No description available.

The distinction between cavernous haemangiomas of the liver (which are the second most common hepatic mass lesions) from malignant lesions, is often difficult. An incorrect diagnosis of cavernous haemangioma, in a patient with malignancy, may adversely influence the outcome of subsequent treatment in these patients, due to delay in therapy. Although previous studies have suggested that ⁹⁹ᵐTc erythrocyte blood pool scintigraphy is both highly sensitive and specific for haemangiomas, a basic flaw in all previous studies has been the small number of control patients studied. Bayesian analysis clearly shows that specificity for a test is dependant on the pre-test probability of the lesion being present. Thus all the studies done to date, may reflect an inappropriately high specificity for ⁹⁹ᵐTc scintigraphy, in diagnosing cavernous haemangiomas, because they have mainly studied patients with haemangiomas and relatively few patients with other lesions. This study was thus undertaken to clarify the true accuracy of this technique, in distinguishing haemangiomas from other hepatic mass lesions, by studying a large number of patients with haemangiomas and other hepatic mass lesions.

Homocysteine is a natural occurring aminothiol. It is an intermediate product in the metabolism of methionine. Methionine is an essential amino acid required for protein synthesis. Metabolic irregularities disrupt homocysteine levels in plasma. Elevated homocysteine levels are directly linked to folate and cobalamin (vitamin B12) deficiencies, and are an independent risk factor for cardiovascular diseases. High homocysteine levels have also been associated with Alzheimer's, osteoporosis, renal failure, cancer, birth defects and pregnancy complications. The association of elevated homocysteine levels with cardiovascular disease and other diseases has generated great interest in the detection of homocysteine. An optical method for the detection of homocysteine has been developed using fluorescein mono- and dialdehydes. Selectivity for homocysteine was achieved based on the characteristic differences between 5- and 6-membered ring heterocyclic amines formed upon the reaction with fluorescein mono- and dialdehydes. 6-membered ring homocysteine-derived thiazinane-4-carboxylic acids were found to be more basic than 5-membered cysteine-derived thiazolidine-4-carboxylic acids. Fluorescence enhancement in response to homocysteine was thus attained by tuning pH and excitation wavelengths. Furthermore, the design and synthesis of a more sensitive fluorophore, fluorescein tri aldehyde has been accomplished based on the aforementioned findings to enable the detection of homocysteine at physiological levels. Calculations of Mulliken charges revealed that the formation of thiazinanes results in modulation of the electron density on the fluorophore leading to higher fluorescence.

Bismuth based nanomaterials have recently attracted attention as heavy element X-ray contrast agents because of the high atomic number and predicted biological compatibility of bismuth. Nanoparticle X-ray contrast agents may enable a number of novel medical imaging applications, including blood pool and site-directed imaging. However these hypothetical applications are hindered by lack of suitable synthetic methods for production of imaging agents. This dissertation describes synthesis of a novel class of bismuth nanoparticles that are aqueously stabilized using poly and monosaccharides. These particles are synthesized using highly biologically compatible reagents and are oxidatively stable in water and in moderately basic buffered solutions. Bismuth nanoparticles stabilized by the polysaccharide dextran have a large hydrodynamic radius and a relatively small bismuth nanocrystal core (4% bismuth by volume.) Glucose-capped particles have a much higher ratio of bismuth by volume (>60%), and experimental CT scans of these particle solutions demonstrate higher X-ray contrast versus a current clinically used radiocontrast agent. Additional syntheses of hydrophobic organoamine-capped bismuth nanoparticles by reduction of an iodobismuth cluster, and development of other X-ray contrast materials, such as a radiopaque surgical sponge marker and ink, using bismuth micoparticles produced by a top-down ball milling method, are also described.

No description available.

No description available.

Nucleic acid probes against intracellular targets can find essential applications in biodosimetry. This thesis describes the development of multiple nucleic acid probes, including aptamers and molecular beacons, against radiation-responsive intracellular molecular targets via microfluidic technology. Aptamers are single-stranded oligonucleotide molecules that bind with high affinity and specificity to a wide range of target molecules. The method of systematic evolution of ligands by exponential enrichment (SELEX) plays an essential role in the isolation of aptamers from a randomized oligonucleotide library. To date, significant modifications and improvements of the SELEX process have been achieved, engendering various forms of implementation from conventional SELEX to microfluidics-based full-chip SELEX. While full-chip SELEX is generally considered advantageous over conventional SELEX, there has not yet been a conclusive comparison between the methods. Herein, we present a comparative study of three SELEX strategies for aptamer isolation, including those using conventional agarose bead-based partitioning, microfluidic affinity selection, and fully integrated microfluidic affinity selection and PCR amplification. Using immunoglobulin E (IgE) as a model target molecule, we compare these strategies in terms of the time and cost for each step of the SELEX process, including affinity selection, amplification, and oligonucleotide conditioning. Target-binding oligonucleotides in the enriched pools are sequenced and compared to assess the relative efficacy of the SELEX strategies. We show that the microfluidic strategies are more time- and cost-efficient than conventional SELEX. Aptamers are an alternative category of affinity probes that are much smaller in size, making them ideal probes for intracellular targets. However, few aptamers are developed against intracellular targets, and the few intracellular-targeting aptamers are mainly used as intramers engineered to be expressed inside the target cells, which are unsuitable for intracellular biodosimetry applications. Herein, we use a radiation biomarker BAX as a target, and present an intracellular aptamer developed via microfluidic technologies. The isolated BAX aptamer would allow for in situ labeling of intracellular BAX protein, and we have preliminarily demonstrated the dose-dependent labeling in ex vivo human blood samples. This method could enable the development of aptamers for a panel of intracellular proteins towards radiation biodosimetry applications. Aptamer development involves a screening process following the sequencing of the enriched pool. This process would usually be performed with affinity determination methods, which are often time-consuming and may hinder the development of aptamers. Herein, we reported a graphene-based nanosensor designed for the aptamer screening process. Screening of enriched pool against IgE protein was performed on this sensor. By comparative validation, this sensor showed the capacity to identify the strong binders in the enriched aptamer candidate pools and can be used to expedite aptamer development. Molecular beacons are single-stranded oligonucleotides that adopt a stem-loop structure for in situ hybridization. They can be designed to target radiation-responsive mRNAs, which is a class of biomarkers that are attractive for biodosimetry. We design and use molecular beacons as probes for the measurement of radiation-induced changes of intracellular mRNA in a microfluidic device for the determination of radiation dosage. Our experiments, in which fixed TK6 cells labeled with a molecular beacon specific to BAX mRNA exhibited dose-dependent fluorescence in a manner consistent with RT-qPCR analysis, demonstrate the potential utility of this approach in point-of-care biodosimetry. Molecular beacons against FDXR mRNA have also been developed preliminarily. In summary, this thesis presents the development of multiple molecular probes for intracellular targets, aiming to be applied towards biodosimetry applications. Opportunities for future research are discussed at the end of the thesis, including enhancements in microfluidic measurements of intracellular biomarkers, the development of nucleic acid probes for multiplexed measurements, and the creation of integrated microfluidic devices for point-of-care intracellular biodosimetry.

INTRODUÇÃO. A definição de insuficiência hepática pós-operatória (IHP) não é ainda padronizada, dificultando a comparação de inovações em procedimentos hepáticos e tornando complexo o uso de possíveis intervenções terapêuticas pós- operatórias em um momento adequado. CASUÍSTICA E MÉTODOS. Entre 1998 e 2002, 775 resecções hepáticas eletivas, dos quais 531 (69%) por doenças malignas e 464 (60%) consistindo em hepatectomias maiores, foram incluídas de maneira prospectiva em um banco de dados. O parênquima hepático não-tumoral foi anormal em 330 pacientes (43%) incluindo esteatose em mais que 30% dos hepatócitos em 107 (14%), fibrose sem cirrose em 237 (43%) e cirrose em 94 (12%). Foi analisado o impacto sobre a mortalidade da ocorrência de tempo de protrombina (TP) menor que 50% e bilirrubina total sérica (BT) maior que 50 µmol/L (3 mg/dl) (critério 50-50) nos dias pós-operatórios (PO) 1, 3, 5 e 7. RESULTADOS. A cinética pós-operatória do TP e da BT foram diferentes. O menor nível de TP foi no primeiro dia pós-operatório (PO) e o pico de BT foi no terceiro dia PO. A tendência ao retorno para valores pré-operatórios destes dois fatores bioquímicos se firmou claramente no quinto DPO. A mortalidade operatória global foi de 3.4% (26 pacientes), incluindo 21 (81%) casos com parênquima não-tumoral anormal e 20 (77%) após uma hepatectomia maior. O índice de mortalidade foi maior em pacientes com TP < 50% ou BT > 50 µmol/L (3 mg/dl) no pós-operatório. A conjunção de TP < 50% e BT > 50 µmol/L (3 mg/dl) no quinto DPO foi potente fator preditivo de mortalide, a qual atingiu 59% quando esta associação ocorreu. CONCLUSÕES. A partir do quinto dia PO, a associação de TP > 50% e BT > 50 µml/L (3 mg/dl) (critério 50-50) foi preditor prático e acurado de índice de mortalidade após hepatectomia. Propõe-se assim este critério como definição de insuficiência hepática pós-operatória. / INTRODUCTION. Definition of postoperative liver failure (PLF) is not standardized, rendering complex the comparison of novelties in liver procedures and also the use of possible postoperative therapeutic interventions in due time. METHODS. Between 1998 and 2002, 775 elective liver resections, whence 531 (69%) were for malignancies and 464 (60%) for major resections, were included in a prospective database. The non- tumorous hepatic parenchima was abnormal in 330 patients (43%) including steatosis > 30% in 107 (14%), non-cirrhotic fibrosis in 237 (43%) and cirrhosis in 94 (12%). The clinical impact of Prothrombin Time (PT) < 50% and Serum Bilirubin (SB) > 50µmol/L (3 mg/dl) (50-50 criteria) on postoperative days (POD) 1, 3, 5 and 7 was analyzed. RESULTS. Kinetic of postoperative PT and SB were different. Lowest PT levels were on POD1 and the peak of SB was on POD 3. The tendency to return to preoperative values of these two biochemical factors was clearly affirmed on POD 5. Operative mortality was 3.4% (26 patients), including 21 (81%) cases with abnormal liver parenchyma and 20 (77%) following major hepatectomies. Mortality rate was increased in patients with PT < 50% or SB > 50µmol/L (3mg/dl). The conjunction of PT < 50% and SB > 50µmol/L (3 mg/dl) on POD 5 was a strong predictive factor of increased mortality, which reached 59%. CONCLUSIONS We found that after postoperative day 5, the association of PT > 50% and SB > 50µml/L (3 mg/dl) (50-50 criteria) was a simple and accurate predictor of mortality after hepatectomy. These results allow us to propose this criteria as a definition of postoperative liver failure.

A Síndrome de Martin-Bell é uma forma hereditária de retardo mental determinada pela perda da expressão do gene FMR1 que está associado com a expansão da repetição dos tri-nucleotídeos citosina-guanina¬-guanina (CGG). Os indivíduos com um alto grau dessa expansão apresentam o silenciamento da expressão desse gene, com conseqüente alteração no desenvolvimento do sistema nervoso do embrião, causando danos neurológicos irreparáveis. A citogenética é uma metodologia clássica que contribui para o diagnóstico da síndrome em casos sem esclarecimentos, porém sua sensibilidade isoladamente em muitos casos é insuficiente para um diagnóstico positivo mesmo diante de características clínicas evidentes. Na busca de uma alternativa para suprir esta necessidade de definir exatamente as alterações encontradas em cada caso propôs-se a otimização de uma PCR de alta fidelidade no diagnóstico diferencial da Síndrome e simultaneamente comparar com os dados da citogenética clássica. Para tanto, foram coletadas amostras de sangue periférico de 102 pacientes e avaliou-se 100 a 150 metáfases para cada indivíduo pela citogenética clássica e para a PCR duplex. Os resultados demonstram pelo teste de Kruskal-Wallis que a PCR com a citogenética não apresentou diferenças significativas (p&#62;0,05). Porém quando avaliadados pelo índice de Kappa sugere-se que os dois critéiros de diagnósticos devem ser utilizados simultaneamente com caracteristicas clínicas do paciente. A PCR mostrou-se rápida e com custo relativamente menor, sendo portanto, aplicável no auxílio ao aconselhamento genético dos indivíduos e suas famílias, bem como para um acompanhamento psico-pedagógico adequado. / The Martin-Bell Syndrome is a heredity mental retard form determined by the loss of FMR1 gene expression which is associated with the tri-nucleotides cytosine-guanine-guanine (CGG) repetition expansion. The individuals showing a high degree of this expansion present the silencing of this gene expression, with a consequent alteration of the embryo nervous system evolution, causing irreparable neurological damage The cytogenetics is a classical methodology that contributes for diagnosing the syndrome in cases without clarification, thus its sensitivity isolated in many cases is insufficient for a positive diagnosis even in front of evident clinical characteristics. On searching for an alternative to fulfill this need to define the found alterations in each case, an optimization of a high fidelity PCR to Syndrome diagnosis and simultaneously to compare with classical cytogenetics. Peripheral blood samples were collected from 102 patients for evaluating 100 to 150 metaphases evaluation by classical cytogenetics for each sample and to duplex PCR. The results showed by the Kruskal-Wallis test that the PCR with the cytogenetics have not presented significant differences (p&#62;0,05). However, when evaluated by the Kappa index it was suggested that the two diagnosis criteria should be used simultaneously with patient s clinical characteristics. The PCR showed itself quick and with a relatively lower cost , and in this way, applicable in helping genetically counseling individuals and their families, as well as sending them to a more adequate psycho-pedagogical treatment.

A asma é uma doença crônica inflamatória das vias aéreas, de importância mundial pela sua elevada prevalência, com considerável impacto na qualidade de vida dos pacientes. Dentre os diferentes fenótipos de asma, a asma alérgica constitui a maioria dos casos. Dentre os diferentes desencadeantes de exacerbações na asma, os aeroalérgenos têm papel de destaque, sendo os ácaros o grupo mais importante e prevalente. Entre os ácaros, os mais relevantes para estudo são o Dermatophagoides pteronyssinus (Der p) e a Blomia tropicalis (Blo t), com importância significativa nos países tropicais. Pacientes podem ser sensibilizados a esses dois ácaros ou a um deles somente, mas a positividade do teste in vivo ou in vitro não significa reatividade clínica e que haja concordância com o alérgeno relevante para o desencadeamento dos sintomas. A reatividade cruzada entre esses dois ácaros vem sendo estudada. In vivo, há poucos trabalhos demonstrando a reatividade cruzada entre Der p e Blo t e analisando a correlação entre os testes cutâneos e os de provocação brônquica. O objetivo desse estudo é avaliar a reatividade clínica em pacientes com asma sensibilizados a ambos os ácaros, Der p e Blo t. Para isso, pacientes com asma do Ambulatório do Serviço de Imunologia Clínica e Alergia do HC-FMUSP foram selecionados. Broncoprovocações específicas foram realizadas com os dois ácaros, em diferentes momentos. Dezoito pacientes com asma foram selecionados, e trinta e seis provocações foram realizadas. Todas as provocações com o ácaro Der p foram positivas. Em relação à Blo t, o resultado foi positivo em 93% dos testes. No presente estudo, houve concordância na maioria dos casos entre a presença de sensibilização aos ácaros estudados e a positividade na boncoprovocação. Portanto, as sensibilizações aos ácaros identificados no teste cutâneo são relevantes para o desencadeamento dos sintomas de asma nesses pacientes / Asthma is a chronic inflammatory disease of the airways of global importance due to its high prevalence, with considerable impact on quality of life of patients. Among the different phenotypes of asthma, allergic asthma constitutes the majority of cases. Among the different triggers of asthma exacerbations, aeroallergens have the leading role, being mites group more important and prevalent. Among the mites, the most relevant to the study are Dermatophagoides pteronyssinus (Der p) and Blomia tropicalis (Blo t), with significant importance in tropical countries. Patients can be sensitive to these two mites or only one of them, but the positivity of test in vivo or in vitro clinical reactivity and does not mean that there is agreement with the relevant allergen for the triggering of symptoms. The cross-reactivity between these two mites has been studied. In vivo, there are few studies demonstrating the cross-reactivity between Der p and Blo t analyzing the correlation between skin tests and bronchial provocation. The aim of this study is to evaluate the clinical reactivity in patients with asthma sensitized to both house dust mites, Der p and Blo t. For this reason, patients with asthma, Ambulatory Service of Clinical Immunology and Allergy HCFMUSP were selected. Specific bronchial provocation tests were performed with both mites at different times. Eighteen patients with asthma were selected, and thirty-six provocations were performed. All provocations with the mite Der p were positive. Regarding Blo t, the result was positive in 93% of tests. In the present study, there was agreement in most cases between the presence of sensitization to mites and positivity in bronchial provocation test. Therefore, sensitization to mites in skin test identified is relevant to the triggering of asthma symptoms in these patients