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Iron-Deficiency Anemia Management in Gynecological Surgery: A Review of Current Evidence and Best Practices

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Open journal of Obstetrics and Gynecology 2024年第8期14卷 1223-1241页

作者： Aline Evangelista Santiago Artur Lima Sendin Víctor Nilo Nogueira Rogério Adão Braga Admilson Lemos Costa Filho Eduardo Batista Cândido Agnaldo lopes Silva Filho Department of Gynecology and Obstetrics Faculty of Medicine Santo Amaro University (UNISA) So Paulo Brazil Department of Gynecology and Obstetrics Federal University of Minas Gerais (UFMG) Belo Horizonte Brazil Department of Gynecology and Obstetrics Faculty of Medicine So Paulo State University (UNESP) So Paulo Brazil

Purpose: Due to the high prevalence of iron deficiency anemia in women undergoing gynecological surgeries and its association with worse postoperative results, it is necessary to identify and treat anemia preoperatively. However, although anemia and iron deficiency are significant global health problems, there are still disparities in the recognition and implementation of “Patient Blood Management” (PBM) as a comprehensive approach to mitigating the risks associated with these diseases. The purpose of the study is to review best practices for the treatment of anemia based on the Enhanced Recovery After Surgery (ERAS) protocol and PBM recommendations. Methods: This study reviewed the literature on preoperative iron deficiency anemia in patients undergoing gynecological surgery. We identified references through searches in PubMed using relevant search terms. Results: Among the various strategies used in PBM, perhaps the most important is the early detection and management of anemia. In gynecological surgery, there are several approaches to reducing perioperative blood loss, highlighting the use of gonadotropin-releasing hormone (GnRH) agonists (aGnRh) and antifibrinolytics. Oral and intravenous iron supplementation can be performed in addition to blood transfusion to treat anemia. Conclusion: Addressing preoperative and postoperative anemia through systematic correction, following the guidelines of the ERAS protocol and PBM guidelines, is essential to improving perioperative outcomes in women undergoing gynecological surgery.

关键词： Anemia Gynecological Surgery Iron Supplementation Iron Deficiency

Delay Times and Clinical Outcomes in Acute Myocardial Infarction: Comparison of Periods before and during the COVID-19 Pandemic—Myocardial Infarction and the Pandemic

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World journal of Cardiovascular Diseases 2024年第6期14卷 392-400页

作者： Clarice Teixeira Silva Araújo Arnon Salviato Mameri Thúlio Carrera Guarçoni Venturini Marcus Tadeu Aguilar Constantino Matos Igor Morais Araujo lopes Luiz Gustavo Ribeiro de Carvalho Murad Cleberson Duartes Ovani Guilherme Vassalo Morais Fernanda Venturini de Castro Danielle lopes Rocha Lucas Crespo de Barros Rodolfo Costa Sylvestre Luiz Fernando Machado Barbosa Roberto Ramos Barbosa Internal Medicine Universidade Federal do Esprito Santo (UFES) Vitria Brazil Hospital Santa Casa de Misericrdia de Vitria Vitria Brazil Hospital Santa Rita de Cssia Vitria Brazil Hospital Estadual Dr. jayme Santos Neves Serra Brazil Grupo Kora Sade Vitria Brazil Hospital Estadual Infantil e Maternidade Alzir Bernardino Alves (HIMABA) Vila Velha Brazil

Introduction: At the beginning of the COVID-19 pandemic, a drop in the number of patients treated for cardiac emergencies raised concern about cardiovascular mortality in that period. An increase in care delay for patients with ST-segment elevation myocardial infarction (STEMI) may have affected clinical outcomes. Objectives: To analyze delay times and clinical outcomes of patients with STEMI undergoing primary percutaneous coronary intervention (PPCI), before and during the COVID-19 pandemic. Methods: Retrospective observational study that included patients with STEMI undergoing PPCI from December 2018 to july 2021. The COVID-19 pandemic cases were divided into two groups: pandemic I—from March to August 2020;and pandemic II—from September 2020 to july 2021. Patients were compared according to the period of hospitalization. Primary outcomes were delay times in assistance and clinical outcomes (acute kidney injury [AKI], post-procedural vascular complications and in-hospital mortality). Results: 108 patients were included, 39 (36.1%) in the pre-pandemic period, 13 (12.1%) in pandemic I and 56 (51.8%) in pandemic II. Time from onset of symptoms to arrival at the service and door-to-balloon time did not differ significantly among groups. Vascular complications were more frequent during the pandemic (I and II) than in the pre-pandemic period (2.5% pre-pandemic vs 15.4% pandemic vs 12.5% pandemic II;p = 0.03). AKI incidence was similar in all three periods. There was a non-significant increase in in-hospital mortality during the COVID-19 pandemic. Conclusion: In patients with STEMI, there was an increase in vascular complications and a trend toward increased mortality during the COVID-19 pandemic. Delay times to admission and reperfusion did not differ significantly between before and during the pandemic.

关键词： Myocardial Infarction Primary Percutaneous Coronary Intervention Coronary Reperfusion Pandemic COVID-19

Towards curative therapy in gastric cancer:Faraway, so close!

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World journal of Gastroenterology 2015年第41期21卷 11609-11620页

作者： Marília Cravo Catarina Fidalgo Rita Garrido Tania Rodrigues Gon?alo Luz Carolina Palmela Marta Santos Fábio lopes Rui Maio Gastroenterology Department Surgery and Oncology ClinicsHospital Beatriz Angelo

Although recent diagnostic and therapeutic advances have substantially improved the survival of patients with gastric cancer(GC), the overall prognosis is still poor. Surgery is the only curative treatment and should be performed in experienced centers. Due to high relapse following surgery, complementary and systemic treatment aimed at eradicating micrometastasis should be performed in most cases. Cytotoxic treatments are effective in downstaging locally advanced cancer, but different sensitivities and toxicities probably exist in different GC subtypes. Current treatment protocols are based primarily on clinical data and histological features, but molecular biomarkers that would allow for the prediction of treatment responses are urgently needed. Understanding how host factors are responsible for inter-individual variability of drug response or toxicity will also contribute to the development of more effective and less toxic treatments.

关键词： Gastric cancer Multidisciplinary treatment Therapeutic strategies Curative surgery

Hyperonic neutron stars: reconciliation between nuclear properties and NICER and LIGO/VIRGO results

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Communications in Theoretical Physics 2022年第1期74卷 57-63页

作者： Luiz L lopes Centro Federal de Educagao Tecnologica de Minas Gerais Campus VIII CEP 37.022-560Varginha-MG-Brasil

Using an extended version of quantum hadrodynamics,I propose a new microscopic equation of state(EoS)that is able to correctly reproduce the main properties of symmetric nuclear matter at the saturation density,as well as produce massive neutron stars and satisfactory results for the radius and the tidal parameter.I show that this EoS can reproduce at least a 2.00 solar mass neutron star,even when hyperons are *** constraints about the radius of a 2.00 M_(⊙) and the minimum mass that enables a direct Urea effect are also checked.

关键词： neutron star nuclear matter tidal deformability DU process hyperons

A Differential Evolution Approach for Protein Folding Using a Lattice Model

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journal of Computer Science & Technology 2007年第6期22卷 904-908页

作者： Heitor Silverio lopes Reginaldo Bitello Bioinformatics Laboratory Federal University of Technology-ParanáAv.7 de setembro3165 80230-901 CuritibaBrazil

Protein folding is a relevant computational problem in Bioinformatics, for which many heuristic algorithms have been proposed. This work presents a methodology for the application of differential evolution （DE） to the problem of protein folding, using the bi-dimensional hydrophobic-polar model. DE is a relatively recent evolutionary algorithm, and has been used successfully in several engineering optimization problems, usually with continuous variables. We introduce the concept of genotype-phenotype mapping in DE in order to provide a mapping between the real-valued vector and an actual folding. The methodology is detailed and several experiments with benchmarks are done. We compared the results with other similar implementations. The proposed DE has shown to be competitive, statistically consistent and very promising.

关键词： bioinformatics differential evolution evolutionary computation protein folding

Sarcopenia and Anemia Are Predictors of Poor Prognostic in Cervical Cancer Patients

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Open journal of Obstetrics and Gynecology 2024年第5期14卷 693-704页

作者： Leandro Santos de Araujo Resende Francine Vilela de Amorim Miguel Soares Conceição Rodrigo Menezes jales Patrick Nunes Pereira Luis Otávio Sarian Glauco Baiocchi Sophie Derchain Agnaldo lopes da Silva Filho Department of Gynecology and Obstetrics Botucatu Medical School S&#227o Paulo State University UNESP S&#227o Paulo Brazil Department of Health Sciences University of Sao Francisco S&#227o Paulo Brazil Department of Obstetrics and Gynecology School of Medical Science State University of Campinas (UNICAMP) Campinas Brazil Department of Gynecologic Oncology AC Camargo Cancer Center Sao Paulo Brazil Department of Gynecology and Obstetrics School of Medicine of the Federal University of Minas Gerais Belo Horizonte Brazil

Objective: Evaluate pretreatment sarcopenia and anemia as prognostic factors in women undergoing treatment for cervical cancer (CC) with concurrent chemoradiotherapy (CCRT). Methods: 151 women with CC were analysed in this cohort study. Pretreatment computed tomography (CT) images were analysed to assess skeletal muscle index (SMI). Hazard ratios (HR) and multivariate Cox proportional HR were used to analyse association between low SMI, age, body mass index (BMI), haemoglobin levels, histological type, and International Federation of Gynaecology and Obstetrics (FIGO) stage with PFS and OS. Results: A total of 151 patients were included, 53 (35.1%) presented pretreatment sarcopenia;51 (34%) stage I/II and 100 (66%) stage III/IV. Among those patients in advanced stage (III/IV) 37 (70%) (p = 0.28) were sarcopenic at the beginning of treatment. Sarcopenia was associated with worse progression-free survival (PFS) and overall survival (OS) in our cohort [HR 0.97 (p = 0.01)] [HR 0.73 (p = 0.001)], as well as anemia [HR 0.73 (p = 0.001)] [HR 0.78 (p = 0.001)]. Linear regression models indicated that despite showing no association with age, neutrophil or platelet counts, sarcopenia was associated with pretreatment anemia levels (p = 0.01). After a multivariate analysis, only haemoglobin (anemia) and complete CCRT remained associated with PFS and OS. Sarcopenia and anemia were associated with worse PFS and OS in FIGO stage I/II. Conclusion: Pretreatment sarcopenia was significantly associated with low haemoglobin levels. Anemia and incomplete CCRT were independently associated with poor prognosis in women with CC. Pretreatment sarcopenia, as low SMI, was a predictor of poor prognostic in early stages of CC.

关键词： Cervical Cancer Sarcopenia Anemia Chemoradiotherapy

Monitoring of Ultrafine Particles in the Surrounding Urban Area of In-Land Passenger Ferries

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journal of Environmental Protection 2019年第6期10卷 838-860页

作者： Margarida lopes Ana Russo Célia Gouveia Francisco Ferreira Department of Sciences and Environmental Engineering NOVA School of Science and Technology NOVA University of Lisbon Caparica Portugal Instituto Dom Luiz (IDL) Faculdade de Ciências da Universidade de Lisboa Lisboa Portugal Portuguese Institute for Sea and Atmosphere Lisbon Portugal Centre for Environmental and Sustainability Research (CENSE) NOVA School of Science and Technology NOVA University of Lisbon Caparica Portugal

Maritime transportation, widely used both in international transport of goods and touristic purposes, has been identified as a significant source of ultrafine particles (UFP). In-land passenger ferry is a source of UFP far less addressed;however, in locations with relatively high frequency of this transportation mode, it is expected that they contribute to an increase of their concentration. Moreover, the negative effects of UFP on human health and environment are known and therefore, monitoring UFP produced by ferries is vital to assess the degree of exposure of who work or live close to ferries’ terminals or downwind to their cruising path. This work aims to study the influence of in-land ferries activities on UFP in the urban/suburban areas near ferries’ terminals and downwind across the cruising path. The UFP monitoring campaign was carried out from September to December 2018 for 19 non-consecutive periods. The sampling sites were chosen in order to maximize measurements under downwind conditions and allow the association between ferry operation and UFP concentration response. Based on data collected, correlation analysis was performed between ferry’s traffic and particle number counting (PNC) of UFP, and also with meteorological variables. Results show an increase in PNC ranging from 25 to 197% during the third minute around a ferry movement and are moderate to positive significant correlations between PNC values and the number of ferry operations (r = 0.79 to r = 0.94), showing that UFP emitted by in-land ferries contributes to PNC increase. Moreover, negative correlations (r = -0.85 to r = -0.93) between PNC and wind intensity were also found.

关键词： Air Pollution PNC In-Land Passenger Ferries Monitoring Campaign Health

Explicit bivariate rate functions for large deviations in AR(1)and MA(1)processes with Gaussian innovations

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Probability, Uncertainty and Quantitative Risk 2023年第2期8卷 177-212页

作者： Maicon j.Karling Artur O.lopes Sílvia R.C.lopes Mathematics and Statistics Institute Federal University of Rio Grande do Sul91500-900 Porto AlegreRSBrazil

We investigate the large deviations properties for centered stationary AR(1)and MA(1)processes with independent Gaussian innovations,by giving the explicit bivariate rate functions for the sequence of two-dimensional random *** the Contraction Principle,we provide the explicit rate functions for the sample mean and the sample second *** the AR(1)case,we also give the explicit rate function for the sequence of two-dimensional random vectors(W_(n))n≥2=(n^(-1(∑_(k=1)^(n)X_(k),∑_(k=1)^(n)X_(k)^(2))))_(n∈N)n≥2,but we obtain an analytic rate function that gives different values for the upper and lower bounds,depending on the evaluated set and its intersection with the respective set of exposed points.A careful analysis of the properties of a certain family of Toeplitz matrices is *** large deviations properties of three particular sequences of one-dimensional random variables will follow after we show how to apply a weaker version of the Contraction Principle for our setting,providing new proofs for two already known results on the explicit deviation function for the sample second moment and Yule-Walker *** exhibit the properties of the large deviations of the first-order empirical autocovariance,its explicit deviation function and this is also a new result.

关键词： Autoregressive processes Empirical autocovariance Large deviations Moving average processes Sample moments Toeplitz matrices Yule-Walker estimator

In vitro toxicity of particulate matter emissions from residential pellet combustion

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journal of Environmental Sciences 2022年第5期34卷 215-226页

作者： Estela D.Vicente Daniela Figueiredo Catia Goncalves Isabel lopes Helena Oliveira Nora Kovats Teresa Pinheiro Celia A.Alves Department of Environment and Planning and CESAM-Centre for Environmental and Marine Studies University of Aveiro3810-193 AveiroPortugal Department of Biology and CESAM-Centre for Environmental and Marine Studies University of Aveiro3810-193 AveiroPortugal Centre of Natural Environmental Sciences University of PannoniaEgyetem str.108200 VeszpremHungary Instituto de Bioengenharia e Biociencias Departamento de Engenharia e Ciencias NuclearesInstituto Superior TecnicoUniversidade de LisboaAv.Rovisco Pais 11049-001 LisboaPortugal

Particulate matter emissions(PM10)from the combustion,in a residential stove,of two com-mercial brands of certified(ENplus A1)pellets,a non-certified brand and laboratory made pellets of acacia were tested for their ability to induce ecotoxic,cytotoxic,and mutagenic re-sponses in unicellular organisms and a human cell *** was evaluated through the Vibrio fischeri bioluminescence inhibition ***,cytotoxicity was assessed at two time points(24-and 48-hr)through two complementary techniques in order to evaluate the cellular metabolic activity and membrane integrity of human lung epithelial cells *** Ames test using two Salmonella typhimurium strains(TA100 and TA98)was employed to assess the mutagenic potential of the polycyclic aromatic hydrocarbon fraction extracted from the PM10 *** obtained with the bioluminescent bacteria indicated that only particles from the combustion of acacia pellets were *** samples induced im-pairment on the A549 cells metabolic activity,while no significant release of lactate dehy-drogenase was ***10 emissions from acacia pellets were the most cytotoxic,while samples from both certified pellets evoked significant cytotoxicity at lower ***-icity time-dependency was only observed for PM10 from the combustion of acacia pellets and one of the brands of certified *** activity was not detected in both *** murium *** study emphasises the role of the raw material for pellet manu-facturing on the toxicological profile of PM *** raw materials should be deeply investigated before their use in pelletisation and combustion in residential appli-ances.

关键词： Ecotoxicity Cytotoxicity Mutagenicity Fuel quality Pellet combustion PM10 emissions