Effect of Moringa olifera leaves on growth and gut microbiota of Nile tilapia (Oreochromis niloticus) / Efeito das folhas da Moringa olifera no crescimento e na microbiota intestinal da tilápia do Nilo (Oreochromis niloticus)

Abstract The study was conducted to evaluate the effect of Moringa olifera on the growth and gut health of Tilapia (Oreochromis niloticus). The feed having 30% crude protein was prepared as an experimental diet with 4%, 8% and 10% M. olifera leaf supplementation, respectively. The control diet was devoid of M. olifera leaves. The 10 weeks feeding trial was carried out on 60 fish in aquaria. Fish was fed @ 3% of body weight twice a day. Diet with the high level of inclusion of M. olifera leaves significantly increased the growth rate, Survival Rate (SR), Specific Growth Rate (SGR) and Feed Conversion Efficiency (FCE) in all treatment groups compared to the control group. Similarly, Feed Conversion Ratio (FCR) gradually decreased and found highly-significant. To check the gut health of the Tilapia, random samples were selected and dissected. Nutrient agar was used as culture media to check the growth of bacteria. Pour Plate Method was used for viable colonies count by colony counter. Through staining method, the different bacteria such as Escherichia coli, Salmonella, Shigella and Pseudomonas aeruginosa were identify abundantly in the intestine of control diet fish but less number present in treatment diets groups. These results showed that M. olifera leaves up to 10% of dietary protein can be used for Nile tilapia for significant growth and healthy gut microbiota of fish.

Resumo O estudo foi conduzido para avaliar o efeito da Moringa olifera no crescimento e saúde intestinal da tilápia (Oreochromis niloticus). A ração com 30% de proteína bruta foi preparada como dieta experimental com 4%, 8% e 10% de suplementação de folhas de M. olifera, respectivamente. A dieta controle foi desprovida de folhas de M. olifera. O ensaio de alimentação de 10 semanas foi realizado em 60 peixes em aquários. O peixe pesava 3% do peso corporal duas vezes ao dia. A dieta com alto nível de inclusão de folhas de M. olifera aumentou significativamente a taxa de crescimento, taxa de sobrevivência (SR), taxa de crescimento de sobrevivência (SGR) e eficiência de conversão alimentar (FCE) em todos os grupos de tratamento em comparação com o grupo de controle. Da mesma forma, a taxa de conversão de alimentação (FCR) diminuiu gradualmente e foi considerada altamente significativa. Para verificar a saúde intestinal da tilápia, amostras aleatórias foram selecionadas e dissecadas. O ágar nutriente foi usado como meio de cultura para verificar o crescimento das bactérias. O método da placa de Verter foi usado para a contagem de colônias viáveis ​​por contador de colônias. Através do método de coloração, diferentes como Escherichia coli, Salmonella, Shigella e Pseudomonas aeruginosa foram identificados abundantemente no intestino de peixes da dieta controle, mas em menor número nos grupos de dieta de tratamento. Esses resultados mostraram que M. olifera deixa até 10% da proteína dietética e pode ser usado para tilápia do Nilo para um crescimento significativo e microbiota intestinal saudável de peixes.

Growth performance and survivability of the Asian seabass Lates calcarifer (Bloch, 1790) reared under hyper-saline, hypo-saline and freshwater environments in a closed aquaculture system / Desempenho de crescimento e sobrevivência do robalo asiático Lates calcarifer (Bloch, 1790) criado em ambientes hipersalinos, hipossalinos e de água doce em um sistema de aquicultura fechado

Salinity is one of the most critical environmental parameters regarding fish physiology, modifying food intake and growth performance in many fish species. The present study has investigated the effects of different salinity levels on growth performance, feeding and survival of Asian seabass Lates calcarifer juveniles. Asian seabass juveniles were reared at 0 (T1), 5 (T2), 22 (T3), 36 (T4), and 42 (T5) ppt salinity. Approximately eight hundred thirty fish individuals with an average weight of 1.24±0.52 g were randomly distributed (166 fish/Tank) in 5 concrete tanks (each tank 30×6×4 ft, volume 19,122 L) for forty days. Juveniles were initially fed 42% crude protein-containing diets at a rate of 6% of their body weight per day. The results showed that salinity level had a significant effect on the weight gain (WG), average daily weight gain (ADWG), specific growth rate (SGR), feed conversion ratio (FCR), survival rate (SR), total biomass and health indices (p<0.05). The highest WG (39.11±1.49 g), ADWG (1.00±0.12 g), SGR (8.74±0.03% d-1) and lowest FCR (0.96±0.20) were observed with T3 treatment, which was significantly higher compared to other treatment groups (p<0.05). Among the health indices, the highest hepatosomatic index and viscerosomatic index were found with T3 treatment, significantly higher than the other groups (p<0.05). No significant differences were found among the treatments in terms of survival rate (p>0.05), but the maximum survival rate (98.89±0.0%) was observed in the T3 and T2 treatments. The maximum level of crude proteins (19.99±1.4%) was found in the whole-body biochemical composition of Asian seabass juveniles in the T3 treatment group. The second-order polynomial regression showed that 20 ppt salinity is optimum for the best growth of Asian seabass. Thus, the present study recommends 20 to 36 ppt salinity for the commercial farming of Asian seabass under a closed aquaculture system.

A salinidade é um dos parâmetros ambientais mais críticos em relação à fisiologia dos peixes, modificando a ingestão de alimentos e o desempenho de crescimento em muitas espécies. O presente estudo investigou os efeitos de diferentes níveis de salinidade no desempenho de crescimento, alimentação e sobrevivência de jovens espécies de robalos asiáticos Lates calcarifer, as quais foram criadas sob salinidade 0 (T1), 5 (T2), 22 (T3), 36 (T4) e 42 (T5) ppt. Aproximadamente 830 indivíduos de peixes com peso médio de 1,24 ± 0,52 g foram distribuídos aleatoriamente (166 peixes / tanque) em cinco tanques de concreto (cada tanque tinha 30 × 6 × 4 pés (9,1 x 1,8 x 1,2 metros), com volume de 19,12 litros) por 40 dias. Os peixes foram inicialmente alimentados com uma dieta contendo 42% de proteína bruta a uma taxa de 6% do seu peso corporal por dia. Os resultados mostraram que o nível de salinidade teve um efeito significativo no ganho de peso (GP), ganho de peso médio diário (GPMD), taxa de crescimento específico (TCE), taxa de conversão alimentar (TCA), taxa de sobrevivência (TS), biomassa total e índices de saúde (p < 0,05). O maior GP (39,11 ± 1,49 g), GPMD (1,00 ± 0,12 g), TCE (8,74 ± 0,03% d-1) e o menor TCA (0,96 ± 0,20) foram observados com o tratamento T3, que foi significativamente superior em comparação com os outros tratamentos (p < 0,05). Entre os índices de saúde, os maiores índices hepatossomáticos e viscerossomáticos foram encontrados no tratamento T3, significativamente superior do que os demais grupos (p < 0,05). Não foram encontradas diferenças significativas entre os tratamentos quanto à TS (p > 0,05), mas a TS máxima (98,89 ± 0,0%) foi observada nos tratamentos T3 e T2. O nível máximo de proteína bruta (19,99 ± 1,4%) foi encontrado na composição bioquímica dos corpos dos jovens robalos asiáticos no grupo T3. A regressão polinomial de segunda ordem mostrou que a salinidade de 20 ppt é ótima para o melhor crescimento do robalo asiático. Assim, o presente estudo recomenda salinidade de 20 a 36 ppt para o cultivo comercial de robalo asiático em sistema de aquicultura fechado.

A new approach to mark termites (Cornitermes cumulans (Kollar) Blattodea: Isoptera) for laboratory bioassays / Uma nova abordagem de marcador tópico em cupins para bioensaios de laboratório

Abstract Behavioral lab bioassays involving termites must be promptly performed to allow intended observations prior to death from dissecation, typical of these soft-bodied insects. To this end, topic markers have been proposed as an alternative to histological stains which, while not always toxic are inevitably lengthy to apply. Among recommended topic markers, gouache is easy to apply, dries out quickly, but it is known affect termites in the long run, being suitable only to short-term bioassays. Its alternative, colored glue, is also easy to apply, but it takes long to dry and it is too dense and heavy, being thus prone to affect termite walking patterns. Here we tested a mix of gouache and colored glue aiming to combine the qualities of both into a suitable topical marker for Cornitermes cumulans termites. Similar patterns of survival presented by marked and unmarked termites ruled out concerns about toxicity of this mixture. Such results were consistent across distinct group densities evidencing that the mixture does not interfere with, nor it is affected by, crowding effects. Because crowding regulates interindividual interactions and these underlie most behaviors, the mixture can be thought to be suitable to behavioral studies. We argue that this 1:2 glue:gouache mixture is an excellent alternative to mark termites for lab bioassays. Being atoxic, cheap, easy to apply, and non-invasive, this mixture may happen to be useful not only for termites but also in bioassaying other similarly soft-bodied insects.

Resumo Bioensaios comportamentais em laboratório com cupins devem ser realizados rapidamente a fim de garantir observações antes da morte por dissecação, típico desses insetos de corpo mole. Para este fim, marcadores tópicos têm sido propostos como uma alternativa para marcadores histológicos que, embora nem sempre tóxico, possuem uma aplicação demorada. Entre os marcadores tópicos recomendados, tinta guache é de fácil aplicação, rápida secagem, porém afeta os cupins em bioensaios longos, sendo adequado apenas para bioensaios curtos. Sua alternativa, cola colorida, também é de fácil aplicação mas leva muito tempo para secar e é muito denso e pesado, afetando os padrões de caminhamento dos cupins. No presente estudo, nós testamos uma mistura de tinta guache e cola colorida objetivando combinar as qualidades de ambos os marcadores tópicos em um marcador tópico adequado para Cornitermes cumulans. Padrões similares de sobrevivência entre cupins marcados e controle indicam a ausência de toxicidade na mistura de tinta guache e cola colorida. Tais resultados são consistentes em grupos de densidades distintas, o que comprova que a mistura não interfere, nem sofre efeitos de aglomeração. Uma vez que a aglomeração regula as interações inter-individuais e afetam a maioria dos comportamentos, a mistura pode ser adequada para estudos comportamentais. Nós argumentamos que a mistura de tinta guache e cola (1:2) é uma excelente alternativa como marcador tópico em cupins para bioensaios em laboratório. Sendo atóxico, barato, fácil de aplicar e não invasivo, esta mistura pode ser útil não só para os cupins, mas também em bioensaios com outros insetos de corpo mole.

Determinants of time to viral clearance among SARS-CoV-2 infected individuals at Millennium COVID-19 care center in Ethiopia: A prospective observational study

Background: Understanding the COVID-19 disease course in terms of viral shedding is important to assist in providing a tailored isolation and treatment practice. Therefore, the current study aimed to estimate time to viral clearance and identify determinants among SARS-CoV-2 infected individuals admitted to Millennium COVID-19 Care Center in Ethiopia. Methods: A Prospective observational study was conducted among 360 randomly selected SARS-CoV-2 infected individuals who were on follow up from 2nd June to 5th July 2020. Kaplan Meier plots, median survival times, and Log-rank test were used to describe the data and compare survival distribution between groups. Association between time to viral clearance and determinants was assessed using the Cox proportional hazard survival model, where hazard ratio, P-value, and 95% CI for hazard ratio were used for testing significance Results: The Median time to viral clearance was 16 days. The log-rank test shows that having moderate and severe disease, one or more symptoms at presentation, and presenting with respiratory and constitutional symptoms seems to extend the time needed to achieve viral clearance. The Final Cox regression result shows that the rate of achieving viral clearance among symptomatic patients was 44% lower than patients who were asymptomatic (AHR=0.560, 95% CI=0.322-0.975, p-value=0.040). Conclusions: Presence of symptoms was found to be associated with delayed viral clearance implying that symptomatic patients are more likely to be infectious and therefore, attention should be paid to the practices regarding isolation and treatment of COVID-19 patients.

Infectious interface keratitis after Descemet membrane endothelial keratoplasty / Ceratite infecciosa de interface após ceratoplastia endotelial da membrana de Descemet

ABSTRACT Purpose: To evaluate the clinical course and management of infectious interface keratitis after Descemet membrane endothelial keratoplasty. Methods: A total of 352 cases that had undergone Descemet membrane endothelial keratoplasty were retrospectively reviewed. Patients with infectious interface keratitis during follow-up were analyzed. The microbiological analyses, time to infection onset, clinical findings, follow-up duration, treatment, and post-treatment corrected distance visual acuity were recorded. Results: IIK was detected in eight eyes of eight cases. Three fungal and three bacterial pathogens were identified in all cases. All patients received medical treatment according to culture sensitivity. Antifungal treatment was initiated in two cases with no growth on culture, with a preliminary diagnosis of fungal interface keratitis. Intrastromal antifungal injections were performed in all patients with fungal infections. The median time to infection onset was 164 days (range: 2-282 days). The postoperative infectious interface keratitis developed in the early period in two cases. The mean follow-up duration was 13.4 ± 6.2 months (range: 6-26 months). Re-Descemet membrane endothelial keratoplasty was performed in two patients (25%) and therapeutic penetrating keratoplasty in four patients (50%) who did not recover with medical treatment. The final corrected distance visual acuity was 20/40 or better in five patients (62.5%). Conclusion: The diagnosis and treatment of infectious interface keratitis following Descemet membrane endothelial keratoplasty are challenging. Early surgical intervention should be preferred in the absence of response to medical treatment. Better graft survival and visual acuity can be achieved with therapeutic penetrating keratoplasty and re-Descemet membrane endothelial keratoplasty in patients with infectious interface keratitis.

RESUMO Objetivo: Avaliar o curso clínico e o manejo da ceratite infecciosa de interface após ceratoplastia endotelial da membrana de Descemet. Métodos: Um total de 352 casos submetidos a ceratoplastia endotelial da membrana de Descemet foram revisados retrospectivamente. Pacientes com ceratite infecciosa de interface foram analisados durante o acompanhamento. As análises microbiológicas, o tempo até o início da infecção, os achados clínicos, a duração do acompanhamento, o tratamento e a acuidade visual para longe corrigida pós-tratamento foram registrados. Resultados: Ceratite infecciosa de interface foi detectada em 8 olhos de 8 casos. Três patógenos fúngicos e três bacterianos foram identificados em todos os casos e receberam tratamento médico de acordo com a sensibilidade da cultura. O tratamento antifúngico foi iniciado em dois casos sem crescimento em cultura, com diagnóstico preliminar de ceratite infecciosa fúngica. Injeções antifúngicas intraestromais foram usadas em todos os casos com infecções fúngicas. O tempo médio para o início da infecção foi de 164 dias (variação: 2-282 dias). A ceratite infecciosa de interface pós-operatória desenvolveu-se no período inicial em dois casos. A duração média do acompanhamento foi de 13,4 ± 6,2 meses (variação: 6-26 meses). A ceratoplastia endotelial de membrana de Descemet foi realizada em dois casos (25%) e ceratoplastia penetrante terapêutica em quatro casos (50%) que não se recuperaram com tratamento médico. A acuidade visual para longe corrigida final foi de 20/40 ou melhor em 5/8 (62,5%) dos pacientes. Conclusões: O diagnóstico e o tratamento da ceratite infecciosa de interface após ceratoplastia endotelial da membrana de Descemet são difíceis. A intervenção cirúrgica precoce deve ser o procedimento preferido se não houver resposta ao tratamento médico. Melhor sobrevida do enxerto e melhor acuidade visual podem ser alcançadas com ceratoplastia penetrante terapêutica e ceratoplastia endotelial da membrana de Descemet em pacientes com ceratite infecciosa de interface

Ingenieria y ciencias de la vida: Relación simbiótica para la supervivencia humana / Engineering and Life Sciences: Symbiotic relationship for the human survival / Engenharia e Ciências da Vida: Relação simbiótica para a sobrevivência humana

RESUMEN Aunque los desarrollos que surgen del trabajo conjunto entre ingenieros y científicos de la vida han aumentado y mejorado en las últimas décadas, todavia hay muchas cosas que hacer en esta relación. Una de ellas es la mejora urgente del sistema de salud, porque si bien la tecnologia es importante para mejorar el diagnóstico y el tratamiento, también es necesario superar los complejos problemas de cobertura, calidad, equidad y atención oportuna que sufren los pacientes en muchas partes del planeta. Los gobiernos deben tener el presupuesto adecuado para satisfacer las necesidades en salud de sus ciudadanos y fortalecer el sistema para ampliar la cobertura y mejorar su calidad. Estas son tareas pendientes que deben abordarse desde la experiencia de la ingenieria para gestionar y organizar sistemas, en un trabajo armonioso con científicos de la salud e involucrando a pacientes, médicos, gobiernos, fabricantes, otras disciplinas y la sociedad en general.

AВSTRАСT Although the developments that arise from the joint work between engineers and life scientists have increased and improved in recent decades, there are still many things to do in this relationship. One of them is the urgent improvement of the health system because although technology is important to improve diagnosis and treatment, it is also necessary to overcome the complex problems of coverage, quality, equity and timely attention that patients suffer in many parts of the planet. Governments need to have the appropriate budget to meet the health needs of their citizens and strengthen the health system to expand coverage and improve its quality These are pending tasks that must be addressed from the experience of engineering to manage and arrange systems, in harmonious work with health scientists and involving patients, doctors, governments, manufacturers, other disciplines and society in general.

RESUMO Embora os desenvolvimentos decorrentes do trabalho conjunto entre engenheiros e cientistas da vida tenham aumentado e melhorado nas últimas décadas, ainda há muito a ser feito nesta relação. Uma delas é a melhoria urgente do sistema de saúde, pois embora a tecnologia seja importante para melhorar o diagnóstico e o tratamento, também é necessário superar os complexos problemas de cobertura, qualidade, eqüidade e cuidado oportuno que os pacientes sofrem em muitas partes do mundo. Os governos devem ter orçamentos adequados para atender às necessidades de saúde de seus cidadãos e fortalecer o sistema para expandir a cobertura e melhorar a qualidade. Estas são tarefas pendentes que devem ser abordadas pela engenharia especializada para administrar e organizar sistemas, trabalhando harmoniosamente com cientistas da saúde e envolvendo pacientes, médicos, governos, fabricantes, outras disciplinas e a sociedade em geral.

Selvester Score May Be a Predictor of ICD Therapies in Patients with Non-Ischemic Dilated Cardiomyopathy

ABSTRACT Introduction: The benefit of implantable cardioverter-defibrillator (ICD) in patients with non-ischemic dilated cardiomyopathy (DCM) is still an issue under discussion. Studies examining the relationship between ventricular scar tissue and ICD shock with cardiac magnetic resonance (CMR) are promising. CMR studies have shown that ventricular scar tissue size and Selvester score show a correlation. In the light of this information, this study aimed to investigate the potential relationship between Selvester score and ICD therapies. Methods: The study included 48 patients who had undergone ICD implantation with a diagnosis of DCM and who had undergone routine 6-month ICD control in outpatient clinic controls between December 2018 and October 2019. Selvester score and other data were compared between patients who received ICD therapy (n=10) and those who did not (n=38). Results: Selvester score (P<0.001) was higher in ICD therapy group. Positive correlation was found between ICD shock therapy and Selvester score (P=0.002, r=0.843). Selvester score was detected as an independent predictor for ICD therapy after multiple linear regression analysis (P=0.004). Receiver operating characteristic curve analysis showed that Selvester score (P<0.001) was a significant predictor of ICD therapy. Selvester score cutoff points of 5 for were calculated to estimate ICD therapy, with a sensitivity of 100% and specifity of 81%. Conclusion: In our study, it was found that a high Selvester score may be a predictor for ICD therapies in patients with DCM. As an inexpensive and non-invasive method, Selvester score can help in the decision-making in these patients.

Factors related to mortality in patients with stage 5 chronic kidney disease on dialysis with COVID-19: An exploratory case series analysis / Factores relacionados con mortalidad de pacientes con enfermedad renal crónica en estadio 5 en diálisis con COVID-19: Análisis exploratorio de una serie de casos

Introduction Different studies describe the clinical profile and factors that could explain the evolution and outcome of patients with chronic kidney disease and COVID-19. This study aims to evaluate the factors related to the mortality of patients with stage-5 chronic kidney disease on chronic dialysis hospitalized for COVID-19 at the Hospital Nacional Arzobispo Loayza from April to December 2020. Methods Retrospective case series and exploratory analysis were performed. Patients with stage-5 chronic kidney disease on dialysis, older than 18 years, and hospitalized for COVID-19 disease were included. Hospital medical records were the primary data source. Results A total of 105 medical records were reviewed. 57 were male (54.3%), with a mean age of 58.6 years (standard deviation: 14.3). Eighty-four patients survived (80%), and 21 died (20%). The main cause of hospital admission, present in 80 patients (76.2%), was respiratory failure; the mean hospital stay was of 11.8 days (SD: 7.8). In the bivariate analysis: patients with moderate to severe COVID-19, overweight and obesity, increased levels of leukocytes, D-dimer, ferritin, C-reactive protein, lactate dehydrogenase, as well as, decreased levels of lymphocytes, bicarbonate and arterial oxygen pressure/inspired oxygen fraction were related to mortality risk. In multivariate analysis, only severe COVID-19 disease (OR 1.48; 95% CI 2.24 to 7.77), C-reactive protein > 10 mg/dL (OR: 9.72; 95% CI: 1.41 to 18.58), and arterial oxygen pressure/inspired oxygen fraction ≤ 150 millimeters of mercury (OR: 10.23; 95% CI: 5.87 to 36.06) were factors associated with poor survival. Conclusions In patients with stage-5 chronic kidney disease hospitalized for COVID-19, severe COVID-19 disease, C-protein reactive levels > 10 milligrams per deciliter, arterial oxygen pressure / inspired oxygen fraction ≤ 150 millimeters of mercury and severe COVID-19 disease were the main factors related to mortality.

Introducción Diferentes estudios describen el perfil clínico y los factores que podrían explicar la evolución y el resultado de los pacientes con enfermedad renal crónica y COVID-19. El objetivo de este estudio fue evaluar los factores relacionados con la mortalidad de los pacientes con enfermedad renal crónica estadio-5 en diálisis crónica hospitalizados por COVID-19 en el Hospital Nacional Arzobispo Loayza de abril a diciembre de 2020. Métodos Serie de casos retrospectiva y análisis exploratorio. Se incluyeron pacientes con enfermedad renal crónica estadio 5 en diálisis, mayores de 18 años, hospitalizados por COVID-19. La fuente primaria de datos fueron las historias clínicas. Resultados Se revisaron 105 historias clínicas. 57 (54,3%) eran varones, con una edad media de 58,6 años (desviación estándar: 14,3). Sobrevivieron 84 (80%) pacientes y fallecieron 21 (20%). La principal causa de ingreso hospitalario fue la insuficiencia respiratoria en 80 (76,2%). La estancia hospitalaria fue de 11,8 días (desviación estándar: 7,8). En el análisis bivariante: los pacientes con COVID-19 moderada a grave, sobrepeso y obesidad, aumento de los niveles de leucocitos, dímero D, ferritina, proteína c reactiva, lactato deshidrogenasa, así como, disminución de los niveles de linfocitos, bicarbonato y presión arterial de oxígeno/fracción inspirada de oxígeno se relacionaron con el riesgo de mortalidad. En el análisis multivariante, sólo la enfermedad grave por COVID-19 (odds ratio: 1,48; intervalo de confianza del 95%: 2,24 a 7,77), la proteína C reactiva > 10 mg/dL (odds ratio: 9,72; intervalo de confianza del 95%: 1,41 a 18,58) y una presión arterial de oxígeno/fracción de oxígeno inspirado ≤ 150 milímetros de mercurio (odds ratio: 10,23; intervalo de confianza del 95%: 5,87 a 36,06) fueron factores asociados a una mala supervivencia. Conclusiones En los pacientes con enfermedad renal crónica en estadio-5 hospitalizados por COVID-19, la enfermedad grave por COVID-19, los niveles de proteína C reactiva > 10 miligramos por decilitro, la presión arterial de oxígeno/fracción inspirada de oxígeno ≤ 150 milímetros de mercurio y la enfermedad grave por COVID-19 fueron los principales factores relacionados con la mortalidad.

Utilização de enxerto autógeno fixado por implantes / Use of autogenous graft fixed by implants / Uso de injerto autógeno fijado mediante implantes

OBJETIVO: Relatar um caso clínico em que foi utilizado enxerto autógeno na região anterior da maxila fixado com implantes. RELATO DE CASO: Paciente do gênero feminino, 46 anos, há 13 anos compareceu à Clínica de Implantodontia do Programa de Pós Graduação da UFPA tendo como queixa principal desconforto estético e dificuldade na mastigação, durante o exame clínico intraoral observou-se a ausência dos elementos 11,12, 21,22 e grande defeito ósseo em formato de U invertido. O tratamento foi dividido em duas etapas: na primeira foi realizada a correção do defeito ósseo em espessura com enxerto ósseo em bloco retirado da região mentoniana, e na segunda etapa foi realizada a correção em altura com enxerto ósseo em bloco retirado do ramo mandibular, na fixação do referido enxerto instalou-se simultaneamente os implantes. Após 13 anos, a paciente retornou para uma consulta de controle e durante a avaliação dos exames clínicos e radiológicos, observou-se que os implantes encontravam-se osseointegrados, sem sintomatologia e com ligeira perda óssea. CONCLUSÃO: Os implantes quando associados ao enxerto autógeno em bloco demonstraram-se eficazes em relação á estética e função no decorrer dos anos... (AU)

OBJECTIVE: To report a clinical case in which autogenous graft was used in the anterior region of the maxilla fixed with implants. CASE REPORT: 13years ago, a 46-year-old female patient, attended the Implantology Clinic of the UFPA Graduate Program with aesthetic discomfort and difficulty chewing as the main complaint, during the intraoral clinical examination, the absence of elements 11, 12, 21, 22 and large bone defect in inverted U format was observed. The treatment was divided into two stages: in the first one, the bone defect was correct in thickness with a block osseum graft removed from the mentionian region, and in the second stage, the correction was performed in height with block bone graft removed from the mandibular branch, and the implants were installed in the fixation of the said graft. After 13 years, the patient returned for a control consultation, and during the evaluation of clinical and radiological examinations, it was observed that the implants were Osseo integrated, without symptomatology and with slight bone loss. CONCLUSION: Implants when associated with autogenou block graft have been shown to be effective in relation to aesthetics and function over the years... (AU)

OBJETIVO: Relatar un caso clínico en que fue utilizado injerto autógeno en la región anterior de la maxila fijado con implantes. CASO CLÍNICO: Paciente del género femenino,46 años, compareció a Clínica de Implantología del Programa de Post-Graduación de la UFPA teniendo como queja principal, el malestar estético y la dificultad para masticar, durante el examen clínico intraoral, se observó la ausencia de elementos 11,12,21,22 y grande defecto óseo en formato U invertida. El tratamiento fue dividido en dos etapas: en la primera fue realizada la corrección de lo defecto óseo en espesor con material retirado de la región mentoniana, y en la segunda etapa fue realizada la corrección en altura con injerto óseo retirado de la rama mandibular, en la fijación de dicho injerto, se instalaron los implantes simultáneamente. Después de 13 años, el paciente retornó para una consulta de control, y durante la evaluación de los exámenes clínicos y radiológicos, se observó que los implantes estaban osteointegrados, sin sintomatología y con ligera pérdida ósea. CONCLUSIÓN: Los implantes cuando asociados el injerto de bloqueo autógeno se demostraron eficaces en relación con la estética y la función, en el trascurso de los años... (AU)

Aspectos Clínicos e de Sobrevida de Pacientes pós Implante de Valva Mecânica, com Ênfase em Trombose de Prótese Valvar / Clinical Features and Survival Analysis of Patients after Mechanical Heart Valve Replacement, with an Emphasis on Prosthetic Valve Thrombosis

Resumo Fundamento As doenças oro-valvares têm prevalência mundial expressiva, e a cirurgia de troca valvar melhorou a sobrevida dos pacientes. Objetivos Descrever aspectos clínico-laboratoriais dos pacientes submetidos a implante valvar mecânico e determinar a incidência de trombose de próteses valvares (TPV). Métodos Estudo de coorte retrospectivo com seguimento até nove anos; as variáveis de estudo foram buscadas em prontuários físicos e eletrônicos. Os cálculos foram realizados pelo programa Jamovi 1.2.2.; p<0,05 foi considerado estatisticamente significante. Foram construídas curvas de Kaplan Meier, e realizada análise de regressão de Cox para fatores relacionados à mortalidade. Resultados Foram incluídos 473 pacientes com média de idade de 46,9 ±11,3 anos. A doença reumática foi a principal etiologia. Em média de acompanhamento de 4,43 anos, a mortalidade foi de 16,1%. Pacientes com implantes de próteses na posição aórtica tiveram sobrevida melhor que os portadores em posição mitro-aórtica (p=0,026). Entre os fatores ajustados para mortalidade, apenas classe funcional e insuficiência renal crônica apresentaram significância estatística. A incidência de TPV foi de 0,24/100 pacientes/ano, com primeiro evento após 1000 dias da cirurgia. Tabagismo e pannus foram estatisticamente associados a TPV. Não houve diferenças na variabilidade de INR entre pacientes com e sem trombose por posição protética, mas houve diferença estatística no INR pré-evento trombótico comparado aos que não apresentaram trombose (INR= 2,20[1,80-2,20] vs 2,80[2,20-3,40]; p= 0,040). Identificamos 4,4% de acidentes vasculares cerebrais e 5,2% de sangramentos. Conclusões A população mostrou-se jovem e valvopatia reumática foi frequente. A frequência de TPV foi semelhante à descrita na literatura, apesar da baixa renda e escolaridade da amostra.

Abstract Background Valvular heart diseases are highly prevalent in the world, and surgical valve replacement has improved patients' survival. Objectives To describe clinical and laboratory data of patients undergoing mechanical valve replacement, and to determine the incidence of prosthetic valve thrombosis (PVT). Methods Retrospective cohort study with a follow-up of up to nine years. The study variables were collected from conventional and electronic medical charts. Statistical calculations were performed using the Jamovi software version 1.2.2.; a p<0.05 was considered statistically significant. Kaplan Meier curves were constructed, and Cox regression analysis was performed for analysis of factors related to mortality. Results A total of 473 patients were included, mean age of 46.9 ±11.3 years. Rheumatic disease was the most common etiology. In a mean follow-up period of 4.43 years, mortality rate was 16.1%. Patients with aortic prosthesis showed higher survival than patients with double implant (mitral and aortic) (p=0.026). Of the factors adjusted for mortality, only functional class and chronic renal failure showed statistically significant association. The incidence of PVT was 0.24/100 patients/year, and the first event occurred more than 1000 days after the implant. Smoking and pannus formation were significantly associated with PVT. No differences were found in INR variability between patients with and without thrombosis by prosthetic position, but significant differences were found in INR before thrombosis as compared with patients without thrombosis (INR= 2.20 [1.80-2.20] vs. 2.80 [2.20-3.40]; p= 0.040). The incidence of stroke and bleeding was 4.4% and 5.2% respectively. Conclusions The study population was young, and rheumatic valve disease was common in this group. The prevalence of PVT was similar to that described in the literature, despite the low income and low educational level of our sample.

Prognostic role of neutrophil-to-lymphocyte ratio to laryngeal squamous cell carcinoma: a meta-analysis / Papel prognóstico da relação neutrófilo-linfócito no carcinoma espinocelular da laringe: uma metanálise

Abstract Introduction New evidence suggests that the ratio of neutrophils to lymphocytes is associated with the prognosis of other carcinoma, but the ratio of neutrophils to lymphocytes in laryngeal squamous cell carcinoma remains controversial. Objective The objective of this meta-analysis was to clarify the prognostic effectiveness of the ratio of neutrophils to lymphocytes in laryngeal squamous cell carcinoma. Methods According to the meta-analysis of the free guide, we searched EMBASE, Pubmed, the Cochrane Library databases. The ratio of neutrophils to lymphocytes of laryngeal squamous cell carcinoma patients was evaluated using mean standard vehicle and confidence interval. The overall survival, disease-free survival and progression free survival of patients with laryngeal squamous cell carcinoma were expressed by standard mean carrier method and confidence interval. The risk ratio of 95% confidence interval was used as an evaluation index for patients with laryngeal squamous cell carcinoma. Results Eight studies, including 1780 patients, used a variety of different end values to classify the ratio of neutrophils to lymphocytes (range 1.78-4.0). Among the eight studies that reported risk ratio of the overall survival, the higher median value was 2.72, and 2 of 4 studies reported disease-free survival results. The critical value of ratio of neutrophils to lymphocytes and overall survival deterioration (risk ratio = 1.68, 95% confidence interval 1.43-1.99, p< 0.001), disease-free survival (risk ratio = 2.09, 95% confidence interval 1.62-2.6, p< 0.001) and progression free survival (risk ratio = 1.92, 95% confidence interval 1.75-2.10, p< 0.001) was associated with with laryngeal aquamous cell carcinoma. The ratio of neutrophils to lymphocytes had prognostic value for laryngeal squamous cell carcinoma. Conclusion The results of this meta-analysis showed that the increase of neutrophils to lymphocytes ratio was related to poor prognosis of laryngeal squamous cell carcinoma. The neutrophils to lymphocytes ratio may serve as a cost-effective prognostic biomarker of poor prognosis of laryngeal squamous cell carcinoma. More high-quality prospective trials are needed to assess the practicability of evaluating the ratio of neutrophils to lymphocytes in laryngeal squamous cell carcinoma.

Resumo Introdução Novas evidências sugerem que a relação neutrófilo-linfócito está associada ao prognóstico de vários carcinomas, mas a relação neutrófilo-linfócito no carcinoma espinocelular da laringe ainda permanece controversa. Objetivo Esclarecer a eficácia prognóstica da relação neutrófilo-linfócito no carcinoma espinocelular de laringe. Método De acordo com as diretrizes de metanálise, conduzimos uma busca nas bases de dados Embase, PubMed, e Cochrane Library. A relação neutrófilo-linfócito de pacientes com carcinoma espinocelular de laringe foi avaliado com a diferença de médias padronizadas e intervalo de confiança. A sobrevida global, sobrevida livre de doença e sobrevida livre de progressão de pacientes com carcinomaespinocelular de laringe foram expressas pelo método da diferença de médias padronizadas e intervalo de confiança. A razão de risco do intervalo de confiança 95% foi usada como um índice de avaliação para pacientes com carcinoma espinocelular de laringe. Resultados Oito estudos, que incluíram 1.780 pacientes, usaram uma variedade de valores finais diferentes para classificar a relação neutrófilo-linfócito (intervalo de 1,78-4,0). Entre os oito estudos que relataram a razão de risco de sobrevida global, o maior valor médio foi de 2,72 e 2 de 4 estudos relataram resultados com sobrevida livre de doença. O valor crítico de relação neutrófilo-linfócito e deterioração da sobrevida global (razão de risco = 1,68, intervalo de confiança 95% 1,43-1,99, p ˂ 0,001), sobrevida livre de doença (razão de risco = 2,09, intervalo de confiança 95% 1,62-2,6, p ˂ 0,001) e sobrevida livre de progressão (razão de risco = 1,92, intervalo de confiança 95% 1,75-2,10, p ˂ 0,001) foi associado com carcinoma espinocelular de laringe. A relação neutrófilo-linfócito tem valor prognóstico para carcinoma espinocelular de laringe. Conclusão Os resultados da metanálise mostraram que o aumento da relação neutrófilo-linfócito estava relacionado ao mau prognóstico do carcinoma espinocelular de laringe. A relação neutrófilo-linfócito pode servir como um biomarcador custo-efetivo de prognóstico do carcinoma espinocelular de laringe. Entretanto, mais estudos prospectivos de alta qualidade são necessários para avaliar a sua praticabilidade.

Impacto de infecciones y enterobacterias productoras de betalactamasa de espectro extendido en la supervivencia del injerto y del paciente en un programa de trasplante renal en México / Impact of infections and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae on graft and patient survival in a kidney transplantation program in Mexico

Resumen Introducción: Los tratamientos inmunosupresores han mejorado las tasas de supervivencia del injerto y del paciente, pero pueden incrementar las infecciones postrasplante. Objetivos: Analizar los datos de pacientes con trasplante renal y describir las bacterias responsables de las infecciones que presentan. Métodos: Estudio observacional, longitudinal y analítico de 103 pacientes sometidos a trasplante renal. El periodo de seguimiento fue de 5.07 ± 1.28 años. Resultados: La tasa de mortalidad fue de 10.68 % y la de pérdida del injerto de 14.56 %. Respecto al riesgo de muerte del receptor, el modelo de regresión de Cox mostró un cociente de riesgo (HR, hazard ratio) de 5.66 en los pacientes con cultivo bacteriano positivo y de 2.22 en aquellos con cepas productoras de betalactamasas de espectro extendido (BLEE); en cuanto a la pérdida del injerto, el HR fue de 4.59 en quienes tuvieron cultivo bacteriano positivo y de 4.25 en aquellos con cepas productoras de BLEE. Conclusiones: Se encontró riesgo significativo de muerte en receptores de trasplante renal con cultivo bacteriano positivo y mayor riesgo de pérdida del injerto en aquellos con cultivo bacteriano positivo y aislamiento de cepas productoras de BLEE. La tasa de enterobacterias productoras de BLEE es alta, por ello son necesarias estrategias más estrictas para controlar del uso de antibióticos.

Abstract Introduction: Immunosuppressive treatments have improved graft and patient survival rates, but can increase the incidence of post-transplant infections. Objectives: To analyze data from kidney transplant patients and describe the pathogens responsible for the infections they experience. Methods: Longitudinal, analytical, observational study of 103 patients who underwent kidney transplantation. The follow-up period was 5.07 ± 1.28 years. Results: Overall mortality rate was 10.68% and graft loss rate was 14.56%. Regarding recipient risk of death, the Cox regression model showed a hazard ratio (HR) of 5.66 for positive bacterial cultures and 2.22 for positive extended-spectrum beta-lactamase (ESBL)-producing strains; as for graft loss, HR was 4.59 in those with positive bacterial cultures and 4.25 in those who were positive for ESBL-producing strains Conclusions: Significant death risk was found in kidney transplant recipients with positive bacterial cultures and an increased risk of graft loss in those with positive bacterial cultures and in those who were positive for ESBL-producing Enterobacteriaceae isolates. The rate of ESBL-producing Enterobacteriaceae is high, and stricter strategies are therefore necessary to control the use of antibiotics.

Supervivencia de pacientes con cáncer de pulmón de células no pequeñas / Survival of patients with non-small cell lung cancer / Sobrevivência de pacientes com câncer de pulmão de células não pequenas

RESUMEN Introducción: el cáncer de pulmón tiene elevada incidencia a nivel mundial. En cuanto a mortalidad, es la primera localización en ambos sexos, con una tasa de 58,0 por 100 000 y 32,5 por 100 000 en el año 2017 en hombre y mujeres respectivamente. Objetivos: identificar los factores relacionados con la supervivencia de los pacientes con cáncer de pulmón de células no pequeñas. Métodos: se realizó un estudio analítico y observacional de cohorte en pacientes atendidos con el diagnóstico de cáncer de pulmón de células no pequeñas en el servicio de Oncología de del hospital general universitario "Carlos Manuel de Céspedes" de Bayamo, Granma, en el período comprendido desde el 1º de enero del 2014 al 31 de diciembre de 2019. Resultados: el factor más relevante y de carácter independiente fue clasificar en estadio IV al incrementar el riesgo de morir a 1,304 veces (IC: 1,011-2,025; p: 0,000) seguido del estadio IIIB (HR: 1,070; IC: 1,004-2,113; p: 0,000). El modelo de regresión de Cox tiene una capacidad discriminativa adecuada para predecir los pacientes que fallecerán de los que no en pacientes con cáncer de pulmón de células no pequeñas (área: 0,727; IC: 0,516-0,737; p: 0,025). Conclusiones: el estadio del cáncer de pulmón de células no pequeñas tuvo una relación inversamente proporcional con la sobrevida de los pacientes; la edad avanzada incrementó el riesgo de morir. El modelo de regresión proporcional de Cox tuvo una capacidad discriminativa adecuada para precisar la menor supervivencia de los pacientes con el mencionado diagnóstico.

ABSTRACT Introduction: lung cancer has a high incidence worldwide. In terms of mortality, it is the first location in both sexes, with a rate of 58.0 per 100,000 and 32.5 per 100,000 in 2017 in men and women respectively. Objectives: to identify factors related to the survival of patients with non-small cell lung cancer. Methods: an analytical and observational cohort study was conducted in patients treated with the diagnosis of non-small cell lung cancer in the Oncology service of the "Carlos Manuel de Céspedes" general university hospital in Bayamo, Granma, in the period from January 1, 2014 to December 31, 2019. Results: the most relevant and independent factor was to classify in stage IV by increasing the risk of dying to 1,304 times (CI: 1.011-2.025; p: 0.000) followed by stage IIIB (HR: 1.070; CI: 1.004-2.113; p: 0.000). The Cox regression model has an adequate discriminative capacity to predict patients who will die from those who will not in patients with non-small cell lung cancer (area: 0.727; CI: 0.516-0.737; p: 0.025). Conclusions: the stage of non-small cell lung cancer had an inversely proportional relationship with the survival of patients; older age increased the risk of dying. The Cox proportional regression model had an adequate discriminative capacity to specify the shortest survival of patients with the aforementioned diagnosis.

RESUMO Introdução: o câncer de pulmãot em alta incidência em todo o mundo. Em termos de mortalidade, é a primeira localização em ambos os sexos, comum ataxa de 58,0 por 100.000 e 32,5 por 100.000 em 2017 em homens e mulheres, respectivamente. Objetivos: identificar fatores relacionados à sobrevivência de pacientes com câncer de pulmão de células não pequenas. Métodos: estudo de coorte analítica e observacional foi realizado em pacientes tratados com o diagnóstico de câncer de pulmão de células não pequenas no serviço de Oncologia do Hospital Universitário Geral Carlos Manuel de Céspedes, em Bayamo, Granma, no período de 1º de janeiro de 2014 a 31 de dezembro de 2019. Resultados: o fator mais relevante e independente foi classificar na fase IV o aumento do risco de morrer para 1.304 vezes (IC: 1.011-2.025; p: 0,000) seguido da etapa IIIB (HR: 1.070; CI: 1.004-2.113; p: 0,000). O modelo de regressão de Cox tem uma capacidade discriminatória adequada para prever pacientes que morrerão daqueles que não morrerão em pacientes com câncer de pulmão de células não pequenas (área: 0,727; CI: 0.516-0.737; p: 0,025). Conclusões: o estágio do câncer de pulmão de células não pequenas teve uma relação inversamente proporcional com a sobrevivência dos pacientes; a idade mais velha aumentou o risco de morrer. O modelo de regressão proporcional de Cox apresentou capacidade discriminatória adequada para especificar a menor sobrevida dos pacientes com o diagnóstico acima mencionado.

Learning Curve in Left Ventricular Assist Device Implantation: Low Volumes Do Not Equate Bad Outcomes

ABSTRACT Introduction: Most implantations of left ventricular assist devices (LVAD) are performed in low-volume centers. This study aimed to evaluate the procedural learning curve of HeartMate II (HM2) implantations by comparing outcomes between two time periods in a low-volume center. Methods: All 51 consecutive patients undergoing HM2 implantation between January 2009 and December 2017 were reviewed and allocated into 2 groups: early-era group (from 2009 to 2014; n=25) and late-era group (from 2015 to 2017; n=26). The primary outcome was the 90-day mortality rate, and the secondary outcome was a composite of mortality, neurological event, reoperation for bleeding, need for temporary right ventricular assist device, and pump thrombosis at 90 days. Median follow-up time was 51 months (0-136). A cumulative sum (CUSUM) control analysis was used to establish a threshold of implantations that optimizes outcomes. Results: Patients in the early era had a higher rate of diabetes, previous stroke, and inotrope support before HM2 implantation. The 90-day mortality rate was not significantly higher in the early era (24% vs. 15%, P=0.43), but the composite endpoint was significantly higher (76% vs. 42%, P=0.01). The CUSUM analysis found a threshold of 23 operations after which the composite endpoint was optimized. Conclusion: Patients undergoing HM2 implantation in a low-volume center have improving outcomes with number of cases and optimized results after a threshold of 23 cases. Significant changes in patient selection, surgical techniques, and patient management might lead to improved outcomes after LVAD implantation.

Coexisting Coronary and Carotid Artery Disease: What We Did, What Happened

ABSTRACT Introduction: There is no complete consensus on the three surgical methods and long-term consequences for coexisting coronary and carotid artery disease. We retrospectively evaluated the surgical results in this high-risk group in our clinic for a decade. Methods: Between 2005 and 2015, 196 patients were treated for combined carotid and coronary artery disease. A total of 50 patients were operated on with the staged method, 40 of which had carotid endarterectomy (CEA) priority, and 10 had coronary artery bypass grafting (CABG) priority. CABG and CEA were simultaneously performed in 82 patients; and in 64 asymptomatic patients with unilateral carotid artery lesions and stenosis over 70%, only CABG was done (64 patients). Results were evaluated by uni-/multivariate analyses for perioperative, early, and late postoperative data. Results: In the staged group, interval between the operations was 2.82±0.74 months. Perioperative and early postoperative (30 days) parameters did not differ between groups (P-value < 0.05). Postoperative follow-up time was averaged 94.9±38.3 months. Postoperative events were examined in three groups as (A) deaths (all cause), (B) cardiovascular events (non-fatal myocardial infarction, recurrent angina, congestive heart failure, palpitation), and (C) fatal neurological events (amaurosis fugax, transient ischemic attack, and stroke). When group C events were excluded, event-free actuarial survival rates were similar in all three methods (P=0.740). Actuarial survival rate was significantly different when all events were included (P=0.027). Neurological events increased markedly between months 34 and 66 (P=0.004). Conclusion: Perioperative and early postoperative event-free survival rates were similar in all three methods. By the beginning of the 34th month, the only CABG group has been negatively separated due to neurological events. In the choice of methodology, "most threatened organ priority'' was considered as clinical parameter.

A Retrospective Study of the Relationship Between Blood Transfusion and 30-Day Postoperative Outcomes in Patients Undergoing Isolated Off-Pump Coronary Artery Bypass Grafting

ABSTRACT Introduction: The objective of this single-center study it to retrospectively analyze the relationship between transfusion and 30-day postoperative outcomes in patients undergoing isolated off-pump coronary artery bypass grafting. Methods: Perioperative data of 2,178 patients who underwent isolated off-pump coronary artery bypass grafting from 2018 to 2019 were collected. A 1:1 propensity score matching was performed to control for potential biases between patients who received blood transfusion and those who did not. After propensity score matching, we analyzed the clinical outcomes of transfusion and non-transfusion patients. Postoperative complications and the survival of patients within 30 days after surgery in both groups were analyzed. Kaplan-Meier survival curve and log-rank test were used for survival analysis. Results: The total blood transfusion rate of all patients was 29%, including red blood cell (27.6%), plasma (7.3%), and platelet (1.9%). Four hundred and forty patients in each group were compared after propensity score matching. There were no significant differences in the incidence of stroke, myocardial infarction, atrial fibrillation, acute kidney function injury, and sternal wound infection of both groups (P>0.05). However, higher incidence of postoperative pulmonary infection and more mechanical ventilation time and days of stay in the intensive care unit and postoperative in-hospital stay were associated with blood transfusion (P<0.05). The 30-day cumulative survival rate of the transfusion group was lower than that of the control group (P<0.05). Conclusion: Perioperative blood transfusion increases the risks of postoperative pulmonary infection and short-term mortality in off-pump coronary artery bypass grafting patients.

High Residual Gradient Following a Self-Expandable Transcatheter Aortic Valve-in-Valve Implantation — Risk Factor Analysis, Outcomes, and Survival

Abstract Introduction: Transcatheter aortic valve-in-valve implantation (TAVI-ViV) can be associated with unfavorable hemodynamic outcomes. This study aimed to estimate the prevalence, identify the risk factors, and evaluate the outcomes and survival of patients with high residual gradients after TAVI-ViV. Methods: A total of 85 patients were included in the study. The cohort was divided into group A, with postprocedural mean pressure gradient (PG) ≥ 20 mmHg, and group B, with mean PG < 20 mmHg. Results: Postprocedural PG ≥ 20 mmHg was observed in 24.7% of the patients. In a univariate analysis, preoperative gradient, pre-existing patient-prosthesis mismatch (PPM), deep valve implantation, small degenerated valves, and an older generation of transcatheter aortic valves were found to be risk factors for high residual gradient. Multivariate analysis showed that preexisting maxPG > 60 mmHg, implantation level of 4 mm below neo-annulus, and degenerated valve size ≤ 23 mm were independent predictors of high residual gradient. There were no differences in early morbidity (myocardial infarction, pacemaker implantation, stroke, acute renal insufficiency) between groups. Kaplan-Meier estimated that the survival rate was comparable at one and five years regardless of postoperative gradient. Survivors with high residual mean gradient were significantly affected by a high New York Heart Association (NYHA) class. Conclusion: High residual transvalvular gradient after TAVI-ViV is not rare, but it does not significantly affect mortality. High residual mean gradient has a negative impact on NYHA functional class improvement after the procedure. High preoperative gradient, implantation level, and small failed bioprosthesis may predispose to increased residual gradient.

Definitive Radiotherapy versus Surgery for the Treatment of Verrucous Carcinoma of the Larynx: A National Cancer Database Study

Abstract Introduction Traditionally, larger lesions of laryngeal verrucous carcinoma are treated with surgical excision, with definitive radiotherapy generally reserved for smaller lesions. However, data utilizing modern databases is limited. Objective The authors sought to assess, utilizing the National Cancer Database, whether overall survival for patients with laryngeal verrucous carcinoma was equivalent when treated with definitive radiotherapy versus definitive surgery. Methods A retrospective cohort study was conducted utilizing the National Cancer Database. All cases of laryngeal verrucous carcinoma within the National Cancer Database between 2006 and 2014 were reviewed. Patients with T1-T3 (American Joint Commission on Cancer 7th Edition) laryngeal verrucous carcinoma were included and stratified by treatment modality. Demographics, treatment, and survival data were analyzed. Results A total of 392 patients were included. Two hundred and fifty patients underwent surgery and 142 received radiotherapy. The two groups differed in age, transition of care, clinical T stage, and clinical stages. There was no significant difference in survival between T1-T3 lesions treated with surgery or radiotherapy (p =0.32). Age, comorbidities, insurance status, and clinical T stage impacted overall hazard on multivariate analysis (p <0.01). For patients treated with radiotherapy, age, insurance status, and clinical T stage were predictive of increased hazard. Conclusion Overall survival is equivalent for patients with clinical T1 and clinical T2 laryngeal verrucous carcinoma treated with primary radiotherapy versus primary surgery. Thus, radiotherapy should be considered as a non-inferior treatment modality for certain patients with laryngeal verrucous carcinoma.

Inovação em cânula de lipoaspiração para coleta de enxerto de gordura para uso em reconstrução mamária / Innovation in liposuction cannula to harvest fat graft to use in breast reconstruction

Introdução: A evolução da técnica de lipoaspiração e da enxertia de gordura associada a segurança oncológica permitiram utilizar a gordura como preenchedor autólogo em pacientes com neoplasia de mama que eram submetidas a reconstrução mamária. O objetivo é apresentar uma inovação no instrumento de coleta de gordura que será utilizada como enxerto, para uso em reconstrução mamária. Métodos: Foi realizada a busca de anterioridade nos bancos de dados internacionais e nacional e a confecção de um protótipo de cânula de coleta de gordura de 35cm de comprimento, com diâmetro do tubo de 4mm, com 10 furos redondos na sua extremidade distal com 2mm de diâmetro. Foi realizado um experimento de aspiração de substância viscosa comparando o protótipo com dois modelos de cânulas com desenho padrão da indústria, de três furos tipo Mercedes e de cinco furos tipo Pitanguy. Resultados: Foram encontrados quatro patentes de alta relevância e uma patente de média relevância, que diferem do modelo de utilidade proposto quando se comparam o tipo de desenho da extremidade distal das cânulas estudadas e a função dos instrumentos identificados. Quando comparou-se a eficiência do protótipo, a cânula de cinco furos foi a mais eficiente na aspiração da substância viscosa, e não houve diferença estatística na velocidade de aspiração entre o protótipo e a cânula de três furos tipo Mercedes. Conclusão: A inovação apresentada para a coleta de enxerto de gordura para uso em reconstrução mamária apresentou a mesma eficiência que a cânula Mercedes de três furos neste modelo experimental.

Introduction: The evolution of liposuction and fat graft technique with the oncologic safety allowed to use the fat as autologous filler in patients with breast cancer and submitted to breast reconstruction. The objective is to introduce an innovation in the instrument used to harvest fat grafts for breast reconstruction. Methods: Search of anteriority and trademarks were performed at international and national databases, and a prototype was built as a fat harvest instrument with 35cm in length, 4cm in diameter, with 10 holes at the distal extremity, with 2mm diameter each. It was experimented with a harvest of a viscous substance, comparing the prototype with two regular industry cannulas types: three holes Mercedes' type and five roles Pitanguy's type. Results: Four high-relevance patents and one medium-relevance patent were found, which differ from the proposed utility model when comparing the type of design of the distal end of the studied cannulas and the function of the instruments identified. When the prototype's efficiency was compared with the other cannulas, the cannula with five holes in Pitanguy's type was the most efficient, and it was no statistical difference between the prototype and the cannula with three roles in Mercedes' type. Conclusion: The innovation presented to harvest fat graft for breast reconstruction had the same efficiency in harvesting the viscose substance as the cannula Mercedes type with three holes in this experimental model.

The effects of thymoquinone on pancreatic cancer and immune cells

SUMMARY OBJECTIVES: Black cumin is widely used as a spice and as a traditional treatment. The active ingredient in black cumin seeds is thymoquinone. Thymoquinone has shown anticancer effects in some cancers. We planned to investigate its anticancer effect on pancreatic cancer cell lines. METHODS: Thymoquinone chemical component in various doses was prepared and inoculated on pancreatic cancer cell culture, healthy mesenchymal stem cells, and peripheral blood mononuclear cell culture. IC50 values were calculated by absorbance data and measuring cell viability by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide staining of cells incubated with thymoquinone at 24, 48, and 72 h. RESULTS: There was dose-related cytotoxicity. Maximal cytotoxicity was observed at 24 h and 100 μM thymoquinone concentrations in pancreatic cancer cell culture and mesenchymal stem cells. Any concentration of thymoquinone was not cytotoxic to peripheral blood mononuclear cell. Thymoquinone even caused proliferation at a concentration of 6.25 μM. CONCLUSIONS: Since the cytotoxic concentration of thymoquinone on pancreatic cancer cell culture and mesenchymal stem cells is the same, it is not appropriate to use thymoquinone to achieve cytotoxicity in pancreatic cancer. However, since thymoquinone provides proliferation in peripheral blood mononuclear cell at a noncytotoxic dose, it may have an immune activator effect. Therefore, in vivo studies are needed to investigate the effect of thymoquinone on the immune system.