Effect of treadmill gait on bone markers and bone mineral density of quadriplegic subjects

Quadriplegic subjects present extensive muscle mass paralysis which is responsible for the dramatic decrease in bone mass, increasing the risk of bone fractures. There has been much effort to find an efficient treatment to prevent or reverse this significant bone loss. We used 21 male subjects, mean age 31.95 ± 8.01 years, with chronic quadriplegia, between C4 and C8, to evaluate the effect of treadmill gait training using neuromuscular electrical stimulation, with 30-50% weight relief, on bone mass, comparing individual dual-energy X-ray absorptiometry responses and biochemical markers of bone metabolism. Subjects were divided into gait (N = 11) and control (N = 10) groups. The gait group underwent gait training for 6 months, twice a week, for 20 min, while the control group did not perform gait. Bone mineral density (BMD) of lumbar spine, femoral neck, trochanteric area, and total femur, and biochemical markers (osteocalcin, bone alkaline phosphatase, pyridinoline, and deoxypyridinoline) were measured at the beginning of the study and 6 months later. In the gait group, 81.8% of the subjects presented a significant increase in bone formation and 66.7% also presented a significant decrease of bone resorption markers, whereas 30% of the controls did not present any change in markers and 20% presented an increase in bone formation. Marker results did not always agree with BMD data. Indeed, many individuals with increased bone formation presented a decrease in BMD. Most individuals in the gait group presented an increase in bone formation markers and a decrease in bone resorption markers, suggesting that gait training, even with 30-50% body weight support, was efficient in improving the bone mass of chronic quadriplegics.1357136

Urinary Protein Excretion Profile: A Contribution For Subclinical Renal Damage Identification Among Environmental Heavy Metals Exposure In Southeast Brazil

In Southeast Brazil. Ribeira Valley region has been a major public health concern due to the environmental heavy metals contamination indexes of vegetation, rocks and aquifers, caused by local mining in the past. Human contamination by low levels of heavy metals doesn't cause acute intoxication but in chronic exposure, renal damage may occur with progressive tubulointerstitial changes evolving to glomerular lesion. In this study we investigated the relationship between the profile of urinary excreted proteins (glomerular or tubular origin) of arsenic and mercury and blood lead concentration in children and adults from highly exposed regions of the Ribeira Valley. The subjects were classified as GROUP 1 (G1; higher environmental risk, n=333) and GROUP 2 (G2; lower risk of contamination, n=104). In order to determine the urinary excretion of total protein, albumin (MA, glomerular marker) and alpha I microglobulin (A1M, tubular marker) and the blood lead concentrations, random urine and blood samples were obtained. Plasmatic lead levels were assessed by atomic absorption spectrometry with graphite furnace. Total protein concentration (PROT) was assessed on a biochemical analyzer (pyrogallol red method). MA and A1M were determined by nephelometric method. Group 1 showed a higher frequency of altered urinary excretion of PROT (G1=3.4%; G2=1.0%), MA (G1=9.0%; G2=5.1%) and A1M (G1=7.5%; G2=3.8%), without significant differences between both groups. Elevated arsenic levels were more prevalent among subjects from Group 1 (28.8%) and demonstrated a significant correlation with abnormal urinary excretion of albumin and alpha-1-microglobulin (p=0.019). Lead and mercury levels showed no difference among the groups and no correlation with MA and/or A1M. Our data suggests that abnormal urinary protein excretion is relatively frequent in this population independently of the plasmatic or urinary heavy metal levels. The early detection of possible renal damage become necessary for effective measures can be taken to prevent clinical nephropathies.107I513516Eysink, G.G.J., Avaliação da qualidade ambiental do Rio Ribeira do Iguape- Considerações preliminares, relatório técnico da CETESB (1991), p. 54. , CETESB, São PauloPaoliello, M.M.B., De Capitani, E.M., Cunha, F.G., Matsuo, T., Carvalho, M.F., Sakuma, A., Figueiredo, B.R., Exposure of children to lead and cadmium from a mining area of Brazil (2002) Environmental Research, 88, pp. 120-128Bennet, B.G., Exposure of man to environmental arsenic - an exposure commitment assessment (1981) Sci Total Environ, 20 (2), pp. 99-107Hewitt, D.J., Millner, G.C., Nye, A.C., Simmons, H.F., Investigation of arsenic exposure from soil at a superfund site (1995) Environ. Research, 68, pp. 73-81Goyer, R.A., Mechanisms of lead and cadmium nephrotoxicity (1989) Toxicol Lett., 46, pp. 153-162Chia, K.S., Jeyaratnam, J., Lee, J., Tan, C., Ong, H.Y., Ong, C.N., Lee, E., Lead-induced nephropathy: Relationship between various biological exposure indices and early markers of nephrotoxicity (1995) Am J Ind Med, 27 (6), pp. 883-895Kim, R., Rotnitsky, A., Sparrow, D., Weiss, S., Wager, C., Hu, H., A longitudinal study of low level lead exposure and impairment of renal function. The normative aging study (1996) JAMA, 275, pp. 1177-1181Cardenas, A., Roels, H., Bernard, A.M., Markers of early renal changes induced by industrial pollutants. II. Application to workers exposed to lead (1993) Br J Ind Med, 50, pp. 28-36Kusano, E., Suzuki, M., Asano, Y., Takagi, K., Tadashi, K., Human alfa-1-microglobulin and its relationship to renal function (1985) Nephron, 41, pp. 320-324Pergande, M., Jung, K., Precht, S., Fels, L.M., Herbort, C., Stolte, H., Changed excretion of urinary proteins and enzymes by chronic exposure to lead (1994) Nephrol Dial Transplant, 9 (6), pp. 613-618Preventing lead poisoning in young children: A statement by the centers for disease control (1991), Centers for Disease Control and Prevention-USDHHS- PHS, Washington, octoberPaschal, D.C., Trace metals in urine of United States residentes: Reference range concentrations (1998) Environ Research, 76, pp. 53-59not

Urinálise: comparação entre microscopia óptica e citometria de fluxo

INTRODUÇÃO E OBJETIVO: O exame de urina é um procedimento de alta demanda, trabalhoso e pouco padronizado. Este estudo teve por objetivo avaliar o desempenho de um citômetro de fluxo na realização do exame de urina de rotina. CASUÍSTICA E MÉTODOS: Foram analisadas 1.140 amostras de urina através de microscopia óptica comum e de citometria de fluxo (UF-100/SYSMEX). A precisão foi estabelecida com a análise de quatro amostras de urina (20 replicações cada). O cálculo da reprodutibilidade foi realizado a partir de 30 determinações de dois controles comerciais em dias consecutivos. RESULTADOS: As contagens de hemácias e leucócitos mostraram concordância de 91% e 93%, respectivamente. Cilindros, células e bactérias mostraram sobreposição dos valores fornecidos pelo UF-100 quando comparados com os relatados na análise microscópica. A precisão do UF-100 variou de 4% a 155%, com reprodutibilidade de 3% e 25%, dependendo do parâmetro avaliado. CONCLUSÃO: O equipamento UF-100/SYSMEX demonstra boa precisão, reprodutibilidade e concordância com a microscopia óptica. A utilização da citometria de fluxo implica numa maior agilização e padronização da rotina, bem como em uma nova maneira de reportar e interpretar o exame de urina de rotina

Urinalysis: comparison between microscopic and flow cytometry analysis

INTRODUCTION: Urinalysis is a high demand procedure, with large amount of manual labor and poorly standardized. The purpose of this investigation was to analyze the performance of an automated system based on flow cytometry for routine urinalysis. MATERIAL AND METHODS: We analyzed 1,140 urine samples by light field microscopy and by flow cytometry (UF-100/SYSMEX). For the precision study of the UF-100, we calculated the within-run and between-run coefficients of variation using two different levels of commercial controls and four different urine samples. RESULTS: Erythrocytes and leukocytes counts by the two methods showed an agreement of 91% and 93%, respectively. Casts, epithelial cells and bacteria counts by the UF-100 showed a significant overlap when compared to microscopic analysis. Intra assay precision (within-run) ranged from 4% to 155% and interassay precision (between-run) varied from 3% to 25%, depending on the considered parameter. CONCLUSION: Flow cytometry is a precise and reproducible technique, with a strong correlation with the results obtained by microscopic analysis. Flow cytometry allows a better workflow and a new manner of reporting and interpreting routine urinalysis.INTRODUÇÃO E OBJETIVO: O exame de urina é um procedimento de alta demanda, trabalhoso e pouco padronizado. Este estudo teve por objetivo avaliar o desempenho de um citômetro de fluxo na realização do exame de urina de rotina. CASUÍSTICA E MÉTODOS: Foram analisadas 1.140 amostras de urina através de microscopia óptica comum e de citometria de fluxo (UF-100/SYSMEX). A precisão foi estabelecida com a análise de quatro amostras de urina (20 replicações cada). O cálculo da reprodutibilidade foi realizado a partir de 30 determinações de dois controles comerciais em dias consecutivos. RESULTADOS: As contagens de hemácias e leucócitos mostraram concordância de 91% e 93%, respectivamente. Cilindros, células e bactérias mostraram sobreposição dos valores fornecidos pelo UF-100 quando comparados com os relatados na análise microscópica. A precisão do UF-100 variou de 4% a 155%, com reprodutibilidade de 3% e 25%, dependendo do parâmetro avaliado. CONCLUSÃO: O equipamento UF-100/SYSMEX demonstra boa precisão, reprodutibilidade e concordância com a microscopia óptica. A utilização da citometria de fluxo implica numa maior agilização e padronização da rotina, bem como em uma nova maneira de reportar e interpretar o exame de urina de rotina.15716

Importância do diagnóstico laboratorial da criptosporidiose humana e outras coccidioses

Human infection by Cryptosporidium spp and other coccidia are due to opportunist non-host specific microorganisms. In HIV seropositive patients, the gastrointestinal symptoms accompanying such infections may be serious and prolonged and may include nausea, low-grade fever, abdominal cramps, anorexia and watery diarrhoea. We studied 188 stool samples from 111 patients (84 men and 27 women) with diarrhoea. A modified Ziehl-Nielsen technique for the detection of Cryptosporidium spp and Isospora belli was employed. The mean age of the patients was 31 years. Cryptosporidium spp was seen in 18% (n=20) of the patients, 90% (n=18) of whom were HIV seropositive. Isospora belli was recorded only from HIV seropositive patients (5.4% of all the patients studied and 6.5% of those who were HIV seropositive). These data confirm the good results obtained with this technique for the identification of Cryptosporidium spp and other coccidia and also reaffirm the clinical importance of correctly diagnosing the cause of diarrhoea, particularly in HIV seropositive patients.Infecção humana por Cryptosporidium spp e outros coccideos deve-se a microrganismos oportunistas hospedeiros não-específicos e, em pacientes HIV positivos, os sintomas gastro-intestinais podem ser sérios e prolongados incluindo náuseas, febre baixa, dores abdominais, anorexia e diarréia aquosa. Estudamos 188 amostras de fezes provenientes de 111 pacientes (84 homens e 27 mulheres, com idade média de 31 anos) com diarréia, atendidos no Hospital das Clínicas da Universidade Estadual de Campinas. Para detecção de Cryptosporidium spp e lsospora belli empregou-se a técnica de Ziehl-Nielsen modificada. Oitenta e três porcento dos pacientes (n=92) eram HIV positivos. Cryptosporidium spp foi observado em 18% de todos os pacientes, sendo que destes, noventa porcento eram HIV positivos, lsospora belli foi evidenciada somente em pacientes HIV positivos, com uma freqüência de 5.4% de todos os pacientes e de 6.5% considerando-se apenas os pacientes HIV positivos. Este estudo confirma os bons resultados obtidos com a técnica empregada para identificação de Cryptosporidium spp e outros coccideos, além de ressaltar a importância da investigação etiológica apropriada em casos de diarréia prolongada, especialmente em pacientes imunossuprimidos

Urinalysis: Comparison Between Microscopic Analysis And A New Automated Microscopy Image-based Urine Sediment Instrument

Background: Urinalysis is a high demand procedure, with a large amount of manual labor and poorly standardized. Recently a new walk-away automated urine analyzer has been introduced. The aim of this study was to evaluate the performance of UriSed as an alternative to the microscopic analysis of urine samples. Methods: Four hundred mid-stream urine samples from patients with several clinical conditions were analyzed by bright field microscopy and by UriSed. The validation protocol included studies of precision, carryover, and comparison with the gold standard microscopy. Results: Our data showed that UriSed is a precise method. Repeatability and reproducibility ranged from 8 to 15%. Carryover was negligible. All the elements showed good agreement between both methods, with an extremely high correlation between the erythrocyte and leukocyte counts (r > 0.95) Conclusions: UriSed is a precise and accurate alternative to microscopy that allows a better workflow and may significantly improve turnaround time.604693697Winkel, P., Statland, B.E., Jorgenson, J., Urine microscopy: An ill-defined method examined by a multifactorial technique (1974) Clin Chem, 20, pp. 436-439Delanghe, J.R., Kouri, T.T., Huber, A.R., The role of automated urine particle flow cytometry in clinical practice (2000) Clinica Chimica Acta, 301, pp. 1-18Langlois, M.R., Delanghe, J.R., Steyaert, S.R., Everaert, K.C., De Buyzere, M.L., Automated flow cytometry compared with an automated dipstick reader for urinalysis (1999) Clinical Chemistry, 45, pp. 1118-1122Block, D.R., Lieske, J.C., Automated urinalysis in the clinical lab (2012) Medical Laboratory Observer, 44 (10), pp. 8-10Barta, Z., Tünde, K., Bayer, G., UriSed technology - A standardised automatic method of urine sediment analysis (2011) European Infectious Disease, 5 (2), pp. 139-142Evaluation of precision performance of quantitative measurement methods (2004) CLSI Document EP05-A2, , Clinical and Laboratory Standards Institute. Wayne, PA, USA: CLSIUser verification of performance for precision and truenessapproved guideline (2005) CLSI Document EP15-A2, , Clinical and Laboratory Standards Institute. second edition. Wayne, PA, USA: CLSIGuidelines for the evaluation of blood cell analysers including those used for differential leucocyte and reticulocyte counting and cell marker applications (1994) Clin Lab Haemat, 16, pp. 157-174. , International Council for Standardization in HaematologySzwed, J.J., Schaust, C., The Importance of microscopic examination of the urinary sediment (1982) American Journal of Medical Technology, 48 (2), pp. 141-143Shaw Jr., S.T., Poon, S.Y., Wong, E.T., "Routine urinalysis": Is the dipstick enough? (1985) JAMA, 253, pp. 1596-1600Resnick, M., Comment on simplifying urinalysis (1985) Clin Chem, 31, pp. 450-451Wald, R., Bell, C.M., Nisenbaum, R., Interobserver reliability of urine sediment interpretation (2009) Clin J Am Soc Nephrol, 4, pp. 567-571Tsai, J.J., Yeun, J.Y., Kumar, V.A., Don, B.R., Comparison and interpretation of urinalysis performed by a nephrologist versus a hospital-based clinical laboratory (2005) American Journal of Kidney Diseases, 46 (5), pp. 820-829Akin, O.K., Serdat, M.A., Cizmeci, Z., Comparison of LabUMat-with-UriSed and iQ®200 fully automatic urine sediment analysers with manual urine analysis (2009) Biotechnol Appl Biochem, 53, pp. 139-144Block, D.R., Lieske, J.C., Automated urinalysis in the clinical lab (2012) MLO Med Lab Obs, 44 (10), pp. 8-10+12. , quiz 14Mayo, S., Acevedo, D., Quiñones-Torrelo, C., Canós, I., Sancho, M., Clinical laboratory automated urinalysis: Comparison among automated microscopy, flow cytometry, two test strips analyzers, and manual microscopic examination of the urine sediments (2008) J Clin Lab Anal, 22 (4), pp. 262-270Zaman, Z., Fogazzi, G.B., Garigali, G., Urine sediment analysis: Analytical and diagnostic performance of sediMAX® - A new automated microscopy image-based urine sediment analyser (2010) Clinica Chimica Acta, 411, pp. 147-154Jiang, T., Chen, P., Ouyang, J., Zhang, S., Cai, D., Urine particles analysis: Performance evaluation of Sysmex UF-1000i and comparison among urine flow cytometer, dipstick, and visual microscopic examination (2011) Scand J Clin Lab Invest, 71 (1), pp. 30-37Manoni, F., Tinello, A., Fornasiero, L., Urine particle evaluation: A comparison between the UF-1000i and quantitative microscopy (2010) Clin Chem Lab Med, 48 (8), pp. 1107-1111Manoni, F., Gessoni, G., Alessio, M.G., Mid-stream vs. first-voided urine collection by using automated analyzers for particle examination in healthy subjects: An Italian multicenter study (2011) Clin Chem Lab Med, 50 (4), pp. 679-68