Einstein-Sao Paulo最新文献

Objective: This study tests a suitable model for training robot-assisted peripheral vascular interventions and examines the learning curves of endovascular surgeons with different levels of previous experience and main focus of work, analyzing procedure time, fluoroscopy time, use of contrast, and radiation emission.

Methods: Sixteen endovascular surgeons with different previous experience and training performed nine manual and 18 robotic angioplasties using the CorPath GRX platform on a 3D-printed life-size immersed infragenicular arterial phantom.

Results: All participants considered the model reliable. When analyzing manual angioplasty outcomes, the juniors took significantly longer to perform angioplasties than the seniors (p=0.044). Among the seniors, interventionists were faster only on the first angioplasty (p=0.046). Analysis of the robotic angioplasty results showed that only one junior failed to cannulate one of the target arteries once. The total duration, fluoroscopy time, and radiation emission did not differ between juniors and seniors (p=0.095, p=0.60, and p=0.64, respectively). In addition, the learning curves for the maximum benefit required two attempts for procedure duration, one for fluoroscopy time, and three for radiation emission. There were no significant differences between senior vascular surgeons and interventionists. Among juniors, residents had a significantly lower procedure duration (p=0.042) and radiation emission (p=0.046) only for the first angioplasty.

Conclusion: The learning curves for robotic peripheral arterial interventions were short, with a plateau for the procedure and fluoroscopy times and radiation emission after the third attempt. We observed no differences in the learning curves in relation to previous experience or training.

Objective: The efficacy of icodextrin versus glucose patients undergoing peritoneal dialysis remains unclear. The study was designed to compare the effects of once-daily long-dwell icodextrin versus glucose on markers of hypervolemia and survival among patients with kidney failure undergoing an unplanned initiation of automated peritoneal dialysis.

Methods: This was a randomized, non-blinded, and prospective controlled study. Prevalent and stable patients undergoing automated peritoneal dialysis with a recent peritoneal equilibration test showing a dialysate/plasma creatinine of >0.50 were randomized to receive either 7.5% icodextrin or 2.5% glucose solution. Patients were evaluated at baseline (one month after the start of peritoneal dialysis), 3 months, and 6 months after inclusion. The peritoneal dialysis solution was used for at least 3 months, with a follow-up period of 24 months.

Results: Thirty patients were enrolled. There were no baseline differences between the groups. During the study period, patients in the Icodextrin Group showed improvements in the phase angle and ultrafiltration, whereas there were no changes in the Glucose Group. Additionally, extracellular water was significantly lower in the Icodextrin Group at the end of the study than at baseline. No statistical differences between the two groups were observed in urine volume, ultrafiltration, extracellular water, phase angle, renal creatinine clearance, use of diuretics and antihypertensives, or blood pressure. During the 24-month follow-up, the number of events related to overall mortality was seven (Icodextrin Group, n=4; Glucose Group, n=3), with no difference between the groups for this outcome or technique survival.

Conclusion: Icodextrin significantly improved ultrafiltration, extracellular water, and phase angle at the end of the study compared to baseline in patients on the urgent start of automated peritoneal dialysis.

Registry of clinical trials: (www.ctri.nic.in) under the number RBR-97z4wh6.

Objective: This study examined the correlation between immunodominance of the major egg antigen Sm-p40234-246, a robust Th1/Th17 anti-egg CD4 T-cell response, and severe liver immunopathology in experimental murine schistosomiasis. It serves as a platform to analyze how varying degrees of immunodominance affect CD4+ T cell modulation and disease outcomes.

Methods: We used a murine model of schistosomiasis to investigate the effects of immunodominance. Infected mice were divided into two groups: one treated with a combination of epitopes targeting immunodominance of the major egg antigen Sm-p40 and the other with a mock mixture of non-immunogenic epitopes. Liver granuloma area, a hallmark of schistosomiasis pathology, was quantified using histological and morphometric analyses. The average granuloma areas between the treated and untreated groups were compared using one-way ANOVA with Tukey's multiple comparison test. Additionally, we isolated CD4+ T cells from mesenteric lymph nodes, stimulated them with specific egg antigens, and collected purified supernatants to assess their signature cytokine secretion profiles for each treatment group.

Results: Results showed that strong immunodominance of a single egg epitope undermines effective CD4+ T-cell modulation, promoting a strongly polarized Th1/Th17 pathogenic response. Conversely, neutralizing this immunodominance produces the opposite restorative effect.

Conclusion: Immunodominance is an important pathogenic component that influences CD4+ T cell modulation in experimental murine schistosomiasis. Moreover, immunodominance can be used to treat these and other important CD4+ T cell-mediated diseases.

The development of alloantibodies or autoantibodies is a complication observed in sickle cell disease. Autoimmunization occurs in 7.6-12% of chronically or intermittently transfused patients with sickle cell disease; however, the clinical implications of autoAbs are unclear. Few studies have focused on pediatric sickle cell disease and autoimmune hemolytic anemia. Herein, we present the coexistence of sickle cell disease and autoimmune hemolytic anemia in two adolescent patients, focusing on their pathophysiology, diagnosis, clinical management, and outcomes.

Hematopoiesis is characterized by the differentiation and maturation of multipotent stem cells into hematopoietic cells. Common lymphoid progenitor cells differentiate into B and T lymphocytes; natural killer cells can also originate from common lymphoid progenitors. In recent years, a cellular subtype of lymphocytes, called innate lymphocytes, has been described. Innate lymphoid cells (ILCs) play an important effector and regulatory role in innate immunity, and similar to natural killer cells, depend on the γc and Id2 chains for their development. These cells are divided into three main subtypes according to their characteristics, namely type 1 innate lymphocytes (ILC1), type 2 (ILC2), and type 3 (ILC3); the production of cytokines and transcription factors is essential for this classification. Furthermore, these cells have high plasticity, which allows them to change their phenotype in response to the environment. ILCs have recently been characterized further and emerged as a family of effectors and regulators of innate immune responses. Uncontrolled activation of these cells can contribute to inflammatory, autoimmune diseases and cancer. The current review aimed to describe their main characteristics, immunophenotypes, and plasticity, and based on the existing literature, suggested a phenotypic analysis to differentiate innate lymphocytes from natural killer cells, and across the subsets.

Objective: MicroRNAs are small non-coding RNAs that are abundantly expressed in various biofluids, making them promising candidates for cancer biomarkers. This review aims to present current evidence on the use of miRNA as biomarkers for the non-invasive diagnosis of bladder cancer.

Methods: A systematic literature review, using the Medline database, was performed in July 2022 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All articles were required to satisfy the risk-of-bias assessment using the Joanna Briggs Institute Critical Assessment Tools. Data were collected based on miRNA expression, sample type, expression profiles, and accuracy.

Results: The initial search retrieved 437 studies, 21 of which were included in the final analysis. Most studies on miRNA expression in human fluids used urine samples for analysis.

Conclusion: There is a trend to cluster the expressed miRNAs to build diagnostic panels or use them in association with other diagnostic methods to achieve reasonable accuracy.Prospero database registration: (https://www.crd.york.ac.uk/prospero/) under ID CRD42022351686.

Agents that inhibit programmed cell death (IPD-1) in T lymphocytes are indicated for patients with advanced cancer. However, some individuals may develop endocrinological conditions, such as diabetes, thyroid dysfunction, and lipodystrophy, after treatment. This systematic review and case report of IPD-1 lipodystrophies describes a patient who received nivolumab treatment for advanced clear cell renal carcinoma and subsequently developed diabetes as well as facial and body lipodystrophy. The patient complained of social distress due to her facial appearance. We treated the facial lipodystrophy with autologous fat grafting, which proved to be effective for more than three years. This study showed the efficacy of IPD-1 lipodystrophy treatment with long-term follow-up.

A 42-year-old female patient with a surgical history of iliac venous angioplasty with stenting developed dyspnea on exertion 9 months later. Chest computed tomography angiography revealed a fractured vascular stent in the right cardiac chamber. Doppler echocardiography confirmed that the stent was anchored by the tricuspid valve, causing mild obstruction of the right ventricular filling. The patient underwent robot-assisted cardiac surgery with stent removal, annuloplasty under general anesthesia, and cardiopulmonary bypass via an axillary incision. No sternotomy, cardioplegia, or aortic clamping was required. The right atrium was opened, and no surgical or anesthetic complications occurred. The patient was extubated in the operating room, with no requirement for vasoactive drugs after surgery. She was discharged on the fifth postoperative day in a good general condition, eupneic, and without lower-limb venous symptoms. Re-do iliac venous angioplasty was not necessary.

Radical treatment for prostate cancer is associated with significant morbidity. Percutaneous image-guided irreversible electroporation is a non-thermal ablative technique that has emerged as a valuable option. This study describes the case of a patient with prostate cancer who was successfully treated using irreversible electroporation. We report the case of a 72-year-old male patient who presented with elevated PSA (4.0ng/mL) during routine testing. Multiparametric magnetic resonance imaging of the prostate revealed a 0.8 cm lesion in the posterolateral aspect of the right midgland with marked hypointensity on ADC (ACR PI-RADS 4). The transperineal prostate revealed acinar adenocarcinoma (Gleason Score 3+3=6; International Society of Urological Pathology=1). Serum PSA levels reduced to 1.04ng/mL 32 days after the procedure and remained within normal limits (1.26ng/mL) after 349 days. Follow-up imaging performed 90 days later with prostate-specific membrane antigen PET/MRI showed size reduction, retraction, and diffuse hypointensity in the peripheral zone of the right prostate lobe, with no increase in prostate-specific membrane antigen uptake. Magnetic resonance imaging found no suspicious lesions 367 days after irreversible electroporation. At the final clinical follow-up at 390 days, the patient was asymptomatic. Our findings illustrate the potential of irreversible electroporation as a possible alternative treatment for prostate cancer.