Association of polymorphisms in the erythropoietin gene with diabetic retinopathy : a case–control study and systematic review with meta-analysis

Background: Diabetic retinopathy (DR) is characterized by ischemia, hypoxia, and angiogenesis. Erythropoietin (EPO), an angiogenic hormone, is upregulated in DR, and the association of EPO genetic variants with DR is still uncertain, as conflicting results have been reported. Therefore, we performed a case–control study followed by a metaanalysis to investigate whether the rs1617640, rs507392, and rs551238 polymorphisms in EPO gene are associated with DR. Methods: The case–control study included 1042 Southern Brazilians with type 2 diabetes (488 without DR and 554 with DR). Eligible studies for the meta-analysis were searched from electronic databases up to June 1, 2021. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for five genetic inheritance models. Results: The minor alleles of the EPO polymorphisms had nearly the same frequency in all groups of patients (35%), and no association was detected with DR in the case–control study. The meta-analysis included 14 independent sets of cases and controls with 9117 subjects for the rs1617640 polymorphism and nine independent sets with more than 5000 subjects for the rs507392 and rs551238 polymorphisms. The G allele of the rs1617640 polymorphism was suggestively associated with DR under the dominant (OR = 0.82, 95% CI: 0.68–0.98), heterozygous additive (OR = 0.82, 95% CI: 0.69–0.97), and overdominant (OR = 0.88, 95% CI: 0.79–0.97) models. In the subgroup analyses, the G allele was also suggestively associated with proliferative DR (PDR), non-proliferative DR (NPDR), and DR (PDR + NPDR) among patients with type 1 diabetes (T1DM) or non-Asian ancestry. After considering the Bonferroni correction for multiple comparisons, the G allele remained associated with NPDR and DR in T1DM. Regarding the rs507392 and rs551238 polymorphisms, no association was found between these variants and DR. Conclusion: Our findings provide additional support to EPO as a susceptibility gene for DR, with the rs1617640 polymorphism deserving further investigation

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Decision-making analysis of palliative care physicians about antibiotic use in terminally ill patients

Introdução: Na prática, existe uma grande incerteza sobre a introdução, não introdução ou retirada de antibióticos em uso, em pacientes com doenças terminais. Muitos pacientes irão falecer em uso de esquema antibiótico e isso gera questionamentos sobre a real utilidade dessas medicações para pacientes com doenças terminais. Quando usados até momentos próximos ao óbito, seu uso deve ser reconsiderado, pois podem significar o prolongamento desnecessário do sofrimento. A maioria dos estudos sobre o uso de antibióticos no fim da vida é retrospectiva. Esta heterogeneidade torna difícil a avaliar quais decisões os médicos que atuam em cuidados paliativos tomariam quando expostos a um mesmo cenário. Objetivos: Avaliar a decisão de médicos atuantes em cuidados paliativos sobre a introdução e ampliação de espectro de antibióticos para infeções em pacientes no fim da vida portadores de Câncer, doença de Alzheimer, Doença Pulmonar Obstrutiva Crônica, Acidente Vascular Encefálico Maligno de Artéria Cerebral Média e Falência Múltipla de Órgãos em unidade de terapia intensiva. Métodos: Foi elaborado um questionário online com casos de infecção e casos de não resposta após 72 horas de uso de antibióticos para cada tipo de doença terminal. Estas vinhetas foram enviadas a médicos que atuam em cuidados paliativos no formato survey. Foi feita a análise descritiva e em seguida foi feita uma análise bivariada de cada situação clínica, avaliando possíveis associações de alguma variável com o início ou ampliação do esquema antibiótico para cada cenário. As variáveis com valor de p de 0,10 ou menor foram incluídas no modelo de regressão logística para análise multivariada. Resultados: Dos 900 questionários enviados, 224 foram respondidos. Em 100% dos cenários, a maioria dos médicos optou por iniciar antibióticos nos casos de infecção. Especificamente para os casos de não resposta do antibiótico após 72 horas para cenários de demência avançada e falência múltipla de órgãos em unidade de terapia intensiva, a maioria dos médicos optou por suspender definitivamente o esquema antibiótico. Porém nos casos de câncer com PPS 30%, Doença Pulmonar Obstrutiva Crônica GOLD- D, e acidente vascular encefálico maligno, a maioria dos médicos decidiu pela ampliação ou manutenção do esquema antibiótico. As variáveis mais associadas ao uso dos antibióticos foram ausência de formação especializada em cuidados paliativos e tempo desde a graduação maior que 13 anos. Outras variáveis associadas a esta conduta foram predominância dos atendimentos em ambiente extra-hospitalar, atuação predominante do médico no setor público, possuir mais de 4 médicos na equipe, ser do sexo feminino, possuir cargo de coordenador do serviço. Conclusão: Para esta amostra, médicos de cuidados paliativos, em sua maioria opta por iniciar antibióticos nos casos de infecção em pacientes no fim da vida, e, com exceção dos casos de demência avançada e falência múltipla de órgãos na unidade de terapia intensiva, a maioria ainda decide por ampliar ou manter esquema antibiótico nos casos de não resposta em 72 horas de início do mesmo. Médicos com mais tempo de formado e sem especialização formal em cuidados paliativos foram os principais fatores associados à decisão por utilizar antibióticosIntroduction: In practice, there is great uncertainty concerning the administration or withdrawal of antibiotics in terminal patients. As many patients will die on antibiotic treatment, the real benefits of these medications for terminal patients are questionable. The administration of antibiotics should be reconsidered as signs of death appear in order to avoid unnecessary prolongation of suffering. Most studies on end-of-life antibiotic use are retrospective. This heterogeneity and contrasting findings further limit any conclusions about whether palliative care physicians would prescribe antibiotics under the same scenario. Objectives: To evaluate palliative care physicians\' decisions on the start and broadening spectrum antibiotics for infections in end-of-life cancer patients, Alzheimer\'s disease, Chronic Obstructive Pulmonary Disease, Malignant Stroke, and Multiple Organs Failure in intensive care unit. Methods: An online questionnaire with cases of infection and non-response after 72 hours of antibiotic use was developed for each type of terminal disease. These stickers were sent to doctors working in palliative care in a survey format. Descriptive analysis was performed and then a bivariate analysis of each clinical situation was performed, assessing possible associations of any variable with the initiation or expansion of the antibiotic regimen for each scenario. Variables with pvalues of 0.10 or less were included in the logistic regression model for multivariate analysis. Results: Of the 900 questionnaires sent, 224 were answered. In 100% of scenarios, most doctors chose to start antibiotics in cases of infection. Specifically for cases of antibiotic non-response after 72 hours for scenarios of advanced dementia and multiple organ failure in the intensive care unit, most physicians chose to permanently discontinue the antibiotic regimen. But in cases of cancer with 30% PPS, GOLD-D Chronic Obstructive Pulmonary Disease, and malignant stroke, most doctors decided to extend or maintain the antibiotic regimen. The variables most associated with antibiotic use were absence of specialized training in palliative care and time since graduation over 13 years. Other variables associated with this conduct were the predominance of outpatient care, the predominant role of the physician in the public sector, having more than 4 doctors in the team, being female, having the position of service coordinator. Conclusion: For this sample, most palliative care physicians prefer to introduce antibiotics in cases of infection in end-of-life patients, and with the exception of cases of advanced dementia and multiple organ failure in the intensive care unit, most still decide to extend or maintain antibiotic regimen in cases of non-response within 72 hours of its initiation. Doctors graduated longer ago and without formal specialization in palliative care were the main factors associated with the decision to use antibiotic

Palliative care in lung cancer: from the challenges to the home care

Background: Lung cancer is currently one of the mostcommon malignant neoplasms worldwide. Distress symptomsrelated to the primary disease or in combination with diseaseprogression have challenges faced by the patients, family, andthe health care team. Aims: Demonstrate the benefits of an integrated palliativecare approach for lung cancer patients at the time ofdiagnosis and also the benefits of care these patients athome. Methods: Integrative review on the ISI Web of Knowledge,PubMed, CINAHL and Academic Search Complete. Thekeywords were “Lung Cancer”, “Palliative Care”, “Approaches”and “Therapies”. The inclusion criteria were articles in theEnglish published until 2015 with full-text and referencesavailable and peer-reviewed. The research anddocumentation were carried out in accordance with thePrisma 2009 Referencia guidelines. Results: 164 articles were found, of which 33 were selectedto full analysis. Most of the lung cancer patients suffer frommultiple distressing symptoms with high levels of intensityand are simultaneously influenced by disease progressionand the undertaken therapies. Palliative interventions havean integrative philosophy that has been demonstrate to be aneffective relief of the patients suffer. Moreover, palliativedevelops interventions that control the symptoms related tothe disease and integrates the different dimensions of peopleand their problems in the evaluation of their health status andtherapeutic intervention to respond favorably to the patientsand family’s needs because many cancer patients prefer aconservative or supportive treatment. Conclusion/discussion: The provision of specialized palliativecare at home allows the respect of the patients’ preferencesand providing humane care throughout the course of thedisease, particularly at the end-of-life.info:eu-repo/semantics/publishedVersio

How to Advance Palliative Care Research in South America? Findings From a Delphi Study

Context. Progress in palliative care (PC) necessarily involves scientific development. However, research conducted in South America (SA) needs to be improved. Objectives. To develop a set of recommendations to advance PC research in SA. Methods. Eighteen international PC experts participated in a Delphi study. In round one, items were developed (open- ended questions); in round two, each expert scored the importance of each item (from 0 to 10); in round three, they selected the 20 most relevant items. Throughout the rounds, the five main priority themes for research in SA were defined. In Round three, consensus was defined as an agreement of ≥75%. Results. 60 potential suggestions for overcoming research barriers in PC were developed in round one. Also in Round one, 88.2% (15 of 17) of the experts agreed to define a priority research agenda. In Round two, the 36 most relevant suggestions were defined and a new one added. Potential research priorities were investigated (open-ended). In Round three, from the 37 items, 10 were considered the most important. Regarding research priorities, symptom control, PC in primary care, public poli- cies, education and prognosis were defined as the most relevant. Conclusion. Potential strategies to improve scientific research on PC in SA were defined, including stimulating the formation of collaborative research networks, offering courses and workshops on research, structuring centers with infrastructure resour- ces and trained researchers, and lobbying governmental organizations to convince about the importance of palliative care. In addition, priority research topics were identified in the region

Environmental enrichment improved learning and memory, increased telencephalic cell proliferation, and induced differential gene expression in Colossoma macropomum

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), the Brazilian Research Council (CNPq) Edital Universal Grant 440722/2014-4 and Grant 302199/2014-4; Fundação Amazônia Paraense de Amparo à Pesquisa (FAPESPA), Grant Centro de Piscicultura do IFPA Campus Bragança and Núcleos Emergentes, Instituto Federal de Educação ciência e Tecnologia do Pará (IFPA), Editais APIPA 2018 e 2019 . DD and CD were supported by Programa PROCAD AMAZÔNIA/CAPES 88887.310939/2018-00.Instituto Federal de Educação, Ciência e Tecnologia do Pará. Laboratório de Biologia Molecular e Neuroecologia. Bragança, PA, Brazil.Instituto Federal de Educação, Ciência e Tecnologia do Pará. Laboratório de Biologia Molecular e Neuroecologia. Bragança, PA, Brazil.Universidade Federal do Pará. Instituto de Ciências Biológicas. Hospital Universitário João de Barros Barreto. Laboratório de Investigação em Neurodegeneração e Infecção. Belém, PA, Brazil.Universidade Federal Rural da Amazônia. Instituto Ciências Agrárias. Capitão Poço, PA, Brazil.Universidade Federal do Pará. Instituto de Ciências Biológicas. Hospital Universitário João de Barros Barreto. Laboratório de Investigação em Neurodegeneração e Infecção. Belém, PA, Brazil.Universidade Federal do Pará. Instituto de Ciências Biológicas. Hospital Universitário João de Barros Barreto. Laboratório de Investigação em Neurodegeneração e Infecção. Belém, PA, Brazil.Universidade Federal do Pará. Instituto de Ciências Biológicas. Hospital Universitário João de Barros Barreto. Laboratório de Investigação em Neurodegeneração e Infecção. Belém, PA, Brazil.Universidade Federal do Pará. Instituto de Ciências Biológicas. Hospital Universitário João de Barros Barreto. Laboratório de Investigação em Neurodegeneração e Infecção. Belém, PA, Brazil.Universidade Federal do Pará. Instituto de Ciências Biológicas. Hospital Universitário João de Barros Barreto. Laboratório de Investigação em Neurodegeneração e Infecção. Belém, PA, Brazil.Instituto Federal de Educação, Ciência e Tecnologia do Pará. Laboratório de Biologia Molecular e Neuroecologia. Bragança, PA, Brazil.Instituto Federal de Educação, Ciência e Tecnologia do Pará. Laboratório de Biologia Molecular e Neuroecologia. Bragança, PA, Brazil.Instituto Federal de Educação, Ciência e Tecnologia do Pará. Laboratório de Biologia Molecular e Neuroecologia. Bragança, PA, Brazil.Instituto Federal de Educação, Ciência e Tecnologia do Pará. Laboratório de Biologia Molecular e Neuroecologia. Bragança, PA, Brazil.Instituto Federal de Educação, Ciência e Tecnologia do Pará. Laboratório de Biologia Molecular e Neuroecologia. Bragança, PA, Brazil.Instituto Federal de Educação, Ciência e Tecnologia do Pará. Laboratório de Biologia Molecular e Neuroecologia. Bragança, PA, Brazil.Universidade Federal do Oeste do Pará. Laboratório de Fisiologia Ambiental Aplicada. Oriximiná, PA, Brazil.Instituto Federal de Educação, Ciência e Tecnologia do Pará. Laboratório de Biologia Molecular e Neuroecologia. Bragança, PA, Brazil.Instituto Federal de Educação, Ciência e Tecnologia do Pará. Laboratório de Biologia Molecular e Neuroecologia. Bragança, PA, Brazil.Universidade Federal do Pará. Instituto de Ciências Biológicas. Hospital Universitário João de Barros Barreto. Laboratório de Investigação em Neurodegeneração e Infecção. Belém, PA, Brazil / Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Microscopia Eletrônica. Ananindeua, PA, Brasil.Fish use spatial cognition based on allocentric cues to navigate, but little is known about how environmental enrichment (EE) affects learning and memory in correlation with hematological changes or gene expression in the fish brain. Here we investigated these questions in Colossoma macropomum (Teleostei). Fish were housed for 192 days in either EE or in an impoverished environment (IE) aquarium. EE contained toys, natural plants, and a 12-h/day water stream for voluntary exercise, whereas IE had no toys, plants, or water stream. A third plus maze aquarium was used for spatial and object recognition tests. Compared with IE, the EE fish showed greater learning rates, body length, and body weight. After behavioral tests, whole brain tissue was taken, stored in RNA-later, and then homogenized for DNA sequencing after conversion of isolated RNA. To compare read mapping and gene expression profiles across libraries for neurotranscriptome differential expression, we mapped back RNA-seq reads to the C. macropomum de novo assembled transcriptome. The results showed significant differential behavior, cell counts and gene expression in EE and IE individuals. As compared with IE, we found a greater number of cells in the telencephalon of individuals maintained in EE but no significant difference in the tectum opticum, suggesting differential plasticity in these areas. A total of 107,669 transcripts were found that ultimately yielded 64 differentially expressed transcripts between IE and EE brains. Another group of adult fish growing in aquaculture conditions were either subjected to exercise using running water flow or maintained sedentary. Flow cytometry analysis of peripheral blood showed a significantly higher density of lymphocytes, and platelets but no significant differences in erythrocytes and granulocytes. Thus, under the influence of contrasting environments, our findings showed differential changes at the behavioral, cellular, and molecular levels. We propose that the differential expression of selected transcripts, number of telencephalic cell counts, learning and memory performance, and selective hematological cell changes may be part of Teleostei adaptive physiological responses triggered by EE visuospatial and somatomotor stimulation. Our findings suggest abundant differential gene expression changes depending on environment and provide a basis for exploring gene regulation mechanisms under EE in C. macropomum