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Disertaciones |
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1
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Natália Lombardi Assumpção
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Effect of melatonin on otoprotection in rodents: A systematic review.
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Líder : ANDRE LUIZ LOPES SAMPAIO
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MIEMBROS DE LA BANCA :
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ANDRE LUIZ LOPES SAMPAIO
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EDUARDO MAGALHAES DA SILVA
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ELIETE NEVES DA SILVA GUERRA
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Monique Antunes de Souza Chelminski Barreto
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Data: 08-mar-2023
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Resumen Espectáculo
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Melatonin is a promising antioxidant substance that can minimize the effects of ototoxicity-induced hearing loss. Experimental studies have been performed to test the otoprotective efficacy of melatonin. Objective: To analyze the methodology presented by primary studies on determining the otoprotective efficacy of melatonin. The study is a systematic review with meta-analysis to clarify if the hormone is promising in preventing/minimizing human ototoxicity. Methods: Altogether, 154 articles were found in four databases. The PICOS strategy (Population, Intervention, Comparison, and Outcome) was used to define the eligibility criteria. Studies that met the inclusion criteria for the second step were included in a qualitative synthesis. Each study type was analyzed with the Critical Appraisal Checklist for Quasi-experimental Studies and the Critical Appraisal Checklist for Randomized Controlled Trials of the Joanna Briggs Institute. Results: Seven articles were selected, and four were included in the meta-analysis. It was possible to obtain seven outcomes according to the standard auditory frequencies presented among the studies, considering a minimum of three standard frequencies. The outcomes analyzed were for the frequencies of 1500, 2000, 3000, 4000, 5000, 6000, and 8000 Hz. Conclusion: Melatonin can provide protection against the ototoxic effects of cisplatin and aminoglycosides at 5000 Hz, 6000 Hz, and 8000 Hz, thereby minimizing the reduction in Otoacustic Emissions (OAE) amplitude. The same effect was not observed in the lower frequencies. Despite the limited number of studies that were evaluated, the results appeared consistent in higher frequencies. However, the methodology of the available studies did not meet the necessary methodological rigor that promotes the safe replicability of these studies.
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2
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Gustavo Lopes Rodrigues
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Beat-to-beat variability of blood pressure in patients with Parkinson's disease
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Líder : LAURO CASQUEIRO VIANNA
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MIEMBROS DE LA BANCA :
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LAURO CASQUEIRO VIANNA
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RICARDO JACO DE OLIVEIRA
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ANDRE LUIZ DA SILVA TEIXEIRA
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JEANN LUCCAS DE CASTRO SABINO DE CARVALHO
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Data: 15-mar-2023
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Resumen Espectáculo
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Parkinson's disease (PD) is a progressive neurodegenerative disease characterized by motor and non-motor symptoms, including autonomic dysfunction (AD), which can appear up to 10 years before the motor symptoms. In the cardiovascular system, AD can result in blood pressure (BP) abnormalities, such as changes in its variability. Considering that beat-to-beat resting BP variability (ABPV) is an important predictor of cardiovascular risk and target-organ damage, the aim of the study was to evaluate the ABPV of patients with PD. For this, beat-to-beat heart rate (electrocardiogram) and BP (digital photoplethysmography) were continuously measured in 18 PD volunteers, 16 age-matched controls and 18 youths. The systolic volume was estimated from the BP waveform (ModelFlow) allowing the calculation of cardiac output (CO) and total peripheral resistance (PTR). The PD group had lower VPA across standard deviation in systolic BP (5.6 ± 1.8 vs. 7.5 ± 2.5 mmHg, P = 0.017), diastolic BP (2.5 ± 0.7 vs. 3.7 ± 0.9 mmHg, P = 0.000) and mean BP ( 3.3 ± 0.8 vs. 4.6 ± 1.3 mmHg, P = 0.001), as well as in TPR (1.2 ± 0.9 vs. 2.5 ± 1.6 mmHg/L/min, P = 0.001), but not in DC (0.4 ± 0.1 vs. 0.3 ± 0.1 L/mmHg, P = 0.409), when compared to the Elderly group. Similar results were found using CV%. Taken together, the findings suggest that PD causes a decrease in VPA through mechanisms associated with TPR, but not with CD.
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3
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Stefhani Martins de Barcelos
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: Evaluation of the regenerative potential of extracellular vesicles derived from bovine mesenchymal stem cells on ovarian stromal cells and in vivo ovarian injury model.
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Líder : JULIANA LOTT DE CARVALHO
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MIEMBROS DE LA BANCA :
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CAROLINA MADEIRA LUCCI
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JULIANA LOTT DE CARVALHO
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PATRÍCIA FURTADO MALARD
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RINALDO WELLERSON PEREIRA
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Data: 30-jun-2023
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Resumen Espectáculo
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With an increase in infertility, there is a growing demand for assisted reproduction techniques and in vitro embryo production. However, specific treatments are required for the underlying causes of infertility. Mesenchymal stem cells (MSCs) have been used to treat ovarian dysfunction. Because part of the mechanism of action of MSCs is due to their paracrine action, in this study, we investigated the therapeutic potential of extracellular defeats derived from MSCs (MSC-EVs) resulting from ultrafiltration (UF) and ultracentrifugation (UC), evaluating their effects on bovine ovarian stromal cell migration and their use in an animal model of acute ovarian injury. MSCs were acquired from bovine adipose tissue and characterized according to the International Society for Cell Therapy guidelines. MSC-VEs were instructed on the secretome of these cells using UF and UC and evaluated for size, concentration, induction potential, and migration of bovine ovarian stromal cells using experiments and cell migration assays. After comparing the isolation methods, we evaluated the rate of viable oocyte retrieval and the number of embryos produced in cows treated with three different therapeutic regimens of MSCEVs in an acute injury model. Four follicular puncture sessions were performed for each group. The first group received only the vehicle after the first follicular puncture. In the second group, proteins produced by 7.5 × 106 MSCs were injected after the first follicular puncture. In the third group, fruit trees produced by 2.5 × 106 MSCs were injected after the first session, and in the fourth group, the same amount of vengeful was injected after sessions 1, 2, and 3. The characterization of the experimental experiments showed that there was no difference in particle size between the isolation methods, but UF showed a higher yield. Regardless of the method used, these possibilities were able to induce cell migration and anticipation. Considering that there was no difference between the methodologies in functional assays, the yield obtained through UF proved to be a determining factor for large-scale use in vivo. We evaluated three therapeutic regimens for holiday treatment, observed follicular punctures, and observed that the group treated with the least amount of insufficiencies in the three doses maintained oocyte production and increased in vitro embryo production. Therefore, MSC-EVs demonstrated beneficial effects on both cell and external migration in vitro and on vacation fertiertility with follicular puncture injury in vivo.
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4
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SAULO QUEIROZ BORGES
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Prevalence of and factors associated with hypersexuality in patients with dementia
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Líder : EINSTEIN FRANCISCO DE CAMARGOS
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MIEMBROS DE LA BANCA :
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EINSTEIN FRANCISCO DE CAMARGOS
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MARIA ALICE DE VILHENA TOLEDO
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LUCIANA LILIAN LOUZADA MARTINI
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PEDRO RENATO DE PAULA BRANDÃO
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Data: 25-jul-2023
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Resumen Espectáculo
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Hypersexuality, a psychological and behavioral symptom of dementia, remains understudied despite its high negative impact on patient quality of life and caregiver burden. The findings in the literature are inconsistent regarding its prevalence and associated factors. Objectives: To determine the prevalence of hypersexuality in patients with dementia, describe associated factors, and qualitatively report the most common presentations, treatments, and evidence of clinical response. Methods: This retrospective cross-sectional study collected data from semi-structured charts of dementia patients who were followed up at a secondary care reference center between 2015 and 2019. Results: Of 552 total patients, 52 (9.3%) were hypersexual, which was associated with male sex (p < 0.000; OR 2.95, 95% CI 1.73-5.01), frontotemporal dementia (p < 0.007), alcohol use (p < 0.015; OR 2.35, 95% CI 1.16-4.73) tobacco use (p < 0.000; OR 2.88, 95% CI 1.61-5.13), and semi-dependence/independence in basic activities of daily living (n = 0.041). Conclusions: Although our findings were, to a great extent, similar to the literature, their significant variability reflects the limited and low quality of the available evidence and a lack of standardization regarding terminology, definitions, and diagnostic criteria for hypersexuality. Further studies in different settings with specific instruments validated for hypersexuality could contribute to a better characterization of this challenging behavio
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5
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Lara Rilve Gonçalves
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Auditory Processing in stutterers
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Líder : CARLOS AUGUSTO COSTA PIRES DE OLIVEIRA
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MIEMBROS DE LA BANCA :
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CARLOS AUGUSTO COSTA PIRES DE OLIVEIRA
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Monique Antunes de Souza Chelminski Barreto
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LISIANE HOLDEFER
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VALÉRIA GOMES DA SILVA
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Data: 14-ago-2023
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Resumen Espectáculo
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Considering the relationship between Central Auditory Processing (PAC) and disfluencies, this study aims to analyze auditory processing in individuals with stuttering disfluencies. Methods: 30 individuals, with a mean age off 22.4 years and minimum age of 12 years, 26 males (86.67%) and four females (13.33%), were submitted to anamnesis, meatoscopy, basic audiological evaluation (tonal audiometry, vocal audiometry and impedance metry), specific assessment of stuttering (SSI-3) and behavioral tests of the PAC. For the evaluation of PAC, the following tests were applied: Binaural Interaction Processing (MLD), Temporal Processing (RGDT, PPS and DPS), Integration and binaural separation in dichotic listening (TDD) and monotic listening of low redundancy (SSI). Results: Regarding the degree of classification of stuttering, nests and study, the mild degree prevailed. In the overall result of all the skills evaluated, it was observed that 76.67% (23 individuals) presented pca alteration. In the analysis of all tests of behavioral evaluation of auditory processing performed, no correlation was found between the degree of stuttering and the alteration of the PAC. Conclusion: It was found that most of the gaga sample presentes PAC disorder, especially in auditory abilities of auditory closure and temporal ordering. In the comparison of the degrees of severity of stuttering,a change in the abilities of auditory closure, binaural integration and figure-background was -identified.
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6
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Giulia Causin Vieira
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In silico characterization and evaluation of the anti-hemostatic activity of antigen 5 from the saliva of Rhodnius neglectus, vector of Chagas disease
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Líder : CARLA NUNES DE ARAUJO
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MIEMBROS DE LA BANCA :
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CARLA NUNES DE ARAUJO
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OTAVIO DE TOLEDO NOBREGA
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LUCAS SILVA DE OLIVEIRA
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MELINA MOTTIN
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Data: 19-sep-2023
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Resumen Espectáculo
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Triatomines are hematophagous insects that transmit the protozoan Trypanosoma cruzi, the etiological agent of Chagas disease. Their saliva is rich in compounds that counteract host hemostatic and immune responses. Antigen 5 (Ag5), a member of the CAP superfamily, composed of proteins rich in cysteine residues of cysteine (CRISP - cysteine rich secretory proteins), Antigen 5 and proteins related to pathogenicity in plants (Pathogenesis-related - PR1), has been reported in arthropod saliva as responsible for causing strong allergic responses. The Ag5 activity already found in triatomines is correlated to neutrophil oxidative burst inhibition and prevention of collagen-induced platelet aggregation. This study aimed to use bioinformatics approaches to characterize R. neglectus salivary antigen 5 (RnAg5), produce the recombinant RnAG5 protein and evaluate its inhibitory potential for platelet aggregation and blood clotting. In silico analyzes were performed to predict the putative signal peptide, cellular localization and post-translational modifications. The 3D structure of RnAg5 was obtained by artificial intelligence, through the Alphafold server, and the amino acids that compose B cell epitopes were predicted with the ElliPro, BepiPred and SeRenDIP servers. In order to identify promising ligands, molecular docking calculations were performed using the DockThor web server against small molecules to identify promising ligands. The Ag5 sequence was cloned into the pET100/D-TOPO vector, expressed in Escherichia coli Rosetta(DE3)pLysS with 1 mM isopropyl B-D-thiogalactopyranoside at 37ºC, with a molecular mass of approximately 31 kDa. It was possible to obtain RnAg5 in soluble fraction and in inclusion bodies, and this recombinant protein was purified by immobilized metal ion affinity chromatography. RnAg5 has a signal peptide at the N-terminus and can be secreted by the classical pathway. It contains 25 putative phosphorylation sites and 10 potential glycosylation residues. The ability of Ag5 to interact with lipids is associated with a conserved region in CAP superfamily, the binding site has two parallel alpha-helices, which form a long hydrophobic cavity. However, despite the predicted 3D model reflects this described structure, it does not form the binding cavity. Though, another potential hydrophobic binding site was predicted in our model. Docking results showed that platelet-activating factor, leukotriene D4 and prostaglandin can bind to RnAg5 with docking score of -8,72; -8,16 and -7,80 Kcal·mol-1, respectively. In addition, 176 residues that form linear epitopes and 201 residues that form conformational epitopes were predicted. These results were extremely relevant, since Ag5 proteins are allergens already characterized in other species of arthropods and may become a possible marker of exposure to triatomine bites. Understanding the role of salivary Ag5 on the triatomine-host-pathogen interface may lead to development of new strategies to control Chagas disease transmission.
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7
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ANDRÉ ARAUJO DE MEDEIROS SILVA
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STUDY OF THE CLINICAL PRESENTATION, PATHOLOGICAL STAGE AND ONCOLOGICAL RESULTS OF COLORECTAL CANCER IN YOUNG ADULTS
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Líder : JOAO BATISTA DE SOUSA
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MIEMBROS DE LA BANCA :
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JOAO BATISTA DE SOUSA
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PAULO GONCALVES DE OLIVEIRA
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HÉLIO MOREIRA JÚNIOR
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MARCELO DE MELO ANDRADE COURA
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Data: 29-sep-2023
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Resumen Espectáculo
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Background: Colorectal cancer is the second most common and deadliest tumor around the world. In recent decades, the incidence of colorectal cancer has progressively increased among young patients. Previous analyzes have shown that colorectal cancer in this population has a worse prognosis due to more aggressive characteristics and more advanced stages at the time of diagnosis. However, these findings are not uniform across different parts of the globe. Objective: To evaluate the effect of age on the clinical presentation, pathological staging, therapy and oncological outcomes of colorectal cancer. Methods: The medical records of 434 patients with colorectal adenocarcinoma were reviewed. Patients were divided into two groups according to age. The young group (age < 50 years) consisted of 78 patients, and the older group (age ≥ 50 years) consisted of 356 patients. Clinical variables, time interval between onset of symptoms and diagnosis, pathological stage, operative mortality and oncological stages were compared between groups. Results: The average follow-up in months was 35.59 ± 16.27. Age was an independent factor for longer hospital stays in patients > 50 years old [PR = 0.11 (95% CI: 0.01; 0.21), p = 0.0336]. Patients < 50 years old had more undifferentiated histological types > 50 years old [PR= 2.38 (95% CI: 1.18; 4.78; p = 0.0147)]. There were no other differences on surgical and clinical presentation and oncological outcome. Conclusion: Young patients have a higher frequency of undifferentiated tumors. Age has not been shown to impact oncological outcomes.
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8
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Luiza Moreira Campos
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EVALUATION OF INTESTINAL STOMA DEMARCATIONS AS A MEASUREMENT PREVENTION OF COMPLICATIONS: A TEMPORAL ANALYSIS
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Líder : JOAO BATISTA DE SOUSA
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MIEMBROS DE LA BANCA :
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JOAO BATISTA DE SOUSA
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ANA LUCIA DA SILVA
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SIMONE ROQUE MAZONI
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SANDRA DE NAZARÉ COSTA MONTEIRO
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Data: 04-oct-2023
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Resumen Espectáculo
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Introduction: Ostomy is a surgically made opening in the digestive system, urinary and/or respiratory tract. In the case of intestinal ostomy, part of the intestine is externalized through the abdomen to allow feces to drain. Demarcation is the act of marking the ideal place on the abdominal wall for the creation of the stoma. A well-located stoma can provide better self-care, prevention of complications, safety in self-care, quality of life and reintegration into the social life of the person with a stoma. Objective: To evaluate the demarcations of intestinal ostomies as a preventive measure for complications, over the period of a decade, and compare with non-demarcated patients. Methology: This is a descriptive study both retrospective and prospective, with a quantitative approach. The study was carried out in a teaching hospital in Brasília, with patients undergoing intestinal ostomies, from surgeries carried out between 2014 and 2023. A questionnaire was applied, covering sociodemographic and clinical data, and an interview by telephone was conducted with each patient. The analysis of the results was based on the information collected, tabulated and organized for the preparation of tables and their interpretation, using the Microsoft Excel for Windows 2017® the sociodemographic characterization of the sample was carried out using descriptive analysis. For the study of clinical data, in addition to exploratory data analysis, relationships were also studied with the application of the Chi Square test and Multiple Correspondence Analysis (MCA) and Hierarchical Cluster Analysis (HCA) were also used. Results: 71 people with an intestinal ostomy participated in the study. The majority 44 (62%) women aged between 50 and 59 years. Regarding the level of education, 36 (51%) had completed secondary education. Regarding marital status, 36 (51%) declared that they currently have a partner (married/in a stable relationship). The underlying disease that most indicated ostomy preparation was colorectal cancer, appearing in 35 (49%) of cases, accompanied by inflammatory bowel diseases in 18 (25%). Of the majority of participants, 36 (51%) declared they had a partner and 61 (86%) felt confident in self-care. In this study, there was a predominance of temporary colostomies, 39 (55%) and 47 (66%). The scenario observed in the preoperative period shows that 60 (85%) patients stated that they received guidance before the surgery performed and 33 (46%) stated that there was a demarcation. Regarding complications, the most common in this study was parastomal dermatitis with 49% of cases. Conclusion: Responding to the objectives initially proposed and based on the results obtained, the present study made it possible to identify that in this group the pre-operative demarcation prior to the surgery to create intestinal ostomies was evaluated, by a health professional qualified for this, with specific knowledge , is a trend line for an action that prevents postoperative complications, late or not, related to colostomy or ileostomy
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9
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Gabriel dos Santos Silva
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Integration of Computational and Experimental Approaches to Characterize a Salivary Odorant-Binding Protein from Rhodnius neglectus, Vector of Chagas Disease
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Líder : CARLA NUNES DE ARAUJO
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MIEMBROS DE LA BANCA :
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CARLA NUNES DE ARAUJO
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AISEL VALLE GARAY
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PAULA BEATRIZ DE MEDEIROS SANTIAGO
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CLEVER GOMES CARDOSO
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Data: 06-oct-2023
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Resumen Espectáculo
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Rhodnius neglectus, an insect from the Reduviidae family (Hemiptera), is a potential vector of Trypanosoma cruzi, the causative protozoan of Chagas disease. Triatomine saliva comprises a rich mixture of molecules synthesized by the salivary glands to counter host responses, aid the uptake of blood and, indirectly, T. cruzi transmission. Therefore, the saliva of this hematophagous insect has been a relevant subject of studies due to the presence of these molecules with high biotechnological potential. The goal of this work was to study an Odorant Binding Protein from R. neglectus saliva (RnOBP) using computational and experimental approaches aiming, to contribute to the understanding of its structural and functional characteristics. RnOBP molecular modeling, computational molecular dynamics and clustering tests were performed to obtain information about the protein's flexibility. Next, molecular docking assays were carried out to verify the affinity of RnOBP with agonists of vertebrate coagulation pathways. Finally, putative RnOBP oligomers were observed. To obtain the recombinant RnOBP, its nucleotide sequence was obtained from the R. neglectus transcriptome, cloned into the pET100/D-TOPO expression vector and produced by Escherichia coli Rosetta(DE3)pLysS bacteria. The recombinant RnOBP was purified by affinity chromatography, refolded, and used in biophysical characterization assays. This protein is modeled to be entirely formed by α-helices and have a significant internal cavity, potentially a ligand-binding site. Compared with insect OBPs, regardless of the composition or classification of the OBP, the binding site region is well conserved. The recombinant RnOBP purified from inclusion bodies revealed a secondary structure composition different than expected. Initial functional indicated rRnOBP could act to inhibit platelet aggregation, but not coagulation. This study showed RnOBP structural properties and may contribute to the understanding of its functions and biotechnological potential.
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10
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ANA CAROLINA ODORIZZI ZICA
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EVALUACIÓN AUDIOLÓGICA EN BEBÉS NACIDOS DE MADRES QUE TENÍAN COVID-19 DURANTE LA GESTACIÓN
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Líder : ANDRE LUIZ LOPES SAMPAIO
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MIEMBROS DE LA BANCA :
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ANDRE LUIZ LOPES SAMPAIO
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IRUENA MORAES KESSLER
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JULIANA GUSMÃO DE ARAUJO
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LUCIENY SILVA MARTINS SERRA
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Data: 27-nov-2023
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Resumen Espectáculo
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Introducción: A finales de diciembre de 2019, se informó un grupo de casos de neumonía inexplicable en Wuhan, China. Unos días después, el agente causante de esta misteriosa enfermedad fue identificado como un nuevo coronavirus que se propagó rápidamente. Las infecciones maternas, contraídas antes o durante el embarazo, pueden transmitirse al feto durante el embarazo (infección congénita), durante el parto (infección perinatal) y a través de la lactancia (infección posnatal) y pueden causar daños al feto o al recién nacido. Objetivo: describir la evaluación audiológica realizada a una serie de niños cuyas madres tuvieron COVID-19, en su forma leve, durante el período gestacional. Metodología: Para la evaluación audiológica se realizaron pruebas de anamnesis y otoemisiones acústicas de productos de distorsión, en frecuencias de 1,5 a 12KHz y potencial auditivo de tronco encefálico mediante click. Resultados: La muestra estuvo compuesta por 47 recién nacidos. Los resultados de las pruebas de distorsión producto de emisiones otoacústicas evocadas indicaron funcionalidad de las estructuras evaluadas, apuntando a una función coclear normal con un nivel de respuesta adecuado para los resultados promedio obtenidos hasta una frecuencia de 11kHz para la amplitud de respuesta y la relación señal-ruido. . Se pudo encontrar en toda la muestra la presencia de ondas I, III y V con una intensidad de 80dBHL y la presencia de la onda V con intensidades de 50 y 35dBHL de forma bilateral. Conclusión: No se estableció una correlación directa entre la infección materna por el virus Covid-19 y los hallazgos audiológicos en los recién nacidos. Cabe mencionar que este fue un estudio preliminar y que estos niños necesitan seguir siendo monitoreados para investigar futuros resultados tardíos con el audífono.
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11
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RAFAEL DE NEGREIROS BOTAN
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CREATION OF A DATABASE WITH REAL-TIME RESULTS OF GLOBAL SURVIVAL OF BREAST CANCER PATIENTS
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Líder : JOAO BATISTA DE SOUSA
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MIEMBROS DE LA BANCA :
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CLAYTON FRANCO MORAES
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Hélio Humberto Angotti Carrara
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JOAO BATISTA DE SOUSA
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SALETE DA SILVA RIOS CHEN
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Data: 08-dic-2023
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Resumen Espectáculo
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Introduction. Breast cancer globally represents one of the leading causes of mortality among women, which underscores the need for effective pathways for the treatment of individuals with this disease. The collection, storage, and processing of survival data with the interest of understanding the correlation between treatment and survival demands time from researchers and institutions. Objective. The present study was designed to create an innovative real-time survival data network, with the aim of correlating survival time with used treatments, with the purpose of generating hypotheses for future prospective studies regarding the survival benefits of treatment in different clinical, social, and geographic contexts. Methods: After defining the data conventionally considered as crucial in the treatment of breast cancer, a data network was designed that returns to the physician the overall survival, progression-free survival, and event-free survival in real time. The criteria for each survival metric were defined and a real-time chart was generated where all survivals are represented and, when combined, result in the overall survival. Results: With free and simple registration, the network was created and allows access to any Brazilian oncologist. Patient entry is fully parameterized, allowing the quick and safe input of information about the disease and treatment. The physician can access patient data in real time and thus can compare it with results from the literature, especially survival data, using advanced filters. Consent for the submission of information is obtained electronically from the patient, also in real time, from an email address or phone. Conclusion: This data network is feasible and can be a tool of interest in research institutions, particularly as a screening for larger studies.
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12
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Agostinho de Alencar Guerra
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Levodopa-responsive dystonia due to mutations in the GCH1/TH genes: cohort of patients treated at the Sarah Network of Rehabilitation Hospital
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Líder : FELIPE VON GLEHN SILVA
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MIEMBROS DE LA BANCA :
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FELIPE VON GLEHN SILVA
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CLARICE LISTIK
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INGRID FABER DE VASCONCELOS
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PEDRO RENATO DE PAULA BRANDÃO
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Data: 22-dic-2023
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Resumen Espectáculo
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Introduction: Dopa-responsive dystonia (DRD), also known as Segawa Disease, was first described in 1971. Variants in the GCH1 gene inherited in an autosomal dominant pattern are the most common cause of DRD. In Latin America, there have been few published studies on DRD. This study aims to describe the genetic and clinical profile of a cohort of patients from a rehabilitation hospital network in Brazil. Materials and Methods: This is a descriptive study of a group of 22 patients treated in our hospital network. For each patient who underwent genetic testing by next-generation sequencing (NGS), a retrospective analysis of clinical features and evolution was performed for a phenotype-genotype correlation. Results: Variants associated with DRD were detected in 17 out of the 22 patients (77%). Among these 17 patients, variants in the GCH1 gene were detected in 16 (94%), while only one patient had a variant in the TH gene (5%). Among the 16 patients with variants in the GCH1 gene, 10 patients had variants classified as pathogenic, 5 patients had variants likely to be pathogenic, and 1 patient had a variant of unknown significance (VUS). The variant of the TH gene was classified as VUS. Five patients had no variants detected. The clinical findings were highly similar to other studies, such as an average age of onset around 8 years old, a predominance of females, a good response to low doses of levodopa, and a significant diagnostic delay. However, complex phenotypes were identified in this large cohort of cases, including a substantial number of unrelated individuals without a family history. Another notable point was the frequency of levodopa-induced motor dyskinesias. Additionally, patients experienced behavioral symptoms severe enough to require medication for psychiatric disorders. Conclusion: This descriptive study of a group of 22 patients treated in a hospital network showed classical phenotypic findings previously described in other studies, along with uncommon characteristics such as levodopa-induced dyskinesias, frequent behavioral findings, medication use for psychiatric disorders, and complex phenotypes. These findings highlight the need for further research regarding the GCH1 and TH genes:
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Tesis |
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1
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Laís Sevilha dos Santos
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QUANTIFICAÇÃO DO DNA DE Mycobacterium leprae EM DIFERENTES CAMADAS DA PELE: ESTUDO SOBRE ELIMINAÇÃO TRANSEPIDÉRMICA, PROGRESSÃO PARA CURA E TRANSMISSÃO
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Líder : CIRO MARTINS GOMES
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MIEMBROS DE LA BANCA :
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AMILCAR SABINO DAMAZO
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Ana Carolina Tardin Martins
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CIRO MARTINS GOMES
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DANIEL HOLANDA BARROSO
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LETÍCIA FERNANDES BARROSO
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Data: 24-feb-2023
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Resumen Espectáculo
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The progress of molecular techniques was essential for the previous diagnosis of leprosy. However, current studies in the area have not been able to clarify the performance of these techniques in clinical practice yet. The main objective of this project was to test in clinical practice the accuracy, sensitivity and specificity of a new pair of primers developed for the repetitive element target (RLEP) of Mycobacterium leprae. Furthermore, as a secondary objective, was sought to identify the transmission potential of patients with multibacillary and paucibacillary leprosy. Thus, a crosssectional cohort study of diagnostic accuracy was carried out with a total of one hundred patients with a clinical picture compatible with leprosy. In this study, real-time Polymerase Chain Reaction (qPCR) was used to quantify M. leprae in different layers of the skin and in nasal swabs. Skin samples were divided into four layers: epidermis, upper dermis, lower dermis and hypodermis. The results of quantification of the bacillus in nasal swab samples were related to the number of household contacts. As a positivity criterion for the qPCR reaction, three cutoff points were established: 1 - any quantifiable bacillus DNA, 2 - quantification greater than or equal to 0.1 bacillus, 3 - quantification greater than or equal to 1 bacillus. Validation of the in vitro quantification of the reaction resulted in a quantification limit of 0.03 bacilli. The best sensitivity was observed in the upper dermis according to the first established cut-off point [sensitivity = 59.26% (95% CI = 45.97 – 71.32)]. In the epidermis, the third cutoff point resulted in 100% specificity (95% CI = 92.29 - 100). The best accuracy was found in the hypodermis at the first cutoff point [accuracy = 68.09% (95% CI = 58.11 – 76.64)]. For swab samples, the best sensitivity was 20.83% (95% CI = 11.73 – 34.26), and was achieved at the first cutoff point. At the three tested cutoff points, 100% specificity was obtained in the swab samples. The number of bacilli found in nasal swabs was not significantly related to the number of household contacts also diagnosed with leprosy. Paucibacillary patients tested positive only for bacillus fragments in nasal swabs, but not for the entire bacillus. This fact demonstrates that paucibacillary patients may not be a relevant source of disease transmission. It was concluded that different types of skin samples have little influence on the accuracy of the qPCR test. However, in contrast to this result, different cutoff points may influence the accuracy, sensitivity and specificity of the qPCR test. xviii Keywords: L
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2
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ANA LUCIA CARNEIRO SARMENTO
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EFFECT OF TRANSVAGINAL ELECTROSTIMULATION ON FLOOR AND PELVIC ORGANS TISSUES OF MULTIPARAUS AND
NULIPARAUS WISTAR RATS
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Líder : SELMA APARECIDA SOUZA KUCKELHAUS
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MIEMBROS DE LA BANCA :
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SELMA APARECIDA SOUZA KUCKELHAUS
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AMILCAR SABINO DAMAZO
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LEONEL ALVES DE OLIVEIRA
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LETICIA MARTINS PAIVA
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RENATA OLIVEIRA SOARES
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Data: 27-feb-2023
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Resumen Espectáculo
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The pelvic floor (PF), formed by muscles and fascia, is responsible for supporting the abdominal and pelvic organs, with an important role in urinary/fecal/anal continence, in the closure of the urogenital hiatus and in sexual functioning. Structural and/or functional alterations of the AP due to aging, vaginal delivery, multiparity, obesity and other risk factors can cause dysfunctions such as incontinence and prolapses. The treatment for these dysfunctions can be surgical or conservative. The electrical stimulation (EE), a physiotherapy resource, has been used as a conservative treatment and consists of the application of intermittent electrical stimuli of low current levels that cause muscle contraction. However, there is a lack of studies that evaluate the effects of EE directly on the tissues of the pelvic region and perineum. Thus, this study evaluated the effect of transvaginal electrical stimulation (VE) on the histomorphometry of the PF muscles (PFMs) and tissues associated with the vagina, urethra and rectum of multiparous and nulliparous Wistar rats. This is a descriptive, analytical, comparative, experimental and prospective longitudinal study, carried out in multiparous (n=10) and nulliparous (n=10) Wistar rats aged 12 months. The EE (30 sessions) was performed with an intravaginal probe with biphasic current, 700 ms pulse width, 50 Hz frequency and 2 mA intensity. Histomorphometric data were obtained from epithelial, connective, and muscular tissues in pelvic histological specimens processed with routine techniques and stained with hematoxylin and eosin, Gomori's trichrome, and immunostaining with Ki67. The results showed that VE: 1) increased the force of contraction of PFMs in nulliparous and multiparous; 2) increased the thickness of PFMs (muscle hypertrophy) in nulliparous and multiparous; 3) did not increase the thickness of the epithelium lining the vagina of nulliparous and multiparous, in relation to their control groups, but increased in the urethra of multiparous; 4) increased thickness of connective tissue associated with the three pelvic organs in nulliparous and multiparous; 5) increased the thickness of the smooth muscle tissue layer of the vagina, urethra and rectum in multiparous, as well as the urethra and rectum in nulliparous; 6) increased the total number of leukocytes/200 µm2 in the mucous membranes of nulliparous and multiparous; 7) increased total fibroblasts/fibrocytes/700 µm2 in the mucous membranes of multiparous compared to the other groups; 8) produced a greater immunostaining with Ki67+ in basal epithelial, endothelial, smooth muscle cells and in fibroblasts in multiparous, in comparison with its control group; 9) produced a greater immunostaining with Ki67+ in PFMs satellite cells from nulliparous and multiparous. The set of results demonstrated that the application of 30 sessions of VE, in the parameters used, favored the structural/functional gain, mainly in the connective and muscular tissues, reflecting in the increase of the force of muscular contraction of the PF. In conclusion, these results showed the effectiveness of VE in multiparous and nulliparous Wistar rats, which can contribute to reinforce its use in the medical clinic, aiming at strengthening the PF and maintaining continence by the pelvic organs in women, who are the most commonly affected by dysfunctions of the PF.
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3
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FLAVIA ZATTAR PIAZERA
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Characterization and evaluation of viability, immune markers and differentiation of cryopreserved human hematopoietic stem cells.
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Líder : SELMA APARECIDA SOUZA KUCKELHAUS
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MIEMBROS DE LA BANCA :
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CARLOS ALBERTO PINTO DA SILVEIRA
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CIRO MARTINS GOMES
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LEONEL ALVES DE OLIVEIRA
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SELMA APARECIDA SOUZA KUCKELHAUS
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TATIANA KARLA DOS SANTOS BORGES
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Data: 18-mar-2023
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Resumen Espectáculo
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Introduction: Hematopoietic stem cells (HSC) have numerous therapeutic applications in the treatment of hematologic malignancies, autoimmune diseases and in regenerative medicine. The clinical, biochemical and immunological characteristics of individuals are relevant factors in the quality of HSC collected and cryopreserved, thus interfering with the results of hematopoietic stem cell transplants. Culture media and culture substrates are in vitro models necessary to enable experimental research and therapeutic use. This study aimed to characterize and evaluate the viability and immune markers of human HSC, as well as to evaluate the role of platelet-rich fibrin (PRF) as a substrate for their cultivation. Methods: This is a retrospective, descriptive and experimental study conducted with 14 HSC samples obtained by apheresis from 14 healthy adult individuals. The samples were submitted to typing for HLA antigens by the SSO technique and ABO/Rh systems by immunohematology. Viability and types of regulated killing were assessed by flow cytometry. Reactive species were evaluated by flow cytometry (ROS/DCFDA; ERNs/DAFFM Diacetate). HSC differentiation potential was evaluated using a PRF as substrate; the results were tabulated and analyzed using the Prism 5.0 program. Results: HSC donors were young adults with hematological and biochemical parameters within normal reference values. The cryopreservation time of 34 ± 15 months reduced in 2% the total HSC-CD34+. There was greater expression of the A*02, DRB1*04, DRB1*07 loci for HLA antigens. As for the type of regulated cell death, there was no difference between the percentages of initial apoptosis, late apoptosis and by unknown mechanism. As for the ABO system, there was a predominance of type O (6 individuals), followed by type A (5 individuals). For the Rh factor there was a predominance of the positive type (10 individuals). After cryopreservation, there was great individual variability in the production of reactive species and greater production of ERNs than ROS by the group of individuals. The fibrin mesh favored the anticipation of cell grouping (homing / 2 days of incubation), while in the absence of fibrin, grouping was observed after 3 days. The fibrin mesh favored the appearance of signs of cell differentiation (pseudopods and evident nucleolus) after 3 days of incubation. Conclusion: The set of results showed that HSC cryopreservation parameters should be considered to ensure their quality, as there was a reduction in cell viability when thawed and some samples had mitochondrial metabolism close to 0 (zero). Considering that, the PRF mesh provided adhesion, homing and cell differentiation signals, it is believed that the parameters related to the freezing/thawing method and the cryopreservation time were appropriate to guarantee the quality of the samples. However, it is suggested the continuity of studies to determine the effect of the curve of time x cell quality to help the decision making of national banks of stem cell cryopreservation.
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4
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Ida Perea Monteiro
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Sexually transmitted infections prevalence in adolescents assisted in a family planning clinic in Western Amazonia
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Líder : NADJAR NITZ SILVA LOCIKS DE ARAUJO
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MIEMBROS DE LA BANCA :
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LUIZ CLAUDIO GONCALVES DE CASTRO
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MARIA DA CONCEIÇÃO RIBEIRO SIMÕES
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MAURO ROMERO LEAL PASSOS
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NADJAR NITZ SILVA LOCIKS DE ARAUJO
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WALTER MASSA RAMALHO
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Data: 28-mar-2023
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Resumen Espectáculo
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The WHO defines adolescence as a period of life between 10 and 19 years old and its high complexity is linked to the emergence of secondary sexual characters, development of psychosocial process and definitions of standards to differentiate the infant and adult phase. In addition to being a period of discovery, it is in this moment that they tend to seek their independence and social maturity, reflected mainly by their choices and attitudes. Among these, are highlighted, drinking and narcotics and the beginning of sexual life. Globally, adolescents and young adults represents 25% of the sexually active population and are also responsible for almost 50% of all recently acquired STIs. STIs are one of the most common public health problems in the world and are directly related to maternal and child mortality. Besides that, 500 million new cases of curable infections are estimated each year. Although the numbers are startling, we are currently experiencing a shortage of data and epidemiological studies aimed at understanding STIs, especially in developing countries, such as Brazil, and in specific groups, such as adolescents assisted by family planning services. Bases on this, our mainly aim was to understand and analyze the behaviors related to sexual and reproductive health of adolescents in a family planning clinic in Porto Velho (RO), as well as to access the prevalence of the main STIs. Thus, 196 adolescents between 14 and 19 years old, patients at the Porto Velho outpatient clinic, answered a questionnaire, underwent clinical evaluation and gynecological examination to collect biological material. Rapid tests provides by the Ministry of Health were used for syphilis, HIV and viral hepatitis B and C research, and the Ruo Kit Multiples STIs 9-64 RX (Fast-Track) for others. The results showed a socio-demographic profile of older adolescents, without paid work or students, biracial, religious, with at least one child and the average age of the group’s sexarche was 16.2 years (SD=1.6). The responses indicated high knowledge and recognition of STIs by the adolescents, except for chlamydia and trichomonas. The questionnaire showed that the low frequency of use of condoms, relationships with more than one sexual partner, casual relationships, alcohol and tobacco intake, and poor adherence to gynecological exams, were frequent risk behaviors in this population. Rapid tests identified two participants with syphilis and the prevalence for chlamydia and gonorrhea infections was quite high when compared to the literature. More specific analyzes reveled an association between vaginal pH and condom in all sexual relations (*p=0.041), as well as with the presence of U. urealyticum/parvum (*p=0.043). In the analysis of concomitant infections, G. vaginalis was significantly associated with M. genitalium (*p=0.046) and tended to U. urealyticum/parvum (p=0.065). The absence of an association between chlamydia and gonorrhea with the symptoms and complaints analyzed reinforces the need to evaluate patients in addition to the clinical examination and to improve screening methods. Taken together, this study reports the importance of having updated epidemiological data to compose and assist in population improvement protocols and programs, as well as reinforcing the importance of the care provided in family planning outpatient clinics and other programs promoted by the government.
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5
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MARIANA UBALDO BARBOSA PAIVA
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Metabolomics and Leaman CT score as non-invasive methods for risk stratification in asymptomatic patients with intermediate Framingham score: a translational pilot study
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Líder : FERNANDO ANTIBAS ATIK
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MIEMBROS DE LA BANCA :
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CARLOS HENRIQUE REIS ESSELIN RASSI
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DANIEL FRANCA VASCONCELOS
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FERNANDO ANTIBAS ATIK
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FRANCISCO RAFAEL MARTINS LAURINDO
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GUILHERME URPIA MONTE
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Data: 30-mar-2023
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Resumen Espectáculo
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Early detection of subclinical atherosclerosis on patients with Framingham intermediate risk is a major unmet clinical need and additional tests are recommended to personalize the risk estimates. A prognostic revelation of CT-adapted Leaman score coupled with the analysis of potentials candidates for biomarkers by comprehensive metabolomic profile can deepen the current knowledge of the phenotype of patients and be used as a complementary technique for re-stratification of the risk. To test the hypothesis that CT-LeSC is able to discriminate different metabolomic profiles in intermediate risk subjects and aid physicians in the decision-making in order to better stratify these patients. We studied 40 subjects with an intermediate CV risk profile, subdividing them according to the presence or absence of CAD, assessed by computed tomography angiography. They were recruited into three groups according to CT-LeSc score (Low: < 5 and High > 5), and Control, and another analysis in four groups according to CT-LeSc tertiles (T1: 0.3-3.7; T2: 3.8-8.2; T3: 8.3-24.1 and Control). Metabolomic analysis of serum from patients in each group was performed with a global approach based on undirected performance liquid chromatography coupled with time-of-flight mass spectrometry (LC-QTOF/MS) and gas chromatography (GC MSMS). Data were analyzed between January 2018 and July 2020. Among the patients, 28 (70%) had identifiable plaques in the coronary tree; of these, 16 patients (40%) were high-risk, 12 (30%) were low-risk, and 12 (30%) were controls. In the GC MSMS approach, high concentrations of pipecolic acid, 2-hydroxy-3-methylbutyric acid, palmitic acid, oleic acid, asparagine, linoleic acid, L-phenylalanine, L-glutamic acid were found in the control group, while L-5- oxoproline was expressed more intensely in the High CT-LeSc group when compared to the Low CT-LeSc and Control groups. The sPLS-DA model had a low misclassification error rate and the value of the Area Under Curve (AUC) from ROC curves was 0.789 (95% CI: 0.559-0.952), 0.734 (95% CI: 0.424-0.955) and 0.654 (95% CI: 0.389-0.812) in the plaque group vs control, High-CT LeSc group vs control and High-CT LeSc group vs Low-CT LeSc, respectively. In the LC MSMS approach, the data show a discriminating metabolite profile between the extreme phenotypes of the intermediate group (High CT-LeSc versus Control and T3 versus Control), with AUC of 0.926 and 0.967, respectively. In this pilot, prospective, translational study, metabolomics analysis revealed discriminatory metabolic fingerprints of high CT-LeSc and T3 phenotypes, despite comparable intermediate CV risk profiles with controls, which seems to indicate, even in this global analysis, a hint of there may be a discriminating molecular signature for these patients. Ultimately, a specific grouping of metabolites, rather than a single marker, may improve the biological understanding of CVD risk.
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6
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CLEANDRO PIRES DE ALBUQUERQUE
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“Long-term effectiveness of early rheumatoid arthritis treatment under real life in brazil”
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Líder : LEOPOLDO LUIZ DOS SANTOS NETO
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MIEMBROS DE LA BANCA :
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LEOPOLDO LUIZ DOS SANTOS NETO
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LAILA SALMEN ESPINDOLA
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ANGELA LUZIA BRANCO PINTO DUARTE
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CLARISSA DE CASTRO FERREIRA
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LUCIANA FEITOSA MUNIZ
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Data: 12-abr-2023
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Resumen Espectáculo
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Background: Early treatment (within 3 months of symptoms, ideally) and tight disease control are fundamentals in the management of rheumatoid arthritis (RA), although not always achievable in real life. Objectives: To assess the delays in diagnosis and treatment of RA, in Brazil, and the long-term effects of early access to the rheumatologist, early treatment and mode of disease control (tight vs. standard) regarding RA after long disease duration, under real-life conditions. Methods: Adults meeting (ACR/EULAR 2010) criteria for RA, from 11 Brazilian hospitals were recruited between August/2015 and April/2016 to this follow-up study. Clinical features, disease activity (DAS28), physical function (HAQ), erosive disease, diagnostic and therapeutic delays, mode of disease control (tight vs. standard) and the specialties of the physicians who first consulted the patient (upon symptoms onset) and who established the diagnosis were evaluated. Chi-squared, students’ t, Mann-Whitney’s U, ANOVA, correlation, Mann-Kendall’s trend tests and multiple regression models (significance level: 0.05) were conducted in SPSS 25 e R 3.6.2. The study received ethical approval; all participants granted informed consent. Results: 1116 participants were included; women: 89.4%; white race: 56.8%; mean (SD) age: 57.5 (11.5) years; disease duration: 174.9 (115.0) months; disease activity (DAS28): 3.62 (1.52); physical function (HAQ): median [Q1; Q3] = 0.875 [0.250; 1.500]; erosive disease found in 54.9%; positive rheumatoid factor in 78.6%. Downtrends in diagnostic (tau = -0.677, p < 0.001) and therapeutic (tau = -0.695, p < 0.001) delays were observed since from 1990. However, in the years 2011-2015, the median [Q1; Q3] therapeutic delay was still 11 [5; 17] months. In 80.7%, RA diagnosis was established only by the rheumatologist. Early access to the rheumatologist was associated with early treatment (OR 2.57 [1.54; 4.27]; p<0.001) and, in the long term, with lower disease activity (DAS28 difference in means [95%CI]: -0.25 [-0.46; -0.04]; p = 0.020) and better physical function (HAQ: -0.20 [-0.31; -0.09]; p < 0.001). Early treatment (in bivariate analyses) was associated with lower disease activity, better physical function and less erosive disease, however losing significance (p ≥ 0.05) after adjustments for age, schooling and disease duration. Tight disease control was associated, in the long term, with less corticosteroid (χ2 = 59.1; p < 0.001) and biologics usage (χ2 =10.2; p = 0.017), less erosive disease (χ2 = 32.1; p <0.001), higher remission rates (χ2 =14.4; p = 0.002) and lower DAS28 (F = 3.44; p = 0.018) and HAQ (F = 5.2; p = 0.002) scores. Conclusions: The delays in diagnosis and treatment of RA diminished in Brazil over the last decades, although substantial delays were still observed. The diagnosis of RA was highly dependent on the rheumatologist. Early access to the rheumatologist was associated with better clinical outcomes in the long run. Early treatment when adjusted for confounders could not predict better long-term clinical outcomes; tight disease control, nevertheless, was associated with lower disease activity, better physical function and less radiographic damage under real-life conditions.
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7
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Natália Ribeiro de Magalhães Alves
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ELEVATED SERUM IL-6 LEVELS PREDICT TREATMENT DISCONTINUATION IN PATIENTS WITH MODERATE TO SEVERE PSORIASIS: A REAL-LIFE COHORT STUDY FOR 6 YEARS.
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Líder : CIRO MARTINS GOMES
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MIEMBROS DE LA BANCA :
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CIRO MARTINS GOMES
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DANIEL HOLANDA BARROSO
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RODOLFO REGO DEUSDARA RODRIGUES
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RICARDO ROMITI
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IVONISE FOLLADOR
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Data: 10-may-2023
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Resumen Espectáculo
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Real-world, primary data on the treatment of psoriasis are scarce, especially concerning the role of soluble biomarkers as outcome predictors. Objective: We evaluated the utility of Th1/Th17 serum cytokines along with clinical characteristics as predictors of drug survival in the treatment of psoriasis. Methods: We consecutively included participants with moderate to severe psoriasis who were followed up for 6 years. Baseline interferon-gama (IFN-γ), tumor necrosis factor-alpha and interleukin (IL)-2, IL-4, IL-6, IL-10 and IL-17A were measured using a cytometric bead array (CBA); clinical data were assessed. We calculated hazard ratios (HRs) for drug survival using a Cox proportional hazards model. Results: We included 262 patients, most of whom used systemic immunosuppressants or biologics. In the multivariate model, poor quality of life measured by the Dermatology Life Quality Index (HR = 1.04; 95% CI = 1.01-1.07; p = 0.012) and elevated baseline IL-6 (HR = 1.99; 95% CI = 1.29-3.08; p = 0.002) were associated with treatment interruption. Conclusions: Poor quality of life and elevated baseline serum IL-6 level predicted treatment interruption in patients with moderate to severe psoriasis. Although IL-6 is not the most important mediator of the inflammatory pathway in the skin environment, it is an interesting candidate biomarker for predicting psoriasis treatment response.
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8
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FLAVIO JOSE DUTRA DE MOURA
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Keywords: Erithropoiesis. Metabolism markers. Ionic markers. Nutritional markers. Toxicity markers. Inflammatory markers
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Líder : SELMA APARECIDA SOUZA KUCKELHAUS
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MIEMBROS DE LA BANCA :
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SELMA APARECIDA SOUZA KUCKELHAUS
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AMILCAR SABINO DAMAZO
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MARIA ALICE DE VILHENA TOLEDO
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JOSÉ CARLOS DE ALMEIDA
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RENATA OLIVEIRA SOARES
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Data: 26-may-2023
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Resumen Espectáculo
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Introduction: Chronic kidney disease (CKD) is characterized by low glomerular filtration rate, proteinuria, tissue damage in the kidneys and time of clinical manifestation. For the diagnosis, the anatomical/structural and functional criteria are considered, as well as the time of symptom manifestation. Once diagnosed, DRC patients are required to undergo renal replacement therapies such as hemodialysis (HD) and hemodiafiltration (HDF). HD removes low molecular weight molecules, while HDH purifies small and large molecules, favoring a reduction in oxidative stress, hospitalization, and mortality. Objectives: Considering all the benefits, this study evaluated the hematological, biochemical and immune parameters of individuals with CKD treated with HD and subsequently converted to DHT. Material and Methods: This was a descriptive and comparative cross-sectional study conducted with 25 individuals (66±10 years) treated with HD and subsequently converted to HDF (convenience sample). Hematological, biochemical and immune parameters were analyzed in blood samples (cells and serum) obtained from the individuals. Results: the etiology of CKD was type II DM (48%) and SAH (32%), the duration of HD was 4.7±4.9 years, the venous access was predominantly arteriovenous fistula (60%) and long-term catheter (36%). The dry weight (PS) of the subjects at the end of HD was 70.8±17.1 Kg, with ∆PS of 0.0±1.4 Kg. There was a negative correlation between HD time and ages. Cells and serum markers: HDF reduced serum levels of erythropoietin (EPO), glucose, Aspartate aminotransferase, ꞵ2-Microglobulin and EPO resistance index, increased alkaline phosphatase and C-reactive protein; HDF did not alter alanine aminotransferase, triglycerides, lipoproteins (low and high density), ions (HCO3-, Na+, K+, Mg2+, PO43-, Ca2+), vitamin D, albumin, ferritin, and parathormone. Furthermore, HDF increased hematocrit and hemoglobin (Hb) in diabetics, reduced Hb in hypertensives, and did not alter WBC, WBC, mean corpuscular volume, mean corpuscular hemoglobin, or red cell distribution amplitude in subjects with SAH or DM-II. Immunological markers: HDF normalized the phagocytic index in PMP or opsonin-mediated phagocytosis with 5 or 20 yeast/cell (C > HD < HDF), as well as normalized the stimulated corpuscular index (C > HD < HDF), but increased TNF and IL-4 production compared to HD. Furthermore, HDF normalized basal O2●- production, as well as, normalized its production in the absence of phagocytosis, but when compared to HD, HDF increased O2●- production, in the presence or absence of yeast ingestion. Conclusion: The set of results indicates that the HDF is safe, feasible and effective to improve the biochemical and inflammatory markers of individuals with CKD. Considering that this technique is little used in Brazil, being restricted to private organizations, it is suggested the continuity of studies to improve the technical parameters of HDF and thus promote greater visibility and acceptance of patients and the medicacommunity, aiming its future deployment in the single health system country.
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9
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Caio Athayde Neves
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Application of deep learning algorithms in the preoperative evaluation of otologic surgery through medical imaging
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Líder : IRUENA MORAES KESSLER
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MIEMBROS DE LA BANCA :
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ANDRE LUIZ LOPES SAMPAIO
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HENRIQUE FERNANDES DE OLIVEIRA
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IRUENA MORAES KESSLER
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LUCIANA MIWA NITA WATANABE
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MARCIO NAKANISHI
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Data: 30-jun-2023
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Resumen Espectáculo
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Otologic surgery plays a crucial role in the treatment of hearing loss, infections, and lateral skull base tumors. Accurate segmentation of otologic structures from computed tomography (CT) scans can significantly enhance surgical planning and intraoperative guidance. This manuscript presents two experiments that leverage deep learning algorithms for automated segmentation of key temporal bone structures in CT scans.
In the first experiment, three convolutional neural network (CNN) models (AH-Net, U-Net, ResNet) were compared using 150 manually segmented CT scans. The performance of the models was evaluated based on Dice coefficient, Hausdorff distance, and segmentation speed for the inner ear, ossicles, facial nerve, and sigmoid sinus. AH-Net achieved the best results, with Dice coefficients of 0.91, 0.85, 0.75, and 0.86 for the respective structures. The automated segmentation pipeline demonstrated good correlation with manual segmentation performed by a specialist, opening up possibilities for augmented reality, simulation, and automation applications in otologic procedures.
In the second experiment, a state-of-the-art deep learning algorithm (Swin UNETR) was used to build a prediction model for rapid segmentation of nine key temporal bone structures in 325 clinical CT scans. The model achieved high Dice coefficients, Balanced Accuracy, Volume Similarity, Average Symmetric Surface Distance, and 95th Hausdorff Distance, with a mean processing time of 9.1 seconds per study. This robust model offers valuable new datasets for otologic surgical planning and navigation.
In conclusion, the application of deep learning algorithms in this project demonstrates the potential for improved preoperative evaluation and intraoperative guidance in otologic surgery through automated segmentation of otologic structures from temporal bone CT scans.
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10
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Ana Claudia Cavalcante Nogueira
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Effectiveness and cost-effectiveness analysis of cardioprotective antidiabetic drugs for type 2 diabetes in a middle-income country
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Líder : ANDREI CARVALHO SPOSITO
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MIEMBROS DE LA BANCA :
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CARISI ANNE POLANCZYK
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ALESSANDRA MENEZES CAMPOS
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ALEXANDRE ANDERSON DE SOUSA MUNHOZ SOARES
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ANDREI CARVALHO SPOSITO
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RODRIGO FONSECA LIMA
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Data: 04-ago-2023
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Resumen Espectáculo
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The steady increase in the prevalence of type 2 diabetes (T2DM), particularly in low- and middle-income countries, represents an unprecedented economic and social disaster. Cardiovascular disease, in particular coronary disease, the most prevalent macrovascular complication in diabetics, constitutes the main source of health costs for these patients, accounting for approximately 76% in hospitalizations alone. Objectives: To analyze the efficacy and cost-effectiveness of cardioprotective antidiabetic drugs in individuals with T2D in a middle-income country. Methods: A systematic search was performed for randomized clinical trials published until April 2021 reporting the incidence of the composite outcome of cardiovascular death, nonfatal myocardial infarction, and stroke for pioglitazone, GLP1A, or SGLT2i. Based on the dataset of two large national cohorts of T2D, we developed a multi-state Markov model to estimate the outcomes for each treatment based on incremental cost- effectiveness ratio (ICER) and the disease-adjusted life years [DALYs] averted per dollar spent projected over a lifetime horizon using a 3,5% annual discount rate. Results: A total of 157 RCT including 267,508 patients and 176 active arms were considered. Compared with sulfonylureas, SGLT2i, GLP1A and pioglitazone reduced the relative risk of non-fatal MACE with HR of 0.81 (95% CI 0.69 to 0,96, p=0.011), 0.79 (95% CI 0.67 to 0,94, p=0.0039) and 0.73 (95% CI 0.59 to 0.91, p=0.0057), respectively. Pioglitazone resulted in incremental effectiveness of 0.2339 DALYs averted per patient, at a mean incremental cost of Int$ 1660 and a Int$ 7,082 (95% CI: 4,521; 10,770) incremental cost per DALY averted, when compared to standard care. The addition of SGLT2i or GLP1A led to more evident incremental effectiveness (0.261 and 0.259, respectively) but the incremental costs of these therapies headed to higher ICERs [Int$ 12,061 (95% CI: 7,227; 18,121) and Int$ 29,119 (95% CI: 23,811; 35,367) per DALY averted, respectively]. Compared to SGLT2i and GLP1A, pioglitazone had the highest probability of being cost-effective based on the estimated maximum willingness-to-pay threshold. Conclusions: The three therapies bear similar effectiveness in reducing cardiovascular events. In a middle-income country, pioglitazone presents a higher probability of being cost-effective followed by SGLT2i and then GLP1A.
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11
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Rayssa Medeiros Léda
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Conventional Phacoemulsification Surgery Versus Femtosecond Laser phacoemulsification Surgery: A Comparative Analysis of Cumulative Dissipated Energy and Corneal Endothelial Loss in Cataract Patients
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Líder : RIVADAVIO FERNANDES BATISTA DE AMORIM
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MIEMBROS DE LA BANCA :
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RIVADAVIO FERNANDES BATISTA DE AMORIM
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LICIA MARIA HENRIQUE DA MOTA
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EDUARDO DAMOUS FONTENELE FEIJÓ
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FABIO FERREIRA AMORIM
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MARIZE LIMA DE SOUSA HOLANDA BIAZOTTO
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Data: 23-ago-2023
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Resumen Espectáculo
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- In most patients who undergo phacoemulsification, the cataracts are immature, there are no anatomical changes and, therefore, the surgeries don’t have a high risk of complications. In these patients, is the addition of the femtosecond laser beneficial based on the parameters of Cumulative Dissipated Energy (CDE) and endothelial loss? Purpose: To analyze whether femtosecond laser-assisted surgery leads to less CDE and decreased endothelial cell loss compared to conventional surgery. Patients and Methods: This non-blinded, non-randomized, quasi-experimental clinical trial was conducted at one center and involved one surgeon. Patients with cataracts and 50–80 years old were included, and the exclusion criteria were radial keratotomy, trabeculectomy, drain tube implant, corneal transplant, posterior vitrectomy, and reimplantation of intraocular lens. In total, 298 patients were recruited between October 2020 and April 2021, and the data collected included sex, laterality, age, ocular comorbidities, systemic comorbidities and CDE. An endothelial cell count was performed before and after surgery. Patients were divided according to femtosecond laser-assisted phacoemulsification or conventional phacoemulsification. The femtolaser patients were submitted to the equipment, and then, immediately after treatment, phacoemulsification surgery was performed. In the conventional method, the “divide and conquer” technique was used. The statistical analysis was made using an analysis of covariance linear model, using SAS version 9.4 (SAS Institute, Inc., 1999). Values with p < 0.05 were considered significant. Results: A total of 132 patients were analyzed. The only statistically relevant predictors of CDE were the severity of the cataract (p < 0.0001) and age of ≥75 years (p = 0.0003). The following factors were not significant: technique with or without laser (p = 0.6862), sex (p = 0.8897), systemic arterial hypertension (p = 0.1658), and diabetes (p = 0.9017). Grade 4 cataracts were associated with higher CDE than grade 3 cataracts, which in turn were associated with higher CDE than grade 2 cataracts. A comparison of pre- and post-operative specular microscopy with and without laser revealed no significant discrepancy (p = 0.5017). Conclusion: FLACS didn’t reduce CDE or endothelial cell loss compared to conventional surgery regardless of severity. This result is important for hospitals to be able to make precise indications for the use of FLACS, optimizing costs without reducing the quality of results.
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12
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Tais Milene Santos de Paiva
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Risk factors associated with death in adult patients hospitalized with the syndrome severe acute respiratory illness due to COVID-19 at the University Hospital of Brasília
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Líder : MARIANA MACHADO HECHT
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MIEMBROS DE LA BANCA :
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MARIANA MACHADO HECHT
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LUIZ CLAUDIO GONCALVES DE CASTRO
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MICHELINE MARIE MILWARD DE AZEVEDO MEINERS
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ALINE SILVA MORAES
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THAIS TAMARA CASTRO E SOUZA MINUZZI
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Data: 30-oct-2023
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Resumen Espectáculo
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The characteristics of COVID-19 transmission have contributed negatively to the long- term escalation of the pandemic, overloading the healthcare systems worldwide.
Different responses and strategies were adopted depending on the capacity of each healthcare system to restructure and accommodate the increasing demand for supplies, human resources, operational and clinical resources, as well as critical care beds. The objective of this study was to assess the epidemiological and clinical characteristics of COVID-19 hospitalized patients at the University Hospital of Brasília (HUB) to identify clinical and laboratory predictors related to the outcome of death. The study is part of a retrospective clinical cohort, utilizing data from individual records of severe acute respiratory syndrome (SARS) cases hospitalized at HUB from May 2020 to December 2021. Survival functions were calculated using the Kaplan-Meier method. To evaluate factors associated with death, hazard ratios (HR) were calculated following the Cox proportional hazards model. Hospitalization duration until the outcome was also assessed. After database adjustments, 404 medical records were included in the overall descriptive analysis. Among these, 60% were male, with an average age of 60 years (60.89 ± 16.98), ranging from 19 to 98 years. The average length of hospital stay was 19 days (19.08 ± 34.14), with a minimum of 24 hours and a maximum of 375 days. From the multiple Cox regression model adjustment, the variables pronation, age, chronic kidney disease, leukocytes, creatinine, and potassium showed a significant
association (p < 0.05) with the time until the occurrence of the outcome of death, and thus, they were considered risk factors for death in COVID-19 hospitalized patients at HUB. According to data obtained by the Kaplan- Meier estimator, the estimated survival probability was 92.62% for surviving the first 5 days of hospitalization (95% CI; 81.87 – 97.11), 84.03% for surviving the first 10 days of hospitalization (95% CI; 75.53 – 89.78), and 49.85% for surviving 30 days of hospitalization (95% CI; 37.12 – 58.25). The results underscore the importance of identifying clinical and sociodemographic characteristics that may impact the prognosis of patients with acute respiratory distress syndrome (ARDS) due to COVID-19. Additionally, it provides information that can assist healthcare professionals and managers in making decisions.
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13
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GERALDO MAGELA FERNANDES
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"Overview of soluble inflammatory mediators in pregnant women diagnosed with COVID-19 in different trimesters of pregnancy, neonatal clinical outcomes and anthropometric profile in the first year of life: an exploratory study
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Líder : LUIZ CLAUDIO GONCALVES DE CASTRO
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MIEMBROS DE LA BANCA :
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LUIZ CLAUDIO GONCALVES DE CASTRO
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JULIANA FORTE MAZZEU DE ARAUJO
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MEIMEI GUIMARAES JUNQUEIRA DE QUEIROS
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MARTA DAVID ROCHA DE MOURA
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PAULO ROBERTO MARGOTTO
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Data: 06-nov-2023
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Resumen Espectáculo
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Background: The description of the maternal, fetal and pediatric consequences of SARS-CoV-2 infection occurring during pregnancy and investigating the underlying mechanisms is crucial for a better understanding of the disease and providing evidence for better care and treatments for the mother dyad -son, based on scientific evidence. Objectives: To characterize the physiological changes that occur in the profile of immunological mediators during pregnancy, to study changes in the immunological response in pregnant women infected by SARS-CoV-2 in different trimesters of pregnancy and to correlate them with clinical and anthropometric outcomes in their newborns. born in the perinatal period and in the first year of the infants' lives. Methods: Study carried out in two phases. In the first phase, a prospective observational study designed to characterize the immunological status of pregnant women with convalescent COVID-19 and panoramic analysis of the interaction between soluble serum inflammatory mediators took place. A sample of 141 pregnant women from all gestational periods comprised patients with convalescent SARS-CoV-2 infection between 3 and 20 weeks after the onset of symptoms (COVID, n=89) and a control group of uninfected pregnant women whose material for analysis of serum
inflammatory mediators was collected in the pre-pandemic period (CG, n=52). In the second phase, a total of 262 newborns born to pregnant women who had SARS-CoV-2 infection with the onset of symptoms during the gestational period were divided into three groups according to the trimester in which the maternal infection occurred: 1st trimester (n=58), 2nd trimester (n=80) and 3rd trimester (n=124). In this group, correlations were studied between the immunological profile of pregnant women and the severity of maternal COVID with clinical and anthropometric outcomes of their children at birth and during the first year of life. Results: In the first phase of the study, levels of chemokines, pro-inflammatory cytokines, regulatory cytokines and growth factors were quantified using a high- throughput microsphere array. In the GC group, the majority of serum soluble inflammatory mediators showed a progressive physiological decrease in the 2nd and 3rd trimester of pregnancy, while higher levels of chemokines, cytokines and growth factors were observed in the COVID-19 patient group. Soluble serum inflammatory mediator signatures and heatmap analysis indicated that the greatest increase observed in the COVID group was related to pro-inflammatory cytokines (IL-6, TNF-, IL-12, IFN- and IL-17 ) . Analysis of a larger set of biomarkers showed an increase in the ratio of inflammatory mediators in the COVID/GC groups in the 2nd (three-fold increase) and 3rd (three- to 15-fold increase) trimesters. Integrative network analysis demonstrated that pregnancy in GC evolves with decreasing connectivity between pairs of serum soluble inflammatory mediators towards the 3rd trimester. Although the COVID group had a similar profile, the number of connections was notably lower throughout the pregnancy. In the second phase of the study, a higher incidence of pregnant women who developed more severe conditions when infected in the 3rd trimester (p<0.001) and a higher incidence of prematurity (p=0.0246) was found. There were no differences in anthropometric measurements at birth when neonates were compared by the gestational trimester in which the maternal infection occurred or by the severity of maternal COVID-19. Regarding longitudinal anthropometry follow-up in the first year of life of this group of children, less weight gain was found in the first month of life among infants whose mothers had COVID-19 in the 2nd and 3rd trimesters of pregnancy compared to the 1st trimester group. (p=0.0152) and less weight gain in the group whose mothers had severe COVID (p=0.0148). In relation to length, there was no difference in gains over the first year of life between the groups, but in the intra-group assessment, lower gains were observed in the first month of life among children of mothers with severe COVID and with infection in the 3rd trimester of pregnancy. . In relation to head circumference, the intragroup assessment showed a smaller gain in the first month in all groups, which persisted in the 6th month of life
among infants, except in the group whose mothers had COVID in the 1st gestational trimester. The improvement in head circumference gain occurred at 12 months, except in the group of children of mothers with non-severe COVID. Conclusion: In the group of pregnant women with COVID-19, a pronounced increase in serum levels of soluble inflammatory mediators was found in the 3rd trimester, associated with a decrease in the network interaction between them. Greater severity of COVID in pregnant women was linked to a higher incidence of prematurity and referral of newborns to the Neonatal Intensive Care Unit. There were no differences in the anthropometric profile of the newborns at birth, regardless of the group. However, the anthropometric profile of infants during the first year of life revealed distinct patterns in terms of weight gain, length, and head circumference, when comparing the groups based on the severity of maternal COVID and the gestational period during which the SARS-CoV-2 infection occurred.
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14
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Fabiana Christina Araújo Pereira Lisboa
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COMPARATIVE ANALYSIS BETWEEN THE AESTHETIC RESULTS OF ONCOPLASTIC SURGERY AND TOTAL BREAST RECONSTRUCTION ACCORDING TO THE DEGREE OF SATISFACTION OF WOMEN AND DOCTORS: STUDY CARRIED OUT IN BRAZILIAN MASTOLOGY SERVICES
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Líder : JOAO BATISTA DE SOUSA
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MIEMBROS DE LA BANCA :
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Hélio Humberto Angotti Carrara
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JOAO BATISTA DE SOUSA
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JOAO NUNES DE MATOS NETO
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SALETE DA SILVA RIOS CHEN
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SILVANA MARQUES E SILVA
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Data: 08-dic-2023
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Resumen Espectáculo
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Introduction: Women’s satisfaction after breast neoplasms surgery has an impact on body image, sexual function, self-esteem, and quality of life and may differ from the perception of the attending physician. This study aimed to to compare the aesthetic outcomes and satisfaction of surgeons and women with breast tumors regarding conservative oncoplastic surgeries and total breast reconstruction.
Methods: Were included 760 women diagnosed with invasive breast carcinoma or phyllodes tumors who returned at least 6 months after surgery or radiotherapy at two public hospitals (Clinics Hospital of the Federal University of Goias and Araujo Jorge Cancer Hospital) and a private clinic between 2014 and 2022. Data was collected prospectively from patients and retrospectively from their medical records using a specific form after obtaining their informed consent. Aesthetic outcomes and quality of life were assessed using the BREAST-Q©, Harris Scale, and BCCT.core software. Data were evaluated using the SPSS statistical software. Statistical significance was set at p < 0.05. This study was approved by the hospital ethics committees.
Results: A total of 405 (53.29%) partial and 355 (46.71%) total reconstructions were included. Women who underwent partial reconstruction were older and had higher body mass index. Women who underwent total reconstruction had larger tumors with advanced clinical and pathological stages. Clinical and surgical complications occurred more frequently in the total reconstruction group. A greater number of reparative surgeries and lipofilling procedures were required for total reconstruction. According to the BREAST-Q, the partial reconstruction group showed significantly higher levels of women's satisfaction with their breasts, the surgical outcomes, psychosocial and sexual well-being, provision of information, and the reconstructive surgeon. Only physical well-being was slightly higher in the total reconstruction group. In most cases, the results were rated good or excellent. Surgeons considered partial reconstructions to have better results than total reconstructions, although this difference was not perceived by the BCCT.core software.
Conclusion: Women who underwent partial breast reconstruction had higher levels of satisfaction in several domains, lower frequency of complications, and required fewer surgeries to complete their reconstruction than women who underwent total reconstruction. Surgeons were also more satisfied with the results of partial reconstructions.
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15
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DIOGENES DIEGO DE CARVALHO BISPO
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COGNITIVE, OLFACTORY AND BRAIN MICROSTRUCTURAL ASSESSMENT AFTER COVID-19
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Líder : NEYSA APARECIDA TINOCO REGATTIERI
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MIEMBROS DE LA BANCA :
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BERNARDO CORRÊA DE ALMEIDA TEIXEIRA
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IRUENA MORAES KESSLER
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MARIA CLOTILDE HENRIQUES TAVARES
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NASSER ALLAM
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NEYSA APARECIDA TINOCO REGATTIERI
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Data: 13-dic-2023
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Resumen Espectáculo
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Background. Fatigue, cognitive complaints, and olfactory disfunction are the most frequent
persistent symptoms in patients after severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) infection. This study aimed to assess fatigue and neuropsychological performance and
investigate changes in the thickness and volume of gray matter and microstructural abnormalities in the white matter in a group of patients with mild-to-moderate coronavirus disease 2019 (COVID-19). Additionally, we aimed to investigate changes in olfactory bulb volume and brain network in the white matter in patients with persistent hyposmia following COVID-19. Methods. We studied 56 COVID-19 patients and 37 matched controls using magnetic resonance imaging (MRI). Cognition was assessed using Montreal Cognitive Assessment and Cambridge Neuropsychological Test Automated Battery, and fatigue was assessed using Chalder Fatigue Scale (CFQ-11). The Sniffin' Sticks smell identification test (SS-16) was used to evaluate participants' ability to identify odors. T1-weighted MRI was used to assess gray matter thickness and volume. The olfactory bulbs were manually segmented from T2-weighted MRI. Fiber-specific apparent fiber density (FD), free water index, and diffusion tensor imaging data were extracted using diffusion-weighted MRI (d-MRI). Network-Based Statistics (NBS) and graph theoretical analysis were used to explore the WM. d-MRI data were correlated with clinical, cognitive measures, and SS-16 score using partial correlations and general linear modeling. Results. COVID-19 patients had mild-to-moderate acute illness (95% non-hospitalized). The average period between real-time quantitative reverse transcription polymerase chain
reaction-based diagnosis and clinical/MRI assessments was 93.3 (±26.4) days. The COVID- 19 group had higher total CFQ-11 scores than the control group (p < 0.001). There were no
differences in neuropsychological performance between groups. The COVID-19 group had lower FD in the association, projection, and commissural tracts, but no change in gray matter. The corona radiata, corticospinal tract, corpus callosum, arcuate fasciculus, cingulate, fornix, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, superior longitudinal fasciculus, and uncinate fasciculus were involved. CFQ-11 scores, performance in reaction
time, and visual memory tests correlated with microstructural changes in patients with COVID- 19.
The COVID-19 persistent hyposmia group had reduced olfactory bulb volume compared to controls. In NBS, COVID-19 patients showed increased structural connectivity in a subnetwork comprising parietal brain regions. Regarding global network topological properties, patients exhibited lower global and local efficiency and higher assortativity than controls. Concerning local network topological properties, patients had reduced local efficiency (left lateral orbital gyrus and pallidum), increased clustering (left lateral orbital gyrus), increased nodal strength (right anterior orbital gyrus), and reduced nodal strength (left amygdala). SS-16 test score was negatively correlated with clustering of whole-brain white matter in the COVID-19 group. Conclusions. Quantitative d-MRI detected changes in the white matter microstructure of patients recovering from COVID-19. This study suggests a possible brain substrate underlying the symptoms caused by SARS-CoV-2 during medium- to long-term recovery. Additionally, patients with olfactory disfunction after COVID-19 had relevant white matter network dysfunction with increased connectivity in the parietal sensory cortex. Reduced integration and increased segregation are observed within olfactory-related brain areas might be due to compensatory plasticity mechanisms devoted to recovering olfactory function.
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