Introduction
Sialorrhea, also known as drooling, hypersalivation, or ptyalism, has a significant impact on the medical and psychosocial well‐being of children. Onabotulinum toxin A (BoNT‐A) is the ...most commonly used botulinum toxin worldwide for the treatment of sialorrhea in children.
Objectives
To conduct a comprehensive systematic review and meta‐analysis to assess the clinical efficacy and potential adverse effects of BoNT‐A as a treatment for drooling in children.
Methods
Cochrane, Embase, and Medline databases were systematically searched (up to May 2023). Out of 535 identified publications, 20 were found eligible for inclusion. A systematic review and meta‐analysis were performed to determine the efficacy of BoNT‐A treatment in children in reducing the frequency and severity of drooling.
Results
Out of the 20 studies included, a meta‐analysis was conducted on the complete dataset of eight studies involving 131 patients. BoNT‐A was found to significantly decrease the severity of drooling in patients with sialorrhea (standardized mean difference SMD, −2.07; 95% confidence interval CI, −2.91 to −1.23; p < 0.0001) when compared with the conditions before injections using random‐effects models. Six studies out of 20 reported dysphagia as an adverse effect after injection. Other side effects included thickness of saliva and pain at the site of injection.
Conclusion
BoNT‐A is a clinically effective therapy that improves drooling severity in children with sialorrhea. Although there were some adverse side effects reported, they were transient and not severe. Future studies are needed to further evaluate the best techniques and to identify the ideal dosages required to achieve the optimal outcomes. Laryngoscope, 134:3012–3017, 2024
BoNT‐A is a clinically effective therapy that improves drooling severity in children with sialorrhea. Although there were some adverse side effects reported, they were transient and not severe. Future studies are needed to further evaluate the best techniques and to identify the ideal dosages required to achieve the optimal outcomes.
Background
Voice changes are frequently reported after thyroidectomy due to injury to the external branch of the superior laryngeal nerve (EBSLN) and paralysis of the cricothyroid muscle, The ...objective is to evaluate the advantage of intraoperative neuromonitoring (IONM) in identifying EBSLN during thyroid surgery.
Methods
Data sources were MEDLINE, PubMed, Web of Science, and Cochrane Library from January 1, 1995, through July 1, 2018. Published studies of adult patients who had thyroid surgery and an attempt to identify EBSLN done by conventional methods and/or IONM were selected.
Results
Seven studies met all inclusion criteria. Patients who had IONM during thyroid surgery had a significantly increased number of identified EBSLN at risk, compared to the control group.
Conclusion
The use of IONM during open thyroid surgery increases EBSLN identification/visualization, and hence it may decrease the incidence of post‐thyroidectomy voice disorders.
Nutrition impact symptoms (NIS) are common in cancer patients and the negative impacts on nutritional status indicate the need for research, diagnosis and nutritional intervention in order to reduce ...the risk of malnutrition. We aimed to verify the presence of malnutrition, the need for nutritional intervention, NIS and their influence on the nutritional status of surgical patients with cancer.
This cross-sectional study was carried out in a public tertiary hospital, from March 2017 to October 2019. Nutritional status, the need for nutritional intervention and NIS were assessed through the Patient-Generated Subjective Global Assessment (PG-SGA) in the first 48 hours of hospital admission.
Among the 135 patients evaluated, 55.6% were elderly and 51.1% were male; patients had a median age of 62 years and a predominance of cancer located in the lower gastrointestinal tract (35.6%). Malnutrition and the need for nutritional intervention were identified in 60.0% and 90.4% of cases, respectively. The presence of three or more NIS was reported by 51.9% of patients. Significant differences in NIS were observed according to sex, PG-SGA classification and PG-SGA score. After logistic regression analysis, it was determined that the symptoms that increased the chances of malnutrition were anorexia, constipation, strange taste, mouth sores and others (depression, dental or financial problems).
Malnutrition, the need for nutritional intervention and the presence of three or more NIS were elevated in the patients evaluated. Malnutrition was associated with the presence of NIS, indicating the need for attention and care in antineoplastic treatment.
•The present study is a systematic literature review.•The studies emphasize occupational safety issues compared to worker health issues.•The analysis pointed to weaknesses in use of epidemiological ...indicators in the management of OHS.•These indicators allow companies to proactively manage events with their employees.
Occupational accidents and disease are events that can and should be controlled preventively by planning, organization and assessment of the performance of the means of control implemented. Excellence in Occupational Health and Safety (OHS) depends on models that allow the adoption of preventive measures to reduce work-related risks by proactive action to improve the workers’ health, safety and satisfaction. The objective of this article was to verify success factors, barriers and indicators present in the process of implementing an Occupational Health and Safety Management System. A systematic review of literature was performed by two independent researchers, based on the protocol of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). After a search in the databases Scopus, Science Direct and Web of Science, applying inclusion and exclusion criteria, 21 articles in English language, published between the years 2007 and 2018, remained in the final analysis. The results allowed evidencing the methodologies, tools and indicators used in OHS management. The analyses pointed out weaknesses in the existing models, particularly about the use of epidemiological indicators that allow helping the organizations to manage the occurrences with their workers proactively. A predominance of analysis was observed focusing on matters related to occupational safety to the detriment of analysis referring to occupational health which are given less enphasis.
Mast cells, known as pro‐inflammatory effector cells, are immunocytes present in the meninges and may be involved in the pathophysiology of migraine. This study aims to evaluate the histomorphometric ...parameters of mast cells located in the convexity of the human intracranial dura mater. For this, samples of intracranial dura mater from eight human fresh cadavers were collected between 8‐ and 24‐h post‐mortem. The whole samples were fixed and, subsequently, two fragments of 1.5 cm² each were cut from four different areas of the dura mater convexity, containing a segment of the middle meningeal artery, totaling 64 fragments. After histological processing, the fragments were submitted to microtomy (5 and 10 µm), stained with toluidine blue (0.1%), or immunohistochemically labeled for tryptase, and analyzed using optical microscopy. The following histomorphometric parameters were evaluated: distance from mast cells to vessels, the density of mast cells, and percentage of mast cells with degranulation. Histomorphometric analyzes showed a higher density of mast cells in the vicinity of blood vessels (arterial and venous), with distances around 0–150 µm. A greater number of mast cells was detected near venous vessels in the periosteal layer (17.0 ± 10.1 cells/mm²) than in the meningeal layer (14.1 ± 7.0 cells/mm²) (p < 0.05). Mast cells from the region close to the superior sagittal sinus were found in greater quantity close to the venous vessels (16.7 ± 10.1 cells/mm²) than to the arterial vessels (11.2 ± 7.5 cells/mm²) (p < 0.05). In short, in the convexity of the human intracranial dura mater, mast cells are located close to blood vessels, with a greater number of cells next to the venous vessels of the periosteal layer and in the proximal region of the superior sagittal sinus.
The mast cells observed in the convexity of human intracranial dura are located near arterial and venous vessels. A higher density of the mast cells is in the vicinity of venous vessels in the periosteal layers and proximal to the superior sagittal sinus.
Stemness and chromosomal instability (CIN) are two common contributors to intratumor heterogeneity and therapy relapse in advanced cancer, but their interplays are poorly defined. Here, in anaplastic ...thyroid cancer (ATC), we show that ALDH+ stem-like cancer cells possess increased CIN-tolerance owing to transcriptional upregulation of the scaffolding protein NEDD9. Thyroid patient tissues and transcriptomic data reveals NEDD9/ALDH1A3 to be co-expressed and co-upregulated in ATC. Compared to bulk ALDH- cells, ALDH+ cells were highly efficient at propagating CIN due to their intrinsic tolerance of both centrosome amplification and micronuclei. ALDH+ cells mitigated the fitness-impairing effects of centrosome amplification by partially inactivating supernumerary centrosomes. Meanwhile, ALDH+ cells also mitigated cell death caused by micronuclei-mediated type 1 interferon secretion by suppressing the expression of the DNA-sensor protein STING. Both mechanisms of CIN-tolerance were lost upon RNAi-mediated NEDD9 silencing. Both in vitro and in vivo, NEDD9-depletion attenuated stemness, CIN, cell/tumor growth, while enhancing paclitaxel effectiveness. Collectively, these findings reveal that ATC progression can involve an ALDH1A3/NEDD9-regulated program linking their stemness to CIN-tolerance that could be leveraged for ATC treatment.
In forensic entomology, the minimum postmortem interval (PMImin) estimative is usually based on the oldest immature recovered from a local of death. The time spent by fly immatures in the ...intrapuparial period comprises more than 50% of their complete life cycles. An accurate estimate of the duration of this period will improve PMImin estimates. The blow fly Hemilucilia semidiaphana (Rondani 1850) was found in six criminal cases in the city of Curitiba. Even though there is data on the morphology of the larval instars and developmental rate of H. semidiaphana, the intrapuparial period has not been investigated. Here, we provide a detailed description of the intrapuparial morphological changes of H. semidiaphana, which might be useful to estimate minimum PMI. Samples of H. semidiaphana in the intrapuparial period were obtained from immatures reared on an artificial diet in incubators adjusted to 25°C or 20°C temperature regimes. Blow fly puparia of H. semidiaphana were fixed at intervals of 3 and 6 h until emergence of the adult. The external morphological traits of sampled immatures were analyzed using light microscopy. Our analysis of the intrapuparial period of H. semidiaphana provided 21 traits from which nine were age informative. These nine characteristics divide the developmental time (144 h at 25°C and 192 h at 20°C) into smaller sections. The developmental data provided, together with the time line allows a practical way to make interspecific comparisons as well as to estimate the age of H. semidiaphana based on the intrapuparial development.
Agriculture 4.0 can drive the growth of the agricultural production in emerging countries like Brazil, which is known as one of the primary food and meat producers worldwide, by offering a range of ...technologies such as the Internet of Things (IoT), Artificial Intelligence (AI), Blockchain, and Machine Learning. However, the development of agriculture 4.0 in Brazil is a complex process, and more needs to be known about the real barriers that impact its adoption among the actors of the agricultural production chain. There is a need for more empirical studies about the perception of Brazilian farmers regarding the barriers that may compromise the successful path of agriculture 4.0.
This article aims to validate the barriers that hinder the development of agriculture 4.0 in the agricultural production chain of Southern Brazil.
Twenty-five barriers were chosen for validation based on a systematic review of the existing literature. A confirmatory factor analysis was performed using the statistical tests of Kaiser-Meyer-Olkin and Bartlett. Validation was performed through the perception of farmers (n = 347) located in the states of Rio Grande do Sul, Santa Catarina, and Paraná. The data were collected from an online questionnaire that identified the importance of the barriers for the farmers in the sample.
The most frequent and important barriers mentioned by the farmers were: lack of infrastructure, lack of solutions accessible to farmers, need to foster R&D and innovative business models, age group risk, and lack of efficacy in the data on the rural environment. This information can contribute to constructing a framework that seeks to overcome these barriers, thus facilitating the expansion and dissemination of agriculture 4.0 in Brazil.
This study found that there is an open discussion about the barriers that hinder the adoption of agriculture 4.0 in the agricultural production chain. It will be necessary to further investigate the most prominent barriers in this study, as these may have significant impacts on other barriers. Thus, a systemic research that seeks to improve the conditions for implementing agriculture 4.0 is of great importance.
Display omitted
•The barriers that hinder the development of agriculture 4.0 in the Southern region of Brazil are validated.•Validation took place through the perception of farmers located in the states of Rio Grande do Sul, Santa Catarina, and Paraná.•Many barriers analyzed here were not properly investigated in previous studies, either in Brazil or in other countries.•This research provides relevant insights that contribute to a systemic view about the development of agriculture 4.0.
Background
Physical exercise in women with breast cancer has shown benefits in reducing fatigue levels during adjuvant radiotherapy and chemotherapy. However, it is not well understood which type of ...exercise is more effective.
Objective
Assess the impact of different types of physical exercises on fatigue and which is the most effective in reducing this adverse effect during adjuvant treatment in breast cancer.
Methods
The inclusion criteria were randomized clinical trials of physical exercise in women diagnosed with breast cancer in stages I to IV, above 18 years, evaluating fatigue using validated questionnaires. The meta-analysis pooled results by standardized mean difference (SMD).
Results
A total of 20 randomized clinical trials involving 1793 participants revealed that the practice of physical exercise was statistically effective in reducing fatigue (SMD = − 0.46; 95% CI: − 0.66, − 0.27). Our analysis of subgroups suggests that the supervised combination of resistance training (RT) with aerobic training (AT) is the most effective physical exercise to reduce fatigue (SMD = − 1.13; 95% CI: − 2.09, − 0.17). The supervised RT was more effective (SMD = − 0.30; 95% CI: − 0.46, − 0.15) than supervised AT or mind–body techniques. It was observed that only during chemotherapy, women with breast cancer in the intervention groups showed a significant reduction in fatigue (SMD = − 0.38; 95% CI: − 0.55 to − 0.20).
Conclusion
Physical exercise during adjuvant chemotherapy and/or radiotherapy in women with breast cancer can be considered beneficial in reducing fatigue, especially for women undergoing chemotherapy and for supervised training of resistance or combined RT and AT.
Malnutrition is common in patients with cancer, and its early diagnosis can reduce or prevent further complications and improve the clinical and nutritional prognosis. Adductor Pollicis Muscle ...Thickness (APMT) and Handgrip Strength have been explored in this population to identify a reduction in strength and muscle mass prior to the use of conventional methods. We aimed to correlate APMT and Handgrip Strength with conventional anthropometric variables in cancer patients and verify their association with nutritional status as determined by the Patient-Generated Subjective Global Assessment (PG-SGA).
A cross-sectional study was conducted with 80 patients diagnosed with cancer who were candidates for surgery. Nutritional status was obtained from the PG-SGA. Conventional anthropometric measurements were taken, as well as APMT and Handgrip Strength. Pearson's correlation analysis and multivariate linear regression were applied to detect the influence of variables on APMT and HGS. A significance level of 5.0% was considered.
A high prevalence of malnutrition and the need for dietotherapic intervention was found, identified by the PG-SGA. Correlations between APMT and Handgrip Strength with anthropometric variables and with the PG-SGA score were observed. After regression adjustments, the variables that interacted with APMT were TSF and AC, and the PG-SGA score, corrected Muscle Arm Area (CAMA), and age interacted with Handgrip Strength.
Correlations between anthropometric measurements and the PG-SGA score with APMT and Handgrip Strength were observed, even after adjusting for age and sex. These associations demonstrate that APMT and Handgrip Strength can be used with criterion in patients with cancer as complementary methods to evaluate nutritional risk and the need for nutritional intervention.
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