The diagnostic value of transthoracic ultrasonographic features in predicting malignancy in undiagnosed pleural effusions: a prospective observational study.

BACKGROUND: Transthoracic ultrasound (US) is an important instrument to identify pleural effusions and safely conduct invasive procedures. It also allows systematic scanning of the pleural surface, though its value remains uncertain for differentiation between malignant (MPE) and nonmalignant pleural effusion (non-MPE) in routine clinical practice. OBJECTIVES: To evaluate the utility of US features to predict malignancy in undiagnosed pleural effusions in a real-life clinical setting. METHODS: The US features of 154 consecutive patients with a pleural effusion were prospectively assessed. Anonymous images were recorded by an operator blinded to the clinical and radiological results. The US findings were classified by independent reviewers and compared to the final diagnosis. RESULTS: A total of 133 patients were included (age 67 ± 16 years; BMI 25.1 ± 4.6; 54.1% females). The final diagnosis was MPE in 66 cases and non-MPE in 67 cases. US had an overall sensitivity of 80.3%, a specificity of 83.6%, and positive and negative predictive values of 82.8 and 81.2%, respectively, for the detection of malignancy. US accuracy was 81.9%. The presence of pleural/diaphragmatic nodules, pleural/diaphragmatic thickness >10 mm, and a swirling sign was significantly different between both groups (p < 0.001). Lung air bronchogram sign and a septated US pattern were more common in non-MPE patients (p < 0.01). The existence of nodularity and the absence of air bronchograms were more likely to indicate malignancy (OR 29.0, 95% CI 7.65-110.08 and OR 10.4, 95% CI 1.65-65.752, respectively). CONCLUSIONS: In the presence of an undiagnosed pleural effusion, US morphological characteristics can aid in differentiating MPE from non-MPE. Pleural/diaphragmatic nodularity was the most relevant feature although no finding was pathognomonic of MPE.

Diagnostic value of endobronchial and endoscopic ultrasound-guided fine needle aspiration for accessible lung cancer lesions after non-diagnostic conventional techniques: a prospective study.

BACKGROUND: Lung cancer diagnosis is usually achieved through a set of bronchoscopic techniques or computed tomography guided-transthoracic needle aspiration (CT-TTNA). However these procedures have a variable diagnostic yield and some patients remain without a definite diagnosis despite being submitted to an extensive workup. The aim of this study was to evaluate the efficacy and cost of linear endobronchial (EBUS) and endoscopic ultrasound (EUS) guided fine needle aspiration (FNA), performed with one echoendoscope, for the diagnosis of suspicious lung cancer lesions after failure of conventional procedures. METHODS: One hundred and twenty three patients with an undiagnosed but suspected malignant lung lesion (paratracheal, parabronchial, paraesophageal) or with a peripheral lesion and positron emission tomography positive mediastinal lymph nodes who had undergone at least one diagnostic flexible bronchoscopy or CT-TTNA attempt were submitted to EBUS and EUS-FNA. Patients with endobronchial lesions were excluded. RESULTS: Of the 123 patients, 88 had a pulmonary nodule/mass and 35 were selected based on mediastinal PET positive lymph nodes. Two patients were excluded because an endobronchial mass was detected at the time of the procedure. The target lesion could be visualized in 121 cases and FNA was performed in 118 cases. A definitive diagnosis was obtained in 106 cases (87.6%). Eighty-eight patients (72.7%) had non-small cell lung cancer, 15 (12.4%) had small cell lung cancer and metastatic disease was found in 3 patients (2.5%). The remaining 15 negative cases were subsequently diagnosed by surgical procedures. Twelve patients (9.9%) had a malignant tumor and in 3 (2.5%) a benign lesion was found. The overall sensitivity, specificity, positive and negative predictive values of EBUS and EUS-FNA to diagnose malignancy were 89.8%, 100%, 100% and 20.0% respectively. The diagnostic accuracy was 90.1% in a population with 97.5% prevalence of cancer. The ultrasonographic approach avoided expensive surgical procedures and significantly reduced costs (p < 0.001). CONCLUSIONS: Linear EBUS and EUS-FNA are able to improve the diagnostic yield of suspicious lung cancer lesions after non-diagnostic conventional techniques. These techniques, performed with one scope, can be offered to patients with accessible lesions as an intermediate step for diagnosis since they may avoid more invasive procedures and hence reduce costs.

Functional annotation and comparative modeling of ligninolytic enzymes from Trametes villosa (SW.) Kreisel for biotechnological applications.

Functional annotation of Trametes villosa genome was performed to search Class II peroxidase proteins in this white-rot fungus, which can be valuable for several biotechnological processes. After sequence identification and manual curation, five proteins were selected to build 3 D models by comparative modeling. Analysis of sequential and structural sequences from selected targets revealed the presence of two putative Lignin Peroxidase and three putative Manganese Peroxidase on this fungal genome. All 3 D models had a similar folding pattern from selected 3 D structure templates. After minimization and validation steps, the best 3 D models were subjected to docking studies and molecular dynamics to identify structural requirements and the interactions required for molecular recognition. Two reliable 3 D models of Class II peroxidases, with typical catalytic site and architecture, and its protein sequences are indicated to recombinant production in biotechnological applications, such as bioenergy.Communicated by Ramaswamy H. Sarma.

Draft genome sequence of Trametes villosa (Sw.) Kreisel CCMB561, a tropical white-rot Basidiomycota from the semiarid region of Brazil.

Herein, we present the draft genome of Trametes villosa isolate CCMB561, a wood-decaying Basidiomycota commonly found in tropical semiarid climate. The genome assembly was 57.98 Mb in size with an L50 of 691. A total of 16,711 putative protein-encoding genes was predicted, including 590 genes coding for carbohydrate-active enzymes (CAZy), directly involved in the decomposition of lignocellulosic materials. This is the first genome of this species of high interest in bioenergy research. The draft genome of Trametes villosa isolate CCMB561 will provide an important resource for future investigations in biofuel production, bioremediation and other green technologies.

Ultrafiltração e gravidade de pacientes renais agudos associadas com complicações clínicas decorrentes da hemodiálise / Ultrafiltración y gravedad de pacientes renales agudos asociadasa complicaciones clínicas derivadas de la hemodiálisis / Ultrafiltration and critical acute kidney patients associated with clinical complications due to hemodialysis

RESUMO Objetivo: Analisar a associação entre ultrafiltração e gravidade de pacientes diagnosticados com lesão renal aguda com complicações clínicas decorrentes da hemodiálise. Método: Estudo transversal realizado num hospital universitário do Sul do Brasil. Foram incluídas todas as fichas diárias de sessões de hemodiálise de pacientes com lesão renal aguda submetidos à hemodiálise entre setembro e novembro de 2017. Para obtenção dos dados, elaborou-se um instrumento de coleta. Adotou-se nível de significância inferior a 5%. Resultados: Os 103 pacientes estudados fizeram um total de 519 sessões de hemodiálise. Prevaleceram pacientes do sexo masculino (66,7%) com 60 anos ou mais (51,5%). Cerca de metade dos pacientes apresentou volume médio de ultrafiltração >1501ml (51,5%). A maioria foi considerada grave (72,8%). Dentre as complicações, a mais prevalente foi a hipotensão (69,9%). A realização de um maior volume de ultrafiltração não se associou às complicações estudadas. Pacientes graves apresentaram maior chance para ocorrência de hipotensão (p<0,001 e OR: 33,73). Conclusão: Hipotensão durante a hemodiálise foi uma complicação frequente, ocorrendo em cerca de metade dos pacientes. Como não esteve associada a volumes maiores de ultrafiltração, conclui-se que, possivelmente, a maior gravidade do paciente seja um fator explicativo para o desenvolvimento dessa complicação.

RESUMEN Objetivo: analizar la asociación entre ultrafiltración y gravedad de pacientes diagnosticados con lesión renal aguda con complicaciones clínicas derivadas de la hemodiálisis. Método: estudio transversal realizado en un hospital universitario del Sur de Brasil. Se incluyeron todas las fichas diarias de sesiones de hemodiálisis de pacientes con lesión renal aguda sometidos a hemodiálisis entre septiembre y noviembre de 2017. Para obtener los datos, se elaboró un instrumento de recolección. Se adoptó un nivel de significancia inferior al 5%. Resultados: los 103 pacientes estudiados realizaron un total de 519 sesiones de hemodiálisis. Prevalecieron pacientes varones (66,7%) con 60 años o más (51,5%). Cerca de la mitad de los pacientes presentó volumen medio de ultrafiltración >1501ml (51,5%). La mayoría fue considerada grave (72,8%). Entre las complicaciones, la más prevalente fue la hipotensión (69,9%). La realización de un mayor volumen de ultrafiltración no se asoció a las complicaciones estudiadas. Pacientes graves presentaron mayor predicción de ocurrencia de hipotensión (P0,001 y OR: 33,73). Conclusión: hipotensión durante la hemodiálisis fue una complicación frecuente, ocurriendo en aproximadamente la mitad de los pacientes. Como no estuvo asociada a volúmenes mayores de ultrafiltración, se concluye que, posiblemente, la mayor gravedad del paciente sea un factor explicativo para el desarrollo de esa complicación.

ABSTRACT Objective: To analyze the association between ultrafiltration and severity of patients diagnosed with acute renal injury with clinical complications resulting from hemodialysis. Method: A cross-sectional study was conducted in a teaching hospital in southern Brazil. We included all daily records of hemodialysis sessions of patients with acute kidney injury who underwent hemodialysis between September and November 2017. For data collection, an instrument was developed. A significance level of less than 5% was adopted. Results: The 103 patients under studywent through a total of 519 hemodialysis sessions. Most were male patients (66.7%) aged 60 years or older (51.5%). About half of the patients had mean ultrafiltration volume >1501ml (51.5%). Most were considered critical (72.8%). Among the complications, hypotension (69.9%) was the most prevalent. The performance of a higher volume of ultrafiltration was not associated with the studied complications. Patients with severity showed a higher chance of hypotension (p<0.001 and OR: 33.73). Conclusion: Hypotension during hemodialysis was a frequent complication, presented by nearly half of the patients. As it was not associated with larger ultrafiltration volumes, it is concluded that, possibly, the greater severity of the patient is an explanatory factor for the onset of this complication.

Incidência de lesão por pressão e medidas preventivas em pacientes críticos / Incidencia de lesión por presión y medidas preventivas en pacientes críticos / Pressure injury incidence and preventive measures in critical patients

RESUMO Considerando que o paciente crítico é mais suscetível ao desenvolvimento de lesão por pressão, objetivou-se analisar a incidência de lesão por pressão em pacientes críticos e identificar as medidas preventivas instituídas. Foi realizado um estudo transversal baseado na análise de 198 prontuários de pacientes admitidos nas duas unidades de terapia intensiva de um hospital universitário do Sul do Brasil, entre julho e dezembro de 2015. Os dados foram coletados no período de abril a maio de 2016, utilizando-se um instrumento elaborado pelos próprios autores. Posteriormente, os dados foram duplamente digitados no Epi Info® e analisados pelo programa Statistical Package for the Social Sciences®. Predominaram pacientes do sexo masculino (60,1%), raça branca (73,2%), com média de idade de 57,5 anos e incidência de lesão por pressão de 39,4%. As medidas preventivas mais registradas (97,9%) foram: inspeção da pele, mudança de decúbito a cada duas horas, cabeceira elevada até 30º e uso de coxins. Não houve associação entre medidas preventivas e desenvolvimento de lesão por pressão. O estudo mostrou elevada incidência de lesão por pressão e identificou as medidas instituídas para prevenção, possibilitando uma reflexão sobre as ações prescritas pelo enfermeiro para redução de tais eventos, promoção da saúde dos pacientes e melhoria da qualidade da assistência de enfermagem.

RESUMEN Considerando que el paciente crítico es más susceptible al desarrollo de lesión por presión, el objetivo fue analizar la incidencia de lesión por presión en pacientes críticos e identificar las medidas preventivas determinadas. Fue realizado un estudio transversal basado en el análisis de 198 registros médicos de pacientes admitidos en las dos unidades de cuidados intensivos de un hospital universitario del Sur de Brasil, entre julio y diciembre de 2015. Los datos fueron recolectados en el período de abril a mayo de 2016, utilizándose un instrumento elaborado por los propios autores. Posteriormente, los datos fueron doblemente digitados en el Epi Info® y analizados por el programa Statistical Package for the Social Sciences®. Predominaron pacientes del sexo masculino (60,1%), raza blanca (73,2%), con promedio de edad de 57,5 años e incidencia de lesión por presión de 39,4%. Las medidas preventivas más registradas (97,9%) fueron: examen de la piel, cambio de decúbito a cada dos horas, cabecera elevada hasta 30º y uso de cojines. No hubo asociación entre medidas preventivas y desarrollo de lesión por presión. El estudio señaló elevada incidencia de lesión por presión e identificó las medidas determinadas para la prevención, posibilitando una reflexión sobre las acciones prescriptas por el enfermero para reducción de tales eventos, promoción de la salud de los pacientes y mejoría de la calidad del cuidado de enfermería.

ABSTRACT Considering that the critical patient is more susceptible to the development of pressure lesions, this study aims to analyze the incidence of pressure lesion in critical patients, and to identify the preventive measures instituted. A cross-sectional study was carried out based on the analysis of 198 medical records of patients admitted in the two intensive care units of a university hospital in southern Brazil between July and December 2015. Data were collected from April to May 2016, using an instrument drawn up by the authors. Subsequently, the data were double-digitized in Epi Info® and analyzed by the Statistical Package for the Social Sciences® program. There is a prevalence of male patients (60.1%), white race (73.2%), mean age 57.5 years-old and the incidence of pressure injury was 39.4%. The most recorded preventive measures (97.9%) were: skin inspection, change of decubitus in every two hours, bedside elevation up to 30º, and use of cushions. There was no association between preventive measures and development of pressure injury. The study showed a high incidence of pressure injury and identified measures for prevention, allowing a reflection on the actions prescribed by the nurse to reduce such events, to promote the health of patients and to improve the quality of nursing care.