Xylella fastidiosa and Xanthomonas citri subsp. citri, that cause citrus variegated chlorosis (CV... more Xylella fastidiosa and Xanthomonas citri subsp. citri, that cause citrus variegated chlorosis (CVC) and citrus canker diseases, respectively, utilize diffusible signal factor (DSF) for quorum sensing. DSF, produced by RpfF, are similar fatty acids in both organisms, although a different set of genes is regulated by DSF in each species. Because of this similarity, Xylella fastidiosa DSF might be recognized and affect the biology of Xanthomonas citri. Therefore, trans-genic Citrus sinensis and Carrizo citrange plants overex-pressing the Xylella fastidiosa rpfF were inoculated with Xanthomonas citri and changes in symptoms of citrus can-ker were observed. X. citri biofilms formed only at wound sites on transgenic leaves and were thicker; however, bacteria were unable to break through the tissue and form pus-tules elsewhere. Although abundant growth of X. citri occurred at wound sites on inoculated transgenic leaves, little growth was observed on unwounded tissue. Genes in the DFS-responsive core in X. citri were downregulated in bacteria isolated from transgenic leaves. DSF-dependent expression of engA was suppressed in cells exposed to xylem sap from transgenic plants. Thus, altered symptom development appears to be due to reduced expression of virulence genes because of the presence of antagonists of DSF signaling in X. citri in rpfF-expressing plants.
Since manipulation of DNA sequences was feasible, it has also become feasible to insert such sequ... more Since manipulation of DNA sequences was feasible, it has also become feasible to insert such sequences into distinct genomes. The possibility of creating plants with completely new characteristics conferred by one or more genetic sequences is undoubtedly an exciting platform to be explored, and for sure, a point of divergence between to accept or to deny such new variations created. Currently, several products present new traits ranging from insects resistance to vaccine synthesis, and the technique is still a subject of great criticism. Different nomenclatures are adopted for plants that had their genome altered and in this work they will be named genetically modified plants, which encloses plants presenting traits from non-related organisms such as viruses and bacteria, as well as plants belonging to the new concepts of cisgenic and intragenic. These concepts were created due to the possibility of obtaining isolated genes containing their own regulatory elements or genetic combinations between plant regulatory sequences and target genes, allowing the cisgenic technique to be partially considered an improvement on the classical reproduction technique. In this review we will discuss the three generations of GMs developed, as well as the recent questions about the concept of cisgenic and intragenic, and how these new approaches on genome engineered plants can collaborate to overcome public acceptance of an increasing in availability of GM foods for consumers. ABBREVIATIONS GM: Genetically Modified
Xylella fastidiosa is a phytopathogen that causes diseases in different plant species. The develo... more Xylella fastidiosa is a phytopathogen that causes diseases in different plant species. The development of disease symptoms is associated to the blockage of the xylem vessels caused by biofilm formation. In this study, we evaluated the sensitivity of biofilm and planktonic cells to copper, one of the most important antimicrobial agents used in agriculture. We measured the exopolysaccharides (EPS) content in biofilm and planktonic cells and used real-time reverse transcription polymerase chain reaction to evaluate the expression of the genes encoding proteins involved in cation/multidrug extru-sion (acrA/B, mexE/czcA, and metI) and others associated with different copper resistance mechanisms (copB, cutA1, cutA2, and cutC) in the X. fastidiosa biofilm formed in two different media. We confirmed that biofilms are less susceptible to copper than planktonic cells. The amount of EPS seems to be directly related to the resistance and it varies according to the media where the cells are grown. The same was observed for gene expression. Nevertheless, some genes seem to have a greater importance in biofilm cells resistance to copper. Our results suggest a synergistic effect between diffusion barriers and other mechanisms associated with bacterial resistance in this phytopathogen. These mechanisms are important for a bacterium that is constantly under stress conditions in the host.
There is considerable uncertainty about the reproducibility of the various instruments used to me... more There is considerable uncertainty about the reproducibility of the various instruments used to measure dyspnea, their ability to reflect changes in symptoms, whether they accurately reflect the patient's experience and if its evolution is similar between acute heart failure syndrome patients and nonacute heart failure syndrome patients. URGENT was a prospective multicenter trial designed to address these issues. Methods Patients were interviewed within 1 hour of first physician evaluation, in the emergency department or acute care setting, with dyspnea assessed by the patient using both a five-point Likert scale and a 10-point visual analog scale (VAS) in the sitting (60º) and then supine (20º) position if dyspnea had not been considered severe or very severe by the sitting versus decubitus dyspnea measurement. Results Very good agreements were found between the five-point Likert and VAS at baseline (0.891, P <0.0001) and between changes (from baseline to hour 6) in the five-point Likert and in VAS (0.800, P <0.0001) in acute heart failure (AHF) patients. Lower agreements were found when changes from baseline to H6 measured by Likert or VAS were compared with the seven-point comparative Likert (0.512 and 0.500 respectively) in AHF patients. The worse the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours; this relationship is stronger when dyspnea is measured with VAS (Spearman's rho coefficient = 0.672) than with the five-point Likert (0.272) (both P <0.0001) in AHF patients. By the five-point Likert, only nine patients (3% (1% to 5%)) reported an improvement in their dyspnea, 177 (51% (46% to 57%)) had no change, and 159 (46% (41% to 52%)) reported worse dyspnea supine compared with sitting up in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Conclusions Both clinical tools five-point Likert and VAS showed very good agreement at baseline and between changes from baseline to tests performed 6 hours later in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Dyspnea is improved within 6 hours in more than threequarters of the patients regardless of the tool used to measure the change in dyspnea. The greater the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours.
Model-based neuro-fuzzy control of FiO 2 for intensive care mechanical ventilation HF Kwok, GH Mi... more Model-based neuro-fuzzy control of FiO 2 for intensive care mechanical ventilation HF Kwok, GH Mills, M Mahfouf, DA Linkens P3 Comparison of closed with open tracheal aspiration system A Sanver, A Topeli, Y Çetinkaya, S Kocagöz, S Ünal P4 A laboratory assessment of the learning and retention of skills required to use the Combitube and Laryngeal Mask Airway by non-anaesthetists C Coles, C Elding, M Mercer P5 Pediatric airway exchange catheter can be a lifesaving device for the adult patients who have risk factors for difficult tracheal reintubation L Dosemeci, F Gurpinar, M Yilmaz, A Ramazanoglu P6 Cricothyroidotomy for elective airway management in critically ill trauma patients SM Wanek, EB Gagnon, C Rehm, RJ Mullins P7 Comparison of two percutaneous tracheostomy techniques I . Ö Akinci, P Ozcan, S Tug v rul, N Çakar, F Esen, L Telci, K Akpir P8 Percutaneous tracheostomy in patients with ARDS on HFOV S Shah, M Read, P Morgan P9 The dilatational tracheotomy -minimally-invasive, bed-side, inexpensive -but safe? MG Baacke, I Roth, M Rothmund, L Gotzen P10 Combination stenting for central airway stenosis P11 Ulcerative laryngitis in children admitted to intensive care M Hatherill, Z Waggie, L Reynolds, A Argent P12 Bronchial asthma in intensive care department: the factors influencing on exacerbation severity TA Pertseva, KE Bogatskaya, KU Gashynova P13 Severe BOOP M Mer, R Taylor, GA Richards P14 Facial continuous positive airway pressure therapy for cardiogenic pulmonary oedema: a study of its efficacy in an emergency department setting within the UK C Read, P16 Noninvasive positive pressure ventilation in patients with blunt chest trauma and acute respiratory failure S Milanov, M Milanov P17 Helium-oxygen (He-O 2 ) enhances oxygenation and increases carbon dioxide clearance in mechanically ventilated patients JAS Ball, R Cusack, A Rhodes, RM Grounds P18 Optimal method of flow and volume monitoring in patients mechanically ventilated with helium-oxygen (He-O 2 ) mixtures JAS Ball, A Rhodes, RM Grounds P19 Lessons learned from airway pressure release ventilation LJ Kaplan, H Bailey P20 Patient controlled pressure support ventilation D Chiumello, P Taccone, L Civardi, E Calvi, M Mondino, N Bottino, P Caironi P21 Impact of weaning failure in the evolution of patients under mechanical ventilation A Bruhn, P22 Abstract withdrawn P23 Rapid reduction of oxygenation index by employment of a recruitment technique in patients with severe ARDS GA Richards, H White, M Hopley P24 The effects of recruitment maneuver on oxygenation in primary and secondary adult respiratory distress syndrome S Tug v rul, N Çakar, IÖ Akinci, P Ergin Özcan, M Tug v rul, F Esen, L Telci, K Akpir Contents Available online http://ccforum.com/supplements/5/S1 Critical Care Vol 5 Suppl 1 Contents P25 Comparison of the P/V curve obtained by the supersyringe and the optoelectronic plethysmography D Chiumello, E Calvi, E Noe', L Civardi, E Carlesso, A Aliverti, R Dellacà P26 Assessment of static compliance and estimated lung recruitment as a tool for PEEP setting in ARDS patients P Dostal, V Cerny, R Parizkova P27 Positive end-expiratory pressure does not increase intraocular pressure in patients with intracranial pathology K Kokkinis, P Manolopoulou, J Katsimpris, S Gartaganis P28 Effects of lung recruitment and PEEP after CPB on pressure-absolute volume curves T Dyhr, A Larsson P29 The histopathological changes comparison in healthy rabbit lung ventilated with ZEEP, Sigh and PEEP Ç Yardimci, G Meyanci, H Öz, I Paksoy
Introduction: The benefits of higher positive end expiratory pressure (PEEP) in patients with acu... more Introduction: The benefits of higher positive end expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS) have been modest, but few studies have fully tested the "open-lung hypothesis". This hypothesis states that most of the collapsed lung tissue observed in ARDS can be reversed at an acceptable clinical cost, potentially resulting in better lung protection, but requiring more intensive maneuvers. The short-/ middle-term efficacy of a maximum recruitment strategy (MRS) was recently described in a small physiological study. The present study extends those results, describing a case-series of non-selected patients with early, severe ARDS submitted to MRS and followed until hospital discharge or death.
Introduction Cardiac surgery with cardiopulmonary bypass (CPB) is a recognized trigger of systemi... more Introduction Cardiac surgery with cardiopulmonary bypass (CPB) is a recognized trigger of systemic inflammatory response, usually related to postoperative acute lung injury (ALI). As an attempt to dampen inflammatory response, steroids have been perioperatively administered to patients. Macrophage migration inhibitory factor (MIF), a regulator of the endotoxin receptor, is implicated in the pathogenesis of ALI. We have previously detected peak circulating levels of MIF, 6 hours post CPB. Experimental data have shown that steroids may induce MIF secretion by mononuclear cells. This study aims to correlate levels of MIF assayed 6 hours post CPB to the intensity of postoperative pulmonary dysfunction, analysing the impact of perioperative steroid administration.
Background: Ventilator-associated pneumonia (VAP) is one of the most common health care-associate... more Background: Ventilator-associated pneumonia (VAP) is one of the most common health care-associated infections (HAIs) in critical care settings. Objective: Our objective was to examine the effect of a series of interventions, implemented in 3 different periods to reduce the incidence of VAP in an intensive care unit (ICU). Methods: A quasiexperimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed during different phases. From (P3), we continued P2 interventions and implemented the Institute for Healthcare Improvement's ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions. Results: The incidence density of VAP in the ICU per 1000 patient-days was 16.4 in phase 1, 15.0 in phase 2, and 10.4 in phase 3, P 5 .05. Getting to zero VAP was possible only in P3 when compliance with all interventions exceeded 95%. Conclusion: These results suggest that reducing VAP rates to zero is a complex process that involves multiple performance measures and interventions.
Background: Prevention of health care-associated infections is well described in critical care. H... more Background: Prevention of health care-associated infections is well described in critical care. However, surveillance in step-down unit (SDU) patients who need intermediate care with bilevel mechanical ventilation pressure through tracheotomy needs to be better understood. We evaluated the implementation of preventive measures in SDU over 2 different periods on device (bilevel mechanical ventilation)-associated pneumonia. Methods: A quasi-experimental, interrupted time series study was conducted in SDUs. Interventions were implemented to optimize the prevention of pneumonia associated with tracheostomy and evaluated in 2 phases. From January to October of 2007 (phase 1), some practices recommended by the Centers for Disease Control and Prevention were implemented, and the epidemiology unit carried out surveillance for pneumonia associated with tracheostomy. From November of 2007 to August of 2008 (phase 2) the same practices recommended by the Centers for Disease Control and Prevention were followed, but, in addition, the assessment of these processes as well as bedside interventions were initiated. Results: The mean incidence density of tracheostomy associated pneumonia per 1,000 tracheostomy-days in the SDUs was 6.0 in phase 1 and 0.7 in phase 2, P 5 .002. Conclusion: Reducing pneumonia associated with tracheostomy is a continuous multidisciplinary process that involves the measurement of multiple performance metrics.
Complete sequencing of the Xylella fastidiosa genome revealed characteristics that have not been ... more Complete sequencing of the Xylella fastidiosa genome revealed characteristics that have not been described previously for a phytopathogen. One characteristic of this genome was the abundance of genes encoding proteins with adhesion functions related to biofilm formation, an essential step for colonization of a plant host or an insect vector. We examined four of the proteins belonging to this class encoded by genes in the genome of X. fastidiosa: the PilA2 and PilC fimbrial proteins, which are components of the type IV pili, and XadA1 and XadA2, which are afimbrial adhesins. Polyclonal antibodies were raised against these four proteins, and their behavior during biofilm development was assessed by Western blotting and immunofluorescence assays. In addition, immunogold electron microscopy was used to detect these proteins in bacteria present in xylem vessels of three different hosts (citrus, periwinkle, and hibiscus). We verified that these proteins are present in X. fastidiosa biofilms but have differential regulation since the amounts varied temporally during biofilm formation, as well as spatially within the biofilms. The proteins were also detected in bacteria colonizing the xylem vessels of infected plants. * Corresponding author. Mailing address: Centro APTA Citros Sylvio Moreira/IAC, Rodovia Anhanguera Km 158, Cordeirópolis SP, Brazil 13490-970. Phone and
This work reports the in vitro expression of Citrus leprosis virus C (CiLV-C) putative coat prote... more This work reports the in vitro expression of Citrus leprosis virus C (CiLV-C) putative coat protein (p29) and the production of a polyclonal antibody to be used as a tool for serological diagnosis of citrus leprosis. The ORF2/RNA1, corresponding to p29, was cloned in pET28a and transformed into Escherichia coli cells (BL21). Expression of p29 was induced in vitro and the protein was purified and used for immunization of rabbits to produce the polyclonal antibody. The anti p29 serum was shown to be highly specific to CiLV-C detection by immunological methods (Western blot, PTA-ELISA, tissue blot and in situ immunolocalization), without cross reaction with healthy citrus plants or other cytoplasmic and nuclear viruses transmitted by Brevipalpus mites. These results demonstrate that the antibody against CiLV-C p29 protein is highly specific for CiLV-C detection. In situ immunogold labeling assays on thin sections of sweet orange leaf cells infected by CiLV-C demonstrated that short, bacilliform particles present within cisternae of the endoplasmic reticulum were specifically labeled, confirming their viral nature. The dense cytoplasmic viroplasm was also heavily labeled indicating that it represents a site of p29 accumulation.
Xylella fastidiosa and Xanthomonas citri subsp. citri, that cause citrus variegated chlorosis (CV... more Xylella fastidiosa and Xanthomonas citri subsp. citri, that cause citrus variegated chlorosis (CVC) and citrus canker diseases, respectively, utilize diffusible signal factor (DSF) for quorum sensing. DSF, produced by RpfF, are similar fatty acids in both organisms, although a different set of genes is regulated by DSF in each species. Because of this similarity, Xylella fastidiosa DSF might be recognized and affect the biology of Xanthomonas citri. Therefore, trans-genic Citrus sinensis and Carrizo citrange plants overex-pressing the Xylella fastidiosa rpfF were inoculated with Xanthomonas citri and changes in symptoms of citrus can-ker were observed. X. citri biofilms formed only at wound sites on transgenic leaves and were thicker; however, bacteria were unable to break through the tissue and form pus-tules elsewhere. Although abundant growth of X. citri occurred at wound sites on inoculated transgenic leaves, little growth was observed on unwounded tissue. Genes in the DFS-responsive core in X. citri were downregulated in bacteria isolated from transgenic leaves. DSF-dependent expression of engA was suppressed in cells exposed to xylem sap from transgenic plants. Thus, altered symptom development appears to be due to reduced expression of virulence genes because of the presence of antagonists of DSF signaling in X. citri in rpfF-expressing plants.
Since manipulation of DNA sequences was feasible, it has also become feasible to insert such sequ... more Since manipulation of DNA sequences was feasible, it has also become feasible to insert such sequences into distinct genomes. The possibility of creating plants with completely new characteristics conferred by one or more genetic sequences is undoubtedly an exciting platform to be explored, and for sure, a point of divergence between to accept or to deny such new variations created. Currently, several products present new traits ranging from insects resistance to vaccine synthesis, and the technique is still a subject of great criticism. Different nomenclatures are adopted for plants that had their genome altered and in this work they will be named genetically modified plants, which encloses plants presenting traits from non-related organisms such as viruses and bacteria, as well as plants belonging to the new concepts of cisgenic and intragenic. These concepts were created due to the possibility of obtaining isolated genes containing their own regulatory elements or genetic combinations between plant regulatory sequences and target genes, allowing the cisgenic technique to be partially considered an improvement on the classical reproduction technique. In this review we will discuss the three generations of GMs developed, as well as the recent questions about the concept of cisgenic and intragenic, and how these new approaches on genome engineered plants can collaborate to overcome public acceptance of an increasing in availability of GM foods for consumers. ABBREVIATIONS GM: Genetically Modified
Xylella fastidiosa is a phytopathogen that causes diseases in different plant species. The develo... more Xylella fastidiosa is a phytopathogen that causes diseases in different plant species. The development of disease symptoms is associated to the blockage of the xylem vessels caused by biofilm formation. In this study, we evaluated the sensitivity of biofilm and planktonic cells to copper, one of the most important antimicrobial agents used in agriculture. We measured the exopolysaccharides (EPS) content in biofilm and planktonic cells and used real-time reverse transcription polymerase chain reaction to evaluate the expression of the genes encoding proteins involved in cation/multidrug extru-sion (acrA/B, mexE/czcA, and metI) and others associated with different copper resistance mechanisms (copB, cutA1, cutA2, and cutC) in the X. fastidiosa biofilm formed in two different media. We confirmed that biofilms are less susceptible to copper than planktonic cells. The amount of EPS seems to be directly related to the resistance and it varies according to the media where the cells are grown. The same was observed for gene expression. Nevertheless, some genes seem to have a greater importance in biofilm cells resistance to copper. Our results suggest a synergistic effect between diffusion barriers and other mechanisms associated with bacterial resistance in this phytopathogen. These mechanisms are important for a bacterium that is constantly under stress conditions in the host.
There is considerable uncertainty about the reproducibility of the various instruments used to me... more There is considerable uncertainty about the reproducibility of the various instruments used to measure dyspnea, their ability to reflect changes in symptoms, whether they accurately reflect the patient's experience and if its evolution is similar between acute heart failure syndrome patients and nonacute heart failure syndrome patients. URGENT was a prospective multicenter trial designed to address these issues. Methods Patients were interviewed within 1 hour of first physician evaluation, in the emergency department or acute care setting, with dyspnea assessed by the patient using both a five-point Likert scale and a 10-point visual analog scale (VAS) in the sitting (60º) and then supine (20º) position if dyspnea had not been considered severe or very severe by the sitting versus decubitus dyspnea measurement. Results Very good agreements were found between the five-point Likert and VAS at baseline (0.891, P <0.0001) and between changes (from baseline to hour 6) in the five-point Likert and in VAS (0.800, P <0.0001) in acute heart failure (AHF) patients. Lower agreements were found when changes from baseline to H6 measured by Likert or VAS were compared with the seven-point comparative Likert (0.512 and 0.500 respectively) in AHF patients. The worse the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours; this relationship is stronger when dyspnea is measured with VAS (Spearman's rho coefficient = 0.672) than with the five-point Likert (0.272) (both P <0.0001) in AHF patients. By the five-point Likert, only nine patients (3% (1% to 5%)) reported an improvement in their dyspnea, 177 (51% (46% to 57%)) had no change, and 159 (46% (41% to 52%)) reported worse dyspnea supine compared with sitting up in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Conclusions Both clinical tools five-point Likert and VAS showed very good agreement at baseline and between changes from baseline to tests performed 6 hours later in AHF patients. The PDA test with VAS was markedly different between AHF and non-AHF patients. Dyspnea is improved within 6 hours in more than threequarters of the patients regardless of the tool used to measure the change in dyspnea. The greater the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours.
Model-based neuro-fuzzy control of FiO 2 for intensive care mechanical ventilation HF Kwok, GH Mi... more Model-based neuro-fuzzy control of FiO 2 for intensive care mechanical ventilation HF Kwok, GH Mills, M Mahfouf, DA Linkens P3 Comparison of closed with open tracheal aspiration system A Sanver, A Topeli, Y Çetinkaya, S Kocagöz, S Ünal P4 A laboratory assessment of the learning and retention of skills required to use the Combitube and Laryngeal Mask Airway by non-anaesthetists C Coles, C Elding, M Mercer P5 Pediatric airway exchange catheter can be a lifesaving device for the adult patients who have risk factors for difficult tracheal reintubation L Dosemeci, F Gurpinar, M Yilmaz, A Ramazanoglu P6 Cricothyroidotomy for elective airway management in critically ill trauma patients SM Wanek, EB Gagnon, C Rehm, RJ Mullins P7 Comparison of two percutaneous tracheostomy techniques I . Ö Akinci, P Ozcan, S Tug v rul, N Çakar, F Esen, L Telci, K Akpir P8 Percutaneous tracheostomy in patients with ARDS on HFOV S Shah, M Read, P Morgan P9 The dilatational tracheotomy -minimally-invasive, bed-side, inexpensive -but safe? MG Baacke, I Roth, M Rothmund, L Gotzen P10 Combination stenting for central airway stenosis P11 Ulcerative laryngitis in children admitted to intensive care M Hatherill, Z Waggie, L Reynolds, A Argent P12 Bronchial asthma in intensive care department: the factors influencing on exacerbation severity TA Pertseva, KE Bogatskaya, KU Gashynova P13 Severe BOOP M Mer, R Taylor, GA Richards P14 Facial continuous positive airway pressure therapy for cardiogenic pulmonary oedema: a study of its efficacy in an emergency department setting within the UK C Read, P16 Noninvasive positive pressure ventilation in patients with blunt chest trauma and acute respiratory failure S Milanov, M Milanov P17 Helium-oxygen (He-O 2 ) enhances oxygenation and increases carbon dioxide clearance in mechanically ventilated patients JAS Ball, R Cusack, A Rhodes, RM Grounds P18 Optimal method of flow and volume monitoring in patients mechanically ventilated with helium-oxygen (He-O 2 ) mixtures JAS Ball, A Rhodes, RM Grounds P19 Lessons learned from airway pressure release ventilation LJ Kaplan, H Bailey P20 Patient controlled pressure support ventilation D Chiumello, P Taccone, L Civardi, E Calvi, M Mondino, N Bottino, P Caironi P21 Impact of weaning failure in the evolution of patients under mechanical ventilation A Bruhn, P22 Abstract withdrawn P23 Rapid reduction of oxygenation index by employment of a recruitment technique in patients with severe ARDS GA Richards, H White, M Hopley P24 The effects of recruitment maneuver on oxygenation in primary and secondary adult respiratory distress syndrome S Tug v rul, N Çakar, IÖ Akinci, P Ergin Özcan, M Tug v rul, F Esen, L Telci, K Akpir Contents Available online http://ccforum.com/supplements/5/S1 Critical Care Vol 5 Suppl 1 Contents P25 Comparison of the P/V curve obtained by the supersyringe and the optoelectronic plethysmography D Chiumello, E Calvi, E Noe', L Civardi, E Carlesso, A Aliverti, R Dellacà P26 Assessment of static compliance and estimated lung recruitment as a tool for PEEP setting in ARDS patients P Dostal, V Cerny, R Parizkova P27 Positive end-expiratory pressure does not increase intraocular pressure in patients with intracranial pathology K Kokkinis, P Manolopoulou, J Katsimpris, S Gartaganis P28 Effects of lung recruitment and PEEP after CPB on pressure-absolute volume curves T Dyhr, A Larsson P29 The histopathological changes comparison in healthy rabbit lung ventilated with ZEEP, Sigh and PEEP Ç Yardimci, G Meyanci, H Öz, I Paksoy
Introduction: The benefits of higher positive end expiratory pressure (PEEP) in patients with acu... more Introduction: The benefits of higher positive end expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS) have been modest, but few studies have fully tested the "open-lung hypothesis". This hypothesis states that most of the collapsed lung tissue observed in ARDS can be reversed at an acceptable clinical cost, potentially resulting in better lung protection, but requiring more intensive maneuvers. The short-/ middle-term efficacy of a maximum recruitment strategy (MRS) was recently described in a small physiological study. The present study extends those results, describing a case-series of non-selected patients with early, severe ARDS submitted to MRS and followed until hospital discharge or death.
Introduction Cardiac surgery with cardiopulmonary bypass (CPB) is a recognized trigger of systemi... more Introduction Cardiac surgery with cardiopulmonary bypass (CPB) is a recognized trigger of systemic inflammatory response, usually related to postoperative acute lung injury (ALI). As an attempt to dampen inflammatory response, steroids have been perioperatively administered to patients. Macrophage migration inhibitory factor (MIF), a regulator of the endotoxin receptor, is implicated in the pathogenesis of ALI. We have previously detected peak circulating levels of MIF, 6 hours post CPB. Experimental data have shown that steroids may induce MIF secretion by mononuclear cells. This study aims to correlate levels of MIF assayed 6 hours post CPB to the intensity of postoperative pulmonary dysfunction, analysing the impact of perioperative steroid administration.
Background: Ventilator-associated pneumonia (VAP) is one of the most common health care-associate... more Background: Ventilator-associated pneumonia (VAP) is one of the most common health care-associated infections (HAIs) in critical care settings. Objective: Our objective was to examine the effect of a series of interventions, implemented in 3 different periods to reduce the incidence of VAP in an intensive care unit (ICU). Methods: A quasiexperimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed during different phases. From (P3), we continued P2 interventions and implemented the Institute for Healthcare Improvement's ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions. Results: The incidence density of VAP in the ICU per 1000 patient-days was 16.4 in phase 1, 15.0 in phase 2, and 10.4 in phase 3, P 5 .05. Getting to zero VAP was possible only in P3 when compliance with all interventions exceeded 95%. Conclusion: These results suggest that reducing VAP rates to zero is a complex process that involves multiple performance measures and interventions.
Background: Prevention of health care-associated infections is well described in critical care. H... more Background: Prevention of health care-associated infections is well described in critical care. However, surveillance in step-down unit (SDU) patients who need intermediate care with bilevel mechanical ventilation pressure through tracheotomy needs to be better understood. We evaluated the implementation of preventive measures in SDU over 2 different periods on device (bilevel mechanical ventilation)-associated pneumonia. Methods: A quasi-experimental, interrupted time series study was conducted in SDUs. Interventions were implemented to optimize the prevention of pneumonia associated with tracheostomy and evaluated in 2 phases. From January to October of 2007 (phase 1), some practices recommended by the Centers for Disease Control and Prevention were implemented, and the epidemiology unit carried out surveillance for pneumonia associated with tracheostomy. From November of 2007 to August of 2008 (phase 2) the same practices recommended by the Centers for Disease Control and Prevention were followed, but, in addition, the assessment of these processes as well as bedside interventions were initiated. Results: The mean incidence density of tracheostomy associated pneumonia per 1,000 tracheostomy-days in the SDUs was 6.0 in phase 1 and 0.7 in phase 2, P 5 .002. Conclusion: Reducing pneumonia associated with tracheostomy is a continuous multidisciplinary process that involves the measurement of multiple performance metrics.
Complete sequencing of the Xylella fastidiosa genome revealed characteristics that have not been ... more Complete sequencing of the Xylella fastidiosa genome revealed characteristics that have not been described previously for a phytopathogen. One characteristic of this genome was the abundance of genes encoding proteins with adhesion functions related to biofilm formation, an essential step for colonization of a plant host or an insect vector. We examined four of the proteins belonging to this class encoded by genes in the genome of X. fastidiosa: the PilA2 and PilC fimbrial proteins, which are components of the type IV pili, and XadA1 and XadA2, which are afimbrial adhesins. Polyclonal antibodies were raised against these four proteins, and their behavior during biofilm development was assessed by Western blotting and immunofluorescence assays. In addition, immunogold electron microscopy was used to detect these proteins in bacteria present in xylem vessels of three different hosts (citrus, periwinkle, and hibiscus). We verified that these proteins are present in X. fastidiosa biofilms but have differential regulation since the amounts varied temporally during biofilm formation, as well as spatially within the biofilms. The proteins were also detected in bacteria colonizing the xylem vessels of infected plants. * Corresponding author. Mailing address: Centro APTA Citros Sylvio Moreira/IAC, Rodovia Anhanguera Km 158, Cordeirópolis SP, Brazil 13490-970. Phone and
This work reports the in vitro expression of Citrus leprosis virus C (CiLV-C) putative coat prote... more This work reports the in vitro expression of Citrus leprosis virus C (CiLV-C) putative coat protein (p29) and the production of a polyclonal antibody to be used as a tool for serological diagnosis of citrus leprosis. The ORF2/RNA1, corresponding to p29, was cloned in pET28a and transformed into Escherichia coli cells (BL21). Expression of p29 was induced in vitro and the protein was purified and used for immunization of rabbits to produce the polyclonal antibody. The anti p29 serum was shown to be highly specific to CiLV-C detection by immunological methods (Western blot, PTA-ELISA, tissue blot and in situ immunolocalization), without cross reaction with healthy citrus plants or other cytoplasmic and nuclear viruses transmitted by Brevipalpus mites. These results demonstrate that the antibody against CiLV-C p29 protein is highly specific for CiLV-C detection. In situ immunogold labeling assays on thin sections of sweet orange leaf cells infected by CiLV-C demonstrated that short, bacilliform particles present within cisternae of the endoplasmic reticulum were specifically labeled, confirming their viral nature. The dense cytoplasmic viroplasm was also heavily labeled indicating that it represents a site of p29 accumulation.
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