Aumento da probabilidade diagnóstica de síndrome de cushing subclínica em uma amostra populacional de pacientes adultos obesos com diabetes mellitus tipo 2

Endogenous Cushing s Syndrome (CS) is unusual. Patients with subclinical CS (SCS) present altered cortisol dynamics without obvious manifestations. CS occurs in 2-3% of obese poorly controlled diabetics. We studied 103 overweight adult outpatients with type 2 diabetes to examine for cortisol abnormalities and SCS. All collected salivary cortisol at 23:00 h and salivary and serum cortisol after a 1 mg dexamethasone suppression test (DST). Patients whose results were in the upper quintile for each test (253 ng/dL, 47 ng/dL, and 1.8 mg/dL, respectively for the 23:00 h and post-DST saliva and serum cortisol) were re-investigated. Average values from the upper quintile group were 2.5-fold higher than in the remaining patients. After a confirmatory 2 mg x 2 day DST the investigation for CS was ended for 61 patients with all normal tests and 33 with only one (false) positive test. All 8 patients who had two abnormal tests had subsequent normal 24h-urinary cortisol, and 3 of them were likely to have SCS (abnormal cortisol tests and positive imaging). However, a final diagnosis could not to be confirmed by surgery or pathology. Although not confirmatory, the results of this study suggest that the prevalence of SCS is considerably higher in populations at risk than in the general population.A síndrome de Cushing (SC) endógena é rara. Pacientes com SC subclínica (SCS) apresentam hipercortisolismo sem manifestações clínicas. SC ocorre em 2-3% de diabéticos mal controlados. Estudamos 103 pacientes adultos obesos ambulatoriais com diabetes mellitus tipo 2 para avaliar alterações do cortisol e SCS. Todos coletaram cortisol salivar às 23:00 h e cortisol salivar e sérico após teste de supressão com 1 mg de dexametasona (DST). Pacientes cujos resultados de qualquer teste estavam no quintil superior (253 ng/dL, 47 ng/dL e 1,8 mg/dL, respectivamente para cortisol salivar 23:00 h e salivar e sérico pós-DST) foram reavaliados. Os valores médios desse grupo encontravam-se 2,5 vezes acima dos valores dos demais pacientes. Após um teste confirmatório com 2 mg x 2 dias DST, a investigação da SC foi encerrada para 61 pacientes com todos os testes normais e 33 com apenas um teste (falso) positivo. Todos os 8 pacientes com dois testes alterados apresentaram cortisol urinário normal, mas 3 deles mostraram maior probabilidade diagnóstica de SCS (hipercortisolismo e alterações em exames de imagem). Contudo, o diagnóstico final não pode ser confirmado por cirurgia ou patologia em nenhum deles. Embora não confirmatórios, os resultados deste estudo sugerem que a prevalência de SCS seja maior em populações de risco do que na população geral.Federal University of São Paulo Department of Medicine Division of EndocrinologyUNIFESP, Department of Medicine Division of EndocrinologySciEL

Untargeted fingerprinting of cider volatiles from different geographical regions by HS-SPME/GC-MS

The volatomic fingerprint of ciders produced in different geographical regions from Madeira Island was estab lished using headspace solid phase microextraction combined with gas chromatography mass spectrometry (HS SPME/GC–MS) in order to explore the effects of geographical region on the volatile pattern ciders in addition to identify potential molecular geographic markers. A total of 107 volatile organic compounds (VOCs) belonging to different chemical families were identified from which 50 VOCs are common to all ciders analysed. Significant differences in the relative content of VOCs from ciders of different geographical regions were observed. The potential of the identified VOCs for ciders discrimination according to region was assessed through chemometric tools, such as principal components analysis (PCA) and partial least squares-discriminant analysis (PLS-DA). The PCA showed significant differences among ciders from different island geographical regions. Fifteen VOCs re sponsible for ciders discrimination were identified by PLS-DA. Fifteen VOCs, namely five terpenoids, four al cohols, three acids and three esters, present variable importance in projection (VIP) values higher than one. Our findings provide relevant information related to volatile signature of ciders produced in Madeira Island, which may be a useful tool to cider-making process contributing to improve the quality of the final product. In addition, the geographical discrimination recognizes the unique and distinctive characteristics that will allow in the future to protect the quality and typicity of products originating in certain geographical regions.info:eu-repo/semantics/publishedVersio

Geographical differentiation of apple ciders based on volatile fingerprint

With the globalization of food trade, it’s traceability and genuineness becomes increasingly more difficult. Therefore, it is necessary to develop analytical tools to define the authenticity and genuineness of food-derived products. In the current work, headspace solid-phase microextraction followed by gas chromatography-mass spectrometry (HS-SPME/GC–MS) combined with chemometric tools was used to establish the volatile fingerprint of apple ciders produced in different geographical regions of Madeira Island, in order to define their typicity and to identify putative geographical markers. A total of 143 volatile organic compounds (VOCs) belonging to dif ferent chemical families have been identified, of which 28 were found in all apple ciders independently of geographical region. Esters, terpenic and furanic compounds presented on average a higher contribution for the total volatile fingerprint in cider produced in northern region of the Island, whereas alcohols, acids, volatile phenols, carbonyl compounds and lactones in cider from southern region. Considering the relative areas of the VOCs, 43 revealed statistically significant differences (p < 0.001) between geographical regions, and 11 be tween northern and southern regions. A clear differentiation among cider-producing regions was observed on the developed partial least squares-discriminant analysis (PLS-DA) model. Two alcohols (1-hexanol, 1-octanol), 6 esters (methyl acetate, (Z)-3-hexen-1-ol acetate, ethyl hexanoate, ethyl nonanote, ethyl octanoate, isoamyl oc tanoate) and 1 terpenic compound (limonene), can be considered putative geographic markers due to their discriminatory ability. The results obtained recognize the specific and typical geographical characteristics of the cider, which will allow the forthcoming guarantee for the construction of a sustainable platform for the es tablishment of the authenticity and typicality of the regional cider.info:eu-repo/semantics/publishedVersio

Exploring access to end of life care for ethnic minorities with end stage kidney disease through recruitment in action research

BACKGROUND: Variation in provision of palliative care in kidney services and practitioner concerns to provide equitable access led to the development of this study which focussed on the perspectives of South Asian patients and their care providers. As people with a South Asian background experience a higher risk of Type 2 Diabetes (T2DM) and end stage kidney failure (ESKF) compared to the majority population but wait longer for a transplant, there is a need for end of life care to be accessible for this group of patients. Furthermore because non English speakers and people at end of life are often excluded from research there is a dearth of research evidence with which to inform service improvement. This paper aims to explore issues relating to the process of recruitment of patients for a research project which contribute to our understanding of access to end of life care for ethnic minority patients in the kidney setting. METHODS: The study employed an action research methodology with interviews and focus groups to capture and reflect on the process of engaging with South Asian patients about end of life care. Researchers and kidney care clinicians on four NHS sites in the UK recruited South Asian patients with ESKF who were requiring end of life care to take part in individual interviews; and other clinicians who provided care to South Asian kidney patients at end of life to take part in focus groups exploring end of life care issues. In action research planning, action and evaluation are interlinked and data were analysed with emergent themes fed back to care providers through the research cycle. Reflections on the process of patient recruitment generated focus group discussions about access which were analysed thematically and reported here. RESULTS: Sixteen patients were recruited to interview and 45 different care providers took part in 14 focus groups across the sites. The process of recruiting patients to interview and subsequent focus group data highlighted some of the key issues concerning access to end of life care. These were: the identification of patients approaching end of life; and their awareness of end of life care; language barriers and informal carers' roles in mediating communication; and contrasting cultures in end of life kidney care. CONCLUSIONS: Reflection on the process of recruitment in this action research study provided insight into the complex scenario of end of life in kidney care. Some of the emerging issues such as the difficulty identifying patients are likely to be common across all patient groups, whilst others concerning language barriers and third party communication are more specific to ethnic minorities. A focus on South Asian ethnicity contributes to better understanding of patient perspectives and generic concepts as well as access to end of life kidney care for this group of patients in the UK. Action research was a useful methodology for achieving this and for informing future research to include informal carers and other ethnic groups.Peer reviewedFinal Published versio

Use of the same polymer for synthesis and purification of peptides

This work reveals an uncommon but valuable biotechnological approach regarding the use of a same polymer (benzhydrylamine-resin, BHAR) for synthesis and anion exchange purification of peptides. Initially, the octapeptide DRVYIHPF-NH2 was synthesized in 1% and 3% cross-linked BHAR, attaching 2.5 mmol g-1 ammonium groups. Due certainly to its less rigid polymeric backbone, higher synthesis yield (about 80%) was achieved with the former resin. Next, the negatively charged peptides DEVYEHPF-NH2 and DEVYEDPF-NH2 (-1 and -3 in neutral pH, respectively), both synthesized in 1% BHAR were submitted to chromatographic separation test in this same type of resin (1% and 3%). Following comparative results of peptide synthesis and swelling data of resin beads obtained by microscopy, an improved separation of both peptides occurred with 1% BHAR batch. These findings demonstrated that BHAR applied so far for peptide synthesis, when containing high amount of positively charged ammonium groups, can be also used alternatively as a solid support for chromatographic purification of this type of biological molecule.Este trabalho revela uma estratégia biotecnológica incomum mas valiosa e relacionada com o uso de um mesmo polímero (benzidrilamino-resina, BHAR) para fins de síntese e purificação por troca aniônica de peptídeos. Inicialmente, o octapeptídeo DRVYIHPF-NH2 foi sintetizado em BHAR com 1% e 3% de intercruzamento e contendo 2,5 mmol g-1 de grupos amônio. Devido certamente a uma menor rigidez da sua estrutura polimérica, um maior rendimento na síntese (cerca de 80%) foi obtido com a primeira resina. A seguir, os peptídeos DEVYEHPF-NH2 e DEVYEDPF-NH2 carregados negativamente (-1 e -3 em pH neutro, respectivamente), ambos sintetizados em 1% BHAR, foram submetidos a um teste de separação cromatográfica no mesmo tipo de resina (1% e 3%). Concordante com resultados da síntese de peptídeos e de valores de inchamento dos grãos das resinas, obtidos por microscopia, uma melhor separação entre ambos os peptídeos ocorreu com o lote de 1% BHAR. Estes achados demonstraram que a BHAR, aplicada até o momento somente para a síntese peptídica, se contiver elevado teor de grupos amônio positivos, pode ser utilizada alternativamente como suporte sólido para purificação cromatográfica deste tipo de molécula biológica.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo (UNIFESP) Departmento de BiofísicaUNIFESP, Departmento de BiofísicaSciEL

O Audiovisual publicitário no contexto das mídias digitais: um olhar sobre a prática do advertainment

The starting point of this study is the dialogue of the advertising with the digital media environment, more specifically what is called in the marketing studies, advertainment. Joint advertising and entertainment, attended and shared voluntarily, the advertainment is analyzed here in the context of YouTube. As framework, we used the campaign Unleash your fingers, created to launch a smartphone in France in 2011. The analysis is based in three vectors: the aesthetic dimension of the audiovisual product (ALVES), the context of its exhibition (BURGESS; GREEN) and the activation of fan behavior (JENKINS, FISKE, STAIGER) in its viewers.O foco deste estudo é a recepção da publicidade no ambiente das mídias digitais, mais especificamente daquilo que é chamado, no âmbito dos estudos de marketing, de advertainment. Misto de publicidade e entretenimento, assistido e compartilhado voluntariamente, o advertainment é aqui analisado no contexto do YouTube. Como recorte, utilizamos a campanha Unleash your fingers, criada para o lançamento de um smartphone na França em 2011. Para tanto, propomos um modelo teórico que esquematiza essa recepção em três instâncias: a dimensão estética do produto audiovisual, o contexto da recepção e a ativação do comportamento de fã. São utilizados autores e conceitos oriundos dos estudos da recepção, como a estética da recepção (Jauss), a semiopragmática (Odin) e os estudos sobre fãs num contexto de novas formas de participação online (Jenkins, Fiske, Staiger).The audiovisual advertising in the context of digital media: a look at the practice of the advertainmentAbstract: The starting point of this study is the dialogue of the advertising with the digital media environment, more specifically what is called in the marketing studies, advertainment. Joint advertising and entertainment, attended and shared voluntarily, the advertainment is analyzed here in the context of YouTube. As framework, we used the campaign Unleash your fingers, created to launch a smartphone in France in 2011. The analysis is based in three vectors: the aesthetic dimension of the audiovisual product (ALVES), the context of its exhibition (BURGESS; GREEN) and the activation of fan behavior (JENKINS, FISKE, STAIGER) in its viewers

Structural features and pro-inflammatory effects of water-soluble organic matter in inhalable fine urban air particles

The impact of inhalable fine particulate matter (PM2.5, aerodynamic diameter < 2.5 µm) on public health is of great concern worldwide. Knowledge on their harmful effects are mainly due to studies carried out with whole air particles, being the contribution of their different fractions largely unknown. Herein, a set of urban PM2.5 samples were collected during day and nighttime periods in Autumn and Spring, aiming to address the seasonal and day-night variability of water-soluble organic matter (WSOM) composition. In vitro analysis of oxidative and pro-inflammatory potential of WSOM samples was carried out in both acute (24 h) and chronic (3 weeks) exposure setups using Raw264.7 macrophages as cell model. Findings revealed that the structural composition of WSOM samples differs between seasons and in a day-night cycle. Cells exposure resulted in an increase in the transcription of the cytoprotective Hmox1 and pro-inflammatory genes Il1b and Nos2, leading to a moderate pro-inflammatory status. These macrophages showed an impaired capacity to subsequently respond to a strong pro-inflammatory stimulus such as bacterial lipopolysaccharide, which may implicate a compromised capacity to manage harmful pathogens. Further investigation on aerosol WSOM could help to constrain the mechanisms of WSOM-induced respiratory diseases and contribute to PM2.5 regulations.publishe

Uso de drogas entre crianças e adolescentes em situação de rua: o que ajuda?

The aim of this study was to investigate factors associated to frequent and heavy drug use among street children and adolescents aged 10 to 18 years. A sample of 2,807 street children and adolescents from the 27 Brazilian state capital cities was analyzed. A World Health Organization questionnaire for non-students was adapted for use in Brazil. Data analysis was performed using logistic regression and decision tree models. Factors inversely associated with frequent and heavy drug use were: being age nine to 11 years (OR = 0.1); school attendance (OR = 0.3); daily time (one to five hours) spent on the streets (OR = 0.3 and 0.4); not sleeping on the streets (OR = 0.4); being on the streets for less than one year (OR = 0.4); maintenance of some family bonds (OR = 0.5); presence on the streets of a family member (OR = 0.6); not suffering domestic violence (OR = 0.6); being female (OR = 0.8). All of these variables were significant at the p < 0.05 level. The findings suggest that being younger, having family bonds and engagement in school are important protective factors that affect drug use among this population and should be considered in the formulation of public policies.O objetivo do estudo foi verificar fatores associados ao uso frequente e pesado de drogas entre adolescentes em situação de rua no Brasil. Estudo transversal com amostra representativa nacional de 2.807 crianças e adolescentes (10-18 anos). Foi usado um questionário da Organização Mundial da Saúde adaptado para o Brasil e análise dos dados, modelo de regressão logística. Fatores inversamente associados ao uso frequente e pesado de drogas: faixa etária entre 9-11 anos (OR = 0,1); frequentar escola (OR = 0,3); permanecer entre 1 e 5 horas na rua (OR = 0,3 e 0,4); não dormir na rua (OR = 0,4); estar na rua há menos de um ano (OR = 0,4); manter algum vínculo familiar (OR = 0,5); permanecer na rua com algum membro da família (OR = 0,6); não ter sofrido violência doméstica (OR = 0,6); gênero feminino (OR = 0,8). Todas essas variáveis apresentaram p < 0,05. Os achados sugerem que ser mais jovem, ficar menos tempo na rua e manter vínculos com escola e família são importantes fatores de proteção para essa população quanto ao uso frequente e pesado de drogas. Esses são fatores importantes na formulação de políticas públicas para essa população.Universidade Federal de São Paulo (UNIFESP) Departamento de PsicobiologiaUniversidade Federal de São Paulo (UNIFESP) Departamento de Medicina PreventivaUniversidade Federal do Rio Grande Instituto de Ciências Humanas e da InformaçãoUniversidade Federal do Rio Grande do Sul Instituto de PsicologiaUNIFESP, Depto. de PsicobiologiaUNIFESP, Depto. de Medicina PreventivaSciEL

Nonextensive Thermostatistics and the H Theorem

The kinetic foundations of Tsallis' nonextensive thermostatistics are investigated through Boltzmann's transport equation approach. Our analysis follows from a nonextensive generalization of the "molecular chaos hypothesis." For q>0, the q-transport equation satisfies an H theorem based on Tsallis entropy. It is also proved that the collisional equilibrium is given by Tsallis' q-nonextensive velocity distribution.Facultad de Ciencias Astronómicas y Geofísica