MRI with DWI improves detection of liver metastasis and selection of surgical candidates with pancreatic cancer: a systematic review and meta-analysis.

OBJECTIVE: To perform a systematic review and meta-analysis to evaluate if magnetic resonance imaging (MRI) with diffusion weighted imaging (DWI) adds value compared to contrast-enhanced computed tomography (CECT) alone in the preoperative evaluation of pancreatic cancer. METHODS: MEDLINE, EMBASE, and Cochrane databases were searched for relevant published studies through October 2022. Studies met eligibility criteria if they evaluated the per-patient diagnostic performance of MRI with DWI in the preoperative evaluation of newly diagnosed pancreatic cancer compared to CECT. Our primary outcome was the number needed to treat (NNT) to prevent one futile surgery using MRI with DWI, defined as those in which CECT was negative and MRI with DWI was positive for liver metastasis (i.e., surgical intervention in metastatic disease missed by CECT). The secondary outcomes were to determine the diagnostic performance and the NNT of MRI with DWI to change management in pancreatic cancer. RESULTS: Nine studies met the inclusion criteria with a total of 1121 patients, of whom 172 had liver metastasis (15.3%). The proportion of futile surgeries reduced by MRI with DWI was 6.0% (95% CI, 3.0-11.6%), yielding an NNT of 16.6. The proportion of cases that MRI with DWI changed management was 18.1% (95% CI, 9.9-30.7), corresponding to an NNT of 5.5. The per-patient sensitivity and specificity of MRI were 92.4% (95% CI, 87.4-95.6%) and 97.3% (95% CI, 96.0-98.1). CONCLUSION: MRI with DWI may prevent futile surgeries in pancreatic cancer by improving the detection of occult liver metastasis on preoperative CECT with an NNT of 16.6. CLINICAL RELEVANCE STATEMENT: MRI with DWI complements the standard preoperative CECT evaluation for liver metastasis in pancreatic cancer, improving the selection of surgical candidates and preventing unnecessary surgeries. KEY POINTS: • The NNT of MRI with DWI to prevent potential futile surgeries due to occult liver metastasis on CECT, defined as those in which CECT was negative and MRI with DWI was positive for liver metastasis, in patients with pancreatic cancer was 16.6. • The higher performance of MRI with DWI to detect liver metastasis occult on CECT can be attributed to an increased detection of subcentimeter liver metastasis.

Angiotensin Receptor-Neprilysin Inhibitor Effects on Atherosclerotic Cardiovascular Disease Events: A Meta-Analysis of Randomized Controlled Trials.

Sacubitril-valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) associated with a decreased risk of death and hospitalization for selected patients with heart failure (HF). However, its association with improved atherosclerotic cardiovascular disease (ASCVD) events remains unclear. We performed a meta-analysis to evaluate the association of ARNI with ASCVD events in patients with HF. We systematically searched PubMed, Embase, Cochrane, and ClinicalTrials.gov for studies comparing ARNIs with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in terms of myocardial infarction, stroke, angina pectoris, peripheral artery disease, and the composite end point in patients with HF. A total of 8 randomized controlled trials were included, with 17,541 patients assigned to either the ARNI (8,764 patients) or ACEi/ARB (8,777 patients) groups. The incidence of composite end point (risk ratio [RR] 1.03, 95% confidence interval [CI] 0.93 to 1.13, p = 0.63), myocardial infarction (RR 1.02, 95% CI 0.81 to 1.30, p = 0.85), angina pectoris (RR 0.96, 95% CI 0.80 to 1.17, p = 0.70), and stroke (RR 0.99, 95% CI 0.85 to 1.16, p = 0.93) were not statistically different between the ARNI and ACEi/ARB groups. However, ARNI was associated with a higher incidence of peripheral artery disease (RR 1.63, 95% CI 1.05 to 2.52, p = 0.03). In conclusion, this meta-analysis found no association between ARNI therapy and improved ASCVD events in patients with HF.

Effect of Simvastatin on induced apical periodontitis in rats: a tomographic and biochemical analysis / Efeito da Sinvastatina sobre a periodontite apical induzida em ratos: análise radiográfica e bioquímica

Introduction: Simvastatin is one of several statins that are used to treat hypercholesterolemia, and in dentistry, few studies have attempted to associate the administration of this compound with bone repair. Objective: To evaluate the effect of simvastatin on the progression of induced apical periodontitis in rats. Material and method: To this end, 36 male Wistar rats were divided into 3 groups (N=12): Induced Apical Periodontitis Associated with Simvastatin Group (APSG N=12), Induced Periodontitis Apical Induced Group (APG N=12) and Negative Control Group (CG). On the first day, APG and APSG were anesthetized, and the coronal opening of the mandibular first molar was performed. For thirty days, the APSG received 6 mg of simvastatin daily via gavage. On the thirty-first day, all groups underwent blood collection and euthanasia. The jaws were removed and fixed in formalin. CT scans were performed to measure the periapical regions. In addition, the body mass and lipid profile were analyzed. The data were subjected to statistical analysis (ANOVA and Tukey’s test). Result: The APG (3.42±0.65) showed the highest perimeters for the space periapical ligament, followed by APSG (1.54±0.78) and CG (0.64±0.24) (p< 0.05). The lipid profile revealed the effect of simvastatin on the amount of glucose, triglycerides, HDL, and VLDL (p< 0.05). Body mass APG showed the most weight gain (264.75±44.11), followed by CG (252.00±44.36) and APSG (245.41±42.56). The three groups showed significant differences in decreasing order (p< 0.05). Conclusion: The use of simvastatin decreased the progression of the increasing periapical ligament space in rats.

Introdução: A sinvastatina é uma das várias estatinas utilizadas no tratamento da hipercolesterolemia e, na odontologia, alguns estudos têm buscado relacioná-la ao reparo ósseo. Objetivo: Avaliar o efeito da sinvastatina na progressão da periodontite apical induzida em ratos. Material e método: Para tanto, 36 ratos Wistar, previamente selecionados, foram divididos em 3 grupos (N=12). Grupo Controle (GC); Grupo Periodontite Apical (GPA); Grupo Periodontite Apical Associada à Sinvastatina (GPAS). No primeiro dia do ensaio o GPA e o GPAS foram anestesiados e submetidos à abertura coronária do primeiro molar inferior direito. Durante trinta dias, o GPAS recebeu diariamente 6mg de sinvastatina, através de gavagem. No trigésimo primeiro dia, todos os grupos foram submetidos à coleta de sangue e a eutanásia. As mandíbulas foram removidas e fixadas em formol. Para a mensuração das regiões periapicais, foram realizadas tomografias. Além disso, avaliou-se a massa corporal, glicemia e o lipidograma. Os dados foram submetidos à análise estatística ANOVA de uma via e teste Post Hoc de Tukey (p< 0,05). Resultado: Os resultados demonstram que o GPA (3,42±0,65) apresentou os maiores perímetros para espaço do ligamento periapical, seguido pelo GPAS (1,54±0,78) e GC (0,64±0,24), respectivamente (p<0,05). Em relação ao lipidograma percebe-se o efeito da sinvastatina avaliando-se a quantidade de glicose, triglicérides, HDL, VLDL (p< 0,05). Para a massa corporal o GPA foi o que mais ganhou peso (264,75±44,11); seguido pelo GC (252,00±44,36); e GPAS (245,41±42,56). Os três grupos apresentaram diferenças estatísticas entre si, de forma decrescente (p< 0,05). Conclusão: O uso da sinvastatina diminuiu a progressão do aumento do espaço do ligamento periapical em ratos.

Tecnologia móvel para a gestão da saúde de idosos: revisão da literatura / Mobile technology for mananging health of elderly: a literature review

Este estudo tem como objetivo identificar como a telefonia móvel tem sido utilizada no gerenciamento da saúde de idosos. MÉTODO: Realizada revisão sistemática da literatura nas bases de dados PubMed, Cinhal e BVS. RESULTADOS: Foram encontrados sete estudos desenvolvidos especificamente com a população idosa, os quais abordavam a adesão ao tratamento através do uso da tecnologia em doenças comuns na velhice, tais como insuficiência cardíaca, Parkinson, Alzheimer e doenças reumatológicas. Os achados apontam este recurso como viável, tendo aumentado a adesão ao tratamento e com boa aceitação pelos usuários. A investigação sobre a temática é recente e, apesar dos bons resultados, poucas pesquisas tem sido desenvolvidas com o foco nesta população.

This study aims to identify how the mobile phone has been used in managing the health of the elderly. METHOD: Conducted systematic review of the literature in the databases PubMed, Cinhal and BVS. RESULTS: We found seven studies specifically developed with the elderly population, which addressed the compliance through the use of technology in common diseases in old age, such as heart failure, Parkinson's, Alzheimer's and rheumatologic diseases. The findings point to this as viable resource, increasing adherence to treatment, with good acceptance by users. Research on the subject is recent and, despite the good results, little research has been developed with the focus on this population.

Conhecimentos e usos da fauna cinegética pelos caçadores indígenas "Tupinambá de Olivença" (Bahia) / Knowledge and faunal game uses by indigenous hunters "Tupinambá from Olivença" (Bahia)

Este estudo registra como os caçadores indígenas "Tupinambá de Olivença" (Bahia) conhecem e utilizam a fauna cinegética. Como métodos de obtenção de dados foram utilizados entrevistas abertas e semi-estruturadas no período de agosto 2006 a julho de 2008. Foram entrevistados 48 caçadores indígenas, com idades que variaram de 18 a 65 anos. Quando foram solicitados a mencionar os animais ocorrentes na região, os caçadores indígenas exemplificaram 42 espécies diferentes. O tatu-verdadeiro (Dasypus novemcinctus) é o animal mais capturado pelos caçadores. Foram observados dois principais usos da fauna silvestre: como recurso alimentar e como recurso medicinal. As armadilhas são os métodos mais utilizados para a captura dos animais. De acordo com os investigados, a atividade de caça é praticada com menor intensidade no verão. A maioria dos indígenas caça com maior freqüência em capoeiras próximas de suas residências, assim como preferem caçar animais machos e adultos. Os dados obtidos neste estudo poderão ser utilizados como fonte de conhecimento para subsidiar estratégias de conservação nas áreas protegidas federais existentes na região.

This study shows how indigenous hunters "Tupinambá de Olivença" (Bahia) know and use wildlife hunting. As methods for obtaining data were used open interviews and semi-structured from August 2006 to July 2008. We interviewed 48 native hunters, with ages ranging from 18 to 65 years. When they were asked to mention the animals occurring in the region, the indigenous hunters illustrated 42 different species. The real armadillo (Dasypus novemcinctus) is the largest animal captured by hunters. There were two main uses of wildlife: a resource such as food and medicinal use. Among the methods used for hunting the most used are traps. According to the investigation, the activity of hunting is practiced less frequently in summer. Most indigenous hunting more often in barns nearby, as prey on males and adults. The data obtained in this study may be used as a source of knowledge to support conservation strategies in federal protected areas in the region.