Estudo Histopatológico e Viabilidade de Análises do DNA em Ossadas Humanas Expostas a Condições Tafonômicas: aplicações na identificação forense

BV UNIFESP: Teses e dissertaçõe

Minimally clinically important improvement: all non-responders are not really non-responders an illustration from total knee replacement

Canadian Institutes of Health Research operating grant to Davis #7751

Using Mutli Criteria Decision Analysis To Develop Sustainability Assessment Tools: Biomass Supply Chains

Energy access remains a significant challenge in nations lacking access to resources and strong infrastructure systems, creating barriers to economic development and to increased standards of living. Small scale biomass gasification energy (BGE) systems have been developed to meet energy needs in rural areas, creating synergies between agricultural and agro-forestry systems through utilization of biomass feedstock for energy generation. The sustainability of such systems requires sophisticated planning and coordination of the biomass supply chain. The goal of this thesis is to investigate and improve structural and process related characteristics of sustainability assessments for small scale bio-energy systems, specifically focusing on establishment and management of biomass supply chains through the development and dissemination of a generic sustainability assessment framework for biomass supply chains of small-scale BGE systems in rural East Africa. Building on a preliminary sustainability assessment framework (Christensen, 2013; Joerg, 2013) this research develops an assessment tool designed to capture sustainability requirements of the biomass supply chain in the ecological, social, and economic spheres through testing on three case studies in rural Uganda. Application and analysis of a preliminary framework on pilot projects in a rural east African context using Multi Criteria Decision Analysis (MCDA) methodologies contributes to development of strategies for energy system analysis and building stakeholder capacity to incorporate social, economic, and environmental considerations. The assessment process is outlined, including scoring, data collection, contextual considerations. Model application is discussed, including the impact of weighting on decision outcomes, uncertainty management, sensitivity analysis, and identification of tradeoffs among criteria. Finally, discussion of tool usefulness verses usability contributes to bridging academic research with practitioner priorities

Racial Differences in Serum Adipokine and Insulin Levels in a Matched Osteoarthritis Sample: A Pilot Study

Background. In an attempt to correlate biomarkers with disease, serum-based biomarkers often are compared between individuals with osteoarthritis (OA) and control subjects. However, variable results have been reported. Some studies have suggested an association between certain adipokines and insulin and OA. We know that there are racial differences in OA prevalence and incidence, and from general population-based studies, those of Asian race consistently demonstrate a unique adipokine/insulin serum concentration profile as compared to Caucasians. Whether similar racial differences exist within OA samples is unknown and may have implications for selecting appropriate controls in comparative studies. Methods. Serum levels of adipokines, leptin, and adiponectin, along with insulin, were determined by ELISA in patients scheduled for total hip or knee replacement surgery for OA. Fifteen Asian patients were matched 1 : 1 on age (±2 years), gender, body mass index (±1.5 kg/m2), and surgical joint with Caucasian patients. Differences in serum concentrations were tested using paired t-tests. Results. Serum leptin and insulin levels were significantly higher in Asians compared to Caucasians (p<0.05). While serum adiponectin levels were lower among Asians, the difference did not reach statistical significance (p=0.12). Conclusion. Findings from this work suggest that when studying serum biomarker concentrations in OA versus controls, race may be an important factor to consider. Our findings warrant confirmation in larger studies

Does the person’s context influence engagement in life activities following primary knee replacement? Results from a Canadian prospective cohort study

Peer reviewe

Stem cell therapy for the treatment of early stage avascular necrosis of the femoral head: a systematic review

BACKGROUND: Avascular necrosis (AVN) of the femoral head (FH) is believed to be caused by a multitude of etiologic factors and is associated with significant morbidity in younger populations. Eventually, the disease progresses and results in FH collapse. Thus, a focus on early disease management aimed at joint preservation by preventing or delaying progression is key. The use of stem cells (SC) for the treatment of AVN of the FH has been proposed. We undertook a systematic review of the medical literature examining the use of SC for the treatment of early stage (precollapse) AVN of the FH, in both pre-clinical and clinical studies. METHODS: Data collected included: Pre-clinical studies – model of AVN, variety and dosage of SC, histologic and imaging analyses. Clinical studies – study design, classification and etiology of AVN, SC dosage and treatment protocol, incidence of disease progression, patient reported outcomes, volume of necrotic lesion and hip survivorship. RESULTS: In pre-clinical studies, the use of SC uniformly demonstrated improvements in osteogenesis and angiogenesis, yet source of implanted SC was variable. In clinical studies, groups treated with SC showed significant improvements in patient reported outcomes; however hip survivorship was not affected. Discrepancies regarding dose of SC, AVN etiology and disease severity were present. CONCLUSIONS: Routine use of this treatment method will first require further research into dose and quality optimization as well as confirmed improvements in hip survivorship

A prospective cohort study examining medical and social factors associated with engagement in life activities following total hip replacement

Objectives: Studies show limited improvement in the frequency of engaging in life activities after joint replacement. However, there is a paucity of research that has examined factors, including other life events, which influence engagement following total hip replacement (THR). This research sought to identify factors associated with engaging in life activities following THR. Methods: A prospective cohort study was conducted with 376 people who had a THR for osteoarthritis (OA). Data were collected pre-surgery and 1 year post-surgery. The primary outcome was change in frequency in engagement in life activities (Late Life Disability Index (LLDI): higher scores indicate higher frequency of engagement (range 0e80)). Analyses included multivariable regression. Factors considered included: positive/negative life events, a new comorbidity, another joint replacement and complications post-surgery. Results: Participants' mean age was 64 years; 46% were male. 68% of participants had at least one comorbidity pre-surgery; 36% reported at least one new comorbidity after surgery. The mean change in LLDI frequency was an increase of 6.29 (+/- 8.10). 36% reported one or more positive impact life events in the year following surgery; 63% reported one or more negative life events. The number of positive life events (beta=1.24; 95% CI: 0.49, 1.99) was significantly associated with change in LLDI frequency after adjusting for age, sex, education, body mass index (BMI), comorbidities pre-surgery, number of symptomatic joints and pre-surgery pain and function, LLDI limitations and depression. Conclusions: These findings highlight the significant influence of social factors and life circumstances on engagement in life activities following THR. (C) 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Postgrafting administration of granulocyte colony-stimulating factor impairs functional immune recovery in recipients of human leukocyte antigen haplotype–mismatched hematopoietic transplants

AbstractIn human leukocyte antigen haplotype–mismatched transplantation, extensive T-cell depletion prevents graft-versus-host disease (GVHD) but delays immune recovery. Granulocyte colony-stimulating factor (G-CSF) is given to donors to mobilize stem cells and to recipients to ensure engraftment. Studies have shown that G-CSF promotes T-helper (Th)-2 immune deviation which, unlike Th1 responses, does not protect against intracellular pathogens and fungi. The effect of administration of G-CSF to recipients of mismatched hematopoietic transplants with respect to transplantation outcome and functional immune recovery was investigated. In 43 patients with acute leukemia who received G-CSF after transplantation, the engraftment rate was 95%. However, the patients had a long-lasting type 2 immune reactivity, ie, Th2-inducing dendritic cells not producing interleukin 12 (IL-12) and high frequencies of IL-4– and IL-10–producing CD4+ cells not expressing the IL-12 receptor β2 chain. Similar immune reactivity patterns were observed on exposure of donor cells to G-CSF. Elimination of postgrafting administration of G-CSF in a subsequent series of 36 patients with acute leukemia, while not adversely affecting engraftment rate (93%), resulted in the anticipated appearance of IL-12–producing dendritic cells (1-3 months after transplantation versus &gt; 12 months in transplant recipients given G-CSF), of CD4+ cells of a mixed Th0/Th1 phenotype, and of antifungal T-cell reactivity in vitro. Moreover, CD4+ cell counts increased in significantly less time. Finally, elimination of G-CSF–mediated immune suppression did not significantly increase the incidence of GVHD (&lt; 15%). Thus, this study found that administration of G-CSF to recipients of T-cell–depleted hematopoietic transplants was associated with abnormal antigen-presenting cell functions and T-cell reactivity. Elimination of postgrafting administration of G-CSF prevented immune dysregulation and accelerated functional immune recovery