Thesis (M.Tech.: Biotechnology)- Dept. of Biotechnology, Durban University of Technology, 2007 xv, 127 leaves / The human gut microbiota play a major role in host health, and attempts are being made to manipulate the composition of the gut microbiota-increase the composition of bacterial groups, such as lactobacilli and bifidobacteria that are perceived as exerting health promoting properties. These bacteria defined as food supplements (probiotics) beneficially affect the host by improving the intestinal microbial balance, and have been used to change the composition of the colonic microbiota. However, such changes may be transient, and the implantation of exogenous bacteria therefore becomes limited. In contrast, prebiotics are naturally occurring carbohydrates that are classified as non-digestible oligosaccharides present in edible plants. These carbohydrates enter the colon as intact compounds, elicit systemic physiological functions and act as fermentable substrates for colonic microflora-influencing the species composition and metabolic characteristics of intestinal microflora providing important health attributes. Currently, a widely marketed prebiotic, inulin is extracted from plants of the family Asteraceae. There are many unexploited plants that are regularly consumed and that may have a prebiotic effect or can have very high levels of inulin which could make them commercially viable. In this study, we investigated prebiotic compounds, especially inulin from locally growing, non-commercialised leafy plants. The aqueous extracts of 22 plants from the families Asparagaceae, Alliaceae, Asteraceae, Solanaceae, Cucurbitaceae, Amaranthaceae, Acanthaceae, Polygonaceae, Portulaceae, Fabaceae, Chenopodiaceae, Pedaliaceae and Apiaceae from Kwa-Zulu Natal were investigated for a prebiotic effect using a modified batch-culture technique with Lactobacillus bulgaricus, Lactobacillus lactis, Lactobacillus reuteri and Bifidobacterium longum, four common probiotics and the inulin content of the plants was determined using high performance liquid chromatography. Of the 22 plants studied, Solanum nigrum, Amaranthus spinosus, Amaranthus hybridus, Asystasia gangetica, Senna occidentalis, Cerathoteca triloba, Asparagus sprengeri, Tulbaghia violacea, Sonchus oleraceus and Taraxacum officinale exhibited a prebiotic effect. The prebiotic effect of the Taraxacum officinale, Sonchus oleraceus and Asparagus sprengeri extracts on L. lactis and L. reuteri was higher than or equivalent to inulin-a commercial prebiotic. In this study, Sonchus oleraceus exhibited the best prebiotic effect-was the only plant to stimulate all the probiotics including B. longum. Of all the plants analysed, Asparagus sprengeri tuber contained the highest amount of inulin (3.55%).

bgbrady@hotmail.com / The primary intestinal follicular lymphoma is a rare disease described in the last classification of lymphomas from WHO. It is a localized disease with excellent prognosis. We describe in this article ,a 64 year-old Peruvian female with abdominal pain and delayed vomiting for the last two years, has undergone a partial intestinal resection due to bowel obstruction. There was a well-circumscribed annular tumor. A diagnosis of non-polypoid primary intestinal follicular lymphoma was made. We report the case and review the literature in this article. / El linfoma folicular primario intestinal es un desorden raro descrito en la última clasificación de linfomas de la WHO. Es una entidad localizada con excelente pronóstico. En el presente artículo, reportamos una mujer peruana de 64 años de edad diagnosticada con linfoma folicular primario intestinal. Ella tuvo dos años con dolor abdominal y vómitos tardíos. Ella desarrolló una obstrucción intestinal y tuvo una resección completa del tumor. Se describe el caso y se realiza una revisión de la literatura de esta entidad.

More than 1.2 million people are estimated to be currently living with the human immunodeficiency virus (HIV) in the United States of America. The gastrointestinal (GI) tract is both a major target and an important component of HIV pathogenesis. The GI processes that are dysregulated during HIV infection are controlled by the enteric nervous system (ENS). Indeed, both clinical and experimental studies have implicated the ENS in HIV and simian immunodeficiency virus (SIV) pathogenesis. In addition to direct viral effects, the HIV virus also indirectly affects the GI tract via cellular and/or viral toxins released by infected cells. Trans-activator of transcription (Tat) is a viral toxin that plays an important role in replication of the HIV virus. While, the HIV virus does not directly infect neurons, Tat has been shown to modulate neuronal function. HIV infection in the gut is accompanied by: translocation of bacteria and bacterial products from the gut lumen to peripheral blood, immune activation and inflammation. Lipopolysaccharide (LPS) is a major bacterial product that is used to determine the rate of bacterial translocation and to drive inflammation. Despite reports of enteric ganglionitis in SIV infected monkeys and autonomic denervation in the jejunum of HIV patients, little is known of the mechanism underlying enteric neuropathogenesis in HIV and the role of the ENS in HIV pathogenesis. In the present study, we assessed the effects of Tat on enteric neuronal excitability and how Tat and LPS interact in the ENS to bring about inflammation and GI motility problems observed in HIV patients. We show that Tat significantly increased enteric neuronal excitability by modulating sodium channels expressed on enteric neurons. Tat sensitized ENS cells to LPS-mediated increase in pro-inflammatory cytokines via a TLR4-mediated pathway involving MyD88. Mice expressing the tat transgene (Tat+) had faster GI transit rates and significantly higher frequencies of diameter changes in the proximal ileum than controls (Tat-). Tat+ mice were also more sensitive to LPS-mediated decreases in colonic transit rate. This study highlights the role of viral and bacterial proteins in HIV pathogenesis in the gastrointestinal tract and also demonstrates a critical role of the ENS in HIV pathogenesis.

Os efeitos benéficos que as bactérias probióticas proporcionam à saúde humana dependem de sua quantidade e atividade biológica no intestino humano. Esse trabalho objetivou estabelecer as melhores condições laboratoriais para o cultivo e enumeração diferencial de cinco culturas de bactérias, sendo três probióticas (Bifidobacterium animalis Bb12, Lactobacillus acidophilus La05, Lactobacillus casei Lc01) e duas láticas não probióticas (Lactobacillus delbrueckii subsp. bulgaricus e Streptococcus thermophilus). O trabalho objetivou também avaliar a capacidade de duas linhagens de bactérias probióticas de Lactobacillus casei (Shirota e Lc01) sobreviverem ao transito pelo trato gastrintestinal humano (TGI), empregando modelos simulados in vitro. Foram testados vinte e um meios de cultura diferentes, semeados em superfície e em profundidade, e incubados a 37°C e a 42°C, em condições de aerobiose e anaerobiose. Para a avaliação da resistência ao TGI, empregou-se modelos simulados constituídos de solução de NaCI estéril (0,5% p/v) contendo pepsina (3g/L), com pH 1,5, 2,0, 2,5 e 3,0 (suco gástrico) e solução de NaCI estéril (0,5% p/v) contendo pancreatina (1g/L) e bile (10g/L), com pH 8,0 (suco entérico). As culturas foram expostas ao suco gástrico por até 120min, e em seguida ao suco entérico por até 240min. Os resultados indicaram que a suplementação do ágar MRS com diferentes compostos e o uso de combinações apropriadas de forma de semeadura e condições de incubação permitem tornar o ágar MRS um meio seletivo e diferencial para as diferentes espécies testadas. Em função dos resultados da avaliação dos meios de cultura, selecionou-se o ágar MRS pH 5,4 com semeadura em profundidade e incubação a 37°C em aerobiose para avaliar a resistência de L. casei (Shirota e Lc01) ao TGI. Os resultados revelaram que, após a exposição por 30min ao suco gástrico com pH 1,5 e 2,0, as duas linhagens de L. casei não eram mais cultiváveis. Em pH 2,5, houve redução de 4 ciclos log após 2h e, em pH 3,0, não houve modificação no número de células viáveis. A transferência para o suco entérico resultou na reversão parcial da injúria causada pelo suco gástrico extremamente ácido. Além disso, foi demonstrado que o leite pode proteger as bactérias do estresse decorrente da passagem pelo TGI. / The beneficial effects of probiotic bacteria to the human health depend on their quantity and biological activity in the human gut. This study aimed to establish the best laboratorial conditions for the differential cultivation and enumeration of five bacterial cultures, including three probiotic (Bifidobacterium animalis Bb12, Lactobacillus acidophilus La05 and Lactobacillus casei Lc01) and two nonprobiotic (Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus) strains. In addition, this study also aimed to evaluate the capability of two probiotic strains (Lactobacillus casei Shirota and Lc01) to survive the transit through the human gastrointestinal tract, using in vitro simulated models. Twenty one different culture media were tested. They were inoculated using pour-plating and spread-plating techniques. Plates were incubated at 37°C and 42°C, under aerobiosis and anaerobiosis. Resistance to the gastrointestinal tract was tested using simulated models, constituted by 0.5% saline containing pepsin (3g/L) at pH 1.5, 2.0, 2.5 and 3.0 (gastric juice) and by 0.5% saline containing pancreatin (1g/L) and bile (10g/L) at pH 8.0 (enteric juice). The cultures were exposed to gastric juice (up to 120min) and then to enteric juice (up to 240min). Results indicated that supplementation of MRS agar with certain compounds and use of appropriate combinations of plating procedures and incubation conditions can turn MRS agar a selective and differential medium for the tested species. The combination MRS agar at pH 5,4, pour-plating and incubation at 37°C under aerobiosis was selected for evaluation of resistance of the L. casei (Shirota e Lc01) to the gastrointestinal tract. Results indicated that both cultures became non-culturable after 30min exposure to the gastric juice at pH 1.5 and 2.0. After 2h at pH 2.5, a 4 log reduction was observed. At pH 3.0, no change in the number of viable cells was detected. The subsequent transfer to the enteric juice caused a partial reversion in injury induced by the acid pH. In addition, it was observed that milk can protect the probiotic bacteria from the stress caused by the transit through the gastrointestinal tract.

Em função de sua disponibilidade no mercado e qualidade nutricional, derivados da soja são importantes fontes de proteína na alimentação animal. Apresentam perfil de aminoácidos semelhante ao de fontes animais, o que estimula seu uso como potencial substituto da farinha de peixe nas rações para aquicultura. No entanto, são deficientes em aminoácidos sulfurados e apresentam fatores antinutricionais que prejudicam o crescimento de peixes. O processamento da soja permite obter produtos mais refinados e altamente digestíveis, como concentrados proteicos (CPS), que têm elevado teor proteico e baixa quantidade de fatores antinutricionais, extraídos no processo de fabricação. Neste contexto, foi determinado o Coeficiente de Digestibilidade Aparente (CDA) do CPS em dietas para juvenis de duas espécies de Characidae autóctones: pacu (Piaractus mesopotamicus) e dourado (Salminus brasiliensis). Também foram avaliados os efeitos do uso deste ingrediente em níveis crescentes de substituição da farinha de peixe na dieta (ensaios com seis tratamentos e quatro repetições), com o objetivo de determinar o nível seguro de substituição sem prejudicar o ganho de peso. O pacu apresentou CDA para proteína (95,33 %) e energia (84,29 %) mais altos que o dourado (CDAproteína = 82,6 %; CDAenergia = 66,6 %), indicando maior plasticidade da espécie para o aproveitamento de fontes vegetais. Baseado em ensaios de desempenho, nas dietas para pacu foi possível substituir até 78,05 % da farinha de peixe das dietas experimentais, enquanto que para dourados, até 37,2%. Acima destes níveis, houve redução no crescimento. A substituição crescente da farinha de peixe pelo CPS exerceu efeito regulatório sobre a atividade de enzimas pancreáticas nos primeiros segmentos do intestino das duas espécies, mensurada através da atividade da protease inespecífica, lipase inespecífica e α-amilase. Também promoveu redução na altura das dobras intestinais quando a substituição foi total, detectada através da morfometria da parede intestinal do intestino anterior. Estes efeitos podem ser consequência da ação conjunta de fatores antinutricionais da soja, principalmente inibidores de enzimas, potencializados quando a farinha de peixe foi totalmente substituída pelo CPS; e da habilidade com a qual cada espécie digere / absorve os nutrientes. Com base nos resultados obtidos, foi possível concluir que o CPS pode ser utilizado em substituições parciais da farinha de peixe em dietas para peixes onívoros e carnívoros. / Because of market availability and nutritional quality, soybean and its by-products are important sources of protein for the animal feed industry. The amino acid profile of soy products is similar to that of animal sources, encouraging their use as surrogate protein source to fishmeal (FM) in aquafeeds. However, soy products and by-products are deficient in sulfur amino acids and contain anti-nutritional factors that hamper fish growth. Secondary processing of soybean meals yield more refined and highly digestible protein ingredients such as the soy protein concentrate (SPC), which have higher protein contents and lower concentration of anti-nutritional factors, partially extracted or inactivated during the manufacturing process. In such a context, this work determined SPC\'s Apparent Digestibility Coefficient (ADC) in diets for two juveniles neotropical, native Characins species: pacu (Piaractus mesopotamicus), and dourado (Salminus brasiliensis), and also studied the effects of replacing graded levels of FM by SPC (six treatment levels and four repetions) in the aim to determine the optimum substitution level for better growth. Pacu presented higher ADC for protein (95,33 %) and energy (84,29 %) than dourado (ADCprotein = 82,6 %; ADCenergy = 66,6 %), indicating the plasticity of the specie to utilize plant sources. Based on growth performance, for pacu it was possible to substitute until 78,05% of FM, whereas for dourado, until 37,20%. Above these levels, there were reduction on growth performance. The increasing replacement of FM by SPC had regulatory effect on the activity of pancreatic enzymes in the first segment of the intestine of both species, measured through enzymatic assays for unspecific protease, unspecific lipase and α-amylase. It also caused a reduction on intestinal fold height of proximal intestine. All of these effects can be attributed to soybean anti-nutritional factors, especially enzyme inhibitors, whose action was enhanced when FM was completely replaced by the SPC; and the specific ability of each specie to digest / absorb plant nutrients. It is safe to infer that SPC can only be used as partial replacement of FM in diets for omnivore and carnivore fish.

INTRODUÇÃO: Estudos recentes têm demonstrado que ocorre geração normal de trombina na cirrose hepática mesmo nos pacientes com diminuição da atividade de protrombina e plaquetopenia, de forma que a utilidade dos testes convencionais de coagulação em predizer o risco de sangramento associado a procedimentos seria questionável. OBJETIVO: O objetivo principal deste estudo foi avaliar se as alterações dos parâmetros de coagulação influenciam a frequência e gravidade do sangramento por úlcera após ligadura elástica de varizes de esôfago. CASUÍSTICA E MÉTODOS: Neste estudo prospectivo de coorte realizado no período de dois anos, no Hospital das Clínicas da Faculdade de Medicina da USP, foram incluídos 150 pacientes com o diagnóstico de cirrose hepática, encaminhados para realização de ligadura elástica como profilaxia primária (n=45) e secundária (n=105) de sangramento por varizes de esôfago. Os critérios de inclusão foram: a) presença de varizes de esôfago de médio ou grosso calibre; b) idade superior a 18 anos; c) concordância em participar do estudo. Os critérios de exclusão foram: a) doenças pulmonares e cardíacas graves ou síndrome hepatorrenal associada; b) carcinoma hepatocelular avançado; c) insuficiência renal com uremia; d) doenças ou uso de drogas que alteram a coagulação sanguínea. Foram analisados em todos os pacientes: International Normalized Ratio (INR), tempo de tromboplastina parcial ativada e contagem de plaquetas. Em 92 pacientes foram avaliados: atividade do fator V, fator de von Willebrand, fibrinogênio, proteínas C e S, dímero-D e tromboelastografia. Os pacientes foram estratificados de acordo com: a) grau de disfunção hepática, avaliado pela classificação de Child-Pugh [Child A, n=74 (49%); Child B, n=42 (28%); Child C, n=34 (23%)]; b) valores de corte de INR [>1,5 (n=28); 1,5 (n=122)]; e plaquetas [<50x103/mm3(n=18); 50x103/mm3 (n=132)]; c) padrões da tromboelastografia; d) valores e/ou atividade dos fatores pró-coagulantes e anticoagulantes naturais. As sessões de ligadura foram realizadas a cada 2 semanas. Os dados de cada paciente foram registrados até dois meses após erradicação das varizes. RESULTADOS: Onze pacientes apresentaram sangramento por úlcera após LE. Sangramento ocorreu em cinco pacientes com Child A/B (4,3%) e em 6 pacientes com Child C (17%) (p=0,0174 para Child A/B versus Child C). Oito pacientes (7,3%) apresentaram sangramento entre os 110 pacientes com valores de corte tradicionalmente considerados seguros para INR e plaquetas e apenas três (7,5%) entre os 40 pacientes com valores de risco (p=1,0). Dentre os 92 pacientes com testes expandidos de coagulação, o sangramento ocorreu em cinco. Não houve diferença em nenhum dos parâmetros de coagulação incluindo os padrões da tromboelastografia entre os pacientes com e sem sangramento. CONCLUSÕES: O sangramento por úlcera após ligadura elástica de varizes de esôfago foi associado com o grau de disfunção hepática (Child C), mas não com os fatores convencionais ou expandidos da coagulação em pacientes cirróticos sem insuficiência renal ou infecção submetidos à ligadura elástica eletiva. Estes resultados tornam discutível a necessidade de administração profilática de agentes pró-coagulantes previamente a procedimentos invasivos eletivos / BACKGROUND & AIMS. There is controversy over whether coagulation status predicts bleeding caused by ulceration after esophageal varices band ligation (EVL). METHODS: EVL was performed for primary (n=45) or secondary (n=105) prophylaxis in 150 patients with cirrhosis (Child A, n=74 [49%]; Child B, n=42 [28%]; Child C, n=34 [23%]). International Normalized Ratio (INR) and platelet counts (PC) were assessed in all. In 92 patients, levels of factor V, fibrinogen, D-dimer, protein C and protein S, von Willebrand factor and thromboelastography (TEG) were assessed. PC <50x103/mm3 and INR >1.5 were considered high-risk cutoffs for bleeding. Conversely, PC 50x103/mm3 with INR 1.5 were safe cutoffs. RESULTS: Overall, 11 patients (7.3%) had post-EVL ulcer bleeding. Bleeding occurred in 5 patients with Child A/B (4.3%) and 6 patients with Child C (17%) (p=0.0174 for Child A/B versus Child C). Eight patients with bleeding were among the 110 below the cutoff for INR and PC, whereas only 3 of the patients with bleeding were among the 40 patients with purported high-risk values (p=1.0). Among the 92 patients with expanded coagulation tests, bleeding occurred in 5. There was no difference in any of the coagulation parameters, including overall TEG patterns, between patients who did and did not bleed. CONCLUSION: Post-EVL ulcer bleeding was associated with Child C status but not with conventional or expanded coagulation indices in cirrhotic patients without renal failure or infection undergoing elective EVL. These results call into question the common use of prophylactic procoagulants in the elective setting. common use of prophylactic procoagulants in the elective setting

A desconexão ázigo-portal e esplenectomia (DAPE) é a operação mais aceita e realizada em nosso meio para a profilaxia da recidiva hemorrágica por ruptura de varizes esofágicas ou gástricas em pacientes portadores de esquistossomose hepato-esplênica. Menores índices de ressangramento são obtidos através da associação da DAPE com escleroterapia ou ligadura elástica endoscópica das varizes esofágicas realizada no pós-operatório. Faltam trabalhos mostrando a evolução, a longo prazo, dos doentes esquistossomóticos submetidos a este tratamento. Este estudo retrospectivo tem como objetivo avaliar a evolução destes pacientes com tempo mínimo de seguimento de 5 anos. Foram analisados os prontuários dos pacientes operados no Serviço de Cirurgia de Fígado e Hipertensão Portal da Disciplina de Cirurgia do Aparelho Digestivo do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período compreendido entre março de 1989 a março de 2001 e que foram acompanhados prospectivamente. Avaliamos dados clínicos, laboratoriais, endoscópicos e ultra-sonográficos de 97 pacientes com seguimento de 116,4 ± 46,7 meses. Nenhum paciente cursou com insuficiência hepática clínica ou laboratorial. Ocorreu, no pós-operatório tardio, correção da anemia, leucopenia e plaquetopenia, diminuição dos níveis de bilirrubinas total e indireta séricas e aumento do tempo de atividade da protrombina. Houve significativa redução do número e calibre das varizes esofágicas, assim como da presença de sinais de manchas vermelhas e de varizes gástricas. Houve aumento na freqüência de gastropatia congestiva, entretanto, sem repercussão clínica significativa. A recidiva hemorrágica xviii ocorreu em 24,7% dos pacientes, sendo em 14,6% quando considerada apenas por varizes esofágicas, gástricas ou duodenais. A probabilidade estimada de não ocorrer ressangramento em 20 anos é de 67,1%, sendo de 82,5% quando considerada recidiva por varizes. Em quatro pacientes a recidiva hemorrágica ocorreu por varizes, mesmo após o relato, em exame endoscópico prévio, de erradicação das varizes esofágicas. À avaliação ultrassonográfica observou-se redução do calibre da veia porta no pósoperatório tardio, em comparação ao pré-operatório. Concluímos que a desconexão ázigo-portal com esplenectomia, associada ao tratamento endoscópico de varizes esofágicas no pós-operatório, propicia bons resultados do ponto de vista clínico com baixa morbidade e mortalidade; permite melhora laboratorial da função hepática e correção do hiperesplenismo; determina a redução da incidência dos sinais endoscópicos preditivos de sangramento digestivo por hipertensão portal (varizes esofágicas de grosso calibre, sinais de manchas vermelhas e varizes de fundo gástrico), porém, a gastropatia congestiva é mais freqüente; permite adequada profilaxia da recidiva hemorrágica em 67% dos pacientes ao longo de 20 anos. A recidiva hemorrágica por varizes pode ocorrer mesmo após a erradicação das varizes esofágicas, tanto por recidiva de varizes como por varizes de outro sítio (gástrica ou duodenal). Ocorre redução do calibre da veia porta no pós-operatório tardio, observado em exame ultrassonográfico em comparação ao pré-operatório. / Esophagogastric devascularization and splenectomy (EGDS) is nowadays the most performed operation for esophageal varices bleeding recurrence prophylaxis in hepatosplenic schistosomiasis. Lower rebleeding rates are obtained through the association of EGDS with postoperative endoscopic sclerotherapy or elastic bandage of esophageal varices, however, there is a lack of studies showing long term results. The objectives of this study were to evaluate retrospectively EGDS results in patients with at least five years of follow-up. Clinical, laboratorial, endoscopic and ultrasonographic data of 97 patients submitted to EGDS from March 1989 to March 2001 were analyzed. The mean follow-up was 116.4 months. There was no postoperative clinical or laboratorial hepatic insufficiency. In the late follow-up we observed normalization of preexisting anemia, leucopenia, thrombocytopenia, hyperbilirubinemia, and a prothrombin activity time increase. There was a significant esophageal varices caliber and number reduction, cherry red spots signs and gastric varices decrease. Congestive gastropathy was observed more frequently but without clinical importance. Bleeding recurrence occurred in 24.7% of the patients, however, in 14.6% when esophageal varices hemorrhage was considered. Estimated probability of rebleeding prophylaxis over 20 years is 67.1% and 82.5% when variceal recurrence was considered. Bleeding recurrence occurred in four patients even after endoscopic evaluation showing esophageal varices eradication. There was a significant portal vein caliber reduction on late ultrasound assessment, compared to preoperative. We concluded that the EGDS with postoperative endoscopic treatment leads to good clinical results with low morbidity and mortality; provides laboratorial liver function improve and xx hypersplenism correction; determines endoscopic predictive signs of portal hypertension digestive bleeding decrease (large esophageal varices, cherry red spots signs and gastric varices), however congestive gastropathy is more frequent; allows appropriate bleeding prophylaxis in 67% of the patients over 20 years. Variceal hemorrhagic recurrence may occur even when esophageal varices eradication is reached suggesting the need of an endoscopic surveillance even in this group of patients.

O cuidador familiar é aquela pessoa da família com ou sem experiência na área da saúde, que assume os cuidados ao familiar no domicílio, ajudando-o a suprir suas necessidades proporcionando conforto, lazer e garantindo o bem-estar a pessoa necessitada. Neste sentido este estudo caracteriza o cuidador familiar de pacientes submetidos à cirurgia gastro-intestinal de grande porte quanto a idade, sexo, religião, parentesco, estado marital, ocupação, grau de instrução e também quanto a pessoa que ajuda, experiências anteriores e tempo de dedicação aos cuidados. Outro objetivo proposto foi identificar os cuidados realizados no domicílio pelos cuidadores familiares quanto a higiene e conforto, sono e repouso, cuidados com a pele, cuidados com sondas e/ou drenos e/ou catéteres e/ou bolsas coletoras, alimentação e hidratação, eliminações intestinal e urinária, administração de medicamentos, atividade física e de lazer. Identifica, ainda, a utilização de materiais e equipamentos, bem como de adaptações feitas no ambiente físico no domicílio do doente e o uso de terapias complementares desenvolvidas para a realização do cuidado. Por fim, identifica as vias de contato utilizadas pelos cuidadores familiares voltadas para esclarecimento de dúvidas. É um estudo do tipo descritivo, exploratório, correlacional, de campo, longitudinal com abordagem quantitativa, constando de uma amostra de 15 cuidadores que residiam no município de São Paulo, tinham como cuidador principal alguém da família e concordavam em participar do estudo. Os dados foram coletados pela pesquisadora no período de janeiro a abril de 2001 no domicílio dos doentes em dois momentos, sendo o primeiro entre o 2o e 4o dia após a alta hospitalar e o segundo entre o 10o e 12o dias. O estudo mostrou que os cuidadores familiares deixaram de lado suas atividades profissionais ou não, para estarem disponíveis ao familiar durante o dia e a noite, realizando atividades até então só observadas durante a internação hospitalar. Durante as entrevistas constatou-se estarem inseguros, com dúvidas no cuidar, sozinhos, indecisos, inseguros, com dúvidas no cuidado, mas permaneciam firmes superando todos os obstáculos. / The familiar caregivers is the person from the family with or without experience in the health area that assumes the cares to the family in the home, helping her/him to provide their needs giving comfort, spare time and assuring the person well being. In this course this study characterizes the family caregiver of patients underwent to a large gastrointestinal surgery related to age, sex, religion, relationship, marital status, occupation, education level and about the person that care, her/his previous experiences and period of dedication to the cares. Another proposed aim was to identify the achieved cares in the home by family caregivers regarding to the hygiene and comfort, sleep and rest, skin cares, probe and/or drain and/or catheter and/or collect bag, nutrition and hydration, urinary and intestinal elimination, medicine administration, physical and spare time activities This study identifies yet the use of material and equipments as well as adaptation realized in the physical environment. In the patient home and the use of complementary therapies developed for the care realization. At last it identifies the contact ways used by family caregivers turned to the doubts explanation. It is a descriptive, exploratory, co-relational and longitudinal study, of field, with quantitative approach, consisting of a sample of 15 caregivers that lived in São Paulo City and that have as a main caregiver the family member and they agreed with participate of this study. Researcher collected the data in the period from January to April 2001, on patients home in two moments, being the first between the 2th and 4th day after the discharge from hospital. The second moment occurs between the 10th and 12th days. The study showed that the family caregivers have laid aside their professional activities or not aiming to be available to the family during the day and the night, realizing activities up until then only observed during the nosocomial admission. During the interviews it was verified that the caregivers were alone, hesitant, insecure, with doubts about the care, they have no one to help them, but they stay resolute to overcome difficulties.

Animals acquire immunity against gastrointestinal (GI) nematode infection depending on their age and continual exposure to larvae, however, expression of this acquired immunity is often penalized during pregnancy and lactating period. This is described as periparturient relaxation in immunity (PPRI), and suggested to have nutritional basis. Although dietary protein has positive effect on immunity against GI nematode infection in mammalian host, we have not fully achieved to characterise the detailed interaction between PPRI and dietary protein. Therefore, this PhD aimed to further investigate this interaction in a well-established Nippostrongylus brasiliensis re-infected lactating rat model. Feeding high protein diet (HP) as opposed to low protein diet (LP) during pregnancy was necessary in maintaining sufficient maternal performances and systemic immune response (Chapter 2 and 3). Accumulation of host’s body protein reserve during pregnancy was significantly higher in HP fed animals compared to LP fed counterparts, which led to improvement in both maternal performances and immunity during the early stage of lactation. However, as lactation period progressed and re-infection of N. brasiliensis took place, importance of current dietary status, rather than the accumulated protein reserve, became evident for maternal performances and immunity. Indeed, animals fed HP during lactation showed significantly heavier pup weight compared to LP fed animals; HP animals showed higher serum immunoglobulin levels and reduced worm burden compared to LP. N. brasiliensis, however, goes through systemic migration, entering host’s skin and migrating to lung parenchyma through blood vessels before reaching the intestine. In Chapter 4, a detailed lung pathology study following N. brasiliensis infection was performed to generate data on the effects of the nematode in the lung of the rat host as such data were scarce. Rat host showed similar lung pathology to that of mice; up-regulation of genes related to type 2 immunity and development of emphysema-like pathology were observed following N. brasiliensis re-infection. In Chapter 5, the effect of dietary protein supplementation on lung and intestinal histology and gene expression analysis was investigated. It was shown that HP fed animals showed higher expression of genes related to type 2 immunity compared to LP in the lung. This effect of protein supplementation in the lung may have contributed to fewer worm burdens in HP fed rats compared to LP in the intestine. Dietary protein supplementation significantly affected the expression of genes related to goblet cells; it resulted in up-regulation of the expression of Retnlb and down-regulation of Agr2 and Tff3 in HP fed animals compared to LP. It is evident that dietary protein is modulating intestinal immunity, and this may be targeted towards specific pathways. In addition, the effect of dietary protein supplementation on immune cell populations of secondary lymphoid organs was analysed. Marked increase in the percentage of macrophage in the spleen and T cell in the mesenteric lymph node was observed following protein supplementation, highlighting the importance of dietary protein on systemic immunity during the parasite infection. These results demonstrate that dietary protein supplementation is effective for improving both maternal performances and immune responses, not only at the intestinal phase but also at the migrating phase, when animal is undergoing PPRI during N. brasiliensis infection. Such information is expected to define strategic utilisation of nutrient supply and to result in development of sustainable parasite control strategies in mammals.

For the purpose of developing an effective therapeutic strategy for HSCR, the enteric neural crest stem cells were investigated firstly which were isolated from the E14.5 mouse embryonic gut, cultured as neurospheres and characterized by multiple immunofluorescence and reverse transcription-PCR, population doubling time, frequency of forming secondary neurospheres and limited dilution assay. In the differentiation culture medium, several types of cells were induced to form from the neurospheres derived from single cells. Hence the putative enteric neural crest stern cells, which were isolated from the embryonic mouse gut tube and cultured as neurospheres for many passages ex vivo with the demonstrated capacity of proliferation, self-renewal and differentiation, showed properties of stem cells. / Hirschsprung's disease (HSCR) is caused by the absence of the enteric neural crest-derived neurons at the distal region of the gut. Cell-based therapy using stem cells or progenitors gives the potential to supplement these missing enteric neurons in the gut. Enteric neural crest stem cells isolated from the human or rodent gut can give rise to neurons and glia after they are transplanted into the recipient guts of the mouse or rat. However, numbers of issues are unresolved about the basic biology of the enteric nervous system, the characteristics of the stem cells isolated from the enteric nervous system and the biological significance of these cells in prenatal and postnatal periods. In this study, the characteristics and therapeutic potential on HSCR of the enteric neural crest stem cells were explored. / In addition to the above, a recombination organotypic gut culture ex vivo showed that the colonization of enteric neural crest-derived cells in the recipient gut was influenced not only by the genotypes of enteric neural crest-derived cells themselves but also the microenvironment of the gut through which enteric neural crest-derived cells migrated. For instance, the developmental stage of the recipient gut and also the presence of endogenous enteric neural crest-derived cells along the migratory pathway of neural crest-derived cells both affected the extent of the migration and colonization of exogenous enteric neural crest-derived cells and stem cells. The gradual maturation and differentiation of the neighboring structures, such as the smooth muscle layer, during the time period of the enteric neural crest cells migration, might also suggest that these neighboring tissues may have a role in regulating the neural crest-derived cells migration. / In conclusion, enteric neural crest stem cells isolated from the embryonic mouse gut tube showed properties of stem cells, and had the potential to compensate missing enteric neural crest-derived cells both ex vivo and in vivo. However, the colonization of enteric neural crest-derived cells in the developing gut was affected cell-autonomously and also by the microenvironment of the gut and the presence of existing enteric neural crest-derived cells. / Their potential applications in the transplantation experiments were shown by transplantation of the neurospheres isolated to the gut tube maintained in an organotypic culture or to the descending colon of neonates at postnatal day 7. The development of the enteric neural crest stern cells from the neurospheres was found to be compatible to endogenous enteric neural crest-derived cells in the recipient gut as evidenced by the formation of interconnected cellular networks of donor stem cells and endogenous neural crest-derived cells. The enteric neural crest stem cells also possess the potential to compensate the loss of enteric neural crest-derived cells ex vivo and in vivo in recipient prenatal and postnatal guts. / Bao, Lihua. / Adviser: Wood Yee Chan. / Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 208-228). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.