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Impact of multidrug resistance on the management of bacterial infections in cirrhosis

World Journal of Clinical Cases 2023年第3期11卷 534-544页

作者： Carlos Terra Ângelo Zambam de Mattos Marcelo Souza Chagas Andre Torres Denusa Wiltgen Barbara Muniz Souza renata mello Perez Gastroenterology-Liver Unit State University of Rio de JaneiroRio de Janeiro 20551-030Rio de JaneiroBrazil Liver Unit Casa de Saúde São José-Rede Santa CatarinaRio de Janeiro 22271-080Rio de JaneiroBrazil Alliance of Brazilian Centers for Cirrhosis Car The ABC GroupRio de Janeiro 20551-030Rio de JaneiroBrazil Liver Unit Federal Hospital of LagoaRio de Janeiro 22470-050Rio de JaneiroBrazil Graduate Program in Medicine:Hepatology Federal University of Health Sciences of Porto AlegrePorto Alegre 90020-090Rio Grande do SulBrazil Gastroenterology and Hepatology Unit Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Rio Grande do SulBrazil Internal Medicine Federal Hospital of LagoaRio de Janeiro 22470-050Rio de JaneiroBrazil Department of Internal Medicine Federal University of Health Sciences of Porto AlegrePorto Alegre 90020-090Brazil Hepatology Division Federal University of Rio de JaneiroRio de Janeiro 21941-617Rio de JaneiroBrazil IDOR D’Or Institute for Research and EducationRio de Janeiro 22281-100Rio de JaneiroBrazil

Patients with cirrhosis have an increased risk of infection and differently from other complications,that over the years are improving in their outcomes,infections in cirrhotic patients are still a major cause of hospitalization and death(up to 50%in-hospital mortality).Infections by multidrug-resistant organisms(MDRO)have become a major challenge in the management of cirrhotic patients with significant prognostic and cost-related *** one third of cirrhotic patients with bacterial infections is infected with MDR bacteria and their prevalence has increased in recent *** infections have a worse prognosis compared to infections by non-resistant bacteria because they are associated with lower rate of infection *** adequate management of cirrhotic patients with infections caused by MDR bacteria depends on the knowledge of some epidemiological aspects,such as the type of infection(spontaneous bacterial peritonitis,pneumonia,urinary tract infection and spontaneous bacteremia),bacteriological profile of antibiotic resistance at each health care unit and site of infection acquisition(community acquired,healthcare associated or nosocomial).Furthermore,regional variations in the prevalence of MDR infections determine that the choice of empirical antibiotic therapy must be adapted to the local microbiological *** treatment is the most effective measure to treat infections caused by ***,optimizing antibiotic prescribing is critical to effectively treat these *** of risk factors for multidrug resistance is essential to define the best antibiotic treatment strategy in each case and the choice of an effective empirical antibiotic therapy and its early administration is cardinal to reduce *** the other hand,the supply of new agents to treat these infections is very ***,specific protocols that include preventive measures must be implemented in order to limit the negative impact of this sev

关键词： Cirrhosis Infection Multidrug-resistance Bacterial Antibiotics Microbiota

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Parenthood in Childbirth: Reports by Mothers and Fathers

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Advances in Reproductive Sciences 2022年第2期10卷 27-36页

作者： Mariana de Gouvêa Matos Andrea Seixas Magalhães renata mello Department of Psychology Pontifical Catholic University of Rio de Janeiro Rio de Janeiro Brazil

Nowadays childbirth care in Brazil is mainly guided by the technocratic model, with a high rate of unnecessary interventions that may cause iatrogenesis. Emotional aspects inherent to birth tend to be disregarded in this scenario, which produces risks for the psychological health of the mother, father, and baby. The aim of this study was to look into the subjective experiences of fathers and mothers regarding childbirth in contemporary Brazil. For this purpose, a collective case study was carried out in which 30 birth reports published on personal blogs were analyzed, 15 written by women and 15 by men. The results pointed to the helplessness experienced by fathers and mothers in the face of technocratic care which may sometimes be violent, and to the idealization of health care professionals who work according to the humanized paradigm. The choice of the mode of delivery often appeared in the subjects’ discourse, denoting a scenario in which caesarean section is understood as a consumer good. Respect for the temporality of childbirth was considered essential to ensure that giving birth is not experienced in a traumatic way, and pain was reported as a central element to elaborate the symbolic death intrinsic to the process of parenthood appropriation. The lack of support from the environment seems to be a constitutive factor in the experience of obstetric violence and the writing of birth reports a resource to reinterpret this traumatic experience. We came to the conclusion that it is extremely important that the professional team be trained to understand the emotional aspects present in the childbirth experience, with interdisciplinary exchanges being a powerful resource to provide good quality of care for the parental couple.

关键词： Childbirth Humanization Obstetric Violence Parenthood Maternal Child Health

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Complex diseases demand novel treatment strategies: understanding drug combination

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Drug Combination Therapy 2022年第2期4卷 5-16页

作者： renata Siqueira de mello Vanessa Fernandes Arnaud-Sampaio Lucas Ferreira Maciel Vanessa de Sá Talita Glaser Henning Ulrich Claudiana Lameu Departamento de Bioquímica Instituto de QuímicaUniversidade de São PauloSPBrazil

For many multigene or multifactorial diseases,the one-drug therapy for inhibiting a defined molecular target is often less effective than combined ***,drug combination therapies are multitargeted,so the mechanisms or even interactions are often *** drug-drug interactions may promote alteration of pharmacokinetic or pharmacodynamic activities of one drug by another *** interactions may change the expected effect of medications through polymorphisms that alter the expression or activity of the drug-mediated enzyme and the cell signaling cascade,such as drug-gene interactions and drug-drug-gene *** number of possible existing interactions requires appropriate methods of *** this review,we summarized combination therapies for cancer,as well as for viral,cardiovascular,and neurological ***,we also highlight known methodologies,such as in vitro methods based on Loewe’s and Bliss’s pioneer models and in silico methods based on online available *** more elaborate methods and reliable results,multitarget therapies through drug combinations may increasingly benefit patients suffering from complex diseases.

关键词： drug combinations multitarget therapy combination therapy drug-drug interaction in vitro in silico methods and models

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Can gadoxetic acid–enhanced magnetic resonance imaging be used to avoid liver biopsy in patients with nonalcoholic fatty liver disease?

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World Journal of Hepatology 2020年第9期12卷 661-671页

作者： Viviane Brandão Amorim Daniella Braz Parente Fernando Fernandes Paiva Jaime Araújo Oliveira Neto Amanda Almeida Miranda Cláudia Cravo Moreira Flávia Ferreira Fernandes Carlos Frederico FerreiraCampos Nathalie Carvalho Leite renata de mello Perez Rosana Souza Rodrigues Research Department D’Or Institute for Research and EducationRio de Janeiro 22281Brazil Radiology Department Brazilian National Cancer InstituteRio de Janeiro 20230-130Brazil Radiology Department Fleury Group S.A.Rio de Janeiro 20765-000Brazil Radiology Department Hospital Universitário Clementino Fraga FilhoFederal University of Rio de JaneiroRio de Janeiro 21941-590Brazil São Carlos Institute of Physics University of São PauloSão Carlos 13560-970Brazil Radiology Department Quinta D'Or HospitalRio de Janeiro 20941-150Brazil Radiology Department Centro de Diagnóstico Médico do MaranhãoMaranhão 65074-441Brazil Department of Clinical Medicine Hospital Universitário Clementino Fraga FilhoFederal University of Rio de JaneiroRio de Janeiro 21941-590Brazil Gastroenterology and Hepatology Department Hospital Federal de BonsucessoRio de Janeiro 21041-030Brazil Department of Pathology and Laboratories University of the State of Rio de JaneiroRio de Janeiro 20551-030Brazil Internal Medicine Department Hospital Universitário Clementino Fraga FilhoFederal University of Rio de JaneiroRio de Janeiro 21941-590Brazil Gastroenterology Department Hospital Universitário Pedro ErnestoUniversity of the State of Rio de JaneiroRio de Janeiro 20551-030Brazil

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is a major cause of liver disease *** diagnosis of nonalcoholic steatohepatitis(NASH),the most severe form of NAFLD,is crucial and has prognostic and therapeutic ***,currently this diagnosis is based on liver biopsy and has several *** To evaluate the performance of gadoxetic acid–enhanced magnetic resonance imaging(GA-MRI)in differentiating isolated steatosis from NASH in patients with *** In this prospective study,56 patients with NAFLD(18 with isolated steatosis and 38 with NASH)underwent *** contrast enhancement index(CEI)was calculated as the rate of increase of the liver-to-muscle signal intensity ratio from before and 20 min after intravenous GA ***-group differences in mean CEI were examined using Student's t *** area under the receiver operator characteristic curve and the diagnostic performance of gadoxetic acid–enhanced magnetic resonance imaging were *** The mean CEI for all subjects was 1.82±*** mean CEI was significantly lower in patients with NASH than in those with isolated steatosis(P=0.008).Two CEI cut-off points were used:2.00(89%sensitivity)to characterize isolated *** values between 1.66 and 2.00 indicated liver biopsy,and the procedure could be avoided in 40%of patients with *** GA-MRI is an effective noninvasive method that may be useful for the differentiation of NASH from isolated steatosis,and could help to avoid liver biopsy in patients with NAFLD.

关键词： Fatty liver Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis Gadoxetic

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Fibrosis assessment using Fibro Meter combined to first generation tests in hepatitis C

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World Journal of Hepatology 2017年第6期9卷 310-317页

作者： Maria Chiara Chindamo Jerome Boursier Ronir Raggio Luiz Isabelle Fouchard-Hubert Vera Lúcia Nunes Pannain Joao Marcello de Araújo Neto Henrique Sérgio Moraes Coelho renata de mello Perez Paul Calès Cristiane Alves Villela-Nogueira Departament of Internal Medicine Federal University of Rio de Janeiro Department of Hepatology University Hospital HIFIH Laboratory UPRES 3859SFR 4208Bretagne Loire University Institute of Public Health Studies Federal University of Rio de Janeiro Departament of Pathology Federal University of Rio de Janeiro Gastroenterology Department University of the State of Rio de Janeiro D’Or Institute for Research and Education

AIMTo evaluate the performance of FibroMeterVirus3G combined to the first generation tests aspartate aminotransferase-to-platelet ratio index (APRI) or Forns index to assess significant fibrosis in chronic hepatitis C (CHC). METHODSFirst generation tests APRI or Forns were initially applied in a derivation population from Rio de Janeiro in Brazil considering cut-offs previously reported in the literature to evaluate significant fibrosis. FibroMeterVirus3G was sequentially applied to unclassified cases from APRI or Forns. Accuracy of non-invasive combination of tests, APRI plus FibroMeterVirus3G and Forns plus FibroMeterVirus3G was evaluated in the Brazilian derivation population. APRI plus FibroMeterVirus3G combination was validated in a population of CHC patients from Angers in France. All patients were submitted to liver biopsy staged according to METAVIR score by experienced hepatopathologists. Significant fibrosis was considered as METAVIR F ≥ 2. The fibrosis stage classification was used as the reference for accuracy evaluation of non-invasive combination of tests. Blood samples for the calculation of serum tests were collected on the same day of biopsy procedure or within a maximum 3 mo interval and stored at -70 °C. RESULTSSeven hundred and sixty CHC patients were included (222 in the derivation population and 538 in the validation group). In the derivation population, the FibroMeterVirus3G AUROC was similar to APRI AUROC (0.855 vs 0.815, P = 0.06) but higher than Forns AUROC (0.769, P Virus3G cut-off to discriminate significant fibrosis was 0.61 (80% diagnostic accuracy; 75% in the validation population, P = 0.134). The sequential combination of APRI or Forns with FibroMeterVirus3G in derivation population presented similar performance compared to FibroMeterVirus3G used alone (79% vs 78% vs 80%, respectively, P = 0.791). Unclassified cases of significant fibrosis af

关键词： Chronic hepatitis C Fibrosis Liver biopsy Non-invasive methods FibroMeterVirus3G Combination algorithms

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The effect of abiotic stresses on plant C:N:P homeostasis and their mitigation by silicon

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The Crop Journal 2024年第2期12卷 340-353页

作者： Milton Garcia Costa Renato de mello Prado Luiz Fabiano Palaretti Jonas Pereira de Souza Júnior Department of Agricultural Production Science School of Agricultural and Veterinarian SciencesSão Paulo State UniversityJaboticabalBrazil

In crop plants, various environmental stresses affect the balance of carbon, nitrogen, and phosphorus(C:N:P), leading to biochemical and physiological alterations and reductions in yield. Silicon(Si) is a beneficial element that alleviates plant stress. Most studies involving silicon have focused on physiological responses, such as improvements in photosynthetic processes, water use efficiency, and antioxidant defense systems. But recent research suggests that stressed plants facing either limited or excessive resources(water, light, nutrients, and toxic elements), strategically employ Si to maintain C:N:P homeostasis, thereby minimizing biomass losses. Understanding the role of Si in mitigating the impact of abiotic stresses on plants by regulating C:N:P homeostasis holds great potential for advancing sustainable agricultural practices in crop production. This review presents recent advances in characterizing the influence of environmental stresses on C:N:P homeostasis, as well as the role of Si in preserving C:N:P equilibrium and attenuating biological damage associated with abiotic stress. It underscores the beneficial effects of Si in sustaining C:N:P homeostasis and increasing yield via improved nutritional efficiency and stress mitigation.

关键词： Nutritional stoichiometry Elemental stoichiometry Beneficial element Environmental stresses Nutritional efficiency Carbon use efficiency Agricultural sustainability

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Tribologically induced nanostructural evolution of carbon materials: A new perspective

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Friction 2024年第1期12卷 144-163页

作者： Guilherme Oliveira NEVES Nicolás ARAYA Diego Berti SALVARO Thiago de Souza LAMIM Renan Oss GIACOMELLI Cristiano BINDER Aloisio Nelmo KLEIN JoséDaniel Biasoli de mello Laboratório de Materiais Universidade Federal de Santa CatarinaSanta Catarina 88040-900Brazil Departamento de Ingeniería Mecánica Facultad de IngenieríaUniversidad del Bío-BíoConcepcion 4070-386Chile Universidad de Concepción Concepcion 4070-386Chile SENAI Innovation Institute for Laser Processing Santa Catarina 89218-153Brazil Universidade Federal de Uberlândia Minas Gerais 38408-100Brazil

Carbon-based solid lubricants are excellent options to reduce friction and wear,especially with the carbon capability to adopt different allotropes *** the macroscale,these materials are sheared on the contact along with debris and contaminants to form tribolayers that govern the tribosystem *** a recently developed advanced Raman analysis on the tribolayers,it was possible to quantify the contactinduced defects in the crystalline structure of a wide range of allotropes of carbon-based solid lubricants,from graphite and carbide-derived carbon particles to multi-layer graphene and carbon *** addition,these materials were tested under various dry sliding conditions,with different geometries,topographies,and solid-lubricant application *** of the initial tribosystem conditions and allotrope level of atomic ordering,there is a remarkable trend of increasing the point and line defects density until a specific saturation limit in the same order of magnitude for all the materials tested.

关键词： carbon nanostructures tribology Raman spectroscopy defects quantification tribolayer solid lubrication

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Effect of Spray Rails on Takeoff Performance of Amphibian Aircraft

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World Journal of Engineering and Technology 2024年第1期12卷 117-140页

作者： Soham S. Bahulekar Alberto W. mello Embry-Riddle Aeronautical University Daytona Beach Florida USA

Amphibian aircraft have seen a rise in popularity in the recreational and utility sectors due to their ability to take off and land on both land and water, thus serving a myriad of purposes, such as aerobatics, surveillance, and firefighting. Such seaplanes must be aerodynamically and hydrodynamically efficient, particularly during the takeoff phase. Naval architects have long employed innovative techniques to optimize the performance of marine vessels, including incorporating spray rails on hulls. This research paper is dedicated to a comprehensive investigation into the potential utilization of spray rails to enhance the takeoff performance of amphibian aircraft. Several spray rail configurations obtained from naval research were simulated on a bare Seamax M22 amphibian hull to observe an approximate 10% - 25% decrease in water resistance at high speeds alongside a 3% reduction in the takeoff time. This study serves as a motivation to improve the design of the reference airplane hull and a platform for detailed investigations in the future to improve modern amphibian design.

关键词： Seaplane Spray Rails Hull Optimization Take-Off Performance

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Assessment of programmed death-ligand 1 expression in primary tumors and paired lymph node metastases of gastric adenocarcinoma

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 883-893页

作者： Brendha Cação Coimbra Marina Alessandra Pereira Leonardo Cardili Venancio Avancini Ferreira Alves Evandro Sobroza de mello Ulysses Ribeiro Jr Marcus Fernando Kodama Pertille Ramos Department of Gastroenterology Instituto do CancerHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloFaculdade de MedicinaUniversidade de São PauloSão Paulo 01246000Brazil Department of Pathology Instituto do CancerHospital das Clínicas da Faculdade de Medicina da Universidade de São PauloSão Paulo 01246000Brazil

BACKGROUND Anti-programmed death-1/programmed death-ligand 1(PD-1/PD-L1)immuno-therapy has demonstrated promising results on gastric cancer(GC).However,PD-L1 can express differently between metastatic sites and primary tumors(PT).AIM To compare PD-L1 status in PT and matched lymph node metastases(LNM)of GC patients and to determine the correlation between the PD-L1 status and clinicopathological *** We retrospectively reviewed 284 GC patients who underwent ***-L1 was evaluated by immunohistochemistry(clone SP142)using the com-bined positive *** PD-L1+PT staged as pN+were also tested for PD-L1 expression in their ***-L1(-)GC with pN+served as the comparison *** Among 284 GC patients included,45 had PD-L1+PT and 24 of them had pN+.For comparison,44 PD-L1(-)cases with pN+were included(sample loss of 4 cases).Of the PD-L1+PT,54.2%(13/24 cases)were also PD-L1+in the *** PD-L1(-)PT,9.1%(4/44)had PD-L1+in the *** agreement between PT and LNM had a kappa value of *** tumor size and moderate/severe peritumoral inflammatory response were associated with PD-L1 positivity in both *** was no statistical difference in overall survival for PT and LNM according to the PD-L1 status(P=0.166 and P=0.837,respectively).CONCLUSION Intra-patient heterogeneity in PD-L1 expression was observed between the PT and matched *** disagreement in PD-L1 status may emphasize the importance of considering different tumor sites for analyses to select patients for immunotherapy.

关键词： Gastric cancer Lymph node Programmed death ligand 1 Stomach neoplasms Immunohistochemistry Metastasis

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Epidemiologic investigation of pediatric distal humerus fractures: An American insurance claims database study

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World Journal of Orthopedics 2024年第1期15卷 52-60页

作者： Kyle Jay Klahs Jake E Dertinger Grant T mello Kevin Thapa Alexis B Sandler E'Stephan J Jesus Garcia Nata Parnes Department of Orthopaedic Surgery Texas Tech University Health Sciences-El PasoEl PasoTX 79905United States Medical School California Health Sciences University College of Osteopathic MedicineClovisCA 93611United States Undergraduate School Binghampton UniversityVestalNY 13902United States Department of Orthopaedic Surgery William Beaumont Army Medical CenterFort BlissTX 79918United States Department of Orthopaedic Surgery Carthage Area HospitalCarthageNY 13619United States

BACKGROUND Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types:Supracondylar(SC),lateral condyle(LC),and medial epicondyle(ME)*** To evaluate the epidemiology of pediatric distal humerus fractures(SC,LC,and ME)from an American insurance claims *** A retrospective review was performed on patients 17 years and younger with the ICD 9 and 10 codes for SC,LC and ME fractures based on the IBM Truven MarketScan®Commercial and IBM Truven MarketScan Medicare Supplemental *** from 2015 to 2020 were queried for treatments,patient age,sex,length of hospitalization,and *** A total of 1133 SC,154 LC,and 124 ME fractures were *** fractures had the highest percentage of operation at 83%,followed by LC(78%)and ME fractures(41%).Male patients were,on average,older than female patients for both SC and ME *** In the insurance claims databases used,SC fractures were the most reported,followed by LC fractures,and finally ME *** was identified to be a factor for how a pediatric distal humerus fractures,with patients with SC and LC fractures being younger than those with ME *** peak age per injury per sex was similar to reported historic central tendencies,despite reported trends for younger physiologic development.

关键词： Supracondylar humerus fracture Lateral condyle fracture Medial epicondyle fracture Pediatric elbow Truven Epidemiology

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