Kaplan-Meier Survival Analysis: Practical Insights for Clinicians.

This article aims to provide a guide that will help healthcare professionals and clinical researchers from all fields that deal with Kaplan-Meier curves. Survival analysis methods are among the most frequently used in the medical sciences and in clinical research. Overall survival, progression free survival, time to recurrence, or any other clinically relevant parameter represented by a Kaplan-Meier curve will be discussed. We will present a practical and straightforward interpretation of these curves, setting aside intricate mathematical considerations. Our focus will be on essential concepts that interface with biological sciences and medicine in order to guarantee proficiency in one of the most popular yet frequently misunderstood methods in clinical research. Being familiar with these concepts is not only essential for designing new clinical studies but also for critically assessing and interpreting published data.

Gut microbiota predicts severity and reveals novel metabolic signatures in acute pancreatitis.

OBJECTIVE: Early disease prediction is challenging in acute pancreatitis (AP). Here, we prospectively investigate whether the microbiome predicts severity of AP (Pancreatitis-Microbiome As Predictor of Severity; P-MAPS) early at hospital admission. DESIGN: Buccal and rectal microbial swabs were collected from 424 patients with AP within 72 hours of hospital admission in 15 European centres. All samples were sequenced by full-length 16S rRNA and metagenomic sequencing using Oxford Nanopore Technologies. Primary endpoint was the association of the orointestinal microbiome with the revised Atlanta classification (RAC). Secondary endpoints were mortality, length of hospital stay and severity (organ failure >48 hours and/or occurrence of pancreatic collections requiring intervention) as post hoc analysis. Multivariate analysis was conducted from normalised microbial and corresponding clinical data to build classifiers for predicting severity. For functional profiling, gene set enrichment analysis (GSEA) was performed and normalised enrichment scores calculated. RESULTS: After data processing, 411 buccal and 391 rectal samples were analysed. The intestinal microbiome significantly differed for the RAC (Bray-Curtis, p value=0.009), mortality (Bray-Curtis, p value 0.006), length of hospital stay (Bray-Curtis, p=0.009) and severity (Bray-Curtis, p value=0.008). A classifier for severity with 16 different species and systemic inflammatory response syndrome achieved an area under the receiving operating characteristic (AUROC) of 85%, a positive predictive value of 67% and a negative predictive value of 94% outperforming established severity scores. GSEA revealed functional pathway units suggesting elevated short-chain fatty acid (SCFA) production in severe AP. CONCLUSIONS: The orointestinal microbiome predicts clinical hallmark features of AP, and SCFAs may be used for future diagnostic and therapeutic concepts. TRIAL REGISTRATION NUMBER: NCT04777812.

Discharge protocol in acute pancreatitis: an international survey and cohort analysis.

There are several overlapping clinical practice guidelines in acute pancreatitis (AP), however, none of them contains suggestions on patient discharge. The Hungarian Pancreatic Study Group (HPSG) has recently developed a laboratory data and symptom-based discharge protocol which needs to be validated. (1) A survey was conducted involving all members of the International Association of Pancreatology (IAP) to understand the characteristics of international discharge protocols. (2) We investigated the safety and effectiveness of the HPSG-discharge protocol. According to our international survey, 87.5% (49/56) of the centres had no discharge protocol. Patients discharged based on protocols have a significantly shorter median length of hospitalization (LOH) (7 (5;10) days vs. 8 (5;12) days) p < 0.001), and a lower rate of readmission due to recurrent AP episodes (p = 0.005). There was no difference in median discharge CRP level among the international cohorts (p = 0.586). HPSG-protocol resulted in the shortest LOH (6 (5;9) days) and highest median CRP (35.40 (13.78; 68.40) mg/l). Safety was confirmed by the low rate of readmittance (n = 35; 5%). Discharge protocol is necessary in AP. The discharge protocol used in this study is the first clinically proven protocol. Developing and testifying further protocols are needed to better standardize patients' care.

Perfil e impacto dos bolsistas de produtividade em pesquisa do CNPq da Faculdade de Medicina da UFMG / Profile and impact of CNPq research productivity fellows at the Faculty of Medicine of UFMG

INTRODUÇÃO: Os programas de iniciação científica e pós-graduação são um instrumento essencial na formação de recursos humanos e na perpetuação da produção científica nacional. O papel dos professores pesquisadores no adequado desenvolvimento científico dos estudantes de graduação e pós-graduação tem sido continuamente reafirmado em diversas pesquisas sobre a qualidade do ensino superior brasileiro, apesar da contínua desvalorização das universidades públicas no país. Avaliar a carreira e o perfil dos bolsistas de produtividade em pesquisa pode fornecer elementos em relação ao impacto desses profissionais no ensino, na pesquisa e na internacionalização das universidades. OBJETIVO: Caracterizar o perfil profissional e a produção científica dos bolsistas do Programa de Produtividade em Pesquisa da Faculdade de Medicina da Universidade Federal de Minas Gerais. MÉTODOS: Estudo descritivo baseado na análise de dados públicos disponíveis na Plataforma Lattes. Os bolsistas de produtividade em pesquisa foram apurados com base nos resultados dos editais de 2013, 2016 e 2019. RESULTADOS: A análise das variáveis evidenciou diminuição do número de docentes bolsistas da instituição, que passou de 34 para 29. Observamos um número significativamente maior de projetos financiados por profissionais do sexo masculino quando comparados às pesquisadoras (p=0,03) e uma forte correlação entre os anos de doutorado e o número de doutores orientados que atualmente se dedicam à pesquisa. CONCLUSÃO: Professores pesquisadores exercem impacto direto na formação de recursos humanos qualificados e na formação de recursos humanos qualificados e na internacionalização das universidades públicas.

INTRODUCTION: Mentoring through scientific initiation and post-graduate programs are an essential instrument on the formation of human resources and the perpetuation of national scientific production. The role of research professors in the proper scientific development of graduate and post-graduate medical students has been continuously reaffirmed in several surveys on the quality of Brazilian superior education, despite the continuous desvalorization of higher education in the country. Determine the career and profile of research productivity fellows could measure the impact of these professionals in teaching, researching and internationalization of our university. OBJECTIVE: To characterize the professional profile and scientific production of the Productivity in Research Program fellows from the Faculty of Medicine of the Federal University of Minas Gerais. METHODS: This descriptive study is based on the analysis of public data available at Lattes Platform. Research productivity fellows were determined based on the results of the 2013, 2016 and 2019 calls for tenders. RESULTS: Analysis of the variables showed a decrease in the number of professors with scholarships at the institution, which went from 34 to 29. We observed a significantly higher number of funded projects of male professionals when compared to female researchers (p=0.03) and a strong correlation between years of doctorate degree and the number of mentored doctors currently dedicating to research. CONCLUSION: Experient research professors exert direct impact on the formation of qualified human resources and the internationalization of the federal university.

Estabilidade de cor de diferentes sistemas cerâmicos fresados no CAD/CAM e polidos com diferentes métodos / Color stability of different ceramic systems milled in CAD/CAM and polished with different methods

A descoloração ou perda de translucidez dos materiais cerâmicos usados em odontologia ainda hoje é um problema, especialmente pelo comprometimento estético. Com o objetivo de comparar a estabilidade de cor, blocos de dissilicato de lítio (IPS e.max CAD HT) e de silicato de lítio reforçado com zircônia (Vita Suprinity HT) fresados no desenho de um disco com dimensões de 1,5 × 7 × 12 mm3 (n = 120) foram preparados usando 3 procedimentos de acabamento de superfície: glaze, polimento mecânico e coloração externa e glaze. Em seguida, cada grupo foi dividido em 2 subgrupos de armazenamento, chá preto e café (n = 10/grupo). As mensurações de cor foram medidas com espectrofotômetro (VITA Easyshade) no estágio inicial e após 1 semana, 2 semanas, 1 mês, 2 meses de armazenamento. As alterações de cor (ΔE) foram calculadas e analisadas estatisticamente usando ANOVA (α < 0,05). Observamos que, para ambos os materiais cerâmicos, o procedimento de glaze apresentou valores de mudança de cor estatisticamente menores do que os outros grupos (p < 0,05) após o armazenamento em ambas as bebidas. Os grupos de dissilicato de lítio apresentaram valores de alteração de cor estatisticamente menores em relação aos grupos de silicato de lítio reforçados com zircônia. Conclui-se que, o glaze sozinho levou a uma maior estabilidade de cor em relação ao polimento mecânico e coloração externa o dissilicato de lítio apresentou maior estabilidade de cor em comparação com o silicato de lítio reforçada com zircônia.

The discoloration or loss of translucency of ceramic materials used in dentistry is still a problem today, especially due to aesthetic compromise. In order to compare color stability, lithium disilicate (IPS e.max CAD HT) and zirconia-reinforced lithium silicate (Vita Suprinity HT) blocks were milled into a disc design with dimensions of 1.5 × 7 × 12 mm3 (n = 120). The specimens were prepared using 3 surface finishing procedures: glaze, mechanical polishing and external staining and glaze. Then, each group was divided into 2 storage subgroups, black tea and coffee (n = 10/group). Color measurements were measured with a spectrophotometer (VITA Easyshade) at the initial stage and after 1 week, 2 weeks, 1 month, 2 months of storage. Color changes (ΔE) were calculated and statistically analyzed using ANOVA (α < 0.05). We observed that, for both ceramic materials, the glaze procedure presented statistically lower color change values ​​than the other groups (p < 0.05) after storage in both beverages. The lithium disilicate groups showed statistically lower color change values ​​than the zirconia-reinforced lithium silicate groups. It is concluded that, glaze alone led to greater color stability compared to mechanical polishing and external staining, lithium disilicate showed greater color stability compared to zirconia-reinforced lithium silicate.

Chronic Kidney Disease-Mineral Bone Disease Biomarkers in Kidney Transplant Patients.

BACKGROUND: Kidney transplant patients frequently suffer from Chronic Kidney Disease associated with Mineral Bone Disease (CKD-MBD), a complex condition that affects mainly kidney transplant patients. Post-transplantation bone disease is complex, especially in patients with pre-existing metabolic bone disorders that are further affected by immunosuppressive medications and changes in renal allograft function. Main biochemical abnormalities of mineral metabolism in kidney transplantation (KTx) include hypophosphatemia, hyperparathyroidism (HPTH), insufficiency or deficiency of vitamin D, and hypercalcemia. OBJECTIVE: This review aims to summarize the pathophysiology and main biomarkers of CKD-MBD in KTx. METHODS: A comprehensive and non-systematic search in PubMed was independently made, emphasizing biomarkers in mineral bone disease in KTx. RESULTS: CKD-MBD can be associated with numerous factors, including secondary HPTH, metabolic dysregulations before KTx, and glucocorticoid therapy in post-transplant subjects. Fibroblast growth factor 23 (FGF23) reaches normal levels after KTx with good allograft function, while calcium, vitamin D, and phosphorus, ultimately result in hypercalcemia, persistent vitamin D insufficiency, and hypophosphatemia, respectively. As for PTH levels, there is an initial tendency of a significant decrease, followed by a rise due to secondary or tertiary HPTH. In regard to sclerostin levels, there is no consensus in the literature. CONCLUSION: KTx patients should be continuously evaluated for mineral homeostasis and bone status, both in cases with successful kidney transplantation and those with reduced functionality. Additional research on CKD-MBD pathophysiology, diagnosis, and management is essential to guarantee long-term graft function, better prognosis, good quality of life, and reduced mortality for KTx patients.

Spontaneous internal hernia through a defect in the hepatogastric ligament.

Transomental internal hernias are a rare cause of intestinal obstruction and most commonly iatrogenic, resulting from previous surgical interventions, abdominal trauma or inflammation. Occasionally, they may occur spontaneously. We report the case of a 44-year-old healthy male admitted to the emergency room with acute abdominal pain and vomiting, consistent with intestinal obstruction. An internal hernia of small bowel in the lesser sac was suspected after performing a computed tomography (CT) scan and emergent laparotomy confirmed herniation of a jejunal loop through a defect in the hepatogastric ligament, resulting in strangulation and requiring enterectomy. The patient had a favourable outcome and was discharged a few days after surgery. Both radiologists and surgeons must be aware of rare internal hernia subtypes, to avoid delays in diagnosis and treatment. Abdominal CT is the first-line imaging of choice, providing useful diagnostic hallmarks. Nevertheless, surgical exploration is typically essential to confirm the diagnosis, identify the defect and assess bowel viability.

Inflammatory and nutritional biomarkers as predictors of non-resectability and early recurrence in pancreatic and periampullary cancer.

BACKGROUND: Some pancreatic tumors considered resectable on the preoperative staging are unresectable during surgical exploration. Moreover, some patients subjected to tumor resection have an early recurrence. METHODS: Patients with pancreatic or periampullary carcinoma diagnosed between January 2005 and August 2017 at the Prof. Doutor Fernando Fonseca Hospital were retrospectively analyzed. Biochemical and radiological inflammatory biomarkers were compared according to disease staging at diagnosis, intraoperative staging and early recurrence (<6 months). RESULTS: Three hundred ninety-one patients were included. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio, C-reactive-protein-to-albuminemia ratio (CRP/ALB), Prognostic Nutritional Index, modified Glasgow Prognostic Score and CA19-9 were associated with metastatic disease at diagnosis. NLR, CRP/ALB, mGPS and CA19-9 were independent predictors of disease staging at diagnosis on multivariate analysis. One hundred eight patients underwent surgery, of which 23.8% were found to have unresectable disease at intra-operative staging. 26.9% had early disease recurrence. CRP/ALB and CA19-9 were significantly higher in patients with evidence of disease at 6 months postoperatively. Computed tomography sarcopenia index HUAC was significantly lower in patients with evidence of disease at 6 months postoperatively. When adjusted for histology, none of the biomarkers were independent predictors of unresectable disease or early recurrence. CONCLUSIONS: NLR, CRP/ALB, mGPS and CA19-9 at diagnosis were predictors of disease staging with low performance. Preoperative inflammatory biomarkers were not predictors of unresectable disease or early recurrence.

Discourse and manipulation: Nursing in question.

The history of Brazilian nurses is marked by several challenges, in part resulting from discontinuous and fragile activity boundaries among the health professions that share the same work objective in care services. A field of constant disputes, the Brazilian health system, was the target of a lawsuit filed by the Federal Council of Medicine that temporarily suspended nurses' activities in primary care. This study aimed to demonstrate the manipulative discourse present in the text of the injunction request by medical doctors against legislation by the Brazilian Federal Government in 2017. This is a qualitative and documental study that used the theoretical-methodological framework of critical discourse studies based on Teun Van Dijk's analytical categories. The results pointed to manipulative discourse through a polarization between manipulators' good qualities and intentions and the bad qualities of nurses and Brazilian primary care policies; episodic manipulation by the presentation of documental and historical evidence of the submission of nursing roles; and social manipulation marked by strong emotional appeal. The study demonstrated that manipulative discourse extrapolated linguistic categories in the form of ideology and history.

In-hospital institutional violence in the childcare practice: discourse analysis from the foucauldian perspective / Violencia institucional hospitalaria en la práctica de la atención de la salud infantil: análisis del discurso desde la perspectiva de foucault / Violência institucional hospitalar na prática de cuidado à criança: análise do discurso na perspectiva foucaultiana

ABSTRACT Objective: to interpret speeches by health professionals and companions about in-hospital institutional violence in childcare practices, based on the Foucauldian concept of discipline. Method: a qualitative, descriptive and exploratory research study with a pediatric unit from a university hospital in Salvador/Bahia as study field. The study participants were 10 companions of hospitalized children and 39 health professionals. Data collection took place from November 2018 to October 2019 using semi-structured interviews. Discourse analysis in the light of Foucauldian Thought was employed in data interpretation. Results: institutional violence in the care practices is understood by the disciplinary device, having the following as elements: time control and spatial separation; control over the bodies; norms and training; and thorough examination. With care being guided by such elements, situations of care omission, disrespect for autonomy and privacy, lack of listening, lack of attention, physical harms, deprivations and multiple manipulations of the children's bodies were identified, resulting in violations of these individuals' human dignity. Conclusion: it is necessary for professionals, users, managers and the academic community to propose a change in the modes of care for hospitalized children, strengthening dissemination and debate of human rights in the health services that serve children and their families.

RESUMEN Objetivo: interpretar discursos de profesionales de la salud y de acompañantes acerca de la violencia institucional hospitalaria en las prácticas de atención de la salud infantil, sobre la base de la concepción de disciplina de Foucault. Método: investigación cualitativa, descriptiva y exploratoria en la que el campo de estudio fue una unidad pediátrica de un hospital universitario de Salvador/Bahía. Los participantes del estudio fueron 10 acompañantes de niños internados y 39 profesionales de la salud. La recoléccion de datos ocurrió de noviembre de 2018 a octubre de 2019 mediante la entrevistas semiestructuradas. En la interpretación de los datos se recurrió al análisis del discurso a la luz del pensamiento de Foucault. Resultados: la violencia institucional en las prácticas de atención de la salud se comprende como el dispositivo disciplinario, con los siguientes elementos: control del tiempo y separación espacial; control de los cuerpos; normas y entrenamiento; y examen minucioso. Como la atención de la salud está guiada por dichos elementos, se identificaron situaciones de omisión de atención, falta de respeto por la autonomía y la privacidad, falta de interés por escuchar a los pacientes, falta de atención, perjuicios físicos, privaciones y múltiples manipulaciones del cuerpo infantil, derivando en violaciones a la dignidad humana de estos individuos. Conclusión: es necesario que profesionales, usuarios, gerentes y la comunidad académica propongan un cambio en las modalidades de atención a niños internados, fortaleciendo la difusión y el debate de los derechos humanos en los servicios de salud que atienden a niños y a sus familias.

RESUMO Objetivo: interpretar discursos de profissionais de saúde e de acompanhantes acerca da violência institucional hospitalar nas práticas de cuidado à criança, fundamentado na concepção foucaultiana de disciplina. Método: pesquisa qualitativa descritiva exploratória tendo como campo de estudo uma unidade pediátrica de um hospital universitário em Salvador/Bahia. Participaram do estudo 10 acompanhantes de crianças hospitalizadas e 39 profissionais de saúde. A coleta de dados ocorreu de novembro de 2018 a outubro de 2019 utilizando-se a entrevista semiestruturada. Na interpretação dos dados, foi empregada a análise do discurso à luz do pensamento foucaultiano. Resultados: a violência institucional nas práticas de cuidado é compreendida pelo dispositivo disciplinar, tendo como elementos: controle do tempo e separação espacial; controle dos corpos; normas e adestramento; e o exame minucioso. Estando o cuidado balizado por tais elementos, foram identificadas situações de omissão de cuidados, desrespeito à autonomia, privacidade, falta de escuta, falta de atenção, danos físicos, privações e múltiplas manipulações do corpo infantil, resultando em violações na dignidade humana destes indivíduos. Conclusão: é necessário que profissionais, usuários e gestores e a comunidade acadêmica proponham uma mudança nos modos de atenção à criança hospitalizada, fortalecendo a difusão e debate dos direitos humanos nos serviços de saúde que atendem crianças e suas famílias.

Direitos da criança hospitalizada: percepção da equipe de enfermagem / Rights of hospitalized children: perception of the nursing team

Objetivo: Apreender a percepção da equipe de enfermagem sobre os direitos da criança hospitalizada. Método: Estudo qualitativo exploratório com 13 profissionais de enfermagem em unidade pediátrica de um hospital universitário em Salvador-BA. A coleta de dados ocorreu em novembro de 2018, através de entrevista semi-estruturada. Foi utilizada a análise de conteúdo de Bardin. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: As categorias foram: cumprimento das obrigações legais; garantia do cuidado integral e humanizado; Implementação das ações relacionadas ao tratamento e segurança do paciente; desconhecimento dos direitos da criança hospitalizada. Conclusão: Os profissionais conhecem parcialmente ou desconhecem os direitos infantis, sendo necessário empenho para capacitação dos profissionais e gestores. (AU)

Objective: To apprehend the perception of the nursing team about the rights of hospitalized children. Methods: Qualitative exploratory study with 13 nursing professionals in a pediatric unit of a university hospital in Salvador-BA. Data collection took place in November 2018, through semi-structured interviews. Bardin's content analysis was used. The study was approved by the Research Ethics Committee. Results: The categories were: compliance with legal obligations; guarantee of comprehensive and humanized care; Implementation of actions related to treatment and patient safety; ignorance of the rights of hospitalized children. Conclusion: Professionals partially know or are unaware of children's rights, requiring efforts to train professionals and managers. (AU)

Objetivo: Aprehender la percepción del equipo de enfermería sobre los derechos de los niños hospitalizados. Metodos: Estudio exploratorio cualitativo con 13 profesionales de enfermería en una unidad pediátrica de un hospital universitario en Salvador-BA. La recopilación de datos tuvo lugar en noviembre de 2018, a través de entrevistas semiestructuradas. Se utilizó el análisis de contenido de Bardin. El estudio fue aprobado por el Comité de Ética en Investigación. Resultados: Las categorías fueron: cumplimiento de obligaciones legales; garantía de atención integral y humanizada; Implementación de acciones relacionadas con el tratamiento y la seguridad del paciente; ignorancia de los derechos de los niños hospitalizados. Conclusión: los profesionales conocen parcialmente o desconocen los derechos del niño, lo que requiere esfuerzos para capacitar a profesionales y gerentes. (AU)

Design and validation of a patient-reported outcome measure scale in acute pancreatitis: the PAN-PROMISE study.

OBJECTIVE: This study aimed to develop and validate a patient-reported outcome measure (PROM) in acute pancreatitis (AP) as an endpoint centred on the patient. DESIGN: A PROM instrument (PAtieNt-rePoRted OutcoMe scale in acute pancreatItis, an international proSpEctive cohort study, PAN-PROMISE scale) was designed based on the opinion of patients, professionals and an expert panel. The scale was validated in an international multicentre prospective cohort study, describing the severity of AP and quality of life at 15 days after discharge as the main variables for validation. The COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) methodology was applied. Both the design and validation stages considered the content and face validity of this new instrument; the metric properties of the different items, reliability (reproducibility and internal consistence), the construct, structural and criterion validity, responsiveness and interpretability of this scale. RESULTS: PAN-PROMISE consists of a seven-item scale based on the symptoms that cause the most discomfort and concern to patients with AP. The validation cohort involved 15 countries, 524 patients. The intensity of symptoms changed from higher values during the first 24 hours to lower values at discharge and 15 days thereafter. Items converged into a unidimensional ordinal scale with good fit indices. Internal consistency and split-half reliability at discharge were adequate. Reproducibility was confirmed using test-retest reliability and comparing the PAN-PROMISE score at discharge and 15 days after discharge. Evidence is also provided for the convergent-discriminant and empirical validity of the scale. CONCLUSION: The PAN-PROMISE scale is a useful tool to be used as an endpoint in clinical trials, and to quantify patient well-being during the hospital admission and follow-up. TRIAL REGISTRATION NUMBER: NCT03650062.

Preoperative color Doppler ultrasound parameters for surgical decision-making in upper arm arteriovenous fistula maturation.

OBJECTIVE: Current scientific evidence is insufficient to determine the best vascular access for each patient. It is an unmet clinical need because vascular access dysfunction accounts for 20% to 30% of hospital admissions. Our aim was to evaluate preoperative color flow Doppler ultrasound (CDUS)-derived parameters (vein diameter and brachial artery flow and diameter) and their effect interaction with comorbidities as predictors of brachiocephalic (BC) and brachiobasilic (BB) arteriovenous fistula (AVF) maturation. METHODS: A prospective analysis was performed of patients who underwent BC and BB AVF as primary definitive vascular access between January 2016 and May 2017. Variables included patients' demographics, comorbidities, medication, preoperative blood pressure, and CDUS-derived parameters. Outcomes were patency 48 hours after surgery and fistula maturation at 6 and 12 weeks. Nonparametric descriptive and univariate statistics were used. Logistic regression models and receiver operating characteristic curve analyses were performed. RESULTS: There were 132 patients (91 with BC AVF and 41 with BB AVF) included. The 48-hour patency was 91.7%. AVF maturation at 6 weeks was observed in 71.3%, and AVF maturation at 12 weeks was observed in 66.3%. There were no associations in univariate and multivariate logistic regression analysis between AVF maturation and comorbidities. Systolic blood pressure was an independent predictor of 48-hour patency with an optimized cutoff of 154 mm Hg (area under the curve, 0.73; P = .013; Youden index, 0.40). Vein diameter with tourniquet was an independent predictor of AVF maturation at 6 and 12 weeks with an optimized cutoff of 3.9 mm (area under the curve, 0.74; P < .001; Youden index, 0.38). CONCLUSIONS: AVF maturation was independent of comorbidities. Systolic blood pressure ≥154 mm Hg and vein diameter with tourniquet ≥3.9 mm were the associated conditions that better predicted BC and BB AVF maturation. There were no effect interactions between CDUS-derived parameters and associated comorbidities.

Ocotea glomerata (Nees) Mez Extract and Fractions: Chemical Characterization, Anti-Candida Activity and Related Mechanism of Action.

BACKGROUND: Opportunistic fungal infections are increasingly common, with Candida albicans being the most common etiological agent; however, in recent years, episodes of candidiasis caused by non-albicans Candida species have emerged. Plants belonging to the Lauraceae family have shown remarkable antifungal effects. This study assessed the anti-Candida activity of Ocotea glomerata extracts and fractions, time of death and the synergistic effects with conventional antifungals. The possible mechanism of action was also addressed. METHODS: Minimal inhibitory concentrations (MIC) were determined by broth microdilution technique, and the mechanism of action was assessed by ergosterol, sorbitol, cell viability, reactive oxygen species (ROS) generation and phosphatidylserine externalization tests. RESULTS: All the tested extracts evidenced antifungal activity, but the methanol extract was revealed to be the most effective (MIC = 3.12 µg/mL) on C. krusei. The combination of methanol extract with ketoconazole and fluconazole revealed a synergistic effect for C. krusei and C. albicans, respectively. Fractions 1 and 5 obtained from the methanol extract had fungicidal activity, mainly against C. krusei. Methanol extract did not reveal effects by ergosterol and sorbitol assays; however, it led to an increase in intracellular ROS levels, decreased cell viability, and consequently, cell death. CONCLUSION: O. glomerata methanol extract may be viewed as a rich source of biomolecules with antifungal activity against Candida spp.

Zebrafish xenografts as a fast screening platform for bevacizumab cancer therapy.

Despite promising preclinical results, average response rates to anti-VEGF therapies, such as bevacizumab, are reduced for most cancers, while incurring in remarkable costs and side effects. Currently, there are no biomarkers available to select patients that can benefit from this therapy. Depending on the individual tumor, anti-VEGF therapies can either block or promote metastasis. In this context, an assay able to predict individual responses prior to treatment, including the impact on metastasis would prove of great value to guide treatment options. Here we show that zebrafish xenografts are able to reveal different responses to bevacizumab in just 4 days, evaluating not only individual tumor responses but also the impact on angiogenesis and micrometastasis. Importantly, we perform proof-of-concept experiments where clinical responses in patients were compared with their matching zebrafish Patient-Derived Xenografts - zAvatars, opening the possibility of using the zebrafish model to screen bevacizumab therapy in a personalized manner.

Upper limb vascular mapping with Doppler ultrasound: Technique precision evaluated in healthy volunteers.

INTRODUCTION: Doppler ultrasound is recommended by international societies for preoperative vascular mapping in vascular access surgery. Literature is scarce regarding data on Doppler ultrasound-associated errors. OBJECTIVES: Our aim was to evaluate Doppler ultrasound precision for upper limb vascular mapping. METHODS: Fifty-two adult healthy volunteers were evaluated for superficial vein diameter, brachial artery flow and diameter in the lower third of non-dominant arm by a dedicated vascular access radiologist blinded for the identification of the participants. Each participant was scheduled for three evaluations one week apart. Friedman test and multivariate analysis of variance for repeated measures were used. RESULTS: There were no statistical differences within subjects across the three weeks except for brachial artery flow in participants who had basilic vein as the dominant vein. DISCUSSION: Repeated anatomical and haemodynamic parameters measured by Doppler ultrasound performed by an experienced medical sonographer, according to our protocol, did not show statistical differences within subjects, independently of age, gender and body mass index.