Abstract Laboratory medicine is under constant pressure from changes in the operating environment. Organisational changes and tendering processes have led to a trend towards shorter turn-around times and more cost-effective choices. Analysis tools that were previously only available at research laboratories, such as the mass spectrometer and polymerace chain reaction (PCR), have now made their way to university hospital laboratories and even mid-sized laboratories. Organisational changes have increased the need to monitor the pre-analytical steps. The specimen can be drawn from the patient in a satellite laboratory, which may be located several hours from the central laboratory. The increased transportation times may change the analytical properties of the specimens, which is why the stability of different analytes should be investigated thoroughly in different temperatures. It should be born in mind that doctors are treating the patients based on the results they receive from the laboratory. To avoid possible malpractice, the analytical properties should remain reliable. Traditionally, some analyses have been carried out manually, which is known to be time-consuming and carries the possibility of wide intra-observatory mistakes. For that reason, it would be reasonable to perform some manual analyses, such as body fluid analysis, in an automated manner. Automating the manual steps taken in the laboratory would release labour for other tasks and may increase the cost-effectiveness of the work. Organisational changes have redirected the needs of a clinical laboratory towards automated options instead of manual ones and finding more economically-based alternatives to replace or complement traditional methods. / Tiivistelmä Laboratoriolääketiede on jatkuvan muutospaineen alla. Organisaatiomuutokset ja kilpailutus ovat saaneet aikaan sen, että laboratorioiden analytiikkatarjonnan tulee olla kilpailukykyistä niin hinnan kuin tulosten vastausnopeuden suhteen. Aikaisemmin pelkästään tutkimuskäytössä olleet menetelmät, kuten PCR ja massaspektrometri, ovat jalkautuneet jo keskussairaalatasoiseen tutkimusvalikoimaan. Organisaatiomuutokset ovat saaneet aikaan myös sen, että näytteet voidaan ottaa potilaasta alueellisissa toimipisteissä ja kuljettaa päivän aikana keskuslaboratorioon analysoitavaksi. Kuljetusmatkat ja -ajat saattavat olla hyvinkin pitkiä. Tämän johdosta on erittäin tärkeää selvittää näytteiden säilyvyys niin, että tulokset pysyvät luotettavina eikä potilaan hoito kärsi. Perinteisesti osa tutkimuksista, kuten punktionesteen solut, on tehty käsin mikroskopoimalla, jonka tiedetään olevan aikaa vievää ja näin ollen myös kallista analysointia. Kyseisen tutkimuksen siirtäminen analysaattoreille tehtäväksi voi tuoda laboratoriolle taloudellisen säästön lisäksi työvoiman vapautumista manuaalisesti suoritettavalta mikroskopoinnilta. Muutospaineet laboratoriotoiminnoissa ovat saaneet aikaan tarpeen automatisaation lisääntymiselle ja taloudellisempien vaihtoehtojen löytämiselle perinteisten menetelmien rinnalle tai niiden sijaan.

This study has been triggered by the fact that stainless steel is being increasingly used in new applications, where possible environmental effects may be a matter of concern. When stainless steel is exposed to a given environment, a key issue is the release of small amounts of the main alloying elements iron, chromium, nickel and molybdenum. Published release rate data of these elements turned out to be sparse. Furthermore, only little was known about the role of different parameters that may affect the release rate, such as degree of alloying, exposure time and surface finish. Hence, the aim of this study was to develop methodological means and to provide accurate metal release rates of alloying constituents from different grades of stainless steels- austenitic, ferritic and duplex- when exposed to selected environments: artificial rain and synthetic body fluids. The results and discussion have been summarised in this thesis by formulating and answering ten questions, all believed to be crucial for the understanding of possible environmental effects of stainless steels. Some common conclusions could be drawn, independent of stainless steel grade and exposure condition. Iron was always preferentially released, and the release rates of chromium, nickel and molybdenum (when measured) were significantly lower than of iron, also when considering the bulk proportion of these elements. The release rate of all elements was initially high and decreased with exposure time, mainly because of an observed enrichment of chromium in the passive film formed. The release rates of iron (2 μgcm-2week-1) and nickel (0.08 μgcm-2week-1) from stainless steel from grades 304 and 316 exposed to artificial rain were much lower than corresponding rates for the pure metals (750 μgcm-2week-1 released Fe and 15 μgcm-2week-1 released Ni), whereas chromium exhibited similar release rates from stainless steel and the pure metal (0.1 μgcm-2week-1). This implies that the common procedure to calculate release rates, based on the pure metals and the nominal steel composition, significantly overestimates release rates of iron and nickel from stainless steel, but not of chromium. Total release rates from seven stainless steel grades in synthetic body fluid were found to decrease with increasing alloy content in the following release rate order: grade 409 >> grade 430 > grades 316L ≈ 201 ≈ 2205 ≈ 304 > grade 310. The release rate was highly sensitive to pH of the synthetic body fluid but only slightly sensitive to stainless steel surface finish. / QC 20120217

Tissue Engineering is a scientific discipline that aims to regenerate tissues and organs that are diseased, lost or congenitally absent. It encompasses the use of suitable synthetic equivalents of native extracellular matrix that may or may not be supplemented with cells or relevant growth factors. Such scaffolds are designed to reside at the site of implantation for a variable period of time during which they induce the regeneration of native tissue. During this time, they also provide a template for new cells to attach, infiltrate, differentiate into appropriate phenotype and eventually restore function of the concerned tissue. Among the factors that affect the outcome are the composition of scaffold, methods of fabrication, bulk properties of the scaffold and topography and architecture at the cellular level. Bone is unique in the body in that it is one of the few tissues capable of complete regeneration even in adults, as seen during fracture healing. However, certain conditions (non-union of fractures, congenital and acquired bone deficiencies) exist in which the regenerative capacities of bone are exceeded and appropriate intervention becomes necessary. Current treatment options include autologous bone grafts harvested from iliac crest or de-cellularized allografts or synthetic substitutes made from metals, ceramics and polymers. However these options have serious limitations: while autografts are limited in supply, necessitate second surgery and show inadequate vascularization, allografts can transmit viral infections. Metals, ceramics and polymers are in essence structural replacements without performing any biological function. Other problems associated with these synthetic materials include adverse immune reactions, corrosion, stress-shielding and secondary fractures due to inadequate osseo-integration. Bone tissue engineering is a specialized field of research that provides an alternative strategy to repair bone defects by exploiting the advances in engineering and better understanding of bone biology. Scaffold-based tissue engineering approach is a promising field that involves implantation of a biomaterial that is specifically matched in terms of biological and material properties to the tissue it replaces. This study explores the feasibility of using electrospinning as a potential fabrication strategy for bone tissue engineering applications, more specifically intended for cleft palate repair. This model represents a congenital deformity that affects both hard and soft tissues and presents unique challenges and opportunities. Among the challenges are: the need for the implant allow growth of the most complex areas of the facial skeleton, integrate and grow with the patient through adolescence, the ability of the implant to not interfere with vital functions including breathing and feeding. Further the implant should provide a flexible matrix that can effectively support erupting teeth. In spite of these extreme demands, maxilla is a non load-bearing membranous bone, a favorable consideration from materials engineering perspective. The present study is organized into three independent sections. The first section investigates developing strategies intended to improve the material properties of electrospun bone scaffold. Bone is composed of a high volume fraction (50%) of inorganic hydroxyapatite nanocrystals that is closely associated with collagen. The dispersal of brittle mineral is critical in not only strengthening the bone in compression but also contributes to the osteoconductivity of the matrix. Since loading of mineral in a bone scaffold is a serious limitation, we attempted to achieve improved loading of bone mineral by dual mineralization approach. We first incorporated nanocrystalline hydroxyapatite (nHA) directly into the scaffold by adding it to the electrospinning polymer solution. The second step involves inducing biomimetic mineralization of electrospun scaffolds by incubating them in simulated body fluid (SBF) for 2 weeks. The hypothesis was that the nanocrystalline hydroxyapatite seeded during electrospinning would act as sites for nucleation and further crystal growth when incubated in solution supersaturated with respect to calcium and phosphate ions. We tested this approach in two synthetic, biocompatible polymers-polydioxanone and poly (lactide: glycolide) and four formulations of SBF with differential loading of nHA (0-50% by wt. of polymer). A modified Alizarin Red S (ARS) staining that specifically binds to calcium was developed that allowed us to quantify the mineral content of 3D scaffold with great accuracy. Results indicated a unique combination of factors: PDO scaffolds containing 50% nHA incubated in 1x revised-SBF incubated under static conditions gave maximum mineralization over a period of two weeks. We then sought to exploit these findings to engineer a stiffer scaffold by stacking multiple layers together and cold welding them under high pressure. Electrospun scaffolds (1, 2 or 4 layered stacks) were either compressed before or after mineralizing treatment with SBF. After two weeks, scaffolds were analyzed for total mineral content and stiffness by uniaxial tensile testing. Results indicated while compression of multiple layers significantly increases the stiffness of scaffolds, it also had lower levels of mineralization partly due to increased density of fibers and loss of surface area due to fiber welding. However this can be offset to a reasonable degree by increasing the number of stacks and hence this strategy can be successfully adopted to improve the mechanical properties of electrospun scaffolds. The second section introduces a novel infrared imaging technique to quantify and characterize the biological activity of biomaterials, based on cell adhesion. Cells attach to the surface by the formation of focal contacts where multiple proteins including vinculin and talin assemble to signal critical processes like cell survival, migration, proliferation and differentiation. After allowing MG-63 osteoblasts to adhere to 2D biomaterial surface coated with extracellular matrix proteins (collagen, gelatin, fibronectin) cells were fixed and probed with antibodies for vinculin and talin. Secondary antibodies, tagged with infrared-sensitive fluorescent dyes, were used to quantify the molecules of interest. In addition, the kinetics of focal contact formation in these different substrates was followed. Successful quantification of focal contacts were made and further research revealed phosphorylation of vinculin at pY-822 as one potential mechanism for recruitment of vinculin to focal contacts. Hence it could represent a subset of vinculin and might serve as a specific molecular marker for focal contacts. As an extension, we evaluated the possibility of using such an assay to quantify 3D electrospun tissue engineering scaffolds. We fabricated scaffolds of graded biological activity by electrospinning blends of polydioxanone and collagen in different ratios. Vinculin and talin expressed by MG-63 cultured on these scaffolds for 24 hours were quantified in a similar manner. Results indicate that while talin does not show a significant difference in expression among different scaffolds, vinculin showed a positive correlation with increasing biological activity of scaffolds. In conclusion, we have identified vinculin as a reliable marker of focal contacts in 3D scaffolds while phosphovinculin (pY-822) was more specific to focal contacts in coated 2D substrates. In both instances, infrared imaging proved to be reliable in study of focal contacts. The third section aims to make the bone scaffolds osteoinductive- a property of a material to induce new bone formation even when implanted in subcutaneous and intramuscular heterotopic sites. Bone morphogenetic proteins (BMP) are potent cytokines that can induce migration, proliferation and differentiation of stem cells along osteoblastic lineage. The therapeutic efficacy of BMPs in the treatment of severe bone defects has been identified and is currently FDA approved for specific orthopedic applications. BMPs are clinically administered in a buffer form that not only makes the treatment expensive but less effective. Suitable delivery systems for BMP delivery have been an intense area of investigation. We rationalized electrospinning as a strategy to incorporate BMP within the scaffold and that would enable controlled release when implanted. One of the drawbacks of using electrospinning to deliver bioactive molecules is the potential denaturing effect and eventual loss of activity of BMPs. The final section of this dissertation tries to develop sensitive and relevant assays that could answer intriguing questions about solvent-protein interaction. We chose to use the BMP-2/7 heterodimer as the osteoinductive molecule of choice because of its superior potency compared to homodimer counterparts. We characterized the detection and quantification of BMP-2/7 using a slot blot technique. Further, we used a novel cell line (C2C12 BRA) to test the retention of activity of BMP-2/7 that has been exposed to organic solvents. Results indicate significant loss of activity when BMPs are exposed to organic solvents but complete recovery was possible by diluting the solvent with an aqueous buffer.

Síndrome nefrótica é definida pela presença simultânea de edema sistêmico, hipoalbuminemia e proteinúria intensa. Vários componentes da composição corporal, principalmente relacionados à água corporal, sofrem rápidas e frequentes alterações nessa síndrome. A espectroscopia por bioimpedância (BIS) é um método de fácil execução, baixo custo, que pode ser repetido e praticamente isento de riscos que permite avaliar água corporal, massa magra e gordura corporal e tem sido pouco utilizado na síndrome nefrótica. Objetivo. Avaliar as alterações da água e de outros componentes da composição corporal através da BIS em pacientes com síndrome nefrótica. Métodos. Pacientes foram avaliados na ocasião da biópsia renal e no desfecho com ou sem remissão do edema. Foram medidos o peso corporal, albumina sérica e proteinúria de 24 h e, pela BIS, variáveis relacionadas à água corporal e a outros parâmetros de composição corporal. Resultados. Foram estudados 17 pacientes (idade: 51,1 + 17,4 anos) com síndrome nefrótica. Dez pacientes obtiveram remissão do edema (grupo R), sendo que em nove ocorreu também remissão da síndrome nefrótica. Em sete pacientes o edema permaneceu presente, sem remissão (grupo SR). A variação entre a primeira e a segunda medida para a sobrecarga hídrica foi de -5,4 L (-8,5 L; -1,8 L) no grupo R e de 0,0 L (-1,1 L; 1,2 L) no grupo SR (p < 0,05). A água corporal total variou de -4,75 L (- 10,20 L; -2,50 L) e de 4,80 L (-1,30 L; 6,10 L) nos grupos R e SR, respectivamente (p < 0,05), e a água extracelular variou de -5,90 L (-10,10 L; -0,42 L) e de 1,20 L (-0,80 L; 2,70 L) nos mesmos grupos (p < 0,05). Não houve diferença estatisticamente significante na variação entre as duas avaliações nos grupos R e SR para a água intracelular, massa de tecido magro, massa de tecido adiposo, massa gorda total e massa celular corporal. A variação do ângulo de fase entre as avaliações foi de 1,55° (0,41°; 2,24°) no grupo R e 0,10° (-0,28°; 0,46°) no grupo SR (p < 0,05). Houve correlação estatisticamente significante entre cada variável definidora da síndrome nefrótica (peso corporal, proteinúria e albumina sérica) versus sobrecarga hídrica, água corporal total, água extracelular e ângulo de fase, mas não versus as demais medidas de composição corporal obtidas pela BIS. Conclusão. A espectroscopia por bioimpedância mostrou-se eficiente em detectar mudanças da água corporal e do ângulo de fase em pacientes com síndrome nefrótica, mas não para identificar variações relacionadas à massa de tecido magro, massa de tecido adiposo, massa gorda total e massa celular corporal. . / Nephrotic syndrome is established by the simultaneous presence of systemic edema, hypoalbuminemia, and severe proteinuria. Several components of the body composition, mainly related to the body fluid, undergo to rapid and frequent changes in this syndrome. Spectroscopy by bioimpedance (BIS) is a reliable, cost-effective and easy-to-perform method to evaluate body water, adipose tissue mass, and body cell mass. Despite these advantages, BIS has barely been used to evaluate patients with nephrotic syndrome. Aims. To evaluate body fluid variable changes and other components of the body composition in patients with nephrotic syndrome by bioimpedance spectroscopy. Methods. Patients were studied in two moments: at the occasion of the renal biopsy (1st evaluation), and at the end-point (2nd evaluation). Patients were grouped according to they reached remission (Group R) or remained without remission (Group WR) of the edema at the 2nd evaluation. Body weight, serum albumin and 24 hours proteinuria were measured at the two time-points, as well as other variables associated with body fluid and other components of the body composition obtained by the BIS. Results. Seventeen patients (age: 51,1 + 17,4 years-old) with nephrotic syndrome were studied. Ten patients reached remission of the edema while nine of them were also in remission of the nephrotic syndrome. Seven patients remained with edema at the end-point. The variation between the 1st and the 2nd measurement for the overhydration was of -5,4 L (-8,5L; -1,8L) at the group R and of 0,0 (-1,1 L; 1,2 L) at the group NR (p < 0,05). Total body water changes were of -4,75 L (-10,20 L; -2,50 L) and of 4,80 L (-1,30 L; 6,10 L) at the groups R and WR, respectively (p < 0,05), and the extracellular water changed of the -5,90 L (-10,10 L; -0,42 L) and of 1,20 L (-0,80 L; 2,70 L) at the same groups, respectively (p < 0,05). There was no statistically significant difference in the variation between the two evaluations for the groups R and NR for intracellular water, lean tissue mass, fat mass, adipose tissue mass, and body cell mass. The variation of the phase angle between the two evaluations was of the 1,55° (0,41°; 2,24°) at the group R and 0,10° (-0,28°; 0,46°) at the group WR (p < 0,05). There was a statistically significant correlation between each related nephrotic syndrome variable compared with overhydration, total body water, extracellular water, and phase angle, but no difference when compared with the other variables related to the body composition measured by the BIS. Conclusion. The spectroscopy by bioimpedance was efficient to measure body water changes and the phase angle in patients with nephrotic syndrome. However, the BIS could not detect changes related to the intracellular water, lean tissue mass, fat mass, adipose tissue mass, and body cell mass.

Introdução: A tuberculose (TB) é uma das infecções mais prevalentes na humanidade, sendo o comprometimento pulmonar a principal causa de morbimortalidade. A cultura é o padrão de referência para diagnóstico, porém apresenta baixa sensibilidade. Das formas extrapulmonares, a TB pleural é a mais comum e apresenta diagnóstico confirmatório difícil por ser paucibacilar e conter interferentes intrínsecos na amostra. A reação em cadeia da polimerase (PCR), por amplificar o DNA da micobactéria, apresenta-se como teste mais sensível que a cultura, sendo positivo em amostras que apresentam a partir de 102 UFC/mL (unidades formadoras de colônia por mL) de M. tuberculosis (MTB). Entretanto, quando utilizada em amostras de escarro, lavado broncoalveolar e/ou líquido pleural pode ter seu desempenho comprometido pela presença de inibidores intrínsecos da amostra (variáveis pré-analíticas) e pelas técnicas de amplificação e detecção (variáveis analíticas) utilizadas na reação. Objetivo: Avaliar a influência de variáveis pré-analíticas (concentração de células, hemácias e proteínas) na detecção do DNA do M. tuberculosis em amostras de escarro, lavado broncoalveolar (LBA) e líquido pleural (LP), utilizando combinações de métodos de extração/detecção. Métodos: Amostras de escarro, lavado broncoalveolar e líquido pleural de pacientes não infectados pelo M. tuberculosis foram obtidas através de indução à expectoração, broncoscopia respiratória e/ou toracocentese, respectivamente, em volumes suficientes para o estudo. Para testar o limiar de detecção do M. tuberculosis, as amostras foram preparadas \"in vitro\" de maneira a conter concentrações variadas dos interferentes pré-analíticos e de UFC/mL da micobactéria. Para a técnica de PCR, o DNA foi extraído pelo método de extração QIAamp® DNA Mini Kit (Qiagen, Hilden, Germany) e pelo AMPLICOR® Respiratory Specimen Preparation (Roche Molecular Systems, Inc., Branchburg, NJ, USA) e amplificado e detectado por três métodos: 1) COBAS® TaqMan® MTB Test (Roche Molecular Systems, Inc., Branchburg, NJ, USA); 2) MTB Q - PCR Alert Kit (Nanogen Advanced Diagnosis, Trezzano, Italy) e 3) \"in-house\" ou caseiro. Desta maneira, foram testadas as seguintes combinações: Extração Roche/detecção Roche (R/R); Extração Roche/detecção Nanogen (R/N); Extração Roche/detecção \"in house\" (R/IH); Extração Qiagen/detecção Roche (Q/R); Extração Qiagen/detecção Nanogen (Q/N) e Extração Qiagen/detecção \"in house\" (Q/IH). Resultados: Em amostras de escarro, a quantidade de células e de hemácias não interferiu na detecção do M. tuberculosis, com exceção do método de extração/detecção Roche. Nas amostras de LBA, médias e altas concentrações de células e altas concentrações de hemácias contribuíram para menor detecção do MTB quando utilizado o método de detecção Roche, enquanto que no líquido pleural, a concentração de hemácias foi a variável que mais interferiu na detecção do agente. Em ambas as situações a menor detecção foi obtida com a combinação Q/N. Conclusão: A qualidade pré-analítica das amostras biológicas recebidas no laboratório clínico pode interferir no desempenho diagnóstico dos testes moleculares. A escolha dos métodos de extração e detecção é de fundamental importância na sensibilidade analítica do teste, para garantia de melhores resultados, especialmente quando trabalhamos com amostras paucibacilares que contém potenciais inibidores da reação / Introduction: Tuberculosis (TB) is one of the most prevalent infections in humanity, and pulmonary compromise is the leading cause of morbidity and mortality. Culture is the reference standard for diagnosis, but has low sensitivity. Of the extrapulmonary forms, pleural TB is the most common and presents difficult confirmatory diagnosis due to be paucibacillary and to contain intrinsic interfering in the sample. The polymerase chain reaction (PCR), for amplifying DNA of the mycobacterium, appears as more sensitive test than the culture, with positive results from 102 CFU/ml (colony forming units per ml) of M. tuberculosis (MTB). However, when used in sputum samples, bronchoalveolar lavage and/or pleural fluid, this test can also have its performance compromised by the presence of intrinsic sample inhibitors (pre-analytical variables) and by the amplification and detection techniques (analytical variables) used in the reaction. Objective: To evaluate the influence of pre-analytical variables (concentration of cells, red blood cells and proteins) in DNA detection of M. tuberculosis from sputum, bronchoalveolar lavage (BAL) and pleural fluid (PF) samples by using combinations of extraction/detection methods. Methods: Samples of sputum, bronchoalveolar lavage and pleural fluid of patients not infected with M. tuberculosis were obtained by inducing sputum, respiratory bronchoscopy and/or thoracentesis, respectively, in sufficient volumes for the study. To test the detection threshold of M. tuberculosis, samples were prepared \"in vitro\" to contain variable concentrations of pre-analytical interfering and CFU/mL of mycobacteria. For PCR, DNA was extracted by two methods: the QIAamp® DNA Mini Kit (Qiagen, Hilden, Germany) and Respiratory Specimen Preparation Amplicor (Roche Molecular Systems, Inc., Branchburg, NJ, USA) and amplified and detected by three methods: 1) COBAS® TaqMan® MTB Test (Roche Molecular Systems, Inc., Branchburg, NJ, USA); 2) MTB Q - PCR Alert Kit (Nanogen Advanced Diagnosis, Trezzano, Italy) and 3) \"in-house\". Thus, the following combinations were tested: Roche extraction and detection (R/R); Roche extraction and Nanogen detection (R/N); Roche extraction and \"in house\" detection (R/IH); Qiagen extraction and Roche detection (Q/R); Qiagen extraction and Nanogen detection (Q/N) and Qiagen extraction and \"in house\" detection (Q/IH). Results: In sputum samples, the amount of cells and red blood cells did not interfere with M. tuberculosis detection, an exception for Roche extraction/detection method. In BAL samples, medium and high cell concentrations and high concentrations of red blood cells contributed to lower detection of MTB when using the Roche detection method, while in the pleural fluid, the concentration of red blood cells was the variable that most interfered with the MTB detection. In both situations, the smallest detection was obtained with the combination Q/N. Conclusion: The pre-analytical quality of biological samples received in the clinical laboratory can interfere with the performance of molecular diagnostic tests. The choice for the extraction/detection methods is of fundamental importance in the analytical sensitivity of PCR, in order to guarantee better results, especially when working with paucibacillary samples containing potential reaction inhibitors

Síndrome nefrótica é definida pela presença simultânea de edema sistêmico, hipoalbuminemia e proteinúria intensa. Vários componentes da composição corporal, principalmente relacionados à água corporal, sofrem rápidas e frequentes alterações nessa síndrome. A espectroscopia por bioimpedância (BIS) é um método de fácil execução, baixo custo, que pode ser repetido e praticamente isento de riscos que permite avaliar água corporal, massa magra e gordura corporal e tem sido pouco utilizado na síndrome nefrótica. Objetivo. Avaliar as alterações da água e de outros componentes da composição corporal através da BIS em pacientes com síndrome nefrótica. Métodos. Pacientes foram avaliados na ocasião da biópsia renal e no desfecho com ou sem remissão do edema. Foram medidos o peso corporal, albumina sérica e proteinúria de 24 h e, pela BIS, variáveis relacionadas à água corporal e a outros parâmetros de composição corporal. Resultados. Foram estudados 17 pacientes (idade: 51,1 + 17,4 anos) com síndrome nefrótica. Dez pacientes obtiveram remissão do edema (grupo R), sendo que em nove ocorreu também remissão da síndrome nefrótica. Em sete pacientes o edema permaneceu presente, sem remissão (grupo SR). A variação entre a primeira e a segunda medida para a sobrecarga hídrica foi de -5,4 L (-8,5 L; -1,8 L) no grupo R e de 0,0 L (-1,1 L; 1,2 L) no grupo SR (p < 0,05). A água corporal total variou de -4,75 L (- 10,20 L; -2,50 L) e de 4,80 L (-1,30 L; 6,10 L) nos grupos R e SR, respectivamente (p < 0,05), e a água extracelular variou de -5,90 L (-10,10 L; -0,42 L) e de 1,20 L (-0,80 L; 2,70 L) nos mesmos grupos (p < 0,05). Não houve diferença estatisticamente significante na variação entre as duas avaliações nos grupos R e SR para a água intracelular, massa de tecido magro, massa de tecido adiposo, massa gorda total e massa celular corporal. A variação do ângulo de fase entre as avaliações foi de 1,55° (0,41°; 2,24°) no grupo R e 0,10° (-0,28°; 0,46°) no grupo SR (p < 0,05). Houve correlação estatisticamente significante entre cada variável definidora da síndrome nefrótica (peso corporal, proteinúria e albumina sérica) versus sobrecarga hídrica, água corporal total, água extracelular e ângulo de fase, mas não versus as demais medidas de composição corporal obtidas pela BIS. Conclusão. A espectroscopia por bioimpedância mostrou-se eficiente em detectar mudanças da água corporal e do ângulo de fase em pacientes com síndrome nefrótica, mas não para identificar variações relacionadas à massa de tecido magro, massa de tecido adiposo, massa gorda total e massa celular corporal. . / Nephrotic syndrome is established by the simultaneous presence of systemic edema, hypoalbuminemia, and severe proteinuria. Several components of the body composition, mainly related to the body fluid, undergo to rapid and frequent changes in this syndrome. Spectroscopy by bioimpedance (BIS) is a reliable, cost-effective and easy-to-perform method to evaluate body water, adipose tissue mass, and body cell mass. Despite these advantages, BIS has barely been used to evaluate patients with nephrotic syndrome. Aims. To evaluate body fluid variable changes and other components of the body composition in patients with nephrotic syndrome by bioimpedance spectroscopy. Methods. Patients were studied in two moments: at the occasion of the renal biopsy (1st evaluation), and at the end-point (2nd evaluation). Patients were grouped according to they reached remission (Group R) or remained without remission (Group WR) of the edema at the 2nd evaluation. Body weight, serum albumin and 24 hours proteinuria were measured at the two time-points, as well as other variables associated with body fluid and other components of the body composition obtained by the BIS. Results. Seventeen patients (age: 51,1 + 17,4 years-old) with nephrotic syndrome were studied. Ten patients reached remission of the edema while nine of them were also in remission of the nephrotic syndrome. Seven patients remained with edema at the end-point. The variation between the 1st and the 2nd measurement for the overhydration was of -5,4 L (-8,5L; -1,8L) at the group R and of 0,0 (-1,1 L; 1,2 L) at the group NR (p < 0,05). Total body water changes were of -4,75 L (-10,20 L; -2,50 L) and of 4,80 L (-1,30 L; 6,10 L) at the groups R and WR, respectively (p < 0,05), and the extracellular water changed of the -5,90 L (-10,10 L; -0,42 L) and of 1,20 L (-0,80 L; 2,70 L) at the same groups, respectively (p < 0,05). There was no statistically significant difference in the variation between the two evaluations for the groups R and NR for intracellular water, lean tissue mass, fat mass, adipose tissue mass, and body cell mass. The variation of the phase angle between the two evaluations was of the 1,55° (0,41°; 2,24°) at the group R and 0,10° (-0,28°; 0,46°) at the group WR (p < 0,05). There was a statistically significant correlation between each related nephrotic syndrome variable compared with overhydration, total body water, extracellular water, and phase angle, but no difference when compared with the other variables related to the body composition measured by the BIS. Conclusion. The spectroscopy by bioimpedance was efficient to measure body water changes and the phase angle in patients with nephrotic syndrome. However, the BIS could not detect changes related to the intracellular water, lean tissue mass, fat mass, adipose tissue mass, and body cell mass.

Ajonuma Louis Chukwuemeka. / "March 2004." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (p. 215-238). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Introdução: A tuberculose (TB) é uma das infecções mais prevalentes na humanidade, sendo o comprometimento pulmonar a principal causa de morbimortalidade. A cultura é o padrão de referência para diagnóstico, porém apresenta baixa sensibilidade. Das formas extrapulmonares, a TB pleural é a mais comum e apresenta diagnóstico confirmatório difícil por ser paucibacilar e conter interferentes intrínsecos na amostra. A reação em cadeia da polimerase (PCR), por amplificar o DNA da micobactéria, apresenta-se como teste mais sensível que a cultura, sendo positivo em amostras que apresentam a partir de 102 UFC/mL (unidades formadoras de colônia por mL) de M. tuberculosis (MTB). Entretanto, quando utilizada em amostras de escarro, lavado broncoalveolar e/ou líquido pleural pode ter seu desempenho comprometido pela presença de inibidores intrínsecos da amostra (variáveis pré-analíticas) e pelas técnicas de amplificação e detecção (variáveis analíticas) utilizadas na reação. Objetivo: Avaliar a influência de variáveis pré-analíticas (concentração de células, hemácias e proteínas) na detecção do DNA do M. tuberculosis em amostras de escarro, lavado broncoalveolar (LBA) e líquido pleural (LP), utilizando combinações de métodos de extração/detecção. Métodos: Amostras de escarro, lavado broncoalveolar e líquido pleural de pacientes não infectados pelo M. tuberculosis foram obtidas através de indução à expectoração, broncoscopia respiratória e/ou toracocentese, respectivamente, em volumes suficientes para o estudo. Para testar o limiar de detecção do M. tuberculosis, as amostras foram preparadas \"in vitro\" de maneira a conter concentrações variadas dos interferentes pré-analíticos e de UFC/mL da micobactéria. Para a técnica de PCR, o DNA foi extraído pelo método de extração QIAamp® DNA Mini Kit (Qiagen, Hilden, Germany) e pelo AMPLICOR® Respiratory Specimen Preparation (Roche Molecular Systems, Inc., Branchburg, NJ, USA) e amplificado e detectado por três métodos: 1) COBAS® TaqMan® MTB Test (Roche Molecular Systems, Inc., Branchburg, NJ, USA); 2) MTB Q - PCR Alert Kit (Nanogen Advanced Diagnosis, Trezzano, Italy) e 3) \"in-house\" ou caseiro. Desta maneira, foram testadas as seguintes combinações: Extração Roche/detecção Roche (R/R); Extração Roche/detecção Nanogen (R/N); Extração Roche/detecção \"in house\" (R/IH); Extração Qiagen/detecção Roche (Q/R); Extração Qiagen/detecção Nanogen (Q/N) e Extração Qiagen/detecção \"in house\" (Q/IH). Resultados: Em amostras de escarro, a quantidade de células e de hemácias não interferiu na detecção do M. tuberculosis, com exceção do método de extração/detecção Roche. Nas amostras de LBA, médias e altas concentrações de células e altas concentrações de hemácias contribuíram para menor detecção do MTB quando utilizado o método de detecção Roche, enquanto que no líquido pleural, a concentração de hemácias foi a variável que mais interferiu na detecção do agente. Em ambas as situações a menor detecção foi obtida com a combinação Q/N. Conclusão: A qualidade pré-analítica das amostras biológicas recebidas no laboratório clínico pode interferir no desempenho diagnóstico dos testes moleculares. A escolha dos métodos de extração e detecção é de fundamental importância na sensibilidade analítica do teste, para garantia de melhores resultados, especialmente quando trabalhamos com amostras paucibacilares que contém potenciais inibidores da reação / Introduction: Tuberculosis (TB) is one of the most prevalent infections in humanity, and pulmonary compromise is the leading cause of morbidity and mortality. Culture is the reference standard for diagnosis, but has low sensitivity. Of the extrapulmonary forms, pleural TB is the most common and presents difficult confirmatory diagnosis due to be paucibacillary and to contain intrinsic interfering in the sample. The polymerase chain reaction (PCR), for amplifying DNA of the mycobacterium, appears as more sensitive test than the culture, with positive results from 102 CFU/ml (colony forming units per ml) of M. tuberculosis (MTB). However, when used in sputum samples, bronchoalveolar lavage and/or pleural fluid, this test can also have its performance compromised by the presence of intrinsic sample inhibitors (pre-analytical variables) and by the amplification and detection techniques (analytical variables) used in the reaction. Objective: To evaluate the influence of pre-analytical variables (concentration of cells, red blood cells and proteins) in DNA detection of M. tuberculosis from sputum, bronchoalveolar lavage (BAL) and pleural fluid (PF) samples by using combinations of extraction/detection methods. Methods: Samples of sputum, bronchoalveolar lavage and pleural fluid of patients not infected with M. tuberculosis were obtained by inducing sputum, respiratory bronchoscopy and/or thoracentesis, respectively, in sufficient volumes for the study. To test the detection threshold of M. tuberculosis, samples were prepared \"in vitro\" to contain variable concentrations of pre-analytical interfering and CFU/mL of mycobacteria. For PCR, DNA was extracted by two methods: the QIAamp® DNA Mini Kit (Qiagen, Hilden, Germany) and Respiratory Specimen Preparation Amplicor (Roche Molecular Systems, Inc., Branchburg, NJ, USA) and amplified and detected by three methods: 1) COBAS® TaqMan® MTB Test (Roche Molecular Systems, Inc., Branchburg, NJ, USA); 2) MTB Q - PCR Alert Kit (Nanogen Advanced Diagnosis, Trezzano, Italy) and 3) \"in-house\". Thus, the following combinations were tested: Roche extraction and detection (R/R); Roche extraction and Nanogen detection (R/N); Roche extraction and \"in house\" detection (R/IH); Qiagen extraction and Roche detection (Q/R); Qiagen extraction and Nanogen detection (Q/N) and Qiagen extraction and \"in house\" detection (Q/IH). Results: In sputum samples, the amount of cells and red blood cells did not interfere with M. tuberculosis detection, an exception for Roche extraction/detection method. In BAL samples, medium and high cell concentrations and high concentrations of red blood cells contributed to lower detection of MTB when using the Roche detection method, while in the pleural fluid, the concentration of red blood cells was the variable that most interfered with the MTB detection. In both situations, the smallest detection was obtained with the combination Q/N. Conclusion: The pre-analytical quality of biological samples received in the clinical laboratory can interfere with the performance of molecular diagnostic tests. The choice for the extraction/detection methods is of fundamental importance in the analytical sensitivity of PCR, in order to guarantee better results, especially when working with paucibacillary samples containing potential reaction inhibitors

Pour combiner les bonnes propriétés mécaniques des matériaux métalliques et obtenir des surfaces bioactives, des revêtements de phosphate de calcium (Ca-P) ont été développés. Le but est d’améliorer la biocompatibilité et la bioactivité du système et créer une barrière contre l’éventuelle libération d’ions toxiques du substrat métallique. Notre démarche a été de développer une nouvelle voie de synthèse. Après un polissage mécanique et décapage chimique du substrat de Titane ou Ti–6Al–4V une couche intermédiaire en titanate de sodium a été obtenue par un prétraitement alcalin sur les substrats. Elle a été ensuite soumise à un traitement thermique afin de créer une couche alvéolaire nanométrique. Celle-ci facilite la croissance une couche de phosphate de calcium par voie autocatalytique d'une manière similaire au procédé de formation de l'os naturel. La caractérisation et l’étude des revêtements des Ca-P obtenus par les trois bains (acides, alcalins et oxydant) sur les substrats métalliques ont été réalisés. Les dépôts ont été étudiés d’un point de vue structural et morphologique. La stabilité des couches de Ca-P a été mesurée dans le fluide corporel (SBF) pour des périodes différentes utilisant des analyses biochimiques. En conclusion, cette méthode est une solution peu coûteuse, fiable, et utilisable à l'échelle industrielle. La couche de Ca-P aussi bien que le titanate de sodium obtenus peuvent permettre d’être imprégnés par des agents actifs comme un ou plusieurs agents antibactériens. / To combine the good mechanical properties of metallic substrate with the bioactivity of some ceramics, to obtain bioactive surface, a calcium phosphate (Ca-P) coating has been developed. The goal is to improve the biocompatibility and bioactivity of metallic implant and create a barrier against the possible release of toxic ions from the metallic substrate. Our approach has been to develop a new synthetic route. After mechanical polishing and chemical etching of the titanium or Ti-6Al-4V substrates, an interlayer of sodium titanate was obtained by an alkaline pretreatment of the substrates. Then, it was subjected to a heat treatment to create a nanometeric layer. The latter facilitates the growth of a layer of Ca-P by means of an electroless manner similar to the forming process of the natural bone. Characterization and study of Ca-P coatings obtained by the three baths (acids, alkalis and oxidizing) on metallic substrates have been made. The deposits were studied from a structural and morphological point of view. The stability of Ca-P layers was measured in simulated body fluid (SBF) for different periods using biochemical analyzes. In conclusion, this method is a cheap and reliable solution that can be used on an industrial scale. The Ca-P as well as the sodium titanate layers can afford to be impregnated with active agents such as one or more antibacterial agents.

This thesis deals with the characterization of electrochemical corrosion properties of magnesium alloys as promising materials for biomedical applications. The wrought alloys AZ31 and AZ61 were used and exposed to corrosive environments of Hanks solutions (SBF) to simulate environmental conditions in living organisms. For the evaluation of the surfaces was used scanning electron microscopy (SEM) with elemental analysis measured by energy-dispersive spectroscopy (EDS). Short-term (5 min) and long-term (72 h) corrosion tests were conducted in order to optimize the measurement methodology and obtain corrosion parameters - especially corrosion potential (Ekor), corrosion current density (ikor) and polarisation resistance (RP). To evaluation of the short-term tests were by potentiodynamic tests, namely the linear polarization (LP) test. Long-term tests were measured by electrochemical impedance spectroscopy (EIS). Effects of the composition of the alloys (AZ31 and AZ61), surface treatment (grinding and polishing) and the composition of the solution (SBF without Ca, Mg, and with Ca, Mg) were compared. Complex corrosion behaviour in time was characterized and corrosion mechanisms were discussed.