Noninvasive mechanical ventilation may be useful in treating patients who fail weaning from invasive mechanical ventilation: a randomized clinical trial

Results Of 65 patients who failed T-piece trials, 28 were placed on NPPV and 37 were placed on IMV. The ages of patients in the NPPV and IMV groups were 67.6 ± 15.5 and 59.7 ± 17.6 years, respectively. Heart disease, post-surgery respiratory failure, and chronic pulmonary disease aggravation were the most frequent causes of IMV use. In both groups, ventilation time before T-piece trial was 7.3 ± 4.1 days. Heart and respiratory parameters were similar for the two groups at 1 and 30 minutes of T-piece trial. The percentage of complications in the NPPV group was lower (28.6% versus 75.7%), with lower incidences of pneumonia and tracheotomy. Length of stay in the intensive care unit and mortality were not statistically different when comparing the groups. Conclusion The results suggest that NPPV is a good alternative for ventilation of patients who fail initial weaning attempts. NPPV reduces the incidence of pneumonia associated with mechanical ventilation and the need for tracheotomy

Is SAPS 3 better than APACHE II at predicting mortality in critically ill transplant patients?

OBJECTIVES: This study compared the accuracy of the Simplified Acute Physiology Score 3 with that of Acute Physiology and Chronic Health Evaluation II at predicting hospital mortality in patients from a transplant intensive care unit. METHOD: A total of 501 patients were enrolled in the study (152 liver transplants, 271 kidney transplants, 54 lung transplants, 24 kidney-pancreas transplants) between May 2006 and January 2007. The Simplified Acute Physiology Score 3 was calculated using the global equation (customized for South America) and the Acute Physiology and Chronic Health Evaluation II score; the scores were calculated within 24 hours of admission. A receiver-operating characteristic curve was generated, and the area under the receiver-operating characteristic curve was calculated to identify the patients at the greatest risk of death according to Simplified Acute Physiology Score 3 and Acute Physiology and Chronic Health Evaluation II scores. The Hosmer-Lemeshow goodness-of-fit test was used for statistically significant results and indicated a difference in performance over deciles. The standardized mortality ratio was used to estimate the overall model performance. RESULTS: The ability of both scores to predict hospital mortality was poor in the liver and renal transplant groups and average in the lung transplant group (area under the receiver-operating characteristic curve = 0.696 for Simplified Acute Physiology Score 3 and 0.670 for Acute Physiology and Chronic Health Evaluation II). The calibration of both scores was poor, even after customizing the Simplified Acute Physiology Score 3 score for South America. CONCLUSIONS: The low predictive accuracy of the Simplified Acute Physiology Score 3 and Acute Physiology and Chronic Health Evaluation II scores does not warrant the use of these scores in critically ill transplant patients

Three-Dimensional Spectral Classification of Low-Metallicity Stars Using Artificial Neural Networks

We explore the application of artificial neural networks (ANNs) for the estimation of atmospheric parameters (Teff, logg, and [Fe/H]) for Galactic F- and G-type stars. The ANNs are fed with medium-resolution (~ 1-2 A) non flux-calibrated spectroscopic observations. From a sample of 279 stars with previous high-resolution determinations of metallicity, and a set of (external) estimates of temperature and surface gravity, our ANNs are able to predict Teff with an accuracy of ~ 135-150 K over the range 4250 <= Teff <= 6500 K, logg with an accuracy of ~ 0.25-0.30 dex over the range 1.0 <= logg <= 5.0 dex, and [Fe/H] with an accuracy ~ 0.15-0.20 dex over the range -4.0 <= [Fe/H] <= +0.3. Such accuracies are competitive with the results obtained by fine analysis of high-resolution spectra. It is noteworthy that the ANNs are able to obtain these results without consideration of photometric information for these stars. We have also explored the impact of the signal-to-noise ratio (S/N) on the behavior of ANNs, and conclude that, when analyzed with ANNs trained on spectra of commensurate S/N, it is possible to extract physical parameter estimates of similar accuracy with stellar spectra having S/N as low as 13. Taken together, these results indicate that the ANN approach should be of primary importance for use in present and future large-scale spectroscopic surveys.Comment: 51 pages, 11 eps figures, uses aastex; to appear in Ap

Effect of physical exercise on muscle strength in adults following bariatric surgery : a systematic review and meta-analysis of different muscle strength assessment tests

Individuals following bariatric surgery are considered at high risk for the development of sarcopenic obesity (excess fat mass, low muscle mass and low physical function), and exercise may play an important role in its prevention and treatment. We systematically reviewed 5 scientific databases (Embase, Medline, Scopus, SPORTDiscus, and Web of Science) and 2 grey literature databases (ProQuest and Google Scholar) for clinical trials that evaluated the effect of exercise on muscle strength in adults following bariatric surgery and conducted a separate meta-analysis for studies that used different muscle strength tests. Random-effect models, restricted maximum likelihood method and Hedges’ g were used. The review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42020152142). Fifteen studies were included (638 patients), none had a low risk of bias, and all were included in at least 1 of the 5 meta-analyses (repetition maximum [lower and upper limbs], sit-to-stand, dynamometer, and handgrip tests). Exercise interventions improved both upper (effect size, 0.71; 95% CI, 0.41–1.01; I 2 = 0%) and lower (effect size, 1.37; 95% CI, 0.84–1.91; I2 = 46.14) limb muscle strength, as measured by repetition maximum tests. Results were similar for the sit-to-stand (effect size, 0.60; 95% CI, 0.20–1.01; I2 = 68.89%) and dynamometer (effect size, 0.46; 95% CI, 0.06–0.87; I2 =31.03%), but not for the handgrip test (effect size, 0.11; 95% CI, -0.42–0.63; I2 = 73.27%). However, the certainty level of the meta-analyses was very low. Exercise with a resistance training component performed post bariatric surgery may improve muscle strength, which is related to sarcopenic obesity, functional capacity, and mortality risk, therefore should be included in the follow-up

Partitioning of environmental and taxonomic controls on Brazilian foliar content of carbon and nitrogen and stable isotopes

The Neotropics harbor some of the most diversified woody species in the world, and to understand the nutrient dynamics in these ecosystems, it is crucial to understand the role of plant taxonomy. In addition, biological nitrogen (N) fixation (BNF) in the tropics is one of the key processes affecting the global N cycle. Our objective was to (i) investigate the role of taxonomy and sampling site as predictors of foliar carbon (C) and N concentration and its stable isotopes (i.e., δ13C and δ15N); (ii) assess differences in foliar N, C:N ratio, and δ15N among three functional groups: species of N2-fixers and non-fixers of the Fabaceae family, as well as non-Fabaceae species; and (iii) examine the effect of wood density on tree foliar properties. We hypothesized that Fabaceae specimens in symbiosis with N2-fixers would possess a higher foliar N than non-fixing plants, including those of the Fabaceae family, as well as high-density trees would have higher foliar C and C:N ratio relative to low-density trees, where the latter invest in nutrients instead of structural C. We used a data set composed of 3,668 specimens sampled in three main biomes of Brazil: Amazon, Atlantic Forest, and Cerrado. The partitioning of variance had a higher influence of taxonomy on leaf C, N, and C:N ratio. Conversely, foliar δ13C and δ15N were environmentally constrained. While family was the most important taxonomy level for C, N, and C:N ratio, species played a major role for δ13C and δ15N. Foliar N followed the pattern fixers > non-fixers > non-Fabaceae, while C:N ratio had an opposite trend. In addition, foliar C was correlated with wood density, where high-density > medium-density and low-density woods. The large variability of δ15N was observed among Fabaceae species, demonstrates the complexity of using δ15N as an indicator of BNF. The higher foliar N of Fabaceae non-fixers than non-Fabaceae specimens support the hypothesis that an N-demanding lifestyle is an inherent pattern in this family. Lastly, although observed in some studies, the prediction of foliar properties using wood density is challenging, and future research on this topic is needed

Hypomineralized Second Primary Molars as Predictor of Molar Incisor Hypomineralization

Molar incisor hypomineralization (MIH) is a developmental defect of dental enamel that shares features with hypomineralized second primary molars (HSPM). Prior to permanent tooth eruption, second primary molars could have predictive value for permanent molar and incisor hypomineralization. To assess this possible relationship, a cross-sectional study was conducted in a sample of 414 children aged 8 and 9 years from the INMA cohort in Valencia (Spain). A calibrated examiner (linear-weighted Kappa 0.83) performed the intraoral examinations at the University of Valencia between November 2013 and 2014, applying the diagnostic criteria for MIH and HSPM adopted by the European Academy of Paediatric Dentistry. 100 children (24.2%) presented MIH and 60 (14.5%) presented HSPM. Cooccurrence of the two defects was observed in 11.1% of the children examined. The positive predictive value was 76.7% (63.9-86.6) and the negative predictive value 84.7% (80.6-88.3). The positive likelihood ratio (S/1-E) was 10.3 (5.9-17.9) and the negative likelihood ratio (1-S/E) 0.57 (0.47-0.68). The odds ratio was 18.2 (9.39-35.48). It was concluded that while the presence of HSPM can be considered a predictor of MIH, indicating the need for monitoring and control, the absence of this defect in primary dentition does not rule out the appearance of MIH

The Barretos Cancer Hospital Animal Facility: implementation and results of a dedicated platform for preclinical oncology models

The Barretos Cancer Hospital Animal Facility (BCHAF) is a unique facility in Brazil exclusively dedicated to working with animal models for cancer research. In this article, we briefly present our modern facility and the main experiments performed, focusing on mutant strains of mice (PTCH-knockout and ApcMin mice), xenograft models, and patient-derived xenografts (PDXs). Our results show the progress and challenges in establishing these models and the need for having an appropriate representation of our cancer population to better understand tumor biology and to identify cancer biomarkers, which could be putatively targeted, allowing for personalized therapy.This study was funded by the Public Ministry of Labor Campinas (Research, Prevention and Education of Occupational Cancer) and by Pio XII Foundation, Barretos Cancer Hospital internal funds, Grant Number: 13/2021