Fibroblast growth factor 23 is related to profiles indicating volume overload, poor therapy optimization and prognosis in patients with new-onset and worsening heart failure

Background: Fibroblast growth factor (FGF) 23 is a hormone that increases urinary phosphate excretion and regulates renal sodium reabsorption and plasma volume. We studied the role of plasma FGF23 in therapy optimization and outcomes in patients with new-onset and worsening heart failure (HF). Methods: We measured plasma C-terminal FGF23 levels at baseline in 2399 of the 2516 patients included in the BIOlogy Study to Tailored Treatment in Chronic HF (BIOSTAT-CHF) trial. The association between FGF23 and outcome was evaluated by Cox regression analysis adjusted for potential confounders. Results: Median FGF23 was 218.0 [IQR: 117.1–579.3] RU/ml; patients with higher FGF23 levels had a worse NYHA class, more signs of congestion, and were less likely to use an ACE-inhibitor (ACEi) or angiotensin receptor blocker (ARBs) at baseline (all P < 0.01). Higher FGF23 levels were independently associated with higher BNP, lower eGFR, the presence of oedema and atrial fibrillation (all P < 0.001). In addition, higher FGF23 was independently associated with impaired uptitration of ACEi/ARBs after 3 months, but not of beta-blockers. In multivariable Cox regression analysis, FGF23 was independently associated with all-cause mortality (hazard ratio: 1.17 (1.09–1.26) per log increase, P < 0.001), and the combined endpoint of all-cause mortality and HF hospitalization (1.15 (1.08–1.22) per log increase, P < 0.001). Conclusions: In patients with new-onset and worsening HF, higher plasma FGF23 levels were independently associated with volume overload, less successful uptitration of ACEi/ARBs and an increased risk of all-cause mortality and HF hospitalization

Neoadjuvant Chemotherapy for Intrahepatic, Perihilar, and Distal Cholangiocarcinoma:a National Population-Based Comparative Cohort Study

IntroductionData supporting the utilization of neoadjuvant chemotherapy (NAC) in patients receiving resection for cholangiocarcinoma (CCA) remains uncertain. We aimed to determine whether NAC followed by resection improves long-term survival in intrahepatic (iCCA), perihilar (hCCA), and distal (dCCA) cholangiocarcinoma, analyzed separately.MethodsPatients undergoing surgery for iCCA, hCCA, and dCCA, receiving either none, NAC, or adjuvant chemotherapy (AC) from 2010 to 2016 were identified from the National Cancer Database (NCDB). Cox regression was performed to account for selection bias and to assess the impact of surgery alone (SA) versus either NAC or AC on overall survival (OS).ResultsThere were 9411 patients undergoing surgery for iCCA (n = 3772, 39.5%), hCCA (n = 1879, 20%), and dCCA (n = 3760, 40%). Of these, 10.6% (n = 399), 6.5% (n = 123), and 7.2% (n = 271) with iCCA, hCCA, and dCCA received NAC, respectively. On adjusted analyses, patients receiving NAC followed by surgery had significantly improved OS, compared to SA for iCCA (HR 0.75, CI95% 0.64-0.88, p < 0.001), hCCA (HR 0.72, CI95% 0.54-0.97, p = 0.033), and for dCCA (HR 0.65, CI95% 0.53-0.78, p < 0.001). However, sensitivity analyses demonstrated no differences in OS between NACs, followed by surgery or AC after surgery in iCCA (HR 1.19, CI95% 0.99-1.45, p = 0.068), hCCA (HR 0.83 CI95% 0.59-1.19, p = 0.311), and dCCA (HR 1.13 CI95% 0.91-1.41, p = 0.264).ConclusionsThis study associated NAC with increased OS for all CCA subtypes, even in patients with margin-negative and node-negative disease; however, no differences were found between NAC and AC. Our results highlight that a careful and interdisciplinary evaluation should be sought to consider NAC in CCA and warrant the need of larger studies to provide robust recommendation

Potencialidades da cinza de biomassa do beneficiamento de óleo de palma para materiais à base de cimento. Parte I: caracterização microestutural, mineralógica e atividade pozolânica / Potentialities of biomass ash from palm oil processing for cement-based materials. Part I: microstructural, mineralogical and pozzolanic activity characterization

A biomassa do processo de extração de óleo de palma (dendê) comumente utilizada como combustível em caldeiras produzem elevados volumes de cinzas da queima da biomassa. A biomassa e cinza constituem um resíduo sólido capaz de causar danos e impactos ambientais. As cinzas apresentam potencialidade para uso alternativo em materiais à base de cimento. Esta pesquisa tem a intenção de valorizar as cinzas de biomassa de óleo de palma. Deste modo nesta primeira parte desta pesquisa foi realizada a caracterização por meio de microestrutura eletrônica de varredura (MEV) e Espectroscopia de raios X por energia dispersiva (EDS) da cinza obtida por resfriamento ao ambiente (lento) e por choque térmico (brusco). Enquanto a análise somente da cinza obtidas a partir de resfriamento choque térmico (brusco) para a difração de raios X (DRX) e atividade pozolânica. Os resultados indicaram a presença de fibras com cavidades na superfície preenchidas por partículas de morfologias globulares com predominância do elemento químico silício (Si) na análise de caracterização elementar por EDS. A difração de raios X apresentou um halo amorfo entre 20° e 30° (2?) com a identificação de picos das fases de quartzo e de calcita. As amostras com substituição do cimento Portland por cinza de biomassa apresentaram atividade pozolânica com índice desempenho de 100%. Desta maneira, a valorização da cinza de biomassa de óleo de palma (dendê) pode apresentar potencialidade para uso como adição mineral em materiais à base de cimento

RECONSTRUÇÃO COM PRÓTESE BUCOMAXILOFACIAL EM PACIENTES ONCOLÓGICOS: SUA IMPORTÂNCIA NA ODONTOLOGIA

Facial maxillofacial prosthesis (P.B.M.F) is a specialty of dentistry responsible for oral, facial and functional rehabilitation with extraoral and intraoralintraoral prostheses of patients with maxillofacial defects. The shortage of specialized professionals is critical, as during the treatment of a malignant neoplasm, loss of facial structure may occur, where the specialized professional has the possibility of prosthetically rehabilitating the lost part, be it the eyeball, oculopalpebral, auricular, nasal, palate obturator aimed at improving the patient's self-esteem and social reintegration. Contact with the discipline is important for the evolution of the specialty, as well as the interest of undergraduates and students. P.B.M.F plays an important role in the social reintegration of a patient mutilated by oral neoplasia today. The advancement of aesthetic dentistry came with the need to enhance a more beautiful, harmonious and younger appearance of a patient who meets beauty standards. On the other hand, the patient with the loss of part of the face he fought for, with a diagnosis that threatened his life, seeks to become inconspicuous in the crowd. The objective of this work is to carry out a literature review exposing the need for professionals and academics to contact the P.B.M.F. and the types of prostheses used. The methodology was based on data taken from the Scielo, Pubmed and Google Scholar platforms over the last 10 years, with articles found that were mostly case reports. Maxillofacial prosthesis is a branch of dental prosthesis associated with the restoration and/or replacement of stomatognathic and craniofacial structures with prostheses, which may or may not be removed regularly or electively.A prótese bucomaxilofacial (P.B.M.F,) facial é uma especialidade da odontologia responsável pela reabilitação oral, facial e funcional com próteses extraorais e intra-oraisintraorais de pacientes com defeitos maxilofaciais. A escassez de profissionais especializados é crítica, pois durante um tratamento de uma neoplasia maligna pode ocorrer a perda de estrutura da face, onde o profissional especializado tem a possibilidade de reabilitar proteticamente a parte perdida seja ela de globo ocular, oculopalpebral, auricular, nasal, obturadora de palato visando a melhora da auto estima e a reintegração social do paciente. O contato com a disciplina é importante para a evolução da especialidade, assim como interesse de graduandos e discentes. A P.B.M.F tem um papel importante na reintegração social de um paciente mutilado pela neoplasia bucal nos dias de hoje. O avanço da odontologia estética veio com a necessidade de se enaltecer uma aparência mais bela, harmoniosa e mais jovem de um paciente que se enquadra nos padrões de beleza. Em contrapartida, o paciente com perda de parte da face que lutou, com um diagnóstico que ameaçou sua vida, busca se tornar imperceptível no meio da multidão. O objetivo deste trabalho é realizar uma revisão de literatura expondo a necessidade do contato dos profissionais e acadêmicos com a P.B.M.F.  e os tipos de próteses usadas. A metodologia se baseou em dados retirados das plataformas Scielo, Pubmed e Google Acadêmico dos últimos 10 anos, sendo encontrados artigos que na sua maioria eram relatos de caso. A prótese maxilofacial é um ramo da prótese dentária associada à restauração e/ou substituição de estruturas estomatognáticas e craniofaciais por próteses, que podem ou não ser removidas de forma regular ou eletiva

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

PROJETO DE INTERVENÇÃO EM SAÚDE: IMUNIZAÇÃO CONTRA INFLUENZA

A influenza é uma infecção viral aguda, que afeta o sistema respiratório. A estratégia de vacinação contra a influenza tem o propósito de reduzir internações, complicações e óbitos na população-alvo. A vacinação permite minimizar a carga e prevenir o surgimento de complicações decorrentes da doença, reduzindo os sintomas, que podem ser confundidos com os da covid-19, além de reduzir sobrecarga sobre os serviços de saúde. Tal imunização em um ambiente escolar é extremamente importante devido à área de abrangência e quantidade de pessoas que serão protegidas. Com possibilidade de retorno das aulas presenciais, o que se busca é um ambiente seguro e protegido contra a gripe

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks