Development and validation of the Ex-Care BR model: a multicentre initiative for identifying Brazilian surgical patients at risk of 30-day in-hospital mortality.

BACKGROUND: Surgical risk stratification is crucial for enhancing perioperative assistance and allocating resources efficiently. However, existing models may not capture the complexity of surgical care in Brazil. Using data from various healthcare settings nationwide, we developed a new risk model for 30-day in-hospital mortality (the Ex-Care BR model). METHODS: A retrospective cohort study was conducted in 10 hospitals from different geographic regions in Brazil. Data were analysed using multilevel logistic regression models. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC), Brier score, and calibration plots. Derivation and validation cohorts were randomly assigned. RESULTS: A total of 107,372 patients were included, and 30-day in-hospital mortality was 2.1% (n=2261). The final risk model comprised four predictors related to the patient and surgery (age, ASA physical status classification, surgical urgency, and surgical size), and the random effect related to hospitals. The model showed excellent discrimination (AUROC=0.93, 95% confidence interval [CI], 0.93-0.94), calibration, and overall performance (Brier score=0.017) in the derivation cohort (n=75,094). Similar results were observed in the validation cohort (n=32,278) (AUROC=0.93, 95% CI, 0.92-0.93). CONCLUSIONS: The Ex-Care BR is the first model to consider regional and organisational peculiarities of the Brazilian surgical scene, in addition to patient and surgical factors. It is particularly useful for identifying high-risk surgical patients in situations demanding efficient allocation of limited resources. However, a thorough exploration of mortality variations among hospitals is essential for a comprehensive understanding of risk. CLINICAL TRIAL REGISTRATION: NCT05796024.

Climate change in cold regions.

Cold regions around the world include Arctic, Antarctic and High Mountain regions featuring low temperatures, ice-covered landscapes, permafrost, and unique ecologic interrelations. These environments are among the most sensitive to climate change and are changing rapidly as the global climate gets warmer. This editorial explores the complexity of the impacts of climate change on cold regions, highlighting recent changes across Earth system. The Special Issue here presented compiles studies that explore the climate change in different cold regions from various perspectives, including paleoclimatic reconstructions, isotherm shifts and climate projections. Despite progress, significant questions remain, demanding interdisciplinary approaches to better understand the interconnected factors shaping cold regions.

Minimally Invasive Treatment for Lumbar Disc Herniation: A Matched Comparison Between Tubular Microdiscectomy and Percutaneous Endoscopic Lumbar Discectomy.

Background and objectives Discectomy for lumbar disc herniation is the most common spinal surgical procedure. Technological advances have led to the emergence of minimally invasive surgical approaches such as tubular microdiscectomy (TMD) and percutaneous endoscopic lumbar discectomy (PELD). The purpose of this study was to compare the clinical outcomes of PELD to those of TMD at one-year follow-up. Materials and methods This observational registry-based (Spine Tango) cohort study included patients with symptomatic lumbar disc herniation submitted to PELD or TMD. The inclusion criteria were patients who underwent minimally invasive lumbar discectomy (PELD or TMD), patients who attended a follow-up after a minimum of 12 months post surgery, and valid pre- and postoperative questionaries. The primary endpoint was defined as the difference between pre- and postoperative Core Outcome Measures Index (COMI) for the back. The matching was based on a 1:1 nearest neighbor matching without replacement. Results A total of 109 patients were included in this study. Propensity score matching (PSM) was performed achieving 86 patients in the matched sample. Regarding COMI improvement, we found no significant difference between the PELD and TMD groups (paired t-test: estimate, -0.23; standard error, 0.6; p=0.7), and we also did not find any significant difference between groups concerning Oswestry Disability Index (ODI) and EuroQol 5 Dimension (EQ-5D). Medication usage and return to work were similar among the matched groups. Conclusions PELD is a technique that minimizes tissue damage achieving good clinical outcomes similar to TMD. This was observed one year after surgery from patient-reported outcome measures (PROMs) that measured pain improvement, disability, and quality of life.

Effectiveness of postsurgical rehabilitation following lumbar disc herniation surgery: A systematic review.

Introduction: The effectiveness of post-surgical rehabilitation following lumbar disc herniation (LDH) surgery is unclear. Research question: To investigate the effectiveness and safety of rehabilitation interventions initiated within three months post-surgery for adults treated surgically for LDH. Material and methods: This systematic review searched seven databases from inception to November 2023. Independent reviewers screened studies, assessed and extracted data, and rated the certainty of the evidence using the GRADE approach. Results: This systematic review retrieved 20,531 citations and included 25 randomized controlled trials. The high certainty evidence suggests that adding Pilates exercise to routine care and cognitive behavioral therapy may improve function immediately post-intervention (1 RCT), and that adding whole-body magnetic therapy to exercise, pharmacological and aquatic therapy may reduce low back pain intensity (1 RCT) immediately post-intervention. Compared to placebo, pregabalin did not reduce low back pain or leg pain intensity (1 RCT) (moderate to high certainty evidence). We found no differences between: 1) behavioral graded activity vs. physiotherapy (1 RCT); 2) exercise and education vs. neck massage or watchful waiting (1 RCT); 3) exercise, education, and in-hospital usual care vs. in-hospital usual care (1 RCT); 4) functional or staged exercise vs. usual post-surgical care including exercise (2 RCTs); and 5) supervised exercise with education vs. education (1 RCT). No studies assessed adverse events. Discussion and conclusion: Evidence on effective and safe post-surgical rehabilitation interventions is sparse. This review identified two interventions with potential short-term benefits (Pilates exercises, whole-body magnetic therapy) but safety is unclear, and one with an iatrogenic effect (pregabalin).

The presence of Leptospira spp. in the follicular fluid of naturally infected cows affects the overall efficiency of the in vitro embryo production technique.

The relationship between Leptospira infection and reproductive failures, as well as the mechanisms that lead to it, has not yet been fully established. It has been hypothesized that the presence of Leptospira spp. in the follicular fluid (FF) could impair the oocyte developmental competence. Thus, the impact of the presence of Leptospira spp. in the FF on in vitro embryo production (IVEP) outcomes was assessed. Dairy cows (n=244) from different farms were subjected to ovum pick-up for cumulus-oocyte complexes (COCs) collection. After PCR analysis of the FF, cows were retrospectively allocated into either: positive (POS-FF) or negative (NEG-FF) group. Statistical modeling was conducted using the farm, PCR result, and laboratory in which the IVEP was performed as effects. Noteworthy, 26.6% of the animals were positive for Leptospira spp., and 70% of farms had at least one POS-FF cow in the herd. POS-FF cows had a lower number of COCs recovered (22.6 ± 1.2 vs 15.0 ± 2.8, P=0.036), rate of viable COCs (85.6 ± 0.9% vs 78.1 ± 2.8%, P=0.015), number of good-quality COCs (16.0 ± 0.9 vs 9.8 ± 2.1, P=0.026), cleaved embryos (11.9 ± 0.7 vs 7.5 ± 1.5, P=0.032), and blastocysts (7.3 ± 0.4 vs 2.3 ± 0.7, P=0.044) yielded per cow. In conclusion, the presence of Leptospira spp. in the FF of naturally infected cows impaired the amount of COCs recovered, decreasing the overall IVEP efficiency.

Land degradation neutrality assessment and factors influencing it in China's arid and semiarid regions.

The ecosystems in China's arid and semiarid regions are notably fragile and experiencing dramatic land degradation. At the 12th Conference of the Parties (COP12) to the United Nations Convention to Combat Desertification (UNCCD) in October 2015, a definition for land degradation neutrality (LDN) was proposed and subsequently integrated into the Sustainable Development Goals (SDGs). Research on LDN has developed in terms of conceptual framework constructions, quantitative assessments, and empirical studies. However, LDN and its drivers must be clarified in China's arid and semiarid regions since some representative processes have yet to be fully considered in the assessment. Here, we develop an LDN indicator system specialised for the area, assess their LDN status, and determine the impacts of human activities and climate change on LDN. Our research aims to refine the LDN indicator system tailored for China's arid and semiarid regions by incorporating the trends of wind and water erosion. We also identify the influence of human activity and climate change on LDN, which provides insightful strategies for ecological restoration and sustainable development in drylands with climate-sensitive ecosystems. The results show that: (1) In 2020, more than half of areas of China's arid and semiarid regions achieved LDN, with more pronounced success in the southeastern areas compared to the central regions. (2) For LDN drivers, elevation shows negligible influence on LDN, whereas increased temperature promotes LDN achievement. Conversely, factors like vapour pressure deficit and v-direction wind speed hinder it. In conclusion, China's arid and semiarid regions achieved LDN, and the dominant factor that substantially influences LDN varies across geographical zones, with higher wind speeds and elevated GDP levels generally obstructing LDN in most areas.

Transradial access for the endovascular treatment of intracranial aneurysms using the Woven EndoBridge device: A systematic review and pooled analysis.

BACKGROUND: The Woven EndoBridge (WEB) device is a minimally invasive endovascular treatment option for patients with cerebral aneurysms. Transradial access (TRA) is a technique that involves accessing the arterial system through the radial artery in the wrist rather than the femoral artery in the groin. Several studies have investigated the use of TRA for WEB device deployment in treating intracranial aneurysms. METHODS: A systematic review was conducted to evaluate the TRA for WEB device deployment in treating intracranial aneurysms. The databases PubMed, Cochrane, Embase, Scopus, and Web of Science were searched. To reduce the risk of bias, this systematic review only included studies reporting on using TRA in WEB device deployment for intracranial aneurysm treatment with a minimum of four patients. RESULTS: In this systematic review, 186 patients were included across five studies, with TRA used in 183 cases analyzed. The study population had a higher proportion of females (n = 118%-69%) than males, with a mean age of 62 years old. Among the aneurysms treated, 46 were ruptured, and 119 were located at bifurcation sites, with a mean maximum diameter/width of 6.6 mm and mean height of 5.9 mm. Adjunctive coiling was used in three cases, and adjunctive stenting was used in nine cases. In two cases, conversion to a femoral artery access was necessary. CONCLUSION: The available results suggest TRA with the WEB device is a safe and effective alternative. However, using TRA versus TFA should be individualized based on patient factors and operator experience.

Optimizing resources: financial evaluation of flow diverters versus stent assisted coiling in large and giant cerebral aneurysm management in Brazil public health system.

BACKGROUND: Cerebral aneurysms, especially large and giant aneurysms, pose challenges in neurointerventional surgery. Treatment choices involve clinical presentation, aneurysm details, and global resource variations. Neurointerventional methods, while innovative, may be cost restrictive in certain regions. In public healthcare, cost is crucial, notably in countries like Brazil. This study examines the device specific cost estimation of flow diverters (FD) and traditional stent assisted coiling (SAC) for large and giant cerebral aneurysms, providing insights into optimizing neurosurgical interventions within the Brazilian public health system's unique challenges. METHODS: A comprehensive retrospective analysis was conducted at our medical center of cases of large and giant aneurysms treated between 2013 and 2023. Determination of the estimated number of coils for aneurysms previously treated with FDs at our center was made, with the cost of each case, and the difference between both treatments was calculated. RESULTS: We investigated the profiles of 77 patients: 40 had large aneurysms (51.9%) and 37 had giant aneurysms (48.1%). Large aneurysms had a mean cost difference of US$274 (standard deviation (SD) $2071), underscoring the device specific cost estimation of FDs over SAC in their treatment. For giant aneurysms, the mean cost difference increased to $6396 (SD $2694), indicating FDs as the more economically sound choice. CONCLUSION: Our study indicated that, for the treatment of giant aneurysms and some large aneurysms, the FD intervention was more economical than SAC.

Analyzing the Influence of Conservation Tillage and Manure on Soil Parameter Modulations in Croplands.

Nowadays, when the human impact on the environment becomes prominent daily, specific steps are needed to mitigate or halt those changes. By far, agricultural land is most affected by the degradation process, leading to soil erosion and decreased soil quality. Sustainable measures are needed to find a solution to that problem. This study, located in an agricultural area in northwestern Croatia, gives an insight into how different tillage systems (conventional and conservation) with the addition of manure will affect soil physicochemical properties, hydrology response, and overall yield. To assess hydrological response, a rainfall simulator was used; meanwhile, soil samples were taken to determine bulk density, soil water content, water-stable aggregates, and soil organic matter. Soil water content did not show significant differences, whereas bulk density and penetration resistance yielded significantly higher values at 15-30 cm depth compared to 0-15 cm depth. Also, the conservation manure recorded lower bulk density and penetration resistance values than conventional tilled treatments. Water-stable aggregates and soil organic matter were severely affected by manure addition and yielded an increase after harvest. Hydrological response was delayed for the treatments with manure addition. Crop yield was also significantly higher for the conventional treatment with manure addition, whereas the control plots had lower yields. The results of this study show the positive aspects of conservation tillage, especially with manure addition, where soil quality is preserved or even increased.

Enhancing Sensory Quality of Coffee: The Impact of Fermentation Techniques on Coffea arabica cv. Catiguá MG2.

Fermentation, a critical post-harvest process, can be strategically manipulated to augment coffee quality. This enhancement is achieved through the activity of microorganisms, which generate metabolites instrumental in the formation of distinct sensory profiles. This study investigated the impact of different fermentation methods on the quality of coffee beverages, specifically utilizing the Catiguá MG2 variety. The experimental setup involved fermenting the coffee in 200 L bioreactors, employing both natural and pulped coffee beans. The fermentation process utilized was self-induced anaerobic fermentation (SIAF), conducted in either a solid-state or submerged medium over a 96 h period. Analytical sampling was conducted initially and at 24 h intervals thereafter to quantify the concentration of sugars, alcohols, and organic acids. Sensory evaluation was performed using the established protocols of the Specialty Coffee Association (SCA). The outcomes of this investigation reveal that fermentation substantially enhances the quality of coffee, with each treatment protocol yielding divergent profiles of acids and alcohols, thereby influencing the sensory characteristics of the resulting beverage. Notably, superior quality beverages were produced from naturally processed coffee subjected to solid-state fermentation for durations exceeding 24 h. These findings underscore the significant influence of fermentation techniques and duration on the sensory attributes and overall quality of coffee.

Spotlights on the trends in performance assessment of qualitative in vitro diagnostic medical devices in transfusion medicine.

For reliable clinical decisions in transfusion medicine, assessing the performance of qualitative tests performed in medical laboratories is critical. When false results are reported, these can lead to an adverse reaction to blood components. Good performance assessment practices are essential for this kind of scenario, and they still remain as one of the many unmet high-priority challenges in this area. This paper aims to provide an overview of the current trends in this field. A review of the IFCC-IUPC. qualitative vocabulary was carried out, and a particular focus was given to the evaluation protocols CLSI EP12-A3 and Eurachem AQA, such as the European Union Regulation for class D in vitro diagnostic medical devices. There is a consistency between the current protocols and recognized performance assessment principles, which are mandatory in transfusion service labs. We believe that a revised imprecision interval approach and models based on emerging qualitative test types may prove beneficial in the long run. It is also important to emphasize the uncertainty of proportions to mitigate the risk of misclassification.

A targeted survey on teachers' perception of training/education for blood donation in high school students: An invited case report for enhancing and retention of dedicated donors in Portugal.

Promoting blood donation requires understanding and identifying the factors that motivate donations so that strategies for retaining and increasing loyalty can be developed. Transfusion literacy can be improved through school-based teaching and information about giving and solidarity to promote the development of future donors. For the purpose of aligning any strategies and motivational dynamics that promote adherence to informed donation and loyalty among students in the municipality of Coimbra. This study was undertaken to assess the perception of secondary school teachers regarding the students' knowledge of blood donation. A survey was conducted among teachers from seven public schools in Coimbra with regard to the 3rd and Secondary cycles. Based on the data, people give blood for a feeling of personal satisfaction and peer influence, as well as for the satisfaction of helping others. Blood donation should be made a focal point of relevance and interest in the school community, by implementing programs, projects, and dissemination actions targeting this target group. We are extremely glad and most enthusiastic to be invited to share our study through what's happening with the readers globally.

Core-Shell Nanocables Decorated with Carbon Spherical Shells and Silver Nanoparticles for Sensing Ethinylestradiol Hormone in Water Sources and Pills.

The selective, rapid detection of low levels of hormones in drinking water and foodstuffs requires materials suitable for inexpensive sensing platforms. We report on core-shell Ag@C nanocables (NCs) decorated with carbon spherical shells (CSSs) and silver nanoparticles (AgNPs) by using a hydrothermal green approach. Sensors were fabricated with homogeneous, porous films on screen-printed electrodes, which comprised a 115 nm silver core covered by a 122 nm thick carbon layer and CSSs with 168 nm in diameter. NCs and CSSs were also decorated with 10-25 nm AgNPs. The NC/CSS/AgNP sensor was used to detect ethinylestradiol using square wave voltammetry in 0.1 M phosphate buffer (pH 7.0) over the 1.0-10.0 µM linear range with a detection limit of 0.76 µM. The sensor was then applied to detect ethinylestradiol in tap water samples and a contraceptive pill with recovery percentages between 93 and 101%. The high performance in terms of sensitivity and selectivity for hormones is attributed to the synergy between the carbon nanomaterials and AgNPs, which not only increased the sensor surface area and provided sites for electron exchange but also imparted an increased surface area.

Cross-cultural adaptation, validation and establishment of the minimal clinically important change score of the European Portuguese core outcome measures index in patients with lumbar degenerative spine disease.

PURPOSE: The core outcome measures index (COMI) for the back is a questionnaire that evaluates five domains and has been translated into several languages and validated for different populations. We aimed to translate, cross-culturally adapt and validate it in European Portuguese for use in patients with degenerative lumbar disease. Additionally, we aimed to establish the minimal clinically important change score (MCIC). METHODS: The translation and cultural adaptation were done according to published guidelines. Patients awaiting surgery at a neurosurgical center completed the COMI, Oswestry Disability Index (ODI), EQ-5D questionnaires and a pain visual analog scale (VAS). To evaluate COMI's reproducibility, patients completed the questionnaire twice within two weeks, preoperatively, in addition to answering a transition question. The MCIC was determined by analysis of postoperative changes in total COMI score, using the anchor method, with a question ascertaining surgical outcome as perceived by the patient. RESULTS: The first set of questionnaires was answered by 108 patients and the second, by 98 patients. COMI's construct validity was confirmed by demonstrating the hypothesized correlation between each domain's score (Spearman Rho > 0.4) and the corresponding questionnaire score (ODI, EQ-5D and VAS) and through adequate correlation (Spearman > 0.6) between COMI's total score and ODI and EQ-5D total scores. Intraclass correlation coefficients between each domain and COMI's total score were > 0.8. The MCIC was calculated as 2.1. CONCLUSION: The cross-culturally adapted COMI questionnaire is a valid clinical assessment tool for European Portuguese-speaking patients with degenerative lumbar disease, with an MCIC of 2.1 points.

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

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

Evaluating the efficacy of stent retriever and catheter aspiration combination in refractory cerebral venous sinus Thrombosis: A comprehensive Meta-Analysis.

BACKGROUND: Cerebral Venous Sinus Thrombosis (CVST) is a rare but potentially life-threatening condition, often associated with specific risk factors. The primary treatment for CVST is anticoagulation, but some cases progress to Refractory CVST (rCVST), requiring endovascular treatment. A combination of stent retriever and catheter aspiration is emerging as a promising technique to enhance treatment effectiveness. We conducted a systematic review and meta-analysis to assess the safety and efficacy of this approach, aiming to improve recanalization success and neurological outcomes while reducing complications in rCVST patients. METHODS: A search following PRISMA guidelines was conducted across Pubmed, Embase, Web of Science, and Cochrane databases to identify studies on the use of stent retrievers and catheter aspiration for rCVST. Pooled analysis with 95 % confidence intervals was used to assess the effects. Heterogeneity was evaluated using I2 statistics and a random-effects model was used. Complete recanalization. good clinical outcomes (mRS ≤ 2), hemorrhagic, neurological, ischemic, and total complications, poor clinical outcomes (mRS > 2), and mortality were assessed. RESULTS: A meta-analysis of five retrospective studies involving 55 patients examined outcomes in CVST. The median mean age was 40 years. Complete recanalization rate: 36 % (95 % CI: 9 % to 62 %, I2 = 90 %). Good clinical outcomes: 72 % (95 % CI: 50 % to 94 %, I2 = 76 %). Hemorrhagic complications: 2 % (95 % CI: 0 % to 8 %, I2 = 15 %). Ischemic complications: 0 % (95 % CI: 0 % to 6 %, I2 = 0 %). Neurological complications: 7 % (95 % CI: 0 % to 14 %, I2 = 0 %). Poor clinical outcomes: 26 % (95 % CI: 6 % to 46 %, I2 = 70 %). Total complications: 6 % (95 % CI: 0 % to 15 %, I2 = 10 %). Mortality rate: 5 % (95 % CI: 0 % to 13 %, I2 = 19 %). CONCLUSION: This systematic review and meta-analysis scrutinized the efficacy of combining Stent Retriever and Catheter Aspiration for rCVST. Findings highlighted varied outcomes, including recanalization rates, complications, and mortality. The dichotomy between good and poor outcomes underscores the necessity for personalized therapeutic decisions. While offering a comprehensive overview, the study emphasizes literature heterogeneity, suggesting a need for more rigorous and standardized research to optimize therapeutic strategies in clinical practice.