Infrapopliteal Bypass In Patients On Dialysis: Patency And Survival.

INTRODUCTION: Portugal has one of the highest prevalence of patients on a regular dialysis program. This population has a higher incidence of peripheral arterial disease with higher rates of postoperative morbidity and mortality. Our goal was to compare outcomes between dialysis and non-dialysis patients with chronic limb threatening ischemia (CLTI) submitted to infrapopliteal bypass. MATERIALS AND METHODS: A retrospective single-center study of infrapopliteal bypass for CLTI was performed between 2012 and 2019. Patients were divided in two groups based on dialysis status (group 1 incorporated patients on dialysis). Primary end point was 1-year freedom from CLTI. Secondary end points were limb-salvage, survival and primary (PP) and tertiary patency (TP) rates at 3 years of follow-up. RESULTS: A total of 352 infrapopliteal bypasses were performed in 310 patients with CLTI. Fourteen percent of the revascularizations were performed on dialysis patients (48/352). Median age was 73 years (interquartile range - IQR 15) and 74% (259/352) were male. Median follow-up was 26 months (IQR 42). Overall, 92% (325/352) had tissue loss and 44% (154/352) had some degree of infection. The majority of revascularization procedures were performed with vein grafts (61%, 214/352). The 30-day mortality was 4% (11/310), with no difference between groups (p = 0.627). Kaplan-Meier analysis showed no difference between groups regarding freedom from CLTI (76% vs. 79%; HR 0.96, CI 0.65-1.44, p=0.857), limb-salvage (70% vs. 82%; HR 1.40, CI 0.71-2.78, p=0.327) and survival (62% vs. 64%; HR 1.08, CI 0.60-1.94, p=0.799). PP rates were 39% in group 1 and 64% in group 2 (HR 1.71, CI 1.05-2.79, p=0.030). TP rates were not different between groups (57% and 78%; HR 1.79, CI 0.92-3.47, p=0.082). CONCLUSION: Infrapopliteal bypass for CLTI, on dialysis patients, resulted in lower PP rates. No differences were observed in freedom from CLTI, TP, limb salvage and survival.

Heparin-Bonded Expanded Polytetrafluoroethylene Is a Solution for Infrapopliteal Revascularization in the Absence of an Adequate Autologous Vein Graft.

BACKGROUND: To analyze the outcomes of heparin-bonded expanded polytetrafluoroethylene (HePTFE) graft as an alternative conduit in infrapopliteal revascularization of chronic limb-threatening ischemia (CLTI) in the absence of an autologous vein conduit. METHODS: A single-center retrospective analysis of patients with CLTI submitted to infrapopliteal bypasses with autologous vein graft (VEIN group) or HePTFE graft (HePTFE group) was implemented. Primary end points were freedom from CLTI at 12 months and recurrence of CLTI at 3 years. Secondary end points included freedom from major amputation, amputation-free survival (AFS), survival, and primary (PP) and secondary patency (SP) rates at 3 years of follow-up. RESULTS: A total of 348 limbs submitted to infrapopliteal bypasses, 214 with venous graft and 134 with HePTFE graft, were followed-up for a median of 25 months. Most patients of the HePTFE group were male (69%), with a median age of 76 years (interquartile range [IQR] 15). Fifty-nine percent of the limbs of the HePTFE group had Wound grade ≥2, being 46% of them infected. Eighty-eight percent were GLASS stage III. Freedom from CLTI was not significantly different between HePTFE and VEIN groups (75% vs. 84%, adjusted hazard ratio [aHR] 0.88, confidence interval [CI] 0.66-1.18, P = 0.401). Recurrence of CLTI was higher in the HePTFE group (42% vs.18% at 3 years; aHR 2.82, CI 1.59-5.00, P < 0.001). The VEIN group achieved higher rates of freedom from major amputation (87% vs.69% at 3 years; aHR 2.21, CI 1.31-3.75, P = 0.003) and AFS (59% vs. 37% at 3 years; aHR 1.39, CI 1.02-1.88, P = 0.036), but no significance in survival (aHR 1.10, CI 0.72-1.66, P = 0.667). Patency rates were inferior in the HePTFE group, with 2-year PP and SP rates of 52% vs. 74%, and 76% vs. 90%, respectively (PP: aHR 1.70, CI 1.11-2.59, P = 0.014; SP: aHR 2.51, CI 1.42-4.42, P = 0.001). CONCLUSIONS: Infrapopliteal bypass with autologous vein graft is the gold standard to treat CLTI limbs. HePTFE graft should be regarded as an alternative for complex infrapopliteal revascularization when lacking an autologous vein conduct.

Comparing follow-up of patients with vitamin K antagonists in a health center: pre- and post-COVID-19 pandemic / Comparação do seguimento de doentes hipocoagulados com antagonistas da vitamina K numa unidade de saúde: pré e pós pandemia COVID-19

Introduction and objectives: During the COVID-19 pandemic, the follow-up of patients treated with vitamin K antagonists (VKAs) may have been affected. This study aims to compare how these patients were monitored pre- and post-COVID-19 pandemic and understand the impact of non-face-to-face appointments on their follow-up. Methods: We conducted a retrospective cohort study in a Portuguese Health Center. The study included patients treated with VKAs and followed at the Health Center for international normalized ratio (INR) monitoring between March 2019 and March 2021. Data collected: sex, age, type of VKA; INR; date of INR assessment, type of appointment (face-to-face or phone/e-mail). Rosendaal's method was used to calculate pre-COVID-19 and post-COVID-19 time in therapeutic range (TTR). Good TTR control was defined if values ≥ 70%. Results: 44 patients were included. The mean TTR in the pre-COVID-19 period was 64.55% (95% CI: 58.10 - 71.00%). The post-COVID-19 mean was slightly higher (+ 2.26%), 66.81% (95% CI: 59.66 - 73.97%), but the difference was not statistically significant (p = 0.576). The use of non-face-to-face appointments did not contribute to worsening post-pandemic TTR, show-ing no lower follow-up than during pre-pandemic period in which all contacts were face-to-face [CI (95%) -0.397 - 0.196 for a reference range -0.489 - 0.693]. Conclusions: The TTR value in both periods was similar and lower than the value defined for effective hypocoagulation. The use of non-face-to-face consultation in the post-COVID-19 period does not seem to have influenced the quality of hypocoagulation (AU).

Introdução e objetivos: Durante a pandemia COVID-19 o acompanhamento de doentes medicados com antagonistas da vitamina K (AVKs) pode ter sido afetado. Este estudo pretende comparar a forma como estes doentes foram monitorizados antes e depois da pandemia COVID-19 e compreender o impacto da consulta não presencial no seu seguimento. Métodos: Estudo de coorte retrospetivo num Centro de Saúde em Portugal. O estudo incluiu doentes tratados com AVKs e seguidos no Centro de Saúde para monitorização do International Normalized Ratio(INR) entre março de 2019 e março de 2021. Dados recolhidos: sexo, idade, tipo de AVK; INR; data da avaliação do INR, tipo de consulta (presencial ou por telefone/e-mail). Foi utilizado o método de interpolação linear de Rosendaal para calcular o tempo em intervalo terapêutico (TTR) pré- e pós-COVID-19. Foi definido um bom controle se valores de TTR ≥ 70%. Resultados: Foram incluídos 44 doentes. A média de TTR no período pré-COVID-19 foi de 64,55% (95% IC: 58,10 - 71,00%). A média pós-COVID-19 foi ligeiramente superior (+ 2,26%), 66,81% (95% IC: 59,66 - 73,97%), mas a diferença não foi estatisticamente significativa (p = 0,576). A utilização da consulta não presencial não contribuiu para o agravamento do TTR no período pós-pandemia, não mostrando um seguimento inferior ao do período pré-pandemia em que todos os contatos foram presenciais [IC (95%) -0,397 - 0,196 para um intervalo de referência -0,489 - 0,693]. Conclusões: O valor de TTR em ambos os períodos foi semelhante e inferior ao valor definido para hipocoagulação eficaz. A utilização da consulta não presencial no período pós-COVID-19 não parece ter influenciado a qualidade da hipocoagulação (AU).

Prognostic Factors and Markers in Non-Small Cell Lung Cancer: Recent Progress and Future Challenges.

Lung cancer is a highly aggressive neoplasm and, despite the development of recent therapies, tumor progression and recurrence following the initial response remains unsolved. Several questions remain unanswered about non-small cell lung cancer (NSCLC): (1) Which patients will actually benefit from therapy? (2) What are the predictive factors of response to MAbs and TKIs? (3) What are the best combination strategies with conventional treatments or new antineoplastic drugs? To answer these questions, an integrative literature review was carried out, searching articles in PUBMED, NCBI-PMC, Google Academic, and others. Here, we will examine the molecular genetics of lung cancer, emphasizing NSCLC, and delineate the primary categories of inhibitors based on their molecular targets, alongside the main treatment alternatives depending on the type of acquired resistance. We highlighted new therapies based on epigenetic information and a single-cell approach as a potential source of new biomarkers. The current and future of NSCLC management hinges upon genotyping correct prognostic markers, as well as on the evolution of precision medicine, which guarantees a tailored drug combination with precise targeting.

An Epithelioid Hemangioma Camouflaged As Radial Aneurysm.

Epithelioid hemangioma (EH) is an uncommon benign vascular lesion usually present as subcutaneous nodules in the head and neck area. Sometimes, these lesions can occur in the peripheral arteries, and when they do, they can be mistaken for aneurysmal dilatations of that respective vessel. We report a case of a 43-year-old male who underwent surgical recession of a radial aneurysm, which after anatomopathological examination, revealed an EH.

Embarque na residência integrada em saúde: relato de experiências com ênfase em saúde coletiva / Boarding on the integrated health residence: report of experiences with emphasis on public health / Abordaje de la residencia sanitaria integrada: relato de experiencias con énfasis en salud pública

Este trabalho tem o objetivo de relatar a experiência de imersão na especialização com caráter de residência integrada com ênfase em Saúde Coletiva. Trata- se de um estudo descritivo, qualitativo, utilizando-se como referencial teórico para descrição a observação participante, memória afetiva, diário de bordo e da textualização. Foi desenvolvido na Residência Integrada em Saúde, da Escola de Saúde Pública do Estado do Ceará, ênfase em Saúde Coletiva, no período de dois anos, em Fortaleza, Ceará. Os cenários de prática foram setores relacionados à Atenção Primária à Saúde, Vigilância Epidemiológica, Sanitária e Ambiental, Controle de Endemias e Zoonoses, Imunização, além dos espaços de gestão, assistência e controle social. A imersão na especialização em caráter de residência viabilizou ferramentas para a vivência, por meio da interprofissionalidade e integração contínuas, e da realização das atividades, circulação de informações, compreensão das experiências, entendimento de macroprocessos, políticas e indicadores. Rodas de Campo e de Equipe viabilizaram o aprofundamento das temáticas administrativa, formativa, teórica e terapêutica. Percebeu-se resistência e desejo de remodelações, mediante inovação e diálogo intersetorial. A relação entre as categorias profissionais e ser sanitarista foi desafiadora. Oportunizou-se, também, habilidades de gestão, autonomia e governança, com pluralidade formativa e riqueza de atuação. A vivência favoreceu a percepção do programa de residência como processo formativo plural e significativo. O elemento político se destacou como base para a formação dos residentes e fortalecimento do sistema de saúde, e a residência integrada em saúde, como modalidade diferenciada de formação, com desafios e potencialidades.

The object of this study was to report the experience of immersion in the specialization as an integrated residency with emphasis on Public Health. A descriptive, qualitative study, of the experience report type, using participant observation, affective memory, logbook and textualization as theoretical references for description. It was developed in the Integrated Residency in Health, of the School of Public Health. emphasis on Public Health, during two years, in Fortaleza, Ceará, Brazil. The practice scenarios were sectors related to Primary Health Care, Epidemiological, Sanitary and Environmental Surveillance, Endemic and Zoonosis Control, Immunization, in addition to management, assistance and social control spaces. The immersion in the specialization in a residency character has enabled tools for the experience, through continuous interprofessionalism and integration, and the realization of activities, circulation of information, understanding of experiences, understanding of macro processes, policies and indicators. Field and team meetings made it possible to deepen the administrative, formative, theoretical, and therapeutic themes. Resistance and a desire for remodeling was perceived, through innovation and intersectoral dialogue. The relationship between the professional categories and being a sanitarian was challenging. It also provided opportunities for management skills, autonomy, and governance, with formative plurality and richness of action. The experience favored the perception of the residency program as a plural and significant formative process. The political element stood out as the basis for training residents and strengthening the health system, and the integrated health residency as a differentiated training modality, with challenges and potentialities.

El objeto de este estudio fue relatar la experiencia de inmersión en la especialización como residencia integrada con énfasis en Salud Pública. Estudio descriptivo, cualitativo, del tipo relato de experiencias, utilizando la observación participante, la memoria afectiva, la bitácora y la textualización como referentes teóricos para la descripción. Se desarrolló en la Residencia Integrada en Salud, de la Escuela de Salud Pública. énfasis en Salud Pública, durante dos años, en Fortaleza, Ceará, Brasil. Los escenarios de la práctica fueron sectores relacionados con la Atención Primaria de Salud, Vigilancia Epidemiológica, Sanitaria y Ambiental, Control de Endemias y Zoonosis, Inmunización, además de espacios de gestión, asistencia y control social. La inmersión en la especialización en carácter de residencia ha posibilitado herramientas para la experiencia, a través de la continua interprofesionalidad e integración, y la realización de actividades, circulación de información, comprensión de experiencias, entendimiento de macro procesos, políticas e indicadores. Reuniones de campo y de equipo posibilitaron la profundización de los temas administrativos, formativos, teóricos y terapéuticos. Se percibieron resistencias y deseos de remodelación, a través de la innovación y el diálogo intersectorial. La relación entre las categorías profesionales y el ser sanitario fue desafiante. También proporcionó oportunidades para la capacidad de gestión, autonomía y gobernanza, con pluralidad formativa y riqueza de acción. La experiencia favoreció la percepción del programa de residencia como un proceso formativo plural y significativo. Se destacó el elemento político como base para la formación de residentes y fortalecimiento del sistema de salud, y la residencia integrada en salud como modalidad formativa diferenciada, con desafíos y potencialidades.

Aprendizagem significativa na educação em enfermagem: uma revisão integrativa / Meaningful learning in nursing education: an integrative review / Aprendizaje significativo en la formación de enfermería: una revisión integrativa

Objetivo: Analisar a produção científica acerca das estratégias educativas, baseadas em evidências, utilizadas no processo de ensino aprendizagem em enfermagem à luz da abordagem da aprendizagem significativa. Método: Revisão integrativa desenvolvida de acordo com as etapas: identificação do tema e seleção da hipótese de pesquisa; estabelecimento dos critérios de elegibilidade; identificação dos estudos nas bases científicas/categorização dos estudos; avaliação dos estudos selecionados; análise crítica e interpretação dos resultados; apresentação dos dados na estrutura da revisão integrativa. Resultados: Diferentes estratégias educativas baseadas na aprendizagem significativa foram identificadas tais como: mapa conceitual, estudo de caso, uso de simulador, cursos on-line e jogos. Como principais resultados das intervenções, observou-se a promoção da aprendizagem significativa e o desenvolvimento do raciocínio reflexivo e crítico em estudantes e profissionais de enfermagem, atuando como sujeitos de sua própria práxis. Conclusão: A aprendizagem significativa é uma linha pedagógica fundamental, devendo ser inserida no processo de educação em diversas áreas do saber. Dessa maneira, foi possível identificar que a mesma ancorou estratégias de ensino que se mostraram eficazes, com destaque para o uso de mapas conceituais e as tecnologias educacionais digitais.

Objective: To analyze the scientific production about educational strategies, based on evidence, used in the teaching-learning process in nursing in the light of the meaningful learning approach. Method: Integrative review developed according to the steps: identification of the theme and selection of the research hypothesis; establishment of eligibility criteria; identification of studies in scientific bases/categorization of studies; evaluation of selected studies; critical analysis and interpretation of results; presentation of data in the framework of the integrative review. Results: Different educational strategies based on meaningful learning were identified, such as: conceptual map, case study, use of simulator, online courses and games. As main results of the interventions, it was observed the promotion of meaningful learning and the development of reflective and critical reasoning in students and nursing professionals, acting as subjects of their own praxis. Conclusion: Meaningful learning is a fundamental pedagogical line and should be inserted in the education process in several areas of knowledge. In this way, it was possible to identify that it anchored teaching strategies that proved to be effective, with emphasis on the use of concept maps and digital educational technologies.

Objetivo: Analizar la producción científica sobre estrategias educativas basadas en la evidencia utilizadas en el proceso de enseñanza-aprendizaje en enfermería a la luz del enfoque del aprendizaje significativo. Método: Revisión integrativa desarrollada de acuerdo con los siguientes pasos: identificación del tema y selección de la hipótesis de investigación; establecimiento de criterios de elegibilidad; identificación de estudios en bases de datos científicas/categorización de estudios; evaluación de los estudios seleccionados; análisis crítico e interpretación de los resultados; presentación de los datos en la estructura de revisión integrativa. Resultados: Se identificaron distintas estrategias educativas basadas en el aprendizaje significativo como: mapa conceptual, estudio de casos, uso de simulador, cursos online y juegos. Los principales resultados de las intervenciones fueron la promoción del aprendizaje significativo y el desarrollo del pensamiento reflexivo y crítico en estudiantes y profesionales de enfermería, actuando como sujetos de su propia praxis. Conclusión: El aprendizaje significativo es una línea pedagógica fundamental y debe insertarse en el proceso educativo en diversas áreas del conocimiento. Así, fue posible identificar que ancló estrategias de enseñanza que se mostraron eficaces, con énfasis en el uso de mapas conceptuales y tecnologías educativas digitales.

Effects of Photodynamic Therapy with Laser Photobiomodulation as an Adjunct to Scaling and Root Planing: Systematic Review / Efeitos da Terapia Fotodinâmica com Fotobiomodulação Laser Adjuvante a Raspagem e Alisamento Radicular: Revisão Sistemática

Scaling and root planing is the gold standard procedure in the periodontal disease treatment. Although this therapy has the ability to reduce or eliminate periodontopathogens mthrough periodontal instrumentation, sometimes the response to treatment may not promote the complete eradication of pathogens, affecting the healing process and leading to the presence of residual periodontal pockets. The aim of this study was to analyze the effectiveness of photodinamic therapy with laser photobiomodulation and as an adjunct to scaling and root planing (having as a conductive agent a fiber optic tip radiating inside the periodontal pocket), compared to scaling and root planing alone in patients with periodontitis on randomized trials. This systematic review was carried out complying with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta Analyses. The databases used were Pubmed, Lilacs, Biblioteca Virtual em Saúde - Odontologia and Medline. "Periodontal Disease" OR "Periodontal Treatment" AND m"Photodinamic Theraphy" were the descriptors used. A total of five articles were included. Two studies have shown superior results in relation to the referred association; a study indicated benefits in biochemical and/or microbiological aspects; it suggests, however, that clinical relevance needs to be better evaluated; two studies did not reveal benefits that categorize photodynamic therapy + scaling and root planning as superior to conventional treatment. The association in question, when well standardized and performed, can result in promising responses in the control of periodontal disease; however, the clinical benefits that demonstrate its superiority will certainly be subject to new researches. (AU)

A raspagem e alisamento radicular é o procedimento padrão-ouro no tratamento da doença periodontal. Embora essa terapia seja capaz de reduzir ou eliminar os periodontopatógenos por meio da instrumentação periodontal, algumas vezes a resposta ao tratamento pode não promover completa erradicação dos patógenos, afetando assim, o processo de cicatrização e levando à presença de bolsas periodontais residuais. O objetivo do presente estudo foi analisar a eficácia da terapia fotodinâmica com fotobiomodulação laser adjuvante a raspagem e alisamento radicular (tendo como agente condutor uma ponta de fibra óptica que irradia o interior da bolsa periodontal), em comparação com a raspagem e alisamento radicular isoladamente em pacientes com periodontite, avaliados em estudos clínicos randomizados. Esta revisão sistemática foi realizada de acordo com as recomendações Principais Itens para Relatar Revisões sistemáticas e Meta-análises. As bases de dados utilizadas foram Pubmed, Lilacs, Biblioteca Virtual em Saúde - Odontologia e Medline. "Doença periodontal" OR "Tratamento periodontal" AND "Terapia fotodinâmica" foram os descritores utilizados. Um total de cinco artigos foram incluídos. Dois estudos mostraram resultados superiores em relação à referida associação; um estudo indicou benefícios nos aspectos bioquímicos e/ou microbiológicos; sugere, no entanto, que a relevância clínica precisa ser melhor avaliada; dois estudos não revelaram benefícios que categorizassem a terapia fotodinâmica + raspagem e alisamento radicular como superiores ao tratamento convencional. A associação em questão, quando bem padronizada e realizada, pode resultar em respostas promissoras no controle da doença periodontal; entretanto, os benefícios clínicos que demonstram sua superioridade certamente serão alvo de novas pesquisas. (AU)

Evaluation of global limb anatomic staging system for patients with chronic limb-threatening ischemia treated with autogenous bypass grafts.

OBJECTIVE: We evaluated the relationship of the global limb anatomic staging system (GLASS) stage with the clinical outcomes for patients with chronic limb-threatening ischemia (CLTI) who had undergone distal bypass with vein grafting. METHODS: We performed a single-center, retrospective analysis of patients with CLTI who had undergone distal bypass with vein grafting from January 2012 to December 2019. The primary end point was freedom from CLTI, including amputation-free survival, complete wound healing, and no ischemic rest pain. The secondary end points included a composite outcome of recurrence (patients who had achieved freedom from CLTI but had developed a new wound or ischemic rest pain), major limb amputation, amputation free-survival, overall survival, major adverse limb events, limb-based patency, and primary and secondary patency rates. RESULTS: A total of 190 patients had undergone 211 distal bypasses with a median follow-up of 30 months. Of these patients, 80% had had diabetes or end-stage renal disease requiring dialysis. Most patients (63%) had experienced major or extensive tissue loss (WIfI [wound, ischemia, foot infection] wound class ≥2), and more than one half of these had had some degree of infection of the foot. A severe anatomic pattern (GLASS stage III) was predominant, with a prevalence of 78%. No significant differences were found between GLASS stage I and II and GLASS stage III groups for all the outcomes analyzed. Approximately 80% of the 211 revascularized limbs were free of CLTI at 12 months after treatment. At 4 years of follow-up, we observed that 25% of the patients had had CLTI recurrence, 83% were free from major amputation, and 61% were free from major adverse limb events. Limb-based patency, primary patency, and secondary patency were 79%, 80%, and 93% at 1 year and 64%, 65%, and 81% at 4 years, respectively. CONCLUSIONS: The GLASS stage was not related to patency or the clinical outcomes after distal bypass with vein grafting. Distal open revascularization resulted in excellent rates of freedom from CLTI with low rates of CLTI recurrence, two key time-integrated outcomes of clinical disease severity for patients with CLTI.

Application of ozonized oils in human body and oral cavity systems / Aplicação dos óleos ozonizados nos sistemas do corpo humano e cavidade oral

ABSTRACT Wound healing consists of the coordinated cascade of molecular, cellular and biochemical events that interact for tissue recomposition to occur. The interruption or failure in this process can trigger the delay in closing the lesion and chronic wounds, in addition to infections. Ozonotherapy proves to be a promising alternative, capable of assisting in the tissue healing process, modulating the inflammatory response and preventing the development of infection. To present, analyze and discuss, through a literature review, the use of Ozonated Oils in the repair of the human body and oral cavity systems. SciELO, LILACS, MEDLINE and PubMed databases were consulted, using the following DeCS / MeSH descriptors: "ozonized oil"; "healing"; "ozone therapy". After crossing, counting and analyzing, 13 studies were selected, according to the theme. Due to the complementary theoretical foundation, 44 articles were included, totaling 57 articles used for the present review. Ozonized Oil therapy has beneficial clinical effects, which include antimicrobial, immunostimulating, analgesic, antipoxic, immunoregulatory and antioxidant action. Topical management of ozone has proven effective for the treatment of foot-and-mouth disease, gingivitis, ulcers and dermatitis, contributing to pain relief and healing. Infectious skin diseases, abscesses, allergic skin diseases, scaly erythema, psoriasis and palmoplantar pustulosis are pathological conditions, the treatment of which benefits from the application of Ozonized Oils. Ozonized Oils have been shown to be effective in the treatment of local infections, when in appropriate formulations and in controlled cases, being a promising therapeutic alternative for tissue repair.

RESUMO A cicatrização de feridas consiste na coordenada cascata de eventos moleculares, celulares e bioquímicos que interagem para que ocorra a recomposição tecidual. A interrupção ou falha nesse processo, pode desencadear o atraso no fechamento da lesão e feridas crônicas, além de infecções. A Ozonioterapia revela-se uma alternativa promissora, capaz de auxiliar no processo de cicatrização tecidual, modular a resposta inflamatória e prevenir o desenvolvimento de infecção. Apresentar, analisar e discutir, através de uma revisão da literatura, o emprego de Óleos Ozonizados no reparo dos sistemas do corpo humano e cavidade oral. Bases de dados SciELO, LILACS, MedLine e PubMed foram consultadas, utilizando os seguintes descritores DeCS/MeSH: "ozonized oil"; "healing"; "ozone therapy". Após cruzamento, apuração e análise, foram selecionados 13 estudos, de acordo com a temática. Devido à fundamentação teórica complementar, 44 artigos foram incluídos, totalizando 57 artigos utilizados para a presente revisão. A terapia com Óleo Ozonizado possui efeitos clínicos benéficos, que incluem ação antimicrobiana, imunoestimulante, analgésica, antipóxica, imunorreguladora e antioxidante. O manejo tópico de ozônio revelou-se eficaz para o tratamento de estomatite aftosa, gengivite, úlceras e dermatite, contribuindo para o alívio da dor e cicatrização. Doenças infecciosas da pele, abscessos, doenças alérgicas da pele, eritema escamoso, psoríase e pustulose palmoplantar são condições patológicas, cujo tratamento é beneficiado pela aplicação de Óleos Ozonizados. Os Óleos Ozonizados têm demonstrado eficácia no tratamento de infecções locais, quando em formulações apropriadas e em casos controlados, sendo uma alternativa terapêutica promissora para o reparo de tecidos.

Discovering the N-Terminal Methylome by Repurposing of Proteomic Datasets.

Protein α-N-methylation is an underexplored post-translational modification involving the covalent addition of methyl groups to the free α-amino group at protein N-termini. To systematically explore the extent of α-N-terminal methylation in yeast and humans, we reanalyzed publicly accessible proteomic datasets to identify N-terminal peptides contributing to the α-N-terminal methylome. This repurposing approach found evidence of α-N-methylation of established and novel protein substrates with canonical N-terminal motifs of established α-N-terminal methyltransferases, including human NTMT1/2 and yeast Tae1. NTMT1/2 are implicated in cancer and aging processes but have unclear and context-dependent roles. Moreover, α-N-methylation of noncanonical sequences was surprisingly prevalent, suggesting unappreciated and cryptic methylation events. Analysis of the amino acid frequencies of α-N-methylated peptides revealed a [S]1-[S/A/Q]2 pattern in yeast and [A/N/G]1-[A/S/V]2-[A/G]3 in humans, which differs from the canonical motif. We delineated the distribution of the two types of prevalent N-terminal modifications, acetylation and methylation, on amino acids at the first position. We tested three potentially methylated proteins and confirmed the α-N-terminal methylation of Hsp31 by additional proteomic analysis and immunoblotting. The other two proteins, Vma1 and Ssa3, were found to be predominantly acetylated, indicating that proteomic searching for α-N-terminal methylation requires careful consideration of mass spectra. This study demonstrates the feasibility of reprocessing proteomic data for global α-N-terminal methylome investigations.

RECURRENT VARICOSE VEINS FOLLOWING SMALL SAPHENOUS VEIN SURGERY: A 5-YEAR FOLLOW-UP DUPLEX ULTRASOUND STUDY.

INTRODUCTION: Chronic venous disease (CVD) of the lower limbs is a very prevalent medical condition with important socioeconomic repercussions. Small saphenous vein (SSV) incompetence, although less frequent than great saphenous vein (GSV) incompetence, presents a more challenging treatment, with higher rates of complication and recurrence. OBJECTIVES: To determine the incidence and associated risk factors of varicose veins recurrence in patients submitted, for the first time and exclusively, to SSV surgery with 5 years of follow-up. METHODS: Retrospective analysis of all exclusively first-time SSV surgeries, at Angiology and Vascular Surgery Service of Hospital Beatriz Ângelo, between January 1st, 2013, and December 31st, 2014. In March 2019, the authors performed clinical and venous doppler ultrasound reassessment of all included patients. RESULTS: A total of 23 limbs were evaluated, 56.5% were female and the mean age was 51.8 years. All patients were symptomatic and underwent ligation of the saphenopopliteal junction (SPJ), 26.1% and 43.5% had total and partial SSV stripping, respectively. After venous doppler ultrasound at 5-year follow-up, we found that 21.7% did not present a correct SPJ ligation due to failure to identify its location, with a statistically significant association between SPJ ligation and varicose vein recurrence. In follow-up, we also diagnosed GSV incompetence in 21.7% for the first time, which is in agreement with the fact that this is a chronic disease. Finally, we found that all patients with symptomatic recurrence at 5-year follow-up had CVD, however, some asymptomatic patients also had ultrasound changes. CONCLUSION: Routine preoperative localization of the SPJ by doppler ultrasound guidance could have an impact in minimizing varicose vein recurrence. Imaging recurrence does not always translate into clinical recurrence. Because this is a chronic disease, patients should keep general care to prevent disease progression, even after surgery.

In-depth investigation of Sodium percarbonate as oxidant of PAHs from soil contaminated with diesel oil.

Sodium percarbonate (SPC, 2Na2CO3∙3H2O2), is a compound that can be used under multiple environmental applications. In this work, SPC was employed as oxidant in the treatment of soil contaminated with diesel oil. The soil samples were collected during the earthmoving stage of RNEST Oil Refinery (Petrobras), Brazil. Then, the samples were air-dried, mixed and characterized. Subsequently, raw soil was contaminated with diesel and treated by photo-Fenton reaction (H2O2/Fe2+/UV). SPC played a significant role in the generation of hydroxyl radicals under the catalytic effect of ferrous ions (Fe2+), hydrogen peroxide (H2O2) and radiation. These radicals provoked the photodegradation of polycyclic aromatic hydrocarbons (PAHs), in the soil remediation. A factorial design 33 was carried out to assess the variables which most influenced the decrease in total organic carbon (TOC). The study was performed with the following variables: initial concentration of [H2O2] and [Fe2+], between 190.0 and 950.0 mmol L-1 and 0.0-14.4 mmol L-1, respectively. UV radiation was supplied from sunlight, blacklight lamps, and system without radiation. All experiments were performed with 5.0 g of contaminated soil in 50.0 mL of solution. The initial concentration of Fe2+ showed the statistically most significant effect. The oxidation efficiency evaluated in the best condition showed a decrease from 34,765 mg kg-1 to 15,801 mg kg-1 in TOC and from 85.750 mg kg-1 to 20.770 mg kg-1 in PAHs content. Moreover, the sums of low and high molecular weight polycyclic aromatic hydrocarbons (LMW-PAHs and HMW-PAHs) were 19.537 mg kg-1 and 1.233 mg kg-1, respectively. Both values are within the limits recommended by the United Sates Environmental Protection Agency (USEPA) and evidenced the satisfactory removal of PAHs from contaminated soil, being an alternative to classic oxidation protocols.

Proteomic and metabolomic profiling reveals the involvement of apoptosis in meat quality characteristics of ovine M. longissimus from different callipyge genotypes.

Proteome and metabolome changes in muscles from callipyge mutation (+/C) and non-callipyge phenotype (+/+, C/+, and C/C) lambs were profiled to provide insight into the biochemical changes affecting meat quality attributes. M. longissimus thoracis from lambs with all four possible callipyge genotype (n = 4, C/+, C/C, +/C, and +/+) were collected after 3d aging and analyzed using mass-spectrometry based platforms. Among identified proteomes, cytochrome c (pro-apoptotic protein) was detected with significantly lower abundances in +/C. Anti-apoptotic HSP70, BAG3, and PARK7 were over-abundant in +/C, which could result in delayed apoptosis and possibly attributed to tougher meat in callipyge lambs. Eight glycolysis enzymes were overabundant in +/C lambs, whereas 3 enzymes involved in TCA cycle were overabundant in non-callipyge ones (C/C and/or C/+). Twenty-five metabolites were affected by genotypes (P < .05), including metabolic co-factors, polyphenols, and AA/short peptides. Our omics results provided insightful information for revealing the differences in biochemical attributes caused by callipyge mutation.

Global Proteomic Analyses of STING-Positive and -Negative Macrophages Reveal STING and Non-STING Differentially Regulated Cellular and Molecular Pathways.

PURPOSE: Cyclic guanosine monophosphate-adenosine monophosphate and other bacterial-derived cyclic di-guanosine monophosphate or cyclic di-adenosine monophosphate trigger innate immune responses through binding to stimulator of interferon genes (STING). Thus in chronic infection, such as in periodontitis, immune cells can be exposed to bacterial DNA and/or cyclic dinucleotides, potentially activating STING to cause inflammation. Thus far the cyclic GMP-AMP synthase-STING- TANK-binding kinase 1 pathway has been well characterized but a global perspective of how the presence or lack of STING affect the proteome is lacking. The aim of this study is to identify macrophage proteins that are affected by STING. EXPERIMENTAL DESIGN: Proteins are extracted from a macrophage cell line harboring STING (RAW-Blue ISG) as well as a STING knockout (STING KO) cell line (RAW-Lucia ISG-KO-STING) and global proteomics analyses are performed. RESULTS: Proteins related to kinase and phosphatase signaling, spliceosome, terpenoid backbone biosynthesis, glycosylation, ubiquitination, and phagocytosis are affected by STING knock out. CONCLUSIONS AND CLINICAL RELEVANCE: STING pathway in macrophages is related to the regulation of several proteins that are known as potent biomarkers of various cancers and autoimmune diseases. Moreover, the relation between STING and phagocytosis is demonstrated for the first time. Further validation studies will help identify molecules and pathways that may function as diagnostic or therapeutic targets.

The Os Peroneum incidence - A cadaveric study.

BACKGROUND: The Os Peroneum (OP) is a small sesamoid bone, which can be found in the Peroneus Longus Tendon (PLT) sheath, near the calcaneocuboid joint. Size and shape variability is quite common as well as a multipartite OP that can be found in some cases. Trying to explore and understand this variability, this study was carried out in order to provide us with answers about the presence and shape of OP in our specimens. METHODS: Twenty cadaveric lower extremities were obtained according to the body donation program of our institution. Dissections were performed to expose the OP (when present) starting proximally at the origin of the PLT and Peroneal Brevis Tendon (PBT) finalizing at the insertion of the PLT in the first metatarsal. RESULTS: In twenty feet, nine distinct OP were found, whilst six feet had a thickening of the tendon. On the remaining five foot, we did not identify an OP. CONCLUSIONS: In this study, 45% of the feet analyzed had an OP. The authors believe the variability of OP prevalence reported in the literature can be associated with differences in its definition.

Different tray cell volumes for lettuce grown in conventional and hydroponic system / Diferentes volumes de célula da bandeja para alface cultivada em sistema convencional e hidropônico

ABSTRACT: Nowadays, an important economic movement is involved in the improvement of polyethylene trays for the production of seedlings, being developed with different volumes, numbers and cell formats in an each culture-specific manner. The objective of the present study was to evaluate the performance of curly lettuce originated from seedlings from trays with different volumes, through the comparison between conventional and hydroponic-NFT cultivation. Five volumes of trays (10, 20, 30, 40 and 50 cm³ of cell-1) were tested in conventional and hydroponic cultivation, from February to March 2016. For the purpose of comparison, the plants were evaluated through the characteristics of height, circumference, stem diameter, number of leaves, fresh shoot mass and productivity. The use of volumes greater than 10 cm³ showed higher precocity in both cultivation systems, with hydroponic cultivation being more precocious and productive when compared to conventional cultivation.

RESUMO: Atualmente, um importante movimento econômico está envolvido na aprimoração das bandejas de polietileno para a produção de mudas, sendo desenvolvido com diferentes volumes, números e formatos de células de forma específica para cada cultura. O objetivo do presente estudo foi avaliar o desempenho de alface crespa, oriunda de mudas de bandejas com diferentes volumes, através da comparação entre cultivo convencional e hidropônico-NFT. Cinco volumes de bandejas (10, 20, 30, 40 e 50 cm³ de célula-1) foram testados em cultivo convencional e hidropônico, no período de fevereiro a março de 2016. Para fins de comparação, as plantas foram avaliadas através das características de altura, circunferência, diâmetro do caule, número de folhas, massa fresca da parte aérea e produtividade. O uso de volumes superiores a 10 cm³ apresentou maior precocidade em ambos os sistemas de cultivo, sendo o cultivo hidropônico mais precoce e produtivo quando comparado ao cultivo convencional.

Proteomic Analysis of 3T3-L1 Adipocytes Treated with Insulin and TNF-α.

Insulin resistance is an indication of early stage Type 2 diabetes (T2D). Insulin resistant adipose tissues contain higher levels of insulin than the physiological level, as well as higher amounts of intracellular tumor necrosis factor-α (TNF-α) and other cytokines. However, the mechanism of insulin resistance remains poorly understood. To better understand the roles played by insulin and TNF-α in insulin resistance, we performed proteomic analysis of differentiated 3T3-L1 adipocytes treated with insulin (Ins), TNF-α (TNF), and both (Ins + TNF). Out of the 693 proteins identified, the abundances of 78 proteins were significantly different (p < 0.05). Carnitine parmitoyltransferase-2 (CPT2), acetyl CoA carboxylase 1 (ACCAC-1), ethylmalonyl CoA decarboxylase (ECHD1), and methylmalonyl CoA isomerase (MCEE), enzymes required for fatty acid ß-oxidation and respiratory electron transport, and ß-glucuronidase, an enzyme responsible for the breakdown of complex carbohydrates, were down-regulated in all the treatment groups, compared to the control group. In contrast, superoxide dismutase 2 (SOD2), protein disulfide isomerase (PDI), and glutathione reductase, which are the proteins responsible for cytoskeletal structure, protein folding, degradation, and oxidative stress responses, were up-regulated. This suggests higher oxidative stress in cells treated with Ins, TNF, or both. We proposed a conceptual metabolic pathway impacted by the treatments and their possible link to insulin resistance or T2D.

Influência da idade do lodo na colmatação das membranas em um biorreator à membrana tratando esgoto sanitário / Effect of solids retention time on membrane fouling in a membrane bioreactor treating municipal wastewater

RESUMO O presente estudo avaliou o efeito da idade do lodo (θc) no potencial incrustante do licor misto em um biorreator à membrana (BRM) tratando esgoto sanitário. Tal avaliação foi conduzida em BRM construído em escala de bancada, com volume útil de 15 L, operado por 420 dias na modalidade de batelada sequencial. Durante o período experimental, foram aplicadas 3 estratégias operacionais, E-1, E-2 e E-3, em que foram testadas as idades de lodo de 80, 40 e 20 dias, respectivamente. Os resultados revelaram que a utilização da idade de lodo de 20 dias resultou em licor misto com maior potencial incrustante, apresentando, neste caso, uma velocidade de colmatação (VC) das membranas de 1,95 mbar dia-1, aproximadamente 2 vezes maior do que a observada nas idades de lodo de 80 e 40 dias. A maior colmatação observada foi atribuída a maior concentração de produtos microbianos solúveis (PMSs) no licor misto e a maior relação proteínas/polissacarídeos (PN/PS) dos flocos biológicos nesse período em questão. Por outro lado, a aplicação da idade de lodo de 80 dias resultou em menor VC das membranas do BRM, com valor de 0,82 mbar dia-1. Contudo, no período final dessa estratégia foi observado crescimento excessivo de bactérias filamentosas, que se refletiu em piora da filtrabilidade do licor misto e aumento da VC das membranas. De maneira geral, os resultados obtidos mostraram que a aplicação da idade de lodo de 40 dias resultou em licor misto com menor potencial incrustante.

ABSTRACT This study evaluated the effect of solids retention time (SRT) on membrane fouling rate in a membrane bioreactor (MBR) treating municipal wastewater. The evaluation was conducted in a membrane bioreactor built in bench scale, with a volume of 15 L, operated for 420 days in the sequential batch regime. During this period, three experimental runs were applied, E-1, E-2 and E-3, in which the solids retention time of 80, 40 and 20 days, respectively, were tested. The results showed that use of 20-days solids retention time resulted in a higher membrane fouling rate (MFR), with value of 1,95 mbar d-1, approximately two times higher than observed in the solids retention time of 80 and 40 days. The higher membrane fouling rate observed was attributed to a higher concentration of soluble microbial products (SMP) in the mixed liquor and to the higher proteins/polysaccharides ratio of the biological flocs in this period. On the other hand, the use of 80-days solids retention time resulted in a lower membrane fouling rate, with a value of 0.82 mbar d-1. However, it was observed in the final period of this experimental run an excessive growth of filamentous bacteria, which was reflected in a deterioration of the mixed liquor filterability and an increase of membrane fouling rate. Overall, the results showed that the 40-days solids retention time resulted in a mixed liquor with lower fouling propensity.