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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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A cognitive model＇s view of animal cognition

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Current Zoology 2011年第4期57卷 499-513页

作者： Sidney D'mello Stan FRANKLIN Department of Psychology University of Memphis Memphis TN 38152 USA Institute of Intelligent Systems University of Memphis Memphis TN 38152 USA

Although it is a relatively new field of study, the animal cognition literature is quite extensive and difficult to synthesize. This paper explores the contributions a comprehensive, computational, cognitive model can make toward organizing and assimilating this literature, as well as toward identifying important concepts and their interrelations. Using the LIDA model as an example, a framework is described within which to integrate the diverse research in animal cognition. Such a framework can provide both an ontology of concepts and their relations, and a working model of an animal＇s cognitive processes that can compliment active empirical research. In addition to helping to account for a broad range of cognitive processes, such a model can help to comparatively assess the cognitive capabilities of different animal species. After deriving an ontology for animal cognition from the LIDA model, we apply it to develop the beginnings of a database that maps the cognitive facilities of a variety of animal species. We conclude by discussing future avenues of research, particularly the use of computational models of animal cognition as valuable tools for hypotheses generation and testing [Current Zoology 57 （4）： 499-513, 2011].

关键词： Cognitive models Computational models LIDA Ontology Taxonomy

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Contributions of anatomy to forensic sex estimation: focus on head and neck bones

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Forensic Sciences Research 2022年第1期7卷 11-23页

作者： Thamires mello-Gentil Vanessa Souza-mello Department of Anatomy Rio de Janeiro State UniversityRio de JaneiroBrazil

This study sought to provide an up-to-date review of the importance of anatomy to human identification,focusing on the usefulness of anatomical knowledge about the head and neck bones and teeth to sex estimation in routine forensic anthropology methods.A detailed search of osteology applications in forensic sex estimation was conducted through the electronic databases for the 10 years prior to July *** articles and classic literature on the subject were gathered and outlined in this *** the available literature,several metric analyses showed accuracy superior to 80%in sexual *** measured from the inclination of glabellae and analysis of the external frontal bone surface through three-dimensional computer-aided design emerge as reliable cranial indexes for sex *** the mandible,the condylar and coronoid height,bigonial width,and condylion-gonion distance express significant sexual *** of the canine are the best option for sex estimation using teeth,as well as the thickness of the dentine or enamel of *** axis vertebra surpasses other neck bones for sex estimation due to its atypical shape and the presence of the odontoid *** analyses based on anatomy can provide reliable accuracy in sexual *** training and anatomical knowledge can reduce bias and interobserver differences,and the use of three-dimensional models and computed tomography images can enhance the accuracy of these methods for sex ***,every method should be validated before being applied to a different population.

关键词： Forensic sciences forensic anthropology sex estimation anatomy head neck teeth

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Gastrointestinal stromal tumors:Thirty years experience of an Institution

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World Journal of Gastroenterology 2011年第14期17卷 1836-1839页

作者： Simone Arolfo Paolo mello Teggia Mario Nano Department of Clinical and Biological Sciences San Luigi Gonzaga Teaching HospitalUniversity of Turin-Second School of MedicineReg. Gonzole 1010043 OrbassanoTurinItaly

AIM:To report our experience of gastrointestinal stromal tumors (GISTs) during the last 29 years. METHODS:Thirty two cases of GIST referred to our Institution from the 1st January 1981 to the 10th June 2010 were reviewed. Metastases,recurrence and survival data were collected in relation to age,history,clinical presentation,location,size,resection margins and cellular features. RESULTS:Mean age was 63.7 years (range,40-90) and incidence was slightly higher in males (56%). R0 resection was performed in 90.7% of cases,R1 in 6.2% (2 cases) and R2 in 3.1% (one case). Using Fletcher's classification 8/32 (25%) had high risk,9/32 (28%) intermediate and 15/32 (47%) low risk tumors. Follow-up varied from 1 mo to 29 years,with a median of 8 years; overall survival was 75% (24/32),disease-free survival was 72% and tumor-related mortality was 9.3%. Three patients with high risk GIST were treated with imatinib mesylate:one developed a recurrence after 36 mo,and 2 are free from disease at 41 mo. CONCLUSION:Surgical treatment remains the gold standard therapy for resectable GISTs. Pathological and biological features of the neoplasm represent the most important factors predicting the prognosis.

关键词： Gastrointestinal stromal tumors Fletcher’s classification Resection margins Recurrence

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Pathogenesis of alcoholic liver disease:Role of oxidative metabolism

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World Journal of Gastroenterology 2014年第47期20卷 17756-17772页

作者： Elisabetta Ceni Tommaso mello Andrea Galli Gastroenterology Unit Department of Experimental and Clinical Biochemical SciencesUniversity of Florence50139 FlorenceItaly Center of Excellence for Research Transfer and High EducationDENOtheUniversity of Florence50139 FlorenceItaly Fior Gen Foundation 50123 FlorenceItaly

Alcohol consumption is a predominant etiological factor in the pathogenesis of chronic liver diseases, resulting in fatty liver, alcoholic hepatitis, fibrosis/cirrhosis, and hepatocellular carcinoma (HCC). Although the pathogenesis of alcoholic liver disease (ALD) involves complex and still unclear biological processes, the oxidative metabolites of ethanol such as acetaldehyde and reactive oxygen species (ROS) play a preeminent role in the clinical and pathological spectrum of ALD. Ethanol oxidative metabolism influences intracellular signaling pathways and deranges the transcriptional control of several genes, leading to fat accumulation, fibrogenesis and activation of innate and adaptive immunity. Acetaldehyde is known to be toxic to the liver and alters lipid homeostasis, decreasing peroxisome proliferator-activated receptors and increasing sterol regulatory element binding protein activity via an AMP-activated protein kinase (AMPK)-dependent mechanism. AMPK activation by ROS modulates autophagy, which has an important role in removing lipid droplets. Acetaldehyde and aldehydes generated from lipid peroxidation induce collagen synthesis by their ability to form protein adducts that activate transforming-growth-factor-β-dependent and independent profibrogenic pathways in activated hepatic stellate cells (HSCs). Furthermore, activation of innate and adaptive immunity in response to ethanol metabolism plays a key role in the development and progression of ALD. Acetaldehyde alters the intestinal barrier and promote lipopolysaccharide (LPS) translocation by disrupting tight and adherent junctions in human colonic mucosa. Acetaldehyde and LPS induce Kupffer cells to release ROS and proinflammatory cytokines and chemokines that contribute to neutrophils infiltration. In addition, alcohol consumption inhibits natural killer cells that are cytotoxic to HSCs and thus have an important antifibrotic function in the liver. Ethanol metabolism may also interfere with ce

关键词： Alcohol metabolism Acetaldehyde Reactive oxygen species Alcoholic liver disease Protein adducts Hepatic stellate cells Liver fibrosis CYP2E1

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Multi-planet extrasolar systems-detection and dynamics

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Research in Astronomy and Astrophysics 2012年第8期12卷 1044-1080页

作者： Cristian Beaug Sylvio Ferraz-mello Tatiana A.Michtchenko Instituto de Astronomía Teóricay Experimental Observatório Astronómico de CórdobaUniversidad de CórdobaArgentina Instituto de Astronomia Geofísica e Cie ncias AtmosfricasUniversidade de So PauloBrasil

20 years after the discovery of the first planets outside our solar system, the current exoplanetary population includes more than 700 confirmed planets around main sequence stars. Approximately 50% belong to multiple-planet systems in very diverse dynamical configurations, from two-planet hierarchical systems to multiple resonances that could only have been attained as the consequence of a smooth large- scale orbital migration. The first part of this paper reviews the main detection tech- niques employed for the detection and orbital characterization of multiple-planet sys- tems, from the （now） classical radial velocity （RV） method to the use of transit time variations （TTV） for the identification of additional planetary bodies orbiting the same star. In the second part we discuss the dynamical evolution of multi-planet systems due to their mutual gravitational interactions. We analyze possible modes of motion for hi- erarchical, secular or resonant configurations, and what stability criteria can be defined in each case. In some cases, the dynamics can be well approximated by simple ana- lytical expressions for the Hamiltonian function, while other configurations can only be studied with semi-analytical or numerical tools. In particular, we show how mean- motion resonances can generate complex structures in the phase space where different libration islands and circulation domains are separated by chaotic layers. In all cases we use real exoplanetary systems as working examples.

关键词： planetary systems -- planetary systems: formation

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