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Abstract Background Cardiovascular complications of COVID-19 are important aspects of the disease’s pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce. Objectives To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry. Methods This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05. Results Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels. Conclusion Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients.

Resumo Fundamento As complicações cardiovasculares da COVID-19 são aspectos importantes da patogênese e do prognóstico da doença. Evidências do papel prognóstico da troponina e da lesão miocárdica em pacientes hospitalizados com COVID-19 na América Latina são ainda escassos. Objetivos Avaliar a lesão miocárdica como preditor independente de mortalidade hospitalar e suporte ventilatório mecânico em pacientes hospitalizados, do registro brasileiro de COVID-19. Métodos Este estudo coorte é um subestudo do registro brasileiro de COVID-19, conduzido em 31 hospitais brasileiros de 17 cidades, de março a setembro de 2020. Os desfechos primários incluíram mortalidade hospitalar e suporte ventilatório mecânico invasivo. Os modelos para os desfechos primários foram estimados por regressão de Poisson com variância robusta, com significância estatística de p<0,05. Resultados Dos 2925 pacientes [idade mediana de 60 anos (48-71), 57,1%], 27,3% apresentaram lesão miocárdica. A proporção de pacientes com comorbidades foi maior nos pacientes com lesão miocárdica [mediana 2 (1-2) vs. 1 (0-20)]. Os pacientes com lesão miocárdica apresentaram maiores valores medianos de peptídeo natriurético cerebral, lactato desidrogenase, creatina fosfoquinase, N-terminal do pró-peptídeo natriurético tipo B e proteína C reativa em comparação a pacientes sem lesão miocárdica. Como fatores independentes, proteína C reativa e contagem de plaquetas foram relacionados com o risco de morte, e neutrófilos e contagem de plaquetas foram relacionados ao risco de suporte ventilatório mecânico invasivo. Os pacientes com níveis elevados de troponina apresentaram um maior risco de morte (RR 2,03, IC95% 1,60-2,58) e suporte ventilatório mecânico (RR 1,87;IC95% 1,57-2,23), em comparação àqueles com níveis de troponina normais. Conclusão Lesão cardíaca foi um preditor independente de mortalidade hospitalar e necessidade de suporte ventilatório mecânico em pacientes hospitalizados com COVID-19.

https://doi.org/10.36660/abc.20220151

Guidelines from the Brazilian society of surgical oncology regarding indications and technical aspects of neck dissection in papillary, follicular, and medullary thyroid cancers
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Farias, Terence

; Kowalski, Luiz Paulo

; Dias, Fernando

; Barreira, Carlos S. Ritta

; Vartanian, José Guilherme

; Tavares, Marcos Roberto

; Vaisman, Fernanda

; Momesso, Denise

; Oliveira, Alexandre Ferreira

; Pinheiro, Rodrigo Nascimento

; Ribeiro, Heber Salvador de Castro

Archives of Endocrinology and Metabolism

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2023, Volume 67 N. 4 elocation e000607

Abstract: En | Text: En | PDF: En

ABSTRACT Objective: The purpose of these guidelines is to provide specific recommendations for the surgical treatment of neck metastases in patients with papillary, follicular, and medullary thyroid carcinomas. Materials and methods: Recommendations were developed based on research of scientific articles (preferentially meta-analyses) and guidelines issued by international medical specialty societies. The American College of Physicians’ Guideline Grading System was used to determine the levels of evidence and grades of recommendations. The following questions were answered: A) Is elective neck dissection indicated in the treatment of papillary, follicular, and medullary thyroid carcinoma? B) When should central, lateral, and modified radical neck dissection be performed? C) Could molecular tests guide the extent of the neck dissection? Results/conclusion: Recommendation 1: Elective central neck dissection is not indicated in patients with cN0 well-differentiated thyroid carcinoma or in those with noninvasive T1 and T2 tumors but may be considered in T3-T4 tumors or in the presence of metastases in the lateral neck compartments. Recommendation 2: Elective central neck dissection is recommended in medullary thyroid carcinoma. Recommendation 3: Selective neck dissection of levels II–V should be indicated to treat neck metastases in papillary thyroid cancer, an approach that decreases the risk of recurrence and mortality. Recommendation 4: Compartmental neck dissection is indicated in the treatment of lymph node recurrence after elective or therapeutic neck dissection; “berry node picking” is not recommended. Recommendation 5: There are currently no recommendations regarding the use of molecular tests in guiding the extent of neck dissection in thyroid cancer.

https://doi.org/10.20945/2359-3997000000607

Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023
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Marin-Neto, José Antonio

; Rassi Jr, Anis

; Oliveira, Gláucia Maria Moraes

; Correia, Luís Claudio Lemos

; Ramos Júnior, Alberto Novaes

; Luquetti, Alejandro Ostermayer

; Hasslocher-Moreno, Alejandro Marcel

; Sousa, Andréa Silvestre de

; Paola, Angelo Amato Vincenzo de

; Sousa, Antônio Carlos Sobral

; Ribeiro, Antonio Luiz Pinho

; Correia Filho, Dalmo

; Souza, Dilma do Socorro Moraes de

; Cunha-Neto, Edecio

; Ramires, Felix Jose Alvarez

; Bacal, Fernando

; Nunes, Maria do Carmo Pereira

; Martinelli Filho, Martino

; Scanavacca, Maurício Ibrahim

; Saraiva, Roberto Magalhães

; Oliveira Júnior, Wilson Alves de

; Lorga-Filho, Adalberto Menezes

; Guimarães, Adriana de Jesus Benevides de Almeida

; Braga, Adriana Lopes Latado

; Oliveira, Adriana Sarmento de

; Sarabanda, Alvaro Valentim Lima

; Pinto, Ana Yecê das Neves

; Carmo, Andre Assis Lopes do

; Schmidt, Andre

; Costa, Andréa Rodrigues da

; Ianni, Barbara Maria

; Markman Filho, Brivaldo

; Rochitte, Carlos Eduardo

; Macêdo, Carolina Thé

; Mady, Charles

; Chevillard, Christophe

; Virgens, Cláudio Marcelo Bittencourt das

; Castro, Cleudson Nery de

; Britto, Constança Felicia De Paoli de Carvalho

; Pisani, Cristiano

; Rassi, Daniela do Carmo

; Sobral Filho, Dário Celestino

; Almeida, Dirceu Rodrigues de

; Bocchi, Edimar Alcides

; Mesquita, Evandro Tinoco

; Mendes, Fernanda de Souza Nogueira Sardinha

; Gondim, Francisca Tatiana Pereira

; Silva, Gilberto Marcelo Sperandio da

; Peixoto, Giselle de Lima

; Lima, Gustavo Glotz de

; Veloso, Henrique Horta

; Moreira, Henrique Turin

; Lopes, Hugo Bellotti

; Pinto, Ibraim Masciarelli Francisco

; Ferreira, João Marcos Bemfica Barbosa

; Nunes, João Paulo Silva

; Barreto-Filho, José Augusto Soares

; Saraiva, José Francisco Kerr

; Lannes-Vieira, Joseli

; Oliveira, Joselina Luzia Menezes

; Armaganijan, Luciana Vidal

; Martins, Luiz Cláudio

; Sangenis, Luiz Henrique Conde

; Barbosa, Marco Paulo Tomaz

; Almeida-Santos, Marcos Antonio

; Simões, Marcos Vinicius

; Yasuda, Maria Aparecida Shikanai

; Moreira, Maria da Consolação Vieira

; Higuchi, Maria de Lourdes

; Monteiro, Maria Rita de Cassia Costa

; Mediano, Mauro Felippe Felix

; Lima, Mayara Maia

; Oliveira, Maykon Tavares de

; Romano, Minna Moreira Dias

; Araujo, Nadjar Nitz Silva Lociks de

; Medeiros, Paulo de Tarso Jorge

; Alves, Renato Vieira

; Teixeira, Ricardo Alkmim

; Pedrosa, Roberto Coury

; Aras Junior, Roque

; Torres, Rosalia Morais

; Povoa, Rui Manoel dos Santos

; Rassi, Sergio Gabriel

; Alves, Silvia Marinho Martins

; Tavares, Suelene Brito do Nascimento

; Palmeira, Swamy Lima

; Silva Júnior, Telêmaco Luiz da

; Rodrigues, Thiago da Rocha

; Madrini Junior, Vagner

; Brant, Veruska Maia da Costa

; Dutra, Walderez Ornelas

; Dias, João Carlos Pinto

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 6 elocation e20230269

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

https://doi.org/10.36660/abc.20230269

Evaluation of the dosimetry and centralization of scout-view function in CBCT
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Vilela, Danúsia da Silva

; Manhães Júnior, Luiz Roberto Coutinho

; Nascimento, Monikelly do Carmo Chagas

; Oenning, Anne Caroline Costa

; Junqueira, José Luiz Cintra

; Martinez, Elizabeth Ferreira

Brazilian Dental Journal

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aug 2022, Volume 33 N. 4 Pages 31 - 39

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Este estudo avaliou a centralização da região de interesse (ROI) na aquisição das imagens de TCFC, quando a função scout-view (SV) posicionável livremente é aplicada. Adicionalmente, a dosimetria das imagens adquiridas foi avaliada isoladamente na presença da função SV, bem como após aquisição de imagem tomográfica completa em dois diferentes campos de visão (FOV) (50x50 e 78x150mm). Um dispositivo de três localizações foi criado para acomodar os dosímetros e os espécimes, na localização direita, central e esquerda, durante a aquisição das imagens. Para avaliação da dose, dosímetros termoluminescentes foram irradiados dentro dos campos de visão e analisados em leitor portátil. Para avaliação da ROI, três espécimes de guta percha foram colocados no mesmo aparelho e as tomografias foram adquiridas (CBCT OP 300 Maxio, 90kV, 13mA, 85 μm tamanho de voxel, FOV de 50X50mm), com e sem a SV, em três posições (3-9, 1-7 e 5-11 horas), simulando diferentes regiões da boca. Foram realizadas duas avaliações de imagem, uma objetiva e outra subjetiva. Houve um leve aumento percentual (1,36% para 1,40%) da dose de radiação com o uso de SV. As distâncias foram significativamente maiores nas imagens adquiridas sem SV (p < 0,05). Todas as imagens obtidas com SV foram classificadas como sendo do centro do FOV. Em conclusão, os resultados do presente estudo demonstraram que a função scout view é eficaz para centralizar a ROI no FOV, aumentando a precisão do escaneamento e evitando repetições devido a erros de posicionamento.

Abstract This study evaluated the centralization of the region of interest (ROI) in acquisition of the CBCT images, when the freely positionable scout-view (SV) function is applied. Additionally, the dosimetry of the acquired images was assessed in the SV function alone as well as in complete tomographic image in two different fields of view (FOV) (50x50 and 78x150mm). A three-location device was created to accommodate the dosimeters and the specimens, in the right, middle and left location during image acquisition. For dose assessment, thermoluminescent dosimeters were irradiated within the FOV and analyzed in a portable reader. For ROI evaluation, three specimens of gutta-percha stick were placed on the same device and the CT scans were acquired (CBCT OP 300 Maxio device, 90kV, 13mA, 85 µm voxel size, FOV of 50X50mm), with and without the SV, in three positions (3-9, 1-7 and 5-11 o’clock), simulating different regions of the mouth. Two image evaluations were performed, an objective and subjective. There was a slight percentage increase (1.36% to 1.40%) of the radiation dose with the use of SV. The distances were significantly greater in the images acquired without SV (p < 0.05). Every image obtained with SV was classified as being at the FOV’s center. In conclusion, the results demonstrated that SVs function is effective to centralize the ROI in the FOV, increasing the scan precision and avoiding repetitions due to positioning errors.

https://doi.org/10.1590/0103-6440202204926

Inhibition of tuber sprouting in potato cultivars Asterix and Challenger by 1.4-dimethylnaphthalene
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Mendonça Neto, Abelardo Barreto de

; Pereira, Ariana Mota

; Guimarães, Maria Eduarda da Silva

; Gonçalves, Dreice Nascimento

; Soares, Luciana Gomes

; Cruz, Renata Ranielly Pedroza

; Freire, Ana Izabella

; Finger, Fernando Luiz

; Cecon, Paulo Roberto

Ciência Rural

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2022, Volume 52 N. 8 elocation e20210131

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO: Objetivou-se com este estudo verificar a eficiência do 1,4-dimetilnaftaleno na supressão da brotação e a consequente manutenção da qualidade de tubérculos de batata das cultivares Asterix e Challenger, em diferentes temperaturas e tempos de armazenamento. Foram testados seis tratamentos, com e sem 1,4-DNM, nas temperaturas de 8 °C e 20 °C. As avaliações foram feitas aos 0, 45, 90, 135 e 180 dias após a aplicação. Os parâmetros avaliados foram: número de brotos, teores de açúcares solúveis totais, teores de açúcares redutores, e não redutores, e coloração dos palitos de batata após a fritura. Os efeitos do 1,4-DMN no controle da qualidade das batatas resultaram no controle da brotação e em menores teores de açúcares solúveis totais e de açúcares redutores, sobretudo na cultivar Challenger e à temperatura de 20 ºC.

ABSTRACT: The aim of this study was to verify the efficiency of 1,4-dimethylnapthalene in suppressing sprouting and the consequent maintenance of the quality of potato tubers of Asterix and Challenger cultivars, at different temperatures and storage regimes. Six treatments were tested, with and without 1.4-DNM, at temperatures of 8 ° C and 20 ° C. Assessments were made at 0, 45, 90, 135 and 180 days after application. The parameters evaluated were: number of sprouts, levels of total soluble sugars, levels of reducing and non-reducing sugars and coloration of potato strips after frying. The effects of 1.4-DMN on the quality control of potatoes resulted in sprout control and lower levels of total soluble sugars and reducing sugars, especially in the Challenger cultivar and at a temperature of 20 ºC.

https://doi.org/10.1590/0103-8478cr20210131

Effect of Addition of Previously-Synthesized Ce-TZP/Al2O3 Submicrometric Powder on the Properties of Al2O3-Based Ceramics
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Nascimento, Anne Caroline de Paula

; Coutinho, Maycol Moreira

; Alves, Manuel Fellipe Rodrigues Pais

; Santos, Claudinei dos

; Ferreira, Jorge Luiz de Almeida

; Silva, Cosme Roberto M.

Materials Research

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2022, Volume 25 elocation e20210510

Abstract: En | Text: En | PDF: En

This work investigated the effect of a composite of tetragonal zirconia with alumina-reinforced Ceria (ATZ) previously synthesized, on the properties of alumina-based ceramics (Al2O3). Monolithic alumina powder and Al2O3 powder mixtures containing 5, 10, 15 and 20 wt.% of Ce-TZP/Al2O3 were processed by high energy milling, compacted and then sintered at 1600 °C - 2 h. Sintered pure alumina and composites were characterized by relative density, scanning electron microscopy, X-ray diffraction and surface roughness. Then, the elastic modulus, the Vickers hardness, the fracture toughness and the 4-point flexural strength were evaluated. The results indicated an increase in relative density as a function of the addition of ATZ, with values between 94.3 ± 0.8% and 98.9 ± 0.7%. The observed microstructure after sintering showed tetragonal ZrO2 grains with average sizes of 0.6 μm well dispersed in the Al2O3 matrix, which presents average grain sizes of around 1.5 μm. The crystalline phases identified in the composites were ZrO2-tetragonal and Al2O3 hexagonal. The addition of the composite (ATZ) in the alumina matrix generates a gradual reduction in the elastic modulus (398 ± 15 GPa ~366 ± 34 GPa) and in the hardness (20.5 ± 1 GPa ~17.3 ± 0.7 GPa) of the sintered ceramics. On the other hand, the addition of this same composite (ATZ) in the alumina matrix considerably increases the materials fracture toughness, reaching values of approximately 6.7 ± 0.9 MPa.m1/2. The same trend was observed in the flexural strength results which ranged from 258 MPa (5wt.% Ce-TZP/Al2O3) to 316 MPa (20wt.% Ce,Y-TZP/Al2O3). The Ce-TZP reinforcement acts as a toughening agent of the Al2O3 matrix due to the coupled mechanisms of toughening by zirconia phase transformation, residual stresses due to the difference in thermal expansion of the crystalline phases and differences in microstructural morphologies.

https://doi.org/10.1590/1980-5373-mr-2021-0510

Soil quality literature in Brazil: A systematic review
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Simon, Carla da Penha

; Gomes, Taciana Figueiredo

; Pessoa, Thaís Nascimento

; Soltangheisi, Amin

; Bieluczyk, Wanderlei

; Camargo, Plínio Barbosa de

; Martinelli, Luiz Antônio

; Cherubin, Maurício Roberto

Revista Brasileira de Ciência do Solo

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2022, Volume 46 elocation e0210103

Abstract: En | Text: En | PDF: En

ABSTRACT Brazilian soil scientists have increased the use of the term “soil quality” in their scientific publications in the last decade. However, it remains unclear if those publications only mention “soil quality” in a broad context, or the studies are focused on soil quality assessments, integrating soil chemical, physical and biological indicators. The objective of this systematic review was to carry out a critical analysis of the conception in using the term “soil quality” in recent publications derived from studies performed in Brazil. For this purpose, the terms [(“soil health” or “soil quality” or “qualidade do solo”) and (“Brazil*” or “Brasil*”)] were searched in databases of Web of Science, Scopus, and Scielo from 2014 to 2021. Initially, 1,284 peer-reviewed papers were found, subsequently selected according to the criteria established in two filters: (i) First filter - studies carried out in Brazil, which mentioned at least one of the terms of interest (“soil health” or “soil quality” or “qualidade do solo”) and that evaluated soil biological, physical or chemical indicators, assessing at least one of them; (ii) Second filter - studies in which all three groups of soil indicators were assessed and integrated, and presented a specific discussion about soil quality. According to the results, 36 % of the papers met the first criteria (n = 464), and only 2 % (n = 30) attended the second filter. The terms “soil health” or “soil quality” or “qualidade do solo” were mentioned 7 and 37 times per paper for those papers selected in the first and second filter, respectively. We evidenced in our study that the term soil quality in agricultural science papers has been predominantly used in a broad context, mostly to refer to the suitable soil conditions for plant growth. Thus, we concluded that even if the use of soil quality term is increasing in Brazilian literature, there are still very few researchers working specifically with soil quality assessments, in its full conception (i.e., integrating chemical, physical and biological indicators). Therefore, there is a promising research field to be explored to promote scientific advances in the soil quality area (e.g., new concepts, assessment frameworks, on-farm monitoring protocols), as well as disseminate the soil quality assessment among the Brazilian farmers, environmentalists, and other stakeholders.

https://doi.org/10.36783/18069657rbcs20210103

Importance of 1,4-dimethylnaphthalene in maintaining the quality of stored tubers of Asterix and Challenger cultivars
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MENDONÇA NETO, Abelardo Barreto de

; GUIMARÃES, Maria Eduarda da Silva

; PEREIRA, Ariana Mota

; CRUZ, Renata Ranielly Pedroza

; GONÇALVES, Dreice Nascimento

; SOARES, Luciana Gomes

; FREIRE, Ana Izabella

; FINGER, Fernando Luiz

; CECON, Paulo Roberto

Food Science and Technology

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2022, Volume 42 elocation e10521

Abstract: En | Text: En | PDF: En

Abstract This work aimed to analyze 1,4-DMN efficiency in the suppression of sprouting and the consequent maintenance of quality in potato tubers of Asterix and Challenger cultivars stored during different periods under varying temperatures: eight treatments with and without 1,4-DMN under temperatures of 8 °C and 20 °C. Treatments effect were evaluated after 0, 45, 90, 135 and 180 days after application. The evaluated parameters were the loss of fresh mass, length of the sprouts and activity of the enzymes polyphenoloxidase and peroxidase. The results indicate that the application of 1,4-DMN reduces the loss of fresh mass, this effect was more intense for the cultivar Challenger, at 8 °C. There were also significant effects in reducing the average length of the sprouts for both cultivars evaluated, after 180 days, at 20 °C. There was little or no difference in the level of oxidative stress caused in the tubers. Hence, the effects of 1,4-DMN on the quality control of potatoes included reduced loss of fresh mass and a shorter average length of sprouts for both cultivars evaluated compared to control, for both temperatures. These effects intensify in the cultivar Challenger and treatments with temperatures of 20 °C.

https://doi.org/10.1590/fst.10521

Four-Point Bending Fatigue Behavior of Al2O3-ZrO2 Ceramic Biocomposites Using CeO2 as Dopant
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Coutinho, Maycol Moreira

; Nascimento, Anne Caroline de Paula

; Amarante, José Eduardo Vasconcelos

; Santos, Claudinei dos

; Ferreira, Jorge Luiz de Almeida

; Silva, Cosme Roberto Moreira da

Materials Research

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2022, Volume 25 elocation e20220199

Abstract: En | Text: En | PDF: En

This work investigated the effect of adding ceria-stabilized tetragonal zirconia (Ce-TZP) on the fatigue behavior of alumina-based ceramic composites. Alumina powder (control group) and mixtures containing 5 wt.% (group A) and 20 wt.% (group B) of a commercial m-ZrO2/Al2O3/CeO2 powder mixture were milled/homogenized, compacted, sintered at 1600°C-2h, and submitted to hydrothermal degradation. The samples were characterized by relative density, microstructure, crystalline phases, and static mechanical properties. The cyclic fatigue strength was determined using the modified staircase method in 4-point bending tests. The results indicate that adding the m-ZrO2/Al2O3/CeO2 powder mixture to the Al2O3-matrix increases the tetragonal-ZrO2 grains (Ce-TZP) content, presenting 2.9 wt.% of Ce-TZP and 11.9 wt.% of Ce-TZP for group A and group B, respectively. Furthermore, the addition of Ce-TZP improves densification (98.5% → 99.1%) with a slight reduction in hardness and modulus of elasticity and a significant KIC increase of the composite (KIC = 6.7 MPa.m1/2, group B) when compared to monolithic alumina (KIC=2.4 MPa.m1/2). The fatigue strength limit of the control group was around 100 MPa, while the composites (groups A and B) presented the values of 279 MPa and 239 MPa, respectively. The results indicated that the incorporation of Ce-TZP significantly improves the fracture toughness of alumina-based ceramics. On the other hand, regarding the fatigue behavior, there was an increase in fatigue resistance in group A, resulting from the benefits of the t→m Ce-TZP grains transformation, which occurs during cyclic loading, producing a zone shielding that involves the tip of the crack, slowing its growth. The increase in the amount of Ce-TZP (group B) leads to an increase in the internal residual stresses between the phases due to anisotropy and difference in the thermal expansion coefficients, which accelerates the phase transformation and formation of microcracks at grain boundaries, reducing the fatigue strength of composites of group B.

https://doi.org/10.1590/1980-5373-mr-2022-0199

10.

Acoustic radiation force impulse elastography and liver fibrosis risk scores in severe obesity
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Silva Junior, Roberto Gomes da

; Miranda, Maria Luiza Queiroz de

; Brant, Paulo Eugênio de Araújo Caldeira

; Schulz, Perla Oliveira

; Nascimento, Maria de Fátima Araujo

; Schmillevitch, Joel

; Vieira, Andrea

; Freitas Junior, Wilson Rodrigues de

; Szutan, Luiz Arnaldo

Archives of Endocrinology and Metabolism

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dec 2021, Volume 65 N. 6 Pages 730 - 738

Abstract: En | Text: En | PDF: En

ABSTRACT Objective: Identifying significant fibrosis is crucial to evaluate the prognosis and therapeutic interventions in patients with nonalcoholic fatty liver disease (NAFLD). We assessed the performance of acoustic radiation force impulse (ARFI) elastography, APRI, FIB-4, Forns, NFS and BARD scores in determining liver fibrosis in severe obesity. Subjects and methods: A prospective study included 108 patients undergoing bariatric surgery. Liver biopsy specimens were obtained intraoperatively and classified according to the NAFLD Activity Score. Patients were assessed with serological markers and shear wave velocity of the liver was measured with the Siemens S2000 ultrasound system preoperatively. Optimal cut-off values were determined using the area under the receiver operating characteristic curves (AUROC). Results: In the entire cohort prevalence of NAFLD was 80.6%, steatohepatitis 25.9% and significant fibrosis 19.4%. The best tests for predicting significant fibrosis were FIB-4 and Forns scores (both AUROC 0.78), followed by APRI (AUROC 0.74), NFS (AUROC 0.68), BARD (AUROC 0.64) and ARFI (AUROC 0.62). ARFI elastography was successful in 73% of the patients. Higher body mass index (BMI) correlated with invalid ARFI measurements. In patients with BMI < 42 kg/m2, ARFI showed 92.3% sensitivity and 82,6% specificity for the presence of significant fibrosis, with AUROC 0.86 and cut-off 1.32 m/s. Conclusions: FIB-4 and Forns scores were the most accurate for the prediction of significant fibrosis in bariatric patients. Applicability and accuracy of ARFI was limited in individuals with severe obesity. In patients with BMI < 42 kg/m2, ARFI elastography was capable for predicting significant fibrosis with relevant accuracy.

https://doi.org/10.20945/2359-3997000000397 2 downloads

11.

COVID-19 in the Perioperative Period of Cardiovascular Surgery: the Brazilian Experience
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Gomes, Walter J.

; Rocco, Isadora

; Pimentel, Wallace S.

; Pinheiro, Aislan H. B.

; Souza, Paulo M. S.

; Costa, Luiz A. A.

; Teixeira, Marjory M. P.

; Ohashi, Leonardo P.

; Bublitz, Caroline

; Begot, Isis

; Moreira, Rita Simone L

; Hossne Jr, Nelson A.

; Vargas, Guilherme F.

; Branco, João Nelson R.

; Teles, Carlos A.

; Medeiros, Eduardo A. S.

; Sáfadi, Camila

; Rampinelli, Amândio

; Moratelli Neto, Leopoldo

; Rosado, Anderson Rosa

; Mesacasa, Franciele Kuhn

; Capriata, Ismael Escobar

; Segalote, Rodrigo Coelho

; Palmieri, Deborah Louize da Rocha Vianna

; Jardim, Amanda Cristina Mendes

; Vianna, Diego Sarty

; Coutinho, Joaquim Henrique de Souza Aguiar

; Jazbik, João Carlos

; Coutinho, Henrique Madureira da Rocha

; Kikuta, Gustavo

; Almeida, Zely Sant'Anna Marotti de

; Feguri, Gibran Roder

; Lima, Paulo Ruiz Lucio de

; Franco, Anna Carolina

; Borges, Danilo de Cerqueira

; Cruz, Felipe Ramos Honorato De La

; Croti, Ulisses Alexandre

; Borim, Bruna Cury

; Marchi, Carlos Henrique De

; Goraieb, Lilian

; Postigo, Karolyne Barroca Sanches

; Jucá, Fabiano Gonçalves

; Oliveira, Fátima Rosane de Almeida

; Souza, Rafael Bezerra de

; Zilli, Alexandre Cabral

; Mas, Raul Gaston Sanchez

; Bettiati Junior, Luiz Carlos

; Tranchesi, Ricardo

; Bertini Jr, Ayrton

; Franco, Leandro Vieira

; Fernandes, Priscila

; Oliveira, Fabiana

; Moraes Jr, Roberto

; Araújo, Thiago Cavalcanti Vila Nova de

; Braga, Otávio Penna

; Pedrosa Sobrinho, Antônio Cavalcanti

; Teixeira, Roberta Tavares Barreto

; Camboim, Irla Lavor Lucena

; Gomes, Eduardo Nascimento

; Reis, Pedro Horigushi

; Garcia, Luara Piovan

; Scorsioni, Nelson Henrique Goes

; Lago, Roberto

; Guizilini, Solange

Brazilian Journal of Cardiovascular Surgery

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dec 2021, Volume 36 N. 6 Pages 725 - 735

Abstract: En | Text: En | PDF: En

Abstract Introduction: We investigated the clinical course and outcomes of patients submitted to cardiovascular surgery in Brazil and who had developed symptoms/signs of coronavirus disease 2019 (COVID-19) in the perioperative period. Methods: A retrospective multicenter study including 104 patients who were allocated in three groups according to time of positive real time reverse transcriptase-polymerase chain reaction (RT-PCR) for the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2): group 1, patients who underwent cardiac surgery > 10 days after positive RT-PCR; group 2, patients with a positive RT-PCR within 10 days before or after surgery; group 3, patients who presented positive RT-PCR > 10 days after surgery. The primary outcome was mortality and secondary outcomes were postoperative complications, intensive care unit (ICU) length of stay, and postoperative days of hospitalization. Results: The three groups were similar with respect to age, the European System of Cardiac Operative Risk Evaluation score, and comorbidities, except hypertension. Postoperative complications and death were significantly higher in groups 2 and 3 than in group 1, and no significant difference between groups 2 and 3 was seen. Group 2 showed a high prevalence of surgery performed as an urgent procedure. Although no significant differences were observed in ICU length of stay, total postoperative hospitalization time was significantly higher in group 3 than in groups 1 and 2. Conclusion: COVID-19 affecting the postoperative period of patients who underwent cardiovascular surgery is associated with a higher rate of morbidity and mortality. Delaying procedures in RT-PCR-positive patients may help reduce risks of perioperative complications and death.

https://doi.org/10.21470/1678-9741-2021-0960

12.

Posicionamento Brasileiro sobre o Uso da Multimodalidade de Imagens na Cardio-Oncologia – 2021
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Melo, Marcelo Dantas Tavares de

; Paiva, Marcelo Goulart

; Santos, Maria Verônica Câmara

; Rochitte, Carlos Eduardo

; Moreira, Valéria de Melo

; Saleh, Mohamed Hassan

; Brandão, Simone Cristina Soares

; Gallafrio, Claudia Cosentino

; Goldwasser, Daniel

; Gripp, Eliza de Almeida

; Piveta, Rafael Bonafim

; Silva, Tonnison Oliveira

; Santo, Thais Harada Campos Espirito

; Ferreira, Waldinai Pereira

; Salemi, Vera Maria Cury

; Cauduro, Sanderson A.

; Barberato, Silvio Henrique

; Lopes, Heloísa M. Christovam

; Pena, José Luiz Barros

; Rached, Heron Rhydan Saad

; Miglioranza, Marcelo Haertel

; Pinheiro, Aurélio Carvalho

; Vrandecic, Bárbara Athayde Linhares Martins

; Cruz, Cecilia Beatriz Bittencourt Viana

; Nomura, César Higa

; Cerbino, Fernanda Mello Erthal

; Costa, Isabela Bispo Santos da Silva

; Coelho Filho, Otavio Rizzi

; Carneiro, Adriano Camargo de Castro

; Burgos, Ursula Maria Moreira Costa

; Fernandes, Juliano Lara

; Uellendahl, Marly

; Calado, Eveline Barros

; Senra, Tiago

; Assunção, Bruna Leal

; Freire, Claudia Maria Vilas

; Martins, Cristiane Nunes

; Sawamura, Karen Saori Shiraishi

; Brito, Márcio Miranda

; Jardim, Maria Fernanda Silva

; Bernardes, Renata Junqueira Moll

; Diógenes, Tereza Cristina

; Vieira, Lucas de Oliveira

; Mesquita, Claudio Tinoco

; Lopes, Rafael Willain

; Segundo Neto, Elry Medeiros Vieira

; Rigo, Letícia

; Marin, Valeska Leite Siqueira

; Santos, Marcelo José

; Grossman, Gabriel Blacher

; Quagliato, Priscila Cestari

; Alcantara, Monica Luiza de

; Teodoro, José Aldo Ribeiro

; Albricker, Ana Cristina Lopes

; Barros, Fanilda Souto

; Amaral, Salomon Israel do

; Porto, Carmen Lúcia Lascasas

; Barros, Marcio Vinícius Lins

; Santos, Simone Nascimento dos

; Cantisano, Armando Luís

; Petisco, Ana Cláudia Gomes Pereira

; Barbosa, José Eduardo Martins

; Veloso, Orlando Carlos Glória

; Spina, Salvador

; Pignatelli, Ricardo

; Hajjar, Ludhmilla Abrahão

; Kalil Filho, Roberto

; Lopes, Marcelo Antônio Cartaxo Queiroga

; Vieira, Marcelo Luiz Campos

; Almeida, André Luiz Cerqueira

Arquivos Brasileiros de Cardiologia

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oct 2021, Volume 117 N. 4 Pages 845 - 909

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20200266 103 downloads

13.

Performance Diagnóstica da FFR por Angiotomografia de Coronárias através de Software Baseado em Inteligência Artificial
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Morais, Thamara Carvalho

; Assunção-Jr, Antonildes Nascimento

; Dantas Júnior, Roberto Nery

; Silva, Carla Franco Grego da

; Paula, Caroline Bastida de

; Torres, Roberto Almeida

; Magalhães, Tiago Augusto

; Nomura, César Higa

; Ávila, Luiz Francisco Rodrigues de

; Parga Filho, José Rodrigues

Arquivos Brasileiros de Cardiologia

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jun 2021, Volume 116 N. 6 Pages 1091 - 1098

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento A quantificação não invasiva da reserva fracionada de fluxo miocárdico (FFR TC ) através de software baseado em inteligência artificial em versão mais atualizada e tomógrafo de última geração (384 cortes) apresenta elevada performance na detecção de isquemia coronariana. Objetivos Avaliar o desempenho diagnóstico da FFR TC na detecção de doença arterial coronariana (DAC) significativa em relação ao FFRi, em tomógrafos de gerações anteriores (128 e 256 cortes). Métodos Estudo retrospectivo com pacientes encaminhados à angiotomografia de artérias coronárias (TCC) e cateterismo (FFRi). Foram utilizados os tomógrafos Siemens Somatom Definition Flash (256 cortes) e AS+ (128 cortes). A FFR TC e a área luminal mínima (ALM) foram avaliadas em software (cFFR versão 3.0.0, Siemens Healthineers, Forchheim, Alemanha). DAC obstrutiva foi definida como TCC com redução luminal ≥50% e DAC funcionalmente obstrutiva como FFRi ≤0,8. Todos os valores de p reportados são bicaudais; e quando <0,05, foram considerados estatisticamente significativos. Resultados Noventa e três pacientes consecutivos (152 vasos) foram incluídos. Houve boa concordância entre FFR TC e FFRi, com mínima superestimação da FFR TC (viés: –0,02; limites de concordância: 0,14 a 0,09). Diferentes tomógrafos não modificaram a relação entre FFR TC e FFRi (p para interação = 0,73). A FFR TC demonstrou performance significativamente superior à classificação visual de estenose coronariana (AUC 0,93 vs. 0,61, p <0,001) e à ALM (AUC 0,93 vs. 0,75, p <0,001) reduzindo o número de casos falso-positivos. O melhor ponto de corte para a FFR TC utilizando um índice de Youden foi de 0,85 (sensiblidade, 87%; especificidade, 86%; VPP, 73%; NPV, 94%), com redução de falso-positivos. Conclusão FFR TC baseada em inteligência artificial, em tomógrafos de gerações anteriores (128 e 256 cortes), apresenta boa performance diagnóstica na detecção de DAC, podendo ser utilizada para reduzir procedimentos invasivos.

Abstract Background The non-invasive quantification of the fractional flow reserve (FFRCT) using a more recent version of an artificial intelligence-based software and latest generation CT scanner (384 slices) may show high performance to detect coronary ischemia. Objectives To evaluate the diagnostic performance of FFRCT for the detection of significant coronary artery disease (CAD) in contrast to invasive FFR (iFFR) using previous generation CT scanners (128 and 256- detector rows). Methods Retrospective study with patients referred to coronary artery CT angiography (CTA) and catheterization (iFFR) procedures. Siemens Somatom Definition Flash (256-detector rows) and AS+ (128-detector rows) CT scanners were used to acquire the images. The FFRCT and the minimal lumen area (MLA) were evaluated using a dedicated software (cFFR version 3.0.0, Siemens Healthineers, Forchheim, Germany). Obstructive CAD was defined as CTA lumen reduction ≥ 50%, and flow-limiting stenosis as iFFR ≤0.8. All reported P values are two-tailed, and when <0.05, they were considered statistically significant. Results Ninety-three consecutive patients (152 vessels) were included. There was good agreement between FFRCT and iFFR, with minimal FFRCT overestimation (bias: -0.02; limits of agreement:0.14-0.09). Different CT scanners did not modify the association between FFRCT and FFRi (p for interaction=0.73). The performance of FFRCT was significantly superior compared to the visual classification of coronary stenosis (AUC 0.93vs.0.61, p<0.001) and to MLA (AUC 0.93vs.0.75, p<0.001), reducing the number of false-positive cases. The optimal cut-off point for FFRCT using a Youden index was 0.85 (87% Sensitivity, 86% Specificity, 73% PPV, 94% NPV), with a reduction of false-positives. Conclusion Machine learning-based FFRCT using previous generation CT scanners (128 and 256-detector rows) shows good diagnostic performance for the detection of CAD, and can be used to reduce the number of invasive procedures.

https://doi.org/10.36660/abc.20190329 391 downloads

14.

Student perspective on public health training in speech-language-hearing undergraduate programs at public universities in Northeastern Brazil
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Telles, Maurício Wiering Pinto

; Chaves, Letícia Jadsa Lemos

; Nascimento, Milyane Cardoso do

; Abreu, Maria Helena Dantas

; Noro, Luiz Roberto Augusto

Revista CEFAC

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2021, Volume 23 N. 3 elocation e12320

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: analisar a compreensão dos discentes sobre a formação em saúde coletiva dos cursos de fonoaudiologia das universidades públicas do Nordeste brasileiro. Métodos: estudo qualitativo, estudo de caso múltiplo, o qual se utilizou da realização de entrevistas com informantes-chave discentes de sete universidades do Nordeste para a produção dos dados. Para a análise, foi utilizada a técnica da Análise Temática de Conteúdo, tendo como referencial teórico a concepção de atos de currículo. Resultados: três categorias emergiram a partir da análise: experiências formativas na saúde coletiva, influência das vivências no SUS para a formação do fonoaudiólogo e potencialidades e limites na formação em saúde coletiva. Conclusão: identificou-se que os estudantes das universidades públicas do Nordeste brasileiro percebem a saúde coletiva na formação como meio de preparação para a sua futura inserção e prática profissional no âmbito do SUS.

ABSTRACT Purpose: to analyze the students’ understanding of public health training in the speech-language-hearing programs at public universities in Northeastern Brazil. Methods: a qualitative, multiple-case study that interviewed key informing students of seven universities in the Northeast to collect data. The analysis was based on the theme content analysis technique, having as theoretical reference the conception of curricula. Results: three categories emerged from the analysis: public health training experiences, influence of the experiences at the Unified Health System (Sistema Único de Saúde - SUS) on the speech-language-hearing therapist’s training, and potentials and limitations in public health training. Conclusion: the public university students of Northeastern Brazil perceive public health training as a means to prepare them for their future inclusion and professional practice at SUS.

https://doi.org/10.1590/1982-0216/202123312320 301 downloads

15.

PERIPHERAL BLOOD ENDOTOXIN LEVELS ARE NOT ASSOCIATED WITH SMALL INTESTINAL BACTERIAL OVERGROWTH IN NONALCOHOLIC FATTY LIVER DISEASE WITHOUT CIRRHOSIS
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GUIMARÃES, Vivian Mota

; SANTOS, Virgínia Nascimento

; BORGES, Patrícia Souza de Almeida

; DE FARIAS, João Luiz Rodrigues

; GRILLO, Penelope

; PARISE, Edison Roberto

Arquivos de Gastroenterologia

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dec 2020, Volume 57 N. 4 Pages 471 - 476

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO CONTEXTO: A doença hepática gordurosa não alcoólica (DHGNA) é uma das doenças hepáticas crônicas mais comuns em todo o mundo. Aproximadamente 20% dos indivíduos com DHGNA desenvolvem esteato-hepatite não alcoólica (EHNA) que está associada a maior risco de cirrose, hipertensão portal e/ou carcinoma hepatocelular. Alterações da microflora intestinal, incluindo o supercrescimento bacteriano intestinal (SBI), parecem ter um papel importante na patogênese da doença, como demonstrado em estudos clínicos e experimentais, pela alteração da permeabilidade intestinal e permitindo que endotoxinas bacterianas alcancem a circulação sanguínea. OBJETIVO: Determinar a relação entre o SBI e níveis de endotoxina sérica em pacientes não cirróticos com DHGNA, com os aspectos clínicos, laboratoriais e histopatológicos da doença e a relação entre SBI e níveis séricos de endotoxina antes e após tratamento com antibiótico. MÉTODOS: Foram incluídos pacientes maiores de 18 anos e com diagnóstico histológico de DHGNA, sem cirrose. Foram realizados: avaliação bioquímica geral, teste do H2 expirado com lactulose para diagnóstico de SBI e dosagem de endotoxina sérica - ensaio cromogênico para LAL. Para o tratamento do SBI utilizamos o metronidazol 250 mg de 8/8 horas por 10 dias e para os casos de retratamento foi utilizado ciprofloxacino 500 mg de 12/12 horas por 10 dias. RESULTADOS: Incluímos 42 pacientes com diagnóstico histopatológico de DHGNA. A prevalência de SBI foi de 26,2%. Quando comparamos o grupo dos pacientes com SBI com aquele sem SBI e analisamos suas variáveis demográficas e bioquímicas, não encontramos diferença estatisticamente significante entre elas, exceto pela utilização de inibidores de bomba de próton, que foi significantemente mais frequente nos pacientes com teste respiratório positivo. A presença de SBI também esteve associada à maior intensidade de balonização na biópsia hepática, quando comparados àqueles sem SBI. Embora o grupo como um todo apresentasse elevação dos níveis circulantes de endotoxinas, não pudemos encontrar diferenças estatísticas entre os grupos com e sem SBI. Os valores de endotoxinas pré e pós tratamento antibiótico não diferiram entre si, mesmo em análise pareada, sugerindo ausência de relação entre esses fatores. Os níveis de endotoxina sérica apresentaram correlação inversa com os níveis de HDL e correlação direta com os níveis de triglicerídeos. CONCLUSÃO: Níveis de endotoxinas séricas não diferiram entre os pacientes com e sem SBI, e que esses níveis não se modificaram após tratamento medicamentoso da proliferação bacteriana, praticamente excluindo a possibilidade de que os níveis elevados de endotoxemia estejam relacionados à SBI. A presença dessa proliferação bacteriana esteve associada à maior intensidade de balonização na biópsia hepática, mas não à maior prevalência de EHNA entre os portadores de SBI. Estudos complementares são necessários para avaliar a reprodutibilidade e a importância desse achado em portadores de DHGNA com SBI.

ABSTRACT BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is one of the most common forms of chronic liver disease worldwide. Approximately 20% of individuals with NAFLD develop nonalcoholic steatohepatitis (NASH), which is associated with increased risk of cirrhosis, portal hypertension, and hepatocellular carcinoma. Intestinal microflora, including small intestinal bacterial overgrowth (SIBO), appear to play an important role in the pathogenesis of the disease, as demonstrated in several clinical and experimental studies, by altering intestinal permeability and allowing bacterial endotoxins to enter the circulation. OBJECTIVE: To determine the relationship between SIBO and endotoxin serum levels with clinical, laboratory, and histopathological aspects of NAFLD and the relationship between SIBO and endotoxin serum levels before and after antibiotic therapy. METHODS: Adult patients with a histological diagnosis of NAFLD, without cirrhosis were included. A comprehensive biochemistry panel, lactulose breath test (for diagnosis of SIBO), and serum endotoxin measurement (chromogenic LAL assay) were performed. SIBO was treated with metronidazole 250 mg q8h for 10 days and refractory cases were given ciprofloxacin 500 mg q12h for 10 days. RESULTS: Overall, 42 patients with a histopathological diagnosis of NAFLD were examined. The prevalence of SIBO was 26.2%. Comparison of demographic and biochemical parameters between patients with SIBO and those without SIBO revealed no statistically significant differences, except for use of proton pump inhibitors, which was significantly more frequent in patients with positive breath testing. The presence of SIBO was also associated with greater severity of hepatocellular ballooning on liver biopsy. Although the sample, as a whole, have elevated circulating endotoxin levels, we found no significant differences in this parameter between the groups with and without SIBO. Endotoxin values before and after antibiotic treatment did not differ, even on paired analysis, suggesting absence of any relationship between these factors. Serum endotoxin levels were inversely correlated with HDL levels, and directly correlated with triglyceride levels. CONCLUSION: Serum endotoxin levels did not differ between patients with and without SIBO, nor did these levels change after antibacterial therapy, virtually ruling out the possibility that elevated endotoxinemia in non-cirrhotic patients with NAFLD is associated with SIBO. Presence of SIBO was associated with greater severity of ballooning degeneration on liver biopsy, but not with a significantly higher prevalence of NASH. Additional studies are needed to evaluate the reproducibility and importance of this finding in patients with NAFLD and SIBO.

https://doi.org/10.1590/s0004-2803.202000000-82 931 downloads

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