Efficacy of dexmedetomidine as an adjuvant to local anesthetics in peribulbar block: a meta-analysis with trial-sequential analysis.

PURPOSE: To assess the role of dexmedetomidine as an adjuvant to local anesthetics (LA) in enhancing the duration and quality of peribulbar blocks for ophthalmic surgeries. DESIGN: Systematic review with meta-analysis and trial sequential analysis Methods: We systematically searched MEDLINE, Embase, and Cochrane for randomized controlled trials (RCTs) involving adult patients undergoing ophthalmic surgery under peribulbar block, comparing LA alone versus LA + dexmedetomidine. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were computed using a random effects model. Sensitivity and trial-sequential analyses (TSA) were performed to assess inconsistencies, weight type II and II errors, and estimate the required information size of the samples for all endpoints. RESULTS: Sixteen RCTs (1,220 patients) were included. Compared with LA alone, dexmedetomidine was associated with prolonged (1) motor block duration (MD 65.01 minutes, p<0.001) and (2) sensory block duration (MD 81.94 minutes, p<0.001); (3) reduced intraocular pressure (IOP) (MD -2.6 mmHg, p<0.001), and (4) decreased need for supplemental injections (RR 0.44, p=0.007). Additionally, dexmedetomidine showed (5) longer time to analgesic request (MD 97.15 minutes, p<0.001) and (6) increased surgeon satisfaction (RR 1.52, p=0.01). Sensitivity analyses and TSA were consistent across all endpoints, and the required information size was achieved for most endpoints, indicating that pooled analyses were reliable and sample sizes were sufficient. CONCLUSIONS: Compared with LA alone, dexmedetomidine significantly prolonged sensory and motor block duration and the time to the first analgesic request; decreased IOP and the need for supplemental injections, while increasing surgeon satisfaction.

Photoprotective mechanisms and higher photorespiration are key points for iron stress tolerance under heatwaves in rice.

Considering the current climate change scenario, the development of heat-tolerant rice cultivars (Oryza sativa L.) is paramount for cultivation in waterlogged systems affected by iron (Fe) excess. The objective of this work was to investigate the physiological basis of tolerance to excess Fe in rice cultivars that would maintain photosynthetic efficiency at higher temperatures. In an experimental approach, two rice cultivars (IRGA424 - tolerant and IRGA417- susceptible to Fe toxicity) were exposed to two concentrations of FeSO4-EDTA, control (0.019 mM) and excess Fe (7 mM) and subsequent exposition to heatwaves at different temperatures (25 °C - control, 35, 40, 45, 50, and 55 °C). The increase in temperatures resulted in a higher Fe concentration in shoots accompanied by a lower Rubisco carboxylation rate in both cultivars, but with lower damage in the tolerant one. Stomatal limitation only occurred as a late response to Fe toxicity, especially in the sensitive cultivar. The activation of photorespiration as electron sink under Fe excess with increasing temperature during heatwaves appear as a major mechanism to alleviate oxidative stress in cultivars tolerant to excess Fe. The tolerance to iron toxicity and heat stress is associated with increased photoprotective mechanisms driving non-photochemical dissipation.

Photochemical attributes determine the responses of plant species from different functional groups of ferruginous outcrops when grown in iron mining substrates.

Environments originating from banded iron formations, such as the canga , are important reference ecosystems for the recovery of degraded areas by mining. The objective of this work was to evaluate if the relationship between morphofunctional and photosynthetic attributes of native canga species from different functional group results in distinct responses when grown in iron mining tailings substrate. The experiment was carried out with species belonging to different functional groups: a widespread semi-deciduous tree-shrub, Myrcia splendens ; an endemic deciduous shrub, Jacaranda caroba ; and a nitrogen-fixing herbaceous species, Periandra mediterranea . The species were grown in two conditions, reference soil and iron ore tailing. Despite belonging to different functional groups when grown in tailings, the morphofunctional attributes presented similar responses between species. M. splendens was the species most affected by the conditions imposed by the iron ore mining tailings, with decreased light-use efficiency and electron transport. P. mediterranea had satisfactory growth and maintenance of photosynthetic attributes. J. caroba growing in the tailings increased the effective quantum yield of PSII. The photochemical and growth assessments were able to better explain the adaptive strategies developed by the species, guaranteeing a greater chance of success during the rehabilitation of mining substrates.

Diffusion-weighted imaging does not seem to be a predictor of consistency in pituitary adenomas.

PURPOSE: To prospectively evaluate the usefulness of T1-weighted imaging (T1WI) and diffusion-weighted imaging (DWI) sequences in predicting the consistency of macroadenomas. In addition, to determine their values ​​as prognostic factors of surgical outcomes. METHODS: Patients with pituitary macroadenoma and surgical indication were included. All patients underwent pre-surgical magnetic resonance imaging (MRI) that included the sequences T1WI before and after contrast administration and DWI with the apparent diffusion coefficient (ADC) map. Post-surgical MRI was performed at least 3 months after surgery. The consistency of the macroadenomas was evaluated at surgery, and they were grouped into soft and intermediate/hard adenomas. Mean ADC values, signal on T1WI and the ratio of tumor ADC values ​​to pons (ADCR) were compared with tumor consistency and grade of surgical resection. RESULTS: A total of 80 patients were included. A softened consistency was found at surgery in 53 patients and hardened in 27 patients. The median ADC in the soft consistency group was 0.532 × 10-3 mm2/sec (0.306 - 1.096 × 10-3 mm2/sec), and in the intermediate/hard consistency group was 0.509 × 10-3 mm2/sec (0.308 - 0.818 × 10-3 mm2/sec). There was no significant difference between the median values ​​of ADC, ADCR and signal on T1W between the soft and hard tumor groups, or between patients with and without tumor residue. CONCLUSION: Our results did not show usefulness of the DWI and T1WI for assessing the consistency of pituitary macroadenomas, nor as a predictor of the degree of surgical resection.

Tensile bond strength of adhesive mortars with hydroxypropyl methyl cellulose and vinyl acetate-ethylene polymers after thermal storage.

The properties of adhesive mortars can change due to heating, compromising the durability of the coating systems. The aim of this article was to evaluate the influence of cement and polymer contents on the tensile bond strength of adhesive mortars after thermal storage. Ceramic tiling system specimens were prepared with seventeen formulations of adhesive mortars. These specimens were stored under dry (reference) at temperature of 23 ± 2 °C and 60 ± 5% of relative humidity and thermal (temperature of 70 ± 2 °C) conditions. The results showed that the cement content was the major factor concerning tensile bond strength. The vinyl acetate-ethylene (VAE) polymer improved the tensile bond strength of mortars under thermal storage. However, the hydroxypropyl methyl cellulose (HPMC) content contributed to the tensile bond strength only when higher cement contents were used. Besides, microstructure analysis showed that ettringite was degraded during thermal storage.

In vitro galactose impairs energy metabolism in the brain of young rats: protective role of antioxidants.

We, herein, investigated the in vitro effects of galactose on the activity of pyruvate kinase, succinate dehydrogenase (SDH), complex II and IV (cytochrome c oxidase) of the respiratory chain and Na+K+-ATPase in the cerebral cortex, cerebellum and hippocampus of 30-day-old rats. We also determined the influence of the antioxidants, trolox, ascorbic acid and glutathione, on the effects elicited by galactose. Galactose was added to the assay at concentrations of 0.1, 3.0, 5.0 and 10.0 mM. Control experiments were performed without galactose. Galactose, at 3.0, 5.0 and 10.0 mM, decreased pyruvate kinase activity in the cerebral cortex and at 10.0 mM in the hippocampus. Galactose, at 10.0 mM, reduced SDH and complex II activities in the cerebellum and hippocampus, and reduced cytochrome c oxidase activity in the hippocampus. Additionally, decreased Na+K+-ATPase activity in the cerebral cortex and hippocampus; conversely, galactose, at 3.0 and 5.0 mM, increased this enzyme's activity in the cerebellum. Data show that galactose disrupts energy metabolism and trolox, ascorbic acid and glutathione addition prevented the majority of alterations in the parameters analyzed, suggesting the use of antioxidants as an adjuvant therapy in Classic galactosemia.

High Incidence of Respiratory Syncytial Virus in Children with Community-Acquired Pneumonia from a City in the Brazilian Pre-Amazon Region.

INTRODUCTION: Although fewer children have been affected by the severe form of the coronavirus disease 2019 (COVID-19), community-acquired pneumonia (CAP) continues to be the leading global cause of child hospitalizations and deaths. AIM: This study investigated the incidence of respiratory syncytial virus (RSV) as well its subtypes (RSV A and B), adenovirus (ADV), rhinovirus (HRV), metapneumovirus (HMPV), coronavirus (NL63, OC43, 229E and HKU1), parainfluenza virus subtypes (PI1, PI2 and PI3), bocavirus and influenza A and B viruses (FluA and FluB) in children diagnosed with CAP during the COVID-19 pandemic. METHODS: A total of 200 children with clinically confirmed CAP were initially recruited, of whom 107 had negative qPCR results for SARS-CoV-2 and were included in this study. Viral subtypes were identified using a real-time polymerase chain reaction in the nasopharyngeal swab samples. RESULTS: Viruses were identified in 69.2% of the patients. RSV infections were the most frequently identified (65.4%), with type RSV B being the most prevalent (63.5%). In addition, HCoV 229E and HRV were detected in 6.5% and 3.7% of the patients, respectively. RSV type B was associated with severe acute respiratory infection (ARI) and a younger age (less than 24 months). CONCLUSIONS: New strategies for preventing and treating viral respiratory infections, particularly RSV infections, are necessary.

Severe equinus cavo-varus correction through triplanar tarsectomy and posterior tibial tendon transfer based on 3D-printed biomodel.

Surgery for severe equine cavo-varus is complex and must be individualized. The interindividual phenotypic variability demands a personalized planning of each foot to be operated. The study's primary goal was to evaluate the function and satisfaction of a series of patients with severe equinus cavo-varus deformity who underwent a triplanar tarsectomy and transposition of the posterior tibial tendon in a single stage surgery after a patient specific 3D biomodel planning. A series of 12 feet (5 patients bilaterally) operated with this technique was analyzed. The cohort comprised 2 females (28.5 %) and 5 males (71.4 %). The median follow-up time was 38.5 months (interquartile range: 24.75-48.75). The Foot and Ankle Disability Index pre (median 32.85; interquartile range: 20-46) and postsurgery (median 72; interquartile range: 56-75.5) were collected and statistically significant differences were observed (p < 0.002). Furthermore, the main variable evaluated was obtaining a plantigrade stable foot. This was clinically evaluated and was achieved in all patients except 1 patient who presented a residual equinus of 5º. This study shows that triplanar tarsectomy and posterior tibial tendon transfer in a single surgical procedure after patient-specific 3D biomodel planning allows for improved function in patients with severe equinus cavus varus foot deformity.

Benefits of Tranexamic Acid in Total Knee Arthroplasty: A Classification and Regression Tree Analysis in Function of Instrumentation, BMI, and Gender.

Tranexamic acid (TXA) is an antifibrinolytic drug that reduces blood loss in patients that undergo Total knee arthroplasty (TKA). Few studies compare its effect on conventional instrumentation (CI) versus patient-specific instrumentation (PSI). The main objective of this study was to understand analytically how TXA usage in both instrumentations influenced blood loss in TKA differently and see if the differences seen could be explained by the patient's body mass index (BMI) and gender. This nonrandomized retrospective study sample consisted of 688 TKA procedures performed on patients who had symptomatic arthrosis resistant to conservative treatment. Descriptive analysis was used to evaluate blood loss using hemoglobin (Hb) mean values and mean variation (%). The Classification and Regression Tree (CRT) method was applied to understand how the independent variables affected the dependent variable. Comparing patients submitted to the same instrumentation, where some received TXA and others did not, patients that received TXA had lower blood loss. Comparing patients who underwent TKA with different instrumentations and without the use of TXA, it was found that patients who underwent TKA with PSI had lower blood loss than those who underwent TKA with CI. However, when these same instruments were compared again, but associated with the use of TXA, the opposite was true with patients undergoing TKA with PSI showing greater blood loss than patients undergoing TKA with CI. TXA usage in TKA is significantly beneficial in minimizing blood loss and regardless of instrumentation. When using TXA, the lowest blood loss was obtained in patients with higher BMI and submitted to TKA with CI. This is most likely explained by the synergistic antifibrotic effect of TXA with adipokines, such as plasminogen activator inhibitor-1 (PAI-1), found in the femoral bone marrow which is perforated using CI. If, however, TXA wasn't used, the lowest blood loss was obtained in patients submitted to TKA with PSI.

Revegetation of an area impacted by iron ore tailings: evaluating fertilization alternatives in native pioneer and secondary trees.

The iron ore tailings released into the Rio Doce basin after the Fundão dam collapse (Brazil), suppressed a large extent of local vegetation. The use of native species and appropriate fertilization techniques, with less economic and environmental impact, must be considered in the process for the restoration of affected areas by the tailings. For this purpose, six native tree species, pioneer (Anadenanthera colubrina, Bixa orellana, and Peltophorum dubium) and secondary (Cedrela fissilis, Handroanthus impetiginosus, and Handroanthus serratifolius), were selected. We used different conditions of fertilization: (1) inorganic fertilization, (2) inoculation with arbuscular mycorrhizal fungi and plant growth-promoting rhizobacteria, (3) combined treatment (fertilizer + inoculum), to evaluate leaf nutrient concentrations, photosynthetic capacity [chlorophyll index, maximum quantum efficiency of photosystem II (Fv/Fm) and gas exchange variables], and oxidative metabolism (H2O2, MDA, and antioxidant enzymes). Inoculation resulted in higher concentrations of foliar nitrogen, especially in pioneer species. In all treatments, the secondary species exhibited iron values considered phytotoxic, but showed reduced photosynthetic capacity only when inoculated. The highest concentrations of MDA were observed in inoculated plants of both successional groups. The antioxidant system proved to be effective in preventing oxidative damage for most of the species. These results showed that the use of inoculum can be considered an ecological alternative to inorganic additives in the area affected by iron ore tailings. Despite presenting different photosynthetic and antioxidant strategies, the evaluated species demonstrated potential for use in tailings revegetation projects.

Active Neutralizing Mats for Corrosive Chemical Storage.

Laboratories and industries that handle chemicals are ubiquitously prone to leakages. These may occur in storage rooms, cabinets or even in temporary locations, such as workbenches and shelves. A relevant number of these chemicals are corrosive, thus commercial products already exist to prevent material damage and injuries. One strategy consists of the use of absorbing mats, where few display neutralizing properties, and even less a controlled neutralization. Nevertheless, to the authors' knowledge, the commercially available neutralizing mats are solely dedicated to neutralizing acid or alkali solutions, never both. Therefore, this work describes the development and proof of a completely novel concept, where a dual component active mat (DCAM) is able to perform a controlled simultaneous neutralization of acid and alkali leakages by using microencapsulated active components. Moreover, its active components comprise food-grade ingredients, embedded in nonwoven polypropylene. The acid neutralizing mats contain sodium carbonate (Na2CO3) encapsulated in sodium alginate microcapsules (MC-ASC). Alkali neutralizing mats possess commercial encapsulated citric acid in hydrogenated palm oil (MIRCAP CT 85-H). A DCAM encompasses both MC-ASC and MIRCAP CT 85-H and was able to neutralize solutions up to 10% (v/v) of hydrochloric acid (HCl) and sodium hydroxide (NaOH). The efficacy of the neutralization was assessed by direct titration and using pH strip measurement tests to simulate the leakages. Due to the complexity of neutralization efficacy evaluation based solely on pH value, a thorough conductivity study was performed. DCAM reduced the conductivity of HCl and NaOH (1% and 2% (v/v)) in over 70%. The composites were characterized by scanning electron microscopy (SEM), differential calorimetry (DSC) and thermogravimetric analysis (TGA). The size of MC-ASC microcapsules ranged from 2 µm to 8 µm. Finally, all mat components displayed thermal stability above 150 °C.

Effects of contact lens wear on tear inflammatory biomarkers.

PURPOSE: This review article intends to critically review the available literature relating to the behavior of tear-borne inflammatory biomarkers during contact lens wear. METHODS: The workflow protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. An exhaustive search was carried out using the PubMed database. The analysis included a list of 34 eligible clinical trials: Thirty addressed the use of soft contact lenses, three focused on rigid gas permeable lenses; and one on scleral lenses. The biomarkers' presence was described as changes in the molecular concentration compared to control groups - non-contact lens wearers - or baseline measurements. RESULTS: Contact lens wear inflates the concentration of several inflammatory molecules in tears. Most relevant changes were found for IL-1ß, IL-6, IL-8, IL-17, LTB4, and MMP-9. The use of rigid gas permeable lenses seems to produce a more robust sub-clinical inflammatory response than soft contact lenses, with significant contributions of IL-8, MMP-9, and EGF. Reusable lenses that are worn continuously or on a daily modality are more likely to raise the expression of biomarkers compared to daily disposables. CONCLUSION: Mechanical trauma, hypoxia, and wearing schedules may be associated with a distinct sub-clinical inflammatory response in contact lens wearers. The relationship between these responses and contact lens-induced discomfort remains unclear, as the existing scientific evidence is still scarce. More clinical studies are still needed to prove the impact of reverse geometry and scleral lens wear on the behavior of tear-borne biomarkers.

Inherited metabolic diseases mimicking hereditary spastic paraplegia (HSP): a chance for treatment.

The syndromic group of hereditary spastic paraplegias has a heterogeneous clinical profile and a broad differential diagnosis, including neurometabolic disorders that are potentially treatable. This group includes 5,10-methylenetetrahydrofolate reductase deficiency, cobalamin C deficiency disease, dopamine responsive dystonia, cerebrotendinous xanthomatosis, biotinidase deficiency, GLUT1 deficiency syndrome, delta-e-pyrroline-carboxylase-synthetase deficiency, hyperonithinemia-hyperammonemia-homocitrullinuria syndrome, arginase deficiency, multiple carboxylase deficiency, and X-linked adrenoleukodystrophy. This review describes these diseases in detail, highlighting the importance of early diagnosis and effective treatment aiming at preserving functionality and quality of life in these patients. For the purpose of this study, we carried a non-systematic review on PUBMED, finding an initial sample of 122 papers; upon refining, 41 articles were found relevant to this review. Subsequently, we added review articles and works with historical relevance, totalizing 76 references. An adequate diagnostic workup in patients presenting with spastic paraplegia phenotype should include screening for these rare conditions, followed by parsimonious ancillary investigation.

Design and baseline characteristics of participants in the COcoa Supplement and Multivitamin Outcomes Study (COSMOS).

Background Cocoa extract and multivitamins have been proposed to reduce the risk of cardiovascular disease (CVD) and cancer, respectively. However, few randomized clinical trials have tested their long-term effects on these outcomes. Methods The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is a randomized, double-blind, placebo-controlled, 2 × 2 factorial trial of a cocoa extract supplement and a multivitamin supplement to reduce the risk of CVD and cancer. Here we describe the pragmatic, hybrid design of the trial and baseline characteristics of the trial participants. Results The nationwide study population includes 21,442 U.S. women aged ≥65 years and men aged ≥60 years without baseline myocardial infarction (MI), stroke, or a recent (within the past 2 years) cancer diagnosis. Participants were randomized in a 2 × 2 factorial design to one of four groups: (1) cocoa extract (containing 500 mg/d flavanols, including 80 mg (-)-epicatechin) and a multivitamin (Centrum Silver©); (2) cocoa extract and multivitamin placebo; (3) multivitamin and cocoa extract placebo; or (4) both placebos. Randomization successfully distributed baseline demographic, clinical, behavioral, and dietary characteristics across treatment groups. Baseline biospecimens were collected from 6867 participants, with at least one follow-up biospecimen from 2142 participants. The primary outcome for the cocoa extract intervention is total CVD (a composite of MI, stroke, cardiovascular mortality, coronary revascularization, unstable angina requiring hospitalization, carotid artery surgery, and peripheral artery surgery); the primary outcome for the multivitamin intervention is total invasive cancer. Conclusion COSMOS will provide important information on the health effects of cocoa extract and multivitamin supplementation in older U.S. adults. Clinical Trials Registration: clinicaltrials.gov #NCT02422745.

NEOADJUVANT CHEMORADIOTHERAPY FOLLOWED BY TRANSHITAL ESOPHAGECTOMY IN LOCALLY ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA: IMPACT OF PATHOLOGICAL COMPLETE RESPONSE.

BACKGROUND: Multimodal therapy with neoadjuvant chemoradiotherapy, followed by esophagectomy has offered better survival results, compared to isolated esophagectomy, in advanced esophageal cancer. In addition, patients who have a complete pathological response to neoadjuvant treatment presented greater overall survival and longer disease-free survival compared to those with incomplete response. AIM: To compare the results of overall survival and disease-free survival among patients with complete and incomplete response, submitted to neoadjuvant chemoradiotherapy, with two therapeutic regimens, followed by transhiatal esophagectomy. METHODS: Retrospective study, approved by the Research Ethics Committee, analyzing the medical records of 56 patients with squamous cell carcinoma of the esophagus, divided into two groups, submitted to radiotherapy (5040 cGY) and chemotherapy (5-Fluorouracil + Cisplatin versus Paclitaxel + Carboplatin) neoadjuvants and subsequently to surgical treatment, in the period from 2005 to 2012, patients. RESULTS: The groups did not differ significantly in terms of gender, race, age, postoperative complications, disease-free survival and overall survival. The 5-year survival rate of patients with incomplete and complete response was 18.92% and 42.10%, respectively (p> 0.05). However, patients who received Paclitaxel + Carboplatin, had better complete pathological responses to neoadjuvant, compared to 5-Fluorouracil + Cisplatin (47.37% versus 21.62% - p = 0.0473, p <0.05). CONCLUSIONS: There was no statistical difference in overall survival and disease-free survival for patients who had a complete pathological response to neoadjuvant. Patients submitted to the therapeutic regimen with Paclitaxel and Carboplastin, showed a significant difference with better complete pathological response and disease progression. New parameters are indicated to clarify the real value in survival, from the complete pathological response to neoadjuvant, in esophageal cancer.

Differentiation between normal and tumor mammary glands with depth-resolved attenuation coefficient from optical coherence tomography.

Optical coherence tomography (OCT) is a well-established imaging technology for high-resolution, cross-sectional imaging of biological tissues. Imaging processing and light attenuation coefficient estimation allows to further improve the OCT diagnostic capability. In this paper we use a commercial OCT system, Telesto II-1325LR from Thorlabs, and demonstrate its ability to differentiate normal and tumor mammary mouse glands with the OCT attenuation coefficient. Using several OCT images of normal and tumor mammary mouse glands (n = 26), a statistical analysis was performed. The attenuation coefficient was calculated in depth, considering a slope of 0.5 mm. The normal glands present a median attenuation coefficient of 0.403 mm-1, comparatively to 0.561 mm-1obtained for tumor mammary glands. This translates in an attenuation coefficient approximately 39% higher for tumor mammary glands when compared to normal mammary glands. The OCT attenuation coefficient estimation eliminates the subjective analysis provided by direct visualization of the OCT images.

How does drought affect native grasses' photosynthesis on the revegetation of iron ore tailings?

The revegetation of areas degraded by iron ore mining is a difficult challenge mainly due to water availability and impoverished metal-rich substrates. We sought to understand the photosynthetic responses to drought of native tropical grasses Paspalum densum (Poir.) and Setaria parviflora (Poir.) grown in iron ore tailing. The grass P. densum presented better photosynthetic adjustments when grown in the iron ore tailing and S. paviflora in response to water stress. Both species accumulated iron above the phytotoxic threshold when grown in an iron ore tailing. The net photosynthesis, stomatal conductance, transpiration, and water use efficiency decreased followed by a reduction in leaf relative water content in response to water stress for both species. The photochemical efficiency of photosystem II only decreased at the point of maximum drought. At this point, the water-stressed grass grown in the iron ore tailing presented higher H2O2 concentrations, particularly S. parviflora. After rehydration, full recovery of photosynthetic variables was achieved with decreased malondialdehyde concentrations, increased catalase activity, and, consequently, decreased H2O2 concentrations in leaves for both species. The fast recovery of the native grasses P. densum and S. parviflora to drought in the iron ore tailing substrate is indicative of their resistance and potential use in the revegetation of impoverished mined areas with high iron content and seasonal water deficit.