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We study the dynamics of a discrete model with two different stages of the population, the pre-adult stage governed by a Beverton-Holt-type map and the adult stage by a [Formula: see text]-Ricker map. The composition of both maps gives the dynamics. The existence of the Allee effect is easily observed. We check that the model can evolve from a sure extinction to complicated dynamics. The presence of an almost sure extinction is proved to exist when the dynamical complexity is the highest possible.
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Modelos Biológicos , Dinâmica Populacional , Densidade DemográficaRESUMO
Background: Endoscopic treatment of ureteral strictures provides a minimally invasive approach with a shorter hospital stay and less postoperative pain. There are different therapeutic options, the dilatation balloon and endoureterotomy with holmium yttrium-aluminum-garnet (Ho:YAG) laser are the most used. To assess histological changes after endoureterotomy in the ureteral stricture treatment comparing Ho:YAG laser endoureterotomy versus balloon dilatation endoureterotomy. Methods: The subjects used were a total of 48 female pigs. The initial assessment consisted of an endoscopic, nephrosonographic, and contrast fluoroscopic evaluation of the urinary tract. Subsequently, a model of ureteral stricture was performed. Three weeks later, the ureteral stricture was diagnosed and treated. Then animals were randomly assigned to two groups (group A, Balloon dilatation endoureterotomy and group B, Holmium laser retrograde endoureterotomy) in which a double-pigtail ureteral stent was placed for 3 weeks. Follow-up assessments were performed at 3-6 weeks. The final follow-up was completed at 5 months and included the pathological study. Results: In terms of therapeutic effectiveness, the overall success was 81.2%. The success rate was 91.7% in group B and 70.8%in group A without statistical significance. No evidence of vesicoureteral reflux nor urinary tract anomalies were observed. Histological assessment showed statistical significance in overall score, lamina propria fibrosis and serosal alterations in group A with higher histological changes. Conclusions: The overall histopathological score after ureteral stricture treatment in an animal model showed better remodeling of incised ureteral wall healing after Ho:YAG laser endoureterotomy. Laser endoureterotomy tends to have higher success rate compared to balloon dilatation.
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Central venous catheter-related infection is the most common complication in patients on hemodialysis. Nursing care is essential for its maintenance, minimizing risk factors, and avoiding complications, such as bacteremia. A systematic review was conducted to identify the influence of nursing care on the prevention of bacteremia due to hemodialysis catheter. The primary endpoint was the bacteremia rate measured as number of events per 1000 catheter days. The rate of bacteremia in the studies ranged from 0.2 to 5.47 events per 1000 catheter days after the application of nursing care. Several studies have shown a significant reduction in central venous catheter bacteremia with the application of management protocols, appropriate vigilance, and monitoring, as well as the inclusion of the Plan Do Check Act cycle and education.
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Bacteriemia , Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Cateteres Venosos Centrais , Humanos , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Diálise Renal/efeitos adversos , Bacteriemia/etiologia , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/etiologiaRESUMO
Visual tracking of objects is a fundamental technology for industry 4.0, allowing the integration of digital content and real-world objects. The industrial operation known as manual cargo packing can benefit from the visual tracking of objects. No dataset exists to evaluate the visual tracking algorithms on manual packing scenarios. To close this gap, this article presents 6D-ViCuT, a dataset of images, and 6D pose ground truth of cuboids in a manual packing operation in intralogistics. The initial release of the dataset comprehends 28 sessions acquired in a space that rebuilds a manual packing zone: indoors, area of (6 × 4 × 2) m3, and warehouse illumination. The data acquisition experiment involves capturing images from fixed and mobile RGBD devices and a motion capture system while an operator performs a manual packing operation. Each session contains between 6 and 18 boxes from an available set of 10 types, with each type varying in height, width, depth, and texture. Each session had a duration in the range of 1 to 5 minutes. Each session exhibits operator speed and box type differences (box texture, size heterogeneity, occlusion).
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Multiscale versions of weighted (and non-weighted) permutation entropy for two dimensions are considered in order to compare and analyze the results when different experiments are conducted. We propose the application of these measures to analyze encrypted images with different security levels and encryption methods.
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INTRODUCTION: Detection of subclinical atheromatosis disease (SAD) in patients with human immunodeficiency virus (HIV) infection is usually based on carotid ultrasound. However, studies in other pathologies have shown a probable underestimation of SAD when its detection is exclusively based on carotid exploration. This study evaluates the impact on detection of SAD in patients with HIV through combined carotid and femoral exploration. METHODS: Cross-sectional and prospective study of patients with HIV, diagnosed between 2008-2017. Carotid and femoral ultrasound examination was performed in all patients. EAS was defined according to Mannheim criteria. RESULTS: One hundred two patients were included (mean age: 40 years, 73.5% being male). The prevalence of carotid SAD in the total sample was 15.7% (n=16), and the prevalence of femoral SAD was 18.6% (n=19). The proportion of patients with global SAD criteria (carotid or femoral) was 23.5% (n=24), which implies an absolute increase in SAD detection of 7.84% (95% CI; 2.63-13.06%) at the total sample. CONCLUSIONS: Detection of SAD is significantly increased by the combined use of carotid and femoral arterial ultrasound in the population affected by HIV infection.
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Aterosclerose , Doenças das Artérias Carótidas , Infecções por HIV , Placa Aterosclerótica , Humanos , Masculino , Adulto , Feminino , Infecções por HIV/complicações , Placa Aterosclerótica/complicações , Placa Aterosclerótica/diagnóstico por imagem , Estudos Prospectivos , Estudos Transversais , Fatores de Risco , Aterosclerose/complicações , Aterosclerose/diagnóstico por imagem , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologia , Artérias , Artéria Femoral/diagnóstico por imagemRESUMO
BACKGROUND: In this study, we aim to evaluate microangiopathy in HIV positive patients by using capillaroscopy. To date, few studies have been published on the topic. Capillaroscopy may be a tool for early diagnosis of cardiovascular involvement in this patient population. METHODOLOGY: Cross-sectional study with HIV positive patients >18 years. The enrolment period was set from January to June 2018. The following data were collected: demographic (sex, age), laboratory tests (duration of infection, CD4 cell count, CD4:CD8 ratio, coinfection with other viruses), antiretroviral treatment, dyslipidemia, and comorbidities (active smoking, alcoholism, high blood pressure, dyslipidaemia, diabetes, cardiopathy). The capillaroscopy and blood tests were performed simultaneously. The following alterations were evaluated in the capillaroscopy: congestion, tortuosity, haemorrhage, dilations, capillary loss, and presence of megacapillaries. RESULTS: One hundred and two patients were included; 73.5% were male, mean age was 40 years (SD: 10), and mean duration of infection 4.5 years (SD: 3.1). At diagnosis, mean CD4 cell count was 408/mm3 and CD4/CD8 ratio 0.4. A number of patients (14.7%) were coinfected with the hepatitis B virus; 31.3% were active smokers and 13.7% alcoholics. Capillaroscopy alterations were found in most study patients (93.1%): congestion (78.5%), tortuosity (77.5%), haemorrhage (13.8%), dilations (11.8%), capillary loss (5%), and megacapillaries (1%). Capillary tortuosity was associated with age and smoking; and haemorrhage with age, CD4, antiretroviral treatment, and hypertension. CONCLUSION: Prevalence of capillaroscopy alterations is high in HIV positive patients, particularly tortuosity and congestion. To the best of our knowledge, the later alteration has not been previously reported in this group of patients.
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Infecções por HIV , Cardiopatias , Hipertensão , Humanos , Masculino , Adulto , Feminino , Angioscopia Microscópica , Estudos Transversais , Infecções por HIV/complicaçõesAssuntos
Aquicultura , Conservação dos Recursos Naturais , Salmão , Animais , Alimentos Marinhos , Chile , Espécies IntroduzidasRESUMO
In this study, we performed multi-objective model-based optimization of a potato-frying process balancing between acrylamide production and a quality parameter (yellowness). Solution analysis revealed that, for most of the Pareto solutions, acrylamide levels exceeded the EFSA recommendation. Almost equivalent optimal solutions were found for moderate processing conditions (low temperatures and/or processing times) and the propagation of the uncertainty of the acrylamide production model parameters led to Pareto fronts with notable differences from the one obtained using the nominal parameters, especially in the ranges of high values of acrylamide production and yellowness. These results can help to identify processing conditions to achieve the desired acrylamide/yellowness balance and design more robust processes allowing for the enhancement of flexibility when equivalent optimal solutions can be retrieved.
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Marine-derived nutrients (MDN) contained in gametes (mature eggs and sperm), carcasses and metabolic wastes from anadromous migratory salmon can transfer energy and materials to fresh water, thereby affecting the structure and function of stream ecosystems. This is crucial among ecosystems where humans have mediated biological invasions by propagating non-native species. Previous studies have demonstrated that consumption of MDN from salmon can benefit both native and invasive resident fishes. Yet, a more detailed understanding of the transfer of biomolecules with important physiological functions such as ω-3 highly unsaturated fatty acids (HUFAs) have received less attention among researchers. Here we demonstrate that consumption of MDN contained in invasive Chinook salmon eggs transfers ω-3 HUFAs (e.g., EPA and DHA) to resident invasive rainbow trout in a river food web. We conducted a field study in river sections previously identified as spawning areas for Chinook salmon in the Cisnes River, Patagonia. Rainbow trout were sampled around salmon spawning areas before, during, and after the salmon spawning season. Additionally, we collected tissue from different food web resources and components of different origin (e.g., primary producers, aquatic and terrestrial items) from the Cisnes River system. Analyses of stomach contents of trout were performed in conjunction with analyses of both lipid content and fatty acid profiles of trout tissue and food web components. Chinook salmon eggs showed higher content of ω-3 HUFAs, especially EPA (31.08 ± 23.08 mg g DW-1) and DHA (27.50 ± 14.11 mg g DW-1) than either freshwater or terrestrial components (0-6.10 mg g DW-1 both EPA and DHA). We detected marked shifts in the fatty acid profile (~six-fold increase in EPA and DHA) of trout following consumption of Chinook salmon eggs. Our findings suggest that MDN via consumption of salmon eggs by resident rainbow trout may positively influence resident trout and likely contribute to gauge synergistic interactions between invaders on receiving ecosystems of Patagonia.
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Oncorhynchus mykiss , Salmão , Animais , Ecossistema , Ácidos Graxos , Ácidos Graxos Insaturados , Humanos , Masculino , Nutrientes , Salmão/fisiologia , SêmenRESUMO
Globally, more than 4 million have died from COVID-19, World Health Organization (WHO) to declare COVID-19 a pandemic. The COVID 19 pathology, produced by SARS-COV2, a virus from the coronavirus family, emerged at the end of 2019. The majority of cases usually have a mild or moderate form, characterized by fever, cough, intense asthenia and multiple symptoms derived from the initial replicative effect and subsequent hyperimmune effect. Severe cases present with Acute Respiratory Distress Syndrome (ARDS), due to pneumonia with bilateral involvement, which lead to hospital admission of patients and the need for admission to intensive care units (ICU) of approximately 10â20%. According to the different series; the mortality of the condition once the patient is admitted to the ICU is close to 35â45%. Currently, more than 4 million people have died in the world due to this pathology. The volume of infections generated the declaration by the World Health Organization (WHO) of the pandemic situation. Factors associated with a higher risk of progression into severe disease include age and comorbidities, especially systemic arterial hypertension due to its high incidence in the general population. Clevidipine can be rapidly and effectively adjusted to the clinical status of the patient, since it can be withdrawn and its effects reversed in just a few minutes, and contains high concentrations of lipids, and it could reduce the inflammatory response induced by SARS-COV2, which is key to progression into severe disease. However, its application in pro-inflammatory settings has not yet been explored, although it must play a key role in inflammation as a scavenger molecule.
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Quality of life (QOL) plays an important role in independent living in Parkinson's disease (PD) patients, being crucial to know what factors impact QoL throughout the course of the disease. Here we identified predictors of QoL impairment in PD patients from a Spanish cohort. PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016, to November 2017, were followed up during 2 years. Health-related QoL (HRQoL) and global QoL (GQoL) were assessed with the 39-item Parkinson's disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8), respectively, at baseline (V0) and at 24 months ± 1 month (V2). Clinically significant QoL impairment was defined as presenting an increase (PDQ-39SI) or decrement (EUROHIS-QOL8) at V2 ≥ 10% of the score at baseline (V0). A comparison with a control group was conducted for GQoL. GQoL did not change significantly in PD patients (N = 507; p = 0.686) or in the control group (N = 119; p = 0.192). The mean PDQ-39SI was significantly increased in PD patients (62.7 ± 8.5 years old; 58.8% males; N = 500) by 21.6% (from 16.7 ± 13 to 20.3 ± 16.4; p < 0.0001) at V2. Ninety-three patients (18.6%) presented a clinically significant HRQoL impairment at V2. To be younger (OR = 0.896; 95% CI 0.829-0.968; p = 0.006), to be a female (OR = 4.181; 95% CI 1.422-12.290; p = 0.009), and to have a greater increase in BDI-II (Beck Depression Inventory-II) (OR = 1.139; 95% CI 1.053-1.231; p = 0.001) and NMSS (Non-Motor Symptoms Scale) (OR = 1.052; 95% CI 1.027-1.113; p < 0.0001) total scores from V0 to V2 were associated with clinically significant HRQoL impairment at the 2-year follow-up (Hosmer-Lemeshow test, p = 0.665; R2 = 0.655). An increase in ≥5 and ≥10 points of BDI-II and NMSS total score at V2 multiplied the probability of presenting clinically significant HRQoL impairment by 5 (OR = 5.453; 95% CI 1.663-17.876; p = 0.005) and 8 (OR = 8.217; 95% CI, 2.975-22.696; p = 0.002), respectively. In conclusion, age, gender, mood, and non-motor impairment were associated with clinically significant HRQoL impairment after the 2-year follow-up in PD patients.
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To adopt prevention strategies in gastric cancer, it is imperative to develop robust biomarkers with acceptable costs and feasibility in clinical practice to stratified populations according to risk scores. With this aim, we applied an unbiased genome-wide CpG methylation approach to a discovery cohort composed of gastric cancer (n = 24), and non-malignant precursor lesions (n = 64). Then, candidate-methylation approaches were performed in a validation cohort of precursor lesions obtained from an observational longitudinal study (n = 264), with a 12-year follow-up to identify repression or progression cases. H. pylori stratification and histology were considered to determine their influence on the methylation dynamics. As a result, we ascertained that intestinal metaplasia partially recapitulates patterns of aberrant methylation of intestinal type of gastric cancer, independently of the H. pylori status. Two epigenetically regulated genes in cancer, RPRM and ZNF793, consistently showed increased methylation in intestinal metaplasia with respect to earlier precursor lesions. In summary, our result supports the need to investigate the practical utilities of the quantification of DNA methylation in candidate genes as a marker for disease progression. In addition, the H. pylori-dependent methylation in intestinal metaplasia suggests that pharmacological treatments aimed at H. pylori eradication in the late stages of precursor lesions do not prevent epigenome reprogramming toward a cancer signature.
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BACKGROUND/AIMS: Peroral endoscopic myotomy (POEM) has been increasingly used for achalasia in Latin America, where Chagas disease is prevalent, and this makes POEM more challenging. The aim of this study was to determine the learning curve for POEM in Latin America. METHODS: Patients undergoing POEM in Latin America with a single operator were included from a prospective registry over 4 years. Non-linear regression and cumulative sum control chart (CUSUM) analyses were conducted for the learning curve. RESULTS: A total of 125 patients were included (52% male; mean age, 59 years), of which 80 had type II achalasia (64%), and 38 had Chagas disease (30%). The average pre-procedure and post-procedure Eckardt scores were 6.79 and 1.87, respectively. Technical success was achieved in 93.5% of patients, and clinical success was achieved in 88.8%. Adverse events occurred in 27 patients (22%) and included bleeding (4 patients), pneumothorax (4 patients), mucosal perforation (13 patients), mediastinitis (2 patients), and leakage (4 patients).
The CUSUM chart showed a median procedure time of 97 min (range, 45-196 min), which was achieved at the 61st procedure. Procedure duration progressively decreased, with the last 10 procedures under 50 min approaching a plateau (p-value <0.01). CONCLUSION: Mastering POEM in Latin America requires approximately 61 procedures for both POEM efficiency and to accomplish the procedure within 97 minutes.
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Several studies have examined the transmission dynamics of the novel COVID-19 disease in different parts of the world. Some have reported relationships with various environmental variables, suggesting that spread of the disease is enhanced in colder and drier climates. However, evidence is still scarce and mostly limited to a few countries, particularly from Asia. We examined the potential role of multiple environmental variables in COVID-19 infection rate [measured as mean relative infection rate = (number of infected inhabitants per week / total population) × 100.000) from February 23 to August 16, 2020 across 360 cities of Chile. Chile has a large climatic gradient (≈ 40º of latitude, ≈ 4000 m of altitude and 5 climatic zones, from desert to tundra), but all cities share their social behaviour patterns and regulations. Our results indicated that COVID-19 transmission in Chile was mostly related to three main climatic factors (minimum temperature, atmospheric pressure and relative humidity). Transmission was greater in colder and drier cities and when atmospheric pressure was lower. The results of this study support some previous findings about the main climatic determinants of COVID-19 transmission, which may be useful for decision-making and management of the disease.
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COVID-19/transmissão , Meio Ambiente , SARS-CoV-2/isolamento & purificação , Estações do Ano , Altitude , Pressão Atmosférica , COVID-19/epidemiologia , COVID-19/virologia , Chile/epidemiologia , Humanos , Umidade , Pandemias , SARS-CoV-2/fisiologia , Temperatura , TundraRESUMO
La terapia de resincronización cardiaca mediante estimulación hisiana ha demostrado ser efectiva en pacientes con bloqueo de rama izquierda del haz de His e insuficiencia cardiaca. Paciente masculino, con 47 años de edad, con insuficiencia cardiaca, fracción de expulsión del 17% y miocardio dilatada idiopática, electrocardiograma en ritmo sinusal, bloqueo auriculoventricular de 1.er grado, intervalo PR 400 ms, bloqueo completo de rama derecha del haz de His, bloqueo del fascículo anterior de la rama izquierda del haz de His, duración del QRS 200 ms. Se decidió realizar estimulación selectiva del haz de His. La resincronización cardiaca biventricular convencional en pacientes con presencia de bloqueo completo de la rama derecha del haz de His no está indicada debido a la pobre respuesta al tratamiento. La estimulación hisiana permite reclutar la rama bloqueada y reestablecer la conducción a través de ella, de tal forma que, en ausencia de necrosis, se logre sincronía biventricular. En el caso presentado el reclutamiento de la rama derecha mediante estimulación hisiana se reflejó en el restablecimiento de la sincronía biventricular, medida por rastreo de marcas (speckle tracking) e incremento significativo de la fracción de expulsión del ventrículo izquierdo del 17 al 36.6%, con un incremento absoluto del 19.6%.Cardiac resynchronization therapy has proven to be an effective therapy in patients with left bundle branch block and heart failure. Male, 47 years old, heart failure with a left ventricle ejection fraction of 17%, idiopathic heart failure. ECG with sinus rhythm, 1st degree AV block, PR 400 ms, complete right bundle branch block, anterior hemi-fascicle of the left bundle of His, and QRS duration 200 ms. We decided to perform a selective His bundle pacing. In patients with right bundle branch block the biventricular cardiac resynchronization is not indicated due to low treatment response. His bundle pacing allows recruiting the blocked branch and restoring conduction throughout it, therefore, in the absence of necrosis the biventricular synchrony is achieved. We presented a case of His bundle pacing with recruitment of the right bundle branch, which reestablish biventricular synchrony measured by speckle tracking, and with a significant increase of the left ventricle ejection fraction from 17 to 36.6%, with an absolute increase of 19.6%.
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Fascículo Atrioventricular , Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca , Bloqueio de Ramo/complicações , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Resumen La terapia de resincronización cardiaca mediante estimulación hisiana ha demostrado ser efectiva en pacientes con bloqueo de rama izquierda del haz de His e insuficiencia cardiaca. Paciente masculino, con 47 años de edad, con insuficiencia cardiaca, fracción de expulsión del 17% y miocardio dilatada idiopática, electrocardiograma en ritmo sinusal, bloqueo auriculoventricular de 1.er grado, intervalo PR 400 ms, bloqueo completo de rama derecha del haz de His, bloqueo del fascículo anterior de la rama izquierda del haz de His, duración del QRS 200 ms. Se decidió realizar estimulación selectiva del haz de His. La resincronización cardiaca biventricular convencional en pacientes con presencia de bloqueo completo de la rama derecha del haz de His no está indicada debido a la pobre respuesta al tratamiento. La estimulación hisiana permite reclutar la rama bloqueada y reestablecer la conducción a través de ella, de tal forma que, en ausencia de necrosis, se logre sincronía biventricular. En el caso presentado el reclutamiento de la rama derecha mediante estimulación hisiana se reflejó en el restablecimiento de la sincronía biventricular, medida por rastreo de marcas (speckle tracking) e incremento significativo de la fracción de expulsión del ventrículo izquierdo del 17 al 36.6%, con un incremento absoluto del 19.6%.
Abstract Cardiac resynchronization therapy has proven to be an effective therapy in patients with left bundle branch block and heart failure. Male, 47 years old, heart failure with a left ventricle ejection fraction of 17%, idiopathic heart failure. ECG with sinus rhythm, 1st degree AV block, PR 400 ms, complete right bundle branch block, anterior hemi-fascicle of the left bundle of His, and QRS duration 200 ms. We decided to perform a selective His bundle pacing. In patients with right bundle branch block the biventricular cardiac resynchronization is not indicated due to low treatment response. His bundle pacing allows recruiting the blocked branch and restoring conduction throughout it, therefore, in the absence of necrosis the biventricular synchrony is achieved. We presented a case of His bundle pacing with recruitment of the right bundle branch, which reestablish biventricular synchrony measured by speckle tracking, and with a significant increase of the left ventricle ejection fraction from 17 to 36.6%, with an absolute increase of 19.6%.
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Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio de Ramo/terapia , Fascículo Atrioventricular , Terapia de Ressincronização Cardíaca , Bloqueio de Ramo/complicações , Insuficiência Cardíaca/complicaçõesRESUMO
Urothelial bladder cancer is the tenth most common cancer worldwide. It is divided into muscle and non-muscle invading bladder cancer. Primary cilia have been related to several cancer hallmarks such as proliferation, epithelial-to-mesenchymal transition (EMT) or tumoral progression mainly through signaling pathways as Hedgehog (Hh). In the present study, we used immunohistochemical and ultrastructural techniques in human tissues of healthy bladder, non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) to study and clarify the activation of epithelial-to-mesenchymal transition and Hedgehog signaling pathway and the presence of primary cilia. Thus, we found a clear correlation between EMT and Hedgehog activation and bladder cancer stage and progression. Moreover, we identified the presence of primary cilia in these tissues. Interestingly, we found that in NMIBC, some ciliated cells cross the basement membrane and localized in lamina propria, near blood vessels. These results show a correlation between EMT beginning from urothelial basal cells and primary cilia assembly and suggest a potential implication of this structure in tumoral migration and invasiveness (likely in a Hh-dependent way). Hence, primary cilia may play a fundamental role in urothelial bladder cancer progression and suppose a potential therapeutic target.
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Cílios/metabolismo , Neoplasias da Bexiga Urinária/metabolismo , Cílios/patologia , Humanos , Neoplasias da Bexiga Urinária/patologiaRESUMO
BACKGROUND: Numerous studies have demonstrated that halogenated agents elicit myocardial conditioning effects when administered perioperatively in cardiac surgery. Recent evidence has been published on the benefits of maintaining exposure to halogenated agents during the early postoperative period. The enzymatic mechanisms by which this beneficial effect is exerted were explained recently. OBJECTIVES: Our study was performed to investigate whether this phenomenon is mediated by either the activation or suppression of miRNAs targeted by halogenated anesthetics. METHODS: A double-blind, two-stage trial was conducted. The results of the first stage of the trial are presented in this paper. The sample was composed of patients undergoing off-pump myocardial revascularization surgery. Patients were randomized to receive either sevoflurane [S] or propofol [P] during the intraoperative and early postoperative period (during the first six hours after the intervention). Hemodynamics (heart rate, blood pressure, central venous pressure, cardiac index, systolic volume index, LVEF) and myocardial enzymes (troponin I) were monitored at six hour intervals during the first 48 hours. In the first stage of the trial, blood was drawn for gene sequencing from eight patients (four per group) at baseline and at 24 h. In the second stage of the study, a qPCR analysis was performed of the miRNAs identified as significant by gene sequencing. Levels of cardioprotective enzymes (serine/threonine protein kinase (Akt), tumor necrosis factor alpha (TNFα), extracellular regulated protein kinase (ERK 1/2), and caspase 3) were measured to assess their role in myocardial conditioning pathways. The purpose was to identify the miRNAs that play a major role in myocardial conditioning induced by halogenated agents. Concentrations of cardioprotective enzymes were higher in patients who received sevoflurane than the patients who were administered propofol. RESULTS: NGS differences were observed between baseline and 24-h values in the two study groups. In group P, miRNA 197-3p was overexpressed, whereas miRNAs 4443 and 1294, 708-3p were underexpressed. In group S, miRNAs 615-3p, 4466, 29, 937-3p, 636, 197-3P, 184, 4685, 296-3p, 147b, 3199, 6815, 1294 and 3176 were underexpressed; whereas 708-3p was overexpressed. qPCR showed significant variations in miRNAs 197-3p, 4443, 708-3p and 1294 in the P group, and in miRNAs 937-3p, 636, 197- 3p, 296-3p and 708-3p in the S group. CONCLUSION: In the P Group, changes in the expression of some miRNAs were associated with lower concentrations of the enzymes involved in myocardial pre- and postconditioning. In contrast, in Group S, variations in miRNAs were associated with the activation of mediators of anesthetic-induced pre- and post-conditioning, a reduction in cell apoptosis, and a decrease in caspase and TnBF alpha concentrations. Changes in these miRNAs were associated with better prognosis in patients with ischemic heart disease. The main limitation of this study will be overcome in the second stage of the trial, where the specific role of each miRNA will be determined.
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Éteres Metílicos , MicroRNAs , Propofol , Humanos , MicroRNAs/genética , Revascularização Miocárdica , Propofol/uso terapêutico , SevofluranoRESUMO
Background and study aims Both Heller myotomy (HM) and per-oral endoscopic myotomy (POEM) are efficacious therapies for achalasia. The efficacy and safety of POEM vs HM in Latin America and specifically in patients with Chagas disease is unknown. Patients and methods Consecutive patients undergoing either HM or POEM for achalasia were included from nine Latin American centers in a prospective registry over 5 years. Technical success was defined as undergoing a successful myotomy. Clinical success was defined as achieving an Eckardt score <â3. Data on demographics, procedure info, Eckardt score, and adverse events (AEs) were collected. Student's t test, Chi squared, and logistic regression analyses were conducted. Results One hundred thirty-three patients were included (59 male; 44â%; mean age 47). POEM was performed in 69 patients, HM in 64 patients. A total of 35 patients had Chagas disease, 17 of 69 in the POEM group, 18 of 64 in the HM group.âBoth groups had significant reduction in Eckardt scores ( P â<â0.00001), but successful initial therapy was significantly higher in the POEM group compared to the HM group ( P â=â0.01304). AEs were similar in both group (17â% vs 14â%) and consisted of pneumothorax (nâ=â3 vs 2), bleeding requiring transfusion (nâ=â3 vs 2), and mediastinitis (nâ=â3 vs 1). Hospital stay was longer in the HM group than in the POEM group ( P â<â0.00001). In the Chagas subgroup, post-procedure Eckardt score in the POEM group was significantly reduced by 5.71 points ( P â<â0.00001) versus 1.56 points in the HM group ( P â=â0.042793). Conclusion Both HM and POEM are efficacious for achalasia, but POEM was associated with higher initial therapy success and shorter hospital stay in Latin America. In Chagas patients with achalasia, POEM was significantly more effective than HM.