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Protein supplementation may be beneficial for patients with chronic liver disease (CLD). This study compared the effects of whey protein isolate (WP) and casein (CA) supplementation on nutritional status and immune parameters of CLD patients who were randomly assigned to take 20 g of WP or CA twice per d as a supplement for 15 d. Body composition, muscle functionality and plasmatic immunomarkers were assessed before and after supplementation. Patients were also classified according to the model for end-stage liver disease (MELD) into less (MELD < 15) and more (MELD ≥ 15) severe disease groups. Malnutrition, determined by the Subjective Global Assessment at baseline, was observed in 57·4 % and 54·2 % of patients in the WP and CA groups, respectively (P = 0·649). Protein intake was lower at baseline in the WP group than in the CA group (P = 0·035), with no difference after supplementation (P = 0·410). Both the WP and CA MELD < 15 groups increased protein intake after supplementation according to the intragroup analysis. No differences were observed in body composition, muscle functionality, most plasma cytokines (TNF, IL-6, IL-1β and interferon-γ), immunomodulatory proteins (sTNFR1, sTNFR2, brain-derived neurotrophic factor and glial cell line-derived neurotrophic factor) or immunomodulatory hormones (adiponectin, insulin and leptin) after supplementation in the WP groups at the two assessed moments. WP supplementation increased the levels of interferon-γ-induced protein-10/CXCL10 (P = 0·022), eotaxin-1/CCL11 (P = 0·031) and monocyte chemoattractant protein-1/CCL2 (P = 0·018) and decreased IL-5 (P = 0·027), including among those in the MELD ≥ 15 group, for whom IL-10 was also increased (P = 0·008). Thus, WP consumption by patients with CLD impacted the immunomodulatory responses when compared with CA with no impact on nutritional status.
Dementia is one of the leading causes of disability and burden in Western countries. In Portugal, there is a lack of data regarding dementia prevalence in hospitalized elderly patients and factors associated with in-hospital adverse outcomes of these patients.
Determine dementia prevalence in acutely-ill medical hospitalized elderly patients and its impact in health outcomes.
All male patients (> 65 years) admitted to a medical ward (> 48 h) between 1.03.2015 to 31.08.2015 were included in the study. Patients were excluded if unable to be assessed due to sensorial deficits, communication problems or severity of the acute medical condition. Baseline evaluation included socio-demographic variables, RASS, NPI, Barthel Index and Confusion Assessment Method.
The final sample consisted of 270 male subjects with a mean age of 80.9 years, 116 (43%) having prior dementia. Dementia patients were significantly older (83.5 vs 78.9; P < 0.001) and had lower values of Barthel Index (dementia: 34.8 vs non-dementia: 85.8; P < 0.001). Mortality rate (9,3%) and length of hospitalization (11.2 days) were similar between groups (12.1 vs 7.1; P = 0.204 and 11.9 vs 10.6; P = 0.218, respectively). Patients with dementia had higher rates of all neuropsychiatric symptoms except depression, anxiety and mood elation. The level of consciousness (measured by RASS) was impaired in 50% of patients with dementia, which was significantly higher than in non-demented subjects (12.3%; P < 0.001). Delirium rates were 29.5% in dementia compared with 7.1% in controls (P < 0.001).
There is a high prevalence of dementia and an appreciable rate of delirium among these patients.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
A significant proportion of acutely ill hospitalised elderly patients have impaired consciousness and this has been associated with increased mortality. It remains unclear which factors underlie this relation. Identification of mortality predictors in this population is important to improve care.
Determine if advanced age, cognitive impairment, high burden of comorbidities and poor functional status are predictors of increased mortality during hospitalisation in acutely-ill medical hospitalised elderly patients with altered state of consciousness.
All male patients (> 65 years) admitted to a medical ward (> 48 h) between 01/03/2015 to 31/08/2015 with delirium or RASS lower than–2 were included in the study. Patients were excluded if unable to be assessed due to sensorial deficits, communication problems or medical condition precluding the evaluation. Baseline evaluation included socio-demographic variables, RASS, CAM, IQCODE-SF, DSM-IV-TR criteria for dementia, Charlson Comorbidity Index and Barthel Index. The variables were entered in a logistic regression model (significance level < 0.05).
The final sample consisted of 75 male subjects with altered state of consciousness, 14 of them died during hospitalisation. Dementia and Barthel Index were significantly associated with mortality during hospitalisation (P = 0.01 and P < 0.01, respectively). On the other hand, age and Charlson Co-morbidity Index were not associated significantly with mortality during hospitalisation (P = 0.22 and P = 0.1, respectively).
Acutely ill elderly patients with altered state of consciousness at admission have higher risk of death during hospitalisation if they have prior dementia or poor functional status. Health care should be improved to provide better response to this type of patients.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Although accumulating evidence supports the hypothesis that immune/inflammatory mechanisms are associated with the pathophysiology of bipolar disorder (BD), data about the profile of chemokines (chemotactic cytokines) and chemokine receptors are still scarce. The current study was designed to evaluate the expression of chemokine receptors on lymphocytes of patients with BD in comparison with controls.
Thirty-three patients with type I BD (N = 21 in euthymia; N = 6 in mania/hypomania; N = 6 in depression) and 22 age- and sex-matched controls were subjected to clinical evaluation and peripheral blood draw. The expression of chemokine receptors CCR3, CCR5, CXCR4, and CXCR3 on CD4+ and CD8+ lymphocytes was assessed by flow cytometry.
Patients with BD had decreased percentage of CD4+CXCR3+ (p = 0.024), CD4+CCR3+ (p = 0.042), and CD4+CCR5+ (0.013) lymphocytes in comparison with controls. The percentage of both CD4+ and CD8+ lymphocytes expressing the chemokine receptor CXCR4 was similar in patients with BD and controls. Likewise, the percentages of CD8+CXCR3+, CD8+CCR3+, and CD8+CCR5+ lymphocytes were similar in patients with BD and controls.
Our findings reinforce the hypothesis that immune pathways, especially involving CD4+ lymphocytes, are involved in the physiopathology of BD.
We assessed whether paternal demographic, anthropometric and clinical factors influence the risk of an infant being born large-for-gestational-age (LGA). We examined the data on 3659 fathers of term offspring (including 662 LGA infants) born to primiparous women from Screening for Pregnancy Endpoints (SCOPE). LGA was defined as birth weight >90th centile as per INTERGROWTH 21st standards, with reference group being infants ⩽90th centile. Associations between paternal factors and likelihood of an LGA infant were examined using univariable and multivariable models. Men who fathered LGA babies were 180 g heavier at birth (P<0.001) and were more likely to have been born macrosomic (P<0.001) than those whose infants were not LGA. Fathers of LGA infants were 2.1 cm taller (P<0.001), 2.8 kg heavier (P<0.001) and had similar body mass index (BMI). In multivariable models, increasing paternal birth weight and height were independently associated with greater odds of having an LGA infant, irrespective of maternal factors. One unit increase in paternal BMI was associated with 2.9% greater odds of having an LGA boy but not girl; however, this association disappeared after adjustment for maternal BMI. There were no associations between paternal demographic factors or clinical history and infant LGA. In conclusion, fathers who were heavier at birth and were taller were more likely to have an LGA infant, but maternal BMI had a dominant influence on LGA.
Each year in the United States, an estimated 525 000 infections, 2900 hospitalizations, and 82 deaths are attributed to consumption of pork. We analyzed the epidemiology of outbreaks attributed to pork in the United States reported to the Centers for Disease Control and Prevention (CDC) 1998–2015. During that period, 288 outbreaks were attributed to pork, resulting in 6372 illnesses, 443 hospitalizations, and four deaths. The frequency of outbreaks attributed to pork decreased by 37% during this period, consistent with a decline in total foodborne outbreaks. However, outbreaks attributed to pork increased by 73% in 2015 (19 outbreaks) compared with the previous 3 years (average of 11 outbreaks per year), without a similar increase in total foodborne outbreaks. Most (>99%) of these outbreaks occurred among people exposed in the same state. The most frequent etiology shifted from Staphylococcus aureus toxin during 1998–2001 (19%) to Salmonella during 2012–2015 (46%). Outbreaks associated with ham decreased from eight outbreaks per year during 1998–2001, to one per year during 2012–2015 (P < 0·01). Additional efforts are necessary to reduce outbreaks and sporadic illnesses associated with pork products.
Salmonella causes an estimated 1·2 million illnesses annually in the USA. Salmonella enterica serotype Javiana (serotype Javiana) is the fourth most common serotype isolated from humans, with the majority of illnesses occurring in southeastern states. The percentage of wetland cover by wetland type and the average incidence rates of serotype Javiana infection in selected counties of the Foodborne Disease Active Surveillance Network (FoodNet) were examined. This analysis explored the relationship between wetland environments and incidence in order to assess whether regional differences in environmental habitats may be associated with observed variations in incidence. Findings suggest that environmental habitats may support reservoirs or contribute to the persistence of serotype Javiana, and may frequently contribute to the transmission of infection compared with other Salmonella serotypes.
Licuri (Syagrus coronate) cake is a biodiesel by-product used in ruminant feed as a beneficial energy source for supplementation in managed pastures. The objective was to evaluate the performance, digestibility, nitrogen balance, blood metabolites, ingestive behavior and diet profitability of eight crossbred Holstein (3/4)×Gyr (5/8) multiparous cows (480±25 kg BW and 100 days milking) grazing and supplemented with licuri cake partially replacing ground corn and soybean meal in concentrate (0, 200, 400 and 600 g/kg in dry matter (DM)), distributed in an experimental duplicated 4×4 Latin square design. Licuri cake partially replacing ground corn and soybean meal increased (P<0.01) the intake and digestibility of ether extract and decreased the non-fiber carbohydrates; however, there were no influences on the intakes of DM, CP, NDF and total digestible nutrients (TDN). The digestibilities of DM, CP and NDF were not influenced by licuri cake addition. There was a decrease trend on TDN digestibility (P=0.08). Licuri cake replacing ground corn and soybean meal in concentrate did not affect the intake; fecal, urinary and mammary excretions; N balance; and triglycerides concentrations. However, the blood urea nitrogen (P=0.04) concentration decreased with the licuri cakes inclusion in cow supplementation. There was an increasing trend for serum creatinine (P=0.07). Licuri cake inclusion did not affect body condition score, production, yield, protein, lactose, total solids and solid non-fat contents of milk and Minas frescal cheese. There was a linear decrease in average daily weight gain (g/day). The milk fat concentration and cheese fat production (P<0.1) presented a linear increase with partial replacement of ground corn and soybean meal with licuri cakes. The addition of licuri cake did not alter the time spent feeding, ruminating or idling. There was an increasing trend in NDF feeding efficiency (P=0.09). The replacing of ground corn and soybean meal with licuri cake up to 600 g/kg decreased the concentrate cost by US$0.45/cow per day. Licuri cake replacing corn and soybeans (400 g/kg) in concentrate promoted a profit of US$0.07/animal per day. Licuri cake is indicated to concentrate the supplementation of dairy cows with average productions of 10 kg/day at levels up to 400 g/kg in the concentrate supplement because it provides an additional profit of US$0.07/animal per day and increased milk and Minas frescal cheese fat without negative effects on productive parameters.
To this date ψ Per is the only classical Be star that was angularly resolved in radio (by the VLA at λ = 2 cm). Gaussian fit to the azimuthally averaged visibility data indicates a disk size (FWHM) of ~500 stellar radii (Dougherty & Taylor 1992). Recently, we obtained new multi-band cm flux density measurements of ψ Per from the enhanced VLA. We modeled the observed spectral energy distribution (SED) covering the interval from ultraviolet to radio using the Monte Carlo radiative transfer code HDUST (Carciofi & Bjorkman 2006). An SED turndown, that occurs between far-IR and radio wavelengths, is explained by a truncated viscous decretion disk (VDD), although the shallow slope of the radio SED suggests that the disk is not simply cut off, as is assumed in our model. The best-fit size of a truncated disk derived from the modeling of the radio SED is 100+5−15 stellar radii, which is in striking contrast with the result of Dougherty & Taylor (1992). The reasons for this discrepancy are under investigation.
The magnetic flux emergence can help understand the physical mechanism responsible for solar atmospheric phenomena. Emerging magnetic flux is frequently related to eruptive events, because when emerging they can reconnected with the ambient field and release magnetic energy. We will use a physic-based model to reconstruct the evolution of the solar emission based on the configuration of the photospheric magnetic field. The structure of the coronal magnetic field is estimated by employing force-free extrapolation NLFFF based on vector magnetic field products (SHARPS) observed by HMI instrument aboard SDO spacecraft from Sept. 29 (2013) to Oct. 07 (2013). The coronal plasma temperature and density are described and the emission is estimated using the CHIANTI atomic database 8.0. The performance of the our model is compared to the integrated emission from the AIA instrument aboard SDO spacecraft in the specific wavelengths 171Å and 304Å.
The density and temperature profiles in the solar corona are complex to describe, the observational diagnostics is not easy. Here we present a physics-based model to reconstruct the evolution of the electron density and temperature in the solar corona based on the configuration of the magnetic field imprinted on the solar surface. The structure of the coronal magnetic field is estimated from Potential Field Source Surface (PFSS) based on magnetic field from both observational synoptic charts and a magnetic flux transport model. We use an emission model based on the ionization equilibrium and coronal abundances from CHIANTI atomic database 8.0. The preliminary results are discussed in details.
The Total Solar Irradiance (TSI), which is the total radiation arriving at Earth's atmosphere from the Sun, is one of the most important forcing of the Earths climate. Measurements of the TSI have been made employing instruments on board several space-based platforms during the last four solar cycles. However, combining these measurements is still challenging due to the degradation of the sensor elements and the long-term stability of the electronics. Here we describe the preliminary efforts to design an absolute radiometer based on the principle of electrical substitution that is under development at Brazilian's National Institute for Space Research (INPE).
Extreme solar-terrestrial events are those in which very energetic solar ejections hit the earth?s magnetosphere, causing intense energization of the earth?s ring current. Statistically, their occurrence is approximately once per Gleissberg solar cycle (70-100yrs). The solar transient occurred on July, 23rd (2012) was potentially one of such extreme events. The associated coronal mass ejection (CME), however, was not ejected towards the earth. Instead, it hit the STEREO A spacecraft, located 120 degrees away from the Sun-Earth line. Estimates of the geoeffectiveness of such a CME point to a scenario of extreme Space Weather conditions. In terms of the ring current energization, as measured by the Disturbance Storm-Time index (Dst), had this CME hit the Earth, it would have caused the strongest geomagnetic storm in space era.
Some key physical processes that impact the evolution of Earth's atmosphere on time-scale from days to millennia, such as the EUV emissions, are determined by the solar magnetic field. However, observations of the solar spectral irradiance are restricted to the last few solar cycles and are subject to large uncertainties. We present a physics-based model to reconstruct short-term solar spectral irradiance (SSI) variability. The coronal magnetic field is estimated to employ the Potential Field Source Surface extrapolation (PFSS) based on observational synoptic charts and magnetic flux transport model. The emission is estimated to employ the CHIANTI atomic database 8.0. The performance of the model is compared to the emission observed by TIMED/SORCE.
The development of an absolute radiometer instrument is currently a effort at INPE for TSI measurements. In this work, we describe the development of black Ni-P coatings for TSI radiometers absorptive cavities. We present a study of the surface blackening process and the relationships between morphological structure, chemical composition and coating absorption. Ni-P deposits with different phosphorous content were obtained by electroless techniques on aluminum substrates with a thin zincate layer. Appropriate phosphorus composition and etching parameters process produce low reflectance black coatings.
Maternal diet-induced obesity can cause detrimental developmental origins of health and disease in offspring. Perinatal exposure to a high-fat diet (HFD) can lead to later behavioral and metabolic disturbances, but it is not clear which behaviors and metabolic parameters are most vulnerable. To address this critical gap, biparental and monogamous oldfield mice (Peromyscus polionotus), which may better replicate most human societies, were used in the current study. About 2 weeks before breeding, adult females were placed on a control or HFD and maintained on the diets throughout gestation and lactation. F1 offspring were placed at weaning (30 days of age) on the control diet and spatial learning and memory, anxiety, exploratory, voluntary physical activity, and metabolic parameters were tested when they reached adulthood (90 days of age). Surprisingly, maternal HFD caused decreased latency in initial and reverse Barnes maze trials in male, but not female, offspring. Both male and female HFD-fed offspring showed increased anxiogenic behaviors, but decreased exploratory and voluntary physical activity. Moreover, HFD offspring demonstrated lower resting energy expenditure (EE) compared with controls. Accordingly, HFD offspring weighed more at adulthood than those from control fed dams, likely the result of reduced physical activity and EE. Current findings indicate a maternal HFD may increase obesity susceptibility in offspring due to prenatal programming resulting in reduced physical activity and EE later in life. Further work is needed to determine the underpinning neural and metabolic mechanisms by which a maternal HFD adversely affects neurobehavioral and metabolic pathways in offspring.
The Helioseismic and Magnetic Imager (HMI) on board the Solar Dynamics Observatory (SDO) provides continuous monitoring of the Sun's vector magnetic field through full-disk photospheric data with both high cadence and high spatial resolution. Here we investigate the evolution of AR 11249 from March 6 to March 7, 2012. We make use of HMI Stokes imaging, SDO/SHARPs, the HMI magnetic field line-of-sight (LOS) maps and the transverse components of the magnetic field as well as LOS velocity maps in order to detect regions with significant flux emergence and/or cancellation. In addition, we apply the Local Correlation Tracking (LCT) technique to the total and signed magnetic flux data and derive maps of horizontal velocity. From this analysis, we were able to pinpoint localized shear regions (and a shear channel) where penumbrae and pore formation areas, with strong linear polarization signals, are stretched and squeezed, showing also important downflows and upflows. We have also utilized Hinode/SP data and compared them to the HMI-SHARPs and the HMI-Stokes spectrograms. The aforementioned shear channel seems to correspond well with the X-class flare main channel of March 7 2012, as observed in AIA/SDO 171, 304 and 1600 Å.
We describe the preliminary design of a magnetograph and visible-light imager instrument to study the solar dynamo processes through observations of the solar surface magnetic field distribution. The instrument will provide measurements of the vector magnetic field and of the line-of-sight velocity in the solar photosphere. As the magnetic field anchored at the solar surface produces most of the structures and energetic events in the upper solar atmosphere and significantly influences the heliosphere, the development of this instrument plays an important role in reaching the scientific goals of The Atmospheric and Space Science Coordination (CEA) at the Brazilian National Institute for Space Research (INPE). In particular, the CEA's space weather program will benefit most from the development of this technology. We expect that this project will be the starting point to establish a strong research program on Solar Physics in Brazil. Our main aim is acquiring progressively the know-how to build state-of-the-art solar vector magnetograph and visible-light imagers for space-based platforms to contribute to the efforts of the solar-terrestrial physics community to address the main unanswered questions on how our nearby Star works.
Although rare, typhoid fever cases acquired in the United States continue to be reported. Detection and investigation of outbreaks in these domestically acquired cases offer opportunities to identify chronic carriers. We searched surveillance and laboratory databases for domestically acquired typhoid fever cases, used a space–time scan statistic to identify clusters, and classified clusters as outbreaks or non-outbreaks. From 1999 to 2010, domestically acquired cases accounted for 18% of 3373 reported typhoid fever cases; their isolates were less often multidrug-resistant (2% vs. 15%) compared to isolates from travel-associated cases. We identified 28 outbreaks and two possible outbreaks within 45 space–time clusters of ⩾2 domestically acquired cases, including three outbreaks involving ⩾2 molecular subtypes. The approach detected seven of the ten outbreaks published in the literature or reported to CDC. Although this approach did not definitively identify any previously unrecognized outbreaks, it showed the potential to detect outbreaks of typhoid fever that may escape detection by routine analysis of surveillance data. Sixteen outbreaks had been linked to a carrier. Every case of typhoid fever acquired in a non-endemic country warrants thorough investigation. Space–time scan statistics, together with shoe-leather epidemiology and molecular subtyping, may improve outbreak detection.
We describe microbiological, clinical and epidemiological aspects of a diphtheria outbreak that occurred in Maranhão, Brazil. The majority of the 27 confirmed cases occurred in partially (n = 16) or completely (n = 10) immunized children (n = 26). Clinical signs and characteristic symptoms of diphtheria such as cervical lymphadenopathy and pseudomembrane formation were absent in 48% and 7% of the cases, respectively. Complications such as paralysis of lower limbs were observed. Three cases resulted in death, two of them in completely immunized children. Microbiological analysis identified the isolates as Corynebacterium diphtheriae biovar intermedius with a predominant PFGE type. Most of them were toxigenic and some showed a decrease in penicillin G susceptibility. In conclusion, diphtheria remains endemic in Brazil. Health professionals need to be aware of the possibility of atypical cases of C. diphtheriae infection, including pharyngitis without pseudomembrane formation.