RESUMO
INTRODUCTION: Food allergies represent a growing public health concern, particularly among children. This study aims to examine egg allergy in pediatric patients and analyze the value of serum-specific immunoglobulin E (sIgE) levels as predictive biomarkers for oral food challenge (OFC) outcomes. METHODS: Retrospective study, involving pediatric patients with suspected IgE-mediated egg allergy, conducted at a tertiary hospital. RESULTS: Data from 176 pediatric patients were analyzed, revealing a higher male prevalence (59.1%). Most cases (40.3%) presented symptoms in the first year of life, predominantly mucocutaneous symptoms (46%). OFC results varied across various forms of egg presentation, with cooked egg being the most frequently tested food. Positive OFCs were observed in 14.6% (n = 36) of cases. The study identified specific egg protein biomarkers for positive OFC, with ovalbumin for raw egg (sIgE > 1.28 KUA/L; area under the curve [AUC] = 0.917; sensitivity [S] 100%; and specificity [Sp] 92%), ovomucoid for cooked egg (sIgE > 0.99 KUA/L; AUC = 0.788, 95%; S: 79%; and Sp: 74%), and ovomucoid for baked egg (sIgE> 4.63 KUA/L; AUC = 0.870; S: 80%; and Sp: 85%) showing predictive capacities. CONCLUSIONS: The findings underscore the importance of considering various forms of egg presentation in the diagnosis and management of egg allergy. The findings highlight the valuable discriminatory capacity and provided reliable biomarkers, such as ovalbumin for raw egg and ovomucoid for cooked and baked egg in risk assessment, aiding in predicting OFC outcomes and helping clinicians to make informed decisions in diagnosing and managing egg allergies, thus improving patient care and quality of life.
Assuntos
Alérgenos , Biomarcadores , Hipersensibilidade a Ovo , Imunoglobulina E , Humanos , Hipersensibilidade a Ovo/diagnóstico , Hipersensibilidade a Ovo/imunologia , Hipersensibilidade a Ovo/epidemiologia , Hipersensibilidade a Ovo/sangue , Imunoglobulina E/sangue , Imunoglobulina E/imunologia , Masculino , Feminino , Estudos Retrospectivos , Pré-Escolar , Criança , Lactente , Portugal/epidemiologia , Alérgenos/imunologia , Biomarcadores/sangue , Adolescente , Prevalência , Ovos/efeitos adversosRESUMO
Associations between subjective well-being (SWB) and dietary habits, employment status, and habitual activities are increasingly capturing the focus of researchers as well as policymakers worldwide. This study aimed to explore these associations in a sample of the population in Greece and Cyprus via an online survey. In total, 936 questionnaires (470: Cyprus, 466: Greece) were analyzed to study the associations between the Mediterranean Diet (MD) (using the 14-item MEDAS score, (14-MEDAS)), subjective well-being (SWB), and several socioeconomic factors. Key remarks of this survey highlight the positive impact of MD adherence on some well-being items. Namely, statistically significant differences were found on the following items: Satisfied with life (p < 0.001), Life worthwhile (p < 0.001), Feeling happy (p < 0.001), worried (p = 0.005), and depressed (p = 0.001), when comparing Low MD adherence (14-MEDAS < 5) to High MD adherence (14-MEDAS > 10). Other lifestyle habits such as spending time with friends and family, spending time in nature, and habitual physical activity were associated with aspects of SWB such as Life satisfaction, Life worthwhile, Feeling happy, and energetic. The findings support adherence to the MD, since it is associated with higher life satisfaction and self-reported happiness in this sample and should be considered when developing health policies on well-being.
Assuntos
Dieta Mediterrânea , Humanos , Dieta Mediterrânea/estatística & dados numéricos , Dieta Mediterrânea/psicologia , Grécia , Chipre , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Inquéritos e Questionários , Satisfação Pessoal , Comportamento Alimentar/psicologia , Fatores Socioeconômicos , Estilo de Vida , Qualidade de Vida , Idoso , Exercício Físico/psicologia , Adulto JovemRESUMO
The use of atherectomy for peripheral vascular interventions (PVIs) has increased exponentially and reached 18% of all PVI in the United States. The theoretical benefit on extensive arterial calcification relies on the concept of plaque modification and removal instead of displacement, as with other endovascular techniques. To date, there are no prospective studies comparing the different atherectomy technologies (directional, rotational, orbital, and laser). Moreover, most related prospective comparative studies have a small number of patients, and larger studies are single arm in patients with relatively mild to moderate disease burden. While available literature shows lower dissection risk and reduced bailout stenting, the superiority of this technology compared to other endovascular techniques has yet to be proven. Despite the lack of level 1 evidence to support its superiority, the lucrative reimbursement fueled the overuse of this technology as first-line therapy, particularly in office-based laboratories and ambulatory surgery centers. The use of atherectomy ought to be selective and complementary to other endovascular technologies, and individualized patient-level decision-making based on the practitioner's preference and expertise is essential to selectively incorporate atherectomy in managing complex atherosclerotic lesions.
RESUMO
BACKGROUND: Vein ablation is a common and effective treatment for patients with chronic venous insufficiency. The overuse of vein ablation despite the existence of evidence-based guidelines has resulted in insurance companies developing restrictive policies for coverage that create barriers to appropriate care. This study compares the insurance coverage by single-state carriers (SSCs) and multistate carriers (MSCs), highlighting the variations and inconsistencies in the various policies. METHODS: The American Venous Forum Venous Policy Navigator was reviewed for the various policies available in the United States. The policies were divided into SSCs and MSCs. The characteristics of the policies, including the anatomic and hemodynamic criteria for specific veins, duration of conservative treatment, disease severity, symptoms, and types of procedures covered, were compared between the two groups. SAS, version 9.4 (SAS Institute Inc) was used for statistical analysis. RESULTS: A total of 122 policies were analyzed and divided between SSCs (n = 85; 69.7%) and MSCs (n = 37; 30.3%). A significant variation was found in the size requirement for great saphenous vein ablation. Although 48% of the policies did not specify a size criterion, the remaining policies indicated a minimal size, ranging from 3 to 5.5 mm. However, no significant differences were found between SSCs and MSCs. Similar findings were encountered for the small and anterior accessory saphenous veins. MSCs were more likely to define a saphenous reflux time >500 ms compared with SSCs (81.1% vs 58.8%; P = .04). A significant difference was found between the SSCs and MSCs in the criteria for perforator ablation in terms of size and reflux time. MSCs were significantly more likely to provide coverage for mechanochemical ablation than were SSCs (24.3% vs 8.2%; P = .03). SSCs were more likely to require ≥12 weeks of compression stocking therapy than were MSCs (76.5% vs 48.7%; P = .01). No significant differences were found in the clinical indications between the two groups; however, MSCs were more likely to mention major hemorrhage than were SSCs. CONCLUSIONS: The results of this study highlight the variations in policies for venous ablation, in particular, the striking inconsistencies in size criteria. MSCs were more likely to cover mechanochemical ablation and require a shorter duration of conservative therapy before intervention compared with SSCs. Evidence-based guidance is needed to develop more coherent policies for venous ablation coverage.
Assuntos
Ablação por Cateter , Varizes , Insuficiência Venosa , Humanos , Estados Unidos , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/cirurgia , Resultado do Tratamento , Veia Safena/diagnóstico por imagem , Veia Safena/cirurgia , Veia Femoral/cirurgia , Ablação por Cateter/efeitos adversos , Varizes/cirurgia , Estudos RetrospectivosRESUMO
Background and Objectives: Research on female soccer players that analyzes playing status is scarce and has previously only examined load monitoring, while other markers, such as physical (i.e., strength, power, and agility), physiological (i.e., maximal oxygen uptake), and body composition (i.e., body fat mass, fat-free mass, body water, and phase angle) markers, warrant further investigation. Thus, the study aims were to (a) compare physical, physiological, body composition, and load markers between starters and non-starters; (b) compare measurements pre- and post-training intervention (five weeks); and (c) analyze any relationships between physical, physiological, body composition, and load markers in an elite female soccer team. Materials and Methods: Fourteen first-team players participated in the study (age 23.29 ± 3.19 years, weight 59.14 ± 6.87 kg, height 1.66 ± 0.08 m). Several physical (n = 15), physiological (n = 1), body composition (n = 11), and load markers (n = 14) were collected. In addition, participants were sub-divided into starters (n = 7) and non-starters (n = 7). Results: No differences were revealed between starters and non-starters in any of the examined variables. Moreover, following the training intervention, a significantly lower value was found for total body water/fat-free mass ratio (p = 0.043; ES = 0.582). In addition, there were several correlations detected between load and physical/physiological markers (n = 28); load and body composition markers (n = 6); physical/physiological and body composition markers (n = 34); and physical and physiological markers (n = 42). Conclusions: In conclusion, only a slight tendency of higher load values for starters than non-starters was observed. In addition, no differences in physical, physiological, and body composition markers were found between starters and non-starters, possibly suggesting that five weeks were not enough to improve such variables. Finally, the present results provide novel information assessing the effects of the pre-season in elite female Portuguese soccer players and contribute to a better understanding of the associations between different types of measurements.
Assuntos
Desempenho Atlético , Futebol , Humanos , Feminino , Adulto Jovem , Adulto , Futebol/fisiologia , Estações do Ano , Composição Corporal/fisiologia , Antropometria , Desempenho Atlético/fisiologiaRESUMO
Introduction: There was an increase in telemedicine during the COVID-19 pandemic to follow patients with multiple sclerosis (MS). However, there is scarce data if online evaluations can cover important information assessed during in-clinic appointments, especially the Expanded Disability Status Score (EDSS). This study aims to develop a remote evaluation tool for EDSS functional systems and compare the performance with face-to-face evaluations. Methods: This was a single-center study that included all MS patients followed up at outpatient clinics of Hospital São Lucas Pontifícia Universidade Católica do Rio Grande do Sul, between April and August 2022. Initially, patients were routinely in-clinic evaluated by one trained neurologist for EDSS. After, patients were evaluated remotely without any information about the in-clinic EDSS results. We used a standardized interview with an interactive video platform to evaluate EDSS functional systems by telemedicine. Results: Forty-nine participants completed the two steps. Intra-class coefficient was 0.97 (95% CI: 0.95-0.98), concordance for EDSS below 4.0 was 0.87 (95% CI: 0.77-0.93) and ≥4.0 was 0.97 (95% CI: 0.89-0.99). There was perfect agreement in the final EDSS in 71.4% of the online and in-clinic evaluations. In the multivariate analysis, the visual (beta = 0.453; p = 0.003) and pyramidal (beta = 0.403; p = 0.009) systems contributed significantly to the difference in the final EDSS. Conclusion: The telemedicine tool created in this study can detect changes in functional systems with reliable results compared to in-clinic EDSS assessment. Telemedicine evaluations may reduce the number of in-clinic visits and the disease burden for patients with MS.
RESUMO
BACKGROUND: Autoantibodies against surface neuronal antigens have been associated with specific neurological presentations including autoimmune encephalitis (AE), with variable association with neoplasia and infections. METHODS: We described the phenotype and environmental associations of patients with neurological syndromes associated with antibodies against neuronal surface antigens who were referred to a tertiary center in the South of Brazil. All patients were tested for neuronal autoantibodies using cell-based assays. Clinical, radiological, and laboratory findings were retrospectively reviewed. RESULTS: We identified 16 patients, 15 had subacute, and one had a progressive disease course. Among patients with subacute onset, 11 (73 %) were N-Methyl-d-Aspartate receptor (NMDAr-IgG)+, 3 (20 %) were Leucine-rich Glioma-Inactivated-1 (LGI1-IgG)+, and 1 (6 %) was positive for Glycine receptor-IgG. The patient with a progressive disease course had antibodies against IgLON5. Most patients had disease onset in spring and summer suggesting environmental factors for the development of AE. Also, we observed a different pattern of brain lesions when NMDAr-IgG encephalitis followed herpes encephalitis and a previously unreported association with Rosai-Dorfman-Destombe disease. All patients with encephalopathy met criteria for possible AE and all proven NMDAr-IgG+ met criteria for NMDAr-IgG encephalitis. However, only one LGI1-IgG+ patient fulfilled clinical criteria for limbic encephalitis. All but one received high-dose intravenous methylprednisolone, 11 also had intravenous human immunoglobulin, and 4 plasma exchange. Furthermore, all patients received second-line immunotherapy. Importantly, most patients improved with immunotherapy, even when initiated later in the disease course. CONCLUSION: We identified seasonal variability associated with neuronal surface antibodies suggesting environmental triggers. Also, we described the coexistence of NMDAr-IgG encephalitis with histiocytosis. In our series, most patients received second-line immunotherapy. We observed neurologic improvement after treatment even in cases of delayed diagnosis. Increasing the recognition and availability of tests and treatments for these conditions is of paramount importance in low- and middle-income countries.
Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato , Encefalite por Herpes Simples , Humanos , Estudos Retrospectivos , Antígenos de Superfície , Autoanticorpos , Síndrome , Imunoglobulina G , Moléculas de Adesão Celular NeuronaisRESUMO
We investigated the extent to which adherence to the Mediterranean diet (MD) in combination with Mediterranean lifestyle factors influenced students' perceptions of subjective well-being (SWB) and distress. 939 undergraduates completed a survey to assess sociodemographic and lifestyle characteristics, including adherence to the MD, depression, anxiety, stress, and SWB. Data were analysed with correlation, logistic, and multiple linear regression models. Higher adherence to MD correlated with better SWB. Fruit, red meat, sweet and caffeinated beverages contributed significantly. However, it was the combination of adherence to MD with other factors, including quality of social relationships, income, smoking, sleep, and physical activity that better predicted SWB. Our results confirm the positive influence of MD on SWB. However, they also suggest the need to consider perceptions of well-being by a more holistic approach that considers physical and social factors simultaneously to improve the development of more effective educational and motivational programmes.
Assuntos
Dieta Mediterrânea , Estilo de Vida , Humanos , Universidades , Estudantes , Itália , PercepçãoRESUMO
Insects have been consumed as food in diverse cultures worldwide, gaining recognition as a sustainable and nutritious food source. This systematic review aims to update information on the impact of insect consumption on human health based on human randomized controlled trials (RCTs) and allergenicity assessment studies. Following PRISMA guidelines, studies published in the last 10 years were analyzed. From one-thousand and sixty-three retrieved references, nine RCTs and five allergenicity studies were analyzed. Post-prandial amino acid levels increased after insect protein consumption. In comparison with other protein sources, insect protein showed no significant differences in the area under the curve (AUC) values for essential amino acids but tended to have lower peaks and peak later. In terms of muscle protein synthesis, there were no significant differences between insect protein and other protein sources. Glucose levels did not differ; however, insulin levels were lower after the consumption of insect-based products. The effects on inflammatory markers and microbiota composition were inconclusive and the studies did not show significant effects on appetite regulation. Allergenicity assessments revealed a sensitisation and cross-reactivity between insect allergens and known allergens. A partial reduction of cross-allergenicity was observed via thermal processing. Insect protein is an adequate protein source with promising health benefits; however, further research is needed to fully understand its potential and optimise its inclusion into the human diet.
Assuntos
Alimentos , Insetos , Animais , Humanos , Dieta , Alérgenos , Proteínas de InsetosRESUMO
BACKGROUND: In 2009, Portugal ratified the UN CRPD and a turn to a rights-based approach in disability law and policy has intensified since. It thus becomes important to understand whether these legal changes are furthering the social inclusion of adults with intellectual and complex disabilities. METHOD: Questionnaires were applied to a stratified sample of 127 adults with intellectual and complex disabilities attending social care and vocational training programmes across the country. RESULTS: Participants reported low rates of social participation, and many (49%) were found to live below the poverty line. High rates of discrimination and violence and feelings of loneliness and sadness were also reported, which can be strong indicators of the oppression that many of them daily endure. CONCLUSION: Adults with intellectual and complex disabilities in Portugal face exclusion, discrimination, and violence. The poverty and isolation in which many of them live compounds their (de)citizenship status in Portuguese society.
Assuntos
Pessoas com Deficiência , Deficiência Intelectual , Humanos , Adulto , Portugal , Cidadania , Condições SociaisRESUMO
OBJECTIVE: To analyze the relationship between one-minute sit-to-stand test (1MSTST) parameters and a diagnosis of post COVID-19 condition in a cohort of patients who previously had COVID-19. METHODS: This was a prospective cohort study of patients with post COVID-19 condition referred for body plethysmography at a tertiary university hospital. Post COVID-19 condition was defined in accordance with the current WHO criteria. RESULTS: Fifty-three patients were analyzed. Of those, 25 (47.2%) met the clinical criteria for post COVID-19 condition. HR was lower in the patients with post COVID-19 condition than in those without it at 30 s after initiation of the 1MSTST (86.2 ± 14.3 bpm vs. 101.2 ± 14.7 bpm; p < 0.001) and at the end of the test (94.4 ± 18.2 bpm vs. 117.3 ± 15.3 bpm; p < 0.001). The ratio between HR at the end of the 1MSTST and age-predicted maximal HR (HRend/HRmax) was lower in the group of patients with post COVID-19 condition (p < 0.001). An HRend/HRmax of < 62.65% showed a sensitivity of 78.6% and a specificity of 82.0% for post COVID-19 condition. Mean SpO2 at the end of the 1MSTST was lower in the patients with post COVID-19 condition than in those without it (94.9 ± 3.6% vs. 96.8 ± 2.4%; p = 0.030). The former group of patients did fewer repetitions on the 1MSTST than did the latter (p = 0.020). CONCLUSIONS: Lower SpO2 and HR at the end of the 1MSTST, as well as lower HR at 30 s after initiation of the test, were associated with post COVID-19 condition. In the appropriate clinical setting, an HRend/HRmax of < 62.65% should raise awareness for the possibility of post COVID-19 condition.
Assuntos
COVID-19 , Humanos , COVID-19/diagnóstico , Estudos Prospectivos , Teste para COVID-19RESUMO
Getting prompt insights about health and well-being in a non-invasive way is one of the most popular features available on wearable devices. Among all vital signs available, heart rate (HR) monitoring is one of the most important since other measurements are based on it. Real-time HR estimation in wearables mostly relies on photoplethysmography (PPG), which is a fair technique to handle such a task. However, PPG is vulnerable to motion artifacts (MA). As a consequence, the HR estimated from PPG signals is strongly affected during physical exercises. Different approaches have been proposed to deal with this problem, however, they struggle to handle exercises with strong movements, such as a running session. In this paper, we present a new method for HR estimation in wearables that uses an accelerometer signal and user demographics to support the HR prediction when the PPG signal is affected by motion artifacts. This algorithm requires a tiny memory allocation and allows on-device personalization since the model parameters are finetuned in real time during workout executions. Also, the model may predict HR for a few minutes without using a PPG, which represents a useful contribution to an HR estimation pipeline. We evaluate our model on five different exercise datasets - performed on treadmills and in outdoor environments - and the results show that our method can improve the coverage of a PPG-based HR estimator while keeping a similar error performance, which is particularly useful to improve user experience.
RESUMO
Rigid polyurethane foams (RPUFs) were synthesized using exclusively lignin-based polyol (LBP) obtained via the oxyalkylation of kraft lignin with propylene carbonate (PC). Using the design of experiments methodology combined with statistical analysis, the formulations were optimized to obtain a bio-based RPUF with low thermal conductivity and low apparent density to be used as a lightweight insulating material. The thermo-mechanical properties of the ensuing foams were compared with those of a commercial RPUF and a RPUF (RPUF-conv) produced using a conventional polyol. The bio-based RPUF obtained using the optimized formulation exhibited low thermal conductivity (0.0289 W/m·K), low density (33.2 kg/m3), and reasonable cell morphology. Although the bio-based RPUF has slightly lower thermo-oxidative stability and mechanical properties than RPUF-conv, it is still suitable for thermal insulation applications. In addition, the fire resistance of this bio-based foam has been improved, with its average heat release rate (HRR) reduced by 18.5% and its burn time extended by 25% compared to RPUF-conv. Overall, this bio-based RPUF has shown potential to replace petroleum-based RPUF as an insulating material. This is the first report regarding the use of 100% unpurified LBP obtained via the oxyalkylation of LignoBoost kraft lignin in the production of RPUFs.
RESUMO
BACKGROUND: Increased complication rates following laparoscopic cholecystectomies have been described, likely related to surgical difficulty, anatomical variations, and gallbladder inflammation severity. Parkland Grading Scale (PGS) stratifies the severity of intraoperative findings to predict operative difficulty and complications. This study aims to validate PGS as a postoperative-outcome predictive tool, comparing its performance with Tokyo Guidelines Grading System (TGGS). METHODS: This is a single-center retrospective cohort study where PGS and TGGS performances were evaluated regarding intraoperative and postoperative outcomes. Both univariate and bivariate analyses were performed on each severity grading scale using STATA-SE 16.0 software. Additionally, we proposed a Logistic Regression Model for each scale. Their association with outcomes was compared between both scales by their Receiver Operating Characteristic Curve. RESULTS: 400 Patients were included. Grade 1 predominance was observed for both PGS and TGGS (47.36% and 25.3%, respectively). A positive association was observed between higher PGS grades and inpatient postoperative care, length of stay, ICU care, and antibiotic requirement. Based on the area under the ROC curve, better performance was observed for PGS over TGGS in the evaluated outcomes. CONCLUSION: PGS performed better than TGGS as a predictive tool for inpatient postoperative care, length of stay, ICU, and antibiotic requirement, especially in severe cases.
Assuntos
Colecistectomia Laparoscópica , Colecistite Aguda , Colecistite , Humanos , Estudos Retrospectivos , Índice de Gravidade de Doença , Colecistite/cirurgia , Tempo de Internação , Antibacterianos , Colecistite Aguda/cirurgiaRESUMO
Pork-cat syndrome is a rare clinical syndrome that can cause lifethreatening reactions. Occuring in patients allergic to cat dander, it involves cross-reactivity between cat and pig serum albumin. Cat allergy usually precedes food allergies, suggesting primary sensitization to cat serum albumin. Since these proteins are thermolabile, the reaction tends to be more severe in undercooked meat. A 27-year-old woman with persistent moderate-to-severe rhinoconjunctivitis since childhood reported 2 immediate mucocutaneous reactions after eating small amounts of pork. Skin prick tests with commercial extracts showed sensitization to pork, and prick-to-prick tests confirmed sensitization to raw pork and raw beef. Specific IgE was positive for pork, and ISAC microarray also showed sensitization to Fel d 2. SDS-PAGE and IgE immunoblotting assays were performed with raw and cooked pork extract and detected in a 60 kDa band. In the immunoblotting-inhibition assays, cat serum albumin completely inhibited IgE binding to pork extract. The patient underwent 2 oral food challenges with well-cooked pork and beef, both causing an anaphylactic reaction. The patient's history and in-vivo and in-vitro tests led to a diagnosis of pork-cat syndrome with clinical cross-reactivity to another mammalian serum albumin. This case should stimulate oral food challenges with other well-cooked mammalian meats in patients with this syndrome to establish a tolerance threshold and avoid possible unexpected anaphylactic reactions.
A síndrome gato-porco é rara e ocorre em doentes alérgicos ao pêlo de gato, envolvendo reatividade cruzada entre as albuminas séricas (AS) de gato e de porco. Normalmente, a doença respiratória a pêlo de gato precede a alergia alimentar, sugerindo uma sensibilização primária à albumina sérica de gato. Uma vez que estas proteínas são termolábeis, as reações tendem a ser mais graves com carnes menos cozidas. Mulher de 27 anos com rinoconjuntivite persistente moderada a grave desde a infância que refere duas reações imediatas mucocutâneas após ingestão de pequenas quantidades de carne de porco. Os testes cutâneos por picada com extratos comerciais mostraram sensibilização à carne de porco e os testes prick-to-prick confirmaram sensibilização à carne de porco e de vaca cruas. A IgE específica (sIgE) foi positiva para carne de porco, e o ensaio ISAC mostrou sensibilização a Fel d 2. Foram realizados ensaios de immunoblotting SDS-PAGE IgE com extratos de carne de porco crua e cozidas que detectaram uma banda de 60 kDA. Nos ensaios de inibição por immunoblotting a albumina sérica de gato produziu uma inibição total da ligação da IgE ao extrato de carne de porco. A doente realizou duas provas de provocação oral com carne de porco e de vaca cozidas, ambas positivas com desenvolvimento de reação anafilática. A história clínica, os testes in-vivo e in-vitro levaram ao diagnóstico de síndrome gato-porco com reatividade cruzada clínica a outras albuminas séricas de mamíferos. A síndrome gato-porco é rara e pode causar reações fatais. Este caso frisa a importância da realização de provas de provocação oral com outras carnes de mamíferos bem cozidas em doentes com esta síndrome, de forma a estabelecer um limiar de tolerância e evitar possíveis reações anafiláticas inesperadas.
Assuntos
Humanos , Feminino , AdultoRESUMO
Hardwood vessel elements generate problems in industrial uncoated wood-free printing paper operation, causing vessel picking and ink refusal. These problems are mitigated using mechanical refining at the cost of paper quality. Vessel enzymatic passivation, altering its adhesion to the fiber network and reducing its hydrophobicity is a way of improving paper quality. The object of this paper is to study how the enzymatic treatment by xylanase and by an enzymatic cocktail containing cellulases and laccases affect elemental chlorine free bleached Eucalyptus globulus vessel and fiber porosities, bulk, and surface chemical compositions. Thermoporosimetry revealed the vessel structure to be more porous, surface analysis showed its lower O/C ratio and bulk chemistry analysis its higher hemicellulose content. Enzymes had different effects on porosity, bulk and surface composition of fibers and vessels, affecting vessel adhesion and hydrophobicity. Vessel picking count decreased 76% for papers containing vessels treated with xylanase and 94% for the papers with vessels treated with the enzymatic cocktail. Fiber sheet samples had lower water contact angle (54.1º) than vessels rich sheets (63.7º), that reduced with xylanase (62.1º) and cocktail (58.4º). It is proposed that differences in vessel and fiber porosity structures affect the enzymatic attacks, eventually causing vessel passivation.
Assuntos
Celulases , Eucalyptus , Eucalyptus/química , Carboidratos , Indústrias , Cloro , PapelRESUMO
Varicose veins are commonly due to saphenous vein reflux, but they can manifest more complex venous pathologies. A 45-year-old woman presented with painful leg varicosities and pelvic pain. Duplex examination showed bilateral superficial venous reflux, and, on further interrogation, cross-sectional imaging demonstrated enlarged ovarian veins and nonthrombotic iliac vein compression. Ovarian vein embolization followed by iliac vein stenting and bilateral lower extremity venous ablations and sclerotherapy was performed. After 5 years, she reports no pelvic symptoms and minimal leg symptoms. This case highlights the complex interplay of these venous pathologies and their successful treatment.
RESUMO
Background: Predicting the roughly 50% of melanoma patients that will respond to immunotherapy is challenging. We tested if splenic volume could be a predictive biomarker. Methods: Splenic volume was measured by a semiautomated commercial software tool in pre- and post-treatment PET/CT, CT or MRI in 50 melanoma patients treated with immune checkpoint inhibitors. Results: Subjects with smaller spleens had better progression-free survival (median not achieved after 30.6 months of follow-up vs median 11.2 months; p = 0.0213) than their counterparts. A cut-off of <244 cm3 yielded a sensitivity of 83% and specificity of 54% to identify responders. Conclusion: Measuring splenic volume on imaging scans is feasible. Smaller pretreatment spleen volume is associated with better responses to immune checkpoint inhibitors.
For patients with relapsed or advanced melanoma, immunotherapy is the main treatment option. Not all patients respond to it and there are few ways of knowing the odds beforehand. Treatment can be costly and dangerous. We investigated if measuring the spleen using imaging scans already routinely done to monitor the disease could give doctors an idea of whether the patient had higher chances of responding to immunotherapy. Our main finding was that patients with smaller spleens before treatment initiation were more likely to respond to immunotherapy and live longer without the disease. This finding can potentially be used in day-to-day care to inform patients and their physicians of the patient's odds and help them make an informed joint decision.