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Abstract Background Increased arterial tortuosity has been associated with various cardiovascular complications. However, the extent and role of arterial tortuosity in non-atherosclerotic vascular diseases remain to be fully elucidated. This study aimed to assess arterial tortuosity index (ATI) in patients with non-atherosclerotic vascular diseases and the associated factors. Methods This is a retrospective analysis of patients with non-atherosclerotic vascular diseases referred to the Malformation and Rare Vascular Disease Center at the University Hospital in Lausanne (Switzerland). Computed tomography angiography (CTA) images performed between October 2010 and April 2022 were retrieved and the aortic tortuosity index (ATI) was calculated. Patients were classified based on diagnosis into the following groups: arterial dissection & aneurysm, arteritis & autoimmune disease, hereditary connective tissue diseases, and fibromuscular dysplasia (FMD). Univariate and multivariate logistic regression analysis was used to determine potentially relevant predictors of aortic tortuosity. Results The mean age upon computed tomography angiography (CTA) was 46.8 (standard deviation [SD] 14.6) years and 59.1% of the patients were female. Mean ATI was higher in patients over 60 years old (1.27), in those with arterial aneurysms (mean: 1.11), and in those diagnosed with hypertension (mean: 1.13). When only patients over 60 years old were considered, those diagnosed with connective tissue diseases had the highest ATI. At multivariate regression analysis, increasing age (p

Resistant hypertension (RH) is defined as systolic blood pressure (SBP) or diastolic blood pressure (DBP) that remains ≥140 mmHg or ≥90 mmHg, respectively, despite an appropriate lifestyle and the use of optimal or maximally tolerated doses of a three-drug combination, including a diuretic. This definition encompasses the category of controlled RH, defined as the presence of blood pressure (BP) effectively controlled by four or more antihypertensive agents, as well as refractory hypertension, referred to as uncontrolled BP despite five or more drugs of different classes, including a diuretic. To confirm RH presence, various causes of pseudo-resistant hypertension (such as improper BP measurement techniques and poor medication adherence) and secondary hypertension must be ruled out. Inadequate BP control should be confirmed by out-of-office BP measurement. RH affects about 5% of the hypertensive population and is associated with increased cardiovascular morbidity and mortality. Once RH presence is confirmed, patient evaluation includes identification of contributing factors such as lifestyle issues or interfering drugs/substances and assessment of hypertension-mediated organ damage. Management of RH comprises lifestyle interventions and optimisation of current medication therapy. Additional drugs should be introduced sequentially if BP remains uncontrolled and renal denervation can be considered as an additional treatment option. However, achieving optimal BP control remains challenging in this setting. This review aims to provide an overview of RH, including its epidemiology, pathophysiology, diagnostic work-up, as well as the latest therapeutic developments.

We assessed the frequency of serological markers of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in 365 alcoholics by determining, by ELISA, the presence of HBsAg, anti-HBc, anti-HBs and anti-HCV. Fifty patients were cirrhotics and 315 had no evidence of hepatic cirrhosis; of the latter HBsAg was assessed in all, anti-HBc and anti-HBs in 130, and anti-HCV in 210. Among the alcoholics the frequencies of HBsAg (1.9%), anti-HBc (28.3%) and anti-HCV (3.8%) were higher (p

Introducción: La diabetes mellitus tipo 2 (DM2) y el cáncer son entidades de alta prevalencia que contribuyen de manera independiente a gran parte de la morbimortalidad mundial. El metabolismo alterado de los hidratos de carbono está presente en aproximadamente 3/4 de los casos del adenocarcinoma ductal pancreático que, además, es el responsable de aproximadamente el 90% de todos los casos de cáncer de páncreas. Considerar a la hiperglucemia como un biomarcador temprano y un factor de riesgo para este tipo tumoral en personas con DM de nueva aparición (o progresión rápida de la hiperglucemia con necesidad temprana de insulina) y en mayores de 60 años acompañada de pérdida de peso (>4 kg) debe ser un incentivo para una investigación rápida y detallada para excluir el adenocarcinoma ductal pancreático dado que el diagnóstico temprano mejora el pronóstico y la sobrevida de esta entidad de baja frecuencia, pero alta letalidad. Objetivos: General: destacar la relevancia de la DM en la aparición, progresión y pronóstico de la patología oncológica. Específicos: resaltar la importancia de la DM como marcador de enfermedad tumoral subyacente; aportar aspectos clínicos relacionados con el metabolismo de los hidratos de carbono que favorezcan un diagnóstico temprano de cáncer de páncreas. Materiales y métodos: se llevó a cabo una revisión bibliográfica y actualización sobre el tema, además de la experiencia aportada por un estudio retrospectivo sobre el tema realizado por este Comité. Se realizó una búsqueda bibliográfica de los últimos 5 años en los buscadores PubMed, ScienceDirect, SciELO y Wiley de artículos en inglés y en español, bajo el motor de búsqueda “pancreatic cancer and diabetes”. En total se seleccionaron 542 artículos, por su relevancia y calidad, y de estos se usaron 23. También se incluyeron artículos de alta relevancia, con una antigüedad de más de 5 años. Hallazgos: la DM es un marcador del riesgo temprano y un factor de riesgo para el desarrollo de cáncer de páncreas. Conclusiones: la abundante evidencia existente en cuanto a la relación entre la patología oncológica, la obesidad y la DM obliga a repensar la enfermedad oncológica por sus aspectos fisiopatológicos, y vincular su etiología con la enfermedad metabólica y la inflamación de bajo grado.

Background: Clostridioides difficile infection (CDI) represents a prevalent and potentially severe health concern linked to the usage of broad-spectrum antibiotics. The aim of this study was to evaluate a new lyophilized product based on human fecal microbiota for transplant, including cost–benefit analysis in the treatment of recurrent or refractory CDI. Methods: The product for fecal microbiota transplant was obtained from two donors. Microbiological, viability, and genomic analysis were evaluated. After validation, a clinical pilot study including recurrent or refractory CDI with 24 patients was performed. Clinical response and 4-week recurrence were the outcome. Cost–benefit analysis compared the fecal microbiota transplant with conventional retreatment with vancomycin or metronidazole. Results: The microbiota for transplant presented significant bacterial viability, with and adequate balance of Firmicutes and Bacteroidetes. The clinical response with the microbiota transplant was 92%. In financial terms, estimated expenditure for CDI solely related to recurrence, based on stochastic modeling, totals USD 222.8 million per year in Brazil. Conclusions: The lyophilized human fecal microbiota for transplant is safe and can be an important step for a new product with low cost, even with genomic sequencing. Fecal microbiota transplantation emerges as a more cost-effective alternative compared to antimicrobials in the retreatment of CDI.

Sarcoidosis and Granulomatous and Lymphocytic Interstitial Lung Diseases (GLILD) are two rare entities primarily characterised by the development of Interstitial Lung Disease (ILD) in the context of systemic immune dysregulation. These two conditions partially share the immunological background and pathologic findings, with granuloma as the main common feature. In this narrative review, we performed a careful comparison between sarcoidosis and GLILD, with an overview of their main similarities and differences, starting from a clinical perspective and ending with a deeper look at the immunopathogenesis and possible target therapies. Sarcoidosis occurs in immunocompetent individuals, whereas GLILD occurs in patients affected by common variable immunodeficiency (CVID). Moreover, peculiar extrapulmonary manifestations and radiological and histological features may help distinguish the two diseases. Despite that, common pathogenetic pathways have been suggested and both these disorders can cause progressive impairment of lung function and variable systemic granulomatous and non-granulomatous complications, leading to significant morbidity, reduced quality of life, and survival. Due to the rarity of these conditions and the extreme clinical variability, there are still many open questions concerning their pathogenesis, natural history, and optimal management. However, if studied in parallel, these two entities might benefit from each other, leading to a better understanding of their pathogenesis and to more tailored treatment approaches.

High levels of serum uric acid (SUA) and triglycerides (TG) might promote high-cardiovascular-risk phenotypes, including subclinical atherosclerosis. An interaction between plaques xanthine oxidase (XO) expression, SUA, and HDL-C has been recently postulated. Subjects from the URic acid Right for heArt Health (URRAH) study with carotid ultrasound and without previous cardiovascular diseases (CVD) (n = 6209), followed over 20 years, were included in the analysis. Hypertriglyceridemia (hTG) was defined as TG ≥ 150 mg/dL. Higher levels of SUA (hSUA) were defined as ≥5.6 mg/dL in men and 5.1 mg/dL in women. A carotid plaque was identified in 1742 subjects (28%). SUA and TG predicted carotid plaque (HR 1.09 [1.04–1.27], p < 0.001 and HR 1.25 [1.09–1.45], p < 0.001) in the whole population, independently of age, sex, diabetes, systolic blood pressure, HDL and LDL cholesterol and treatment. Four different groups were identified (normal SUA and TG, hSUA and normal TG, normal SUA and hTG, hSUA and hTG). The prevalence of plaque was progressively greater in subjects with normal SUA and TG (23%), hSUA and normal TG (31%), normal SUA and hTG (34%), and hSUA and hTG (38%) (Chi-square, 0.0001). Logistic regression analysis showed that hSUA and normal TG [HR 1.159 (1.002 to 1.341); p = 0.001], normal SUA and hTG [HR 1.305 (1.057 to 1.611); p = 0.001], and the combination of hUA and hTG [HR 1.539 (1.274 to 1.859); p = 0.001] were associated with a higher risk of plaque. Our findings demonstrate that SUA is independently associated with the presence of carotid plaque and suggest that the combination of hyperuricemia and hypertriglyceridemia is a stronger determinant of carotid plaque than hSUA or hTG taken as single risk factors. The association between SUA and CVD events may be explained in part by a direct association of UA with carotid plaques.

The Regional Natural Park of the Monts d'Ardèche, located in south-eastern France, became the Monts d’Ardèche UNESCO Global Geopark in September 2014. This territory possesses significant volcanic features dating from the Miocene to the late Pleistocene. The UNESCO Global Geopark label helped to formalize a long-standing partnership with the University of Clermont Auvergne which includes support for scientific research, establishing conservation and protection priorities, establishing geosites for the public and involvement of local people and communities in geotouristic initiatives. Here we focus on some peculiar geosites that allow us to question magmatic processes, eruptive dynamics, morphological evolution of landscapes, the chronology of eruptions, relationships between humans and volcanoes during the Pleistocene, and highlight the delicate alliance between economic pressures, heritage conservation, and scientific tourism.

This field guide provides a detailed outcrop logistics, access and description of the sand-rich turbidite deposits of the Taciba Formation (Rio do Segredo Member), the uppermost unit of the Pennsylvanian Itararé Group (Paraná Basin), which crops out in the Santa Catarina State, southern Brazil. This area has become a classic destination for professional’ field courses and students interested in outcrop analogous to offshore turbidite reservoirs. Although some of the outcrops have been widely described, some localities remain unexplored. These turbidite systems are here subdivided on the basis of their degree of confinement, relative to the Precambrian basin floor topography. The bedrock morphology was shaped during the Late Paleozoic Ice Age. Advance and retreat phases of glaciers are represented by superficial scouring into the crystalline basement. This glacially-carved topography in turn controlled the subsequent sedimentation by forming a basal nonconformity in the Taciba Formation. Thus, the turbidity currents and their deposits, exposed in three main areas along the eastern margin of the Paraná basin, were classified as confined and/or unconfined. This field guide is also valuable for nourishing the ongoing debate on the turbidity currents interpretations based on sedimentological descriptions of the main localities and their major features. Field guides are quite popular in North America and Europe, among other places, but not so popular in Brazilian literature. The present contribution aims to bring details on some little known turbidite-outcropping localities of the Taciba Formation. It also intends, through its format, to attract interest the of national and international geologists on Brazilian key outcrops and offer a synthesis and a starting point for teaching purposes and future studies.

BackgroundThis study evaluated the long-term effects of percutaneous intervention in children and adolescents with transplant renal artery stenosis (TRAS).MethodsTwenty patients had significant stenosis (>50%) and underwent percutaneous transluminal angioplasty (PTA/stenting) (TRAS group-intervention); 14 TNS (non-significant group -control) patients did not have significant stenosis (≤50%) and were treated clinically. The combined primary endpoints were death from all causes and late graft failure. The secondary endpoints were serum creatinine (SCr), systolic blood pressure (SBP), and diastolic blood pressure (DBP).ResultsNo statistically significant difference was found between TRAS-Intervention(N = 20) and TNS groups-Control (N = 14) for these clinical parameters: deaths, 1 (5.0%) vs. 0 (0.0%) (p = 1.000) and graft loss, 4 (20.0%) vs. 2 (14.3%) (p = 1.000). For the secondary endpoints, after 1 month and 1 year the values of SCr, SBP, and DBP were similar between the two groups but not statistically significant.DiscussionIn the TRAS group (intervention), the stent implantation was beneficial for treating refractory hypertension and reducing blood pressure (BP) in children and adolescents. Despite the outcomes being similar in the two groups, it can be inferred that the patients in the TRAS group (intervention) would have had a worse outcome without the percutaneous intervention.ConclusionTRAS treatment with stenting can be considered for children and adolescents. Because the sample in the present study comprised of only a specific population, further studies are needed for generalization.Trial registrationThe trial was registered at clinictrials.gov with trial registration number NCT04225338.

Abstract Background Sweetened beverage intake may play a role in non-alcoholic fatty liver disease (NAFLD) development, but scientific evidence on their role is limited. This study examined associations between sugar-sweetened beverages (SSB), low/no-calorie beverages (LNCB) and fruit juice (FJ) intakes and NAFLD in four European studies. Methods Data for 42,024 participants of Lifelines Cohort, NQPlus, PREDIMED-Plus and Alpha Omega Cohort were cross-sectionally analysed. NAFLD was assessed using Fatty Liver Index (FLI) (≥60). Restricted cubic spline analyses were used to visualize dose–response associations in Lifelines Cohort. Cox proportional hazard regression analyses with robust variance were performed for associations in individual cohorts; data were pooled using random effects meta-analysis. Models were adjusted for demographic, lifestyle, and other dietary factors. Results Each additional serving of SSB per day was associated with a 7% higher FLI-defined NAFLD prevalence (95%CI 1.03–1.11). For LNCB, restricted cubic spline analysis showed a nonlinear association with FLI-defined NAFLD, with the association getting stronger when consuming ≤1 serving/day and levelling off at higher intake levels. Pooled Cox analysis showed that intake of >2 LNCB servings/week was positively associated with FLI-defined NAFLD (PR 1.38, 95% CI 1.15–1.61; reference: non-consumers). An inverse association was observed for FJ intake of ≤2 servings/week (PR 0.92, 95% CI: 0.88–0.97; reference: non-consumers), but not at higher intake levels. Theoretical replacement of SSB with FJ showed no significant association with FLI-defined NAFLD prevalence (PR 0.97, 95% CI 0.95–1.00), whereas an adverse association was observed when SSB was replaced with LNCB (PR 1.12, 95% CI 1.03–1.21). Conclusions Pooling results of this study showed that SSB and LNCB were positively associated with FLI-defined NAFLD prevalence. Theoretical replacement of SSB with LNCB was associated with higher FLI-defined NAFLD prevalence. An inverse association was observed between moderate intake of FJ and FLI-defined NAFLD. Our results should be interpreted with caution as reverse causality cannot be ruled out.

Ustekinumab is a monoclonal antibody targeting the p40 subunit of IL-12 and IL-23, approved for treating psoriasis, psoriatic arthritis, and inflammatory bowel disease. Despite a remarkable success in treating chronic inflammatory conditions and a generally favorable safety profile, its role in inducing rare adverse events, such as interstitial pneumonia and acute respiratory distress syndrome (ARDS), remains largely uncharted. We report a case of a 66-year-old male patient treated with Ustekinumab for severe psoriasis who, after almost two years of treatment, developed dyspnea, asthenia, and fever progressing to non-infectious pneumonia and ARDS leading to ICU admission. Moreover, we conducted a literature review on Ustekinumab-associated pulmonary complications. Our case underscores the importance of appropriate and long-term clinical monitoring in patients on Ustekinumab treatment, particularly considering the potential lung complications. The possibility of non-infectious pneumonitis should be considered alongside infectious causes, facilitating prompt management in the case of negative infectious screening. Additionally, the severity of ARDS underscores the importance of timely recognition and proper management. Further investigations are recommended to investigate the immunological basis of Ustekinumab-induced ARDS for designing appropriate monitoring strategies.

O milho é uma cultura de grande importância socioeconômica, devido seu alto valor energético e utilização na alimentação humana e animal. Objetivou-se neste trabalho avaliar as características agronômicas da cultura do milho cultivada com fontes e doses de B. O delineamento experimental foi em blocos ao acaso, esquema fatorial 3x4 com três fontes de B (ácido bórico, bórax e ulexita) e quatro doses (0; 1,5; 3,0 e 4,5 kg ha-1), com quatro repetições por tratamento. O experimento foi realizado em 2 safras consecutivas. As variáveis analisadas foram: altura de planta, altura de inserção da primeira espiga, comprimento da espiga, número de fileiras de grãos por espiga, número de grãos por fileira, massa de mil grãos e produtividade. Os dados foram submetidos à análise de variância e as médias comparadas pelo Teste de Tukey a 5% de significância. Para comprimento da espiga houve interação entre os fatores no primeiro ano, na dose de 1,5 kg ha-1 o Ácido Bórico foi superior ao Boráx e Ulexita. Para produtividade houve diferença entre as fontes e doses nas duas safras e a Ulexita foi superior às demais fontes, pela análise de regressão a dose de 1,6 kg ha-1 apresentou maior produtividade na primeira safra, e a dose de 2,03 kg ha-1 na segunda safra. Para altura de planta, altura de inserção da primeira espiga, número de fileiras de grãos, número de grãos por fileira e massa de 1000 grãos não houve diferença entre as fontes e doses de B.