Clinics最新文献

Introduction: Patients with a moderate to severe clinical condition of COVID-19 who need hospitalization may have dysfunction in Cardiac Autonomic Control (CAC) and functional capacity.

Objective: To assess the association of HRV with cardiorespiratory fitness and respiratory and peripheral muscle strength in patients after hospitalization for COVID-19.

Method: Cross-sectional study with individuals > 18-years old, post-hospitalization for COVID-19, with a positive RT-PCR test. Data on clinical condition and hospital admission were collected, and parameters of respiratory and peripheral muscle strength and functional capacity were evaluated with the 6-Minute Walk Test (6MWT). CAC was assessed by analyzing (Heart Rate Variability) HRV in the time (SDNN, RMSSD) and frequency domains (HF, LF, HF/LF ratio). Pearson correlation was performed between HRV measures and functional parameters.

Results: The results showed low HRV in study participants, with positive correlations between 6MWT and RMSSD and between SDNN and HF power and negative correlations between Heart Rate and the LF/HF ratio. On the other hand, respiratory and peripheral muscle strength correlated positively with parameters that represent sympathetic nervous system expression (LF nu and LF power) and negatively with the LF/HF ratio. However, changes in HRV parameters were not associated with disease severity.

Conclusion: The dysautonomia of COVID-19 patients was correlated with functional sequelae, though not associated with disease severity parameters. There was low HRV, with low vagal expression, and imbalance in sympathetic/parasympathetic modulation in the study group.

Objective: This study aims to investigate the expression levels of Nerve Growth Factor (NGF), the precursor form of NGF (proNGF), and p75 neurotrophin receptor (p75^NTR) in lung injury induced by cerebral Ischemia-Reperfusion (I/R) in both young and elderly rats.

Methods: Male Sprague-Dawley rats, categorized as young (3-months-old) and elderly (16-months-old), were divided into four experimental groups: Young Sham, Young I/R, Elderly Sham, and Elderly I/R. Each group underwent either sham surgery or ischemia-reperfusion treatment. Following 24 h post-procedure, the severity of cerebral ischemia was assessed using the Zea Longa 5-point scoring system, and lung tissue pathological changes were examined using Hematoxylin and Eosin (HE) staining. Western blot analysis was utilized to measure the expression levels of NGF, proNGF, and p75^NTR proteins in lung tissue.

Results: Both young and elderly I/R groups exhibited lung tissue congestion and edema compared to their respective sham groups, with a significant increase in pathological scores (p < 0.05). Furthermore, the elderly I/R group demonstrated a significantly higher pathological score compared to the young I/R group (p < 0.05). Western blot analysis revealed that compared to the young sham group, the expression of NGF in the lung tissue of elderly sham rats decreased (p < 0.05), while proNGF and p75^NTR increased (p < 0.05). Additionally, compared to the sham group, the levels of NGF, proNGF, and p75^NTR in lung tissue were elevated in both young and elderly I/R groups of rats (p < 0.05). Moreover, the expression of proNGF and p75^NTR in lung tissue was higher in the elderly I/R group than in the young I/R group (p < 0.05).

Conclusion: Cerebral ischemia-reperfusion-induced lung injury was associated with increased expression of proNGF and p75^NTR, as well as decreased NGF expression in lung tissue. These alterations in NGF, proNGF, and p75^NTR may contribute to the susceptibility to age-related lung injury.

Background: The newborn's intestinal microbiota can vary with gestational age. Reliable analyses of stool samples require establishing the steps of collection, packaging, transportation, and storage.

Objective: To describe the development of a protocol and test an algorithm for the sequence of actions and procedures for the collection, packaging, transportation, and storage of stool samples from Preterm Newborn (PTNB) admitted to a Neonatal Intensive Care Unit (NICU).

Materials and methods: This is a descriptive, observational study linked to a non-randomized controlled clinical trial conducted in the NICU of two public hospitals covenanted to the Unified Health System of a large city in inland northeastern Brazil. The methodology adopted in its development followed the Brazilian Ministry of Health Preparation Guide recommendations.

Results: The flow of actions and procedures was consistent with scientific evidence. The sequence of work process steps to implement the proposed protocol was tested and resulted in a graphical representation of an algorithm compatible with the reality of Brazilian public hospitals.

Conclusion: Following the protocol steps with the description of the rules of conduct and recommendations regarding the collection, packaging, transportation, and storage of stool samples from PTNBs ensured the preservation and integrity of the bacterial DNA in the stools sample. The details of the recommendations will allow their reproducibility and improvement by professionals and researchers with similar study objects.

Trial registration: World Health Organization (WHO) under Universal Trial Number (UTN) code U1111-1266-2295, under register RBR-3mm7cs in the Brazilian Registry of Clinical Trials (REBEC).

Objective: Colorectal cancer is one of the most common malignant tumors in the world, which seriously threatens human health. It is essential for the search for new oncogene targets in colorectal cancer.

Methods: Samples from 57 colorectal cancer patients were collected in this study. Next-Generation Sequencing (NGS) was performed to detect gene mutation, assess Microsatellite Instability (MSI), and evaluate Tumor Mutational Burden (TMB). RNA data from 528 CRC patients from the TCGA database were analyzed.

Results: A total of 57 colon cancer patients were included in this study, including 30 males and 27 females, with a mean age of 56 years. In this study, the most common mutations were APC (79 %), TP53 (61 %), TTN (48 %), KRAS (42 %), SYNE1 (28 %), MUC16 (25 %), PIK3CA (25 %), FAT4 (22 %), RYR2 (19 %), OBSCN (18 %), and ZFHX4 (18 %). Subsequently, the authors analyzed gene mutations in colorectal cancer patients according to gender, age, and TMB status. Significant differences in immune cell infiltration were found between colorectal cancer tissues and normal tissues by CIBERSORT analysis. LRP1B may serve as a potential colorectal cancer therapeutic target, and its absence leads to changes in immune cell infiltration.

Conclusion: The authors described the molecular characteristics of CRC. Loss of LRP1B leads to changes in immune cell infiltration and can be used as a therapeutic target for colorectal cancer.

Education in basic life support is widely proposed to increase survival in out-of-hospital sudden cardiac arrest. The authors aimed to assess knowledge, skills, and attitudes, including willingness to help, regarding myocardial infarction and sudden cardiac arrest among university students of all fields of knowledge.

Methods: An Ethical Research Committee approved this cross-sectional study. An electronic survey "KIDS SAVE LIVES BRAZIL" was sent to 58,862 students of 82 disciplines in three universities, aged ≥ 18 years. The survey covered three categories: knowledge, skills, and attitude. Each category was graded between 0 and 10 points (the highest).

Results: Among students, 4,803 undergraduates (8.2 %) answered the survey, and were divided into three groups of disciplines: medicine (219, ∼21.7 years, 38 % male), other-healthcare (n = 1,058; ∼22.9 years; 36 % male), and non-health-care (n = 3,526; ∼22.9 years; 35 % male). All three groups showed significant differences between them (p < 0.001). The non-health-care compared with medicine and other healthcare groups showed, respectively, the lowest median scores (25 %‒75 %) in knowledge (4.0 [0.0‒9.3], 4.0 [4.0‒8.0], and 4.0 [4.0‒4.7]), skills (2.4 [1.2‒3.3], 6.4 [4.0‒8.3], 4.0 [2.4‒6.2]), and attitude (5.9 [5.9‒6.8], 7.3 [5.9‒7.3], and 7.3 [5.9‒7.3]).

Conclusion: University students who answered the e-survey have the willingness to help victims suffering from myocardial infarction or sustaining sudden cardiac arrest. However, non healthcare students markedly lack the knowledge and skills to perform cardiopulmonary resuscitation and automated external defibrillation. These findings reveal a stark difference in basic life support competencies between students in related healthcare fields and those in non-health fields, emphasizing the need for universal basic life support training.

Cervical cancer, whose well-recognized etiological agent is the Human Papillomavirus (HPV), is responsible for approximately 300,000 deaths worldwide, 80% of cases occurring in developing countries. In Brazil, 17,010 cases were expected, with 2,550 cases in São Paulo State, in 2023. The Papanicolaou test is the diagnostic method for the detection of precancerous lesions of the cervix, and HPV vaccination is now available for prevention.

Materials and methods: This is a descriptive and exploratory, retrospective investigation, carried out through analysis of data obtained from Brazilian Information Technology (DATASUS) of the Brazilian Federal Government: Cancer Information System (SISCAN), Brazilian National Immunization Program (PNI) and Mortality Information System (SIM). Electronic Library and data made available by the Government of the State of São Paulo.

Results: The number of women in São Paulo State who underwent cytological examinations and histological tests for cervical cancer decreased between the Years 2013 and 2022.

Conclusion: The continuous increase in cervical cancer over the study period was probably due to the lack of adherence to the primary and secondary prevention opportunities offered by the Public Health Authorities.

Objective: The authors hypothesized that ventilation and hyperoxia may harm the cochlea vasculature in an experimental model of Congenital Diaphragmatic Hernia (CDH) performed in rabbits.

Methods: New Zealand rabbits underwent CDH creation at 25 days of gestation (term = 30 days). CDH was created in fetuses (n = 15) and compared with Controls (n = 15). Six groups were studied: Control, Control Ventilated 21% FiO₂ (Control 21%), Control Ventilated 100% FiO₂ (Control 100%), CDH, CDH Ventilated 21% FiO₂ (CDH 21%) and CDH Ventilated 100% FiO₂ (CDH 100%). Dynamic Compliance (CRS), dynamic Elastance (ERS), and dynamic Resistance (RRS) were measured. The cochleae were then removed, and the apical, middle, and basal slopes of the cochleae were evaluated. Samples were graded using a scoring system for the severity of bleeding: 0 (absent), 1 (mild), 2 (moderate), and 3 (severe). Statistical analysis was performed by contingence and ANOVA.

Results: There was no difference in the severity of cochlear bleeding between Controls and CDH without ventilation. Control 21% and 100% had average scores of 2 and 1.2 respectively; CDH 21% and 100% had average scores of 0.4 and 3.8 respectively; RR [CDH 100% / Control 100%] (95% CI) = 3.16 (p < 0.005).

Conclusions: The severity of bleeding was 3.16 times worse with 100% oxygenation in CDH. This information may be helpful for future therapeutic strategies for decreasing SNHL in CDH patients.

Background: Alpha-1-Antitrypsin (A1AT) is a protease inhibitor encoded by the SERPINA1 gene. A1AT serves as the primary natural inhibitor of Proteinase 3 (PR3), an enzyme found in neutrophils. PR3 is an antigenic target of Anti-Neutrophil Cytoplasmic Antibodies (ANCA). While numerous studies have established a connection between Single Nucleotide Polymorphisms (SNPs) in the SERPINA1 gene and ANCA-Associated Vasculitis (AAV), limited research has delved into the impact of these polymorphisms on the prognosis of these patients.

Objective: The present study's objective is to investigate mortality disparities among Brazilian AAV patients carrying SERPINA1 SNPs (rs7151526, rs28929454) compared to non-carriers. Additionally, the authors analyzed demographic, clinical, and serologic data in these two groups.

Methods: In this single-center prospective cohort study, the authors enrolled AAV patients who were monitored for a duration of up to three years. The identification of SNPs was conducted through RT-PCR. Survival analysis, including Kaplan-Meier survival curves, and Cox proportional regression analysis was subsequently performed to evaluate outcomes.

Results: The authors assessed 115 patients (65.2% with granulomatosis with polyangiitis, 17.4% with eosinophilic granulomatosis with polyangiitis, and 17.4% with microscopic polyangiitis). All patients were aged ≥ 18 years, with 37.4% being female, and 54.7% identified as White. The association between SERPINA1 SNPs proved to be the most significant factor linked to mortality in the cohort (HR = 6.2, 95% CI 1.4‒27.1, p = 0.015). SERPINA1 SNP carriers exhibited a lower mean survival [rs7151526: 57.4 (42.7‒72.2) years, p < 0.007; rs28929454: 54.9 (40.9‒68.9) years, p < 0.0001] than non-carriers (68.0 [67.2‒69.0] years).

Conclusion: SERPINA1 SNPs are associated with increased mortality in Brazilian AAV patients.

Background: Cell Migration Inducing Hyaluronidase 1 (CEMIP) is a protein that plays regulatory functions in a variety of cellular processes in many diseases. Nevertheless, its role and molecular mechanism in keloid hyperplasia are still elusive.

Methods: Expressions of CEMIP and Secreted Protein acidic and Rich in Cysteine (SPARC) were detected by qRT-PCR and western blot. CCK-8 assay, along with immunofluorescence staining, was applied for the assessment of cell proliferation. The capabilities of cells to migrate and invade were evaluated utilizing wound healing and Transwell, while Extracellular Matrix (ECM) deposition was measured by immunofluorescence and western blot. The interaction of CEMIP and SPARC was predicted by the Coexpedia and PPA-red databases and verified by co-IP. Western blot was adopted for the estimation of TGF-β/Smad pathway-related proteins.

Results: The data demonstrated that CEMIP expression was elevated in Keloid Fibroblasts (KF). CEMIP interference suppressed cell proliferative, migrative and invasive capabilities and ECM deposition in KF. Mechanistically, bioinformatics analysis revealed that CEMIP was co-expressed with SPARC and CEMIP protein could bind to SPARC. SPARC expression was reduced in CEMIP-silenced cells. SPARC overexpression counteracted the impacts of CEMIP silencing on cell proliferative, migrative and invasive capabilities and ECM deposition in KF. In addition, the expressions of TGF-β/Smad signaling-related proteins were decreased by CEMIP silencing via the inhibition of SPARC.

Conclusion: In summary, this study revealed that CEMIP modulated KF proliferation, migration, invasion and ECM deposition by TGF-β/Smad signaling through binding to SPARC.