Lysosomal enzymes are decreased in the kidney of diabetic rats

The objective of the present study was to investigate the expression and activities of lysosomal enzymes that act upon proteins and sulfated polysaccharides in diabetic rat kidney. Cathepsins, glycosidases and sulfatases were studied on the 10th (DM-10) and on the 30th (DM-30) day of streptozotocin-induced diabetes mellitus (DM). the activity of cathepsin B, the main kidney cysteine protease, was decreased both in DM-10 and DM-30. Gel filtration chromatography of urinary proteins has shown the prevalence of low molecular weight peptides in normal and DM-10 urine, in contrast to the prevalence of high molecular weight peptides and intact proteins in DM-30. These results show that the decrease in lysosomal proteases could explain, at least in part, the increased albuminuria detected by radial immunodiffusion (RID), due to the excretion of less degraded or intact albumin. Concerning sulfated polysaccharides, the activities of beta-glucuronidase, N-acetyl-beta-D-glucosaminidase, and N-acetyl-beta-D-galactosaminidase were also decreased in DM-30, while aryl sulfatases did not vary. Increased toluidine blue metachromatic staining of the tissue suggests that the lower activities of glycosidases could lead to intracellular deposition of partially digested molecules, and this could explain the decreased urinary excretion and increased tissue buildup of these molecules. the main morphological changes observed in kidney were proximal convoluted tubules with thinner walls and thinner brush border. Immunohistochemistry revealed that most of cathepsin B was located in the brush border of proximal tubular cells, highlighting the involvement of proximal convoluted tubules in diabetic nephropathy. (C) 2012 Elsevier B.V. All rights reserved.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, Disciplina Biol Mol, Dept Bioquim, Escola Paulista Med, BR-04044020 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biofis, Escola Paulista Med, BR-04044020 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Morfol, Escola Paulista Med, BR-04044020 São Paulo, BrazilUniversidade Federal de São Paulo, Disciplina Biol Mol, Dept Bioquim, Escola Paulista Med, BR-04044020 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biofis, Escola Paulista Med, BR-04044020 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Morfol, Escola Paulista Med, BR-04044020 São Paulo, BrazilFAPESP: 2010/16022-5FAPESP: 2009/11817-2CNPq: 308642/2010-4Web of Scienc

Nutritional evolution of hospitalized children who were under nutritional orientation

OBJECTIVE: This study aimed at evaluating the nutritional evolution of hospitalized children with infectious diseases, who were put under nutritional orientation. METHODS: Evaluate the effect of therapeutic nutritional orientation on 125 children between 6 and 36 months of age, who were admitted at the Pediatric Infectology Ward of the Hospital São Paulo, São Paulo, Brazil, between March 2001 and December 2002. The evaluations of nutritional status and energetic intake were based on data obtained from inquiry-forms on feeding-patterns and anthropometric measurements. RESULTS: Of the children being evaluated, 53,6% (67) were male. The mean age was 17 months, and the average period spent in the hospital was 10 days. At admission, 24,8% (31) of the children were undernourished and 10,0% (23) were overweight or obese. The diagnosis of acute diseases affected 69,6% (87) of the children. Nutritional support was provided for 21.6% (27) of the children, out of which, 81.5% (22) received nutritional support orally. The undernourished group presented a significant improvement of the Z-score of Weight over Height - Z W/H (p=0.001); the eutrophic group had no significant change of the Z-score Weight over Height (p=0.651), and the group overweight/obese showed a significant reduction of the Z-score Weight over Height (p=0.026). No significant associations were found between nutritional support therapy and improvement of the nutritional status (p=0.37). The children who had an energy intake higher than the one recommended for their age, had a significant improvement of the Z-score Weight over Height (p<0.001). CONCLUSION: The children followed up in this study had their nutritional condition significantly improved, making it evident that nutritional orientation, or diet therapy, can improve the treatment of hospitalized children.OBJETIVOS: Este estudo teve como finalidade avaliar a evolução nutricional de crianças hospitalizadas com doenças infecciosas, que estiveram sob acompanhamento nutricional. MÉTODOS: Foram estudadas 125 crianças com idade de 6 a 36 meses de vida, admitidas na enfermaria de infectologia pediátrica do Hospital São Paulo, durante o período de Março de 2001 a Dezembro de 2002. As avaliações do estado nutricional e da ingestão energética basearam-se nos dados obtidos em inquéritos alimentares e medições antropométricas. RESULTADOS: Das crianças avaliadas, 67 eram do sexo masculino (53,6%); a mediana de idade foi 17 meses e o tempo médio de internação, dez dias. Na época da admissão, 24,8% das crianças estavam desnutridas enquanto 10,0% delas apresentavam sobrepeso e obesidade. Prevaleceu o diagnóstico de doenças agudas (69,6%). Realizaram terapia nutricional 21,6% das crianças, sendo que destas, 81,5% receberam terapia nutricional via oral. O grupo de desnutridos teve melhora significativa do escore-Z de peso para estatura-Z peso/estatura (p=0,001); o grupo de eutróficos não teve alteração significativa de escore-Z peso/estatura (p=0,651) e o grupo com sobrepeso/obesos teve redução significativa do escore-Z peso/estatura (p=0,026). Não houve associação significativa entre realização de terapia nutricional e melhora do estado nutricional (p=0,37). A melhora doescore-Z peso/estatura esteve relacionada à ingestão de energia maior que a recomendação normal para a idade (p<0,001). CONCLUSÃO: As crianças acompanhadas neste estudo tiveram melhora significativa do estado nutricional, tornando-se evidente a importância do acompanhamento nutricional durante a internação.Escola Paulista de Medicina Universidade Federal de São Paulo (UNIFESP) Departamento de PediatriaUniversidade de Santo Amaro Faculdade de MedicinaUNIFESP, EPM, EPM, Depto. de PediatriaSciEL

Compositions created with constraint programming

This chapter surveys music constraint programming systems, and how composers have used them. The chapter motivates and explains how users of such systems describe intended musical results with constraints. This approach to algorithmic composition is similar to the way declarative and modular compositional rules have successfully been used in music theory for centuries as a device to describe composition techniques. In a systematic overview, this survey highlights the respective strengths of different approaches and systems from a composer's point of view, complementing other more technical surveys of this field. This text describes the music constraint systems PMC, Score-PMC, PWMC (and its successor Cluster Engine), Strasheela and Orchidée -- most are libraries of the composition systems PWGL or OpenMusic. These systems are shown in action by discussing the composition process of specific works by Jacopo Baboni-Schilingi, Magnus Lindberg, Örjan Sandred, Torsten Anders, Johannes Kretz and Jonathan Harvey

Severity and prognosis in intensive care: prospective application of the Apache II Index

CONTEXT: The performance of each ICU needs to be assessed within the overall context of medical care, as well as by the institution which the ICU forms part of. Evaluation mechanisms in the field of intensive care have been developed that are recognized worldwide within the scientific literature. OBJECTIVE: To study outcomes from groups of critical patients and to compare their actual and estimated mortality rates. DESIGN: Prospective study of patients' outcomes. SETTING: A tertiary care unit for a period of 13 months (anesthesiology intensive care unit at the Escola Paulista de Medicina). PARTICIPANTS: 520 patients selected according to sex, age and nature of hospitalization. DIAGNOSTIC TEST: The modified APACHE II prognostic index was applied in order to assess clinical severity and anticipation of mortality in three groups who had non-surgical treatment, emergency surgery and elective surgery. MAIN MEASUREMENTS: The APACHE II index. RESULTS: The application of this index allowed patients to be stratified and expected death risks for both subgroups and the entire sample population to be calculated. The observed mortality rate was greater than the expected rate (28.5% versus 23.6%, respectively), with a statistically significant difference. The standardized mortality rate was 1.20. Patients who obtained scores above 25 presented a significant outcome towards death. The most severe and worst evolving cases were, in decreasing order: non-surgical, emergency surgical and scheduled surgical patients; the actual general mortality rate was higher than the expected one. CONCLUSIONS: The use of the APACHE II index made it possible to stratify critical patient groups according to the severity of their condition.CONTEXTO: É necessário que cada UTI possa avaliar seu próprio desempenho no contexto global da assistência médica e possa ser igualmente avaliada pela instituição em que está inserida. Existem mecanismos avaliadores do tratamento intensivo, amplamente reconhecidos pela literatura médica mundial. OBJETIVOS: Estudar a evolução de grupos de doentes críticos e comparar as respectivas taxas de mortalidade real e esperada. TIPO DE ESTUDO: Estudo prospectivo da evolução de pacientes. LOCAL: Unidade de cuidados terciários de um hospital-escola durante 13 meses. (UTI da Anestesiologia da Escola Paulista de Medicina). PARTICIPANTES: 520 pacientes, agrupados segundo sexo, idade e caráter da internação. TESTE DIAGNÓSTICO: Para avaliação da gravidade e previsão de mortalidade, foi aplicado nos três grupos - doentes não-cirúrgicos, cirúrgicos em urgências e cirúrgicos eletivos - o índice prognóstico APACHE II modificado. VARIÁVEIS ESTUDADAS: Índice APACHE II. RESULTADOS: O índice permitiu a estratificação e o cálculo do risco de óbito de grupos de doentes. A taxa de mortalidade observada foi superior à esperada (28,5% e 23,6%, respectivamente), com diferença estatisticamente significante, sendo que a razão mortalidade observada/mortalidade esperada foi 1,20. Dos pacientes com escore acima de 25, 89% evoluíram para óbito. Os grupos de pior evolução foram, pela ordem: pacientes não cirúrgicos, cirúrgicos em urgências e cirúrgicos eletivos; a mortalidade geral observada foi superior à esperada. CONCLUSÕES: A aplicação do índice serviu para estratificar grupos de pacientes críticos de acordo com a sua gravidade.Universidade Federal de São Paulo (UNIFESP)Federal University of CearáUNIFESPSciEL

Eletroneurografia do nervo facial: variabilidade em indivíduos normais

Twenty normal individuals were submitted to facial nerve electroneurography using different techniques in order to determine the most accurate to obtain the latencies and amplitudes of the compound muscle action potentials (CMAP) of the facial muscles. First of all it was determined in which muscle or muscle group highest amplitude CMAP could be recorded with the lowest variability between sides and in test-retest. Different techniques were studied in order to determine which could give the best results. This was shown to be an arrangement of bipolar surface electrodes fixed to a plastic bar. The records with higher amplitude where obtained from the nasolabial fold muscles. Therefore 65 normal volunteers were examined using this technique and recording the potentials obtained over the nasolabial fold muscles. Normal values were determined (latency lower than 4.5 ms and amplitude larger than 2 mV - 95% confidence limits).Vinte voluntários normais foram submetidos a eletroneurografia do nervo facial utilizando-se diferentes técnicas para a determinação da mais acurada para a obtenção das latências e amplitudes do potencial de ação muscular composto (CMAP) dos músculos faciais. Inicialmente determinou-se em qual músculo ou grupo muscular registra-se CMAP com maior amplitude e menor variabilidade entre lados e entre testes, assim como determinou-se qual técnica proporcionou melhores resultados. A que mostrou melhores resultados foi realizada com eletrodos de superfície bipolares de discos fixos em barra de plástico e os melhores registros foram obtidos nos músculos do sulco nasolabial. A seguir 65 voluntários normais foram estudados com esta técnica registrando-se os potenciais nos músculos do sulco nasolabial e foram determinados os valores normais para a latência (menor que 4,5 ms) e amplitude (acima de 2 mV).Federal University of São Paulo Escola Paulista de Medicin Clinical Neurophysiology LaboratoryUNIFESP, Escola Paulista de Medicin Clinical Neurophysiology LaboratorySciEL

Evaluation of the greater saphenous vein with classification C2 e C3 (CEAP) by air plethysmography and color Doppler ultrasonography

BACKGROUND: With the presence of venous reflux, there is need evaluate the clinical severity by quantifying the hemodynamic effect of venous incompetence and definition of their anatomical distribution. OBJECTIVE: To determine and correlate the degree of reflux of the greater saphenous vein (insufficiency) in a clinical CEAP C2/C3 by air plethysmography and color Doppler ultrasonography. METHODS: We prospectively investigated 87 limbs with reflux of the greater saphenous vein as ascertained by Doppler ultrasound and 32 limbs without signs or symptoms of the venous disease. All patients underwent clinical examinations using air plethysmography and Doppler ultrasound of the lower limbs. The parameters used with the Doppler ultrasound were: the diameter of the saphenous vein (seven levels) and the speed and time of reflux. In the plethysmography, the venous filling index, ejection fraction and residual volume fraction were also considered. RESULTS: Of the 119 limbs, 61 were class C2. In comparing the diameters of the vein of the control group with the study group there were statistically significant differences. There was an exception at the malleolus level. Using the Spearman correlation to analyze the indices for the plethysmography and Doppler ultrasound it showed some difference, but the coefficient of determination (r²) showed that they were weak. CONCLUSIONS: The parameters of the plethysmography did not correlate with the degree of reflux in the greater saphenous vein. There was a very weak correlation between their values, time and speed of reflux. Only the venous filling index correlated with venous reflux. The ejection fraction and residual volume fraction were not important for discrimination of clinical severity.CONTEXTO: Com a presença de refluxo venoso, há necessidade de avaliar a gravidade clínica da doença pela quantificação do efeito hemodinâmico da incompetência venosa e definição de sua distribuição anatômica. OBJETIVO: Determinar a correlação da pletismografia a ar com o grau de refluxo pelo eco-Doppler na insuficiência da veia safena magna no quadro clínico C2 e C3 da CEAP. MÉTODOS: Foram examinados, prospectivamente, 87 membros com refluxo da veia safena magna determinado pelo eco-Doppler e 32 membros sem sinais ou sintomas de doença venosa. Todos foram submetidos ao exame clínico, pletismografia e eco-Doppler de membros inferiores. Do eco-Doppler foram utilizados os parâmetros: diâmetro da veia safena em sete níveis, velocidade e tempo de refluxo. Da pletismografia foram considerados o índice de enchimento venoso, a fração de ejeção e a fração de volume residual. RESULTADOS: Dos 119 membros, 61 pertenciam à classe C2. Na comparação do diâmetro da veia nos grupos controle e estudo houve diferença estatisticamente significante, exceto ao nível do maléolo. Utilizando-se a Correlação de Spearman para análise dos índices da pletismografia e eco-Doppler foram observadas algumas significâncias, porém o coeficiente de explicação (r²) mostrou que foram fracas. CONCLUSÕES: Os parâmetros da pletismografia não se correlacionam com o grau de refluxo na veia safena magna, pois houve uma correlação muito fraca entre seus valores e o tempo e a velocidade do refluxo. Somente o índice de enchimento venoso tem correlação com refluxo venoso. A fração de ejeção e de volume residual não se mostraram importantes na discriminação da gravidade clínica.UEM Curso de MedicinaUEM curso de MedicinaUNIFESP-EPM Departamento de Medicina PreventivaUniversidade de Santo Amaro Departamento de Saúde PúblicaUNIFESP-EPM Departamento de CirurgiaUNIFESP, EPM, Depto. de Medicina PreventivaUNIFESP, EPM Depto. de CirurgiaSciEL

Outcomes analysis of breast reduction in Brazilian women using the BREAST-Qs questionnaire: a crosssectional controlled study

OBJECTIVE: The aim of this study was to analyse patient-reported outcomes of reduction mammoplasty among Brazilian women. METHODS: A total of 100 women were enrolled in this cross-sectional controlled study, 50 with breast hypertrophy (Hypertrophy Group) and 50 who had undergone breast reduction at least six and up to 12 months before (Mammoplasty Group). The Brazilian version of the BREAST-Qs was applied to assess patient-reported outcomes. The module reduction/mastopexy was used, and the preoperative and postoperative versions were applied to the hypertrophy and mammoplasty groups, respectively. RESULTS: The mammoplasty group presented higher scores for the subscales satisfaction with breasts, psychosocial well-being, sexual well-being and physical well-being (p=0.0001 for all of these subscales). CONCLUSION: These results suggest that patients submitted to reduction mammoplasty are satisfied with the outcomes and present better quality of life scores compared with women with breast hypertrophy