Recent publications
The Ti5553 alloy (5Al-5Mo-5 V-3Cr-0.5Fe) has been in the last years widely used in the manufacturing of high responsibility components for landing gear of large aircrafts, such as Boeing 787 and Airbus A380. It presents high resistance to corrosion and fatigue, high tensile strength, and hardness, allowing to produce thinner and lighter components. The machining of the Ti5553 alloy presents difficulty, due to its low thermal conductivity and the fact that maintaining its mechanical properties at high temperatures. So it must be performed using high-performance cutting fluids and special cutting tools. Recently, research works related to the addition of nanoparticles to MQL fluids have been explored to improve the performance of the machining process of titanium alloys. This work presents an investigation on the performance of turning Ti5553 using PCD as the cutting tool, using spherical copper nanoparticles, carbon nanotubes, and a hybrid nanoparticle (spherical copper + carbon nanotubes) added to the cutting fluid by MQL technique. It was evaluated the PCD tool wear mechanisms, the machining forces, and the surface integrity of Ti5553 workpieces, using high cutting speeds in the finishing process conditions. The results indicate that the best performance was achieved with nanofluid with the addition of spherical copper in all aspects analyzed, mainly in tool life and machining forces, while the hybrid nanofluid showed lower performance, like the base MQL fluid.
O Desmoplaquina (DSP) é um componente essencial do desmossomo, um complexo de junção celular que ancora filamentos intermediários. Na arquitetura molecular do coração, os desmossomos desempenham um papel relevante na adesão celular e na transdução de força através do miocárdio. Mutações no gene DSP causam cardiomiopatia arritmogênica distinta com lesão miocárdica, fibrose ventricular esquerda, disfunção sistólica adicional e alta incidência de arritmias ventriculares. Descrevemos os casos clínicos de três irmãos com cardiomiopatias DSP diagnosticadas após o paciente índice ter sido encaminhado para uma investigação de doença cardíaca hereditária devido a miocardite recorrente. Uma nova mutação nonsense no gene DSP foi diagnosticada e os pacientes foram tratados para evitar morte súbita cardíaca.
The breast cancer resistance protein (BCRP/ABCG2) plays a major role in the multidrug resistance of cancers toward chemotherapeutic treatments. It was demonstrated that cholesterol regulates the ABCG2 activity, suggesting that lower levels of membrane cholesterol decrease the ABCG2 activity in mammalian cells. However, the precise mechanism remains unclear. To better understand the role of cholesterol in the ABCG2 activity, we studied the ABCG2‐mediated efflux of different substrates in the presence of different concentrations of cholesterol. Moreover, we synthetized derivatives of cholesterol linked either to known ABCG2 inhibitors or fluorescents probes. A chalcone‐cholesterol was synthetized to investigate the influence of cholesterol on ABCG2 inhibition, and a BODIPY‐cholesterol was developed to track cholesterol trafficking on mammalian cells and investigate the behavior of cholesterol as an ABCG2 substrate. The obtained results with three different substrates of ABCG2 showed that cholesterol did not affect the intracellular amount of substrates nor the transport activity.
BACKGROUND:
A minority of patients with stroke qualify for intravenous thrombolysis (IVT) within 4.5-hour window. The safety and efficacy of IVT beyond this period have not been well studied.
METHODS:
We systematically searched MEDLINE, Embase, Cochrane, and ClinicalTrials.gov for relevant randomized clinical trials. Randomized clinical trials comparing IVT versus standard medical care in patients with ischemic stroke beyond 4.5 hours of symptom onset or last known well without mechanical thrombectomy (MT) were included. Primary outcomes were excellent (modified Rankin Scale score of 0–1) and good (modified Rankin Scale score of 0–2) functional outcomes at 90 days, symptomatic intracerebral hemorrhage (sICH), and death at 90 days. Pooled odds ratios (ORs) with 95% CIs were calculated using a random-effects model. Heterogeneity was assessed by Q test and quantified by I² values.
RESULTS:
Eight randomized clinical trials (1742 patients; mean age, 69.8±9 years, 63.5% men) were included. Compared with standard medical care, IVT achieved higher rates of excellent (OR, 1.43 [95% CI, 1.17–1.75]; Q=2.30; P=0.94; I2=0%) and good functional outcomes (OR, 1.36 [95% CI, 1.12–1.66]; Q=2.07; P=0.96; I2=0%) at 90 days but also increased sICH rates (OR, 4.25 [95% CI, 1.67–10.84], Q=0.48; P=0.99; I2=0%). Mortality at 90 days did not significantly differ between treatment groups (OR, 1.28 [95% CI, 0.87–1.89]; Q=4.63; P=0.59; I2=0%). Subanalyses yielded numerically higher odds of excellent functional outcomes when patients were selected with perfusion imaging (3 studies, OR, 1.45 [95% CI, 1.08–1.94]) compared with diffusion-weighted imaging–fluid-attenuated inversion recovery mismatch (3 studies, OR, 1.34 [95% CI, 0.94–1.91]) and when treated with tenecteplase (3 studies, OR, 1.47 [95% CI, 1.06–2.04]) compared with alteplase (5 studies, OR, 1.38 [95% CI, 1.08–1.78]).
CONCLUSIONS:
IVT for ischemic stroke beyond 4.5 hours, without MT, led to increased odds of excellent and good functional outcomes compared with standard medical care, despite higher odds of sICH, and a nonsignificant numerical increase in mortality.
The advent of the COVID-19 pandemic has profoundly transformed grief around the world. What are the impacts of context factors regarding the COVID-19 pandemic on dysfunctional symptoms of grief? This is a study with a qualitative approach, integrative review, whose article data collection was carried out in the following databases: Biblioteca Virtual de Saúde (BVS), Portal Brasileiro de Publicações e Dados Científicos em Acesso Aberto (Oasisbr), United States National Library of Medicine (PubMed), Scientific Electronic Library (SciELO) and Web of Science. Thirty-three articles were selected for the analysis. The studies showed different results when the risk factors were detailed individually. However, the pandemic context proved to be a complex element that created vulnerability associated with grieving. Bioethics presents itself as a locus of interdisciplinary discussion for a more profound understanding of the complex specificities and, based on the social and political responsibility of Protection Bioethics to protect vulnerable populations, it is recommended to mental health professionals who intentionally explore the impacts of the pandemic on the grieving process. The suffering of people bereaved during the pandemic must be publicly recognized, offering safe spaces for reception and sharing.
Purpose
Carotid-cavernous fistulas (CCFs) are abnormal connections between the carotid artery and cavernous sinus, often causing ocular symptoms like chemosis, proptosis, and diplopia. Endovascular embolization is the preferred treatment, typically performed via the transfemoral transvenous route through the inferior petrosal sinus (IPS). However, we present a case and a systematic review of indirect CCF treated through deep orbital puncture of the superior ophthalmic vein (SOV) for embolization.
Methods
We systematically revised the current literature on PubMed, Web of Science, and Embase, based on PRISMA guideline, concerning the deep orbital puncture of the SOV for embolization of indirect CCFs.
Results
Our systematic review identified only eight eligible studies encompassing 17 patients, ranging in age from 34 to 82 years, underscoring the rarity of this specific approach. The most frequently used trajectory directed the needle along the floor of the orbit towards the superior orbital fissure or orbital apex, and a variety of embolization materials were used in the studies. While the technique has been mentioned in the literature, our analysis indicates that it remains infrequently reported, with many cases lacking consistent procedural details. Furthermore, we present a case of a 63-year-old woman with imaging suggesting a CCF and compatible symptoms. A transorbital puncture of the SOV was performed. Embolization was successfully achieved with ethylene vinyl alcohol copolymer. The follow-up confirmed the resolution of the CCF without new neurological deficits and no new symptoms.
Conclusion
This case highlights transorbital SOV puncture as a feasible and minimally invasive alternative for treating CCFs when conventional access is unsuccessful.
Study Design
Literature Review with clinical recommendations.
Objective
To highlight impactful studies on pyogenic spondylodiscitis (PS), identified by the AO Spine Knowledge Forum Trauma and Infection, with recommendations for their integration into clinical practice.
Methods
Five influential studies on PS that have the potential to shape current practice in spinal infections were selected and reviewed. Each study was chosen for its contribution to a critical phase in PS management: diagnosis, imaging, surgical vs conservative treatment, and antibiotic duration. Recommendations were graded as strong or conditional following the GRADE methodology.
Results
Five studies were highlighted. Article 1: Pluemer et al introduced the Spinal Infection Treatment Evaluation (SITE) Score, a novel scoring tool for standardizing treatment decision-making. Conditional recommendation to incorporate the SITE Score or SISS Score for improved treatment outcomes. Article 2: Maamari et al conducted a meta-analysis comparing imaging modalities, with conditional recommendation to consider 18F-FDG PET/CT to diagnosis PS as an adjunct to MRI which remains the gold standard. Article 3: Thavarajasingam et al demonstrated the potential survival benefit of early surgery in specific PS cases, leading to a strong recommendation for early intervention in appropriate patients. Article 4: Neuhoff et al compared conservative and surgical treatments in well-resourced settings, concluding a strong recommendation for early surgery in appropriate patients. Article 5: Bernard et al evaluated antibiotic treatment duration, with a conditional recommendation for a 6-week course in confirmed cases, based on comparable efficacy to a 12-week regimen.
Conclusions
Management of PS remains complex and varied. This perspective provides spine surgeons with evidence-based recommendations to enhance standardization and effectiveness in clinical practice.
Background
Contrast‐associated acute kidney injury (CA‐AKI) is frequent in patients with chronic kidney disease who are submitted to cardiac endovascular procedures using iodinated contrast. In hemoadsorption, cartridges containing styrene‐divinylbenzene sorbent resin are applied to remove substances from the blood through an extracorporeal circuit. Importantly, iodinated contrast is also removed via adsorption. We aimed to determine the adsorptive kinetics of the iodinated contrast medium iohexol using a 1:3 scale model of the HA380 cartridge.
Methods
An experimental in vitro study utilizing a closed‐loop extracorporeal circuit with an interposed sorbent cartridge. A solution spiked with iohexol was recirculated for 60 min. Samples for the measurement of iohexol were drawn at 0, 5, 10, 15, 20, 30, 40, and 60 min. The experiment was carried out twice.
Results
In experiments 1 and 2, the reduction ratio after 60 min was 53.0% and 53.1%, respectively. In experiment 1, iohexol clearance was 46.79 mL/min during the first 5 min and decayed to 3.57 mL/min during the last 20 min. In experiment 2, iohexol clearance was 46.72 mL/min and decayed to 3.87 mL/min during the last 20 min. The ratio of adsorbate/sorbent was 155 mg/g.
Conclusion
A 1:3 scale model of the HA380 cartridge efficiently removes iodinated contrast in a clinical‐scale in vitro circuit. These findings provide a rationale for hemoadsorption as an intervention in clinical trials to prevent or attenuate CA‐AKI.
Long-term data are limited comparing percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (S-DES) vs coronary artery bypass grafting (CABG) in patients with complex coronary artery disease (CAD). We aimed to conduct a systematic review and meta-analysis comparing these interventions in patients with left main or multivessel CAD. We systematically reviewed PubMed, Embase, and Cochrane for studies that compared PCI with S-DES and CABG in patients with left main or multivessel CAD with a minimum mean follow-up period of 3 years. Outcomes of interest were all-cause mortality, myocardial infarction (MI), stroke, and major adverse cardiovascular events (MACE). We extracted data from observational studies as multivariable-adjusted or propensity score-matched hazard ratio to minimize confounding and pooled hazard ratios with 95% confidence intervals (CIs) using a random effects model in Review Manager 5.4.1. We included 10 studies, 3 of which were randomized controlled trials, comprising a total of 26964 patients, of whom 14928 underwent PCI. As compared with CABG, S-DES had a significantly higher risk of all-cause mortality (hazard ratio 1.35; 95% CI 1.22–1.49; P < 0.001; I ² = 0%), MACE (hazard ratio 1.27; 95% CI 1.08–1.50; P = 0.005; I ² = 67%), and MI (hazard ratio 2.43; 95% CI 1.80–3.28; P < 0.01; I ² = 0%). There was no significant difference between groups in incidence of stroke. In this meta-analysis of patients with complex CAD, PCI with S-DES was associated with an increased risk of mortality, MI, and MACE compared with CABG.
Objective
To analyze the consumption frequency and factors associated with hookah usage.
Methods
This cross-sectional study involved adults, hookah users, residing in the city of Curitiba. Hookah groups were contacted on social networking sites via an invitation that contained a link to the questionnaire, which comprised 21 questions covering demographic and socioeconomic characteristics, user profiles, use of cigarettes and alcohol, symptoms, and perceptions of the risks of hookah use. The dependent variables were low and high consumption frequency. Multivariate analysis was performed using the backward method with p ≤ 0.20 in the chi-square test, and variables with p ≤ 0.05 were included in the final model.
Results
Two hundred and seven questionnaires were included, and most hookah users were aged 22 years or older, resident in the south region, male, higher education, single, with high income, and categorized as low-consumption users. They started using hookah at up to 17 years old, discovered it through friends, purchased hookah essence from a tobacconist, and used it in groups, with 3 sessions or more per day, and the session duration was 50 min or more. They did not smoke conventional cigarettes, either during the hookah session or otherwise, and consumed alcohol during the hookah session, felt dizzy while using the device, and most believed that hookahs could harm their health. Higher values for high consumption compared to low consumption were observed in individuals aged up to 22 years, those with high school education, and those who purchase hookah essence from a distributor. High consumption was associated with individual use and the absence of symptoms when using hookah. Smoking conventional cigarettes during hookah session, experiencing dizziness, and reporting that symptoms disappeared after cessation of use were higher in the low-consumption group. Among high-consumption users, the majority resided in the northern region (Prevalence Ratio 6.736), were under 22 years of age (1.445) and bought essence from the distributor (1.463). Those who experienced dizziness (0.671) consumed hookah less frequently.
Conclusion
High consumption was associated with region, age, and place of purchase of essence, indicating that effective public policies necessitate formulating. Categories: Behavioral, Epidemiologic, and Health Services Research.
Women’s health is related to several factors that include physical, mental, and reproductive health. Additionally, the vaginal microbiota modulation performs a fundamental role in the regulation of physiological homeostasis and dysbiosis, which provides us a potential overview of the use of different biotic agents and their implications for female health. The objective of this work was propitiated insights and conception about the influence of probiotics, prebiotics, synbiotics, and postbiotics as adjuvants for prevention/treatment on the main infections that can affect women’s health. Therefore, seventy-one studies published in the Web of Science Core Collection database from 1999 to 2024 were evaluated and performed to a bibliometric analysis employing the VOSviewer software for scientific mapping and network analysis. Our results suggest that administration of biotic agents as adjuvants are relevant for the prevention and/or treatment of the main diseases that affect female health, since they contribute to a healthy vaginal microbiota through anti-inflammatory and antimicrobial activities. Most clinical studies have demonstrated the effectiveness of intervention using probiotics to the detriment of other biotic agents in women’s health, being bacterial vaginosis, polycystic ovary syndrome, and vulvovaginal candidiasis, the main diseases evaluated. However, preclinical studies have emphasized that the inhibition of pathogens responsible for the process of vaginal dysbiosis may be due to the formation of biofilm and the synthesis of compounds that could prevent the adhesion of these microorganisms. Future perspectives point to the beneficial modulation of the vaginal microbiota by biotic agents as a promising adjuvant approach to improve women’s health.
Purpose
Abdominal wall endometriosis consists of endometrial tissue between the peritoneum and the abdominal wall. The established treatment involves amenorrheic drugs—not always successful and tolerated—or invasive surgery. In this scenario, minimally invasive techniques such as cryoablation are a potential option. In this study, we primarily aimed to evaluate the efficacy of percutaneous cryoablation in reducing pain scores of abdominal wall endometriosis patients and analyze their satisfaction with the procedure and its related adverse events.
Materials and Methods
MEDLINE, EMBASE, and Cochrane's databases were systematically searched for studies that employed percutaneous cryoablation therapy for abdominal wall endometriosis and reported any of the outcomes of interest. The primary outcome was the reduction in the visual analog scale score after treatment. R Software was used for the statistical analysis. Heterogeneity was assessed using I2 statistics. The Risk Of Bias In Non-Randomized Studies—of Interventions framework assessed potential bias in each selected study.
Results
We included 4 studies, containing 126 patients. All articles were retrospective studies. The difference between the visual analog scale scores before and after treatment was on average 5.97 points (95% CI 5.42-6.52; p < 0.01; I2 = 0%). The pooled satisfaction rate among patients in the selected studies was 93.1% (95% CI 88.66-97.34; p = 0.51; I2=0%). The pooled prevalence of adverse events was only 5.48% (95% CI 1.71-11.20; p = 0.58; I2=0%). Bias analysis showed an overall moderate risk in all included articles.
Conclusion
Our study demonstrated that cryoablation could reduce pain complaints in patients, while presenting a low incidence rate of adverse effects. Randomized clinical trials with a larger number of patients are necessary for greater conclusions.
This study aimed to standardize qPCR techniques using these molecular markers kDNA and 18S rDNA across three sample types: peripheral blood, guanidine-treated blood, and tissue. The secondary objective is to evaluate the performance of 18S rDNA target in samples from 46 patients with confirmed tegumentary leishmaniasis. After obtaining the standard curve from reference strains with Leishmania, qPCR curves were standardizations and the Cts results of the patient samples were described using abstract measures. Specific specification equations (EEG) with normal distribution and identity link function were constructed to compare each type of clinical sample. To identify the differences among samples and techniques, multiple comparisons with Bonferroni post-test was performed. The kDNA and 18S rDNA demonstrated high sensitivity, detecting as few as 10⁻¹ parasites/mL. However, 18S rDNA showed limited species discrimination. qPCR performance was evaluated using blood and tissue samples, showing a sensitivity of 54.2% in blood, 12.5% in guanidine-treated blood, and 86.4% in tissue. qPCR agreement with the 18S rDNA target with the three types of samples, positive and negative, in relation to screening were 56.2% in blood, 31.8% in guanidine- blood and tissue 78.6%. As for true positives (PPV), tissue samples presented a probability percentage of individuals being sick of 86.4%, while in blood it was 81.3%. The results underscore the importance of molecular diagnostics in blood samples, improving the accuracy and monitoring of tegumentary leishmaniasis.
Background
Microvascular decompression (MVD) is the gold-standard surgical treatment for cranial nerve compression disorders, including trigeminal neuralgia (TN), hemifacial spasm (HFS), and glossopharyngeal neuralgia (GPN). This review synthesizes historical milestones, recent advances, and evolving techniques in MVD, with a primary focus on these conditions.
Methods
A comprehensive literature review was conducted using databases such as PubMed, SpringerLink, Google Scholar, BioMed Central, Scopus, and ScienceDirect. Studies published between 1970 and 2024 were analyzed, emphasizing surgical techniques, clinical outcomes, and technological innovations in MVD. Articles addressing TN, HFS, GPN, and other cranial nerve disorders treated with MVD were selected for detailed evaluation.
Results
MVD demonstrates high efficacy, with 80–90% of patients achieving immediate symptom relief. Nevertheless, 15–25% of patients experience symptom recurrence, though long-term outcomes remain favorable. Fully endoscopic MVD has shown potential for enhanced intraoperative visualization, particularly in complex anatomical regions; however, its impact on surgical precision and clinical outcomes is still under investigation. Moreover, innovations in visualization technologies, including three-dimensional exoscopic systems and artificial intelligence-assisted surgery, continue to improve procedural safety and outcomes. Despite these advancements, complications such as hearing loss (1–2%) and cerebrospinal fluid leakage (2–4%) persist, highlighting the need for continuous refinement of techniques.
Conclusions
MVD is evolving with the integration of cutting-edge technologies, resulting in improved clinical outcomes and reduced complication rates. Emerging innovations such as robotic-assisted MVD and gene therapies for cranial nerve disorders, including TN and GPN, promise even greater efficacy and precision. However, further research is necessary to standardize surgical protocols and address disparities in healthcare systems globally.
Graphical Abstract
Background
The association of Alzheimer’s disease (AD) and sarcopenia diagnoses is quite common, but frequently sarcopenia is underdiagnosed in this population and it may be contributing to the worsening of functionality in the person with AD.
Method
Fifty‐five adults over age 60 from a public outpatient clinic in Londrina – Parana‐ Brazil diagnosed with Alzheimer’s disease were followed during the years 2022 and 2023. They were subjected to a sociodemographic questionnaire, BMI assessment, cognitive assessment using the MMSE, functionality assessment using the Katz Index and to a sarcopenia screening test SARC‐F +CC. They were evaluated at the beginning, after 4 and 8 months.
Result
Of the fifty‐five older patients evaluated, 60% were female, 47.3% were between 70 and 79 years old, 43.6% had less than 4 years of schooling, 98.2% had mild Alzheimer’s (CDR I) and 25.5% had a BMI < 22 kg/m ² in the beginning of the assessment. Only 18.2% were smokers, but few practiced physical activity regularly (21.8%). The majority had a diagnosis of Arterial Hypertension (69.1%). Almost half used five or more medications regularly (43.6%) and 36.4% used some medication with anorectic potential. Regarding the treatment of Alzheimer’s disease, 54.5% were using donepezil. Of the 55 older patients analyzed, 15 (27.3%) had probable sarcopenia at the end of 8 months of follow‐up. There was no association between the diagnosis of sarcopenia and gender, but the older the age, the greater the risk of sarcopenia, a risk of 1.091 (1.018‐ 1.170, p = 0.013). There was an association between the reduction in calf circumference and sarcopenia, with a CC < 33‐34cm risk of 9.391 (2.973‐29.664, p<0.001). In relation to patients without sarcopenia, those with probable sarcopenia had a reduction in BMI (p = 0.051). Older patients with probable sarcopenia had more falls, a risk of 1.744 (1.239‐2.456) and worsened functionality, a risk of 1.465 (1.078‐1.991) compared to older patients without sarcopenia (95% CI, p<0.001).
Conclusion
The incidence of sarcopenia in older people with Alzheimer’s disease is high and should be investigated during the follow‐up of every older person to prevent negative outcomes such as falls and loss of functionality.
The move from outright denialism by the fossil fuel and related industries to ‘soft denial’ urges reassessing the mechanisms and networks of actors involved in anti-environmentalism. One high-level tactic which harnesses evolutionary psychology and organizational self-protective tendencies to willfully overlook negative outcomes involves compartmentalization. Segmented judgment applies to multiple domains, including highlighting commitments, declarations, and philanthropy as a mask for continuing unsustainability. Selective accounting gives the impression that states and companies are doing enough on climate, that things are not as bad as they seem, and that much-touted sustainable actions compensate for continuing environmental harms–in effect reducing the impetus for responsible action and diverting attention from climate change’s primary drivers. This bait-and-switch strategy fragments climate accounting by avoiding including both sustainable and unsustainable initiatives in the same ledger. This study categorizes strategies of compartmentalization according to sectoral, narrative, political, behavioral, and structural perspectives, with examples among agrochemical, fossil, and mining industries. Each of these facets is evaluated through examples of actions undertaken by corporations and public agents, often exploiting Global North-South dynamics. In spite of these aspects having different spheres of influence, acts of compartmentalization are interconnected and represent a core background frame enabling the climate denial machine.
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