This is a narrative review in which the advances in technical aspects,the main indications,limitations and clinical results of the transjugular intrahepatic portosystemic shunt(TIPS)in portal hypertension(PH)are addre...This is a narrative review in which the advances in technical aspects,the main indications,limitations and clinical results of the transjugular intrahepatic portosystemic shunt(TIPS)in portal hypertension(PH)are addressed.With the emergence of the coated prosthesis,a better shunt patency,a lower incidence of hepatic encephalopathy(HE)and better survival when compared to TIPS with the conventional prosthesis are demonstrated.The main indications for TIPS are refractory ascites,acute variceal bleeding unresponsive to pharmacological/endoscopic therapy and,lastly,patients considered at high risk for rebleeding preemptive TIPS(pTIPS).Absolute contraindications to the use of TIPS are severe uncontrolled HE,systemic infection or sepsis,congestive heart failure,severe pulmonary arterial hypertension,and biliary obstruction.The control of hemorrhage due to variceal rupture can reach up to 90%-100%of cases,and 55%in refractory ascites.Despite evidences regarding pTIPS in patients at high risk for rebleeding,less than 20%of eligible patients are treated.TIPS may also decrease the incidence of future decompensation in cirrhosis and increase survival in selected patients.In conclusion,TIPS is an essential treatment for patients with PH,but is often neglected.It is important for the hepatologist to form a multidisciplinary team,in which the role of the radiologist with experience in interventional procedures is prominent.展开更多
Service Science,Engineering and Management(SSME)is emerging as a new discipline and several universities have been evolving or creating courses/programs to educate for the needs of the service fields of the economy.Th...Service Science,Engineering and Management(SSME)is emerging as a new discipline and several universities have been evolving or creating courses/programs to educate for the needs of the service fields of the economy.The University of Porto started in 2007 a master program in Service Engineering and Management,and Masaryk University started in 2008 a program in Service Science,Management,and Engineering.Both programs concentrate on services that are supported by technology,in particular information and communication technologies.This paper presents a summary of both programs and a proposal for a joint 2 year master program involving the two universities that is expected to start in 2010.Students in this program will take courses in the two universities,and lecturers will be involved in joint research projects. Individual students will have a semester research or applied project in a European service organization,being supervised by a lecturer or a researcher from each universities.It is expected that graduates will understand technological,organizational and cultural aspects of the diverse businesses in a wide European context and will be ready for service requirements of this century.展开更多
BACKGROUND Biliary atresia(BA)is the most common indication for pediatric liver transplantation,although portoenterostomy is usually performed first.However,due to the high failure rate of portoenterostomy,liver trans...BACKGROUND Biliary atresia(BA)is the most common indication for pediatric liver transplantation,although portoenterostomy is usually performed first.However,due to the high failure rate of portoenterostomy,liver transplantation has been advocated as the primary procedure for patients with BA.It is still unclear if a previous portoenterostomy has a negative impact on liver transplantation outcomes.AIM To investigate the effect of prior portoenterostomy in infants un-dergoing liver transplantation for BA.METHODS This was a retrospective cohort study of 42 pediatric patients with BA who underwent primary liver transplantation from 2013 to 2023 at a single tertiary center in Brazil.Patients with BA were divided into two groups:Those undergoing primary liver transplantation without portoenterostomy and those undergoing liver transplantation with prior portoenterostomy.Continuous variables were compared using the Student’s t-test or the Kruskal-Wallis test,and categorical variables were compared using theχ2 or Fisher’s exact test,as appropriate.Multivariable Cox regression analysis was performed to determine risk factors for portal vein thrombosis.Patient and graft survival analyses were conducted with the Kaplan–Meier product-limit estimator,and patient subgroups were compared using the two-sided log-rank test.RESULTS Forty-two patients were included in the study(25[60%]girls),23 undergoing liver transplantation without prior portoenterostomy,and 19 undergoing liver transplantation with prior portoenterostomy.Patients with prior portoenterostomy were older(12 vs 8 months;P=0.02)at the time of liver transplantation and had lower Pediatric End-Stage Liver Disease scores(13.2 vs 21.4;P=0.01).The majority of the patients(35/42,83%)underwent livingdonor liver transplantation.The group of patients without prior portoenterostomy appeared to have a higher incidence of portal vein thrombosis(39 vs 11%),but this result did not reach statistical significance.Prior portoenterostomy was not a protective factor against portal vein thrombosis in the multivariable analysis after adjusting for age at liver transplantation,graft-to-recipient weight ratio,and use of vascular grafts.Finally,the groups did not significantly differ in terms of post-transplant survival.CONCLUSION In our study,prior portoenterostomy did not significantly affect the outcomes of liver transplantation.展开更多
Background: Diabetes mellitus is one of the most common non-communicable diseases in the world. The aim of our study was to assess the level of knowledge of the adult population of Porto-Novo on clinical manifestation...Background: Diabetes mellitus is one of the most common non-communicable diseases in the world. The aim of our study was to assess the level of knowledge of the adult population of Porto-Novo on clinical manifestations and complications of diabetes mellitus. Methods: It is a descriptive cross-sectional study conducted under STEP wise approach. It took place from June 1 to July 28, 2014. Results: A total of 240 subjects were included in the study. The mean age of the subjects was 46.07 years ± 12.63 years, ranging from 25 to 80 years. Subjects age between 35 - 45 years are the most represented. Women were mostly represented 162 against 78 men respectively 67.5% against 32.5% with sex ratio of 0.48. The majority of the subjects were scholar (73.3%). For clinical manifestations of diabetes mellitus, 64.2% of subjects had quoted polyuria, asthenia 57.5%, 56.7% weight loss. Polydipsia and polyphagia were less familiar with, respectively, 27.5% and 23.3%. Regarding the complications of diabetes, diabetic foot and coma were the best known, respectively, 78.8% and 58.8%. Nephropathy (45.0%), 39.6% retinopathy and neuropathy (21.7%) were the least known. The prevalence of physical inactivity in this study population was 95.0%. It was 98.1% in women versus 88.5% for men. Conclusion: Diabetes mellitus, whose prevalence is steadily increasing, is not yet well known in our population.展开更多
<strong>Background:</strong> Chronic hyperglycemia promotes the development of degenerative diseases such as dementia. Our objective is to study dementia in diabetic patients in a hospital environment in P...<strong>Background:</strong> Chronic hyperglycemia promotes the development of degenerative diseases such as dementia. Our objective is to study dementia in diabetic patients in a hospital environment in Porto-Novo. <strong>Methods:</strong> This is a cross-sectional, prospective study with a descriptive and analytical aim that took place from May 18 to September 18, 2017, <i>i.e.</i> 4 months. The study population consists of all diabetic patients who consulted in the internal medicine departments of the Oueme-Plateau Teaching Hospital and at Saint Gérard clinic in Porto-Novo during the study period and who gave their enlightened consent. <strong>Results:</strong> The study included 246 patients with a mean age of 56.47 ± 11.97 years. There were 172 (69.9%) women, <i>i.e.</i> a sex ratio of 0.43. Diabetes had been known for less than 10 years in the majority (67.9%). Type 2 diabetics were in the majority (95.5%). Of the 246 patients, 42 (17.1%) had a Mini Mental State Examination (MMSE) less than or equal to 24. Of these 42 patients, 32 met the DSM V (Diagnostic and Statistical Manual disorders, 5th edition) criteria for dementias, i.e. a frequency of 13.0%. Of the 32 demented patients, 21 (65.6%) had vascular dementia and 34.4% had degenerative dementia. We did not note a mixed etiology. Dementia was severe in 15.6% of cases. In multivariate analysis, only age (OR = 10.09;95% CI [4.19 - 24.27];p < 0.001), arterial hypertension (OR = 7.10;95% CI [1.92 - 26.22];p = 0.003), and alcohol consumption (OR = 3.95;95% CI [1.29 - 12.15];p = 0.017) were statically associated with the onset of dementia in our diabetic patients. <strong>Conclusion:</strong> Screening for dementia should be systematic in diabetics, especially at old age.展开更多
Introduction: The distribution of arteriopathy of the lower limbs (ALL) is not familiar in the city of Porto-Novo. The aim of this study was to determine the prevalence and associated factors of ALL in diabetic patien...Introduction: The distribution of arteriopathy of the lower limbs (ALL) is not familiar in the city of Porto-Novo. The aim of this study was to determine the prevalence and associated factors of ALL in diabetic patients in treatment at the Oueme-Plateau Provincial Teaching Hospital. Methods: This was a cross-sectional, descriptive, and analytical study from July 12 to October 10, 2021, at the Oueme-Plateau Provincial Teaching Hospital in Porto-Novo. ALL was screened by performing systolic pressure index (SPI) in all diabetic patients aged at least 18 years, seen in consultation or hospitalization during the study period and who had given their consent. Results: The study registered 165 diabetics and 98.2% of them were type 2. Subjects aged between 55 and 65 years were the most represented (33.9%), with an average age of 59.4 years. Women were in the majority (61.2%), with a sex ratio of 0.6. High blood pressure was associated with diabetes in 61.2% of patients. The prevalence of ALL was 48.5% (80 patients). Obliterative arteriopathy of the lower limbs (OALL) was observed in 70 patients (42.4%), mediacalcosis in 8 patients (4.8%), and mixed arteriopathy in 2 patients (1.2%). In 88.5% of patients, the pathology was symptomless. Factors significantly associated with ALL included advanced age (p = 0.01), the age of the glycemic imbalance (p = 0.03), lack of regular physical activity (p = 0.001) and dyslipidemia (p = 0.008). Conclusion: Pelvic limb arteriopathy is usual among diabetics at Oueme-Plateau Provincial Teaching Hospital. The use of SPI, which enables diagnosis, requires simple, low-cost means, and should be encouraged.展开更多
Urban lakes and fountains provide recreational activities that could facilitate the contact between humans, animals and biological agents. The objective of this work was to assess the water quality and safety of 17 la...Urban lakes and fountains provide recreational activities that could facilitate the contact between humans, animals and biological agents. The objective of this work was to assess the water quality and safety of 17 lakes and 13 fountains in the city of Porto (Portugal), by detecting the presence of Escherichia coli, enterococci and Salmonella spp., and analyzing their antimicrobial resistance. (For more information,please refer to the pdf.)展开更多
Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications ...Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications arising from cirrhosis. The aim of this paper is to report a case of a patient with liver cirrhosis and the complications of a transjugular intrahepatic portosystemic shunt.</span><b> </b><span style="font-family:Verdana;">Male, elderly, and ex-alcoholic, diagnosed with liver cirrho</span><span style="font-family:Verdana;">sis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital</span> <span style="font-family:Verdana;">after 24 hours with agitation and mental confusion. He had a bowel move</span><span style="font-family:Verdana;">ment stop, neurological worsening, loss of renal function, hepatic hydrothorax, hepatic encephalopathy, hypernatremia, hypocalcemia, and hypophosphatemia. He underwent a new procedure to occlude the transjugular intrahepatic portosystemic shunt, showing improvement of the mental status and ascites. However, continued with decompensation and hydro-electrolytic disorders. He evolved with worsening of the ventilatory pattern, and neurological and renal function, with a fatal outcome.</span><b> </b><span style="font-family:Verdana;">Esophageal varices due to portal hypertension can be corrected with the transjugular intrahepatic portosystemic shunt. However, complications such as hypernatremia, hepatic hydrothorax, and hepatic encephalopathy may occur. Therefore, there is a need for reintervention to shunt or reduce its caliber. Thus, for patients with advanced age and decompensated cirrhosis, the potential risks and benefits of this procedure should be carefully evaluated due to the risk of complications and death.展开更多
Wastewater-based epidemiology(WBE)may be successfully used to comprehensively monitor and determine the scale and dynamics of some infections in the community.We monitored severe acute respiratory syndrome coronavirus...Wastewater-based epidemiology(WBE)may be successfully used to comprehensively monitor and determine the scale and dynamics of some infections in the community.We monitored severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)RNA in raw wastewater samples from Porto Alegre,Southern Brazil.The samples were collected and analyzed every week between May 2020 to May 2021.Meanwhile,different social restrictions were applied according to the number of hospitalized patients in the region.Weekly samples were obtained from two wastewater treatment plants(WWTP),named Navegantes and Serraria.To determine the SARS-CoV-2 RNA titers in wastewater,we performed RT-qPCR analysis targeting the N gene(N1).The highest titer of SARS-CoV-2 RNA was observed between epidemiological weeks(EWs)33-37(August),42-43(October),45-46(November),49-51(December)in 2020,and 1-3(January),7-13(February to March)in 2021,with viral loads ranging from 1-106-3-106 genomic copies/Liter.An increase in positive confirmed cases followed such high viral loads.Depending on the sampling method used,positive cases increased in 6-7 days and 15 days after the rise of viral RNA titers in wastewater,with composite sampling methods showing a lower time lag and a higher resolution on the analyses.The results showed a direct relation between strict social restrictions and the loads of detected RNA reduction in wastewater,corroborating the number of confirmed cases.Differences in viral loads between different sampling points and methods were observed,as composite samples showed more stable results during the analyzed period.Besides,viral loads obtained from samples collected at Serraria WWTP were consistently higher than the ones obtained at Navegantes WWTP,indicating differences in local dynamics of SARS-CoV-2 spread in different regions of Porto Alegre.In conclusion,wastewater sampling to monitor SARS-CoV-2 is a robust tool to evaluate the viral loads contributing to hospitalized patients’data and confirmed cases.In addition,SARS-CoV-2 detection in sewage may inform and alert the government when there are asymptomatic or nontested patients.展开更多
This is a descriptive study of quantitative approach, developed at the Federal University of Rond?nia located in the Western Amazon. With the aim of analyzing the frequency of visualization of alcoholic content in the...This is a descriptive study of quantitative approach, developed at the Federal University of Rond?nia located in the Western Amazon. With the aim of analyzing the frequency of visualization of alcoholic content in the Facebook, Instagram and Snapchat, patterns of consumption, reasons that lead them to drink, most used social network and to correlate how often the users are exposed to alcoholic publications, determining if there was an important link between individual drinking practice during the beginning period and six months later. The information was obtained through the application of questionnaires for incoming students of the freshmen semester, in two moments: a period from August to December 2016/2, and, asking the same students again, from March to June 2017/1. 52.8% were males in 2016/2 and 57, 9% of females in 2017/1 with age ranging between 18 and 20 years in both periods. Facebook has proven to be the most used platform among college students. In 2016/2, 63.9% reported seeing alcohol content at Facebook and consuming that substance, comparing to Instagram with 70.4%, and to Snapchat with 74.1%. In 2017/2, academics reporting viewing alcoholic content on Facebook and consuming those alcoholic beverages accounted for 65.8%, compared to Instagram, 74.1% and Snapchat 74.4%. “Celebrating a special occasion with friends” is the most cited reason of why claim to consume alcohol. Therelation between exposure to the alcohol content of the virtual media and the network of friends was found imperceptible to the majority of the students, as they mostly do not consider themselves exposed. Many university students start the graduation already consuming alcoholic substances, which explains why there is no significant change in alcohol consumption between the observed moments, although it was found a relationship between the visualization of alcohol content in social networks and consumption, with greater impact on Snapchat.展开更多
Objective: To study the postoperative evolution of corneal astigmatism following phaco-alternative at the University Hospital Center of Ouémé-Plateau (UHC-OP) in Porto-Novo. Method: This was a prospective, c...Objective: To study the postoperative evolution of corneal astigmatism following phaco-alternative at the University Hospital Center of Ouémé-Plateau (UHC-OP) in Porto-Novo. Method: This was a prospective, cross-sectional study with a descriptive and analytical purpose conducted from April 19 to September 20, 2021;a period of 6 months. The study included all patients presenting with senile or non-senile cataracts without a history of corneal trauma and who underwent phaco-alternative during the study period. Results: A total of 62 eyes underwent phaco-alternative. The average age was 63 ± 12 years with a male predominance of 59.7%. Phaco-alternative was performed with 74.2% linear incision and 25.8% smile incision. Perioperative incidents were mainly capsular ruptures with vitreous loss occurring in 8.1% of cases. The mean preoperative astigmatism was 1.29 ± 1.5 D with an axis of 180˚ ± 20˚, indicating with-the-rule astigmatism. The mean postoperative astigmatism was 2.2 ± 1.5 D with an axis of 90˚ ± 20˚, indicating against-the-rule astigmatism. The mean induced astigmatism at Day 30 was 1.4 ± 1.2 D for smile incision and 1.8 ± 1.2 D for linear incision. Conclusion: Phaco-alternative yields good results with few complications but remains astigmatogenic. The smile incision appears to be less astigmatogenic.展开更多
Traffic-related air pollution is an alarming source of pollutants exposure and consequently to the development of several adverse health effects. Otherwise, green spaces are reported to improve health status. Although...Traffic-related air pollution is an alarming source of pollutants exposure and consequently to the development of several adverse health effects. Otherwise, green spaces are reported to improve health status. Although, in an urban scenario most of these areas are located near air pollutants sources, as vehicle fleet. Thus, the aim of the present study was to determine, during one year, the levels of nitrogen dioxide (NO2) and ozone (O3) in the main parks from Porto Alegre—Brazil. This study focused on three urban parks: Germania, Moinhos de Vento and Marinha do Brasil Park. Nitrogen dioxide and ozone measurements were accessed by passive monitoring in four campaigns including all seasons and performed at distances of 0 m, 15 m, 30 m, 45 m, 60 m and 75 m from the main road at each park. NO2 and O3 concentration among the parks was not different (p > 0.05), as well as the mean concentration of NO2 and O3 of all parks in the six sites did not differ (p > 0.05). However, season 1 and 3 showed increased NO2 and O3 concentration. Temperature were decreased in season 1 and 3 (p p > 0.05). Traffic flow was higher in Moinhos de Vento Park and Marinha do Brasil Park compared to Germania Park (p 2 and O3 concentration in urban parks from Porto Alegre.展开更多
Contrary to the adult central nervous system,the peripheral nervous system has an intrinsic ability to regenerate that relies on the expression of regenerationassociated genes,such as some kinesin family members.Kines...Contrary to the adult central nervous system,the peripheral nervous system has an intrinsic ability to regenerate that relies on the expression of regenerationassociated genes,such as some kinesin family members.Kinesins contribute to nerve regeneration through the transport of specific cargo,such as proteins and membrane components,from the cell body towards the axon periphery.We show here that KIF4A,associated with neurodevelopmental disorders and previously believed to be only expressed during development,is also expressed in the adult vertebrate nervous system and up-regulated in injured peripheral nervous system cells.KIF4A is detected both in the cell bodies and regrowing axons of injured neurons,consistent with its function as an axonal transporter of cargoes such asβ1-integrin and L1CAM.Our study further demonstrates that KIF4A levels are greatly increased in Schwann cells from injured distal nerve stumps,particularly at a time when they are reprogrammed into an essential proliferative repair phenotype.Moreover,Kif4a m RNA levels were approximately~6-fold higher in proliferative cultured Schwann cells compared with non-proliferative ones.A hypothesized function for Kif4a in Schwann cell proliferation was further confirmed by Kif4a knockdown,as this significantly reduced Schwann cell proliferation in vitro.Our findings show that KIF4A is expressed in adult vertebrate nervous systems and is up-regulated following peripheral injury.The timing of KIF4A up-regulation,its location during regeneration,and its proliferative role,all suggest a dual role for this protein in neuroregeneration that is worth exploring in the future.展开更多
Neuroinflammation is an inflammatory response in the central nervous system associated with various neurological conditions.The inflammatory process is typically treated with non-steroidal and steroidal anti-inflammat...Neuroinflammation is an inflammatory response in the central nervous system associated with various neurological conditions.The inflammatory process is typically treated with non-steroidal and steroidal anti-inflammatory drugs,which have a range of serious adverse effects.As an alternative,naturally derived molecules such as quercetin and its derivatives show promising anti-inflammatory properties and beneficial effects on various physiological functions.Our objective was to synthesize the evidence on the anti-inflammatory effect of quercetin and its derivatives in in vivo models,in the face of neuroinflammatory insults induced by lipopolysaccharide,through a systematic review and meta-analysis.A search of the preclinical literature was conducted across four databases(Pub Med,Web of Science,Scielo,and Google Scholar).Studies were selected based on inclusion and exclusion criteria,assessed for methodological quality using CAMARADES,and risk of bias using the SYRCLE tool,and data were extracted from the studies.The quantitative assessment of quercetin effects on the expression of pro-inflammatory cytokines and microgliosis was performed through a meta-analysis.A total of 384 potentially relevant articles were identified,of which 11 studies were included in the analysis.The methodological quality was assessed,resulting in an average score of 5.8/10,and the overall risk of bias analysis revealed a lack of methodological clarity in most studies.Furthermore,through the meta-analysis,it was observed that treatment with quercetin statistically reduces pro-inflammatory cytokines,such as tumor necrosis factor alpha,interleukin 6,interleukin 1β(n=89;SMD=–2.00;95%CI:–3.29 to–0.71),and microgliosis(n=33;SMD=–2.56;95%CI:–4.07 to–1.10).In terms of underlying mechanisms,quercetin and its derivatives exhibit antioxidant and anti-apoptotic properties,possibly through the nuclear factor erythroid 2-related factor 2(Nrf2)/HO-1 pathways,increasing the expression of antioxidant enzymes and reducing reactive species,and modulating the caspase pathway,increasing levels of anti-apoptotic proteins and decreasing proapoptotic proteins.Quercetin and its derivatives exhibit highly pleiotropic actions that simultaneously contribute to preventing neuroinflammation.However,despite promising results in animal models,future directions should focus on well-designed clinical studies to assess the safety,bioavailability,and efficacy of quercetin and its derivatives in humans.Additionally,standardization of methods and dosages in studies is crucial to ensure consistency of findings and optimize their application in clinical settings.展开更多
Non-tumoral portal vein thrombosis(PVT)is a frequent and challenging complication in liver transplant candidates.The prevalence reaches up to 26%in patients with cirrhosis on a transplant waiting list.Its severity inc...Non-tumoral portal vein thrombosis(PVT)is a frequent and challenging complication in liver transplant candidates.The prevalence reaches up to 26%in patients with cirrhosis on a transplant waiting list.Its severity increases with liver disease progression and significantly impacts post-transplant outcomes.Advanced PVT increases postoperative mortality to 30%.Effective management requires a multidisciplinary approach,especially in advanced cases.Preoperative strategies emphasize anticoagulation with low molecular weight heparin,while interventional radiology,including transjugular intrahepatic portosystemic shunts,offers alternatives in some cases.Intraoperatively,management is guided by PVT classification systems,ranging from thrombectomy and portal vein reconstruction to non-physiological reconstructions in complex cases.This manuscript explores the management of PVT in liver transplantation candidates,discusses strategies to optimize outcomes,and presents our institutional protocol for addressing this high-risk condition.展开更多
Fecal incontinence is a common condition that can significantly impact patients’quality of life.Obstetric anal sphincter injury and anorectal surgeries are common etiologies.Endoanal ultrasound and anorectal manometr...Fecal incontinence is a common condition that can significantly impact patients’quality of life.Obstetric anal sphincter injury and anorectal surgeries are common etiologies.Endoanal ultrasound and anorectal manometry are important diagnostic tools for evaluating patients.There are various treatment options,including diet,lifestyle modifications,drugs,biofeedback therapy,tibial and sacral nerve neuromodulation therapy,and surgery.In this editorial,we will discuss current controversies and novel approaches to fecal incontinence.Screening for asymptomatic anal sphincter defects after obstetric anal sphincter injury and in patients with inflammatory bowel disease is not generally recommended,but may be helpful in selected patients.The Garg incontinence score is a new score that includes the assessment of solid,liquid,flatus,mucous,stress and urge fecal incontinence.Novel tests such as translumbosacral anorectal magnetic stimulation and novel therapies such as translumbosacral neuromodulation therapy are promising diagnostic and treatment options,for both fecal incontinence and neuropathy.Home biofeedback therapy can overcome some limitations of the office-based therapy.Skeletal muscle-derived cell implantation of the external anal sphincter has been further studied as a possible treatment option.Sacral neuromodulation may be useful in scleroderma,congenital fecal incontinence and inflammatory bowel disease but merits further study.展开更多
BACKGROUND Liver transplantation(LT)is the preferred treatment for end-stage liver diseases.Early allograft failure(EAF)can result in death or retransplantation.One of the key factors predicting EAF is the degree of g...BACKGROUND Liver transplantation(LT)is the preferred treatment for end-stage liver diseases.Early allograft failure(EAF)can result in death or retransplantation.One of the key factors predicting EAF is the degree of graft injury,which is typically assessed by elevated alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels.Aminotransferase levels exceeding 5000 U/L within 48 hours of LT are indicative of poor short-term graft survival.AIM To investigate outcomes in liver transplant recipients with peak aminotransferase levels exceeding 5000 U/L and to identify predictors of EAF.METHODS Adult patients who underwent LT from a deceased(brain-dead)donor between 2011 and 2024 at Hospital de Clínicas de Porto Alegre were screened.Patients with peak AST or ALT levels>5000 U/L post-LT were included,excluding those with vascular thrombosis.EAF was defined as death or retransplantation within 90 days.A receiver operating characteristic curve were generated for each EAF predictor to determine the area under the curve(AUC).Sensitivity,specificity,negative predictive value,and positive predictive value were calculated for each predictor’s best cutoff,as defined by the Youden Index.Survival curves were plotted using the Kaplan-Meier method.RESULTS Between 2011 and 2024,341 patients underwent LT.Of these,29(8.5%)patients had AST and/or ALT levels exceeding 5000 U/L within the first 48 hours post-LT.Four patients were excluded due to vascular thrombosis,resulting in a study cohort of 25 patients.EAF were also observed in 11 patients.One-year and five-year graft survival rates were 51.7%and 42.6%,respectively.For patients without EAF,one-year and five-year graft survivals were 92.3%and 76.2%,respectively.The key predictors of EAF included serum factor V and arterial lactate levels on postoperative day(POD)1,with AUCs of 0.936 and 0.919,respectively.The optimal cutoff for EAF prediction were 26.2%for serum factor V and 9 mmol/L for arterial lactate.CONCLUSION Aminotransferase levels>5000 U/L were associated with high EAF risk.However,favorable graft function indicators on POD 1 were associated with long-term survival comparable to that of general LT recipients.Serum factor V and arterial lactate levels emerged as valuable prognostic markers.展开更多
Neuroimmunology is emerging as a pivotal field,shedding light on the intricate dialogues between the central nervous system(CNS)and the immune system.This exploration is particularly significant in understanding micro...Neuroimmunology is emerging as a pivotal field,shedding light on the intricate dialogues between the central nervous system(CNS)and the immune system.This exploration is particularly significant in understanding microglia,the CNS’s innate immune cells,beyond the conventional conflation of“neuroinflammation”and“microglial activation.”This conflation has clouded the true complexity of these processes,potentially stalling scientific progress and the development of new therapies.We challenge the long-standing perspectives that have oversimplified these interactions,advocating for a deeper exploration of the dynamic relationship between neuroinflammation and microglial activation.By dissecting specific molecular pathways,we aim to illuminate their elaborate roles in neuroinflammatory responses,especially in the context of Alzheimer’s disease(AD).Here,neuroinflammation is not merely a passive observer or a direct antagonist but a complex agent in the disease’s progression.This article calls for a significant paradigm shift towards an integrative,multi-omics approach to neuroimmunology.Adopting such a comprehensive framework is crucial for advancing our understanding of neuroinflammatory conditions and paving the way for targeted therapeutic strategies for brain diseases.展开更多
Here we compare the efficacy of anti-obesity drugs alone or combined with exercise training on body weight and exercise capacity of obese patients.Randomized clinical trials that assessed the impact of any anti-obesit...Here we compare the efficacy of anti-obesity drugs alone or combined with exercise training on body weight and exercise capacity of obese patients.Randomized clinical trials that assessed the impact of any anti-obesity drug alone or combined with exercise training on body weight,body fat,fat-free mass and cardiorespiratory fitness in obese patients were retrieved from Pubmed and EMBASE up to May 2024.Risk of bias assessment was performed with RoB 2.0,and the GRADE approach assessed the certainty of evidence(CoE)of each main outcome.We included four publications summing up 202 patients.Two publications used orlistat as an anti-obesity drug treatment,while the other two adopted GLP-1 receptor agonist(liraglutide or tirzepatide)as a pharmacotherapy for weight management.Orlistat combined with exercise was superior to change body weight(mean difference(MD):−2.27 kg;95%CI:−2.86 to−1.69;CoE:very low),fat mass(MD:−2.89;95%CI:−3.87 to−1.91;CoE:very low),fat-free mass(MD:0.56;95%CI:0.40–0.72;CoE:very low),and VO_(2)Peak(MD:2.64;95%CI:2.52–2.76;CoE:very low).GLP-1 receptor agonist drugs combined with exercise had a great effect on body weight(MD:−3.96 kg;95%CI:−5.07 to−2.85;CoE:low),fat mass(MD:−1.76;95%CI:−2.24 to−1.27;CoE:low),fat-free mass(MD:0.50;95%CI:−0.98 to 1.98;CoE:very low)and VO_(2)Peak(MD:2.47;95%CI:1.31–3.63;CoE:very low).The results reported here suggest that exercise training remains an important approach in weight management when combined with pharmacological treatment.展开更多
文摘This is a narrative review in which the advances in technical aspects,the main indications,limitations and clinical results of the transjugular intrahepatic portosystemic shunt(TIPS)in portal hypertension(PH)are addressed.With the emergence of the coated prosthesis,a better shunt patency,a lower incidence of hepatic encephalopathy(HE)and better survival when compared to TIPS with the conventional prosthesis are demonstrated.The main indications for TIPS are refractory ascites,acute variceal bleeding unresponsive to pharmacological/endoscopic therapy and,lastly,patients considered at high risk for rebleeding preemptive TIPS(pTIPS).Absolute contraindications to the use of TIPS are severe uncontrolled HE,systemic infection or sepsis,congestive heart failure,severe pulmonary arterial hypertension,and biliary obstruction.The control of hemorrhage due to variceal rupture can reach up to 90%-100%of cases,and 55%in refractory ascites.Despite evidences regarding pTIPS in patients at high risk for rebleeding,less than 20%of eligible patients are treated.TIPS may also decrease the incidence of future decompensation in cirrhosis and increase survival in selected patients.In conclusion,TIPS is an essential treatment for patients with PH,but is often neglected.It is important for the hepatologist to form a multidisciplinary team,in which the role of the radiologist with experience in interventional procedures is prominent.
文摘Service Science,Engineering and Management(SSME)is emerging as a new discipline and several universities have been evolving or creating courses/programs to educate for the needs of the service fields of the economy.The University of Porto started in 2007 a master program in Service Engineering and Management,and Masaryk University started in 2008 a program in Service Science,Management,and Engineering.Both programs concentrate on services that are supported by technology,in particular information and communication technologies.This paper presents a summary of both programs and a proposal for a joint 2 year master program involving the two universities that is expected to start in 2010.Students in this program will take courses in the two universities,and lecturers will be involved in joint research projects. Individual students will have a semester research or applied project in a European service organization,being supervised by a lecturer or a researcher from each universities.It is expected that graduates will understand technological,organizational and cultural aspects of the diverse businesses in a wide European context and will be ready for service requirements of this century.
文摘BACKGROUND Biliary atresia(BA)is the most common indication for pediatric liver transplantation,although portoenterostomy is usually performed first.However,due to the high failure rate of portoenterostomy,liver transplantation has been advocated as the primary procedure for patients with BA.It is still unclear if a previous portoenterostomy has a negative impact on liver transplantation outcomes.AIM To investigate the effect of prior portoenterostomy in infants un-dergoing liver transplantation for BA.METHODS This was a retrospective cohort study of 42 pediatric patients with BA who underwent primary liver transplantation from 2013 to 2023 at a single tertiary center in Brazil.Patients with BA were divided into two groups:Those undergoing primary liver transplantation without portoenterostomy and those undergoing liver transplantation with prior portoenterostomy.Continuous variables were compared using the Student’s t-test or the Kruskal-Wallis test,and categorical variables were compared using theχ2 or Fisher’s exact test,as appropriate.Multivariable Cox regression analysis was performed to determine risk factors for portal vein thrombosis.Patient and graft survival analyses were conducted with the Kaplan–Meier product-limit estimator,and patient subgroups were compared using the two-sided log-rank test.RESULTS Forty-two patients were included in the study(25[60%]girls),23 undergoing liver transplantation without prior portoenterostomy,and 19 undergoing liver transplantation with prior portoenterostomy.Patients with prior portoenterostomy were older(12 vs 8 months;P=0.02)at the time of liver transplantation and had lower Pediatric End-Stage Liver Disease scores(13.2 vs 21.4;P=0.01).The majority of the patients(35/42,83%)underwent livingdonor liver transplantation.The group of patients without prior portoenterostomy appeared to have a higher incidence of portal vein thrombosis(39 vs 11%),but this result did not reach statistical significance.Prior portoenterostomy was not a protective factor against portal vein thrombosis in the multivariable analysis after adjusting for age at liver transplantation,graft-to-recipient weight ratio,and use of vascular grafts.Finally,the groups did not significantly differ in terms of post-transplant survival.CONCLUSION In our study,prior portoenterostomy did not significantly affect the outcomes of liver transplantation.
文摘Background: Diabetes mellitus is one of the most common non-communicable diseases in the world. The aim of our study was to assess the level of knowledge of the adult population of Porto-Novo on clinical manifestations and complications of diabetes mellitus. Methods: It is a descriptive cross-sectional study conducted under STEP wise approach. It took place from June 1 to July 28, 2014. Results: A total of 240 subjects were included in the study. The mean age of the subjects was 46.07 years ± 12.63 years, ranging from 25 to 80 years. Subjects age between 35 - 45 years are the most represented. Women were mostly represented 162 against 78 men respectively 67.5% against 32.5% with sex ratio of 0.48. The majority of the subjects were scholar (73.3%). For clinical manifestations of diabetes mellitus, 64.2% of subjects had quoted polyuria, asthenia 57.5%, 56.7% weight loss. Polydipsia and polyphagia were less familiar with, respectively, 27.5% and 23.3%. Regarding the complications of diabetes, diabetic foot and coma were the best known, respectively, 78.8% and 58.8%. Nephropathy (45.0%), 39.6% retinopathy and neuropathy (21.7%) were the least known. The prevalence of physical inactivity in this study population was 95.0%. It was 98.1% in women versus 88.5% for men. Conclusion: Diabetes mellitus, whose prevalence is steadily increasing, is not yet well known in our population.
文摘<strong>Background:</strong> Chronic hyperglycemia promotes the development of degenerative diseases such as dementia. Our objective is to study dementia in diabetic patients in a hospital environment in Porto-Novo. <strong>Methods:</strong> This is a cross-sectional, prospective study with a descriptive and analytical aim that took place from May 18 to September 18, 2017, <i>i.e.</i> 4 months. The study population consists of all diabetic patients who consulted in the internal medicine departments of the Oueme-Plateau Teaching Hospital and at Saint Gérard clinic in Porto-Novo during the study period and who gave their enlightened consent. <strong>Results:</strong> The study included 246 patients with a mean age of 56.47 ± 11.97 years. There were 172 (69.9%) women, <i>i.e.</i> a sex ratio of 0.43. Diabetes had been known for less than 10 years in the majority (67.9%). Type 2 diabetics were in the majority (95.5%). Of the 246 patients, 42 (17.1%) had a Mini Mental State Examination (MMSE) less than or equal to 24. Of these 42 patients, 32 met the DSM V (Diagnostic and Statistical Manual disorders, 5th edition) criteria for dementias, i.e. a frequency of 13.0%. Of the 32 demented patients, 21 (65.6%) had vascular dementia and 34.4% had degenerative dementia. We did not note a mixed etiology. Dementia was severe in 15.6% of cases. In multivariate analysis, only age (OR = 10.09;95% CI [4.19 - 24.27];p < 0.001), arterial hypertension (OR = 7.10;95% CI [1.92 - 26.22];p = 0.003), and alcohol consumption (OR = 3.95;95% CI [1.29 - 12.15];p = 0.017) were statically associated with the onset of dementia in our diabetic patients. <strong>Conclusion:</strong> Screening for dementia should be systematic in diabetics, especially at old age.
文摘Introduction: The distribution of arteriopathy of the lower limbs (ALL) is not familiar in the city of Porto-Novo. The aim of this study was to determine the prevalence and associated factors of ALL in diabetic patients in treatment at the Oueme-Plateau Provincial Teaching Hospital. Methods: This was a cross-sectional, descriptive, and analytical study from July 12 to October 10, 2021, at the Oueme-Plateau Provincial Teaching Hospital in Porto-Novo. ALL was screened by performing systolic pressure index (SPI) in all diabetic patients aged at least 18 years, seen in consultation or hospitalization during the study period and who had given their consent. Results: The study registered 165 diabetics and 98.2% of them were type 2. Subjects aged between 55 and 65 years were the most represented (33.9%), with an average age of 59.4 years. Women were in the majority (61.2%), with a sex ratio of 0.6. High blood pressure was associated with diabetes in 61.2% of patients. The prevalence of ALL was 48.5% (80 patients). Obliterative arteriopathy of the lower limbs (OALL) was observed in 70 patients (42.4%), mediacalcosis in 8 patients (4.8%), and mixed arteriopathy in 2 patients (1.2%). In 88.5% of patients, the pathology was symptomless. Factors significantly associated with ALL included advanced age (p = 0.01), the age of the glycemic imbalance (p = 0.03), lack of regular physical activity (p = 0.001) and dyslipidemia (p = 0.008). Conclusion: Pelvic limb arteriopathy is usual among diabetics at Oueme-Plateau Provincial Teaching Hospital. The use of SPI, which enables diagnosis, requires simple, low-cost means, and should be encouraged.
文摘Urban lakes and fountains provide recreational activities that could facilitate the contact between humans, animals and biological agents. The objective of this work was to assess the water quality and safety of 17 lakes and 13 fountains in the city of Porto (Portugal), by detecting the presence of Escherichia coli, enterococci and Salmonella spp., and analyzing their antimicrobial resistance. (For more information,please refer to the pdf.)
文摘Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications arising from cirrhosis. The aim of this paper is to report a case of a patient with liver cirrhosis and the complications of a transjugular intrahepatic portosystemic shunt.</span><b> </b><span style="font-family:Verdana;">Male, elderly, and ex-alcoholic, diagnosed with liver cirrho</span><span style="font-family:Verdana;">sis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital</span> <span style="font-family:Verdana;">after 24 hours with agitation and mental confusion. He had a bowel move</span><span style="font-family:Verdana;">ment stop, neurological worsening, loss of renal function, hepatic hydrothorax, hepatic encephalopathy, hypernatremia, hypocalcemia, and hypophosphatemia. He underwent a new procedure to occlude the transjugular intrahepatic portosystemic shunt, showing improvement of the mental status and ascites. However, continued with decompensation and hydro-electrolytic disorders. He evolved with worsening of the ventilatory pattern, and neurological and renal function, with a fatal outcome.</span><b> </b><span style="font-family:Verdana;">Esophageal varices due to portal hypertension can be corrected with the transjugular intrahepatic portosystemic shunt. However, complications such as hypernatremia, hepatic hydrothorax, and hepatic encephalopathy may occur. Therefore, there is a need for reintervention to shunt or reduce its caliber. Thus, for patients with advanced age and decompensated cirrhosis, the potential risks and benefits of this procedure should be carefully evaluated due to the risk of complications and death.
基金supported by CAPES(No 88887.509240/2020-00)FAPERGS(21/2551-0000069-4),ACFFSC are PQ2 CNPq fellow.
文摘Wastewater-based epidemiology(WBE)may be successfully used to comprehensively monitor and determine the scale and dynamics of some infections in the community.We monitored severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)RNA in raw wastewater samples from Porto Alegre,Southern Brazil.The samples were collected and analyzed every week between May 2020 to May 2021.Meanwhile,different social restrictions were applied according to the number of hospitalized patients in the region.Weekly samples were obtained from two wastewater treatment plants(WWTP),named Navegantes and Serraria.To determine the SARS-CoV-2 RNA titers in wastewater,we performed RT-qPCR analysis targeting the N gene(N1).The highest titer of SARS-CoV-2 RNA was observed between epidemiological weeks(EWs)33-37(August),42-43(October),45-46(November),49-51(December)in 2020,and 1-3(January),7-13(February to March)in 2021,with viral loads ranging from 1-106-3-106 genomic copies/Liter.An increase in positive confirmed cases followed such high viral loads.Depending on the sampling method used,positive cases increased in 6-7 days and 15 days after the rise of viral RNA titers in wastewater,with composite sampling methods showing a lower time lag and a higher resolution on the analyses.The results showed a direct relation between strict social restrictions and the loads of detected RNA reduction in wastewater,corroborating the number of confirmed cases.Differences in viral loads between different sampling points and methods were observed,as composite samples showed more stable results during the analyzed period.Besides,viral loads obtained from samples collected at Serraria WWTP were consistently higher than the ones obtained at Navegantes WWTP,indicating differences in local dynamics of SARS-CoV-2 spread in different regions of Porto Alegre.In conclusion,wastewater sampling to monitor SARS-CoV-2 is a robust tool to evaluate the viral loads contributing to hospitalized patients’data and confirmed cases.In addition,SARS-CoV-2 detection in sewage may inform and alert the government when there are asymptomatic or nontested patients.
文摘This is a descriptive study of quantitative approach, developed at the Federal University of Rond?nia located in the Western Amazon. With the aim of analyzing the frequency of visualization of alcoholic content in the Facebook, Instagram and Snapchat, patterns of consumption, reasons that lead them to drink, most used social network and to correlate how often the users are exposed to alcoholic publications, determining if there was an important link between individual drinking practice during the beginning period and six months later. The information was obtained through the application of questionnaires for incoming students of the freshmen semester, in two moments: a period from August to December 2016/2, and, asking the same students again, from March to June 2017/1. 52.8% were males in 2016/2 and 57, 9% of females in 2017/1 with age ranging between 18 and 20 years in both periods. Facebook has proven to be the most used platform among college students. In 2016/2, 63.9% reported seeing alcohol content at Facebook and consuming that substance, comparing to Instagram with 70.4%, and to Snapchat with 74.1%. In 2017/2, academics reporting viewing alcoholic content on Facebook and consuming those alcoholic beverages accounted for 65.8%, compared to Instagram, 74.1% and Snapchat 74.4%. “Celebrating a special occasion with friends” is the most cited reason of why claim to consume alcohol. Therelation between exposure to the alcohol content of the virtual media and the network of friends was found imperceptible to the majority of the students, as they mostly do not consider themselves exposed. Many university students start the graduation already consuming alcoholic substances, which explains why there is no significant change in alcohol consumption between the observed moments, although it was found a relationship between the visualization of alcohol content in social networks and consumption, with greater impact on Snapchat.
文摘Objective: To study the postoperative evolution of corneal astigmatism following phaco-alternative at the University Hospital Center of Ouémé-Plateau (UHC-OP) in Porto-Novo. Method: This was a prospective, cross-sectional study with a descriptive and analytical purpose conducted from April 19 to September 20, 2021;a period of 6 months. The study included all patients presenting with senile or non-senile cataracts without a history of corneal trauma and who underwent phaco-alternative during the study period. Results: A total of 62 eyes underwent phaco-alternative. The average age was 63 ± 12 years with a male predominance of 59.7%. Phaco-alternative was performed with 74.2% linear incision and 25.8% smile incision. Perioperative incidents were mainly capsular ruptures with vitreous loss occurring in 8.1% of cases. The mean preoperative astigmatism was 1.29 ± 1.5 D with an axis of 180˚ ± 20˚, indicating with-the-rule astigmatism. The mean postoperative astigmatism was 2.2 ± 1.5 D with an axis of 90˚ ± 20˚, indicating against-the-rule astigmatism. The mean induced astigmatism at Day 30 was 1.4 ± 1.2 D for smile incision and 1.8 ± 1.2 D for linear incision. Conclusion: Phaco-alternative yields good results with few complications but remains astigmatogenic. The smile incision appears to be less astigmatogenic.
基金support funding from Fundacao de Amparo a Pesquisa do Estado do Rio Grande do Sul(FAPERGS).
文摘Traffic-related air pollution is an alarming source of pollutants exposure and consequently to the development of several adverse health effects. Otherwise, green spaces are reported to improve health status. Although, in an urban scenario most of these areas are located near air pollutants sources, as vehicle fleet. Thus, the aim of the present study was to determine, during one year, the levels of nitrogen dioxide (NO2) and ozone (O3) in the main parks from Porto Alegre—Brazil. This study focused on three urban parks: Germania, Moinhos de Vento and Marinha do Brasil Park. Nitrogen dioxide and ozone measurements were accessed by passive monitoring in four campaigns including all seasons and performed at distances of 0 m, 15 m, 30 m, 45 m, 60 m and 75 m from the main road at each park. NO2 and O3 concentration among the parks was not different (p > 0.05), as well as the mean concentration of NO2 and O3 of all parks in the six sites did not differ (p > 0.05). However, season 1 and 3 showed increased NO2 and O3 concentration. Temperature were decreased in season 1 and 3 (p p > 0.05). Traffic flow was higher in Moinhos de Vento Park and Marinha do Brasil Park compared to Germania Park (p 2 and O3 concentration in urban parks from Porto Alegre.
基金supported by the Portuguese Foundation for Science and Technology(FCT),Centro 2020 and Portugol2020 and the EU FEDER program,via the project GoBack to SIV(PTDC/CVT-CVT/32261/2017,CENTRO-01-0145-FEDER-032261)the doctoral grants of PDC(SFRH/BD/139974/2018)and BMS(2020.06525.BD and DOI 10.54499/2020.06525.BD)+5 种基金the post-doctoral grant to JPF(SFRH/BPD/113359/2015-program-contract described in paragraphs 4,5,6 of art.23 of Law no.100157/2016,of August 29,as amended by Law no.57/2017 of July 2019),the project PTDC/MED-NEU/1677/2021 to JBRthe Institute of Biomedicine iBiMED(UIDB/04501/2020 and DOI 10.54499/UIDB/04501/2020,UIDP/04501/2020 and DOI 10.54499/UIDP/04501/2020)its LiM Bioimaging Facility-a PPBI node(POCI-01-0145-FEDER-022122)supported by the Research Commission of the Medical Faculty of the Heinrich-Heine-University(HHU)Düsseldorf,of the Biologisch-Medizinisches Forschungszentrum(BMFZ)of HHUfinanced by the Spanish"Plan Nacional de Investigacion Cientifica,Desarrollo e Innovacion Tecnologica,Ministerio de Economia y Competitividad(Instituto de Salud CarlosⅢ)",co-financed by the European Union(FEDER program),(grant FIS P/20/00318 and FIS P23/00337 to VC)grant CPP2021-009070 to VC by the"Proyectos de colaboracion publico-privada,Plan de Investigacion Cientifica,Tecnica y de inovacion 2021-2023,Ministerio de Ciencia e Innovacion,Union Europea,Agencia Estatal de Investigacion,Espana"。
文摘Contrary to the adult central nervous system,the peripheral nervous system has an intrinsic ability to regenerate that relies on the expression of regenerationassociated genes,such as some kinesin family members.Kinesins contribute to nerve regeneration through the transport of specific cargo,such as proteins and membrane components,from the cell body towards the axon periphery.We show here that KIF4A,associated with neurodevelopmental disorders and previously believed to be only expressed during development,is also expressed in the adult vertebrate nervous system and up-regulated in injured peripheral nervous system cells.KIF4A is detected both in the cell bodies and regrowing axons of injured neurons,consistent with its function as an axonal transporter of cargoes such asβ1-integrin and L1CAM.Our study further demonstrates that KIF4A levels are greatly increased in Schwann cells from injured distal nerve stumps,particularly at a time when they are reprogrammed into an essential proliferative repair phenotype.Moreover,Kif4a m RNA levels were approximately~6-fold higher in proliferative cultured Schwann cells compared with non-proliferative ones.A hypothesized function for Kif4a in Schwann cell proliferation was further confirmed by Kif4a knockdown,as this significantly reduced Schwann cell proliferation in vitro.Our findings show that KIF4A is expressed in adult vertebrate nervous systems and is up-regulated following peripheral injury.The timing of KIF4A up-regulation,its location during regeneration,and its proliferative role,all suggest a dual role for this protein in neuroregeneration that is worth exploring in the future.
基金supported by the Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior-Brasil(CAPES)[Finance Code 001](to MGS)Conselho Nacional de Desenvolvimento Cientifico e Tecnologico(CNPq)fellowship[research grants 309840/2022-8]。
文摘Neuroinflammation is an inflammatory response in the central nervous system associated with various neurological conditions.The inflammatory process is typically treated with non-steroidal and steroidal anti-inflammatory drugs,which have a range of serious adverse effects.As an alternative,naturally derived molecules such as quercetin and its derivatives show promising anti-inflammatory properties and beneficial effects on various physiological functions.Our objective was to synthesize the evidence on the anti-inflammatory effect of quercetin and its derivatives in in vivo models,in the face of neuroinflammatory insults induced by lipopolysaccharide,through a systematic review and meta-analysis.A search of the preclinical literature was conducted across four databases(Pub Med,Web of Science,Scielo,and Google Scholar).Studies were selected based on inclusion and exclusion criteria,assessed for methodological quality using CAMARADES,and risk of bias using the SYRCLE tool,and data were extracted from the studies.The quantitative assessment of quercetin effects on the expression of pro-inflammatory cytokines and microgliosis was performed through a meta-analysis.A total of 384 potentially relevant articles were identified,of which 11 studies were included in the analysis.The methodological quality was assessed,resulting in an average score of 5.8/10,and the overall risk of bias analysis revealed a lack of methodological clarity in most studies.Furthermore,through the meta-analysis,it was observed that treatment with quercetin statistically reduces pro-inflammatory cytokines,such as tumor necrosis factor alpha,interleukin 6,interleukin 1β(n=89;SMD=–2.00;95%CI:–3.29 to–0.71),and microgliosis(n=33;SMD=–2.56;95%CI:–4.07 to–1.10).In terms of underlying mechanisms,quercetin and its derivatives exhibit antioxidant and anti-apoptotic properties,possibly through the nuclear factor erythroid 2-related factor 2(Nrf2)/HO-1 pathways,increasing the expression of antioxidant enzymes and reducing reactive species,and modulating the caspase pathway,increasing levels of anti-apoptotic proteins and decreasing proapoptotic proteins.Quercetin and its derivatives exhibit highly pleiotropic actions that simultaneously contribute to preventing neuroinflammation.However,despite promising results in animal models,future directions should focus on well-designed clinical studies to assess the safety,bioavailability,and efficacy of quercetin and its derivatives in humans.Additionally,standardization of methods and dosages in studies is crucial to ensure consistency of findings and optimize their application in clinical settings.
文摘Non-tumoral portal vein thrombosis(PVT)is a frequent and challenging complication in liver transplant candidates.The prevalence reaches up to 26%in patients with cirrhosis on a transplant waiting list.Its severity increases with liver disease progression and significantly impacts post-transplant outcomes.Advanced PVT increases postoperative mortality to 30%.Effective management requires a multidisciplinary approach,especially in advanced cases.Preoperative strategies emphasize anticoagulation with low molecular weight heparin,while interventional radiology,including transjugular intrahepatic portosystemic shunts,offers alternatives in some cases.Intraoperatively,management is guided by PVT classification systems,ranging from thrombectomy and portal vein reconstruction to non-physiological reconstructions in complex cases.This manuscript explores the management of PVT in liver transplantation candidates,discusses strategies to optimize outcomes,and presents our institutional protocol for addressing this high-risk condition.
文摘Fecal incontinence is a common condition that can significantly impact patients’quality of life.Obstetric anal sphincter injury and anorectal surgeries are common etiologies.Endoanal ultrasound and anorectal manometry are important diagnostic tools for evaluating patients.There are various treatment options,including diet,lifestyle modifications,drugs,biofeedback therapy,tibial and sacral nerve neuromodulation therapy,and surgery.In this editorial,we will discuss current controversies and novel approaches to fecal incontinence.Screening for asymptomatic anal sphincter defects after obstetric anal sphincter injury and in patients with inflammatory bowel disease is not generally recommended,but may be helpful in selected patients.The Garg incontinence score is a new score that includes the assessment of solid,liquid,flatus,mucous,stress and urge fecal incontinence.Novel tests such as translumbosacral anorectal magnetic stimulation and novel therapies such as translumbosacral neuromodulation therapy are promising diagnostic and treatment options,for both fecal incontinence and neuropathy.Home biofeedback therapy can overcome some limitations of the office-based therapy.Skeletal muscle-derived cell implantation of the external anal sphincter has been further studied as a possible treatment option.Sacral neuromodulation may be useful in scleroderma,congenital fecal incontinence and inflammatory bowel disease but merits further study.
基金Supported by Financiamento e IncentivoàPesquisa of Hospital de Clínicas de Porto Alegre,No.170271.
文摘BACKGROUND Liver transplantation(LT)is the preferred treatment for end-stage liver diseases.Early allograft failure(EAF)can result in death or retransplantation.One of the key factors predicting EAF is the degree of graft injury,which is typically assessed by elevated alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels.Aminotransferase levels exceeding 5000 U/L within 48 hours of LT are indicative of poor short-term graft survival.AIM To investigate outcomes in liver transplant recipients with peak aminotransferase levels exceeding 5000 U/L and to identify predictors of EAF.METHODS Adult patients who underwent LT from a deceased(brain-dead)donor between 2011 and 2024 at Hospital de Clínicas de Porto Alegre were screened.Patients with peak AST or ALT levels>5000 U/L post-LT were included,excluding those with vascular thrombosis.EAF was defined as death or retransplantation within 90 days.A receiver operating characteristic curve were generated for each EAF predictor to determine the area under the curve(AUC).Sensitivity,specificity,negative predictive value,and positive predictive value were calculated for each predictor’s best cutoff,as defined by the Youden Index.Survival curves were plotted using the Kaplan-Meier method.RESULTS Between 2011 and 2024,341 patients underwent LT.Of these,29(8.5%)patients had AST and/or ALT levels exceeding 5000 U/L within the first 48 hours post-LT.Four patients were excluded due to vascular thrombosis,resulting in a study cohort of 25 patients.EAF were also observed in 11 patients.One-year and five-year graft survival rates were 51.7%and 42.6%,respectively.For patients without EAF,one-year and five-year graft survivals were 92.3%and 76.2%,respectively.The key predictors of EAF included serum factor V and arterial lactate levels on postoperative day(POD)1,with AUCs of 0.936 and 0.919,respectively.The optimal cutoff for EAF prediction were 26.2%for serum factor V and 9 mmol/L for arterial lactate.CONCLUSION Aminotransferase levels>5000 U/L were associated with high EAF risk.However,favorable graft function indicators on POD 1 were associated with long-term survival comparable to that of general LT recipients.Serum factor V and arterial lactate levels emerged as valuable prognostic markers.
基金funded by Portuguese funds through FCT——Funda??o para a Ciência e a Tecnologia/Ministério da Ciência,Tecnologia e Ensino Superior in the framework of the project PTDC/MEDNEU/1677/2021(to JBR)。
文摘Neuroimmunology is emerging as a pivotal field,shedding light on the intricate dialogues between the central nervous system(CNS)and the immune system.This exploration is particularly significant in understanding microglia,the CNS’s innate immune cells,beyond the conventional conflation of“neuroinflammation”and“microglial activation.”This conflation has clouded the true complexity of these processes,potentially stalling scientific progress and the development of new therapies.We challenge the long-standing perspectives that have oversimplified these interactions,advocating for a deeper exploration of the dynamic relationship between neuroinflammation and microglial activation.By dissecting specific molecular pathways,we aim to illuminate their elaborate roles in neuroinflammatory responses,especially in the context of Alzheimer’s disease(AD).Here,neuroinflammation is not merely a passive observer or a direct antagonist but a complex agent in the disease’s progression.This article calls for a significant paradigm shift towards an integrative,multi-omics approach to neuroimmunology.Adopting such a comprehensive framework is crucial for advancing our understanding of neuroinflammatory conditions and paving the way for targeted therapeutic strategies for brain diseases.
基金supported by Brazilian agencies CAPES(Finance Code 001)CNPq through PQ productivity scholarship.
文摘Here we compare the efficacy of anti-obesity drugs alone or combined with exercise training on body weight and exercise capacity of obese patients.Randomized clinical trials that assessed the impact of any anti-obesity drug alone or combined with exercise training on body weight,body fat,fat-free mass and cardiorespiratory fitness in obese patients were retrieved from Pubmed and EMBASE up to May 2024.Risk of bias assessment was performed with RoB 2.0,and the GRADE approach assessed the certainty of evidence(CoE)of each main outcome.We included four publications summing up 202 patients.Two publications used orlistat as an anti-obesity drug treatment,while the other two adopted GLP-1 receptor agonist(liraglutide or tirzepatide)as a pharmacotherapy for weight management.Orlistat combined with exercise was superior to change body weight(mean difference(MD):−2.27 kg;95%CI:−2.86 to−1.69;CoE:very low),fat mass(MD:−2.89;95%CI:−3.87 to−1.91;CoE:very low),fat-free mass(MD:0.56;95%CI:0.40–0.72;CoE:very low),and VO_(2)Peak(MD:2.64;95%CI:2.52–2.76;CoE:very low).GLP-1 receptor agonist drugs combined with exercise had a great effect on body weight(MD:−3.96 kg;95%CI:−5.07 to−2.85;CoE:low),fat mass(MD:−1.76;95%CI:−2.24 to−1.27;CoE:low),fat-free mass(MD:0.50;95%CI:−0.98 to 1.98;CoE:very low)and VO_(2)Peak(MD:2.47;95%CI:1.31–3.63;CoE:very low).The results reported here suggest that exercise training remains an important approach in weight management when combined with pharmacological treatment.
