Postoperative Time and Anatomic Location Influence Skin Graft Reperfusion Assessed With Laser Speckle Contrast Imaging.

OBJECTIVES: Under optimal conditions, afferent and efferent human skin graft microcirculation can be restored 8-12 days postgrafting. Still, the evidence about the reperfusion dynamics beyond this period in a dermato-oncologic setting is scant. We aimed to characterise the reperfusion of human skin grafts over 4 weeks according to the necrosis extension (less than 20%, or 20%-50%) and anatomic location using laser speckle contrast imaging (LSCI). METHODS: Over 16 months, all eligible adults undergoing skin grafts following skin cancer removal on the scalp, face and lower limb were enroled. Perfusion was assessed with LSCI on the wound margin (control skin) on day 0 and on the graft surface on days 7, 14, 21 and 28. Graft necrosis extension was determined on day 28. RESULTS: Forty-seven grafts of 47 participants were analysed. Regardless of necrosis extension, graft perfusion equalled the control skin by day 7, surpassed it by day 21, and stabilised onwards. Grafts with less than 20% necrosis on the scalp and lower limb shared this reperfusion pattern and had a consistently better-perfused centre than the periphery for the first 21 days. On the face, the graft perfusion did not differ from the control skin from day 7 onwards, and there were no differences in reperfusion within the graft during the study. CONCLUSION: Skin graft reperfusion is a protracted process that evolves differently in the graft centre and periphery, influenced by postoperative time and anatomic location. A better knowledge of this process can potentially enhance the development of strategies to induce vessel ingrowth into tissue-engineered skin substitutes.

Association between telomere length and anorexia of ageing: a cross-sectional study conducted with community-dwelling older people.

BACKGROUND: To verify whether shorter telomere length is associated with anorexia of ageing in community-dwelling older people. METHODS: Conducted as a cross-sectional investigation, the study enrolled 448 participants residing in an urban area of a municipality in Brazil. Relative telomere length in blood samples was measured using quantitative polymerase chain reaction (qPCR), whereas the presence of anorexia of ageing was determined using the Simplified Appetite Nutritional Questionnaire. Data analysis employed multiple logistic regression. RESULTS: Among the 448 older individuals surveyed, 70.69% were female, and the predominant age bracket ranged from 60 to 69 years (45.08%). Approximately 25% exhibited the shortest telomeric length, with a corresponding anorexia of ageing prevalence of 41.16%. Older individuals with diminished telomere lengths displayed an increased likelihood of experiencing anorexia of ageing (odds ratio [OR] = 1.92; 95% confidence interval [CI] = 1.12-3.29), independent of factors such as gender, age group, depressive symptoms, pain and performance in basic daily life activities. CONCLUSIONS: The observed association between anorexia of ageing and a telomeric biomarker underscores the imperative to meticulously evaluate the nutritional dimensions of older people, with a view to implementing interventions that may enhance their overall health status.

Assessing CO2 Capture in Porous Sorbents via Solid-State NMR-Assisted Adsorption Techniques.

Adsorption isotherms obtained through volumetric measurements are widely used to estimate the gas adsorption performance of porous materials. Nonetheless, there is always ambiguity regarding the contributions of chemi- and physisorption processes to the overall retained gas volume. In this work, we propose, for the first time, the use of solid-state NMR (ssNMR) to generate isotherms of CO2 adsorbed onto an amine-modified silica sorbent. This method enables the separation of six individual isotherms for chemi- and physisorbed CO2 components, a feat only possible using the discrimination power of NMR spectroscopy. The adsorption mechanism for each adsorbed species was ascertained by tracking their adsorption profiles at various pressures. The proposed method was validated against conventional volumetric adsorption measurements. The isotherm curves obtained by the proposed ssNMR-assisted approach enable advanced analysis of the sorbents, revealing the potential of variable-pressure NMR experiments in gas adsorption applications.

The First Brazilian Cardiovascular Registry of Atrial Fibrillation: Primary Results of the RECALL Study.

BACKGROUND: It is estimated that atrial fibrillation (AF) affects approximately 1.5 million people in Brazil; however, epidemiological data are limited. We sought to evaluate the characteristics, treatment patterns, and clinical outcomes in patients with AF in Brazil by creating the first nationwide prospective registry. METHODS: RECALL was a multicenter, prospective registry that included and followed for 1 year 4,585 patients with AF at 89 sites across Brazil from April 2012 to August 2019. Patient characteristics, concomitant medication use, and clinical outcomes were analyzed using descriptive statistics and multivariable models. RESULTS: Of 4,585 patients enrolled, the median age was 70 (61, 78) years, 46% were women, and 53.8% had permanent AF. Only 4.4% of patients had a history of previous AF ablation and 25.2% had a previous cardioversion. The mean (SD) CHA2DS2-VASc score was 3.2 (1.6); median HAS-BLED score was 2 (2, 3). At baseline, 22% were not on anticoagulants. Of those taking anticoagulants, 62.6% were taking vitamin K antagonists and 37.4% were taking direct oral anticoagulants. The primary reasons for not using an oral anticoagulant were physician judgment (24.6%) and difficulty in controlling (14.7%) or performing (9.9%) INR. Mean (SD) TTR for the study period was 49.5% (27.5). During follow-up, the use of anticoagulants and INR in the therapeutic range increased to 87.1% and 59.1%, respectively. The rates/100 patient-years of death, hospitalization due to AF, AF ablation, cardioversion, stroke, systemic embolism, and major bleeding were 5.76 (5.12-6.47), 15.8 (14.6-17.0), 5.0 (4.4-5.7), 1.8 (1.4-2.2), 2.77 (2.32-3.32), 1.01 (0.75-1.36), and 2.21 (1.81-2.70). Older age, permanent AF, New York Heart Association class III/IV, chronic kidney disease, peripheral arterial disease, stroke, chronic obstructive pulmonary disease, and dementia were independently associated with increased mortality while the use of anticoagulant was associated with lower risk of death. CONCLUSIONS: RECALL represents the largest prospective registry of patients with AF in Latin America. Our findings highlight important gaps in treatment, which can inform clinical practice and guide future interventions to improve the care of these patients.

Human Term Pregnancy Decidual NK Cells Generate Distinct Cytotoxic Responses.

Decidual NK cells (dNK) are the main lymphocyte population in early pregnancy decidual mucosa. Although dNK decrease during pregnancy, they remain present in decidual tissues at term. First trimester dNK facilitate trophoblast invasion, provide protection against infections, and were shown to have many differences in their expression of NKRs, cytokines, and cytolytic capacity compared with peripheral blood NK cells (pNK). However, only limited data are available on the phenotype and function of term pregnancy dNK. In this study, dNK from human term pregnancy decidua basalis and decidua parietalis tissues were compared with pNK and first trimester dNK. Profound differences were found, including: 1) term pregnancy dNK have an increased degranulation response to K562 and PMA/ionomycin but lower capacity to respond to human CMV-infected cells; 2) term pregnancy dNK are not skewed toward recognition of HLA-C, as was previously shown for first trimester dNK; and 3) protein and gene expression profiles identified multiple differences between pNK, first trimester, and term pregnancy dNK, suggesting term pregnancy dNK are a distinct type of NK cells. Understanding the role of dNK throughout pregnancy is of high clinical relevance for studies aiming to prevent placental inflammatory disorders as well as maternal-to-fetal transmission of pathogens.

Diffuse dermal angiomatosis: a rare cause of painful ulceration in renal insufficiency.

Diffuse dermal angiomatosis is a rare, benign, reactive cutaneous vascular proliferation that has been reported in the context of end-stage renal failure and can rarely be associated with arteriovenous fistulas. We report a striking clinical resolution following prompt diagnosis and subsequent arteriovenous fistula reversal. This case further demonstrates that accurate diagnosis is particularly rewarding since correct therapeutic approach can be curative.

New Skin Flaps for Triangular Surgical Defects: Design, Assessment on Experimental Model, and Clinical Outcomes.

BACKGROUND: Most skin flaps are designed to repair circular surgical defects after skin tumor excisions, but few flaps have been described to reconstruct triangular defects. OBJECTIVE: The aim of this study was to describe new skin flaps for triangular surgical defects using an innovative experimental model. METHODS: We tested new flap designs in an experimental pig skin model using a tension sensor to measure maximum tension and tension augmentation when the flap is performed in an area of increased basal tension. The results were compared with those from classic flaps. Finally, the new flaps were performed on a series of patients with triangular surgical defects. RESULTS: Six new flaps with adequate levels of tension were obtained and named after their morphology: spider crab, mantis, toy windmill, nautilus, origami bird, and clover. These new flaps were successfully performed on a series of 40 patients; among them, spider crab and mantis flaps showed a better response to basal tension augmentation. CONCLUSIONS: Six new flaps for triangular surgical defects were proposed and successfully performed in a series of 40 patients, using an experimental pig skin model and a tensiometer.

A randomized clinical trial to evaluate the efficacy and safety of rivaroxaban in patients with bioprosthetic mitral valve and atrial fibrillation or flutter: Rationale and design of the RIVER trial.

The efficacy and safety of rivaroxaban in patients with bioprosthetic mitral valves and atrial fibrillation or flutter remain uncertain. DESIGN: RIVER was an academic-led, multicenter, open-label, randomized, non-inferiority trial with blinded outcome adjudication that enrolled 1005 patients from 49 sites in Brazil. Patients with a bioprosthetic mitral valve and atrial fibrillation or flutter were randomly assigned (1:1) to rivaroxaban 20 mg once daily (15 mg in those with creatinine clearance <50 mL/min) or dose-adjusted warfarin (target international normalized ratio 2.0-30.); the follow-up period was 12 months. The primary outcome was a composite of all-cause mortality, stroke, transient ischemic attack, major bleeding, valve thrombosis, systemic embolism, or hospitalization for heart failure. Secondary outcomes included individual components of the primary composite outcome, bleeding events, and venous thromboembolism. SUMMARY: RIVER represents the largest trial specifically designed to assess the efficacy and safety of a direct oral anticoagulant in patients with bioprosthetic mitral valves and atrial fibrillation or flutter. The results of this trial can inform clinical practice and international guidelines.

Root morphophysiology changes during the habitat transition from soil to canopy of the aroid vine Rhodospatha oblongata.

BACKGROUND AND AIMS: The aroid vine Rhodospatha oblongata is characterized by a habitat change from terrestrial to canopy, relying on aerial roots at maturity to obtain water and nutrients from the forest soil. We hypothesize that morphophysiological acclimation occurs in roots as they grow under atmospheric conditions. These changes would guarantee the whole-plant survival of aroid vines in the new and potentially stressful habitat of the canopy. METHODS: Terrestrial and aerial roots were compared on a morphophysiological basis. Root anatomy, water balance, water absorption capacity via fluorescent tracer, and photochemical activity via chlorophyll fluorescence were measured. KEY RESULTS: While thin fasciculate roots occur on terrestrial crawling individuals, two clearly distinct aerial roots (anchor and feeder) are produced on canopy individuals, which both adhere to the host trunk. The colour of both aerial roots changes during development from red and brownish to striped and green at maturity. Colour changes are induced by the replacement of epidermis, exodermis and outer cortex by an inner layer of lignified cork on the root region exposed to the atmosphere. In the root region that is in contact with the host, covering substitutions do not occur and both exodermis and lignified cork, along with several epidermal hairs, appear. Water retention capacity was higher in green roots than in other root types. Rehydration capacity via water absorption by hairs of aerial roots was confirmed by fluorescence. Chlorophyll fluorescence data indicated low levels of photosynthetic capacity in aerial roots. CONCLUSIONS: Plants should evolve strategies to survive stress situations. The transition from soil to canopy imposes abiotic changes and potentially stressful situations on R. oblongata. We conclude that the morphophysiological changes observed represent an important strategy that permits the maintenance of aroid roots and the survival of R. oblongata in the canopy.

Blood Perfusion of Random Skin Flaps in Humans-In Vivo Assessment by Laser Speckle Contrast Imaging.

BACKGROUND: The viability of random skin flaps (RSFs) depends on an adequate perfusion pressure to avoid necrosis. Laser speckle contrast imaging is a new method to monitor skin flap microcirculation. OBJECTIVE: The authors aimed to use laser speckle contrast imaging in evaluating the correlation between the perfusion pressure and the length-to-width ratio (LTWR) of RSFs. MATERIALS AND METHODS: Sixty patients submitted to flaps were included: 20 advancement, 20 rotation, and 20 transposition flaps. Laser speckle contrast imaging measurements of perfusion were obtained-after the flaps were planned, dissected, and sutured-from the base to the tip of the flaps, allowing the creation of plot charts and calculation of linear regression equations. RESULTS: Perfusion consistently and significantly decreased with the dissection of all flaps. A significant correlation between LTWR and perfusion was observed in undermined and sutured stages; a mathematical model was then delineated, explaining objectively the drop of perfusion along LTWR, with statistical significance, in all flaps. CONCLUSION: Laser speckle contrast imaging allows accurate, rapid, reproducible, and noncontact measurements of skin blood perfusion over RSF, ultimately leading to an optimization of skin flap planning. This study proves that variation of perfusion pressure along the flap is dependent on the LTWR in a linear decreasing function.

Impact of social media on the oral hygiene habits of children and adolescents: a randomized controlled clinical trial.

This study compared the impact of conventional oral health education with that of combined conventional and digital education on the oral hygiene outcomes and habits of children and adolescents. A double-blind, parallel, randomized controlled prevention clinical trial with 2 arms involved 80 students aged 10 to 17 years old. Students were randomly allocated to the control group (n = 40), which received conventional oral health education, or the experimental group (n = 40), which received both conventional oral health education and digital educational content through WhatsApp Messenger. Before the randomization of the groups and after the conclusion of the educational interventions, 2 examiners (κ > 0.7) who were blinded as to the groups evaluated the students and recorded the Plaque Index (PI); Gingival Bleeding Index (GBI); number of decayed, missing, and filled permanent teeth (DMFT); and number of decayed, missing, and filled primary teeth (dmft). The toothbrushing and flossing habits of the students were evaluated through questionnaires. The Fisher exact test, chi-square test, Mann-Whitney U test, Wilcoxon test for paired samples, and sign test were applied to the data (α = 0.05). After 3 students in the control group were excluded because they received fixed orthodontic appliances, 37 students participated in the control group and 40 in the experimental group. Both groups presented a 30% reduction in PI (P < 0.001) after the interventions. The experimental group flossed significantly more frequently (P = 0.003) than the control group. The interventions had no statistically significant effect on GBI, and there were no significant differences in toothbrushing frequency after interventions or between groups. Both approaches to oral health education-conventional and digital-had a positive impact on the reduction of the PI, and the use of a smartphone app seemed to be an effective resource for providing oral health education to students. Trial registration: Registro Brasileiro de Ensaios Clinicos (ReBEC) No. U1111-1216-4770.

Structure of the Bacterial Community in Different Stages of Early Childhood Caries.

PURPOSE: To characterise in vivo the structure of bacterial communities in decayed and sound primary teeth. MATERIALS AND METHODS: Samples of biofilms were collected from three groups of patients with complete and exclusively primary dentition (n = 45): G1: sound teeth (n = 15); G2: enamel lesion (n = 15); G3: dentin lesion (n = 15). DNA was extracted (CTAB 2%) from the biofilm, the partial 16S rRNA gene was amplified with Bacteria Universal Primers (BA338fGC - UN518r) and subjected to DGGE (denaturing gradient gel electrophoresis). Multidimensional scaling and ANOSIM (analysis of similarity) were employed to determine the structure of the bacterial communities. The amplicon richness was determined by averaging amplicons, with the differences between treatments determined with ANOVA, while means were compared using Tukey's test (p < 0.05). RESULTS: Compared to sound teeth, a greater variety of bacterial communities was found in decayed teeth. Despite the differences between the bacterial communities of sound teeth and decayed teeth, the Venn diagram showed that the samples had 38 amplicons in common. Greater amplicon richness was observed in samples of decayed teeth (enamel: 20.5 ± 2.7; dentin: 20.1 ± 2.8) compared with the sound samples (12.0 ± 4.3) (p <0.05), indicating enhanced growth for specific groups of bacteria on decayed teeth. CONCLUSION: Although there is less bacterial diversity on sound than ECC-decayed teeth, the bacterial communities are very similar.

Fitting mathematical models to lactation curves from Holstein cows in the southwestern region of the state of Parana, Brazil.

The objective of this study was to evaluate four mathematical models with regards to their fit to lactation curves of Holstein cows from herds raised in the southwestern region of the state of Parana, Brazil. Initially, 42,281 milk production records from 2005 to 2011 were obtained from "Associação Paranaense de Criadores de Bovinos da Raça Holandesa (APCBRH)". Data lacking dates of drying and total milk production at 305 days of lactation were excluded, resulting in a remaining 15,142 records corresponding to 2,441 Holstein cows. Data were sorted according to the parity order (ranging from one to six), and within each parity order the animals were divided into quartiles (Q25%, Q50%, Q75% and Q100%) corresponding to 305-day lactation yield. Within each parity order, for each quartile, four mathematical models were adjusted, two of which were predominantly empirical (Brody and Wood) whereas the other two presented more mechanistic characteristics (models Dijkstra and Pollott). The quality of fit was evaluated by the corrected Akaike information criterion. The Wood model showed the best fit in almost all evaluated situations and, therefore, may be considered as the most suitable model to describe, at least empirically, the lactation curves of Holstein cows raised in Southwestern Parana.

Antibiotic resistance is widespread in urban aquatic environments of Rio de Janeiro, Brazil.

Bacterial resistance to antibiotics has become a public health issue. Over the years, pathogenic organisms with resistance traits have been studied due to the threat they pose to human well-being. However, several studies raised awareness to the often disregarded importance of environmental bacteria as sources of resistance mechanisms. In this work, we analyze the diversity of antibiotic-resistant bacteria occurring in aquatic environments of the state of Rio de Janeiro, Brazil, that are subjected to distinct degrees of anthropogenic impacts. We access the diversity of aquatic bacteria capable of growing in increasing ampicillin concentrations through 16S rRNA gene libraries. This analysis is complemented by the characterization of antibiotic resistance profiles of isolates obtained from urban aquatic environments. We detect communities capable of tolerating antibiotic concentrations up to 600 times higher than the clinical levels. Among the resistant organisms are included potentially pathogenic species, some of them classified as multiresistant. Our results extend the knowledge of the diversity of antibiotic resistance among environmental microorganisms and provide evidence that the diversity of drug-resistant bacteria in aquatic habitats can be influenced by pollution.

Long-term analysis of left ventricular ejection fraction in patients with stable multivessel coronary disease undergoing medicine, angioplasty or surgery: 10-year follow-up of the MASS II trial.

BACKGROUND: Assuming that coronary interventions, both coronary bypass surgery (CABG) and percutaneous coronary intervention (PCI), are directed to preserve left ventricular function, it is not known whether medical therapy alone (MT) can achieve this protection. Thus, we evaluated the evolution of LV ejection fraction (LVEF) in patients with stable coronary artery disease (CAD) treated by CABG, PCI, or MT as a post hoc analysis of a randomized controlled trial with a follow-up of 10 years. METHODS: Left ventricle ejection fraction was assessed with transthoracic echocardiography in patients with multivessel CAD, participants of the MASS II trial before randomization to CABG, PCI, or MT, and re-evaluated after 10 years of follow-up. RESULTS: Of the 611 patients, 422 were alive after 10.32 ± 1.43 years. Three hundred and fifty had LVEF reassessed: 108 patients from MT, 111 from CABG, and 131 from PCI. There was no difference in LVEF at the beginning (0.61 ± 0.07, 0.61 ± 0.08, 0.61 ± 0.09, respectively, for PCI, CABG, and MT, P = 0.675) or at the end of follow-up (0.56 ± 0.11, 0.55 ± 0.11, 0.55 ± 0.12, P = 0.675), or in the decline of LVEF (reduction delta of -7.2 ± 17.13, -9.08 ± 18.77, and -7.54 ± 22.74). Acute myocardial infarction (AMI) during the follow-up was associated with greater reduction in LVEF. The presence of previous AMI (OR: 2.50, 95% CI: 1.40-4.45; P = 0.0007) and during the follow-up (OR: 2.73, 95% CI: 1.25-5.92; P = 0.005) was associated with development of LVEF <45%. CONCLUSION: Regardless of the therapeutic option applied, LVEF remains preserved in the absence of a major adverse cardiac event after 10 years of follow-up. CLINICAL TRIAL REGISTRATION URL: http://www.controlled-trials.com. Registration number ISRCTN66068876.

Clitoria ternatea L. as a Potential High Quality Forage Legume.

Samples of Clitoria ternatea L. (Cunhã) were harvested at 35, 50, 70, and 90 d after a uniformity harvest in a field study designed as a completely randomized design with a total of 18 experimental plots. The dry matter yield of the whole plant was separated quantitatively into leaves, stems, and pods at each harvesting age. Chemical analyses and in vitro gas production kinetics were performed to assess the quality of the plant parts. Yields, chemical composition, and estimates of gas production parameters were analyzed by fitting a mixed statistical model with two types of covariance structures as follows: variance components and an unrestricted structure with heterogeneous variances. Fast and slow gas yielding pools were detected for both leaves and stems, but only a single pool was detected for pods. The homoscedasticity assumption was more likely for all variables, except for some parameters of the gas production kinetics of leaves and stems. There was no presence of typical pods at 35 and 50 d. In the leaves, the fibrous fractions were affected, whereas the non-fibrous fractions were unaffected by the harvesting age. The harvesting age affected the majority of the chemical constituents and gas kinetic parameters related to the stems. The leaves of this legume were the least affected part by the aging process.

Critical analysis of the scientific production on Jean Watson's Theory of Human Care.

OBJECTIVES: to analyze current scientific production on the use of the theoretical-methodological precepts of Jean Watson's Theory of Human Care/Clinical Caritas Process. METHODS: quantitative, exploratory, descriptive study using data from 1979 to 2023 in the Scopus database. Analysis was carried out using VOSviewer software. RESULTS: the 73 studies included establish a network of collaboration among 221 authors from 155 institutions in 18 countries, who discuss the development of ethical behavior in nursing staff, through technical improvement, implementation, and validation of instrumental strategies capable of measuring and evaluating the quality of holistic and empathetic care. The Theory of Human Caring contributes to nursing training and care, and Process Clinical Caritas-Veritas is useful for the different possibilities of practice and education. CONCLUSIONS: it is important to strengthen with more empirical data a nursing work model centered on individual human care, supporting the evolution of scientific nursing knowledge.

Unravelling the structure of CO2 in silica adsorbents: an NMR and computational perspective.

This comprehensive review describes recent advancements in the use of solid-state NMR-assisted methods and computational modeling strategies to unravel gas adsorption mechanisms and CO2 speciation in porous CO2-adsorbent silica materials at the atomic scale. This work provides new perspectives for the innovative modifications of these materials rendering them more amenable to the use of advanced NMR methods.