Clinics最新文献

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.

Introduction: Short Bowel Syndrome (SBS) is a rare gastrointestinal disorder associated with Intestinal Failure (SBS-IF) that leads to morbidity, mortality, and a burden on healthcare costs. Intestine Transplantation (IT) is a treatment option for patients with SBS-IF as it replaces the missing or diseased intestine and offers the potential for return to normal activities and intestinal function. This study aims to describe the clinical course and demographical and clinical characteristics of subjects with SBS-IF who underwent IT in Brazil.

Methods: This retrospective observational study included all SBS-IF patients who underwent IT in two reference centers in Brazil from April 2011 to December 2021.

Results: A total of 7 young male participants were included in the study. The most frequent underlying condition was surgical complications, followed by intestinal volvulus and incisional hernia. The most frequent indication for IT was a hepatic disease associated with total Parenteral Nutrition (PN). The main type of IT performed was intestine only. The median time from underlying condition to IT was 67.3 (16.5‒88.5) months. The mean (SD) number of yearly hospitalizations per patient was 0.5 (0.3). The most common reason for hospitalization was PN-related complications. Sixty exams were performed in-hospital and 53 in the outpatient setting.

Conclusion: The findings of this study may be helpful to understand better the journey of patients with SBS-IF to IT in Brazil, providing real-world evidence to develop health policy guidelines and improve the quality of life of these patients.

Background: According to growing evidence, sleep disruption harms biological processes and circadian homeostasis. Diurnal motor symptom volatility in Parkinson's Disease (PD) has been extensively studied. Few studies examined seasonal variability in PD symptoms, some showing it and others not.

Objective: To investigate whether PD patients' deaths follow a rhythmic pattern due to circadian rhythm alterations.

Methods: This study used only unidentified patient databases. People with PD, ICD10 code G20, in at least one death certificate field were selected. The Continuous Wavelet Transform and Fourier Transform were checked for oscillation and its duration.

Results: The 18-year analysis found 43,072 PD deaths. The Continuous Wavelet transform revealed a 351.87-day annual component (p < 0.05). Winter in the southern hemisphere saw more deaths, mainly in July. The Continuous Wavelet transform identified a significant daily component (p < 0.05) of 22.81 hours. Fatalities peaked around 9 a.m. Pneumonia is the leading cause of death in PD, and women and men have the same rhythm pattern.

Conclusion: Parkinson's disease mortality in Brazil follows a pattern. Using over 40.000 death certificates from 18 years, the authors found that Parkinson's patient fatalities rise in winter and peak in July at about 9 a.m. Sunlight reduction increases mortality risk in the long term. Low sunshine lowers temperatures, increasing short-term death risk. This is crucial because it prioritizes the sun, seasons, and circadian rhythm over low temperatures.

Objective: To evaluate the evolution of Psychiatric Disorders (PD) and weight loss at different postoperative intervals up to 9 years after Metabolic and Bariatric Surgery (MBS).

Methods: This is a nine-year longitudinal study conducted at a single university-based bariatric center in Brazil. The Generalized Estimating Equation (GEE) and multiple linear regression models were used to evaluate the proportion of lifetime PD according to TPS, and its relationship with weight. The Structured Clinical Interview for DSM-5 assessed the PD and the percentage of Excess Lost Weight (%EWL) for weight changes. The study included 142 participants who had undergone MBS, mostly women (82 %), mean age of 52 years.

Results: Depression and anxiety disorders were the most common PD. Regardless of the time elapsed since MBS, there was an increase of 32 % in lifetime mood disorders, bipolar disorders, and eating disorders. The average EWL for Time Post-Surgery (TPS) ≤ 24 months was 69 % and remained consistent until 72 months; after was 57 % and 58 % for ≤ 72 and 96 months, respectively. There was not a significant association between %EWL and PD when controlling for sex, age, and time post-surgery.

Conclusion: Psychiatric disorders can be associated and remain prevalent, regardless of time post-surgery; however, this does not significantly impact weight losss maintenance. It is recommended that individuals who have undergone MBS be monitored and supported over an extended period to address psychiatric comorbidities.

Background and purpose: The extent to which the effects of BMI on cholelithiasis are mediated by metabolic factors (including blood pressure, blood lipids, body mass, and fasting blood glucose) is unclear. Therefore, in this study, the authors used genetic evidence to test the effects of these characteristics.

Methods: Summary-level data for exposures and main outcomes were extracted from GWAS consortia. The authors used a two-step, two-sample Multivariable Mendelian Randomization (MVMR) analysis to illustrate the effect of BMI on cholelithiasis and a stepwise test method to quantify the possible mediating effects of cardiometabolic factors on cholelithiasis.

Results: For each one-unit logarithmic increase in body mass index, the risk of cholelithiasis increased by 98 % (Odds Ratio [OR = 1.98], 95 % CI: 1.73 %‒2.28 %). After mediation analysis, the authors found that high-density lipoprotein and triglycerides were the main mediating factors, while the mediating effects of other metabolic factors were not significant. The total effect ratios of HDL and TG on cholelithiasis were 7.3 % (95 % CI: 8.51 %‒12.85 %) and 3.5 % (95 % CI: 3.59 %‒6.50 %), respectively. HDL and TG played a significant role in regulating cholelithiasis, but there was no evidence to show the regulatory effect of LDL on cholelithiasis. The total effects of BMI and triglycerides on cholelithiasis were 10.7 % and 5.0 %, respectively.

Conclusion: The authors found that among the metabolic factors evaluated, the decrease of HDL and the increase of TG mediated a high proportion of the effect of BMI on cholelithiasis. Therefore, intervention with these factors may reduce the increased risk of cholelithiasis in patients with high BMI.

Objective: To explore the changes of Pigment Epithelium-Derived Factor (PEDF), Matrix Metalloproteinase-2 (MMP-2), and Transforming Growth Factor-β2 (TGF-β2) levels in the aqueous humor of cataract patients and their correlation with disease severity.

Methods: 93 cataract patients and 56 healthy subjects were study objects. PEDF, MMP-2, and TGF-β2 levels of aqueous humor were compared, and the correlation between each index and Lens Opacity Classification System (LOCS) III classification was analyzed. ROC curve was used to analyze the evaluation value of the combined detection of each index on cataract development, and logistic regression to analyze the influence of the changes of each index on cataract development.

Results: PEDF levels were lower and MMP-2 and TGF-β2 levels were higher in the aqueous humor of cataract patients than in healthy subjects. PEDF levels in the aqueous humor were negatively correlated with LOCS III classification, while MMP-2 and TGF-β2 levels were positively correlated with LOCS III classification. The AUC value of combined detection was higher than that of PEDF, MMP-2, and TGF-β2 in the aqueous humor alone. MMP-2 ≥ 15.13 pg/mL, TGF-β2 ≥ 385.91 pg/mL and PEDF < 198.85 ng/mL were risk factors for cataract development.

Conclusion: The changes in PEDF, MMP-2, and TGF-β2 levels in the aqueous humor of cataract patients are related to LOCS III classification. The combined detection is valuable in evaluating cataract development.

Background: Chest wall tumors are uncommon. The surgical objective is local disease control and the relief of symptoms. Due to the heterogeneity of cases, the great variety of reconstructions, size of resection, and clinical and surgical outcomes are still uncertain.

Methods: Patients were submitted to sternectomies for tumors between 1997 and 2019. Oncological, and surgical characteristics were taken into consideration. The outcomes were related to the size of resection and classified into local and systemic complications. The authors used univariate and multivariate analyses to determine predictors of complications. Survival analysis and Kaplan-Meier curves were obtained.

Results: Thirty resections were performed due to metastatic disease. Partial sternectomy was accomplished in 48.8 %, followed by subtotal in 40 %. Primary closure using Pectoralis major was performed in 48.8 %, and Latissimus dorsi in 35.5 %. Polypropylene mesh was used in 86.6 % of reconstructions. The prosthesis removal was necessary in 6.66 %. Respiratory failure was evidenced in 6.66 %. The resection area was a predictor of local and systemic complications (p = 0.0029; p = 0.0004 respectively) in univariate analysis. However, the size of resection was the only predictor of systemic complications regarding multivariate analysis (p = 0.014, 95 % CI 1.00‒1.07).

Conclusion: The size of the resection was related to systemic complications, and the mesh reconstruction resulted in a low percentage of prosthesis removal and respiratory failure. This suggests a high resistance to local issues and a low respiratory failure rate.

Objective: Gender differences may interfere with the association between Negative Life Events (NLEs) and prevalent/incident depression. This study evaluated the effect of gender in this association using data from the ELSA-Brazil cohort.

Methods: The authors analyzed 15,088 participants (mean age, 52.1 (9.1), 54.4 % women). NLEs (robbery, hospitalization, death of a close relative, financial hardship, and rupture of a love relationship) were accessed at baseline. Depression was assessed at baseline and follow-ups. The authors built logistic (Odds Ratio [OR], 95 % Confidence Interval [95 % CI]) and Poisson regression models (Relative Risk [RR], [95 % CI]) to evaluate this association.

Results: Women reported more NLEs compared to men. The authors found associations between NLEs and prevalent depression: for men, hospitalization (OR = 1.83; 95 % CI 1.16‒2.91), financial hardship (OR = 2.42; 95 % CI 1.69‒3.49), rupture of a love relationship (OR = 2.54; 95 % CI 1.50‒4.29), and any NLE (OR = 2.30; 95 % CI 1.59‒3.35); and for women, robbery (OR = 1.81; 95 % CI 1.31‒2.49), hospitalization (OR = 1.46; 95 % CI 1.11‒1.92), financial hardship (OR = 1.76; 95 % CI 1.43‒2.17), rupture of a love relationship (OR = 1.66; 95 % CI 1.20‒2.32), and any NLE (OR = 1.65; 95 % CI 1.34‒2.04). For incident depression only financial hardship (RR = 2.09; 95 % CI 1.55‒2.83) was associated with depression in men, while, for women, robbery (RR = 1.54; 95 % CI 1.16‒2.04); hospitalization (RR = 1.36; 95 % CI 1.07‒1.74), financial hardship (RR = 1.37; 95 % CI 1.14‒1.65), and any NLE (RR = 1.25; 95 % CI 1.04‒1.49) were associated with incident depression. No association was found between the death of a close relative and prevalent/incident depression.

Conclusion: NLEs were associated with depression in men and women, with a higher impact in the latter.