Einstein-Sao Paulo最新文献

{"title":"Chemical transdifferentiation of somatic cells to neural cells: a systematic review.","authors":"Paulo Victor Visintin, Bruna Lancia Zampieri, Karina Griesi-Oliveira","doi":"10.31744/einstein_journal/2024RW0423","DOIUrl":"10.31744/einstein_journal/2024RW0423","url":null,"abstract":"<p><strong>Introduction: </strong>Transdifferentiation is the conversion of a specific somatic cell into another cell type, bypassing a transient pluripotent state. This implies a faster method to generate cells of interest with the additional benefit of reduced tumorigenic risk for clinical use.</p><p><strong>Objective: </strong>We describe protocols that use small molecules as direct conversion inducers, without the need for exogenous factors, to evaluate the potential of cell transdifferentiation for pharmacological and clinical applications.</p><p><strong>Methods: </strong>In this systematic review, using PRISMA guidelines, we conducted a personalized search strategy in four databases (PubMed, Scopus, Embase, and Web Of Science), looking for experimental works that used exclusively small molecules for transdifferentiation of non-neural cell types into neural lineage cells.</p><p><strong>Results: </strong>We explored the main biological mechanisms involved in direct cell conversion induced by different small molecules used in 33 experimental in vitro and in vitro transdifferentiation protocols. We also summarize the main characteristics of these protocols, such as the chemical cocktails used, time for transdifferentiation, and conversion efficiency.</p><p><strong>Conclusion: </strong>Small molecules-based protocols for neuronal transdifferentiation are reasonably safe, economical, accessible, and are a promising alternative for future use in regenerative medicine and pharmacology.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eRW0423"},"PeriodicalIF":1.1,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electronic health record implementation: how to identify and analyze the possible negative impacts.","authors":"Paula Fuscaldo Calderon, Silvia Sato, Nelson Wolosker","doi":"10.31744/einstein_journal/2024AO0916","DOIUrl":"10.31744/einstein_journal/2024AO0916","url":null,"abstract":"<p><strong>Objective: </strong>Identify potential negative impacts arising from implementing an electronic medical record system, classify them according to the level of criticality, and analyze method's effectiveness after implementation.</p><p><strong>Methods: </strong>The research involved identifying the negative impacts, classifying them according to the criteria for criticality, stratifying them as high, medium, or low severity, and finally, analyzing the effectiveness of the identification and classification methods.</p><p><strong>Results: </strong>Findings confirmed that 89.20% of identified impacts occurred as predicted, and 88.94% of impacts had a level of criticality compatible with the severity of the problem.</p><p><strong>Conclusion: </strong>Predicting and classifying negative impacts are important stages in implementing electronic health records in hospitals. The method for identification and classification of impacts were, in most cases, considered effective.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO0916"},"PeriodicalIF":1.1,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver-first approach to the treatment of patients with synchronous colorectal liver metastases: a systematic review and meta-analysis.","authors":"Bruno Mirandola Bulisani, Milena Arruda de Oliveira Leite, Jaques Waisberg","doi":"10.31744/einstein_journal/2024RW0596","DOIUrl":"10.31744/einstein_journal/2024RW0596","url":null,"abstract":"<p><strong>Objective: </strong>The optimal approach to the treatment of colorectal carcinoma and synchronous liver metastases remains controversial. The objective of this review was to analyze the outcomes of adopting the liver-first approach for the treatment of patients with colorectal cancer with synchronous hepatic metastases who initially underwent systemic chemotherapy and/or resection of the metastatic lesions and primary colorectal carcinoma.</p><p><strong>Methods: </strong>This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The MEDLINE, EMBASE, LILACS, and Cochrane Central Register of Controlled Trials databases were searched for the identification and retrieval of eligible studies. Studies that included details of using the liver-first approach for the treatment of synchronous liver metastases of colorectal cancer and its outcomes, including the patients' survival data, were included. Proportional meta-analysis was performed using the random-effects restricted maximum likelihood method to summarize the three- and five-year overall survival and recurrence rates of the patients.</p><p><strong>Results: </strong>Eight hundred and fifty-five articles describing the results of studies on the liver-first approach were identified. Three independent reviewers screened the titles and abstracts of the articles and excluded 750 articles. Thereafter, 29 retrospective and comparative studies that met the inclusion criteria were included. No randomized controlled trials were identified in the database search.</p><p><strong>Conclusion: </strong>Neoadjuvant treatment with systemic chemotherapy for hepatic metastasis can prepare a patient for resection of liver metastases, offering the opportunity for potentially curative treatment of synchronous hepatic metastases initially considered unresectable. The decision regarding the resection of primary colorectal carcinoma and liver metastases should be based on individualized patient response. Prospero database registration ID: CRD42022337047 (www.crd.york.ac.uk/prospero).</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eRW0596"},"PeriodicalIF":1.1,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver cirrhosis with the development of transdiaphragmatic collateral circulation.","authors":"Lucas Gabriel Annechini Marques, Eduardo Kaiser Ururahy Nunes Fonseca","doi":"10.31744/einstein_journal/2024AI0564","DOIUrl":"10.31744/einstein_journal/2024AI0564","url":null,"abstract":"","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAI0564"},"PeriodicalIF":1.1,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse events and safety concerns among university students who misused stimulants to increase academic performance.","authors":"Joyce Emanuelle Moreira, Mariana Camile Las-Casas Rodrigues, Carlos Vinícius Teixeira Palhares, Thiago Henrique Caldeira de Oliveira, Gleisy Kelly Neves Gonçalves","doi":"10.31744/einstein_journal/2024AO0895","DOIUrl":"10.31744/einstein_journal/2024AO0895","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate psychostimulant drug use among academics in the health area of a higher education institution in Minas Gerais, Brazil.</p><p><strong>Methods: </strong>We conducted an online cross-sectional study of 389 university students from various health-related fields. This study used a questionnaire to investigate the social and behavioral aspects associated with using psychostimulants.</p><p><strong>Results: </strong>The prevalence of psychostimulant use was 21%, primarily in men (23.07%), medicine students (19.70%), and psychology students (18.91%). Methylphenidate was the most commonly used drug (57%). Concomitant use of psychostimulants was reported in 37% and 35% of participants who started using them during graduation. A justifiable medical diagnosis was reported by 65% of the participants; however, a large portion had no indication for their use, and 77% acquired the medication without a medical prescription. The most frequently reported effects by users included lack of appetite (68%), tachycardia (58%), insomnia (43.5%), and agitation (50%). More than 70% of users also reported concurrent use of alcohol and illicit drugs, as well as depression and anxiety, which are contraindications for psychostimulant use. Additionally, 75% of students reported using psychostimulants for neuroenhancement purposes, with the majority (52%) perceiving their course performance as good and believing that it would be different without the drug (75.8%).</p><p><strong>Conclusion: </strong>Psychostimulant use in the study population revealed significant risks, including a lack of a valid diagnosis, unsupervised use, drug interactions, and side effects. Therefore, the data obtained in this study may contribute to the development of educational policies focused on preventing and controlling the indiscriminate use of these medications.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO0895"},"PeriodicalIF":1.1,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autologous platelet concentrate for the treatment of macular hole: a systematic review and meta-analysis.","authors":"Dillan Cunha Amaral, Mário Luiz Ribeiro Monteiro, Milton Ruiz Alves, Ivar Vargas Belizario, Lucas de Sousa Tebicherane, Raíza Jacometti, José Eduardo Ferreira Manso, Agma Juci Machado Traina, Ricardo Noguera Louzada","doi":"10.31744/einstein_journal/2024RW0832","DOIUrl":"10.31744/einstein_journal/2024RW0832","url":null,"abstract":"<p><p>Autologous platelet concentrates are rich in growth factors and have shown potential for high anatomical success rates in macular hole treatment. However, no systematic review has yet assessed its impact. Therefore, this study aimed to conduct a comprehensive review and meta-analysis on the comparative efficacy and safety of autologous platelet concentrates in treating macular hole. A systematic review of the literature on autologous platelet concentrate therapy for macular hole was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines on September 9, 2023. Databases, including PubMed, the Cochrane Library, Web of Science, and Embase, were queried. A meta-analysis of random effects was performed. Efficacy was evaluated through anatomical closure, reopening of the macular hole at 6 months, average improvement of 2 lines, and visual field loss. Safety was evaluated by monitoring complications. A systematic search of multiple databases identified six studies (three randomized controlled trials and three non-randomized cohort studies) involving 616 patients (626 eyes). Autologous platelets concentrate therapy significantly improved macular hole closure compared to that in the controls (OR=4.35; 95%CI=2.08-9.10; p<0.0001; I²=9%). No significant differences were observed in hole reopening at 6 months, post-operative visual acuity improvement by 2 lines or more, or visual field loss between autologous platelets concentrate and control groups. The overall complication rates were similar between groups. Thus, autologous platelet concentrate therapy shows promise for promoting macular hole closure, particularly in smaller holes. Further research with standardized protocols, prolonged follow-ups, and larger sample sizes is needed to fully understand its benefits and limitations in macular hole closure. (https://www.crd.york.ac.uk/prospero/) under ID CRD42023455815.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eRW0832"},"PeriodicalIF":1.1,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic endovascular peripheral arterial interventions: a proposal of a new learning model.","authors":"Andressa Cristina Sposato Louzada, Pedro Henrique Araujo Souza, Marcelo Passos Teivelis, Pedro Alves Lemos Neto, Felipe Nasser, Nelson Wolosker","doi":"10.31744/einstein_journal/2024AO1058","DOIUrl":"10.31744/einstein_journal/2024AO1058","url":null,"abstract":"<p><strong>Objective: </strong>This study tests a suitable model for training robot-assisted peripheral vascular interventions and examines the learning curves of endovascular surgeons with different levels of previous experience and main focus of work, analyzing procedure time, fluoroscopy time, use of contrast, and radiation emission.</p><p><strong>Methods: </strong>Sixteen endovascular surgeons with different previous experience and training performed nine manual and 18 robotic angioplasties using the CorPath GRX platform on a 3D-printed life-size immersed infragenicular arterial phantom.</p><p><strong>Results: </strong>All participants considered the model reliable. When analyzing manual angioplasty outcomes, the juniors took significantly longer to perform angioplasties than the seniors (p=0.044). Among the seniors, interventionists were faster only on the first angioplasty (p=0.046). Analysis of the robotic angioplasty results showed that only one junior failed to cannulate one of the target arteries once. The total duration, fluoroscopy time, and radiation emission did not differ between juniors and seniors (p=0.095, p=0.60, and p=0.64, respectively). In addition, the learning curves for the maximum benefit required two attempts for procedure duration, one for fluoroscopy time, and three for radiation emission. There were no significant differences between senior vascular surgeons and interventionists. Among juniors, residents had a significantly lower procedure duration (p=0.042) and radiation emission (p=0.046) only for the first angioplasty.</p><p><strong>Conclusion: </strong>The learning curves for robotic peripheral arterial interventions were short, with a plateau for the procedure and fluoroscopy times and radiation emission after the third attempt. We observed no differences in the learning curves in relation to previous experience or training.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO1058"},"PeriodicalIF":1.1,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Icodextrin versus Glucose 2.5% on markers of hypervolemia and survival of patients undergoing automated peritoneal dialysis with an unplanned start: a randomized controlled trial.","authors":"Leonardo Sotello Azevedo, Vanessa Burgugi Banin, Dayana Bitencourt Dias, Marcela Lara Mendes, Camila Albuquerque Alves, Maryanne Zilli Canedo Silva, Thyago Proença de Moraes, Daniela Ponce","doi":"10.31744/einstein_journal/2024AO0980","DOIUrl":"10.31744/einstein_journal/2024AO0980","url":null,"abstract":"<p><strong>Objective: </strong>The efficacy of icodextrin versus glucose patients undergoing peritoneal dialysis remains unclear. The study was designed to compare the effects of once-daily long-dwell icodextrin versus glucose on markers of hypervolemia and survival among patients with kidney failure undergoing an unplanned initiation of automated peritoneal dialysis.</p><p><strong>Methods: </strong>This was a randomized, non-blinded, and prospective controlled study. Prevalent and stable patients undergoing automated peritoneal dialysis with a recent peritoneal equilibration test showing a dialysate/plasma creatinine of >0.50 were randomized to receive either 7.5% icodextrin or 2.5% glucose solution. Patients were evaluated at baseline (one month after the start of peritoneal dialysis), 3 months, and 6 months after inclusion. The peritoneal dialysis solution was used for at least 3 months, with a follow-up period of 24 months.</p><p><strong>Results: </strong>Thirty patients were enrolled. There were no baseline differences between the groups. During the study period, patients in the Icodextrin Group showed improvements in the phase angle and ultrafiltration, whereas there were no changes in the Glucose Group. Additionally, extracellular water was significantly lower in the Icodextrin Group at the end of the study than at baseline. No statistical differences between the two groups were observed in urine volume, ultrafiltration, extracellular water, phase angle, renal creatinine clearance, use of diuretics and antihypertensives, or blood pressure. During the 24-month follow-up, the number of events related to overall mortality was seven (Icodextrin Group, n=4; Glucose Group, n=3), with no difference between the groups for this outcome or technique survival.</p><p><strong>Conclusion: </strong>Icodextrin significantly improved ultrafiltration, extracellular water, and phase angle at the end of the study compared to baseline in patients on the urgent start of automated peritoneal dialysis.</p><p><strong>Registry of clinical trials: </strong>(www.ctri.nic.in) under the number RBR-97z4wh6.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO0980"},"PeriodicalIF":1.1,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe murine schistosomiasis results from disrupted CD4+ T-cell modulation by immunodominance of a single egg epitope.","authors":"Eduardo Finger, Thaissa Melo Galante Coimbra, Alessandra Finardi Dastoli","doi":"10.31744/einstein_journal/2024AO0839","DOIUrl":"10.31744/einstein_journal/2024AO0839","url":null,"abstract":"<p><strong>Objective: </strong>This study examined the correlation between immunodominance of the major egg antigen Sm-p40234-246, a robust Th1/Th17 anti-egg CD4 T-cell response, and severe liver immunopathology in experimental murine schistosomiasis. It serves as a platform to analyze how varying degrees of immunodominance affect CD4+ T cell modulation and disease outcomes.</p><p><strong>Methods: </strong>We used a murine model of schistosomiasis to investigate the effects of immunodominance. Infected mice were divided into two groups: one treated with a combination of epitopes targeting immunodominance of the major egg antigen Sm-p40 and the other with a mock mixture of non-immunogenic epitopes. Liver granuloma area, a hallmark of schistosomiasis pathology, was quantified using histological and morphometric analyses. The average granuloma areas between the treated and untreated groups were compared using one-way ANOVA with Tukey's multiple comparison test. Additionally, we isolated CD4+ T cells from mesenteric lymph nodes, stimulated them with specific egg antigens, and collected purified supernatants to assess their signature cytokine secretion profiles for each treatment group.</p><p><strong>Results: </strong>Results showed that strong immunodominance of a single egg epitope undermines effective CD4+ T-cell modulation, promoting a strongly polarized Th1/Th17 pathogenic response. Conversely, neutralizing this immunodominance produces the opposite restorative effect.</p><p><strong>Conclusion: </strong>Immunodominance is an important pathogenic component that influences CD4+ T cell modulation in experimental murine schistosomiasis. Moreover, immunodominance can be used to treat these and other important CD4+ T cell-mediated diseases.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eAO0839"},"PeriodicalIF":1.1,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coexistent sickle cell anemia and autoimmune hemolytic anemia in two adolescents.","authors":"Vinícius Reis Soares, Bruna Paccola Blanco, Carla Luana Dinardo, Marlene Pereira Garanito","doi":"10.31744/einstein_journal/2024RC1105","DOIUrl":"10.31744/einstein_journal/2024RC1105","url":null,"abstract":"<p><p>The development of alloantibodies or autoantibodies is a complication observed in sickle cell disease. Autoimmunization occurs in 7.6-12% of chronically or intermittently transfused patients with sickle cell disease; however, the clinical implications of autoAbs are unclear. Few studies have focused on pediatric sickle cell disease and autoimmune hemolytic anemia. Herein, we present the coexistence of sickle cell disease and autoimmune hemolytic anemia in two adolescent patients, focusing on their pathophysiology, diagnosis, clinical management, and outcomes.</p>","PeriodicalId":47359,"journal":{"name":"Einstein-Sao Paulo","volume":"22 ","pages":"eRC1105"},"PeriodicalIF":1.1,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}