Analysis of Antibody and Cytokine Markers for Leprosy Nerve Damage and Reactions in the INFIR Cohort in India

Leprosy is one of the oldest known diseases. In spite of the established fact that it is least infectious and a completely curable disease, the social stigma associated with it still lingers in many countries and remains a major obstacle to self reporting and early treatment. The nerve damage that occurs in leprosy is the most serious aspect of this disease as nerve damage leads to progressive impairment and disability. It is important to identify markers of nerve damage so that preventive measures can be taken. This prospective cohort study was designed to look at the potential association of some serological markers with reactions and nerve function impairment. Three hundred and three newly diagnosed patients from north India were recruited for this study. The study attempts to reflect a model of nerve damage initiated by mycobacterial antigens and maintained by ongoing inflammation through cytokines such as Tumour Necrosis Factor alpha and perhaps extended by antibodies against nerve components

Teste cardiopulmonar do exercício na prática clínica Cardiopulmonary stress testing in clinical practice

O teste cardiopulmonar do exercício (CPX) apresenta-se como uma metodologia de grande utilidade diagnóstica e prognóstica. O presente estudo teve por objetivo demonstrar que os dados obtidos em laboratório fora do ambiente hospitalar comportam-se como os dados descritos na literatura, com aplicabilidade na prática clínica em nosso meio. METODOLOGIA: Trata-se de um relato de experiência, através da análise retrospectiva dos casos. O CPX foi realizado em condições de laboratório controladas, com bocal e clipe nasal, protocolo de rampa em esteira rolante e eletrocardiograma de 13 canais. RESULTADOS: Entre os 261 testes, 53,3% eram em homens, idade média de 48,2 ± 14,3 anos; ativos (45,2%) ou sedentários (34,5%). A capacidade aeróbia máxima foi superior e com declínio significativo para cada década de aumento na faixa etária entre os homens, enquanto nas mulheres o declínio significativo ocorreu entre os 30 e 60 anos. As mulheres apresentaram maior distribuição (p = 0,0006) nas classes funcionais "em programa de treinamento ou bem treinadas e motivadas". O consumo de oxigênio pico (<img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2) foi significativamente superior nos testes máximos, mas o <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 do limiar anaeróbio (<img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2LA) não apresentou diferenças significativas, quando o teste obtido foi máximo ou submáximo. A capacidade funcional, avaliada pelo <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2LA como porcentagem do <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 máximo previsto, comparado à porcentagem do <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 máximo atingido, classificou mais indivíduos com compromisso circulatório (p = 0,002) ou com menor aptidão física em comparação com pacientes ativos ou em programa de treinamento (p < 0,00001), exceto quando entre 50,0 e 59,0%, em que o critério empregado não influenciou a classificação funcional (p = 0,221). Não haver atingido 85,0% do <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 máximo previsto foi a causa mais comum de anormalidade, mais freqüente e significativo entre as mulheres. CONCLUSÃO: Os dados obtidos são comparáveis aos descritos na literatura, sugerindo que o CPX é uma metodologia factível, que poderia ser empregada rotineiramente na prática clínica em nosso meio.<br>Cardiopulmonary stress testing (CPT) is a very useful tool to determine the diagnosis and prognosis in clinical practice. The objective of this study is to demonstrate that data obtained in a laboratory outside the hospital are similar to those described in the literature. METHODOLOGY: Patients were submitted to CPT, treadmill ramp protocol, and 13 lead electrocardiogram to evaluate CPT in the clinical practice. RESULTS: Among 261 CPT, 53.3% were male, mean age 48.2 ± 14.3 years, with active (45.2%) or sedentary (34.5%) lifestyle. Male patients showed higher maximal aerobic capacity (<img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 max) and a significant decrease of <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 for each ten years of increment in age, but it decreased from 30 to 69 years in females. Females showed a significant higher (p = 0.0006) distribution in functional classes described as "in training programs or well trained and high motivation". A <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 max was superior in maximal effort tests, but anaerobic threshold (<img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2AT) did not show differences between maximal or submaximal tests. The functionalcapacity evaluated by <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2AT as a fraction (%) of the <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 max predicted in comparison to the fraction of the <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 max measured was more rigorous, which implies a higher number of patients with circulatory impairment (p = 0.002) and also with lower physical capacity as opposed to active patients or patients under training programs (p < 0.00001); however, between 50.0% and 59.0% of the patients could be classified equally by one or the other criteria (p = 0.221). The more frequent abnormality in CPT was that it did not achieve 85.0% of the <img border=0 width=32 height=32 src="../../../../../img/revistas/rbme/v6n6/V-com-pontinho-menor.gif">O2 max predicted, more significant for females. CONCLUSION: Despite the limitations, this experience indicates that CPT data are reproducible in a laboratory outside the hospital, suggesting that CPT may be applied in clinical practice

Reentrant FMS scheduling in loop layout with consideration of multi loading-unloading stations and shortcuts

This article is closed access.The scheduling problem in flexible manufacturing systems (FMS) environment with loop layout configuration has been shown to be a NP-hard problem. Moreover, the improvement and modification of the loop layout add to the difficulties in the production planning stage. The introduction of multi loading-unloading points and turntable shortcut resulted on more possible routes, thus increasing the complexity. This research addressed the reentrant FMS scheduling problem where jobs are allowed to reenter the system and revisit particular machines. The problem is to determine the optimal sequence of the jobs as well as the routing options. A modified genetic algorithm (GA) was proposed to generate the feasible solutions. The crowding distance-based substitution was incorporated to maintain the diversity of the population. A set of test was applied to compare the performance of the proposed approach with other methods. Further computational experiments were conducted to assess the significance of multi loading-unloading and shortcuts in reducing the makespan, mean flow time, and tardiness. The results highlighted that the proposed model was robust and effective in the scheduling problem for both small and large size problems