Lacticaseibacillus casei decrease long-chain fatty acids and most substances in an experimental model of intestinal mucositis.

PURPOSE: To evaluate the long-chain fatty acid and major compounds levels in the feces after prophylactic oral use of Lacticaseibacillus casei in an experimental model of intestinal mucositis. METHODS: Fifteen Swiss mice were randomly divided into three groups (n=5/group): The negative or positive control groups (n = 5) received saline orally for 18 days and an the intraperitoneal (i.p.) of saline or 5 Fluorouracil (450 mg/kg) in 15th day, respectability. L. casei group received oral concentration of L. casei (1x109 CFU/mL) for 18 days, the i.p. injection of 5-fluorouracil (450 mg/kg) in 15th days. Tissue samples from colon and each small intestine segment were collected for histopathological analysis. Stool samples were collected. Fecal composition of long-chain fatty acids and sterols were analysed by gas chromatography-mass spectrometry on the 15th and the 18th day. RESULTS: The mucosa layer of all small intestine segments of animals from L. casei showed well preserved epithelium and glands, without necrosis signs, but Goblet cells number decreased. Several long-chain fatty acids and sterols have been identified before and after in the groups. L. casei administration after 5-FU treatment reduced concentrations of linoleic acid (18:2) (p < 0.001) and oleic acid (18:1) (p < 0.001) in feces. CONCLUSIONS: L. casei prevented the mucosal damage associated with 5-FU-induced intestinal mucositis reduced long-chain fatty acid levels in the feces.

Postoperative Resting Metabolic Rate and Successful Weight Loss After Roux-en-Y Gastric Bypass.

OBJECTIVE: To analyze whether changes in RMR 6 months after RYGB could be a predictor of weight loss on late follow-up. METHODS: Prospective study of 45 individuals submitted to RYGB in a university tertiary care hospital. Body composition was evaluated by bioelectrical impedance analysis and RMR by indirect calorimetry before (T0), 6 (T1), and 36 months (T2) after surgery. RESULTS: RMR/day was lower in T1 (1.552 ± 275 kcal/day) than in T0 (1734 ± 372 kcal/day; p < 0.001) with a return to similar values at T2 (1.795 ± 396 kcal/day; p < 0.001). In T0, there was no correlation between RMR/kg and body composition. In T1, there was a negative correlation between RMR and BW, BMI, and % FM, and a positive correlation with % FFM. The results in T2 were similar to T1. There was a significant increase in RMR/kg between T0, T1, and T2 (13.6 ± 2.2 kcal/kg, 16.9 ± 2.7 kcal/kg, and 19.9 ± 3.4 kcal/kg) in the total group and according to gender. Eighty percent of the patients who had increased RMR/kg ≥ 2 kcal at T1 achieved > 50% EWL in T2, particularly in women (odds ratio: 27.09, p < 0.037). CONCLUSIONS: The increase in RMR/kg after RYGB is a major factor related to a satisfactory % excess weight loss on late follow-up.

Lacticaseibacillus casei decrease long-chain fatty acids and most substances in an experimental model of intestinal mucositis

Purpose: To evaluate the long-chain fatty acid and major compounds levels in the feces after prophylactic oral use of Lacticaseibacillus casei in an experimental model of intestinal mucositis. Methods: Fifteen Swiss mice were randomly divided into three groups (n=5/group): The negative or positive control groups (n = 5) received saline orally for 18 days and an the intraperitoneal (i.p.) of saline or 5 Fluorouracil (450 mg/kg) in 15th day, respectability. L. casei group received oral concentration of L. casei (1x109 CFU/mL) for 18 days, the i.p. injection of 5-fluorouracil (450 mg/kg) in 15th days. Tissue samples from colon and each small intestine segment were collected for histopathological analysis. Stool samples were collected. Fecal composition of long-chain fatty acids and sterols were analysed by gas chromatography-mass spectrometry on the 15th and the 18th day. Results: The mucosa layer of all small intestine segments of animals from L. casei showed well preserved epithelium and glands, without necrosis signs, but Goblet cells number decreased. Several long-chain fatty acids and sterols have been identified before and after in the groups. L. casei administration after 5-FU treatment reduced concentrations of linoleic acid (18:2) (p < 0.001) and oleic acid (18:1) (p < 0.001) in feces. Conclusions: L. casei prevented the mucosal damage associated with 5-FU-induced intestinal mucositis reduced long-chain fatty acid levels in the feces.

Eventos focalizadores e a pandemia da COVID-19: a renda básica emergencial na agenda governamental brasileira / Eventos focales y la pandemia de COVID-19: La renta básica de emergencia en la agenda del gobierno brasileño / Focusing events and the COVID-19 pandemic: the emergency basic income on the Brazilian agenda

Resumo Observar e analisar as causas, os efeitos e as múltiplas consequências econômicas, sociais e sanitárias da pandemia da COVID-19 têm sido primordiais não apenas para a compreensão desse fenômeno mundial, mas também para a elaboração de alternativas e soluções que minimizem os impactos na vida das populações ao redor do mundo. Este artigo tem como principal objetivo entender a ascensão da renda básica emergencial como alternativa viável de política pública no cenário brasileiro, por meio do Auxílio Emergencial. Baseado na literatura de agenda-setting, em específico no conceito de eventos focalizadores (focusing events), recuperamos um breve histórico das políticas de transferência de renda e de combate à pobreza e os principais atores envolvidos, para entender mudanças, adaptações e soluções propostas para que a alternativa de renda básica emergencial pudesse ser considerada e aceita neste momento específico de crise.

Resumen Observar y analizar las causas, efectos y las múltiples consecuencias económicas, sociales y de salud de la pandemia de COVID-19 han sido primordiales no solo para comprender este fenómeno mundial, sino también para el desarrollo de alternativas y soluciones que minimicen los impactos en la vida de poblaciones de todo el mundo. El principal objetivo de este artículo es entender el reconocimiento de la renta básica de emergencia como una alternativa viable de política pública en el escenario brasileño, que ha adoptado un "beneficio de emergencia". Con base en la literatura de agenda-setting, específicamente en el concepto de eventos focales, recuperamos una reseña de las políticas de transferencia de renta, de reducción de la pobreza y los principales actores involucrados, para comprender los cambios, adaptaciones y soluciones propuestas para que la alternativa de renta básica de emergencia pudiera considerarse y aceptarse en este momento específico de crisis.

Abstract Observing and analyzing the causes, effects, and multiple economic, social, and health consequences of the COVID-19 pandemic have been essential to understand this worldwide phenomenon and find solutions that minimize the impacts on peoples' lives. This article aims to understand the rise of the emergency basic income as a viable policy to tackle the pandemic in Brazil. Based on the agenda-setting literature, specifically on the concept of focusing events, we present a brief history of cash transfer and poverty reduction policies, as well as the actors involved. The study discusses the changes, adaptations, and solutions proposed during the formulation of the emergency basic income as a policy to be considered and effectively adopted in this specific moment of crisis.

Antimicrobial Activity of Chitosan Oligosaccharides with Special Attention to Antiparasitic Potential.

The global rise of infectious disease outbreaks and the progression of microbial resistance reinforce the importance of researching new biomolecules. Obtained from the hydrolysis of chitosan, chitooligosaccharides (COSs) have demonstrated several biological properties, including antimicrobial, and greater advantage over chitosan due to their higher solubility and lower viscosity. Despite the evidence of the biotechnological potential of COSs, their effects on trypanosomatids are still scarce. The objectives of this study were the enzymatic production, characterization, and in vitro evaluation of the cytotoxic, antibacterial, antifungal, and antiparasitic effects of COSs. NMR and mass spectrometry analyses indicated the presence of a mixture with 81% deacetylated COS and acetylated hexamers. COSs demonstrated no evidence of cytotoxicity upon 2 mg/mL. In addition, COSs showed interesting activity against bacteria and yeasts and a time-dependent parasitic inhibition. Scanning electron microscopy images indicated a parasite aggregation ability of COSs. Thus, the broad biological effect of COSs makes them a promising molecule for the biomedical industry.

Probing the 3D molecular and mineralogical heterogeneity in oil reservoir rocks at the pore scale.

Innovative solutions have been designed to meet the global demand for energy and environmental sustainability, such as enhanced hydrocarbon recovery and geo-sequestration of CO2. These processes involve the movement of immiscible fluids through permeable rocks, which is affected by the interfacial properties of rocks at the pore scale. Overcoming major challenges in these processes relies on a deeper understanding about the fundamental factors that control the rock wettability. In particular, the efficiency of oil recovery strategies depends largely on the 3D wetting pattern of reservoir rocks, which is in turn affected by the adsorption and deposition of 'contaminant' molecules on the pores' surface. Here, we combined high-resolution neutron tomography (NT) and synchrotron X-ray tomography (XRT) to probe the previously unobserved 3D distribution of molecular and mineralogical heterogeneity of oil reservoir rocks at the pore scale. Retrieving the distribution of neutron attenuation coefficients by Monte Carlo simulations, 3D molecular chemical mappings with micrometer dimensions could be provided. This approach allows us to identify co-localization of mineral phases with chemically distinct hydrogen-containing molecules, providing a solid foundation for the understanding of the interfacial phenomena involved in multiphase fluid flow in permeable media.

Local anti-inflammatory activity: Topical formulation containing Kalanchoe brasiliensis and Kalanchoe pinnata leaf aqueous extract.

Kalanchoe brasiliensis and Kalanchoe pinnata are used interchangeably in traditional medicine in the treatment of wound healing. In this context, the objective of the present study was to evaluate the local anti-inflammatory activity of a topical formulation containing aqueous extract of both species. The in vivo model used was ear edema induced by croton oil and paw edema induced by carrageenan. The Swiss mice treatments use formulations containing aqueous extract at different concentrations (1.25%, 2.5%, and 5%) or dexamethasone (1 mg/g), all administered topically and immediately after edema induction. The treatment with formulations containing aqueous extract of both species reduced ear and paw edema, besides that, the decrease in edema was evidenced by reduction of myeloperoxidase activity, IL-1ß, and TNF-α levels and increase IL-10 levels. In conclusion, the two species showed local anti-inflammatory activity; however K. brasiliensis showed a better result in both edematogenic models since it had activity in the lowest concentration.

Processo ensino-aprendizagem do treinamento resistido: pedagogia aplicada na educação não formal / Teaching and learning process of strength training: pedagogy applied to nonformal education

OBJETIVO: Analisar se as dimensões conceitual, procedimental e atitudinal do conteúdo são ensinadas pelos instrutores de treinamento resistido (TR) MÉTODO: Para a realização do estudo, participaram 8 profissionais de Educação Física, todos instrutores de TR em 4 academias de duas cidades da microrregião de Jaboticabal/SP. Os voluntários foram avaliados em três etapas denominadas observação, simulação e entrevista. Na primeira, os voluntários foram acompanhados em sua atuação profissional em um dia normal de trabalho. Na simulação, os profissionais participaram de uma atividade prática, como em uma entrevista de emprego. Na última, os profissionais foram questionados sobre o conhecimento e a orientação de seus alunos nas dimensões do conteúdo. As informações foram organizadas por meio de análise de conteúdo e frequência de ocorrência de casos. RESULTADOS: Foi observado que os profissionais ensinam procedimentos como postura, amplitude de movimento, volume e intensidade de treinos. Em relação aos conceitos, poucas informações são ensinadas. Para o conteúdo atitudinal, apenas disciplina é ensinada. Quando comparadas as três situações analisadas, apenas para a dimensão procedimental a simulação e a entrevistas concordam com que o que foi observada na prática in loco. CONCLUSÃO: Pode-se concluir que a dimensão procedimental do conteúdo é trabalhada mais intensamente pelos instrutores de TR se comparada à dimensão conceitual; já a dimensão atitudinal praticamente não é abordada. Há lacunas no processo de ensino-aprendizagem, principalmente nas dimensões conceitual e atitudinal, o que demonstra que é preciso mais comprometimento dos profissionais na atuação referente a essas dimensões do conteúdo.

OBJECTIVE: The aim of this study was to analyse if the strength training instructors teach the conceptual dimensions of content, procedural dimensions of content and attitudinal dimensions of contents. METHODS: Eight physical education professionals took part in order to accomplish this study. They are strength training instructors of four fitness centers at two cities from the Jaboticabal region. The volunteers were evaluated in three stages called observation, simulation and interview. In the first stage the volunteers were followed in their professional performance in a normal day of work. In the simulation phase the professionals participated in a practical activity such as in a job interview. The last step the physical education professionals were inquired about the knowledge and orientation of their students in the dimensions of contents. The information was organized through analysis of content and frequency that it happened the cases. RESULTS: It was observed that the professionals teach procedures such as posture, range of motion, bulk and intensity of training. Regarding concepts few information is taught, highlighting the names of muscle groups. For attitudinal content only discipline is taught. When the three situations analyzed on this study only for the procedural dimension, the simulation and interviews got an agreement that were observed in practice. CONCLUSION: It can be concluded that the procedural dimension of the content is more taught by the strength training instructors if compared to the conceptual dimension. The attitudinal dimension is almost not addressed. There are gaps in the teaching learning process mainly in the conceptual and attitudinal dimensions which shows that it is necessary more commitment from the physical education professionals linked to these dimensions of contents.

Short-term effects of drought on tropical forest do not fully predict impacts of repeated or long-term drought: gas exchange versus growth.

Are short-term responses by tropical rainforest to drought (e.g. during El Niño) sufficient to predict changes over the long-term, or from repeated drought? Using the world's only long-term (16-year) drought experiment in tropical forest we examine predictability from short-term measurements (1-2 years). Transpiration was maximized in droughted forest: it consumed all available throughfall throughout the 16 years of study. Leaf photosynthetic capacity [Formula: see text] was maintained, but only when averaged across tree size groups. Annual transpiration in droughted forest was less than in control, with initial reductions (at high biomass) imposed by foliar stomatal control. Tree mortality increased after year three, leading to an overall biomass loss of 40%; over the long-term, the main constraint on transpiration was thus imposed by the associated reduction in sapwood area. Altered tree mortality risk may prove predictable from soil and plant hydraulics, but additional monitoring is needed to test whether future biomass will stabilize or collapse. Allocation of assimilate differed over time: stem growth and reproductive output declined in the short-term, but following mortality-related changes in resource availability, both showed long-term resilience, with partial or full recovery. Understanding and simulation of these phenomena and related trade-offs in allocation will advance more effectively through greater use of optimization and probabilistic modelling approaches.This article is part of a discussion meeting issue 'The impact of the 2015/2016 El Niño on the terrestrial tropical carbon cycle: patterns, mechanisms and implications'.

Minipuberty and Sexual Dimorphism in the Infant Human Thymus.

AIRE expression in thymus is downregulated by estrogen after puberty, what probably renders women more susceptible to autoimmune disorders. Here we investigated the effects of minipuberty on male and female infant human thymic tissue in order to verify if this initial transient increase in sex hormones - along the first six months of life - could affect thymic transcriptional network regulation and AIRE expression. Gene co-expression network analysis for differentially expressed genes and miRNA-target analysis revealed sex differences in thymic tissue during minipuberty, but such differences were not detected in the thymic tissue of infants aged 7-18 months, i.e. the non-puberty group. AIRE expression was essentially the same in both sexes in minipuberty and in non-puberty groups, as assessed by genomic and immunohistochemical assays. However, AIRE-interactors networks showed several differences in all groups regarding gene-gene expression correlation. Therefore, minipuberty and genomic mechanisms interact in shaping thymic sexual dimorphism along the first six months of life.

Isolation, spectral characterization, molecular docking, and cytotoxic activity of alkaloids from Erythroxylum pungens O. E. Shulz.

Stem bark, root bark, and leaf extracts of Erythroxylum pungens were subjected to phytochemical analysis. N,N-dimethyltryptamine (DMT) was isolated and characterized from E. pungens roots. This unprecedented result is remarkable since no indole alkaloid has been previously reported from Erythroxylaceae so far. Eleven known tropane alkaloids were identified by their mass spectra and 3-(2-methylbutyryloxy)tropan-6,7-diol as well as 3-(2-methylbutyryloxy)nortropan-6,7-diol were isolated and characterized based on mass spectrometry, 1H, 13C, COSY, and NOESY NMR analysis. The complete NMR data are reported for the first time. Inverse Structure-based and Ligand-Based virtual screening were carried out to identify possible targets for 3-(2-methylbutyryloxy)tropan-6,7-diol. The level of cytotoxicity of this tropane alkaloid aliphatic ester was discrete with potencies on the order of 0.3-1.0 mg/mL and better results against HeLa (50% cell viability reduction). Otherwise, atropine (0.3 mg/mL), a Solanaceae tropane alkaloid, and DMT (0.5 mg/mL) from E. pungens roots impaired at 50% the cell viability against HeLa, SiHa, PC3, and 786-0. This study stimulates scientific investigation of the impact of edaphoclimatic features in a semi-arid environment on tropane alkaloid biosynthesis.

Liver biopsy may facilitate pancreatic graft evaluation: Positive association between liver steatosis and pancreatic graft adipose infiltration.

OBJECTIVES: The number of pancreatic transplants has decreased in recent years. Pancreatic grafts have been underutilized compared to other solid grafts. One cause of discard is the macroscopic appearance of the pancreas, especially the presence of fatty infiltration. The current research is aimed at understanding any graft-related association between fatty tissue infiltration of the pancreas and liver steatosis. METHODS: From August 2013 to August 2014, a prospective cross-sectional clinical study using data from 54 multiple deceased donor organs was performed. RESULTS: Micro- and macroscopic liver steatosis were significantly correlated with the donor body mass index ([BMI]; p=0.029 and p=0.006, respectively). Positive gamma associations between pancreatic and liver macroscopic and microscopic findings (0.98; confidence interval [CI]: 0.95-1 and 0.52; CI 0.04-1, respectively) were observed. Furthermore, comparisons of liver microscopy findings showed significant differences between severe versus absent (p<0.001), severe versus mild (p<0.001), and severe versus moderate classifications (p<0.001). The area under the receiver operating curve was 0.94 for the diagnosis of steatosis by BMI evaluation using a cut-off BMI of 27.5 kg/m2, which yielded 100% sensitivity, 87% specificity, and 100% negative predictive value. CONCLUSIONS: We observed a positive association of macroscopic and microscopic histopathological findings in steatotic livers with adipose infiltration of pancreatic grafts.

Gastroprotective and Antioxidant Activity of Kalanchoe brasiliensis and Kalanchoe pinnata Leaf Juices against Indomethacin and Ethanol-Induced Gastric Lesions in Rats.

Kalanchoe brasiliensis and Kalanchoe pinnata are used interchangeably in traditional medicine for treating peptic ulcers and inflammatory problems. In this context, this study aims to characterize the chemical constituents and evaluate the gastroprotective activity of the leaf juices of the two species in acute gastric lesions models. Thin Layer Chromatography (TLC) and Ultra High Performance Liquid Chromatography coupled to Mass Spectrometer (UHPLC-MS) were performed for chemical characterization. Wistar rats were pre-treated orally with leaf juices (125, 250 and 500 mg/kg) or ranitidine (50 mg/kg). The peaks observed in the chromatogram of K. brasiliensis showed similar mass spectra to flavonoid glycosides derived from patuletin and eupafolin, while K. pinnata showed mass spectra similar to compounds derived from quercetin, patuletin, eupafolin and kaempferol. K. brasiliensis at all doses and K. pinnata at doses of 250 mg/kg and 500 mg/kg significantly reduced the lesions in the ethanol induction model. In the indomethacin induction model, both species showed significant results at doses of 250 and 500 mg/kg. Also, the pre-treatment with leaf juices increased the antioxidant defense system, glutathione (GSH), whereas malondialdehyde (MDA), myeloperoxidase (MPO), interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) levels were significantly decreased. Treatment with leaf juices led to the upregulation of zone occludes-1 (ZO-1) and the downregulation of inducible nitric oxide synthase (iNOS) and factor nuclear-κβ transcription (NF-κB-p65), while also showing a cytoprotective effect and maintaining mucus production. These findings show that the leaf juices of the two species showed gastroprotective effects on ethanol and gastric indomethacin injury which were a consequence of gastric inflammation suppression, antioxidant activity and the maintenance of cytoprotective defenses and mucosal structure architecture.

Influência da técnica de colocação do cimento endodôntico na obturação de incisivos inferiores / Influence of sealer placement technique on the filling of mandibular incisors

Objetivo: o objetivo desse estudo foi comparar três técnicas de inserção do cimento endodôntico em canais achatados. A técnica convencional, na qual o cimento é introduzido com o cone principal, foi comparada com dois grupos experimentais: lima Easy Clean em movimento reciprocante e inserto ultrassônico Irrisonic. Métodos: quarenta e cinco incisivos inferiores com anatomia do canal radicular achatada foram selecionados para o estudo. O canal radicular foi preparado até o instrumento Reciproc R40. Em seguida, as amostras foram divididas em três grupos (n = 15), de acordo com a técnica de colocação do cimento, e obturadas. Para obturação, em todos os grupos, foi utilizado o Touch'n Heat. Secções aos níveis de 2 e 4mm aquém do forame apical foram obtidas e examinadas em lupa estereoscópica com 40 vezes de magnificação. Na sequência, imagens foram obtidas com câmera digital e mensurou-se, com o software Axion Vision LE, a área total do canal radicular, áreas vazias e preenchidas com guta-percha e cimento. Resultados: aos níveis de 2 mm (p = 0,131) e 4 mm (p > 0,05) não existiram diferenças entre os grupos com relação às áreas vazias avaliadas. Áreas vazias foram comparadas, também, entre os níveis de 2 mm e 4 mm, e não houve diferença apresentada em qualquer grupo testado. (Easy Clean, p = 0,309; Cone Principal, p = 0,164; Irrisonic, p = 0,867). Conclusões: o inserto ultrassônico Irrisonic e a lima Easy Clean não obtiveram um melhor resultado de preenchimento do que a técnica convencional com o cone principal.

Liver biopsy may facilitate pancreatic graft evaluation: positive association between liver steatosis and pancreatic graft adipose infiltration

OBJECTIVES: The number of pancreatic transplants has decreased in recent years. Pancreatic grafts have been underutilized compared to other solid grafts. One cause of discard is the macroscopic appearance of the pancreas, especially the presence of fatty infiltration. The current research is aimed at understanding any graft-related association between fatty tissue infiltration of the pancreas and liver steatosis. METHODS: From August 2013 to August 2014, a prospective cross-sectional clinical study using data from 54 multiple deceased donor organs was performed. RESULTS: Micro- and macroscopic liver steatosis were significantly correlated with the donor body mass index ([BMI]; p=0.029 and p=0.006, respectively). Positive gamma associations between pancreatic and liver macroscopic and microscopic findings (0.98; confidence interval [CI]: 0.95-1 and 0.52; CI 0.04-1, respectively) were observed. Furthermore, comparisons of liver microscopy findings showed significant differences between severe versus absent (p<0.001), severe versus mild (p<0.001), and severe versus moderate classifications (p<0.001). The area under the receiver operating curve was 0.94 for the diagnosis of steatosis by BMI evaluation using a cut-off BMI of 27.5 kg/m2, which yielded 100% sensitivity, 87% specificity, and 100% negative predictive value. CONCLUSIONS: We observed a positive association of macroscopic and microscopic histopathological findings in steatotic livers with adipose infiltration of pancreatic grafts.

Higher MELD score increases the overall cost on the waiting list for liver transplantation: a micro-costing analysis based study.

BACKGROUND:: The pre-transplant period is complex and includes lots of procedures. The severity of liver disease predisposes to a high number of hospitalizations and high costs procedures. Economic evaluation studies are important tools to handle costs on the waiting list for liver transplantation. OBJECTIVE:: The objective of the present study was to evaluate the total cost of the patient on the waiting list for liver transplantation and the main resources related to higher costs. METHODS:: A cost study in a cohort of 482 patients registered on waiting list for liver transplantation was carried out. In 24 months follow-up, we evaluated all costs of materials, medicines, consultations, procedures, hospital admissions, laboratorial tests and image exams, hemocomponents replacements, and nutrition. The total amount of each resource or component used was aggregated and multiplied by the unitary cost, and thus individual cost for each patient was obtained. RESULTS:: The total expenditure of the 482 patients was US$ 6,064,986.51. Outpatient and impatient costs correspond to 32.4% of total cost (US$ 1,965,045.52) and 67.6% (US$ 4,099,940.99) respectively. Main cost drivers in outpatient were: medicines (44.31%), laboratorial tests and image exams (31.68%). Main cost drivers regarding hospitalizations were: medicines (35.20%), bed use in ward and ICU (26.38%) and laboratorial tests (13.72%). Patients with MELD score between 25-30 were the most expensive on the waiting list (US$ 16,686.74 ± 16,105.02) and the less expensive were those with MELD below 17 (US$ 5,703.22 ± 9,318.68). CONCLUSION:: Total costs on the waiting list for liver transplantation increased according to the patient's severity. Individually, hospitalizations, hemocomponents reposition and hepatocellular carcinoma treatment were the main cost drivers to the patient on the waiting list. The longer the waiting time, the higher the total cost on list, causing greater impact on health systems.

Higher MELD score increases the overall cost on the waiting list for liver transplantation: a micro-costing analysis based study / Altos valores de MELD aumentam o custo total em lista de espera para o transplante hepático. Um estudo de microcusteio

ABSTRACT BACKGROUND: The pre-transplant period is complex and includes lots of procedures. The severity of liver disease predisposes to a high number of hospitalizations and high costs procedures. Economic evaluation studies are important tools to handle costs on the waiting list for liver transplantation. OBJECTIVE: The objective of the present study was to evaluate the total cost of the patient on the waiting list for liver transplantation and the main resources related to higher costs. METHODS: A cost study in a cohort of 482 patients registered on waiting list for liver transplantation was carried out. In 24 months follow-up, we evaluated all costs of materials, medicines, consultations, procedures, hospital admissions, laboratorial tests and image exams, hemocomponents replacements, and nutrition. The total amount of each resource or component used was aggregated and multiplied by the unitary cost, and thus individual cost for each patient was obtained. RESULTS: The total expenditure of the 482 patients was US$ 6,064,986.51. Outpatient and impatient costs correspond to 32.4% of total cost (US$ 1,965,045.52) and 67.6% (US$ 4,099,940.99) respectively. Main cost drivers in outpatient were: medicines (44.31%), laboratorial tests and image exams (31.68%). Main cost drivers regarding hospitalizations were: medicines (35.20%), bed use in ward and ICU (26.38%) and laboratorial tests (13.72%). Patients with MELD score between 25-30 were the most expensive on the waiting list (US$ 16,686.74 ± 16,105.02) and the less expensive were those with MELD below 17 (US$ 5,703.22 ± 9,318.68). CONCLUSION: Total costs on the waiting list for liver transplantation increased according to the patient's severity. Individually, hospitalizations, hemocomponents reposition and hepatocellular carcinoma treatment were the main cost drivers to the patient on the waiting list. The longer the waiting time, the higher the total cost on list, causing greater impact on health systems.

RESUMO CONTEXTO: O período pré-transplante é complexo e inclui grande quantidade de procedimentos. A gravidade da doença hepática predispõe a um alto número de internações e procedimentos de alto custo. Estudos em avaliação econômica são uma importante ferramenta para o manejo dos custos em lista de espera para o transplante hepático. OBJETIVO: O objetivo do presente estudo foi avaliar o custo total do paciente em lista de espera para o transplante hepático e os principais recursos relacionados ao alto custo. MÉTODOS: Foi realizado um estudo de coorte em 482 pacientes registrados em lista de espera para o transplante hepático. Os pacientes foram acompanhados por um período de 24 meses, no qual foram avaliados todos os custos de materiais, medicamentos, consultas, procedimentos internações, exames laboratoriais e de imagem, reposição de hemocomponentes e nutrição recebida. A quantidade total de cada recurso e componente utilizado foi obtida e multiplicada pelo seu valor unitário e, desta maneira, o custo individual de cada paciente foi obtido. RESULTADOS: O total gasto pelos 482 pacientes foi de US$ 6.064.986,51. Os custos ambulatoriais corresponderam a 32,4% do total (US$ 1.965.045,52) e os custos em internação corresponderam a 67,6% do total (US$ 4.099.940,99). Os principais determinantes do custo em ambulatório foram: medicamentos (44,31%) e exames laboratoriais e de imagem (31,68%). Os principais determinantes de custo em internações foram: medicamentos (35,20%), utilização do leito em enfermaria e em UTI (26,38%) e exames laboratoriais (13,72%) Pacientes com valores de MELD entre 25-30 foram os de maiores custos em lista de espera (US$ 16.686,74 ± 16,105.02) e os de menor custo foram os pacientes com MELD abaixo de 17 (US$ 5.703,22 ± 9.318,68). CONCLUSÃO: O custo total em lista de espera para o transplante hepático aumenta de acordo com a gravidade do paciente. Individualmente, internações, reposição de hemocomponentes e o tratamento do paciente com carcinoma hepatocelular são os principais determinantes de custo para os pacientes em lista de espera para o transplante hepático. Quanto maior o tempo de espera, maiores serão os custos em lista, causando maior impacto nos sistemas de saúde.

Structure and in vitro activities of a Copper II-chelating anionic peptide from the venom of the scorpion Tityus stigmurus.

Anionic Peptides are molecules rich in aspartic acid (Asp) and/or glutamic acid (Glu) residues in the primary structure. This work presents, for the first time, structural characterization and biological activity assays of an anionic peptide from the venom of the scorpion Tityus stigmurus, named TanP. The three-dimensional structure of TanP was obtained by computational modeling and refined by molecular dynamic (MD) simulations. Furthermore, we have performed circular dichroism (CD) analysis to predict TanP secondary structure, and UV-vis spectroscopy to evaluate its chelating activity. CD indicated predominance of random coil conformation in aqueous medium, as well as changes in structure depending on pH and temperature. TanP has chelating activity on copper ions, which modified the peptide's secondary structure. These results were corroborated by MD data. The molar ratio of binding (TanP:copper) depends on the concentration of peptide: at lower TanP concentration, the molar ratio was 1:5 (TanP:Cu2+), whereas in concentrated TanP solution, the molar ratio was 1:3 (TanP:Cu2+). TanP was not cytotoxic to non-neoplastic or cancer cell lines, and showed an ability to inhibit the in vitro release of nitric oxide by LPS-stimulated macrophages. Altogether, the results suggest TanP is a promising peptide for therapeutic application as a chelating agent.

Are Hybrid Liver Resections Truly Minimally Invasive? A Propensity Score Matching Analysis.

BACKGROUND: Hybrid liver resection is considered a modality of minimally invasive surgery; however, there are doubts regarding loss of benefits of laparoscopy due to the use of an auxiliary incision. We compared perioperative results of patients undergoing hybrid × open and hybrid × pure laparoscopic resections. METHODS: Consecutive patients undergoing liver resection between June 2008 and January 2016 were studied. Study groups were compared after propensity score matching (PSM). RESULTS: Six hundred forty-four resections were included in the comparative analysis: 470 open, 120 pure laparoscopic, and 54 hybrids. After PSM, 54 patients were included in each group. Hybrid × open: hybrid technique had shorter operative time (319.5 ± 108.6 × 376.2 ± 155.8 minutes, P = .033), shorter hospital stay (6.0 ± 2.7 × 8.1 ± 5.6 days, P = .001), and lower morbidity (18.5% × 40.7%, P = .003). Hybrid × pure laparoscopic: hybrid group had lower conversion rate (0% × 13%, P = .013). There was no difference regarding estimated blood loss, transfusion rate, hospital stay, complications, or mortality. CONCLUSIONS: Hybrid resection has better perioperative results than the open approach and is similar to pure laparoscopy. The hybrid technique should be considered a minimally invasive approach.

Species richness and composition of epiphytic bryophytes in flooded forests of Caxiuanã National Forest, Eastern Amazon, Brazil

ABSTRACT This study aimed to compare the richness and composition of the epiphytic bryoflora between várzea and igapó forests in Caxiuanã National Forest, Brazilian Amazon. Bryophytes were collected on 502 phorophytes of Virola surinamensis. Average richness per phorophyte and composition between forests and between dry and rainy periods was tested by two-way analysis and by cluster analysis, respectively. In total, 54 species of 13 families were identified. Richness was greater in igapó forest (44 species) compared to várzea forest (38 species). There was no significant difference in the number of species between the studied periods. Cluster analysis showed the bryoflora composition was different between várzea and igapó, but not between dry and rainy periods. Results did not corroborate the hypothesis that várzea forests harbor higher species richness than igapó forests.