BACKGROUND: Unlike cigarette smoking, environmental tobacco smoke (ETS) has not been as well described as an environmental risk for Multiple sclerosis (MS) nor as a risk factor for disease progression. OBJECTIVE: We systematically reviewed the association between ETS and the risk of onset and/or progression of MS. METHODS: We systematically screened MedLine/PubMed, Science Direct, LILACs, and SciELO searching for publications between January 1st, 2010, and July 5, 2021, with the following keywords: "multiple sclerosis and smoking"; "multiple sclerosis and passive smoking"; "multiple sclerosis and secondhand smoking". RESULTS: Fifteen articles were included in this review, which consisted of systematic reviews with meta-analysis (N = 2), systematic reviews (N = 2), and observational studies (N = 11). Both meta-analyses reported an impact of ETS on MS onset among secondhand smokers. One of the systematic reviews selected two observational studies showing the association between ETS and MS development, and one study that did not find a significant association between ETS and the risk of MS development. The other systematic review identified selected eight articles showing a relationship between ETS and MS. Seven observational studies reported higher odds of MS onset when associated with ETS. Four observational studies did not show a relationship between ETS and MS onset or progression. CONCLUSION: Most articles showed a positive association between ETS exposure and the risk of developing MS. On the other hand, an association between ETS and a higher risk for MS progression could not be established.
ANTECEDENTES: Ao contrário do tabagismo ativo, o fumo passivo (FP) não é tão bem estabelecido como risco para o desenvolvimento de esclerose múltipla (EM) nem como um fator de risco para a progressão da doença. OBJETIVO: Revisamos sistematicamente a associação entre FP e o risco de aparecimento e/ou progressão da EM. MéTODOS: Fizemos uma triagem sistemática nas bases de dados MedLine/PubMed, Science Direct, LILACs e SciELO em busca de publicações entre 1° de janeiro de 2010 e 5 de julho de 2021 com as seguintes palavras-chave: "multiple sclerosis and smoking"; "multiple sclerosis and passive smoking"; "multiple sclerosis and secondhand smoking". RESULTADOS: Quinze artigos foram incluídos nesta revisão, que consistiu em revisões sistemáticas com metanálise (N = 2), revisões sistemáticas (N = 2) e estudos observacionais (N = 11). As metanálises relataram um impacto do FP no surgimento da EM entre fumantes passivos. Um revisão sistemática selecionou dois estudos observacionais mostrando a associação entre FP e desenvolvimento de EM, e um estudo que não encontrou associação significativa entre FP e o risco de desenvolvimento de EM. Outra revisão sistemática identificou oito artigos selecionados mostrando uma relação entre FP e EM. Sete estudos observacionais relataram maiores chances de aparecimento de EM quando associados a FP. Quatro estudos observacionais não mostraram uma relação entre FP e o desenvolvimento ou progressão da EM. CONCLUSãO: A maioria dos artigos mostrou uma associação positiva entre a exposição ao FP e o risco de desenvolver EM. Por outro lado, não foi possível estabelecer uma associação entre FP e maior risco de progressão da EM.
Multiple Sclerosis , Tobacco Smoke Pollution , Humans , Tobacco Smoke Pollution/adverse effects , Systematic Reviews as Topic , Multiple Sclerosis/etiology , Risk Factors , Environmental Exposure , Observational Studies as Topic
ABSTRACT Introduction: We aim to publish our innovative modified biplanar 0-90 endoscopic guided puncture technique for percutaneous nephrolithotomy in supine recorded with a GoPro® camera for standardization of the technique. It solves drawbacks of the fluoroscopic technique, i.e., in kidneys with complex anatomy, it may be challenging to distinguish calyces as they are often superposed, and it does not allow for all benefits of a combined endoscopic approach (1, 2). Our technique shortens puncture and fluoroscopic time and is easy to teach and reproduce. Methods: A 77-year-old female patient had previous double J insertion due to an obstructing stone in the right distal ureter. She managed to pass the distal stone but remained with the double J and a 20mm stone (1300HU) in the right renal pelvis. The shared decision was for the actual standard of care (3, 4) endoscopic combined intrarenal surgery (ECIRS). The MiniECIRS started with flexible ureteroscopy and a posterior calix which gave direct access to the stone was chosen. The tip of the flexible scope was used to mark point A with the C-arm in the 0-degree position and line B in the 90-degree position. Puncture was fast and the MiniECIRS was uneventful with a single mid-pole access guided by the flexible scope. The surgeon had a Full-HD GoPro® camera mounted on his head, controlled by the surgical staff. All essential surgical steps were recorded. Results: The quality of the recorded movie was graded as excellent, and the camera did not cause any discomfort to the surgeon. Operative and X-Ray time were 120minutes and 2minutes (7.64mGy). Hemoglobin drop was 0.8g/dL. The post-operative day-1 computed tomography scan was stone-free. The patient was discharged 24h after surgery. Kidney stent was left with a string and removed after 5days. The patient remained asymptomatic and metabolic evaluation revealed a calcium oxalate stone, low urinary volume and hypocitraturia which were treated with potassium citrate and hydration. Conclusion: The Modified Biplanar (0-90 degree) Endoscopic-Guided Puncture Technique for Percutaneous Nephrolithotomy joins the reproducibility of the same technique under fluoroscopy with advantages regarding safety and efficiency of ECIRS.
INTRODUCTION: We aim to publish our innovative modified biplanar 0-90 endoscopic guided puncture technique for percutaneous nephrolithotomy in supine recorded with a GoPro® camera for standardization of the technique. It solves drawbacks of the fluoroscopic technique, i.e., in kidneys with complex anatomy, it may be challenging to distinguish calyces as they are often superposed, and it does not allow for all benefits of a combined endoscopic approach (1, 2). Our technique shortens puncture and fluoroscopic time and is easy to teach and reproduce. METHODS: A 77-year-old female patient had previous double J insertion due to an obstructing stone in the right distal ureter. She managed to pass the distal stone but remained with the double J and a 20mm stone (1300HU) in the right renal pelvis. The shared decision was for the actual standard of care (3, 4) endoscopic combined intrarenal surgery (ECIRS). The MiniECIRS started with flexible ureteroscopy and a posterior calix which gave direct access to the stone was chosen. The tip of the flexible scope was used to mark point A with the C-arm in the 0-degree position and line B in the 90-degree position. Puncture was fast and the MiniECIRS was uneventful with a single mid-pole access guided by the flexible scope. The surgeon had a Full-HD GoPro® camera mounted on his head, controlled by the surgical staff. All essential surgical steps were recorded. RESULTS: The quality of the recorded movie was graded as excellent, and the camera did not cause any discomfort to the surgeon. Operative and X-Ray time were 120minutes and 2minutes (7.64mGy). Hemoglobin drop was 0.8g/dL. The post-operative day-1 computed tomography scan was stone-free. The patient was discharged 24h after surgery. Kidney stent was left with a string and removed after 5days. The patient remained asymptomatic and metabolic evaluation revealed a calcium oxalate stone, low urinary volume and hypocitraturia which were treated with potassium citrate and hydration. CONCLUSION: The Modified Biplanar (0-90 degree) Endoscopic-Guided Puncture Technique for Percutaneous Nephrolithotomy joins the reproducibility of the same technique under fluoroscopy with advantages regarding safety and efficiency of ECIRS.
Nephrostomy, Percutaneous , Ureteroscopy , Female , Humans , Aged , Ureteroscopy/methods , Operative Time , Reproducibility of Results , Nephrostomy, Percutaneous/methods , Punctures , Fluoroscopy
BACKGROUND: Volumetric capnography in healthy ventilated neonates showed deformed waveforms, which are supposedly due to technological limitations of flow and carbon dioxide sensors. AIMS: This bench study analyzed the role of apparatus dead space on the shape of capnograms in simulated neonates with healthy lungs. METHODS: We simulated mechanical breaths in neonates of 2, 2.5, and 3 kg of body weight using a neonatal volumetric capnography simulator. The simulator was fed by a fixed amount of carbon dioxide of 6 mL/kg/min. Such simulator was ventilated in a volume control mode using fixed ventilatory settings with a tidal volume of 8 mL/kg and respiratory rates of 40, 35, and 30 breaths per minute for the 2, 2.5 and 3 kg neonates, respectively. We tested the above baseline ventilation with and without an additional apparatus dead space of 4 mL. RESULTS: Simulations showed that adding the apparatus dead space to baseline ventilation increased the amount of re-inhaled carbon dioxide in all neonates: 0.16 ± 0.01 to 0.32 ± 0.03 mL (2 kg), 0.14 ± 0.02 to 0.39 ± 0.05 mL (2.5 kg), and 0.13 ± 0.01 to 0.36 ± 0.05 mL (3 kg); (p < .001). Apparatus dead space was computed as part of the airway dead space, and therefore, the ratio of airway dead space to tidal volume increased from 0.51 ± 0.04 to 0.68 ± 0.06, from 0.43 ± 0.04 to 0.62 ± 0.01 and from 0.38 ± 0.01 to 0.60 ± 0.02 in the 2, 2.5 and 3 kg simulated neonates, respectively (p < .001). Compared to baseline ventilation, adding apparatus dead space decreased the ratio of the volume of phase III to VT size from 31% to 11% (2 kg), from 40% to 16% (2.5 kg) and from 50% to 18% (3 kg); (p < .001). CONCLUSIONS: The addition of a small apparatus dead space artificially deformed the volumetric capnograms in simulated neonates with healthy lungs.
Carbon Dioxide , Respiration, Artificial , Infant, Newborn , Humans , Respiratory Dead Space , Lung , Tidal Volume , Capnography
METHODS: An infant lung simulator was fed with CO2 supplied by a mass flow controller (VCO2-IN) and ventilated using standard settings. A volumetric capnograph was placed between the endotracheal tube and the ventilatory circuit. We simulated ventilated babies of different body weights (2, 2.5, 3, and 5 kg) with a VCO2 ranging from 12 to 30 mL/min. The correlation coefficient (r2), bias, coefficient of variation (CV = SD/x × 100), and precision (2 × CV) between the VCO2-IN and the elimination of CO2 recorded by the capnograph (VCO2-OUT) were calculated. The quality of the capnogram's waveforms was compared with real ones belonging to anesthetized infants using an 8-point scoring system, where 6 points or greater meant that the simulated capnogram showed good, 5 to 3 points acceptable, and less than 3 points an unacceptable shape. RESULTS: The correlation between VCO2-IN and VCO2-OUT was r2 = 0.9953 (P < 0.001), with a bias of 0.16 (95% confidence intervals from 0.12 to 0.20) mL/min. The CV was 5% or less and the precision was 10% or less. All simulated capnograms showed similar shapes compared with real babies, scoring 6 points for 3 kg and 6.5 points for 2-, 2.5-, and 5-kg babies. CONCLUSIONS: The simulator of volumetric capnograms was reliable, accurate, and precise for simulating the CO2 kinetics of ventilated infants.
Introduction: the first COVID-19 case in Brazil was confirmed on February 26, 2020. As of March 17, 2023, the Ministry of Health reported 699,634 deaths from COVID-19, with a case fatality rate of 1.9%. The impact of the COVID-19 pandemic in Brazil extends to socioeconomic and healthcare systems, reflecting significant regional disparities. Objective: To analyze mortality, incidence, and case fatality rates for COVID-19 in the states of Paraná and Santa Catarina, in the southern region of Brazil. Methods: This is an ecological time-series study using official Brazilian secondary data for COVID-19 cases and deaths. Data were extracted from the dashboard of the State Health Department of Santa Catarina and Paraná. Temporal series were developed for trend analysis using the Prais-Winsten regression model. Statistical analyses were performed using STATA 14.0 software (College Station, TX, USA, 2013). Results: In the analysis of rates over the entire period, trends for mortality, case fatality, and incidence in the state of Santa Catarina are decreasing, decreasing, and stationary, respectively. In Paraná, rates over the entire period showed a stationary trend for mortality, decreasing for case fatality, and increasing for incidence. Conclusion: COVID-19 had a devastating effect on the states of Santa Catarina and Paraná. Both states experienced the progression of the COVID-19 pandemic, with higher case fatality and mortality rates observed in Paraná, while Santa Catarina had a higher incidence rate over the three years of the COVID-19 pandemic.
Introduction: Low back pain is a clinical condition with a multifactorial etiopathogenesis, which has a high socioeconomic impact, especially in the economically active population, as it is associated with frequent absenteeism and reduced quality of life. Through intervertebral disc degeneration, a progressive instability of the compromised region is observed, triggering a harmful positive feedback mechanism that further promotes intervertebral disc disease. Built by the interaction between the predisposing biopsychosocial components, a multidisciplinary therapeutic proposition is suggested. In persistent low back pain, treatment involves surgical procedures such as Percutaneous Lumbar Discectomy. Objectives: to evaluate the scientific evidence regarding the clinical outcomes and safety of this surgery. Method: systematic review duly registered in Prospero (CRD42022370811), based on the PICOD question, elaborated from a Boolean search in different databases for scientific articles, evaluated and selected in a paired way based on the eligibility criteria. In addition to extracting data related to the proposed objectives, the articles included were evaluated in relation to their level of evidence and strength of recommendation. Results: among the 12 articles included, it was observed that it is a clinically effective and safe procedure. In the set of evidences gathered, they are of high and moderate level of evidence with respective strength of recommendation strong/good and weak/moderate. Conclusion: Percutaneous Lumbar Discectomy promotes significant reduction of pain and increase in body functionality, in addition to preserving local musculoskeletal structures and preventing post-surgical joint instability. It is, therefore, a safe and clinically effective minimally invasive procedure for patients with herniated discs.
Introdução: a lombalgia é uma condição clínica de etiopatogenia multifatorial, que desencadeia um elevado impacto socioeconômico especialmente na população economicamente ativa, por associar-se ao absenteísmo frequente e à redução da qualidade de vida. Observa-se mediante a degeneração do disco intervertebral, uma instabilidade progressiva da região comprometida desencadeando um mecanismo de feedback positivo prejudicial que promove ainda mais a doença do disco intervertebral. Edificada pela interação entre os componentes biopsicossocial predisponentes, sugere-se uma proposição terapêutica multidisciplinar. Na dor lombar persistente o tratamento envolve procedimentos cirúrgicos como a Discectomia Percutânea Lombar. Objetivo: avaliar as evidencias científicas relativas aos desfechos clínicos e à segurança desta cirurgia. Método: revisão sistemática devidamente registrada no Prospero (CRD42022370811), fundamentada na pergunta PICOD acrônimo para Paciente, Intervenção, Comparação, Desfechos (outcomes) e Design, elaborada a partir de busca booleana em diferentes bases de dados por artigos científicos, avaliados e selecionados de forma pareado com base nos critérios de elegibilidade. Além da extração de dados relativos aos objetivos propostos, os artigos incluídos foram avaliados em relação ao respectivo nível de evidencia e força de recomendação. Resultados: dentre os 12 artigos incluídos, observou-se que se trata de um procedimento clinicamente efetivo e seguro. No conjunto de evidencias reunidas são de alto e moderado nível de evidencia com respectiva força de recomendação forte/boa e, fraca/moderada. Conclusão: a Discectomia Percutânea Lombar promove relevante redução da dor e aumento da funcionalidade corporal, além de preservar as estruturas musculoesqueléticas locais e prevenir a instabilidade articular pós-cirúrgica. Trata-se, portanto, de um procedimento minimamente invasivo seguro e clinicamente efetivo para os pacientes portadores de hérnia discal.
Plants have evolved elaborate surveillance systems that allow them to perceive the attack by pests and pathogens and activate the appropriate defenses. Mechanical stimulation, such as mechanical wounding, represents one of the most reliable cues for the perception of potential herbivore aggressors. Here we demonstrate that mechanical wounding disturbs the growth versus defense balance in tomato, a physiological condition where growth reduction arises as a pleiotropic consequence of the activation of defense responses (or vice-versa). We observed that multiple lesions on tomato leaves impairs the formation of several growth-related traits, including shoot elongation, leaf expansion and time for flowering, while concomitantly activating the production of defense responses such as trichome formation and the upregulation of defense-related genes. We also provide genetic evidence that this wound-induced growth repression is possibly a consequence of tomato plants sensing the injuries via jasmonates (JAs), a class of plant hormones known to be master regulators of the plant growth versus defense balance. Besides providing a mechanistic explanation on how the growth and defense balance is shifted when plants are subjected to a specific type of mechanical stimulus, our results may offer a practical explanation for why tomato productivity is so negatively impacted by herbivore attack.
Solanum lycopersicum , Herbivory , Plant Growth Regulators , Cyclopentanes/pharmacology , Oxylipins/pharmacology , Plant Leaves
Antimicrobial peptides are small molecules, up to 10 kDa, present in all kingdoms of life, including in plants. Several studies report that these molecules have a broad spectrum of activity, including antibacterial, antifungal, antiviral, and insecticidal activity. Thus, they can be employed in agriculture as alternative tools for phytopathogen and pest control. However, the application of peptides in agriculture can present challenges, such as loss of activity due to degradation of these molecules, off-target effects, and others. In this context, nanotechnology can offer versatile structures, including metallic nanoparticles, liposomes, polymeric nanoparticles, nanofibers, and others, which might act both in protection and in release of AMPs. Several polymers and biomaterials can be employed for the development of nanostructures, such as inorganic metals, natural or synthetic lipids, synthetic and hybrid polymers, and others. This review addresses the versatility of NanoAMPs (Nanoparticles in association with antimicrobial peptides), and their potential applications in agribusiness, as an alternative for the control of phytopathogens in crops.
INTRODUCTION: Robotic surgery has expanded on it's surgical application and it is also noted an increase in surgical procedures complexity. Occurrence of emergency situations that require conversion of the minimally invasive access route to open access routes is uncommon. The urgent undocking of the robotic platform is a complex and neglected process in robotic surgery training. OBJECTIVE: To establish specific actions and comands for a safe emergency robotic undocking in a simulation environment. METHOD: Two surgical teams, interventional group (IG) and control group (CG), were submitted to a simulation environment in which there was a need for emergency undocking of the robotic system. The intervention group underwent training with the robotic undocking for life emergency support (RULES) protocol. RESULT: Undocking time of the robotic platform from the IG was reduced by 66% and the CG by only 20%. After RULES protocol training, during the second simulation, the IG acquired more critical actions necessary for emergency undocking and developed more non-technical skills. CONCLUSION: The RULES protocol proved to be effective, promoting an improvement in technical and non-technical skills of all surgical team menbers, resulting in more effective actions that resut in a coordinated and faster robotic undocking. It is also concluded that the surgeon and bed side surgeon are the key elements for the efficient robotic system undocking in emergency situations.
Robotic Surgical Procedures , Robotics , Surgeons , Humans , Robotic Surgical Procedures/methods , Computer Simulation , Communication , Clinical Competence
OBJECTIVE: to develop a training program in minimally invasive surgery, based on simulation and with an emphasis on the acquisition of laparoscopic competences. METHODS: this was a prospective, observational study carried out at a university hospital in Belo Horizonte, Brazil, between April 2020 and January 2021. We recruited residents of surgical specialties for structured, progressive training according to instructional principles to promote learning, such as motivation, activation, demonstration, application, and integration. We filmed the skill tests at the program's beginning, middle, and end, which were then anonymously evaluated by a surgical education expert. Individual performances were scored using the global assessment tools "GOALS" and "specific checklist for suture". At the end, all participants received individual feedback and completed a questionnaire to assess the impact of training on the Kirkpatrick model. RESULTS: 43 residents completed the program. The evolution of performances was evident and grew between tests. The average achievements were 29% in the initial test, 43% in the intermediate test, and 88% in the final test, with significant differences between all mean scores, with H=97.59, GL=2, p<0.0001. The program evaluation and learning perceptions were excellent, but only 10.7% of residents felt fully capable of performing unsupervised, low-complexity laparoscopic surgery at the end of training. CONCLUSIONS: the training program developed in this study proved to be feasible and promising as a strategy for teaching laparoscopic surgery.
General Surgery , Internship and Residency , Laparoscopy , Simulation Training , Clinical Competence , Curriculum , General Surgery/education , Humans , Laparoscopy/education , Minimally Invasive Surgical Procedures/education , Prospective Studies
Phloem/metabolism , Plant Leaves/metabolism , Plant Roots/metabolism , Plant Stems/metabolism , Solanum lycopersicum/growth & development , Solanum lycopersicum/metabolism , Xylem/metabolism , Crops, Agricultural/growth & development , Crops, Agricultural/metabolism , Forecasting , Metabolic Networks and Pathways , Phloem/growth & development , Plant Leaves/growth & development , Plant Roots/growth & development , Plant Stems/growth & development , Xylem/growth & development
KEY MESSAGE: Chemical defenses are imperative for plant survival, but their production is often associated with growth restrictions. Here we review the most recent theories to explain this complex dilemma of plants. Plants are a nutritional source for a myriad of pests and pathogens that depend on green tissues to complete their life cycle. Rather than remaining passive victims, plants utilize an arsenal of chemical defenses to fend off biotic attack. While the deployment of such barriers is imperative for survival, the production of these chemical defenses is typically associated with negative impacts on plant growth. Here we discuss the most recent theories which explain this highly dynamic growth versus defense dilemma. Firstly, we discuss the hypothesis that the antagonism between the accumulation of chemical defenses and growth is rooted in the evolutionary history of plants and may be a consequence of terrestrialization. Then, we revise the different paradigms available to explain the growth versus chemical defense antagonism, including recent findings that update these into more comprehensive and plausible theories. Finally, we highlight state-of-the-art strategies that are now allowing the activation of growth and the concomitant production of chemical barriers in plants. Growth versus chemical defense antagonism imposes large ecological and economic costs, including increased crop susceptibility to pests and pathogens. In a world where these plant enemies are the main problem to increase food production, we believe that this review will summarize valuable information for future studies aiming to breed highly defensive plants without the typical accompanying penalties to growth.
Plant Breeding , Plants , Biological Evolution , Plant Development
ABSTRACT Objective: to develop a training program in minimally invasive surgery, based on simulation and with an emphasis on the acquisition of laparoscopic competences. Methods: this was a prospective, observational study carried out at a university hospital in Belo Horizonte, Brazil, between April 2020 and January 2021. We recruited residents of surgical specialties for structured, progressive training according to instructional principles to promote learning, such as motivation, activation, demonstration, application, and integration. We filmed the skill tests at the program's beginning, middle, and end, which were then anonymously evaluated by a surgical education expert. Individual performances were scored using the global assessment tools "GOALS" and "specific checklist for suture". At the end, all participants received individual feedback and completed a questionnaire to assess the impact of training on the Kirkpatrick model. Results: 43 residents completed the program. The evolution of performances was evident and grew between tests. The average achievements were 29% in the initial test, 43% in the intermediate test, and 88% in the final test, with significant differences between all mean scores, with H=97.59, GL=2, p<0.0001. The program evaluation and learning perceptions were excellent, but only 10.7% of residents felt fully capable of performing unsupervised, low-complexity laparoscopic surgery at the end of training. Conclusions: the training program developed in this study proved to be feasible and promising as a strategy for teaching laparoscopic surgery.
RESUMO Objetivo: desenvolver programa de treinamento em cirurgia minimamente invasiva, baseado em simulação e com ênfase na aquisição de competências laparoscópicas. Métodos: trata-se de estudo prospectivo observacional que foi realizado em hospital universitário de Belo Horizonte, Brasil, entre abril de 2020 e janeiro de 2021. Foram recrutados residentes de clínicas cirúrgicas para treinamento progressivo estruturado de acordo com princípios instrucionais de promoção da aprendizagem, como: motivação, ativação, demonstração, aplicação e integração. Testes de habilidades foram filmados no início, meio e final do programa, e, então, avaliados em anonimato por perito em educação cirúrgica. As performances individuais foram pontuadas por meio das ferramentas de avaliação global "GOALS" e "checklist específico de sutura". Ao final, todos participantes receberam feedbacks individuais e preencheram questionário destinado a avaliar o impacto do treinamento, baseado no modelo de Kirkpatrick. Resultados: 43 residentes concluíram o treinamento. A evolução das performances foi crescente e evidente entre os testes. Os aproveitamentos médios foram: 29% no teste inicial; 43% no teste intermediário; e 88% no teste final, com diferenças significativas entre todas as médias de pontuação, sendo H=97,59; GL=2; p<0,0001. A avaliação do programa e percepções de aprendizagem foram excelentes, mas apenas 10,7% dos residentes sentiram-se totalmente capazes a realizar cirurgia laparoscópica de baixa complexidade sem supervisão ao final do treinamento. Conclusões: o programa de treinamento desenvolvido nesse estudo mostrou-se factível e promissor como estratégia de ensino da cirurgia laparoscópica.
Humans , General Surgery/education , Laparoscopy/education , Simulation Training , Internship and Residency , Prospective Studies , Clinical Competence , Minimally Invasive Surgical Procedures/education , Curriculum
