performance assessment of patient on dialysis

Patients on dialysis are poorly active and show a low level of physical functioning. Questionnaires and objective measurements of spontaneous physical activity are available as well as complex-expensive or simple-unexpensive tests useful to assess the patient's exercise capacity. Performance assessment unravels patients' capabilities, enables a tailored exercise prescription and provides predictive information on main clinical outcomes and therefore this topic should be of interest for nephrologists. A routinary minimal pool of tests might be usefully performed in a dialysis centre to stratify the patient's risk and to recognize patients in need of exercise training in order to address them to community-based or rehabilitative programs

Circulating hemocytes from larvae of the paper wasp Polistes dominulus (Hymenoptera, Vespidae)

Circulating hemocytes from larval stages of the paper wasp Polistes dominulus were characterized by light and transmission electronmicroscopy. Three types were identified: prohemocytes, plasmatocytes and granulocytes. The first two are agranular cells while the latterpresent typical cytoplasmic inclusions called granules. Plasmatocytes differ from prohemocytes being larger, showing lower nucleus/cytoplasmratio and they possess many phagolysosomes. The substantial uniformity of most subcellular features and the presence of \u201cintermediate forms\u201d support the \u201csingle-cell theory\u201d i.e., there is only one cell line that originates from the prohemocyte and leads to the granular cell passing through the plasmatocyte. This hypothesis seems to be confirmed by functional tests. Indeed, most part of cells adheres to the glass and is able to phagocytize fluorescent microspheres

The strepsipteran endoparasite Xenos vesparum alters the immunocompetence of its host, the paper wasp Polistes dominulus

It is unexplained how strepsipteran insects manipulate the physiology of their hosts in order to undergo endoparasitic development without being entrapped by the innate immune defences of the host. Here we present pioneering work that aimed to explore for the first time several components of the cellular and humoral immune response among immature stages of the paper wasp Polistes dominulus, in both unparasitized insects and after infection by the strepsipteran endoparasite Xenos vesparum. We carried out hemocyte counts, phagocytosis assays in vitro and antibacterial response in vivo. On the whole, hemocyte load does not seem to be drastically affected by parasitization: a non-significant increase in hemocyte numbers was observed in parasitized wasps as respect to control, while the two dominant hemocyte types were present with similar proportions in both groups. On the other hand, phagocytosis was significantly reduced in hemocytes from parasitized wasps while the antibacterial response seemed to be less effective in control. These somewhat unexpected results are discussed, along with the implications of a multiple approach in immune response studies. \uc2\ua9 2009 Elsevier Ltd. All rights reserved

Fire ant viruses: host-parasite dynamics and transcriptomics of the infection

Trabalho final de mestrado integrado em Medicina (Oftalmologia), apresentado à Faculdade de Medicina da Universidade de CoimbraObjectives To characterize the progression of eye fundus changes by multimodal imaging and to identify morphological and/or functional predictors of conversion in wet AMD in the fellow eyes of patients with exudative AMD. Sample Description and Methods Single-center, prospective, observational, longitudinal 2-year study. Sixty-two patients were enrolled in the study, with diagnosis of neovascular age-related macular degeneration in one eye and age-related maculopathy in the fellow eye. Each patient underwent a detailed ocular and medical history, a complete ophthalmologic examination with color fundus photography, fluorescein angiography, indocyanine green angiography and fundus autofluorescence imaging at baseline and repeated at six-month intervals. CFP images were graded resorting to the RetmarkerAMD (Critical Health SA) software, a computer assisted grading system based on the International Classification Grading System guidelines (Bird, Bressler et al., 1995). Results Fifty-three patients completed the two-year follow-up period, eighteen of which converted to the exudative form in the fellow eye during the study period. No measurable evolution was found in consecutive fundus autofluorescence and indocyanine green angiography images. Total drusen area in CFP images presented no significant increase between each visit and the subsequent (p=0.100), but significant increase was found between the first and the last (p=0.048). IGC images: 23% of patients presented a normal exam; observations have shown that the hot spots or areas and the hypofluorescent spots or areas where either attributable to drusens or drusenoid pigmentary epitelium dettachments or did not correspond to any lesion visible in the CFP images; the sensitivity of the overall exam result was 88% and the specificity of presence of early hot spots or areas was 97%. FAF Abstract Multimodal Image: Assessment of Risk Factors for the Development of Choroidal Neovascularisation in the Fellow Eye images: the distribution of patterns for the cases that converted and those that did not is significantly different. CFP images: drusen area was significantly higher in the group of patients which did not convert when considering total area (p=0.012), sub-field 4 (p=0.020) and sub-field 5 (p=0.039); two main groups were identified by hierarchical cluster analysis, with Ward's linkage, when considering total area of drusens of the last visit available; principal component analysis identified total area as the most characterizing feature; no significant differences were found between the groups in what concerns the areas of drusen with specific sizes (C1: p=0.28; C2: p=0.11; C3: p=0.31); no correlation was found between age or total drusen area and conversion, and these two variables are not correlated. Conclusion The percentage of patients which converted during the study (34%) exceeds the expected rate for this time period. In what concerns evolution, further study including a longer follow-up period is suggested as it was only apparent for total drusen area calculated in CFP images between the first and last visits available. FAF images: FAF may be an interesting exam for predicting AMD progression but further studies are necessary to pinpoint the characterizing patterns. ICG images: the most characterizing features for conversion were the overall exam result and the presence of early hot spots or areas. CFP images: in this sample conversion does not occur for patients with the higher extension of lesions; no relation was found between conversion and patient’s age or drusen of specific sizes.Estudar a progressão das alterações do fundo ocular através de imagem multimodal e identificar os fatores de risco para conversão em degenerescência macular relacionada com a idade (DMRI) neovascular no olho contra-lateral de doentes com DMRI exsudativa. Descrição da Amostra e Métodos Estudo de centro único, prospetivo, observacional, longitudinal com a duração de dois anos. Foram incluídos no estudo 62 doentes com o diagnóstico de DMRI neovascular num dos olhos e maculopatia relacionada com a idade no outro. Cada doente foi submetido a uma história médica e ocular detalhada, um exame oftalmológico completo com retinografia a cores (CFP), angiografia fluoresceínica (FA), angiografia com verde de indocianina (ICG) e imagem de autofluorescência do fundo na linha de base e repetidos com intervalos de seis meses. As CFP foram classificadas com recurso ao software RetmarkerAMD (Critical Software SA), um sistema de classificação assistida por computador baseado nas linhas guias do sistema de classificação internacional (Bird, Bressler et al., 1995). Resultados Cinquenta e três doentes completaram o período de seguimento de dois anos, dezoito dos quais converteram para a forma exsudativa no olho em estudo durante a duração do estudo. Não foi encontrada evolução mensurável em imagens consecutivas de angiografia com verde de indocianina e imagem de autofluorescência do fundo. A área total de drusens nas CFP não revelou aumento significativo entre visitas subsequentes (p=0,100), mas verificou-se a existência de aumento significativo de área entre a primeira e a última (p=0,048). Imagens de ICG: 23% dos casos apresentavam um exame normal; as zonas de hiperfluorescência e hipofluorescência foram atribuídas a drusens ou descolamentos drusenoides do epitélio pigmentar da retina ou não correspondiam a nenhuma lesão identificável nas imagens de CFP; a sensibilidade do resultado global do exame é de 88% e a Resumo Multimodal Image: Assessment of Risk Factors for the Development of Choroidal Neovascularisation in the Fellow Eye especificidade da presença de hiperfluorescências é de 97%. Imagens de FAF: foram encontradas diferenças significativas entre a distribuição de padrões de cada grupo (doentes que converteram e doentes que não converteram). Imagens de CFP: a área de drusens é significativamente maior no grupo de doentes que não converteu quando se considera a área total (p=0,012), sub-área 4 (p=0,020) e sub-área 5 (p=0,039); foram identificados dois grandes grupos através da análise hierárquica de agrupamentos, com ligação de Ward, quando se considera a área total de drusens da última visita disponível; a análise de componentes principais identificou a área total como a variável mais caracterizadora; não foram encontradas diferenças significativas entre os grupos no que diz respeito à área de drusens com tamanhos específicos (C1: p=0,28; C2: p=0,11; C3: p=0,31); não se encontrou correlação entre a idade ou a área total de drusens e a conversão e estas duas variáveis não estão correlacionadas entre si. Conclusão A percentagem de doentes que converteu durante o estudo (33%) é superior à esperada para este período de tempo. No que diz respeito à evolução, parece pertinente realizar estudos com período de seguimento mais alargado uma vez que esta só foi manifesta para a área total de drusens calculada através das imagens de CFP entre a primeira e a última visitas disponíveis. Imagens de FAF: a imagem de FAF pode ser interessante para prever a progressão da DMRI mas são necessários mais estudos para determinar os padrões caracterizadores. Imagens de ICG: os achados mais caracterizadores para a conversão são o resultado global do exame e a presença de hiperfluorescências precoces. Imagens de CFP: nesta amostra a conversão não ocorre nos doentes com extensão de lesões superior; não se encontrou relação entre a conversão e a idade ou drusens de tamanhos específico

Terapia de ejercicios para enfermedades crónicas: discapacidad y resultados clínicos a largo plazo en una cohorte de pacientes con enfermedad arterial periférica inscritos en un programa de rehabilitación original

INTRODUCTION Peripheral artery disease (PAD) at intermediate stages is responsible for walking disability and quality of life reduction among 3-10% of the population and 15-20% of patients over 70 years. Surgery is unable to fully reverse the disability and has a risk of complications and high costs. Exercise is an effective intervention, which can increase the functional capacity of patients with PAD and claudication. Unfortunately, the recommended programs carried out at a hospital under supervision are poorly available and limited by low adherence. Therefore, based on new evidence, the approach to exercise in PAD is progressively moving towards novel models of intervention and alternative forms of exercise. Fifteen years ago, an original structured model of exercise without supervision, based on home-based symptomfree walking sessions at a prescribed speed with check-ups at the hospital, was developed by Manfredini F and coworkers in PAD. The model was also successfully tested in dialysis patients and stroke survivors. The present thesis, which focuses on the management of PAD patients with claudication, in particular on the exercise therapy, aims to test the hypothesis that rehabilitative outcomes may be associated with better long-term vascular and clinical outcomes. This issue, reported in the literature for cardiac rehabilitation, is poorly described for vascular rehabilitation. Confirmation of the hypothesis would underline the importance of rehabilitative programs that are also sustainable in elderly and frail patients, which may have a positive impact on the fate of patients with PAD. AIMS/OBJECTIVES This study retrospectively evaluated the association between rehabilitative outcomes following an original structured home-based program and the risk of peripheral revascularizations and mortality in elderly PAD patients with claudication. SUBJECTS AND METHODS Eight-hundred thirty-five patients were enrolled. Ankle-brachial index (ABI) and maximal walking speed (Smax) by an incremental treadmill test were measured at baseline and at discharge from a symptom-free walking program prescribed at a hospital and executed at home. For the analysis, patients were divided according to a baseline ABI value into the Severe (ABI ≤0.5) or Moderate (ABI ≥0.5) group and according to hemodynamic or functional rehabilitative outcomes into responders (ABI ≥ 0.10 and/or Smax ≥ 0.5 km/h) or non-responders to rehabilitation. Data about PAD-related revascularizations and mortality for a 3-year period were collected for the regional registry of the Emilia-Romagna Region. RESULTS According to the inclusion criteria, patients aged 80 years, with ABI value ≥0.80 or unmeasurable, or patients who interrupted the rehabilitation program were excluded. The final sample included 457 patients, specifically, 146 Severe and 311 Moderate. The whole population, with significantly improved functional and hemodynamic values at discharge, at follow-up showed 56 revascularizations and 69 deaths, with the rate of revascularization (12%) strongly associated with ABI at discharge (hazard ratio, HR:0.03; 95% confidence interval 0.004−0.16). Severe patients who at discharge showed superimposable adherence, functional and hemodynamic outcomes compared to Moderate, at follow-up showed an expected higher rate of revascularization (17% vs 10%, respectively p<0.001) and death (29% vs 8%, respectively; p<0.001). However, Severe patients with an improved ABI showed a lower rate of revascularization than Severe ABI nonresponders (13% vs 21%, respectively; HR:0.52; 0.20−1.40) and no difference from Moderate (9%). Superimposable outcomes were observed for Smax responders (13% vs. 21%; HR: 0.55; Moderate 10%). Among responders, similar benefits were observed for mortality. CONCLUSIONS Elderly patients with severe PAD, who at discharge from rehabilitation attained aceptable hemodynamic and mobility improvements, showed lower rates of peripheral revascularization and death at 3-year follow-up, which is comparable to patients with moderate disease. Patient-centered programs that are reproducible at low cost in an outpatient setting and able to improve both function and hemodynamics with low doses of exercise even in the presence of severe disease may represent an option in the decision-making for elderly patients with low mobility. To the best of our knowledge, the present results represent a novel report that requires further assessment in prospective studies.INTRODUCCIÓN La enfermerdad arterial periférica (EAP) en las etapas intermedias es responsable de la incapacidad para caminar y de la reducción de la calidad de vida entre el 3% y 10% de la población y entre el 15% y 20% de los pacientes mayores de 70 años. La cirugía no puede revertir completamente la incapacidad y presenta riesgo de complicaciones y altos costos. El ejercicio es una intervención efectiva, que puede aumentar la capacidad funcional de los pacientes con EAP y claudicación. Desafortunadamente, los programas recomendados realizados en un hospital bajo supervisión están poco desarrollados y limitados por una baja adherencia. Por lo tanto, en base a la evidencia científica, el enfoque del ejercicio en EAP está avanzando progresivamente hacia nuevos modelos de intervención y formas alternativas de ejercicio. Hace quince años, Manfredini F y colaboradores desarrollaron un modelo estructurado original de ejercicio sin supervisión en pacientes con EAP, basado en sesiones de caminata sin síntomas en el hogar a una velocidad prescrita con controles en el hospital. El modelo también fue probado con éxito en pacientes en diálisis y supervivientes de accidente cerebrovascular. La presente tesis, la cual se centra en el tratamiento de pacientes con EAP con claudicación, en particular en el tratamiento con ejercicios, tiene como objetivo probar la hipótesis de que los resultados de rehabilitación están asociados con mejores resultados clínicos y vasculares a largo plazo. Este problema, descrito en la literatura para la rehabilitación cardíaca, se describe pobremente en la rehabilitación vascular. La confirmación de la hipótesis subraya la importancia de los programas de rehabilitación que también son sostenibles en pacientes ancianos y frágiles, lo que puede tener un impacto positivo en el destino de los pacientes con EAP. OBJETIVOS Este estudio evalúa retrospectivamente la asociación de los resultados de rehabilitación después de un programa original estructurado en el hogar y el riesgo de revascularizaciones periféricas y la mortalidad en pacientes ancianos con EAP con claudicación. SUJETOS Y MÉTODOS Ochocientos treinta y cinco pacientes se incluyeron en el estudio. Se midió el índice tobillobraquial (ABI) y la velocidad máxima de caminata (Smax) mediante una prueba incremental en cinta rodante, al inicio y alta de un programa de caminata sin síntomas prescrito en un hospital y ejecutado en casa. Para el análisis, los pacientes se dividieron según el valor ABI de referencia en el grupo Severo (ABI ≤0,5) o Moderado (ABI ≥0,5) y de acuerdo con los resultados de rehabilitación hemodinámicos o funcionales en los que se ajustaban (ABI ≥ 0.10 y / o Smax ≥ 0.5 km / h) o no a la rehabilitación. Se recopilaron datos sobre las revascularizaciones y la mortalidad relacionadas con EAP durante un período de 3 años, según el registro regional de la región de Emilia-Romagna. RESULTADOS De acuerdo con los criterios de inclusión, los pacientes de <60 u 80 años, con un valor de ABI ≥0.80 o no medible, o los pacientes que interrumpieron el programa de rehabilitación fueron excluidos. La muestra final incluyó 457 pacientes, específicamente, 146 graves y 311 moderados. La población total, con valores funcionales y hemodinámicos significativamente mejorados en el momento del alta, durante el período de seguimiento mostró 56 revascularizaciones y 69 muertes, con una tasa de revascularización (12%) fuertemente asociada con el ABI al alta (HR: 0,03; CI 95%: 0,004-0,16). Los pacientes graves que en el momento del alta mostraron una adherencia, resultados funcionales y hemodinámicos superpuestos con aquellos moderados, en el período de seguimiento mostraron una esperada mayor tasa de revascularización (17% vs. 10%, respectivamente, p <0,001) y muerte (29% vs. 8%, respectivamente; p <0.001). Sin embargo, los pacientes del grupo severo con un ABI mejorado mostraron una tasa de revascularización más baja que aquellos con ABI grave que no respondían (13% vs. 21%, respectivamente; HR: 0.52; 0.201.40) y ninguna diferencia para el grupo Moderado (9%). Se observaron resultados superponibles para los que respondían a la Smax (13% vs. 21%; HR: 0,55; Grupo Moderado: 10%). Entre los que respondían se observaron beneficios similares para la mortalidad. CONCLUSIONES Los pacientes ancianos con EAP grave, que al momento del alta hospitalaria lograron mejoras hemodinámicas y de movilidad aceptables, mostraron tasas más bajas de revascularización periférica y muerte a los 3 años de seguimiento, lo cual es comparable a los pacientes con enfermedad moderada. Los programas centrados en el paciente que son reproducibles a bajo costo en un entorno ambulatorio y capaces de mejorar tanto la función como la hemodinámica con bajas dosis de ejercicio, incluso en presencia de una enfermedad grave, pueden representar una opción en la toma de decisiones para pacientes ancianos con poca movilidad. A nuestro conocimiento, los resultados actuales representan un informe novedoso que requiere una evaluación adicional en estudios prospectivos

Implication of the Mosquito Midgut Microbiota in the Defense against Malaria Parasites

Malaria-transmitting mosquitoes are continuously exposed to microbes, including their midgut microbiota. This naturally acquired microbial flora can modulate the mosquito's vectorial capacity by inhibiting the development of Plasmodium and other human pathogens through an unknown mechanism. We have undertaken a comprehensive functional genomic approach to elucidate the molecular interplay between the bacterial co-infection and the development of the human malaria parasite Plasmodium falciparum in its natural vector Anopheles gambiae. Global transcription profiling of septic and aseptic mosquitoes identified a significant subset of immune genes that were mostly up-regulated by the mosquito's microbial flora, including several anti-Plasmodium factors. Microbe-free aseptic mosquitoes displayed an increased susceptibility to Plasmodium infection while co-feeding mosquitoes with bacteria and P. falciparum gametocytes resulted in lower than normal infection levels. Infection analyses suggest the bacteria-mediated anti-Plasmodium effect is mediated by the mosquitoes' antimicrobial immune responses, plausibly through activation of basal immunity. We show that the microbiota can modulate the anti-Plasmodium effects of some immune genes. In sum, the microbiota plays an essential role in modulating the mosquito's capacity to sustain Plasmodium infection

A Potential Role for Phenotypic Plasticity in Invasions and Declines of Social Insects

This work was supported by a Fulbright Science and Technology Scholarship to AT and National Geographic Species Recovery Grant Number NGS-57001R-19 to MA and AT.Peer reviewedPublisher PD

Candidate genes for cooperation and aggression in the social wasp Polistes dominula

Acknowledgements The authors would like to thank Amy Geffre for assistance with field work and experimental setup, and for providing all kinds of support for FM wasp-related work at ISU. We would also like to thank Ali Berens and Erin McCall for valuable feedback on rearing wasp colonies at ISU. Many thanks also to Jeanne Serb for providing support during the molecular work at ISU and Emilie Snell-Rood for guidance on collecting wasp colonies at the University of Minnesota. This work was supported by a Marie Curie International Incoming Fellowship (FP7-PEOPLE-2013-15 IIF-625487).Peer reviewedPublisher PD