Interventions To Improve Patients' Compliance With Therapies Aimed At Lowering Glycated Hemoglobin (hba1c) In Type 1 Diabetes: Systematic Review And Meta-analyses Of Randomized Controlled Clinical Trials Of Psychological, Telecare, And Educational Interventions

Brazilian records on glycemic control in patients with type 1 diabetes show treatment efficacy. Poor patient adherence to therapeutic proposals influences these results and can be associated with social, psychological, and economic aspects, besides others factors. The aim of this study was to evaluate the efficacy of psychological, telecare, and educational interventions to improve treatment compliance among patients with type 1 diabetes. Compliance was assessed indirectly using reduction of glycated hemoglobin (HbA1c) as the principal outcome measure. Methods: Systematic review and meta-analyses of randomized controlled clinical trials (RCTs) were performed using Medline, Embase, Cochrane and Scopus databases up to April 2015. The following medical subject headings were used: Diabetes Mellitus, Type 1, Patient Compliance or Adherence, Hemoglobin A, glycated, and Randomized Controlled Trial. The principal outcome was change in HbA1c between baseline and follow-up. Where appropriate, trials were combined in meta-analysis using fixed effects models. Results: From 191 articles initially identified, 57 were full text reviewed, and 19 articles met the inclusion criteria providing data from 1782 patients (49.4 % males, age 18 years). The RCTs (2 to 24 months in duration) were divided into four groups according to type of intervention: psychology (seven studies; 818 patients), telecare (six studies; 494 patients); education (five studies; 349 patients), and psychoeducation (one study; 153 patients). All studies reported some type of adherence measurement of the interventions. Decrease in HbA1c was observed after psychology (MD -0.310; 95 % CI, -0.599 to -0.0210, P = 0.035) but not after telecare (MD -0.124 %; 95 % CI, -0.268, 0.020; P = 0.090) or educational (MD -0.001; 95 % CI, -0.202, 0.200; P = 0.990) interventions. Conclusion: Psychological approaches to improve adherence to diabetes care treatment modestly reduced HbA1c in patients with type 1 diabetes; telecare and education interventions did not change glycemic control. However, the limited number of studies included as well as their methodological quality should be taken into account. © 2016 Viana et al.17

Chlamydia trachomatis infection in patients selected for HPV detection

Background: The significance of the association between the human papillomavirus (HPV) and other sexually transmitted infections in the development of cervical, penile or anal neoplasias has been investigated, and the more consistent data have pointed to an association with Chlamydia trachomatis. In Portugal, the lack of information on STI precludes any knowledge on this subject. Objective: To determine CT infection in a group of individuals selected for HPV detection in the major Portuguese STD clinic. Methods: This opportunistic screening comprehended 177 outpatients (148 women, 29 men; age: 16-61 years) suspected of HPV infection (warts, abnormal histology) between 2008 and 2010. Demographic and sexual behaviour data and a full medical history were obtained at enrolment. Genital samples (cervical, vulvar, vaginal, penile or anal) were collected from all the subjects. HPV DNA was detected by CLART HPV2 assay, which allowed the detection of 35 genotypes. CT DNA was detected by Cobas 4800. Results and Discussion: Overall, 84.5% of the individuals had at least one of the infections. Evidencing an excellent correlation with clinical signs, HPV infection was detected in 68.2% of the women and in 75.9% of the men, where CT positivity was 10.1% and 13.8%, respectively. Coinfection was observed in 8.9% of the women and in 13.8% of the men. No correlation with HPV or CT genotypes could be established. HPV infection was more frequent in CT negative (87.1%) than in CT positive women (13.8%), and the same was observed for men (81.8% versus 18.2%). Full results will be presented and discussed. Conclusions: No correlation between HPV-CT coinfection, and clinical signs was observed. However, further long-term studies are needed to elucidate the effects of HPV-CT coinfection in the clinical history of the infected patient, which would greatly contribute towards a better management of patients

Screening polymeric ionic liquids for chromatography-based purification of bacteriophage M13

M13 bacteriophage is a key instrument in phage display applications, as well as a possible antibacterial therapeutic agent due to its highly restrictive bacterial pathogenesis, and other applications. The traditional phage purification process is usually achieved by gradient ultracentrifugation or a combination of precipitation, centrifugation and microfiltration. These approaches easily lead to long process times, high operational costs, phage aggregation and consequent product loss (approximately 60%). This work is thus focused on an alternative potential large-scale process to achieve high yield and purity while minimizing the operational costs. Electrostatic-based separation processes are also common biomolecules purification techniques. Although anion exchange chromatography has been used before to purify several viral particles, this technique has been poorly reported for the purification of M13 phage. In a recent work, our group has demonstrated the use of a predominant anion exchange process, where a polymeric ionic liquid (PIL) was used as an alternative separation matrix for M13 bacteriophage. In this work, a variety of system parameters was studied, including chemical structure of the cation and the anion, the crosslinker nature and its concentration, either in batch adsorption/elution or chromatographic operation mode. The PIL-based chromatographic operation mode revealed to be a suitable separation process for M13 from directly filtered E. coli supernatant, reaching over 70% M13 recovery and 4.6 purification factor in a single step. To our knowledge, this is the first time that PILs have been reported as separation agents for bioproducts from complex mixtures.publishe

Maneio reprodutivo em ovinos e caprinos 6. Flushing Alimentar

Ao longo do processo evolutivo, os animais desenvolveram mecanismos que lhes permitem, em períodos de escassez de alimentos, direcionar os nutrientes para a manutenção de funções fisiológicas essenciais à vida, em detrimento de outras que não contribuem, no imediato, para a sua sobrevivência (caso da atividade reprodutiva) (l). A sazonalidade reprodutiva, sendo uma consequência destes mecanismos (2), garante que a maioria dos animais se reproduz em uma época específica do ano, para que os partos coincidam com o momento do ano em que as disponibilidades naturais de alimentos e as condições climatéricas são mais favoráveis ao crescimento fetal final e à lactação (2-7), aumentando a probabilidade de sobrevivência das progenitoras e das crias (2, 5, 7). No entanto, esta sincronia endógena pode, em sistemas comerciais de produção, não coincidir com o início da época de cobricão desejada pelo criador. Nos pequenos ruminantes domésticos (ovinos e caprinos), a sazonalidade reprodutiva varia em função da latitude, sendo reduzida nas regiões tropicais e elevada nas regiões mais meridionais e setentrionais (4, 5, 7). Nas regiões temperadas, o fotoperíodo é o principai fator exógeno regulador da sazonalidade (atividade) reprodutiva (3-6, 8) modelando-a diretamente - através do sistema neuroendócrino - e indiretamente - através da disponibilidade natural de alimento (3). Nestas regiões, a nutrição é provavelmente o mais importante regulador secundário da atividade reprodutiva (6, 8), capaz de modelar a ação do fotoperíodo (6). Já nas regiões tropicais, a sazonalidade da disponibilidade natural de alimentos e o clima são os principais fatores exógenos reguladores da atividade reprodutiva (4, 5, 7).info:eu-repo/semantics/publishedVersio

IMAGINE-IMpact Assessment of Guidelines Implementation and Education : The Next Frontier for Harmonising Urological Practice Across Europe by Improving Adherence to Guidelines

Funding support: The IMAGINE ADT audit is supported by a seeding grant from the EAU Research Foundation.Peer reviewedPostprin

mHealth in urology

Introduction: Smartphones are increasingly playing a role in healthcare and previous studies assessing medical applications (apps) have raised concerns about lack of expert involvement and low content accuracy. However, there are no such studies in Urology. We reviewed Urology apps with the aim of assessing the level of participation of healthcare professionals (HCP) and scientific Urology associations in their development. Material and Methods: A systematic search was performed on PubMed, Apple's App Store and Google's Play Store, for Urology apps, available in English. Apps were reviewed by three graders to determine the app's platform, target customer, developer, app type, app category, price and the participation of a HCP or a scientific Urology association in the development. Results: The search yielded 372 apps, of which 150 were specific for Urology. A fifth of all apps had no HCP involvement (20.7%) and only a third had been developed with a scientific Urology association (34.7%). The lowest percentage of HCP (13.4%) and urological association (1.9%) involvement was in apps designed for the general population. Furthermore, there was no contribution from an Urology society in "Electronic Medical Record" nor in "Patient Information" apps. A limitation of the study is that only Android and iOS apps were reviewed. Conclusions: Despite the increasing Mobile Health (mHealth) market, this is the first study that demonstrates the lack of expert participation in the design of Urology apps, particularly in apps designed for the general public. Until clear regulation is enforced, the urological community should help regulate app development. Maintaining a register of certified apps or issuing an official scientific seal of approval could improve overall app quality. We propose that urologists become stakeholders in mHealth, shaping future app design and promoting peer-review app validation

N-terminal-pro-B type natriuretic peptide as a useful tool to evaluate pulmonary hypertension and cardiac function in CDH infants

Objective: In congenital diaphragmatic hernia (CDH) the severity of pulmonary hypertension (PH) is considered, by several authors, determinant of clinical outcome. Plasmatic N-terminal-pro-B type natriuretic peptide (NT-proBNP) might be useful in diagnosis and management of PH in newborns, although its interest in CDH infants remains to be defined. Early NT-proBNP levels were assessed in CDH infants and correlated with cardiovascular echocardiographic parameters. Patients and Methods: 28 newborns, CDH and age-matched controls were enrolled in a prospective study. Clinical condition, NT-proBNP plasmatic levels, echo parameters of PH and biventricular function were assessed at 24 h after delivery as well as survival outcome. Results: Estimated mean pulmonary pressure and NT-proBNP were significantly higher in CDH than control infants. NT-proBNP significantly correlated with estimated pulmonary artery pressure, right ventricular Tei index, and tricuspid E/A ratio. Additionally, we found that CDH infants with NT-proBNP >11,500 pg/ml experienced a worse prognosis. Conclusions: We demonstrated that PH is associated with NT-proBNP elevation and diastolic impairment in CDH infants. Early elevations in NT-proBNP levels seem to alert for a subset of CDH infants with worse prognosis. Copyrigh

Extraction of cocoa butter by supercritical carbon dioxide: optimization of operating conditions and effect of particle size.

The optimum operating conditions for the extraction of cocoa butter from cocoa liquor using supercritical carbon dioxide and the effect of sample particle size on cocoa butter extraction under optimized operating conditions were investigated. The optimization was conducted at 10–45 MPa and 35–75C, with extraction times of 1–12 h by response surface methodology. The effect of particle size was studied using cocoa liquor, ground cocoa nibs and crushed cocoa nibs with particle sizes of approximately 74 µm, 0.85–1 mm and 4–6 mm, respectively. The yield was analyzed for total fat content by gravimetric method and triacylglycerol (TAG) profile by high-performance liquid chromatography. The results showed higher yield of cocoa butter with higher values of pressure, temperature and extraction time. The optimum conditions for cocoa butter extraction were 45 MPa, 75C and 12 h. The smaller particle size produced a higher yield of cocoa butter. 1,3-Dipalmitoyl-2-oleoyl-glycerol (POP), 1-palmitoyl-2-oleoyl-3-stearoyl-glycerol (POS) and 1,3-distearoyl-2-oleoyl-glycerol (SOS) were the major TAGs present in the extracted cocoa butter, with POS being the highest (>30%) for all treatments studied

How brains make decisions

This chapter, dedicated to the memory of Mino Freund, summarizes the Quantum Decision Theory (QDT) that we have developed in a series of publications since 2008. We formulate a general mathematical scheme of how decisions are taken, using the point of view of psychological and cognitive sciences, without touching physiological aspects. The basic principles of how intelligence acts are discussed. The human brain processes involved in decisions are argued to be principally different from straightforward computer operations. The difference lies in the conscious-subconscious duality of the decision making process and the role of emotions that compete with utility optimization. The most general approach for characterizing the process of decision making, taking into account the conscious-subconscious duality, uses the framework of functional analysis in Hilbert spaces, similarly to that used in the quantum theory of measurements. This does not imply that the brain is a quantum system, but just allows for the simplest and most general extension of classical decision theory. The resulting theory of quantum decision making, based on the rules of quantum measurements, solves all paradoxes of classical decision making, allowing for quantitative predictions that are in excellent agreement with experiments. Finally, we provide a novel application by comparing the predictions of QDT with experiments on the prisoner dilemma game. The developed theory can serve as a guide for creating artificial intelligence acting by quantum rules.Comment: Latex file, 20 pages, 3 figure

Noncanonical and reversible cysteine ubiquitination prevents the overubiquitination of PEX5 at the peroxisomal membrane

PEX5, the peroxisomal protein shuttling receptor, binds newly synthesized proteins in the cytosol and transports them to the organelle. During its stay at the peroxisomal protein translocon, PEX5 is monoubiquitinated at its cysteine 11 residue, a mandatory modification for its subsequent ATP-dependent extraction back into the cytosol. The reason why a cysteine and not a lysine residue is the ubiquitin acceptor is unknown. Using an established rat liver-based cell-free in vitro system, we found that, in contrast to wild-type PEX5, a PEX5 protein possessing a lysine at position 11 is polyubiquitinated at the peroxisomal membrane, a modification that negatively interferes with the extraction process. Wild-type PEX5 cannot retain a polyubiquitin chain because ubiquitination at cysteine 11 is a reversible reaction, with the E2-mediated deubiquitination step presenting faster kinetics than PEX5 polyubiquitination. We propose that the reversible nonconventional ubiquitination of PEX5 ensures that neither the peroxisomal protein translocon becomes obstructed with polyubiquitinated PEX5 nor is PEX5 targeted for proteasomal degradation