•Hepatocellular carcinoma was detected in 51% of patients who had a liver transplant in 10 years at a university transplant center.•Patients meeting Milan Criteria in explant had a higher survival ...than those outside the criteria, and those within Brazilian expanded criteria had a higher survival than those outside the criteria.•Patients exceeding both Milan and Brazilian Criteria had the lowest survival rate.•Finding of tumor exceeding Milan criteria in the explant was an independent risk factor for death in patients with hepatocellular carcinoma.
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy, accounting for up to 90% of all primary liver neoplasms. HCC treatment options depend on tumor burden, the degree of liver dysfunction, and performance status. Orthotopic liver transplant offers the best chance for cure. The selection criteria adopted for transplant are based on the Milan Criteria (MC), which depend on tumor size and number (1 lesion ≤5 cm or up to 3 lesions of ≤3 cm, without vascular invasion or extrahepatic spread). In Brazil, an expanded version of the original MC, named the Brazilian Criteria (BC), takes into consideration only tumors larger or equal to 2 cm. This retrospective cohort aims to describe the prevalence of primary liver tumors and analyze the macro and microscopic characteristics of HCC on explant pathology in a university hospital over 10 years. Of 485 transplants, 243 (50.1%) had HCC. Most patients were men (77.4%) with a mean age of 58.4 years, and the most common primary etiology of liver disease was hepatitis C infection (64.2%). The total number of tumors was 628, generally multicentric (55.6%); segment VIII was the most affected, and alpha-fetoprotein was altered in 70.7% of the cases. Most patients had tumors meeting MC at pretransplant and on explant evaluation, along with higher overall survival when compared to those exceeding MC and BC, and especially with those outside both criteria. In addition, tumors outside MC represent an independent risk factor associated with death.
•Prone position in intubated patients with COVID-19 improves gas exchange.•Elderly and severe comorbidities increase mortality risk after prone sessions for ARDS-COVID-19.•ARDS-COVID-19 better ...respond when prone is applied early in patients with good health status.
Elderly patients are more susceptible to Coronavirus Disease-2019 (COVID-19) and are more likely to develop it in severe forms, (e.g., Acute Respiratory Distress Syndrome ARDS). Prone positioning is a treatment strategy for severe ARDS; however, its response in the elderly population remains poorly understood. The main objective was to evaluate the predictive response and mortality of elderly patients exposed to prone positioning due to ARDS-COVID-19.
This retrospective multicenter cohort study involved 223 patients aged ≥ 65 years, who received prone position sessions for severe ARDS due to COVID-19, using invasive mechanical ventilation. The PaO2/FiO2 ratio was used to assess the oxygenation response. The 20-point improvement in PaO2/FiO2 after the first prone session was considered for good response. Data were collected from electronic medical records, including demographic data, laboratory/image exams, complications, comorbidities, SAPS III and SOFA scores, use of anticoagulants and vasopressors, ventilator settings, and respiratory system mechanics. Mortality was defined as deaths that occurred until hospital discharge.
Most patients were male, with arterial hypertension and diabetes mellitus as the most prevalent comorbidities. The non-responders group had higher SAPS III and SOFA scores, and a higher incidence of complications. There was no difference in mortality rate. A lower SAPS III score was a predictor of oxygenation response, and the male sex was a risk predictor of mortality.
The present study suggests the oxygenation response to prone positioning in elderly patients with severe COVID-19-ARDS correlates with the SAPS III score. Furthermore, the male sex is a risk predictor of mortality.
Cataract surgery is one of the most frequently performed eye surgeries worldwide, and among several techniques, phacoemulsification has become the standard of care due to its safety and efficiency. ...We evaluated the advantages and disadvantages of two phacoemulsification techniques: phaco-chop and divide-and-conquer.
PubMed, Cochrane, Embase, and Web of Science databases were queried for randomized controlled trial (RCT), prospective and retrospective studies that compared the phaco-chop technique over the divide-and-conquer technique and reported the outcomes of (1) Endothelial cell count change (ECC); (2) Ultrasound time (UST); (3) Cumulated dissipated energy (CDE); (4) Surgery time; and (5) Phacoemulsification time (PT). Heterogeneity was examined with I
statistics. A random-effects model was used for outcomes with high heterogeneity.
Nine final studies, (6 prospective RCTs and 3 observational), comprising 837 patients undergoing phacoemulsification. 435 (51.9%) underwent the phaco-chop technique, and 405 (48.1%) underwent divide-and-conquer. Overall, the phaco-chop technique was associated with several advantages: a significant difference in ECC change postoperatively (Mean Difference MD -221.67 Cell/mm
; 95% Confidence Interval CI -401.68 to -41.66; p < 0.02; I2=73%); a shorter UST (MD -51.16 sec; 95% CI -99.4 to -2.79; p = 0.04; I2=98%); reduced CDE (MD -8.68 units; 95% CI -12.76 to -4.60; p < 0.01; I2=84%); a lower PT (MD -55.09 sec; 95% CI -99.29 to -12.90;
= 0.01; I2=100). There were no significant differences in surgery time (MD -3.86 min; 95% CI -9.55 to 1.83; p = 0.18; I2=99%).
The phaco-chop technique proved to cause fewer hazards to the corneal endothelium, with less delivered intraocular ultrasound energy when compared to the divide-and-conquer technique.
Obesity has been described as a predictor of cardiovascular mortality, and some studies have reported an association with obesity and increased aortic stiffness. Other studies have not identified ...obesity to be an independent risk factor. Therefore, the purpose of our study was to determine the association between aortic stiffness and obesity in the Brazilian population.
A cross-sectional study recruited 1,662 individuals aged 25-64 years from the population of Vitória, Brazil following the guidelines of the MONICA-WHO Project. Anthropometric, clinical, and hemodynamic measurements and analyses of aortic stiffness (using carotid-femoral pulse wave velocity <PWV) were obtained in 1,608 subjects.
PWV correlated positively with age, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure, heart rate (HR), body mass index (BMI), waist circumference (WC), cholesterol levels, triglyceride levels, and blood glucose levels. A multivariate regression analysis demonstrated that the mean BP (β = 0.405, P < 0.01), age (β = 0.314, P < 0.01), HR (β = 0.107, P < 0.01), BMI (β = -103, P < 0.01), and blood glucose levels (β = 0.093, P < 0.01) explained nearly 37% of the PWV variability. A multivariate regression analysis using the WC instead of the BMI failed to reveal any significant effect of this parameter on the PWV.
In conclusion, our study failed to provide evidence of a positive, blood pressure (BP)-independent association between obesity on aortic stiffness. Our data suggests that the previously reported finding of an association between obesity and aortic stiffness was probably confounded by the progressive increase in BP observed in obesity.
A new specialist group for Brazilian fungi Drechsler-Santos, Elisandro Ricardo; Calaça, Francisco J. Simões; Martins-Cunha, Kelmer ...
Oryx,
07/2023, Letnik:
57, Številka:
4
Journal Article
Bacterial superantigens are potent T cell activators that can activate T cells with specificity for antigens of the central nervous system (CNS). In this study, we compared the effect of two S. ...aureus strains on experimental autoimmune encephalomyelitis (EAE) development. C57BL/6 female mice were infected with S. aureus ATCC 51650, which produces toxic shock syndrome toxin 1 (TSST-1+) or S. aureus ATCC 43300, which does not produce toxins (TOX-). Three days later, the animals were subjected to EAE induction by immunization with myelin oligodendrocyte glycoprotein (MOG). The weight variation, disease incidence and clinical score were recorded daily. Cytokines and Foxp3+ regulatory T cells in the brain were evaluated during the acute disease phase. Cytokines and Foxp3+ regulatory T cells in the spleen and histopathological analysis of the CNS were assessed during the chronic stage.
Previous infection with both strains similarly decreased the clinical score; however, only the TSST-1+ strain clearly diminished inflammation in the CNS. The infections also modulated cytokine production in the spleen and CNS. Reduced production of IL-5 and IL-10 was detected in MOG-stimulated spleen cultures in the TOX- and TSST-1+ infected groups, respectively. In S. aureus stimulated cultures, there was an increased production of IFN-γ and IL-10 in both infected groups and an increased level of IL-5 in the TSST-1+ group. CNS infiltrating cell cultures from previously infected mice produced less IL-17 in response to MOG and more IFN-γ in response to S. aureus stimulation.
These results indicated that both strains attenuated clinical EAE manifestations, but only TSST-1 clearly decreased CNS inflammation.
Abstract
Brazil presented a very high number of maternal deaths and evident delays in healthcare. We aimed at evaluating the characteristics of SARS-CoV-2 infection and associated outcomes in the ...obstetric population. We conducted a prospective cohort study in 15 Brazilian centers including symptomatic pregnant or postpartum women with suspected COVID-19 from Feb/2020 to Feb/2021. Women were followed from suspected infection until the end of pregnancy. We analyzed maternal characteristics and pregnancy outcomes associated with confirmed COVID-19 infection and SARS, determining unadjusted risk ratios. In total, 729 symptomatic women with suspected COVID-19 were initially included. Among those investigated for COVID-19, 51.3% (n = 289) were confirmed COVID-19 and 48% (n = 270) were negative. Initially (before May 15th), only 52.9% of the suspected cases were tested and it was the period with the highest proportion of ICU admission and maternal deaths. Non-white ethnicity (RR 1.78 1.04–3.04), primary schooling or less (RR 2.16 1.21–3.87), being overweight (RR 4.34 1.04–19.01) or obese (RR 6.55 1.57–27.37), having public prenatal care (RR 2.16 1.01–4.68), planned pregnancies (RR 2.09 1.15–3.78), onset of infection in postpartum period (RR 6.00 1.37–26.26), chronic hypertension (RR 2.15 1.37–4.10), pre-existing diabetes (RR 3.20 1.37–7.46), asthma (RR 2.22 1.14–4.34), and anaemia (RR 3.15 1.14–8.71) were associated with higher risk for SARS. The availability of tests and maternal outcomes varied throughout the pandemic period of the study; the beginning was the most challenging period, with worse outcomes. Socially vulnerable, postpartum and previously ill women were more likely to present SARS related to COVID-19.
•Two dynamically stable Neptunian Trojans with inclination > 30°, 2013 VX30 and 2014 UU240, were found by the Dark Energy Survey.•2013 VX30 is the first known ultra-red Neptunian Trojan.•Our survey ...simulation suggested that there are 162 +/- 73 Trojans with Hr < 10 at the L4 Lagrange point of Neptune.•The blue-to-ultra-red Neptunian Trojan population ratio should be higher than 17:1.•This ratio is still higher than the putative parent population, the dynamically excited TNOs, which has blue-to-ultra-red object ratio about 4.4–11.0.
In the current model of early Solar System evolution, the stable members of the Jovian and Neptunian Trojan populations were captured into resonance from the leftover reservoir of planetesimals during the outward migration of the giant planets. As a result, both Jovian and Neptunian Trojans share a common origin with the primordial disk population, whose other surviving members constitute today’s trans-Neptunian object (TNO) populations. The cold (low inclination and small eccentricity) classical TNOs are ultra-red, while the dynamically excited “hot” (high inclination and larger eccentricity) population of TNOs contains a mixture of ultra-red and blue objects. In contrast, Jovian and Neptunian Trojans are observed to be blue. While the absence of ultra-red Jovian Trojans can be readily explained by the sublimation of volatile material from their surfaces due to the high flux of solar radiation at 5 AU, the lack of ultra-red Neptunian Trojans presents both a puzzle and a challenge to formation models. In this work we report the discovery by the Dark Energy Survey (DES) of two new dynamically stable L4 Neptunian Trojans, 2013 VX30 and 2014 UU240, both with inclinations i > 30°, making them the highest-inclination known stable Neptunian Trojans. We have measured the colors of these and three other dynamically stable Neptunian Trojans previously observed by DES, and find that 2013 VX30 is ultra-red, the first such Neptunian Trojan in its class. As such, 2013 VX30 may be a “missing link” between the Trojan and TNO populations. Using a simulation of the DES TNO detection efficiency, we find that there are 162 ± 73 Trojans with Hr < 10 at the L4 Lagrange point of Neptune. Moreover, the blue-to-red Neptunian Trojan population ratio should be higher than 17:1. Based on this result, we discuss the possible origin of the ultra-red Neptunian Trojan population and its implications for the formation history of Neptunian Trojans.
Building bridges between environmental and political agendas is essential nowadays in face of the increasing human pressure on natural environments, including wetlands. Wetlands provide critical ...ecosystem services for humanity and can generate a considerable direct or indirect income to the local communities. To meet many of the sustainable development goals, we need to move our trajectory from the current environmental destructive development to a wiser wetland use. The current article contain a proposed agenda for the Pantanal aiming the improvement of public policy for conservation in the Pantanal, one of the largest, most diverse, and continuous inland wetland in the world. We suggest and discuss a list of 11 essential interfaces between science, policy, and development in region linked to the proposed agenda. We believe that a functional science network can booster the collaborative capability to generate creative ideas and solutions to address the big challenges faced by the Pantanal wetland.
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