Pseudomonas aeruginosa Induced Airway Epithelial Injury Drives Fibroblast Activation:A Mechanism in Chronic Lung Allograft Dysfunction

Bacterial infections after lung transplantation cause airway epithelial injury and are associated with an increased risk of developing bronchiolitis obliterans syndrome. The damaged epithelium is a source of alarmins that activate the innate immune system, yet their ability to activate fibroblasts in the development of bronchiolitis obliterans syndrome has not been evaluated. Two epithelial alarmins were measured longitudinally in bronchoalveolar lavages from lung transplant recipients who developed bronchiolitis obliterans syndrome and were compared to stable controls. In addition, conditioned media from human airway epithelial cells infected with Pseudomonas aeruginosa was applied to lung fibroblasts and inflammatory responses were determined. Interleukin‐1 alpha (IL‐1α) was increased in bronchoalveolar lavage of lung transplant recipients growing P. aeruginosa (11.5 [5.4–21.8] vs. 2.8 [0.9–9.4] pg/mL, p < 0.01) and was significantly elevated within 3 months of developing bronchiolitis obliterans syndrome (8.3 [1.4–25.1] vs. 3.6 [0.6–17.1] pg/mL, p < 0.01), whereas high mobility group protein B1 remained unchanged. IL‐1α positively correlated with elevated bronchoalveolar lavage IL‐8 levels (r(2) = 0.6095, p < 0.0001) and neutrophil percentage (r(2) = 0.25, p = 0.01). Conditioned media from P. aeruginosa infected epithelial cells induced a potent pro‐inflammatory phenotype in fibroblasts via an IL‐1α/IL‐1R‐dependent signaling pathway. In conclusion, we propose that IL‐1α may be a novel therapeutic target to limit Pseudomonas associated allograft injury after lung transplantation

Conhecimento tático-estratégico dos levantadores brasileiros campeões de voleibol: da formação ao alto nível

O objetivo deste estudo consistiu na identificação do conhecimento tático-estratégico dos levantadores "experts", de diferentes escalões, tendo como indicativo as ações de organização ofensiva do voleibol. Da presente investigação científica participaram dezoito levantadores de ambos os sexos: campeões de São Paulo e Minas Gerais, das competições promovidas pelas Federações destes estados nos escalões Mirim (sub-14), Infantil (sub-15), Infanto (sub-17) e Juvenil (sub-20), mais um campeão Adulto (Profissional) da Superliga Masculina e Feminina. Foi aplicada uma entrevista individual e semi-estruturada com referência na grelha de conhecimento tático-estratégico do levantador (Mesquita & Graça, 2002a, 2002b; Queiroga, 2005; Queiroga et al., 2010). Os textos das 18 entrevistas semi-estruturadas foram codificados, comparados e agrupados por similaridade de sentido (Duarte, 2002; Jones, 2005; Minayo & Sanches, 1993; Thomas & Nelson, 2002). Entre os resultados apurados, evidenciou-se que o levantador, mesmo com condições ideais na qualidade do primeiro toque, concentra as suas ações em determinados atacantes, por não ter confiança e por limitações táticas e técnicas dos outros jogadores em suas ações ofensivas finais. Além disto, os resultados indicam que os levantadores estão em constante evolução, independente dos anos de prática no voleibol, com referências de todos eles quanto à importância do treino como uma fonte de conhecimento, dentre outras.The aim of this study was to identify strategic-tactical knowledge of the setter's of different categories. We analyzed the organization of offensive action of 18 setter's of both sexes, champions at São Paulo and Minas Gerais, under-14 old age, under-15 old age, under-17 old age, under-20 old age and Adult champion (Professional) Men's and Women's at Brazilian National Championship (Superliga). It was used a semi-structured and individual interview with reference in aspects of knowledge tactical and strategic of setter (Mesquita & Graça, 2002a, 2002b; Queiroga, 2005; Queiroga et al., 2010). The texts of 18 semi-structured interviews were coded, compared and grouped by similarity of meaning (Duarte, 2002; Jones, 2005; Minayo & Sanches, 1993; Thomas & Nelson, 2002). The results showed that the setter, even with ideal conditions of quality of pass, focuses its actions to certain striker's, for not having trust in others players and because attacking tactics and technical limitations of the other players in their final offensive actions. Furthermore, was noted that the setters are in constantly development, independent of how many years they are playing volleyball, they are said how important a training as a knowledge source, and others more is

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

•We report INICC device-associated module data of 50 countries from 2010-2015.•We collected prospective data from 861,284 patients in 703 ICUs for 3,506,562 days.•DA-HAI rates and bacterial resistance were higher in the INICC ICUs than in CDC-NHSN's.•Device utilization ratio in the INICC ICUs was similar to CDC-NHSN's. Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically