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Acetamiprid (ACDP) is a widely used neonicotinoid insecticide that is popular for its efficacy in controlling fleas in domestic settings and for pets. Our study aims to offer a comprehensive examination of the toxicological impacts of ACDP and the prophylactic effects of cinnamon nanoemulsions (CMNEs) on the pathological, immunohistochemical, and hematological analyses induced by taking ACDP twice a week for 28 days. Forty healthy rats were divided into four groups (n = 10) at random; the first group served as control rats; the second received CMNEs (2 mg/Kg body weight); the third group received acetamiprid (ACDP group; 21.7 mg/Kg body weight), and the fourth group was given both ACDP and CMNEs by oral gavage. Following the study period, tissue and blood samples were extracted and prepared for analysis. According to a GC-MS analysis, CMNEs had several bioactive ingredients that protected the liver from oxidative stress by upregulating antioxidant and anti-inflammatory agents. Our findings demonstrated that whereas ACDP treatment considerably boosted white blood cells (WBCs) and lymphocytes, it significantly lowered body weight gain (BWG), red blood cells (RBCs), hemoglobin (Hb), hematocrit (HCT), and platelets (PLT). ACDP notably reduced antioxidant enzyme activities: superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) and elevated hydrogen peroxide and malondialdehyde levels compared with other groups. ACDP remarkably raised alanine aminotransferase (ALT), aspartate amino transaminase (AST), and alkaline phosphatase (ALP) levels.Moreover, the histopathological and immunohistochemistry assays discovered a severe toxic effect on the liver and kidney following ACDP delivery. Furthermore, cyclooxygenase 2 (COX-2) + immunoexpression was enhanced after treatment with CMNEs. All of the parameters above were returned to nearly normal levels by the coadministration of CMNEs. The molecular docking of cinnamaldehyde with COX-2 also confirmed the protective potential of CMNEs against ACDP toxicity. Our findings highlighted that the coadministration of CMNEs along with ACDP diminished its toxicity by cutting down oxidative stress and enhancing antioxidant capacity, demonstrating the effectiveness of CMNEs in lessening ACDP toxicity.
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Cinnamomum zeylanicum , Emulsões , Inseticidas , Fígado , Simulação de Acoplamento Molecular , Neonicotinoides , Animais , Neonicotinoides/farmacologia , Cinnamomum zeylanicum/química , Inseticidas/toxicidade , Ratos , Emulsões/química , Emulsões/farmacologia , Masculino , Fígado/efeitos dos fármacos , Fígado/patologia , Rim/efeitos dos fármacos , Rim/patologia , Estresse Oxidativo/efeitos dos fármacos , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Doença Hepática Induzida por Substâncias e Drogas/prevenção & controle , Antioxidantes/farmacologia , Nefropatias/induzido quimicamente , Nefropatias/prevenção & controle , Nefropatias/patologia , Ratos Sprague-DawleyRESUMO
ABSTRACT: Lymphedematous fibroepithelial polyps are rare proliferations involving the glans penis typically associated with chronic condom catheter usage. To the best of our knowledge, less than 20 cases have been reported in the literature with relatively similar clinical presentation. Herein, we report a case of lymphedematous fibroepithelial polyp not associated with condom usage in a 74-year-old man treated with surgical excision. On histopathological examination, the lesion displayed a hypocellular proliferation of spindled and stellate fibroblasts with intermixed Touton-like giant cells embedded within an edematous stroma with thickened vasculature. Immunohistochemical profiling exhibits strong immunoreactivity for smooth muscle actin, weak positivity for factor XIIIa, and no reactivity for CD34 or desmin. We also conducted a review of the reported range of clinical and histopathological features of this entity in addition to the various hypotheses regarding its pathogenesis. We hope to increase awareness and accurate diagnosis of this entity, which could affect clinical management.
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Linfedema , Pólipos , Neoplasias Cutâneas , Masculino , Humanos , Idoso , Preservativos/efeitos adversos , Pólipos/etiologia , Pólipos/cirurgia , Pênis/patologia , Neoplasias Cutâneas/patologia , Catéteres/efeitos adversos , Linfedema/patologiaRESUMO
BACKGROUND: This study compared the effectiveness of three bone grafting materials used for treating class II fresh extraction sockets in the esthetic zone with immediate implant placement using Vestibular Socket Therapy (VST) to evaluate the pink esthetic score (PES), peri-implant mucosal levels (PML), and facial bone thickness (FBT). METHODS: Twenty-four surgical sites in the maxillary anterior region presented with type II socket defects received immediate implants and simultaneous bone grafting with either a collagen plug soaked in blood, demineralized bone matrix Grafton, or a particulate mixture of 2/3 autogenous bone chips and 1/3 deproteinized bovine bone mineral MinerOss X. The outcome measures were evaluated at 6 and 12 months. The study was registered on www. CLINICALTRIAL: gov (12/07/2021 - ID: NCT04957654). RESULTS: Twenty-two cases (91.6%) showed a total PES score of > 10, without a significant difference between all groups. The vertical height soft tissue changes showed significant improvement in the Collagen plug and Grafton groups at 6 and 12 months, while MinerOss X showed no significant difference at 6 and 12 months compared to baseline. Radiographically, FBT was 0.72 ± 0.20, 0.44 ± 0.12, and 0.95 ± 0.37 at baseline, which significantly increased to 1.61 ± 0.88, 1.48 ± 1.20 and 2.31 ± 0.86 at 12 months for all three groups, respectively. CONCLUSION: The use of a particulate bone graft mixture significantly increases the FBT compared to collagen plugs and DBM-Grafton when performing VST during immediate implant placement in compromised Class II extraction sockets.
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Implantes Dentários , Animais , Bovinos , Humanos , Estética Dentária , Transplante Ósseo , Ossos FaciaisRESUMO
BACKGROUND: Cartilaginous disorders comprise a wide range of diseases that affect normal joint movement, ear and nose shape; and they have great social and economic impact. Mesenchymal stem cells (MSCs) provide a promising regeneration alternative for treatment of degenerative cartilaginous disorders. This study aimed to compare therapeutic potential of different types of laser activated MSCs to promote auricular cartilage regeneration. Twelve adult rabbit allocated equally in four groups, all animals received a surgical mid auricular cartilage defect in one ear; Group I (Positive control) injected sub-perichondrially with phosphate-buffered saline (PBS), Group II (ADMSC-transplanted group) injected adipose-derived MSCs (ADMSCs), Group III (BMMSCs-transplanted group) received bone marrow-derived MSCs (BMMSCs), and Group IV (EMSC-transplanted group) received ear MSCs (EMSCs) in the defected ear. The auricular defect was analyzed morphologically, histopathologically and immunohistochemically after 4 weeks. In addition, a quantitative real-time polymerase chain reaction was used to examine expression of the collagen type II (Col II) and aggrecan as cartilage growth factors. RESULTS: The auricles of all treatments appeared completely healed with smooth surfaces and similar tissue color. Histopathologically, defective areas of control positive group, ADMSCs and EMSCs treated groups experienced a small area of immature cartilage. While BMMSCs treated group exhibited typical features of new cartilage formation with mature chondrocytes inside their lacunae and dense extracellular matrix (ECM). In addition, BMMSC treated group showed a positive reaction to Masson's trichrome and orcein stains. In contrary, control positive, ADMSC and EMSC groups revealed faint staining with Masson's trichrome and Orcein. Immunohistochemically, there was an intense positive S100 expression in BMMSCs (with a significant increase of area percentage + 21.89 (P < 0.05), a moderate reaction in EMSCs (with an area percentage + 17.97, and a mild reaction in the control group and ADMSCs (area percentages + 8.02 and + 11.37, respectively). The expression of relative col II and aggrecan was substantially highest in BMMSCs (± 0.91 and ± 0.89, respectively). While, Control positive, ADMSCs and EMSCs groups recorded (± 0.41: ± 0.21, ± 0.6: ± 0.44, ± 0.61: ± 0.63) respectively. CONCLUSION: BMMSCs showed the highest chondrogenic potential compared to ADMSCs and EMSCs and should be considered the first choice in treatment of cartilaginous degenerative disorders.
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Cartilagem da Orelha , Células-Tronco Mesenquimais , Animais , Coelhos , Agrecanas/metabolismo , Condrócitos , Matriz Extracelular , Células Cultivadas , Diferenciação CelularRESUMO
Boosting the sales of e-commerce services is guaranteed once users find more items matching their interests in a short amount of time. Consequently, recommendation systems have become a crucial part of any successful e-commerce service. Although various recommendation techniques could be used in e-commerce, a considerable amount of attention has been drawn to session-based recommendation systems in recent years. This growing interest is due to security concerns over collecting personalized user behavior data, especially due to recent general data protection regulations. In this work, we present a comprehensive evaluation of the state-of-the-art deep learning approaches used in the session-based recommendation. In session-based recommendation, a recommendation system counts on the sequence of events made by a user within the same session to predict and endorse other items that are more likely to correlate with their preferences. Our extensive experiments investigate baseline techniques (e.g., nearest neighbors and pattern mining algorithms) and deep learning approaches (e.g., recurrent neural networks, graph neural networks, and attention-based networks). Our evaluations show that advanced neural-based models and session-based nearest neighbor algorithms outperform the baseline techniques in most scenarios. However, we found that these models suffer more in the case of long sessions when there exists drift in user interests, and when there are not enough data to correctly model different items during training. Our study suggests that using the hybrid models of different approaches combined with baseline algorithms could lead to substantial results in session-based recommendations based on dataset characteristics. We also discuss the drawbacks of current session-based recommendation algorithms and further open research directions in this field.
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Date palm (Phoenix dactylifera) is one of the most widespread fruit crop species and can tolerate drastic environmental conditions that may not be suitable for other fruit species. Excess UV-B stress is one of the greatest concerns for date palm trees and can cause genotoxic effects. Date palm responds to UV-B irradiation through increased DEG expression levels and elaborates upon regulatory metabolic mechanisms that assist the plants in adjusting to this exertion. Sixty-day-old Khalas date palm seedlings (first true-leaf stage) were treated with UV-B (wavelength, 253.7 nm; intensity, 75 µW cm-2 for 72 h (16 h of UV light and 8 h of darkness). Transcriptome analysis revealed 10,249 and 12,426 genes whose expressions were upregulated and downregulated, respectively, compared to the genes in the control. Furthermore, the differentially expressed genes included transcription factor-encoding genes and chloroplast- and photosystem-related genes. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to detect metabolite variations. Fifty metabolites, including amino acids and flavonoids, showed changes in levels after UV-B excess. Amino acid metabolism was changed by UV-B irradiation, and some amino acids interacted with precursors of different pathways that were used to synthesize secondary metabolites, i.e., flavonoids and phenylpropanoids. The metabolite content response to UV-B irradiation according to hierarchical clustering analysis showed changes in amino acids and flavonoids compared with those of the control. Amino acids might increase the function of scavengers of reactive oxygen species by synthesizing flavonoids that increase in response to UV-B treatment. This study enriches the annotated date palm unigene sequences and enhances the understanding of the mechanisms underlying UV-B stress through genetic manipulation. Moreover, this study provides a sequence resource for genetic, genomic and metabolic studies of date palm.
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Phoeniceae/metabolismo , Phoeniceae/efeitos da radiação , Raios Ultravioleta/efeitos adversos , Regulação da Expressão Gênica de Plantas/efeitos da radiação , Genes de Cloroplastos/efeitos da radiação , Genes de Plantas/efeitos da radiação , Redes e Vias Metabólicas/genética , Redes e Vias Metabólicas/efeitos da radiação , Anotação de Sequência Molecular , Fosforilação Oxidativa/efeitos da radiação , Phoeniceae/genética , Fotossíntese/efeitos da radiação , Folhas de Planta/genética , Folhas de Planta/metabolismo , Folhas de Planta/efeitos da radiação , Proteínas de Plantas/genética , RNA-Seq , Estresse Fisiológico/efeitos da radiação , Fatores de Transcrição/genética , Transcriptoma/efeitos da radiaçãoRESUMO
Vitamins maintain growth and development in humans, animals, and plants. Because plants serve as essential producers of vitamins, increasing the vitamin contents in plants has become a goal of crop breeding worldwide. Here, we begin with a summary of the functions of vitamins. We then review the achievements to date in elucidating the molecular mechanisms underlying how vitamins are synthesized, transported, and regulated in plants. We also stress the exploration of variation in vitamins by the use of forward genetic approaches, such as quantitative trait locus mapping and genome-wide association studies. Overall, we conclude that exploring the diversity of vitamins could provide new insights into plant metabolism and crop breeding.
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Vitaminas/metabolismo , Estudo de Associação Genômica Ampla , Melhoramento VegetalRESUMO
Detecting cognitive profiles is critical to efficient adaptive learning systems that automatically adjust the content delivered depending on the learner's cognitive states and skills. This study explores electroencephalography (EEG) and facial expressions as physiological monitoring tools to build models that detect two cognitive states, namely, engagement and instantaneous attention, and three cognitive skills, namely, focused attention, planning, and shifting. First, while wearing a 14-channel EEG Headset and being videotaped, data has been collected from 127 subjects taking two scientifically validated cognitive assessments. Second, labeling was performed based on the scores obtained from the used tools. Third, different shallow and deep models were experimented in the two modalities of EEG and facial expressions. Finally, the best performing models for the analyzed states are determined. According to the used performance measure, which is the f-beta score with beta = 2, the best obtained results for engagement, instantaneous attention, and focused attention are EEG-based models with 0.86, 0.82, and 0.63 scores, respectively. As for planning and shifting, the best performing models are facial expressions-based models with 0.78 and 0.81, respectively. The obtained results show that EEG and facial expressions contain important and different cues and features about the analyzed cognitive states, and hence, can be used to automatically and non-intrusively detect them.
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Cognição , Eletroencefalografia , Expressão Facial , Reconhecimento Automatizado de Padrão , Atenção , Sinais (Psicologia) , HumanosRESUMO
Whispering gallery mode resonators hold great promises as very sensitive detectors, with a wide range of applications, notably as biosensors. However, in order to monitor the fine variations in their resonances, a costly and bulky apparatus is required, which confines the use of these efficient tools within specialised labs. Here, we consider a micro-ring resonator that is completely covered by a Bragg grating and propose to functionalize it only over a quarter of its perimeter. As target molecules progressively bind to the active region of the resonator, some particular resonances near the edge of the band gap undergo monotonous frequency splitting. Such a splitting, within the GHz range, can be monitored by conventional electronics and, hence, does not require finely tunable lasers or spectrometers. Meanwhile, the ultrahigh sensitivity that is characteristic of whispering gallery mode resonators is maintained. This robust and sensitive self-heterodyne detection scheme may pave the way to portable whispering-gallery-mode-based detectors, and in particular to point-of-care diagnostic tools.
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BACKGROUND: Extralevator abdominoperineal excision (ELAPE) is increasingly used to treat locally advanced low rectal cancer as it has been related to superior oncological outcomes than traditional abdominoperineal excision.However, ELAPE also has been associated with high perineal wound morbidity rates as it creates a larger perineal cavity than standard abdominoperineal excision. This greater defect, along with the effects of preoperative chemoradiation on wound healing, makes uneventful perineal reconstruction post-ELAPE a real challenge for the plastic surgeon.In this paper, the authors present a new technique for perineal reconstruction post-ELAPE, using a perforator, islanded, turnover, de-epithelialized local flap (perineal turnover perforator [PTO] flap). METHODS: The PTO flap is raised based on perforators from internal pudendal artery. The flap is based on the concept that thick gluteal dermis can act as an "autologous dermal vascularized" substitute for the excised pelvic floor muscles, whereas the bulk of its subcutaneous tissue is used to obliterate dead space.Fourteen patients underwent perineal reconstruction using this approach. Patients' demographics, neoadjuvant chemoradiotherapy, histopathology, duration of surgery, follow-up, and complications were analysed retrospectively. RESULTS: Median operating time was 49 minutes. There were no flap, donor site, or major wound complications. One patient had superficial skin dehiscence, and one patient developed perineal hernia. None of the patients developed chronic perineal pain. CONCLUSIONS: The PTO flap is a quick, simple yet safe and reliable option for perineal reconstruction after ELAPE that offers many advantages over the heretofore used reconstructive techniques including primary closure, myocutaneous flaps, and biological meshes.
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Retalho Perfurante/transplante , Períneo/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Protectomia/métodos , Neoplasias Retais/cirurgia , Idoso , Feminino , Humanos , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Ectopic pregnancy is a one of the primary causes of maternal mortality in first trimester. The most common site of ectopic pregnancy is the fallopian tube. Surgical management of tubal ectopic pregnancy includes salpingotomy or salpingectomy. Persistent ectopic pregnancy can happen after salpingotomy due to incomplete removal of ectopic tissue. However, it is very rare after salpingectomy. In our case, the patient had right-sided salpingectomy and histology confirmed right-sided tubal ectopic pregnancy. She presented 19 days' later with abdominal pain, haemoperitoneum and persistent high beta-HCG (B-HCG). A second laparoscopy was done and tissue implants were removed from the surface of the right ovary and the omentum, which were confirmed to be products of conception on histology. The pain settled postoperative. However, B-HCG remained high postoperative. Subsequently, methotrexate treatment was given leading to full resolution of the pregnancy with one dose.
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Laparoscopia , Gravidez Ectópica , Gravidez Tubária , Gravidez , Feminino , Humanos , Metotrexato/uso terapêutico , Gravidez Ectópica/tratamento farmacológico , Gravidez Ectópica/cirurgia , Gravidez Tubária/cirurgia , Salpingectomia/efeitos adversos , Laparoscopia/efeitos adversosRESUMO
This study utilizes Mentha piperita (MI) for the first time to investigate the uptake and translocation of chlorpyrifos (CPF; 10 µg g-1) from soil, introducing a new approach to improve the efficacy of this technique, which includes using biosurfactants (Bacillus subtilis and Pseudomonas aeruginosa) at 107 CFU/mL to degrade CPF under greenhouse conditions. Moreover, antioxidant enzymes, including superoxide dismutase (SOD) and peroxidase (Prx), and oxidative stress due to hydrogen peroxide (H2O2) and malondialdehyde (MDA) in MI roots and leaves were evaluated under CPF stress. Our results demonstrated that amending soil with MI and B. subtilis followed by P. aeruginosa significantly reduced CPF levels in the soil (p > 0.05) and enhanced CPF concentrations in MI roots and leaves after 1, 3, 7, 10, and 14 days of the experiment. Furthermore, CPF showed its longest half-life (t1/2) in soil contaminated solely with CPF, lasting 15.36 days. Conversely, its shortest half-life occurred in soil contaminated with CPF and treated with MI along with B. subtilis, lasting 4.65 days. Soil contaminated with CPF and treated with MI and P. aeruginosa showed a half-life of 7.98 days. The half-life (t1/2) of CPF-contaminated soil with MI alone was 11.41 days. A batch equilibrium technique showed that B. subtilis is better than P. aeruginosa for eliminating CPF from soil in In vitro experiments. Notably, CPF-polluted soil treated with coadministration of MI and the tested bacteria improved the activities of SOD and Prx and reduced H2O2 and MDA compared with CPF-polluted soil treated with MI alone. Our findings demonstrated that using B. subtilis and P. aeruginosa as biosurfactants to augment phytoremediation represents a commendable strategy for enhancing the remediation of CPF contamination in affected sites while reducing the existence of harmful pesticide remnants in crop plants.
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Purpose: The main aim of the trial was to assess the effectiveness of inspiratory muscle training on respiratory muscle strength, functional capacity, fatigue, and stress in post-surgical breast cancer survivors. Methods: Forty-seven females who had undergone unilateral post-mastectomy were randomly assigned to an intervention group (IG; n = 24) and a control group (CG; n = 23). Both groups received aerobic exercise training. In addition, the intervention group received inspiratory muscle training 3 days a week for 8 weeks. Maximum inspiratory and expiratory pressure (Pimax) (Pemex), 6-minute walk test, Handgrip strength by hand-held dynamometer, Fatigue Assessment Scale (FAS), and Perceived Stress Scale pss 10 values were measured before the training and then at the eighth week for both groups. Results: No differences were detected between the groups in terms of sample and clinical characteristics 8 weeks post-intervention. In favor of the intervention group, a significant difference with medium to high effect size was found in terms of Pimax, Pemax, FAS, PS, and 6MWT (p < 0.05). However, there was no difference in terms of handgrip strength (p-value: 0.072), with a medium effect size (0.070). Regarding within-group comparisons, IG exhibited substantial differences in all outcome measures (p < 0.05) compared to CG, with the exception of PImax and 6MWT. Conclusion: In post-operative breast cancer survivors, respiratory muscle training combined with aerobic training increases respiratory muscle strength and functional ability while lowering stress and tiredness.
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We are introducing a new continuous hydrostatic pressure system for identification and catheterization of epidural space in adults. One hundred and eight patients scheduled for elective endoscopic urological procedures were enrolled in this prospective randomized study. They were assigned to perform loss of resistance epidural technique by either the conventional saline-filled syringe (group C) or the new pressure technique (group P). The latter depends on observing passage of free flow of pressurized normal saline (50 mmHg) connected to epidural needle during its advancement, and then the epidural catheter was inserted to "float" easily while saline was flowing. Ten ml of bupivacaine 0.5 % with 50 µg fentanyl were injected. Time to identify epidural space, number of attempts, ease of catheterization, sensory and motor block by Bromage scale after 20 min, quality of anesthesia and any side effects were recorded. Significant reduction was found in group P versus group C concerning time to identify epidural space [20 (6-40) vs. 60.5 (23-75) s with p = 0.001], number of attempts [1 (1-2) vs. 1 (1-4) with p = 0.02] and motor block [1 (0-3) vs. 2 (0-2) with p = 0.02], respectively. No significant difference in epidural catheterization, sensory block, quality of anesthesia and incidence of side effects. We concluded that this new technique is an easy way to identify epidural space using available tools in the operating room.
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Anestesia Epidural/instrumentação , Anestesia Epidural/métodos , Cateterismo/instrumentação , Cateterismo/métodos , Pressão Hidrostática , Cloreto de Sódio/administração & dosagem , Seringas , Bupivacaína/administração & dosagem , Espaço Epidural/efeitos dos fármacos , Feminino , Fentanila/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Agulhas , Bloqueio Nervoso/instrumentação , Bloqueio Nervoso/métodos , Projetos Piloto , Estudos ProspectivosRESUMO
Over the past 50 years, although categorized as the "Information Age" or "Digital Age," the vast amounts of digitized data have been sorely underutilized. Only recently, in response to the COVID-19 pandemic, efforts have accelerated to harness these data using blockchain technology as it pertains to healthcare. Today, through the blockchain infrastructure and its tokenization applications, we are able to leverage healthcare data effectively into more efficient business processes. In addition, we can secure better patient engagement and outcomes, while generating new revenue streams for an array of healthcare stakeholders. It is in the application of blockchain technology to compile these stockpiled data into new, compliant business models that we can reap the full potential of the blockchain. Here are predictions by members of the BHTY editorial board members on how we might further advance the role of blockchain in healthcare in 2023.
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Insulin resistance is linked to cardiovascular disease (CVD), even in non-diabetic patients. Therefore, insulin resistance contributes to the development of CVDs, which are the most important cause of morbidity and mortality in chronic kidney disease (CKD) and patients receiving dialysis replacement therapy. Furthermore, CKD greatly affects the enzyme activities responsible for the metabolism of high-density lipoprotein (HDL), causing an abnormal composition and function of HDL, which results in the loss of the anti-inflammatory effect of HDL and its protective effect against CVD. The study aimed to find the relationship between HDL-C, inflammation, and insulin resistance in nondiabetic CKD patients undergoing different modalities of treatment. This prospective cross-sectional comparative study included 80 subjects divided into the control group (20 healthy participants), Group 1 (15 predialysis CKD patients on conservative treatment), Group 2 (10 peritoneal dialysis patients), and Group 3 (35 hemodialysis patients). A full history, medical examination, and a laboratory investigation were carried out on all subjects from June 2018 to June 2019. The patient groups had significantly lower HDL and higher serum insulin than the control group. HDL was negatively correlated with the Homeostatic Model Assessment of Insulin Resistance. There was a strong negative association between HDL and insulin resistance in CKD patients. Therefore, lifestyle modifications and dyslipidemia treatment in CKD might help to prevent cardiovascular events even in nondiabetic nonobese CKD patients.
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Doenças Cardiovasculares , Resistência à Insulina , Insuficiência Renal Crônica , Humanos , HDL-Colesterol , Estudos Transversais , Estudos Prospectivos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Lipoproteínas HDL , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controleRESUMO
BACKGROUND AND OBJECTIVES: Post-transplant cyclophosphamide (PTCy) has shown promising results with low rates of severe graft-versus-host-disease (GVHD), either alone or combined with conventional immunosuppression (CIS). However, studies comparing PTCy with CIS as a GVHD prophylaxis are scarce. The study aimed to determine the rates of GVHD and survival outcomes for patients undergoing peripheral blood stem cell transplant (PBSCT) from HLA-matched related donors (MRD) receiving PTCy-based GVHD prophylaxis and compare these outcomes with those of patients receiving methotrexate (MTX) and cyclosporine-A (CsA) as a GVHD prophylaxis. PATIENTS AND METHODS: Seventy-five patients with advanced hematologic malignancies who underwent MRD allogeneic hematopoietic cell transplantation (allo-HCT) were analyzed prospectively. These patients received PTCy and CSA as a GVHD prophylaxis (therapeutic group) and their outcomes were compared with those of 75 retrospectively collected patients who received methotrexate and CsA as a GVHD prophylaxis (historical group) from the same two transplant centers. RESULTS: The median recipient age was significantly lower in the MTX/CsA group at 28 years compared to 34 years in the PTCy/CSA group. Peripheral blood was the only graft source used. All patients had a complete MRD, with two patients having a one-antigen mismatched related donor within the PTCy/CsA group. The 1-year cumulative incidence (CI) of chronic GVHD was 13.4% with PTCy/CsA and 38.6% with MTX/CsA (P = .001). Acute GVHD CI across all grades did not differ between the groups, with 10.7% for PTCy/CsA and 14.7% for MTX/CsA (P = .46). At two years, the overall survival (OS) (54.4% vs 67.2%, P = 0.282), disease-free survival (DFS) (54.1% vs 66.1%, P = 0.358), relapse rates (27.4% vs 20.1%, P = 0.245), and non-relapse mortality (NRM) (29.3% vs 25%, P = 0.904) did not differ between PTCy/CsA and MTX/CsA, respectively. CONCLUSION: PTCy-based GVHD prophylaxis in MRD transplant is feasible and leads to lower chronic GVHD rates without causing a significantly different risk of relapse or survival than MTX/CsA. More extensive studies are needed to confirm our results.
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Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Humanos , Adulto , Ciclosporina/uso terapêutico , Metotrexato/uso terapêutico , Estudos Retrospectivos , Recidiva Local de Neoplasia , Transplante de Células-Tronco Hematopoéticas/métodos , Ciclofosfamida/uso terapêutico , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/prevenção & controleRESUMO
During the COVID-19 pandemic, we witnessed how sharing of biological and biomedical data facilitated researchers, medical practitioners, and policymakers to tackle the pandemic on a global scale. Despite the growing use of electronic health records (EHRs) by medical practitioners and wearable digital gadgets by individuals, 80% of health and medical data remain unused, adding little value to the work of researchers and medical practitioners. Legislative constraints related to health data sharing, centralized siloed design of traditional data management systems, and most importantly, lack of incentivization models are thought to be the underpinning bottlenecks for sharing health data. With the advent of the General Data Protection Regulation (GDPR) of the European Union (EU) and the development of technologies like blockchain and distributed ledger technologies (DLTs), it is now possible to create a new paradigm of data sharing by changing the incentivization model from current authoritative or altruistic form to a shared economic model where financial incentivization will be the main driver for data sharing. This can be achieved by setting up a digital health data marketplace (DHDM). Here, we review papers that proposed technical models or implemented frameworks that use blockchain-like technologies for health data. We seek to understand and compare different technical challenges associated with implementing and optimizing the DHDM operation outlined in these articles. We also examine legal limitations in the context of the EU and other countries such as the USA to accommodate any compliance requirement for such a marketplace. Last but not least, we review papers that investigated the short-, medium-, and long-term socioeconomic impact of such a marketplace on a wide range of stakeholders.