Does blood transfusion harm cardiac surgery patients?

Over recent years there has been a substantial body of evidence demonstrating strong associations between transfusion and adverse outcomes, including myocardial, neurological and renal injury, in a range of clinical settings where transfusion is administered for reasons other than life-threatening bleeding. The strength of these associations across a range of clinical settings suggests that confounding and bias, the chief limitations of all observational studies, are unlikely to account for all of these observations. Given the wide range in transfusion rates in cardiac centres, with up to 100% of patients in some centres exposed to allogenic blood components, this evidence, albeit circumstantial, presents a strong argument for prospective randomised trials to attempt to determine, firstly, if transfusion causes adverse outcomes, and secondly, in which patient groups does the benefit of transfusion outweigh these risks? These issues are discussed in the context of an article published this month in BMC Medicine

Tobacco Rattle Virus Vector: A Rapid and Transient Means of Silencing Manduca sexta Genes by Plant Mediated RNA Interference

Background: RNAi can be achieved in insect herbivores by feeding them host plants stably transformed to express double stranded RNA (dsRNA) of selected midgut-expressed genes. However, the development of stably transformed plants is a slow and laborious process and here we developed a rapid, reliable and transient method. We used viral vectors to produce dsRNA in the host plant Nicotiana attenuata to transiently silence midgut genes of the plant’s lepidopteran specialist herbivore, Manduca sexta. To compare the efficacy of longer, undiced dsRNA for insect gene silencing, we silenced N. attenuata’s dicer genes (NaDCL1- 4) in all combinations in a plant stably transformed to express dsRNA targeting an insect gene. Methodology/Principal Findings: Stable transgenic N. attenuata plants harboring a 312 bp fragment of MsCYP6B46 in an inverted repeat orientation (ir-CYP6B46) were generated to produce CYP6B46 dsRNA. After consuming these plants, transcripts of CYP6B46 were significantly reduced in M. sexta larval midguts. The same 312 bp cDNA was cloned in an antisense orientation into a TRV vector and Agro-infiltrated into N. attenuata plants. When larvae ingested these plants, similar reductions in CYP6B46 transcripts were observed without reducing transcripts of the most closely related MsCYP6B45. We used this transient method to rapidly silence the expression of two additional midgut-expressed MsCYPs. CYP6B46 transcripts were further reduced in midguts, when the larvae fed on ir-CYP6B46 plants transiently silenced for tw

Down Regulation of a Gene for Cadherin, but Not Alkaline Phosphatase, Associated with Cry1Ab Resistance in the Sugarcane Borer Diatraea saccharalis

The sugarcane borer, Diatraea saccharalis, is a major target pest of transgenic corn expressing Bacillus thuringiensis (Bt) proteins (i.e., Cry1Ab) in South America and the mid-southern region of the United States. Evolution of insecticide resistance in such target pests is a major threat to the durability of transgenic Bt crops. Understanding the pests' resistance mechanisms will facilitate development of effective strategies for delaying or countering resistance. Alterations in expression of cadherin- and alkaline phosphatase (ALP) have been associated with Bt resistance in several species of pest insects. In this study, neither the activity nor gene regulation of ALP was associated with Cry1Ab resistance in D. saccharalis. Total ALP enzymatic activity was similar between Cry1Ab-susceptible (Cry1Ab-SS) and -resistant (Cry1Ab-RR) strains of D. saccharalis. In addition, expression levels of three ALP genes were also similar between Cry1Ab-SS and -RR, and cDNA sequences did not differ between susceptible and resistant larvae. In contrast, altered expression of a midgut cadherin (DsCAD1) was associated with the Cry1Ab resistance. Whereas cDNA sequences of DsCAD1 were identical between the two strains, the transcript abundance of DsCAD1 was significantly lower in Cry1Ab-RR. To verify the involvement of DsCAD1 in susceptibility to Cry1Ab, RNA interference (RNAi) was employed to knock-down DsCAD1 expression in the susceptible larvae. Down-regulation of DsCAD1 expression by RNAi was functionally correlated with a decrease in Cry1Ab susceptibility. These results suggest that down-regulation of DsCAD1 is associated with resistance to Cry1Ab in D. saccharalis

Prevalence of human norovirus and Clostridium difficile coinfections in adult hospitalized patients

Janelle N Stokely,1 Sandra Niendorf,2 Stefan Taube,1 Marina Hoehne,2 Vincent B Young,1,3 Mary AM Rogers,4 Christiane E Wobus1 1Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA; 2Department of Infectious Diseases, Consultant Laboratory for Noroviruses, Robert Koch Institute, Berlin, Germany; 3Department of Internal Medicine, Division of Infectious Diseases, 4Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI, USA Objective: Human norovirus (HuNoV) and Clostridium difficile are common causes of infectious gastroenteritis in adults in the US. However, limited information is available regarding HuNoV and C. difficile coinfections. Our study was designed to evaluate the prevalence of HuNoV and C. difficile coinfections among adult patients in a hospital setting and disease symptomatology. Study design and setting: For a cross-sectional analysis, 384 fecal samples were tested for the presence of C. difficile toxins from patients (n=290), whom the provider suspected of C. difficile infections. Subsequent testing was then performed for HuNoV genogroups I and II. Multinomial logistic regression was performed to determine symptoms more frequently associated with coinfections. Results: The final cohort consisted of the following outcome groups: C. difficile (n=196), C. difficile + HuNoV coinfection (n=40), HuNoV only (n=12), and neither (n=136). Coinfected patients were more likely to develop nausea, gas, and abdominal pain and were more likely to seek treatment in the winter season compared with individuals not infected or infected with either pathogen alone. Conclusion: Our study revealed that patients with coinfection are more likely to experience certain gastrointestinal symptoms, in particular abdominal pain, suggesting an increased severity of disease symptomatology in coinfected patients. Keywords: human norovirus, C. difficile, gastroenteritis, coinfectio

Professor e aluno compartilhando da experiência de ensino-aprendizagem: a disciplina de enfermagem pediátrica da Universidade Federal de Mato Grosso do Sul Profesor y alumno compartiendo de la experiencia de enseñanza-aprendizaje: la asignatura de enfermería pediátrica de la Universidad de Mato Grosso do Sul, Brasil Teacher and learner sharing the teaching-learning experience: the pediatric nursing course at Universidade Federal de Mato Grosso do Sul, Brazil

As autoras apresentam a experiência de ensino de enfermagem pediátrica na Universidade Federal de Mato Grosso do Sul (UFMS). Realizaram análise qualitativa das avaliações dos alunos no ano de 2000, das quais emergiram duas categorias: 'sendo uma experiência diferente' e 'modificando o olhar para a criança e família'. Concluem que a opção pela abordagem de ensino centrada na pessoa tem sido fundamental para que o aluno consiga alcançar autonomia pessoal e profissional.<br>Las autoras presentan la experiencia de enseñanza de enfermería pediátrica en la Universidad Federal de Mato Grosso do Sul (UFMS). Realizaron un análisis cualitativo de las evaluaciones de los alumnos en el año de 2.000, de las cuales emergieron dos categorías: "siendo una experiencia diferente" y "cambiando la manera de mirar al niño y la familia". Concluyen que la opción por el abordaje de enseñanza centralizada en la persona había sido fundamental para que el alumno logre autonomía personal y profesional.<br>The authors present the experience of teaching pediatric nursing at the Universidade Federal de Mato Grosso do Sul (UFMS), Brazil. They carried out a qualitative analysis of the learners' evaluation for the year 2000, from which two categories emerged: "being a different experience" and "changing the way the learners see the child and the family". They conclude that choosing the person-centered teaching approach has been of fundamental importance for the learner to achieve personal and professional autonomy

Psicologia de orientação positiva: uma proposta de intervenção no trabalho com grupos em saúde mental Positive psychology orientation: an intervention proposal for group work in mental health

Este estudo visa à proposta de uma psicologia de orientação positiva aplicada à Saúde Mental no acompanhamento de portadores de transtornos mentais. Foi realizado em grupos terapêuticos com portadores num Centro de Atenção Psicossocial (CAPS). A análise do trabalho em grupo avaliado baseou-se na abordagem humanista e sua visão de homem e mundo, no método (con)texto de letramentos múltiplos e na psicologia positiva. Usaram-se as metodologias quantitativa e qualitativa fenomenológica. Os resultados foram listados em categorias que versam sobre a facilitação de grupos de portadores de transtornos depressivos. Ao buscar a prática de um novo modelo em saúde mental, que tenha como aspecto fundamental o zelo pela humanidade e a cidadania dos usuários deste serviço, o CAPS surge como resultado histórico da construção dos conceitos de saúde/doença, com fins de exercer os princípios norteadores da reforma psiquiátrica no Brasil. Neste processo de mudança, a psicologia de orientação positiva adentra os horizontes de uma prática fundada num novo olhar sobre o sujeito, buscando a ênfase e o desenvolvimento de aspectos " virtuosos" como possibilidade de alcançar a saúde em seu sentido mais pleno, caminhando junto à promoção de saúde e instalando um diferencial em relação a práticas anteriores em psicologia.<br>This investigation aims at presenting a positive approach to psychology applied to the field of mental health in the treatment of patients with mental disorders. The intervention here presented was conducted in therapeutic groups with patients from a psychosocial care center (called CAPS). The analysis of the group work was based on three basic concepts: the humanistic approach and its vision of men and the world, the (con)text method of multiple literacies, and positive psychology. Quantitative and qualitative phenomenological research methodologies were used. The research results were divided into categories based on the group work with patients with depression-related disorders. Seeking for a new model of mental health care aimed at preserving the humanistic approach and the rights of the citizen, the Psychosocial Care Center (CAPS) emerges as a historical result of the construction of the health/disease concept in order to put into practice the principles guiding the psychiatric reform in Brazil. Within this process, a positive approach to psychology is opening horizons for a practice based on a new view of the subject, emphasizing and developing " virtuous" aspects like the possibility of achieving health in its broader meaning, together health promotion and the employment of different psychological practices