Class of 2010 Abstract / OBJECTIVES: Cystic fibrosis (CF) is a disease that adversely affects the lung resulting in a reduction of lung diffusion. Stimulation of the β2 adrenergic receptors results in mucocilliary clearance, and therefore, lung diffusion. We sought to determine the influence of an inhaled β-­‐agonist on the diffusing capacity of the lungs for carbon monoxide (DLCO), alveolar-­‐capillary membrane conductance (DM), pulmonary capillary blood volume (Vc), and peripheral oxygen saturation (SaO2) in subjects with CF and compare the data to matched healthy subjects. METHODS: To determine this we recruited 20 healthy subjects and 18 subjects with CF (age=23±7 vs. 24±4years, ht=168±8 vs. 174±12cm. wt=64±16 vs. 70±13kg, BMI= 23±4 vs. 23±3kg/m2, FEV1= 72±27 vs. 92±12%pred., VO2peak = 45±25 vs. 99±24%pred., P<0.05 for FEV1 and VO2peak, mean±SD) for the study and measured DLCO, DM, Vc and SaO2 before and 30, 60, and 90 minutes following the administration of inhaled albuterol. RESULTS: Within the healthy subjects, there were no differences in DLCO, DM, Vc, DM/Vc at baseline or in response to albuterol according to genetic variation of the ADRB2 at amino acid 27. Within the CF group, the Glu27Glu/Gln27Glu group had higher DM/Vc when compared to the Gln27Gln group at baseline. Both genotype groups had a significant decline in Vc and a significant improvement in DM/Vc and SaO2 in response to albuterol, but not in DLCO or DM. CONCLUSIONS: These results suggest that there are differences in lung diffusion and peripheral SaO2 according to genetic variants of the ADRB2 at position 27 and could play a potential role in treatment options.

The trans-differentiation of injury-activated fibroblasts to myofibroblasts is a process that provides contractile strength for wound closure. Persistent myofibroblast differentiation, however, is associated with fibrotic pathologies such as organ fibrosis, vascular remodeling, and atherosclerotic plaque formation. Myofibroblasts acquire a contractile phenotype with biochemical properties characteristic of both smooth muscle cells and stromal fibroblasts. The cyto-contractile protein, smooth muscle α-actin (SMαA) is a biomarker of myofibroblast differentiation. Expression of the SMαA gene, ACTA2, is regulated by cis-acting elements and transcription factors that activate or repress the ACTA2 promoter. Purine-rich element binding proteins A (Purα) and B (Purβ) are sequence-specific, single-stranded DNA (ssDNA)/RNA-binding proteins that act as transcriptional repressors of ACTA2 expression. Both Pur proteins interact with the purine-rich strand of a cryptic muscle-CAT (MCAT) enhancer motif in 5'-flanking region of the ACTA2 promoter. Despite significant sequence homology with Purα, Purβ was identified as the dominant repressor of ACTA2 expression in mouse embryonic fibroblasts and vascular smooth muscle cells by virtue of gain-of function and loss-of-function analyses in cultured cells. Biophysical studies indicated that Purβ reversibly self-associates in solution to form a homodimer. Quantitative DNA-binding assays revealed that Purβ interacts with the purine-rich strand of the ACTA2 MCAT motif via a cooperative, multisite binding mechanism to form a high-affinity 2:1 Purβ-ssDNA complex. In this dissertation, a combination of computational, biochemical, and cell-based approaches were employed to elucidate the molecular basis of Purβ repressor interaction with the ACTA2 gene. Limited proteolysis of recombinant mouse Purβ in the presence and absence of the purine-rich strand of the ACTA2 MCAT element led to the identification of a core ssDNA-binding region that retains the ability to dimerize in solution. Knockdown of endogenous Purβ in mouse embryonic fibroblasts via RNA interference induced SMαA expression and conversion to a myofibroblast-like phenotype. To map the specific structural domains in the core region of Purβ that account for its unique ACTA2 repressor and ssDNA-binding functions, computational homology models of the Purβ monomer and dimer were generated based on the x-ray crystal structure of an intramolecular subdomain of Drosophila melanogaster Purα. Empirical biochemical and cell-based analyses of rationally-designed Purβ truncation proteins revealed that the assembled Purβ homodimer is composed of three separate purine-rich ssDNA-binding subdomains. Evaluation of the effects of anionic detergent and high-salt on the binding of Purβ to ssDNA implicated the involvement of hydrophobic and electrostatic interactions in mediating high-affinity nucleoprotein complex formation. This inference was validated by site-directed mutagenesis experiments, which identified several basic amino acid residues required for the ACTA2 repressor activity of Purβ. Collectively, the findings described herein establish the structural and chemical basis for the cooperative interaction of Purβ with the ACTA2 MCAT enhancer and for Purβ-dependent suppression of myofibroblast differentiation.

Pseudomonas aeruginosa (PA) infections in Cystic Fibrosis (CF) patients are not easily cleared due to the conversion from a nonmucoid to a mucoid phenotype. Alginate is an acetylated exopolysaccharide produced by mucoid PA that is responsible for increased resistance to antibiotics, host phagocytic killing, and propagating biofilm formation. Understanding the interaction between PA and host cells is critical to understanding chronic infection and inflammation in CF. In order to investigate this, we used A549 pulmonary epithelial cells and murine alveolar macrophages (MH-S) to examine host response to nonmucoid versus mucoid PA infection. Adhesion assays in A549 pulmonary epithelial cells revealed that mucoid PA mutants adhere poorly compared to their nonmucoid counterparts. Similarly, phagocytosis assays using MH-S infected with PA revealed that mucoid PA are increasingly resistant to phagocytosis. The alginate acetylation mutant FRD1175 is more susceptible to phagocytic killing than alginate+ FRD1. Adherence and phagocytosis of mucoid FRD1 was increased by increasing the multiplicity of infection (MOI) from 50:1 to 500:1. Furthermore, confocal microscopy revealed that mucoid PA are inherently less inflammatory than nonmucoid strains in both A549 and MH-S. Increasing the MOI of mucoid FRD1 from 50:1 to 500:1 significantly increased caspase-1 activation in MH-S but not in A549, revealing that intensity of inflammatory signaling by epithelial cells is likely independent of increased adherence. FRD1175 infection in both A549 and MH-S revealed that alginate acetylation plays a significant role in reducing inflammasome activation. Western analysis revealed that PA does not actively induce TGF-β secretion by A549 epithelial cells. Similarly, NF-κB expression was reduced in both A549 and MH-S when infected with mucoid FRD strains, but not PA from the PAO background, suggesting FRD strains have accumulated additional mutations facilitating escape of inflammation. MH-S treated with cytochalasin D to block phagocytosis were still able to activate NF-κB signaling, suggesting NF-κB activation is adherence but not phagocytosis dependent. These data increase our understanding of the various mechanisms in which mucoid PA is able to evade host immune defenses and provides insight into potential therapies to treat PA infections.

Cystic Fibrosis (CF) is the most common hereditary genetic disorder among Caucasians. Pseudomonas aeruginosa is a major cause of morbidity in cystic fibrosis patients. Chronic infection with P. aeruginosa eventually occurs and is associated with a switch to biofilm formation of the bacteria. The symptoms and pathology of acute and chronic P. aeruginosa infections differ greatly. The first line of defense within the lung is the physical barrier of the lung epithelia. The examination of established biofilm interactions with lung epithelia is difficult. Here, I use the Calgary Biofilm Device co-culture system to conduct the concurrent analysis of established biofilms and planktonic bacteria with A549 lung cells. Comparison of P. aeruginosa biofilm and planktonic bacteria’s effects on A549 lung cells showed that planktonic bacteria caused more A549 cell rounding and death, while biofilm stimulated more IL-8 release by epithelial cells. Biofilm was shown to secrete significantly more Pseudomonal Elastase than planktonic, causing A549 morphological changes and loss of tight junctions. The antimicrobial peptide LL-37 was shown to differentially affect biofilm and planktonic bacteria. LL-37 caused a decrease in twitching of planktonic bacteria and exposure to LL-37 for 48 hours resulted in a decrease in elastase secretion likely due to down-regulated type 2 secretion. When established biofilms were compared with newly adherent biofilms, young biofilms were shown to have characteristics similar to both planktonic bacteria and mature biofilms. From this data we can follow the pattern of bacterial virulence as P. aeruginosa transitions from the planktonic mode of growth to the eventual mature biofilm that is associated with chronic infection. In conclusion, this study provides the foundation for a co-culture system that can be used to study the host-pathogen interactions of mammalian epithelia with established P. aeruginosa biofilms. The future adaptations of this model will better represent the in vivo characteristics of chronic lung infection to delineate ongoing virulence mechanisms of the bacteria causing host cell stimulation and damage. / May 2016

ABSTRACT INTRODUCTION: Cystic fibrosis (CF) is an autosomal recessive disease caused by mutations in the CFTR gene. The gene mutation profile is extremely heterogeneous and mutations show a variable distribution among population groups. In SA the 3120+1G->A splice site mutation has been found predominantly in Black and Coloured patients. It occurs in Black CF patients at an estimated frequency of 46%. The CF carrier frequency is estimated at 1/34 in Black and 1/55 in Coloured populations, and based on these rates, it is clear that a significant number of Black and Coloured patients remain undiagnosed. Point mutations account for the majority of the mutations that have been found in the CFTR gene. Copy number mutations are, however, increasingly being detected in CF patients through the use of gene dosage-dependant assays. These mutations have been found to occur in the CFTR gene in various African American families and exon rearrangements are thought to account for 1.3% of all CF chromosomes across all populations. AIMS: To use haplotypes to analyse the origin(s) of the 3120+1G->A mutation and the likely frequencies of the remaining unknown mutations. To increase mutation detection in the SA Black and Coloured groups by searching for CFTR gene exons for copy number mutations. METHODS: In patients with at least one copy of the 3120+1G>A mutation haplotype studies will be used to elucidate the origin(s) of this mutation in SA Black and Coloured CF patients, by analyzing pyrosequencing SNP genotype data. In patients with at least one unknown mutation, haplotype studies will reveal the likely relative frequencies of the unknown mutations in these populations. In Black and Coloured CF patients with at least one unknown mutation, a multiplex ligation dependant probe amplification (MLPA) CF kit will be used for the detection of exon copy number mutations. RESULTS: The results of the haplotype data show that there is a G-G-C-G-T-A haplotype, for markers MetD-KM19-J44-T854T-Tub18-J32, associated with the 3120+1G->A mutation in both Black and Coloured patients. Unknown mutation-associated haplotypes indicate that there are two relatively common unknown mutations in each of these populations. MLPA results show that one patient is a carrier of an exon 2 deletion. CONCLUSION: A single origin for the 3120+1G>A mutation in Black and Coloured CF patients is supported by the data. Exon copy number changes in the CFTR gene are not a major mutational mechanism leading to CF in SA Black and Coloured patients.

A infecção crônica do trato respiratório é responsável pela grande morbidade e mortalidade em pacientes com fibrose cística (FC). P. aeruginosa, S. aureus e bactérias do complexo Burkholderia cepacia (CBc) estão entre os patógenos mais encontrados em pulmões de pacientes com FC, mas também são encontradas outros bacilos gram-negativos não fermentadores (BGN-NF) emergentes como Achromobacter sp., Stenotrophomonas maltophilia, Ralstonia sp., Pandoraea sp., entre outros. A correta caracterização desses patógenos impacta na sobrevida e qualidade de vida desses pacientes, e é um dos grandes desafios para laboratórios de microbiologia clínica devido à similaridade fenotípica entre eles. Este estudo tem como objetivo avaliar e propor estratégias e esquema de identificação acessível à maioria dos laboratórios para a identificação de BGN-NF emergentes e listar bactérias isoladas de pacientes com FC atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP (HCFMRP-USP), com ênfase nos BGN-NF emergentes. Foram utilizados meios de cultura seletivos, reação em cadeia da polimerase (PCR), análise de polimorfirmos (RFLP). Foram coletadas 264 amostras clínicas de 107 pacientes com FC no HCFMRP-USP entre julho/2011 a setembro/2012. Inicialmente, para selecionar os BGNNF dos pacientes com FC, deve ser realizada triagem fenotípica (coloração de Gram, teste da oxidação/fermentação de glicose e produção de oxidase). Devido à dificuldade de identificação dos BGN-NF emergentes por provas bioquímicas, deve ser realizada PCR com DNA destes microrganismos para identificação de gênero e/ou espécie, utilizando os primers específicos, nas condições estabelecidas pela padronização, a qual foi realizada para aumentar a especificidade de alguns primers que apresentaram amplificação de produtos inespecíficos. Provas bioquímicas convencionais devem ser realizadas para confirmar gêneros e identificar algumas espécies não detectadas por PCR, e para resultados fenotípicos diferente da PCR deve ser realizado API® - NE. Para identificação das bactérias do CBc, deve ser realizado análise de polimorfismo, o qual se mostrou mais efetivo do que PCR para identificação de espécies e genomovares. Dos 107 pacientes, 17 estavam colonizados por bactérias do CBc, 13 colonizados por Achromobacter sp., 10 colonizados por S. maltophilia, 2 colonizados por Ralstonia sp. e um paciente colonizado por Cupriavidus sp. e Pandoraea sp., com um isolamento de cada gênero. Os genomovares mais prevalentes foram B. cenocepacia IIIB, seguido de B. vietnamiensis, B. pyrrocinia, B. cepacia e B. multivorans. A maioria dos BGNNF esteve presente em crianças com idade até 17 anos. Os meios de cultura seletivos foram extremamente necessários por permitir o isolamento de vários BGN-NF, não isolados em outros meios de cultura utilizados. A metodologia de identificação empregada foi capaz de identificar todos BNG-NF isolados e pode ser muito útil e acessível à maioria dos laboratórios clínicos. / Chronic infection of the respiratory tract accounts for the high rate of morbidity and mortality of patients suffering from cystic fibrosis (CF). P. aeruginosa, S. aureus and bacteria of the Burkholderia cepacia (BCc) complex are among the pathogens most commonly found in the lungs of CF patients, but other emergent non-fermenting gram-negative bacilli (NFGNB), such as Achromobacter sp., Stenotrophomonas maltophilia, Ralstonia sp., Pandoraea sp., among others, are found as well. The correct identification of these pathogens affects the survival rate of patients and, due to their phenotypic similarity, presents itself as one of the great challenges that clinical microbiology laboratories face. The purpose of this study is to evaluate and propose strategies and methods that are accessible to the majority of laboratories for identifying emergent NFGNBs and listing isolated bacteria (with a focus on emergent NFGNB) in CF patients receiving routine care at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - USP (HCFMRPUSP). The study employed selective culture media, polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). From July 2011 to September 2012, 264 clinical samples were gathered from 107 CF patients at the HCFMRP-USP. A phenotypic screening (Gram staining, oxidase production and oxidation/fermentation of glucose) should be conducted as the first step to select the NFGNBs of CF patients. Due to the difficulty in identifying emergent NFGNBs via biochemical tests, a PCR using the DNA of these microorganisms should be carried out to identify their genus and/or species. The PCR should utilize the specific primers, at conditions established by this study, which was performed to increase the specificity of some primers that showed nonspecific amplification products. Conventional biochemical tests should be conducted to confirm genera and identify some species that the PCR failed to detect, and, in the case of phenotypic results that differ from those of the PCR, an API bacterial identification test should be conducted. RFLP analysis proven more effective than PCR in identifying species and genomovars, should be conducted to identify BCc bacteria. Of the 107 patients, 17 had positive cultures for BCc, 13 for Achromobacter sp., 10 for S. maltophilia, two for Ralstonia sp. and one patient had positive culture for Cupriavidus sp. and Pandoraea sp., with the genera isolated from each other. The most prevalent genomovar was the B. cenocepacia IIIB, followed by B. vietnamiensis, B. pyrrocinia, B. cepacia and B. multivorans. The majority of the NFGNBs were present in children up to age 17. Selective culture media were extremely necessary to allow the isolation of various NFGNBs that could not be isolated via alternative culture media. The identification methodology employed enabled the identification of all isolated NFGNBs and can be very useful and accessible to the majority of clinical laboratories.

Achromobacter sp. e Burkholderia sp. são considerados patógenos problemáticos em pacientes com fibrose cística (FC), principalmente por apresentarem linhagens que podem ser transmissíveis e multidroga resistentes. Este trabalho teve como objetivo analisar isolados de Achromobacter e do complexo Burkholderia cepacia (CBc) de pacientes com FC atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP-USP) e no Hospital das Clínicas da Faculdade de Ciências Médicas de Campinas (HCFCM-UNICAMP): identificar gênero/espécies; avaliar a sensibilidade a antimicrobianos; investigar relações genéticas entre os isolados por Pulsed-field Gel Electrophoresis (PFGE); elucidar a taxonomia e epidemiologia molecular dos isolados por Multilocus Sequence Typing (MLST) e correlacionar os resultados com dados clínicos. Entre julho/2011 a setembro/2014, nos dois hospitais, as espécies mais prevalentes de Achromobacter e CBc foram A. xylosoxidans e B. vietnamiensis, respectivamente. Os antibióticos mais efetivos contra isolados de Achromobacter sp. de pacientes do HCFMRP-USP foram imipenem e meropenem e do HCFCM-UNICAMP foram meropenem e ceftazidima. Os antibióticos mais efetivos contra CBc de pacientes do HCFMRP-USP foram sulfametoxazol-trimetoprim e meropenem e do HCFCM-UNICAMP foram ceftazidima e meropenem. Houve suspeita de contaminação cruzada entre alguns pacientes que apresentaram isolados com o mesmo perfil de PFGE. No HCFMRP-USP, isolados de B. vietnamiensis de pacientes diferentes tiveram o mesmo perfil de PFGE e apenas 2 pacientes tinham infecção crônica. No HCFCM-UNICAMP, isolados de B. cenocepacia IIIB de 4 pacientes apresentaram o mesmo pulsotipo, porém nenhum dos pacientes tinha infecção crônica. Isolados de B. vietnamiensis e B. multivorans de pacientes diferentes no HCFCM-UNICAMP também apresentaram o mesmo pulsotipo, e apenas um paciente colonizado por B. multivorans tinha infecção crônica. No HCFCM-UNICAMP, isolados de Achromobacter apresentaram perfis únicos de PFGE, enquanto que no HCFMRP-USP houve suspeita de contaminação cruzada somente entre pacientes colonizados por A. xylosoxidans, sendo que 3 destes pacientes estavam com infecção crônica. Nos dois hospitais, 17 STs foram identificados em isolados do CBc, 14 deles pela primeira vez e 3 STs (ST17, ST369 e ST911) apresentaram distribuição intercontinental. Em isolados de pacientes dos dois hospitais foram identificados alguns STs em comum (STs 1056, 1057, 369 e 911), o que pode sugerir ancestral comum. No total, 6 STs diferentes foram identificados em isolados de A. xylosoxidans de pacientes do HCFMRP-USP, dos quais 3 STs apareceram pela primeira vez e os outros 3 STs apresentaram distribuição intercontinental. Nenhuma das espécies apresentou linhagens epidêmicas descritas. Os pacientes colonizados cronicamente por A. xylosoxidans apresentaram valores de escore de Shwachman, índice de massa corporal (IMC) e função pulmonar menos preservados e exacerbações ligeiramente mais frequentes do que pacientes colonizados por bactérias do CBc. Este estudo possibilitou a correta identificação dos patógenos proporcionando a adoção de medidas de controle mais efetivas e tratamentos mais adequados, além de atualização do banco de dados epidemiológicos, o que facilita a análise colaborativa multicêntrica e auxilia no controle de infecção global destes patógenos. / Achromobacter sp. and Burkholderia sp. are troublesome pathogens in cystic fibrosis (CF) patients, mainly because they may have transmissible and multidrug resistant strains. The aim of this study was to analyze the Achromobacter and Burkholderia cepacia complex (Bcc) isolates from CF patients treated at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP-USP) and Hospital das Clínicas da Faculdade de Ciências Médicas de Campinas (HCFCM-UNICAMP); to identify genus/species; to evaluate antimicrobial susceptibility; to investigate clonal relatedness among isolates by Pulsed-field Gel Electrophoresis (PFGE); to elucidate taxonomy and molecular epidemiology of the isolates by Multilocus Sequence Typing (MLST), and to relate the results to clinical data. Between July/2011 and September/2014, in both hospitals, the most prevalent species of Achromobacter and Bcc were A. xylosoxidans and B. vietnamiensis, respectively. The most effective antibiotics against Achromobacter sp. isolates of patients from HCFMRP-USP were imipenem and meropenem, and from HCFCM-UNICAMP were meropenem and ceftazidime. The most effective antibiotics against Bcc isolates of patients from HCFMRP-USP were sulfamethoxazole-trimethoprim and meropenem, and from HCFCM-UNICAMP were ceftazidime and meropenem. Cross-contamination was suspected among some patients who presented isolates with the same PFGE profile. In HCFMRP-USP, isolates of B. vietnamiensis from different patients showed the same PFGE profile, and only 2 patients had chronic infection. In HCFCM-UNICAMP, isolates of B. cenocepacia IIIB of 4 patients showed the same pulsetype, but none of the patients had chronic infection. Isolates of B. vietnamiensis and B. multivorans from different patients from HCFCM-UNICAMP also showed the same pulsetype, and only one patient colonized by B. multivorans had chronic infection. In HCFCM-UNICAMP, Achromobacter isolates showed unique profiles of PFGE, whereas in HCFMRP-USP cross-contamination was only suspected among patients colonized by A. xylosoxidans, and 3 of these patients had chronic infection. In both hospitals, 17 STs were identified in Bcc isolates, 14 of them for the first time and 3 STs (ST17, ST369 and ST911) presented intercontinental distribution. In both hospitals, some common STs (STs 1056, 1057, 369 and 911) were identified, which may suggest a common ancestor. In total, 6 different STs were identified in A. xylosoxidans isolates of patients from HCFMRP-USP, of which 3 STs were identified for the first time, and the other 3 STs presented intercontinental distribution. None of the species presented described epidemic strains. Patients chronically colonized by A. xylosoxidans showed less preserved Shwachman score, body mass index (BMI) and lung function, and slightly more frequent exacerbations than patients colonized by Bcc bacteria. This study provided the correct identification of the pathogens, allowing the adoption of more effective control measures and adequate treatments, besides updating the epidemiological database, which facilitates the multicentric collaborative analysis and assists in the control of global infection of these pathogens

INTRODUÇÃO: O tratamento da fibrose cística (FC) envolve o uso de medicamentos fornecidos através de nebulizadores e seu funcionamento adequado é essencial. OBJETIVOS: Avaliar o desempenho de nebulizadores a jato utilizados por pacientes com FC e comparar dois manômetros para avaliação dos compressores. MÉTODOS: Estudo descritivo, transversal, de avaliação dos nebulizadores usados pelos pacientes com FC da Associação Mineira de Assistência a Mucoviscidose. Os pacientes trouxeram compressores (Proneb Ultra®) e nebulizadores (Pari LC plus®) para avaliação. O desempenho do compressor foi avaliado por medidas de pressão operacional através dos manômetros PARI PG101® (PARI GmbH, Starnberg, Alemanha) e FSA analógico (Famabras, Itaquaquecetuba, Brasil).As variáveis de eficiência do nebulizador foram: O débito de volume nebulizado (DVN), taxa de oferta da medicação (TOR) e volume residual (VR) foram calculados por diferenças de peso de cada nebulizador após 10 minutos de nebulização de solução salina (2,5ml). O diâmetro médio de massa da partícula (DMM) foi calculado através da equação proposta por Standaert et al. A análise estatística incluiu o pacote R (v.2.15) e MINITAB, com alfa=0,05. O coeficiente Kappa foi calculado para avaliar concordância de valores entre os equipamentos, e curva ROC construída para calcular o valor aferido no manômetro FSA com melhor sensibilidade/especificidade, utilizando o manômetro PARI PG101® como referência. A associação entre valores de pressão, DVN, TOR e VR foi calculada pela correlação de Spearman. RESULTADOS: Avaliados 146 sistemas com tempo mediano de uso de 32(12-60) meses±36 meses. Cinquenta e sete (39%) não funcionaram adequadamente, com valores pressóricos inferiores à metade da referência. Os sistemas com funcionamento inadequado comprometeram as variáveis de eficiência dos nebulizadores A concordância entre os diferentes métodos de avaliação de acordo com a classificação; com funcionamento adequado e inadequado através do coeficiente Kappa foi 0,81(IC95%- 0,65-0,97), p<0,001. Na avaliação da sensibilidade e especificidade foi observado o ponto de corte de 23,5 PSI no manômetro FSA mostrou sensibilidade=99% e especificidade=79% (p<0,001). Houve associação significativa entre DVN, VR e pressões aferidas. CONCLUSÕES: Uma proporção significativa dos sistemas de nebulização não funcionou adequadamente. As variáveis de eficiência da nebulização estavam comprometidas indicando que a pressão gerada no compressor é um aspecto crítico na eficiência do tratamento. O método alternativo da avaliação dos compressores se apresentou adequado para ser utilizado nos compressores utilizados no tratamento da FC. / INTRODUCTION: Cystic fibrosis (CF) treatment of involves the use of medications supplied through nebulizers and their proper functioning is essential. OBJECTIVES: To evaluate the performance of jet nebulizers used by CF patients and to compare two pressure gauges Compressors evaluation. METHODS: This was a descriptive, cross - sectional study of the nebulizers used by patients with CF of the Mucoviscidosis Care Association of Minas Gerais. The patients brought compressors (Proneb Ultra®) and nebulizers (Pari LC plus®) for evaluation. The performance of the compressor was evaluated by operating pressure measurements using PARI PG101® manometers (PARI GmbH, Starnberg, Germany) and analog FSA (Famabras, Itaquaquecetuba, Brazil). The variables of efficiency of nebulization under study were: nebulizer delivery volume (NDV), drug output rate (DOR), and residual volume (RV), which were calculated by weighing each nebulizer before nebulization and 10 minutes after nebulization using a saline solution (2.5 mL). The mass median diameter (MMD) was calculated using the equation proposed by Standaert et al. Statistical analysis included the package R (v.2.15) and MINITAB, with alpha = 0.05. The Kappa coefficient was calculated to evaluate agreement of values between the equipment\'s, and ROC curve constructed to calculate the value measured in the FSA manometer with better sensitivity / specificity, using the PARI PG101® manometer as reference. The association between pressure values, NDV, DOR and RV was calculated by the Spearman correlation. RESULTS: We evaluated 146 systems with a median time of use of 32 (12-60) months ± 36 months. Fifty-seven (39%) did not function properly, with pressure values lower than half the reference. The systems with inadequate functioning compromised the efficiency variables of the nebulizers. The agreement between the different evaluation methods according to the classification; with adequate and inadequate functioning through the Kappa coefficient was 0.81 (95% CI -0.65-0.97), p <0.001. In the evaluation of sensitivity and specificity, the cut-off point of 23.5 PSI on the FSA manometer showed sensitivity = 99% and specificity = 79% (p <0.001). There was a significant association between NDV, DOR, RV and measured pressures. CONCLUSIONS: A significant number of the nebulizer systems were ineffective. The variables of nebulization efficiency were compromised, which indicated that the pressure generated by the compressor was a critical aspect for treatment efficiency. The alternative method of compressors evaluation was suitable for use in CF treatment routine.

Infection with hepatitis C virus (HCV) can cause liver damage known as fibrosis, which often leads to liver disease and hepatocellular carcinoma. The impairment of circulating, bulk (non-specific and specific) CD8+ T cells within HCV-infection, characterized by an altered phenotype and the increased expression of pro-apoptotic genes, is observed when compared to uninfected controls. The relationship between bulk CD8+ T cell function and the extent of liver damage has not been demonstrated. In this study, widespread immune alterations were observed in untreated HCV infection with advanced liver fibrosis. Untreated HCV-infected individuals with advanced fibrosis possessed a significantly decreased proportion of naïve CD8+ T cells and an increased proportion of late effector memory CD8+ T cells compared to uninfected controls. Upon T cell receptor (TCR) stimulation, these individuals also had an increased intracellular IFN-γ expression for four CD8+ T cell subsets, a decreased CD107a expression for central memory CD8+ T cells, and a decreased perforin induction for naïve and central memory CD8+ T cells. These immune alterations did not reverse 24 weeks after viral cure. This study indicates there is a relationship between the differentiation and function of bulk CD8+ T cells and the extent of liver damage within HCV infection.

A conexina 32 (Cx32) é uma estrutura protéica que constitui os canais que promovem as comunicações intercelulares via junções comunicantes (GJIC), permitindo difusão de pequenas moléculas citoplasmáticas de uma célula à outra. Este trabalho objetivou os estudos destas estruturas devido a sua importância em processos hepáticos, mais especificamente, a fibrose hepática. O presente estudo foi realizado através da administração oral da droga hepatotoxica dimetilnitrosamina (DMN) em ratas Wistar duas vezes por semana em dias consecutivos no prazo de cinco semanas. A necropsia destes animais foi realizada após cinco semanas da última administração da droga e revelou um quadro de fibrose hepática, em contra partida aos resultados obtidos em um grupo controle com a mesma quantidade de animais. O material fibrótico foi submetido à análise imunohistoquímica que revelou uma presença preferencial de Cx32 dispersa no citoplasma, o que pode levar à hipótese de problemas no mecanismo de transporte citoplasmático destas estruturas, em contrapartida ao material pertencente ao grupo controle que evidenciou a presença das Cx32 na membrana plasmática formando placas juncionais. Quando submetido à análises moleculares o fígado fibrótico revelou uma diminuição da expressão gênica embora o produto protéico deste material quando comparado ao grupo controle não tenha se mostrado diminuído. / The connexin 32 (Cx32) is a proteic structure that constitute the channels that promote the cell communication by means of the gap junction (GJIC), allowing the diffusion of short cytoplasmic molecules from a cell to another. This work aimed to study these structures due to their importance in the hepatic metabolic processes. The hepatic fibrosis was triggered by the oral administration of dimethylnitrosamine (DMN) in the female rat Wistars twice a week in consecutive days during five weeks. The necropsy of these animals was carried out after the last drug administration. They presented a hepatic fibrosis state. The fibrotic material was submitted to the imunohistochemical analysis, which showed a preferencial presence of Cx32 in the cytoplasm, whereas in the control group the Cx32 was located at the membranes, in the junctional plaques. The molecular analysis showed a decrease of the genic expresson of the fibrotic material, however the proteic product wasn? t reduced in comparison with the control group as it was shown by western blot. We concluded that the fibrotic state introduced a disturbance in the intracellular distribution and genic expression of the connexin 32.