Einstein-Sao Paulo最新文献

This paper examines the fitness industry as a by-product of neoliberal ideology, using "The New Way of the World: On Neoliberal Society" as a conceptual framework. Neoliberalism, as articulated by Dardot and Laval, extends beyond economic policy to shape governance and human behavior by embedding market-driven rationality into everyday life. The fitness industry, with its emphasis on individual responsibility for health and self-optimization, exemplifies core neoliberal tenets. It fosters the notion of the "entrepreneurial self," wherein success or failure is attributed to personal merit, thereby marginalizing collective health initiatives. The proliferation of fitness influencers further reinforces this paradigm, often disseminating misinformation and promoting unrealistic ideals of health and fitness. We argue that the commodification of health within the fitness industry aligns with neoliberalism's foundational principles: competitiveness, self-regulation, and the erosion of collective structures. In response, we advocate for a shift toward health frameworks rooted in inclusivity, equity, and shared responsibility, challenging the individualistic ethos embedded in current fitness discourse. Reimagining health policy through a lens of solidarity offers a pathway to dismantling neoliberal rationality and fostering a more democratic and equitable health system.

Objective: This study aimed to analyze the possible association between rs2814778, rs12075 ( ACKR1 gene), and rs4073 ( CXCL8 gene) single nucleotide variants and COVID-19 severity.

Methods: This cross-sectional study included 319 COVID-19 diagnosed patients at two hospitals in Paraná, Brazil between 2020 and 2021. Among them, 171 cases were classified as severe or critical and 148 were classified as non-severe. Genotyping was performed using polymerase chain reaction.

Results: We found an association between the rs2814778 variant of the ACKR1 gene and COVID-19 severity. The C allele in both the T/C and C/C genotypes was identified as a risk factor for severe COVID-19, independent of sex, age, smoking status, cardiovascular disease, diabetes, or obesity. No evidence of an association was observed for the other variants.

Conclusion: The presence of the C allele in the rs2814778 variant indicated an increased risk of severe or critical COVID-19 in the southern Brazilian population across all possible genotypes and genetic inheritance models.

Postoperative intestinal obstruction is most commonly associated with adhesions but may also arise from unusual causes such as surgical staples adhering to adjacent structures. Although the use of endoscopic staplers in laparoscopic appendectomy is effective and generally safe, it can occasionally result in complications, including intestinal obstruction. We report the case of a 41-year-old woman who underwent surgical treatment for pelvic endometriosis, including appendectomy, and subsequently developed intestinal obstruction caused by an internal hernia formed by the entrapment of a surgical staple from the appendiceal suture line in the jejunal loop. The patient recovered uneventfully after laparoscopic release and removal of staple, with complete resolution of symptoms. This case underscores the importance of vigilance during staple application and reinforces the need for continued improvements in stapling techniques to prevent similar complications.

Objective: To describe the clinical characteristics and perform a multi-step bioinformatics evaluation of the pathogenicity of NM_000251.3(MSH2):c.1894_1898del (p.Ile633Lysfs*9), an MSH2 germline variant detected in a family with Lynch syndrome.

Methods: Clinical evaluation included description of phenotype, family history, and immunohistochemical characterization of the proband's tumors. For pathogenicity classification according to the American College of Genetics and Genomics/Association for Molecular Pathology (ACMG/APA) criteria, bioinformatics analyses included: (i) literature and database screening, searching for the variant allele frequency, case reports, or functional studies, including ClinVar, VarSome, Ensembl, PubMed, EVA, and ABraOM; (ii) prediction of variant impacts using ExPASy Translate, Pfam, and Modeller 9.24; and, (iii) mechanisms that could mitigate the effects of the variant included alternative splicing and exon skipping (UniProt and GTex) and nonsense-mediated decay (NMD; MutationTaster2021).

Results: The proband, a 55-year-old female, was diagnosed with two metachronous colorectal cancers. Immunohistochemical analysis showed loss of expression ( MSH2 in one tumor, and MSH2 and MSH6 in the other). Seven deceased family members were diagnosed with cancer (four colorectal, one uterine, and two unspecified). This variant caused a stop codon in MSH2 exon 12 of 16. When translated, the protein loses 294 C-terminal residues, which may prompt protein degradation. If the mutated protein escapes degradation, dimerization and DNA-binding domains will be present. Therefore, negative dominance effects were possible. No isoforms ending in exon 12 have been identified in the literature or in RNA splicing databases. A stop codon before the last exon-exon boundary indicated the occurrence of NMD.

Conclusion: No evidence of protein-rescuing mechanisms was found, supporting the classification of this variant as likely pathogenic/pathogenic.

Objective: To evaluate whether pulmonary nodules adjacent to fissures, particularly perifissural nodules detected on chest computed tomography in patients with hepatocellular carcinoma, can be reliably classified as benign based on their radiological characteristics.

Methods: This retrospective cohort study included patients diagnosed with hepatocellular carcinoma (LI-RADS 5) between 2018 and 2022 at two reference hospitals. The patients underwent at least two follow-up chest computed tomography scans, with a minimum interval of 1 year, to identify at least one pulmonary nodule adjacent to the fissures. Statistical analyses were performed to assess the nodule classification, growth rates, and their association with metastatic progression.

Results: In total, 55 patients (mean age 62.4±7.7 years) and 92 nodules were analyzed. Perifissural nodules were classified as typical (n=55, 59.8%), atypical (n=17, 18.5%), or non-perifissural nodule (n=20, 21.7%). Only two nodules (2.2%) progressed to metastasis: one non-perifissural nodule and one atypical perifissural nodule with histopathological confirmation. Statistical analysis did not reveal a significant association between perifissural nodule classification and metastatic progression (p=0.155); however, nodules that progressed to metastasis exhibited significantly higher annual growth rates (p<0.001).

Conclusion: Most perifissural nodules in patients with hepatocellular carcinoma showed radiological stability and did not progress to metastasis, indicating a low probability of malignancy. However, given the limited sample size and the number of metastatic events, these findings should be interpreted with caution. Typical perifissural nodules may be considered low risk, whereas atypical perifissural nodule and non-perifissural nodules require closer follow-up. Further studies are required to confirm these preliminary findings.

Objective: To compare the predictive abilities of medical professionals and the Epimed Monitor Performance© (EMP) software for intensive care unit length of stay and to assess EMP software effectiveness in identifying patients at risk of prolonged stays.

Methods: This prospective multicenter observational study was conducted in three Brazilian intensive care units, enrolling adult patients admitted between August and December 2019. Data were collected using the Epimed Monitor System©. Both physicians and the EMP system predicted intensive care unit length of stay.

Results: A total of 555 patients were included. The median age was 63.3 years (IQR=48.3-74.3), and 58.5% were males. Comorbidities were present in 72%, with 37.2% having cancer. The median intensive care unit length of stay was 3 days (IQR=2-6). Observed length of stay showed a correlation of 0.34 (p<0.001) with physician prediction and 0.36 (p<0.001) with EMP. Categorizing the length of stay improved the predictive performance by 60% for both methods. EMP demonstrated good accuracy in identifying patients at risk of prolonged stay (AUC: 0.76; 95%CI=0.70-0.81).

Conclusion: Absolute prediction of intensive care unit length of stay remains challenging, but period categorization is a viable alternative. EMP aids in identifying patients at risk of prolonged stays and thus can complement clinical judgment. Our findings highlight the value of integrating predictive tools with medical expertise to enhance intensive care unit planning, decision making, and resource allocation.

This study reports the decade of in-house synthesis of 68Galabeled radiopharmaceuticals ([68Ga]Ga-DOTATATE and [68Ga] Ga-PSMA-11) for PET imaging under GMP at a tertiary hospital, enabling over 7,500 PET scans. Novel tracers, [68Ga]Ga-DOTAUBI and [68Ga]Ga-FAPi-46, were successfully introduced and synthesized with high yield and purity, and were used to obtain high-quality clinical images.

Atherosclerosis remains the leading cause of mortality worldwide. The characterization of atherosclerotic lesions reveals that they represent a chronic and progressive inflammatory condition affecting the arterial wall. Despite extensive investigations, its complex pathogenesis remains incompletely understood. Single-cell RNA sequencing (scRNA-seq) has recently emerged as a transformative tool, enabling detailed analysis of the cellular composition within atherosclerotic plaques. This approach provides a more comprehensive and nuanced understanding of plaque biology. This review provides a concise overview of current scRNA-seq methodologies and highlights their applications in atherosclerosis studies to elucidate the mechanisms underlying its onset, progression, and potential therapeutic targets.