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BACKGROUND AND AIMS: Current laboratory methods for opioid detection involve an initial screening with immunoassays which offers efficient but non-specific results and a subsequent liquid chromatography-tandem mass spectrometry (LC-MS/MS) confirmation which offers accurate results but requires extensive sample preparation and turnaround time. Direct Analysis in Real Time (DART) tandem mass spectrometry is evaluated as an alternative approach for accurate opioid detection with efficient sample preparation and turnaround time. MATERIALS AND METHODS: DART-MS/MS was optimized by testing the method with varying temperatures, operation modes, extraction methods, hydrolysis times, and vortex times. The method was evaluated for 12 opioids by testing the analytical measurement range, percent carryover, precision studies, stability, and method-to-method comparison with LC-MS/MS. RESULTS: DART-MS/MS shows high sensitivity and specificity for the detection of 6-acetylmorphine, codeine, hydromorphone, oxymorphone, hydrocodone, naloxone, buprenorphine, norfentanyl, and fentanyl in urine samples. However, its performance was suboptimal for norbuprenorphine, morphine and oxycodone. CONCLUSION: In this proof-of-concept study, DART-MS/MS is evaluated for its rapid quantitative definitive testing of opioids drugs in urine. Further research is needed to expand its application to other areas of drug testing.
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Analgésicos Opioides , Espectrometria de Massas em Tandem , Humanos , Espectrometria de Massas em Tandem/métodos , Analgésicos Opioides/urina , Cromatografia Líquida/métodos , Fatores de TempoRESUMO
OBJECTIVES: To evaluate the long-term angiographic patency of saphenous vein grafts (SVG) harvested using the no-touch technique compared to the conventional technique. METHODS: This was a single-center, retrospective, cohort study. The inclusion criteria were individuals who underwent a CABG (coronary artery bypass grafting) between January 1995 and July 2020, and who successively needed a clinically-driven angiography. The primary endpoint was long-term patency. The secondary endpoints were differences in patency based on sub-group analysis (single vs. sequential graft, divided by target vessel). RESULTS: The study included 1520 individuals (618 no-touch, 825 conventional and 77 arterial grafts). The mean clinical follow-up time was 8.4 years ± 5.5 years. The patency per patient was 70.7% in the no-touch grafts vs. 46.7% in the conventional grafts (p < 0.001, OR = 2.8). The graft patency was 75.9% in the no-touch grafts vs. 62.8% in the conventional grafts (p < 0.001, OR = 1.8). CONCLUSIONS: The no-touch vein grafts were associated with statistically significantly higher patency at long-term compared to the conventional grafts. CLINICAL TRIAL REGISTRATION: NCT04656366, 7 December 2020.
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Ponte de Artéria Coronária , Veia Safena , Grau de Desobstrução Vascular , Humanos , Feminino , Veia Safena/transplante , Masculino , Estudos Retrospectivos , Ponte de Artéria Coronária/métodos , Idoso , Pessoa de Meia-Idade , Oclusão de Enxerto Vascular , Angiografia Coronária/métodos , Fatores de Tempo , Coleta de Tecidos e Órgãos/métodos , SeguimentosRESUMO
Clinical diagnosis of intraoperative transfusion anaphylaxis using clinical symptoms is challenging and should be made carefully, as an incorrect clinical diagnosis can exacerbate surgical bleeding secondary to stopping a clinically indicated blood transfusion. The timing of onset of anaphylaxis to start of transfusion may be the key to correctly diagnosing intraoperative transfusion anaphylaxis clinically. However, the reliability of this measure remains unknown. A literature search was conducted using MEDLINE, Embase, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials up to June 29, 2021. No language restriction was applied. Two pairs of review authors independently reviewed intraoperative transfusion anaphylaxis cases and extracted data on the timing of onset of anaphylaxis to start of transfusion. A total of 8,918 articles were reviewed, the full texts of 186 articles were assessed, and 20 intraoperative transfusion anaphylaxis cases were included in this study. The 20 intraoperative transfusion anaphylaxis cases included a precise timing of onset. With nine cases, cardiovascular surgery was the most prevalent, and one case was fatal. Fifteen cases had a timing of onset in minutes, and of those, 14 reported timeframes within 30 minutes of initiation of transfusion (median: 15.5, 5-30 minutes). Almost all cases of intraoperative transfusion anaphylaxis occurred within 30 minutes of the transfusion initiation. This timeframe may be helpful in the clinical diagnosis of intraoperative transfusion anaphylaxis.
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Anafilaxia , Humanos , Anafilaxia/etiologia , Anafilaxia/diagnóstico , Fatores de Tempo , Reação Transfusional/diagnóstico , Transfusão de Sangue , Complicações Intraoperatórias/etiologia , Perda Sanguínea CirúrgicaRESUMO
BACKGROUND: The actual prognostic impact of prior lupus nephritis (LN) diagnosis on end-stage kidney disease (ESKD) patients remains questionable, especially in relation to outcomes of kidney transplantation (KTx) We aim to determine the survival of the graft and recipient after the KTx procedure among patients with ESKD due to LN in comparison to non-LN. METHODS: This meta-analysis included retrospective studies from the last two decades, focusing on the KTx's outcomes among ESKD due to LN in comparison to non-LN. We establish the graft/recipient survival rate at different follow-up intervals as the primary outcome, and acute graft rejection and pooled graft failure rate as secondary outcomes. All analyses were performed with the random-effect model (REM) and were presented as odd ratio (OR; within 95% confidence interval (CI)). The protocol of this study was registered in PROSPERO: CRD42023394310. RESULTS: A total of 1,299 KTx (368 LN patients) from 10 studies with >10 years of follow-up were thoroughly reviewed. All checkpoints (at 1-, 5-, 10, and 15-year post-KTx) on graft survival rate demonstrated comparable outcomes in either LN or non-LN (e.g., at 10-year follow up (OR, 1.08 [0.40, 2.91]; p = 0.88). Similar findings at all checkpoints for recipient survival rate were also observed without statistically significant difference between LN and non-LN arm (e.g., at 10-year checkpoint; OR, 0.99 [0.68, 1.46]; p = 0.98). Both of our secondary analyses also presented insignificant differences (p = 0.70 and = 0.16, respectively). CONCLUSIONS: Our findings suggested that prognosis of ESKD due to complicated LN is equal compared to ESKD associated with non-LN etiologies, suggesting the impact of LN as the inducing cause of ESKD on KTx outcome is relatively neglectable.
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Sobrevivência de Enxerto , Falência Renal Crônica , Transplante de Rim , Nefrite Lúpica , Humanos , Nefrite Lúpica/cirurgia , Falência Renal Crônica/cirurgia , Adulto , Rejeição de Enxerto , Fatores de Tempo , Estudos Retrospectivos , PrognósticoRESUMO
BACKGROUND: This study determined pooled estimates of short- and long-term complications of early versus delayed implantation of penile prosthesis in patients with ischemic priapism. METHODS: We searched Pubmed, ProQuest, Scopus, EBSCOHost, and other sources from January 1, 2013, to March 2023. All study designs were included except animal studies, review articles, and consensus documents. Of the 214 articles, four studies were included in the systematic review, and further meta-analysis included three studies (PROSPERO CRD42023411005). RESULTS: The short-term complication rate was lower with early implantation than with later implantation (ß= -2.08; 95% Confidence Interval [CI] = -3.54, -0.6; p = < 0.05). A similar value was also found in the pooled analysis for long-term outcomes, defined as overall satisfaction rate, which is better with early implantation than later (ß = 2.18; 95% CI = 1.35, 3.02; p= < 0.05). CONCLUSIONS: The results of the pooled analysis confirmed that short-term complications were significantly lower with early implantation than with delayed implantation. Overall satisfaction rates were higher in early implantation than in delayed implantation of penile prostheses.
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Isquemia , Implante Peniano , Prótese de Pênis , Complicações Pós-Operatórias , Priapismo , Humanos , Priapismo/etiologia , Priapismo/cirurgia , Masculino , Isquemia/etiologia , Isquemia/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Implante Peniano/métodos , Fatores de Tempo , Tempo para o TratamentoRESUMO
INTRODUCTION: To determine the very early functional as well as oncological outcomes after robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) at a single institution. METHODS: We identified patients who underwent RARP or ORP at our institution between August 2021 and July 2023. The main criterion for surgical technique selection was patient preference. Primary endpoints included anastomosis leakage rate, very early continence rate reported by standardized pad-test, and positive surgical margin rate. Furthermore, we analyzed operation time, hospital stay, postoperative analgesia, and complication rates. RESULTS: In this prospective study, we analyzed data from 222 radical prostatectomies (111 RARP and 111 ORP). There were no significant differences in preoperative age, prostate size, and risk stratification among the groups. Patients who underwent RARP had lower anastomosis leakage rates (8.1% vs. 18.9%) and slightly lower early continence rates (76.6% vs. 78.4%) when compared to patients who underwent ORP. Positive surgical margin rates were similar, and complication rates were also comparable. Operation time was similar for both techniques, but the hospital stay was significantly shorter in the RARP group (6.3 vs. 9.1 days, p=0.03). The ORP group experienced significantly higher opioid administration postoperatively (p<0.001). CONCLUSIONS: From a functional and oncological point of view, both techniques are safe and provide excellent outcomes when performed by experienced surgeons. Nevertheless, patients are likely to benefit from a shortened hospital stay and reduced postoperative pain after RARP.
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Prostatectomia , Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Humanos , Prostatectomia/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Idoso , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/patologia , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Fatores de Tempo , Incontinência Urinária/etiologia , Incontinência Urinária/epidemiologia , Duração da CirurgiaRESUMO
INTRODUCTION: Ureteroscopy has become increasingly chosen as a treatment of choice for patients with kidney stone disease and laser as the energy source for stone lithotripsy is a key part of this. Our aim was to analyse a national database to evaluate the burden of adverse events related to laser fibers and laser machines. METHODS: Search was performed of the Manufacturer User and Facility Device Experience (MAUDE) database in the United States for all events related to holmium laser fibers and holmium laser machines during ureteroscopy between 2012-2021. Information collected included the following: problem, timing, prolonged anaesthesia, early termination of procedure, injury and retained parts. RESULTS: 699 holmium laser fiber events were reported and these had been manufactured by 13 different companies. The commonest problems were breakage outside the patient while in use (26.3%) and breakage of the laser fiber tip (21.2%). Manufacturers concluded root cause to be device failure in 8.9%. 29% of issues occurred before the laser had been activated. 5.2% of cases had to be cancelled as a result of an event. Significantly more injuries were sustained intra-operatively by operating staff compared to patients (6% vs. 0.2%, p < 0.001). All these injuries were superficial burns to the skin with the hand being the most affected body part (88.1%). Zero ocular injuries were reported. Only eight events were related to laser machines and all involved sudden hardware failure but no patient injury. CONCLUSIONS: Laser fibers are fragile. Most adverse events are due to operator error. Direct patient injury from laser fiber is scarce but operating staff should be aware of the risk of sustaining minor burns. Laser machines rarely incur problems and, in this study, did not result in any safety issues beyond need to abort the procedure due to lack of spare equipment.
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Bases de Dados Factuais , Cálculos Renais , Lasers de Estado Sólido , Litotripsia a Laser , Ureteroscopia , Humanos , Ureteroscopia/efeitos adversos , Ureteroscopia/métodos , Litotripsia a Laser/métodos , Litotripsia a Laser/efeitos adversos , Litotripsia a Laser/instrumentação , Estados Unidos , Lasers de Estado Sólido/uso terapêutico , Lasers de Estado Sólido/efeitos adversos , Cálculos Renais/cirurgia , Cálculos Renais/terapia , Falha de Equipamento/estatística & dados numéricos , Fatores de TempoRESUMO
The aim of this study was to develop a mixture of dimethacrylate isomers (PG6EMA) as a potential monomer for dental adhesives and composites. PG6EMA was synthesized de novo and characterized in the presence of ethanol (3%, 6% or 9%). BisGMA/TEGDMA (BTEG, 50/50 wt.%) was used as the resin control. Composites were formulated with 60 wt.% of either PG6EMA or BisGMA (40 wt.% TEGDMA and 70 wt.% filler). DMPA (0.2 wt.%) and DPI-PF6 (0.4 wt.%) were added as photoinitiators, irradiated with a mercury arc lamp (320-500 nm, 500 mW/cm2; Acticure). All materials were tested for polymerization kinetics (near-infrared), viscosity (η) and storage modulus (G', oscillatory rheometry). The composites were further characterized for water sorption/solubility, wet/dry flexural strength/modulus and polymerization stress. Data were analyzed with one-way ANOVA/Tukey's test (α = 0.05). The PG6EMA resins showed lower rates of polymerization compared with BTEG (p = 0.001) but high degrees of conversion (p = 0.002). Solvent concentration did not affect RPMAX but the 6% and 9% mixtures showed higher final DC, likely due to reduced viscosity. PG6EMA had much higher viscosity than BTEG (p <0.001) and lower G' (p = 0.003). Composites modified with PG6EMA have slower polymerization rates (p = 0.001) but higher final DC (p = 0.04) than the control. PG6EMA/TEGDMA showed lower dry/wet flexural strength and comparable dry modulus. The PG6EMA/TEGDMA composite showed a 18.4% polymerization stress reduction compared to the BTEG composite. Both base monomers had similar WS/SL and G'. Within its limitations, this study demonstrated that the newly synthesized PG6EMA was a viable alternative to BisGMA in dental composites.
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Bis-Fenol A-Glicidil Metacrilato , Resinas Compostas , Teste de Materiais , Metacrilatos , Polimerização , Ácidos Polimetacrílicos , Resinas Compostas/química , Resinas Compostas/efeitos da radiação , Bis-Fenol A-Glicidil Metacrilato/química , Metacrilatos/química , Viscosidade , Ácidos Polimetacrílicos/química , Análise de Variância , Fatores de Tempo , Reprodutibilidade dos Testes , Valores de Referência , Resistência à Flexão , Polietilenoglicóis/química , Propriedades de Superfície , Solubilidade , Cinética , Reologia , Cimentos Dentários/química , Cura Luminosa de Adesivos Dentários/métodosRESUMO
BACKGROUND: Jomar et al. demonstrated that death due to COVID-19 did not affect the time under exclusive palliative care among patients with advanced cancer, even during the first year of the pandemic caused by a hitherto little-known disease. BACKGROUND: â¼ Fatality due to COVID-19 does not alter the time under oncological palliative care. BACKGROUND: â¼ The retrospective design of this pioneering study allows causal inference. BACKGROUND: â¼ Access to oncological palliative care frequently approaches terminality of life. OBJECTIVE: This study aimed at investigating the extent to which COVID-19-induced fatalities affect the duration of palliative care among patients with advanced cancer. METHODS: A retrospective cohort study was conducted at the Palliative Care Unit of the Brazilian Instituto Nacional de Câncer in Rio de Janeiro, Brazil, on 1,104 advanced cancer patients who died under exclusive palliative care between March 11, 2020, and March 31, 2021. Wilcoxon rank-sum (Mann-Whitney U) and log-rank tests were performed to examine statistical differences between the medians of time, and the Kaplan-Meier estimator was used to graphically illustrate survival over time under exclusive palliative care contingent upon the underlying causes of death of the two experimental groups (cancer versus COVID-19). RESULTS: A total of 133 (12.05%) patients succumbed to COVID-19. In both groups, the median time under exclusive palliative care was less than one month. The exclusive palliative care survival curves did not exhibit any statistically significant difference between the groups. CONCLUSION: Death due to COVID-19 did not modify the duration of exclusive palliative care among patients with advanced cancer.
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COVID-19 , Neoplasias , Cuidados Paliativos , Humanos , COVID-19/mortalidade , COVID-19/terapia , Cuidados Paliativos/estatística & dados numéricos , Neoplasias/mortalidade , Neoplasias/terapia , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Brasil/epidemiologia , Idoso , Fatores de Tempo , SARS-CoV-2 , Pandemias , Idoso de 80 Anos ou mais , Adulto , Estudos de CoortesRESUMO
PURPOSE: To describe an experimental surgical model in rats using a dual-plane technique for evaluation of biomaterials in an in-vivo silicone implant coverage. METHODS: This study was developed following the ISO 10993-6 standard. In this study, 40 male Wistar rats weighing between 250 and 350 g were used, distributed into two groups: experimental, biomaterial superimposed on the minimammary prosthesis (MP); and control, MP without implantation of the biomaterial, with eight animals at each biological point: 1, 2, 4, 12, and 26 weeks. Thus, at the end of biological points (1, 2, 4, 12, and 26 weeks; n = 8 animals per week), the tissue specimens achieved were fixed in buffered formalin and stained with hematoxylin-eosin. RESULTS: Macroscopically, throughout the study, no postoperative complications were apparent. In the histological analysis, it was possible to observe the evolution of the inflammatory response, tissue repair, and fibrous capsule during the biological points. CONCLUSIONS: The experimental model described in this study proved to be suitable for evaluating the biomaterial used in the coverage of breast silicone implants.
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Materiais Biocompatíveis , Implantes de Mama , Ratos Wistar , Géis de Silicone , Animais , Masculino , Ratos , Teste de Materiais , Modelos Animais , Silicones , Fatores de TempoRESUMO
BACKGROUND: We examined the sedentary behavior and physical activity of 260 patients with peripheral artery disease. Women engaged in more light physical activity than men did. Light physical activity was associated with lower arterial stiffness in men only, while no significant associations were found between sedentary behavior, moderate-vigorous physical activity, and cardiovascular outcomes. BACKGROUND: â¼ Women with peripheral artery disease exhibited higher blood pressure and arterial stiffness than men. BACKGROUND: â¼ Low levels of physical activity, particularly moderate to vigorous activity, were observed in individuals with peripheral artery disease. OBJECTIVE: To analyze the association between the time spent in sedentary behavior and physical activity of different intensities with cardiovascular health in men and women with peripheral artery disease. METHODS: Two hundred and sixty patients with peripheral artery disease and claudication symptoms (65.7% men; 66±1 years; ankle brachial index 0.57±0.18) were evaluated. Physical activity and sedentary behavior were assessed using an accelerometer. Physical activity was classified into light and moderate-vigorous intensities. The cardiovascular outcomes included blood pressure (oscillometric method), cardiac autonomic modulation (heart rate variability), and arterial stiffness (pulse wave velocity). RESULTS: Women spent more time engaged in light physical activity than men (341±14 min/day versus 306±9 min/day; p=0.040, respectively). There was no significant difference in the time spent on sedentary behavior and moderate-vigorous physical activity. Women had a higher systolic blood pressure (p=0.025), higher augmentation index (p<0.001), and lower sympathovagal balance (p=0.047) than men. Pulse wave velocity was only negatively associated with light physical activity (ß= -4.66; 95%CI= -8.57; -0.76) in men. Light and moderate-vigorous physical activity and sedentary behavior were not associated with other cardiovascular outcomes. CONCLUSION: Higher levels of light physical activity were associated with lower arterial stiffness in men with peripheral artery disease.
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Índice Tornozelo-Braço , Pressão Sanguínea , Exercício Físico , Doença Arterial Periférica , Análise de Onda de Pulso , Comportamento Sedentário , Rigidez Vascular , Humanos , Masculino , Feminino , Doença Arterial Periférica/fisiopatologia , Idoso , Rigidez Vascular/fisiologia , Pessoa de Meia-Idade , Exercício Físico/fisiologia , Pressão Sanguínea/fisiologia , Fatores Sexuais , Frequência Cardíaca/fisiologia , Estudos Transversais , Acelerometria , Fatores de TempoRESUMO
OBJECTIVE: For treatment of medication-related osteonecrosis of the jaw, one proposed approach is the use of a topical agent to block entry of these medications in oral soft tissues. We tested the ability of phosphonoformic acid (PFA), an inhibitor of bisphosphonate entry through certain sodium-dependent phosphate contransporters (SLC20A1, 20A2, 34A1-3) as well as Dynasore, a macropinocytosis inhibitor, for their abilities to prevent zoledronate-induced (ZOL) death in human gingival fibroblasts (HGFs). METHODOLOGY: MTT assay dose-response curves were performed to determine non-cytotoxic levels of both PFA and Dynasore. In the presence of 50 µM ZOL, optimized PFA and Dynasore doses were tested for their ability to restore HGF viability. To determine SLC expression in HGFs, total HGF RNA was subjected to quantitative real-time RT-PCR. Confocal fluorescence microscopy was employed to see if Dynasore inhibited macropinocytotic HGF entry of AF647-ZOL. Endosomal acidification in the presence of Dynasore was measured by live cell imaging utilizing LysoSensor Green DND-189. As a further test of Dynasore's ability to interfere with ZOL-containing endosomal maturation, perinuclear localization of mature endosomes containing AF647-ZOL or TRITC-dextran as a control were assessed via confocal fluorescence microscopy with CellProfiler™ software analysis of the resulting photomicrographs. RESULTS: 0.5 mM PFA did not rescue HGFs from ZOL-induced viability loss at 72 hours while 10 and 30 µM geranylgeraniol did partially rescue. HGFs did not express the SLC transporters as compared to the expression in positive control tissues. 10 µM Dynasore completely prevented ZOL-induced viability loss. In the presence of Dynasore, AF647-ZOL and FITC-dextran co-localized in endosomes. Endosomal acidification was inhibited by Dynasore and perinuclear localization of both TRITC-dextran- and AF647-ZOL-containing endosomes was inhibited by 30 µM Dynasore. CONCLUSION: Dynasore prevents ZOL-induced viability loss in HGFs by partially interfering with macropinocytosis and by inhibiting the endosomal maturation pathway thought to be needed for ZOL delivery to the cytoplasm.
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Sobrevivência Celular , Difosfonatos , Endossomos , Fibroblastos , Gengiva , Hidrazonas , Imidazóis , Ácido Zoledrônico , Ácido Zoledrônico/farmacologia , Humanos , Fibroblastos/efeitos dos fármacos , Gengiva/efeitos dos fármacos , Gengiva/citologia , Difosfonatos/farmacologia , Imidazóis/farmacologia , Sobrevivência Celular/efeitos dos fármacos , Endossomos/efeitos dos fármacos , Hidrazonas/farmacologia , Células Cultivadas , Fatores de Tempo , Reação em Cadeia da Polimerase em Tempo Real , Conservadores da Densidade Óssea/farmacologia , Reprodutibilidade dos Testes , Microscopia Confocal , Relação Dose-Resposta a Droga , Pinocitose/efeitos dos fármacosRESUMO
OBJECTIVE: This study sought to investigate the relationship between clinical response to nonsurgical periodontal therapy (NSPT) and serum changes in leukocyte count, fasting blood glucose, hemoglobin, hematocrit, creatinine, and uric acid in kidney transplant recipients (KTR). METHODOLOGY: A prospective study was performed on 20 KTRs. Periodontal and serum data were collected before and 90 days after NSPT, and delta values (Δ = after NSPT - before) were calculated. Periodontal assessment included periodontal probing depth (PPD), clinical attachment level (CAL), and bleeding on probing (BOP). Patients were classified based on the presence of periodontitis and then categorized into stages. RESULTS: Patients showed a reduction in the percentage of sites with PPD≥3mm, PPD≥4 mm and BOP, after NSPT. There was a direct correlation between the deltas of leukocyte count and CAL ≥3 mm (r=0.645, P=0.002) and BOP (r=0.663, P=0.001), and the deltas of uric acid and CAL ≥3 mm (r=0.562, P=0.010). CONCLUSION: A good clinical response to NSPT may affect the reduction of serum levels of leukocyte count and uric acid, suggesting a beneficial effect on systemic health in KTR.
Assuntos
Glicemia , Transplante de Rim , Índice Periodontal , Ácido Úrico , Humanos , Ácido Úrico/sangue , Ácido Úrico/análise , Masculino , Feminino , Estudos Prospectivos , Pessoa de Meia-Idade , Contagem de Leucócitos , Adulto , Resultado do Tratamento , Fatores de Tempo , Glicemia/análise , Estatísticas não Paramétricas , Creatinina/sangue , Hematócrito , Hemoglobinas/análise , Valores de Referência , Periodontite/sangue , Periodontite/terapia , IdosoRESUMO
BACKGROUND: High levels of physical conditioning are associated with improvements in cognitive performance. In this sense, electroencephalographic (ECG) correlates are used to investigate the enhancing role of physical exercise on executive functions. Oscillations in the ß frequency range are proposed to be evident during sensorimotor activity. OBJECTIVE: To investigate the ECG changes influenced by aerobic and resistance exercises performed in an attention task by analyzing the differences in absolute ß power in the prefrontal and frontal regions before, during, and after the oddball paradigm in practitioners and nonpractitioners of physical exercise. METHODS: There were 15 physical activity practitioners (aged 27 ± 4.71) and 15 nonpractitioners (age 28 ± 1.50) recruited. A two-way analysis of variance (ANOVA) was implemented to observe the main effect and the interaction between groups and moments (rest 1, pre-stimulus, and rest 2). RESULTS: An interaction between group and moment factors was observed for Fp1 (p < 0.001); Fp2 (p = 0.001); F7 (p < 0.001); F8 (p < 0.001); F3 (p < 0.001); Fz (p < 0.001); and F4 (p < 0.001). Electrophysiological findings clarified exercisers' specificity and neural efficiency in each prefrontal and frontal subarea. CONCLUSION: Our findings lend support to the current understanding of the cognitive processes underlying physical exercise and provide new evidence on the relationship between exercise and cortical activity.
ANTECEDENTES: Níveis elevados de condicionamento físico estão associados a melhorias no desempenho cognitivo. Nesse sentido, correlatos eletroencefalográficos são utilizados na investigação do papel aprimorador do exercício físico sobre as funções executivas. Tem sido proposto que as oscilações na faixa de frequência ß são evidenciadas durante a atividade sensório-motora. OBJETIVO: Investigar as alterações eletroencefalográficas influenciadas por exercícios aeróbio e resistido realizados em uma tarefa atencional analisando as diferenças da potência absoluta de ß nas regiões pré-frontal e frontal antes, na preparação e depois do paradigma oddball em praticantes e não praticantes de exercício físico. MéTODOS: Foram recrutados 15 praticantes de atividade física (idade 27 ± 4.71) e 15 não praticantes (idade 28 ± 1.50). Uma análise de variância (ANOVA) de duas vias foi implementada para observação do efeito principal e a interação entre os grupos e os momentos (repouso 1, pré-estímulo e repouso 2). RESULTADOS: Uma interação entre os fatores grupo e momento para Fp1 (p < 0,001); Fp2 (p = 0,001); F7 (p < 0,001); F8 (p < 0,001); F3 (p < 0,001); Fz (p < 0,001); e F4 (p < 0,001) foi observada. Os achados eletrofisiológicos esclareceram a especificidade e a eficiência neural dos praticantes de exercício físico em cada subárea pré-frontal e frontal. CONCLUSãO: Nossos achados promovem o entendimento atual dos processos cognitivos subjacentes ao exercício físico e acrescentam novas evidências sobre a relação exercício e atividade cortical.
Assuntos
Ritmo beta , Exercício Físico , Humanos , Adulto , Masculino , Exercício Físico/fisiologia , Análise de Variância , Ritmo beta/fisiologia , Feminino , Adulto Jovem , Atenção/fisiologia , Córtex Pré-Frontal/fisiologia , Cognição/fisiologia , Função Executiva/fisiologia , Fatores de Tempo , Eletroencefalografia , EletrocardiografiaRESUMO
BACKGROUND: The University of Florida (UF) Equal Access Clinic Network (EACN) is the largest student-run free healthcare clinic network in Florida. The UF EACN serves those who are underinsured or uninsured in Alachua County and its surrounding area. Nationally, average total clinic time per medical visit has been established to be 84 min. PROBLEM: Before this project, average patient cycle time at the UF EACN was 125.3 min, and there was no established quality improvement (QI) team to implement changes to address inefficiencies. METHODS: This was a prospective QI study that recorded patient cycle times for patients who received healthcare at any of the four primary care free clinics across the UF EACN from 5 July 2022 to 6 April 2023. INTERVENTIONS: Eighteen Plan-Do-Study-Act cycles were tailored to each of the four primary care clinic's needs with a focus on reducing patient cycle time by addressing the following identified problems: prolonged intake process, translation services, limited numbers of volunteers, and other inefficiencies and bottlenecks in workflow. RESULTS: The median patient cycle time at the EACN shifted from 125.3 min to 112.7 min over a nine month period. This drop of 12.6 min meant patients saw a 10.1% reduction in patient cycle time across the EACN. CONCLUSION: Underserved patients at EACN are experiencing increased value by having shorter patient cycle times.
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Melhoria de Qualidade , Clínica Dirigida por Estudantes , Humanos , Florida , Estudos Prospectivos , Clínica Dirigida por Estudantes/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/normas , Fatores de TempoAssuntos
Tempo de Internação , Admissão e Escalonamento de Pessoal , Enfermagem em Pós-Anestésico , Humanos , Tempo de Internação/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Enfermagem em Pós-Anestésico/métodos , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Sala de Recuperação/estatística & dados numéricos , Fatores de TempoRESUMO
Caffeine (CFF) is efficiently absorbed after ingestion, and approximately 80% of ingested CFF is metabolized to paraxanthine (PXT). Although PXT has approximately twice the adenosine receptor antagonist activity of CFF, there are few reports measuring the metabolite concentrations during CFF intoxication. Furthermore, no studies have examined the efficacy of hemodialysis (HD) on PXT or the indicators that contribute to treatment strategies for patients with acute CFF intoxication. This study analyzed the association between CFF and PXT blood levels, the blood biochemical data, and the vital signs of 27 cases with information on CFF intake and elapsed time data. It was found that HD was not as effective as CFF against PXT in CFF intoxication; however, HD was effective in cases with relatively high PXT concentrations (>10 µg/mL). Simultaneous analysis of CFF and PXT would make it possible to estimate the time elapsed from CFF intake and the risk of hyperCKemia, which may develop in cases left untreated for a prolonged period after ingestion. Therefore, the measurement of PXT, in addition to CFF, is expected to provide useful information for understanding the pathogenesis of CFF intoxication and the development of treatment strategies of acute CFF intoxication.
Assuntos
Cafeína , Diálise Renal , Teofilina , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Teofilina/sangue , Adulto , Idoso , Adulto Jovem , Fatores de Tempo , Idoso de 80 Anos ou maisRESUMO
About 100 cases of Langerhans cell histiocytosis (LCH) occur annually in Japan. It predominantly occurs in infants, presenting as multisystem disease or multifocal bone involvement. However, LCH can also occur in adults aged 20 to 40. Single-system skin involvement is rare, with most cases presenting with multisystem disease, including bone lesions, which respond to chemotherapy. In adults, lung lesions that improve with smoking cessation are well-known, although multisystem disease is more common and requires aggressive therapeutic intervention similar to that in children. In some infant cases, progression of liver, spleen, and bone marrow lesions can be difficult to control and can become severe. However, targeted molecular therapies are now available as a lifesaving option. More than 30% of cases of multisystem LCH recur at least once, often leading to long-term complications. In particular, the emergence of central diabetes insipidus, anterior pituitary dysfunction, and central nervous system neurodegenerative disorders several years after the diagnosis of LCH is a unique feature not observed in other diseases. New therapeutic strategies are needed to counter these problems.
Assuntos
Histiocitose de Células de Langerhans , Histiocitose de Células de Langerhans/complicações , Histiocitose de Células de Langerhans/diagnóstico , Humanos , Fatores de TempoRESUMO
Human vision can detect a single photon, but the minimal exposure required to extract meaning from stimulation remains unknown. This requirement cannot be characterised by stimulus energy, because the system is differentially sensitive to attributes defined by configuration rather than physical amplitude. Determining minimal exposure durations required for processing various stimulus attributes can thus reveal the system's priorities. Using a tachistoscope enabling arbitrarily brief displays, we establish minimal durations for processing human faces, a stimulus category whose perception is associated with several well-characterised behavioural and neural markers. Neural and psychophysical measures show a sequence of distinct minimal exposures for stimulation detection, object-level detection, face-specific processing, and emotion-specific processing. Resolving ongoing debates, face orientation affects minimal exposure but emotional expression does not. Awareness emerges with detection, showing no evidence of subliminal perception. These findings inform theories of visual processing and awareness, elucidating the information to which the visual system is attuned.
Assuntos
Estimulação Luminosa , Percepção Visual , Humanos , Feminino , Masculino , Percepção Visual/fisiologia , Adulto , Adulto Jovem , Emoções/fisiologia , Expressão Facial , Conscientização/fisiologia , Fatores de TempoRESUMO
BACKGROUND: It is unclear whether social isolation and loneliness may precede frailty status or whether frailty may precipitate social isolation and loneliness. We investigated the reciprocal and temporal sequence of social isolation, loneliness, and frailty among older adults across 21 years. METHODS: We used seven waves of the Longitudinal Aging Study Amsterdam from 2302 Dutch older adults (M = 72.6 years, SD = 8.6, 52.1% female) ages 55 or older. Using random intercept cross-lagged panel models, we investigated between- and within-person associations of social isolation and loneliness with frailty. Frailty was measured using the Frailty Index. Loneliness was measured using the 11-item De Jong Gierveld Loneliness Scale. Social isolation was measured using a multi-domain 6-item scale. RESULTS: Social isolation and loneliness were weakly correlated across waves. At the between-person level, individuals with higher levels of frailty tended to have higher levels of social isolation but not loneliness. At the within-person level, the cross-lagged paths indicated that earlier frailty status predicted future social isolation and loneliness over time. However, prior social isolation was not associated with subsequent frailty except at time point 5 (T5). Loneliness at specific time points (T1, T4 and T6) predicted greater frailty at later time points (T2, T5 and T7). The results also supported reciprocal and contemporaneous relations between social isolation, loneliness and frailty. CONCLUSIONS: Social isolation and loneliness are potential outcomes of frailty. Public health policies and health practitioners should prioritise interventions targeting social connection among older adults with pre-frailty or frailty.