Tilt Test in Elderly Patients with Syncope of Unknown Etiology: Experience with Pharmacological Stimulation with Nitroglycerin

Está demonstrado o papel do teste de inclinação na avaliação de doentes com síncope de causa não esclarecida. Nos idosos, a prevalência de episódios sincopais aumenta, associa-se a pior prognóstico e, frequentemente, implica o recurso a múltiplos exames de diagnóstico. Objectivos: Avaliar a utilidade do teste de inclinação com recurso a nitroglicerina sub-lingual como agente provocativo em idosos com síncope de etiologia desconhecida. Métodos: Foram estudados 46 doentes consecutivos com > 65 anos (56,5% do sexo feminino; 74 ± 6 anos) por síncope de etiologia não esclarecida. Em 25 doentes(54%) não havia evidência de patologia cardíaca, tendo os restantes cardiopatia hipertensiva (14 doentes) ou isquémica (7 doentes). O protocolo incluiu massagem do seio carotídeo em decúbito a após ortostatismo passivo. O teste de inclinação foi efectuado sob monitorização contínua do electrocardiograma e tensão arterial, com inclinação a 70º durante 20 minutos. Na ausência de síncope, administrou-se 500 mcg de nitroglicerina sub-lingual com monitorização por mais 20 minutos. O teste de inclinação foi considerado positivo quando houve reprodução da sintomatologia acompanhada de bradicardia e/ou hipotensão arterial (respostas cardio-inibitória, vasodepressora ou mista). Considerou-se haver hipotensão ortostática nos casos com queda da tensão arterial sistólica > 20 mmHg ou da tensão arterial diastólica > 10 mmHg nos 3 minutos após ortostatismo; nos doentes com sintomas associados à descida gradual, paralela, da tensão arterial sistólica e diastólica durante o teste de inclinação passivo, admitiu-se um perfil do tipo disautonómico; nos doentes com descida gradual da tensão arterial após nitroglicerina, considerou-se haver resposta exagerada aos nitratos. Resultados: Ocorreu reprodução de sintomas em 34 doentes (73,9%): 19,6% no teste de inclinação passivo (resposta neurocardiogénica vasodepressora – 3 doentes, hipersensibilidade do seio carotídeo – 1 doente, hipotensão ortostática – 1 doente, perfil disautonómico – 4 doentes) e 54,3% após nitroglicerina (resposta neurocardiogénica vasodepressora – 12 doentes, mista – 5 doentes , cardio-inibitória – 2 doentes e resposta exagerada aos nitratos – 6 doentes). A síncope foi neurocardiogénica em 47,8% (teste passivo – 13,6%, pós-nitroglicerina – 86,4%). Em 16,2% dos doentes submetidos a nitroglicerina ocorreu resposta exagerada aos nitratos. Não se registaram complicações durante o exame. Conclusões: O teste de inclinação em idosos com síncope de etiologia não esclarecida: 1. contribui para o diagnóstico diferencial no estudo etiológico da síncope, 2. quando potenciado pela nitroglicerina associa-se a um aumento significativo do número de respostas positivas, e permite identificar um número considerável de doentes com resposta exagerada aos nitratos

Fatores de risco para fratura por osteoporose e baixa densidade óssea em mulheres na pré e pós-menopausa

OBJECTIVE: To estimate the prevalence and analyze risk factors associated to osteoporosis and low-trauma fracture in women. METHODS: Cross-sectional study including a total of 4,332 women older than 40 attending primary care services in the Greater São Paulo, Southeastern Brazil, between 2004 and 2007. Anthropometrical and gynecological data and information about lifestyle habits, previous fracture, medical history, food intake and physical activity were obtained through individual quantitative interviews. Low-trauma fracture was defined as that resulting from a fall from standing height or less in individuals 50 years or older. Multiple logistic regression models were designed having osteoporotic fracture and bone mineral density (BMD) as the dependent variables and all other parameters as the independent ones. The significance level was set at p<0.05. RESULTS: The prevalence of osteoporosis and osteoporotic fractures was 33% and 11.5%, respectively. The main risk factors associated with low bone mass were age (OR=1.07; 95% CI: 1.06;1.08), time since menopause (OR=2.16; 95% CI: 1.49;3.14), previous fracture (OR=2.62; 95% CI: 2.08;3.29) and current smoking (OR=1.45; 95% CI: 1.13;1.85). BMI (OR=0.88; 95% CI: 0.86;0.89), regular physical activity (OR=0.78; 95% CI: 0.65;0.94) and hormone replacement therapy (OR=0.43; 95% CI: 0.33;0.56) had a protective effect on bone mass. Risk factors significantly associated with osteoporotic fractures were age (OR=1.05; 95% CI: 1.04;1.06), time since menopause (OR=4.12; 95% CI: 1.79;9.48), familial history of hip fracture (OR=3.59; 95% CI: 2.88;4.47) and low BMD (OR=2.28; 95% CI: 1.85;2.82). CONCLUSIONS: Advanced age, menopause, low-trauma fracture and current smoking are major risk factors associated with low BMD and osteoporotic fracture. The clinical use of these parameters to identify women at higher risk for fractures might be a reasonable strategy to improve the management of osteoporosis.OBJETIVO: Estimar la prevalencia y analizar los factores de riesgo asociados con osteoporosis y fractura por bajo impacto entre mujeres. MÉTODOS: Estudio transversal realizado con 4.332 mujeres encima de 40 años de edad provenientes de atención primaria de salud en el área metropolitana de la gran São Paulo, SP, entre 2004 2007. Datos antropométricos y ginecológico y relativos a hábitos de vida, fractura previa, antecedentes personales, ingestión alimentaria y actividad física fueron evaluados por medio de entrevista individual y cuantitativa. Fractura por bajo impacto fue definida como decurrente de caída de la propia altura o menos en individuos con más de 50 años de edad. Modelos de regresión multivariada y logística analizaron, respectivamente, la densidad ósea y la fractura por osteoporosis, como variables dependientes y todas las otras como independientes. El nivel de significancia estadística establecido fue p<0,05. RESULTADOS: La prevalencia de osteoporosis y de fracturas por fragilidad ósea fue de 33% y 11,5%, respectivamente. Los principales factores de riesgo asociados con baja densidad ósea fueron edad (OR=1,07; IC 95%: 1,06;1,08), menopausia (OR=2,16; IC 95%: 1,49;3,14), fractura previa (OR=2,62; IC 95%: 2,08;3,29) y tabaquismo actual (OR=1,45; IC 95%: 1,13;1,85). Por otro lado, elevado IMC (OR=0,88; IC 95%: 0,86;0,89), actividad física regular (OR=0,78; IC 95%: 0,65;0,94) y terapia hormonal actual (OR=0,43; IC 95%: 0,33;0,56) desempeñaron papel protector. Los factores de riesgo significantemente relacionados con fractura por osteoporosis fueron edad (OR=1,05; IC 95%: 1,04;1,06), menopausia (OR=4,12; IC 95%: 1,79;9,48), historia familiar de fractura de cuadril (OR=3,59; IC 95%: 2,88;4,47) y baja densidad ósea (OR=2,28; IC 95%: 1,85;2,82). CONCLUSIONES: Edad avanzada, menopausia, fractura previa por bajo impacto y tabaquismo actual son los principales factores de riesgo asociados con baja densidad ósea y esta, con las fracturas por fragilidad ósea. El uso clínico de estos parámetros para identificar mujeres de mayor riesgo para fracturas puede ser una estrategia interesante para mejorar el abordaje de la osteoporosis.OBJETIVO: Estimar a prevalência e analisar os fatores de risco associados com osteoporose e fratura por baixo impacto entre mulheres. MÉTODOS: Estudo transversal realizado com 4.332 mulheres acima de 40 anos de idade provenientes de atendimento primário de saúde na área metropolitana da Grande São Paulo, SP, entre 2004 e 2007. Dados antropométricos e ginecológicos e relativos a hábitos de vida, fratura prévia, antecedentes pessoais, ingestão alimentar e atividade física foram avaliados por meio de entrevista individual e quantitativa. Fratura por baixo impacto foi definida como decorrente de queda da própria altura ou menos em indivíduos com mais de 50 anos de idade. Modelos de regressão multivariada e logística analisaram, respectivamente, a densidade óssea e a fratura por osteoporose como variáveis dependentes e todas as outras como independentes. O nível de significância estatística estabelecido foi p < 0,05. RESULTADOS: A prevalência de osteoporose e de fraturas por fragilidade óssea foi de 33% e 11,5%, respectivamente. Os principais fatores de risco associados com baixa densidade óssea foram idade (OR = 1,07; IC 95%: 1,06;1,08), menopausa (OR = 2,16; IC 95%: 1,49;3,14), fratura prévia (OR = 2,62; IC 95%: 2,08;3,29) e tabagismo atual (OR = 1,45; IC 95%: 1,13;1,85). Por outro lado, elevado IMC (OR = 0,88; IC 95%: 0,86;0,89), atividade física regular (OR = 0,78; IC 95%: 0,65;0,94) e terapia hormonal atual (OR = 0,43; IC 95%: 0,33;0,56) desempenharam papel protetor. Os fatores de risco significativamente relacionados com fratura por osteoporose foram idade (OR = 1,05; IC 95%: 1,04;1,06), menopausa (OR = 4,12; IC 95%: 1,79;9,48), história familiar de fratura de quadril (OR = 3,59; IC 95%: 2,88;4,47) e baixa densidade óssea (OR = 2,28; IC 95%: 1,85;2,82). CONCLUSÕES: Idade avançada, menopausa, fratura prévia por baixo impacto e tabagismo atual são os principais fatores de risco associados com baixa densidade óssea, a qual se associa com as fraturas por fragilidade óssea. O uso clínico desses parâmetros para identificar mulheres de maior risco para fraturas pode ser uma estratégia interessante para melhorar a abordagem da osteoporose.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP-EPM Instituto de Diagnóstico por ImagemUNIFESP-EPM Programa de Pós-Graduação em ReumatologiaUNIFESP-EPM Departamento de RadiologiaUNIFESP, EPM, Instituto de Diagnóstico por ImagemUNIFESP, EPM Programa de Pós-Graduação em ReumatologiaUNIFESP, EPM Depto. de RadiologiaSciEL

Cardiosphere-derived cells suppress allogeneic lymphocytes by production of PGE2 acting via the EP4 receptor

derived cells (CDCs) are a cardiac progenitor cell population, which have been shown to possess cardiac regenerative properties and can improve heart function in a variety of cardiac diseases. Studies in large animal models have predominantly focussed on using autologous cells for safety, however allogeneic cell banks would allow for a practical, cost-effective and efficient use in a clinical setting. The aim of this work was to determine the immunomodulatory status of these cells using CDCs and lymphocytes from 5 dogs. CDCs expressed MHC I but not MHC II molecules and in mixed lymphocyte reactions demonstrated a lack of lymphocyte proliferation in response to MHC-mismatched CDCs. Furthermore, MHC-mismatched CDCs suppressed lymphocyte proliferation and activation in response to Concanavalin A. Transwell experiments demonstrated that this was predominantly due to direct cell-cell contact in addition to soluble mediators whereby CDCs produced high levels of PGE2 under inflammatory conditions. This led to down-regulation of CD25 expression on lymphocytes via the EP4 receptor. Blocking prostaglandin synthesis restored both, proliferation and activation (measured via CD25 expression) of stimulated lymphocytes. We demonstrated for the first time in a large animal model that CDCs inhibit proliferation in allo-reactive lymphocytes and have potent immunosuppressive activity mediated via PGE2

The adaptation of the Affective Norms for English Words (ANEW) for European Portuguese

This study presents the adaptation of the Affective Norms for English Words (ANEW; Bradley & Lang, 1999a) for European Portuguese (EP). The EP adaptation of the ANEW was based on the affective ratings made by 958 college students who were EP native speakers. Participants assessed about 60 words by considering the affective dimensions of valence, arousal, and dominance, using the Self-Assessment Manikin (SAM) in either a paper-and-pencil and a web survey procedures. Results of the adaptation of the ANEW for EP are presented. Furthermore, the differences between EP, American (Bradley & Lang, 1999a), and Spanish (Redondo, Fraga, Padrón, & Comesaña, 2007) standardizations were explored. Results showed that the ANEW words were understood in a similar way by EP, American, and Spanish subjects, although some sex and cross-cultural differences were observed. The EP adaptation of the ANEW is shown to be a valid and useful tool that will allow researchers to control and/or manipulate the affective properties of stimuli as well as to develop cross-linguistic studies. The normative values of EP adaptation of the ANEW can be downloaded at http://brm.psychonomic-journals.org/content/supplemental.COMPETE - Programa Operacional Factores de CompetitividadeFundo Europeu de Desenvolvimento Regional - FEDERQuadro de Referência Estratégico Nacional - QRENFundação para a Ciência e a Tecnologia (FCT) - research project “Procura Palavras (P-Pal ): A software program for deriving objective and subjective psycholinguistic indices for European Portuguese words

Comparison of Yarrowia lipolytica and Pichia pastoris cellular response to different agents of oxidative stress

Yeast cells exposed to adverse conditions employ a number of defense mechanisms in order to respond effectively to the stress effects of reactive oxygen species. In this work, the cellular response of Yarrowia lipolytica and Pichia pastoris to the exposure to the ROSinducing agents’ paraquat, hydrogen peroxide, and increased air pressure was analyzed. Yeast cells at exponential phase were exposed for 3 h to 1 mM paraquat, to 50 mM H2O2, or to increased air pressure of 3 or 5 bar. For both strains, the cellular viability loss and lipid peroxidation was lower for the cells exposed to increased air pressure than for those exposed to chemical oxidants. The glutathione induction occurred only in Y. lipolytica strain and reached the highest level as a response to PQ exposure. In general, antioxidant enzymes were more expressed in Y. lipolytica than in P. pastoris. The enzyme superoxide dismutase was induced in both strains under all the oxidant conditions but was dependent on the cellular growth phase, being undetectable in non-growing cells, whereas glutathione reductase was more induced in those conditions. Hydrogen peroxide was the most efficient inducer of catalase. Both yeast cultures underwent no cellular growth inhibition with increased air pressure, indicating that these yeast species were able to adapt to the oxidative stressful environment.The authors acknowledge the financial support provided by "Fundacao para a Ciencia e Tecnologia" (Grant SFRH/BD/47371/2008)

Galactic and Extragalactic Samples of Supernova Remnants: How They Are Identified and What They Tell Us

Supernova remnants (SNRs) arise from the interaction between the ejecta of a supernova (SN) explosion and the surrounding circumstellar and interstellar medium. Some SNRs, mostly nearby SNRs, can be studied in great detail. However, to understand SNRs as a whole, large samples of SNRs must be assembled and studied. Here, we describe the radio, optical, and X-ray techniques which have been used to identify and characterize almost 300 Galactic SNRs and more than 1200 extragalactic SNRs. We then discuss which types of SNRs are being found and which are not. We examine the degree to which the luminosity functions, surface-brightness distributions and multi-wavelength comparisons of the samples can be interpreted to determine the class properties of SNRs and describe efforts to establish the type of SN explosion associated with a SNR. We conclude that in order to better understand the class properties of SNRs, it is more important to study (and obtain additional data on) the SNRs in galaxies with extant samples at multiple wavelength bands than it is to obtain samples of SNRs in other galaxiesComment: Final 2016 draft of a chapter in "Handbook of Supernovae" edited by Athem W. Alsabti and Paul Murdin. Final version available at https://doi.org/10.1007/978-3-319-20794-0_90-

Batch and fed-batch growth of Pichia pastoris under increased air pressure

Pichia pastoris CBS 2612 behavior under air pressures of 1 bar, 3 bar and 5 bar in culture media of glycerol (pure and crude) and methanol was studied. Generally, the increase in oxygen transfer rate due to the increase of total pressure improved cellular growth for all carbon sources and for batch and fed-batch processes with different feeding rate strategies. In batch cultures, 1.4-fold, 1.2-fold, and 1.5-fold improvement in biomass production was obtained with the increase of air pressure up to 5 bar, using methanol, pure glycerol, and crude glycerol, respectively. The raise of air pressure to 5 bar using exponential feeding rate leaded to 1.4-fold improvement in biomass yield per glycerol mass consumed, for crude and pure glycerol. The current low cost of crude glycerol from the biodiesel production together with the present results shows the possibility of improving cell mass production of P. pastoris using increased air pressure.The authors acknowledge the financial support provided by "Fundacao para a Ciencia e Tecnologia" (Grant SFRH/BD/47371/2008)

Relevance of Circulating Nucleosomes, HMGB1 and sRAGE for Prostate Cancer Diagnosis

Background/Aim: Evasion from cell death occurs in prostate cancer (PCa). We verified whether serum levels of cell death markers can have diagnostic value in PCa. Patients and Methods: A total of 233 men scheduled for prostate biopsy [prostate specific antigen (PSA) level: 2-10 ng/ml] were enrolled. Serum nucleosomes, nucleosomes containing the H3 histone (H3), high mobility group box 1 (HMGB1), and soluble receptor for advanced glycation end products (sRAGE) were analyzed by enzyme immunoassays. Results: There were no differences (p>0.05) in nucleosomes, H3, and sRAGE levels between patients with and without PCa or clinically significant PCa (csPCa). HMGB1 had lower levels in PCa patients (p=0.023) and was a predictor of PCa (p=0.047), but not of csPCa (p=0.180). Conclusion: In patients with critical PSA levels between 2-10 ng/ml, HMGB1 had some diagnostic value for overall PCa detection, but it was not predictive of csPCa. Nucleosomes, H3 and sRAGE did not discriminate between PCa or csPCa and controls.The Authors received no financial support for the research, authorship, and/or publication of this article

Comparison of Three Assays for Total and Free PSA Using Hybritech and WHO Calibrations

Background/Aim: Lack of interchangeability between prostate-specific antigen (PSA) assays could have a clinical impact. We compared PSA assays from different manufacturers and calibrations. Patients and Methods: A total of 233 men who underwent prostate biopsy (PSA: 2-10 ng/ml; Beckman Coulter Access® Hybritech® as reference) were enrolled. Total (tPSA) and free PSA (fPSA) were also measured using the Roche cobas® and the Abbott Architect® methods. Results: Roche tPSA values were ≈1% higher than Beckman, while Abbott values were ≈5% lower. Roche had the highest diagnostic sensitivity (92%) compared to Beckman Coulter (87%) and Abbott (85%). Roche fPSA was ≈3% lower and Abbott ≈17% higher than that of Beckman. For the percentage of fPSA, Roche had the highest sensitivity (98%). Conclusion: Roche cobas® and Beckman Coulter Access® Hybritech® tPSA were almost interchangeable. While the agreement was acceptable for tPSA, this did not happen with fPSA and greater efforts for harmonization are required