The surfactant complex, thanks to its multiple actions including decrease of surface- tension and antimicrobial activity, plays a fundamental role in newborn survival, lowering the risk of ...respiratory distress syndrome. The aim of this work was to determine if the synthesis of two surfactant proteins (SP), SPA and pro-SPB, shows some inter-individual variability during lung development in the intrauterine life. Immunoreactivity for SPA and pro-SPB was investigated in the lungs of 40 subjects, including 15 fetuses, ranging from 14 to 22 weeks of gestation, and 25 neonates, from 24 to 41 weeks. Lung samples were formalin fixed, paraffin-embedded and routinely processed. SPA and pro-SPB were detected utilizing commercial antibodies. A semi-quantitative grading system (1 to 4) was applied, based on the number of reactive cells and the intensity of immunostaining. Surfactant protein immunostaining was found in three compartments: bronchi, bronchioles and alveoli, starting from 14 weeks of gestation in the bronchial epithelium and from the 21st week in the alveolar spaces. Differences were found regarding SPA and pro-SPB expression in the vast majority of subjects: in some lungs, SPA was more expressed whereas in others pro-SPB showed an higher degree of immunoreactivity. The expression of both surfactant proteins was not strictly correlated with gestational age. Whereas the highest levels of reactivity were detected in at term neonates, on the other hand one case with grade 3 was detected at 22 weeks and one negative case for both proteins was observed at 31 weeks. Our data clearly show a marked inter-individual variability regarding the production of SPA and pro-SPB and suggest the existence of other epigenetic factors, acting during gestation, that might influence surfactant production and, consequently, the survival potential of neonates at birth.
Abstract Introduction Thrombotic microangiopathy (TMA) is characterized by endothelial cell injury and formation of fibrin thrombi within capillary and arterioles. In renal allograft recipients, TMA ...mainly presents as hemolytic uremic syndrome. Its occurrence is rare, and diagnosis requires a high degree of suspicion. Drug toxicity, in particular from calcineurin inhibitors (CNIs) and mTOR inhibitors (mTORi), is the most common cause posttransplant and has recently been emphasized in the setting of lung transplantation. Objective The goal of this study was to investigate the role of mTORi as an added risk factor in the development of TMA to propose strategies for modulation of immunosuppressive (IS) therapy. Patients and Methods From a database of 496 renal graft recipients, we analyzed 350 renal graft biopsy specimens gathered at our center from 1998 to 2012. In patients undergoing combined therapy with mTORi and CNI, we compared drugs levels in TMA-affected and TMA-free groups, using mTORi and CNI TLC and the summation of everolimus TLC + (cyclosporine C2/100) (Σ) as a surrogate marker of combined exposition to 2 drugs. Receiver-operating characteristic analysis of association of EVL TLC + (C2/100) was performed for patients exposed to mTORi. Results Histologic features of TMA were found in 36 patients (prevalence of 7.3%). The caseload was divided into 2 groups: not drug-related TMA (n = 19) and drug-related TMA (n = 17). Despite the prevalence of TMA in patients exposed to mTORi being greater (8 of 153; prevalence, 5.3%) compared with therapies without mTORi (9 of 324; prevalence, 2.8%), statistical difference was not reached. Patients treated with mTORi who developed de novo drug-related TMA had higher blood levels of IS drugs compared with those who did not develop TMA. Receiver-operating characteristic analysis found a significant threshold of 12.5 ng/mL (area under the curve, 0.803; P = .006). Conclusions Results confirm the pivotal role of IS drugs in the onset of de novo TMA. On the basis of literature, we could speculate a sequence of endothelial damage by CNI, on which everolimus fits hindering the repair of endothelial injury. Therefore, high blood levels of CNI and mTORi seem to predispose patients to posttransplant TMA. Combined monitoring of these 2 drugs might be used to prevent the complication. Σ everolimus TLC + (cyclosporine C2/100) >12.5 ng/mL should be avoided as a surrogate risk factor for adverse effects.
Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare new syndrome occurring after the ChAdOx1 nCoV-19 vaccine immunization. Patients with VITT are characterized by a variable clinical ...presentation, likewise also the outcome of these patients is very variable. Here we report the lung ultrastructural findings in the course of VITT of a 58-year-old male patient. Alveoli were mainly dilated, irregular in shape, and occupied by a reticular network of fibrin, while interalveolar septa appeared thickened. The proliferation of small capillaries gave rise to plexiform structures and pulmonary capillary hemangiomatosis-like features. Near the alveoli occupied by a dense fibrin network, the medium-sized arteries showed a modified wall and an intraluminal thrombus. This scenario looks quite similar to that found during COVID-19, where the lungs suffer from the attack of the antigen-antibodies complexes and the virus respectively. In both diseases, the final outcome is a severe inflammation, activation of the haemostatic system and fibrinolysis.
The etiologic evaluation of pericardial effusion is frequently unsuccessful when noninvasive methods are used. To determine the cause of the current episode, all patients with echographically ...identified pericardial effusion from May 1998 to December 2002 underwent noninvasive diagnostic testing of blood, throat, and stool samples. Patients with postpericardiotomy syndrome were excluded. To analyze the value of our tests, we tested randomly selected blood donors as negative controls. Among 204 included patients, 107 (52.4%) had a final etiologic diagnosis: the etiology of 52 was highly suspected at first examination and later confirmed (thyroid deficiency, 5 cases; systemic lupus erythematous, 7; rheumatoid arthritis, 7; scleroderma, 3; cancer, 25; and renal insufficiency, 5). A definite etiologic diagnosis was made in 11 patients from pericardial fluid analysis (cancer, 5 cases; tuberculosis, 3; Streptococcus pneumoniae, Citrobacter freundii, and Actinomyces, 1 case each). Among 141 patients considered to have idiopathic pericarditis, 44 (32.1%) gained an etiologic diagnosis by our systematic testing strategy. This included serologic evaluation of serum (Coxiella burnetii, 10 cases; Bartonella quintana, 1; Legionella pneumophila, 1; Mycoplasma pneumoniae, 4; influenza virus, 1), viral culture of throat swabs (enterovirus, 8 cases; and adenovirus, 1), high-level antinuclear antibodies (>1/400, 3 cases), and thyroid-stimulating hormone (15 abnormal results). Antibodies to Toxoplasma and cytomegalovirus, enterovirus recovered from rectal swabs, and low-level antinuclear antibodies were seen with equal frequency in patients and controls. Using our evaluation strategy, the number of pericardial effusions classified as idiopathic was less than in other series. Systematic testing for Q fever, Mycoplasma pneumoniae, thyroid abnormalities, and antinuclear antibodies, accompanied by viral throat cultures, frequently enabled us to diagnose diseases not initially suspected in patients with pericardial effusion.
Case of the month: What's your diagnosis? Peterhans, S; Ghielmetti, G; Botta, C ...
Schweizer Archiv für Tierheilkunde,
11/2018, Letnik:
160, Številka:
11
Journal Article
This study evaluated the acute toxicity of sediment in a eutrophic reservoir after remediation with a calcium nitrate solution to retain phosphorus. The study involved microcosms of surface sediments ...and water from the sediment-water interface in the Ibirité reservoir. This reservoir, located in the vicinity of metropolitan Belo Horizonte (Minas Gerais, SE Brazil), is a water body that receives treated effluents from an oil refinery (REGAP-Petrobras), as well as high loads of untreated urban effluents from the city of Ibirité and surrounding areas and industrial effluents from a major industrial park. Incubation times of the treatment experiments were: t = 0, t = 5, t = 10, t = 25, t = 50, t = 85 and t = 135 days. One control microcosm and three treated microcosms were analysed in each time interval. Acute toxicity of water samples was assessed with Ceriodaphnia silvestrii Daday, 1902 and that of bulk sediment samples with Chironomus xanthus Rempel, 1939. Toxicity tests were carried out concomitantly with chemical analyses of dissolved inorganic nitrogen species (ammonia, nitrate and nitrite), sulfate and metals in the water samples of the microcosms. Acid volatile sulfides (AVS), simultaneously extracted metal (SEM) and potentially bioavailable metal were analyzed in bulk sediment samples. Neither of the tested organisms showed toxicity in the control microcosm samples. The water column of the treated microcosm showed toxicity to C. silvestrii, starting at t = 10 days, while the sediment pore water toxicity started at t = 0 day. However, toxicity was found to decline from t = 85 days to t = 135 days. Sediments showed toxicity to C. xanthus during the entire experiment, except at the longest incubation time (t = 135 days). The overall results indicate that nitrate, which reached concentrations exceeding 1,200 mg N-NO3- L-1 in the sediment pore water of the treated microcosms, was most probably responsible for the toxicity of the samples. Although the calcium nitrate technology proved effective in retaining phosphorus, promoting sediment oxidation via denitrification, from the ecotoxicological standpoint and under the experimental conditions of this study, the application of nitrate for remediation of the sediments in the Ibirité reservoir did not prove effective up to a period of 135 days of incubation. However, we presume that after longer periods of incubation, treated sediments may recover their ability to sustain a benthic community. More advanced experiments are planned involving longer incubation times, thus extending the denitrification process, which may lead to a higher phosphorus retention capacity and to more complete abatement of sediment toxicity.
O presente trabalho visou à avaliação da toxicidade aguda da aplicação de solução de nitrato de cálcio, como procedimento para remediação dos sedimentos de um reservatório eutrofizado com vistas à retenção de fósforo. O estudo foi realizado através de microcosmos com sedimento e amostras de interface sedimento-água da Represa Ibirité. A represa, situada na região metropolitana de Belo Horizonte (Minas Gerais, Brasil), é corpo receptor de efluentes tratados de refinaria de petróleo (REGAP-Petrobras), de altas cargas de esgoto sanitário não tratado da cidade de Ibirité e áreas vizinhas, e de efluentes industriais de importante parque industrial. Os tempos de incubação dos experimentos foram: t = 0, t = 5; t = 10; t = 25; t = 50; t = 85; e t = 135 dias. Em cada um deles, foram analisadas amostras de um microcosmo-controle e três microcosmos-tratamento. A Ceriodaphnia silvestrii Daday, 1902 foi o organismo utilizado para avaliação da toxicidade aguda das amostras de água, enquanto que o Chironomus xanthus Rempel, 1939 foi empregado para a avaliação do sedimento integral. Paralelamente aos testes de toxicidade, foram realizadas análises químicas da série nitrogenada (amônia, nitrato e nitrito), sulfato, e metais nas amostras de água. Nos sedimentos foram analisados os sulfetos volatilizáveis por acidificação (SVA), metais extraídos simultaneamente (MES) e metais potencialmente biodisponíveis. Tanto as amostras de água como dos sedimentos totais dos microcosmos-controle não se mostraram tóxicos aos organismos testados. As amostras de água de interface sedimento-água dos micorocosmos-tratamento foram tóxicas para a C. silvestrii desde o tempo t = 10 dias e as amostras de águas intersticiais, desde o período t = 0. No entanto, foi notada uma diminuição da toxicidade do tempo t = 85 para t = 135 dias. Para o organismo C. xanthus, os sedimentos em tratamento se mostraram tóxicos durante todo o experimento, exceto no tempo t = 135 dias. Os resultados mostraram que o nitrato, com concentração superior a 1.200 mg N-NO3- L-1 nas amostras de água intersticial dos sedimentos dos microcosmos-tratamentos, é a causa mais provável da toxicidade das amostras. Embora a tecnologia de adição de nitrato tenha se mostrado eficaz na retenção de fósforo nos sedimentos, pois causa a oxidação dos sedimentos através do incremento substancialmente da taxa de desnitrificaçao, do ponto de vista ecotoxicológico e para as condições experimentais deste trabalho, a aplicação do nitrato como forma de intervenção para remediação dos sedimentos da Represa Ibirité não se mostrou adequada até o período de 135 dias. Após este período, presume-se que os sedimentos tratados possam recuperar a capacidade de sustentar uma comunidade bentônica. Experimentos mais avançados foram planejados, visando um tempo de incubação mais estendido, que, por conseguinte, pode levar a uma maior capacidade de retenção de P e ao abatimento total da toxicidade dos sedimentos e da água, devido a um maior avanço do processo da desnitrificação.
The Brazilian Air Force (BAF) has developed physical evaluations focused on the demands required in combat scenarios, giving rise to the Simulated Tasks (STs). Therefore, the purpose of the present ...study was to determine test-retest reliability and investigate learning effects of the five STs established among the BAF. Fifty-six subjects performed five STs three times, after completing a previous familiarisation session. Repeated measures analysis of variance (ANOVA) was used to determine the occurrence of learning effects, and the intraclass correlation coefficient (ICC) was used to identify the reliability of each ST. ANOVA revealed no significant differences in the subject's scores across trials for all the STs, and the ICCs ranged from 0.75 to 0.92 (p < 0.01). In conclusion, this study identified that the five STs showed no learning effects across three successive trials and exhibited high levels of reliability.
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