The use of regional citrate anticoagulation (RCA) in liver failure (LF) patients can lead to citrate accumulation. We aimed to evaluate serum levels of citrate and correlate them with liver function ...markers and with the Cat/Cai in patients under intensive care and undergoing continuous venovenous hemodiafiltration with regional citrate anticoagulation (CVVHDF-RCA). A prospective cohort study in an intensive care unit was conducted. We compared survival, clinical, laboratorial and dialysis data between patients with and without LF. Citrate was measured daily. We evaluated 200 patients, 62 (31%) with LF. Citrate was significantly higher in the LF group. Dialysis dose, filter lifespan, systemic ionized calcium and Cat/Cai were similar between groups. There were weak to moderate positive correlations between Citrate and indicators of liver function and Cat/Cai. The LF group had higher mortality (70.5% vs. 51.8%, p = 0.014). Citrate was an independent risk factor for death, OR 11.3 (95% CI 2.74-46.8). In conclusion, hypercitratemia was an independent risk factor for death in individuals undergoing CVVHDF-ARC. The increase in citrate was limited in the LF group, without clinical significance. The correlation between citrate and liver function indicators was weak to moderate.
The Timed-Up and Go (TUG) test is widely utilized by healthcare professionals for assessing fall risk and mobility due to its practicality. Currently, test results are based solely on execution time, ...but integrating technological devices into the test can provide additional information to enhance result accuracy. This study aimed to assess the reliability of smartphone-based instrumented TUG (iTUG) parameters. We conducted evaluations of intra- and inter-device reliabilities, hypothesizing that iTUG parameters would be replicable across all experiments. A total of 30 individuals participated in Experiment A to assess intra-device reliability, while Experiment B involved 15 individuals to evaluate inter-device reliability. The smartphone was securely attached to participants' bodies at the lumbar spine level between the L3 and L5 vertebrae. In Experiment A, subjects performed the TUG test three times using the same device, with a 5 min interval between each trial. Experiment B required participants to perform three trials using different devices, with the same time interval between trials. Comparing stopwatch and smartphone measurements in Experiment A, no significant differences in test duration were found between the two devices. A perfect correlation and Bland-Altman analysis indicated good agreement between devices. Intra-device reliability analysis in Experiment A revealed significant reliability in nine out of eleven variables, with four variables showing excellent reliability and five showing moderate to high reliability. In Experiment B, inter-device reliability was observed among different smartphone devices, with nine out of eleven variables demonstrating significant reliability. Notable differences were found in angular velocity peak at the first and second turns between specific devices, emphasizing the importance of considering device variations in inertial measurements. Hence, smartphone inertial sensors present a valid, applicable, and feasible alternative for TUG assessment.
Systematic review of pelvic floor interventions during pregnancy Schreiner, Lucas; Crivelatti, Isabel; Oliveira, Julia M. ...
International journal of gynecology and obstetrics,
October 2018, 2018-Oct, 2018-10-00, 20181001, Volume:
143, Issue:
1
Journal Article
Peer reviewed
Background
Pelvic floor interventions during pregnancy could reduce the impact of pregnancy and delivery on the pelvic floor.
Objective
To determine the effects of pelvic floor interventions during ...pregnancy on childbirth‐related and pelvic floor parameters.
Search strategy
PubMed, Embase, and LILACS were searched for reports published during between 1990 and 2016 in English, Spanish, or Portuguese. The search terms were “pregnancy,” “pelvic floor muscle training,” and related terms.
Selection criteria
Randomized controlled trials with healthy pregnant women were included.
Data collection and analysis
Baseline and outcome data (childbirth‐related parameters, pelvic floor symptoms) were compared for three interventions: EPI‐NO (Tecsana, Munich, Germany) perineal dilator, pelvic floor muscle training, and perineal massage.
Main results
A total of 22 trials were included. Two of three papers assessing EPI‐NO showed no benefit. The largest study investigating pelvic floor muscle training reported a significant reduction in the duration of the second stage of labor (P<0.01), and this intervention also reduced the incidence of urinary incontinence (evaluated in 10 trials). Two of six trials investigating perineal massage reported that a lower rate of perineal pain was associated with this intervention.
Conclusion
Pelvic floor muscle training and perineal massage improved childbirth‐related parameters and pelvic floor symptoms, whereas EPI‐NO showed no benefit.
Pelvic floor muscle training during pregnancy shortens the second stage of labor and reduces urinary incontinence, whereas perineal massage reduces perineal pain.
This article includes a Portuguese translation of the , available in the Supporting Information section.
Objective
Evaluate the effects of the scanning techniques and the crystallization in the internal and marginal adaptation of milled lithium disilicate crowns by two techniques computer ...microtomography analysis.
Materials and Methods
Sixteen polyurethane teeth prepared for a complete crown were divided into two groups according to the scanner method (n = 8): indirect (IND), dental stone models were scanned with laser‐surface scanner, and direct (DIR), digital typodont creates with an intraoral scanner. Internal and marginal gap were evaluated by micro‐computed tomography (microCT). The replica technique (RT) was applied for analysis of total volume (TV) and marginal volume (MV) gap in microCT. The data showed normal distribution (Shapiro‐Wilk test). One‐way ANOVA (scanner techniques) with repeated measures (crystallization) was performed. Multiple comparisons were performed with Bonferroni adjustment (α = .05).
Results
The axial gap showed a significant difference between the times (P = .017) for lower values after crystallization. The vertical marginal gap presented a significant difference in times for higher value after crystallization (P = .001). The marginal horizontal gap IND was greater than DIR after crystallization (P = .001) and IND before lower than after crystallization. For TV was not significant difference and MV in DIR was reduction (P = .002) after crystallization. Conclusion: Crystallization changes the relationship between the crown and tooth, reducing internal gap and preventing the adequate fit in indirect and direct scanning.
Clinical Significance
The measure gap under technological methodology is useful for adjust clinical parameters prosthetic in the CAD/CAM and the applicability of the new possibilities of analysis.
The role of apoptosis‐associated speck‐like protein containing a caspase‐1 recruitment domain (ASC) in bone healing remains to be understood. To address this issue, we investigated the requirement of ...inflammasome‐related genes in response to bone morphogenetic protein 7 (BMP7)‐induced osteoblast differentiation in vitro. To validate the importance of ASC on osteogenesis, we subjected wild‐type (WT) and ASC knockout C57BL/6 mice (ASC KO) to tibia defect to evaluate the bone healing process (up to 28 days). Our in vitro data showed that there is an involvement of ASC during BMP7‐induced osteoblast differentiation, concomitant to osteogenic biomarker expression. Indeed, primary osteogenic cells from ASC KO presented a lower osteogenic profile than those obtained from WT mice. To validate this hypothesis, we evaluated the bone healing process of tibia defects on both WT and ASC KO mice genotypes and the ASC KO mice were not able to fully heal tibia defects up to 28 days, whereas WT tibia defects presented a higher bone de novo volume at this stage, evidencing ASC as an important molecule during osteogenic phenotype. In addition, we have shown a higher involvement of runt‐related transcription factor 2 in WT sections during bone repair, as well as circulating bone alkaline phosphatase isoform when both were compared with ASC KO mice behavior. Altogether, our results showed for the first time the involvement of inflammasome during osteoblast differentiation and osteogenesis, which opens new avenues to understand the pathways involved in bone healing.
ASC contributes to osteoblast differentiation and bone de novo deposition, opening new avenues to understand the complex mechanism coupling inflammation landscape and osteoblastogenesis during bone healing.
•Starch is a renewable, cheap, and biodegradable natural raw material used widely in the food industry and in many non-food applications.•Potato is one of the most important starchy crops of ...world.•The potato processing for starch extraction is a potential market in Brazil.•The understanding of starch structure and physical properties is essential for the industrial application.
Starches from different potato cultivars were characterized as amylose and phosphorus content, crystallinity, thermal and paste properties. Statistical analysis of amylose content showed difference between starches samples and the cultivars Asterix and BRS Clara showed higher contents than others. Phosphorus content ranged from 633 to 966.7mgkg−1. The X-ray diffraction analysis showed that the crystallization of potato starches can be classified as B-type X-ray pattern, presenting crystallinity index ranging from 20.02% to 21.59%. Regarding thermal properties, the onset temperature did not show statistical difference between starch samples, in gelatinization and retrogradation analysis. As expected there was a significant decrease in peak temperature and enthalpy after the retrogradation of starches. For the pasting properties results showed significant difference in all cultivars. Pearson correlation coefficients showed that amylose content was negatively correlated to the onset, peak and final temperature of gelatinization, final temperature of retrogradation and pasting temperature. Phosphorus content was positively correlated to crystallinity index, peak viscosity and breakdown. Starches extracted from potato varieties showed different characteristics which can be useful to food and related industries that make use of potato starch, allowing wide options of use in various sectors of industrial application in Brazil.
Introduction and hypothesis
Urgency urinary incontinence (UUI) is highly prevalent in elderly individuals and has a great impact on quality of life. Transcutaneous tibial nerve stimulation (TTNS) can ...be an effective treatment option for UUI in older women.
Methods
This is a single-center randomized clinical trial with a 12-month follow-up involving 106 women > 60 years of age. Kegel exercises and bladder retraining were performed alone or in combination with TTNS, which consisted of using a transcutaneous electrical nerve stimulator for 30 min once a week for 12 weeks with the following settings: continuous mode, 10 Hz, 200 ms, and 10 to 50 mA (according to hallux mobilization). Responders to therapy who experienced failure during follow-up were invited for a 3-week protocol with the same parameters as those used for the initial therapy. Patients were evaluated at baseline, 4 weeks after the 12-week protocol, and every 3 months for 12 months, through subjective satisfaction questionnaires, a 3-day bladder diary and the International Consultation on Incontinence Questionnaire-Short Form. King’s Health Questionnaire was applied pretreatment and 4 weeks after the last session of the 12-week protocol.
Results
A total of 101 women completed the initial 12-week protocol. TTNS patients reported 66.7% subjective global satisfaction vs. 32.0% in the control group (
p
< 0.001). The TTNS group showed statistically significant improvement in quality of life (QoL) and UUI parameters compared with the control group. Forty-eight patients were satisfied after the 12-week protocol and completed the 12-month follow-up (32 in the TTNS group and 16 in the control group). A total of 80.5% of responders to TTNS were still satisfied at the end of the 12-month follow-up vs. 30.8% in the control group (
p
= 0.009).
Conclusion
TTNS is effective at the 12-month follow-up for the treatment of UUI in elderly women.
Electrical stimulation is commonly recommended to treat urinary incontinence in women. It includes several techniques that can be used to improve stress, urge, and mixed symptoms. However, the ...magnitude of the alleged benefits is not completely established.
To determine the effects of electrical stimulation in women with symptoms or urodynamic diagnoses of stress, urge, and mixed incontinence.
Our review included articles published between January 1980 and January 2012. We used the search terms ″urinary incontinence″, ″electrical stimulation ″, ″ intravaginal ″, ″ tibial nerve ″ and ″ neuromodulation ″ for studies including female patients.
We evaluated randomized trials that included electrical stimulation in at least one arm of the trial, to treat women with urinary incontinence.
Two reviewers independently assessed the data from the trials, for inclusion or exclusion, and methodological analysis.
A total of 30 randomized clinical trials were included. Most of the trials involved intravaginal electrical stimulation. Intravaginal electrical stimulation showed effectiveness in treating urge urinary incontinence, but reported contradictory data regarding stress and mixed incontinence. Tibial-nerve stimulation showed promising results in randomized trials with a short follow-up period. Sacral-nerve stimulation yielded interesting results in refractory patients.
Tibial-nerve and intravaginal stimulation have shown effectiveness in treating urge urinary incontinence. Sacral-nerve stimulation provided benefits in refractory cases. Presently available data provide no support for the use of intravaginal electrical stimulation to treat stress urinary incontinence in women. Further randomized trials are necessary to determine the magnitude of benefits, with long-term follow-up, and the effectiveness of other electrical-stimulation therapies.
Abstract Native cassava starch was gelatinized under different pretreatment conditions (preheating temperature, starch concentration and heating time) and spray-dried. A rotational compound central ...design was used to test the three independent variables: the preheating temperature, starch concentration, and heating time, and the behavior of the system was assessed by response surface methodology. The results showed a significant effect of both the preheating temperature and heating time on the cold viscosity. The combination of the preheating temperature and starch concentration affected the crystallinity, enthalpy change, solubility, and final viscosity. Modification by spray-drying resulted in a decrease in the crystalline regions, and enthalpy change, as well as an increase in the cold viscosity. The optimal conditions for obtaining partially gelatinized cassava starch with high cold viscosity and lower breakdown, desirable characteristics for commercial pregelatinized starch, are as follows: starch concentration of 25%, preheating temperature of 52 °C, and processing heating time of 10 min.
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