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BACKGROUND: Postoperative pulmonary complications (PPC) are the most frequent postoperative complications, with an estimated prevalence in elective surgery ranging from 20% in observational cohort studies to 40% in randomized clinical trials. However, the prevalence of PPCs in patients undergoing emergency abdominal surgery is not well defined. Lung-protective ventilation aims to minimize ventilator-induced lung injury and reduce PPCs. The open lung approach (OLA), which combines recruitment manoeuvres (RM) and positive end-expiratory pressure (PEEP) titration, aims to minimize areas of atelectasis and the development of PPCs; however, there is no conclusive evidence in the literature that OLA can prevent PPCs. The purpose of this study is to compare an individualized perioperative OLA with conventional standardized lung-protective ventilation in patients undergoing emergency abdominal surgery with clinical signs of intraoperative lung collapse. METHODS: Randomized international clinical trial to compare an individualized perioperative OLA (RM plus individualized PEEP and individualized postoperative respiratory support) with conventional lung-protective ventilation (standard PEEP of 5 cmH2O and conventional postoperative oxygen therapy) in patients undergoing emergency abdominal surgery with clinical signs of lung collapse. Patients will be randomised to open-label parallel groups. The primary outcome is any severe PPC during the first 7 postoperative days, including: acute respiratory failure, pneumothorax, weaning failure, acute respiratory distress syndrome, and pulmonary infection. The estimated sample size is 732 patients (366 per group). The final sample size will be readjusted during the interim analysis. DISCUSSION: The Individualized Perioperative Open-lung Ventilatory Strategy in emergency abdominal laparotomy (iPROVE-EAL) is the first multicentre, randomized, controlled trial to investigate whether an individualized perioperative approach prevents PPCs in patients undergoing emergency surgery.
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Abdome , Laparotomia , Respiração com Pressão Positiva , Complicações Pós-Operatórias , Humanos , Estudos Prospectivos , Abdome/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Respiração com Pressão Positiva/métodos , Emergências , Ensaios Clínicos Controlados Aleatórios como Assunto , Assistência Perioperatória/métodos , Respiração Artificial/métodosRESUMO
In the framework of the Forum for Air Quality Modelling in Europe (FAIRMODE), a modelling intercomparison exercise for computing NO2 long-term average concentrations in urban districts with a very high spatial resolution was carried out. This exercise was undertaken for a district of Antwerp (Belgium). Air quality data includes data recorded in air quality monitoring stations and 73 passive samplers deployed during one-month period in 2016. The modelling domain was 800 × 800 m2. Nine modelling teams participated in this exercise providing results from fifteen different modelling applications based on different kinds of model approaches (CFD - Computational Fluid Dynamics-, Lagrangian, Gaussian, and Artificial Intelligence). Some approaches consisted of models running the complete one-month period on an hourly basis, but most others used a scenario approach, which relies on simulations of scenarios representative of wind conditions combined with post-processing to retrieve a one-month average of NO2 concentrations. The objective of this study is to evaluate what type of modelling system is better suited to get a good estimate of long-term averages in complex urban districts. This is very important for air quality assessment under the European ambient air quality directives. The time evolution of NO2 hourly concentrations during a day of relative high pollution was rather well estimated by all models. Relative to high resolution spatial distribution of one-month NO2 averaged concentrations, Gaussian models were not able to give detailed information, unless they include building data and street-canyon parameterizations. The models that account for complex urban geometries (i.e. CFD, Lagrangian, and AI models) appear to provide better estimates of the spatial distribution of one-month NO2 averages concentrations in the urban canopy. Approaches based on steady CFD-RANS (Reynolds Averaged Navier Stokes) model simulations of meteorological scenarios seem to provide good results with similar quality to those obtained with an unsteady one-month period CFD-RANS simulations.
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Urban air pollution is one of the most important environmental problems for human health and several strategies have been developed for its mitigation. The objective of this study is to assess the impact of single and combined mitigation measures on concentrations of air pollutants emitted by traffic at pedestrian level in the same urban environment. The effectiveness of different scenarios of green infrastructure (GI), the implementation of photocatalytic materials and traffic low emission zones (LEZ) are investigated, as well as several combinations of LEZ and GI. A wide set of scenarios is simulated through Computational Fluid Dynamics (CFD) modelling for two different wind directions (perpendicular (0°) and 45° wind directions). Wind flow for the BASE scenario without any measure implemented was previously evaluated using wind-tunnel measurements. Air pollutant concentrations for this scenario are compared with the results obtained from the different mitigation scenarios. Reduction of traffic emissions through LEZ is found to be the most effective single measure to improve local air quality. However, GI enhances the effects of LEZ, which makes the combination of LEZ + GI a very effective measure. The effectiveness of this combination depends on the GI layout, the intensity of emission reduction in the LEZ and the traffic diversion in streets surrounding the LEZ. These findings, in line with previous literature, suggest that the implementation of GI may increase air pollutant concentrations at pedestrian level for some cases. However, this study highlights that this negative effect on air quality can turn into positive when used in combination with reductions of local traffic emissions.
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OBJECTIVE: Sagittal craniosynostosis (SC) is usually diagnosed during early childhood by the presence of scaphocephaly. Recently, our group found 3.3% of children under 5 years of age with normocephalic sagittal craniosynostosis (NSC) using computed tomography (CT) scans. This paper aims to validate our preliminary findings using a larger cohort of patients, and analyze factors associated with incidental NSC. METHODS: A retrospective review of head CT scans in patients aged 0 to 71 months who presented to the emergency department of our tertiary care institution between 2008 and 2020 was completed. Patients with syndromes associated with craniosynostosis (CS), history of hydrocephalus, or other brain/cranial abnormalities were excluded. Two craniofacial surgeons reviewed the CT scans to evaluate the presence and extent of CS. Demographic information, gestational age, past medical and family history, medications, and chief complaint were recorded as covariates, and differences between patients with and without CS were analyzed. Furthermore, comparison of the prevalence of CS across age groups was studied. Additional analysis exploring association between independent covariates and the presence of CS was performed in two sub-cohorts: patients ≤ 24 months of age and patients > 24 months of age. RESULTS: A total of 870 scans were reviewed. SC was observed in 41 patients (4.71% - 25 complete, 16 incomplete), all with a normal cranial index (width/length > 0.7). The prevalence of SC increased up to 36 months of age, then plateaued through 72 months of age. Patients under 2 years of age with family history of neurodevelopmental disease had 49.32 (95% CI [4.28, 567.2]) times higher odds of developing CS. Sub-cohort of patients above 24 months of age showed no variable independently predicted developing CS. CONCLUSION: NSC in young children is common. While the impact of this condition is unknown, the correlation with family history of neurodevelopmental disease is concerning.
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Craniossinostoses , Criança , Pré-Escolar , Craniossinostoses/diagnóstico por imagem , Craniossinostoses/epidemiologia , Craniossinostoses/cirurgia , Cabeça , Humanos , Lactente , Estudos Retrospectivos , Crânio , Tomografia Computadorizada por Raios XRESUMO
Health impacts of atmospheric pollution is an important issue in urban environments. Its magnitude depends on population exposure which have been frequently estimated by considering different approaches relating pollutant concentration and population exposed to it. However, the uncertainties due to the spatial resolution of the model used to estimate the pollutant concentration or due to the lack of representativeness of urban air quality monitoring station (AQMS) have not been evaluated in detail. In this context, NO2 annual average concentration at pedestrian level in the whole city of Pamplona (Spain) modelled at high spatial resolution (~1 m) by Computational Fluid Dynamic (CFD) simulations is used to estimate the total population exposure and health-related externalities by using different approaches. Air pollutant concentration and population are aggregated at different spatial resolutions ranging from a horizontal grid cell size of 100 m × 100 m to a coarser resolution where the whole city is covered by only one cell (6 km × 5 km). In addition, concentrations at AQMS locations are also extracted to assess the representativeness of those AQMS. The case with a spatial resolution of 100 m × 100 m for both pollutant-concentration distribution and population data is used as a reference (Base case) and compared with those obtained with the other approaches. This study indicates that the spatial resolution of concentration and population distribution in the city should be 1 km × 1 km or finer to obtain appropriate estimates of total population exposure (underestimations <13%) and health-related externalities (underestimations <37%). For the cases with coarser resolutions, a strong underestimation of total population exposure (>31%) and health-related externalities (>76%) was found. On the other hand, the use of AQMS concentrations can induce important errors due to the limited spatial representativeness, in particular in terms of population exposure.
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Poluentes Atmosféricos , Poluição do Ar , Poluentes Ambientais , Pedestres , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Cidades , Monitoramento Ambiental/métodos , Humanos , Material Particulado/análiseRESUMO
Atmospheric pollution is a very relevant risk for the human health, in particular in urban environments, where most people lives and high levels of pollution are found. Population exposure is traditionally estimated through concentration recorded at air quality monitoring stations (AQMS) or modelled at a spatial resolution of the order of 1 km2. However, these methodologies have limitations in urban areas where strong gradients of concentration, even in the same street, exist. In addition, the movements of pedestrians make difficult to compute reliable estimates of pollutant concentration to which people are exposed to. In this context, the main objective of this study is to estimate the exposure of pedestrians to ambient nitrogen oxides (NOx) concentrations with high spatial resolution in a real urban traffic hot-spot under different methodologies. To achieve this objective, a novel methodology which combines high-resolution NOx concentrations from computational fluid dynamic (CFD) simulations with the pedestrian flows obtained by pedestrian mobility microsimulations is applied to an urban area of Madrid, Spain. High-resolution maps show pedestrian exposure peaks, at bus stops and crosswalks, that cannot be captured by the simpler methods based on spatial average concentration (SAC) or concentration measured in an AQMS. Total daily exposure obtained is 1.19 · 109 person s µg m-3, while SAC and AQMS concentration methods yielded 9-23% and 30-40% lower values. In conclusion, the proposed methodology allows to determine the areas with higher exposure in order to design local strategies to reduce the impact on human health. In addition, from a more general point of view, the total exposure in the studied area is better estimated by using spatial average concentration than through concentration recorded by AQMS. The assessment of the spatial representative of AQMS becomes necessary to use AQMS concentration to evaluate air quality and population exposure of an urban area.
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Poluentes Atmosféricos , Poluição do Ar , Pedestres , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Exposição Ambiental/análise , Monitoramento Ambiental , Humanos , Material Particulado/análise , Espanha , Emissões de Veículos/análiseRESUMO
BACKGROUND: Secukinumab has demonstrated sustained long-term efficacy with a favourable safety profile in various psoriatic disease manifestations in adults. OBJECTIVES: Here, the efficacy and safety of two secukinumab dosing regimens [low dose (LD) and high dose (HD)] in paediatric patients with severe chronic plaque psoriasis over one year are reported. METHODS: In this multicentre, double-blind study (NCT02471144), patients aged 6 to <18 years with severe chronic plaque psoriasis were stratified and randomized by weight (<25 kg, 25 to <50 kg, ≥50 kg) and age (6 to <12 years, 12 to <18 years) to receive low-dose (LD: 75/75/150 mg) or high-dose (HD: 75/150/300 mg) subcutaneous secukinumab or placebo or etanercept 0.8 mg/kg (up to a max of 50 mg). RESULTS: Overall, 162 patients were randomized to receive secukinumab LD (n = 40) or HD (n = 40), etanercept (n = 41) or placebo (n = 41). The co-primary objectives of the study were met with both secukinumab doses (LD and HD) showing superior efficacy compared to placebo (P < 0.0001) with respect to PASI 75 response (80.0%, 77.5% vs. 14.6%) and IGA mod 2011, 0 or 1 response (70%, 60% vs. 4.9%) at Week 12. Both secukinumab doses were superior to placebo (P < 0.0001) with respect to PASI 90 response at Week 12 (72.5%, 67.5% vs. 2.4%). The efficacy of both doses was sustained to Week 52 with secukinumab achieving higher responses vs. etanercept (PASI 75/90/100: LD, 87.5%/75.0%/40.0% and HD, 87.5%/80.0%/47.5.% vs. etanercept, 68.3%/51.2%/22.0% and IGA 0 or 1: LD, 72.5% and HD, 75.0% vs. etanercept, 56.1%). The safety profile of secukinumab was consistent with the adult Phase 3 studies, with no new safety signals identified. CONCLUSIONS: Both doses of secukinumab demonstrated high and sustained efficacy up to Week 52 with a favourable safety profile in paediatric patients with severe chronic plaque psoriasis.
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Anticorpos Monoclonais , Psoríase , Adulto , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados , Criança , Método Duplo-Cego , Humanos , Psoríase/tratamento farmacológico , Índice de Gravidade de Doença , Resultado do TratamentoAssuntos
Países em Desenvolvimento , Eutrofização , América , Dinâmica Populacional , Região do CaribeAssuntos
Países em Desenvolvimento , Eutrofização , América , Região do Caribe , Dinâmica PopulacionalRESUMO
Protein O-glucosyltransferase 1 (POGLUT1) activity is critical for the Notch signaling pathway, being one of the main enzymes responsible for the glycosylation of the extracellular domain of Notch receptors. A biallelic mutation in the POGLUT1 gene has been reported in one family as the cause of an adult-onset limb-girdle muscular dystrophy (LGMD R21; OMIM# 617232). As the result of a collaborative international effort, we have identified the first cohort of 15 patients with LGMD R21, from nine unrelated families coming from different countries, providing a reliable phenotype-genotype and mechanistic insight. Patients carrying novel mutations in POGLUT1 all displayed a clinical picture of limb-girdle muscle weakness. However, the age at onset was broadened from adult to congenital and infantile onset. Moreover, we now report that the unique muscle imaging pattern of "inside-to-outside" fatty degeneration observed in the original cases is indeed a defining feature of POGLUT1 muscular dystrophy. Experiments on muscle biopsies from patients revealed a remarkable and consistent decrease in the level of the NOTCH1 intracellular domain, reduction of the pool of satellite cells (SC), and evidence of α-dystroglycan hypoglycosylation. In vitro biochemical and cell-based assays suggested a pathogenic role of the novel POGLUT1 mutations, leading to reduced enzymatic activity and/or protein stability. The association between the POGLUT1 variants and the muscular phenotype was established by in vivo experiments analyzing the indirect flight muscle development in transgenic Drosophila, showing that the human POGLUT1 mutations reduced its myogenic activity. In line with the well-known role of the Notch pathway in the homeostasis of SC and muscle regeneration, SC-derived myoblasts from patients' muscle samples showed decreased proliferation and facilitated differentiation. Together, these observations suggest that alterations in SC biology caused by reduced Notch1 signaling result in muscular dystrophy in LGMD R21 patients, likely with additional contribution from α-dystroglycan hypoglycosylation. This study settles the muscular clinical phenotype linked to POGLUT1 mutations and establishes the pathogenic mechanism underlying this muscle disorder. The description of a specific imaging pattern of fatty degeneration and muscle pathology with a decrease of α-dystroglycan glycosylation provides excellent tools which will help diagnose and follow up LGMD R21 patients.
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Distroglicanas/metabolismo , Glucosiltransferases/genética , Músculo Esquelético/patologia , Distrofia Muscular do Cíngulo dos Membros/genética , Distrofia Muscular do Cíngulo dos Membros/patologia , Animais , Animais Geneticamente Modificados , Drosophila melanogaster , Feminino , Estudos de Associação Genética , Glicosilação , Humanos , Masculino , Músculo Esquelético/metabolismo , Distrofia Muscular do Cíngulo dos Membros/metabolismo , Mutação , Linhagem , Células Satélites de Músculo Esquelético/patologiaRESUMO
BACKGROUND AND OBJECTIVES: Steinert's disease or myotonic dystrophy type 1 (MD1), (OMIM 160900), is the most prevalent myopathy in adults. It is a multisystemic disorder with dysfunction of virtually all organs and tissues and a great phenotypical variability, which implies that it has to be addressed by different specialities with experience in the disease. The knowledge of the disease and its management has changed dramatically in recent years. This guide tries to establish recommendations for the diagnosis, prognosis, follow-up and treatment of the complications of MD1. MATERIAL AND METHODS: Consensus guide developed through a multidisciplinary approach with a systematic literature review. Neurologists, pulmonologists, cardiologists, endocrinologists, neuropaediatricians and geneticists have participated in the guide. RECOMMENDATIONS: The genetic diagnosis should quantify the number of CTG repetitions. MD1 patients need cardiac and respiratory lifetime follow-up. Before any surgery under general anaesthesia, a respiratory evaluation must be done. Dysphagia must be screened periodically. Genetic counselling must be offered to patients and relatives. CONCLUSION: MD1 is a multisystemic disease that requires specialised multidisciplinary follow-up.
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Aconselhamento Genético , Distrofia Miotônica/diagnóstico , Distrofia Miotônica/genética , Guias de Prática Clínica como Assunto/normas , Transtornos de Deglutição , Seguimentos , Humanos , Distrofia Miotônica/complicaçõesRESUMO
Introducción: El Staphylococcus Aureus constituye un agente etiológico frecuente de intoxicaciones alimentarias y se encuentra asociado a diversos alimentos. Objetivo: Describir la frecuencia de portación de Staphylococcus Aureus en manipuladores de alimentos de restaurantes de Asunción durante el 2017. Metodología: Se realizó un estudio observacional, prospectivo, descriptivo de corte transversal a manipuladores de alimentos de restaurantes de Asunción durante los meses de mayo a junio del 2017. Se realizaron tres hisopados nasales a cada uno de los 30 manipuladores de alimentos para determinar si la portación era intermitente, permanente u ocasional. Al mismo tiempo fueron realizadas encuestas donde se midieron variables demográficas. Resultados: La prevalencia de portación de Staphylococcus Aureus fue del 33,3 % (10), siendo el 40% (4) esporádica e intermitente y el 20% (2) permanente. En cuanto a las características demográficas de los manipuladores,el 56,66% (17) fueron del sexo masculino, eran solteros 43,33% (13) y el 50% (15) contaban con estudios secundarios completos. El promedio de edad de 29 de los manipuladores fue de 39,5 años con un rango comprendido entre 18 y 85 años. El 23,33% (7) utilizaban guantes a la hora de manipular los alimentos. Además, se pudo observar que el 26,66% (8) utilizaba gorros. Llamó la atención que el 30% (9) de los encuestados no presentaban uñas limpias durante la manipulación. Palabras clave: Staphylococcus Aureus; manipuladores; alimentos.
Introduction: Staphylococcus Aureus is a frequent etiologic agent of food poisoning and is associated with various foods. Objective : To describe the frequency of Staphylococcus Aureus in food handlers of restaurants in Asunción during 2017. Methodology: An observational, prospective, descriptive, cross-sectional study was carried out on food handlers in restaurants in Asuncion during the months of May to June 2017. Three nasal swabs were made to each of the 30 food handlers to determine if the carriage was intermittent, permanent or occasional. At thesame time, surveys were carried out where demographic variables were measured. Results: The prevalence of carrying Staphylococcus Aureus was 33.3% (10), being 40% (4) sporadic and intermittent and 20% (2) permanent. Regarding the demographic characteristics of the manipulators, 56.66% (17) were male, were single 43.33% (13) and 50% (15) had complete secondary education. The average age of 29 of the manipulators was 39.5 years with ranger between 18 and 85 years. 23.33% (7) used gloves when handling food. In addition, it was observed that 26.66% (8) used caps. It was noted that 30% (9) of theres pondents did not have clean nails during handling. Keywords: Staphylococcus Aureus; manipulators; food.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/isolamento & purificação , Manipulação de Alimentos , Paraguai/epidemiologia , Infecções Estafilocócicas/transmissão , Staphylococcus aureus/efeitos dos fármacos , Resistência Microbiana a Medicamentos , Higiene , Prevalência , Estudos Transversais , Estudos ProspectivosRESUMO
Objetivo: Determinar si las variables: turno de trabajo, situación laboral, el realizar horas laborales extras y servicio en el que se encuentra actualmente, establecen diferencias en el nivel con que se presenta el síndrome de Burnout en los profesionales de enfermería del Hospital Materno Infantil de la ciudad de Durango. Método: Se realizó un estudio correlacional, transversal y no experimental a partir de la aplicación del Maslach Burnout Inventory-General Survey, a 204 enfermeras/os del Hospital Materno Infantil de la ciudad de Durango, en México. Resultados: De las cuatro variables estudiadas (turno de trabajo, situación laboral, el realizar horas laborales extras y servicio en el que se encuentra actualmente), es la del turno laboral la que marca una diferencia significativa en el nivel en que se presenta el síndrome de Burnout en el personal de enfermería. Conclusiones: Las condiciones laborales pueden desencadenar situaciones estresantes que a la larga generen el síndrome de Burnout, tal es el caso de variables como turno en que se labora o el tipo de nombramiento laboral que se posea. La aparición de este síndrome afecta el desempeño profesional del personal de enfermería.
Abstract: Objective: To determine if the variables Work Shift, Labor Situation, Extra Hours, and Service Area, make differences in the levels of Burnout among nursing personnel working in the Mother and Child Hospital of the city of Durango, Mexico. Method: This is a correlational, transversal, and not-experimental study which uses the Maslach Burnout Inventory-General Survey to estimate the level of Burnout of 204 nurses working in the Mother and Child Hospital of the City of Durango, Mexico. Results: From the four studied variables, Work Shift induced significant differences on the levels of reported Burnout. Conclusions: Conditions such as Shift and Position can trigger stressful situations which in the long term can make the nursing personnel develop the Burnout syndrome which profoundly affects their professional performance.
Resumo: Objetivo: Determinar se as variáveis mudam, status de emprego, horas de trabalho e realizar serviço extra que está atualmente, estabelecer diferenças na prevalência da síndrome de Burnout em enfermeiros Hospital Materno-Infantil na cidade de Durango. Método: Um estudo transversal de correlação, não experimental foi conducido a partir da aplicação do Inventário-geral Pesquisa Maslach Burnout 204 enfermeiras/os Hospital Materna e infantil na cidade de Durango, México. Resultados: De las quatro variáveis estudadas (turno de trabajo, situacão laboral, realização de exercícios laborais extras e serviço em que se encontra ativo), é o mercado de trabalho que marca a diferença significativa no nível com que se apresenta o síndrome de Burnout en personal of enfermería. Conclusões: As condições laborales podem gerar situações estresantes que a larga generada o síndrome de Burnout, tal é o caso de variáveis como virar em que se labora ou o tipo de nomeação laboral que se posea. A aparição deste síndrome afecta o desempenho profissional do pessoal da enfermagem.
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Humanos , Masculino , Feminino , Adulto , Síndrome , Esgotamento Psicológico , Recursos Humanos de Enfermagem HospitalarRESUMO
TITLE: Propedeutica medica y neurologia.
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Educação Pré-Médica , Neurologia/educação , Relações Médico-Paciente , HumanosRESUMO
INTRODUCTION: This study evaluated the influence of three-repetition training with a dental anaesthesia simulation model (DASM) on the perception of learning by dental students. MATERIALS AND METHODS: Dental students who had never used a dental anaesthesia technique were randomly divided into two groups that were taught the anterior superior alveolar nerve infiltrative anaesthesia technique. Group 1 (G1; N = 10) followed a three-stage learning method: (i) theoretical lecture, (ii) clinical demonstration and (iii) DASM training, including three repetitions of the anaesthesia technique. Group 2 (G2; N = 10) followed only the 1st and 2nd stages. The students in both groups then performed the anaesthesia technique. The perception of the students was evaluated by four learning concepts. Each was evaluated with a 5-point Likert scale questionnaire. The average score of each item of the questionnaire for G1 was compared with that of G2. Statistically significant differences were identified with the Mann-Whitney test. The average working time of each group was timed and compared by Student's t-test to identify possible statistically significant differences. RESULTS: Students in G1 showed higher average scores of perception in controlling the handling of the dental syringe and confidence in performing the injection (P < 0.05) and showed an average working time shorter than that of the students in G2 (P < 0.05). CONCLUSION: The DASM positively influenced the perception learning of the dental students; it increased their confidence and syringe handling ability, as well as skills to perform the injection of anaesthesia more quickly.
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Anestesia Dentária , Atitude , Educação em Odontologia/métodos , Modelos Educacionais , Treinamento por Simulação , Estudantes de Odontologia/psicologia , Humanos , México , Distribuição Aleatória , AutorrelatoRESUMO
Polymorphisms in candidate genes can produce significant and favorable changes in the phenotype, and therefore are useful for the identification of the best combination of favorable variants for marker-assisted selection. In the present study, an assessment to evaluate the effect of 11 single nucleotide polymorphisms (SNPs) in candidate genes on live weight traits of registered Brahman cattle was performed. Data from purebred bulls were used in this assessment. The dataset included birth (BW), weaning (WW), and yearling (YW) weights. A panel of 11 SNP markers, selected by their formerly reported or apparent direct and indirect association with live weight traits, was included in an assessment previously confirming their minimum allele frequency (<0.05). Live weights were adjusted BW (aBW), WW (aWW), and YW (aYW) using a generalized linear model, which included the fixed effects of herd and season of birth and the random effect of the sire and year of birth. An SNP in a growth hormone gene (GH4.1) was significantly related to aWW (P = 0.035) with an estimate substitution effect of 3.97 kg (P = 0.0210). In addition, a leptin SNP (LEPg.978) was significantly associated with aYW (P = 0.003) with an estimate substitution effect of 9.57 kg (P = 0.0007). The results suggest that markers GH4.1 and LEPg.978 can be considered as candidate loci for assisted genetic improvement programs in Mexican Brahman cattle.
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Peso Corporal , Hormônio do Crescimento/genética , Leptina/genética , Polimorfismo de Nucleotídeo Único , Característica Quantitativa Herdável , Alelos , Animais , Cruzamento , Bovinos , Feminino , Expressão Gênica , Frequência do Gene , Loci Gênicos , Marcadores Genéticos , Modelos Lineares , Masculino , México , Modelos GenéticosRESUMO
Liver transplantation (LT) offers patients with liver disease a real chance for long-term survival. In the past decade, successful survival after LT along with the Model for End-Stage Liver Disease-based allocation policy have increased willingness to accept patients with a higher risk profile and marginal organs and to prioritize the sickest patients on the waiting list. Therefore, the anesthesiologist now deals with very challenging patients. In the present review, we aimed to highlight key aspects of intraoperative LT management in high-risk patients and to place these aspects in the perspective of their impact on perioperative outcomes. Conservative standardized perioperative strategies mandate a switch toward accurate and tailored perioperative anesthetic care to maintain the steady improvement in recipient survival rates after LT. In our opinion, continuous assessment of fluid status and cardiac performance, strategies promoting graft decongestion, rational hemostatic management, and the identification of LT recipients with potential risk of vascular complications should constitute the cornerstone of intraoperative management.
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Transplante de Fígado/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Transplantes , Resultado do TratamentoRESUMO
BACKGROUND: The development of metabolic syndrome (MS) after liver transplantation (LT) is a major source of mortality derived from cardiovascular events. The aim of the present study was to determine the prevalence and risk factors of MS after LT. METHODS: One-hundred seventy-four consecutive LT patients from January 2004 to June 2010 surviving longer than 1 year after LT were included. Median follow-up after LT was 48 months. Independent predictors of MS were obtained by means of multivariate logistic regression. RESULTS: At 3 years after LT, 25.5% of patients reached a body mass index (BMI) ≥30 kg/m2, 35.6% of patients developed arterial hypertension, 54.2% showed impaired fasting glucose, 22.5% had serum cholesterol >200 mg/dL, and 22.5% showed hypertriglyceridemia >150 mg/dL. The prevalence of MS ranged from 49% to 86% depending on the considered period. The pre-LT variables associated with MS were age at LT (odds ratio [OR], 1.08; P = .002), BMI of recipient before LT (OR, 1.23; P = .001), serum glucose (OR, 1.02; P = .005), and non-heart-beating donor (OR, 1.02; P = .046). The post-LT predictors of MS were body weight (OR, 1.04; P = .005), arterial hypertension (OR, 1.02; P = .047), and serum glucose (OR, 1.02; P = .011) at 6 months. CONCLUSIONS: LT patients develop MS in a high proportion and progressively despite current efforts (ie, lifestyle modifications and aggressive management of hypertension, diabetes, and hyperlipidemia). The associated risk factors include age, increased BMI, and pre- and post-LT glucose.