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Care Measures and Health Outcomes in a Pediatric Intensive Care Unit in Brazil

Open Journal of Pediatrics 2023年第5期13卷 697-706页

作者： Arnildo Linck Junior Flávia Lopes Gabani Edmarlon Girotto ana maria rigo silva Selma Maffei Andrade Department of Pediatrics and Pediatric Surgery Universidade Estadual de Londrina Londrina Brazil

Introduction: In low- and middle-income countries, including Brazil, conditions that favor mortality in the PICU remain significant. Compared to developed countries, there is a shortage of skilled human resources, lower availability of technological resources, greater difficulty of access and a higher incidence of infections, including both those acquired prior to admission and those resulting from treatment and hospitalization (i.e., healthcare-associated infections (HAIs)). HAIs in the PICU include ventilator-associated pneumonia and catheter-related bloodstream infections. Actions for the prevention of HAIs can minimize the occurrence of negative outcomes. Materials and Methods: This is an epidemiological study comparing admissions at the PICU of a high-complexity hospital in South Brazil over two three-year periods: 2012-2014 (before the measures were adopted) and 2015-2017 (after the measures). The care measures were adopted mainly at the beginning of 2015 and consisted of expansion of physical therapy care, adoption of care protocols, acquisition of new materials and equipment (transparent dressings for central catheters, high-tech mechanical ventilators and multiparametric monitors) and multidisciplinary team training. The frequency of the outcomes mortality, length of PICU stay, diagnosis of catheter-related bloodstream infection, need for and duration of ventilatory support and diagnosis of ventilator-associated pneumonia were compared between the two trienniums using logistic regression with adjustment for age in months and need of vasoactive drugs. Results: A total of 1140 admissions were analyzed (470 in the first triennium and 670 in the second), representing an increase in the admission rate of 42.6% after the adoption of the measures. After adjustments, significant reductions in the frequency of mortality (adjusted OR [adjOR] = 0.54;CI 95%: 0.34 - 0.84), length of PICU stay > 7 days (adjOR = 0.75;CI 95%: 0.57 - 0.97) and duration of ventilatory suppor

关键词： Pediatric Intensive Care Units Outcomes Assessment In-Hospital Mortality Hospital Stay Mechanical Ventilation Catheter-Related Infections

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Treatment of spinal cord injury with biomaterials and stem cell therapy in non-human primates and humans

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Neural Regeneration Research 2025年第2期20卷 343-353页

作者： ana Milena silva Olaya Fernanda Martins Almeida ana maria Blanco Martinez Suelen Adriani Marques PhD Program in Pathological anatomy Federal University of Rio de JaneiroRio de JaneiroBrazil Biomedical Science Institute Federal University of Rio de JaneiroRio de JaneiroBrazil Graduate Program in Pathological anatomy Federal University of Rio de JaneiroRio de JaneiroBrazil Graduate Program in Pathological anatomy(PPGAP/UFRJ) Department of Neurobiology/Institute of BiologyCampus do GragoatáNiteróiRio de JaneiroBrazil

Spinal cord injury results in the loss of sensory,motor,and autonomic functions,which almost always produces permanent physical ***,in the search for more effective treatments than those already applied for years,which are not entirely efficient,researches have been able to demonstrate the potential of biological strategies using biomaterials to tissue manufacturing through bioengineering and stem cell therapy as a neuroregenerative approach,seeking to promote neuronal recovery after spinal cord *** of these strategies has been developed and meticulously evaluated in several animal models with the aim of analyzing the potential of interventions for neuronal repair and,consequently,boosting functional *** the majority of experimental research has been conducted in rodents,there is increasing recognition of the importance,and need,of evaluating the safety and efficacy of these interventions in non-human primates before moving to clinical trials involving therapies potentially promising in *** article is a literature review from databases(PubMed,Science Direct,Elsevier,Scielo,Redalyc,Cochrane,and NCBI)from 10 years ago to date,using keywords(spinal cord injury,cell therapy,non-human primates,humans,and bioengineering in spinal cord injury).From 110 retrieved articles,after two selection rounds based on inclusion and exclusion criteria,21 articles were ***,this review arises from the need to recognize the experimental therapeutic advances applied in non-human primates and even humans,aimed at deepening these strategies and identifying the advantages and influence of the results on extrapolation for clinical applicability in humans.

关键词： bioengineering biomaterials cell therapy humans non-human primates spinal cord injury stem cell therapy

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Motivations for and barriers to innovation in non-profit organizations: The case of nursing homes in Northern Portugal

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International Journal of Innovation Studies 2024年第1期8卷 25-44页

作者： ana Rita Gonçalves Lopes Aldina Isabel de Azevedo Correia Alexandra maria da silva Braga Center for Research and Innovation in Business Sciences and Information Systems School of Management and TechnologyPolitecnico do PortoRua do Curral-Margaride4610-156 FelgueirasPortugal

To contribute to the empirical literature on innovation in non-profit organizations,this study examines innovation in Private Social Solidarity Institutions with social responses for the elderly in Northern *** enriches the literature by clarifying the concept of innovation applied to non-profit organizations,which represents a perspective different from the business ***,it is important to support the innovation decisionmaking process in similar non-profit *** this study,the population was surveyed through questionnaires based on the PUBLIN research project,which has already been applied in different countries,and the targets were employees of organizations with social responses for the *** sample is small,with 28 respondent institutions and 51 employees,but it is representative,as it includes institutions from all districts in Northern *** study employed a quantitative approach,particularly factor analysis,multiple linear regression,and correlation analyses,using scales already applied in other dimensions of the social sector,to understand the effect of each innovation dimension/determinant on creativity and innovation in nonprofit *** results show that in these organizations with social responses for the elderly,learning orientation,risk-taking,and job satisfaction have a positive impact on innovation.

关键词： Determinants of innovation non-profit organizations social responses for the elderly Northern Portugal

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Urea breath test for Helicobacter pylori infection in adult dyspeptic patients: A meta-analysis of diagnostic test accuracy

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World Journal of Gastroenterology 2024年第6期30卷 579-598页

作者： Fabian Fellipe Bueno Lemos Caroline Tianeze de Castro Marcel silva Luz Gabriel Reis Rocha Gabriel Lima Correa Santos Luís Guilherme de Oliveira silva mariana Santos Calmon Cláudio Lima Souza ana Carla Zarpelon-Schutz Kádima Nayara Teixeira Dulciene maria de Magalhães Queiroz Fabrício Freire de Melo Instituto Multidisciplinar em Saúde Universidade Federal da BahiaVitória da Conquista 45029-094BahiaBrazil Instituto de Saúde Coletiva Universidade Federal da BahiaSalvador 40110040BahiaBrazil Campus Toledo Universidade Federal do ParanáToledo 85919-899ParanáBrazil Laboratory of Research in Bacteriology UFMGBelo Horizonte 30130-100Minas GeraisBrazil

BACKGROUND Helicobacter pylori(***)infection has been well-established as a significant risk factor for several gastrointestinal *** urea breath test(UBT)has emerged as a leading non-invasive method for detecting *** numerous studies confirming its substantial accuracy,the reliability of UBT results is often compromised by inherent *** findings underscore the need for a rigorous statistical synthesis to clarify and reconcile the diagnostic accuracy of the UBT for the diagnosis of *** *** To determine and compare the diagnostic accuracy of 13C-UBT and 14C-UBT for *** infection in adult patients with *** We conducted an independent search of the PubMed/MEDLINE,EMBASE,and Cochrane Central databases until April *** search included diagnostic accuracy studies that evaluated at least one of the index tests(^(13)C-UBT or ^(14)C-UBT)against a reference *** used the QUADAS-2 tool to assess the methodo-logical quality of the *** utilized the bivariate random-effects model to calculate sensitivity,specificity,positive and negative test likelihood ratios(LR+and LR-),as well as the diagnostic odds ratio(DOR),and their 95%confidence *** conducted subgroup analyses based on urea dosing,time after urea administration,and assessment *** investigate a possible threshold effect,we conducted Spearman correlation analysis,and we generated summary receiver operating characteristic(SROC)curves to assess ***,we visually inspected a funnel plot and used Egger’s test to evaluate publication *** both as reliable diagnostic tools in clinical *** In summary,our study has demonstrated that ^(13)C-UBT has been found to outperform the ^(14)C-UBT,making it the preferred diagnostic ***,our results emphasize the significance of carefully considering urea dosage,assessment timing,and measurement techniques for both tests to enh

关键词： Helicobacter pylori Urea breath test Diagnosis Diagnostic test accuracy Meta-analysis

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Alpha-1 antitrypsin deficiency and Pi*Z allele as important co-factors in the development of liver fibrosis

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World Journal of Hepatology 2024年第8期16卷 1099-1110页

作者： ana Isabel Ferreira Catarina Guimarães Vitor Macedo silva Sofia Xavier Joana Magalhães JoséCotter Department of Gastroenterology Hospital da Senhora da Oliveira-GuimarãesGuimarães 4835-044Portugal Life and Health Sciences Research Institute School of MedicineUniversity of MinhoBraga 4710-057Portugal Life and Health Sciences Research Institute/3B’s PT Government Associate LaboratoryBraga 4710-057Portugal Department of Pulmonology Hospital Senhora da Oliveira-GuimarãesGuimarães 4835-044Portugal

BACKGROUND Alpha-1 antitrypsin deficiency(AATD)is a codominant autosomal hereditary condition that predisposes patients to the development of lung and/or liver disease,and Pi*Z allele is the most clinically relevant *** To evaluate the impact of clinical parameters and AATD phenotypes,particularly the Pi*Z allele,in liver *** Cross-sectional cohort study including consecutive patients with AATD followed in Pulmonology or Hepatology *** Included 69 patients,49.3%had Pi*MZ phenotype and 10.1%Pi**** age≥55 years,age at diagnosis≥41 years and AAT at diagnosis<77 mg/dL predicted a nonalcoholic fatty liver disease fibrosis score(NFS)not excluding advanced fibrosis[area under the curve(AUC)=0.840,P<0.001;AUC=0.836,P<0.001;AUC=0.681,P=0.025].An age≥50 years and age at diagnosis≥41 years predicted a fibrosis-4 index of moderate to advanced fibrosis(AUC=0.831,P<0.001;AUC=0.795,P<0.001).Patients with hypertension,type 2 diabetes mellitus(DM),dyslipidaemia,metabolic syndrome,and regular alcohol consumption were more likely to have a NFS not excluding advanced fibrosis(P<0.001,P=0.002,P=0.008,P<0.001,P=0.033).Patients with at least one Pi*Z allele and type 2 DM were 8 times more likely to have liver stiffness measurement≥7.1 kPa(P=0.040).CONCLUSION Risk factors for liver disease in AATD included an age≥50 years,age at diagnosis≥41 years,metabolic risk factors,regular alcohol consumption,at least one Pi*Z allele,and AAT value at diagnosis<77 mg/*** created an algorithm for liver disease screening in AATD patients to use in primary care,selecting those to be referred to Hepatology consultation.

关键词： Alpha-1 antitrypsin deficiency Liver fibrosis Nonalcoholic fatty liver disease fibrosis score Fibrosis-4 index Liver stiffness measurement

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Screening of Environmental Bacterial Strains for Wild Aedes Mosquito Larval Biocontrol

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Open Journal of Applied Sciences 2024年第9期14卷 2431-2442页

作者： Alexandre Paulo Machado Liliana Alves Correa Gabriel de Paula Albuquerque ana Lúcia maria Ribeiro Rosina Djunko Miyazaki Jéssica da silva Gava Dyego Bichofre Cruz Laboratory of Microbiology Medical Faculty Federal University of Mato Grosso Mato Grosso Brazil Laboratory of Entomology Institute of Biosciences Federal University of Mato Grosso Mato Grosso Brazil

The effectiveness of current control measures against Aedes mosquitoes remains low, resulting in persistent epidemics in urban areas. The emergence of resistant mosquito populations to chemical insecticides highlights the need for novel, environmentally friendly, cost-effective control strategies. This study explored the potential of environmental bacterial isolates to biocontrol wild Aedes larvae. Initially, we collected bacterial samples from infectious masses of Aedes fluviatilis larvae. The isolated bacteria were identified using biochemical, enzymatic, and molecular methods, including 16S rRNA sequencing and MALDI-TOF. Previously, Aeromonas hydrophila and Bacillus thuringiensis isolated from these infectious masses showed limited Aedes larval inhibition. Consequently, we screened additional environmental isolates from the bacteriotheque. Six isolates previously identified were tested: Chromobacterium violaceum, Enterobacter cloacae, Bacillus cereus, Bacillus sphaericus, and two strains of Bacillus thuringiensis israelensis. Among these strains, B. thuringiensis and C. violaceum exhibited significant inhibitory activities against wild Aedes larvae. Bacillus thuringiensis cultures grown under daylight conditions showed a slight ability to inhibit Aedes larvae. The potential of B. thuringiensis and C. violaceum strains studied, along with optimized culture growth conditions, will be further investigated to develop bioinsecticide products to provide safer and more sustainable alternatives for controlling larvae of Aedes mosquitoes.

关键词： Bacillus thuringiensis Chromobacterium violaceum Aedes Biocontrol Larval Inhibition

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Care Measures and Health Outcomes in a Pediatric Intensive Care Unit in Brazil

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Open Journal of Pediatrics（儿科学期刊） 2023年第5期

作者： Arnildo Linck Junior Flávia Lopes Gabani Edmarlon Girotto ana maria rigo silva Selma Maffei Andrade

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Carpal Tunnel Syndrome: A Marker for Amyloidosis

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World Journal of Neuroscience 2024年第3期14卷 92-101页

作者： Luciana León Cejas Miguel Saucedo Mayra Aldecoa Gustavo Teruya Fabricio silva Alvaro Muratore Gonzalo Viollaz Cintia Marchesoni ana Pardal Pablo Dezanzo Alejandro Iotti Ricardo Reisin Neurology Department Hospital Britnico de Buenos Aires Buenos Aires Argentina Orthopedics Department Hospital Britnico de Buenos Aires Buenos Aires Argentina Pathology Department Hospital Britnico de Buenos Aires Buenos Aires Argentina

Introduction: Amyloidosis are systemic conditions and carpal tunnel syndrome (CTS) precedes the principal systemic complications and can be used as an early marker. Our objective was to determine the frequency of amyloid deposition in idiopathic CTS and its systemic impact. Methods: We retrospectively evaluated patients with CTS between September 2019 to January 2020. Samples from the anterior carpal ligament were pathologically evaluated and amyloid deposition was confirmed by apple-green birefringence on polarized light using Congo red stain. When amyloid was detected we performed genetic testing for transthyretin variants (ATTRv), immunofixation electrophoresis in serum and urine for light chains and multidisciplinary evaluation. Results: Thirty consecutive patients were included, 19 women, 11 men, mean age 70 years old (range 42 - 89 years). We identified 3 patients (10%) with amyloid deposits (mean age: 78.6 years, 2 men, 1 woman). Genetic testing for ATTRv and light chains studies were negative. During follow-up: The first patient required aortic valve replacement. The second patient developed progressive cardiac failure with syncopal episodes, atrioventricular block and atrial fibrillation and required a pacemaker and anticoagulation. The third patient had unexplained chronic edemas. The cardiac evaluation in all 3 patients revealed left ventricular hypertrophy and myocardial uptake (Perugini Score > 2) in their nuclear bone scintigraphies with technetium pyrophosphate. Two patients were treated with tafamidis and one patient died due to refractory cardiac insufficiency. Discussion: Our findings underline the importance of investigating amyloidosis in idiopathic CTS. The identification of deposits allows early diagnosis of cardiac amyloidosis leading to timely intervention and treatment.

关键词： Carpal Tunnel Amyloid Transthyretin Amyloid Cardiac Transthyretin Variants Light Chains

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Development of a Ready-to-Use PSMA-11 Kit Formulation and Biological Evaluation of Binding Affinity

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Advances in Molecular Imaging 2024年第2期13卷 7-22页

作者： maria Renata Valente Brandão Freire Natália Marchesan Bexiga Marco Antonio Stephano João Ezequiel Oliveira Carlos Roberto Jorge Soares ana Cláudia Camargo Miranda Anna Carolina de Alcântara Barbosa Marycel Figols de Barboza Laura Fernanda Garcia Luiz Felipe S. Teixeira maria Helena Marumo Bellini Natanael Gomes da silva Luiza Mascarenhas Balieiro Joel Mendes Elaine Bortoleti de Araújo Centro de Radiofarmcia Instituto de Pesquisas Energticas e Nucleares (IPEN) Cidade Universitria So Paulo Brasil Departamento de Tecnologia Farmacutica Faculdade de Cincias Farmacuticas (USP) Cidade Universitria So Paulo Brasil Centro de Biotecnologia Instituto de Pesquisas Energticas e Nucleares (IPEN) Cidade Universitria So Paulo Brasil Departamento de Medicina Nuclear do Hospital Israelita Albert Einstein So Paulo/SP Brasil

Introduction: 68Ga-PSMA-11 is considered the gold standard in detection of micro and oligometastases in advanced prostate cancer, being used for therapeutic planning, as well as, potentially, for evaluating response to treatment. The development of ready-to-use lyophilized kit of PSMA-11 adds quality and safety to the routine use of this radiopharmaceutical and represents a pharmacotechnical challenge as it must preserve the integrity and specificity of the ligand. Methods: PSMA-11 kit formulation was proposed, considering radiolabeling parameters and the preservation of the peptide during the lyophilization process, using mannitol as an excipient. Critical temperature characterization studies were carried out using DSC equipment and the freeze-drying process was developed. The direct radiolabeling conditions were evaluated and standardized using 68Ge/68Ga generator eluate from two different manufacturers (ITG and Eckert & Ziegler). The radiochemical purity was evaluated by TLC and HPLC. Biological evaluation was carried out with lyophilized PSMA-11 to demonstrate the integrity of the peptide and preservation of biological activity after the lyophilization process. Results: Based on critical temperature characterization studies, the freeze-drying cycle was designed to reach a freezing temperature of around −40˚C and primary drying at 2˚C. Using 20 mg of mannitol, an intact and elegant lyophilized cake was obtained. PSMA-11 lyophilized kit was directly labeled with 68Ga eluate from 68Ge/68Ga GMP generators (ITG and Eckert & Ziegler) resulting in % RP > 95% at pH 4.0 to 4.5. The results obtained from in vitro and in vivo biological competition studies confirmed the preservation of PSMA-11 affinity for the receptor after lyophilization. Conclusion: A lyophilized formulation (Kit) of PSMA-11 was successfully obtained, which preserved the integrity and biological activity of the peptide and guaranteed radiolabeling efficiency.

关键词： 68Ga-PSMA-11 Prostate-Specific Membrane Antigen (PSMA) Ready-to-Use Kit GMP-Grade Generators Metastatic Prostate Cancer PET Imaging

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Current knowledge on esophageal atresia

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World Journal of Gastroenterology 2012年第28期18卷 3662-3672页

作者： Paulo Fernando Martins Pinheiro ana Cristina Simoes e silva Regina maria Pereira Department of Pediatric Surgery Odilon Behrens HospitalAvenida JoséBonifácioSão CristovãoBelo Horizonte31210-690 Minas GeraisBrazil Department of Pediatrics Faculty of MedicineFederal University of Minas GeraisBelo Horizonte30130-100 Minas GeraisBrazil

Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common congenital anomaly of the esophagus. The improvement of survival observed over the previous two decades is multifactorial and largely attributable to advances in neonatal intensive care, neonatal anesthesia, ventilatory and nutritional support, antibiotics, early surgical intervention, surgical materials and techniques. Indeed, mortality is currently limited to those cases with coexisting severe life-threatening anomalies. The diagnosis of EA is most commonly made during the first 24 h of life but may occur either antenatally or may be delayed. The primary surgical correction for EA and TEF is the best option in the absence of severe malformations. There is no ideal replacement for the esophagus and the optimal surgical treatment for patients with long-gap EA is still contro-versial. The primary complications during the postoperative period are leak and stenosis of the anastomosis, gastro-esophageal reflux, esophageal dysmotility, fistula recurrence, respiratory disorders and deformities of the thoracic wall. Data regarding long-term outcomes and follow-ups are limited for patients following EA/TEF repair. The determination of the risk factors for the complicated evolution following EA/TEF repair may positively impact long-term prognoses. Much remains to be studied regarding this condition. This manuscript provides a literature review of the current knowledge regarding EA.

关键词： Esophageal atresia Tracheoesophageal fistula Esophageal stenosis Long-gap Gastro-esophageal reflux

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