renal disease (ESRD) in hemodialysis.     

Manual and automated reticulocyte counts

Manual reticulocyte counts were examined under light microscopy, using the property whereby supravital stain precipitates residual ribosomal RNA versus the automated flow methods, with the suggestion that in the latter there is greater precision and an ability to determine both mature and immature reticulocyte fractions. Three hundred and forty-one venous blood samples of patients were analyzed of whom 224 newborn and the rest adults; 51 males and 66 females, with ages between 0 and 89 years, as part of the laboratory routine for hematological examinations at the Clinical Laboratory of the Hospital Universitário do Oeste do Paraná. This work aimed to compare manual and automated methodologies for reticulocyte countings and evaluate random and systematic errors. The results obtained showed that the difference between the two methods was very small, with an estimated 0·4% systematic error and 3·9% random error. Thus, it has been confirmed that both methods, when well conducted, can reflect precisely the reticulocyte counts for adequate clinical use.     

Providing more through less: current methods of retraction in SIMIS and NOTES cholecystectomy

Background

As the field of minimally invasive surgery continues to develop, surgeons are confronted with the challenge of performing conventional laparoscopic surgeries through fewer incisions while maintaining the same degree of safety and surgical efficiency. Most of these methods involve elimination of the ports previously designated for retraction. As a result, minimally invasive surgeons have been forced to develop minimally invasive and ingenious methods for providing adequate retraction for these procedures. Herein we present our experience using endoloops and internal retractors to provide retraction during Single Incision Minimally Invasive Surgery (SIMIS) and Natural Orifice Transluminal Endoscopic Surgery (NOTES) cholecystectomy. We also present a review of the alternative retraction methods currently being employed for these surgeries.

Methods

SIMIS was performed on 20 patients and NOTES was performed on 5 patients at our institution. Endoloops or internal retractors were used to provide retraction for all SIMIS procedures. Internal retractors provided retraction for all NOTES procedures.

Results

Successful cholecystectomy was accomplished in all cases. One SIMIS surgery required conversion to standard laparoscopy due to complex anatomy. There were no intraoperative complications. Although adequate retraction was accomplished in all cases, the internal retractors were found to provide superior and more versatile retraction compared to that of endoloops.

Conclusion

Adequate retraction greatly simplifies SIMIS and NOTES surgery. Endograb internal retractors were easy to use and were found to provide optimal retraction and exposure during these procedures without complications.     

The impact of proton-pump inhibitors on intraperitoneal sepsis: a word of caution for transgastric NOTES procedures

Background  

During transgastric natural orifice transluminal endoscopic surgery (NOTES), there is an iatrogenic perforation of the gastric wall with leakage of gastric contents into the peritoneal cavity. The aim of this study is to determine the effect of proton-pump inhibitors (PPI) and alterations of gastric pH on infection during transgastric surgery.     

Efficacy of social worker role in corneal donation in two different periods

Introduction

The Brazilian National System of Transplantation and the Ministry of Health in Brazil establish procedures and effective actions for occupational health care so that there are increasing numbers of organ and tissue donations.

Objective

This study analyzes the performance of social workers at the Intrahospital Donation of Organs and Tissues for Transplantation, Clinical Hospital, State University of Campinas, Brazil (CIHDOTT).

Methods

We retrospectively analyzed the number of potential cornea donors, effective donations, family refusal, and the reasons for nonimplementation of the donations in 2009 (period studied with the presence of social workers) compared with 2006 (period studied without the presence of social workers).

Results

Data analysis revealed that in 2006 there were 141 potential cornea donors achieving 35 (25%) donations and 106 (75%) refusals. In 2009 there were 73 potential donors with 25 (34%) donations and 48 (66%) refusals. The causes of family refusal prevalent in both periods were similar: 65% from indecision and 25% from the family's wishes to maintain the patient's body intact.

Conclusion

The performance of social workers in this case was satisfactory, achieving an increase in donations and reducing the number of patients awaiting corneal transplantation while promoting their quality of life.     

Organ Donation: Cross-Sectional Survey of Knowledge and Personal Views of Brazilian Medical Students and Physicians

Objective

To assess the knowledge, attitudes, and behavior associated with cadaver organ donation and transplantation among medical students and physicians.

Patients and Methods

We randomly selected 350 medical students, 150 physicians, and 150 intensive care unit physicians. Each completed a questionnaire consisting of 9 self-administered items, from which we gathered data about their knowledge about brain death and criteria for the diagnosis of brain death; their hypothetical behaviors, assuming willingness to donate their own or their family's organs; their trust in physicians; and their confidence in a diagnosis of brain death made by physicians.

Results

We observed that knowledge about brain death increased with medical education level; the best results were noted in intensive care unit physicians. Agreement to transplant organs from brain-dead donors (odds ratio [OR], 4.58), confidence in brain-death diagnosis by physicians (OR, 2.17), and knowledge about criteria for the diagnosis of brain death (OR, 2.26) were predictors of willingness to donate one's own organs.

Conclusion

Enhanced medical knowledge of and involvement in donation are needed to achieve cadaver organ donation.