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The biological pathways which link lead (Pb) and long-term outcomes are unclear, though rodent models and a few human studies suggest Pb may alter the body's stress response systems, which over time, can elicit dysregulated stress responses with cumulative impacts. This study examined associations between prenatal and early childhood Pb exposure and adolescent allostatic load, an index of an individual's body burden of stress in multiple biological systems, and further examined sex-based associations. Among 391 (51% male) participants in the ELEMENT birth cohort, we related trimester-specific maternal blood Pb, 1-month postpartum maternal tibia and patella Pb, and child blood Pb at 12-24 months to an allostatic load index in adolescence comprised of biomarkers of cardiovascular, metabolic, neuroendocrine, and immune function. The results were overall mixed, with prenatal exposure, particularly maternal bone Pb, being positively associated with allostatic load, and early childhood Pb showing mixed results for males and females. In adjusted Poisson regression models, 1 mcg/g increase in tibia Pb was associated with a 1% change in expected allostatic load (IRR = 1.01; 95%CI 0.99, 1.02). We found a significant Pb × sex interaction (IRR = 1.05; 95%CI 1.01, 1.10); where males saw an increasing percent change in allostatic load as 12 month Pb levels increased compared to females who saw a decreasing allostatic load. Further examination of allostatic load will facilitate the determination of potential mechanistic pathways between developmental toxicant exposures and later-in-life cardiometabolic outcomes.
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Alostase , Chumbo , Adolescente , Pré-Escolar , Feminino , Humanos , Masculino , Gravidez , Alostase/fisiologia , Biomarcadores , Estudos de Coortes , Família , Vitaminas , LactenteRESUMO
BACKGROUND: HPV cervical cancer screening (CCS) must use validated HPV tests based on the molecular detection of either viral mRNA (Aptima HPV Assay-AHPV) or DNA. AHPV has demonstrated the same cross-sectional and longitudinal sensitivity for the detection of HSIL/CIN2+ lesions but with greater specificity than HPV-DNA tests. The study aimed to estimate the total costs of a CCS with a primary HPV test based on the detection of mRNA compared to DNA in women aged 35-65 years for the National Health System. METHODS: A decision-tree-based model to estimate the cost of the CCS until the first colposcopy was designed based on Spanish CCS guidelines. The total cost (, 2019) for CCS with AHPV or DNA tests (HC2 and Cobas) was calculated, including HPV test, liquid-based cytology (LBC) and colposcopy, for a population of 7,263,529 women aged 35-65 years (assuming 70% coverage). Clinical inputs derived from a literature review were validated by a multidisciplinary expert panel. Data from head-to-head studies between different HPV tests were selected. RESULTS: The use of AHPV showed reduction of 290,541 (- 35%) and 355,913 (- 40%) LBC compared to HC2 or Cobas, respectively. Furthermore, AHPV avoided 151,699 (- 47%) colposcopies versus HC2 and 151,165 (- 47%) versus Cobas. The total cost of CCS was 282,747,877 with AHPV, 322,587,588 with HC2 and 324,614,490 with Cobas. Therefore, AHPV savings - 39,839,711 versus HC2 and - 41,866,613 versus Cobas. CONCLUSIONS: Assuming that 70% of women from 35 to 65 years attend the CCS programme, the cost of screening up to the first colposcopy using AHPV would provide cost savings of up to 41.9 million versus DNA tests in Spain.
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Infecções por Papillomavirus , Neoplasias do Colo do Útero , Colposcopia , Custos e Análise de Custo , Estudos Transversais , DNA Viral , Detecção Precoce de Câncer , Feminino , Humanos , Técnicas de Diagnóstico Molecular , Papillomaviridae/genética , Infecções por Papillomavirus/diagnóstico , Gravidez , Sensibilidade e Especificidade , Espanha , Neoplasias do Colo do Útero/diagnósticoRESUMO
PURPOSE: The aim of this article was to validate the Spanish version of the Home Environment Survey (HES-S) and was divided in two studies: (1) to assess the reliability, convergent validity of HES-S in a survey of 145 parents of children with overweight/obesity; (2) to study the magnitude of the association between children's BMI status with the latent scores theoretically defined by the HES model. METHODS: To test the scale and the model, a confirmatory factor analysis (CFA) and a path analysis were carried out among a sample of 156 parents of preadolescents (106 overweight/obesity and 50 normal-weight children). No CFA or EFA were carried out in the validation of the original instrument. RESULTS: Study 1, both the Physical Activity and the Eating Habits components of the scale showed adequate levels of internal consistency for the majority of the scales, except for two. One of them, Healthy Eating Parental Policies (HEP) subscale was reduced after excluded two items, although it did not improve substantially. This model indicated that there was a significant association between the two Eating Habits scales and the child's weight status, but child's weight was not associated with the Physical Activity components. Convergent validity was confirmed by correlations with related variables: family eating habits (F-EAT), parent's physical activity (IPAQ), and children's physical activity (assessed via accelerometers during one week). Study 2, our results replicated the original four factor structure proposed for physical activity (CFI = 0.99; RMSEA = 0.03), but the original factor structure of the eating habits component was not supported. In addition, the relationship of the child's weight status, the Physical Activity components, and the two scales of Eating Habits (Parental Modeling and Policies) was explored with a path analysis showing good fit indices (CFI = 0.95; RMSEA = 0.06). Child's BMI was negatively associated with Healthy Eating Parental Role Modeling (r = - 0.21) and with Healthy Eating Parental Policies (r = - 0.19), but not with the factors of Child's Physical Activity model. CONCLUSION: To our knowledge, this is the first instrument to assess obesogenic family environment in Spanish speaking countries, which is a relevant dimension within a health perspective so as to implement new policies and strategies in obesity tertiary prevention. Overall, the confirmatory factor analysis of the HES-S has only provided additional support for one part related to Physical Activity. In addition, Child's BMI was correlated with scales of Eating Habits but not with Child's Physical Activity factor. These results clearly suggest that further research is warranted. LEVEL III: Case-control analytic study.
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Obesidade , Sobrepeso , Índice de Massa Corporal , Criança , Comportamento Alimentar , Humanos , Pais , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To examine the associations of maternal and child overweight status across multiple time-points with liver fat content in the offspring during young adulthood. DESIGN: Cohort study. SETTING: ELEMENT Cohort in Mexico City. POPULATION: Pregnant women with singleton births (n = 97). METHODS: We quantified hepatic triglyceride content (liver fat content) by proton magnetic resonance spectroscopy (1H MRS) and conventional T2-weighted MRIs (3T scanner) in 97 young adults from the ELEMENT birth cohort in Mexico City. Historical records of the cohort were used as a source of pregnancy, and childhood and adolescence anthropometric information, overweight and obesity (OWOB) were defined. Adjusted structural equation models were run to identify the association between OWOB in different life stages with liver fat content (log-transformed) in young adulthood. MAIN OUTCOME: Maternal OWOB at the time of delivery was directly and indirectly associated with the liver fat content in the offspring at young adulthood. RESULTS: Seventeen percent of the participants were classified as having NAFLD. We found a strong association of OWOB between all periods assessed. Maternal OWOB at time of delivery (ß = 1.97, 95% CI 1.28-3.05), and OWOB status in the offspring at young adulthood (ß = 3.17, 95% CI 2.10-4.77) were directly associated with the liver fat content in the offspring. Also, maternal OWOB was indirectly associated with liver fat content through offspring OWOB status. CONCLUSION: We found that maternal OWOB status is related to fatty liver content in the offspring as young adults, even after taking into account OWOB status and lifestyle factors in the offspring. TWEETABLE ABSTRACT: There was an association between pre-pregnancy overweight and the development of NAFLD in adult offspring.
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Hepatopatia Gordurosa não Alcoólica/epidemiologia , Obesidade/epidemiologia , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Peso ao Nascer , Índice de Massa Corporal , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , México/epidemiologia , Hepatopatia Gordurosa não Alcoólica/etiologia , Gravidez , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Triglicerídeos/análise , Adulto JovemRESUMO
Zygosaccharomyces rouxii is the main spoilage yeast of grape juice concentrates. Detection and identification of Z. rouxii during the production of grape juice concentrate is critical to prevent spoilage in the final product. In this work, three grape juice concentrate processing plants were assessed by identifying osmophilic yeasts in juices and surfaces during different stages of a complete production line. Subsequently, molecular typing of Z. rouxii isolates was done to determine the strain distribution of this spoilage yeast. Osmotolerant yeast species, other than Z. rouxii, were mainly recovered from processing plant environments. Z. rouxii was only isolated from surface samples with grape juice remains. Z. rouxii was largely isolated from grape juice samples with some degree of concentration. Storage of grape juice pre-concentrate and concentrate allowed an increase in the Z. rouxii population. A widely distributed dominant molecular Z. rouxii pattern was found in samples from all three processing plants, suggesting resident microbes inside the plant.
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Sucos de Frutas e Vegetais/microbiologia , Vitis/microbiologia , Leveduras/isolamento & purificação , Zygosaccharomyces/isolamento & purificação , Contaminação de Alimentos/análise , Microbiologia de Alimentos , Indústria de Processamento de Alimentos , Tipagem Molecular , Técnicas de Tipagem Micológica , Saccharomyces cerevisiae/isolamento & purificação , Saccharomyces cerevisiae/fisiologia , Leveduras/fisiologia , Zygosaccharomyces/genética , Zygosaccharomyces/fisiologiaRESUMO
Mitochondria are dynamic organelles that continually move, fuse and divide. The dynamic balance of fusion and fission of mitochondria determines their morphology and allows their immediate adaptation to energetic needs, keeps mitochondria in good health by restoring or removing damaged organelles or precipitates cells in apoptosis in cases of severe defects. Mitochondrial fusion and fission are essential in mammals and their disturbances are associated with several diseases. However, while mitochondrial fusion/fission dynamics, and the proteins that control these processes, are ubiquitous, associated diseases are primarily neurological disorders. Accordingly, inactivation of the main actors of mitochondrial fusion/fission dynamics is associated with defects in neuronal development, plasticity and functioning, both ex vivo and in vivo. Here, we present the central actors of mitochondrial fusion and fission and review the role of mitochondrial dynamics in neuronal physiology and pathophysiology. Particular emphasis is placed on the three main actors of these processes i.e. DRP1,MFN1-2, and OPA1 as well as on GDAP1, a protein of the mitochondrial outer membrane preferentially expressed in neurons. This article is part of a Special Issue entitled: Mitochondria & Brain.
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Mitocôndrias/metabolismo , Dinâmica Mitocondrial/fisiologia , Doenças Neurodegenerativas/metabolismo , Plasticidade Neuronal/fisiologia , Animais , Encéfalo/metabolismo , Humanos , Neurônios/metabolismoRESUMO
Si x Ge1-x alloys are well-known thermoelectric materials with a high figure of merit at high temperatures. In this work, metal-induced crystallization (MIC) has been used to grow Si0.8Ge0.2 films that present improved thermoelectric performance (zT = 5.6 × 10(-4) at room temperature)--according to previously reported values on films--with a relatively large power factor (σ · S (2) = 16 µW · m(-1) · K(-2)). More importantly, a reduction in the thermal conductivity at room temperature (κ = 1.13 ± 0.12 W · m(-1) · K(-1)) compared to other Si-Ge films (â¼3 W · m(-1) · K(-1)) has been found. Whereas the usual crystallization of amorphous SiGe (a-SiGe) is achieved at high temperatures and for long times, which triggers dopant loss, MIC reduces the crystallization temperature and the heating time. The associated dopant loss is thus avoided, resulting in a nanostructuration of the film. Using this method, we obtained Si0.8Ge0.2 films (grown by DC plasma sputtering) with appropriate compositional and structural properties. Different thermal treatments were tested in situ (by heating the sample inside the deposition chamber) and ex situ (annealed in an external furnace with controlled conditions). From the studies of the films by: x-ray diffraction (XRD), synchrotron radiation grazing incidence x-ray diffraction (SR-GIXRD), micro Raman, scanning electron microscopy (SEM), x-ray photoemission spectroscopy (XPS), Hall effect, Seebeck coefficient, electrical and thermal conductivity measurements, we observed that the in situ films at 500 °C presented the best zT values with no gold contamination.
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AIMS: To isolate and characterize native yeast strains from broilers' environment as feedstuff, faeces and gut, and to evaluate their binding capacity for aflatoxin B1 (AFB1 ). METHODS AND RESULTS: A total of nine yeast strains were isolated: three from feedstuff identified as Pichia kudriavzevii (2) and Clavispora lusitaniae (1), two from gut identified as Candida tropicalis and four from faeces identified as Cl. lusitaniae (3) and Cyberlindnera fabianii (1). AFB1 binding percentages varied among yeast strains and with AFB1 concentrations. To carry out adsorption studies, one strain from each genus and each origin was selected as follows: Cl. lusitaniae and P. kudriavzevii from feedstuff, Cl. lusitaniae and Cy. fabianii from faeces and Ca. tropicalis from gut. The most appropriate concentrations for cells and toxin were 107 cells per ml and 100 ng ml-1 of AFB1 respectively. All the tested yeast strains showed similar adsorption capacities independently of the origin. The adsorption isotherm studies in all yeasts assayed showed behaviour of L type or Langmuir and a varied affinity for the toxin. The stability of the AFB1 -yeast complex demonstrated the irreversibility of the binding process. CONCLUSION: Yeast strains tested in this study constitute potential AFB1 adsorbents and they possess the advantage to be native from the avian environment. SIGNIFICANCE AND IMPACT OF THE STUDY: This study makes a contribution to using native yeasts from broilers' environment for controlling chronic aflatoxicosis in avian production.
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Aflatoxina B1/metabolismo , Galinhas/microbiologia , Leveduras/metabolismo , Adsorção , Ração Animal/microbiologia , Animais , Fezes/microbiologia , Intestinos/microbiologia , Leveduras/isolamento & purificaçãoRESUMO
OBJECTIVE: To explore the relationship between scores on the Test Your Memory (TYM) battery and findings from a more exhaustive neurocognitive assessment. METHODS: The TYM and fourteen psychometric tests were administered to 84 subjects aged 50 or older who attended an outpatient neurology clinic due to cognitive symptoms. Each patient's cognitive state was determined independently from his/her score on the TYM (CDR 0, n=25; CDR 0.5, n=45; CDR 1, n=14). We analysed concurrent validity of TYM scores and results from the psychometric tests, as well as the degree of concordance between the two types of measurement, by contrasting normalised data from each instrument. RESULTS: Although the intraclass correlation coefficient was 0.67 (confidence interval 95%, 0.53-0.77), analysis of the Bland-Altman plot and the curve on the survival-agreement plot (Luiz et al. method) demonstrates that the individual distances between the two methods exhibit excessive dispersion from a clinical viewpoint. TYM-based predictions of the mean z-score on psychometric tests differed substantially from real results in 30% of the subjects. Concordance of 95% can only be achieved by accepting absolute inter-instrument differences of up to 0.87 as identical values. Furthermore, the TYM underestimates cognitive performance for low values and overestimates it for high values. CONCLUSIONS: The TYM is a cognitive screening test which should not be used to predict results on psychometric tests or to detect cognitive changes in clinical trials.
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Memória/fisiologia , Testes Neuropsicológicos/normas , Psicometria , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/complicações , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Feminino , Humanos , Masculino , Transtornos da Memória/diagnóstico , Transtornos da Memória/psicologia , Pessoa de Meia-Idade , Valores de ReferênciaRESUMO
OBJECTIVE: To determine the prospective validity of Test Your Memory (TYM) and its sensitivity to change in cognitive state. METHODS: This longitudinal prospective study followed 71 patients with subjective cognitive symptoms and 48 with mild cognitive impairment for a mean time period of 35.2 ± 15 months. Subjects did not have dementia or depression at the beginning of follow-up and each participant was given the TYM at least two times. A psychometric threshold was established to determine presence of a cognitive deficit (z-score ≤ 1.5 on at least one cognitive domain) and the Disability Assessment for Dementia scale was used to ensure full functional ability. The criterion for deterioration was a change in the stage on the Global Deterioration Scale. RESULTS: Sixty-one patients remained cognitively stable and 58 worsened. There were no differences between them with respect to sex, educational attainment, the initial stage on the GDS, or the score on the first TYM. Subjects who worsened were older than those who did not. The TYM increased an average of 0.04 points per month in patients who remained stable or improved (95% CI, -0.01 to 0.08) and decreased an average of 0.14 points per month in those whose condition worsened (95% CI, -0.19 to -0.09). Subjects with mild cognitive impairment who worsened displayed a sharper loss of TYM points than did subjects with subjective cognitive symptoms. CONCLUSIONS: While the TYM lacks prospective validity, it is sensitive to changes in cognitive state.
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Transtornos da Memória/diagnóstico , Transtornos da Memória/psicologia , Testes Neuropsicológicos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/psicologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Progressão da Doença , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: To validate a Spanish version of the TYM, a self-administered cognitive screening test designed for the detection of Alzheimer's disease and mild cognitive defect. METHODS: A cross-sectional study was conducted in a neurology outpatient clinic. The TYM was administered to individuals of 50 years o more who came to the clinic for whatever the symptom. Their cognitive state was evaluated regardless of the outcome of TYM. They were categorized into 3 groups: 1) Cognitively normal (739), 2) with mild cognitive impairment (183), 3) with dementia (127). An analysis of items was made and the psychometric properties of the TYM were defined. There was a cross-validation, and the predictive validity of the TYM score, adjusted to the demographic variables, was determined by evaluating their performance in ROC curves. RESULTS: The internal consistency, interobserver reliability, short term and long-term test-retest reliability were adequate. The TYM correlated with the MMSE (r=0.779, P<.0001). The cross validation showed consistent results. With the TYM Score adjusted according to the educational level, a sensitivity of 0.86 with a specificity of 0.88 in the cut-off point of ≤40/50 was obtained to identify subjects with cognitive impairment, and a sensitivity of 0.94 with a specificity of 0.89 in the cut-off point of ≤36/50 to identify subjects with dementia. CONCLUSIONS: The TYM is a self-administered global cognitive test, possessing excellent psychometric properties and good predictive validity. It can be used as a cognitive screening test in subjects with 4 years or more of formal education.
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Transtornos da Memória/diagnóstico , Transtornos da Memória/psicologia , Testes Neuropsicológicos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/psicologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Estudos Transversais , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
The effect of pH (1.7-3.2) and sugar concentration (64-68 °Brix) on the growth of Zygosaccharomyces rouxii MC9 using response surface methodology was studied. Experiments were carried out in concentrated grape juice inoculated with Z. rouxii at isothermal conditions (23 °C) for 60 days. pH was the variable with the highest effect on growth parameters (potential maximum growth rate and lag phase duration), although the effect of sugar concentration were also significant. In a second experiment, the time for spoilage by this microorganism in concentrated grape juice was evaluated at isothermal (23 °C) and non-isothermal conditions, in an effort to reproduce standard storage and overseas shipping temperature conditions, respectively. Results show that pH was again the environmental factor with the highest impact on delaying the spoilage of the product. Thereby, a pH value below 2.0 was enough to increase the shelf life of the product for more than 60 days in both isothermal and non-isothermal conditions. The information obtained in the present work could be used by producers and buyers to predict the growth and time for spoilage of Z. rouxii in concentrated grape juice.
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Bebidas/análise , Bebidas/microbiologia , Conservação de Alimentos/métodos , Vitis/microbiologia , Zygosaccharomyces/crescimento & desenvolvimento , Metabolismo dos Carboidratos , Carboidratos/análise , Contaminação de Alimentos/análise , Armazenamento de Alimentos , Concentração de Íons de Hidrogênio , Cinética , Temperatura , Vitis/química , Zygosaccharomyces/química , Zygosaccharomyces/metabolismoRESUMO
BACKGROUND: Peripheral venous catheter-associated Staphylococcus aureus bacteraemia (PVC-SAB) is a potentially life-threatening nosocomial infection. AIM: This cohort study aims to identify the risk factors associated with its mortality and complications. METHODS: Retrospective analysis of a prospective cohort study conducted at two tertiary-care hospitals in Spain. Adult patients admitted between January 2011 and July 2019 which developed PVC-SAB during their hospital stay were included. Primary outcome was all-cause 30- and 90-day mortality. Secondary outcomes were sepsis or septic shock at the onset of bacteraemia, metastatic infection and length of hospital stay. Univariate and multivariate analyses were performed. FINDINGS: A total of 256 PVC-SAB were diagnosed in 243 patients between 2011 and 2019. Thirty-day and 90-day all-cause mortality were 18.3% and 24.2%, respectively. Lack of susceptible antibiotic administration the day after blood culture collection (odds ratio: 4.14; 95% confidence interval: 1.55-11.03; P = 0.005), sepsis and complicated bacteraemia were identified as independent risk factors for 30- and 90-day mortality; meticillin-resistant S. aureus bacteraemia was identified as an independent risk factor only for 30-day mortality and functional dependence only for 90-day mortality. Persistent bacteraemia and sepsis were associated with septic metastases, which significantly increased hospital stay, and endocarditis. A greater proportion of patients experiencing septic shock were subsequently institutionalized compared to those without. CONCLUSION: PVC-SAB remains linked to high mortality rates. Prompt administration of appropriate antibiotics is crucial for lowering mortality. A comprehensive diagnostic approach is essential, especially in patients with persistent bacteraemia and implanted cardiovascular devices, to rule out metastatic complications and endocarditis.
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Few studies have related early life lead exposure to adolescent biological aging, a period characterized by marked increases in maturational tempo. We examined associations between prenatal and childhood lead exposure and adolescent biological age (mean 14.5 years) utilizing multiple epigenetic clocks including: intrinsic (IEAA), extrinsic (EEAA), Horvath, Hannum, PhenoAge, GrimAge, Skin-Blood, Wu, PedBE, as well as DNA methylation derived telomere length (DNAmTL). Epigenetic clocks and DNAmTL were calculated via adolescent blood DNA methylation measured by Infinium MethylationEPIC BeadChips. We constructed general linear models (GLMs) with individual lead measures predicting biological age. We additionally examined sex-stratified models and lead by sex interactions, adjusting for adolescent age and lead levels, maternal smoking and education, and proportion of cell types. We also estimated effects of lead exposure on biological age using generalized estimating equations (GEE). First trimester blood lead was positively associated with a 0.14 increase in EEAA age in the GLMs though not the GEE models (95%CI 0.03, 0.25). First and 2nd trimester blood lead levels were associated with a 0.02 year increase in PedBE age in GLM and GEE models (1st trimester, 95%CI 0.004, 0.03; 2nd trimester, 95%CI 0.01, 0.03). Third trimester and 24 month blood lead levels were associated with a -0.06 and -0.05 decrease in Skin-Blood age, respectively, in GLM models. Additionally, 3rd trimester blood lead levels were associated with a 0.08 year decrease in Hannum age in GLM and GEE models (95%CI -0.15, -0.01). There were multiple significant results in sex-stratified models and significant lead by sex interactions, where males experienced accelerated biological age, compared to females who saw a decelerated biological age, with respect to IEAA, EEAA, Horvath, Hannum, and PedBE clocks. Further research is needed to understand sex-specific relationships between lead exposure and measures of biological aging in adolescence and the trajectory of biological aging into young adulthood.
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Envelhecimento , Chumbo , Masculino , Gravidez , Feminino , Humanos , Adolescente , Criança , Adulto Jovem , Adulto , Chumbo/toxicidade , Chumbo/metabolismo , Envelhecimento/genética , Envelhecimento/metabolismo , Metilação de DNA , Fumar , Biomarcadores/metabolismo , Epigênese GenéticaRESUMO
OBJECTIVES: To analyze the outcomes, predictors of success and predictors of need for hospital admission in our series of patients who underwent ureteroscopy (URS) as a major outpatient surgery (MOS) procedure. METHODS: We carried out a retrospective analysis of 402 patients who had undergone semi-rigid URS for ureteral calculi as a MOS procedure in our center between 2004 and 2012. Patients with previous DJ catheter were excluded. We classified the calculi according to their location (lumbar, pelvic, iliac), size (< or> 1cm) and number (single or multiple). Follow-up was done by plain X-ray of the abdomen and ultrasound one month after surgery. The procedure was considered successful when patients were free from the treated calculi or had ureteral fragments < 3 mm one month after surgery. Univariate and multivariate analyses were carried out to identify the factors involved in success and hospitalization not being required. RESULTS: A total of 269 patients were included. The majority of the stones were single (92.2%), <1 cm in size (76.6%), pelvic (62.1%), and left-sided (57.2%). 89.6% of the procedures were performed as MOS and 82.2% were considered to be successful. In the multivariate analysis, left-sided (p<0.001) and pelvic location of the calculi (p=0,01) were found to be independent predictors for the success of the procedure In terms of hospital admission, the only independent predictor was the presence of intraoperative complications ( p=0.006). CONCLUSIONS: Left-sided and pelvic locations were the independent predictors for the success of the URS. A lack of intraoperative complications was the independent predictor for not requiring hospitalisation.
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Cálculos Ureterais/cirurgia , Ureteroscopia/métodos , Adulto , Procedimentos Cirúrgicos Ambulatórios , Anestesia Geral , Feminino , Hospitalização , Humanos , Terapia a Laser , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Background: Many analytical methods used in gut microbiome research focus on either single bacterial taxa or the whole microbiome, ignoring multi-bacteria relationships (microbial cliques). We present a novel analytical approach to identify multiple bacterial taxa within the gut microbiome of children at 9-11 years associated with prenatal Pb exposure. Methods: Data came from a subset of participants (n=123) in the Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) cohort. Pb concentrations were measured in maternal whole blood from the second and third trimesters of pregnancy. Stool samples collected at 9-11 years old underwent metagenomic sequencing to assess the gut microbiome. Using a novel analytical approach, Microbial Co-occurrence Analysis (MiCA), we paired a machine-learning algorithm with randomization-based inference to first identify microbial cliques that were predictive of prenatal Pb exposure and then estimate the association between prenatal Pb exposure and microbial clique abundance. Results: With second-trimester Pb exposure, we identified a 2-taxa microbial clique that included Bifidobacterium adolescentis and Ruminococcus callidus, and a 3-taxa clique that added Prevotella clara. Increasing second-trimester Pb exposure was associated with significantly increased odds of having the 2-taxa microbial clique below the 50th percentile relative abundance (OR=1.03,95%CI[1.01-1.05]). In an analysis of Pb concentration at or above vs. below the United States and Mexico guidelines for child Pb exposure, odds of the 2-taxa clique in low abundance were 3.36(95%CI[1.32-8.51]) and 6.11(95%CI[1.87-19.93]), respectively. Trends were similar with the 3-taxa clique but not statistically significant. Discussion: Using a novel combination of machine-learning and causal-inference, MiCA identified a significant association between second-trimester Pb exposure and reduced abundance of a probiotic microbial clique within the gut microbiome in late childhood. Pb exposure levels at the guidelines for child Pb poisoning in the United States, and Mexico are not sufficient to protect against the potential loss of probiotic benefits.
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The maximum expression of hemodynamic instability during liver transplant is the so-called postreperfusion syndrome (PRS) that increases both overall mortality and postoperative complications. It was first defined by Aggarwal et al in 1987, but the results are still conflicting when establishing the relationship between PRS and acute kidney failure (AKF). We conducted a retrospective observational study of transplant recipients with deceased-donor liver grafts between January 2002 and December 2018. We analyzed the incidence of PRS and its potential negative impact over kidney function. A total of 551 transplants were analyzed. PRS was recorded in 130 patients (23.6%). The incidence of AKF was 61.5%. A total of 111 patients required kidney replacement therapy (32.7%). Regarding the severity of AKF, 128 patients were classified as acute kidney injury (AKI) 1 (23.2%), 76 as AKI 2 (13.8%), and 135 as AKI 3 (24.5%). In the group with PRS, 75.4% (n = 98) developed AKF vs 57.2% (n = 241) in the group without PRS. In the multivariate analysis we found a relationship between PRS and AKF with an odds ratio of 2.18 (95% CI, 1.30-3.64; P = .003), once adjusted by the length of the anhepatic phase, donor age, Model for End-Stage Liver Disease score, history of ascites, and need for early surgical reintervention. The incidence of AKF decreased (44.5%) ever since the implementation of delayed calcineurin inhibitors therapy and piggyback surgical technique, but a clear influence of the occurrence of PRS on the development of AKF is still observed, with an OR of 3.78 (95% CI, 1.92-7.43; P < .001), once adjusted by albumin and hemoglobin levels, Model for End-Stage Liver Disease score, and Child classification.