Objective
An association between bipolar disorder and cognitive impairment has repeatedly been described, even for euthymic patients. Findings are inconsistent both across primary studies and ...previous meta‐analyses. This study reanalysed 31 primary data sets as a single large sample (N = 2876) to provide a more definitive view.
Method
Individual patient and control data were obtained from original authors for 11 measures from four common neuropsychological tests: California or Rey Verbal Learning Task (VLT), Trail Making Test (TMT), Digit Span and/or Wisconsin Card Sorting Task.
Results
Impairments were found for all 11 test‐measures in the bipolar group after controlling for age, IQ and gender (Ps ≤ 0.001, E.S. = 0.26–0.63). Residual mood symptoms confound this result but cannot account for the effect sizes found. Impairments also seem unrelated to drug treatment. Some test‐measures were weakly correlated with illness severity measures suggesting that some impairments may track illness progression.
Conclusion
This reanalysis supports VLT, Digit Span and TMT as robust measures of cognitive impairments in bipolar disorder patients. The heterogeneity of some test results explains previous differences in meta‐analyses. Better controlling for confounds suggests deficits may be smaller than previously reported but should be tracked longitudinally across illness progression and treatment.
Hyperglycemia is associated with increased mortality in critically ill patients. Randomized trials of intensive insulin therapy have reported inconsistent effects on mortality and increased rates of ...severe hypoglycemia. We conducted a meta-analysis to update the totality of evidence regarding the influence of intensive insulin therapy compared with conventional insulin therapy on mortality and severe hypoglycemia in the intensive care unit (ICU).
We conducted searches of electronic databases, abstracts from scientific conferences and bibliographies of relevant articles. We included published randomized controlled trials conducted in the ICU that directly compared intensive insulin therapy with conventional glucose management and that documented mortality. We included in our meta-analysis the data from the recent NICE-SUGAR (Normoglycemia in Intensive Care Evaluation - Survival Using Glucose Algorithm Regulation) study.
We included 26 trials involving a total of 13 567 patients in our meta-analysis. Among the 26 trials that reported mortality, the pooled relative risk (RR) of death with intensive insulin therapy compared with conventional therapy was 0.93 (95% confidence interval CI 0.83-1.04). Among the 14 trials that reported hypoglycemia, the pooled RR with intensive insulin therapy was 6.0 (95% CI 4.5-8.0). The ICU setting was a contributing factor, with patients in surgical ICUs appearing to benefit from intensive insulin therapy (RR 0.63, 95% CI 0.44-0.91); patients in the other ICU settings did not (medical ICU: RR 1.0, 95% CI 0.78-1.28; mixed ICU: RR 0.99, 95% CI 0.86-1.12). The different targets of intensive insulin therapy (glucose level < or = 6.1 mmol/L v. < or = 8.3 mmol/L) did not influence either mortality or risk of hypoglycemia.
Intensive insulin therapy significantly increased the risk of hypoglycemia and conferred no overall mortality benefit among critically ill patients. However, this therapy may be beneficial to patients admitted to a surgical ICU.
In university hospital settings most prescriptions are written by junior doctors, who are more likely to make prescribing errors than experienced doctors. Prescribing errors can cause serious harm to ...patients and drug harm differs among low, middle and high-income countries. In Brazil, few studies have investigated the causes of these errors. Our aim was to explore medication prescribing errors in a teaching hospital, their causes, and underlying factors from the perspective of junior doctors.
Qualitative, descriptive and exploratory study that used a semi-structured individual interview with questions related to the planning and execution of prescriptions. It was conducted with 34 junior doctors who graduated from twelve different universities located in six Brazilian states. The data were analyzed according to the Reason's Accident Causation model.
Among the 105 errors reported, medication omission stood out. Most errors resulted from unsafe acts during execution, followed by mistakes and violations. Many errors reached the patients; unsafe acts of rule violations and slips accounted for the majority. Work overload and time pressure were the most frequently reported causes. Difficulties faced by the National Health System and organizational problems were identified as latent conditions.
The results reaffirm international findings about the severity of prescribing errors and the multifactorial aspect of their causes. Unlike other studies, we found a large number of violations, which, from the interviewees' perspectives, are related to socioeconomic and cultural patterns. The violations were not seen or mentioned by the interviewees as violations, but as difficulties in accomplishing their tasks on time. Knowing these patterns and perspectives is important for implementing strategies to improve the safety of both patients and professionals involved in the medication process. It is suggested that the exploitation culture of junior doctors' work be discouraged and that their training be improved and prioritized.
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.
Highlights • Short- and long-term spatial memory deficits are present in prediabetic rats. • Memory deficits are concurrent with increases of GluA1 and GLUN1 hippocampal levels. • Prediabetic rats ...display decreased hippocampal IR-β density. • Memory deficits are concurrent with decreased GR hippocampal levels.
Aims
To investigate the probiotic potential of yeasts isolated from naturally fermented Brazilian table olives.
Methods and Results
Eighteen yeast strains were tested in terms of: safety; survival of ...gastrointestinal and digestion conditions; antimicrobial activity; cellular hydrophobicity; autoaggregation ability and adhesion to epithelial cells; coaggregation and inhibition of pathogenic bacteria adhesion. Six yeasts showed favourable results for all probiotic attributes: Saccharomyces cerevisiae CCMA 1746, Pichia guilliermondii CCMA 1753, Candida orthopsilosis CCMA 1748, Candida tropicalis CCMA 1751, Meyerozyma caribbica CCMA 1758 and Debaryomyces hansenii CCMA 1761. These yeasts demonstrated resistance to 37°C, pH 2·0 and bile salts, and survived in vitro digestion (≥106 CFU per ml). Furthermore, the yeasts exhibited a hydrophobic cell surface (42·5–92·2%), autoaggregation capacity (41·0–91·0%) and adhesion to Caco‐2 (62·0–82·8%) and HT‐29 (57·6–87·3%) epithelial cell lines. Also, the strains showed antimicrobial activity against Salmonella Enteritidis as well as the ability to coaggregate and reduce the adhesion of this pathogen to intestinal cells.
Conclusions
Autochthonous yeasts from naturally fermented Brazilian table olives have probiotic properties, with potential for development of new probiotic food products.
Significance and Impact of Study
These data are important and contribute to the knowledge of new potential probiotic yeasts capable of surviving gastrointestinal tract conditions and inhibiting pathogenic bacteria.
A realistic two-dimensional model of Altair Bouchaud, K.; Domiciano de Souza, A.; Rieutord, M. ...
Astronomy and astrophysics (Berlin),
01/2020, Volume:
633
Journal Article
Peer reviewed
Open access
Context.
Fast rotation is responsible for important changes in the structure and evolution of stars and the way we see them. Optical long baseline interferometry now allows for the study of its ...effects on the stellar surface, mainly gravity darkening and flattening.
Aims.
We aim to determine the fundamental parameters of the fast-rotating star Altair, in particular its evolutionary stage (represented here by the core hydrogen mass fraction
X
c
), mass, and differential rotation, using state-of-the-art stellar interior and atmosphere models together with interferometric (ESO-VLTI), spectroscopic, and asteroseismic observations.
Methods.
We use ESTER two-dimensional stellar models to produce the relevant surface parameters needed to create intensity maps from atmosphere models. Interferometric and spectroscopic observables are computed from these intensity maps and several stellar parameters are then adjusted using the publicly available MCMC algorithm Emcee.
Results.
We determined Altair’s equatorial radius to be
R
eq
= 2.008 ± 0.006
R
⊙
, the position angle PA = 301.1 ± 0.3°, the inclination
i
= 50.7 ± 1.2°, and the equatorial angular velocity Ω = 0.74 ± 0.01 times the Keplerian angular velocity at equator. This angular velocity leads to a flattening of
ε
= 0.220 ± 0.003. We also deduce from the spectroscopically derived
v
sin
i
≃ 243 km s
−1
, a true equatorial velocity of ∼314 km s
−1
corresponding to a rotation period of 7h46m (∼3 cycles/day). The data also impose a strong correlation between mass, metallicity, hydrogen abundance, and core evolution. Thanks to asteroseismic data, and provided our frequencies identification is correct, we constrain the mass of Altair to 1.86 ± 0.03
M
⊙
and further deduce its metallicity
Z
= 0.019 and its core hydrogen mass fraction
X
c
= 0.71, assuming an initial solar hydrogen mass fraction
X
= 0.739. These values suggest that Altair is a young star ∼100 Myr old. Finally, the 2D ESTER model also gives the internal differential rotation of Altair, showing that its core rotates approximately 50% faster than the envelope, while the surface differential rotation does not exceed 6%.
A concise synthesis of molnupiravir in a one-pot two-step approach starting from uridine is described. Formally, herein, two sets of one-pot two-reaction steps introducing simplicity for ...purifications and using chemically available reagents are presented. In this context, molnupiravir was obtained in up to 68% overall yield and multigram-scale. In addition, HPLC analysis showed the molnupiravir purity above 99%.
Fast, effective and chromatography column-free chemical synthesis of molnupiravir.
Purpose
To assess the effects of tilted external hexagon implants and splinted restorations in terms of stress distribution on the bone tissue, implants, and prosthetic screws, using ...three‐dimensional finite element analysis.
Materials and Methods
Six models were used to simulate a posterior maxilla bone block (type IV) from the first premolar to the first molar. Each model included three 4.1‐mm‐diameter external hexagon implants with varying inclinations (0°, 17°, and 30°) and crown designs (splinted and nonsplinted restorations). The forces applied were as follows: 400 N axially (50 N for each slope of the cusp) and 200 N obliquely (45° only on the buccal slope of the cusp). Stress distribution on the implants and prosthetic screw was evaluated using Von Mises stress, while the maximum principal stress was used to evaluate the stress distribution in the bone tissue.
Results
The oblique load increased the stress on all the structures in all the models. Increased inclination of the implants resulted in higher stress concentration in the bone tissue, implants, and prosthetic screws. However, splinted restorations contributed to reduction of the stress for the oblique loading, mainly in the bone tissue and prosthetic screw of the first molar, as the stress was shared between the first and second premolar restorations.
Conclusions
Tilted implants increased proportionally the stress on bone tissue and prosthetic screws of models. Additionally, splinting restorations reduced the stress concentration area in the simulated bone tissue, implants, and prosthetic screws in the first molar, as the stress was shared with the adjacent implants.
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