Terrestrial laser scanning and low magnetic field digitization yield similar architectural coarse root traits for 32-year-old Pinus ponderosa trees.

BACKGROUND: Understanding how trees develop their root systems is crucial for the comprehension of how wildland and urban forest ecosystems plastically respond to disturbances such as harvest, fire, and climate change. The interplay between the endogenously determined root traits and the response to environmental stimuli results in tree adaptations to biotic and abiotic factors, influencing stability, carbon allocation, and nutrient uptake. Combining the three-dimensional structure of the root system, with root morphological trait information promotes a robust understanding of root function and adaptation plasticity. Low Magnetic Field Digitization coupled with AMAPmod (botAnique et Modelisation de l'Architecture des Plantes) software has been the best-performing method for describing root system architecture and providing reliable measurements of coarse root traits, but the pace and scale of data collection remain difficult. Instrumentation and applications related to Terrestrial Laser Scanning (TLS) have advanced appreciably, and when coupled with Quantitative Structure Models (QSM), have shown some potential toward robust measurements of tree root systems. Here we compare, we believe for the first time, these two methodologies by analyzing the root system of 32-year-old Pinus ponderosa trees. RESULTS: In general, at the total root system level and by root-order class, both methods yielded comparable values for the root traits volume, length, and number. QSM for each root trait was highly sensitive to the root size (i.e., input parameter PatchDiam) and models were optimized when discrete PatchDiam ranges were specified for each trait. When examining roots in the four cardinal direction sectors, we observed differences between methodologies for length and number depending on root order but not volume. CONCLUSIONS: We believe that TLS and QSM could facilitate rapid data collection, perhaps in situ, while providing quantitative accuracy, especially at the total root system level. If more detailed measures of root system architecture are desired, a TLS method would benefit from additional scans at differing perspectives, avoiding gravitational displacement to the extent possible, while subsampling roots by hand to calibrate and validate QSM models. Despite some unresolved logistical challenges, our results suggest that future use of TLS may hold promise for quantifying tree root system architecture in a rapid, replicable manner.

The cost of genetic diagnosis of suspected hereditary pediatric cataracts with whole-exome sequencing from a middle-income country perspective: a mixed costing analysis.

Up to 25% of pediatric cataract cases are inherited. There is sparse information in the literature regarding the cost of whole-exome sequencing (WES) for suspected hereditary pediatric cataracts. Molecular diagnosis of suspected hereditary pediatric cataracts is important for comprehensive genetic counseling. We performed a partial economic evaluation with a mixed costing analysis, using reimbursement data and microcosting approach with a bottom-up technique to estimate the cost of using WES for genetic diagnosis of suspected hereditary pediatric cataracts from the perspective of the Brazilian governmental health care system. One hundred and ten participants from twenty-nine families in Rio de Janeiro (RJ) were included. Costs of consumables, staff and equipment were calculated. Two scenarios were created: (1) The reference scenario included patients from RJ with suspected hereditary pediatric cataracts plus two family members. (2) The alternative scenario considered other genetic diseases, resulting in 5,280 exams per month. Sensitivity analysis was also performed. In the reference scenario, the total cost per exam was 700.09 United States dollars (USD), and in the alternative scenario, the total cost was 559.23 USD. The cost of WES alone was 527.85 USD in the reference scenario and 386.98 USD in the alternative scenario. Sensitivity analysis revealed that the largest costs were associated with consumables in both scenarios. Economic evaluations can help inform policy decisions, especially in middle-income countries such as Brazil.

Evaluation of polycaprolactone nanofibers' spinnability using green solvent systems by solution blow spinning (SBS).

Solution blow spinning (SBS) is a promising alternative to produce fibrous matrices for a wide range of applications, such as packaging and biomedical devices. Polycaprolactone (PCL) is a biodegradable polyester commonly used for spinning. The usual choices for producing PCL solutions include chlorinated solvents (CS), such as chloroform. However, the high toxicity of CS makes it difficult for biological and green applications. This work evaluates the influence of two less toxic solvents, acetic acid (AA) and acetone (Acet), and their mixtures (AA/Acet) on the properties of PCL fibers produced by SBS. The results showed that Acet does not cause degradation of the PCL chains, in opposition to AA. Furthermore, adding acetone to the acetic acid tended to preserve the size of PCL chains. It was not possible to produce fibers using PCL in 100% acetone. However, the AA/Acet mixture allowed the efficient production of PCL fibers. The proportion of Acet and AA in the mixture modulated the fiber morphology and orientation, making it possible to use this green solvent system according to the desired application.

Genotypic-Phenotypic Correlations of Hereditary Hyperferritinemia-Cataract Syndrome: Case Series of Three Brazilian Families.

Hereditary hyperferritinemia-cataract syndrome (HHCS) is a rare, frequently misdiagnosed, autosomal dominant disease caused by mutations in the FTL gene. It causes bilateral pediatric cataract and hyperferritinemia without iron overload. The objective of this case series, describing three Brazilian families, is to increase awareness of HHCS, as well as to discuss possible phenotypic interactions with concurrent mutations in HFE, the gene associated with autosomal recessive inheritance hereditary hemochromatosis. Whole-exome sequencing was performed in eight individuals with HHCS from three different families, as well as one unaffected member from each family for trio analysis-a total of eleven individuals. Ophthalmological and clinical genetic evaluations were conducted. The likely pathogenic variant c.-157G>A in FTL was found in all affected individuals. They presented slowly progressing bilateral cataract symptoms before the age of 14, with a phenotype of varied bilateral diffuse opacities. Hyperferritinemia was present in all affected members, varying from 971 ng/mL to 4899 ng/mL. There were two affected individuals with one concurrent pathogenic variant in HFE (c.187C>G, p.H63D), who were also the ones with the highest values of serum ferritin in our cohort. Few publications describe individuals with pathogenic mutations in both FTL and HFE genes, and further studies are needed to assess possible phenotypic interactions causing higher values of hyperferritinemia.

Externalized Rectal Duplication in a Newborn - A Differential Diagnosis of Meningomyelocele.

Rectal duplication is a rare congenital anomaly with many clinical presentations, being mostly asymptomatic. Treatment consists of a surgical approach with a good prognosis. We are reporting a case of a full-term female newborn who presented with a mass externalized through the sacral region. The first diagnostic hypothesis was meningomyelocele, but the neurosurgeon verified peristalsis on examination with a surgical microscope. The pediatric surgery team proceeded with the investigation with barium enema, anal electrostimulation, biopsy, and pelvis MRI, confirming presacral rectal duplication. The patient underwent surgery for posterior sagittal surgical excision, with satisfactory evolution. Cases of rectal duplication are rare and we are unaware of reports of its exteriorization through the sacral region. Such presentation may mimic other diagnoses and should be included in the differential diagnosis of meningomyelocele.

Applicability of the drainage effectiveness of Blake drains and Tenckhoff catheters in the peritoneal dialysis of healthy rabbits (Oryctolagus cuniculus).

OBJECTIVE: To compare the efficacy of dialysate drainage between Tenckhoff (TC) catheter and Blake (BL) in peritoneal dialysis (PD) in healthy rabbits. DESIGN: Prospective experimental study. SETTING: University Teaching Hospital and University research laboratory. ANIMALS: Twenty healthy, male, New Zealand rabbits. INTERVENTIONS: PD via the TC catheter and the BL abdominal drain was compared during 3 consecutive days of dialysis delivery. MEASUREMENTS AND MAIN RESULTS: One session of PD was performed per day for 3 consecutive days (S1: first session, S2: second session, S3: third session) and each session included 4 cycles of infusion, dwell of dialysate in the abdomen, and drainage. Data collection included daily urea, creatinine, alanine aminotransferase, albumin, and potassium, in addition to hematological parameters (eg, RBC, HCT, hemoglobin, WBC, and platelet count). Statistical analysis using a mixed linear model with multiple comparisons was performed. The BL drain resulted in an increase in volume drained (ml/kg) when compared to TC catheter on S2 (third and fourth cycles) and S3 (first and second cycles). CONCLUSIONS: The BL drain proved to be superior to the TC catheter, being capable of draining a larger volume of dialysate during the drainage processes in the peritoneal PD of healthy rabbits. The TC catheter had major complications with regard to fluid retention in the abdomen, representing reduced drainage efficiency, while the BL drain showed a greater tendency for the peritoneal fluid to leak.

Robotização da proteção social: impactos e desafios à atuação profissional do assistente social / The robotization of social protection: impacts and challenges to the professional performance of the social worker

Resumo: Este artigo analisa a robotização da proteção social a partir do estudo de benefícios sociais implementados como resposta à pandemia do novo coronavírus. O desenvolvimento metodológico do estudo pauta-se numa compilação de fontes primárias e secundárias referentes ao Auxílio Emergencial (federal) e à Renda Básica Emergencial (municipal). O artigo se propõe a apontar alguns desafios e impactos à atuação profissional do assistente social no contexto de robotização das políticas de proteção social.

Abstract: This article analyzes the robotization of social protection from the study of social benefits implemented in response to the new coronavirus pandemic. The methodological development is guided by a compilation of primary and secondary sources references to the Auxílio Emergencial study (federal) and to the Emergency Basic Income (municipal). The article proposes to indicate some challenges and impacts to the social worker's professional performance in the robotization of social context policies.

Social-single prolonged stress as an ether-free candidate animal model of post-traumatic stress disorder: Female and male outcomings.

BACKGROUND: Single Prolonged Stress (SPS) is a valid animal model that reflects the core of post-traumatic stress disorder (PTSD) phenotypes. Although SPS has been a pivotal tool, it can bring ethics approval difficulties due to the use of ether as a stressor. The present study evaluated if changing a chemical (ether) with a social stressor resembles the PTSD hallmark symptoms. METHODS: Female and male young adult rats were distributed in Sham and Social-SPS groups. Rats in Social-SPS groups were subjected to stress, whereas those in Sham groups remained undisturbed. One set of animals performed the behavioral tests, elevated plus-maze (EPM) and Y-maze. Plasma corticosterone levels and cortical and hippocampal molecular protein contents were analyzed. Another set of animals performed the dexamethasone suppression test. RESULTS: A significant decrease in the percentage of time spent and the number of entries in open arms and an increase in anxiety index in the EPM were observed in rats of the social-SPS groups. In the Social-SPS groups, rats reduced the spontaneous alternations in Y-maze. The Social-SPS exposure enhanced the HPA-axis feedback and increased glucocorticoid receptor contents in the cerebral cortex and hippocampus of rats. A decrease in the content of synaptic integrity-related proteins, synaptophysin, and PSD-95, were found in the cortex and hippocampus of rats subjected to social-SPS. There were no statistical differences between males and females in any parameter analyzed. LIMITATIONS: The absence of a task to recap criterion E 'arousal' and predictive validity experiments. CONCLUSIONS: This study reveals that social-SPS recapitulated the main clusters required for a candidate animal model of PTSD.

The Use of 3-D Models of Echocardiographic Imaging Planes for Teaching Echocardiography Techniques for Use in Dogs and Cats.

Echocardiography is an invaluable technique for the diagnosis of heart disease. The aim of this study was to develop 3-D models of healthy and diseased hearts of dogs and cats, and to evaluate their effectiveness in assisting veterinary undergraduates to understand echocardiographic imaging planes. Resin models depicting the main echocardiographic imaging planes of normal hearts were created, as well as example hearts with features of mitral degeneration in dogs and hypertrophic cardiomyopathy in cats. After a theoretical class, fourth-year students were randomly assigned to one of two groups (model group or control group). The model group had access to the 3-D models, along with self-explanatory text about echocardiographic imaging planes; the control group only had access to the self-explanatory text. Both groups were allowed 2 weeks to study their allocated resources, after which the students undertook an assessment to evaluate their learning and completed a questionnaire about their experiences and satisfaction with the respective teaching method. A total of 39 students participated in the study, 19 in the model group and 20 in the control group. Students assigned to the model group spent more time studying (p = 0.0027). The proportion of students who achieved a satisfactory grade in the assessment was 89.5% in the model group and 60% in the control group (p = 0.0449). The 3-D models facilitated, and significantly improved, the identification of cardiac structures and disease-associated abnormalities, and the learning process in general. Additionally, the models seemed to provide greater student motivation for studying echocardiography.

Biomineralization of lithium nanoparticles by Li-resistant Pseudomonas rodhesiae isolated from the Atacama salt flat.

BACKGROUND: The Atacama salt flat is located in northern Chile, at 2300 m above sea level, and has a high concentration of lithium, being one of the main extraction sites in the world. The effect of lithium on microorganism communities inhabiting environments with high concentrations of this metal has been scarcely studied. A few works have studied the microorganisms present in lithium-rich salt flats (Uyuni and Hombre Muerto in Bolivia and Argentina, respectively). Nanocrystals formation through biological mineralization has been described as an alternative for microorganisms living in metal-rich environments to cope with metal ions. However, bacterial lithium biomineralization of lithium nanostructures has not been published to date. In the present work, we studied lithium-rich soils of the Atacama salt flat and reported for the first time the biological synthesis of Li nanoparticles. RESULTS:  Bacterial communities were evaluated and a high abundance of Cellulomonas, Arcticibacter, Mucilaginibacter, and Pseudomonas were determined. Three lithium resistant strains corresponding to Pseudomonas rodhesiae, Planomicrobium koreense, and Pseudomonas sp. were isolated (MIC > 700 mM). High levels of S2- were detected in the headspace of P. rodhesiae and Pseudomonas sp. cultures exposed to cysteine. Accordingly, biomineralization of lithium sulfide-containing nanomaterials was determined in P. rodhesiae exposed to lithium salts and cysteine. Transmission electron microscopy (TEM) analysis of ultrathin sections of P. rodhesiae cells biomineralizing lithium revealed the presence of nanometric materials. Lithium sulfide-containing nanomaterials were purified, and their size and shape determined by dynamic light scattering and TEM. Spherical nanoparticles with an average size < 40 nm and a hydrodynamic size ~ 44.62 nm were determined. CONCLUSIONS: We characterized the bacterial communities inhabiting Li-rich extreme environments and reported for the first time the biomineralization of Li-containing nanomaterials by Li-resistant bacteria. The biosynthesis method described in this report could be used to recover lithium from waste batteries and thus provide a solution to the accumulation of batteries.

Biomineralization of lithium nanoparticles by Li-resistant Pseudomonas rodhesiae isolated from the Atacama salt flat

BACKGROUND: The Atacama salt flat is located in northern Chile, at 2300 m above sea level, and has a high concentration of lithium, being one of the main extraction sites in the world. The effect of lithium on microorganism communities inhabiting environments with high concentrations of this metal has been scarcely studied. A few works have studied the microorganisms present in lithium-rich salt flats (Uyuni and Hombre Muerto in Bolivia and Argentina, respectively). Nanocrystals formation through biological mineralization has been described as an alternative for microorganisms living in metal-rich environments to cope with metal ions. However, bacterial lithium biomineralization of lithium nanostructures has not been published to date. In the present work, we studied lithium-rich soils of the Atacama salt flat and reported for the first time the biological synthesis of Li nanoparticles. RESULTS: Bacterial communities were evaluated and a high abundance of Cellulomonas, Arcticibacter, Mucilaginibacter, and Pseudomonas were determined. Three lithium resistant strains corresponding to Pseudomonas rodhesiae, Planomicrobium koreense, and Pseudomonas sp. were isolated (MIC > 700 mM). High levels of S2− were detected in the headspace of P. rodhesiae and Pseudomonas sp. cultures exposed to cysteine. Accordingly, biomineralization of lithium sulfide-containing nanomaterials was determined in P. rodhesiae exposed to lithium salts and cysteine. Transmission electron microscopy (TEM) analysis of ultrathin sections of P. rodhesiae cells biomineralizing lithium revealed the presence of nanometric materials. Lithium sulfide-containing nanomaterials were purified, and their size and shape determined by dynamic light scattering and TEM. Spherical nanoparticles with an average size < 40 nm and a hydro-dynamic size ~ 44.62 nm were determined. CONCLUSIONS: We characterized the bacterial communities inhabiting Li-rich extreme environments and reported for the first time the biomineralization of Li-containing nanomaterials by Li-resistant bacteria. The biosynthesis method described in this report could be used to recover lithium from waste batteries and thus provide a solution to the accumulation of batteries.

Caspofungin Inhibits Mixed Biofilms of Candida albicans and Methicillin-Resistant Staphylococcus aureus and Displays Effectiveness in Coinfected Galleria mellonella Larvae.

Candida albicans and Staphylococcus aureus are pathogens commonly isolated from bloodstream infections worldwide. While coinfection by both pathogens is associated with mixed biofilms and more severe clinical manifestations, due to the combined expression of virulence and resistance factors, effective treatments remain a challenge. In this study, we evaluated the activity of echinocandins, especially caspofungin, against mixed biofilms of C. albicans and methicillin-resistant (MRSA) or methicillin-susceptible S. aureus (MSSA) and their effectiveness in vivo using the Galleria mellonella coinfection model. Although caspofungin (CAS) and micafungin (MFG) inhibited the mixed biofilm formation, with CAS exhibiting inhibitory activity at lower concentrations, only CAS was active against preformed mixed biofilms. CAS significantly decreased the total biomass of mixed biofilms at concentrations of ≥2 µg/ml, whereas the microbial viability was reduced at high concentrations (32 to 128 µg/ml), leading to fungus and bacterium cell wall disruption and fungal cell enlargement. Notably, CAS (20 or 50 mg/kg of body weight) treatment led to an increased survival and improved outcomes of G. mellonella larvae coinfected with C. albicans and MRSA, since a significant reduction of fungal and bacterial burden in larval tissues was achieved with induction of granuloma formation. Our results reveal that CAS can be a therapeutic option for the treatment of mixed infections caused by C. albicans and S. aureus, supporting additional investigation. IMPORTANCE Infections by microorganisms resistant to antimicrobials is a major challenge that leads to high morbidity and mortality rates and increased time and cost with hospitalization. It was estimated that 27 to 56% of bloodstream infections by C. albicans are polymicrobial, with S. aureus being one of the microorganisms commonly coisolated worldwide. About 80% of infections are associated with biofilms by single or mixed species that can be formed on invasive medical devices, e.g., catheter, and are considered a dissemination source. The increased resistance to antimicrobials in bacterial and fungal cells when they are in biofilms is the most medically relevant behavior that frequently results in therapeutic failure. Although there are several studies evaluating treatments for polymicrobial infections associated or not with biofilms, there is still no consensus on an effective antimicrobial therapy to combat the coinfection by bacteria and fungi.

Leucine Supplementation Does Not Improve Muscle Recovery from Resistance Exercise in Young Adults: A Randomized, Double-Blinded, Crossover Study.

This study aimed to investigate the effects of free leucine supplementation on muscle recovery from resistance exercise (RE) in young adults. Fourteen untrained subjects (23.9 ± 3.6 years old) underwent RE sessions (leg press and hack squat: three sets of 8-12 reps at 70% 1RM) supplemented with leucine (LEU: two daily doses of 3g) or a placebo (PLA), separated by a seven-day washout period. Following each occasion, participants were evaluated in three subsequent days (24h, 48h, and 72h) for muscle recovery via a repetition-to-failure test. The following markers were assessed: repetition performance, perceived exertion, lactate, creatine kinase, muscle soreness (DOMS), testosterone, and cortisol. No significant difference was observed between LEU and PLA conditions (p > 0.05). Number of repetitions performed in the repetition-to-failure tests, perceived exertion, cortisol, and testosterone:cortisol ratio did not change over time (p > 0.05). Creatine kinase increased immediately after exercise, at 24h, and 48h, and was attenuated at 72h post-exercise, while testosterone, lactate, and DOMS increased at 24h post-exercise (p < 0.05) and remained elevated up to 72h. All outcomes were similar between LEU and PLA. Results indicate that a 6g daily dose of free leucine supplementation does not improve muscle recovery following lower-limb RE in untrained young adults.

Assessment of heart rate turbulence in dogs with myxomatous mitral valve disease.

BACKGROUND: Myxomatous mitral valve degeneration (MMVD) is the most common heart disease affecting small dogs, it reduces cardiac output resulting in compensatory adaptation of the autonomic nervous system. Chronically, it leads to reduced heart rate variability (HRV) which is an accurate marker for autonomic balance. More than two decades ago in human medicine an indicator of autonomic balance that happens after a premature ventricular beat, it was described as heart rate turbulence (HRT). In humans with ischemic heart disease, the absence of HRT has proven to be a more accurate and an independent indicator of mortality than known HRV parameters. Currently, there are very few studies of HRT in dogs and it is still not tested in small dogs within different stages of myxomatous mitral valve disease. AIM: The aim of this study was to assess the HRT indicators, onset and slope, in small dogs with myxomatous mitral valve disease and to statistically test it. METHODS: Dogs under 25 kg had electrocardiogram and echocardiography performed and, in some patients, holter monitoring was carried out. Data were divided into groups B1, B2, C, and D for mean comparison with analysis of variance and Tukey test. In addition, receiver operating characteristic (ROC) curve for differentiating among symptomatic and asymptomatic dogs and for differentiating between remodeled and non-remodeled hearts. The Pearson was executed after correlations of turbulence onset (TO) and turbulence slope (TS) with commonly used echocardiographic parameters. RESULTS: Variance analyses held significant differences in TO and TS between stages B1 from stages C and D, while B2 held similarity to the other groups. In the receiver operating curve was found a very good area under the curve for differentiating among symptomatic and asymptomatic dogs and remodeled and non-remodeled dogs. Few echocardiography parameters held weak correlation with TO while others held weak to moderate correlation with TS. CONCLUSION: In dogs with MMVD and without other diseases, HRT is a feasible indicator for autonomic balance. Our result suggests HRT changes as the MMVD progresses and congestive heart failure is present. More studies with HRT are needed. The number of ventricular premature contractions (VPCs) may be the strongest limitation for the technique.

Effect of a commercial product containing canthaxanthin for in ovo feeding to broiler embryos on hatchability, chick quality, oxidation status, and performance.

In ovo feeding has been indicated to improve hatchability, newly hatched chick quality, and broiler performance. The aim of this study was to investigate the effect of in ovo feeding of a commercial canthaxanthin product (CCX) containing lignosulphonate, corn starch, canthaxanthin, dextrin (yellow), and ethoxyquin through assessing incubation results, newly hatched quality and oxidation status and broiler performance at 1 to 14 d of age. A total of 780 egg were distributed in a randomized complete block design with 5 treatments (levels of CCX: 0.0, 0.35, 0.45, 0.55, and 0.65 mg/0.5 mL of sterilized and distilled water) and 156 eggs per treatment. The blocking factor was setters. At 17.5 d of embryo development, in ovo injected treatments were applied, using a manual needle. The in ovo feeding of CCX resulted in lower hatching rates (P < 0.05) and a longer hatching window (P < 0.05) as compared with noninjected CCX treatment. The CCX injection did not affect the bursa and spleen percentage of newly hatched chick (P > 0.05). In addition, a higher percentage of chicks with poor physical quality score (<71.0 points) was obtained among the chicks from eggs injected with 0.55 and 0.65 mg of CCX (P < 0.05). There were higher total proteins and catalase activity in the livers of the chicks injected with CCX. Broiler chicks in the control group (0.0 mg of CCX) presented higher BW and BW gain during 1 to 7 and 7 to 14 d of after hatch (P < 0.05). The viability (%) of chicks at 1 to 14 d of after hatch decreased with inoculation greater than 0.45 mg of CCX in ovo (P < 0.05). Although the CCX shown an improvement in oxidation status of chicks, the hatchability and performance of broilers decreased. We concluded that a commercial CCX is not recommended for injection in ovo, and furthers studies should carried out to elucidate the use of pure canthaxanthin.

Herbicides That Target Acetohydroxyacid Synthase Are Potent Inhibitors of the Growth of Drug-Resistant Candida auris.

Acetohydroxyacid synthase (AHAS, EC 2.2.1.6), the first enzyme in the branched chain amino acid biosynthesis pathway, is the target for more than 50 commercially available herbicides, and is a promising target for antimicrobial drug discovery. Herein, we have expressed and purified AHAS from Candida auris, a newly identified human invasive fungal pathogen. Thirteen AHAS inhibiting herbicides have Ki values of <2 µM for this enzyme, with the most potent having Ki values of <32 nM. Six of these compounds exhibited MIC50 values of <1 µM against C. auris (CBS10913 strain) grown in culture, with bensulfuron methyl (BSM) being fungicidal and the most potent (MIC50 of 0.090 µM) in defined minimal media. The MIC50 value increases to 0.90 µM in media enriched by the addition of branched-chain amino acids at the expected concentration in the blood serum. The sessile MIC50 for BSM is 0.6 µM. Thus, it is also an excellent inhibitor of the growth of C. auris biofilms. BSM is nontoxic in HEK-293 cells at concentrations >100 µM and thus possesses a therapeutic index of >100. These data suggest that targeting AHAS is a viable strategy for treating C. auris infections.

Nursing interventions in autologous stem cell transplantation for autoimmune diseases.

AIMS: To identify clinical symptoms and nursing interventions for stem cell therapy in autoimmune diseases. DESIGN: This is a retrospective, cross-sectional study. METHODS: This study was undertaken with patients diagnosed with type 1 diabetes or multiple sclerosis, undergoing autologous haematopoietic stem cell transplantation from January 2004 - December 2018. Data were registered in a questionnaire, taken during the conditioning regimen comprising cyclophosphamide and rabbit anti-thymocyte globulin. Descriptive statistics and Fisher's exact test were used for data analysis. RESULTS: There were 68 and 23 patients in the multiple sclerosis and type 1 diabetes groups respectively. Skin rash, nausea, vomiting and fever were more frequent and diverse in the type 1 diabetes group. Steroids were used as prophylaxis for anti-thymocyte globulin-associated allergic reactions in 97% of multiple sclerosis patients. Most of the identified symptoms and nursing interventions were more associated with one or other disease group (p < .05) and were more frequent in the type 1 diabetes group. CONCLUSION: Patients with autoimmune diseases who underwent stem cell therapy present differences in their repertoire of adverse events and require disease-specific nursing actions. IMPACT: Our results may enable nurses to establish transplant and disease-specific guidelines to improve prevention and management of adverse events and therefore optimize patient care and therapeutic success.

Impact of perioperative hemodynamic optimization therapies in surgical patients: economic study and meta-analysis.

BACKGROUND: Several studies suggest that hemodynamic optimization therapies can reduce complications, the length of hospital stay and costs. However, Brazilian data are scarce. Therefore, the objective of this analysis was to evaluate whether the improvement demonstrated by hemodynamic optimization therapy in surgical patients could result in lower costs from the perspective of the Brazilian public unified health system. METHODS: A meta-analysis was performed comparing surgical patients who underwent hemodynamic optimization therapy (intervention) with patients who underwent standard therapy (control) in terms of complications and hospital costs. The cost-effectiveness analysis evaluated the clinical and financial benefits of hemodynamic optimization protocols for surgical patients. The analysis considered the clinical outcomes of randomized studies published in the last 20 years that involved surgeries and hemodynamic optimization therapy. Indirect costs (equipment depreciation, estate and management activities) were not included in the analysis. RESULTS: A total of 21 clinical trials with a total of 4872 surgical patients were selected. Comparison of the intervention and control groups showed lower rates of infectious (RR = 0.66; 95% CI = 0.58-0.74), renal (RR = 0.68; 95% CI = 0.54-0.87), and cardiovascular (RR = 0.87; 95% CI = 0.76-0.99) complications and a nonstatistically significant lower rate of respiratory complications (RR = 0.82; 95% CI = 0.67-1.02). There was no difference in mortality (RR = 1.02; 95% CI = 0.80-1.3) between groups. In the analysis of total costs, the intervention group showed a cost reduction of R$396,024.83-BRL ($90,161.38-USD) for every 1000 patients treated compared to the control group. The patients in the intervention group showed greater effectiveness, with 1.0 fewer days in the intensive care unit and hospital. In addition, there were 333 fewer patients with complications, with a consequent reduction of R$1,630,341.47-BRL ($371,173.27-USD) for every 1000 patients treated. CONCLUSIONS: Hemodynamic optimization therapy is cost-effective and would increase the efficiency of and decrease the burden of the Brazilian public health system.