Thromboelastography to Monitor Clotting/Bleeding Complications in Patients Treated with the Molecular Adsorbent Recirculating System

Background. The Molecular Adsorbent Recirculating System (MARS) has been shown to clear albumin-bound toxins from patients with liver failure but might cause bleeding complications potentially obscuring survival benefits. We hypothesized that monitoring clotting parameters and bed-side thromboelastography allows to reduce bleeding complications. Methods. Retrospective analysis of 25 MARS sessions during which clotting parameters were monitored by a standardized protocol. Results. During MARS therapy median INR increased significantly from 1.7 to 1.9 platelet count and fibrinogen content decreased significantly from 57 fL−1 to 42 fL−1 and 2.1 g/L to 1.5 g/L. Nine relevant complications occurred: the MARS system clotted 6 times 3 times we observed hemorrhages. Absent thrombocytopenia and elevated plasma fibrinogen predicted clotting of the MARS system (ROC 0.94 and 0.82). Fibrinolysis, detected by thromboelastography, uniquely predicted bleeding events. Conclusion. Bed-side thromboelastography and close monitoring of coagulation parameters can predict and, therefore, help prevent bleeding complications during MARS therapy

Editorial

Esta edição abre o ano do décimo aniversário da publicação da Revista Portuguesa e Brasileira de Gestão alicerçada numa parceria entre instituições de ensino em língua portuguesa da doutrina e da prática do management adaptado às condições específicas dos dois lados do Atlântico

Biochemical characterization of the Nocardia lactamdurans ACV synthetase

The L-δ-(α-aminoadipoyl)-L-cysteinyl-D-valine synthetase (ACVS) is a nonribosomal peptide synthetase (NRPS) that fulfills a crucial role in the synthesis of β-lactams. Although some of the enzymological aspects of this enzyme have been elucidated, its large size, at over 400 kDa, has hampered heterologous expression and stable purification attempts. Here we have successfully overexpressed the Nocardia lactamdurans ACVS in E. coli HM0079. The protein was purified to homogeneity and characterized for tripeptide formation with a focus on the substrate specificity of the three modules. The first L-α-aminoadipic acid-activating module is highly specific, whereas the modules for L-cysteine and L-valine are more promiscuous. Engineering of the first module of ACVS confirmed the strict specificity observed towards its substrate, which can be understood in terms of the non-canonical peptide bond position

Editorial - Os domínios «soft»

O conjunto de artigos que seleccionámos para integrar este último número da Revista de 2006, dá particular destaque a temáticas ainda pouco valorizadas nas ciências da gestão: a gestão dos activos intangíveis, em geral, e a gestão do conhecimento e do marketing interno e a gestão do capital intelectual, em particular

The Influence of Intense Tai Chi Training on Physical Performance and Hemodynamic Outcomes in Transitionally Frail, Older Adults

Background. Few data exist to evaluate whether Tai Chi (TC) training improves physical performance and hemodynamic outcomes more than a wellness education (WE) program does among older fallers transitioning to frailty. Methods. This 48-week randomized clinical trial was provided at 10 matched pairs of congregate living facilities in the Atlanta metropolitan area to 291 women and 20 men, who were transitionally frail, ≥70 years old, and had fallen at least once within the past year. Pairs of facilities were randomized to either TC exercise (n = 158) or WE (control) interventions (n = 153) over 48 weeks. Physical performance (freely chosen gait speed, reach, chair-rises, 360° turn, picking up an object from the floor, and single limb support) and hemodynamic outcomes (heart rate and blood pressure) were obtained at baseline and after 4, 8, and 12 months. Results. Mean percent change (baseline to 1 year) for gait speed increased similarly in both cohorts (TC: 9.1% and WE: 8.2%; p =.78). However, time to complete three chair-rises decreased 12.3% for TC and increased 13.7% for WE (p =.006). Baseline to 1 year mean percent change decreased among TC and increased within WE cohorts for: body mass index (-2.3% vs 1.8%; p <.0001), systolic blood pressure (-3.4% vs 1.7%; p =.02), and resting heart rate (-5.9% vs 4.6%; p <.0001). Conclusions. TC significantly improved chair-rise and cardiovascular performance. Because TC training reduced fall occurrences in this cohort, factors influencing functional and cardiovascular improvements may also favorably impact fall event

Os significados da lealdade em Hirschman: o papel da identidade organizacional

SCIELO:S1645-44642014000300006 (Nº de Acesso Web of Science)Tendo por base o trabalho original de Hirschman (1970) e a teoria da identidade organizacional, evidenciamos a existência de duas aceções do conceito de lealdade: como vinculação, descrevendo a ligação entre os indivíduos e as organizações, a dominante no trabalho do autor; como resposta, traduzindo uma postura passiva e confiante, a mais corrente na literatura subsequente. Em linha com a teorização original de Hirschman, os resultados obtidos numa amostra de militares da Marinha de Guerra Portuguesa mostram que: lealdade como vinculação e lealdade como resposta são conceitos distintos e que ambos são explicados pela identidade organizacional percebida; a lealdade como vinculação medeia totalmente a relação entre a identidade organizacional percebida e a voz; o abandono e a lealdade como resposta são influenciados diretamente pela identidade organizacional percebida sem qualquer efeito mediador da lealdade como vinculação. Estes resultados suportam parcialmente a proposição central em Hirschman, segundo a qual o papel da lealdade é o de ativar a voz e afastar o abandono

Phylogenetic Relationships of Malvatheca (Bombacoideae and Malvoideae; Malvaceae sensu lato) as Inferred from Plastid DNA Sequences

Previous molecular phylogenetic analyses have revealed that elements of the former families Malvaceae sensu stricto and Bombacaceae together form a well-supported clade that has been named Malvatheca. Within Malvatheca, two major lineages have been observed; one, Bombacoideae, corresponds approximately to the palmate-leaved Bombacaceae, and the other, Malvoideae, includes the traditional Malvaceae (the mallows or Eumalvoideae). However, the composition of these two groups and their relationships to other elements of Malvatheca remain a source of uncertainty. Sequence data from two plastid regions, ndhF and trnK/matK, from 34 exemplars of Malvatheca and six outgroups were analyzed. Parsimony, likelihood, and Bayesian analyses of the sequence data provided a well-resolved phylogeny except that relationships among five lineages at the base of Malvatheca are poorly resolved. Nonetheless, a 6-bp insertion in matK suggests that Fremontodendreae is sister to the remainder of Malvatheca. Our results suggest that the Malvoideae originated in the Neotropics and that a mangrove taxon dispersed across the Pacific from South America to Australasia and later radiated out of Australasia to give rise to the ca. 1,700 living species of Eumalvoideae. Local clock analyses imply that the plastid genome underwent accelerated molecular evolution coincident with the dispersal out of the Americas and again with the radiation into the three major clades of Eumalvoideae

Acute maternal oxidant exposure causes susceptibility of the fetal brain to inflammation and oxidative stress

Background Maternal exposure to environmental stressors poses a risk to fetal development. Oxidative stress (OS), microglia activation, and inflammation are three tightly linked mechanisms that emerge as a causal factor of neurodevelopmental anomalies associated with prenatal ethanol exposure. Antioxidants such as glutathione (GSH) and CuZnSOD are perturbed, and their manipulation provides evidence for neuroprotection. However, the cellular and molecular effects of GSH alteration in utero on fetal microglia activation and inflammation remain elusive. Methods Ethanol (EtOH) (2.5 g/kg) was administered to pregnant mice at gestational days 16–17. One hour prior to ethanol treatment, N-acetylcysteine (NAC) and L-buthionine sulfoximine (BSO) were administered to modulate glutathione (GSH) content in fetal and maternal brain. Twenty-four hours following ethanol exposure, GSH content and OS in brain tissues were analyzed. Cytokines and chemokines were selected based on their association with distinctive microglia phenotype M1-like (IL-1β, IFN γ, IL-6, CCL3, CCL4, CCL-7, CCL9,) or M2-like (TGF-β, IL-4, IL-10, CCL2, CCL22, CXCL10, Arg1, Chi1, CCR2 and CXCR2) and measured in the brain by qRT-PCR and ELISA. In addition, Western blot and confocal microscopy techniques in conjunction with EOC13.31 cells exposed to similar ethanol-induced oxidative stress and redox conditions were used to determine the underlying mechanism of microglia activation associated with the observed phenotypic changes. Results We show that a single episode of mild to moderate OS in the last trimester of gestation causes GSH depletion, increased protein and lipid peroxidation and inflammatory responses inclined towards a M1-like microglial phenotype (IL-1β, IFN-γ) in fetal brain tissue observed at 6–24 h post exposure. Maternal brain is resistant to many of these marked changes. Using EOC 13.31 cells, we show that GSH homeostasis in microglia is crucial to restore its anti-inflammatory state and modulate inflammation. Microglia under oxidative stress maintain a predominantly M1 activation state. Additionally, GSH depletion prevents the appearance of the M2-like phenotype, while enhancing morphological changes associated with a M1-like phenotype. This observation is also validated by an increased expression of inflammatory signatures (IL-1β, IFN-γ, IL-6, CCL9, CXCR2). In contrast, conserving intracellular GSH concentrations eliminates OS which precludes the nuclear translocation and more importantly the phosphorylation of the NFkB p105 subunit. These cells show significantly more pronounced elongations, ramifications, and the enhanced expression of M2-like microglial phenotype markers (IL-10, IL-4, TGF-β, CXCL10, CCL22, Chi, Arg, and CCR2). Conclusions Taken together, our data show that maintaining GSH homeostasis is not only important for quenching OS in the developing fetal brain, but equally critical to enhance M2 like microglia phenotype, thus suppressing inflammatory responses elicited by environmental stressors