Detection of multidrug-resistant bacteria in the nasal cavities and evaluation of sinus disorders in patients undergoing Le Fort I osteotomy.

INTRODUCTION: Orthognathic surgery can lead to sinus alterations, including sinusitis, attributed to the exposure of maxillary sinuses during Le Fort I osteotomy. Furthermore, being a hospital-based procedure, there is potential risk of complications arising from bacteria prevalent in such environments. This study evaluated maxillary sinusitis occurrence and the presence of multidrug-resistant bacteria in the nasal cavity before and after orthognathic surgery. METHODS: Ten patients with dentofacial deformities underwent Le Fort I osteotomy. Clinical evaluations using SNOT-22 questionnaire were performed, and nasal cavity samples were collected pre-surgery and 3-6 months post-surgery to quantify total mesophilic bacteria and detect Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumoniae. Cone Beam Computed Tomography (CBCT) was performed pre- and post-operatively, and the results were evaluated using the Lund-Mackay system. This study was registered and approved by the Research Ethics Committee of PUCRS (No. 4.683.066). RESULTS: The evaluation of SNOT-22 revealed that five patients showed an improvement in symptoms, while two remained in the same range of interpretation. One patient developed post-operative maxillary sinusitis, which was not detected at the time of evaluation by SNOT-22 or CBCT. CBCT showed a worsening sinus condition in three patients, two of whom had a significant increase in total bacteria count in their nasal cavities. The Brodsky scale was used to assess hypertrophy in palatine tonsils, where 60% of the subjects had grade 1 tonsils, 20% had grade 2 and 20% had grade 3. None of the patients had grade 4 tonsils, which would indicate more than 75% obstruction. Two patients harboured S. aureus and K. pneumoniae in their nasal cavities. Notably, K. pneumoniae, which was multidrug-resistant, was present in the nasal cavity of patients even before surgery, but this did not result in maxillary sinusitis, likely due to the patients' young and healthy condition. CONCLUSION: There was an improvement in signs and symptoms of maxillary sinusitis and quality of life in most patients after orthognathic surgery. However, some patients may still harbour multidrug-resistant bacteria, even if they are asymptomatic. Therefore, a thorough pre-operative assessment is essential to avoid difficult-to-treat post-operative complications.

Increased ompW and ompA expression and higher virulence of Acinetobacter baumannii persister cells.

BACKGROUND: Acinetobacter baumannii is one of the main causes of healthcare-associated infections that threaten public health, and carbapenems, such as meropenem, have been a therapeutic option for these infections. Therapeutic failure is mainly due to the antimicrobial resistance of A. baumannii, as well as the presence of persister cells. Persisters constitute a fraction of the bacterial population that present a transient phenotype capable of tolerating supra-lethal concentrations of antibiotics. Some proteins have been suggested to be involved in the onset and/or maintenance of this phenotype. Thus, we investigated the mRNA levels of the adeB (AdeABC efflux pump component), ompA, and ompW (outer membrane proteins) in A. baumannii cells before and after exposure to meropenem. RESULTS: We found a significant increase (p-value < 0.05) in the expression of ompA (> 5.5-fold) and ompW (> 10.5-fold) in persisters. However, adeB did not show significantly different expression levels when comparing treated and untreated cells. Therefore, we suggest that these outer membrane proteins, especially OmpW, could be part of the mechanism of A. baumannii persisters to deal with the presence of high doses of meropenem. We also observed in the Galleria mellonella larvae model that persister cells are more virulent than regular ones, as evidenced by their LD50 values. CONCLUSIONS: Taken together, these data contribute to the understanding of the phenotypic features of A. baumannii persisters and their relation to virulence, as well as highlight OmpW and OmpA as potential targets for drug development against A. baumannii persisters.

Long-term prognosis of out-of-hospital cardiac arrest due to idiopathic ventricular arrhythmias.

Life-threatening ventricular arrhythmias (VA) may occur in patients with unknown cardiac disease. A sizable part of them remains labeled as Idiopathic VA and limited data is available regarding their natural history. Our aim was to evaluate the long-term clinical outcomes of survivors of an idiopathic life-threatening VA. Patients who survived an idiopathic life-threatening VA referred to an ICD were included and followed for a median follow-up of 7 years. Clinical and device data were collected and a comparison between genders was made. A total of 29 patients, 41% female, mean age of 50 (19) years were studied; all were implanted with an ICD at index hospitalization. At follow-up, an etiological diagnosis was established in 38% of patients. Genetic testing improved the diagnosis and allowed the identification of a distinct clinical entity in 60% of patients (p=0.04, OR=7.0), especially in women. Regarding ICD data, 31% received appropriate therapies with a median time to first appropriate shock of 39 months (IQR 12-46 months). Men had a significantly higher prevalence of appropriated shocks (50% vs 8%, p=0.04), with a similar time to the first arrhythmic event between genders. Two of the patients died, both from non-arrhythmic causes. Etiologic diagnosis and recurrence prediction in patients with idiopathic VA is challenging, even with long-term follow-up and sophisticated diagnostic evaluation.  Genetic testing significantly improved the diagnostic yield, especially in women. Arrhythmia recurrence occurred in about one-third of patients and is significantly higher in men, underscoring the importance of ICD implantation.

Artificial neural networks for performance prediction of full-scale wastewater treatment plants: a systematic review.

Wastewater treatment plants (WWTPs) are complex systems that must maintain high levels of performance to achieve adequate effluent quality to protect the environment and public health. Artificial intelligence and machine learning methods have gained attention in recent years for modeling complex problems, such as wastewater treatment. Although artificial neural networks (ANNs) have been identified as the most common of these methods, no study has investigated the development and configuration of these models. We conducted a systematic literature review on the use of ANNs to predict the effluent quality and removal efficiencies of full-scale WWTPs. Three databases were searched, and 44 records of the 667 identified were selected based on the eligibility criteria. The data extracted from the papers showed that the majority of studies used the feedforward neural network model with a backpropagation training algorithm to predict the effluent quality of plants, particularly in terms of organic matter indicators. The findings of this research may help in the search for an optimum design modeling process for future studies of similar prediction problems.

Municipal wastewater discharge standards for ammonia nitrogen in Brazil: technical elements to guide decisions.

In Brazil, domestic effluents represent the primary source of pressure on water resources. Water pollution can be controlled by defining, applying, and enforcing the effluent standards for wastewater discharge. Discussions are ongoing in Minas Gerais State regarding the possibility of setting a discharge standard for ammonia nitrogen in municipal wastewater, which is currently not required. However, providing technical support for decision-making is challenging because of the difficulties in accessing monitoring data from sewage treatment plants. This study aimed to analyze the monitoring data from 49 sewage treatment plants operating in Minas Gerais to offer guidance for decision making. High concentrations of ammonia nitrogen in the effluents of the treatment plants were found, reinforcing the need for better control and the adoption of more advanced technologies. Furthermore, it was observed an increase in concentrations downstream of the discharges in the receiving water bodies. Adopting a progressive and adaptable discharge standard can be a solution for better control of treatment systems.

Performance of sewage treatment plants and impact of effluent discharge on receiving water quality within an urbanized area.

In Brazil, wastewater treatment coverage is low. Even when treatment is carried out, many municipalities cannot achieve adequate levels of contaminant removal, and the usual practice of releasing raw or treated domestic effluent into water bodies remains. Thus, this pollution source puts pressure on water resources, compromising downstream uses of the disposal. This study has two aims: (1) to evaluate the performance of sewage treatment plants and (2) to determine the impact of discharging treated effluent on the water quality of receiving water bodies located within an urbanized area in the Velhas River basin, Minas Gerais State, Brazil. Monitoring data from raw wastewater were compared with typical ranges reported in literature, and effluent concentrations were compared between plants. The monitoring data of the receiving water bodies collected at points upstream and downstream of each disposal were statistically compared. Different performances between the systems and significant alterations in the receiving bodies resulting from the discharge of the treated effluents were found.

Spatial variability of surface water quality in a large Brazilian semiarid reservoir and its main tributaries.

Brazil has one of the greatest hydroelectric potential in the world with high number of reservoirs for the electricity generation. However, little is known about the influence of these environments on the water quality. The water quality monitoring data from 14 stations distributed throughout the Irapé HPP reservoir (lentic environment), and its main tributaries (lotic environment), between the years 2008 and 2018, were evaluated and compared to assess the spatial variability of water quality. The analyzed parameters included total alkalinity, thermotolerant coliforms, electric conductivity, biochemical oxygen demand, dissolved iron, total phosphorus, nitrate, total ammoniacal nitrogen, dissolved oxygen, pH, total dissolved solids, sulfate, water temperature, and turbidity. Cluster analysis (CA), Kruskal-Wallis (KW) tests, Spearman rank-order correlation, and principal component analysis (PCA) were applied to identify and compare the relationship between the main parameters in the lotic and lentic environments. The CA resulted in four clusters according to proximity and the environment type (lotic or lentic). In general, the water quality showed better conditions in the reservoir and in the lotic stations on the immediate surround. The results may be associated with the greater sedimentation in the lentic environment. The analyses indicated that agricultural activities and the geochemical characteristics of the region are the main responsible for changes in the water quality.

Impact of fecal contamination on surface water quality in the São Francisco River hydrographic basin in Minas Gerais, Brazil.

Proper water quality monitoring is a valuable tool for water resource management, helping to identify polluting sources and risks related to the use of water resources. One of the main types of contamination found in Brazilian water bodies is fecal contamination, which originates mainly from point source pollution through wastewater disposal. Thus, this study analyzed water quality monitoring data from the responsible environmental body (Minas Gerais Institute of Water Management, IGAM), related to the fecal contamination indicator (FCI), for the years 2000-2018. This was done for the Minas Gerais portion of the São Francisco River basin (SFRB-MG), one of the most important basins in the country. The 10 sub-basins in the area were compared using statistical tools. The work found significant differences between the sub-basins in terms of FCI concentration, highlighting the most impacted ones (SF2, SF3, and SF5) as also being the most densely populated. It is necessary to invest in sanitation measures in order to ensure that water resources are preserved, as well as to reduce the public health risks of downstream municipalities that are supplied with previously contaminated water.

Compatibility in pollen-pistil interaction of interspecific crossings with Passiflora spp.

Intraspecies or interspecies crossings transfer relevant alleles between plants. However, some interspecies crossings involving Passiflora species impede ovule fertilization and the viable development of seeds. Thus, the purpose of this study was to verify the viability of interspecific crossings and monitor pollen tube development. The experiment had six species of Passiflora in the reciprocal crossings. Histochemical tests aimed to evaluate the percentage of intraspecies or interspecies crossings that resulted in fruit development and pollen tube development. Ovule fertilization and fruit development occurred in determined directions of crossings when controlling the female or male genitor, but only one case of reciprocal crossing had success. In crossings with no fruit development, histological analysis showed that some callus developed in the stigma and style, confirming unilateral and interspecies incompatibility in the genus Passiflora to some species and some directions of crossings.

Castration-induced prostate epithelial cell apoptosis results from targeted oxidative stress attack of M1142 -macrophages.

Prostate development and function are regulated by androgens. Epithelial cell apoptosis in response to androgen deprivation is caspase-9-dependent and peaks at Day 3 after castration. However, isolated epithelial cells survive in the absence of androgens. Znf142 showed an on-off expression pattern in intraepithelial CD68-positive macrophages, with the on-phase at Day 3 after castration. Rats treated with gadolinium chloride to deplete macrophages showed a significant drop in apoptosis, suggesting a causal relationship between macrophages and epithelial cell apoptosis. Intraepithelial M1-polarization was also limited to Day 3, and the inducible nitric oxide synthase (iNOS) knockout mice showed significantly less apoptosis than wild-type controls. The epithelial cells showed focal DNA double-strand breaks (DSB), 8-oxoguanine, and protein tyrosine-nitrosylation, fingerprints of exposure to peroxinitrite. Cultured epithelial cells induced M1-polarization and showed focal DSB and underwent apoptosis. The same phenomena were reproduced in LNCaP cells cocultured with Raw 264.7 macrophages. In conclusion, the M1 142 -macrophage (named after Znf142) attack causes activation of the intrinsic apoptosis pathway in epithelial cells after castration.

Impact of genetic variations in ADORA2A gene on depression and symptoms: a cross-sectional population-based study.

Genetic variants involved in adenosine metabolism and its receptors were associated with increased risk for psychiatric disorders, including anxiety, depression, and schizophrenia. Here, we examined an association between a single nucleotide polymorphism in A2A receptor gene (ADORA2A, rs2298383 SNP) with current depressive episode and symptom profile. A total of 1253 individuals from a cross-sectional population-based study were analyzed by the Mini International Neuropsychiatric Interview 5.0. Our data showed that the TT genotype of ADORA2A rs2298383 SNP was associated with reduced risk for depression when compared to the CC/CT genotypes (p = 0.020). This association remained significant after adjusting for confounding variables such as smoking, gender, socioeconomic class, and ethnicity (OR = 0.631 (95% CI 0.425-0.937); p = 0.022). Regarding the symptoms associated with depression, we evaluated the impact of the ADORA2A SNP in the occurrence of sad/discouraged mood, anhedonia, appetite changes, sleep disturbances, motion changes, energy loss, feelings of worthless or guilty, difficulty in concentrating, and presence of bad thoughts. Notably, the TT genotype was independently associated with reduced sleep disturbances (OR = 0.438 (95% CI 0.258-0.743); p = 0.002) and less difficulty in concentrating (OR = 0.534 (95% CI 0.316-0.901; p = 0.019). The cross-sectional design cannot evaluate the cause-effect relationship and did not evaluate the functional consequences of this polymorphism. Our data support an important role for ADORA2A rs2298383 SNP in clinical heterogeneity associated with depression. The presence of the TT genotype was associated with decrease risk for current depression and disturbances in sleep and attention, two of the most common symptoms associated with this disorder.

Assessment of spatial variations in the surface water quality of the Velhas River Basin, Brazil, using multivariate statistical analysis and nonparametric statistics.

The Velhas River sub-basin, which is located in the third-largest river basin in Brazil (São Francisco), is in an advanced state of degradation. In this work, the surface water quality of the Velhas River Basin was studied at 65 monitoring sites; 16 water quality parameters were sampled quarterly for 11 years (2008 to 2013). Cluster analysis (CA) and a nonparametric Kruskal-Wallis test were associated with the analysis of violations to water quality standards to interpret the water quality data set from the Velhas River Basin and assess its spatial variations. The CA grouped the 65 monitoring sites into four groups. The Kruskal-Wallis test identified significant differences (p < 0.05) between the groups formed by CA. The results show that watercourses located in the upper region of the Velhas River Basin are more affected by the release of industrial effluent and domestic sewage, and the lower region is more affected by diffuse pollution and erosion. This association between multivariate statistical techniques and nonparametric tests was effective for the classification and processing of large water quality datasets and the identification of major differences between water pollution sources in the basin. Therefore, these results provide an understanding of the factors affecting water quality in the Velhas River Basin. The results can aid in decision-making by water managers and these methods can be applied to other river basins.

Adequacy analysis of drinking water treatment technologies in regard to the parameter turbidity, considering the quality of natural waters treated by large-scale WTPs in Brazil.

This paper seeks to present a performance evaluation of large-scale water treatment plants and verify the adjustment of the treatment to the parameter turbidity of natural waters. Nonparametric and multivariate statistical tools were used to analyze raw water and treated water turbidity of a large on-line monitoring databank for the period from 2013 to 2015, from six large-scale treatment plants utilizing different technologies. Cluster analysis was able to differentiate adequately groups of treatment plants with similar raw and treated water quality. Considering the effluent turbidity as a marker parameter, the results indicated that selection of the technology to be applied must be well studied to always seek the best solution, and that other factors than only the raw water characteristics should be evaluated. It was also demonstrated that utilization of the same treatment technology does not always result in the same effluent quality, since there are many factors related to operation, maintenance, raw water variability, climatic interferences, and others.

Extracts of Peels and Seeds of Five Varieties of Brazilian Jabuticaba Present High Capacity to Deactivate Reactive Species of Oxygen and Nitrogen.

Jabuticaba has a high concentration of phenolic compounds, which have a significant antioxidant capacity. Methodologies have been developed to evaluate the ability of plant extracts to fight free radicals such as H2O2, O2•-, HOCl, ONOO- and ROO•. Thus, the capacity of deactivation of reactive oxygen species (ROS) and reactive nitrogen species (RNS) in peel and seed extracts of five varieties of jabuticaba was evaluated. Sabará peel (SFP) deactivated HOCl with IC50 9.24 µg. mL-1; Paulista seed (PF) deactivated O2•- with IC50 16.15 µg. mL-1; Coroada seed (CFP) deactivated ONOO- with IC50 3.84 µg. mL-1; the peel of CFP deactivated ONOO- with IC50 5.88 µg. mL-1; the peel of SFP deactivated the ROO• at 918.16 µmol TE. g-1; and Sabará seed deactivated H2O2 with 49.11% inhibition at a concentration of 125 µg. mL-1 of extract. These results demonstrate the high antioxidant potential of this fruit, indicating that it could be extremely beneficial to human health.

Correction to: The use of multivariate statistical methods for optimization of the surface water quality network monitoring in the Paraopeba river basin, Brazil.

Unfortunately, the original version of this article was published online with error. The Tables 3 and 4 data was mixed up. The corrected Tables 3 and 4 are shown in the next page. The original article has been corrected.

The use of multivariate statistical methods for optimization of the surface water quality network monitoring in the Paraopeba river basin, Brazil.

This study sought to evaluate and propose adjustments to the water quality monitoring network of surface freshwaters in the Paraopeba river basin (Minas Gerais, Brazil), using multivariate statistical methods. A total of 13,560 valid data were analyzed for 19 water quality parameters at 30 monitoring sites, over a period of 5 years (2008-2013). The cluster analysis grouped the monitoring sites in eight groups based on similarities of water quality characteristics. This analysis made it possible to detect the most relevant monitoring stations in the river basin. The principal components analysis associated with non-parametric tests and the analysis of violation of the standards prescribed by law, allowed for identifying the most relevant parameters which must be maintained in the network (thermotolerant coliforms, total manganese, and total phosphorus). The discharge of domestic sewage and industrial wastewater, that from mining activities and diffuse pollution from agriculture and pasture areas are the main sources of pollution responsible for the surface water quality deterioration in this basin. The BP073 monitoring site presents the most degraded water quality in the Paropeba river basin. The monitoring sites BP094 and BP092 are located geographically close and they measure similar water quality, so a possible assessment of the need to maintain only one of the two in the monitoring network is suggested. Therefore, multivariate analyses were efficient to assess the adequacy of the water quality monitoring network of the Paraopeba river basin, and it can be used in other watersheds.

Using multivariate techniques as a strategy to guide optimization projects for the surface water quality network monitoring in the Velhas river basin, Brazil.

Surface water quality monitoring networks are usually deployed and rarely re-evaluated with regard to their effectiveness. In this sense, this work sought to evaluate and to guide optimization projects for the water quality monitoring network of the Velhas river basin, using multivariate statistical methods. The cluster, principal components, and factorial analyses, associated with non-parametric tests and the analysis of violation to the standards set recommended by legislation, identified the most relevant water quality parameters and monitoring sites, and evaluated the sampling frequency. Thermotolerant coliforms, total arsenic, and total phosphorus were considered the most relevant parameters for characterization of water quality in the river basin. The monitoring sites BV156, BV141, BV142, BV150, BV137, and BV153 were considered priorities for maintenance of the network. The multivariate statistical analysis showed the importance of a monthly sampling frequency, specifically the parameters considered most important.

Performance evaluation of startup for a yeast membrane bioreactor (MBRy) treating landfill leachate.

The startup process of a membrane bioreactor inoculated with yeast biomass (Saccharomyces cerevisiae) and used in the treatment of landfill leachate was evaluated. The yeast membrane bioreactor (MBRy) was inoculated with an exogenous inoculum, a granulated active dry commercial bakers' yeast. The MBRy was successfully started up with a progressive increase in the landfill leachate percentage in the MBRy feed and the use of Sabouraud Dextrose Broth. The membrane plays an important role in the startup phase because of its full biomass retention and removal of organic matter. MBRy is a suitable and promising process to treat recalcitrant landfill leachate. After the acclimation period, the COD and NH3 removal efficiency reached values of 72 ± 3% and 39 ± 2% respectively. MBRy shows a low membrane-fouling potential. The membrane fouling was influenced by soluble microbial products, extracellular polymeric substances, sludge particle size, and colloidal dissolved organic carbon.

Evaluation of violations in water quality standards in the monitoring network of São Francisco River basin, the third largest in Brazil.

The São Francisco River is the largest river located entirely within Brazil, and water scarcity problems have been a major concern of Brazilian society and government. Water quality issues are also a concern and have worsened with the recent intensification of urbanization and industrialization. In this study, violations to water quality standards established by local legislation were calculated as a percentage for 26 selected parameters over a monitoring period of 14 years. The violation percentages were analyzed spatially using the Kruskal-Wallis test, followed by multiple comparison analysis. Temporal analysis was performed using the Mann-Kendall test and Spearman correlation. Some parameters could be identified as cause for concern due to high violation levels, such as the fecal coliform indicator (FCI) and phosphorus-both related to domestic and effluent disposal without treatment or with insufficient treatment-and color, turbidity, manganese, and total suspended solids-which can be affected by erosive processes of natural and anthropogenic causes. The study found that these violations are concentrated in the most urbanized and industrialized areas of the basin. Some metallic parameters, such as iron and arsenic violations, may be related to mining activities in the rich soil of the Iron Quadrangle area located within the Minas Gerais State. Trend analysis results indicated that most monitoring stations did not have significant modification (elevation or reduction) trends over time, which, together with the high violation percentages, might indicate the maintenance of a scenario of constant pressure upon water resources, in particular in those more urbanized areas.

Fissure Integrity and Volume Reduction in Emphysema: A Retrospective Study.

BACKGROUND: One-way endobronchial valves (EBVs) relieve symptoms of emphysema, particularly in patients without collateral ventilation between the target and adjacent lobes. Pretreatment knowledge of fissure integrity could serve as an aid in indicating EBV interventions. OBJECTIVE: This study aimed to investigate the relationship between software-measured lung fissure integrity and clinically relevant lung volume reduction (≥350 ml) in emphysema patients treated with one-way EBVs using a lobar exclusion strategy. METHODS: Of 108 patients treated between March 2008 and July 2014, 38 had both baseline and follow-up computed tomography (CT) scans acquired following a specific protocol for quantitative CT analysis and were included in the study (total of 39 treatments, two lungs treated in 1 patient). Outcome measures were fissure integrity measured on baseline CT scans, difference between pre- and postoperative lung volume (considering the lowest measured postoperative volume), and correlation between fissure integrity and volume change. RESULTS: Fissure integrity ≥75% correlated with volume reduction ≥350 ml (Spearman coefficient: -0.65; p < 0.01). The mean and median volume reductions were 1,223.96 ± 907.5 ml and 663 ml, respectively, for lungs with fissure integrity ≥75% (n = 31). The accuracy of fissure integrity ≥75% in predicting a volume reduction was 87.2%. The positive predictive value of fissure integrity ≥75% to predict a volume reduction ≥350 ml was 83.9%, and it was 70% for fissure integrity 75-90% and 90.5% for fissure integrity >90%. CONCLUSIONS: A target lobe volume reduction using EBVs is possible with lung fissure integrity ≥75%. For patients with fissure integrity between 75 and 90%, a further evaluation of interlobar ventilation should be performed. A clinically relevant volume reduction following treatment with EBVs is likely with any level of fissure integrity >90%.