Correlations between ambient air pollution and the prevalence of hospitalisations and emergency room visits for respiratory diseases in children: a systematic review.

OBJECTIVE: It is known that exposure to air pollution is associated with an increased risk for cardiovascular and respiratory diseases. This review aimed to summarise observational studies on the impact of short and long-term exposure to ambient air pollution on prevalence of hospitalisations and/or emergency department visits caused by respiratory diseases in children and adolescents. SOURCES: Pubmed, Scopus, Embase and Cochrane Library databases were searched for the years 2018 to December 2022, including studies in any language. SUMMARY OF THE FINDINGS: A total of 15 studies published between 2018 and 15 January 2022 were included in this review. PM2.5 was the most type of particulate matter studied. Short-term exposure to PM2,5, PM10, NO2, SO2 and O3, even at concentrations less than the current health-based guidelines, was significantly correlated with increased risk of outpatient/hospital visits and hospitalisations for respiratory diseases by children. CONCLUSIONS: Our findings emphasise the importance and urgency of long-term control of air pollution and pollution-related diseases, especially among children and adolescents. There is a need for further research employing more homogeneous methodologies for assessing exposure and outcome measurements, in order to enable systematic reviews with meta-analysis.

Pressurized pyrolysis of mattress residue: An alternative to landfill management.

Mattresses are a difficult waste to manage in landfills due to their large volume and low density. Pyrolysis treatment could reduce its volume while producing fuel or products valuable for the chemical industry. Pressurized pyrolysis at 400, 450, and 500 °C is carried out in a lab-scale autoclave at initial pressures 4.2, 8.4, and 16.8 bar. Product gas yield increases slightly along with elevated pressure as well as temperature. However, beyond 8.4 bar the initial pressure makes no discernible differences. CO and CO2 are the major gas species followed by CH4. CO contributes the most to the product gas energy content followed by C3 species, C2H6, and H2. Calculated energy content (heating value) is between 2 and 15 MJ·Nm-3. In terms of product gas energy content, low pressure pyrolysis is favorable over high pressure pyrolysis. According to integration areas of chromatographic measurements the liquid phase contains up to 25 % of N-compounds, with benzonitrile being the most abundant, followed by toluene, o-xylene, and ethylbenzene. The solid char maintains constant properties across operating conditions, with carbon and energy contents of approximately 75 wt% and 30 MJ·kg-1, respectively.

Results of the 2023 ISBI challenge to reduce GABA-edited MRS acquisition time.

PURPOSE: Use a conference challenge format to compare machine learning-based gamma-aminobutyric acid (GABA)-edited magnetic resonance spectroscopy (MRS) reconstruction models using one-quarter of the transients typically acquired during a complete scan. METHODS: There were three tracks: Track 1: simulated data, Track 2: identical acquisition parameters with in vivo data, and Track 3: different acquisition parameters with in vivo data. The mean squared error, signal-to-noise ratio, linewidth, and a proposed shape score metric were used to quantify model performance. Challenge organizers provided open access to a baseline model, simulated noise-free data, guides for adding synthetic noise, and in vivo data. RESULTS: Three submissions were compared. A covariance matrix convolutional neural network model was most successful for Track 1. A vision transformer model operating on a spectrogram data representation was most successful for Tracks 2 and 3. Deep learning (DL) reconstructions with 80 transients achieved equivalent or better SNR, linewidth and fit error compared to conventional 320 transient reconstructions. However, some DL models optimized linewidth and SNR without actually improving overall spectral quality, indicating a need for more robust metrics. CONCLUSION: DL-based reconstruction pipelines have the promise to reduce the number of transients required for GABA-edited MRS.

Predicting Surgical Resident Performance With Situational Judgment Tests.

PURPOSE: Situational judgment tests (SJTs) have been proposed as an efficient, effective, and equitable approach to residency program applicant selection. This study examined how SJTs can predict milestone performance during early residency. METHOD: General surgery residency program applicants during 3 selection cycles (2018-2019, 2019-2020, 2020-2021) completed SJTs. Accreditation Council for Graduate Medical Education milestone performance data from selected applicants were collected in March and April 2019, 2020, and 2021 and from residents in March 2020, August 2020, March 2021, September 2021, and March 2022. Descriptive statistics and correlations were computed and analysis of variance tests performed to examine differences among 4 SJT performance groups: green, top 10% to 25%; yellow, next 25% to 50%; red, bottom 50%; and unknown, did not complete the SJT. RESULTS: Data were collected for 70 residents from 7 surgery residency programs. Differences were found for patient care (F3,189 = 3.19, P = .03), medical knowledge (F3,176 = 3.22, P = .02), practice-based learning and improvement (F3,189 = 3.18, P = .04), professionalism (F3,189 = 3.82, P = .01), interpersonal and communication skills (F3,190 = 3.35, P = .02), and overall milestone score (F3,189 = 3.44, P = .02). The green group performed better on patient care, medical knowledge, practice-based learning and improvement, professionalism, and overall milestone score. The yellow group performed better than the red group on professionalism and overall milestone score, better than the green group on interpersonal and communication skills, and better than the unknown group on all but practice-based learning and improvement. The red group outperformed the unknown group on all but professionalism and outperformed the green group on medical knowledge. CONCLUSIONS: Situational judgment tests demonstrate promise for assessing important noncognitive attributes in residency applicants and align with national efforts to review candidates more holistically and minimize potential biases.

Screening of alkaloids and withanolides isolated from Solanaceae plants for antifungal properties against non-wild type Sporothrix brasiliensis.

Antifungal resistance has often been found in animal sporotrichosis in Southern Brazil. The biological potential of compounds from plants of the Solanaceae family against infectious diseases is known, however, it is still unknown against Sporothrix brasiliensis. This study evaluated the anti-Sporothrix brasiliensis activity, synergism, cytotoxicity, and action mechanism of steroidal lactones (withanolides) and alkaloids isolated from these plants. Pure compounds of withanolide D (WNOD), physalin F (PHYF), withanicandin (WNIC), nicandin B (NICB), solasonine (SSON), and solamargine (SMAR) were tested against 12 Sporothrix brasiliensis isolated from cats (n = 11) and dogs (n = 2) through M38-A2 CLSI. For the compounds with the best activity, a checkerboard assay for synergism, sorbitol protection, and ergosterol effect for action mechanism; and MTT test for cytotoxicity were performed. The withanolides WNOD, PHYF, WNIC, and NICB were not antifungal, but SSON (MIC 0.125-1 mg/mL) and SMAR (MIC 0.5-1 mg/mL) were both fungistatic and fungicidal (MFC 0.5-1 mg/mL for both) against wild-type (WT) and non-WT isolates. The activity of SSON and SMAR was indifferent when combined with itraconazole. In the mechanism of action, cell wall and plasma membrane by complexation with ergosterol seemed to be two target structures of SSON and SMAR. SSON was selected for cytotoxicity, whose cell viability in MDBK cells ranged from 28.85 % to 101.75 %, and was higher than 87.49 % at concentrations ≤0.0015 mg/ml. Only the steroidal alkaloids SSON and SMAR were active against non-WT isolates, being promising antifungal candidates for the treatment of feline and canine sporotrichosis with low susceptibility to itraconazole.

Longitudinal estimates of resting energy expenditure using predictive equations in individuals with excess weight after weight loss: A systematic review with meta-analysis.

BACKGROUND & AIMS: To determine which resting energy expenditure (REE) predictive equation has the lowest bias in the aggregate level in individuals with excess weight during weight loss interventions. METHODS: Searches were performed in MEDLINE, Web of Science, Scopus, CENTRAL and gray literature databases. Longitudinal studies on weight loss interventions which evaluated REE by predictive equations compared to that measured by indirect calorimetry in adults with excess weight at different follow-up times were included. Meta-analyses were performed with the differences between biases of predictive equations of the REE at the different follow-up times of weight loss. RESULTS: Of the total of 2178 occurrences found in the databases, only eight studies were included. The Harris-Benedict (1919) equation showed the smallest differences between bias up to the third month (MD = 103.33 kcal; 95%CI = -39.01; 245.67), in the sixth month (MD = 59.16 kcal; 95%CI = 8.74; 109.57) and at the 12th month (MD = -71.41 kcal; 95%CI = -150.38; 7.55) of weight loss follow-up. Weight loss does not seem to have an effect on bias at different follow-up times. CONCLUSION: Harris-Benedict (1919) equation seems to be the most adequate to assess the REE of individuals with excess weight during weight loss. However, the finding of large estimated predictive intervals may indicate that predictive equations may not be handy tools for individuals losing and regaining weight due to changes other than body weight.

Trunk variability and local dynamic stability during gait after generalized fatigue induced by incremental exercise test in young women in different phases of the menstrual cycle.

Purpose: The purpose of this study was to identify how generalized fatigue along with hormonal changes throughout the menstrual cycle affects trunk variability and local dynamic stability during gait. Methods: General fatigue was induced by an incremental test on a treadmill, and the menstrual cycle was divided into three phases: follicular, ovulatory, and luteal. Twenty-six healthy, young volunteers (aged 18 to 28 years) who did not use oral contraceptives or other hormonal drugs with a regular menstrual cycle participated in the study. They walked on the treadmill for 4 min at the preferred speed, before the incremental test, followed by four sets of 4 min alternating between walking, also at preferred speed, and resting. From trunk kinematic data, the following were extracted: the mean of the standard deviation along strides, as a measure of variability, and the maximum Lyapunov exponent, as a measure of local dynamic stability (LDS). Results: After the incremental test, variability increased, and LDS decreased. However, they showed a tendency to return to the initial value faster in women compared to previous results for men. In the follicular phase, which has less hormonal release, the volunteers had an almost complete recovery in LDS soon after the first rest interval, suggesting that female hormones can interfere with fatigue recovery. Nevertheless, concerning the LDS, it was significantly lower in the luteal phase than in the follicular phase. Conclusion: Women that are not taking oral contraceptives should be aware that they are susceptible to increased gait instabilities in the pre-menstrual phase after strenuous activities.

The Role of the Adrenal-Gut-Brain Axis on Comorbid Depressive Disorder Development in Diabetes.

Diabetic patients are more affected by depression than non-diabetics, and this is related to greater treatment resistance and associated with poorer outcomes. This increase in the prevalence of depression in diabetics is also related to hyperglycemia and hypercortisolism. In diabetics, the hyperactivity of the HPA axis occurs in parallel to gut dysbiosis, weakness of the intestinal permeability barrier, and high bacterial-product translocation into the bloodstream. Diabetes also induces an increase in the permeability of the blood-brain barrier (BBB) and Toll-like receptor 4 (TLR4) expression in the hippocampus. Furthermore, lipopolysaccharide (LPS)-induced depression behaviors and neuroinflammation are exacerbated in diabetic mice. In this context, we propose here that hypercortisolism, in association with gut dysbiosis, leads to an exacerbation of hippocampal neuroinflammation, glutamatergic transmission, and neuronal apoptosis, leading to the development and aggravation of depression and to resistance to treatment of this mood disorder in diabetic patients.

RTI-263, a biased neuropeptide S receptor agonist that retains an anxiolytic effect, attenuates cocaine-seeking behavior in rats.

Neuropeptide S (NPS) is a neuromodulatory peptide that acts via a G protein-coupled receptor. Centrally administered NPS suppresses anxiety-like behaviors in rodents while producing a paradoxical increase in arousal. In addition, NPS increases drug-seeking behavior when administered during cue-induced reinstatement. Conversely, an NPS receptor (NPSR) antagonist, RTI-118, decreases cocaine-seeking behavior. A biased NPSR ligand, RTI-263, produces anxiolytic-like effects and has memory-enhancing effects similar to those of NPS but without the increase in arousal. In the present study, we show that RTI-263 decreased cocaine seeking by both male and female rats during cue-induced reinstatement. However, RTI-263 did not modulate the animals' behaviors during natural reward paradigms, such as palatable food intake, feeding during a fasting state, and cue-induced reinstatement of sucrose seeking. Therefore, NPSR biased agonists are a potential pharmacotherapy for substance use disorder because of the combined benefits of decreased drug seeking and the suppression of anxiety.

Toward Sustainable Wax Extraction from the Saccharum officinarum L. Filter Cake Byproduct: Process Optimization, Physicochemical Characterization, and Antioxidant Performance.

Saccharum officinarum L. exploitation and processing result in different byproducts, such as filter cake (FC). This study aimed to establish the most suitable experimental conditions to obtain lipophilic bioactive compounds from FC industrial residues, considering their high efficiency, cost-effectiveness, extraction yield, composition, and physicochemical properties. Results indicated that the most appropriate methodology consisted of the pretreatment of the FC sample with H2SO4, followed by ethanolic extraction (B6 method), avoiding energy-consumption FC drying steps and providing ethanol recovery (approx. 90%). The obtained B6 extract yield was 9.59 ± 0.27 g/100 g of FC dry weight, and this methodology proved to be more efficient in obtaining fatty alcohols (20.28 ± 1.48 g/kg extract) and phytosterols (31.56 ± 0.18 g/kg extract) while maintaining lower total monosaccharide concentration (26.19 ± 1.82 mg/g extract). Furthermore, the geographically related multivariate analysis in wax composition and antioxidant activity was evaluated by comparing B6 waxes from Guariba (G) and Univalem (U), both provided by Brazil and collected in June 2020. Overall, the wax composition is affected, but the antioxidant activity is uncompromised, which indicates that the optimized wax extraction method can be applied to FC.

Diversity and epidemiological profile of Pseudomonas aeruginosa from drinking water in Brazil genotyped using multi-locus sequence typing.

Pseudomonas aeruginosa is a Gram-negative bacillus associated with waterborne diseases. The objective of this study was to determine whether particular P. aeruginosa sequence types (STs) were associated with drinking water contamination in Brazil. This was achieved by searching the Pseudomonas PubMLST database, which contains the records for 8358 strains collected between 1938 and 2023. The majority (97.2%) had the complete 7-loci multilocus sequence typing profile and were assigned to 3486 STs. After eBURST (an algorithm used to infer patterns of evolutionary descent among clusters), 1219 groups with single-locus variant and 575 groups with double-locus variant were formed. Brazil was the South American country with the most isolates (n = 219, 58.24%), and the Simpson's index was 0.9392. Of the 219 Brazilian isolates, eight were isolated in water and identified as STs 252, 1417, 1605, 2502, 2620, 3078, and 3312. ST252, 1417, and 3078 have already been isolated from clinical cases worldwide. Furthermore, ST1605 and 2620, after the eBURST, they were grouped in the same clonal complex as STs involved in human infections. In conclusion, P. aeruginosa STs involved in human infections were found in bottled drinking water commercialized in Brazil, revealing that these types of drinking waters can be a vehicle of contamination.

Anemia in canine chronic kidney disease is multifactorial and associated with decreased erythroid precursor cells, gastrointestinal bleeding, and systemic inflammation.

OBJECTIVE: Compare erythropoiesis-related factors between different stages of canine chronic kidney disease (CKD). ANIMALS: 8 healthy adult dogs (controls), and 24 dogs with CKD, equally divided into 3 groups based on International Renal Interest Society-CKD Guidelines (stage 2, 3, and 4) were recruited between December 2012 and December 2014. METHODS: The following were assessed in all dogs and then compared between groups: bone marrow cytology, CBC, reticulocyte count, urinalysis, serum biochemistry, blood pressure, occult gastrointestinal bleeding, and serum concentrations of parathyroid hormone (PTH), erythropoietin, interleukin-1ß, interleukin-3, tumor necrosis factor-α (TNFα), and interferon-γ. RESULTS: Erythropoiesis inducing and suppressing factors and the results of the bone marrow cytology of dogs in stage 2 CKD did not differ from the control group. The presence of reticulocytosis in CKD stage 2 suggests that blood loss or erythrocyte destruction might be contributing to developing anemia. Anemia in dogs with progressive CKD was associated with increasing PTH and TNFα and with elevation of the ratio of myeloid to erythroid precursor cells caused by hypoplasia of the erythroid series. The latter was represented mainly by a decrease in the population of polychromatophilic rubricytes and metarubricytes. CLINICAL RELEVANCE: Increased PTH and TNFα seem to contribute to the reduced percentage of polychromatophilic rubricytes and erythroid population, thereby aggravating the anemia of dogs with advanced CKD. Gastrointestinal blood loss contributes to anemia in all canine CKD stages.

Effect of essential oil of Alpinia zerumbet on cardiovascular and autonomic function in rats with isoproterenol induced acute myocardial infarction.

Alpinia zerumbet is a plant popularly used to treat hypertension and anxiety. Studies with Alpinia zerumbet demonstrate antihypertensive and vasodilator effects, among others. The objective of this study was to analyze the effect of essential oil of Alpinia zerumbet (EOAz) on cardiovascular and autonomic function in rats with isoproterenol-induced myocardial infarction. Male Wistar rats (n=32) were equally allocated into four groups: Control, ISO (150mg/kg, subcutaneous), EOAz (100mg/kg by gavage), ISO+EOAz. The rats were evaluated for cardiovascular and, autonomic parameters, electrocardiogram, and infarct size. EOAz was not able to reduce the electrocardiographic variations induced by ISO. Heart rate variability showed a decrease in sympathetic modulation on the heart in the groups treated with EOAz. The cardiopulmonary reflex induced by serotonin invoked a superior blood pressure variation at the 2 µg/kg dose in the EOAz treated groups, while the heart rate variation was significantly higher at the 16 µg/kg dose, when compared to other doses, in all groups, except EOAz+ISO. The sympathetic vagal index was higher in ISO group than in control. EOAz did not reduce the infarct size. We conclude that pretreatment with EOAz does not reverse the hemodynamic and electrocardiographic damage caused by isoproterenol but does reduce sympathetic modulation.

Chronic pain after hospital discharge on patients hospitalized for COVID-19: an observational study.

BACKGROUND: There are few studies related to Coronavirus Disease 2019 (COVID-19) on the prevalence and nature of pain symptoms after hospital discharge, especially in individuals who develop moderate to severe disease forms. Therefore, this study aimed to evaluate the presence of chronic pain in patients discharged after hospitalization for COVID-19, and the relationship between the presence of chronic pain and intensive care stay, demographics, and risk factors for the worst Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) outcome. METHODS: A cross-sectional observational study was carried out on patients with COVID-19 who recovered after hospitalization. Patients were recruited at the least 3 months after discharge and their hospital's health files were prospected. The variables evaluated were demographics, the severity of SARS-CoV-2 infection (considering the need for intensive care), and the presence of chronic pain. The results were shown in a descriptive manner, and multivariate analysis expressed as Odds Ratios (ORs) and respective Confidence Intervals (CIs) for the outcomes studied. Statistical significance was set at p < 0.05. RESULTS: Of 242 individuals included, 77 (31.8%) reported chronic pain related to COVID-19, with no correlation with the severity of infection. Female sex and obesity were associated with a higher risk for chronic pain with ORs of 2.69 (Confidence Interval [95% CI 1.4 to 5.0]) and 3.02 (95% CI 1.5 to 5.9). The limbs were the most affected areas of the body. CONCLUSION: Chronic pain is common among COVID-19 survivors treated in hospital environments. Female sex and obesity are risk factors for its occurrence.

Novel Lipids to Regulate Obesity and Brain Function: Comparing Available Evidence and Insights from QSAR In Silico Models.

Lipid molecules, such as policosanol, ergosterol, sphingomyelin, omega 3 rich phosphatidylcholine, α-tocopherol, and sodium butyrate, have emerged as novel additions to the portfolio of bioactive lipids. In this state-of-the-art review, we discuss these lipids, and their activity against obesity and mental or neurological disorders, with a focus on their proposed cellular targets and the ways in which they produce their beneficial effects. Furthermore, this available information is compared with that provided by in silico Absorption, Distribution, Metabolism, Excretion, and Toxicity (ADMET) models in order to understand the usefulness of these tools for the discovery of new bioactive compounds. Accordingly, it was possible to highlight how these lipids interact with various cellular targets related to the molecule transportation and absorption (e.g., α-tocopherol transfer protein for α-Tocopherol, ATP-binding cassette ABC transporters or Apolipoprotein E for sphingomyelins and phospholipids) or other processes, such as the regulation of gene expression (involving Sterol Regulatory Element-Binding Proteins for ergosterol or Peroxisome Proliferator-Activated Receptors in the case of policosanol) and inflammation (the regulation of interleukins by sodium butyrate). When comparing the literature with in silico Quantitative Structure-Activity Relationship (QSAR) models, it was observed that although they are useful for selecting bioactive molecules when compared in batch, the information they provide does not coincide when assessed individually. Our review highlights the importance of considering a broad range of lipids as potential bioactives and the need for accurate prediction of ADMET parameters in the discovery of new biomolecules. The information presented here provides a useful resource for researchers interested in developing new strategies for the treatment of obesity and mental or neurological disorders.

Maximizing Standardization While Ensuring Equity: Exploring the Role of Applicant Experiences, Attributes, and Metrics on Performance of a Surgery-Specific Situational Judgment Test.

BACKGROUND: Situational judgment tests (SJT) are hypothetical but realistic scenario-based assessments that allow residency programs to measure judgment and decision-making among future trainees. A surgery-specific SJT was created to identify highly valued competencies among residency applicants. We aim to demonstrate a stepwise process for validation of this assessment for applicant screening through exploration of two often-overlooked sources of validity evidence - relations with other variables and consequences. METHODS: This was a prospective multi-institutional study involving 7 general surgery residency programs. All applicants completed the SurgSJT, a 32-item test aimed to measure 10 core competencies: adaptability, attention to detail, communication, dependability, feedback receptivity, integrity, professionalism, resilience, self-directed learning, and team orientation. Performance on the SJT was compared to application data, including race, ethnicity, gender, medical school, and USMLE scores. Medical school rankings were determined based on the 2022 U.S. News & World Report rankings. RESULTS: In total, 1491 applicants across seven residency programs were invited to complete the SJT. Of these, 1454 (97.5%) candidates completed the assessment. Applicants were predominantly White (57.5%), Asian (21.6%), Hispanic (9.7%), Black (7.3%), and 52% female. A total of 208 medical schools were represented, majority were allopathic (87.1%) and located in United States (98.7%). Less than a quarter of applicants (22.8%; N=337) were from a top 25 school based on U.S. News & World Report rankings for primary care, surgery, or research. Average USMLE Step 1 score was 235 (SD 37) and Step 2 score was 250 (SD 29). Sex, race, ethnicity, and medical school ranking did not significantly impact performance on the SJT. There was no relationship between SJT score and USMLE scores and medical school rankings. CONCLUSIONS: We demonstrate the process of validity testing and importance of two specific sources of evidence-consequences and relations with other variables, in implementing future educational assessments.

Use of the activPAL® triaxial accelerometer to estimate total energy expenditure in low-income women: differences between body mass index classifications.

Objective: This study aimed to assess the agreement between the total energy expenditure (TEE) estimated by the activPAL® triaxial accelerometers (ACC) and the TEE measured by the doubly labeled water method (DLW), as well as to assess if these values differ between the classifications of body mass index (BMI). Materials and methods: This is a cross-sectional study. Low-income adult women (19-45y) with BMI ≥ 18.5 kg/m2 were included. Accelerometry data (activPAL® ) were collected over 7 consecutive days, which were used to calculate TEE-ACC and compared with DLW data. The Bland-Altman method, concordance correlation coefficient and root mean square error were used to assess agreement between methods. Results: The sample consisted of 55 women with a mean age of 31 ± 5 years. The agreement between TEE-ACC and TEE-DLW showed a bias of -142.5 kcal (-7.1%). Among the BMI classifications, participants with normal weight show a bias of -417.1 kcal (-21.0%), participants with overweight, -87.5 kcal (-3.9%) and participants with obesity, 97.5 kcal (4.3%). Furthermore, the bias between the methods showed a significant and positive correlation with the body weight (r = 0.49; p < 0.01). Conclusion: The TEE-ACC estimates from activPAL® were reasonably accurate when compared to the TEE-DLW, especially in women with overweight and obesity, being much less accurate in individuals with normal weight.