Endometrial polyps in postmenopausal women

The malignancy risk of endometrial polyps in postmenopausal women was correlated with the presence or absence of abnormal uterine bleeding. Of 481 postmenopausal women who presented with endometrial polyps at diagnostic hysteroscopy between 2004 and 2007, 48.9% were asymptomatic and 51.1% had postmenopausal uterine bleeding. Transvaginal ultrasound revealed abnormal endometrial thickness in 60.0% vs. 57.7%, polyps in 37.9% vs. 32.9%, endometrial tumors in 1.3% vs. 0.8%, and submucosal myomas in 0.9% vs. 2.0% by the absence or presence of bleeding. Around three-fourth of the polyps were removed. Histopathologic diagnoses showed mucous polyps in 93.7 of asymptomatic women compared to 80.7% of those with bleeding, while endometrial tumors were only seen in those bleeding (7.2%). The malignancy risk within endometrial polyps in postmenopausal women varies with the presence of vaginal bleeding, and is minimal in asymptomatic women

Transthoracic Echocardiography for Evaluation of Hypotensive Critically Ill Patient

Objectivo e desenho: estudo prospectivo de avaliação da possibilidade de aplicação e utilidade clínica da ecocardiografia transtorácica (ETT) na avaliação da hpotensão numa Unidade de Cuidados Intensivos Polivalente (UCIP). Local: UCIP de 16 camas. Material e métodos: Incluídos doentes com hipotensão (pressão arterial sistólica 90 mmHg ou média (PAM) < 60 mmHg, que não respondeu à administração de soros no espaço de 30 minutos). Os objectivos do ETT foram: excluir cardiopatia estrutural grave, avaliação de outras alterações cardíacas (alterações das dimensões das cavidades e função ventricular esquerda), análise da veia cava inferior (VCI) e determinação do índex cardíaco (IC). Resultados: de um total de 208 doentes foram incluídos 198 (4,5% de exames impossíveis), com média etária de 63,4 +/- 16,2 anos, 129 do sexo masculino, APACHE II 30,1 +/- 9,9, SAPS II 68,8 +/- 20,5, SOFA 11,6 +/- 3,8 MODS 10,9 +/- 3,9. Observou-se uma mortalidade de 51% (n=101), e 168 (85,2%) doentes estavam ventilados. Oitenta e oito (44,4%) doentes apresentaram alterações cardíacas, dos quais 28 (14%) classificadas como graves: três valvulopatias aórticas graves, quatro endocardites, nove miocardiopatias dilatadas, dois tamponamentos (18 doentes com alterações graves insuspeitas, 9%), seis enfartes agudos do miocárdio, quatro alterações da cinética segmentar. Estes doentes apresentaram uma mortalidade e índices de gravidade mais elevados (p <0,001). Em relação ao IC, 157 doentes apresentaram um valor normal ou elevado, os quais apresentaram todos um valor de resistências ventriculares periféricas baixo. Por análise de regressão logística, verificou-se uma relação entre o índex da VCI e os dias de internamento (p = 0,05) e entre o IC, índex da VCI e a mortalidade (p =0,008 e 0,041 respectivamente). Conclusões: Observou-se uma elevada prevalência de patologia cardíaca entre os doentes admitidos numa UCIP com hipotensão (n =88, 44,4%), dos quais 14% consideradas graves. Estes doentes tiveram maior mortalidade e índices de gravidade mais elevados. A análise conjunta do IC e da VCI pode ser útil na definição do padrão hemodinâmico do doente hipotenso e certos parâmetros ecocardiográficos, em especial o índex da VCI, podem ser úteis no prognóstico destes doentes

Involvement of JAK2 and MAPK on type II nitric oxide synthase expression in skin-derived dendritic cells

In this report, we demonstrate that a fetal mouse skin-derived dendritic cell line produces nitric oxide (NO) in response to the endotoxin [lipopolysaccharide (LPS)] and to cytokines [tumor necrosis factor-alpha (TNF-alpha) and granulocyte-macrophage colony-stimulating factor (GM-CSF)]. Expression of the inducible isoform of NO synthase (iNOS) was confirmed by immunofluorescence with an antibody against iNOS. The tyrosine kinase inhibitor genistein decreased LPS- and GM-CSF-induced nitrite (NO(-2)) production. The effect of LPS and cytokines on NO(-2) production was inhibited by the Janus kinase 2 (JAK2) inhibitor tyrphostin B42. The p38 mitogen-activated protein kinase (p38 MAPK) inhibitor SB-203580 also reduced the NO(-2) production evoked by LPS, TNF-alpha, or GM-CSF, but it was not as effective as tyrphostin B42. Inhibition of MAPK kinase with PD-098059 also slightly reduced the effect of TNF-alpha or GM-CSF on NO(-2) production. Immunocytochemistry studies revealed that the transcription factor nuclear factor-kappaB was translocated from the cytoplasm into the nuclei of fetal skin-derived dendritic cells (FSDC) stimulated with LPS, and this translocation was inhibited by tyrphostin B42. Our results show that JAK2 plays a major role in the induction of iNOS in FSDC

Routine Transthoracic Echocardiography in a General Intensive Care Unit: an 18 Month Survey in 704 Patients

The authors analyzed 704 transthoracic echocardiographic (TTE) examinations, performed routinely to all admitted patients to a general 16-bed Intensive Care Unit (ICU) during an 18-month period. Data acquisition and prevalence of abnormalities of cardiac structures and function were assessed, as well as the new, previously unknown severe diagnoses. A TTE was performed within the first 24 h of admission on 704 consecutive patients, with a mean age of 61.5+/-17.5 years, ICU stay of 10.6+/-17.1 days, APACHE II 22.6+/-8.9, and SAPS II 52.7+/-20.4. In four patients, TTE could not be performed. Left ventricular (LV) dimensions were quantified in 689 (97.8%) patients, and LV function in 670 (95.2%) patients. Cardiac output (CO) was determined in 610 (86.7%), and mitral E/A in 399 (85.9% of patients in sinus rhythm). Echocardiographic abnormalities were detected in 234 (33%) patients, the most common being left atrial (LA) enlargement (n=163), and LV dysfunction (n=132). Patients with these alterations were older (66+/-16.5 vs 58.1+/-17.4, p<0.001), presented a higher APACHE II score (24.4+/-8.7 vs 21.1+/-8.9, p<0.001), and had a higher mortality rate (40.1% vs 25.4%, p<0.001). Severe, previously unknown echocardiographic diagnoses were detected in 53 (7.5%) patients; the most frequent condition was severe LV dysfunction. Through a multivariate logistic regression analysis, it was determined that mortality was affected by tricuspid regurgitation (p=0.016, CI 1.007-1.016) and ICU stay (p<0.001, CI 1-1.019). We conclude that TTE can detect most cardiac structures in a general ICU. One-third of the patients studied presented cardiac structural or functional alterations and 7.5% severe previously unknown diagnoses

Outdoor Cultivation of the Microalga Chlorella vulgaris in a New Photobioreactor Configuration: The Effect of Ultraviolet and Visible Radiation

Microalgae can be a future source of biomass with a wide range of applications, including its use to solve current environmental issues. One of the main variables for microalgal cultivation is the light supply: (i) its intensity that often does not present a uniform spatial distribution inside the culture; (ii) photoperiod; and (iii) spectrum. Therefore, this study aims to evaluate the growth of the microalgae Chlorella vulgaris in a tubular photobioreactor with compound parabolic collectors (CPCs) under outdoor conditions. The effect of ultraviolet and visible radiation on biomass productivity and nutrients (nitrogen and phosphorus) uptake was assessed. The maximum biomass productivity was (5 +/- 1) x 10(-3) g.L-1.h(-1), and the specific growth rates ranged from (1.1 +/- 0.3) x 10(-2) to (2.0 +/- 0.6) x 10(-2) h(-1). Regarding nutrient uptake, initial removal rates of (0.9 +/- 0.4) mg N.L-1.h(-1) for nitrogen and (0.17 +/- 0.04) mg P.L-1.h(-1) for phosphorus were reached. These values increased with visible and ultraviolet irradiance until certain values (143 W-VIS.m(-2) and 9 W-UV.m(-2) for biomass productivity; 101 W-VIS.m(-2) and 6 W-UV.m(-2) for nutrient removal) and then decreased for higher ones due to the photoinhibition phenomenon. Therefore, the application of CPCs to photobioreactors (PBRs) may be beneficial for microalgal culture in countries with higher latitude (with lower solar irradiance levels)

Parâmetros Hemodinâmicos Obtidos por Ecocardiografia Transtorácica e Cateterismo da Artéria Pulmonar. Estudo Comparativo em Doentes Submetidos a Transplante Hepático

Objectivo: estudo comparativo simultâneo de medições invasivas utilizando o cateterismo da artéria pulmonar e não invasivas utilizando a ecocardiografia transtorácica (ETT) de 4 parâmetros hemodinâmicos: débito cardíaco (DC), pressão de encravamento da artéria pulmonar (PCP), pressão venosa central (PVC), e pressão sistólica da artéria pulmonar (PSAP). Material e Métodos: estudo prospectivo numa Unidade de Cuidados Intensivos (UCI) médico-cirurgica. Foram estudados 41 doentes em pós-operatório de transplante hepático, nos quais o DC, a PCP, a PVC e a PSAP foram obtidos em simultâneo por 2 observadores independentes, utilizando a ETT e o cateterismo invasivo da artéria pulmonar. Para a quantificação por ETT dos parâmetros foram utilizadas fórmulas descritas na literatura. As medições invasivas e não invasivas foram comparadas através de uma análise de correlação linear e de Bland-Altman. Resultados: Verificou-se uma boa correlação nas medições invasivas e não invasivas do DC (r=0,97) e PVC (r=0,88). As correlações entre as medições invasivas e não invasivas da PCP e da PSAP foram fracas (r=0,41 e r= 0,118 respectivamente). O intervalo de confiança de 95% e bias para o DC foi negligenciável, em especial para valores de DC abaixo dos 6l/minuto. A ETT subestima em regra o DC, mas as duas técnicas mostraram uma correlação significativa entre si. Conclusões: a ETT pode estimar de forma fidedigna o DC em doentes submetidos a transplante hepático. A determinação não invasiva das restantes variáveis hemodinâmicas por ETT pode estar sujeita a uma variabilidade grande relacionada com as características dos doentes. Apesar dos dados terem sido obtidos num grupo específico de doentes, podem ajudar a definir uma aplicação futura da ecocardiografia em Cuidados Intensivos

Differential activation of nuclear factor kappa B subunits in a skin dendritic cell line in response to the strong sensitizer 2,4-dinitrofluorobenzene

Dendritic cell (DC) maturation is essential for the initiation of T-dependent immune responses. Nuclear factor kappa B (NF-kappaB) transcription factors are ubiquitously expressed signalling molecules, known to regulate the transcription of a large number of genes involved in immune responses, including cytokines and cell surface molecules. In this work, we studied the time-dependent activation of five members of the NF-kappaB family, p50, p52, p65, RelB and cRel, in a mouse skin DC line in response to stimulation with the strong sensitizer, 2,4-dinitrofluorobenzene (DNFB). Western blot assay revealed that exposure of fetal skin DC (FSDC) to DNFB induced the degradation of the inhibitor of NF-kappaB (IkappaB). Three out of its five members, i.e. p50, p52, and RelB, were similarly activated upon DNFB stimulation, with subsequent translocation of these subunits from the cytosol to the nucleus, but with different kinetics. In contrast, p65 expression was diminished in both the nucleus and the cytosol. The electrophoretic mobility shift assay (EMSA) showed that exposure of FSDC to DNFB induced DNA binding to NF-kappaB. Together, these results show that DNFB differentially activates the various members of the NF-kappaB family in skin DC

Cardiac Doppler Variation with Volume Status Changes in General Intensive Care

Num grupo de 64 doentes de uma Unidade de Cuidados Intensivos, 24 dos quais submetidos a ventilação mecânica, foi determinada a influência da modificação da volémia nas características do Doppler cardíaco, através da negativização do balanço hídrico e correspondente modificação da pressão venosa central. Com a modificação da volémia, a relação E/A do fluxo transvalvular mitral mostrou uma tendência para reduzir, o tempo de desaceleração da onda E mitral para diminuir, o tempo de relaxamento isovolumétrico para aumentar, e a veia cava inferior reduziu o seu diâmetro expiratório e aumentou o valor do colapso inspiratório. Não se observou uma correlação significativa entre os valores das variáveis estudadas e a modificação da volémia, inclusivamente entre a pressão venosa central e o balanço hídrico. A modificação da volémia em doentes críticos modifica as características de determinados parâmetros de ecocardiografia- -Doppler, mas não é possível predizer a magnitude dessa variação

Granulocyte-macrophage colony-stimulating factor activates the transcription of nuclear factor kappa B and induces the expression of nitric oxide synthase in a skin dendritic cell line.

Nitric oxide (NO) produced by skin dendritic cells and keratinocytes plays an important role in skin physiology, growth and remodelling. Nitric oxide is also involved in skin inflammatory processes and in modulating antigen presentation (either enhancing or suppressing it). In this study, we found that GM-CSF stimulates the expression of the inducible isoform of nitric oxide synthase (iNOS) in a fetal-skin-derived dendritic cell line (FSDC) and, consequently, increases the nitrite production from 11.9 +/- 3.2 micromol/L (basal level) to 26.9 +/- 4.2 micromol/L. Pyrrolidinedithiocarbamate (PDTC) inhibits nitrite production, with a half maximal inhibitory concentration (IC50) of 19.3 micromol/L and the iNOS protein expression in FSDC. In addition, western blot assays revealed that exposure of FSDC to GM-CSF induces the phosphorylation and degradation of the inhibitor of NF-kappaB (IkB), with subsequent translocation of the p50, p52 and RelB subunits of the transcription nuclear factor kappa B (NF-kappaB) from the cytosol to the nucleus. Electrophoretic mobility shift assays (EMSA) showed that FSDC exposure to GM-CSF activates the transcription factor NF-kappaB. Together, these results show that GM-CSF induces iNOS expression in skin dendritic cells by a mechanism involving activation of the NF-kappaB pathway

Control of Pain and Dyspnea in Patients with Oncologic Disease in Acute Care: Non-Pharmacological Intervention

Objective: To identify non-pharmacological strategies in the control of pain and dyspnea, in patient with oncological disease, in acute care. Methodology: Question in PI[C]O format was used and search at EBSCO (MEDLINE with Full TEXT; CINAHL, Plus with Full Text; British Nursing Index) retrospectively from 2009 to 2015. We included also guidelines by reference entities: Oncology Nursing Society (2011) National Comprehensive Cancer Network and Cancer Care Ontario, resulting in a total of 15 articles. Results: The gold standard for an adequate symptom control is a systematized assessment. Non-pharmacological measures: psycho-emotional support, hypnosis, counseling/training/ instruction, therapeutic adherence, music therapy, massage, relaxation techniques, telephone support, functional and respiratory reeducation increase health gains. Conclusion: The control of oncologic pain and dyspnea require a comprehensive and multimodal approach