Variations in phase angle and handgrip strength in patients undergoing cardiac surgery: Prospective cohort study.

BACKGROUND: Bioimpedance phase angle (PA) is a measure of cell membrane integrity, whereas handgrip strength (HGS) is an evaluation of functional capacity. Although both are related to the prognosis of patients undergoing cardiac surgery, their changes over time are less known. This study followed variations in PA and HGS for 1 year in these patients, determining associations with clinical outcomes. METHODS: This prospective cohort study included 272 cardiac surgery patients. PA and HGS were measured at six predetermined times. The evaluated outcomes were surgery type; bleeding; time of surgery, cardiopulmonary bypass, aortic cross-clamp, and mechanical ventilation; postoperative (PO) length of stay (LOS) in the intensive care unit (ICU) and hospital; and infections, hospital readmission, reoperation, and mortality. RESULTS: There were reductions in PA and HGS values after surgery, with total recovery beginning at 6 months for PA and 3 months for HGS. In the PA area under the curve (AUC), age, combined surgery, and sex (ß = -9.66, P < 0.001; ß = -252.85, P = 0.005; ß = -216.56, P < 0.001, respectively) were predictors for PA-AUC reduction. Stratified by sex, age (ß = -93.54, P < 0.001) and PO LOS (ß = -46.91, P = 0.003) were predictors for HGS-AUC reduction in women, but only age was a predictor in men (ß = -77.02, P = 0.010). PA and HGS had an effect in hospital LOS and ICU LOS. CONCLUSION: Age, combined surgery, and female sex were predictors of reduced PA-AUC, whereas reduced HGS-AUC was predicted by age in both sexes and PO hospital LOS in women, which suggests that these factors could interfere in prognosis.

Mn-Based Methacrylated Gellan Gum Hydrogels for MRI-Guided Cell Delivery and Imaging.

This work aims to engineer a new stable injectable Mn-based methacrylated gellan gum (Mn/GG-MA) hydrogel for real-time monitored cell delivery into the central nervous system. To enable the hydrogel visualization under Magnetic Resonance Imaging (MRI), GG-MA solutions were supplemented with paramagnetic Mn2+ ions before its ionic crosslink with artificial cerebrospinal fluid (aCSF). The resulting formulations were stable, detectable by T1-weighted MRI scans and also injectable. Cell-laden hydrogels were prepared using the Mn/GG-MA formulations, extruded into aCSF for crosslink, and after 7 days of culture, the encapsulated human adipose-derived stem cells remained viable, as assessed by Live/Dead assay. In vivo tests, using double mutant MBPshi/shi/rag2 immunocompromised mice, showed that the injection of Mn/GG-MA solutions resulted in a continuous and traceable hydrogel, visible on MRI scans. Summing up, the developed formulations are suitable for both non-invasive cell delivery techniques and image-guided neurointerventions, paving the way for new therapeutic procedures.

Anti-hyperglycemic potential and chemical constituents of Aristolochia triangularis Cham. leaves - A medicinal species native to Brazilian forests.

ETHNOPHARMACOLOGICAL RELEVANCE: Aristolochia triangularis Cham. has been used in Brazilian traditional medicine for various therapeutic purposes, including as a leaf-based infusion for diabetes management. AIM OF THE STUDY: This study was designed to chemically characterize an infusion of in natura A. triangularis leaves and evaluate the in vivo anti-hyperglycemic properties of this infusion. MATERIALS AND METHODS: Chemical composition was examined using liquid-liquid extraction procedure, chromatographic methods, NMR, and LC-MS/MS. The in vivo anti-hyperglycemic activity of the freeze-dried infusion of A. triangularis leaves (Inf-L-At) was assessed using oral glucose tolerance test (OGTT). Initially, normoglycemic male rats were pre-treated with orally administered Inf-L-At at doses of 62.5, 125, and 250 mg/kg for two consecutive days. On the day of the OGTT, fasting animals received a glucose load (4 g/kg) 30 min after treatment with Inf-L-At, and the blood glucose levels were verified at 15, 30, 60, and 180 min. Intestinal maltase, lactase, and sucrase activities and muscle and liver glycogen contents were also assessed after the OGTT. RESULTS: Inf-L-At extract led to glycemic reduction with no dose-response at 15, 30, and 60 min comparable to that of the antidiabetic drug glibenclamide and was accompanied by an increase in hepatic and muscle glycogen contents. Additionally, there was a significant statistically decrease in the in vitro activity of disaccharidases. Maltase and sucrase activities were inhibited at all doses, whereas lactase activity was inhibited only at 62.5 and 250 mg/kg. In total, 75 compounds were found in the infusion, including seven new ones, (7S*,8S*,7ꞌS*,8ꞌR*)-4,4ꞌ-dihydroxy-3,3ꞌ-dimethoxy-7,9ꞌ-epoxylignan-7ꞌ-ol; 4ꞌ-hydroxy-3ꞌ-methoxy-3,4-methylenedioxy-7,9ꞌ-epoxylignan-9,7ꞌ-diol; triangularisines A, B, and C; N-ethyl-N-methyl-affineine; and N-methyl pachyconfine, and one previously not described as a natural product, epi-secoisolariciresinol monomethyl ether. CONCLUSION: The results demonstrated the anti-hyperglycemic activity of the infusion from A. triangularis leaves and showed that it is a rich source of lignoids, alkaloids, and glycosylated flavonoids, which are known to exhibit antidiabetic effects and other biological properties that can be beneficial for patients with chronic hyperglycemia, thus certifying the popular use of this herbal drink.

Antinociceptive and anti-inflammatory properties of aqueous extract obtained from Serjania marginata Casar leaves.

ETHNOPHARMACOLOGICAL RELEVANCE: Serjania marginata Casar (Sapindaceae Family) Leaves are popularly used against abdominal pain. Antiulcer properties of S. marginata were scientifically described, however rare studies showed the antinociceptive effects of this plant. AIM OF STUDY: In this study, we investigated the antinociceptive and anti-inflammatory effects of aqueous extract obtained from Serjania marginata leaves (AESM) in nociception/inflammation models. MATERIAL AND METHODS: AESM was analyzed in FIA-ESI-IT-MS and Mass spectrometer LTQ XL. AESM oral administration (p.o.) (30, 100 and 300 mg/kg), dexamethasone subcutaneous injection (1 mg/kg, s.c.) and morphine (5 mg/kg, s.c.) were tested against the acetic acid-induced nociception, carrageenan-induced acute inflammatory paw edema/hyperalgesia, formalin-induced nociception and carrageenan-induced pleurisy in Swiss mice. RESULTS: Flavonoids rutin was detected in the phytochemical analysis of this extract. Oral treatment of AESM 300 mg/kg significantly reduced the number of acetic acid-induced abdominal writhing. AESM (100 and 300 mg/kg) significantly inhibited formalin-induced nociception, mechanical hyperalgesia and paw edema in carrageenan-model. Furthermore, AESM significantly inhibited leukocyte migration and protein exudation in the carrageenan-induced pleurisy test. CONCLUSION: This study confirms the antinociceptive, and anti-inflammatory activity of AESM, which may explain, in part, the popular use of this plant as a natural antinociceptive agent. This pharmacological action can be caused by flavonoids such as rutin and other compounds present in AESM.

Acute gastrointestinal failure is associated with worse hemodynamic and perfusion parameters over 48 h after admission in patients with septic shock: Retrospective cohort study.

BACKGROUND: This study aimed to investigate the relationship between acute gastrointestinal injury (AGI) and hemodynamic and perfusion parameters in the first week of intensive care unit (ICU) admission and evaluate the association of AGI with ICU and hospital outcomes in patients with septic shock undergoing mechanical ventilation. METHODS: This retrospective cohort study applied the criteria proposed by the European Society of Intensive Medicine to classify the participants into risk/dysfunction group (AGI grade I and II) and failure group (AGI grade III and IV). Hemodynamic and perfusion parameters data previously collected in the first 48 h after ICU admission (admission, 12, 24, 48 h) were analyzed. RESULTS: A total of 163 were included and classified into AGI grades I (n = 79), II (n = 64), III (n = 20), and IV (none). Groups consisted of AGI risk/dysfunction (n = 143, 87.8%) and AGI failure (n = 20, 12.2%) patients. Patients with AGI failure had higher heart rate and mottling score (MS) at admission, lower mean arterial pressure, and an oliguria incidence at 12 h compared with those without AGI failure. Skin MS and abdominal primary site of infection were risk factors for AGI failure. AGI failure tended to be a risk factor for ICU mortality (risk ratio [95% CI]: 1.37 [0.99-1.89]; P = 0.053). CONCLUSION: AGI was frequently observed in patients with septic shock in the first week of ICU admission. Higher heart rate and MS and lower mean arterial pressure and incidence of oliguria were identified in patients with AGI failure compared with those without. AGI failure was associated with ICU mortality.

Engineering Hydrogels for Modulation of Material-Cell Interactions.

Hydrogels are a recurrent platform for Tissue Engineering (TE) strategies. Their versatility and the variety of available methods for tuning their properties highly contribute to hydrogels' success. As a result, the design of advanced hydrogels has been thoroughly studied, in the quest for better solutions not only for drugs- and cell-based therapies but also for more fundamental studies. The wide variety of sources, crosslinking strategies, and functionalization methods, and mostly the resemblance of hydrogels to the natural extracellular matrix, makes these three dimensional hydrated structures an excellent tool for TE approaches. The state-of-the-art information regarding hydrogel design, processing methods, and the influence of different hydrogel formulations on the final cell-biomaterial interactions are overviewed herein.

Comparison of hemodynamic instability among continuous, intermittent and hybrid renal replacement therapy in acute kidney injury: A systematic review of randomized clinical trials.

PURPOSE: To compare hemodynamic instability during continuous, intermittent and hybrid renal replacement therapy (RRT) in critically ill patients, and its association with renal recovery and mortality. MATERIALS AND METHODS: The search was conducted in accordance with the PRISMA guidelines which was registered at the PROSPERO Database (CRD42018086504). Randomized clinical trials (RCTs) involving critically ill patients with acute kidney injury (AKI) treated with continuous, intermittent or hybrid RRT were included. The search was performed using PubMed, Embase and Cochrane databases. RESULTS: Out of 3442 citations retrieved, 12 RCTs were included in the systematic analysis, representing 1419 patients. Most studies (n = 8) did not report differences in hemodynamic parameters across different RTT modalities. The incidence of hypotensive episodes varied from 5 to 60% among the studies. Punctual differences on heart rate and blood pressure were observed among studies. However, studies presented high heterogeneity in terms of outcome definitions and measurement, thus making the conduction of meta-analysis impossible. CONCLUSIONS: There is very few information available regarding hemodynamic tolerance of renal replacement therapy methods. A better standardization of hemodynamic tolerance and further reports are needed before conclusions can be drawn.

Methacrylated Gellan Gum/Poly-l-lysine Polyelectrolyte Complex Beads for Cell-Based Therapies.

Cell encapsulation strategies using hydrogel beads have been considered as an alternative to immunosuppression in cell-based therapies. They rely on layer-by-layer (LbL) deposition of polymers to tune beads' permeability, creating a physical barrier to the host immune system. However, the LbL approach can also create diffusion barriers, hampering the flow of essential nutrients and therapeutic cell products. In this work, the polyelectrolyte complex (PEC) methodology was used to circumvent the drawbacks of the LbL strategy by inducing hydrogel bead formation through the interaction of anionic methacrylated gellan gum (GG-MA) with cationic poly-l-lysine (PLL). The interfacial complexation between both polymers resulted in beads with a cell-friendly GG-MA hydrogel core surrounded by a PEC semipermeable membrane. The beads showed great in vitro stability over time, a semi-permeable behavior, and supported human adipose-derived stem cell encapsulation. Additionally, and regarding immune recognition, the in vitro and in vivo studies pointed out that the hydrogel beads behave as an immunocompatible system. Overall, the engineered beads showed great potential for hydrogel-mediated cell therapies, when immunoprotection is required, as when treating different metabolic disorders.

Uso do SAPS 3 no escore NUTrition RIsk in the Critically ill modificado tem precisão preditiva comparável ao uso do APACHE II como marcador de gravidade / SAPS 3 in the modified NUTrition RIsk in the Critically ill score has comparable predictive accuracy to APACHE II as a severity marker

RESUMO Objetivo: Avaliar o Simplified Acute Physiology Score 3 (SAPS 3) como substituto do Acute Physiology and Chronic Health Evaluation II (APACHE II) como marcador de gravidade na versão modificada do escore NUTrition RIsk in the Critically ill (mNUTRIC; sem interleucina 6), com base em uma análise de sua capacidade discriminativa para predição de mortalidade hospitalar. Métodos: Este estudo de coorte retrospectiva avaliou 1.516 pacientes adultos internados em uma unidade de terapia intensiva de um hospital geral privado entre abril de 2017 e janeiro de 2018. A avaliação de desempenho incluiu as análises Kappa de Fleiss e correlação de Pearson. A capacidade discriminativa para estimar a mortalidade hospitalar foi avaliada com a curva Característica de Operação do Receptor. Resultados: A amostra foi dividida aleatoriamente em dois terços para o desenvolvimento do modelo (n = 1.025; idade 72 [57 - 83]; 52,4% masculino) e um terço para avaliação do desempenho (n = 490; idade 72 [57 - 83]; 50,8 % masculino). A concordância com o mNUTRIC foi Kappa de 0,563 (p < 0,001), e a correlação entre os instrumentos foi correlação de Pearson de 0,804 (p < 0,001). A ferramenta mostrou bom desempenho para prever a mortalidade hospitalar (área sob a curva de 0,825 [0,787 - 0,863] p < 0,001). Conclusão: A substituição do APACHE II pelo SAPS 3 como marcador de gravidade no escore mNUTRIC mostrou bom desempenho para predizer a mortalidade hospitalar. Esses dados fornecem a primeira evidência sobre a validade da substituição do APACHE II pelo SAPS 3 no mNUTRIC como marcador de gravidade. São necessários estudos multicêntricos e análises adicionais dos parâmetros de adequação nutricional.

ABSTRACT Objective: To evaluate the substitution of Acute Physiology and Chronic Health Evaluation II (APACHE II) by Simplified Acute Physiology Score 3 (SAPS 3) as a severity marker in the modified version of the NUTrition RIsk in the Critically ill score (mNUTRIC); without interleukin 6) based on an analysis of its discriminative ability for in-hospital mortality prediction. Methods: This retrospective cohort study evaluated 1,516 adult patients admitted to an intensive care unit of a private general hospital from April 2017 to January 2018. Performance evaluation included Fleiss' Kappa and Pearson correlation analysis. The discriminative ability for estimating in-hospital mortality was assessed with the Receiver Operating Characteristic curve. Results: The sample was randomly divided into two-thirds for model development (n = 1,025; age 72 [57 - 83]; 52.4% male) and one-third for performance evaluation (n = 490; age 72 [57 - 83]; 50.8% male). The agreement with mNUTRIC was Kappa of 0.563 (p < 0.001), and the correlation between the instruments was Pearson correlation of 0.804 (p < 0.001). The tool showed good performance in predicting in-hospital mortality (area under the curve 0.825 [0.787 - 0.863] p < 0.001). Conclusion: The substitution of APACHE II by SAPS 3 as a severity marker in the mNUTRIC score showed good performance in predicting in-hospital mortality. These data provide the first evidence regarding the validity of the substitution of APACHE II by SAPS 3 in the mNUTRIC as a marker of severity. Multicentric studies and additional analyses of nutritional adequacy parameters are required.

Selective anticancer effects of Serjania marginata Casar. extract in gastric cells are mediated by antioxidant response.

Gastric cancer is the fifth most common malignancy worldwide. Serjania marginata Casar. (SM) displays anti-inflammatory properties and has been used to treat gastrointestinal disorders. In the current study, we examined whether the hydroethanolic extract of SM leaves exerted cytotoxic, mutagenic, and protective effects in non-tumor gastric epithelium cells (MNP01) and gastric adenocarcinoma cells (ACP02) in vitro and analyzed whether its action was selective. Initially, cell viability (MTT assay), cell cycle kinetics (flow cytometry), and cell proliferation (total protein content) were analyzed. In addition, genomic instability (cytokinesis-block micronucleus cytome assay), anti/pro-oxidant status (CM-H2 DCFDA probe), and transcriptional expression (RT-qPCR) of genes related to cell cycle, cell death, and antioxidant defense were also evaluated. The SM extract was cytotoxic toward MNP01 and ACP02 cells at concentrations greater than 300 and 100 µg·ml-1 , respectively, and decreased protein content only toward ACP02 cells at 200 µg ml-1 . In ACP02 cells, the SM extract at 100 µg·ml-1 associated with doxorubicin (DXR; 0.2 µg ml-1 ) clearly promoted cell cycle arrest at the G2/M phase. The extract alone was not mutagenic to either cell type and reversed DXR-induced DNA damage and H2 O2 -induced oxidative stress in MNP01 cells. The gene expression experiments showed that SM hydroethanolic extract exerts an antioxidant response via NFE2L2 activation in non-tumor gastric cells, and cell cycle arrest (G2/M) in ACP02 gastric cancer cells via the TP53 pathway. The selective action of SM indicates that it is a promising therapeutic agent to treat gastric diseases and merits further studies.

Changes in cardiac arrest profiles after the implementation of a Rapid Response Team. / Modificações no perfil de paradas cardíacas após implantação de um Time de Resposta Rápida.

OBJECTIVE: To evaluate changes in the characteristics of in-hospital cardiac arrest after the implementation of a Rapid Response Team. METHODS: This was a prospective observational study of in-hospital cardiac arrest that occurred from January 2013 to December 2017. The exclusion criterion was in-hospital cardiac arrest in the intensive care unit, emergency room or operating room. The Rapid Response Team was implemented in July 2014 in the study hospital. Patients were classified into two groups: a Pre-Rapid Response Team (in-hospital cardiac arrest before Rapid Response Team implementation) and a Post-Rapid Response Team (in-hospital cardiac arrest after Rapid Response Team implementation). Patients were followed until hospital discharge or death. RESULTS: We had a total of 308 cardiac arrests (64.6 ± 15.2 years, 60.3% men, 13.9% with initial shockable rhythm). There was a decrease from 4.2 to 2.5 in-hospital cardiac arrest/1000 admissions after implementation of the Rapid Response Team, and we had approximately 124 calls/1000 admissions. Pre-Rapid Response Team cardiac arrest was associated with more hypoxia (29.4 versus 14.3%; p = 0.006) and an altered respiratory rate (14.7 versus 4.2%; p = 0.004) compared with post-Rapid Response Team cardiac arrest. Cardiac arrest due to hypoxia was more common before Rapid Response Team implementation (61.2 versus 38.1%, p < 0.001). In multivariate analysis, return of spontaneous circulation was associated with shockable rhythm (OR 2.97; IC95% 1.04 - 8.43) and witnessed cardiac arrest (OR 2.52; IC95% 1.39 - 4.59) but not with Rapid Response Team implementation (OR 1.40; IC95% 0.70 - 2.81) or premonitory signs (OR 0.71; IC95% 0.39 - 1.28). In multivariate analysis, in-hospital mortality was associated with non-shockable rhythm (OR 5.34; IC95% 2.28 - 12.53) and age (OR 1.03; IC95% 1.01 - 1.05) but not with Rapid Response Team implementation (OR 0.89; IC95% 0.40 - 2.02). CONCLUSION: Even though Rapid Response Team implementation is associated with a reduction in in-hospital cardiac arrest, it was not associated with the mortality of in-hospital cardiac arrest victims. A significant decrease in cardiac arrests due to respiratory causes was noted after Rapid Response Team implementation.

OBJETIVO: Avaliar as modificações nas características das paradas cardíacas no hospital após a implantação de um Time de Resposta Rápida. MÉTODOS: Este foi um estudo observacional prospectivo de paradas cardíacas ocorridas no hospital entre janeiro de 2013 e dezembro de 2017. O critério de exclusão foi parada cardíaca na unidade de terapia intensiva, na emergência ou na sala cirúrgica. O Time de Resposta Rápida foi introduzido no hospital do estudo em julho de 2014. Os pacientes foram classificados em dois grupos: Pré-Time de Resposta Rápida (parada cardíaca no hospital antes da implantação do Time de Resposta Rápida) e Pós- Time de Resposta Rápida (parada cardíaca no hospital após a implantação do Time de Resposta Rápida). Os pacientes foram seguidos até a alta hospitalar ou óbito. RESULTADOS: Ocorreram 308 paradas cardíacas (64,6 ± 15,2 anos; 60,3% homens; 13,9% com ritmo inicial chocável). Houve diminuição de 4,2 para 2,5 no índice de parada cardíaca no hospital por 1.000 admissões após o início da atuação do Time de Resposta Rápida, além de cerca de 124 chamados por 1.000 admissões. A parada antes da implantação do Time de Resposta Rápida se associou com hipóxia (29,4 versus 14,3%; p = 0,006) e alteração da frequência respiratória (14,7 versus 4,2%; p = 0,004) em comparação aos dados referentes à parada cardíaca após a implantação do Time de Resposta Rápida. Parada cardíaca por hipóxia foi mais comum antes da implantação do Time de Resposta Rápida (61,2 versus 38,1%; p < 0,001). Na análise multivariada, o retorno à circulação espontânea se associou com ritmo chocável (RC 2,97; IC95% 1,04 - 8,43) e parada cardíaca testemunhada (RC 2,52; IC95% 1,39 - 4,59) mas não com a implantação do Time de Resposta Rápida (RC 1,40; IC95% 0,70 - 2,81) ou sinais premonitórios (RC 0,71; IC95% 0,39 - 1,28). Na análise multivariada, a mortalidade hospitalar se associou com ritmo não chocável (RC 5,34; IC95% 2,28 - 12,53) e idade (RC 1,03; IC95% 1,01 - 1,05), porém não com a implantação do Time de Resposta Rápida (RC 0,89; IC95% 0,40 - 2,02). CONCLUSÃO: Apesar de a implantação de um Time de Resposta Rápida se associar com redução na incidência de parada cardíaca no hospital, ela não se associou com a redução da mortalidade das vítimas de parada cardíaca no hospital. Observou-se significante diminuição nas paradas cardíacas devidas a causas respiratórias após a implantação do Time de Resposta Rápida.

Rutin present in Alibertia edulis extract acts on human platelet aggregation through inhibition of cyclooxygenase/thromboxane.

Alibertia edulis leaf extract is commonly used in folk medicine, with rutin caffeic and vanillic acids being its major compounds. The Alibertia edulis leaf extract was investigated for its pharmacological effects via platelet aggregation, calcium mobilization, cyclic nucleotides levels, vasodilator-stimulated phosphoprotein Ser157 and Ser239 and protein kinase Cß2 phosphorylation, thromboxane B2, cyclooxygenases 1 and 2, docking and molecular dynamics. Alibertia edulis leaf extract significantly inhibited (100-1000 µg mL-1) platelet aggregation induced by different agonists. Arachidonic acid increased levels of calcium and thromboxane B2, phosphorylation of vasodilator-stimulated phosphoprotein Ser157 and Ser239, and protein kinase Cß, which were significantly reduced by Alibertia edulis leaf extract, rutin, and caffeic acid as well mixtures of rutin/caffeic acid. Cyclooxygenase 1 activity was inhibited for Alibertia edulis leaf extract, rutin and caffeic acid. These inhibitions were firsrtly explored by specific stabilization of rutin and caffeic acid compared to diclofenac at the catalytic site from docking score and free-energy dissociation profiles. Then, simulations detailed the rutin interactions close to the heme group and Tyr385, responsible for catalyzing the conversion of arachidonic acid to its products. Our results reveal the antiplatelet aggregation properties of Alibertia edulis leaf extract, rutin and caffeic acid providing pharmacological information about its origin from cyclooxygenase 1 inhibition and its downstream pathway.

SAPS 3 in the modified NUTrition RIsk in the Critically ill score has comparable predictive accuracy to APACHE II as a severity marker. / Uso do SAPS 3 no escore NUTrition RIsk in the Critically ill modificado tem precisão preditiva comparável ao uso do APACHE II como marcador de gravidade.

OBJECTIVE: To evaluate the substitution of Acute Physiology and Chronic Health Evaluation II (APACHE II) by Simplified Acute Physiology Score 3 (SAPS 3) as a severity marker in the modified version of the NUTrition RIsk in the Critically ill score (mNUTRIC); without interleukin 6) based on an analysis of its discriminative ability for in-hospital mortality prediction. METHODS: This retrospective cohort study evaluated 1,516 adult patients admitted to an intensive care unit of a private general hospital from April 2017 to January 2018. Performance evaluation included Fleiss' Kappa and Pearson correlation analysis. The discriminative ability for estimating in-hospital mortality was assessed with the Receiver Operating Characteristic curve. RESULTS: The sample was randomly divided into two-thirds for model development (n = 1,025; age 72 [57 - 83]; 52.4% male) and one-third for performance evaluation (n = 490; age 72 [57 - 83]; 50.8% male). The agreement with mNUTRIC was Kappa of 0.563 (p < 0.001), and the correlation between the instruments was Pearson correlation of 0.804 (p < 0.001). The tool showed good performance in predicting in-hospital mortality (area under the curve 0.825 [0.787 - 0.863] p < 0.001). CONCLUSION: The substitution of APACHE II by SAPS 3 as a severity marker in the mNUTRIC score showed good performance in predicting in-hospital mortality. These data provide the first evidence regarding the validity of the substitution of APACHE II by SAPS 3 in the mNUTRIC as a marker of severity. Multicentric studies and additional analyses of nutritional adequacy parameters are required.

OBJETIVO: Avaliar o Simplified Acute Physiology Score 3 (SAPS 3) como substituto do Acute Physiology and Chronic Health Evaluation II (APACHE II) como marcador de gravidade na versão modificada do escore NUTrition RIsk in the Critically ill (mNUTRIC; sem interleucina 6), com base em uma análise de sua capacidade discriminativa para predição de mortalidade hospitalar. MÉTODOS: Este estudo de coorte retrospectiva avaliou 1.516 pacientes adultos internados em uma unidade de terapia intensiva de um hospital geral privado entre abril de 2017 e janeiro de 2018. A avaliação de desempenho incluiu as análises Kappa de Fleiss e correlação de Pearson. A capacidade discriminativa para estimar a mortalidade hospitalar foi avaliada com a curva Característica de Operação do Receptor. RESULTADOS: A amostra foi dividida aleatoriamente em dois terços para o desenvolvimento do modelo (n = 1.025; idade 72 [57 - 83]; 52,4% masculino) e um terço para avaliação do desempenho (n = 490; idade 72 [57 - 83]; 50,8 % masculino). A concordância com o mNUTRIC foi Kappa de 0,563 (p < 0,001), e a correlação entre os instrumentos foi correlação de Pearson de 0,804 (p < 0,001). A ferramenta mostrou bom desempenho para prever a mortalidade hospitalar (área sob a curva de 0,825 [0,787 - 0,863] p < 0,001). CONCLUSÃO: A substituição do APACHE II pelo SAPS 3 como marcador de gravidade no escore mNUTRIC mostrou bom desempenho para predizer a mortalidade hospitalar. Esses dados fornecem a primeira evidência sobre a validade da substituição do APACHE II pelo SAPS 3 no mNUTRIC como marcador de gravidade. São necessários estudos multicêntricos e análises adicionais dos parâmetros de adequação nutricional.

Methacrylated gellan gum and hyaluronic acid hydrogel blends for image-guided neurointerventions.

Cell-based therapies delivered via intrathecal injection are considered as one of the most promising solutions for the treatment of amyotrophic lateral sclerosis (ALS). Herein, injectable manganese-based biocompatible hydrogel blends were developed, that can allow image-guided cell delivery. The hydrogels can also provide physical support for cells during injection, and at the intrathecal space after transplantation, while assuring cell survival. In this regard, different formulations of methacrylated gellan gum/hyaluronic acid hydrogel blends (GG-MA/HA) were considered as a vehicle for cell delivery. The hydrogels blends were supplemented with paramagnetic Mn2+ to allow a real-time monitorization of hydrogel deposition via T1-weighted magnetic resonance imaging (MRI). The developed hydrogels were easily extruded and formed a stable fiber upon injection into the cerebrospinal fluid. Hydrogels prepared with a 75 : 25 GG-MA to HA ratio supplemented with MnCl2 at 0.1 mM showed controlled hydrogel degradation, suitable permeability, and a distinct MRI signal in vitro and in vivo. Additionally, human-derived adipose stem cells encapsulated in 75 : 25 GG-MA/HA hydrogels remained viable for up to 14 days of culture in vitro. Therefore, the engineered hydrogels can be an excellent tool for injectable image-guided cell delivery approaches.

Hemodynamic and skin perfusion is associated with successful enteral nutrition therapy in septic shock patients.

BACKGROUND & AIMS: Enteral nutrition is controversial in hemodynamically unstable patients. This study aimed to evaluate the association between hemodynamic and skin perfusion parameters and enteral nutrition therapy (NT) outcomes in septic shock patients. METHODS: Ventilated adults with septic shock were evaluated at bedside upon admission (H0), and at 12 h (H1), 24 h (H2) and 48 h (H3) for mean arterial pressure (MAP), heart rate, urine output, lactate levels, mottling score, capillary refill time (CRT), central-to-toe temperature gradient and norepinephrine dose. Two groups were stratified: NT success (NTS) (≥20 kcal/kg or 11 kcal/kg for obese in the first ICU week) or NT failure (NTF). A generalized linear model and generalized estimating equations were performed. RESULTS: Over a 19-month period, 2167 admissions were assessed and 141 patients were analyzed (63.5 ± 15.0 years, SAPS-3 75 ± 12, 102 [72%] in the NTS vs. 39 [28%] in NTF). At 12 h, the failure group showed more severe mottling scores, higher lactate levels, norepinephrine dose and central-to-toe temperature gradient. Mottling score at 12 h was a predictor of NT failure (RR 1.28 95%CI [1.09-1.50], p = .003). Over 48 h, higher mottling scores, lactate levels and norepinephrine dosage, % of patients with central-to-toe temperature gradient and CRT ≥3 s were observed in the failure group and higher urine output and MAP values were observed in the success group. CONCLUSION: Early improvement in hemodynamic and skin perfusion parameters was associated with success in nutrition therapy, and mottling score at 12 h was a risk factor for nutrition therapy failure. This data could support the recommendation to start NT after hemodynamic and perfusion goals are achieved and to proactively evaluate bedside parameters while implementing NT in critical care setting.

Rede de atenção psicossocial: os desafios da articulação e integração / Psychosocial attention network: the challenges of articulation and integration / Red de atención psicosocial: los desafíos de la articulación e integración / Réseau d'attention psychosociale: les enjeux de l'association et de l'intégration

Este estudo objetivou conhecer a perspectiva de profissionais de saúde com relação a articulação e integração dos pontos de atenção da Rede de Atenção Psicossocial no território. A pesquisa foi realizada com 63 profissionais médicos e enfermeiros das equipes de Estratégia da Saúde da Família (ESF); psicólogos, educadores físicos e assistentes sociais, de duas equipes de Núcleo de Apoio à Saúde da Família (NASF) e psicólogos, assistentes sociais e enfermeiros de três Centros de Apoio Psicossocial (CAPS AD, CAPS II E CAPS i), em Corumbá-MS. Os resultados indicam articulação insatisfatória entre as equipes de ESF e NASF e melhor integração das equipes de CAPS com outros serviços da rede. A realização de ações de educação permanente voltadas para os aspectos dinâmicos implicados no trabalho em rede, típicos do atendimento de usuários com sofrimento mental, tornam-se necessárias.

This study aimed to learn the perspective of health professionals regarding the articulation and integration of the attention points of the Network of Psychosocial Care in the territory. The research was carried out with 63 medical professionals and nurses from the Family Health Strategy (ESF) teams; Psychologists, physical educators and social workers from two teams from the Family Health Support Center (NASF) and psychologists, social workers and nurses from three Psychosocial Support Centers (CAPS AD, CAPS II and CAPS i), in Corumbá-MS (Brazil). The results indicate unsatisfactory articulation between ESF and NASF teams and better integration of CAPS teams with other network services. The implementation of permanent education actions focused on the dynamic aspects involved in networking, typical of the care of users with mental suffering, become necessary.

Este estúdio objetivo conocer la perspectiva de profesionales de salud com relación a la articulación e integración de los puntos de atención de la Red de Atención Psicosocial em el territorio. La investigación fue realizada con 63 profesionales médicos y enfermeros de los equipos de Estrategia de Salud de la Familia (ESF); Psicólogos, educadores físicos y assistentes sociales, de dos equipos de Núcleo de Apoyo a la Salud de la Familia (NASF) y psicólogos, assistentes sociales y enfermeros de tres Centros de Apoyo Psicosocial (CAPS AD, CAPS II Y CAPS i), en Corumbá-MS. Los resultados indican una articulación insatisfactoria entre los equipos de ESF y NASF y una mejor integración de los equipos de CAPS com otros servicios de la red. La realización de acciones de educación permanente orientadas a los aspectos dinámicos implicados en el trabajo en red, típicos del la atención de usuários com sufrimiento mental se hace necesaria.

Cette étude visait à connaître le point de vue des professionnels de la santé en ce qui concerne l'articulation et l'intégration des points d'attention du réseau de soins psychosociaux sur le territoire. La recherche a été réalisée avec 63 professionnels de la santé et infirmières des équipes de la Stratégie de santé de la famille (ESF); psychologues, éducateurs physiques et travailleurs sociaux de deux équipes du centre de soutien pour la santé familiale (NASF) et psychologues, travailleurs sociaux et infirmières de trois centres de soutien psychosocial (CAPS AD, CAPS II et CAPS i), à Corumbá-MS. Les résultats indiquent une articulation insatisfaisante entre les équipes ESF et NASF et une meilleure intégration des équipes CAPS avec d'autres services réseau. La réalisation d'actions d'éducation permanente axées sur les aspects dynamiques impliqués dans la mise en réseau, typique des soins prodigués aux utilisateurs souffrant de souffrance mentale, devient nécessaire.

Investigation of the antioxidant and hypoglycemiant properties of Alibertia edulis (L.C. Rich.) A.C. Rich. leaves.

ETHNOPHARMACOLOGICAL RELEVANCE: Alibertia edulis (L.C. Rich.) A.C. Rich is a vegetable species used in Brazilian folk medicine due to it is putative hypoglycemiant effect but has never been pharmacologically investigated. It is popularly used for the control of diabetes, especially in the state of Mato Grosso, Brazil. Following confirmation of the antioxidant activity of A. edulis by Aquino et al. (2017), the aim of this study was to evaluate the effects of leaves of A. edulis aqueous extract (AEAE) on some biochemical parameters in mice fed a high-fat fed. MATERIAL AND METHODS: Leaves of A. edulis were air-dried in an oven at 40 °C for 10 days and ground into a fine powder by mechanical milling. The AEAE was prepared by decoction (1:10 w/v) at 97 °C for 15 min, and later filtered and lyophilized. Preliminary phytochemical analysis of the AEAE has been already indetified the presence of caffeic acid, quercetin 3-rhamnosyl-(1 â†’ 6)-galactoside and iridois ioxide, ferulic acid and rutin in decocted leaves (Aquino et al., 2017). In one experiment, the acute oral toxicity AEAE was evaluated at 2,000 mg/kg of body weight. The animals were observed periodically for 14 days. In second experiment, the animals were divided into four groups (n = 5): Control, AEAE 200, AEAE 400 mg/kg and positive control (Metformin 100 mg/kg). In a third experiment, animals were divided into: Control RC (standard diet) (n = 24) and Control HFF (high-fat fed) (n = 24) groups for induction of glucose intolerance. After eight weeks, they were further subdivided into six groups (n = 8 each) RC or HFF with or without AEAE at doses of 200 and 400 mg/kg (2-wk) treatments to assess glucose tolerance. Plasma indicators of glucose tolerance and liver damage, skeletal muscle expression of antioxidant enzymes, and expression of the antioxidant proteins of superoxide dismutase (SOD), catalase, glutathione peroxidase (GPx) and phosphorylated IKK were determined. RESULTS: The HF-fed animals developed glucose intolerance which the AEAE failed to revert. Meanwhile, the AEAE treatment did lower the glucose levels in the normolipidic cohorts by virtue of its antioxidant property. It was also observed that the treatment with the AEAE reduced food intake negatively interfering weight accretion. Beyond that, the treatment with AEAE interfered in the SOD and catalase expression and inhibited phosphorylation of IKK thus suggesting that the observed hypoglycemiant power may be related to its known antioxidant potential. No sings of toxicity or hemolysis were detectaed at indicating that, at the concentrations evaluated, the extract was not toxic to normal cells. CONCLUSION: The AEAE showed a hypoglycemiant effect in the normolipidic mice that received the control diet, but not in those that were made glucose-intolerant by consuming a high-fat fed. The extract also exhibited substantial protection against hemolysis and oxidative stress. Moreover, no signs of toxicity were evident at 2000 mg/kg of body weight.

Advanced Biomaterials and Processing Methods for Liver Regeneration: State-of-the-Art and Future Trends.

Liver diseases contribute markedly to the global burden of mortality and disease. The limited organ disposal for orthotopic liver transplantation results in a continuing need for alternative strategies. Over the past years, important progress has been made in the field of tissue engineering (TE). Many of the early trials to improve the development of an engineered tissue construct are based on seeding cells onto biomaterial scaffolds. Nowadays, several TE approaches have been developed and are applied to one vital organ: the liver. Essential elements must be considered in liver TE-cells and culturing systems, bioactive agents or growth factors (GF), and biomaterials and processing methods. The potential of hepatocytes, mesenchymal stem cells, and others as cell sources is demonstrated. They need engineered biomaterial-based scaffolds with perfect biocompatibility and bioactivity to support cell proliferation and hepatic differentiation as well as allowing extracellular matrix deposition and vascularization. Moreover, they require a microenvironment provided using conventional or advanced processing technologies in order to supply oxygen, nutrients, and GF. Herein the biomaterials and the conventional and advanced processing technologies, including cell-sheets process, 3D bioprinting, and microfluidic systems, as well as the future trends in these major fields are discussed.

Maximal heart rate assessment in recreational football players: A study involving a multiple testing approach.

This study aimed at examining the suitability of a standard treadmill test (TT), popular intermittent field tests, and small-sided football matches to induce maximal heart rate (HRmax ) in recreational football players. Sixty-six inactive untrained male subjects (age: 39.3 ± 5.8 years, VO2max : 41.2 ± 6.2 mL kg-1  min-1 , body mass: 81.9 ± 10.8 kg, height: 173.2 ± 6.4 cm) were evaluated. On separate occasions, the players were randomly submitted to a progressive VO2max TT, to the Yo-Yo intermittent endurance level 1 (YYIE1) and level 2 (YYIE2) tests, to the Yo-Yo intermittent recovery level 1 (YYIR1) test, and to 7v7 (43 × 27 m pitch, 83 m2 /player) football matches (45 minutes; 2-4 matches/player). To ensure data consistency, exercise HR was recorded using the same HR monitors in all the experimental conditions. A total of 73%, 24%, 18%, 17%, and 30% of the players achieved their HRmax during the YYIE1, YYIE2, YYIR1, TT, and the small-sided football matches, respectively. The probability of achieving HRmax increased proportionally to test duration, with 7.8 minutes as the cutoff time. Variations in HRpeak of ±2 b min-1 should be regarded as of practical relevance. YYIE1 HRpeak provided the most accurate estimation of a subject's individual HRmax and much higher probability of reaching HRmax . Nevertheless, the results of this study suggest caution in considering a reference test for HRmax assessment in this population. The use of confirmation tests is still highly advisable when the test duration is shorter than 7.8 minutes. In this regard, field tests seem to be suitable and accurate for individual HRmax assessment in recreational football players.

Hepatic and gastroprotective activity of Serjania marginata leaf aqueous extract in Nile tilapia (Oreochromis niloticus).

The aim of this study was to assess the leaf aqueous extract composition of Serjania marginata and the effects of its inclusion on the diet of Nile tilapia (Oreochromis niloticus), with respect to the activity of digestive enzymes and enzymes associated with the metabolism of the liver and intestine and liver histopathology. Fish (initial mean weight, 54.36 ± 17.04 g) were divided into groups: fasting (without feeding), control (commercial feed), and treatment (commercial feed with leaf aqueous extract of Serjania marginata), and in each aquarium, there were five individuals and the fish fed ad libitum for 15 days. Treatment fish had ingested on average 224.3 mg of extract/kg of fish/day. In the extract analysis by mass spectrometry, quercitrin, isoquercitrin, A-type proanthocyanidin trimer, and quinic acid were identified. In the enzymatic activity, fish from the treatment group showed higher level of alkaline phosphatase, while the hepatotoxic markers (AST and ALT) and levels of lipase, amylase, and nonspecific protease did not differ (p > 0.05). In liver histopathological analysis, it was observed that fish from the treatment showed normal structure, while abnormalities were associated with control (fibrosis, loss of cordonal architecture, vacuolated hepatocytes with nucleus displaced to the periphery) and fasting (reduction in hepatocyte size and sinusoidal space). The intestine histopathology evidenced that the extract favored the development of goblet cells and intestinal fold height. The results indicated that the leaf aqueous extract of S. marginata assists in the structural maintenance of the liver and intestine and stimulates intestinal alkaline phosphatase production in Nile tilapia, suggesting that the identified compounds act on the liver and intestine, showing hepatoprotective effects and stimulating intestinal digestion.