BACKGROUND Liver transplantation aims to increase the survival of patients with end-stage liver diseases and improve their quality of life.The number of organs available for transplantation is lower than the demand.To...BACKGROUND Liver transplantation aims to increase the survival of patients with end-stage liver diseases and improve their quality of life.The number of organs available for transplantation is lower than the demand.To provide fair organ distribution,predictive mortality scores have been developed.AIM To compare the Acute Physiology and Chronic Health Evaluation IV(APACHE IV),balance of risk(BAR),and model for end-stage liver disease(MELD)scores as predictors of mortality.METHODS Retrospective cohort study,which included 283 adult patients in the postoperative period of deceased donor liver transplantation from 2014 to 2018.RESULTS The transplant recipients were mainly male,with a mean age of 58.1 years.Donors were mostly male,with a mean age of 41.6 years.The median cold ischemia time was 3.1 hours,and the median intensive care unit stay was 5 days.For APACHE IV,a mean of 59.6 was found,BAR 10.7,and MELD 24.2.The 28-day mortality rate was 9.5%,and at 90 days,it was 3.5%.The 28-day mortality prediction for APACHE IV was very good[area under the curve(AUC):0.85,P<0.001,95%CI:0.76-0.94],P<0.001,BAR(AUC:0.70,P<0.001,95%CI:0.58–0.81),and MELD(AUC:0.66,P<0.006,95%CI:0.55-0.78),P<0.008.At 90 days,the data for APACHE IV were very good(AUC:0.80,P<0.001,95%CI:0.71–0.90)and moderate for BAR and MELD,respectively,(AUC:0.66,P<0.004,95%CI:0.55–0.77),(AUC:0.62,P<0.026,95%CI:0.51–0.72).All showed good discrimination between deaths and survivors.As for the best value for liver transplantation,it was significant only for APACHE IV(P<0.001).CONCLUSION The APACHE IV assessment score was more accurate than BAR and MELD in predicting mortality in deceased donor liver transplant recipients.展开更多
BACKGROUND Ultrasound(US)can be a valuable tool for assessing arthritis associated with inflammatory bowel disease(IBD),especially in cases of psoriatic disease.The clinical case reviewed in this article addresses an ...BACKGROUND Ultrasound(US)can be a valuable tool for assessing arthritis associated with inflammatory bowel disease(IBD),especially in cases of psoriatic disease.The clinical case reviewed in this article addresses an exploratory finding that evaluates the effects of immunobiological treatments on dactylitis and IBD with the use of US techniques.CASE SUMMARY A 40-year-old Caucasian woman with psoriatic arthritis(PsA)and ulcerative colitis(UC)reported experiencing finger pain,knee arthritis,and bloody diarrhea.She showed a high Disease Activity index for PsA score and a severe Mayo score.She began treatment with adalimumab.Over the course of six months,the 18 MHz US procedure was performed on her joints and a 3.5 MHz US on her intestines.The joint US indicated dactylitis and swelling in her finger joints,while the intestinal US revealed 6.6 mm swelling in the sigmoid colon,increased abdominal fat,and high Doppler signal.Her fecal calprotectin level was 5984 mg/kg,and a colonoscopy showed that UC extended to the hepatic flexure,along with mild narrowing of the transverse colon.After six months treatment,all parameters showed improvement,including a remission of the Mayo score,better colonoscopy results,and Limberg score of 0.CONCLUSION More research is needed to find out the importance of using US in patients with PsA and UC as this could improve treatment strategies.展开更多
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
BACKGROUND Hashimoto’s thyroiditis(HT)is an autoimmune dysfunction caused by genetic and environmental changes that attack the thyroid gland.HT affects approximately 2%to 5%of the population,being more prevalent in w...BACKGROUND Hashimoto’s thyroiditis(HT)is an autoimmune dysfunction caused by genetic and environmental changes that attack the thyroid gland.HT affects approximately 2%to 5%of the population,being more prevalent in women.It is diagnosed through a blood test(anti-thyroid peroxidase).Pharmacological treatment consists of daily administration of the synthetic hormone levothyroxine on an empty stomach.The most common signs and symptoms are:Tissue resistance to triiodothyronine T3,weight gain,dry skin,hair loss,tiredness/fatigue,and constipation,and nutritional therapy appears to help reduce these symptoms.AIM To analyze nutritional interventions for treating HT.METHODS This is an integrative review of original studies on nutritional interventions for treating Hashimoto’s disease.Articles were searched in the MEDLINE/PubMed and Latin American and Caribbean Literature on Health Sciences(LILACS)databases via virtual health library,using controlled vocabulary and free terms.A total of 70 articles were found:67 from PubMed and 3 from LILACS.After exclusions,9 articles met the eligibility criteria,including dietary interventions for maintaining and restoring the patient’s quality of life.RESULTS The reviewed articles evaluated the nutritional treatment of HT through supplementation of deficient micronutrients,anti-inflammatory diets,gluten-free diets,exclusion of foods that cause food sensitivities,lactose-free diet,paleo diet,and calorie restriction diets.However,some results were controversial regarding the beneficial effects of HT.CONCLUSION In general,it was observed that nutritional interventions for HT are based on the recovery of micronutrient deficiencies,treatment of the intestinal microbiota,diet rich in foods with anti-inflammatory properties,lifestyle changes,and encouragement of healthy habits.展开更多
BACKGROUND The hepatosplenic schistosomiasis(HSS)with portal hypertension can cause vascular complications such as hepatopulmonary syndrome(HPS).HPS increases the risk of mortality in patients with cirrhosis;however,t...BACKGROUND The hepatosplenic schistosomiasis(HSS)with portal hypertension can cause vascular complications such as hepatopulmonary syndrome(HPS).HPS increases the risk of mortality in patients with cirrhosis;however,there is no data on the mortality of patients with HSS and HPS.AIM To perform a survival analysis of patients with HPS related to cirrhotic and non-cirrhotic(schistosomiasis)portal hypertension.METHODS From August 2023 to January 2024,medical records and the official mortality information service of 121 patients who participated in a cross-sectional study on HPS between 2010 and 2012 were analyzed.Survival curves were created using the Kaplan-Meier method,and comparisons were performed using the log-rank test.Cox regression models estimated the hazard ratios(HR).RESULTS Overall,data of 113 patients were analyzed;most(55.8%)had HSS and concomitant cirrhosis(HSS/cirrhosis).Meanwhile,HPS was present in 39(34.5%)patients.Death occurred in 65 patients[57.5%];95%confidence interval(CI):48%-67%.The average time to death was lower in those with HPS when compared to those without HPS(3.37 years vs 5.65 years;P=0.017).According to the cause of liver disease,patients with HSS/cirrhosis died earlier,and their risk of death was twice as high compared with patients with HSS without cirrhosis(HR:2.17;95%CI:1.3-3.60;P=0.003).Meanwhile,there were no differences when comparing the two groups with and without HPS(HR:1.01;95%CI:0.59-1.73;P=0.967).CONCLUSION Patients with HSS and concomitant cirrhosis had a lower survival rate,but there was no difference in survival regardless of the presence of HPS.展开更多
Objectives:As the Duchenne Muscular Dystrophy(DMD)is a progressive neuromuscular disorder frequently associated with cardiac dysfunction,this study aimed to evaluate the influence of beta-blocker therapy on cardiac au...Objectives:As the Duchenne Muscular Dystrophy(DMD)is a progressive neuromuscular disorder frequently associated with cardiac dysfunction,this study aimed to evaluate the influence of beta-blocker therapy on cardiac autonomic modulation in adolescents withDMDby analyzing heart rate variability(HRV)indices in patients with and without betablockers.Methods:A cross-sectional study was conducted with 90 participants divided into three groups:(1)participants with DMD receiving beta-blocker therapy(DMDB,n=30),(2)participants with DMD without beta-blocker therapy(GMDM,n=30),and(3)age-and sex-matched typically developing participants(GDT,n=30).HRV was assessed using validated beat-to-beat heart rate monitoring(RS800CX,Polar)under controlled conditions.Linear and non-linear HRV indices(including Detrended Fluctuation Analysis and Symbolic Dynamics)were analysed using Kubios HRV software.Results:DMD patients exhibited autonomic impairment,characterized by decreased HRV,increased sympathetic dominance,and reduced parasympathetic modulation.Betablocker therapy was associated with significantly higher Mean Beat-to-beat interval(RR)and lower Mean Heart Rate(HR)compared to the non-beta-blocker DMD group,with values approaching those observed in typically developing participants.Non-linear indices suggested thatDMDpatients receiving beta-blockers demonstrated increased HRV complexity and fractal properties compared to those not receiving beta-blockers,although differences remained between the DMD and control groups.Conclusions:Autonomic dysfunction in DMD is characterized by reduced HRV and altered sympathovagal balance.In our results,beta-blocker therapy was associated with improved HRV and enhanced autonomic control.These findings highlight the potential cardioprotective role of betablockers in DMD management and emphasize the need for further research into optimizing autonomic function in DMD.展开更多
We sincerely thank the authors of the commentary1 for their thoughtful analysis and constructive critique of our systematic review on ischemic preconditioning(IPC)and placebo effects in exercise capacity and athletic ...We sincerely thank the authors of the commentary1 for their thoughtful analysis and constructive critique of our systematic review on ischemic preconditioning(IPC)and placebo effects in exercise capacity and athletic performance.2Their attention to methodological details,particularly concerning the inclusion and timing of warm-up protocols across studies,is commendable and contributes meaningfully to the ongoing refinement of IPC research in sports science.展开更多
Background:Improving medication safety,particularly for high-risk drugs,was identified as the third Global Patient Safety Challenge by the World Health Organization in 2017.Antineoplastic agents are included in the li...Background:Improving medication safety,particularly for high-risk drugs,was identified as the third Global Patient Safety Challenge by the World Health Organization in 2017.Antineoplastic agents are included in the list of high-risk medications because of their high potential to cause adverse events.This study evaluated the effectiveness of a project that was implemented to improve the antineoplastic therapy compounding process at a university hospital.Methods:This study had a quasi-experimental before-and-after design and used a quantitative approach to investigate the effects of implementation of this project in a centralized intravenous admixture service.The compounding of antineoplastic therapy was evaluated using five quality criteria at three time points:an initial evaluation and two post-intervention re-evaluations.The results of the intervention were subjected to statistical analysis and are presented in a Pareto chart.Results:All five quality criteria for correct compounding of antineoplastic therapy improved after implementation of the intervention,with an increase in compliance values for all criteria after the second evaluation.Improvements in criteria 1,3,and 4 were statistically significant.Conclusions:The implementation of the improvement project enhanced the quality criteria and caused a cultural shift in the team,with an improved view towards quality management in work processes.展开更多
Background:Ischemic preconditioning(IPC)is purported to have beneficial effects on athletic performance,although findings are inconsistent,with some studies reporting placebo effects.The majority of studies have inves...Background:Ischemic preconditioning(IPC)is purported to have beneficial effects on athletic performance,although findings are inconsistent,with some studies reporting placebo effects.The majority of studies have investigated IPC alongside a placebo condition,but without a control condition that was devoid of experimental manipulation,thereby limiting accurate determination of the IPC effects.Therefore,the aims of this study were to assess the impact of the IPC intervention,compared to both placebo and no intervention,on exercise capacity and athletic performance.Methods:A systematic search of PubMed,Embase,SPORTDiscus,Cochrane Library,and Latin American and Caribbean Health Sciences Literature(LILACS)covering records from their inception until July 2023 was conducted.To qualify for inclusion,studies had to apply IPC as an acute intervention,comparing it with placebo and/or control conditions.Outcomes of interest were performance(force,number of repetitions,power,time to exhaustion,and time trial performance),physiological measurements(maximum oxygen consumption,and heart rate),or perceptual measurements(RPE).For each outcome measure,we conducted 3 independent meta-analyses(IPC vs.placebo,IPC vs.control,placebo vs.control)using an inverse-variance random-effects model.The between-treatment effects were quantified by the standardized mean difference(SMD),accompanied by their respective 95%confidence intervals.Additionally,we employed the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach to assess the level of certainty in the evidence.Results:Seventy-nine studies were included in the quantitative analysis.Overall,IPC demonstrates a comparable effect to the placebo condition(using a low-pressure tourniquet),irrespective of the subjects'training level(all outcomes presenting p>0.05),except for the outcome of time to exhaustion,which exhibits a small magnitude effect(SMD=0.37;p=0.002).Additionally,the placebo exhibited effects notably greater than the control condition(outcome:number of repetitions;SMD=0.45;p=0.03),suggesting a potential influence of participants'cognitive perception on the outcomes.However,the evidence is of moderate to low certainty,regardless of the comparison or outcome.Conclusion:IPC has significant effects compared to the control intervention,but it did not surpass the placebo condition.Its administration might be influenced by the cognitive perception of the receiving subject,and the efficacy of IPC as an ergogenic strategy for enhancing exercise capacity and athletic performance remains questionable.展开更多
BACKGROUND:Identifying and managing medical emergencies presents challenges in healthcare,where familiarity with established algorithms is essential for high-quality care.This study assessed healthcare professionals’...BACKGROUND:Identifying and managing medical emergencies presents challenges in healthcare,where familiarity with established algorithms is essential for high-quality care.This study assessed healthcare professionals’ understanding of the latest resuscitation guidelines and explored their views on lifelong training models.METHODS:This cross-sectional study used two multiple-choice questionnaires with 50 questions developed by academic emergency and critical care consultants based on the 2021 Consensus on Science with Treatment Recommendations (CoSTRs) by the International Liaison Committee on Resuscitation(ILCOR).Healthcare staff involved in emergency coverage completed assessments on emergency management,self-evaluated their knowledge,and shared perspectives on continuous workplace education.RESULTS:Of the 1,427 distributed questionnaires,1,034 (72.5%) were completed.Knowledge gaps were more pronounced for pediatric algorithms from the European Resuscitation Council (ERC) and American Heart Association (AHA) compared to adult protocols (P<0.001).In multivariate logistic regression,being a physician,holding a Master of Science (MSc) degree,and younger age were independently associated with passing scores≥70%(all P<0.001).Most participants (97.3%) favored brief,employer-funded teamwork refresher sessions every4–6 months over the current four-year training model (0.6%)(P<0.001).CONCLUSION:This study highlights healthcare life support providers’ insufficient expertise in current resuscitation guidelines.The importance of short-format retraining,upskilling,and reskilling programs with post-training assessments is evident,as most respondents expressed a strong learning motivation to participate if employer-funded.展开更多
The woody vegetation is an important plant community constituent of tropical inselbergs,yet it remains largely overlooked.These environments of high socio-cultural and ecological value face pressures in many places,ma...The woody vegetation is an important plant community constituent of tropical inselbergs,yet it remains largely overlooked.These environments of high socio-cultural and ecological value face pressures in many places,mainly related to mining exploitation and fires.This study provides the first systematic overview of inselberg woody vegetation in the Brazilian Atlantic Forest.We used four inselbergs as models to characterize the composition and structure of the woody vegetation.In addition,the biomass and carbon storage were estimated using the general equations for tropical regions and carbon concentration values.Ten transects(50 m×2 m)were systematically installed on each inselberg,and all woody plants with a diameter at breast height≥5 cm were measured,registered,and identified.A total of 312 individuals belonging to 26 species,23 genera,and 14 families were found.The Fabaceae family and the genus Eugenia(Myrtaceae)exhibited a higher richness.The woody community's diameters ranged from 5.0 to 116.9 cm(with a mean of 23.9 cm),and heights ranged from 1.7 to 16.0 m(with a mean of 6.2 m).All specialist lithophyte woody species found on inselbergs are wind-dispersed.Among the endemic species of the Atlantic Forest,four were endemic to inselbergs,with Pseudobombax petropolitanum and Wunderlichia azulensis being threatened.A few species dominated the communities:P.petropolitanum,Guapira opposita,Amburana cearensis,and Tabebuia reticulata.Carbon accumulated in aboveground biomass ranged from 14 to 48 Mg ha-1,indicating variability in woody vegetation structure and growing conditions among inselbergs.Lastly,we highlight target species for potential use for inselberg vegetation restoration in stone mining areas in Atlantic Forest.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
Tropical mountain peatlands in Brazil’s Southern Espinhaço Range are vital ecosystems,acting as carbon reservoirs,hydrological buffers,and biodiversity hotspots while sustaining traditional livelihoods and prese...Tropical mountain peatlands in Brazil’s Southern Espinhaço Range are vital ecosystems,acting as carbon reservoirs,hydrological buffers,and biodiversity hotspots while sustaining traditional livelihoods and preserving paleoenvironmental records.Despite their importance,peatlands outside protected areas face degradation by grazing and fires,threatening their ability to regulate ecosystem processes sensitive to temperature,such as greenhouse gas emissions,water cycling,biological activity,and organic matter decomposition.Since 2016,we have monitored peat temperatures in two contrasting peatlands–one preserved(within a protected area)and one disturbed(outside the protected area)–to understand how anthropogenic disturbances and climate variability impact these fragile ecosystems.Seasonal patterns dominated temperature variation,accounting for 60% of air and 81%–92% of peatland temperature variation.However,average temperatures and amplitudes differed between peatlands and depths.Interannual variability revealed stronger trends in the disturbed peatland,where a 1℃ increase in air temperature caused the trend to increase 0.70℃–0.87℃ on average at depths of 0.85 m–0.92 m.By contrast,the preserved peatland showed smaller increases(0.20℃–0.24℃)at comparable depths(1.06 m–1.24 m),suggesting a greater resilience.Temperature variation in the monitored peatlands was majorly driven by seasonal patterns,as revealed by time series decomposition and sinewave fit.Average temperature and amplitude varied between the two peatlands and among sampling sites,reflecting differences in environmental conditions and measurement depth.Interannual variability also exhibited distinct effects between peatlands and monitoring sites.The time series trend component showed more pronounced fluctuations at shallower depths and in the disturbed peatland.For every 1℃ increase in the trend component of the air temperature,the trend component of the peatland time series increased by 0.70℃ and 0.87℃on average at depths of 0.85 m and 0.92 m,respectively,in the disturbed peatland.In contrast,the preserved peatland exhibited smaller increases of 0.20℃ and 0.24℃ at comparable depths(1.06 m and 1.24 m).These findings highlight the potential for feedback responses between peatland disturbance and climate change,threatening their critical role in regulating carbon and water cycles.Expanding long-term monitoring,strengthening conservation efforts,and raising public awareness are essential to safeguard the ecosystem services provided by tropical mountain peatlands.展开更多
BACKGROUND Bone regeneration is a central focus of regenerative medicine,with applications in orthopedics and dentistry,particularly for treating bone defects caused by trauma,infection,or congenital anomalies.Synthet...BACKGROUND Bone regeneration is a central focus of regenerative medicine,with applications in orthopedics and dentistry,particularly for treating bone defects caused by trauma,infection,or congenital anomalies.Synthetic biomaterials,often combined with fibrin derivatives,offer promising solutions for bone healing and restoration.AIM To Explore the increasingly important role of the association of synthetic biomaterials with fibrin in bone regeneration.METHODS Search terms included:“synthetic biomaterials AND fibrin sealant”,“hydroxyapatite AND fibrin sealant”,“tricalcium phosphate AND fibrin sealant”,and“synthetic biomaterials AND platelet-rich fibrin(PRF)”,resulting in 67 articles.After rigorous screening,21 articles met the inclusion criteria.RESULTS The reviewed studies assessed biomaterials like hydroxyapatite(HA),β-tricalcium phosphate(β-TCP),and fibrin-based products.Key findings highlighted the enhanced osteoconductivity and biocompatibility of HA andβ-TCP,especially when combined with fibrin sealants.These composites show significant potential for improving cellular adhesion,promoting osteogenic differentiation,and accelerating bone regeneration.The antimicrobial properties and structural support for cell growth of certain biomaterials indicate a promising potential for clinical applic-ations.CONCLUSION This systematic review emphasizes the growing role of fibrin-based biomaterials in bone regeneration and urges continued research to improve their clinical use for complex bone defects.展开更多
Background:Social media addiction,one of the behavioural addictions,is a significant predictor of job performance.It has also been posited that individuals whose fundamental requirements(e.g.,sleep)are not sufficientl...Background:Social media addiction,one of the behavioural addictions,is a significant predictor of job performance.It has also been posited that individuals whose fundamental requirements(e.g.,sleep)are not sufficiently met andwho lack adequate support(e.g.,perceived social support)are incapable of effectivelyharnessing theirpotential.The primary objective of this study is to examine themediating effects of sleep disorder and perceived social support on the relationship between social media addiction and job performance.Furthermore,it seeks to explore the moderating effects of perceived social support on sleep disorders and job performance.Methods:The data were collected through the questionnairemethod,and data analysis was performed using SPSS 26.0.Moreover,statistical analysis encompasses correlation analysis,mediation,and moderation analysis.The data were gathered from 488 healthcare professionals(57.2%female),whose ages ranged from 24 to 56 years(Meanage±SD=37.86±6.71),using a convenience sample approach.Results:The results revealed significant relationships between social media addiction,job performance,perceived social support,and sleep disorder.The findings indicate that social media addiction negatively predicts job performance(β=−0.11,p<0.05).Sleep disorder(effect size=−0.02,95%CI=[−0.04,−0.00])and perceived social support(effect size=−0.01,95%CI=[−0.02,−0.00])mediate this relationship.Furthermore,perceived social supportmoderates the pathway between sleep disorder and job performance(index ofmoderatedmediation:−0.0040,95%CI=[−0.0070,−0.0010]).Conclusions:This study suggests that social media addiction negatively affects job performance through sleep disorders and perceived social support among healthcare professionals.The study’s findings are significant,as they suggest that treatments aimed at alleviating sleep disorders and enhancing perceived social support among medical workers may improve their job performance.展开更多
AIM:To compare trabeculectomy with mitomycin C(MMC)alone to trabeculectomy with a combination of MMC and Ologen implant in glaucoma patients.METHODS:A retrospective cohort study including 94 eyes recruited in two grou...AIM:To compare trabeculectomy with mitomycin C(MMC)alone to trabeculectomy with a combination of MMC and Ologen implant in glaucoma patients.METHODS:A retrospective cohort study including 94 eyes recruited in two groups[50 in the mitomycin C(MMC)group and 44 in the combined Ologen+MMC(OLO)group].The medical charts of the patients were collected and analyzed at different time points:1d,10-30d,3-5mo,6-9mo,1,2,and 3y postoperatively.We assessed the intraocular pressure(IOP)reduction,cup-disc(CD)ratio,visual acuity(VA),bleb morphology,and complications.RESULTS:Both groups showed a significant reduction of the mean IOP from 28.8 to 10 mm Hg in 1 and 2y.However,no significant difference was noticed between both groups.We observed a stable visual acuity in 40%and 11.8%,improved in 20%and 41.2%,and worsened in 40%and 47.1%in the MMC and OLO groups,respectively.Complications were statistically significantly lower in the OLO group than in the MMC group.Bleb morphology showed statistically significant differences between the groups,with grade C blebs being more prevalent in the OLO group(43.2%in 1y)compared to the MMC group(16%in 1y)and flat blebs being more prevalent in the OLO group(43.2%in 2y)compare to MMC group(20%in 2y).Both MMC and OLO groups were effective in reducing IOP.CONCLUSION:The combined use of the Ologen implant and MMC may provide better outcomes in terms of preserving the optic nerve structure,reducing complications,and maintaining stable bleb morphology postoperatively.展开更多
BACKGROUND Type 2 diabetes is a chronic,non-communicable disease with a substantial global impact,affecting a significant number of individuals.Its etiology is closely tied to imbalanced dietary practices and sedentar...BACKGROUND Type 2 diabetes is a chronic,non-communicable disease with a substantial global impact,affecting a significant number of individuals.Its etiology is closely tied to imbalanced dietary practices and sedentary lifestyles.Conversely,increasing die-tary fiber(DF)intake has consistently demonstrated health benefits in numerous studies,including improvements in glycemic control and weight management.AIM To investigate the efficacy of DF interventions in the management of type 2 diabetes mellitus(T2DM).METHODS A systematic literature review was conducted to explore the association between DF intake and the management of T2DM.Following the inclusion and exclusion criteria,a total of 26 studies were included in this review.RESULTS The main strategies implied to increased DF intake were:High DF diet plus acarbose(2 studies);DF supplements(14 studies);and high DF diets(10 studies).Overall,most studies indicated that increased DF intake resulted in im-provements in glycemic control and weight management in T2DM patients.CONCLUSION DF represents a valuable strategy in the treatment of type 2 diabetes,improving health outcomes.DF intake offers the potential to improve quality of life and reduce complications and mortality associated with diabetes.Likewise,through supplements or enriched foods,DF contributes significantly to the control of several markers such as HbA1c,blood glucose,triglycerides,low-density lipoprotein,and body weight.展开更多
Inflammatory markers and mediators that affect the development of cardiovascular diseases have been the focus of recent scientific work.Thus,the purpose of this editorial is to promote a critical debate about the arti...Inflammatory markers and mediators that affect the development of cardiovascular diseases have been the focus of recent scientific work.Thus,the purpose of this editorial is to promote a critical debate about the article titled“Nε-carboxymethyl-lysine and inflammatory cytokines,markers,and mediators of coronary artery disease progression in diabetes”,published in the World Journal of Diabetes in 2024.This work directs us to reflect on the role of advanced glycation end products,which are pro-inflammatory products arising from the metabolism of fatty acids and sugars whose main marker in tissues is Nε-carboxymethyllysine(NML).Recent studies have linked high levels of pro-inflammatory agents with the development of coronary artery disease(CAD),especially tumor necrosis factor alpha,interleukins,and C-reactive protein.These inflammatory agents increase the production of reactive oxygen species(ROS),of which people with diabetes are known to have an increased production.The increase in ROS promotes lipid peroxidation,which causes damage to myocytes,promoting myocardial damage.Furthermore,oxidative stress induces the binding of NML to its receptor RAGE,which in turn activates the nuclear factor-kB,and consequently,inflammatory cytokines.These inflammatory cytokines induce endothelial dysfunction,with increased expression of adhesion molecules,changes in endothelial permeability and changes in the expression of nitric oxide.In this sense,the therapeutic use of monoclonal antibodies(inflammatory reducers such as statins and sodium-glucose transport inhibitors)has demonstrated positive results in the regression of atherogenic plaques and consequently CAD.On the other hand,many studies have demonstrated a relationship between mitochondrial dynamics,diabetes,and cardiovascular diseases.This link occurs since ROS have their origin in the imbalance in glucose metabolism that occurs in the mitochondrial matrix,and this imbalance can have its origin in inadequate diet as well as some pathologies.Photobiomodulation(PBM)has recently been considered a possible therapeutic agent for cardiovascular diseases due to its effects on mitochondrial dynamics and oxidative stress.In this sense,therapies such as PBM that act on pro-inflammatory mediators and mitochondrial modulation could benefit those with cardiovascular diseases.展开更多
BACKGROUND Liver transplant(LT)patients have become older and sicker.The rate of post-LT major adverse cardiovascular events(MACE)has increased,and this in turn raises 30-d post-LT mortality.Noninvasive cardiac stress...BACKGROUND Liver transplant(LT)patients have become older and sicker.The rate of post-LT major adverse cardiovascular events(MACE)has increased,and this in turn raises 30-d post-LT mortality.Noninvasive cardiac stress testing loses accuracy when applied to pre-LT cirrhotic patients.AIM To assess the feasibility and accuracy of a machine learning model used to predict post-LT MACE in a regional cohort.METHODS This retrospective cohort study involved 575 LT patients from a Southern Brazilian academic center.We developed a predictive model for post-LT MACE(defined as a composite outcome of stroke,new-onset heart failure,severe arrhythmia,and myocardial infarction)using the extreme gradient boosting(XGBoost)machine learning model.We addressed missing data(below 20%)for relevant variables using the k-nearest neighbor imputation method,calculating the mean from the ten nearest neighbors for each case.The modeling dataset included 83 features,encompassing patient and laboratory data,cirrhosis complications,and pre-LT cardiac assessments.Model performance was assessed using the area under the receiver operating characteristic curve(AUROC).We also employed Shapley additive explanations(SHAP)to interpret feature impacts.The dataset was split into training(75%)and testing(25%)sets.Calibration was evaluated using the Brier score.We followed Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis guidelines for reporting.Scikit-learn and SHAP in Python 3 were used for all analyses.The supplementary material includes code for model development and a user-friendly online MACE prediction calculator.RESULTS Of the 537 included patients,23(4.46%)developed in-hospital MACE,with a mean age at transplantation of 52.9 years.The majority,66.1%,were male.The XGBoost model achieved an impressive AUROC of 0.89 during the training stage.This model exhibited accuracy,precision,recall,and F1-score values of 0.84,0.85,0.80,and 0.79,respectively.Calibration,as assessed by the Brier score,indicated excellent model calibration with a score of 0.07.Furthermore,SHAP values highlighted the significance of certain variables in predicting postoperative MACE,with negative noninvasive cardiac stress testing,use of nonselective beta-blockers,direct bilirubin levels,blood type O,and dynamic alterations on myocardial perfusion scintigraphy being the most influential factors at the cohort-wide level.These results highlight the predictive capability of our XGBoost model in assessing the risk of post-LT MACE,making it a valuable tool for clinical practice.CONCLUSION Our study successfully assessed the feasibility and accuracy of the XGBoost machine learning model in predicting post-LT MACE,using both cardiovascular and hepatic variables.The model demonstrated impressive performance,aligning with literature findings,and exhibited excellent calibration.Notably,our cautious approach to prevent overfitting and data leakage suggests the stability of results when applied to prospective data,reinforcing the model’s value as a reliable tool for predicting post-LT MACE in clinical practice.展开更多
文摘BACKGROUND Liver transplantation aims to increase the survival of patients with end-stage liver diseases and improve their quality of life.The number of organs available for transplantation is lower than the demand.To provide fair organ distribution,predictive mortality scores have been developed.AIM To compare the Acute Physiology and Chronic Health Evaluation IV(APACHE IV),balance of risk(BAR),and model for end-stage liver disease(MELD)scores as predictors of mortality.METHODS Retrospective cohort study,which included 283 adult patients in the postoperative period of deceased donor liver transplantation from 2014 to 2018.RESULTS The transplant recipients were mainly male,with a mean age of 58.1 years.Donors were mostly male,with a mean age of 41.6 years.The median cold ischemia time was 3.1 hours,and the median intensive care unit stay was 5 days.For APACHE IV,a mean of 59.6 was found,BAR 10.7,and MELD 24.2.The 28-day mortality rate was 9.5%,and at 90 days,it was 3.5%.The 28-day mortality prediction for APACHE IV was very good[area under the curve(AUC):0.85,P<0.001,95%CI:0.76-0.94],P<0.001,BAR(AUC:0.70,P<0.001,95%CI:0.58–0.81),and MELD(AUC:0.66,P<0.006,95%CI:0.55-0.78),P<0.008.At 90 days,the data for APACHE IV were very good(AUC:0.80,P<0.001,95%CI:0.71–0.90)and moderate for BAR and MELD,respectively,(AUC:0.66,P<0.004,95%CI:0.55–0.77),(AUC:0.62,P<0.026,95%CI:0.51–0.72).All showed good discrimination between deaths and survivors.As for the best value for liver transplantation,it was significant only for APACHE IV(P<0.001).CONCLUSION The APACHE IV assessment score was more accurate than BAR and MELD in predicting mortality in deceased donor liver transplant recipients.
文摘BACKGROUND Ultrasound(US)can be a valuable tool for assessing arthritis associated with inflammatory bowel disease(IBD),especially in cases of psoriatic disease.The clinical case reviewed in this article addresses an exploratory finding that evaluates the effects of immunobiological treatments on dactylitis and IBD with the use of US techniques.CASE SUMMARY A 40-year-old Caucasian woman with psoriatic arthritis(PsA)and ulcerative colitis(UC)reported experiencing finger pain,knee arthritis,and bloody diarrhea.She showed a high Disease Activity index for PsA score and a severe Mayo score.She began treatment with adalimumab.Over the course of six months,the 18 MHz US procedure was performed on her joints and a 3.5 MHz US on her intestines.The joint US indicated dactylitis and swelling in her finger joints,while the intestinal US revealed 6.6 mm swelling in the sigmoid colon,increased abdominal fat,and high Doppler signal.Her fecal calprotectin level was 5984 mg/kg,and a colonoscopy showed that UC extended to the hepatic flexure,along with mild narrowing of the transverse colon.After six months treatment,all parameters showed improvement,including a remission of the Mayo score,better colonoscopy results,and Limberg score of 0.CONCLUSION More research is needed to find out the importance of using US in patients with PsA and UC as this could improve treatment strategies.
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BACKGROUND Hashimoto’s thyroiditis(HT)is an autoimmune dysfunction caused by genetic and environmental changes that attack the thyroid gland.HT affects approximately 2%to 5%of the population,being more prevalent in women.It is diagnosed through a blood test(anti-thyroid peroxidase).Pharmacological treatment consists of daily administration of the synthetic hormone levothyroxine on an empty stomach.The most common signs and symptoms are:Tissue resistance to triiodothyronine T3,weight gain,dry skin,hair loss,tiredness/fatigue,and constipation,and nutritional therapy appears to help reduce these symptoms.AIM To analyze nutritional interventions for treating HT.METHODS This is an integrative review of original studies on nutritional interventions for treating Hashimoto’s disease.Articles were searched in the MEDLINE/PubMed and Latin American and Caribbean Literature on Health Sciences(LILACS)databases via virtual health library,using controlled vocabulary and free terms.A total of 70 articles were found:67 from PubMed and 3 from LILACS.After exclusions,9 articles met the eligibility criteria,including dietary interventions for maintaining and restoring the patient’s quality of life.RESULTS The reviewed articles evaluated the nutritional treatment of HT through supplementation of deficient micronutrients,anti-inflammatory diets,gluten-free diets,exclusion of foods that cause food sensitivities,lactose-free diet,paleo diet,and calorie restriction diets.However,some results were controversial regarding the beneficial effects of HT.CONCLUSION In general,it was observed that nutritional interventions for HT are based on the recovery of micronutrient deficiencies,treatment of the intestinal microbiota,diet rich in foods with anti-inflammatory properties,lifestyle changes,and encouragement of healthy habits.
文摘BACKGROUND The hepatosplenic schistosomiasis(HSS)with portal hypertension can cause vascular complications such as hepatopulmonary syndrome(HPS).HPS increases the risk of mortality in patients with cirrhosis;however,there is no data on the mortality of patients with HSS and HPS.AIM To perform a survival analysis of patients with HPS related to cirrhotic and non-cirrhotic(schistosomiasis)portal hypertension.METHODS From August 2023 to January 2024,medical records and the official mortality information service of 121 patients who participated in a cross-sectional study on HPS between 2010 and 2012 were analyzed.Survival curves were created using the Kaplan-Meier method,and comparisons were performed using the log-rank test.Cox regression models estimated the hazard ratios(HR).RESULTS Overall,data of 113 patients were analyzed;most(55.8%)had HSS and concomitant cirrhosis(HSS/cirrhosis).Meanwhile,HPS was present in 39(34.5%)patients.Death occurred in 65 patients[57.5%];95%confidence interval(CI):48%-67%.The average time to death was lower in those with HPS when compared to those without HPS(3.37 years vs 5.65 years;P=0.017).According to the cause of liver disease,patients with HSS/cirrhosis died earlier,and their risk of death was twice as high compared with patients with HSS without cirrhosis(HR:2.17;95%CI:1.3-3.60;P=0.003).Meanwhile,there were no differences when comparing the two groups with and without HPS(HR:1.01;95%CI:0.59-1.73;P=0.967).CONCLUSION Patients with HSS and concomitant cirrhosis had a lower survival rate,but there was no difference in survival regardless of the presence of HPS.
文摘Objectives:As the Duchenne Muscular Dystrophy(DMD)is a progressive neuromuscular disorder frequently associated with cardiac dysfunction,this study aimed to evaluate the influence of beta-blocker therapy on cardiac autonomic modulation in adolescents withDMDby analyzing heart rate variability(HRV)indices in patients with and without betablockers.Methods:A cross-sectional study was conducted with 90 participants divided into three groups:(1)participants with DMD receiving beta-blocker therapy(DMDB,n=30),(2)participants with DMD without beta-blocker therapy(GMDM,n=30),and(3)age-and sex-matched typically developing participants(GDT,n=30).HRV was assessed using validated beat-to-beat heart rate monitoring(RS800CX,Polar)under controlled conditions.Linear and non-linear HRV indices(including Detrended Fluctuation Analysis and Symbolic Dynamics)were analysed using Kubios HRV software.Results:DMD patients exhibited autonomic impairment,characterized by decreased HRV,increased sympathetic dominance,and reduced parasympathetic modulation.Betablocker therapy was associated with significantly higher Mean Beat-to-beat interval(RR)and lower Mean Heart Rate(HR)compared to the non-beta-blocker DMD group,with values approaching those observed in typically developing participants.Non-linear indices suggested thatDMDpatients receiving beta-blockers demonstrated increased HRV complexity and fractal properties compared to those not receiving beta-blockers,although differences remained between the DMD and control groups.Conclusions:Autonomic dysfunction in DMD is characterized by reduced HRV and altered sympathovagal balance.In our results,beta-blocker therapy was associated with improved HRV and enhanced autonomic control.These findings highlight the potential cardioprotective role of betablockers in DMD management and emphasize the need for further research into optimizing autonomic function in DMD.
文摘We sincerely thank the authors of the commentary1 for their thoughtful analysis and constructive critique of our systematic review on ischemic preconditioning(IPC)and placebo effects in exercise capacity and athletic performance.2Their attention to methodological details,particularly concerning the inclusion and timing of warm-up protocols across studies,is commendable and contributes meaningfully to the ongoing refinement of IPC research in sports science.
文摘Background:Improving medication safety,particularly for high-risk drugs,was identified as the third Global Patient Safety Challenge by the World Health Organization in 2017.Antineoplastic agents are included in the list of high-risk medications because of their high potential to cause adverse events.This study evaluated the effectiveness of a project that was implemented to improve the antineoplastic therapy compounding process at a university hospital.Methods:This study had a quasi-experimental before-and-after design and used a quantitative approach to investigate the effects of implementation of this project in a centralized intravenous admixture service.The compounding of antineoplastic therapy was evaluated using five quality criteria at three time points:an initial evaluation and two post-intervention re-evaluations.The results of the intervention were subjected to statistical analysis and are presented in a Pareto chart.Results:All five quality criteria for correct compounding of antineoplastic therapy improved after implementation of the intervention,with an increase in compliance values for all criteria after the second evaluation.Improvements in criteria 1,3,and 4 were statistically significant.Conclusions:The implementation of the improvement project enhanced the quality criteria and caused a cultural shift in the team,with an improved view towards quality management in work processes.
基金partially supported by the State Funding Agency of Minas Gerais,Brazil(FAPEMIG),Process No.APQ-01811-21supported by Alexander von Humboldt-Stiftung(AvH)/Coordena??o de Aperfei?oamento de Pessoal de Nível Superior(CAPES)+1 种基金National Council for Scientific and Technological Development-CNPq(Process No.308138/2022-8)supported by National Council for Scientific and Technological Development-CNPq(Process No.BPD-00905-22).
文摘Background:Ischemic preconditioning(IPC)is purported to have beneficial effects on athletic performance,although findings are inconsistent,with some studies reporting placebo effects.The majority of studies have investigated IPC alongside a placebo condition,but without a control condition that was devoid of experimental manipulation,thereby limiting accurate determination of the IPC effects.Therefore,the aims of this study were to assess the impact of the IPC intervention,compared to both placebo and no intervention,on exercise capacity and athletic performance.Methods:A systematic search of PubMed,Embase,SPORTDiscus,Cochrane Library,and Latin American and Caribbean Health Sciences Literature(LILACS)covering records from their inception until July 2023 was conducted.To qualify for inclusion,studies had to apply IPC as an acute intervention,comparing it with placebo and/or control conditions.Outcomes of interest were performance(force,number of repetitions,power,time to exhaustion,and time trial performance),physiological measurements(maximum oxygen consumption,and heart rate),or perceptual measurements(RPE).For each outcome measure,we conducted 3 independent meta-analyses(IPC vs.placebo,IPC vs.control,placebo vs.control)using an inverse-variance random-effects model.The between-treatment effects were quantified by the standardized mean difference(SMD),accompanied by their respective 95%confidence intervals.Additionally,we employed the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach to assess the level of certainty in the evidence.Results:Seventy-nine studies were included in the quantitative analysis.Overall,IPC demonstrates a comparable effect to the placebo condition(using a low-pressure tourniquet),irrespective of the subjects'training level(all outcomes presenting p>0.05),except for the outcome of time to exhaustion,which exhibits a small magnitude effect(SMD=0.37;p=0.002).Additionally,the placebo exhibited effects notably greater than the control condition(outcome:number of repetitions;SMD=0.45;p=0.03),suggesting a potential influence of participants'cognitive perception on the outcomes.However,the evidence is of moderate to low certainty,regardless of the comparison or outcome.Conclusion:IPC has significant effects compared to the control intervention,but it did not surpass the placebo condition.Its administration might be influenced by the cognitive perception of the receiving subject,and the efficacy of IPC as an ergogenic strategy for enhancing exercise capacity and athletic performance remains questionable.
文摘BACKGROUND:Identifying and managing medical emergencies presents challenges in healthcare,where familiarity with established algorithms is essential for high-quality care.This study assessed healthcare professionals’ understanding of the latest resuscitation guidelines and explored their views on lifelong training models.METHODS:This cross-sectional study used two multiple-choice questionnaires with 50 questions developed by academic emergency and critical care consultants based on the 2021 Consensus on Science with Treatment Recommendations (CoSTRs) by the International Liaison Committee on Resuscitation(ILCOR).Healthcare staff involved in emergency coverage completed assessments on emergency management,self-evaluated their knowledge,and shared perspectives on continuous workplace education.RESULTS:Of the 1,427 distributed questionnaires,1,034 (72.5%) were completed.Knowledge gaps were more pronounced for pediatric algorithms from the European Resuscitation Council (ERC) and American Heart Association (AHA) compared to adult protocols (P<0.001).In multivariate logistic regression,being a physician,holding a Master of Science (MSc) degree,and younger age were independently associated with passing scores≥70%(all P<0.001).Most participants (97.3%) favored brief,employer-funded teamwork refresher sessions every4–6 months over the current four-year training model (0.6%)(P<0.001).CONCLUSION:This study highlights healthcare life support providers’ insufficient expertise in current resuscitation guidelines.The importance of short-format retraining,upskilling,and reskilling programs with post-training assessments is evident,as most respondents expressed a strong learning motivation to participate if employer-funded.
基金the project funding from Fundacao de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIGNo: APQ-02049-21)+3 种基金the National Council for Scientific and Technological Development (CNPqgrant 312567/2021-9)the Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro (FAPERJgrant E26/201.007/2022) for funding support
文摘The woody vegetation is an important plant community constituent of tropical inselbergs,yet it remains largely overlooked.These environments of high socio-cultural and ecological value face pressures in many places,mainly related to mining exploitation and fires.This study provides the first systematic overview of inselberg woody vegetation in the Brazilian Atlantic Forest.We used four inselbergs as models to characterize the composition and structure of the woody vegetation.In addition,the biomass and carbon storage were estimated using the general equations for tropical regions and carbon concentration values.Ten transects(50 m×2 m)were systematically installed on each inselberg,and all woody plants with a diameter at breast height≥5 cm were measured,registered,and identified.A total of 312 individuals belonging to 26 species,23 genera,and 14 families were found.The Fabaceae family and the genus Eugenia(Myrtaceae)exhibited a higher richness.The woody community's diameters ranged from 5.0 to 116.9 cm(with a mean of 23.9 cm),and heights ranged from 1.7 to 16.0 m(with a mean of 6.2 m).All specialist lithophyte woody species found on inselbergs are wind-dispersed.Among the endemic species of the Atlantic Forest,four were endemic to inselbergs,with Pseudobombax petropolitanum and Wunderlichia azulensis being threatened.A few species dominated the communities:P.petropolitanum,Guapira opposita,Amburana cearensis,and Tabebuia reticulata.Carbon accumulated in aboveground biomass ranged from 14 to 48 Mg ha-1,indicating variability in woody vegetation structure and growing conditions among inselbergs.Lastly,we highlight target species for potential use for inselberg vegetation restoration in stone mining areas in Atlantic Forest.
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.
基金This study was financed in part by the Coordenacao de Aperfeiçoamento de Pessoal de Nivel Superior-Brasil(CAPES)-Finance Code 001the Brazilian Conselho Nacional de Pesquisa-CNPq(study and research grants and research funding-Process 303666/2018-8,408162/2018-0,441335/2020-9,302969/2021-7,and 50484/2022-4)Fundacao de ApoioaPesquisa do Estado de Minas Gerais-FAPEMIG(study grants and research funding-Process CRA/APQ 0100-18,APQ-03364-21 and CAG/PPM 00568-16).
文摘Tropical mountain peatlands in Brazil’s Southern Espinhaço Range are vital ecosystems,acting as carbon reservoirs,hydrological buffers,and biodiversity hotspots while sustaining traditional livelihoods and preserving paleoenvironmental records.Despite their importance,peatlands outside protected areas face degradation by grazing and fires,threatening their ability to regulate ecosystem processes sensitive to temperature,such as greenhouse gas emissions,water cycling,biological activity,and organic matter decomposition.Since 2016,we have monitored peat temperatures in two contrasting peatlands–one preserved(within a protected area)and one disturbed(outside the protected area)–to understand how anthropogenic disturbances and climate variability impact these fragile ecosystems.Seasonal patterns dominated temperature variation,accounting for 60% of air and 81%–92% of peatland temperature variation.However,average temperatures and amplitudes differed between peatlands and depths.Interannual variability revealed stronger trends in the disturbed peatland,where a 1℃ increase in air temperature caused the trend to increase 0.70℃–0.87℃ on average at depths of 0.85 m–0.92 m.By contrast,the preserved peatland showed smaller increases(0.20℃–0.24℃)at comparable depths(1.06 m–1.24 m),suggesting a greater resilience.Temperature variation in the monitored peatlands was majorly driven by seasonal patterns,as revealed by time series decomposition and sinewave fit.Average temperature and amplitude varied between the two peatlands and among sampling sites,reflecting differences in environmental conditions and measurement depth.Interannual variability also exhibited distinct effects between peatlands and monitoring sites.The time series trend component showed more pronounced fluctuations at shallower depths and in the disturbed peatland.For every 1℃ increase in the trend component of the air temperature,the trend component of the peatland time series increased by 0.70℃ and 0.87℃on average at depths of 0.85 m and 0.92 m,respectively,in the disturbed peatland.In contrast,the preserved peatland exhibited smaller increases of 0.20℃ and 0.24℃ at comparable depths(1.06 m and 1.24 m).These findings highlight the potential for feedback responses between peatland disturbance and climate change,threatening their critical role in regulating carbon and water cycles.Expanding long-term monitoring,strengthening conservation efforts,and raising public awareness are essential to safeguard the ecosystem services provided by tropical mountain peatlands.
文摘BACKGROUND Bone regeneration is a central focus of regenerative medicine,with applications in orthopedics and dentistry,particularly for treating bone defects caused by trauma,infection,or congenital anomalies.Synthetic biomaterials,often combined with fibrin derivatives,offer promising solutions for bone healing and restoration.AIM To Explore the increasingly important role of the association of synthetic biomaterials with fibrin in bone regeneration.METHODS Search terms included:“synthetic biomaterials AND fibrin sealant”,“hydroxyapatite AND fibrin sealant”,“tricalcium phosphate AND fibrin sealant”,and“synthetic biomaterials AND platelet-rich fibrin(PRF)”,resulting in 67 articles.After rigorous screening,21 articles met the inclusion criteria.RESULTS The reviewed studies assessed biomaterials like hydroxyapatite(HA),β-tricalcium phosphate(β-TCP),and fibrin-based products.Key findings highlighted the enhanced osteoconductivity and biocompatibility of HA andβ-TCP,especially when combined with fibrin sealants.These composites show significant potential for improving cellular adhesion,promoting osteogenic differentiation,and accelerating bone regeneration.The antimicrobial properties and structural support for cell growth of certain biomaterials indicate a promising potential for clinical applic-ations.CONCLUSION This systematic review emphasizes the growing role of fibrin-based biomaterials in bone regeneration and urges continued research to improve their clinical use for complex bone defects.
文摘Background:Social media addiction,one of the behavioural addictions,is a significant predictor of job performance.It has also been posited that individuals whose fundamental requirements(e.g.,sleep)are not sufficiently met andwho lack adequate support(e.g.,perceived social support)are incapable of effectivelyharnessing theirpotential.The primary objective of this study is to examine themediating effects of sleep disorder and perceived social support on the relationship between social media addiction and job performance.Furthermore,it seeks to explore the moderating effects of perceived social support on sleep disorders and job performance.Methods:The data were collected through the questionnairemethod,and data analysis was performed using SPSS 26.0.Moreover,statistical analysis encompasses correlation analysis,mediation,and moderation analysis.The data were gathered from 488 healthcare professionals(57.2%female),whose ages ranged from 24 to 56 years(Meanage±SD=37.86±6.71),using a convenience sample approach.Results:The results revealed significant relationships between social media addiction,job performance,perceived social support,and sleep disorder.The findings indicate that social media addiction negatively predicts job performance(β=−0.11,p<0.05).Sleep disorder(effect size=−0.02,95%CI=[−0.04,−0.00])and perceived social support(effect size=−0.01,95%CI=[−0.02,−0.00])mediate this relationship.Furthermore,perceived social supportmoderates the pathway between sleep disorder and job performance(index ofmoderatedmediation:−0.0040,95%CI=[−0.0070,−0.0010]).Conclusions:This study suggests that social media addiction negatively affects job performance through sleep disorders and perceived social support among healthcare professionals.The study’s findings are significant,as they suggest that treatments aimed at alleviating sleep disorders and enhancing perceived social support among medical workers may improve their job performance.
文摘AIM:To compare trabeculectomy with mitomycin C(MMC)alone to trabeculectomy with a combination of MMC and Ologen implant in glaucoma patients.METHODS:A retrospective cohort study including 94 eyes recruited in two groups[50 in the mitomycin C(MMC)group and 44 in the combined Ologen+MMC(OLO)group].The medical charts of the patients were collected and analyzed at different time points:1d,10-30d,3-5mo,6-9mo,1,2,and 3y postoperatively.We assessed the intraocular pressure(IOP)reduction,cup-disc(CD)ratio,visual acuity(VA),bleb morphology,and complications.RESULTS:Both groups showed a significant reduction of the mean IOP from 28.8 to 10 mm Hg in 1 and 2y.However,no significant difference was noticed between both groups.We observed a stable visual acuity in 40%and 11.8%,improved in 20%and 41.2%,and worsened in 40%and 47.1%in the MMC and OLO groups,respectively.Complications were statistically significantly lower in the OLO group than in the MMC group.Bleb morphology showed statistically significant differences between the groups,with grade C blebs being more prevalent in the OLO group(43.2%in 1y)compared to the MMC group(16%in 1y)and flat blebs being more prevalent in the OLO group(43.2%in 2y)compare to MMC group(20%in 2y).Both MMC and OLO groups were effective in reducing IOP.CONCLUSION:The combined use of the Ologen implant and MMC may provide better outcomes in terms of preserving the optic nerve structure,reducing complications,and maintaining stable bleb morphology postoperatively.
文摘BACKGROUND Type 2 diabetes is a chronic,non-communicable disease with a substantial global impact,affecting a significant number of individuals.Its etiology is closely tied to imbalanced dietary practices and sedentary lifestyles.Conversely,increasing die-tary fiber(DF)intake has consistently demonstrated health benefits in numerous studies,including improvements in glycemic control and weight management.AIM To investigate the efficacy of DF interventions in the management of type 2 diabetes mellitus(T2DM).METHODS A systematic literature review was conducted to explore the association between DF intake and the management of T2DM.Following the inclusion and exclusion criteria,a total of 26 studies were included in this review.RESULTS The main strategies implied to increased DF intake were:High DF diet plus acarbose(2 studies);DF supplements(14 studies);and high DF diets(10 studies).Overall,most studies indicated that increased DF intake resulted in im-provements in glycemic control and weight management in T2DM patients.CONCLUSION DF represents a valuable strategy in the treatment of type 2 diabetes,improving health outcomes.DF intake offers the potential to improve quality of life and reduce complications and mortality associated with diabetes.Likewise,through supplements or enriched foods,DF contributes significantly to the control of several markers such as HbA1c,blood glucose,triglycerides,low-density lipoprotein,and body weight.
文摘Inflammatory markers and mediators that affect the development of cardiovascular diseases have been the focus of recent scientific work.Thus,the purpose of this editorial is to promote a critical debate about the article titled“Nε-carboxymethyl-lysine and inflammatory cytokines,markers,and mediators of coronary artery disease progression in diabetes”,published in the World Journal of Diabetes in 2024.This work directs us to reflect on the role of advanced glycation end products,which are pro-inflammatory products arising from the metabolism of fatty acids and sugars whose main marker in tissues is Nε-carboxymethyllysine(NML).Recent studies have linked high levels of pro-inflammatory agents with the development of coronary artery disease(CAD),especially tumor necrosis factor alpha,interleukins,and C-reactive protein.These inflammatory agents increase the production of reactive oxygen species(ROS),of which people with diabetes are known to have an increased production.The increase in ROS promotes lipid peroxidation,which causes damage to myocytes,promoting myocardial damage.Furthermore,oxidative stress induces the binding of NML to its receptor RAGE,which in turn activates the nuclear factor-kB,and consequently,inflammatory cytokines.These inflammatory cytokines induce endothelial dysfunction,with increased expression of adhesion molecules,changes in endothelial permeability and changes in the expression of nitric oxide.In this sense,the therapeutic use of monoclonal antibodies(inflammatory reducers such as statins and sodium-glucose transport inhibitors)has demonstrated positive results in the regression of atherogenic plaques and consequently CAD.On the other hand,many studies have demonstrated a relationship between mitochondrial dynamics,diabetes,and cardiovascular diseases.This link occurs since ROS have their origin in the imbalance in glucose metabolism that occurs in the mitochondrial matrix,and this imbalance can have its origin in inadequate diet as well as some pathologies.Photobiomodulation(PBM)has recently been considered a possible therapeutic agent for cardiovascular diseases due to its effects on mitochondrial dynamics and oxidative stress.In this sense,therapies such as PBM that act on pro-inflammatory mediators and mitochondrial modulation could benefit those with cardiovascular diseases.
文摘BACKGROUND Liver transplant(LT)patients have become older and sicker.The rate of post-LT major adverse cardiovascular events(MACE)has increased,and this in turn raises 30-d post-LT mortality.Noninvasive cardiac stress testing loses accuracy when applied to pre-LT cirrhotic patients.AIM To assess the feasibility and accuracy of a machine learning model used to predict post-LT MACE in a regional cohort.METHODS This retrospective cohort study involved 575 LT patients from a Southern Brazilian academic center.We developed a predictive model for post-LT MACE(defined as a composite outcome of stroke,new-onset heart failure,severe arrhythmia,and myocardial infarction)using the extreme gradient boosting(XGBoost)machine learning model.We addressed missing data(below 20%)for relevant variables using the k-nearest neighbor imputation method,calculating the mean from the ten nearest neighbors for each case.The modeling dataset included 83 features,encompassing patient and laboratory data,cirrhosis complications,and pre-LT cardiac assessments.Model performance was assessed using the area under the receiver operating characteristic curve(AUROC).We also employed Shapley additive explanations(SHAP)to interpret feature impacts.The dataset was split into training(75%)and testing(25%)sets.Calibration was evaluated using the Brier score.We followed Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis guidelines for reporting.Scikit-learn and SHAP in Python 3 were used for all analyses.The supplementary material includes code for model development and a user-friendly online MACE prediction calculator.RESULTS Of the 537 included patients,23(4.46%)developed in-hospital MACE,with a mean age at transplantation of 52.9 years.The majority,66.1%,were male.The XGBoost model achieved an impressive AUROC of 0.89 during the training stage.This model exhibited accuracy,precision,recall,and F1-score values of 0.84,0.85,0.80,and 0.79,respectively.Calibration,as assessed by the Brier score,indicated excellent model calibration with a score of 0.07.Furthermore,SHAP values highlighted the significance of certain variables in predicting postoperative MACE,with negative noninvasive cardiac stress testing,use of nonselective beta-blockers,direct bilirubin levels,blood type O,and dynamic alterations on myocardial perfusion scintigraphy being the most influential factors at the cohort-wide level.These results highlight the predictive capability of our XGBoost model in assessing the risk of post-LT MACE,making it a valuable tool for clinical practice.CONCLUSION Our study successfully assessed the feasibility and accuracy of the XGBoost machine learning model in predicting post-LT MACE,using both cardiovascular and hepatic variables.The model demonstrated impressive performance,aligning with literature findings,and exhibited excellent calibration.Notably,our cautious approach to prevent overfitting and data leakage suggests the stability of results when applied to prospective data,reinforcing the model’s value as a reliable tool for predicting post-LT MACE in clinical practice.
