Background: The prevalence of diabetes is disproportionately distributed in Central Appalachia compared with other regions in the U.S. Previous research reveals that nearly 65% and 17% of patients with diabetes reported having history of cardiovascular heart disease (CHD) and coronary artery disease (CAD) respectively. This study examined the prevalence of factors associated with subclinical atherosclerosis (measured as coronary artery calcium) in patients with diabetes in geographic locations of rural Central Appalachia. Methods: The study population consisted of 2479 asymptomatic individuals from the rural Central Appalachian region of Kentucky, North Carolina, Tennessee, and Virginia between August 2012 and November 2016. Descriptive analysis was completed for the total sample size with sub analysis of individuals with diabetes. T-test was used for comparison of categorical (example: hypertension and physical inactivity) and continuous variables (example: age and BMI), respectively. In addition, multinomial logistic regression was conducted to assess the association between multiple risk factors including CAC scores, and geographic locations of patients with diabetes in rural Central Appalachia. Results: There was no significant difference between ages for diabetic and non-diabetic patients. Individual factors which are associated with diabetes include current CAC score (p<0.001, CI: 45.90 – 189.98), BMI (p<0.001, CI: 3.01 – 5.64), sedentary lifestyle (p<0.005, CI: 0.039 – 0.215), history of CAD (p<0.001, CI: 0.08 - 0.19), hypercholesterolemia (p<0.001, CI: 0.64 – 0.23), and hypertension (p<0.001, CI: 0.18 – 0.34). There was no significant correlation between geographic locations and diabetes. Among male and female genders, hypertension, hypercholesterolemia, history of CAD, sedentary lifestyle, current CAC score, and BMI have a significant positive correlation with diabetes except for self-reported obesity which only has a significant positive correlation with the female gender. Conclusion: Individual factors remain associated with diabetes across the male and female genders regardless of the geographic locations of the diabetic patients in rural Appalachia. There is strong evidence that cardiovascular related factors could be associated with diabetes across both genders in rural Central Appalachia. We suggest the implementation of evidence-based public health strategies to address the modifiable behaviors that can improve the health of people in rural Central Appalachia.

L’objectif de la présente étude était d’évaluer un test d’estérase leucocytaire (LE) pour le diagnostic de l’endométrite subclinique chez les vaches Holstein en période postpartum. Les tests effectués à partir d’échantillons provenant soit de l’endomètre (UtLE) ou du col utérin (CxLE) ont été comparés à la cytologie endométriale (CE). Par ailleurs, deux méthodes d’évaluation des lames ont été comparées. Deux cent quatre vingt-cinq vaches Holstein de 5 troupeaux laitiers commerciaux ont été évaluées entre 21 et 47 jours en lait (JEL). Soixante sept vaches ont été diagnostiquées avec une endométrite clinique suite à un examen transrectal et vaginoscopique et ont été exclues de l’étude. Deux cent dix-huit vaches ont eu des prélèvements pour la CE et le test LE. La fonction ovarienne a été déterminée à la palpation transrectale. La banque de données utilisée pour chacune des vaches a été effectuée à partir du logiciel DSA (Dossier de Santé Animale) laitier. Le pourcentage de neutrophiles était significativement corrélé avec les scores de LE utérin et cervical. L’activité de CxLE et UtLE diminuait significativement avec les JEL, mais n’était pas associée au risque de gestation à 90 JEL (n= 186). Le pourcentage de neutrophiles mesuré à la CE entre 32 et 47 JEL était associé significativement au risque de gestation à 90 JEL (n=94, P=0.04). Pour la même période, selon une analyse de survie, les vaches avec >2,6% de neutrophiles à la CE étaient définies comme étant atteintes d’une endométrite subclinique avec une prévalence de 56%. Les résultats indiquent que le test d’estérase utérin ou cervical a une bonne concordance avec le pourcentage de neutrophiles à la CE. Une endométrite subclinique diagnostiquée par cytologie endometriale entre 32 et 47 JEL est associée à une réduction du risque de gestation au premier service. / The point toward this study was to determine the diagnostic test characteristics of the leukocyte esterase activity test for subclinical endometritis in postpartum Holstein dairy cows. The objectives were 1) to compare uterine leukocyte esterase activity and the endometrial cytology (EC), 2) to compare leukocyte esterase activity of the cervix (CxLE) and the uterus (UtLE), 3) Compare two methods of assessing the slides (i.e. an exhaustive method and a rapid method). Two hundred eighty five post partum Holstein cows from 5 commercial dairy herds had a post partum evaluation between 21 and 47 days in milk (DIM). Sixty seven cows where diagnosed with clinical endometritis by transrectal and vaginoscopy examinations and were excluded from the study. Two hundred eighteen cows were enrolled for endometrial cytology and esterase activity test. The ovarian status was determined by transrectal examination. Computerized databank, dairy DSA (Dossier de Santé Animale) indexing all the cows was used to retrieve individual information for analysis. The percentage of neutrophils was significantly correlated with the LE from the uterus and cervix. The LE from cervix and uterus decreased significantly with DIM, however, they were not statistically associated with pregnancy risk at 90 DIM (n=186). Between 32-47 DIM, the percentage of neutrophils and risk of pregnancy at 90 DIM were associated (n=94, P=0.04). For the same period, survival analysis identified cows with > 2.6 % neutrophils on EC as subclinical endometritis cows with a prevalence of 56%. The two methods for assessing the slides were correlated by 81%. Subclinical endometritis diagnosed by endometrial cytology between 32 and 47 DIM was associated with reduced risk of pregnancy at first service.

INTRODUÇÃO: Infertilidade atinge aproximadamente 15% dos casais em idade reprodutiva e afeta de maneira profunda a vida dessas pessoas. Dentre as causas identificáveis de infertilidade masculina, a varicocele é a mais frequente e acomete cerca de 40% dos homens inférteis ou subférteis. Um dos maiores desafios na abordagem cirúrgica da varicocele é a identificação de indivíduos que apresentarão maior benefício com o tratamento, uma vez que muitos pacientes não apresentam melhora da análise seminal. OBJETIVOS: Identificar um padrão histológico testicular como prognóstico da melhora da capacidade reprodutiva em pacientes submetidos à varicocelectomia microcirúrgica. METODOLOGIA: Estudo retrospectivo composto pela análise de 60 biópsias testiculares bilaterais de homens inférteis atendidos em clínica especializada de fertilidade masculina, entre os anos de 2006 e 2014. Como critérios de inclusão foram considerados homens com diagnóstico de varicocele clínica e subclínica entre 19 e 50 anos de idade com resultados de análise histopatológica testicular. Os sujeitos de pesquisa foram divididos em dois grupos. Grupo 1: homens com diagnóstico de varicocele subclínica (n = 20). Grupo 2: homens com diagnóstico de varicocele clínica (n =40). Foram excluídos do estudo homens com diagnóstico de criptorquidia, azoospermia obstrutiva e não-obstrutiva, usuários de drogas e anabolizantes, além de pacientes portadores de doenças sexualmente transmissíveis e de neoplasias no trato geniturinário. Os participantes foram submetidos ao exame físico urológico com a avaliação do volume testicular por meio de ultrassonografia da bolsa escrotal com Doppler-Colorido. O diagnóstico da varicocele foi realizado por meio da palpação cuidadosa do plexo pampiniforme com o paciente em posição ortostática. A manobra de Valsava foi utilizada para a classificação clínica do grau de varicocele. Para a determinação de um padrão histológico capaz de predizer a melhora da capacidade reprodutiva, foram criados valores de corte que associam os scores de Johnsen, os índices de Copenhagen e o volume testicular à melhora dos parâmetros seminais. RESULTADOS: No grupo 1, para a melhora da concentração espermática o score de Johnsen deve ser superior a 8,2 (lado esquerdo) e o volume testicular acima de 12,8 mL (lado direito). Adicionalmente, para a avaliação da motilidade total de espermatozoides os scores de Johnsen devem ser superiores a 8,2 (bilateral) e o dígito II de Copenhagen inferior a 2,5 em ambos os testículos. Todavia, para a motilidade progressiva de espermatozoides o score de Johnsen deve ultrapassar a 9,1 (bilateral) e na avaliação da morfologia espermática, este deve se apresentar acima de 7,9 e com volume testicular acima de 13,6 mL (lado direito). Quanto aos valores de corte obtidos no grupo 2, para a concentração de espermatozoides, os scores de Johnsen devem ser superiores a 5,5 com volume testicular acima de 11,5 mL em ambos os testículos. Finalmente, quanto à motilidade espermática total e progressiva, o dígito III do índice de Copenhagen deve ser inferior a 1,5 (lado direito). CONCLUSÃO: Valores prognósticos da melhora da capacidade reprodutiva obtidos por meio de biópsia testicular podem auxiliar com eficácia no prognóstico e na avaliação dos pacientes candidatos à correção microcirúrgica da varicocele / BACKGROUND: Infertility affects approximately 15% of couples in reproductive age and profoundly changes the lives of these people. Among the identifiable causes of male infertility, varicocele is the most common and affects about 40% of infertile or subfertile men. One of the challenges in the surgical approach is the identification of individuals who will present benefits with the treatment, since many patients do not show improvement of semen analysis. OBJECTIVE: To identify a testicular histological pattern as prognostic value of improved reproductive capacity in patients submitted to microsurgical correction of varicocele. METHODS: we retrospectively analyzed bilateral testicular biopsies of 60 men attending specialized clinic of male fertility between the years 2006 and 2014. As inclusion criteria were considered men diagnosed with clinical and subclinical varicoceles between 19 and 50 years old with results of testicular histopathology and seminal analysis. The patients were divided into two groups. Group 1: Men diagnosed with subclinical varicocele (n = 20). Group 2: men diagnosed with clinical varicocele (n = 40). Men diagnosed with cryptorchidism, obstructive and non-obstructive azoospermia, users of drugs and anabolic steroids were excluded of the study. All Participants were submitted to urological physical examination with the evaluation of testicular volume by ultrasonography of the scrotum with Color Doppler. The diagnosis of varicocele was performed by careful palpation of pampiniform plexus with the patient in standing position. The Valsalva maneuver was used to classify the grade of varicocele. The determination of a testicular histological pattern as prognostic value of the improved reproductive capacity was performed by the creation of cut-off values that associate Johnsen scores, Copenhagen indices and testicular volume to improvement in semen parameters. RESULTS: In Group 1, for improvement of sperm concentration, the Johnsen score must be greater than 8.2 (in the left testicle) and testicular volume must be greater than 12.8 mL (in the right testicle). Concerning evaluation of sperm total motility, the Johnsen score must be greater than 8.2 (bilateral) and digit II of Copenhagen indices must be less than 2.5 (bilateral). However, for sperm progressive motility, the Johnsen score must exceed 9.1 (bilateral) and evaluation of sperm morphology must be greater than 7.9 with right testicular volume greater than 13.6 mL. In Group 2, the cut-offs values for sperm concentration indicates that Johnsen scores must be greater than 5.5 with testicular volume greater than 11.5 mL in both testicles. Finally, regarding the sperm total and progressive motility, the digit III of Copenhagen indice must be less than 1.5 (in the right testicle). CONCLUSION: Prognostic values of improved reproductive capacity obtained from testicular biopsy can assist effectively in the prognosis and evaluation of patients candidates for microsurgical correction

As doenças cardiovasculares e o diabete melito fazem parte das DCNT prioritárias da OMS, devido às altas taxas de morbimortalidade e incapacidade que geram a cada ano. Estima-se que no mundo existam 387 milhões de diabéticos e outros 316 milhões de pessoas com características de risco, como pré-diabete. Cerca de 60% dos pacientes com DM2 desenvolvem doença cardiovascular, a qual inicia de forma concomitante aos distúrbios do metabolismo da glicose, podendo existir mecanismos fisiopatológicos comuns entre as doenças. Metade dos eventos coronarianos, inclusive a morte súbita, ocorrem em indivíduos assintomáticos, evidenciando a necessidade de novos marcadores precoces, já que em muitos deles a morte é a primeira manifestação. Recentemente, tem sido sugerido que os miRNAs envolvidos na regulação da expressão gênica podem ser caracterizados como biomarcadores em diversas doenças. Nosso objetivo é identificar alterações no perfil de miRNAs circulantes em indivíduos euglicêmicos e pré-diabéticos com e sem aterosclerose subclínica, utilizando a tecnologia de qPCR Arrays, com a finalidade de identificar candidatos a biomarcadores moleculares dessa condição. Encontrou-se que a aterosclerose subclínica esteve associada com o envelhecimento, a menopausa, etnia branca, dislipidemia, resistência à insulina, o aumento da adiposidade, leptina e do TNF-&#945;. O aumento do miR98-5p e a diminuição dos miRNAs miR-212-3p, miR-145-5p, miR-93-5p, miR15a-5p, miR-19a-3p, miR32-5p levaram a ativação da via de sinalização da aterosclerose. Os resultados sugerem que a inflamação foi o principal mecanismo associado com o desenvolvimento de aterosclerose subclínica neste estudo. / Cardiovascular Disease and Diabetes Mellitus are relevant NCDs for the WHO. It´s estimated that, worldwide, there are 387 millions of diabetics and 316 millions of people with risk characteristics like prediabetes. About 60% of patients with T2DM develops cardiovascular disease, which starts at the same time as disorders of glucose metabolism, there may be common pathophysiological mechanisms among diseases. Half of coronary events, including sudden death, occurs in asymptomatic individuals. This fact, highlights the need for new early markers of the disease, especially in asymptomatic patients, since in many of them, death is the first manifestation. It has been recently suggested that miRNAs involved in pos-transcriptional regulation of gene expression, could be characterized as biomarkers of diseases. Our goal is to identify changes in the profile of circulating microRNAs in euglycemic and prediabetic patients with or without subclinical atherosclerosis, by quantitative Polymerase Chain Reaction array (qPCR Array) in order to find molecular biomarkers of this condition. We found that subclinical atherosclerosis was associated with aging, menopause, white ethnicity, dyslipidemia, insulin resistance, increased adiposity, leptin and TNF-&#945;. The up-regulation of miR98-5p and the down-regulation miR-212-3p, miR-145-5p, miR-93-5p, miR15a-5p, miR-19a-3p, miR32-5p led to activation of the signaling pathway of atherosclerosis. The results suggest that inflammation was the main mechanism associated with the development of subclinical atherosclerosis in this study.

Os objetivos do presente estudo foram os de verificar a validade do método de reação em cadeia da polimerase em tempo real (qPCR) para detectar e quantificar o Staphylococcus aureus em amostras de leite conservadas com bronopol oriundas de quartos mamários bovinos subclinicamente infectados, e de avaliar os efeitos da presença e da quantidade de células da bactéria sobre a contagem de células somáticas (CCS), a composição do leite (lactose, gordura, proteína bruta, proteína verdadeira e caseína), e a produção de leite de quartos mamários bovinos subclinicamente infectados pelo patógeno. Para a quantificação do S. aureus e das células somáticas bovinas por meio do qPCR, foi utilizado leite cru bovino para o preparo dos padrões como meio de diluição da inoculação seriada de células somáticas e do S. aureus ATCC 29213, e construídas as equações log10UFC = 37,86 23,54 log10CtSAU e log10CCS = 49,3 - 34,0 log10CtBMCB, com base nos resultados obtidos pelas metodologias de referência para cada procedimento. Para testar a equivalência dessas equações aos respectivos métodos de referência, determinar a sensibilidade e especificidade analíticas e a repetibilidade do método proposto, foram coletadas amostras de leite dos quartos mamários de 60 animais de 2 rebanhos leiteiros da região de Pirassununga dos quais se determinou previamente a ocorrência de casos subclínicos de mastite por S. aureus. Dos quartos mamários também foram mensuradas as produções e coletadas amostras de leite para análise de composição, diagnóstico da mastite, e determinação da sensibilidade e especificidade diagnósticas do procedimento de qPCR estabelecido no estudo. Cada amostra foi submetida à análise de composição, CCS, cultura microbiológica, contagem em placas do S. aureus, processadas para a extração do DNA genômico bovino e do S. aureus, e submetida à reação de qPCR. Para análise da concordância entre os resultados obtidos pelos métodos de referência para o diagnóstico da mastite por S. aureus e o de qPCR foi utilizado o teste Kappa. Para avaliação da equivalência das contagens obtidas pelos métodos de referência do S. aureus e de células somáticas bovinas, foi utilizado o teste das diferenças de Bland-Altman. Para a identificação do efeito da infecção subclínica pelo S. aureus sobre a composição e produção de leite do quarto mamário afetado foi utilizada a análise da variância num delineamento em parcelas subdivididas em faixas. Para estimar o grau de relação entre as contagens de S. aureus, a CCS, produção e composição do leite produzido pelo quarto mamário afetado foi utilizado o coeficiente de correlação de Pearson. A correlação entre os resultados de contagem de células somáticas bovinas determinados pelos métodos de rotina e de qPCR para a quantificação de células somáticas apresentou coeficiente r = - 0,978 (P < 0,001). A correlação entre os resultados da contagem do S. aureus ATCC 29213 determinados pelos métodos de rotina e de qPCR para a quantificação do patógeno apresentou coeficiente r = - 0,989 (P < 0,001). A especificidade analítica do qPCR para a detecção do S. aureus em amostras de leite frente a Escherichia coli, Enterococcus sp., Pseudomonas aeruginosa, Streptococcus agalactiae, Streptococcus dysgalactiae, Streptococcus uberis, os estafilococos coagulase-negativa, e as espécies coagulase-positiva Staphylococcus hyicus e Staphylococcus intermedius foi de 100%. O método de qPCR aplicado à detecção de Staphylococcus aureus ATCC 29213 em amostras de leite é replicável e apresentou sensibilidade analítica com limite de detecção para a faixa de 10 UFC/mL à 4,2 x 106 UFC/mL. Em amostras de leite conservadas com bronopol provenientes de quartos mamários subclinicamente infectados, o S. aureus pôde ser detectado, mas não pôde ser quantificado pelo método de qPCR. Nessas amostras, a CCS pôde ser determinada de forma equivalente ao método de rotina. A CCS independe da contagem de S. aureus viáveis, mas foi observada correlação linear e negativa entre o número total de células do patógeno e a CCS. A mastite subclínica pelo S. aureus aumentou a CCS nos quartos mamários, mas não alterou a composição do leite. A doença diminuiu a produção de leite e de gordura dos quartos mamários anteriores acometidos pela infeção, mas não se observou efeito da interação entre o posicionamento da glândula e a infecção sobre a produção de leite. Houve correlação entre as concentrações de lactose (r = 0,42; P = 0,0051), de gordura (r = 0,46; P = 0,0016), de produção de gordura (r = 0,49; P = 0,001), e de leite com produção ajustada para o teor de 3,5% de gordura (r = 0,41; P = 0,006), e o número de S. aureus presentes na amostra de leite. / The objectives of this study were to verify the validity of the real-time polymerase chain reaction (qPCR) to detect and quantify Staphylococcus aureus in bronopol-preserved milk samples from subclinically infected mammary quarters, and to assess the effects of the presence and amount of the pathogen on the somatic cell count (SCC), the composition of milk and milk yield of bovine mammary quarters subclinically infected by the pathogen. In order to quantify S. aureus and bovine somatic cells through qPCR, raw bovine milk was used as a means of serial inoculation media of somatic cells and S. aureus ATCC 29213. From that, equations based on the reference methods for each procedure were built, log10UFC = 37,86 23,54 log10CtSAU and log10CCS = 49,3 - 34,0 log10CtBMCB, respectively. To test their equivalence with the reference methods, determine the analytical sensitivity and specificity, and repeatability of the proposed method, milk was sampled from quarters of 60 animals from two dairy herds in Pirassununga, where subclinical S. aureus mastitis cases had been previously diagnosed. Also, quarter milk yield had been measured and samples collected for milk composition analysis, diagnosis of mastitis, sensitivity and specificity of the procedure established in the study had been determined. Each sample was subjected to composition analysis, SCC, microbiological culture, plate counting of S. aureus, DNA extraction, and subjected to qPCR reaction. Agreement between results from reference methods and qPCR for the diagnosis of mastitis by S. aureus was assessed by Kappa test. Equivalence between S. aureus, SCC scores obtained by reference and qPCR was assessed with Bland-Altman procedures. The effect of S. aureus subclinical infection on milk composition and milk yield of affected quarters was measured using a strip plot design. To estimate the degree of relationship between the counts of S. aureus, SCC, yield and composition of the milk from affected quarters was assessed by the Pearson Correlation. Correlation between SCC determined by routine methods and qPCR was r = - 0.978 (P <0.001). Correlation between S. aureus ATCC 29213 determined by routine methods and qPCR was r = - 0.989 (P <0.001). Analytical specificity of qPCR to detect S. aureus in milk samples against Escherichia coli, Enterococcus sp., Pseudomonas aeruginosa, Streptococcus agalactiae, Streptococcus dysgalactiae, Streptococcus uberis, coagulase-negative staphylococci and coagulase-positive species, Staphylococcus hyicus and Staphylococcus intermedius was 100%. The use of the qPCR to detect S. aureus ATCC 29213 in milk samples is replicable. Analytical sensitivity detection limit of the method ranged from 10 CFU/mL to 4.2 x 106 CFU/mL. S. aureus could be detected, but not quantified by qPCR in bronopol-conserved milk samples from subclinically infected quarters. In these samples, SCC could be determined by qPCR as it had been done by routine method. SCC was not dependent on S. aureus viable cells, but a negative linear correlation between the total number of cells of the pathogen and SCC was observed. S. aureus subclinical mastitis increased quarters SCC, but did not change milk composition. The disease decreased quarter milk and fat yield, but no interaction effect was observed between the gland positioning and S. aureus subclinical infection on milk production. Correlations between lactose (r = 0.42, P = 0.0051), fat (r = 0.46, P = 0.0016), fat yield (r = 0.49, P = 0.001), and 3.5% fat adjusted milk yield (r = 0.41, P = 0.006), and the number of S. aureus present in the milk sample were observed.

A mastite subclínica (MS) é a doença mais prevalente em rebanhos leiteiros e pode ser identificada pela contagem de células somáticas (CCS) individual das vacas. A partir disso, indicadores podem ser calculados como, por exemplo, prevalência e incidência. A prevalência diz respeito à proporção do rebanho infectada em determinado momento, enquanto que a incidência estima a taxa de novas infecções intramamárias ao longo do tempo. Altos valores de prevalência e incidência acabam resultando em elevada CCS do tanque de resfriamento (CCST), que por consequência leva a penalizações oriundas dos programas de pagamento por qualidade do leite (PPQL). Desta forma, estimar os valores atuais de prevalência e incidência de MS relacionados com valores futuros de CCST e as perdas financeiras oriundas dos PPQLs se torna importante para estimular a melhoria da qualidade do leite produzido no Brasil. Portando, o objetivo deste trabalho é estimar os indicadores epidemiológicos de MS em rebanhos leiteiros brasileiros, além prever a CCST relacionando-a as perdas financeiras devidas ao PPQL. Para isso, foram utilizados dois bancos de dados, sendo o primeiro com dados de CCS individual de vacas para estimação da prevalência e incidência de MS, e o segundo com dados de CCST para a previsão e cálculo de perdas financeiras devido ao PPQL. Como análise estatística, foi utilizado o modelo linear generalizado misto para comparar a prevalência e incidência de MS entre anos, regiões, tamanho de rebanhos e categorias de número de testes enviados durante o período de estudo, além de modelos de séries temporais para previsão da CCST e regressão linear múltipla para prever a probabilidade de mudança de classe de pagamento por qualidade do leite do PPQL. Os resultados encontrados indicam que, ambos, prevalência e incidência de MS permaneceram elevados e com leve tendência de aumento ao longo dos anos estudados, sendo que não houve diferenças entre regiões e tamanho de rebanhos. Por outro lado, rebanhos que realizaram mais testes ao longo do período estudado apresentaram menor prevalência, mostrando a importância da análise rotineira de CCS individual. Para CCST, os valores tem se mantido altos nos recentes anos e sem tendência de melhora. A probabilidade de mudança de classe foi fortemente afetada pela média e desvio padrão de CCST para as classes 1 e 2 (1.000 a 200.000 e 201.000 a 400.000 céls/mL, respectivamente). Os modelos de séries temporais indicaram que em algum ponto do ano, as fazendas não podiam permanecer na sua classe atual do PPQL e acumulavam perdas financeiras. Por fim, este estudo permite concluir que prevalência e incidência de MS estão elevadas e não melhoram ao longo dos anos, sendo que isto acaba elevando os valores de CCST. Além disso, existem perdas financeiras em todas as classes do PPQL, mostrando que os produtores não tem sido eficientes em captar a bonificação máxima dos PPQLs. Por isso, o desenvolvimento de programas de qualidade do leite deve ser uma prioridade em busca da melhoria da qualidade do leite de rebanhos brasileiros. / Subclinical mastitis (SM) is the most prevalent disease in dairy herds and can be identified by individual somatic cell counts (SCC) of cows. From this, indicators can be calculated as, for example, prevalence and incidence. Prevalence refers to the number of infected cows in a herd at a given time, while the incidence estimates the rate of new intramammary infections over time. High prevalence and incidence values result in high bulk tank SCC (BTSCC), which consequently leads to penalties from payment programs based on milk quality (PPBMQ). In this way, estimating current values of prevalence and incidence of SM related to future values of BTSCC and financial losses from PPBMQs becomes important to stimulate the improvement of the quality of milk produced in Brazil. Therefore, the objective of this study is to estimate the epidemiological indicators of SM in Brazilian dairy herds, besides to predicting the BTSCC and relating it to the financial losses due to the PPBMQ. For this, two databases were used, the first one with individual SCC data from cows to estimate the prevalence and incidence of SM, and the second with BTSCC data for prediction and calculation of financial losses due to PPBMQ. For statistical analysis, the mixed generalized linear model was used to compare the prevalence and incidence of SM between years, regions, herd size and number of test-day categories sent during the studied period, as well as time series models for prediction of BTSCC and multiple linear regressions to predict the probability of changing the current payment class for milk quality. The results indicate that both prevalence and incidence of SM remained high and with a slight tendency to increase over the years studied, and there were no differences between regions and herd sizes. On the other hand, herds that performed more test-day during the studied period presented a lower prevalence, showing the importance of the routine analysis of individual SCC. For BTSCC, values have remained high in recent years and no trend for improvement. The probability of class change was strongly affected by the mean and standard deviation of BTSCC for classes 1 and 2 (1,000 to 200,000 and 201,000 to 400,000 cells/mL, respectively). Time series models indicated that at some point of the year, farms could not remain in their current class and accumulated financial losses due to PPBMQ. Finally, this study allows to conclude that the prevalence and incidence of SM are high and do not improve over the years, and this ends up increasing the BTSCC values. In addition, there are financial losses in all classes of PPBMQ, showing that producers have not been efficient in capturing the maximum PPBMQs bonus. Therefore, the development of milk quality programs should be a priority in order to improve the quality of milk from Brazilian herds.

Submitted by admin tede (tede@pucgoias.edu.br) on 2017-11-16T11:05:06Z No. of bitstreams: 1 MARCILON FONSECA DE LIMA.pdf: 1087364 bytes, checksum: 6e2761fa0ab9a541085cc0bf42f4bc54 (MD5) / Made available in DSpace on 2017-11-16T11:05:06Z (GMT). No. of bitstreams: 1 MARCILON FONSECA DE LIMA.pdf: 1087364 bytes, checksum: 6e2761fa0ab9a541085cc0bf42f4bc54 (MD5) Previous issue date: 2017-09-19 / The goal of this study is to diagnose subclinical mastitis in cattle using multivariate classification applying images, Nuclear Magnetic Resonance (NMR) spectra and a bovine data survey set (DIB). The interest objects classification in milk images, NMR and DIB are processed with the algorithm of successive projections, linear discriminant analysis, and partial least squares discriminant analysis. The best diagnostic results obtained by image classification was 75% and 78% with NMR. As a result it can be observed that there is the possibility of classification for the diagnosis of mastitis by image and NMR, however, it is interesting to increase the number of samples for increasing the precision of two evaluated diagnosis methods. / O objetivo do trabalho é fazer o diagnóstico de mastite subclínica em gado bovino empregando classificação multivariada usando imagens, espectros de ressonância magnética nuclear (Nuclear Magnetic Resonance, NMR) e um conjunto de dados de inventário bovino (DIB). A classificação de objetos de interesse nas imagens de leite, NMR e DIB é feita com os algoritmos de projeções sucessivas, análise discriminante linear e análise discriminante por mínimos quadrados parciais. O resultado do diagnóstico obtido por classificação por imagem no melhor caso foi de 75% e com NMR de 78%. Como resultado pode-se observar que há possibilidade de classificação para diagnóstico da mastite por imagem e por NMR, porém é interessante aumentar a quantidade de amostras para um melhor termo.

Poor athletic performance of racehorses is a major and significant problem in the racing industry. Determining the definitive reason for poor-performance is however a real diagnostic challenge since many of the causative conditions are multifactorial and may only be manifested during exercise. A retrospective study, including various breeds of horses, confirmed musculoskeletal, cardiovascular and upper respiratory tract clinical problems to be the most frequently implicated in reducing athletic performance. Evaluation of the lower respiratory tract was though not performed in this study. The aim of the first part of this work were thus to determine the prevalence of different sub-clinical diseases in a population of poorly-performing Standardbred trotters, and to evaluate the sportive repercussions by comparing their physiological response to exercise with control horses. Fifty horses underwent thorough clinical and ancillary examinations, including haematological et biochemical evaluation, Doppler echocardiography, standardised exercise tests on treadmill et racetrack, treadmill video-endoscopy et collection of respiratory fluids. Most of the poorly-performing horses exhibited many concomitant diseases. The most frequently diagnosed sub-clinical problems involved the lower and upper respiratory tract. Poor-performers also exhibited higher values of blood lactate and heart rate, as well as lower values of haematological parameters and anti-oxidants, compared to control horses. Inflammatory airway disease being mostly present in poorly-performing horses, the second part of this work will mainly focus on this syndrome. The negative impact of inflammatory airway disease, as diagnosed by cytological evaluation of bronchoalveolar lavage fluid, has previously been described on respiratory function using either forced expiration or forced oscillations techniques. Sedation or bronchoprovocation were however usually required. On the other hand, the clinical significance of tracheal inflammation remains currently controversial. The aim was therefore to exhibit and define the respiratory dysfunctions present in horses subclinically suffering from inflammatory airway disease. Respiratory function was evaluated at rest by IOS in 34 Standardbred trotters, whereas tracheal mucus score, and both tracheal and bronchoalveolar lavages were performed 60 min post-exercise. According to the cytology of bronchoalveolar lavage fluid, the inflammatory group included 19 horses and 15 horses were used as control. A significant correlation was found between both cytological evaluations concerning neutrophil counts, whereas no association was found between tracheal mucus and any cytology. A significant increase of respiratory resistance at the lower frequencies (1 10 Hz) as well as a significant decrease of respiratory reactance beyond 5 Hz was observed in inflammatory compared to control horses. Both parameters were also significantly different between inspiration and expiration in the inflammatory group only. Both eosinophil and mast cell counts of the bronchoalveolar lavage fluid were significantly correlated with respectively respiratory resistance and reactance. The present work involved intensive clinical and functional evaluation of control and asymptomatic poorly-performing horses. The different studies allowed establishing the prevalence of medical subclinical diseases in these latter and evaluating its sportive impact considering the associated physiological responses to exercise. The presence of respiratory dysfunctions in horses with lower airway inflammation, the major trouble associated with disappointing performance, were also exhibited by impulse oscillometry./ La contre-performance est un problème majeur dans lindustrie des courses. En déterminer la cause exacte reste néanmoins un défi diagnostic puisque la plupart des affections présentes sont souvent subcliniques, multifactorielles et peuvent ne se manifester que pendant lexercice. Une étude rétrospective, incluant des chevaux de différentes races et disciplines, a ainsi confirmé les affections cliniques des voies respiratoires supérieures, musculo-squelettiques et cardiovasculaires comme étant les plus fréquemment impliquées dans la réduction des performances athlétiques. Cependant, lévaluation des voies respiratoires profondes navait pas été effectuée chez ces différents chevaux. Lobjectif de la première partie de ce travail était donc de déterminer la prévalence des différentes affections sub-cliniques induisant une contre-performance chez des Trotteurs Français, et den évaluer les répercussions sportives par la comparaison des réponses physiologiques à lexercice avec celle de chevaux contrôles. Cinquante chevaux ont respectivement été soumis à un examen clinique complet, une prise de sang pour analyse hémato-biochimique au repos et 60 minutes après chaque test deffort, une échocardiographie Doppler, des tests deffort standardisés sur piste et tapis roulant, une endoscopie à leffort, une évaluation locomotrice à grande vitesse, ainsi quun lavage trachéal et broncho-alvéolaire réalisés 60 minutes post-effort. La plupart des chevaux contre-performants ou intolérants à leffort présentaient plusieurs affections concomitantes. Les troubles sub-cliniques les plus fréquemment diagnostiqués concernaient respectivement les voies respiratoires profondes et supérieures. Ces chevaux présentaient par ailleurs des paramètres hématologiques (taux dhémoglobine et volume globulaire moyen) et anti-oxydants significativement inférieurs, et des paramètres pro-oxydants significativement supérieurs aux chevaux contrôles. De plus, les valeurs de fréquence cardiaque et lactatémie étaient, lors des différents tests deffort, significativement supérieures à celles des chevaux contrôles, Linflammation des voies respiratoires profondes étant majoritairement présente chez ces chevaux présentant des performances décevantes, la deuxième partie de ce travail se concentre plus spécifiquement sur ce syndrome. Limpact négatif sur la fonction respiratoire de cette affection, telle que diagnostiquée par lévaluation cytologique du liquide de lavage broncho-alvéolaire, a précédemment été décrite à laide de techniques dexpiration forcée ou doscillations forcées. Une sédation ou une bronchoprovocation étaient cependant généralement requises pour la réalisation de ces tests. Parallèlement, la signification clinique de linflammation trachéale reste actuellement controversée. Lobjectif était ainsi de mettre en évidence et définir les dysfonctions respiratoires présentes chez des chevaux souffrant sub-cliniquement de maladie inflammatoire des voies respiratoires. La fonction respiratoire a été évaluée au repos par oscillométrie à impulsions chez 34 Trotteurs Français asymptomatiques, alors que le score de mucus trachéal et les différents lavages ont été évalués 60 minutes post-effort. Sur base de la cytologie broncho-alvéolaire, le groupe inflammatoire comprenait 19 chevaux et 15 ont été utilisés comme contrôles. Une corrélation significative était observée entre les cytologies concernant le taux de neutrophiles, alors quaucune association nétait présente entre score de mucus trachéal et cytologies des différents lavages. Une augmentation significative de la résistance respiratoire aux faibles fréquences (1 à 10 Hz) et une diminution de la réactance respiratoire au-delà de 5Hz a été observée chez les chevaux inflammatoires comparativement aux contrôles. Ces deux paramètres étaient également significativement différents entre inspiration et expiration dans le groupe inflammatoire uniquement. La résistance et la réactance respiratoire étaient par ailleurs respectivement corrélées aux taux déosinophiles et de mastocytes du lavage broncho-alvéolaire. Ce travail comprenait une évaluation clinique et fonctionnelle intensive chez des chevaux contrôles et des chevaux contre-performants. Les études menées ont permis détablir la prévalence des affections médicales sub-cliniques chez ces derniers et den évaluer limpact sportif par lintermédiaire des réponses physiologiques à lexercice. La présence de dysfonctions respiratoires chez les chevaux avec inflammation des voies respiratoires profondes, premier trouble associé à des performances décevantes, a également pu être mise en évidence à laide de loscillométrie à impulsion.

This study examined the hypothesis that developmental expression of psychometric risk in the form of subclinical psychotic experiences in the general population is usually transitory but in some instances may become abnormally persistent and progress to a clinical psychotic state. A prospective cohort study was conducted in a general population sample of 845 adolescents, aged 14–17 years, in Munich, Germany (Early Developmental Stages of Psychopathology Study). Expression of psychosis was assessed 4 times (T0–T3) over a period of 8.4 years. Transition from subclinical psychosis at T0–T2 to clinical psychosis in terms of impairment at T3 was examined as a function of the level of prior persistence of subclinical psychosis (present never, once, twice, or thrice). The more the subclinical psychosis persisted over the period T0–T2, the greater the risk of transition to clinical psychosis at T3 in a dose-response fashion (subclinical psychosis expression once over T0–T2: odds ratio [OR] = 1.5 [95% confidence interval {CI} = 0.6–3.7], posttest probability [PP] = 5%; twice: OR = 5.0 [95% CI = 1.6–15.9], PP = 16%; at all 3 measurements: OR = 9.9 [95% CI = 2.5–39.8], PP = 27%). Of all clinical psychosis at T3, more than a third (38.3%) was preceded by subclinical psychotic experiences at least once and a fifth (19.6%) at least twice. Consequently, a significant proportion of psychotic disorder may be conceptualized as the rare poor outcome of a common developmental phenotype characterized by persistence of psychometrically detectable subclinical psychotic experiences. This may be summarized descriptively as a psychosis proneness-persistence-impairment model of psychotic disorder.

Die Studie berichtet die Stichtags-Prävalenz depressiver Syndrome bei 20.421 unselegierter Patienten, die an einem Stichtag ihren Hausarzt aufsuchten. Zusätzlich wurde das hausärztliche Erkennungs- und Verschreibungsverhalten ermittelt. Im Rahmen einer Vorstudie wurden die teilnehmenden Arztpraxen (N=633) mittels Fragebogen charakterisiert. Am Erhebungstag erhielten alle Patienten Fragebögen, darunter den „Depression Screening Questionaire“ (DSQ), um die Diagnose einer depressiven Störung gemäß der Kriterien von DSM-IV oder ICD-10 zu stellen. Diese Daten wurden mit den Angaben in den Bewertungsbögen der Ärzte verglichen, die diese am Erhebungstag für jeden Patienten ausfüllten. Die Befunde bestätigen die hohe Prävalenz depressiver Syndrome in der Hausarztpraxis: 11,3% erfüllten die ICD-10-Kriterien für eine depressive Episode. Obwohl die Erkennungsrate von 59% wie auch die Häufigkeit verordneter Behandlungen tendenziell höher erscheint als in früheren Studien, so gibt doch die Situation bei den Depressionen leichterer Ausprägung sowie der hohe Anteil an „Fehldiagnosen“ bei Patienten, die deutlich die Falldefinitionskriterien verfehlen, Anlass zur Besorgnis. / This study examines the prevalence of depressive syndromes among unselected primary care patients as well as doctors' recognition and treatment rates. This nationwide study included a total of 20,421 patients attending their primary care doctors (n=633) on the study's target day. Patients received a self-report questionnaire including the depression screening questionnaire (DSQ) to provide diagnoses of depressive disorders according to the criteria of DSM-IV and ICD- 10.These data were compared to the doctor's evaluation form for each patient to assess the physician's diagnostic decision, assessment of clinical severity, and treatment choices. The findings confirm the high prevalence of depressive syndromes in primary care settings (11.3%) and underline the particular challenge posed by a high proportion of patients near the diagnosis threshold. Although recognition rates among more severe major depressive patients (59%) as well as treatments prescribed appear to be more favourable than in previous studies, the situation in less severe cases and the high proportion of doctors' definite depression diagnoses in patients who do not fulfill the diagnostic criteria still raise significant concerns.