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Objective: The aim of this study was to compare the role of a chest physiotherapy (CP) intervention to no intervention on the respiratory status of children under two years of age, with mild-to-moderate bronchiolitis. Methods: Out of 80 eligible children observed in the Emergency Room, 45 children completed the study with 28 randomized to the intervention group and 17 to the control group. The intervention protocol, applied in an ambulatory setting, consisted of combined techniques of passive prolonged slow expiration, rhinopharyngeal clearance and provoked cough. The control group was assessed with no chest physiotherapy intervention. The efficacy of chest physiotherapy was assessed using the Kristjansson Respiratory Score at the admission and discharge of the visit to the Emergency Room and during clinical visits at day 7 and day 15. Results: There was a significant improvement in the Kristjansson Respiratory Score in the intervention group compared to the control group at day 15 [1.2 (1.5) versus 0.3 (0.5); [Formula: see text]-value[Formula: see text], in the control and intervention groups, respectively], with a mean difference (95% CI) of [Formula: see text] ([Formula: see text] to [Formula: see text]). Conclusion: Chest physiotherapy had a positive impact on the respiratory status of children with mild-to-moderate bronchiolitis. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT04260919 .

Resumo Fundamento: A vitamina D (VD) tem um importante papel na função cardíaca. No entanto, a vitamina exerce uma curva “dose-resposta” bifásica na fisiopatologia cardiovascular e pode causar efeitos deletérios, mesmo em doses não tóxicas. A VD exerce suas funções celulares ligando-se ao seu receptor. Ainda, a expressão da proteína de interação com a tiorredoxina (TXNIP) é positivamente regulada pela VD. A TXNIP modula diferentes visa de sinalização celular que podem ser importantes para a remodelação cardíaca. Objetivos: Avaliar se a suplementação com VD leva à remodelação cardíaca, e se a TXNIP e a tiorredoxina (Trx) estão associadas com esse processo. Métodos: Duzentos e cinquenta ratos Wistar machos foram alocados em três grupos: controle (C, n=21), sem suplementação com VD; VD3 (n = 22) e VD10 (n=21), suplementados com 3,000 e 10,000 UI de VD/ kg de ração, respectivamente, por dois meses. Os grupos foram comparados por análise de variância (ANOVA) com um fator e teste post hoc de Holm-Sidak (variáveis com distribuição normal), ou pelo teste de Kruskal-Wallis e análise post-hoc de Dunn. O nível de significância para todos os testes foi de 5%. Resultados: A expressão de TXNIP foi mais alta e a atividade do Trx foi mais baixa no grupo VD10. Os animais que receberam suplementação com VD apresentaram aumento de hidroperóxido lipídico e diminuição de superóxido dismutase e glutationa peroxidase. A proteína Bcl-2 foi mais baixa no grupo VD10. Observou-se uma diminuição na β-oxidação de ácidos graxos, no ciclo do ácido tricarboxílico, na cadeia transportadora de elétrons, e um aumento na via glicolítica. Conclusão: A suplementação com VD levou à remodelação cardíaca e esse processo pode ser modulado por TXNIP e Trx, e consequentemente por estresse oxidativo. Abstract Background: Vitamin D (VD) has been shown to play an important role in cardiac function. However, this vitamin exerts a biphasic “dose response” curve in cardiovascular pathophysiology and may cause deleterious effects, even in non-toxic doses. VD exerts its cellular functions by binding to VD receptor. Additionally, it was identified that the thioredoxin-interacting protein (TXNIP) expression is positively regulated by VD. TXNIP modulate different cell signaling pathways that may be important for cardiac remodeling. Objective: To evaluate whether VD supplementation lead to cardiac remodeling and if TXNIP and thioredoxin (Trx) proteins are associated with the process. Methods: A total of 250 Male Wistar rats were allocated into three groups: control (C, n=21), with no VD supplementation; VD3 (n = 22) and VD10 (n=21), supplemented with 3,000 and 10,000 IU of VD/ kg of chow respectively, for two months. The groups were compared by one-way analysis of variance (ANOVA) and Holm-Sidak post hoc analysis, (variables with normal distribution), or by Kruskal-Wallis test and Dunn's test post hoc analysis. The significance level for all tests was 5%. Results: TXNIP protein expression was higher and Trx activity was lower in VD10. The animals supplemented with VD showed increased lipid hydroperoxide and decreased superoxide dismutase and glutathione peroxidase. The protein Bcl-2 was lower in VD10. There was a decrease in fatty acid β-oxidation, tricarboxylic acid cycle and electron transport chain with shift to increase in glycolytic pathway. Conclusion: VD supplementation led to cardiac remodeling and this process may be modulated by TXNIP and Trx proteins and consequently oxidative stress.

We simulate a moving bed temperature swing adsorption (MBTSA) process to capture CO2 in postcombustion context using zeolite 13X as adsorbent. Experimental adsorption isotherms for CO2 and N2 were ...

Introduction and objectives: In severe aortic stenosis (AS), the impact of aortic valve replacement (AVR) on left ventricular (LV) systolic function assessed by strain and measured by echocardiography or cardiac magnetic resonance (CMR) has been controversial. We aimed to investigate LV systolic myocardial function changes six months after AVR using global longitudinal (GLS), circumferential (GCS) and radial (GRS) strain derived from CMR imaging. Methods: We included 39 severe AS patients (69.3±7.8 years; 61.5% male) with preserved LV ejection fraction (LVEF) who were recruited as part of the EPICHEART study and underwent successful AVR (aortic valvular area: 0.8 cm2 (IQR: 0.2) pre- to 1.8 cm2 (IQR:0.5) post-AVR). Structural and functional parameters were assessed at baseline and six months after AVR, including LV GRS, GCS and GLS analysis by CMR, using cine short-axial and two-, three-, and four-chamber long-axial view. Comparison between baseline and postoperative LV remodeling was performed using Student t-test and Wilcoxon test. Results: At six-month follow-up, LV mass, end-diastolic and end-systolic volumes, stroke volume, cardiac output, lateral E/e’, tricuspid annular plane systolic excursion, right ventricular (RV) S wave velocity, GLS [-15.6% (IQR: 4.39) to -13.7% (IQR: 4.62)] and GCS [-17.8±3.58% to -16.1±2.94%] reduced significantly, while LVEF and GRS remained unchanged and lateral e’ velocity increased. Conclusions: Despite favorable reverse LV structural and diastolic functional remodeling six months following AVR, GLS and GCS assessed by CMR reduced compared to baseline, LVEF remained unchanged. The clinical utility and timing of assessment of postoperative strain changes as a marker of systolic function progression needs further research. Resumo: Introdução e objetivos: Na estenose aórtica (EA), o impacto da substituição da válvula aórtica (SVA) na função sistólica do ventrículo esquerdo (VE), avaliado por strain medido por ecografia ou ressonância magnética cardíaca (RMC), ainda é controverso. Neste estudo, pretendemos investigar as alterações na função sistólica do VE seis meses após SVA, avaliadas por strain global longitudinal (SGL), circunferencial (SGC) e radial (SGR) medidos por RMC. Métodos: Foram incluídos 39 doentes com EA severa (69,3±7,8 anos; 61,5% sexo masculino) com fração de ejeção do VE (FEVE) preservada, recrutados no estudo EPICHEART, que foram submetidos a SVA bem-sucedida [área valvular aórtica (AVA): 0,8 cm2 (VIQ:0,2) pré-SVA para 1,8 cm2 (VIQ:0,5) pós-SVA]. Foram avaliados parâmetros de estrutura e função, incluindo SGL, SGC e SGR do VE por RMC, através da avaliação de imagens de eixo-curto e de eixo-longo de duas, três e quatro câmaras, antes e seis meses após SVA. Os valores pré e pós-operatórios da função e estrutura do VE foram comparados com o teste t de Student e com o teste de Wilcoxon. Resultados: Aos seis meses após SVA, verificou-se redução significativa da massa do VE, volumes telediastólico e telessistólico, volume de ejeção, débito cardíaco, rácio E/e’ lateral, TAPSE e onda S do ventrículo direito (VD), tal como do SGL [-15,6% (VIQ:4,39) para -13,7% (VIQ:4,62)] e do SGC [-17,8±3,58% para -16,1 ± 2,94%), enquanto a FEVE e o SGR não sofreram alterações significativas e a velocidade e’ aumentou. Conclusões: Apesar de uma remodelagem reversa estrutural e funcional diastólica favorável seis meses após SVA, o SGL e SGC medidos por RMC diminuíram e a FEVE não sofreu alterações significativas. A utilidade clínica e o tempo após intervenção para avaliar as alterações pós-operatórias do strain, como marcador de função sistólica, requerem investigação adicional.

Photovoltaic systems under partial shading conditions (PSC) need to operate at the global maximum power point (GMPP) to extract the maximum possible power. Partial shading is characterized by the exhibition of a multi-peaked behavior in the voltage power (P-V) curve. Hence, there are several methods capable of extracting the GMPP from a multi-peaked P-V curve with various distinct characteristics. However, it is important that these techniques have fast dynamic responses to reduce power losses during the GMPP searching process. To fill this very important research gap by improving performance, an efficient hybrid global maximum power point tracking (GMPPT) technique combining a fast double-diode model-based technique and the classic Perturb and Observe (P&O) is proposed. The double-diode model used was modeled for a large number of series and parallel connected modules in a shaded photovoltaic array, which can be used as a valuable tool in the practical evaluation of a photovoltaic installation under PSC. The proposed method accurately tracks the global maximum power point at any operation point with good tracking speed and excellent efficiency. In addition, simulation and experimental results are presented to demonstrate its performance and comparative results with two other GMPPT techniques.

SUMMARY BACKGROUND: The aim of this study is to evaluate the peptidylarginine deiminase 4 (PAD 4) concentration and PADI4 polymorphisms as predictors of acute kidney injury (AKI) development, the need for renal replacement therapy (RRT), and mortality in patients with septic shock. METHODS: We included all individuals aged ≥ 18 years, with a diagnosis of septic shock at ICU admission. Blood samples were taken within the first 24 hours of the patient's admission to determine serum PAD4 concentration and its PADI4 polymorphism (rs11203367) and (rs874881). Patients were monitored during their ICU stay and the development of SAKI was evaluated. Among the patients in whom SAKI developed, mortality and the need for RRT were also evaluated. RESULTS: There were 99 patients, 51.5% of whom developed SAKI and of these, 21.5% needed RRT and 80% died in the ICU. There was no difference between PAD4 concentration (p = 0.116) and its polymorphisms rs11203367 (p = 0.910) and rs874881 (p = 0.769) in patients in whom SAKI did or did not develop. However, PAD4 had a positive correlation with plasma urea concentration (r = 0.269 and p = 0.007) and creatinine (r = 0.284 and p = 0.004). The PAD4 concentration and PADI4 polymorphisms were also not associated with RRT and with mortality in patients with SAKI. CONCLUSION: PAD4 concentration and its polymorphisms were not associated with SAKI development, the need for RRT, or mortality in patients with septic shock. However, PAD4 concentrations were associated with creatinine and urea levels in these patients. RESUMO OBJETIVO: Avaliar a concentração da peptidilarginina deiminase 4 (PAD4) e os polimorfismos de PADI4, como preditores de desenvolvimento de lesão renal aguda, necessidade de terapia renal substitutiva (TRS) e mortalidade em pacientes com choque séptico. MÉTODOS: Foram incluídos indivíduos com idade ≥18 anos, com diagnóstico de choque séptico na admissão na Unidade de Terapia Intensiva (UTI). Amostras de sangue foram coletadas nas primeiras 24 horas após a admissão do paciente para determinar a concentração sérica de PAD4 e seus polimorfismos PADI4 (rs11203367) e (rs874881). Os pacientes foram acompanhados durante a internação na UTI e tiveram avaliados desenvolvimento da lesão renal aguda séptica (Sepsis-induced acute kidney injury - Saki), necessidade TRS e mortalidade. RESULTADOS: Foram avaliados 99 pacientes; 51,5% desenvolveram Saki e, desses, 21,5% necessitaram de TRS e 80% morreram na UTI. Não houve diferença entre a concentração de PAD4 (p=0,116) e seus polimorfismos rs11203367 (p=0,910) e rs874881 (p=0,769) entre os pacientes. No entanto, o PAD4 apresentou correlação positiva com a concentração plasmática de ureia (r=0,269; p=0,007) e creatinina (r=0,284; p=0,004). A concentração de PAD4 e os polimorfismos da PADI4 também não foram associados à TRS e à mortalidade em pacientes com Saki. CONCLUSÕES: A concentração de PAD4 e seus polimorfismos não foram associados ao desenvolvimento de Saki, à necessidade de TRS ou à mortalidade em pacientes com choque séptico. No entanto, as concentrações de PAD4 foram associadas às concentrações de creatinina e ureia nesses pacientes.

Made available in DSpace on 2022-04-29T08:33:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-03-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Universidade Estadual Paulista Aim: This study aimed to evaluate the association between serum myostatin levels, hospital mortality, and muscle mass and strength following ST-segment elevation myocardial infarction (STEMI). Methods: This was a prospective observational study. Within 48 hours of admission, bioelectrical impedance and handgrip strength were assessed and blood samples collected for myostatin evaluation. Hospital mortality was recorded. A multiple logistic regression model was also constructed, adjusted by parameters that exhibited significant differences in the univariate analysis, to evaluate the association between myostatin levels and hospital mortality. Results: One hundred and two (102) patients were included: mean age was 60.5±10.6 years, 67.6% were male, and 6.9% died during hospital stay. Univariate analysis showed that patients with lower myostatin levels had higher mortality rates. Serum myostatin levels positively correlated with handgrip strength (r=0.355; p

The file attached to this record is the author's final peer reviewed version. The Brazilian care home sector is underdeveloped, and the limited available evidence suggests that care quality falls below international standards. Development of the Brazilian care home sector could be associated with better outcomes for those receiving care, and more efficient use of resources across health and social care. Research has an important role to play. This article summarises research priorities for Brazilian long-term care homes developed as part of an international workshop held in Brazil and the UK, and attended by 71 clinicians and researchers from 6 Brazilian Universities, supported by an international faculty of 8 Brazilian, 8 British, 2 Dutch and 1 Austrian academics. The research priorities identified were: understanding and supporting multidisciplinary working in care homes, with emphasis on describing availability of multidisciplinary teams and how they operate; dignity and sensitivity to cultural needs, with emphasis on collating accounts from Brazilian stakeholders about dignity in care and how it can be delivered; enriching the care home environment with art, music and gardens, with a focus on developing arts in the care home space in a way that is sensitive to Brazilian cultural identity; and benchmarking quality of care, with emphasis on exploring how international quality benchmarking tools can be adapted for use in Brazilian care homes, taking account of new initiatives to include person-centred outcomes as part of benchmarking. Instrumental to research in these priority areas will be establishing care home research capacity in Brazil.

Two types of zeolites (type X and type A) were synthesized from fly ash of two Brazilian coal based power plants via hydrothermal treatment after ash fusion with NaOH. The synthesized zeolites were characterized by means of XRF, XRD, SEM and gas adsorption (N2 and CO2 adsorption/desorption at − 196 and 0 °C, respectively). Pure CO2 and N2 adsorption equilibrium isotherms were performed at 50, 70 and 90 °C to measure the CO2 adsorption capacity and selectivity of CO2 over N2. CO2/N2 binary isotherms (15/85% v/v) were also obtained at the same temperatures. Commercial zeolitic materials used for CO2/N2 separation such as zeolite 13X and zeolite 4A underwent the same characterization and adsorption measurements as benchmarks to evaluate the performance of the synthesized zeolites. The synthesized materials from fly ash are promising low cost adsorbents for CO2 separation, reaching ca. 83% of the CO2 adsorption capacity of their commercial counterparts at 0.15 bar and 50 °C.

Made available in DSpace on 2020-12-12T02:08:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-07-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) The objective of this study was to evaluate Spondias mombin L. (SM) pulp and its influence on cardiac remodelling after myocardial infarction (MI). Male Wistar rats were assigned to four groups: a sham group (animals underwent simulated surgery) that received standard chow (S; n = 20), an infarcted group that received standard chow (MI; n = 24), an infarcted group supplemented with 100 mg of SM/kg bodyweight/d, (MIS100; n = 23) and an infarcted group supplemented with 250 mg of SM/kg bodyweight/d (MIS250; n = 22). After 3 months of treatment, morphological, functional and biochemical analyses were performed. MI induced structural and functional changes in the left ventricle with worsening systolic and diastolic function, and SM supplementation at different doses did not influence these variables as analysed by echocardiography and an isolated heart study (P >.05). However, SM supplementation attenuated cardiac remodelling after MI, reducing fibrosis (P =.047) and hypertrophy (P =.006). Biomarkers of oxidative stress, inflammatory processes and energy metabolism were further investigated in the myocardial tissue. SM supplementation improved the efficiency of energy metabolism and decreased lipid hydroperoxide in the myocardium [group S (n = 8): 267.26 ± 20.7; group MI (n = 8): 330.14 ± 47.3; group MIS100 (n = 8): 313.8 ± 46.2; group MIS250: 294.3 ± 38.0 nmol/mg tissue; P =.032], as well as decreased the activation of the inflammatory pathway after MI. In conclusion, SM supplementation attenuated cardiac remodelling processes after MI. We also found that energy metabolism, oxidative stress and inflammation are associated with this effect. In addition, SM supplementation at the highest dose is more effective. Internal Medicine Department Botucatu Medical School São Paulo State University (UNESP) School of Nutrition Sciences Faculty of Health Sciences University of Ottawa Chemistry and Biochemistry Department Institute of Biosciences São Paulo State University (UNESP) Internal Medicine Department Botucatu Medical School São Paulo State University (UNESP) Chemistry and Biochemistry Department Institute of Biosciences São Paulo State University (UNESP) FAPESP: 2014/23215-5 FAPESP: 2015/18502-8 FAPESP: 2018/03082-1

Congenital Zika syndrome (CZS) is characterized by a diverse group of congenital malformations induced by ZIKV infection during pregnancy. Type III interferons have been associated with placental immunity against ZIKV and restriction of vertical transmission in mice, and non-coding single-nucleotide polymorphisms (SNPs) on these genes are well known to influence susceptibility to other viral infections. However, their effect on ZIKV pathogenesis has not yet been explored. To investigate whether maternal non-coding SNPs at IFNL genes are associated with CZS, 52 women infected with ZIKV during pregnancy were enrolled in a case–control association study. A total of 28 women were classified as cases and 24 as controls based on the presence or absence of CZS in their infants, and seven Interferon-λ non-coding SNPs (rs12980275, rs8099917, rs4803217, rs4803219, rs8119886, rs368234815, rs12979860) were genotyped. The results of logistic regression analyses show an association between the G allele at rs8099917 and increased susceptibility to CZS under a log-additive model (adjustedOR = 2.80; 95%CI = 1.14–6.91; p = 0.02), after adjustment for trimester of infection and genetic ancestry. These results provide evidence of an association between Interferon-λ SNPs and CZS, suggesting rs8099917 as a promising candidate for further studies on larger cohorts.

Simple Summary The tumor-surrounding niche comprises not only cancer cells but also stromal cells, signaling molecules, secreted factors and the extracellular matrix. This niche has a three-dimensional (3D) architecture and is implicated in tumor progression, metastasis and drug resistance. 3D cancer models have been increasingly attracting attention due to their potential to provide a more representative tumor niche compared to traditional two-dimensional (2D) models. Bioengineered 3D models contain multiple cell types and important molecules that interact with each other to resemble crucial features of tumor tissues, including the 3D architecture, mechanical properties, genetic profile and cell responses to therapeutics. These defined characteristics highlight the application of 3D models to study tumor biology, metastatic pathways and drug resistance. Abstract Ovarian cancer (OvCa) is one of the leading causes of gynecologic malignancies. Despite treatment with surgery and chemotherapy, OvCa disseminates and recurs frequently, reducing the survival rate for patients. There is an urgent need to develop more effective treatment options for women diagnosed with OvCa. The tumor microenvironment (TME) is a key driver of disease progression, metastasis and resistance to treatment. For this reason, 3D models have been designed to represent this specific niche and allow more realistic cell behaviors compared to conventional 2D approaches. In particular, self-assembling peptides represent a promising biomaterial platform to study tumor biology. They form nanofiber networks that resemble the architecture of the extracellular matrix and can be designed to display mechanical properties and biochemical motifs representative of the TME. In this review, we highlight the properties and benefits of emerging 3D platforms used to model the ovarian TME. We also outline the challenges associated with using these 3D systems and provide suggestions for future studies and developments. We conclude that our understanding of OvCa and advances in materials science will progress the engineering of novel 3D approaches, which will enable the development of more effective therapies.

Background Describe echocardiographic characteristics in patients admitted to an intensive care unit by COVID-19 and identify clinical and laboratory findings associated with an abnormal echocardiogram and its association with in-hospital mortality. Methods Included all patients with RT-PCR-confirmed COVID-19 who underwent echocardiography during hospitalization. Echocardiographic characteristics were assessed in the entire population and subgroups. We also analyzed clinical characteristics associated with an abnormal echocardiogram. An echocardiogram was defined as abnormal when it demonstrates systolic ventricular dysfunction of any degree (left and/or right ventricle) and/or high filling pressures (E/E' ratio>16; SPAP>40mmHg, RAP>15mmHg or diastolic dysfunction ≥ grade 2) and/or moderate to severe pericardial effusion. Clinical variables were also assessed using a classification tree and binary logistic regression was performed with characteristics that showed a statistical significance in univariate analysis. Finally, echocardiographic variables were assessed for in-hospital mortality outcome using the chi-square test. Results 272 admissions to ICU by COVID-19 were identified. Of these, 159 underwent echocardiography (58.5%). 39 were excluded by incomplete demographic data. 72 echocardiograms (60%) were abnormal according to pre-established criteria. Low occurrence of left and right ventricular systolic dysfunction was observed, as well as 30.8% of the population had a normal diastolic function. In univariate analysis, characteristics associated with abnormal echocardiogram were age, elevated troponin, previous heart failure, and SAPS3 score. In the regression model, troponin was the independent marker of abnormal echocardiography in patients admitted to the intensive care unit by COVID19. This finding was corroborated by the classification tree. The abnormal echocardiogram was not associated with in-hospital mortality (OR 1.60; CI95% 0.75–3.41), but the presence of systolic ventricular dysfunction of any degree was associated with a higher occurrence of this outcome (OR 3.52; CI95% 1.12–11.1). Conclusions In intensive care COVID-19 patients, many manifested elevated ventricular filling pressures, but the occurrence of ventricular dysfunction was low. Elevated serum troponin level was the independent marker associated with an abnormal echocardiogram. Systolic ventricular dysfunction was the only echocardiographic variable associated with in-hospital mortality. Funding Acknowledgement Type of funding sources: None.

Background A methodology to identify patients with ascending aortic aneurysm (AsAA) under high risk of aortic growth is not completely defined. Objective This research seeks to numerically characterize the blood flow and relate resulting stress distribution with AsAA growth. Methods Analytical, observational, single-center study in which a computational fluid dynamics (CFD) protocol was applied to aortic Computed Tomography Angiogram (CTA) images of patients with AsAA. Two (CTA) exams with at least one year of difference were obtained. From the CTA-gathered images, three-dimensional models were generated, and clinical data were registered. Study of velocity field and coherent structures (vortices) was performed aiming to relate them to aneurysm growth or non-growth, and thereafter to compare with the clinical data of these patients. Kolmogorov-Smirnov test was used to evaluate the normality distribution and for non-normal distribution, the non-parametric Wilcoxon signed-rank test was applied for comparisons of paired data of the aortic angles. Statistical significance was set at 5%. Results The incident jet in the aortic wall generated recirculation areas in the posterior region of the jet, inducing complex vortices formation, for the group that presented aneurysm growth, leading to an increase of the average pressure at the ascending aortic wall (Fig. 1), between exams. While for the group without aneurysm growth, the average pressure decreased. Conclusion This pilot study showed that CFD based upon CTA may in the near future be a tool to help identify flow patterns associated with AsAA remodeling process. Funding Acknowledgement Type of funding sources: None. Figure 1. Axialvelocity. Iso-surface-without-growthFigure 2. Isosurface of Q-criterion. Without growth

Background Some studies have shown a higher prevalence of deaths in patients with cardiovascular risk factors (CRF) during hospitalization for COVID-19. The impact of high cardiovascular risk on hospital mortality has not been evaluated. Methods Retrospective study with patients admitted to intensive care and confirmed diagnosis of COVID-19 by RT-PCR and with at least one measurement of troponin during hospitalization. The criteria for defining a high cardiovascular risk patient (HCR) were: history of established cardiovascular disease (myocardial infarction, stroke, or peripheral arterial disease), diabetes, chronic kidney disease with clearance 65 years). The population was divided into 4 groups according to the presence of HCR and elevated troponin. Mortality was assessed using the chi-square method, according to the number of CRF, and was assessed in the 4 predetermined groups through logistic regression adjusted for severity (using the SAPS3 score). Results After evaluating 271 admissions during the study period, 236 patients were included for analysis. The mean age was 61.14±16.2 years, with 63.1% men. The prevalence of hypertension was 55.5% and diabetes, 33.1%. 47.4% of the patients had HCR. There was a significant increase in mortality as the number of risk factors increased (no CRF: 5.9%; 1 CRF: 17.5%; 2 CRF: 32.2% and ≥3 CRF: 41.2%; p=0.001). In logistic regression, patients with high cardiovascular risk and high troponin had a higher incidence of hospital mortality (OR 40.38; 95% CI 11.78–138.39). Patients without high cardiovascular risk, but with high troponin also showed a significant association with the primary outcome (OR 16.7; 95% CI 4.45–62.74). In contrast, patients with high cardiovascular risk and normal troponin were not at higher risk of death (OR 2.06; 95% CI 0.56–7.56). Conclusion In patients admitted to intensive care by COVID-19, the high cardiovascular risk impacts on hospital mortality only in patients who presented an increase in troponin levels. Funding Acknowledgement Type of funding sources: None.

Background Myocardial injury that occurs after non-cardiac surgery (MINS) increases mortality in 30 days. However, few studies have assessed the impact of MINS occurrence on long-term mortality. Methods Retrospective study including all non-cardiac surgery patients admitted to an postoperative care unit who stayed at least one night in this unit, and had at least one measurement of high-sensitive cardiac troponin. Patients undergoing coronary angiography and patients with an underlying disease with a poor prognosis were excluded. The study period was from January/2011 to December/2019, ensuring a minimum follow-up of 2 years. Clinical characteristics and the occurrence of MINS were assessed between deaths and survivors using the chi-square test and Student's t-test. Variables with p Results 2532 patients were included, with a mean follow-up of 8.62±2.72 years, mean age = 63.23±16.5 years and 53.6% women. The prevalence of MINS was 12.5% (317 patients). There were 620 deaths (24.5%). In the univariate analysis, the following variables were associated with death: MINS (OR 2.65; p Conclusion In patients undergoing non-cardiac surgery, the increase in high-sensitive troponin increased the risk of death from all causes in the long term. Funding Acknowledgement Type of funding sources: None. Survival curve

Resumo Fundamento O suco de laranja (SL) é rico em polifenóis com propriedades anti-inflamatórias e antioxidantes. Após o infarto do miocárdio (IM), mudanças complexas ocorrem na estrutura e na função cardíacas, processo conhecido como remodelação cardíaca (RC). O estresse oxidativo e a inflamação podem modular esse processo. Nossa hipótese foi a de que o consumo de SL atenua a RC após o IM. Objetivos Avaliar a influência do SL sobre a RC após IM pela análise de variáveis funcionais, morfológicas, de estresse oxidativo, de inflação, e de metabolismo energético. Métodos Um total de 242 ratos machos pesando entre 200 e 250g foram submetidos a um procedimento cirúrgico (ligação da artéria coronária ou cirurgia simulada). Sete dia após a cirurgia, os animais sobreviventes foram divididos para um dos quatro grupos: 1) SM, animais sham que receberam água e maltodextrina (n= 20); 2) SSL, animais sham que receberam SL (n= 20); 3) IM, animais infartados que receberam água e maltodextrina (n= 40); e 4) ISL, animais infartados que receberam SL (n = 40). A análise estatística foi realizada pelo teste de ANOVA com dois fatores com o teste de Holm-Sidak. Os resultados foram apresentados em média ± desvio padrão, e o nível de significância adotado foi de 5%. Resultados Três meses depois, o IM levou à hipertrofia do ventrículo esquerdo (VE), com disfunção sistólica e diastólica, e aumento nos mediadores inflamatórios e de estresse oxidativo. Os animais que consumiram SL apresentaram menor atividade da glutationa peroxidase e maior expressão da heme-oxigenase-1 (HO-1). Conclusão O SL atenuou a RC, e a HO-1 pode exercer um importante papel nesse processo. Abstract Background Orange juice (OJ) is rich in polyphenols with anti-inflammatory and antioxidant properties. After myocardial infarction (MI), complex changes occur in cardiac structure and function, which is known as cardiac remodeling (CR). Oxidative stress and inflammation can modulate this process. We hypothesized that the consumption of OJ attenuates the CR after MI. Objectives To evaluate the influence of OJ on CR after MI by analysis of functional, morphological, oxidative stress, inflammation, and energy metabolism variables. Methods A total of 242 male rats weighing 200-250 g were submitted to a surgical procedure (coronary artery ligation or simulated surgery). Seven days after surgery, survivors were assigned to one of the four groups 1) SM, sham animals with water and maltodextrin (n= 20); 2) SOJ, sham animals with OJ (n= 20); 3) IM, infarcted animals with water and maltodextrin (n= 40); and 4) IOJ, infarcted animals with OJ (n = 40). Statistical analysis was performed by the two-way ANOVA supplemented by Holm-Sidak. Results are presented as mean ± standard deviation, the level of significance adopted was 5%. Results After 3 months, MI led to left ventricular (LV) hypertrophy, with systolic and diastolic dysfunction, and increased oxidative stress and inflammatory mediators. OJ intake reduced LV cavity and improved systolic and diastolic function. The OJ animals presented lower activity of glutathione peroxidase and higher expression of heme-oxygenase-1 (HO-1). Conclusion OJ attenuated CR in infarcted rats and HO-1 may be play an important role in this process.

Distributed microgeneration and minigeneration offer a solution for the supply of electricity without the need for large investments. This paper uses the data envelopment analysis (DEA) technique to verify the performance of photovoltaic systems managed by the population. During the analysis, data were collected on 123 micro- and minigeneration units distributed over an area of 98 500 km² in the northeast region of Brazil. Using the analysis undertaken in this paper, high dispersions of the performance among photovoltaic systems were verified in Pernambuco because the efficiency levels of approximately 90% of the facilities evaluated can be improved. The analysis sought to understand the factors that have an impact on the good performance of the generating units, in addition to which it identified the generation units that are efficient and that will serve as references for the inefficient units. It is important to emphasize that, although DEA does not directly identify the causes of inefficiency of a unit, it indicates the reference units to be mirrored by the unit, in order to identify the practices to be applied to improve its efficiency level. The systematic method presented in this paper can be replicated and expanded by using a monitoring system in order to guarantee the best way to take advantage of photovoltaic generation in distributed systems, thereby enabling the energy generated to be increased by up to 30%, as shown in this paper.

Pulmonary arterial hypertension is a fatal lung disease caused by the progressive remodeling of small pulmonary arteries (PAs). Sildenafil can prevent the remodeling of PAs, but conventional sildenafil formulations have shown limited treatment efficacy for their poor accumulation in PAs. Here, glucuronic acid (GlcA)-modified liposomes (GlcA-Lips) were developed to improve the delivery of sildenafil to aberrant over-proliferative PA smooth muscle cells via targeting the GLUT-1 (glucose transport-1), and, therefore, inhibiting the remodeling of PAs in a monocrotaline-induced PA hypertension model. GlcA-Lips encapsulating sildenafil (GlcA-sildenafil-Lips) had a size of 90 nm and a pH-sensitive drug release pattern. Immunostaining assay indicated the overexpression of GLUT-1 in PA smooth muscle cells. Cellular uptake studies showed a 1-fold increase of GlcA-Lips uptake by PA smooth muscle cells and pharmacokinetics and biodistribution experiments indicated longer blood circulation time of GlcA-Lips and increased ability to target PAs by 1-fold after 8 hours administration. Two-week treatment indicated GlcA-sildenafil-Lips significantly inhibited the remodeling of PAs, with a 32% reduction in the PA pressure, a 41% decrease in the medial thickening, and a 44% reduction of the right ventricle cardiomyocyte hypertrophy, and improved survival rate. Immunohistochemical analysis showed enhanced expression of caspase-3, after administration of GlcA-sildenafil-Lips, and reduced expression of P-ERK1/2 (phosphorylated ERK1/2) and HK-2 (hexokinase-2), and increased level of eNOS (endothelial nitric oxide synthase) and cyclic GMP (cGMP). In conclusion, targeted delivery of sildenafil to PA smooth muscle cells with GlcA-Lips could effectively inhibit the remodeling of PAs in the monocrotaline-induced PA hypertension.

Pure component adsorption equilibrium of CH4 and CO2 on activated carbon have been studied at three different temperatures, 298, 323, and 348 K within a pressure range of 10–2000 kPa. Binar...

Made available in DSpace on 2022-04-29T08:32:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-06-01 Purpose: The Global Leadership Initiative on Malnutrition (GLIM) is a new nutritional assessment tool but must be validated in different scenarios. Thus, our objective was to evaluate the association between the GLIM criteria with hospital mortality in patients receiving parenteral nutrition (PN). Methods: This was a retrospective clinical study, with clinical and surgical patients receiving PN during hospitalization. Nutritional status was assessed by the GLIM criteria and demographics, laboratorial, anthropometric, and nutritional data were collected. The GLIM criteria include a phenotypic criteria (low BMI < 20 kg/m2 if < 70 years or < 22 kg/m2 if > 70 years) and etiologic criteria (CRP > 1.0 mg/dL). All patients were followed up during the PN period and the hospital mortality was the primary outcome. The logistic regression model was performed to assess hospital mortality. Results: Among the 90 patients evaluated, 46.6% died during hospital stay and 21.1% had malnutrition. The age was 63 (46–74) years, 61.1% were men, and regarding the underlying diseases, 74.4% of the patients had gastrointestinal disorders, 3.3% polytrauma, and 22.38% other diseases. CRP mean was 31.3 ± 19.3 mg/dL and the median of BMI was 24.8 (21.6–28.5) kg/m2. In a logistic regression model adjusted by sex and age, the serum albumin concentration was associated with hospital mortality rate (OR: 0.321; 95% CI: 0.142–0.727; p: 0.006). Despite this adjustment, the diagnosis of malnutrition was not associated with hospital mortality (OR: 1.498; 95% CI: 0.496–4.521; p: 0.473). Conclusion: GLIM-defined malnutrition is not associated with hospital mortality in patients receiving PN. Also, the evaluation of inflammatory markers seems to be more important than only as etiologic criteria.sss Department of Internal Medicine Botucatu Medical School São Paulo State University - UNESP, Av. Prof. Mário Rubens Guimarães Montenegro, s/n, UNESP - Campus de Botucatu Faculty of Nutrition Federal University of Goiás - UFG Department of Internal Medicine Botucatu Medical School São Paulo State University - UNESP, Av. Prof. Mário Rubens Guimarães Montenegro, s/n, UNESP - Campus de Botucatu

Patients with chronic kidney disease (CKD) have a higher risk of death than the general population, the main cause being cardiovascular disease (CVD). Nutrition plays a key role in the prevention and treatment of CVD and kidney diseases. Currently, new evidence reinforces the importance of specific foods and general dietary patterns rather than isolated nutrients for cardiovascular risk. In addition, dietary patterns and healthy eating habits seem extremely relevant in decreasing risk factors. Epidemiologic and clinical intervention studies have suggested that late-night dinner and skipping breakfast are associated with an increased risk of obesity, insulin resistance, and CVD. In CKD, despite important changes in nutritional counseling in recent decades, less attention has been paid to meal timing and frequency. Therefore, the purpose of this review is to discuss the evidence of meal timing and frequency in CKD development and prognosis, presented under three main topics: risk of developing CKD, importance of dietary habits, and implications of fasting.

Purpose Considering the COVID-19 pandemic, vitamin D is a target of research and speculation. Lockdown or home isolation reduces sunlight exposition and increases the risk of vitamin D deficiency. Special attention is needed for older people at risk of both severe forms of COVID-19 and vitamin D deficiency. This review aims to highlight the association of vitamin D and COVID-19 in two instances, the direct influence of vitamin D on the immune system, and the indirect risks for other vitamin D deficiency-related diseases, such as musculoskeletal properties in older persons. Methods We performed a narrative review. Results Whether vitamin D deficiency is associated with COVID-19 poor prognosis, and if vitamin D supplementation may improve the post-infection outcomes is still unclear. In any case, the pandemic generates indirect burden, such as the sequence: home isolation, low sunlight exposition, vitamin D deficiency, and fragility fractures. Conclusion Therefore, it is time to debate how to optimize vitamin D status in older people, especially during the COVID-19 pandemic.

Antimicrobial-resistant (AMR) bacteria are unequivocally identified as the most important global threat to human, animal and plant health in the 21st century. In humans, AMR is predicted to outstrip cancer, cardiovascular, neurological and metabolic disorders as the most important cause of death by 2050. Tackling AMR requires multidisciplinary approaches, including the repurposing and revitalization of older drugs, development of new compounds and novel strategies to deliver them for treating and preventing the spread of multidrug-resistant bacterial infections. In this chapter, research exploiting supramolecular peptide nanotechnology for the development of antimicrobial nanomaterials is summarized, with particular emphasis on the role of molecular design and self-assembly in harnessing antimicrobial activities.

This work was supported by the Institutional Program for Scientifc Initiation Scholarships (PIBIC) funded by the National Council for Scientifc and Technological Development (CNPq) and the Health Surveillance Secretariat of Ministry of Health of Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Programa de Inicia??o Cient?fica. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Servi?o de Epidemiologia. Ananindeua, PA, Brasil. Ophir Loyola Hospital. Bel?m, PA, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. We describe two neurological cases of Oropouche virus infection in northern Brazil, where the virus is endemic but neglected as a pathogen. This study reiterates the necessity of developing protocols for diagnosing infections and training medical personnel to recognize the pathogenicity of Oropouche virus in neurological infections

Made available in DSpace on 2021-06-25T10:52:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-04-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background: The purpose of this study was to evaluate urea to albumin ratio (UAR) as predictor of mortality in patients with septic shock. Methods: We included all individuals aged ≥ 18 years, with the diagnosis of septic shock at Intensive Care Unit (ICU) admission. Laboratorial and clinical data was recorded within the first 24 h of the patient's admission. Serum urea and albumin concentration were used for UAR calculation. All patients were followed during their ICU stay and the mortality rate was recorded. Results: 222 patients were included in the analysis; the mean age was 62.3 ± 15.1 years and 66% were male. Mortality rate during the ICU stay was 59.9% and the median UAR was 40.7 (24.5–66.1). The UAR was also higher in patients who died in the ICU and was positively correlated with APACHE II, SOFA score and CRP. The ROC ICU mortality development (AUC: 0.617; CI 95%: 0.541–0.693; p: 0.003) at the cutoff of ≥47.25. Furthermore, UAR values were associated with ICU mortality when adjusted by age, sex and APACHE II (OR: 1.011; CI95%:1.000–1.022; p = 0.043) and when adjusted by lactate (OR: 1.014; CI95%:1.003–1.024; p = 0.009). Conclusions: Our data suggest that UAR could play a role as predictor of ICU mortality in patients with septic shock. Department of Internal Medicine Botucatu Medical School UNESP – Univ Estadual Paulista Faculty of Nutrition Univ Federal de Goias UFG Department of Internal Medicine Botucatu Medical School UNESP – Univ Estadual Paulista CAPES: 2014/17262-0 FAPESP: 2017/21554-5

Made available in DSpace on 2020-12-12T01:50:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-09-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background & aims: Stroke is the leading cause of disability in adult life. Oropharyngeal dysphagia occurs in 65–90% of patients, and its identification in the acute phase of stroke can prevent complications. The aim of this study was to verify whether oropharyngeal dysphagia during stroke hospitalization is associated with functional capacity, as assessed by the modified Rankin Scale (mRs), and mortality 90 days after stroke. Materials and methods: A prospective cohort study evaluating 201 patients hospitalized in the Stroke Unit was carried out. Dysphagia was evaluated during hospitalization using both a specific protocol to evaluate swallowing biomechanics and the Functional Oral Intake Scale (FOIS), in which FOIS 1–3 reflects tube feeding, 4–5 reflects oral feeding requiring food consistency changes, and 6–7 reflects oral feeding with no changes in food consistency. An mRs≥3 at 90 days after discharge was considered disability. The data were adjusted for the National Institute of Health Stroke Scale score, sex, age, stroke-associated pneumonia, type of stroke, and presence of thrombolysis. The significance level was set at 5%. Results: Of the 201 patients evaluated, 42.8% (86) who had dysphagia were older, had a higher severity of stroke, and pneumonia rate. A FOIS score of 6–7 was a protective factor against disability (mRs≥3) (OR: 0.17; CI: 0.005–0.56; p = 0.004), and tube feeding use at hospital discharge increased the risk of mRs≥3 (OR: 14.97; CI: 2.68–83.65; p = 0.002) and mortality (OR: 9.79; CI: 2.21–43.4; p = 0.003) within 90 days after stroke. Pneumonia was the leading cause of death, however dysphagia and tube feeding at discharge were associated with death from any cause. Conclusion: Dysphagia or tube feeding use at discharge are markers of poor prognosis after the first stroke. Our data suggest the importance of early evaluation of dysphagia and closely monitoring the tube fed patients following stroke. Department of Internal Medicine Sao Paulo State University (Unesp) Medical School Department of Neurology Psychology and Psychiatry Sao Paulo State University (Unesp) Medical School Department of Internal Medicine Sao Paulo State University (Unesp) Medical School Department of Neurology Psychology and Psychiatry Sao Paulo State University (Unesp) Medical School

Data Availability Statement: The datasets generated for this study are available on request to the corresponding author. Copyright © 2020 Maslova, Shi, Sjöberg, Azevedo, Wareham and McCarthy. The primary reason for skin graft failure and the mortality of burn wound patients, particularly those in burn intensive care centers, is bacterial infection. Several animal models exist to study burn wound pathogens. The most commonly used model is the mouse, which can be used to study virulence determinants and pathogenicity of a wide range of clinically relevant burn wound pathogens. However, animal models of burn wound pathogenicity are governed by strict ethical guidelines and hindered by high levels of animal suffering and the high level of training that is required to achieve consistent reproducible results. In this study, we describe for the first time an invertebrate model of burn trauma and concomitant wound infection. We demonstrate that this model recapitulates many of the hallmarks of burn trauma and wound infection seen in mammalian models and in human patients. We outline how this model can be used to discriminate between high and low pathogenicity strains of two of the most common burn wound colonizers Pseudomonas aeruginosa and Staphylococcus aureus, and multi-drug resistant Acinetobacter baumannii. This model is less ethically challenging than traditional vertebrate burn wound models and has the capacity to enable experiments such as high throughput screening of both anti-infective compounds and genetic mutant libraries. Brunel Research Innovation and Enterprise Fund (2018-11143); British Society for Antimicrobial Chemotherapy (BSAC-2018-0095); Innovate UK (37800), FRAME; Young European Research University Network; Seed Award in Science (210122/Z/18/Z) granted by the Wellcome Trust.

In view of the development of apparel collections, it is necessary to consider several factors such as current and future trends, materials (textiles), target/consumer, and principles and elements of design. Simultaneously, it is associated to these the colour factor. This work focuses on the textile attributes and aesthetics (with or without pattern, its colour, the fabric composition and finishes), considering, at the same time, masculine and feminine genders, as well as genderlessness, and how one can influence the other. In this context, based on the theorical research presented, we recognize the importance, not only of form and style, but mainly of colour in clothing and how this can be a problem and a solution for the development of genderless garments.

There has been an increasing demand for Information and Communication Technology (ICT) specialists, namely software engineers. The two-year SWitCH program was created to lower current unemployment rates, help on fulfilling the existing demand for software engineers from ICT companies and promote the reskilling of existing graduate students to the ICT area. This program consists of a one-year academic post-graduation program followed by a one-year paid internship. This paper introduces the SWitCH program, the current approach and post-graduation methodology, its comparison with similar approaches and its results so far.

The targeted delivery of therapies to diseased tissues offers a safe opportunity to achieve optimal efficacy while limiting systemic exposure. These considerations apply to many disease indications but are especially relevant for rheumatoid arthritis (RA), as RA is a systemic autoimmune disease which affects multiple joints. We have identified an antibody that is specific to damaged arthritic cartilage (anti-ROS-CII) that can be used to deliver treatments specifically to arthritic joints, yielding augmented efficacy in experimental arthritis. In the current study, we demonstrate that scaffolds enriched with bioactive payloads can be delivered precisely to an inflamed joint and achieve superior efficacy outcomes consistent with the pharmacological properties of these payloads. As a scaffold, we have used extracellular vesicles (EVs) prepared from human neutrophils (PMNs), which possess intrinsic anti-inflammatory properties and the ability to penetrate inflamed arthritic cartilage. EV fortified with anti-ROS-CII (EV/anti-ROS-CII) retained anti-ROS-CII specificity and bound exclusively to the damaged cartilage. Following systemic administration, EV/anti-ROS-CII (a) exhibited the ability to localize specifically in the arthritic joint in vivo and (b) was able to specifically target single (viral IL-10 or anti-TNF) or combined (viral IL-10 and anti-TNF) anti-inflammatory treatments to the arthritic joint, which accelerated attenuation of clinical and synovial inflammation. Overall, this study demonstrates the attainability of targeting a pro-resolving biological scaffold to the arthritic joint. The potential of targeting scaffolds such as EV, nanoparticles, or a combination thereof alongside combined therapeutics is paramount for designing systemically administered broad-spectrum of anti-inflammatory treatments.

Background: Stroke is the leading cause of disability in adult life. Oropharyngeal dysphagia occurs in 65-90% of patients, and its identification in the acute phase of stroke can prevent complications. Objective: Verify whether Functional Oral Intake Scale (FOIS) score during stroke hospitalization is associated with functional capacity, as assessed by the modified Rankin Scale (mRs), and mortality 90 days after stroke. Methods: A prospective cohort study evaluating 201 patients hospitalized in the Stroke Unit was carried out. Dysphagia was evaluated during hospitalization using both a specific protocol to evaluate swallowing biomechanics and FOIS, in which FOIS 1-3 - tube feeding, 4-5 - oral feeding requiring food consistency changes, and 6-7 - oral feeding with no changes in food consistency. mRs≥3 90 days after discharge was considered disability. The data were adjusted for the NIHSS score, sex, age, type of stroke, and presence of thrombolysis. Significance level of 5%. Results: Of the 201 patients evaluated, 42.8% (86) who had dysphagia were older, had a higher severity of stroke, and pneumonia rate . A FOIS score of 6-7 may be a protective factor against disability (mRs≥3) (OR:0.17; CI:0.005-0.56; p=0.004), and FOIS 1-3 at hospital discharge increased the risk of mRs≥3 (OR:14.97; CI: 2.68-83.65; p=0.002) and mortality (OR:9.79; CI:2.21-43.4; p=0.003) within 90 days after stroke. Pneumonia was the leading cause of death, however dysphagia and FOIS 1-3 at discharge were associated with death from any cause. Important to highlight that the interaction of FOIS 1-3 at discharge and pneumonia further enhanced mortality chance (OR:113; CI:1.40-9.097; p=0.035). Conclusion: Dysphagia or FOIS 1-3 at discharge are markers of poor prognosis after stroke. Our data suggest the importance of early evaluation of dysphagia and closely monitoring the tube fed patients following stroke.

Objective: The objective of this review is to scope the evidence on how researchers, health, and social care professionals in Brazil currently identify and manage frailty in older adults. Introduction: The rapidly aging population and associated increased healthcare usage by older people with frailty are challenging the sustainability of healthcare for older people in Brazil. Understanding how frailty is identified, measured, categorized, and managed in Brazil is an important part of building a response to the challenge. Inclusion criteria: This scoping review will consider studies that included older Brazilian adults (≥60 years old) recruited from different settings (community, primary care, health care centers, hospital, and long-term care institutions). Studies will be included if they involved any kind of frailty assessment (tools, scales, and measures) and/or interventions. This review will consider all study designs, regardless of their rigor. National policies for older people will be also be considered for analysis. Methods: Indexed and gray literature in English or Portuguese from 2001 to the present will be considered. The searches will be conducted using bibliographic databases, university repositories, and the Brazilian Government official database. The studies will be independently screened according to the inclusion criteria by two reviewers based on their title, abstract, and full text. In case of disagreement, a third reviewer will be consulted. A customized data extraction form will be used to extract data from the included studies. The results will be presented in tabular form, accompanied by a narrative summary related to the objective of the present scoping review.

The presence of humidity in gas streams is usually associated to several problems in the performance of industrial unit operations. Therefore, gas drying is one of the most important primar...

Made available in DSpace on 2019-10-06T16:06:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-11-16 BACKGROUND: Oxidative stress is one potential mechanism that explain the direct effects of smoking on cardiac remodeling process. However, no study has compared different myocardial products of macromolecule oxidation after tobacco smoke exposure. Thus, the aim of this study was to investigate the lipid hydroperoxide (LH) levels, protein carbonyl concentrations and DNA damage in cardiac tissue of rats exposed to tobacco smoke. METHODS: Male Wistar rats were divided into two groups: group C (control, n = 14) composed of animals not exposed to cigarette smoke; group ETS (exposed to tobacco smoke, n = 14) composed by animals exposed to cigarette smoke. The animals were exposed to 2 month of ETS and morphological, biochemical and functional analyses were performed. RESULTS: Cardiac cotinine levels were elevated in the ETS group. In addition, the myocyte cross-sectional area was higher in the ETS group. (C = 266.6 ± 23.2 μm2 and ETS = 347.5 ± 15.1 μm2, p

Made available in DSpace on 2018-12-11T17:20:55Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-08-20 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) The objective of our study was to evaluate the influence of the superoxide dismutase 1 (SOD1) polymorphisms on erythrocyte SOD1 activity and the mortality of patients with septic shock. We prospectively evaluated 175 patients aged over 18 years with septic shock upon ICU admission. However, 38 patients were excluded. Thus, 137 patients were enrolled in the study. Blood samples were taken within the first 24 h of the patient's admission to determine erythrocyte SOD1 activity and nine SOD1 gene polymorphisms. The mean patient age was 63 ± 16 years, 58% were men, and ICU mortality rate was 66%. The patients who died were older and more severely ill, with higher Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, as well as higher lactate, urea, and protein carbonyl levels. In the logistic regression model, erythrocyte SOD1 activity was associated with ICU mortality. This relationship was also maintained in the highest tertile of SOD1 activity (odds ratio [OR]: 0.02; 95% confidence interval [CI]: 0.00–0.78; p = 0.037). Only SNP rs2070424 of the SOD1 gene influenced erythrocyte SOD1 activity. For patients with the AA allele, the activity of SOD1 was lower in relation to G-carriers (A/G+G/G genotype) (p = 0.019). None of the nine SOD1 SNPs were associated with ICU mortality. In conclusion, the SNP rs2070424 of the SOD1 gene interferes with erythrocyte SOD1 activity, and higher activity of SOD1 was associated with decreased mortality in patients with septic shock. Department of Internal Medicine Botucatu Medical School UNESP – Univ Estadual Paulista Department of Food and Experimental Nutrition Faculty of Pharmaceutical Science USP - University of São Paulo Chemistry and Biochemistry Department Institute of Biosciences Univ Estadual Paulista (UNESP) Department of Nutrition School of Public Health USP – University of São Paulo Department of Internal Medicine Botucatu Medical School UNESP – Univ Estadual Paulista Chemistry and Biochemistry Department Institute of Biosciences Univ Estadual Paulista (UNESP) FAPESP: 2014/07988-4 FAPESP: FAPESP−2014/17262-0

Made available in DSpace on 2018-12-11T17:17:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-05-01 Background: Nutritional status may influence outcome after stroke. It is possible that some obese individuals present reduced fat-free mass. Aims: We aimed to determine if bedside evaluation of body composition by the body mass index (BMI), adductor pollicis muscle thickness (APMT) and arm muscle area (AMA), and the combination of low APMT or AMA with obesity are associated with disability 90 days after stroke. Methods: A cohort study evaluating 120 patients hospitalized at the Stroke Unit was carried out. Data were expressed as average ± standard deviation or median and percentiles. Obesity was evaluated by BMI and fat-free mass by the APMT and AMA. Receiver operating characteristic (ROC) curves and multivariate logistic regression analysis were used to measure whether APMT and obesity were associated with modified Rankin Scale (mRS) ≥3 (disability) within 90 days of stroke. The data were adjusted for National Institutes of Health Stroke Scale (NIHSS), sex, age, type of stroke, and thrombolysis. The significance level was 5%. Results: Of 120 patients, we came up with the following demographics: men: 66 (55.0%); mean age: 66.6 ± 13.2 years; ischemic stroke: 109 (90.8%); mean NIHSS: 4 (2-10); thrombolysis: 18 (16.5%). Considering mRS ≥3, ROC curve analysis showed that the value of the cutoff for APMT was

Made available in DSpace on 2019-10-06T15:59:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-10-01 Background/Aims: The objective of our study was to evaluate the effects of zinc supplementation on cardiac remodeling following acute myocardial infarction in rats. Methods: Animals were subdivided into 4 groups and observed for 3 months: 1) Sham Control; 2) Sham Zinc: Sham animals receiving zinc supplementation; 3) Infarction Control; 4) Infarction Zinc. After the followup period, we studied hypertrophy and ventricular geometry, functional alterations in vivo and in vitro, changes related to collagen, oxidative stress, and inflammation, assessed by echocardiogram, isolated heart study, western blot, flow cytometer, morphometry, and spectrophotometry. Results: Infarction induced a significant worsening of the functional variables. On the other hand, zinc attenuated both systolic and diastolic cardiac dysfunction induced by infarction. Considering the infarct size, there was no difference between the groups. Catalase and superoxide dismutase decreased in infarcted animals, and zinc increased its activity. We found higher expression of collagens I and III in infarcted animals, but there was no effect of zinc supplementation. Likewise, infarcted animals had higher levels of IL-10, but without zinc interference. Nrf-2 values were not different among the groups. Infarction increased the amount of Treg cells in the spleen as well as the amount of total lymphocytes. Zinc increased the amount of CD4+ in infarcted animals, but we did not observe effects in relation to Treg cells. Conclusion: zinc attenuates cardiac remodeling after infarction in rats; this effect is associated with modulation of antioxidant enzymes, but without the involvement of collagens I and III, Nrf-2, IL-10, and Treg cells. São Paulo State University (Unesp) Botucatu Medical School Internal Medicine Department São Paulo State University (Unesp) Institute of Biosciences of Botucatu Chemistry and Biochemistry Department São Paulo State University (Unesp) Institute of Biosciences of Botucatu Microbiology and Immunology Department Flow Citometry Laboratory Amaral Carvalho Fundation São Paulo State University (Unesp) Botucatu Medical School Internal Medicine Department São Paulo State University (Unesp) Institute of Biosciences of Botucatu Chemistry and Biochemistry Department São Paulo State University (Unesp) Institute of Biosciences of Botucatu Microbiology and Immunology Department

This paper introduces a single-switch, high step-up DC–DC converter for photovoltaic applications such as power optimizers and microinverters. The proposed converter employs two voltage multipliers cells with switched capacitor and magnetic coupling techniques to achieve high voltage gain. This feature, along with a passive clamp circuit, reduces the voltage stress across the switch, allowing for the employment of low RDSon MOSFET. This leads to low conduction loss of the switch. The diodes operate with zero-current switching at their turn-off transition, eliminating the reverse recovery losses. Additionally, the switch turns on with zero-current switching, leading to insignificant switching loss associated with its turn-on transition. The operation principle and steady-state analysis are presented and validated through experimental results obtained from a 140 W prototype of the proposed converter.

Malnutrition, in particular protein-energy malnutrition, is a highly prevalent condition in older adults, and is associated with low muscle mass and function, and increased prevalence of physical frailty. Malnutrition is often exacerbated in the residential care setting due to factors including lack of dentition and appetite, and increased prevalence of dementia and dysphagia. This review aims to provide an overview of the available literature in older adults in the residential care setting regarding the following: links between sarcopenia, frailty, and malnutrition (in particular, protein-energy malnutrition (PEM)), recognition and diagnosis of malnutrition, factors contributing to PEM, and the effectiveness of different forms of protein supplementation (in particular, oral nutritional supplementation (ONS) and protein-fortified foods (PFF)) to target PEM. This review found a lack of consensus on effective malnutrition diagnostic tools and lack of universal requirement for malnutrition screening in the residential care setting, making identifying and treating malnutrition in this population a challenge. When assessing the use of protein supplementation in the residential care setting, the two primary forms of supplementation were ONS and PFF. There is evidence that ONS and PFF increase protein and energy intakes in residential care setting, yet compliance with supplementation and their impact on functional status is unclear and conflicting. Further research comparing the use of ONS and PFF is needed to fully determine feasibility and efficacy of protein supplementation in the residential care setting.

This paper proposes a high step-up high-efficiency converter, comprised of an active switched coupled-inductor cell. The secondary windings are integrated into a rectifier voltage multiplier cell in a boost-flyback configuration, allowing the operation with high voltage gain with low switches duty cycle and low turn-ratios on the coupled-inductors. Both coupled-inductors are integrated into a single core due to the parallel operation of the switches. The leakage inductances of the coupled-inductors are used to mitigate the reverse recovery currents of the diodes, while regenerative clamp circuits are used to protect the switches from the voltage spikes caused by the leakage inductances. The operation of the converter is analyzed both quantitatively and qualitatively, and the achieved results are validated through experimentation of a 400 W prototype. A 97.1% CEC efficiency is also reported.

The increasing worldwide demand for energy bound to a strong dependence of fossil fuels has considerably intensified the concentration of greenhouse gases in the atmosphere, reaching alarming levels. Among those gases, carbon dioxide is considered the main responsible for global warming due to its higher concentration. In order to mitigate the negative effects of global warming and to reduce emissions, many technologies have been developed in the last decades to separate and recover carbon dioxide (CO 2 ) at different capture scenarios. Adsorption processes rely on the use of highly porous solids such as activated carbons, which are either commercially. Pressure Swing Adsorption (PSA) is a cyclic adsorption process, which allows continuous separation of gas streams. PSA is performed by periodic changes of pressure aiming the optimization of contaminants removal and is considered viable for separation of CO 2 from flue gases containing about 5-15% v/v. To achieve a certain performance, a PSA process may consist of several steps, columns and cycle time. One of the most basic configurations comprises four steps: pressurization, feed, blowdown and purge. The performance of a PSA process is usually evaluated by the purity, recovery and productivity reached. This study presents experimental and simulated data obtained from a bench-scale PSA, with a maximum pressure of 6 bar for pressurization and feed steps and minimum of 1 bar for blowdown and purge steps. The unit was tested with a mixture containing 85% of N 2 and 15% of CO 2 (on a molar basis). Carbon dioxide and nitrogen breakthrough curves were obtained under typical conditions of post combustion capture. A mathematical-phenomenological model combining momentum, mass and heat balances and using the Linear Driving Force approach (LDF) for mass transport and Langmuir model for equilibrium was applied in this study to simulate the dynamic behavior of the process. The performance tests presented productivity of 15 mol h -1 kg-ads -1 and, according to the changes of step time, N 2 purity of 97.7%. The model predicted reasonably the breakthrough curves and temperature profiles, with more precision for the latter. The combination of the simulation tool with and experimental PSA unit is very valuable for a deeper understanding of the involved phenomena and helpful with the design of optimized and efficient CO 2 adsorption-based capture processes.