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1.
Proc Natl Acad Sci U S A ; 121(5): e2309575121, 2024 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-38266051

RESUMO

During the last decades, macroecology has identified broad-scale patterns of abundances and diversity of microbial communities and put forward some potential explanations for them. However, these advances are not paralleled by a full understanding of the dynamical processes behind them. In particular, abundance fluctuations of different species are found to be correlated, both across time and across communities in metagenomic samples. Reproducing such correlations through appropriate population models remains an open challenge. The present paper tackles this problem and points to sparse species interactions as a necessary mechanism to account for them. Specifically, we discuss several possibilities to include interactions in population models and recognize Lotka-Volterra constants as a successful ansatz. For this, we design a Bayesian inference algorithm to extract sets of interaction constants able to reproduce empirical probability distributions of pairwise correlations for diverse biomes. Importantly, the inferred models still reproduce well-known single-species macroecological patterns concerning abundance fluctuations across both species and communities. Endorsed by the agreement with the empirically observed phenomenology, our analyses provide insights into the properties of the networks of microbial interactions, revealing that sparsity is a crucial feature.


Assuntos
Microbiota , Teorema de Bayes , Metagenoma , Algoritmos , Metagenômica
2.
Proc Natl Acad Sci U S A ; 120(37): e2217144120, 2023 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-37669363

RESUMO

Multiple ecological forces act together to shape the composition of microbial communities. Phyloecology approaches-which combine phylogenetic relationships between species with community ecology-have the potential to disentangle such forces but are often hard to connect with quantitative predictions from theoretical models. On the other hand, macroecology, which focuses on statistical patterns of abundance and diversity, provides natural connections with theoretical models but often neglects interspecific correlations and interactions. Here, we propose a unified framework combining both such approaches to analyze microbial communities. In particular, by using both cross-sectional and longitudinal metagenomic data for species abundances, we reveal the existence of an empirical macroecological law establishing that correlations in species-abundance fluctuations across communities decay from positive to null values as a function of phylogenetic dissimilarity in a consistent manner across ecologically distinct microbiomes. We formulate three variants of a mechanistic model-each relying on alternative ecological forces-that lead to radically different predictions. From these analyses, we conclude that the empirically observed macroecological pattern can be quantitatively explained as a result of shared population-independent fluctuating resources, i.e., environmental filtering and not as a consequence of, e.g., species competition. Finally, we show that the macroecological law is also valid for temporal data of a single community and that the properties of delayed temporal correlations can be reproduced as well by the model with environmental filtering.


Assuntos
Metagenoma , Microbiota , Filogenia , Estudos Transversais , Metagenômica
3.
Proc Natl Acad Sci U S A ; 120(9): e2208998120, 2023 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-36827262

RESUMO

The brain is in a state of perpetual reverberant neural activity, even in the absence of specific tasks or stimuli. Shedding light on the origin and functional significance of such a dynamical state is essential to understanding how the brain transmits, processes, and stores information. An inspiring, albeit controversial, conjecture proposes that some statistical characteristics of empirically observed neuronal activity can be understood by assuming that brain networks operate in a dynamical regime with features, including the emergence of scale invariance, resembling those seen typically near phase transitions. Here, we present a data-driven analysis based on simultaneous high-throughput recordings of the activity of thousands of individual neurons in various regions of the mouse brain. To analyze these data, we construct a unified theoretical framework that synergistically combines a phenomenological renormalization group approach and techniques that infer the general dynamical state of a neural population, while designing complementary tools. This strategy allows us to uncover strong signatures of scale invariance that are "quasiuniversal" across brain regions and experiments, revealing that all the analyzed areas operate, to a greater or lesser extent, near the edge of instability.


Assuntos
Encéfalo , Neurônios , Animais , Camundongos , Encéfalo/fisiologia , Neurônios/fisiologia
4.
Chem Soc Rev ; 53(17): 8563-8631, 2024 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-38912871

RESUMO

Ionic liquids (ILs) and deep eutectic solvents (DESs) have tremendous potential for reactive capture and conversion (RCC) of CO2 due to their wide electrochemical stability window, low volatility, and high CO2 solubility. There is environmental and economic interest in the direct utilization of the captured CO2 using electrified and modular processes that forgo the thermal- or pressure-swing regeneration steps to concentrate CO2, eliminating the need to compress, transport, or store the gas. The conventional electrochemical conversion of CO2 with aqueous electrolytes presents limited CO2 solubility and high energy requirement to achieve industrially relevant products. Additionally, aqueous systems have competitive hydrogen evolution. In the past decade, there has been significant progress toward the design of ILs and DESs, and their composites to separate CO2 from dilute streams. In parallel, but not necessarily in synergy, there have been studies focused on a few select ILs and DESs for electrochemical reduction of CO2, often diluting them with aqueous or non-aqueous solvents. The resulting electrode-electrolyte interfaces present a complex speciation for RCC. In this review, we describe how the ILs and DESs are tuned for RCC and specifically address the CO2 chemisorption and electroreduction mechanisms. Critical bulk and interfacial properties of ILs and DESs are discussed in the context of RCC, and the potential of these electrolytes are presented through a techno-economic evaluation.

5.
Br J Cancer ; 131(1): 117-125, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38806725

RESUMO

BACKGROUND: Despite differences in tumour behaviour and characteristics between duodenal adenocarcinoma (DAC), the intestinal (AmpIT) and pancreatobiliary (AmpPB) subtype of ampullary adenocarcinoma and distal cholangiocarcinoma (dCCA), the effect of adjuvant chemotherapy (ACT) on these cancers, as well as the optimal ACT regimen, has not been comprehensively assessed. This study aims to assess the influence of tailored ACT on DAC, dCCA, AmpIT, and AmpPB. PATIENTS AND METHODS: Patients after pancreatoduodenectomy for non-pancreatic periampullary adenocarcinoma were identified and collected from 36 tertiary centres between 2010 - 2021. Per non-pancreatic periampullary tumour type, the effect of adjuvant chemotherapy and the main relevant regimens of adjuvant chemotherapy were compared. The primary outcome was overall survival (OS). RESULTS: The study included a total of 2866 patients with DAC (n = 330), AmpIT (n = 765), AmpPB (n = 819), and dCCA (n = 952). Among them, 1329 received ACT, and 1537 did not. ACT was associated with significant improvement in OS for AmpPB (P = 0.004) and dCCA (P < 0.001). Moreover, for patients with dCCA, capecitabine mono ACT provided the greatest OS benefit compared to gemcitabine (P = 0.004) and gemcitabine - cisplatin (P = 0.001). For patients with AmpPB, no superior ACT regime was found (P > 0.226). ACT was not associated with improved OS for DAC and AmpIT (P = 0.113 and P = 0.445, respectively). DISCUSSION: Patients with resected AmpPB and dCCA appear to benefit from ACT. While the optimal ACT for AmpPB remains undetermined, it appears that dCCA shows the most favourable response to capecitabine monotherapy. Tailored adjuvant treatments are essential for enhancing prognosis across all four non-pancreatic periampullary adenocarcinomas.


Assuntos
Adenocarcinoma , Neoplasias Duodenais , Humanos , Masculino , Feminino , Quimioterapia Adjuvante , Pessoa de Meia-Idade , Idoso , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , Neoplasias Duodenais/tratamento farmacológico , Neoplasias Duodenais/patologia , Neoplasias Duodenais/cirurgia , Colangiocarcinoma/tratamento farmacológico , Colangiocarcinoma/patologia , Colangiocarcinoma/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ampola Hepatopancreática/patologia , Pancreaticoduodenectomia , Estudos de Coortes , Neoplasias do Ducto Colédoco/tratamento farmacológico , Neoplasias do Ducto Colédoco/cirurgia , Neoplasias do Ducto Colédoco/patologia , Neoplasias do Ducto Colédoco/mortalidade , Neoplasias dos Ductos Biliares/tratamento farmacológico , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Estudos Retrospectivos , Capecitabina/uso terapêutico , Capecitabina/administração & dosagem
6.
Ann Surg ; 2024 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-39219532

RESUMO

OBJECTIVE: To compare minimally invasive and open pancreatoduodenectomy in different subtypes of ampullary adenocarcinoma. SUMMARY BACKGROUND DATA: Ampullary adenocarcinoma (AAC) is widely seen as the best indication for minimally invasive pancreatoduodenectomy (MIPD) due to the lack of vascular involvement and dilated bile and pancreatic duct. However, it is unknown whether outcomes of MIPD for AAC differ between the pancreatobiliary (AAC-PB) and intestinal (AAC-IT) subtypes as large studies are lacking. METHODS: This is an international cohort study, encompassing 27 centers from 12 countries. Outcome of MIPD and open pancreatoduodenectomy (OPD) were compared in patients with AAC-IT and AAC-PB. Primary end points were R1 rate, lymph node yield, and 5-year overall survival (5yOS). RESULTS: Overall, 1187 patients after MIPD for AAC were included, of whom 572 with AAC-IT (62 MIPD, 510 OPD) and 615 with AAC-PB (41 MIPD and 574 OPD). The rate of R1 resection was not significantly different between MIPD and OPD for both AAC-IT (3.4% vs 6.9%, P=0,425) and AAC-PB (9.8% vs 14.9%, P=0,625). AAC-IT, more lymph nodes were resected with MIPD group (19 vs 16, P=0.007), compared to OPD. The 5y-OS did not differ after MIPD and OPD for both AAC-IT (56.8% vs 59.5%, P=0.827 and AAC-PB (52.5% vs 44.4%, P=0.357). The rates of surgical complication between MIPD and OPD did not differ between AmpIT and AmpPB. DISCUSSION: This international multicenter study found no differences in outcomes between MIPD and OPD for AAC-IT and AAC-PB. MIPD and OPD demonstrated comparable outcomes in oncological resection, survival and surgical outcomes for both subtypes of AAC.

7.
Ann Surg Oncol ; 31(7): 4654-4664, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38602578

RESUMO

BACKGROUND: Standard lymphadenectomy for pancreatoduodenectomy is defined for pancreatic ductal adenocarcinoma and adopted for patients with non-pancreatic periampullary cancer (NPPC), ampullary adenocarcinoma (AAC), distal cholangiocarcinoma (dCCA), or duodenal adenocarcinoma (DAC). This study aimed to compare the patterns of lymph node metastases among the different NPPCs in a large series and in a systematic review to guide the discussion on surgical lymphadenectomy and pathology assessment. METHODS: This retrospective cohort study included patients after pancreatoduodenectomy for NPPC with at least one lymph node metastasis (2010-2021) from 24 centers in nine countries. The primary outcome was identification of lymph node stations affected in case of a lymph node metastasis per NPPC. A separate systematic review included studies on lymph node metastases patterns of AAC, dCCA, and DAC. RESULTS: The study included 2367 patients, of whom 1535 had AAC, 616 had dCCA, and 216 had DAC. More patients with pancreatobiliary type AAC had one or more lymph node metastasis (67.2% vs 44.8%; P < 0.001) compared with intestinal-type, but no differences in metastasis pattern were observed. Stations 13 and 17 were most frequently involved (95%, 94%, and 90%). Whereas dCCA metastasized more frequently to station 12 (13.0% vs 6.4% and 7.0%, P = 0.005), DAC metastasized more frequently to stations 6 (5.0% vs 0% and 2.7%; P < 0.001) and 14 (17.0% vs 8.4% and 11.7%, P = 0.015). CONCLUSION: This study is the first to comprehensively demonstrate the differences and similarities in lymph node metastases spread among NPPCs, to identify the existing research gaps, and to underscore the importance of standardized lymphadenectomy and pathologic assessment for AAC, dCCA, and DAC.


Assuntos
Adenocarcinoma , Ampola Hepatopancreática , Neoplasias do Ducto Colédoco , Neoplasias Duodenais , Excisão de Linfonodo , Metástase Linfática , Neoplasias Pancreáticas , Pancreaticoduodenectomia , Humanos , Estudos Retrospectivos , Ampola Hepatopancreática/patologia , Ampola Hepatopancreática/cirurgia , Neoplasias do Ducto Colédoco/patologia , Neoplasias do Ducto Colédoco/cirurgia , Neoplasias Duodenais/patologia , Neoplasias Duodenais/cirurgia , Masculino , Feminino , Neoplasias Pancreáticas/cirurgia , Neoplasias Pancreáticas/patologia , Adenocarcinoma/cirurgia , Adenocarcinoma/patologia , Adenocarcinoma/secundário , Colangiocarcinoma/cirurgia , Colangiocarcinoma/patologia , Idoso , Pessoa de Meia-Idade , Prognóstico , Seguimentos , Linfonodos/patologia , Linfonodos/cirurgia , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Carcinoma Ductal Pancreático/cirurgia , Carcinoma Ductal Pancreático/patologia , Carcinoma Ductal Pancreático/secundário
8.
Ann Surg Oncol ; 31(9): 6157-6169, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38888860

RESUMO

BACKGROUND: Cancer arising in the periampullary region can be anatomically classified in pancreatic ductal adenocarcinoma (PDAC), distal cholangiocarcinoma (dCCA), duodenal adenocarcinoma (DAC), and ampullary carcinoma. Based on histopathology, ampullary carcinoma is currently subdivided in intestinal (AmpIT), pancreatobiliary (AmpPB), and mixed subtypes. Despite close anatomical resemblance, it is unclear how ampullary subtypes relate to the remaining periampullary cancers in tumor characteristics and behavior. METHODS: This international cohort study included patients after curative intent resection for periampullary cancer retrieved from 44 centers (from Europe, United States, Asia, Australia, and Canada) between 2010 and 2021. Preoperative CA19-9, pathology outcomes and 8-year overall survival were compared between DAC, AmpIT, AmpPB, dCCA, and PDAC. RESULTS: Overall, 3809 patients were analyzed, including 348 DAC, 774 AmpIT, 848 AmpPB, 1,036 dCCA, and 803 PDAC. The highest 8-year overall survival was found in patients with AmpIT and DAC (49.8% and 47.9%), followed by AmpPB (34.9%, P < 0.001), dCCA (26.4%, P = 0.020), and finally PDAC (12.9%, P < 0.001). A better survival was correlated with lower CA19-9 levels but not with tumor size, as DAC lesions showed the largest size. CONCLUSIONS: Despite close anatomic relations of the five periampullary cancers, this study revealed differences in preoperative blood markers, pathology, and long-term survival. More tumor characteristics are shared between DAC and AmpIT and between AmpPB and dCCA than between the two ampullary subtypes. Instead of using collective definitions for "periampullary cancers" or anatomical classification, this study emphasizes the importance of individual evaluation of each histopathological subtype with the ampullary subtypes as individual entities in future studies.


Assuntos
Ampola Hepatopancreática , Carcinoma Ductal Pancreático , Colangiocarcinoma , Neoplasias do Ducto Colédoco , Neoplasias Duodenais , Neoplasias Pancreáticas , Humanos , Masculino , Feminino , Ampola Hepatopancreática/patologia , Ampola Hepatopancreática/cirurgia , Taxa de Sobrevida , Neoplasias Duodenais/patologia , Neoplasias Duodenais/cirurgia , Idoso , Colangiocarcinoma/patologia , Colangiocarcinoma/cirurgia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Pessoa de Meia-Idade , Carcinoma Ductal Pancreático/patologia , Carcinoma Ductal Pancreático/cirurgia , Neoplasias do Ducto Colédoco/patologia , Neoplasias do Ducto Colédoco/cirurgia , Neoplasias do Ducto Colédoco/mortalidade , Seguimentos , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Prognóstico , Estudos de Coortes , Estudos Retrospectivos
9.
Langmuir ; 40(7): 3283-3300, 2024 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-38341773

RESUMO

Developing unconventional electrolytes such as ionic liquids (ILs) and deep eutectic solvents (DESs) has led to remarkable advances in electrochemical energy storage and conversion devices. However, the understanding of the electrode-electrolyte interfaces of these electrolytes, specifically the liquid structure and the charge/electron transfer mechanism and rates, is lacking due to the complexity of molecular interactions, the difficulty in studying the buried interfaces with nanometer-scale resolution, and the distribution of the time scales for the various interfacial events. This Feature Article outlines the standing questions in the field, summarizes some of the exciting approaches and results, and discusses our contributions to probing the electrified interfaces by electrochemical impedance spectroscopy (EIS), surface-enhanced Raman spectroscopy (SERS), and neutron reflectivity (NR). The related findings are analyzed within electrical double-layer models to provide a framework for studying ILs, DESs, and, more broadly, the concentrated hydrogen-bonded electrolytes.

10.
Lupus ; 32(12): 1409-1417, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37840528

RESUMO

BACKGROUND: Pregnancy in SLE continues to be a challenge. The neutrophil-to-lymphocyte ratio (NLR) and chemerin are predictors of preeclampsia in the general population; however, their role as predictors of maternal-fetal complications in pregnant SLE patients has not been analyzed. OBJECTIVE: To investigate the prognostic value of NLR and serum chemerin, to predict maternal-fetal complications in pregnant SLE patients, and compare both biomarkers among three study groups. METHODS: Design: Analytical cross-sectional study of cases and controls with the following study groups: systemic lupus erythematosus (SLE), preeclampsia, and healthy. NLR and chemerin serum were determined between 20 and 25 weeks of gestation. Patients were evaluated every 4-6 weeks until pregnancy resolution. Maternal and fetal outcomes were registered. We employed Receiver Operating Characteristic (ROC) curves to validate prognostic values. RESULTS: Seventy pregnant patients were included: 20 with SLE, 20 with preeclampsia, and 30 healthy pregnant women; NLR values were 4 (2.3-5.6) in SLE, 6 (4.6-9.2) in preeclampsia, and 2.8 (2.1-2.9) in the group of healthy women (p = .0001). Chemerin levels were: 26 (15.3-56.2) in SLE, 96 (37.3-146.2) in preeclampsia, and 24.6 ng/mL (15.3-47.4) in the healthy group (p = .007) Maternal complications were observed in 11 (55%), 20 (100%), and 8 (26%) per group, respectively. Thrombocytopenia was the most frequent complication in all pregnant women, followed by hypertensive disorders. Fetal complications were registered in 12 (60%), 16 (80%), and 2 (6.7%), respectively. Congenital malformations and prematurity were the most frequent fetal complications. NLR had good diagnostic accuracy in predicting maternal-fetal complications (AUROC 0.715) p = .015, CI 95% 0.56-0.86, cut-off point level: 2.9, sensitivity 61%, specificity 78%, positive predictive value (PPV) 65%, negative predictive value (NPV) 75%. Regarding chemerin, a cut-off point level >43 ng/mL had a sensitivity of 75%, specificity of 72% AUROC 0.75, p = .001, CI 95% 0.61-0.89, PPV 51.7% NPV 87.8%, meaning that 51.7% of patients with chemerin levels >43 ng/mL have or will have preeclampsia. CONCLUSION: The NLR may help predict maternal-fetal complications in SLE pregnancy, constituting a marker of subclinical inflammation. Chemerin levels may be associated with preeclampsia. These biomarkers could improve the care of SLE patients with timely intervention of potential complications during pregnancy.


Assuntos
Lúpus Eritematoso Sistêmico , Pré-Eclâmpsia , Complicações na Gravidez , Humanos , Gravidez , Feminino , Lúpus Eritematoso Sistêmico/diagnóstico , Resultado da Gravidez/epidemiologia , Prognóstico , Neutrófilos , Estudos Transversais , Complicações na Gravidez/diagnóstico , Biomarcadores , Linfócitos , Estudos Retrospectivos
11.
PLoS Genet ; 16(8): e1008992, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32797092

RESUMO

Bacterial virulence factors facilitate host colonization and set the stage for the evolution of parasitic and mutualistic interactions. The Sodalis-allied clade of bacteria exhibit striking diversity in the range of both plant and animal feeding insects they inhabit, suggesting the appropriation of universal molecular mechanisms that facilitate establishment. Here, we report on the infection of the tsetse fly by free-living Sodalis praecaptivus, a close relative of many Sodalis-allied symbionts. Key genes involved in quorum sensing, including the homoserine lactone synthase (ypeI) and response regulators (yenR and ypeR) are integral for the benign colonization of S. praecaptivus. Mutants lacking ypeI, yenR and ypeR compromised tsetse survival as a consequence of their inability to repress virulence. Genes under quorum sensing, including homologs of the binary insecticidal toxin PirAB and a putative symbiosis-promoting factor CpmAJ, demonstrated negative and positive impacts, respectively, on tsetse survival. Taken together with results obtained from experiments involving weevils, this work shows that quorum sensing virulence suppression plays an integral role in facilitating the establishment of Sodalis-allied symbionts in diverse insect hosts. This knowledge contributes to the understanding of the early evolutionary steps involved in the formation of insect-bacterial symbiosis. Further, despite having no established history of interaction with tsetse, S. praecaptivus can infect reproductive tissues, enabling vertical transmission through adenotrophic viviparity within a single host generation. This creates an option for the use of S. praecaptivus in the biocontrol of insect disease vectors via paratransgenesis.


Assuntos
Percepção de Quorum/genética , Moscas Tsé-Tsé/genética , Fatores de Virulência/genética , 4-Butirolactona/análogos & derivados , 4-Butirolactona/biossíntese , 4-Butirolactona/genética , Animais , Enterobacteriaceae/genética , Enterobacteriaceae/patogenicidade , Humanos , Insetos Vetores/genética , Insetos Vetores/microbiologia , Insetos/genética , Simbiose/genética , Moscas Tsé-Tsé/microbiologia
12.
Int J Mol Sci ; 24(21)2023 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-37958914

RESUMO

The substance P (SP)/neurokinin-1 receptor (NK-1R) system is involved in cancer progression. NK-1R, activated by SP, promotes tumor cell proliferation and migration, angiogenesis, the Warburg effect, and the prevention of apoptosis. Tumor cells overexpress NK-1R, which influences their viability. A typical specific anticancer strategy using NK-1R antagonists, irrespective of the tumor type, is possible because these antagonists block all the effects mentioned above mediated by SP on cancer cells. This review will update the information regarding using NK-1R antagonists, particularly Aprepitant, as an anticancer drug. Aprepitant shows a broad-spectrum anticancer effect against many tumor types. Aprepitant alone or in combination therapy with radiotherapy or chemotherapy could reduce the sequelae and increase the cure rate and quality of life of patients with cancer. Current data open the door to new cancer research aimed at antitumor therapeutic strategies using Aprepitant. To achieve this goal, reprofiling the antiemetic Aprepitant as an anticancer drug is urgently needed.


Assuntos
Antineoplásicos , Neoplasias , Humanos , Aprepitanto/farmacologia , Aprepitanto/uso terapêutico , Antagonistas dos Receptores de Neurocinina-1/farmacologia , Antagonistas dos Receptores de Neurocinina-1/uso terapêutico , Reposicionamento de Medicamentos , Qualidade de Vida , Antineoplásicos/farmacologia , Antineoplásicos/uso terapêutico , Receptores da Neurocinina-1/metabolismo , Substância P/farmacologia , Substância P/metabolismo , Neoplasias/tratamento farmacológico
13.
Rev Esp Enferm Dig ; 115(8): 452-453, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-35791794

RESUMO

A 22-year-old woman with a history of surgically treated pelvic teratoma and solid liver lesion in the extension study. Radiological follow-up was decided. This liver lesion experienced a progressive increase in size, reaching 6 cm. Contrast-enhanced liver MRI was performed, revealing a heterogeneous mass in the right hepatic lobe with non-hepatocyte-like behaviour. With this information, the following entities were ruled out: haemangioma, adenoma, hepatocarcinoma and focal nodular hyperplasia. Given that it could be a teratoma metastasis, a tumour of any other origin or a non-tumoral lesion with no hepatocyte component, it was decided to perform a 2-[18F]FDG PET/CT scan. It showed the liver mass with notable glycolytic hypermetabolism, suggestive of malignancy. In a multidisciplinary committee, it was decided to perform a laparoscopic right hepatectomy. Pathological examination revealed a benign hepatocytic lesion compatible with a steatotic adenoma.


Assuntos
Adenoma de Células Hepáticas , Adenoma , Carcinoma Hepatocelular , Fígado Gorduroso , Neoplasias Hepáticas , Feminino , Humanos , Adulto Jovem , Adenoma/patologia , Adenoma de Células Hepáticas/complicações , Adenoma de Células Hepáticas/diagnóstico por imagem , Adenoma de Células Hepáticas/cirurgia , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Diagnóstico Diferencial , Fígado Gorduroso/patologia , Fígado/patologia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada
14.
HPB (Oxford) ; 25(4): 400-408, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-37028826

RESUMO

BACKGROUND: The European registry for minimally invasive pancreatic surgery (E-MIPS) collects data on laparoscopic and robotic MIPS in low- and high-volume centers across Europe. METHODS: Analysis of the first year (2019) of the E-MIPS registry, including minimally invasive distal pancreatectomy (MIDP) and minimally invasive pancreatoduodenectomy (MIPD). Primary outcome was 90-day mortality. RESULTS: Overall, 959 patients from 54 centers in 15 countries were included, 558 patients underwent MIDP and 401 patients MIPD. Median volume of MIDP was 10 (7-20) and 9 (2-20) for MIPD. Median use of MIDP was 56.0% (IQR 39.0-77.3%) and median use of MIPD 27.7% (IQR 9.7-45.3%). MIDP was mostly performed laparoscopic (401/558, 71.9%) and MIPD mostly robotic (234/401, 58.3%). MIPD was performed in 50/54 (89.3%) centers, of which 15/50 (30.0%) performed ≥20 MIPD annually. This was 30/54 (55.6%) centers and 13/30 (43%) centers for MIPD respectively. Conversion rate was 10.9% for MIDP and 8.4% for MIPD. Overall 90 day mortality was 1.1% (n = 6) for MIDP and 3.7% (n = 15) for MIPD. CONCLUSION: Within the E-MIPS registry, MIDP is performed in about half of all patients, mostly using laparoscopy. MIPD is performed in about a quarter of patients, slightly more often using the robotic approach. A minority of centers met the Miami guideline volume criteria for MIPD.


Assuntos
Laparoscopia , Neoplasias Pancreáticas , Procedimentos Cirúrgicos Robóticos , Humanos , Neoplasias Pancreáticas/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Pâncreas/cirurgia , Pancreatectomia/efeitos adversos , Pancreaticoduodenectomia/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos , Laparoscopia/efeitos adversos , Sistema de Registros , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
15.
Ann Surg Oncol ; 29(11): 6829-6842, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35849284

RESUMO

BACKGROUND: There is still debate regarding the principal role and ideal timing of perioperative chemotherapy (CTx) for patients with upfront resectable colorectal liver metastases (CRLM). This study assesses long-term oncological outcomes in patients receiving neoadjuvant CTx only versus those receiving neoadjuvant combined with adjuvant therapy (perioperative CTx). METHODS: International multicentre retrospective analysis of patients with CRLM undergoing liver resection between 2010 and 2015. Characteristics and outcomes were compared before and after propensity score matching (PSM). Primary endpoints were long-term oncological outcomes, such as recurrence-free survival (RFS) and overall survival (OS). Furthermore, stratification by the tumour burden score (TBS) was applied. RESULTS: Of 967 patients undergoing hepatectomy, 252 were analysed, with a median follow-up of 45 months. The unmatched comparison revealed a bias towards patients with neoadjuvant CTx presenting with more high-risk patients (p = 0.045) and experiencing increased postoperative complications ≥Clavien-Dindo III (20.9% vs. 8%, p = 0.003). Multivariable analysis showed that perioperative CTx was associated with significantly improved RFS (hazard ratio [HR] 0.579, 95% confidence interval [CI] 0.420-0.800, p = 0.001) and OS (HR 0.579, 95% CI 0.403-0.834, p = 0.003). After PSM (n = 180 patients), the two groups were comparable regarding baseline characteristics. The perioperative CTx group presented with a significantly prolonged RFS (HR 0.53, 95% CI 0.37-0.76, p = 0.007) and OS (HR 0.58, 95% CI 0.38-0.87, p = 0.010) in both low and high TBS patients. CONCLUSIONS: When patients after resection of CRLM are able to tolerate additional postoperative CTx, a perioperative strategy demonstrates increased RFS and OS in comparison with neoadjuvant CTx only in both low and high-risk situations.


Assuntos
Neoplasias Colorretais , Neoplasias Hepáticas , Neoplasias Colorretais/patologia , Neoplasias Colorretais/terapia , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Terapia Neoadjuvante , Pontuação de Propensão , Estudos Retrospectivos
16.
PLoS Comput Biol ; 17(9): e1009417, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34555011

RESUMO

Ecological and evolutionary dynamics have been historically regarded as unfolding at broadly separated timescales. However, these two types of processes are nowadays well-documented to intersperse much more tightly than traditionally assumed, especially in communities of microorganisms. Advancing the development of mathematical and computational approaches to shed novel light onto eco-evolutionary problems is a challenge of utmost relevance. With this motivation in mind, here we scrutinize recent experimental results showing evidence of rapid evolution of tolerance by lag in bacterial populations that are periodically exposed to antibiotic stress in laboratory conditions. In particular, the distribution of single-cell lag times-i.e., the times that individual bacteria from the community remain in a dormant state to cope with stress-evolves its average value to approximately fit the antibiotic-exposure time. Moreover, the distribution develops right-skewed heavy tails, revealing the presence of individuals with anomalously large lag times. Here, we develop a parsimonious individual-based model mimicking the actual demographic processes of the experimental setup. Individuals are characterized by a single phenotypic trait: their intrinsic lag time, which is transmitted with variation to the progeny. The model-in a version in which the amplitude of phenotypic variations grows with the parent's lag time-is able to reproduce quite well the key empirical observations. Furthermore, we develop a general mathematical framework allowing us to describe with good accuracy the properties of the stochastic model by means of a macroscopic equation, which generalizes the Crow-Kimura equation in population genetics. Even if the model does not account for all the biological mechanisms (e.g., genetic changes) in a detailed way-i.e., it is a phenomenological one-it sheds light onto the eco-evolutionary dynamics of the problem and can be helpful to design strategies to hinder the emergence of tolerance in bacterial communities. From a broader perspective, this work represents a benchmark for the mathematical framework designed to tackle much more general eco-evolutionary problems, thus paving the road to further research avenues.


Assuntos
Fenômenos Fisiológicos Bacterianos , Modelos Biológicos , Adaptação Fisiológica , Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Evolução Biológica , Variação Biológica da População , Biologia Computacional , Simulação por Computador , Tolerância a Medicamentos , Microbiota/efeitos dos fármacos , Microbiota/fisiologia , Fenótipo , Estresse Fisiológico
17.
Philos Trans A Math Phys Eng Sci ; 380(2227): 20200424, 2022 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-35599563

RESUMO

Many of the amazing functional capabilities of the brain are collective properties stemming from the interactions of large sets of individual neurons. In particular, the most salient collective phenomena in brain activity are oscillations, which require the synchronous activation of many neurons. Here, we analyse parsimonious dynamical models of neural synchronization running on top of synthetic networks that capture essential aspects of the actual brain anatomical connectivity such as a hierarchical-modular and core-periphery structure. These models reveal the emergence of complex collective states with intermediate and flexible levels of synchronization, halfway in the synchronous-asynchronous spectrum. These states are best described as broad Griffiths-like phases, i.e. an extension of standard critical points that emerge in structurally heterogeneous systems. We analyse different routes (bifurcations) to synchronization and stress the relevance of 'hybrid-type transitions' to generate rich dynamical patterns. Overall, our results illustrate the complex interplay between structure and dynamics, underlining key aspects leading to rich collective states needed to sustain brain functionality. This article is part of the theme issue 'Emergent phenomena in complex physical and socio-technical systems: from cells to societies'.


Assuntos
Encéfalo , Neurônios , Encéfalo/fisiologia , Neurônios/fisiologia
18.
Pain Med ; 23(4): 686-696, 2022 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-34343324

RESUMO

OBJECTIVE: The aim of this study was to characterize the dynamic brain networks underlying the affective modulation of pleasant, unpleasant, and neutral image perception due to painful stimulations in healthy subjects. METHODS: Forty volunteers, 20 men and 20 women, participated in this study. Brain activity was recorded by 64-channel electroencephalography. After data cleaning, brain functional networks were built through the use of the motif synchronization method. RESULTS: We found that increased cerebral connectivity in the left hemisphere under the pain condition broke the connection symmetry. Both women and men showed homophilic connections (intrahemispheric), but women were more homophilic than men. The pain condition increased homophily in the left hemisphere, and emotions could modulate pain. The frontal, central, and left temporal regions showed homophilic variation, depending on the emotional stimulus. CONCLUSIONS: Pain and emotions altered brain activity. There was increased connectivity and homophily in the left brain hemisphere for the painful experience. The emotions modulated brain activity in the pain condition. Overall, the brain presented homophilic characteristics; homophily changed, depending on emotion or pain. The left brain hemisphere seems to be related to pain processing.


Assuntos
Encéfalo , Emoções , Mapeamento Encefálico , Eletroencefalografia , Feminino , Humanos , Masculino , Dor
19.
Heart Lung Circ ; 31(2): 183-193, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34373190

RESUMO

BACKGROUND: Indigenous Australians have a high rate of ischaemic heart disease (IHD). There is a paucity of local data for North Queensland regarding the clinical characteristics of Indigenous people who present to the emergency department (ED) with chest pain. The aim of the study is to compare the cardiovascular risk factors, social characteristics, and the clinical outcomes between Indigenous and non-Indigenous patients who presented with cardiac-related chest pain. METHODS: This is a retrospective single-centre audit. The data was collected through chart reviews of chest pain presentations to the Townsville University Hospital Emergency Department, Queensland, Australia, from January to December 2017. We categorised the patients into Indigenous and non-Indigenous groups and compared their cardiac risk factors and social characteristics. We further classified the patients into three diagnosis groups and we measured the clinical outcomes in the patients with a diagnosis of cardiac-related chest pain. We used a data linkage to the Registry of Births, Deaths and Marriages for the death outcomes. A multivariable analysis was done to determine the risk of major adverse cardiac event (MACE) for Indigenous vs non-Indigenous patients. RESULTS: Indigenous patients were over-represented making up 19.1% of the total cohort (compared with 11.1% of the North Queensland Indigenous population) and presented at a younger age (median age: 45 vs 52, p<0.005). Traditional cardiovascular risk factors were significantly higher in Indigenous patients. The incidence of discharge against medical advice was also higher (6.5% vs 2.7%, p<0.005). There was an underutilisation of the local chest pain pathway amongst the Indigenous group (35.8% vs 44.7%, p<0.005). In patients with a diagnosis of cardiac-related chest pain, the rate of receiving invasive coronary angiogram procedures was similar in both cohorts (44.5% vs 43.7%, p=0.836). With regards to outcomes, Indigenous patients suffered from acute coronary syndrome (ACS) at a younger median age (51 vs 64, p<0.005) and were more likely to have severe three vessel disease (17% vs 6%, p<0.005) leading to coronary bypass graft surgery (CABG) (19% vs 6%, p<0.005). When adjusted for age, gender, and comorbidities, Indigenous patients were more likely to have MACE within 1 year of their chest pain presentation, compared with non-Indigenous patients with the same diagnosis (adjusted odds ration [AOR]=2.0, 95% CI [1.1, 3.8], p=0.03). CONCLUSION: In our study, Indigenous patients carried a heavier burden of cardiovascular risk factors, presented at a younger age, with more severe coronary disease and had a higher rate of CABG. We found an underutilisation of the local chest pain protocol amongst the Indigenous cohort, which suggests a need to improve support structures in the ED. In our multivariable analysis, Indigenous patients suffered from a significantly higher MACE compared to non-Indigenous patients which indicates that more collaborative efforts are needed to improve the cardiovascular health of local Aboriginal and Torres Strait Islander people.


Assuntos
Doença da Artéria Coronariana , Havaiano Nativo ou Outro Ilhéu do Pacífico , Austrália , Dor no Peito/diagnóstico , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Serviço Hospitalar de Emergência , Hospitais , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
20.
Behav Res Methods ; 54(1): 475-492, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34244984

RESUMO

Illusion of control (IOC) is a bias in the judgment of personal success with implications to learning theories and health policies; some important questions in the investigation of IOC may be related to traditional measures in the field, namely self-assessment using Likert scales about the sense of control. Statistical process control (SPC) and Shewhart charts are methods developed to monitor and control industrial processes, never applied in psychological studies before. The present two studies investigated the use of the technique of Shewhart charts in the analysis of IOC. The purpose was to explore the use of SPC and Shewhart charts in the analysis of data sequences from psychological experiments; the objective was to analyze the results of reaction time (RT) data sequences plotted in SPC charts, in comparison with self-assessment judgments from an IOC task. Participants were 63 undergraduate students (Study 1) and 103 mine workers (Study 2) instructed to try to control a traffic light on a computer by pressing or not the keyboard. Higher probabilities of the successful outcome generated judgments of illusion and shifts (due to cognitive activity) in the charts of RT; lower probabilities resulted in null illusion and RT presented a random and stable profile. Patterns for different groups emerged in Shewhart charts. SPC can contribute to the analysis of the behavior of sequences of data in psychological studies, so that the charts indicate changes and patterns not detected by traditional ANOVA and other linear models.


Assuntos
Ilusões , Humanos
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